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Koh DH, Choi S, Park JH, Lee SG, Kim HC, Kim I, Park DU. Evaluation on the Sex-Specific Association Between Cigarette Smoke Exposure and Inflammation Markers-C-Reactive Protein and White Blood Cell Count. Nicotine Tob Res 2024; 26:484-493. [PMID: 37742212 DOI: 10.1093/ntr/ntad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Cigarette smoke increases peripheral white blood cell (WBC) count. However, the dose-dependent association between smoking and C-reactive protein (CRP), an important inflammatory marker, has been reported as inconsistent. AIMS AND METHODS Here, we evaluated the associations between smoking and CRP using both smoking questionnaires and urine cotinine as exposure markers. The Korea National Health and Nutrition Examination Survey data were used for analyzing the associations. Multiple regression analyses were performed to examine the associations between cigarette smoke exposure, as assessed by questionnaires and urine cotinine, and health effects, as measured by CRP and WBC count, controlling for potential confounders. The confounders, including age, sex, body mass index, blood pressure, cholesterol, glucose, alanine aminotransferase, and uric acid, were selected a priori based on the literature. RESULTS A total of 11 435 participants were included for analysis. For the exposure-response relationship, the results indicated a significant increase in CRP levels in male smokers compared to male nonsmokers (p = .002), whereas no significant increase was found in female smokers compared to female nonsmokers (p = .680). For the dose-response relationship, a significant positive association was observed between urine cotinine and CRP in male smokers (p = .018), whereas no significant association was found in female smokers (p = .508). WBC count consistently showed significant exposure-response and dose-response relationships in both sexes. CONCLUSIONS WBC count was found to be a consistent effect marker of cigarette smoke exposure, while the association between CRP level and smoking was inconsistent and varied by sex. The sex-specific response to cigarette smoke exposure warrants further exploration in future studies. IMPLICATIONS Cigarette smoke exposure is known to increase inflammation and has been thought to increase CRP, a significant inflammation marker. However, recent studies have reported conflicting results regarding the dose-dependent association between cigarette smoke exposure and CRP. This study found that the association between smoking and CRP is inconsistent and varies by sex, showing significant exposure response in men but not in women. Furthermore, the study suggests that WBC count is a more consistent marker for cigarette smoke exposure.
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Affiliation(s)
- Dong-Hee Koh
- Department of Occupational and Environmental Medicine, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Sangjun Choi
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Korea
- Catholic Institute for Public Health and Healthcare Management, Seoul, Korea
| | - Ju-Hyun Park
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Sang-Gil Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Korea
| | - Hwan-Cheol Kim
- Department of Occupational and Environmental Medicine, Inha University, Incheon, Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong-Uk Park
- Department of Environmental Health, Korea National Open University, Seoul, Korea
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Zhang JJ, Zheng Y, Vermeulen R, Liu XL, Dai Y, Hu W, He L, Lin Y, Ren D, Duan H, Niu Y, Xu J, Fu W, Meliefste K, Zhou B, Yang J, Ye M, Jia X, Meng T, Bin P, Bassig BA, Hosgood HD, Silverman D, Lan Q, Rothman N. Urinary Amino-PAHs in relation to diesel engine emissions and urinary mutagenicity. Int J Hyg Environ Health 2023; 253:114223. [PMID: 37557062 PMCID: PMC10529049 DOI: 10.1016/j.ijheh.2023.114223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/22/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023]
Abstract
Diesel exhaust has long been of health concern due to established toxicity including carcinogenicity in humans. However, the precise components of diesel engine emissions that drive carcinogenesis are still unclear. Limited work has suggested that nitrated polycyclic aromatic hydrocarbons (NPAHs) such as 1-nitropyrene and 2-nitrofluorene may be more abundant in diesel exhaust. The present study aimed to examine whether urinary amino metabolites of these NPAHs were associated with high levels of diesel engine emissions and urinary mutagenicity in a group of highly exposed workers including both smokers and nonsmokers. Spot urine samples were collected immediately following a standard work shift from each of the 54 diesel engine testers and 55 non-tester controls for the analysis of five amino metabolites of NPAHs, and cotinine (a biomarker of tobacco smoke exposure) using liquid chromatography-mass spectrometry. An overnight urine sample was collected in a subgroup of non-smoking participants for mutagenicity analysis using strain YG1041 in the Salmonella (Ames) mutagenicity assay. Personal exposure to fine particles (PM2.5) and more-diesel-specific constituents (elemental carbon and soot) was assessed for the engine testers by measuring breathing-zone concentrations repeatedly over several full work shifts. Results showed that it was 12.8 times more likely to detect 1-aminopyrene and 2.9 times more likely to detect 2-aminofluorene in the engine testers than in unexposed controls. Urinary concentrations of 1-aminopyrene were significantly higher in engine testers (p < 0.001), and strongly correlated with soot and elemental carbon exposure as well as mutagenicity tested in strain YG1041 with metabolic activation (p < 0.001). Smoking did not affect 1-aminopyrene concentrations and 1-aminopyrene relationships with diesel exposure. In contrast, both engine emissions and smoking affected 2-aminofluorene concentrations. The results confirm that urinary 1-aminopyrene may serve as an exposure biomarker for diesel engine emissions and associated mutagenicity.
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Affiliation(s)
- Junfeng Jim Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA; Duke Kunshan University, Kunshan City, Jiangsu Province, China.
| | - Yuxin Zheng
- School of Public Health, Qingdao University, China
| | | | - Xing Lucy Liu
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Yufei Dai
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Linchen He
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA; College of Health, Lehigh University, Bethlehem, PA, USA
| | - Yan Lin
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Dianzhi Ren
- Chaoyang Center for Disease Control and Prevention, Chaoyang, China
| | - Huawei Duan
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Niu
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Xu
- Hong Kong University, Hong Kong
| | - Wei Fu
- Chaoyang Center for Disease Control and Prevention, Chaoyang, China
| | | | | | - Jufang Yang
- Chaoyang Center for Disease Control and Prevention, Chaoyang, China
| | - Meng Ye
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaowei Jia
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Meng
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ping Bin
- Key Laboratory of Chemical Safety and Health, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bryan A Bassig
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - H Dean Hosgood
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA; Division of Epidemiology, Albert Einstein College of Medicine, New York, USA
| | - Debra Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Park EY, Lim MK, Park E, Kim Y, Lee D, Oh K. Optimum Urine Cotinine and NNAL Levels to Distinguish Smokers from Non-Smokers by the Changes in Tobacco Control Policy in Korea from 2008 to 2018. Nicotine Tob Res 2022; 24:1821-1828. [PMID: 35609337 DOI: 10.1093/ntr/ntac133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION We examined the age- and sex-specific distributions of biomarkers of tobacco smoke exposure to determine the optimal cutoffs to distinguish smokers from non-smokers over the last 10 years in Korea, during which smoking prevalence and secondhand smoke (SHS) exposure declined due to changes in tobacco control policy. METHODS We analyzed data from the Korea National Health and Nutrition Examination Survey on creatinine-adjusted urinary cotinine (2008-2018; 33 429 adults: 15 653 males and 17 776 females) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; 2016-2018; 6337 adults: 3091 males and 3246 females). We determined the optimal cutoffs and confidence intervals (CIs) to distinguish smokers from non-smokers using receiver operator characteristic curve analysis and bootstrapping (1000 resamples). RESULTS The optimal cutoff values of creatinine-adjusted urine cotinine and NNAL concentration were 20.9 ng/mg (95% CI: 20.8-21.0, sensitivity: 96.6%, specificity: 93.8%) and 8.9 pg/mg (95% CI: 8.8-8.9, sensitivity: 94.0%, specificity: 94.7%), respectively, in 2016-2018. The optimal cutoffs of both biomarkers increased with age and were higher in females than in males for NNAL concentration. In both sexes, the optimal cutoff of urine cotinine continuously declined over the study period. CONCLUSIONS The optimal cotinine cutoff declined along with smoking prevalence and levels of SHS exposure due to enforcement of tobacco control policies, including smoke-free ordinances and tax increases. Monitoring of biomarkers of tobacco exposure appears necessary for verification of smoking status and regulatory use. IMPLICATIONS Our results based on nationally representative data suggest that a large decrease in the optimal cutoff value of urine cotinine to distinguish smokers from non-smokers was caused by decreases in smoking prevalence and SHS exposure following enforcement of tobacco control policies over the last 10 years. We determined the optimal cutoff values of urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), which were not previously reported in representative population in Asia, to enable more accurate estimation of exposure to tobacco smoke and proper assessment of disease risks. Gender- and age-specific differences in the optimal cutoffs require further study. Monitoring of biomarkers of tobacco smoke exposure seems necessary for verification of smoking status and regulatory use.
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Affiliation(s)
- Eun Young Park
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Min Kyung Lim
- Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Eunjung Park
- Hanyang University Institute for Rheumatology Research, Seoul, Republic of Korea
| | - Yoonjung Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Dohoon Lee
- Department of Laboratory Medicine, Hospitals, National Cancer Center, Goyang, Republic of Korea
| | - Kyungwon Oh
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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Sim B, Park MB. Exposure to Secondhand Smoke: Inconsistency between Self-Response and Urine Cotinine Biomarker Based on Korean National Data during 2009-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179284. [PMID: 34501873 PMCID: PMC8431172 DOI: 10.3390/ijerph18179284] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to estimate the secondhand smoke (SHS) exposure using urinary cotinine (UCo) to prove that the SHS exposure could not be properly assessed by self-reporting (SR). In total, 28,574 nonsmokers aged >19 years were selected from the Korean National Health and Nutrition Examination Survey data (2009-2018). First, changes in the annual concentration of UCo were analyzed, and the annual SHS exposure rates were measured based on SR and UCo from 2009 to 2018. Then, the average UCo concentration and UCo-measured SHS exposure rate were confirmed according to the subjects' characteristics. Finally, factors associated with the UCo-measured SHS exposure rate were identified based on multiple regression analysis. The findings showed that the annual UCo concentrations and self-reported SHS exposure rates dropped significantly over the past decade. In contrast, the UCo-measured SHS exposure rate indicated that >80% of nonsmokers are still exposed to SHS. Moreover, we found vulnerable groups using UCo-measured SHS exposure rate. In particular, the self-reported SHS exposure at home and in workplaces and house type was highly associated with SHS exposure. Thus, these findings indicate that the actual SHS exposure could not be properly assessed by SR and should be verified using a biomarker, such as UCo. Considering that even a short-term exposure can be harmful to health, the goal of the policy should be to keep cotinine concentration as low as possible.
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Affiliation(s)
- Boram Sim
- Health Insurance Review and Assessment Service (HIRA), Wonju 26465, Korea;
| | - Myung-Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Daejeon 35345, Korea
- Correspondence: ; Tel.: +82-42-520-5037
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Kang SY, Lim MK, Cho HJ. Trends in the Socioeconomic Inequalities Related to Second-Hand Smoke Exposure as Verified by Urine Cotinine Levels Among Nonsmoking Adults: Korea National Health and Nutrition Examination Survey 2008-2018. Nicotine Tob Res 2021; 23:1518-1526. [PMID: 33764416 DOI: 10.1093/ntr/ntab051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/22/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The expansion of smoke-free policies has reduced the prevalence of second-hand smoke (SHS) exposure; however, declines differ according to socioeconomic positions. We evaluated the trends in socioeconomic inequalities related to SHS exposure in nonsmoking Korean adults from 2008 to 2018. METHODS We analyzed 30,027 nonsmoking adults from the Korea National Health and Nutrition Examination Survey 2008 to 2018. We evaluated trends in urine cotinine levels, self-reported prevalence of SHS exposure at workplaces and homes, and people exhibiting nonmeasurable urine cotinine levels between 2008 and 2018. To evaluate the yearly decline differences of urine cotinine levels according to socioeconomic positions, we calculated the interaction effects of year and education, household incomes, and occupation from linear regression analysis. RESULTS In the last 11 years, the geometric means of urine cotinine levels decreased from 3.53 (95% CI 2.96-4.19) ng/mL to 0.60 (0.57-0.64) ng/mL in males, and from 2.36 (2.03-2.73) ng/mL to 0.53 (0.51-0.56) ng/mL in females. The prevalence of SHS exposure at workplaces and homes also declined. In the multivariate model, the interaction effects between education and years were significant; therefore, indicating a substantial yearly decline of urine cotinine levels in higher educated individuals. The interaction effects between household incomes and years were only significant among males; the interaction effects between occupations and years were not significant. CONCLUSIONS SHS exposure in nonsmoking Korean adults has consistently decreased; however, socioeconomic inequalities related to SHS exposure by education level have widened. Policies targeting socioeconomically disadvantaged populations should be implemented to decrease the disparities of SHS exposure. IMPLICATIONS Along with tobacco control policies, the prevalence of self-reported and urinary cotinine verified SHS exposure has decreased in the last 11 years. In contrast, the socioeconomic inequalities related to SHS exposure by education level have increased over time. This study emphasizes the need for implementing tobacco control policies to reduce disparities of SHS exposure.
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Affiliation(s)
- Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, Republic of Korea
| | - Min Kyung Lim
- Division of Cancer Prevention, National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Association between Diabetes Mellitus and Oral Health Status in Patients with Cardiovascular Diseases: A Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094889. [PMID: 34064391 PMCID: PMC8125754 DOI: 10.3390/ijerph18094889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus (DM) can lead to poor oral health. However, oral health among diabetic patients with cardiovascular diseases (CVDs) is scarcely studied. This study aimed to elucidate the prevalence of oral health complications and the relationship between DM and oral health status in diabetic patients with CVDs. This retrospective nationwide cross-sectional study evaluated 3495 patients aged ≥40 years with CVD, with DM (n = 847) and without DM (n = 2648). The participant's characteristics between the two groups were compared using the Chi-square test and t-test. Logistic regression analyses were performed to identify associations between DM and oral health status. The prevalence of periodontitis (54.3% vs. 43.2%) and <20 number of remaining teeth (30.9% vs. 22.8%) was significantly higher in the DM than in the non-DM group. In the multivariate regression analysis, the incidence of periodontitis was 1.4 times higher in the DM group than in the non-DM after adjusting for confounders; however, the number of remaining teeth and active caries were not associated with DM. In conclusion, the oral health status of patients with coexisting CVD and DM should be assessed closely and actively. Healthcare professionals should provide accessible dental care services and develop strategies to improve patients' oral health.
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Lee GM, Yoon JH, Lee WR, Kim LH, Yoo KB. Factors Associated With the Differences Between Self-Report Smoking and Urinary Cotinine Criteria. Asia Pac J Public Health 2021; 33:357-368. [PMID: 33511851 DOI: 10.1177/1010539520986248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During self-reporting, respondents underreport their smoking status for various reasons. We aimed to evaluate the difference between smoking status self-reporting and urinary cotinine tests in Korea respondents. Logistic regression analyses were performed to identify factors associated with the differences between self-reporting and urinary cotinine criteria. The dependent variable was the underreporting of smoking status; independent variables were sociodemographic, health status, and secondhand smoke (SHS) exposure. Total underreporting was 3.6% when Cot ≥164 and 4.0% when Cot-variable (classified) criteria underreported. Positive associations were found between smoking and age, education, drinking, and SHS. Underreporting in the nonsmoker group (odds ratio [OR] = 2.336; confidence interval [CI] = 1.717-3.179) was significantly associated with SHS, but this difference was nonsignificant in the ex-smoker group (OR = 1.184; CI = 0.879-1.638). Underreporting was 3.6% to 4.0%, and C-statistics was about 0.7, indicating that outcomes could be classified. SHS in nonsmokers was positively associated with underreporting; however, only the nonsmoker group had positive associations, demonstrating unintentional underreporting due to SHS.
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Affiliation(s)
- Gyeong-Min Lee
- Department of Health Administration, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Jang-Ho Yoon
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Corvallis, OR, USA
| | - Woo-Ri Lee
- Department of Health Administration, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Li-Hyun Kim
- Department of Health Administration, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Ki-Bong Yoo
- Department of Health Administration, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea.,Department of Information & Statistics, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
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Oh J, Park MS, Chun MR, Hwang JH, Lee JY, Jee JH, Lee SY. A Simple and High-throughput LC-MS/MS Method for Simultaneous Measurement of Nicotine, Cotinine, 3-OH cotinine, Nornicotine, and Anabasine in Urine and its Application in the General Korean Population. J Anal Toxicol 2020; 46:25-36. [PMID: 33231618 DOI: 10.1093/jat/bkaa177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 11/14/2022] Open
Abstract
Measuring nicotine metabolites is the most objective method for identifying smoke exposure. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) can measure multiple metabolites and is sensitive enough to detect low concentrations of metabolites. Therefore, we developed a simple and high-throughput method for measuring nicotine, cotinine, trans-3'-hydroxycotinine (3-OH cotinine), nornicotine, and anabasine for population-based studies using LC-MS/MS. Each 30 µl of urine sample was diluted with 90 µL of acetonitrile containing five deuterated internal standards. Chromatographic separation used a C18 column and LC-MS/MS analysis was performed with a multiple reaction monitoring mode. The chromatographic run time for each sample was 6.5 min. The method was validated by evaluating selectivity, interference, limit of detection, lower limit of quantification, precision, accuracy, linearity, extraction recovery, matrix effect, and carry-over according to guidelines. Our methods required a short preparation time (about 20 minutes) while simultaneously measuring five markers for smoking status. No endogenous or exogenous interference was found. Our method showed excellent precision and accuracy: within-run CV 2.9-9.4%, between-run CV 4.8-8.7%, and bias -10.1 to 5.3%. Linear dynamic ranges were 1-10,000 ng/mL for nicotine, nornicotine, and anabasine; 2-5,000 ng/mL for cotinine; and 5-15,000 ng/mL for 3-OH cotinine. Extraction recovery was consistent (87-109%) across concentrations. No significant matrix effect or carry-over was observed. The validated method was applied to 849 urine samples. In samples from the 125 current smokers, nicotine, cotinine, 3-OH cotinine, nornicotine, and anabasine were detected in 97.6%, 99.2%, 98.4%, 96.8%, and 87.2%, respectively. No markers were detected in 93.9% of 609 non-smokers. The overlapping detection of multiple markers made it possible to identify smoking status even in current smokers with low concentration of cotinine. Our LC-MS/MS method using a simple sample preparation technique is sensitive and effective for screening of smoking status in the general population.
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Affiliation(s)
- Jongwon Oh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Seung Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Ryung Chun
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hye Hwang
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hwan Jee
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee J, Kwon D, Lee Y, Jung I, Hyun D, Lee H, Ahn YS. Hypertension Is Associated with Increased Risk of Diabetic Lung. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207513. [PMID: 33076466 PMCID: PMC7602540 DOI: 10.3390/ijerph17207513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
Lung function is often impaired in diabetic patients, especially in a restrictive pattern, which has recently been described as the diabetic lung. Since hypertension (HTN) is common in diabetic patients, our study investigated whether HTN acts as an aggravating factor in diabetic lung. Within the cross-sectional study from the 6th Korean National Health and Nutrition Examination Survey (KNHANES), fasting plasma glucose (FPG), blood pressure (BP), pulmonary function, and laboratory data were examined in 4644 subjects aged between 40 and 79 years. A multivariate regression model was used to investigate the relationship between BP, FPG, and pulmonary function. Lung function was significantly reduced in the HTN (p = 0.001), impaired fasting glucose (IFG) (p < 0.001), and diabetes mellitus (DM) (p < 0.001) groups. Next, a multivariate logistic regression model was used to derive the odds ratio (OR) of reduced lung function based on the presence of IFG, DM, and HTN. The OR of reduced forced vital capacity (FVCp < 80%) was 3.30 (p < 0.001) in the HTN-DM group and 2.30 (p < 0.001) in the normal BP-DM group, when compared with the normal BP-normal FPG group. The combination of HTN and DM had the strongest negative effect on FVC. The results presented in this study indicate that diabetes and hypertension have a synergistic association with impaired lung function.
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Affiliation(s)
- Jihyun Lee
- Department of Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 26426, Korea; (J.L.); (D.K.); (Y.L.); (I.J.)
| | - Donghwan Kwon
- Department of Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 26426, Korea; (J.L.); (D.K.); (Y.L.); (I.J.)
| | - Youngjang Lee
- Department of Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 26426, Korea; (J.L.); (D.K.); (Y.L.); (I.J.)
| | - Inchan Jung
- Department of Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 26426, Korea; (J.L.); (D.K.); (Y.L.); (I.J.)
| | - Daesung Hyun
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 26426, Korea; (D.H.); (H.L.)
| | - Hunju Lee
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, 20 Ilsan-ro, Wonju 26426, Korea; (D.H.); (H.L.)
| | - Yeon-Soon Ahn
- Department of Preventive Medicine and Genomic Cohort Institute, Yonsei Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-33-741-0347
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Nishihama Y, Nakayama SF, Tabuchi T, Isobe T, Jung CR, Iwai-Shimada M, Kobayashi Y, Michikawa T, Sekiyama M, Taniguchi Y, Nitta H, Yamazaki S. Determination of Urinary Cotinine Cut-Off Concentrations for Pregnant Women in the Japan Environment and Children's Study (JECS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155537. [PMID: 32751831 PMCID: PMC7432074 DOI: 10.3390/ijerph17155537] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/18/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023]
Abstract
Few studies have assessed the accuracy of self-reported questionnaires to determine smoking habits relative to urinary biomarkers. This study investigated urinary cotinine cut-off concentrations distinguishing active, passive and non-smokers among pregnant women who participated in the Japan Environment and Children's Study, a nationwide birth cohort study. Pregnant participants with measured urinary cotinine concentrations (UCCs) and who completed self-reported questionnaires on smoking status were included (n = 89,895). The cut-off values (COVs) for active and passive smokers were calculated by fitting mixed normal distribution functions to UCCs. The sensitivity and specificity of the questionnaires were subsequently evaluated. The median (interquartile range) UCC was 0.24 (0.083-0.96) µg/g-creatinine, with the detection rate of 89%. The COV for distinguishing active smokers from passive and non-smokers was 36.8 µg/g-creatinine. When this COV was considered to represent the true condition, the questionnaire had a sensitivity of 0.523, a specificity of 0.998, a positive predictive value (PPV) of 0.967 and a negative predictive value (NPV) of 0.957. The COV for distinguishing passive smokers from non-smokers was 0.31 µg/g-creatinine, with the questionnaire having a sensitivity of 0.222, a specificity of 0.977, a PPV of 0.868 and an NPV of 0.644. As many as 78% of passive smokers might be misclassified as non-smokers.
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Affiliation(s)
- Yukiko Nishihama
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Shoji F. Nakayama
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
- Correspondence: ; Tel.: +81-29-850-2786
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan;
| | - Tomohiko Isobe
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Chau-Ren Jung
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Miyuki Iwai-Shimada
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Yayoi Kobayashi
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Takehiro Michikawa
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo 143-8540, Japan
| | - Makiko Sekiyama
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Yu Taniguchi
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Hiroshi Nitta
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
| | - Shin Yamazaki
- Japan Environment and Children’s Study Programme Office, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Ibaraki 305-0053, Japan; (Y.N.); (T.I.); (C.-R.J.); (M.I.-S.); (Y.K.); (T.M.); (M.S.); (Y.T.); (H.N.); (S.Y.)
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Bradicich M, Schuurmans MM. Smoking status and second-hand smoke biomarkers in COPD, asthma and healthy controls. ERJ Open Res 2020; 6:00192-2019. [PMID: 32714953 PMCID: PMC7369429 DOI: 10.1183/23120541.00192-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Tobacco smoke worsens COPD and asthma. For healthy individuals, quantifying active and second-hand smoke (SHS) exposure clarifies the epidemiology of tobacco consumption and the efficacy of nonsmoking measures. Identifying tobacco exposure biomarkers and cut-offs might allow the creation of sensitive and specific tests. Aim We describe the state-of-the-art serum, urinary cotinine and exhaled carbon monoxide (CO) cut-offs for assessing smoking status and SHS exposure in adult patients with COPD or asthma, and healthy controls. Methodology After a keyword research in the PubMed database, we included papers reporting on the cut-offs of the investigated biomarkers in one of the populations of interest. Papers published before 2000, not in English, or reporting only data on nonadult subjects or on pregnant women were excluded from the analysis. 14 papers were included in the final analysis. We summarised diagnostic cut-offs for smoking status or SHS exposure in COPD, asthmatic and healthy control cohorts, reporting sensitivity and specificity when available. Conclusion Serum and urinary cotinine and exhaled CO are easy-to-standardise, affordable and objective tests for assessing smoking status and SHS exposure. Evidence on cut-offs with good sensitivity and specificity values is available mainly for healthy controls. For COPD and asthmatic patients, most of the currently available evidence focuses on exhaled CO, while studies on the use of cotinine with definite sensitivity and specificity values are still missing. Solid evidence on SHS exposure is available only for healthy controls. An integrated approach with a combination of these markers still needs evaluation. Reliable cut-off values for smoking status in COPD and asthmatic adults are only available for exhaled COhttps://bit.ly/34lsHhD
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Affiliation(s)
- Matteo Bradicich
- Division of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Jain RB. Estimates of cutoffs with specificities and sensitivities for urine cotinine and hydroxycotinine for US adults aged ≥ 20 years to classify smokers and nonsmokers. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:10882-10887. [PMID: 31953760 DOI: 10.1007/s11356-020-07710-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
Data for urine cotinine and hydroxycotinine became available for the first time in the 2013-2014 cycle of the National Health and Nutrition Examination Survey administered by the US Centers for Disease Control and Prevention. Cutoffs to classify smokers and nonsmokers for both cotinine and hydroxycotinine for US adults aged ≥ 20 years were developed by using receiver operating characteristic curve methodology. The optimality criterion used to determine cutoffs simultaneously maximized both specificity and sensitivity. Cutoffs were determined for the total population, males, females, non-Hispanic whites, non-Hispanic blacks, Hispanics, and non-Hispanic Asians. Cutoffs for both cotinine and hydroxycotinine were determined with a minimum sensitivity of 95.5% and with a minimum specificity of 95.4%. For the total population, cutoff for urine cotinine was 91.7 ng/mL estimated with a specificity as well as a sensitivity of 97.1%. The cutoff for the total population for urine hydroxycotinine was 128.0 ng/mL estimated with a specificity as well as a sensitivity of 96.5%. The order in which cutoffs were observed for cotinine was non-Hispanic blacks (283.0 ng/mL) > non-Hispanic whites (111.0 ng/mL) > males (109.0 ng/mL) > females (91.7 ng/mL) > total population (91.7 ng/mL) > Hispanics (20.8 ng/mL) > non-Hispanic Asians (7.39 ng/mL). The order in which cutoffs were observed for hydroxycotinine was non-Hispanic blacks (530.0 ng/mL) > non-Hispanic whites (180.0 ng/mL) > females (97.0 ng/mL) > total population (96.5 ng/mL) > males (95.9 ng/mL) > Hispanics (20.6 ng/mL) > non-Hispanic Asians (13.8 ng/mL). Thus, the largest cutoffs were observed for non-Hispanic blacks and the lowest cutoffs were observed for non-Hispanic Asians.
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Heo HC, Byun YS, Sohn SH, Jo SM, Park SK, Sakong J. Validity assessment of self-reported smoking status in firefighters using the urine cotinine test. Ann Occup Environ Med 2020; 32:e2. [PMID: 32082584 PMCID: PMC7008589 DOI: 10.35371/aoem.2020.32.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In firefighters, smoking management is important because they are exposed to various harmful substances in their occupational environment. Accurate surveys of smoking status are essential to control tobacco use. The main disadvantage of self-report questionnaires, which are commonly used for investigating smoking status, is the possibility that the subjects' response are invalid. If the validity of firefighters' answers on smoking questionnaires is not adequate, different methods will be needed for investigating smoking status in firefighters. METHODS This study was conducted on 445 male firefighters from 9 fire stations in Daegu (the city in South Korea) who visited a medical institution for medical checkup in 2016. The urine cotinine test strip (DCT-102; CLIAwaived Inc., cut-off value = 200 ng/mL) was used to classify the actual smoking status and to assess the validity of self-reported smoking status on questionnaires. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the smoking questionnaires were analyzed. Subjects testing positive in the urine cotinine test (assumed the actual current smokers) were selected. The frequency at which actual current smokers were misclassified as current non-smokers by the questionnaire was calculated. Subjects' characteristics were analyzed for possible association with any discrepancy between self-reported smoking status and urine cotinine test results. RESULTS The smoking rates among firefighters surveyed using the smoking questionnaire and the urine cotinine test were 22.47% and 51.24%, respectively. Of the all subjects, 29.66% (n = 132) were misclassified. The sensitivity of the smoking questionnaire was 42.98%, the specificity was 99.08%, the PPV was 98.00%, and the NPV was 62.32%. In the 228 subjects classified as current actual smokers by the urine cotinine test, 57.02% (n = 130) were misclassified on the questionnaire. The misclassification rate increased with age. The degree of misclassification also increased when subjects had a history of disease. CONCLUSIONS In present study, the validity of the smoking questionnaire for firefighters was not suitable for investigating smoking status due to low sensitivity. To increase the validity of smoking status monitoring in firefighters, consideration of the various factors like survey environment, subjects' characteristics, and occupational factors is needed.
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Affiliation(s)
- Han Cheol Heo
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Young Seok Byun
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Soo Ho Sohn
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Seong Min Jo
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Sung Kyu Park
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Joon Sakong
- Department of Occupational and Environmental Medicine, Yeungnam University Hospital, Daegu, Korea
- Department of Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, Korea
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Cigarette smoking and antioxidant defences in packed red blood cells prior to storage. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 18:40-48. [PMID: 31855151 DOI: 10.2450/2019.0166-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/14/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Red blood cells from smoking donors can have more lesions from oxidative stress, decreasing the benefits of blood transfusion. We aimed to explore the effect of cigarette smoking on the oxidative status of packed red blood cells (PRBCs) prior to storage. MATERIALS AND METHODS We compared serum vitamin C, plasmatic malondialdehyde (MDA), and non-protein thiol groups (GSH) levels in PRBCs, as well glutathione peroxidase (GPx) and glutathione s-transferase (GST) activity in PRBCs from smoking (n=36) and non-smoking (n=36) donors. We also correlated urinary cotinine levels with these parameters. RESULTS Cigarette smoking was associated with decreased serum levels of vitamin C and GPx, and increased GST activity in PRBCs. We found negative correlations between cotinine, GPx activity and vitamin C levels, and a positive correlation between cotinine and GST activity. DISCUSSION Cigarette smoking changed antioxidant defences of PRBCs prior to storage and these parameters are correlated with cotinine levels. Increased RBC antioxidants such as GST may reflect an exposure to oxidants during erythropoiesis. Because of the inability of mature RBCs to resynthesise antioxidants, PRBCs from smokers may have higher risk of storage lesions than those from non-smoker donors.
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Evaluation of Performance of Inexpensive Laser Based PM2.5 Sensor Monitors for Typical Indoor and Outdoor Hotspots of South Korea. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9091947] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inexpensive (<$300) real-time particulate matter monitors (IRMs), using laser as a light source, have been introduced for use with a Wi-Fi function enabling networking with a smartphone. However, the information of measurement error of these inexpensive but convenient IRMs are still limited. Using ESCORTAIR (ESCORT, Seoul, Korea) and PurpleAir (PA) (PurpleAir U.S.A.), we evaluated the performance of these two devices compared with the U.S. Environmental Protection Agency (EPA) Federal Equivalent Monitoring (FEM) devices, that is, GRIMM180 (GRIMM Aerosol, Germany) for the indoor measurement of pork panfrying or secondhand tobacco smoking (SHS) and Beta-ray attenuation monitor (BAM) (MetOne, Grants Pass, OR) for outdoor measurement at the national particulate matter (PM2.5) monitoring site near an urban traffic hotspot in Daejeon, South Korea, respectively. The PM2.5 concentrations measured by ESCORTAIR and PA were strongly correlated to FEM (r = 0.97 and 0.97 from indoor pan frying; 0.92 and 0.86 from indoor SHS; 0.85 and 0.88 from outdoor urban traffic hotspot). The two IRMs showed that PM2.5 mass concentrations were increased with increased outdoor relative humidity (RH) levels. However, after applying correction factors for RH, the Median (Interquartile range) of difference compared to FEM was (14.5 (6.1~23.5) %) for PA and 16.3 (8.5–28.0) % for ESCORTAIR, supporting their usage in the home or near urban hotspots.
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Aune D, Schlesinger S, Norat T, Riboli E. Tobacco smoking and the risk of heart failure: A systematic review and meta-analysis of prospective studies. Eur J Prev Cardiol 2018; 26:279-288. [DOI: 10.1177/2047487318806658] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background We conducted a systematic review and meta-analysis to clarify the association between smoking and the risk of developing heart failure. Methods PubMed and Embase databases were searched up to 24 July 2018. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of heart failure associated with smoking. Summary RRs and 95% CIs were estimated using a random effects model. Results Twenty-six studies were included. The summary RR was 1.75 (95% CI: 1.54–1.99, I2 = 81%, n = 10) for current smokers, 1.16 (95% CI: 1.08–1.24, I2 = 51%, n = 9) for former smokers, and 1.44 (1.34–1.55, I2 = 83%, n = 10) for ever smokers compared with never smokers. The summary RR was 1.41 (95% CI: 1.01–1.96, I2 = 82%, n = 2) per 10 cigarettes per day, 1.11 (95% CI: 1.04–1.18, I2 = 70%, n = 3) and 1.08 (95% CI: 1.02–1.14, I2 = 34%, n = 2) per 10 pack-years among ever smokers and former smokers, respectively, and 0.79 (95% CI: 0.63–1.00, I2 = 96%, n = 2) per 10 years since quitting smoking. The association between smoking cessation and heart failure reached significance at 15 years of smoking cessation, and at 30 years the summary RR was 0.72 (95% CI: 0.57–0.90), only slightly higher than the summary RR for never smokers (0.64 (95% CI: 0.57–0.72)) when compared with current smokers. Conclusion Smoking is associated with increased risk of heart failure, but the risk decreases with increasing duration since smoking cessation. Any further studies should investigate the association between number of cigarettes per day, duration, pack-years and time since quitting smoking and risk of heart failure.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Sabrina Schlesinger
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Affiliation(s)
- Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation/Division of Cardiology, Yokohama City University Medical Center
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Smoking Topography among Korean Smokers: Intensive Smoking Behavior with Larger Puff Volume and Shorter Interpuff Interval. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051024. [PMID: 29783674 PMCID: PMC5982063 DOI: 10.3390/ijerph15051024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 12/04/2022]
Abstract
The difference of smoker’s topography has been found to be a function many factors, including sex, personality, nicotine yield, cigarette type (i.e., flavored versus non-flavored) and ethnicity. We evaluated the puffing behaviors of Korean smokers and its association with smoking-related biomarker levels. A sample of 300 participants was randomly recruited from metropolitan areas in South Korea. Topography measures during a 24-hour period were obtained using a CReSS pocket device. Korean male smokers smoked two puffs less per cigarette compared to female smokers (15.0 (13.0–19.0) vs. 17.5 (15.0–21.0) as the median (Interquartile range)), but had a significantly larger puff volume (62.7 (52.7–75.5) mL vs. 53.5 (42.0–64.2) mL); p = 0.012). The interpuff interval was similar between men and women (8.9 (6.5–11.2) s vs. 8.3 (6.2–11.0) s; p = 0.122) but much shorter than other study results. A dose-response association (p = 0.0011) was observed between daily total puff volumes and urinary cotinine concentrations, after controlling for sex, age, household income level and nicotine addiction level. An understanding of the difference of topography measures, particularly the larger puff volume and shorter interpuff interval of Korean smokers, may help to overcome a potential underestimation of internal doses of hazardous byproducts of smoking.
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Urinary Cotinine Concentration and Self-Reported Smoking Status in 1075 Subjects Living in Central Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040804. [PMID: 29671826 PMCID: PMC5923846 DOI: 10.3390/ijerph15040804] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/17/2022]
Abstract
Background: Urinary cotinine, a metabolite of nicotine, is a marker of tobacco smoke exposure. A cutoff value for cotinine concentration can be set to distinguish smokers from non-smokers, independently from self-declared status. Method: Cotinine was determined by isotopic dilution High Performance Liquid Chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) between 2013 and 2014 on urine samples of a population of 1075 subjects. Results: 296 subjects have a cotinine level higher than 100 μg/g of creatinine (cutoff), with a median cotinine concentration of 1504.70 μg/g of creatinine. The mean is 27.5% of smokers and 60.5% in this group are females. The median value for non-smokers is 5.6 μg/g of creatinine. Two hundred and seventy-five subjects declared to be smokers in the questionnaire, but 6 (2.2%) present urinary cotinine levels lower than cutoff; 800 subjects declared to be non-smokers, but 26 of them presented urinary cotinine levels that were higher than the cutoff (3.3%). Conclusion: Using the cutoff of 100 μg/g, the misclassification of smokers resulted to be 2.2%, indicating that the selected value is suitable for studying the human exposures to environmental and occupational pollutants, including those produced by smoking.
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Abstract
Supplemental Digital Content is available in the text Objective: Secondhand smoke exposure (SHSE) in nonsmokers has been associated with premature cardiovascular mortality and ischemic heart disease. We conducted a cross-sectional, population-based study evaluating the relationship between SHSE, measured by subjective and objective methods, and conventional cardiovascular risks such as blood pressure, lipid profiles, and fasting glucose. Methods: We extracted information on 7376 healthy adults who had never smoked, for whom there were available urine cotinine levels, from the Korea National Health and Nutrition Examination Survey 2008–2011. SHSE was defined using self-report questionnaires and urine cotinine levels. The main outcomes included SBP and DBP, serum lipid profiles, and fasting glucose. Results: The mean age of the study population was 45.4 ± 0.4 years and 75.2% were women. Self-reported SHSE had no significant association with study outcomes except for DBP, which had marginally positive relationships (P = 0.060). Unadjusted analysis showed higher cotinine levels were associated with lower SBP, total cholesterol, LDL cholesterol, and triglyceride. All associations lost statistical significance after multivariable adjustment. Fasting glucose had a positive relationship with urine cotinine in quartiles but not with logarithm-transformed cotinine. Conclusion: Although SHSE is associated with increased risk of cardiovascular mortality and morbidity, we did not find any consistent relationship among SHSE and blood pressure, lipid, or fasting glucose levels in this cross-sectional study. Using objective measurements of urine cotinine did not alter this relationship. Further long-term prospective studies are needed to evaluate the effect of SHSE as a cardiovascular risk factor.
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Abduljabbar T, Al-Hamoudi N, Al-Sowygh ZH, Alajmi M, Javed F, Vohra F. Comparison of peri-implant clinical and radiographic status around short (6 mm in length) dental implants placed in cigarette-smokers and never-smokers: Six-year follow-up results. Clin Implant Dent Relat Res 2017; 20:21-25. [PMID: 29181892 DOI: 10.1111/cid.12564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is hypothesized that peri-implant clinical and radiographic inflammatory parameters (probing depth [PD], bleeding on probing [BOP] and plaque index [PI]; and radiographic (crestal bone loss [CBL]) are worse among cigarette-smokers (CS) compared with never-smokers (NS) with short implants. PURPOSE The present 6-year follow-up retrospective study compared the peri-implant clinical and radiographic parameters in CS and NS with short dental implants (6 mm in length). MATERIALS AND METHODS Fifty-six male individuals were included. These individuals divided into 2 groups as follows: (a) Group-1: 29 self-reported systemically healthy CS with 48 short-implants; and (b) Group-2: 27 self-reported systemically healthy NS with 43 short implants. Peri-implant PD, PI, BOP, and CBL were measured. Group comparisons were done using the Kruskal-Wallis test and sample size was estimated. Level of significance was set at P values < .05. RESULTS In groups 1 and 2, the follow-up durations were 6.2 ± 0.1 years and 6.1 ± 0.3 years, respectively. A cigarette smoking history of 8.9 ± 3.6 pack years was reported by individuals in Group-1. At follow-up, scores of peri-implant PD, BOP, PI, and mesial and distal CBL were comparable around short implants in both groups. CONCLUSION Under strict oral hygiene maintenance protocols, short dental implants can remain functionally stable in CS in a manner similar to NS.
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Affiliation(s)
- Tariq Abduljabbar
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nawwaf Al-Hamoudi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Zeyad H Al-Sowygh
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alajmi
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Kwak J, Jeong H, Chun S, Bahk JH, Park M, Byun Y, Lee J, Yim HW. Effectiveness of government anti-smoking policy on non-smoking youth in Korea: a 4-year trend analysis of national survey data. BMJ Open 2017; 7:e013984. [PMID: 28706085 PMCID: PMC5577913 DOI: 10.1136/bmjopen-2016-013984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Since the Health Promotion Act was introduced in Korea in 1995, anti-smoking policies and regulations have undergone numerous revisions, and non-smoking areas have gradually been expanded. The purpose of this study was to examine the impact of a partial legislative ban on adolescent exposure to secondhand smoke using objective urinary cotinine levels in a nationwide representative sample. METHODS Urine cotinine levels were measured in the Korea National Health and Nutrition Examination Survey from 2008 to 2011. This study was a trend analysis of 4 years of national survey data from 2197 Korean youth aged 10-18 years. Among non-smokers, the 75th percentile urinary cotinine level was estimated. We also considered the number of household smokers. RESULTS The 75th percentile urine cotinine level of non-smokers showed a significant decreasing trend from 2008 to 2011, from 15.47 to 5.37 ng/mL, respectively. Urine cotinine did not decline significantly in non-smokers living with smokers during the study period. The results did not show a statistically significant reduction in smoking rate in adolescents from 2008 to 2011, although there was a trend towards a decrease (p=0.081). CONCLUSIONS Based on urine cotinine levels, government-initiated anti-smoking policies have only been effective among highly exposed non-smoking adolescents during the study period. Further study needs to evaluate whether or not the legislative ban affects domestic smoking exposure.
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Affiliation(s)
- Jueun Kwak
- Catholic Medical Center, Seoul, Republic of Korea
| | - Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Chun
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hoon Bahk
- Catholic Medical Center, Seoul, Republic of Korea
| | - Misun Park
- Clinical Research Coordinating Center, Catholic Medical Center, Republic of Korea
| | | | - Jina Lee
- Catholic Medical Center, Seoul, Republic of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Clinical Research Coordinating Center, Catholic Medical Center, Republic of Korea
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Kim S. Overview of Cotinine Cutoff Values for Smoking Status Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121236. [PMID: 27983665 PMCID: PMC5201377 DOI: 10.3390/ijerph13121236] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
While cotinine is commonly used as a biomarker to validate self-reported smoking status, the selection of an optimal cotinine cutoff value for distinguishing true smokers from true nonsmokers shows a lack of standardization among studies. This review describes how the cutoff values have been derived, and explains the issues involved in the generalization of a cutoff value. In this study, we conducted an English-language literature search in PubMed using the keywords “cotinine” and “cutoff” or “self-reported” and “smoking status” and “validation” for the years 1985–2014. We obtained 104 articles, 32 of which provided (1) sensitivity and specificity of a cutoff value and (2) determination methods for the given cutoff value. We found that the saliva cotinine cutoff value range of 10–25 ng/mL, serum and urine cotinine cutoff of 10–20 ng/mL and 50–200 ng/mL, respectively, have been commonly used to validate self-reported smoking status using a 2 × 2 table or a receiver operating characteristics (ROC) curve. We also found that recent large population-based studies in the U.S. and UK reported lower cutoff values for cotinine in serum (3 ng/mL) and saliva (12 ng/mL), compared to the traditionally accepted ones (15 and 14 ng/mg, respectively).
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Affiliation(s)
- Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Asan 31538, Korea.
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Lee M, Choi YH, Sagong J, Yu S, Kim Y, Lee D, Kim S. The interactive association of smoking and drinking levels with presence of periodontitis in South Korean adults. BMC Oral Health 2016; 16:80. [PMID: 27557802 PMCID: PMC4997691 DOI: 10.1186/s12903-016-0268-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022] Open
Abstract
Background Periodontitis is a chronic and long-lasting low-grade inflammatory disease. Numerous studies have shown that the severity of periodontitis rose when there was an increase in the amount of smoking or alcohol consumption. However, as periodontitis known as a chronic disease, it is important to consider not only the amount but “duration” with frequency i.e., rates, of smoking or drinking. This study assessed impacts of the amount and duration of smoking and drinking on periodontal health in Korean adults. We also investigated whether or not there is an interactive effect of smoking and drinking on periodontal health. Methods Under a cross-sectional study design, we used data from the fourth and fifth the Korean National Health and Nutrition Examination Survey (KNHANES) sessions (2008–2010). A total of 18,488 subjects (over 19 years) answered both smoking and drinking status and were given the periodontal examination. Periodontal health status was determined by the community periodontal index (CPI) developed by the World Health Organization (WHO). According to the WHO guidelines, if a participant’s CPI was 3 or larger, we classified the person as a case of periodontitis. Participants with a CPI < 3 were assigned to the control group. Results Prevalence of periodontitis for self-reported smokers or drinkers in South Korea was 35.0 or 28.0 %, respectively. We observed 1.20 (0.93~1.56) of odds ratio (95 % CI) for prevalence (POR) of periodontitis for those smoked <13 pack-year (PY) and drank ≥6.8 glass-year (GY). And we had POR of 1.91 (1.34~2.73) for those smoked ≥13 PY and drank <6.8 GY, compared to those nonsmoking nondrinkers. The observed POR of 2.41 (95 % CI: 1.94–3.00), for those smoked ≥13 PY and drank ≥6.8 GY, was higher than a multiplicative effect estimated, i.e., 1.20 (0.93~1.56) [those smoked <13 PY and drank ≥6.8 GY] × 1.91 (1.34~2.73) [those smoked ≥13 PY and drank <6.8 GY], or 2.29. Conclusions We observed a multiplicative interactive effect of smoking and drinking on periodontal status among Korean adults.
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Affiliation(s)
- Mira Lee
- Department of Environmental Health Sciences, Soonchunhyang University, Soonchunhyang-Ro 22, Asan, Chungnam, 336-745, South Korea
| | - Yoon-Hyeong Choi
- Graduate School of Medicine, Gachon University, Incheon, South Korea
| | - Jun Sagong
- Preventive Medicine and Public Health, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Sol Yu
- Department of Environmental Health Sciences, Soonchunhyang University, Soonchunhyang-Ro 22, Asan, Chungnam, 336-745, South Korea
| | - Yongbae Kim
- Department of Preventive Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Dongjae Lee
- Department of Environmental Health Sciences, Soonchunhyang University, Soonchunhyang-Ro 22, Asan, Chungnam, 336-745, South Korea
| | - Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Soonchunhyang-Ro 22, Asan, Chungnam, 336-745, South Korea.
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Lim Y, Chun S, Lee JH, Baek KH, Lee WK, Yim HW, Kang MI. Association of bone mineral density and diabetic retinopathy in diabetic subjects: the 2008-2011 Korea National Health and Nutrition Examination Survey. Osteoporos Int 2016; 27:2249-2257. [PMID: 26883444 DOI: 10.1007/s00198-016-3527-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Because diabetic retinopathy increases fracture risk, we studied the association between bone mineral density (BMD) and diabetic retinopathy in a nationally representative sample. A significant association between the presence of diabetic retinopathy and low BMD was observed. Therefore, diabetic retinopathy might be considered as a marker of low BMD. INTRODUCTION Several diabetic complications, including nephropathy, retinopathy, and peripheral neuropathy, are associated with a higher fracture risk in diabetic subjects. However, in contrast to diabetic nephropathy and peripheral neuropathy, which are associated with low bone mineral density (BMD), little is known about the association between BMD and diabetic retinopathy. The aim of the present study was to determine whether the prevalence of diabetic retinopathy is associated with BMD. METHODS This cross-sectional study included a nationally representative sample consisting of 4357 men aged 50 years and older and 4392 postmenopausal women who participated in the Korea National Health and Nutritional Examination Survey (KNHANES) from 2008 to 2011 and underwent BMD measurement by dual-energy X-ray absorptiometry (DXA) and diabetic retinopathy assessments using seven standard gradable photographs. RESULTS The diabetic women with retinopathy had lower mean BMD at all measured sites than those without retinopathy, although the BMD difference between the two groups was small (3-5 %). In addition, the diabetic women with retinopathy were 2.27 times more likely to have osteoporosis following adjustments for all clinically relevant covariates. However, the prevalence of diabetes mellitus (DM) or diabetic retinopathy was not associated with the prevalence of osteoporosis in men. CONCLUSIONS This study has shown that the presence of diabetic retinopathy is significantly associated with a reduced BMD and increased prevalence of osteoporosis in diabetic women.
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Affiliation(s)
- Y Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Korea
| | - S Chun
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - J H Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - K H Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Korea
| | - W K Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - H-W Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - M-I Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Korea.
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26
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Kim H, Kim SK, Yu EJ, Lee JR, Jee BC, Suh CS, Kim SH. The prevalence of positive urinary cotinine tests in Korean infertile couples and the effect of smoking on assisted conception outcomes. Clin Exp Reprod Med 2015; 42:136-42. [PMID: 26816872 PMCID: PMC4724597 DOI: 10.5653/cerm.2015.42.4.136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/10/2015] [Accepted: 10/30/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Smoking has been reported to harm nearly every organ of the body, but conflicting results have been reported regarding the effects of smoking on assisted conception. In this prospective cohort study, we aimed to investigate the prevalence of positive urinary cotinine tests in infertile couples and whether cotinine positivity was associated with infertility treatment outcomes. METHODS A qualitative urinary cotinine test was administered to 127 couples who underwent in vitro fertilization (IVF, n=92) or intrauterine insemination (IUI, n=35). RESULTS The overall prevalence of positive urinary cotinine test was 43.3% (55/127) in the male partners and 10.2% (13/127) in the female partners with similar prevalence rates in both genders in the IUI and IVF groups. Semen characteristics, serum markers of ovarian reserve, and number of retrieved oocytes were comparable among cotinine-positive and cotinine-negative men or women (with the exception of sperm count, which was higher among cotinine-positive men). The results of urinary cotinine tests in infertile couples were not associated with IVF and IUI outcomes. CONCLUSION The presence of cotinine in the system, as indicated by a positive urinary cotinine test, was not associated with poorer outcomes of infertility treatment.
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Affiliation(s)
- Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Jeong Yu
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Jung SY, Kim S, Lee K, Kim JY, Bae WK, Lee K, Han JS, Kim S. Association between secondhand smoke exposure and blood lead and cadmium concentration in community dwelling women: the fifth Korea National Health and Nutrition Examination Survey (2010-2012). BMJ Open 2015; 5:e008218. [PMID: 26185180 PMCID: PMC4513535 DOI: 10.1136/bmjopen-2015-008218] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the association between secondhand smoke exposure and blood lead and cadmium concentration in women in South Korea. DESIGN Population-based cross-sectional study. SETTING South Korea (Korea National Health and Nutrition Examination Survey V). PARTICIPANTS 1490 non-smoking women who took part in the fifth Korea National Health and Nutrition Examination Survey (2010-2012), in which blood levels of lead and cadmium were measured. PRIMARY OUTCOME MEASURES The primary outcome was blood levels of lead and cadmium in accordance with the duration of secondhand smoke exposure. RESULTS The adjusted mean level of blood cadmium in women who were never exposed to secondhand smoke was 1.21 (0.02) µg/L. Among women who were exposed less than 1 h/day, the mean cadmium level was 1.13 (0.03) µg/L, and for those exposed for more than 1 h, the mean level was 1.46 (0.06) µg/L. In particular, there was a significant association between duration of secondhand smoke exposure at the workplace and blood cadmium concentration. The adjusted mean level of blood cadmium concentration in the never exposed women's group was less than that in the 1 h and more exposed group, and the 1 h and more at workplace exposed group: 1.20, 1.24 and 1.50 µg/L, respectively. We could not find any association between lead concentration in the blood and secondhand smoke exposure status. CONCLUSIONS This study showed that exposure to secondhand smoke and blood cadmium levels are associated. Especially, there was a significant association at the workplace. Therefore, social and political efforts for reducing the exposure to secondhand smoke at the workplace are needed in order to promote a healthier working environment for women.
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Affiliation(s)
- Se Young Jung
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
| | - Suyeon Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
| | - Ju Young Kim
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
| | - Woo Kyung Bae
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
| | - Keehyuck Lee
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
| | - Jong-Soo Han
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
| | - Sarah Kim
- Department of Family Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Gyeongi-do, Korea
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Utility and cutoff value of hair nicotine as a biomarker of long-term tobacco smoke exposure, compared to salivary cotinine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8368-82. [PMID: 25153466 PMCID: PMC4143866 DOI: 10.3390/ijerph110808368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 11/30/2022]
Abstract
While hair samples are easier to collect and less expensive to store and transport than biological fluids, and hair nicotine characterizes tobacco exposure over a longer time period than blood or urine cotinine, information on its utility, compared with salivary cotinine, is still limited. We conducted a cross-sectional study with 289 participants (107 active smokers, 105 passive smokers with self-reported secondhand smoke (SHS) exposure, and 77 non-smokers with no SHS exposure) in Baltimore (Maryland, USA). A subset of the study participants (n = 52) were followed longitudinally over a two-month interval. Median baseline hair nicotine concentrations for active, passive and non-smokers were 16.2, 0.36, and 0.23 ng/mg, respectively, while those for salivary cotinine were 181.0, 0.27, and 0.27 ng/mL, respectively. Hair nicotine concentrations for 10% of passive or non-smokers were higher than the 25th percentile value for active smokers while all corresponding salivary cotinine concentrations for them were lower than the value for active smokers. This study showed that hair nicotine concentration values could be used to distinguish active or heavy passive adult smokers from non-SHS exposed non-smokers. Our results indicate that hair nicotine is a useful biomarker for the assessment of long-term exposure to tobacco smoke.
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Agaku IT, Vardavas CI, Connolly G. Proposed cutoff for identifying adult smokeless tobacco users with urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanonol: an aggregated analysis of NHANES 2007-2010 data. Nicotine Tob Res 2013; 15:1956-61. [PMID: 23956252 DOI: 10.1093/ntr/ntt083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION NNAL [4-(methylnitrosamino)-1-(3-pyridyl)-1-butanonol] is a valid biomarker of tobacco use. However; no study has assessed its use in distinguishing current smokeless tobacco (SLT) users from nonusers. Therefore, this study used aggregated data from the 2007-2008 and 2009-2010 waves of the National Health and Nutrition Examination Survey to determine an optimal threshold for identifying SLT users with NNAL. METHODS Optimal urinary total NNAL concentrations for discriminating SLT-only users from nonusers of any tobacco were determined using receiver operating characteristic analysis. Percentage agreement between self-reported SLT use status and NNAL levels was calculated overall and by sociodemographic characteristics. All analyses were weighted and performed with Stata, Version 11, and MedCalc for Windows, Version 9.5.0.0. RESULTS In total, 264 individuals reported exclusively using SLT (and no other combustible tobacco product) within the past 5 days, whereas 14,824 were self-reported nonusers of any combustible or smokeless tobacco product. The optimal NNAL cutoff point was 34.0 pg/ml, which was associated with a high sensitivity (95.2%), specificity (93.4%), and overall correct classification rate (93.5%). The area under the curve was 98.3% and the corresponding Youden's Index was 88.7%. There was high agreement between the proposed NNAL cutoff point and self-reported SLT-only use (95.6%) and self-reported SLT nonuse (93.9%). CONCLUSION The proposed cutoff point of 34.0 pg/ml had high sensitivity and specificity and may be used by clinicians and researchers to verify or detect recent SLT use. This study also indicated that self-reported SLT use among adults is a reliable measure and has high agreement with biochemical assessment.
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Affiliation(s)
- Israel T Agaku
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
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Han DH, Lee HJ, Lim S. Smoking induced heavy metals and periodontitis: findings from the Korea National Health and Nutrition Examination Surveys 2008-2010. J Clin Periodontol 2013; 40:850-8. [DOI: 10.1111/jcpe.12133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry; School of Dentistry; Seoul National University; Seoul Korea
- Dental Research Institute; Seoul National University; Seoul Korea
| | - Hye-Ju Lee
- Department of Preventive and Social Dentistry; School of Dentistry; Seoul National University; Seoul Korea
| | - Sinye Lim
- Department of Occupational and Environmental Medicine; Kyung Hee University Hospital; Seoul Korea
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