Epidemiology and Health

Original Article

Age-related trajectories of blood lipids and lipoproteins by sex, region, and waist circumference changes in Korea: a longitudinal cohort study: Mi Kyoung Son, Nam-Kyoo Lim, Joong-Yeon Lim, Hyun-Young Park; Epidemiol Health. 2025;47:e2025066. Published online December 9, 2025; DOI: https://doi.org/10.4178/epih.e2025066

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to evaluate the longitudinal trajectories of lipid and lipoprotein levels with aging according to sex and changes in waist circumference (ΔWC) from midlife to late life.
METHODS
We included 4,345 male and 4,804 female participants aged 40-69 years at baseline from the Korean Genome and Epidemiology Study (2001-2018). The annual ΔWC was estimated using linear regression. Marginal models were fitted using mixed-effects regression.
RESULTS
The trajectories of total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels displayed an increasing trend until the 60s age range in females (approximately 10-15 mg/dL) and the late 40s in males (approximately 3-5 mg/dL), with a subsequent decline. In females, HDL-C levels increased until the early 50s, declined thereafter, and rose again from the 70s onward, with a more pronounced rise in urban than in rural areas, while remaining relatively stable in males. Triglyceride (TG) levels decreased with advancing age in males, whereas in females they increased up to the age of 70 years, followed by a decrease. Females exhibited greater increases in TC, non-HDL-C, HDL-C, LDL-C, and TG across all ages compared with males. Both males and females with a decrease in waist circumference (WC) during follow-up showed improvements in lipid and lipoprotein profiles relative to those with stable or increased WC.
CONCLUSIONS
Trends in lipid and lipoprotein levels vary according to age and sex, and a decrease in WC significantly improves lipid and lipoprotein profiles.; Summary

Korean summary
• 40세 이상 한국 성인을 대상으로 한 전향적 코호트에서 지질 및 지단백 궤적은 연령, 성별, 지역에 따라 상이한 양상을 보였으며, 총콜레스테롤, 저밀도 지단백 콜레스테롤, 비고밀도 지단백 콜레스테롤 수준은 농촌 지역에 비해 도시 지역에서 전반적으로 불리한 양상으로 나타났다. • 여성은 남성에 비해 5개 지질 및 지단백 지표 전반에서 더 큰 증가 폭을 보였으며, 여성의 고밀도 지단백 콜레스테롤은 폐경 이행기를 전후로 감소한 이후 다시 증가하였다. • 허리둘레의 지속적인 감소는 지질 및 지단백 프로파일의 개선과 관련되었으며, 이러한 결과는 복부비만 관리에 있어 연령과 성별을 고려한 맞춤형 접근의 중요성을 시사한다.

Key Message
• In a prospective cohort analysis of Korean adults aged 40 years and older, lipid and lipoprotein trajectories varied by age, sex, and region, with total cholesterol, low- density llipoprotein cholesterol, and non-high-density lipoprotein cholesterol levels generally showing less favorable patterns in urban than rural areas. • Females exhibited greater increases across all five lipid and lipoprotein measures than males, while high-density cholesterol levels in females declined around the menopausal transition and increased again in later life. • A sustained decrease in waist circumference was associated with improvements in lipid and lipoprotein profiles, highlighting the importance of age- and sex-specific approaches to abdominal obesity management.

Cohort Profile

Korea Nurses’ Health Study and the health of reproductive-aged women: a cohort profile: Chiyoung Cha, Heeja Jung, Sue Kim, Jung Eun Lee, Kwang-Pil Ko, Eunyoung Cho, Hyun-Young Park, Joong-Yeon Lim, Bo Mi Song, Sihan Song, Soojin Park, Aram Cho; Epidemiol Health. 2024;46:e2024048. Published online April 30, 2024; DOI: https://doi.org/10.4178/epih.e2024048

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Abstract

The Korea Nurses’ Health Study (KNHS) is an ongoing, large-scale, prospective cohort study of women nurses, focusing on the effects of occupational, environmental, and lifestyle factors on the health of women. The first KNHS survey was performed in 2013-2014 (n=20,613). As of December 2023, 11 follow-up surveys have been conducted. Participants who were pregnant were asked to participate in the early pregnancy survey (n=2,179) and postpartum survey after giving birth (n=2,790). The main variables included socio-demographic, work-related, lifestyle, physical, mental, and women’s health factors. Blood, urine, and toenail samples were collected from a participant subgroup of the first survey (n=1,983). The subgroups of the second survey completed a food frequency questionnaire in 2019 (n=300) and 2021 (n=871). In 2020, a subgroup of the first survey answered a coronavirus disease 2019-related survey (n=975). To examine various health-related factors in young adults, new participants were added to the KNHS cohort in the 11th (n=1,000) and 12th (n=1,002) surveys. The KNHS cohort will help identify health and illness determinants in Korean women. Data can be accessed at https://coda.nih.go.kr/frt/index.do.

Summary

Korean summary
한국간호사건강연구(Korea Nurses’ Health Study, KNHS)는 2013년부터 수행되고 있는 대규모 전향적 추적관찰 코호트 연구이다. 본 연구는 질병력, 약물복용력, 임신력, 여성건강, 정신건강(우울, 스트레스, 피로 등), 생활습관(흡연, 음주, 신체활동, 수면 등), 근무특성을 조사하여 여성건강에 장기적으로 미치는 영향을 파악하고 한국 고유의 여성건강 결정요인을 도출하는 것을 목표로 한다.

Key Message
The Korea Nurses' Health Study (KNHS) is a large-scale, prospective cohort study that has been conducted since 2013. It measures various factors affecting reproductive-aged women, including disease history, medication usage, pregnancy, women's health characteristic, mental health (such as depression, stress, and fatigue), lifestyle characteristic (including smoking, drinking, and physical activity, sleep), and work-related characteristics. The study aims to understand the long-term impact on women's health and identify unique determinants of women's health specific to Korea.

Citations

Citations to this article as recorded by

Do physical activity, psychological health, and food group intake change in early pregnancy before and during COVID-19? A secondary analysis of cohort data from the Korea Nurses’ Health Study
Chiyoung Cha, Jung Eun Lee, Jin-hui Han
Women's Health Nursing.2025; 31(1): 22. CrossRef
Factors Affecting Nonresponse Among Female Participants in the Korea Nurses’ Health Study: Longitudinal Cohort Survey Study
Young Taek Kim, Chiyoung Cha, Gumhee Baek, Bohye Kim, Bo Mi Song, Joong-Yeon Lim, Hyun-Young Park, Juh Hyun Shin
JMIR Public Health and Surveillance.2025; 11: e68038. CrossRef

Special Article

Nutrition survey methods and food composition database update of the Korean Genome and Epidemiology Study: Seon-Joo Park, Jieun Lyu, Kyoungho Lee, Hae-Jeung Lee, Hyun-Young Park; Epidemiol Health. 2024;46:e2024042. Published online April 2, 2024; DOI: https://doi.org/10.4178/epih.e2024042

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Abstract Summary PDF Supplementary Material

Abstract

This study presents the nutrition survey methods and the updated food composition database for the Korean Genome and Epidemiology Study (KoGES). The KoGES, which is the largest and longest cohort study in Korea, aims to identify genetic and environmental factors associated with chronic diseases. This study has collected dietary data using a validated semi-quantitative food frequency questionnaire and/or the 24-hour recall method. However, these dietary survey methods use different food composition databases, and their nutritional values are out of date. Therefore, it became necessary to update the food composition database by revising nutrient analysis values to reflect improvements in the performance of food ingredient analysis equipment, revising international values to analysis values of Korean agricultural products, adjusting nutrient units, and adding newly reported nutrients related to chronic diseases. For this purpose, we integrated the different food composition databases used in each nutrition survey, updated 23 nutrients, and expanded 48 new nutrients for 3,648 food items using the latest reliable food composition databases published by national and international institutions. This revised food composition database may help to clarify the relationship between various nutrients and chronic diseases. It could serve as a valuable resource for nutritional, epidemiological, and genomic research and provide a basis for determining public health policies.

Summary

Korean summary
한국인유전체역학조사사업은 우리나라에서 가장 크고 오래된 코호트로 만성질환과 영양과의 관련성을 밝히기 위하여 사용되고 있다. 이 논문에서는 영양조사에 대한 자세한 방법론과 현재 공개하고 있는 23개 영양소의 업데이트 및 48개 새로운 영양소의 확대에 대한 내용을 소개하였다. 이러한 개선을 통해 KoGES 영양 데이터의 활용도가 더욱 높아질 것으로 기대된다.

Key Message
The Korean Genome and Epidemiology Study (KoGES) is the largest and longest-running cohort study in South Korea aimed at identifying the relationship between chronic diseases and nutrient intake. This paper provides a detailed methods of the nutritional surveys and introduces updates to the existing 23 nutrients and the addition of 48 new nutrients. These enhancements are expected to significantly increase the utility of the KoGES nutritional data.

Citations

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Development and Validation of an Algorithm for Constructing an Amino Acid Database for Application to the Korean Genome and Epidemiology Study Cohort
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The inverse relationship between copy number variation burden and age of onset of metabolic syndrome in Korean middle-aged adults
Seong-Hee Ko, Minyeong Kim, Dayeon Shin
BMC Medical Genomics.2026;[Epub] CrossRef
Adherence to the Dietary Approaches to Stop Hypertension score and cardiovascular disease risk in Korean adults: a prospective cohort study using marginal structural models
Soo-Hyun Kim, Hyunju Kim, Dayeon Shin
The American Journal of Clinical Nutrition.2026; 123(6): 101297. CrossRef
Association Between the Empirical Dietary Inflammatory Pattern and Incident Hypertension in the Korean Middle-Aged Adults
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CardioMetabolic Syndrome Journal.2026; 6(1): 12. CrossRef
Association of FHIT gene variant and salty food preference with the incidence of metabolic syndrome
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Original Article

Folate, vitamin B12, and homocysteine status in the Korean population: data from the 2013-2015 Korea National Health and Nutrition Examination Survey: Sihan Song, Bo Mi Song, Hyun-Young Park; Epidemiol Health. 2024;46:e2024007. Published online December 11, 2023; DOI: https://doi.org/10.4178/epih.e2024007

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to assess the serum folate, vitamin B12, and homocysteine status in Korean adolescents and adults using national data.

METHODS

Blood samples were collected from participants aged ≥10 years in the Korea National Health and Nutrition Examination Survey 2013-2015. The stored serum samples were used to measure folate, vitamin B12, and homocysteine concentrations. A total of 8,016 participants were included in this analysis. Unweighted descriptive statistics and adjusted geometric means of the B vitamins and homocysteine concentrations were estimated.

RESULTS

Females had higher serum folate and vitamin B12 concentrations and lower serum homocysteine concentrations than males. Folate deficiency (<6.8 nmol/L) and hyperhomocysteinemia (>15 μmol/L) were found in 8.6% and 11.8% of males, respectively. Approximately 3% of males had low or marginally low vitamin B12 status (≤221 pmol/L). Folate and vitamin B12 deficiencies and hyperhomocysteinemia were found in <2% of females. Suboptimal folate status was prevalent among adolescents and young adults, while suboptimal vitamin B12 status and hyperhomocysteinemia were relatively higher in older adults. Adjusted mean homocysteine concentrations were sharply decreased from the first to second decile of serum folate in males.

CONCLUSIONS

In the Korean population, the proportion of males who achieved desirable folate and homocysteine concentrations were lower than those of females. Although most Koreans have adequate vitamin B12, a suboptimal folate status is common, particularly among adolescents and young adults. These findings could establish a foundation for public health initiatives aimed at improving folate levels in the Korean population.

Summary

Korean summary
엽산과 비타민B12는 전 생애에 걸쳐 건강에 영향을 미치는 필수 비타민이다. 그러나 해당 비타민 상태에 대한 국내 자료는 부족한 실정이다. 본 연구는 국민건강영양조사 참여자로부터 수집된 혈청으로부터 엽산, 비타민B12, 그리고 이들의 기능성 지표인 호모시스테인 농도를 측정하였고 성별과 연령별 분포와 적합 상태를 평가하였다. 엽산 결핍과 고호모시스테인혈증은 남성에서 높은 유병률을 가졌다. 적정 엽산 상태를 충족하지 못하는 비율은 청소년과 젊은 성인에서 흔하게 관찰되었다. 대부분의 한국인은 충분한 비타민B12 수준을 가졌으나, 노인의 경우 정기적인 평가가 필요하다. 본 연구는 한국인이 최적의 엽산과 비타민B12 상태를 유지하기 위한 기반적 근거를 제공한다.

Key Message
Folate and vitamin B12 have significant health impacts throughout the life cycle. However, national-level data on B vitamins in Korea are limited. Serum folate, vitamin B12, and homocysteine concentrations were measured from samples stored during the national survey. In our study, the proportions of folate deficiency and hyperhomocysteinemia were higher in men than in women.Suboptimal folate status was common among adolescents and young adults. Most Koreans had adequate levels of vitamin B12; however, regular monitoring is warranted, especially in the older population. The current data provide a future direction for achieving optimal B vitamin status in the Korean population.

Citations

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Essential micronutrients in children and adolescents with a focus on growth and development: a narrative review
Sukjin Hong
Journal of Yeungnam Medical Science.2025; 42: 25. CrossRef

Data Profile

Integrated dataset of the Korean Genome and Epidemiology Study cohort with estimated air pollution data: Hae Dong Woo, Dae Sub Song, Sun Ho Choi, Jae Kyung Park, Kyoungho Lee, Hui-Young Yun, Dae-Ryun Choi, Youn-Seo Koo, Hyun-Young Park; Epidemiol Health. 2022;44:e2022071. Published online September 7, 2022; DOI: https://doi.org/10.4178/epih.e2022071

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Abstract

Public concern about the adverse health effects of air pollution has grown rapidly in Korea, and there has been increasing demand for research on ways to minimize the health effects of air pollution. Integrating large epidemiological data and air pollution exposure levels can provide a data infrastructure for studying ambient air pollution and its health effects. The Korean Genome and Epidemiology Study (KoGES), a large population-based study, has been used in many epidemiological studies of chronic diseases. Therefore, KoGES cohort data were linked to air pollution data as a national resource for air pollution studies. Air pollution data were produced using community multiscale air quality modeling with additional adjustment of monitoring data, satellite-derived aerosol optical depth, normalized difference vegetation index, and meteorological data to increase the accuracy and spatial resolution. The modeled air pollution data were linked to the KoGES cohort based on participants’ geocoded residential addresses in grids of 1 km (particulate matter) or 9 km (gaseous air pollutants and meteorological variables). As the integrated data become available to all researchers, this resource is expected to serve as a useful infrastructure for research on the health effects of air pollution.

Summary

Korean summary
대기오염이 건강에 미치는 정도를 파악하고 이를 최소화하는 과학적 근거 생산 마련을 위하여 한국인유전체역학조사사업(KoGES) 자료와 대기오염 및 기상 자료를 연계하여 연구 기반을 마련하고자 하였다. 배출량, 기상자료 및 공기의 확산 등을 고려하는 화학수송모델(CMAQ)을 통하여 2005년에서 2017년 사이의 대기오염 및 기상자료를 예측하였으며, 이후 관측소 자료 및 인공위성자료인 에어로졸 광화학두께(AOD)를 추가 적용하여 최종 생산하였다. 미세먼지 자료는 1 km 격자로 기체상 오염물질 및 기상 자료는 9 km 격자 단위로 구성되었다. 생산된 자료는 KoGES 참여자의 주소를 기반으로 연계하여 최종 KoGES-대기오염 연계DB를 구축하였으며, 구축된 자료를 이용하여 KoGES 참여자의 대기오염 노출 수준을 공간적 시간적 분포로 살펴보았다. 구축된 자료는 내외부 연구자에게 공개가 되고 있어 대기오염에 의한 건강영향평가 및 피해를 최소화하는 방안 마련 연구를 위한 좋은 기반 자료가 될 것으로 기대된다.

Key Message
The Korean Genome and Epidemiology Study (KoGES) cohort were linked to air pollution data as a national resource for studying air pollution and its health effect. Air pollution data (2005~2017) were produced using community multiscale air quality modeling with additional adjustment of monitoring data, satellite-derived aerosol optical depth, normalized difference vegetation index, and meteorological data to increase the accuracy and spatial resolution. The modelled air pollution data were linked to the cohort based on participants’ geocoded residential addresses in grids of 1 km (particulate matter) or 9 km (gaseous air pollutants and meteorological variables).

Citations

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