Epidemiology and Health

Cohort profile

Cohort study profile: a cohort of Korean atomic bomb survivors and their offspring: Hamin Lee, Jin-Wu Nam, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;e2024089. Published online November 18, 2024; DOI: https://doi.org/10.4178/epih.e2024089 [Accepted]

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Abstract PDF: Abstract
The Korean Atomic Bomb Survivor Cohort (K-ABC) study was designed to investigate the health impacts of atomic bomb exposure on Korean survivors and to explore whether these effects are passed down genetically to their descendants. This paper outlines the study's design, data collection methods, baseline sociodemographic characteristics, exposure status, and disease prevalence among the participants, based on survey responses and health examinations. From 2020 to 2024, a total of 2,544 individuals, comprising 1,109 atomic bomb survivors (G1), 1,193 children of G1 (G2), and 242 grandchildren of G1 (G3), consented to participate in the study. Of these, 1,828 participants (659 in G1, 927 in G2, and 242 in G3) completed the survey and underwent health examinations, representing a participation rate of 71.9%. Exposure information was gathered using a questionnaire and verified through records from the Korean Red Cross and a handbook issued by the Japanese government. Disease prevalence was determined based on participants' self-reported physician diagnoses. This study presents details about the K-ABC study and provides baseline data on the participants recruited. These data will be valuable for interpreting the results of future K-ABC studies.; Summary

Original article

Sex-specific associations between dietary legume subtypes and type 2 diabetes in a prospective cohort study: Hye Won Woo, Sangmo Hong, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim; Epidemiol Health. 2024;e2024083. Published online October 17, 2024; DOI: https://doi.org/10.4178/epih.e2024083 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Dietary soy, known for its high phytoestrogen content, has been suggested to exhibit a sex-specific association with type 2 diabetes. However, evidence regarding the sex-specific associations of different legume subtypes with type 2 diabetes remains scarce. We aimed to evaluate whether habitual consumption of soy and non-soy legumes (beans and peanuts) was prospectively and sex-specifically associated with the risk of type 2 diabetes incidence, taking into considering significant sex-specific genetic factors beyond legume consumption.
METHODS
A total of 16,666 participants (96,945 person-years) were followed and 945 incident cases were observed. Cumulative intake of legume subtypes was calculated using a food frequency questionnaire administered at baseline and during the revisit surveys.
RESULTS
Non-soy legumes are inversely associated with type 2 diabetes in both men and women. Dietary soy intake, however, demonstrated a unilaterally interacting sex-specific association with type 2 diabetes risk (pinteraction for sex=0.0173). Specifically, there was a significant inverse association with type 2 diabetes risk in women (incidence rate ratio, 0.66; 95% confidence interval, 0.48 to 0.80; ptrend=0.0066), but no such association was observed in men. This sex-specific association persisted and even appeared antagonistic in minor allele carriers of 2 novel single nucleotide polymorphisms, rs10196939 (LRRTM4) and rs11750158 (near GFPT2) (pinteraction for sex=0.0014 and 0.0112, respectively).
CONCLUSIONS
Habitual consumption of legumes shows protective impacts against type 2 diabetes, although these benefits vary by sex. Non-soy legumes provide health advantages for both men and women, whereas soy consumption seems to be beneficial exclusively for women.; Summary

Original Article

Association of the Korean-specific food-based index of dietary inflammatory potential with the risk of mild cognitive impairment in Korean older adults: Se Yeon Hwang, Chong-Su Kim, Mi Kyung Kim, Yoonkyoung Yang, Yoon Jung Yang; Epidemiol Health. 2024;46:e2024067. Published online July 25, 2024; DOI: https://doi.org/10.4178/epih.e2024067

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to examine the association between the food-based index of dietary inflammatory potential (FBDI) and the risk of mild cognitive impairment (MCI) in Korean older adults.
METHODS
The subjects were 798 Korean adults aged 60 years and older. The FBDI was calculated based on the intake of 7 anti-inflammatory and 3 inflammatory food groups. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. A general linear model and multiple logistic regression were applied to assess the association between FBDI and the risk of MCI.
RESULTS
As the FBDI increased, the intake of white rice, cookies/candies, and sweetened drinks tended to increase, but the intake of niacin, β-carotene, calcium, and potassium tended to decrease (p for trend<0.05). The highest FBDI group had a higher MCI risk (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.01 to 2.52) than the lowest FBDI group, adjusted for gender, age, and education level; and this trend was significant in a fully adjusted model (p for trend=0.039). No significant associations were found in men after adjusting for confounding factors. Among women, MCI risk increased as the FBDI increased (p for trend=0.007); and the highest FBDI group had a higher MCI risk (OR, 2.22; 95% CI, 1.04 to 4.74) than the lowest FBDI group in a fully adjusted model.
CONCLUSIONS
These results suggest that the appropriate intake of anti-inflammatory foods and nutrients may be associated with a reduced risk of MCI among older adults.; Summary

Korean summary
본 연구는 60세 이상 노인을 대상으로 한국인 맞춤형 식이 염증 지표와 경도인지장애 위험 사이의 연관성을 조사하였다. 식이 염증 지표 점수는 7개의 항염증 식품 그룹과 3개의 염증 식품 그룹의 섭취를 기반으로 계산하였는데, 식이 염증 지표 점수가 높은 노인들은 경도인지장애 위험이 더 높은 경향이 있음이 확인되었다. 이러한 연구 결과는 염증을 억제하는 식품과 영양소의 적절한 섭취가 경도인지장애 위험 감소와 연관되어 있음을 시사한다.

Key Message
Our study investigated the association between the Korean-specific food-based index of dietary inflammatory potential (FBDI) and risk of mild cognitive impairment (MCI) in adults aged 60 and older. The FBDI was calculated based on the intake of 7 anti-inflammatory and 3 inflammatory food groups. The result showed that older adults with a higher FBDI tended to have a higher risk of MCI. These findings suggest that the appropriate intake of anti- inflammatory foods and nutrients may be associated with a reduced risk of MCI among older adults.

Methods

Validation of self-reported morbidities of the Korean Atomic Bomb Survivor Cohort: Ansun Jeong, Thi Xuan Mai Tran, Seong-geun Moon, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park; Epidemiol Health. 2024;e2024058. Published online June 28, 2024; DOI: https://doi.org/10.4178/epih.e2024058 [Accepted]

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Abstract Summary PDF: Abstract
OBJECTIVES
This study aimed to evaluate the agreement of disease status collected through a survey of the Korean Atomic Bomb Survivor Cohort (K-ABC), compared with medical claim records from the Korean National Health Insurance Service (NHIS) database and the Korean Central Cancer Registry (KCCR).
METHODS
Data on the lifetime physician-diagnosed morbidities of 1,215 K-ABC participants were collected through an interviewer-administered questionnaire between 2020 and 2022. Survey data were linked to the NHIS and KCCR databases. Eleven diseases were included for validation. We evaluated the following indicators: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, the area under the curve (AUC), and the kappa coefficient.
RESULTS
The mean (standard deviation) age was 62.1 (18.7) years, and 42.6% of the participants were aged ≥70 years. Hypertension and cataracts showed the highest prevalence rates (33.8% and 28.8%, respectively). Hypertension, diabetes, and cancer demonstrated high sensitivity (>0.8) and specificity (>0.9), whereas diabetes, cancer, myocardial infarction, angina pectoris, and asthma exhibited high accuracy (>0.9). In contrast, arthritis, allergic rhinitis, and asthma showed low sensitivity (<0.4) and kappa values (<0.3). In the participants aged ≥70 years, the kappa value was ≥0.4 for all diseases except arthritis, allergic rhinitis, and asthma.
CONCLUSIONS
The results from this initial analysis showed relatively high agreement between the survey and NHIS/KCCR databases, especially for hypertension, diabetes, and cancer. Our findings suggest that the information on morbidities collected through the questionnaires in this cohort was valid for both younger and older individuals.; Summary

Korean summary
한국인 원폭피해자 코호트에서 설문으로 조사한 질병 과거력과 국민건강보험공단/암등록자료와의 일치도는 높은 편이었으며, 특히 고혈압, 당뇨, 암에서 높았다. 설문으로 조사한 질병 과거력은 젊은 대상자와 고령 대상자 모두에서 높았다.

Key Message
High agreement between the survey and NHIS/KCCR databases, especially for hypertension, diabetes, and cancer in the Korean Atomic Bomb Survivor Cohort was observed. The information on morbidities collected through the questionnaires in this cohort was valid for both younger and older individuals.

Expansion of a food composition database for the food frequency questionnaire in the Korean Genome and Epidemiology Study (KoGES): a comprehensive database of dietary antioxidants and total antioxidant capacity: Jiseon Lee, Ji-Sook Kong, Hye Won Woo, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024050. Published online May 10, 2024; DOI: https://doi.org/10.4178/epih.e2024050

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study constructed a comprehensive database of dietary antioxidants and total antioxidant capacity (TAC) to facilitate the estimation of daily antioxidant intake using a food frequency questionnaire (FFQ). This database was applied to 3 general population-based cohorts (n=195,961) within the Korean Genome and Epidemiology Study (KoGES).

METHODS

To establish a database of 412 foods derived from recipes of a 106-item FFQ, we followed a pre-established standardized protocol. This included the selection of source databases, matching of foods, substitution of unmatched items with identical foods and input of values, and assessment of coverage. For each food, the TAC was estimated by summing the individual antioxidant capacities, calculated by multiplying the amount of each antioxidant by its vitamin C equivalent antioxidant capacity.

RESULTS

We identified 48 antioxidants across 5 classes: retinol, carotenoids, vitamins C and E, and flavonoids, with flavonoids divided into 7 subclasses. TAC values were then established. Coverage exceeded 90.0% for retinol, carotenoids, vitamin C, and vitamin E, while coverage for flavonoids was 60.9%. The daily intakes of 4 antioxidant classes—all but vitamin E—were higher in women than in men. The Ansan-Ansung cohort exhibited the highest levels of dietary TAC, vitamin E, and flavonoids, while the Health Examinees Study cohort displayed the highest values for retinol, carotenoids, and vitamin C.

CONCLUSIONS

We customized a comprehensive antioxidant database for the KoGES FFQ, achieving relatively high coverage. This expansion could support research investigating the impact of dietary antioxidants on the development of chronic diseases targeted by the KoGES.

Summary

Korean summary
본 연구는 한국인유전체역학조사사업(KoGES) 식품섭취빈도조사(FFQ)에 특화된 항산화 데이터베이스를 확장하여 개발한 첫 번째 연구로, 48종의 항산화제와 TAC 값을 포함하여 기존 연구의 부족한 부분을 채웠습니다. 코호트 별로 식이 항산화제 섭취량에서 큰 차이가 나타났으며, 지역사회 기반 코호트에서는 비타민 E와 플라보노이드 섭취가 가장 높았고, 도시 기반 코호트에서는 레티놀, 카로티노이드, 비타민 C 섭취에서 가장 높았습니다. 반면, 농촌 기반 코호트에서는 대부분의 항산화제 섭취량이 가장 낮았습니다. 또한 성별, 연령, 및 교육 수준에 따른 섭취량의 차이도 확인되었으며, 주로 여성, 젊은 연령층, 그리고 교육 수준이 높은 사람들이 더 많은 항산화제를 섭취한 반면, 고령자와 흡연자는 섭취량이 적게 나타났습니다.

Key Message
This study is the first to develop an expanded antioxidant database specifically for the Korean Genome and Epidemiology Study (KoGES) FFQ, addressing a critical gap in research by including a broad range of 48 antioxidants and total antioxidant capacity (TAC). Significant differences in dietary antioxidant intake were observed across different cohorts, with participants in the Ansan and Ansung (ASAS) study consuming the most vitamin E and flavonoids, while those in the Health Examinee (HEXA) study had the highest intake of retinol, carotenoids, and vitamin C. In contrast, the Cardiovascular Disease Association Study (CAVAS) showed the lowest intake of most antioxidants. Demographic differences were also evident, with women, younger individuals, and those with higher education levels consuming more antioxidants, while older adults and smokers consumed less.

Citations

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Diet-Wide Association Study for the Incidence of Type 2 Diabetes in Three Population-Based Cohorts
Hye Won Woo, Manh Thang Hoang, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim
Nutrients.2024; 16(22): 3798. CrossRef

Original Articles

Association of healthy lifestyle factors with the risk of hypertension, dyslipidemia, and their comorbidity in Korea: results from the Korea National Health and Nutrition Examination Survey 2019-2021: Ji-Sook Kong, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024049. Published online May 1, 2024; DOI: https://doi.org/10.4178/epih.e2024049

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We investigated the association of individual healthy lifestyle factors (HLFs) and their combined healthy lifestyle score (HLS) with hypertension and/or dyslipidemia.
METHODS
We analyzed data from 10,693 adults aged ≥19 from the 2019 to 2021 Korea National Health and Nutrition Examination Survey. HLS was evaluated based on smoking status, alcohol consumption, body mass index (BMI), diet, and physical activity. Using logistic regression models, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the associations of HLFs and HLS with hypertension, dyslipidemia, and their comorbidity.
RESULTS
The prevalence of hypertension alone, dyslipidemia alone, and their comorbidity was 8.7%, 24.6%, and 15.0%, respectively. Multivariable models showed an inverse association of hypertension (OR, 0.37; 95% CI, 0.30 to 0.46) and dyslipidemia (OR, 0.36; 95% CI, 0.32 to 0.41) with healthy BMI. Hypertension was inversely associated with healthy alcohol consumption (OR, 0.46; 95% CI, 0.35 to 0.61) and diet (OR, 0.79; 95% CI, 0.63 to 0.99), whereas dyslipidemia was inversely associated with non-smoking (OR, 0.51; 95% CI, 0.43 to 0.60). Physical activity was inversely associated with their comorbidity (OR, 0.69; 95% CI, 0.56 to 0.85). Adherence to HLS was associated with significantly lower odds of hypertension (81%), dyslipidemia (66%), and their conditions (89%) (all ptrend<0.001). Stratified analyses consistently showed inverse associations between HLS and hypertension and/or dyslipidemia independently of demographic factors (pinteractions>0.05).
CONCLUSIONS
HLFs were associated with lower risk for hypertension and/or dyslipidemia. Obesity may contribute significantly to the risk of these conditions, while relevant HLFs for individual chronic diseases may vary significantly.; Summary

Korean summary
건강한 생활 습관 요인(HLFs)의 개별 구성 요인들은 고혈압 및 이상지질혈증의 동반 위험과 각각의 상태와 음의 연관성을 보였다. 다양한 HLFs 중에서 BMI 상태가 중요한 요인으로 확인되었지만, 개별 만성 질환에 대한 관련 HLFs는 상당히 다를 수 있다. 또한, 명확한 용량-반응 관계가 관찰되어, 더 HLFs를 준수할수록 고혈압, 이상지질혈증 및 그들의 동반 가능성이 유의미하게 감소하는 것으로 나타났다.

Key Message
Individual components of healthy lifestyle factors (HLFs) were inversely associated with the risk of comorbid hypertension and dyslipidemia, as well as with each condition. Among the various HLFs, BMI status was identified as a significant factor, while relevant HLFs for individual chronic diseases may vary significantly. Additionally, clear dose-response associations were observed, indicating that adherence to more HLFs was significantly associated with decreasing odds of hypertension, dyslipidemia, and their comorbidity.

A prospective association between dietary mushroom intake and the risk of type 2 diabetes: the Korean Genome and Epidemiology Study–Cardiovascular Disease Association Study: Yu-Mi Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024017. Published online January 8, 2024; DOI: https://doi.org/10.4178/epih.e2024017

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Mushrooms, known for their nutritious and functional components, are considered healthy and medicinal. This study investigated the prospective association between dietary mushroom consumption and the incidence of type 2 diabetes among Korean adults aged ≥40 years.
METHODS
In total, 16,666 participants who were not taking anti-diabetic medication or insulin and had normal fasting blood glucose (FBG; <126 mg/dL) were included. We used the cumulative average dietary consumption of mushrooms as an exposure metric, calculated from food frequency questionnaires at every follow-up, along with covariates collected during a baseline survey. To estimate incidence rate ratios (IRRs) for type 2 diabetes, a modified Poisson regression model with a robust error estimator was applied.
RESULTS
In multivariable models, dietary mushroom consumption was inversely associated with type 2 diabetes incidence in both genders (men: IRR, 0.65; 95% confidence interval [CI], 0.47 to 0.90; plinearity=0.043 in the highest quartile (Q4) vs. the lowest quartile (Q1); women: IRR, 0.70; 95% CI, 0.54 to 0.93; plinearity=0.114 in Q4 vs. Q1). The inverse association remained after adjustment for dietary factors instead of dietary quality index, the baseline FBG, and the exclusion of incidence within the first year. Additionally, no significant interaction was found regarding the risk of type 2 diabetes between dietary mushroom consumption and participants’ gender or other factors.
CONCLUSIONS
Dietary mushroom consumption was inversely linked with the risk of type 2 diabetes incidence in both genders, indicating the beneficial role of mushrooms in preventing the disease.; Summary

Korean summary
- 흔히 사용하는 버섯의 식이 섭취량이 증가함에 따라 한국 40세 이상 성인에서 제2형 당뇨병 발생 위험이 낮았다. - 이러한 역관계는 성별과 다양한 식이 배경에서도 일관성을 유지하였고, 이는 버섯이 제2형 당뇨병 예방에 있어 잠재적인 식이요소로서의 가능성을 보여주는성을 보여주는 보여주는 결과이다.

Key Message
• Increased dietary consumption of commonly used mushrooms is associated with a lower risk of type 2 diabetes incidence among adults aged 40 years or older in Korea. • This inverse relationship remains consistent across genders and various dietary backgrounds, underscoring the potential of mushrooms as a preventive dietary component against.

Associations of cumulative average dietary total antioxidant capacity and intake of antioxidants with metabolic syndrome risk in Korean adults aged 40 years and older: a prospective cohort study (KoGES_CAVAS): Ji-Sook Kong, Jiseon Lee, Youngjun Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim; Epidemiol Health. 2023;45:e2023067. Published online July 28, 2023; DOI: https://doi.org/10.4178/epih.e2023067

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Limited and inconsistent prospective evidence exists regarding the relationship of dietary total antioxidant capacity (dTAC) and antioxidant intake with metabolic syndrome (MetS) risk. We evaluated the associations of the cumulative averages of dTAC and antioxidant intake (in 5 classes: retinol, vitamin C, vitamin E, carotenoids, and flavonoids, as well as 7 flavonoid subclasses) with the risk of MetS.

METHODS

This study included 11,379 participants without MetS, drawn from the Korean Genome and Epidemiology Study_CArdioVascular disease Association Study (KoGES_CAVAS). The cumulative average consumption was calculated using repeated food frequency questionnaires. Incidence rate ratios were estimated using a modified Poisson regression model with a robust error estimator.

RESULTS

The median follow-up period was 5.16 years, and 2,416 cases of MetS were recorded over 58,750 person-years. In men, significant inverse associations were observed in all 5 antioxidant classes, except for the highest quartile of dTAC. In women, dTAC and total flavonoids were not significantly associated with MetS; however, significant L-shaped associations were found for the remaining 4 antioxidant classes. Of the 7 flavonoid subclasses, only flavones in the highest quartile for men and flavan-3-ols in women lacked significant associations with MetS. The inverse associations were not sex-specific, but they were particularly pronounced among participants with a body mass index (BMI) of 23 kg/m2 or higher.

CONCLUSIONS

The findings suggest that most antioxidant classes and flavonoid subclasses, unlike dTAC, exhibit a clear beneficial association with MetS in an L-shaped pattern in both men and women, particularly those with a high BMI.

Summary

Korean summary
농촌코호트 조사 참여자를 대상으로 식이 총항산화능, 총항산화능 하위분류, 플라보노이드 하위분류와 대사증후군 발생 위험의 전향적 연관성을 평가한 결과, 대부분의 항산화물(5개항산화물 분류:4개 항산화 비타민과 플라보노이드; 플라보노이드 7개 하부분류)에서 대사증후군과 음의 상관성을 확인할 수 있었으며 총항산화능(남자와 여자)과 플라보노이드(여자)에서 약한 연관성을 보였다. 남녀간 유의한 상호작용은 없었고 특히 BMI가 높은 집단에서 두드러졌다. 이 연구의 결과는 특히 식이 총항산화능을 구성하는 하위 유형을 적절히 섭취하는 것이 특히 비만한 성인에서 대사증후군 위험을 낮추는 예방전략으로 효과가 있을 수 있음을 시사한다.

Key Message
We observed that the cumulative average of dietary antioxidant vitamins and most flavonoids may be have pivotal roles in prevention of MetS, although there may be weak associations of dTAC and flavonoids in women. Moreover, these inverse associations were more pronounced in high BMI individuals. Our results suggest that the consumption of antioxidants and flavonoid may mitigate the MetS risk, particularly in overweight/obese individuals at high risk of developing chronic diseases.

Citations

Citations to this article as recorded by

The association of dietary total flavonoids and their subclasses with the risk of type 2 diabetes: a prospective cohort study
Hye Won Woo, Mi Kyung Kim, Kong Ji-Sook, Jiseon Lee, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim
European Journal of Nutrition.2024; 63(4): 1339. CrossRef
A Systematized Review of the Relationship Between Obesity and Vitamin C Requirements
Julia K Bird, Edith JM Feskens, Alida Melse-Boonstra
Current Developments in Nutrition.2024; 8(5): 102152. CrossRef

Systematic Review

Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies: Jee Yeon Hong, Young Jun Kim, Sanghyuk Bae, Mi Kyung Kim; Epidemiol Health. 2023;45:e2023011. Published online December 30, 2022; DOI: https://doi.org/10.4178/epih.e2023011

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality.

METHODS

Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79).

CONCLUSIONS

A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.

Summary

Korean summary
식이로부터 배출되는 GHG양은 메타분석의 고정 효과 모델과 확률 효과 모델 모두에서 만성 질환 발병률 및 사망 위험과 유의미한 양의 상관 관계를 보여주었습니다. 동물성 식단은 더 높은 GHG 배출량을 나타냈으나, 특정 만성질환에 대한 연구의 수가 적었고 질환 별 하위군 분석에서 유의미한 결과를 보이지 않았습니다. 결론적으로 온실가스 배출량이 많은 식단은 모든 원인으로 인한 사망 위험이 더 큰 것으로 나타났습니다.

Key Message
Daily food consumption contributes a large part of greenhouse gas (GHG) emissions, however, no review study was conducted. This study is the first review paper that reviews the relationship between greenhouse gas (GHG) emissions from daily diet and chronic disease risk and all-cause mortality. GHG emissions from the daily diet were significantly positively associated with disease risk and mortality. Animal-based diets contributed most to diet-derived GHG emissions. Men tended to have diets with higher GHG emissions compared to women. At times when the response to climate change is urgent, this study can help many policymakers and health officials.

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Original Articles

Comparison of Prevalence of Metabolic Syndrome Between Korean Emigrants and Host Country Residents in Japan and China-The Korean Emigrant Study: Myung-Hee Shin, Mi Kyung Kim, Zhong Min Li, Hyun-Kyung Oh, Soo Ryang Kim, Miyuki Taniguchi, Jinnv Fang; Epidemiol Health. 2010;32:e2010005. Published online May 7, 2010; DOI: https://doi.org/10.4178/epih/e2010005

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Abstract

<sec><title>OBJECTIVES</title>This study aims to compare the prevalence of metabolic syndrome between Korean emigrants (KEs) and their host country residents in Japan and China.</sec><sec><title>METHODS</title>The Korean Emigrant Study (KES) is a cohort study initiated in 2005 to elucidate the effect of genetic susceptibility and environmental change on hypertension, diabetes, and metabolic syndrome. Equal numbers of KEs and host country residents, aged 30 or over, were recruited from three regions; Kobe-Osaka in Japan (total number=965), Yanbian in China (n=1,019), and Changchun in China (n=949).</sec><sec><title>RESULTS</title>The age-adjusted prevalences of metabolic syndrome among KEs in Kobe-Osaka were significantly higher than those among Japanese (in men 24.0% vs. 15.6%, p=0.04, in women 8.4% vs. 2.7%, p=0.01), while the age-adjusted prevalences among KEs in Changchun were similar to those among Chinese (in men 11.7% vs. 16.1%, p=0.37, in women 28.3% vs. 30.1%, p=0.91). The age-adjusted prevalences were generally higher in Yanbian than other regions, and KEs had higher prevalence than Chinese in men but not in women (in men 37.9% vs. 28.3%, p=0.03, women 46.0% vs. 50.6%, p=0.44). The components with significant ethnic differences in prevalence were high blood pressure and abdominal obesity in Japan, and triglyceride in China. The most influential component in diagnosing metabolic syndrome was abdominal obesity in men and triglyceride in women.</sec><sec><title>CONCLUSION</title>The prevalence of metabolic syndrome was higher in KEs than in host country residents in Japan but not in China. Abdominal obesity and triglyceride are both discriminating and influential components in metabolic syndrome.</sec>

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New Common and Rare Variants Influencing Metabolic Syndrome and Its Individual Components in a Korean Population
Ho-Sun Lee, Yongkang Kim, Taesung Park
Scientific Reports.2018;[Epub] CrossRef
Cohort Profile: The Korean Genome and Epidemiology Study (KoGES) Consortium
Yeonjung Kim, Bok-Ghee Han
International Journal of Epidemiology.2017; 46(2): e20. CrossRef
Is There Disparity in Cardiovascular Health Between Migrant Workers and Native Workers?
Hyeonkyeong Lee, Sunghye Cho, Yune Kyong Kim, Jung Hee Kim
Workplace Health & Safety.2016; 64(8): 350. CrossRef
Coffee Intake and Liver Enzyme Association in Korean Immigrants and Japanese: A Comprehensive Cross-Sectional Study
Soo Ki Kim, Myung-Hee Shin, Kayo Sugimoto, Soo Ryang Kim, Susumu Imoto, Ke Ih Kim, Miyuki Taniguchi, Hyun-Kyung Oh, Yoshihiko Yano, Yoshitake Hayashi, Masatoshi Kudo
Digestive Diseases.2016; 34(6): 665. CrossRef

Relations of Pulse Wave Velocity to Waist Circumference Independent of Hip Circumference: Min Jung Ko, Mi Kyung Kim, Jinho Shin, Bo Youl Choi; Epidemiol Health. 2010;32:e2010004. Published online May 3, 2010; DOI: https://doi.org/10.4178/epih/e2010004

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Abstract

<sec><title>OBJECTIVES</title>Little is known about the effect of waist circumference (WC) on brachial artery pulse wave velocity (baPWV) independent of hip circumference (HC). Therefore, this study aimed to dissociate specific effect of WC on baPWV independent of HC.</sec><sec><title>METHODS</title>Of 1,053 rural residents (2004-2005), 777 subjects with no known history of coronary artery diseases or diabetes mellitus over 40 yr were included. To reduce collinearity, we assessed the independent effect of WC with HC on PWV by residual method (WC [RM]).</sec><sec><title>RESULTS</title>In women, most correlation coefficients were significant between measures of abdominal obesity and baPWV, with the highest (0.32) in waist to hip ratio (WHR), whereas no significance was found in men. All mean values of baPWV among the abdominally obese were higher than those of normal group in women, which were in the order of WHR, WC (RM), and WC. Adjusted OR with 95% CI for baPWV was significantly elevated by increase of WC (RM) upto 4.8 (95% CI: 2.1-11.2), and as 4.3 by WHR (95% CI: 1.6-11.4).</sec><sec><title>CONCLUSION</title>Considering the difficulty in biologically interpreting WHR, WC (RM) may be a useful indicator of abdominal obesity among females in that it reflects the risk of pulse wave velocity.</sec>

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The Current Status and the Perspectives of Nutrition Survey.: Mi Kyung Kim, Kirang Kim, Cho Il Kim, Kyungwon Oh, Yoo Jin Oh, Bo Youl Choi; Korean J Epidemiol. 2007;29(2):111-128.

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Abstract PDF: Abstract
The Korea National Health and Nutrition Examination Survey is a nationwide health survey in Korea. This survey is composed of three parts: the Health Interview Survey, the Health Examination Survey, and the Nutrition Survey. The aim of this study was to refine the nutrition survey system in the Korean National Health and Nutrition Examination Survey (KNHANES). Based on the literature review, we summarized international survey systems and the limitations of the current system in Korea and proposed an improved system. We suggested the following: 1) A government agency which will be exclusively responsible for KNHANES overall is needed. 2) The current short-term nutrition survey should be a year-round survey. 3) The objectives of this survey should be written with more clarity and detail. 4) Biochemical measures in relation to nutritional status should be added. 5) The budget to set up various databases in the nutrition survey should be increased. 6) Various other issues should be addressed, including the definition of raw data (i.e., whether nutrient intake data per day is raw data), ethical issues in survey techniques, and strategies to produce evidence for the public using this survey data. Not all suggestions could be adopted in the short-term, but should be integrated into long-term goals for survey system improvement.; Summary

Trend of the Anthropometric Indices Among Adolescents in a Urban and a Rural Area Over the Period 1996~2005.: SoHyun Park, Minjung Ko, Shin Ah Kim, Mi Kyung Kim, Soo Hun Cho, Bo Youl Choi; Korean J Epidemiol. 2006;28(2):189-198.

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This study investigated the secular trend of anthropometric parameters of 2,153 high school students in one urban and one rural area in Korea. The cross-sectional data was collected in 1996 and 2005 in Seoul and Gyung-gi province. As a result, the height of boys has increased by 2cm, whereas the weight has increased by 6.3kg from 1996 to 2005. By contrast, those parameters, including height or weight, did not change in girls. The prevalence of obesity has been more than doubled from 9.3% in 1996 to 20.5% in 2005 in boys; while that of girls was almost same for the same period (1998, 11.1%; 2005, 11.4%). In particular, the greater increase of obesity among boys was found in urban, which implicates the importance of environmental factor in determining weight gains among adolescents. This result emphasizes that the tailored intervention is strongly warranted, in particular among boys residing in urban area.; Summary

The Effect of Anthropometric Change on Blood Lipids in Adolescents in Rural Area of Korea.: Kyeong Soo Cheon, Myoung Hee Kim, Kirang Kim, Mi Kyung Kim, Young Jeon Shin, Bo Youl Choi; Korean J Epidemiol. 2002;24(1):17-28.

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Primary prevention of atherosclerosis is important for reducing morbidity and mortality from cardiovascular disease. As modifiable risk factors for atherosclerosis which appears and progresses in early life, obesity and hyperlipidemia are related with each other. Especially hyperlipidemia during adolescent period is closely related to cardiovascular morbidity and mortality in later life, but the association between anthropometric changes in growth period and lipids level in adolescence is not known yet. Therefore we investigated the effect of anthropometric changes in growth period on adolescent lipids level among 615 high school students in rural area of Korea. The study results were as the followings; In childhood, the weight and the height of boys didn't differ from those of girls, however, began to exceed them at 14 and 15 years old respectively. The body mass index(BMI) of both genders was appeared to increase with age. The BMI increase of girls was greater than that of boys from twelve years of age. The BMI slope (annual average increment of BMI; coefficient of regression line) of girls was greater than that of boys(t-test, p<0.01). The proportion of high obesity tracking group was 13.1%(82 persons). In multivariate analysis, total cholesterol and LDL-cholesterol were positively correlated with obesity tracking in boys; BMI slope and BMI at 7 years old in girls. The HDL-cholesterol didn't show any significant association with those factors. The triglyceride was related to BMI slope and obesity tracking in boy, but nothing in girls. In this study, the obesity at 7 years old, the BMI slope, and the obesity tracking are associated with adolescent serum lipid level. For primary prevention of cardiovascular disease, it is needed to develop more active prevention or health promotion program for children and adolesecents in Korea.; Summary

Obesity and Physical Activity Related to Colorectal Adenoma by Anatomic Sites in Korea.: Mi Kyung Kim, Won Chul Lee, Kyu Yong Choi, Se Young Lee, Sukil Kim, Yang Cha Lee-Kim, Kwang Ho Meng; Korean J Epidemiol. 1999;21(2):254-265.

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Although the etiology of colorectal adenoma is not yet clear, numerous epidemiologic studies of colorectal adenoma(precursors of cancer) have shown a positive association with obesity and an inverse association with physical activity. The difference of the possible association of colorectal adenoma with body mass index(BMI= wt(kg)/ht2(m2) and physical activity(kcal/day) according to anatomic sites and gender was investigated in this case-control study. Between July 1994 and october 1998, 345 cases of patients(male 181, female 164) with pathologically confirmed incident colorectal adenoma and 1655 control subjects(male 598, female 1,057) were collected from Our Lady of Mercy Hospital, The Catholic University of Korea. After colonoscopy, self-reported weight and height, together with measures of intensity and time of exercise and lifetime job activity was obtained by the interviewers. Site- and gender-specific odds ratios relative to the lowest tertile of BMI and physical activity were determined using unconditional logistic regression after adjusting for potential confounders. Compared with subjects in the lowest terile of body mass index, multivariate-adjusted odds ratio of right colon for male and female in highest tertile were 1.49(95% CI:0.74-3.01) and 1.96(95% CI:0.93-4.15), respectively. Compared with subjects in the lowest tertile of physical activity, multivariate-adjusted odds ratio of right colon for male and female in highest tertile were 0.66(95% CI:0.35-1.26) and 0.83(95% CI:0.50-1.39), respectively. These results support a positive association between body mass index and occurrence or progression of adenoma in left colon and physical activity is associated with an elevated risk of right colon.; Summary

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