Epidemiology and Health

Original Articles

Prospective associations between psychosocial stress and the risk of type 2 diabetes in middle-aged adults: findings from the KoGES_CAVAS: Ji Eun Kim, Hye Won Woo, Yu-Mi Kim, Min-Ho Shin, Sang Baek Koh, Mi Kyung Kim; Epidemiol Health. 2025;47:e2025061. Published online October 31, 2025; DOI: https://doi.org/10.4178/epih.e2025061

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OBJECTIVES
Psychosocial stress is a potential risk factor for type 2 diabetes (T2D); however, the influence of the timing of stress exposure remains uncertain. We examined the prospective associations of baseline, cumulative average, and recent psychosocial stress with the risk of incident T2D in middle-aged adults.
METHODS
We analyzed data from 7,880 participants aged 40-64 years without T2D at baseline. Psychosocial stress was assessed repeatedly using the Psychosocial Well-Being Index-Short Form. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using modified Poisson regression models with robust error estimators.
RESULTS
A total of 437 T2D cases occurred over 47,621 person-years. While baseline stress showed a non-significant association, both cumulative and recent stress demonstrated positive associations with T2D risk. Recent stress exhibited the strongest association in both male (stress vs. healthy group: IRR, 2.23; 95% CI, 1.41 to 3.52; highest [T3] vs. lowest tertile [T1]: IRR, 1.50; 95% CI, 1.07 to 2.10) and female (stress vs. healthy group: IRR, 1.72; 95% CI, 1.11 to 2.66; T3 vs. T1: IRR, 1.73; 95% CI, 1.26 to 2.37). These associations were more pronounced among participants with abdominal obesity, showing a significant positive linear trend (Bonferroni-corrected threshold, p=0.003).
CONCLUSIONS
Recent psychosocial stress was associated with an increased incidence of T2D, underscoring the importance of integrating psychosocial factors into diabetes prevention strategies, particularly for individuals with abdominal obesity.; Summary

Korean summary
최근(진단 전 방문)의 심리사회적 스트레스는 T2D의 위험인자로 확인되었으며, 기저 스트레스와는 유의미하지 않은 관계를 보였고 누적 스트레스와는 보다 약한 연관성을 보였다. 특히, 복부 비만이 있는 대상자에서 이러한 양상이 두드러져, 이 고위험군을 중심으로 한 스트레스 관리의 필요성이 제기된다.

Key Message
Recent psychosocial stress was identified as the strongest risk factor for type 2 diabetes (T2D), showing non-significant relationship with baseline stress and weaker link for cumulative stress. Particularly, it was more pronounced among those with abdominal obesity, highlighting the importance of stress management in T2D prevention focusing on this high-risk subgroup.

Prospective association between handgrip strength in childhood and the metabolic syndrome score and insulin resistance indices in adolescence: an analysis based on the Ewha Birth and Growth Study: Seunghee Jun, Hyunjin Park, Hyelim Lee, Hye Ah Lee, Young Sun Hong, Hyesook Park; Epidemiol Health. 2025;47:e2025001. Published online January 2, 2025; DOI: https://doi.org/10.4178/epih.e2025001

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OBJECTIVES
Low handgrip strength (HGS) in children and adolescents might be associated with the risk of metabolic syndrome (MetS) and insulin resistance. This study prospectively evaluated the association between HGS in childhood and MetS in adolescence.
METHODS
Based on data from the Ewha Birth and Growth Study, this study analyzed HGS at ages 7 to 9 and metabolic indices at ages 13 to 15. In total, 219 participants were analyzed. The risk of MetS was evaluated using the continuous metabolic syndrome score (cMetS), and insulin resistance was assessed using fasting blood insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Relative HGS in childhood was determined by dividing HGS by body weight and categorized as sex-specific quartiles.
RESULTS
This study found an inverse association between relative HGS levels in childhood and MetS and insulin resistance in adolescence. For each 1-group increase in relative HGS quartiles, cMetS (standarard [Std] β=-0.64, p<0.01), HOMA-IR (Std β=-0.21, p<0.01), and fasting blood insulin (Std β=-0.21, p<0.01) all decreased on average. These associations remained significant even after adjusting for confounding factors.
CONCLUSIONS
Our study showed a prospective association between HGS in childhood and the risk of MetS and insulin resistance in adolescence. It provides significant epidemiological evidence, emphasizing the importance of efforts to increase muscle strength from a young age to mitigate the risk of MetS and insulin resistance in adolescence.; Summary

Korean summary
본 연구는 소아기 악력 수준이 청소년기의 대사증후군 및 인슐린 저항성과 연관이 있음을 발견했음. 이러한 결과는 소아기 근력 향상이 향후 대사 위험을 완화하는데 중요함을 강조함.

Key Message
This study found that higher childhood relative handgrip strength was inversely associated with metabolic syndrome and insulin resistance in adolescence. The findings emphasize the importance of enhancing muscle strength early in life to mitigate metabolic risks.

Factors Associated with Insulin Resistance in a Middle-Aged Non-Obese Rural Population: The Chungju Metabolic Disease Cohort (CMC) Study: Sun Young Lim, Hee Sung Ha, Hyuk-Sang Kwon, Jin-Hee Lee, Hyeon Woo Yim, Kun-Ho Yoon, Won-Chul Lee, Ho-Young Son, Yong-Moon Park; Epidemiol Health. 2011;33:e2011009. Published online September 26, 2011; DOI: https://doi.org/10.4178/epih/e2011009

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Abstract

<sec><title>OBJECTIVES</title>We aimed to determine the characteristics affecting insulin resistance in non-obese middle-aged adults in a rural community.</sec><sec><title>METHODS</title>A total of 1,270 non-diabetic adults aged between 40 and 64 years old with body mass index (BMI) less than 25 kg/m2 were analyzed. Subjects with insulin resistance were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population.</sec><sec><title>RESULTS</title>A total of 217 subjects (20.6%) had insulin resistance. Prevalence of metabolic syndrome was significantly higher in insulin-resistant subjects in both men (29.3% vs. 10.3%) and women (34.1% vs. 15.6%). Among metabolic syndrome components, elevated waist circumference and elevated triglyceride were higher in insulin-resistant subjects in both genders. After being controlled for socioeconomic status and lifestyle related covariates, the association between insulin resistance and BMI was statistically significant in the category of 23.0-24.9 kg/m2 in men (adjusted OR, 4.63; 95% confidence interval [95% CI], 1.77-12.15) using the category of 18.5-20.9 kg/m2 as a reference. In addition, the association between insulin resistance and abdominal obesity was statistically significant only for men (adjusted OR, 2.57; 95% CI, 1.29-5.11).</sec><sec><title>CONCLUSION</title>Insulin resistance appears to be highly associated with high BMI and abdominal obesity, even in non-obese, non-diabetic middle-aged men.</sec>

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Citations

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Global prevalence of insulin resistance in the adult population: a systematic review and meta-analysis
Jhosmer Ballena-Caicedo, Fiorella E. Zuzunaga-Montoya, Joan A. Loayza-Castro, Juan Carlos Bustamante-Rodríguez, Luisa Erika Milagros Vásquez Romero, Rafael Tapia-Limonchi, Carmen Inés Gutierrez De Carrillo, Víctor Juan Vera-Ponce
Frontiers in Endocrinology.2025;[Epub] CrossRef
Relapsing-remitting multiple sclerosis patients display an altered lipoprotein profile with dysfunctional HDL
Winde Jorissen, Elien Wouters, Jeroen F. Bogie, Tim Vanmierlo, Jean-Paul Noben, Denis Sviridov, Niels Hellings, Veerle Somers, Roland Valcke, Bart Vanwijmeersch, Piet Stinissen, Monique T. Mulder, Alan T. Remaley, Jerome J. A. Hendriks
Scientific Reports.2017;[Epub] CrossRef
Insulin Resistance of Normal Weight Central Obese Adolescents in Korea Stratified by Waist to Height Ratio: Results from the Korea National Health and Nutrition Examination Surveys 2008–2010
Won Kyoung Cho, Hyojin Kim, Hyun Young Lee, Kyung Do Han, Yeon Jin Jeon, In Ah Jung, Shin Hee Kim, Kyoung Soon Cho, So Hyun Park, Min Ho Jung, Byung-Kyu Suh
International Journal of Endocrinology.2015; 2015: 1. CrossRef
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Ji Yeon Kang, Sook Hee Sung, Yeon Ju Lee, Tae In Choi, Seung Jin Choi
Journal of Korean Medical Science.2014; 29(10): 1353. CrossRef
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Journal of Clinical Lipidology.2013; 7(1): 65. CrossRef

Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population: Sang Yeun Kim, Sun Ju Lee, Hyoun Kyoung Park, Ji Eun Yun, Myoungsook Lee, Jidong Sung, Sun Ha Jee; Epidemiol Health. 2011;33:e2011007. Published online August 20, 2011; DOI: https://doi.org/10.4178/epih/e2011007

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<sec><title>OBJECTIVES</title>Adiponectin is strongly associated with diabetes in the Western population. However, whether adiponectin is independently associated with impaired fasting glucose (IFG) in the non-obese population is unknown.</sec><sec><title>METHODS</title>The serum adiponectin, insulin resistance (IR), and waist circumference (WC) of 27,549 healthy Koreans were measured. Individuals were then classified into tertile groups by gender. IFG was defined as a fasting serum glucose of 100-125 mg/dL without diabetes. IR was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). The association of adiponectin and IFG was determined using logistic regression analysis.</sec><sec><title>RESULTS</title>WC and adiponectin were associated with IFG in both men and women. However, the association of WC with IFG was attenuated in both men and women after adjustment for the HOMA-IR. Adiponectin was still associated with IFG after adjustment for and stratification by HOMA-IR in men and women. Strong combined associations of IR and adiponectin with IFG were observed in men and women. Multivariate adjusted odds ratios (ORs) (95% confidence interval [CI]) among those in the highest tertile of IR and the lowest tertile of adiponectin were 9.8 (7.96 to 12.07) for men and 24.1 (13.86 to 41.94) for women.</sec><sec><title>CONCLUSION</title>These results suggest that adiponectin is strongly associated with IFG, and point to adiponectin as an additional diagnostic biomarker of IFG in the non-diabetic population.</sec>

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Journal of the Endocrine Society.2020;[Epub] CrossRef
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Endocrine.2013; 44(2): 411. CrossRef
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The FASEB Journal.2013; 27(1): 368. CrossRef
Association between ADIPOQ SNPs with plasma adiponectin and glucose homeostasis and adiposity phenotypes in the IRAS Family Study
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Molecular Genetics and Metabolism.2012; 107(4): 721. CrossRef

The association between insulin resistance and Framingham risk score among type 2 diabetes.: Hee Sook Park, Ji Eun Yun, Soo Jin Yoon, Eurin Cho, Kyung A Ahn, Seok Won Park, Chul Woo Ahn, Dae Jung Kim, Young Duk Song, Young Ju Choi, Mi Ae Cho, Eun Jig Lee, Kap Bum Huh, Sun Ha Jee; Korean J Epidemiol. 2007;29(1):46-58.

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BACKGROUND
AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea.
METHODS
We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD.
RESULTS
Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women).
CONCLUSION
Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.; Summary

Insulin resistance and cancer.: Hee Jin Kim, Sun Ha Jee; Korean J Epidemiol. 2005;27(2):38-50.

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Both obesity and diabetes have been proposed as risk factors of cancer. Obesity may be a more significant health problem, which can increase the risk of cancer and cardiovascular disease, which is the most common cause of death. Insulin resistance and metabolic syndrome are suspected of being correlated with cancer risk. Most studies are carried out on the assumption that obesity, diabetes, cardiovascular disease, and cancer are different conditions. However, they have common risk factors-smoking, obesity, and physical inactivity. Although the pathways leading to these diseases are unknown, we brought a focus into the multi-dimensional pathways instead of single pathogenesis. The interaction between pathogenesis can be thought to start from risk factors, and through pathogenesis, diseases can also lead to a severe cause of death. Epidemic of obesity and diabetes is a significant and growing public health problem. This paper reviewed the evidences of the correlation between insulin resistances and cancer and we explored whether insulin resistance may contribute to carcinogenesis.; Summary

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