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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Abstract Summary PDF Supplementary Material: Abstract
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.

Behavioral and psychosocial factors associated with sugar-sweetened beverage consumption among Korean adolescents: a path analysis using the 2022 Korea Youth Risk Behavior Survey: Hye-Young Park, Soo Rack Ryu, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park; Epidemiol Health. 2025;47:e2025047. Published online August 21, 2025; DOI: https://doi.org/10.4178/epih.e2025047

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Abstract

OBJECTIVES
Rising obesity rates among adolescents are a major global health concern and are closely linked to the consumption of sugar-sweetened beverages (SSBs). This study aimed to identify key behavioral and psychosocial factors influencing SSB consumption among adolescents.

METHODS

This cross-sectional study analyzed data from the 2022 Korea Youth Risk Behavior Survey, which included 49,548 participants aged 12-18 years. Information on SSB consumption frequency, socio-demographic characteristics, eating habits, sedentary behaviors, and other health-related factors was collected through self-administered questionnaires. Path analysis was used to model SSB consumption and estimate the direct and indirect effects of modifiable factors.

RESULTS

Male students, current alcohol drinkers, those with higher frequencies of fast-food or late-night snack consumption, and heavy smartphone users were more likely to frequently consume SSBs. Fast-food intake had the strongest direct effect on SSB consumption (B=0.3884), while nighttime eating showed a substantial direct effect (B=0.1437) and mediated 21.7% of the relationship between fast-food intake and SSB consumption. Leisure sitting time exerted both direct (B=0.0741) and indirect effects on SSB intake, mediated through watching mukbang, smartphone use, fast-food consumption, and nighttime eating. Self-perceived health status was negatively associated with SSB consumption (B=-0.0619), with indirect effects mediated by fast-food intake and nighttime eating.

CONCLUSIONS

Among Korean adolescents, SSB consumption was strongly associated with unhealthy eating patterns and prolonged leisure sitting time. Increased fast-food consumption, nighttime eating, watching mukbang, smartphone use, and negative self-perceived health status not only directly influenced SSB intake, but also acted as mediating factors.

Summary

Korean summary
바람직하지 않은 식습관과 과도한 스마트폰 사용은 한국 청소년의 당음료 섭취와 밀접한 관련이 있습니다. 특히 패스트푸드와 야식은 주요한 매개 요인으로 작용하여, 이러한 행동을 줄이면 당음료 섭취를 효과적으로 낮출 수 있습니다. 본 연구는 청소년을 위한 맞춤형 공중보건 개입 전략 수립에 근거를 제공합니다.

Key Message
Unhealthy eating behaviors and excessive screen time are strongly linked to sugar-sweetened beverage (SSB) consumption among Korean adolescents. Fast-food intake and nighttime snacking act as major mediators, suggesting that reducing these behaviors could significantly decrease SSB intake. These findings provide evidence to guide targeted public health interventions for adolescents.

Citations

Citations to this article as recorded by

Sugar-sweetened beverage consumption, waist-to-height ratio and psychological symptoms among Chinese adolescents
Lu Li, Ting Wei, Feng Zhang, Tianyu Zhou
Scientific Reports.2026;[Epub] CrossRef

Impact of body mass index and waist-to-hip ratio on mortality in middle-aged Koreans: a prospective cohort study based on a Health Examinees study: Sooyoung Cho, Aesun Shin, Ji-Yeob Choi, Jong-Koo Lee, Daehee Kang; Epidemiol Health. 2024;46:e2024073. Published online September 2, 2024; DOI: https://doi.org/10.4178/epih.e2024073

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Abstract Summary PDF

Abstract

OBJECTIVES
We aimed to assess the impact of obesity on mortality in middle-aged Koreans using data from a Health Examinees study.

METHODS

We used data from the participants who had complete information on body size and gave informed consent for the linkage of their data with the national death certificate data. Cox proportional hazard model was used to estimate the hazard ratios and 95% confidence intervals (CIs) of body mass index (BMI) and waist-to-hip ratio (WHR) for all-cause, cardiovascular, and cancer mortality.

RESULTS

A total of 115,961 participants were included in the study. The results showed a U-shaped association between BMI and mortality, indicating that both males and females with BMIs of less than 21.0 kg/m2 and greater than or equal to 30.0 kg/m2 are at increased risk. The results showed that males with a BMI of less than 18.5 kg/m² had a significantly higher risk of all-cause mortality (adjusted hazard ratio [aHR], 2.24; 95% CI, 1.73 to 2.91) and cardiovascular mortality (aHR, 2.27; 95% CI, 1.23 to 4.20). Similarly, males with a WHR of less than 0.80 (aHR, 1.38; 95% CI, 1.08 to 1.77), 0.90 to less than 0.95 (aHR, 1.15; 95% CI, 1.02 to 1.29), and greater than or equal to 0.95 (aHR, 1.28; 95% CI, 1.11 to 1.47) showed an increased risk of all-cause mortality. In females, a BMI of less than 18.0 kg/m2 was linked to a higher risk of cardiovascular mortality (aHR, 2.67; 95% CI, 1.13 to 6.33).

CONCLUSIONS

Being underweight was associated with an increased risk of mortality in both sexes, and the lowest risk of death was found in males who were slightly overweight with a BMI of 23.0-25.0 kg/m2.

Summary

Korean summary
중년 한국인으로 구성된 코호트 연구에서 BMI와 WHR이 원인별 사망에 미치는 영향을 평가함. BMI와 WHR이 사망 원인별 사망률과 U자형 연관성을 보였고, 특히 심혈관 질환에서 이러한 경향을 관찰함.

Key Message
This study examined the association between BMI, WHR, and cause-specific mortality in middle-aged Koreans. Both BMI and WHR showed U-shaped associations with mortality, particularly for cardiovascular outcomes. These findings may indicate a need to carefully consider the optimal BMI cut-off values for Asians to better capture mortality risks.

Citations

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Current guidelines and future directions in comprehensive obesity assessment
Sinyoung Cho, Hyuktae Kwon
Korean Journal of Family Medicine.2026; 47(1): 4. CrossRef

Comparative analysis of body mass index and obesity-related anthropometric indices for mortality prediction: a study of the Namwon and Dong-gu cohort in Korea: Ye Rim Kim, Min-Ho Shin, Young-Hoon Lee, Seong-Woo Choi, Hae-Sung Nam, Jeong-Ho Yang, Sun-Seog Kweon; Epidemiol Health. 2024;46:e2024066. Published online July 17, 2024; DOI: https://doi.org/10.4178/epih.e2024066

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Abstract

OBJECTIVES
This study investigated the associations between several obesity-related anthropometric indices and mortality in middle-aged and elderly populations to compare the indices’ predictive ability with that of the body mass index (BMI).

METHODS

We analyzed data on 12 indices calculated from 19,805 community-based cohort participants (average age, 63.27 years; median follow-up, 13.49 years). Each index was calculated using directly measured values of height, weight, waist circumference (WC), and hip circumference (HC). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for each index using Cox regression and evaluated mortality prediction with the Harrell concordance index (c-index).

RESULTS

Adding anthropometric indices to the basic mortality model (c-index, 0.7723; 95% CI, 0.7647 to 0.7799) significantly increased the predictive power of BMI (c-index, 0.7735; 95% CI, 0.7659 to 0.7811), a body shape index (ABSI; c-index, 0.7735; 95% CI, 0.7659 to 0.7810), weight-adjusted waist index (WWI; c-index, 0.7731; 95% CI, 0.7656 to 0.7807), and waist to hip index (WHI; c-index, 0.7733; 95% CI, 0.7657 to 0.7809). The differences between the BMI model and the other 3 models were not statistically significant.

CONCLUSIONS

In predicting all-cause mortality, the ABSI, WWI, and WHI models based on WC or HC had stronger predictive power than conventional risk factors but were not significantly different from the BMI model.

Summary

Korean summary
- 다수의 비만관련 신체계측지표들이 사망률을 유의하게 예측하였지만 체질량지수보다 통계적으로 우월하지는 않았다. - 복부둘레가 고려된 비만지표들이 사망률예측에 더 유용할 것으로 추정된다.

Key Message
- Several obesity indices provided predictive value for all-cause mortality but were not superior to body mass index - Obesity indices that take abdominal circumference into account are likely to be more useful for predicting mortality.

Citations

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A J-shaped association between weight-adjusted waist index and cardiovascular disease: a longitudinal study from the CHARLS database
Jiang Wang, Aizhang Zhu, Rui Zeng, Lihuan Chen, Fayi Xie, Ke Zhu, Tenghui Fan, Dongmei Ye, Yishan Wu, Wan Zhu, Jiahui Bian, Yuxu Huang, Shunrui Xiao, Mengxia Shi, Yi Xiao, Wenwu Zhang, Xiaoming Zhang
BMC Public Health.2025;[Epub] CrossRef
Development of an equation for estimating body fat mass using basic demographic and anthropometric indices
N.V. Zaverukha, N.V. Grygorieva, A.S. Musiienko, N.M. Koshel
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2025; 21(8): 845. CrossRef
Accumulated subcutaneous fat in abdomen is associated with long COVID-19 symptoms among non-hospitalized patients: a prospective observational study
Tingxin Li, Baoming He, Yuping Liu, Chen Wang
Frontiers in Medicine.2024;[Epub] CrossRef

Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey: Minjun Kim, Joonwoong Kim, Inhwan Lee; Epidemiol Health. 2024;46:e2024027. Published online February 2, 2024; DOI: https://doi.org/10.4178/epih.e2024027

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Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

Korean summary
본 연구는 한국의 50세 이상 여성들을 대상으로 비만 및 복부비만과 무릎골관절염의 관계에 대한 다리근육비율의 매개 효과를 분석한 결과, 다리근육비율은 비만의 진단하는 사용되는 체질량지수, 복부비만의 진단에 사용되는 허리둘레와 무릎 골관절염의 진단에 사용되는 KL등급의 관계를 부분적으로 매개하는 것으로 나타났다. 이러한 결과는 다리근육의 강화가 비만 및 복부비만으로 인한 무릎골관절염의 위험을 완화할 수 있음을 시사하며, 건강한 생활습관과 규칙적인 근력운동의 병행을 통해 다리 근육을 강화하는 것이 무릎 골관절염의 예방을 위한 전략으로 권장되어야 함을 시사한다.

Key Message
Research examining the mediating effect of lower extremity muscle mass on the relationships of knee osteoarthritis to general and central obesity is scarce. Herein, we demonstrate the mediating effect of lean mass index on the relationships of knee osteoarthritis with body mass index and waist circumference in Korean women aged 50 years or older. We propose that strengthening leg muscles may mitigate, to some extent, the risk of knee osteoarthritis associated with general and central obesity. We recommend a regimen for strengthening leg muscles through healthy lifestyle habits and regular strength training, in conjunction with weight and abdominal fat management.

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Revealing the mediating mechanisms between BMI and osteoarthritis: a Mendelian randomization and mediation analysis
Hui Yu, Junxiang Wang, Xin Xu, Hui Li, Junfei Guo
Aging Clinical and Experimental Research.2025;[Epub] CrossRef
Does abnormal weight affect sperm quality? A case-control study based on bioelectrical impedance analysis
Huang Liu, Xiaoxia Wang, Li Li, Zhiyong Zhu, Hai Lin, Yu Zhou, Houbin Zheng
Frontiers in Nutrition.2025;[Epub] CrossRef
Advanced nanoparticles for osteoarthritis: a review
Kang Yang, Yong Yuan, Li-Min Guo, Wen-Dong Luo, Chong-Hua Dai, Feng-Xiang Xia, Feng Lin, Xing-Xiong Jiang
Frontiers in Medicine.2025;[Epub] CrossRef
Roles of low muscle strength and sarcopenic obesity on incident symptomatic knee osteoarthritis: A longitudinal cohort study
Laijun Yan, Haiya Ge, Zhengming Wang, Anping Shen, Qinguang Xu, Ding Jiang, Yuelong Cao, Simone Agostini
PLOS ONE.2024; 19(10): e0311423. CrossRef
Letter to the Editor: Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey
Jinyue Chen, Haozhu Chen
Epidemiology and Health.2024; 46: e2024091. CrossRef

Higher energy consumption in the evening is associated with increased odds of obesity and metabolic syndrome: findings from the 2016-2018 Korea National Health and Nutrition Examination Survey (7th KNHANES): Sarang Jeong, Hajoung Lee, Sukyoung Jung, Jee Young Kim, Sohyun Park; Epidemiol Health. 2023;45:e2023087. Published online September 19, 2023; DOI: https://doi.org/10.4178/epih.e2023087

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Chrono-nutrition emphasizes meal timing in preventing obesity and metabolic disorders. This study explores the impact of temporal dietary patterns (TDPs) on obesity and metabolic syndrome (MetS) in Korean adults aged 20 years to 65 years.

METHODS

We utilized dynamic time warping method and Kernel k-means clustering to investigate diet quality and the odds ratios (ORs) of obesity and MetS with different TDPs using data from the 7th Korea National Health and Nutrition Examination Survey.

RESULTS

Participants were divided into three groups based on relative energy intake over 24 hours. After adjusting for age and gender, Cluster 3 (with the highest proportion of energy intake in the evening) had the lowest Healthy Eating Index scores compared to other clusters. Following adjustment for key covariates, Cluster 3 showed the highest values for body mass index, waist circumference, blood pressure, total cholesterol, and triglycerides. Compared to Cluster 1 (with a lower proportion of energy intake in the evening), Cluster 2 and Cluster 3 had ORs for obesity of 1.12 (95% confidence interval [CI], 0.97 to 1.30) and 1.19 (95% CI, 1.03 to 1.37), respectively. For MetS, the ORs were 1.26 (95% CI, 1.08 to 1.48) and 1.37 (95% CI, 1.17 to 1.61) when comparing Cluster 2 and Cluster 3 to Cluster 1.

CONCLUSIONS

This study reveals that individuals with higher energy intake in the evening have increased odds of obesity and MetS, even after adjusting for major covariates, including age and total energy intake.

Summary

Korean summary
본 연구는 하루 중 주요 에너지 섭취 사간에 따른 인구사회학적 특징과 건강지표의 상관성을 분석하였다. 제 7기 국민건강영양조사의 20~65세의 한국 성인을 대상으로 Dynamic Time Warping 방법을 이용하여 군집을 나누어 분석한 결과, 하루 중 저녁시간에 에너지 섭취가 높은 그룹이 그렇지 않은 그룹에 비해 연령이 낮고, 흡연자, 음주자, 스트레스를 느끼는 대상자의 비율이 높았다. 또한, 저녁에 에너지 섭취 비율이 높은 그룹이 그렇지 않은 그룹에 비해 체질량지수, 허리둘레, 혈압, 총 콜레스테롤, 중성지방이 높았으며, 식생활 평가 지수가 가장 낮았다. 마지막으로 하루 섭취하는 총 에너지 양과 생활습관 변수를 보정하고도 저녁에 섭취하는 에너지가 많은 그룹은 그렇지 않은 그룹에 비해 비만 및 대사 증후군 유병이 더 높은 것으로 나타났다.

Key Message
• This study examined the relationship between sociodemographic characteristics and health indicators based on the timing of major energy intake during the day. • Using the Dynamic Time Warping method, the analysis revealed that the group with higher evening energy intake was younger and had a higher proportion of smokers, alcohol consumers, and individuals experiencing stress. • Additionally, the group with higher evening energy intake exhibited higher levels of obesity and metabolic syndrome, even after adjusting for total daily energy intake and lifestyle variables.

Citations

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Dietary calcium intake in relation to metabolic syndrome in adults: A systematic review and dose–response meta‐analysis of epidemiological studies with GRADE assessment
Roxana Nematbakhsh, Parisa Rouhani, Parvane Saneei
Obesity Reviews.2025;[Epub] CrossRef
2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association
Seth S. Martin, Aaron W. Aday, Norrina B. Allen, Zaid I. Almarzooq, Cheryl A.M. Anderson, Pankaj Arora, Christy L. Avery, Carissa M. Baker-Smith, Nisha Bansal, Andrea Z. Beaton, Yvonne Commodore-Mensah, Maria E. Currie, Mitchell S.V. Elkind, Wenjun Fan, G
Circulation.2025;[Epub] CrossRef
Circadian and temporal eating patterns in relation to metabolic syndrome in Iranian women
Azadeh Lesani, Mansooreh Sadat Mojani-Qomi
Scientific Reports.2025;[Epub] CrossRef
Interaction between chronotype and ultra-processed food intake on triglyceride-glucose index in Korean adults
Sarang Jeong, Eunjin Jang, Sukyoung Jung, Jinhyun Kim, Minjeong Jeong, Dahye Han, Sohyun Park
Nutrition Research and Practice.2025; 19(4): 591. CrossRef
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Ming-Zhen Su, Suyeon Lee, Dayeon Shin
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Microorganisms.2024; 12(5): 851. CrossRef

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

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.

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Increased circulating apolipoprotein Cs are implicated in the association between elevated serum retinol and retinol-binding protein 4 and adverse progression of metabolic syndrome in adults: A prospective study
Danyu Chen, Keliang Xie, Chang Gao, Yingdi Yang, Ying Xu, Bang-yan Li, Yue Xi, Ju-Sheng Zheng, Yu-ming Chen
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Regional differences in the associations of diet quality, obesity, and possible sarcopenia using the seventh Korea National Health and Nutrition Examination Survey (2016-2018): Hyeongyeong Lee, Sohyun Park; Epidemiol Health. 2023;45:e2023059. Published online June 19, 2023; DOI: https://doi.org/10.4178/epih.e2023059

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Abstract PDF

Abstract

OBJECTIVES
Sarcopenic obesity is closely related to aging and the prevalence of various chronic diseases and frailty. The purpose of this study was to analyze whether diet quality is related to obesity, sarcopenia, and sarcopenic obesity, and if so, to explore the difference in that relationship between urban and rural settings.

METHODS

Using data from the Korea National Health and Nutrition Examination Survey of 2016-2018, a total of 7,151 participants aged 40 years or older were analyzed. Sarcopenia was diagnosed using handgrip strength. Diet quality was assessed using Korea Healthy Eating Index (KHEI) scores, and obesity was determined based on participants’ abdominal circumference. Multinomial logistic analysis was used for testing statistical significance.

RESULTS

Rural participants had significantly lower KHEI scores and a higher prevalence of sarcopenic obesity than urban participants. The study findings demonstrate that participants without obesity, sarcopenia, or sarcopenic obesity had significantly higher KHEI scores in both rural and urban settings. Multinomial regression analysis further revealed that a higher KHEI score was associated with a lower risk of sarcopenia and sarcopenic obesity among urban residents, while only the risk of obesity was lower with higher diet quality scores among rural residents.

CONCLUSIONS

Since diet quality and health status were lower in rural areas, it is important to address this regional disparity with appropriate policy measures. To mitigate urban health disparities, urban residents in poor health with few resources should also be supported.

Summary

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Comparison of nutrients and ultra-processed food consumption between different phenotypes defined by abdominal obesity and sarcopenia
Eunjin Jang, Sarang Jeong, Jinhyun Kim, Sukyoung Jung, Jee Young Kim, Jung Eun Lee, Sohyun Park, Jang Won Son
Frontiers in Nutrition.2026;[Epub] CrossRef
Association between triglyceride-glucose index and sarcopenic obesity in adults: a population-based study
Zhengmei Zhao, Ruiting Cai, Lili Tao, Yuxiao Sun, Keping Sun
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Evaluation of Dietary Guideline Adherence and Risk of Sarcopenia in Elder Taiwanese
Yih‐Jin Liou, Edward Giovannucci, Wu‐Chien Chien, Li‐Wei Wu
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Associations between diet quality and regional factors in Korea vary according to individuals’ characteristics: a cross-sectional study
Hyunmi Han, Clara Yongjoo Park, Jeonghwa Lee
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Individual- and neighborhood-level factors influencing diet quality: a multilevel analysis using Korea National Health and Nutrition Examination Survey data, 2010-2019
Dahyun Park, Min-Jeong Shin, S V Subramanian, Clara Yongjoo Park, Rockli Kim
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Association of Dietary Protein Sources and Their Adequacy, Body Composition and Risk of Sarcopenic Obesity in South Korean Populations: A Cross-Sectional Study
Jieun Kim, Kyoungsik Jeong, Sueun Lim, Siwoo Lee, Younghwa Baek
Metabolites.2024; 14(2): 130. CrossRef
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Sohye Kim, Soojeong Kim, Kyung Hee Hong
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Longitudinal association between soft drink consumption and handgrip strength in adults: a prospective analysis from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study
Tongfeng Liu, Shengxin Quan, Ge Meng, Hongmei Wu, Yeqing Gu, Shunming Zhang, Xuena Wang, Juanjuan Zhang, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Zhongze Fang, Kaijun Niu
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Changes in metabolic syndrome and the risk of breast and endometrial cancer according to menopause in Korean women: Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park; Epidemiol Health. 2023;45:e2023049. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023049

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated how changes in metabolic syndrome (MetS) are associated with the subsequent risk of breast and endometrial cancer according to menopausal status.

METHODS

This cohort study, using data from the National Health Insurance Service database, included women aged ≥40 years who underwent 2 biennial cancer screenings (2009-2010 and 2011-2012) and were followed up until 2020. Participants were grouped into MetS-free, MetS-recovery, MetS-development, and MetS-persistent groups. Menopausal status (premenopausal, perimenopausal, and postmenopausal) was assessed at 2 screenings. Cox proportional hazard regression was used to assess the association between MetS changes and cancer risk.

RESULTS

In 3,031,980 women, breast and endometrial cancers were detected in 39,184 and 4,298, respectively. Compared with the MetS-free group, those who recovered, developed, or had persistent MetS showed an increased risk of breast cancer, with adjusted hazard ratios (aHRs) of 1.05, 1.05, and 1.11, respectively (p<0.005). MetS persistence was associated with an increased risk of breast cancer in postmenopausal women (aHR, 1.12, 95% confidence interval [CI], 1.08 to 1.16) but not in premenopausal or perimenopausal women. MetS persistence was associated with an increased risk of endometrial cancer in premenopausal, perimenopausal, and postmenopausal women, with aHRs of 1.41 (95% CI, 1.17 to 1.70), 1.59 (95% CI, 1.19 to 2.12), and 1.47 (95% CI, 1.32 to 1.63), respectively.

CONCLUSIONS

Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. Meanwhile, increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.

Summary

Korean summary
- 폐경후 여성에서 대사증후군이 회복되었거나, 지속적으로 대사증후군을 앓고 있거나, 대사증후군이 발병한 여성은 유방암 위험과 관련이 있었습니다. - 한편, 폐경 상태와 관계없이 대사증후군에서 회복되었거나 지속적으로 대사증후군를 앓고 있는 비만 여성은 대사증후군이 없는 여성에 비해 자궁내막암 위험이 증가하는 것으로 나타났습니다.

Key Message
- Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. - Increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.

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Metabolic obesity phenotypes and breast cancer risk before and after menopause: A nationwide cohort study in South Korea
Hea Lim Choi, Bongseong Kim, Yong‐Moon Mark Park, Jung Eun Yoo, Seonghye Kim, Su Min Jeong, Kyungdo Han, Dong Wook Shin
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Jinwei Song, Songkun Gao, Lixia Zhao, Xiaolong Tong
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Risk of gynaecologic cancers in women with metabolic syndrome: A systematic review & meta-analysis
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George Anderson
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The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults: Ziyue Sheng, Shang Lou, Jin Cao, Weidi Sun, Yaojia Shen, Yunhan Xu, Ziyang Ren, Wen Liu, Qian Yi, Peige Song; Epidemiol Health. 2023;45:e2023043. Published online April 10, 2023; DOI: https://doi.org/10.4178/epih.e2023043

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese.
METHODS
Using the 2011-2015 waves of the China Health and Retirement Longitudinal Study, we conducted a cross-sectional analysis included 9,015 subjects and a longitudinal analysis included 4,961 subjects, with 4,872 having full data on the hypertension stage and 4,784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex.
RESULTS
NWCO was associated with normal→stage 2 (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.11 to 3.42), maintained stage 1 (OR, 1.62; 95% CI, 1.14 to 2.29), and normal→ISH (OR, 1.39; 95% CI, 1.05 to 1.85). AWCO was associated with normal→stage 1 (OR, 1.75; 95% CI, 1.40 to 2.19), maintained stage 1 (OR, 2.77; 95% CI, 2.06 to 3.72), maintained stage 2 (OR, 2.80; 95% CI, 1.50 to 5.25), normal→ISH (OR, 1.56; 95% CI, 1.20 to 2.02), and normal→SDH (OR, 2.54; 95% CI, 1.72 to 3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages.
CONCLUSIONS
This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.; Summary

Key Message
This study elucidates the distinct associations between obesity phenotypes and various hypertension stages and phenotypes. Furthermore, it reveals significant sex differences in the risk for hypertension stages, phenotypes, and transitions, providing essential insights for targeted interventions and personalized medicine.

The association between obesity and glaucoma in older adults: evidence from the China Health and Retirement Longitudinal Study: Xiaohuan Zhao, Qiyu Bo, Junran Sun, Jieqiong Chen, Tong Li, Xiaoxu Huang, Minwen Zhou, Jing Wang, Wenjia Liu, Xiaodong Sun; Epidemiol Health. 2023;45:e2023034. Published online March 9, 2023; DOI: https://doi.org/10.4178/epih.e2023034

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Abstract Summary PDF

Abstract

OBJECTIVES
This study evaluated the association between obesity and glaucoma in middle-aged and older people. A population-based retrospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study.

METHODS

Glaucoma was assessed via self-reports. Multivariate logistic regression analysis and a Cox proportional hazards model were used to assess the relationship between obesity and glaucoma risk.

RESULTS

Older males living in urban areas who were single, smokers, and non-drinkers were found to have a significantly higher incidence of glaucoma (all p<0.05). Diabetes, hypertension, and kidney disease were also associated with higher glaucoma risk, while dyslipidemia was associated with lower risk (all p<0.05). After the model was adjusted for demographic, socioeconomic, and health-related variables, obesity was significantly associated with a 10.2% decrease in glaucoma risk according to the Cox proportional hazards model (hazard ratio, 0.90; 95% confidence interval [CI], 0.83 to 0.97) and an 11.8% risk reduction in the multivariate logistic regression analysis (odds ratio, 0.88; 95% CI, 0.80 to 0.97). A further subgroup analysis showed that obesity was associated with a reduced risk of glaucoma in people living in rural areas, in smokers, and in those with kidney disease (all p<0.05). Obesity also reduced glaucoma risk in people with diabetes, hypertension, or dyslipidemia more than in healthy controls (all p<0.05).

CONCLUSIONS

This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease. Obesity exerted a stronger protective effect in people with diabetes, hypertension, or dyslipidemia than in healthy people.

Summary

Key Message
Glaucoma is a neurodegenerative disease and the leading cause of irreversible vision loss worldwide. The diagnosis of glaucoma is frequently delayed, as it may be asymptomatic until a relatively late stage. Thus, there is a need to identify protective and risk factors for glaucoma. Glaucoma is a multifactorial disease, and the impact of obesity on glaucoma risk remains uncertain. This study evaluated the association between obesity and glaucoma in middle-aged and older people. This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease.

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Liu Yuxi, Huo Ye, Liu Jingyuan, Xu Kejia, Luo Shasha, Chen Jiawei
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Piao Xie, Hanze Qiu, Luyu Zhao, Dahai Hu, Hui Tang, Rongzhao Lu, Hongwei Pan
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Jonathan YM Lai, Patrick Mclarnon, Carl Sheridan, Neeru A Vallabh
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Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020: Eunji Kim, Ga Bin Lee, Dong Keon Yon, Hyeon Chang Kim; Epidemiol Health. 2023;45:e2023033. Published online March 7, 2023; DOI: https://doi.org/10.4178/epih.e2023033

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity.

METHODS

This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father’s educational attainment, mother’s educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII).

RESULTS

The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father’s education, and 1.45 for the mother’s education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively.

CONCLUSIONS

These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.

Summary

Korean summary
2006년부터 2020년까지 청소년 비만의 유병은 증가 추세에 있을 뿐 아니라, 가정의 경제상태, 부모의 학력수준에 따른 비만의 위험 격차도 점점 심해지는 추세를 보였다. 특히, 남학생과 고등학생의 비만 유병률이 높게 나타났으나, 사회경제적 지표에 따른 비만의 불평등 격차는 여학생과 중학생에서 높게 나타났다.

Key Message
Not only the prevalence but also socioeconomic inequality in adolescent obesity increased between 2006 and 2020. The potential impact of socioeconomic disparity on obesity was greater in girls and middle school students than their counterparts.

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COVID-19: Special Article

Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey: Chang-Mo Oh, Yangha Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh; Epidemiol Health. 2023;45:e2023018. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023018

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to investigate changes in health behaviors, including cigarette smoking, alcohol drinking, physical activity, dietary behaviors, and obesity, before and during the coronavirus disease 2019 (COVID-19) pandemic using the Korea Youth Risk Behavior Survey (KYRBS) database.

METHODS

KYRBS data from 2015 to 2021 were used in this study. Differences in health behaviors between before (pre-pandemic period: 2018-2019) and during (pandemic period: 2020-2021) the pandemic were examined. Differences were compared using linear regression and the chi-square test considering the complex survey design after adjusting for grade level.

RESULTS

The prevalence of current cigarette smoking and current alcohol drinking significantly decreased in both male and female students during the pandemic compared to the pre-pandemic period. However, the prevalence of obesity significantly increased in both male and female students during the same period. When examining physical activity and dietary behaviors closely related to obesity, fast food consumption increased and fruit consumption decreased during the pandemic in both male and female students, whereas no significant changes in physical activity were observed in either male or female students.

CONCLUSIONS

The deterioration of adolescent dietary behaviors and an increase in the prevalence of obesity can increase the future disease burden, and concerted efforts at the individual and national levels are needed to reduce obesity and promote healthy dietary behaviors.

Summary

Korean summary
이 연구는 한국 청소년건강행태조사자료(KYRBS)를 사용하여 코로나19 유행 전후의 우리나라 청소년들의 흡연, 음주, 신체활동, 식습관, 비만 등의 건강행태의 변화에 대하여 살펴보고자 하였다. 이 연구에서는 2015년부터 2021년까지의 청소년건강행태조사자료를 사용하여, 코로나19 유행 이전 (2018-2019년)과 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화에 대하여 조사하였다. 학년레벨을 보정한 후, 복합표본설계를 고려하여 로지스틱 회귀분석과 카이제곱검정을 이용하여 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화가 있었는지에 대하여 확인하였다. 그 결과, 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나19 유행 기간(2020-2021년) 동안에 현재흡연율과 현재음주율이 유의하게 감소하였다. 그러나 동일한 기간 동안에 남학생과 여학생 모두에서 비만율이 유의하게 증가하였는데, 비만율과 관련된 신체활동 및 식습관에 대하여 살펴보았을 때, 신체활동에서는 유의한 변화가 없었던 반면, 남학생과 여학생 모두에서 패스트푸드 섭취는 증가하고 과일섭취가 감소한 것으로 나타났다. 따라서 코로나19 유행기간 동안 흡연율 및 음주율 등의 청소년 건강에 유익한 변화도 있었으나, 비만율도 같이 증가한 것을 확인할 수 있었다. 청소년기의 식습관의 악화 및 비만율의 증가는 미래 우리나라의 질병부담을 증가시킬 수 있기 때문에, 청소년의 비만율을 낮추고 건강한 식습관을 증진시키기 위한 개인 및 사회 차원의 노력이 필요하다.

Key Message
-The current cigarette smoking and current alcohol drinking rates significantly decreased among Korean adolescents during the pandemic period compared to the pre-pandemic period. -On the other hand, the obesity rate increased significantly especially among Korean male adolescents, which is accompanied by changes in dietary habits such as an increase in fast food intake and a decrease in fruit intake.

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Original Articles

Long-term association of pericardial adipose tissue with incident diabetes and prediabetes: the Coronary Artery Risk Development in Young Adults Study: Minsuk Oh, Wonhee Cho, Dong Hoon Lee, Kara M. Whitaker, Pamela J. Schreiner, James G. Terry, Joon Young Kim; Epidemiol Health. 2023;45:e2023001. Published online December 3, 2022; DOI: https://doi.org/10.4178/epih.e2023001

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We examined whether pericardial adipose tissue (PAT) is predictive of prediabetes and type 2 diabetes over time.
METHODS
In total, 2,570 adults without prediabetes/diabetes from the Coronary Artery Risk Development in Young Adults Study were followed up over 15 years. PAT volume was measured by computed tomography scans, and the new onset of prediabetes/diabetes was examined 5 years, 10 years, and 15 years after the PAT measurements. Multivariable Cox regression models were used to examine the association between the tertile of PAT and incident prediabetes/diabetes up to 15 years later. The predictive ability of PAT (vs. waist circumference [WC], body mass index [BMI], waist-to-height ratio [WHtR]) for prediabetes/diabetes was examined by comparing the area under the receiver operating characteristic curve (AUC).
RESULTS
The highest tertile of PAT was associated with a 1.56 times (95% confidence interval [CI], 1.03 to 2.34) higher rate of diabetes than the lowest tertile; however, no association was found between the highest tertile of PAT and prediabetes in the fully adjusted models, including additional adjustment for BMI or WC. In the fully adjusted models, the AUCs of WC, BMI, WHtR, and PAT for predicting diabetes were not significantly different, whereas the AUC of WC for predicting prediabetes was higher than that of PAT.
CONCLUSIONS
PAT may be a significant predictor of hyperglycemia, but this association might depend on the effect of BMI or WC. Additional work is warranted to examine whether novel adiposity indicators can suggest advanced and optimal information to supplement the established diagnosis for prediabetes/diabetes.; Summary

Korean summary
본 연구는 심장 내 축적되는 내장지방과 5년에서 15년 뒤의 당뇨병 전조 단계 및 당뇨병의 발생률과 연관성이 있음을 제안한다. 또한, 본 연구는 심장 내 내장지방과 당뇨병 발생률의 관계는 체질량 지수 또는 허리둘레의 영향에 따라 상이할 수 있음을 제안한다.

Key Message
Pericardial adipose tissue may be a significant predictor of future hyperglycemia in adults, but this association might depend on the effect of body mass index or waist circumference.

Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets: Sukyoung Jung, Sohyun Park; Epidemiol Health. 2022;44:e2022063. Published online August 2, 2022; DOI: https://doi.org/10.4178/epih.e2022063

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years.

METHODS

This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity.

RESULTS

During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women.

CONCLUSIONS

Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.

Summary

Korean summary
본 연구는 한국인 유전체역학조사사업의 안성안산코호트 조사에 참여한 40-69세 한국 성인 6,054명을 대상으로 식물성 기반의 식이 지수와 복부비만 간 연관성이 식이 노출 기간(기반, 최근, 누적 노출)에 따라 어떻게 다른지 비교 분석하였다. 건강하지 않은 식물성 기반의 식이 지수 점수가 높을수록 복부비만 발생 위험이 증가하였고, 식이 노출 기간에 관계없이 일관된 결과를 보였다. 식물성 기반의 식이가 반드시 건강에 유익한 것은 아니며, 정제된 곡물, 탄산음료, 사탕 등 간식류를 많이 먹는 식이 패턴은 식물성 기반 식이라 할지라도 복부비만 위험을 증가시킬 수 있으므로 주의가 필요하다.

Key Message
Unhealthy plant-based diets, including refined grains, sugar-sweetened beverages, sweets and desserts, and salty plant foods, can have a negative effect on abdominal obesity in Korean adults regardless of its exposure duration.

Citations

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Plant‐based and sustainable diet: A systematic review of its impact on obesity
Sara P. Mambrini, Claudia Penzavecchia, Francesca Menichetti, Andrea Foppiani, Alessandro Leone, Marta Pellizzari, Federica Sileo, Alberto Battezzati, Simona Bertoli, Ramona De Amicis
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Xinyi Shen, Curtis Tilves, Hyunju Kim, Toshiko Tanaka, Adam P Spira, Chee W Chia, Sameera A. Talegawkar, Luigi Ferrucci, Noel T Mueller
The American Journal of Clinical Nutrition.2024; 119(3): 628. CrossRef
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Jong Han Choi, Chen Lulu, Seon-Joo Park, Hae-Jeung Lee
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Scoping review of the association of plant-based diet quality with health outcomes
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Frontiers in Nutrition.2023;[Epub] CrossRef

Differences in accuracy of height, weight, and body mass index between self-reported and measured using the 2018 Korea Community Health Survey data: Yoonsil Ko, Sunhye Choi, Jisoo Won, Yeon-Kyeng Lee, Dong-Hyun Kim, Seon Kui Lee; Epidemiol Health. 2022;44:e2022024. Published online February 19, 2022; DOI: https://doi.org/10.4178/epih.e2022024

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to determine an effective survey method for the accurate calculation of obesity prevalence by comparing the self-reported and measured height, weight, and body mass index (BMI) using the 2018 Korea Community Healthy Survey (CHS) data.

METHODS

Raw data from the 2018 CHS were used to analyze the differences, correlation, and agreement between self-reported and measured height, weight, and BMI.

RESULTS

The self-reported height was over-reported than the measured height (0.59 cm greater for men and 0.71 cm greater for women), while the self-reported weight was under-reported than the measured weight (0.55 kg less for men and 0.67 kg less for women). Subsequently, the self-reported BMI was under-estimated (0.35 kg/m2 lower for men and 0.49 kg/m2 lower for women) compared with the measured BMI. The kappa statistic and agreement between measured and self-reported values per BMI category (underweight, normal, overweight, and obesity) were 0.82 and 79.6%, respectively.

CONCLUSIONS

The prevalence of obesity should be calculated using the measured values provided in the CHS in order to promote local health projects based on accurate evidence.

Summary

Korean summary
본 연구는 2018년 지역사회건강조사 원시자료를 이용하여, 자가보고된 신장, 체중, 그리고 체질량지수 값과 실제 측정한 값 간에 차이를 분석하고 상관성과 일치도를 확인하고자 하였으며, 확인결과 자가보고값 체질량지수는 측정값보다 과소측정(남자의 경우 측정값보다 자가보고값이 0.35kg/m2 낮게, 여자는 0.49kg/m2 낮게 측정)된것을 확인하였다.

Key Message
This study aimed to determine an effective survey method for the accurate calculation of obesity prevalence by comparing the self-reported and measured height, weight, and body mass index (BMI) using the 2018 Community Healthy Survey (CHS) data.

Citations

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Methods

Development and validation of the Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome: Sung Yoon Cho, Danbee Kang, Minji Im, Aram Yang, Min-Sun Kim, Jiyeon Kim, Eu-Seon Noh, Eun Kyung Kwon, Eujin Choi, Sunju Han, Young Ah Park, Min Jung Kwak, Youngha Kim, Juhee Cho, Dong-Kyu Jin; Epidemiol Health. 2022;44:e2022014. Published online January 10, 2022; DOI: https://doi.org/10.4178/epih.e2022014

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Abstract Summary PDF

Abstract

OBJECTIVES
Hyperphagia is a highly stressful, life-threatening feature of Prader-Willi syndrome (PWS). It is important to assess this complex behavior accurately over time. This study aimed to develop and validate the Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome (PYHAP) as a tool targeting children and adolescents.

METHODS

After an extensive literature review and qualitative interviews, the final version of the PYHAP with 14 questions in 3 domains (verbal [5], behavior [4], and social [5]) was developed and tested at Samsung Medical Center in Seoul, Korea from July 2018 to September 2019. Exploratory factor analysis and confirmatory factor analysis (CFA) were performed to confirm construct validity. The correlations between the PYHAP and the Korean Children’s Eating Behavior Questionnaire (K-CEBQ) were calculated to evaluate convergent and discriminant validity. Criterion validity and the validity of the response categories were also tested.

RESULTS

Cronbach’s alpha coefficient of the PYHAP was 0.91. The fit indices for CFA were good (comparative fit index, 0.87; standardized root mean squared residual, 0.08). The domains of the PYHAP were closely correlated with the relevant domains of the K-CEBQ. The accuracy of the PYHAP score for predicting uncontrolled hyperphagia was good (area under the curve, 0.75; 95% confidence interval, 0.65 to 0.85).

CONCLUSIONS

The PYHAP was confirmed to be a reliable and valid tool to evaluate hyperphagia in children and adolescents with PWS via caregivers’ assessments. It is recommended to use the PYHAP to communicate with parents or caregivers about patients’ hyperphagia or to monitor and manage extreme behaviors in children with PWS.

Summary

Korean summary
프래더 윌리 증후군에서 '조절되지 않는 식욕'은 환자의 수명과 삶의 질에 매우 중요한 문제로, 최근 식욕 억제제 개발을 위한 연구가 활발히 이뤄지고 있으나 약제의 유효성을 객관적으로 평가하는 도구는 부족한 상황입니다. 본 연구는 주부양자를 통하여 평가가 가능한 프래더윌리 증후군 소아청소년 환자들의 식욕심각도 평가도구를 개발하였고, 그것의 신뢰성과 타당성을 입증하였습니다.

Key Message
Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome (PYHAP) is a reliable and valid tool to evaluate hyperphagia in children and adolescents with PWS via caregivers’ assessments.

Citations

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Original Articles

Association between body temperature and leukocyte telomere length in Korean middle-aged and older adults: Carolina García-García, Chol Shin, Inkyung Baik; Epidemiol Health. 2021;43:e2021063. Published online September 8, 2021; DOI: https://doi.org/10.4178/epih.e2021063

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Data on associations between body temperature (BT) and leukocyte telomere length (LTL), which has been widely used as a biomarker of cellular senescence in recent epidemiological studies, are limited. Therefore, this study aimed to explore the associations between a normal BT range (35.0-37.5°C) and LTL via 6-year longitudinal observations of 2,004 male and female adults aged 50 or older.

METHODS

BT was obtained by measuring the tympanic temperature, and relative LTL was determined by real-time polymerase chain reaction. Robust regression analysis was used to evaluate the association between the baseline and follow-up LTL values and their differences.

RESULTS

A significant inverse association was found between BT and LTL at baseline. The regression coefficient estimate was -0.03 (95% confidence interval, -0.07 to -0.001; p<0.05). This association was stronger in participants with a body mass index >25 kg/m2 and males (p<0.01). However, there were no associations between BT and LTL at follow-up or BT and 6-year longitudinal differences in LTL.

CONCLUSIONS

These findings suggest that having a high BT between 35°C and 37.5°C (95°F and 99°F) may be detrimental for obese individuals in terms of biological aging.

Summary

Korean summary
본 역학 연구는 한국 성인 2,004명을 연구대상자로 하여 2011-2012년에 고막 체온을 측정하고 전혈을 채취하여 백혈구 텔로미어 길이를 분석하였으며 이러한 분석을 2017-2018년에 반복하여 6년 동안의 백혈구 텔로미어 길이 변화를 계산하였다. 고막 체온과 초기 텔로미어 길이의 관련성을 분석한 결과, 정상 체온 범위 내 체온이 높을수록 텔로미어 길이가 유의적으로 짧아지는 생리적 노화 상태와 관련된 것으로 나타났으며, 이러한 결과는 비만할 경우 더욱 분명하게 나타났다. 본 연구 결과를 통해 비만 시 체내 열발생과 관련된 노화 진행이 체중 감소를 통해 지연될 수 있는 가능성이 제시되었다.

Key Message
In an epidemiological study including Korean adults, a relatively higher normal body temperature between 35°C to 37.5°C was found to be associated with shorter leukocyte telomere length, a cellular senescence biomarker. In particular, this association was observed to be stronger among obese participants, suggesting that attaining normal body weight may be beneficial for anti-aging.

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Higher Daily Air Temperature Is Associated with Shorter Leukocyte Telomere Length: KORA F3 and KORA F4
Wenli Ni, Kathrin Wolf, Susanne Breitner, Siqi Zhang, Nikolaos Nikolaou, Cavin K. Ward-Caviness, Melanie Waldenberger, Christian Gieger, Annette Peters, Alexandra Schneider
Environmental Science & Technology.2022; 56(24): 17815. CrossRef

Obesity parameters in relation to lung function levels in a large Chinese rural adult population: Xiang Zeng, Dongling Liu, Zhen An, Huijun Li, Jie Song, Weidong Wu; Epidemiol Health. 2021;43:e2021047. Published online August 3, 2021; DOI: https://doi.org/10.4178/epih.e2021047

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The association between obesity parameters and lung function indicators in the general Chinese rural adult population remains unclear.

METHODS

In total, 8,284 Chinese adults aged 20 years to 80 years old from Xinxiang were recruited. Obesity-related parameters, including body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waistto-height ratio (WHtR), body fat percentage (BFP), basal metabolism, and visceral fat index, and lung function parameters such as forced vital capacity and forced expiratory volume in first second were measured.

RESULTS

The total prevalence of obesity defined by BMI, WC, WHR, WHtR, and BFP was 23.2%, 58.2%, 66.7%, 69.2%, and 56.5%, respectively. Spearman correlation analyses showed significant correlations between all obesity-related parameters and lung function. Linear regression analyses further demonstrated that BMI, WHtR, BFP, and general obesity defined using those indicators were negatively associated with lung function, while WC, WHR, and central obesity defined accordingly were positively associated with lung function. The relationship between general obesity and lung function was more evident in women than in men, while the link between central obesity and lung function was more obvious in men than in women.

CONCLUSIONS

Obesity is closely related to lung function in the general Chinese adult population. Weight control and loss are important strategies to improve lung function and respiratory health.

Summary

Key Message
This cross-sectional sduty clarify the relationship between several obesity parameters and lung function indicators on rural adult population in central China using big data and stratified analyses. Specifically, the obesity group has a lower level of lung function than the non-obesity group, and there is an opposite effect of general obesity and central obesity on lung function.

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Matthew J. Valente, Biwei Cao, Daniëlle D.B. Holthuijsen, Martijn J.L. Bours, Simone J.P.M. Eussen, Matty P. Weijenberg, Judith J.M. Rijnhart
Journal of Clinical Epidemiology.2026; 190: 112092. CrossRef
Inverted L-shape association between a body shape index and peak expiratory flow among middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study (CHARLS)
Guosong Jiang, Licheng Feng, Xiaoxiao Qu, Jia Wang, Yun Li
Lipids in Health and Disease.2025;[Epub] CrossRef
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Trends in the prevalence and management of major metabolic risk factors for chronic disease over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Yoonjung Kim, Sun Jin Nho, Gyeongji Woo, Hyejin Kim, Suyeon Park, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021028. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021028

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to explore trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from 1998 to 2018 using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The study participants included 79,753 individuals aged ≥ 30 years who had participated in the health examination and health interview of the first (1998) to the seventh (2016-2018) KNHANES. The prevalence and management as well as annual percent change (APC) in chronic diseases were analyzed using SAS and the Joinpoint software program.

RESULTS

The prevalence of obesity in men significantly increased from 26.8% in 1998 to 44.7% in 2018 (APC= 1.9, p< 0.001), whereas that in women decreased slightly from 30.5% in 1998 to 28.3% in 2018 (APC= -0.5, p< 0.001). The prevalence of hypertension in men was 33.2% in 2018, with no significant change, whereas that in women slightly decreased to 23.1% in 2018 (APC= -0.9, p< 0.001). The prevalence of diabetes in men increased slightly from 10.5% in 2005 to 12.9% in 2018 (APC= 1.6, p< 0.001), whereas that in women remained at approximately 8%, with no significant change. The prevalence of hypercholesterolemia in both men and women increased 3-fold in 2018 (20.9% in men [APC = 8.2, p < 0.001] and 21.4% in women [APC= 7.1, p< 0.001]) compared to that in 2005. The awareness rate, treatment rate, and control rate of hypertension and hypercholesterolemia increased 2-3 fold. Regarding diabetes, the treatment rate increased, but the control rate did not change.

CONCLUSIONS

Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리나라 성인의 비만, 고혈압, 당뇨병, 고콜레스테롤혈증 유병률 및 관리수준을 분석한 결과, 20년 동안 비만(남자), 당뇨병, 고콜레스테롤혈증 만성질환의 유병 수준은 악화되고 있는 반면, 만성질환의 인지율, 치료율, 치료자 중 조절률 등 관리지표는 지속적으로 개선되고 있었다.

Key Message
We examined trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

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Comorbidity network analysis related to obesity in middle-aged and older adults: findings from Korean population-based survey data: Hye Ah Lee, Hyesook Park; Epidemiol Health. 2021;43:e2021018. Published online March 5, 2021; DOI: https://doi.org/10.4178/epih.e2021018

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Abstract Summary PDF

Abstract

OBJECTIVES
We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities.

METHODS

The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities.

RESULTS

In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m2. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network.

CONCLUSIONS

Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.

Summary

Korean summary
본 연구는 비만 관련 동반질환을 체계적으로 정량화하기 위해, 제7차 (2016-2018) 국민건강영양조사 자료를 이용하여 동반질환 네트워크 분석을 수행하였습니다. 45세 이상 성인에서 비만(체질량지수≥25.0 kg/m²)은 정상체중에 비해 동반질환에 대한 위험이 2.1배 높은 것으로 나타났습니다. 동반질환 네트워크에서는 고혈압과 이상지질혈증이 비만 여성의 주요 질환 이였으며, 이상지질혈증과 당뇨병은 비만 남성의 주요 질환인 것으로 나타났습니다. 본 연구결과는 비만 관련 동반질환 감소를 위한 중재의 우선 순위를 정하는데 도움이 될 것이라고 생각됩니다.

Key Message
We conducted a comorbidity network analysis using data from the seventh (2016-2018) Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. In subjects over 45 years old, obese (body mass index ≥ 25.0 kg/m²) subjects were 2.1 times more likely to have a comorbidity than normal-weight subjects. In the comorbidity network, hypertension and dyslipi¬demia were the major diseases in obese females, and dyslipidemia and diabetes were the major diseases in obese males. Our results will help prioritize interventions for reducing obesity-related comorbidities.

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Associations of physical activity at work and household income with obesity: a cross-sectional study among rural adults in Korea: Su Yeon Kye, Heeyoun Cho, Tran Thi Phuong Thao, Jin-Kyoung Oh, Min Kyung Lim; Epidemiol Health. 2021;43:e2021003. Published online December 29, 2020; DOI: https://doi.org/10.4178/epih.e2021003

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Abstract Summary PDF

Abstract

OBJECTIVES
This study was performed to identify the effect of physical activity at work on obesity and to analyze the contribution of socioeconomic factors and health behaviors to this association, which has been relatively little studied.

METHODS

From the Korean National Cancer Center Community Cohort, a total of 5,587 adults (2,125 men; 3,462 women) aged more than 30 years living in rural areas were enrolled. Information on socio-demographic factors, health behaviors, and body mass index was gathered using face-to-face interviews and measurements of height and weight.

RESULTS

Inverse associations were identified between vigorous-intensity physical activity at work and obesity in both men and women, while no association was found between vigorous-intensity physical activity during leisure time and obesity. High household income was independently associated with a lower risk of obesity among those who had low levels of vigorous-intensity physical activity at work. Vigorous physical activity at work showed an inverse association with obesity in rural areas where heavy manual labor is common.

CONCLUSIONS

Our findings indicate the necessity to account for various types of physical activity to improve the assessment and prevention of obesity.

Summary

Korean summary
신체활동의 종류에 따라 비만에 미치는 영향의 차이가 있는지를 보기 위하여 육체 노동이 많은 농촌지역 성인을 대상으로 직무신체활동과 비만과의 관련성을 다른 잠재요인을 보정하여 분석하였다. 남녀 모두에서 고강도 직무신체활동과 비만과의 역연관성이 확인된 반면 여가신체활동과 비만과의 연관성은 확인되지 않았다. 가구소득이 높은 경우 직무신체활동의 강도가 낮은 경우에도 비만과 역연관성을 보였다. 향후 비만 예방 및 중재 전략 수립 시 대상집단의 특성을 고려하여 다양한 종류의 신체활동에 대한 평가가 고려되어야 할 것이다.

Key Message
Regarding the inverse association of physical activity at work and household income with obesity identified in the study, various type of physical activity including physical activity at work and characteristics of target population might be concerned for assessment and prevention of obesity.

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Diabetes and prediabetes prevalence among young and middle-aged adults in India, with an analysis of geographic differences: findings from the National Family Health Survey: Siddardha G. Chandrupatla, Isma Khalid, Tejdeep Muthuluri, Satyanarayana Dantala, Mary Tavares; Epidemiol Health. 2020;42:e2020065. Published online September 18, 2020; DOI: https://doi.org/10.4178/epih.e2020065

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Abstract PDF

Abstract

OBJECTIVES
This study aimed to approximate the prevalence of hyperglycemia in India.

METHODS

The study was conducted using the Demographic and Health Survey 2015-16 (also known as the National Family Health Survey-4), which surveyed 811,808 individuals using a stratified, multistage, cluster sampling design. This cross-sectional survey recorded socio-demographic and anthropometric data, including blood glucose levels, of adults aged 18 years to 54 years.

RESULTS

The final analysis included 718,597 individuals, of whom 49.90% (weighted) were males. The overall prevalence of diabetes was 6.65% and that of prediabetes was 5.57%. A positive association was seen with urban residence, geographic region, sex, age, body mass index, socioeconomic status, and hypertension. Approximately two-thirds of individuals with diabetes lived in urban areas, and about half of the urban population was considered overweight/obese. South India showed a higher prevalence of diabetes (prevalence ratio, 2.01; p<0.001) than northern India.

CONCLUSIONS

Hyperglycemia (diabetes and prediabetes) has a high prevalence in India and is a major public health issue. Diabetes is unevenly distributed based on geographic location and urbanization. Prevention, early detection, and treatment strategies should consider this uneven distribution of diabetes.

Summary

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The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis: Suyoung Kim, Seon Cho, Eun-Hee Nah; Epidemiol Health. 2020;42:e2020061. Published online August 31, 2020; DOI: https://doi.org/10.4178/epih.e2020061

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to identify latent classes in hypertensive patients based on the clustering of factors including lifestyle risk factors, metabolic risk factors, and obesity in each sex.

METHODS

This cross-sectional study included 102,780 male and 103,710 female hypertensive patients who underwent health check-ups at 16 centers in Korea, in 2018. A latent class analysis approach was used to identify subgroups of hypertensive patients. Multinomial logistic regression was performed to examine the association between latent classes and comorbidities of hypertension.

RESULTS

A four-class model provided the best fit for each sex. The following latent classes were identified: Class I (male: 16.9%, female: 1.7%; high risk of lifestyle behaviors [HB] with metabolic disorders and obesity [MO]), Class II (male: 32.4%, female: 47.1%; low risk of lifestyle behaviors [LB] with MO), Class III (male: 15.3%, female: 1.8%; HB with metabolic disorders and normal weight [MNW]), Class IV (male: 35.5%, female: 49.4%; LB with MNW). Lifestyle patterns in the latent classes were classified as high-risk or low-risk according to smoking and high-risk drinking among male, and presented complex patterns including physical inactivity alone or in combination with other factors, among female. Stage 2 hypertensive or diabetic individuals were likely to belong to classes including obesity (HB-MO, LB-MO) in both sexes, and additionally belonged to the HB-MNW class in male.

CONCLUSIONS

Metabolic disorders were included in all latent classes, with or without lifestyle risk factors and obesity. Hypertensive females need to manage obesity, and hypertensive males need to manage lifestyle risk factors and obesity. Sex-specific lifestyle behaviors are important for controlling hypertension.

Summary

Korean summary
고혈압 환자에서 이질적인 집단을 확인하기 위해, 생활습관, 대사이상 및 비만에 기반한 잠재계층분석을 실시한 결과, 각 성별에서 4개 계층으로 분류되었다. 모든 계층에는 대사이상 상태가 포함되었으며, 고위험 생활습관과 비만(HB-MO), 저위험 생활습관과 비만(LB-MO), 고위험 생활습관과 정상체중(HB-MNW), 저위험 생활습관과 정상체중(LB-MNW)으로 유형화하였다. 생활습관 및 비만 여부와 상관없이 모든 잠재계층에 대사이상 상태가 포함된 점으로 고혈압과 대사상태의 긴밀한 관련성을 확인하였으며, 성별에 따라 이질적인 생활습관 패턴(여성에서는 비만 관리와 남성에서는 비만과 생활습관 개선을 강조)을 확인하였다.

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An alarmingly high and increasing prevalence of obesity in Jordan: Kamel Ajlouni, Yousef Khader, Anwar Batieha, Hashem Jaddou, Mohammed El-Khateeb; Epidemiol Health. 2020;42:e2020040. Published online June 6, 2020; DOI: https://doi.org/10.4178/epih.e2020040

27,469 View
236 Download
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Abstract PDF

Abstract

OBJECTIVES
The aim of this study was to determine the prevalence of obesity in Jordan, to assess related trends, and to determine associated factors and comorbidities.

METHODS

A multipurpose national household survey of Jordanian adults was conducted over a 4-month period in 2017. Data were collected using a structured validated questionnaire. Anthropometric measurements including waist circumference (WC; measured midway between the iliac crest and the lower rib margin), body mass index (BMI), hip circumference, waist-to-hip ratio, and waist-to-height ratio were obtained to categorize participants with regard to overweight and obesity.

RESULTS

This study included 4,056 persons (1,193 men and 2,863 women) aged 18 years to 90 years (mean±standard deviation, 43.8±14.2 years). According to the International Diabetes Federation WC criteria, the age-standardized prevalence of obesity was 60.4% among men and 75.6% among women, while approximately three-quarters of men and women were overweight or obese as defined by BMI. The age-adjusted odds of obesity in 2017 were approximately twice those in 2009 in men (odds ratio [OR], 1.98) and women (OR, 1.96). In the multivariate analysis, age, region of residence, and marital status were significantly associated with obesity in both genders. Obesity was significantly associated with increased odds of diabetes mellitus, hypertension, elevated triglycerides, and low high-density lipoprotein cholesterol after adjusting for age.

CONCLUSIONS

The rate of obesity in Jordan is high and increasing, and obesity is associated with other metabolic abnormalities. Well-defined programs to control and prevent obesity, as well as intersectoral action, are urgently required to reverse current trends.

Summary

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The double burden of malnutrition among adults in India: evidence from the National Family Health Survey-4 (2015-16): Mili Dutta, Y Selvamani, Pushpendra Singh, Lokender Prashad; Epidemiol Health. 2019;41:e2019050. Published online December 18, 2019; DOI: https://doi.org/10.4178/epih.e2019050

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Abstract PDF

Abstract

OBJECTIVES
India still faces the burden of undernutrition and communicable diseases, and the prevalence of overweight/obesity is steadily increasing. The discourse regarding the dual burden of underweight and overweight/obesity has not yet been widely explored in both men and women. The present study assessed the determinants of underweight and overweight/obesity in India among adult men and women aged 15-49.

METHODS

Population-based cross-sectional and nationally representative data from the National Family Health Survey-4 (2015-16), consisting of a sample of men and women, were analyzed. Stratified 2-stage sampling was used in the NFHS-4 study protocol. In the present study, bivariate and adjusted multinomial logistic regression analyses were performed to determine the correlates of underweight and overweight/obesity.

RESULTS

The results suggested a persistently high prevalence of underweight coexisting with an increased prevalence of overweight/obesity in India. The risk of underweight was highest in the central and western regions and was also relatively high among those who used either smoking or smokeless tobacco. Overweight/obesity was more prevalent in urban areas, in the southern region, and among adults aged 35-49. Furthermore, level of education and wealth index were positively associated with overweight/obesity. More educated and wealthier adults were less likely to be underweight.

CONCLUSIONS

In India, underweight has been prevalent, and the prevalence of overweight/obesity is increasing rapidly, particularly among men. The dual burden of underweight and overweight/obesity is alarming and needs to be considered; public health measures to address this situation must also be adopted through policy initiatives.

Summary

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Effects of adults’ health behaviors and combinations thereof on health outcomes: an analysis using National Health Insurance Service of Korea cohort data: Hyun-Jung Park, Eun-Jung Kim; Epidemiol Health. 2019;41:e2019042. Published online October 8, 2019; DOI: https://doi.org/10.4178/epih.e2019042

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Abstract Summary PDF

Abstract

OBJECTIVES
The purpose of this study was to estimate the effects of health-risk behaviors, alone and in combination, on health outcomes.

METHODS

This study used sample cohort data provided by the National Health Insurance Service focusing on the use of hospital services, direct medical expenses, length of stay, and re-entry rate according to health-risk behaviors. A frequency analysis and the chi-square test were used to investigate associations between the demographic characteristics of study subjects and their health-risk behaviors. The strength of the association of each factor was calculated as the odds ratio in a crossover analysis.

RESULTS

Obesity had the largest effect, especially in combination with smoking and drinking. In particular, significant associations were shown with the duration of hospitalization and direct medical expenses. After adjustment for sex, age, economic status, and pre-existing medical conditions, the duration of hospitalization was 7.37 times longer and that of medical expenses was 5.18 times higher in the obese group relative to the non-obese group. Drinking showed a statistically significant association with the number of days of hospitalization. After adjusting for the control variables, the number of hospital days was 1.24 longer in the drinking group than in the non-drinking group.

CONCLUSIONS

An analysis of combinations of health risk factors showed obesity had the largest effect.

Summary

Korean summary
본 연구에서는 건강위해행동이 건강결과에 미치는 영향을 추정하고, 건강위해행동 간 상호작용을 분석하여 보다 다차원적 측면에서 건강위해행동과 건강결과 간 관계를 다루었다. 그 결과, 흡연, 비만, 음주 중 1개의 위해행위를 가지고 있는 경우, 흡연 집단에서 모든 건강결과와의 관련성이 통계적으로 유의미하지 않았으나, 비만의 경우, 입원일수와 직접의료비간의 관련성이 유의미하였고, 특히, 비만한 집단의 경우, 성별, 연령, 경제적 수준 및 기저 질환을 보정한 후, 그렇지 않은 집단과 비교하여 입원일수와 의료비의 유의미한 증가가 확인되었다. 건강위험행태요인의 조합을 조사하여, 어떤 경우 건강행태에 영향을 크게 미치는지를 분석한 결과, 비만의 영향이 가장 큰 것으로 분석되었으며, 흡연과 음주, 단일의 건강위험행태보다, 비만과 함께 건강위험행태가 동반되었을 때 그 영향이 증가하였다.

Citations

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An analysis of protective health behavior and polypharmacy among older patients: a nationwide cohort study
Zhaoyan Piao, Kyung sun Oh, Euna Han
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Distribution and social determinants of overweight and obesity: a cross-sectional study of non-pregnant adult women from the Malawi Demographic and Health Survey (2015-2016): Leonard Mndala, Abhay Kudale; Epidemiol Health. 2019;41:e2019039. Published online September 27, 2019; DOI: https://doi.org/10.4178/epih.e2019039

26,539 View
290 Download
21 Web of Science
20 Crossref

Abstract PDF

Abstract

OBJECTIVES
Hitherto regarded as a public health issue of well-heeled nations, overweight and obesity have emerged as a problem of concern in developing nations. Although social and demographic factors are equally important as proximal lifestyle factors affecting health, their role is neither well researched nor well understood. We conducted a novel study to determine the distribution, prevalence, and social and demographic determinants of overweight/obesity in Malawi.

METHODS

A population-based, quantitative cross-sectional study using data from the Malawi Demographic and Health Survey (2015-2016) was conducted among non-pregnant women aged 18-49 years. A total of 6,443 women were included in the analysis. Overweight/obesity, defined as a body mass index (BMI) ≥25.0 kg/m2 , was the main outcome variable. The analysis was done in SPSS version 20.0; after calculating descriptive statistics, bivariate and multivariate logistic regression was conducted to evaluate associations and determine odds.

RESULTS

In total, 16.8% and 6.3% of women were overweight and obese, respectively (p<0.001). Overweight and obesity were more prevalent in urban than in rural areas. The BMI distribution among women varied across different background characteristics. Women from the Ngoni ethnicity were more likely to be overweight/obese than others (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.14 to 2.08). Socioeconomic status (SES) and the age of the respondent were highly significant determinants that were strongly associated with being overweight/obese. The richest women were 3 times more likely to be overweight/obese than the poorest (aOR, 3.30; 95% CI, 2.46 to 4.43).

CONCLUSIONS

Overweight and obesity were highly prevalent and significantly associated with increasing SES, age, and being from the Ngoni ethnicity. Holistic interventions should also focus on improving social determinants in order to entirely curb the epidemic.

Summary

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Socioeconomic inequalities in obesity among Korean women aged 19-79 years: the 2016 Korean Study of Women’s Health-Related Issues: Eunji Choi, Ha Na Cho, Da Hea Seo, Boyoung Park, Sohee Park, Juhee Cho, Sue Kim, Yeong-Ran Park, Kui Son Choi, Yumie Rhee; Epidemiol Health. 2019;41:e2019005. Published online February 13, 2019; DOI: https://doi.org/10.4178/epih.e2019005

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Abstract Summary PDF

Abstract

OBJECTIVES
While the prevalence of obesity in Asian women has remained stagnant, studies of socioeconomic inequalities in obesity among Asian women are scarce. This study aimed to examine the recent prevalence of obesity in Korean women aged between 19 years and 79 years and to analyze socioeconomic inequalities in obesity.

METHODS

Data were derived from the 2016 Korean Study of Women’s Health-Related Issues. The chi-square test and logistic regression analysis were used to analyze the associations between socioeconomic factors and obesity using Asian standard body mass index (BMI) categories: low (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23.0-24.9 kg/m2 ), and obese (≥25.0 kg/ m2 ). As inequality-specific indicators, the slope index of inequality (SII) and relative index of inequality (RII) were calculated, with adjustment for age and self-reported health status.

RESULTS

Korean women were classified into the following BMI categories: underweight (5.3%), normal weight (59.1%), overweight (21.2%), and obese (14.4%). The SII and RII revealed substantial inequalities in obesity in favor of more urbanized women (SII, 4.5; RII, 1.4) and against of women who were highly educated (SII, -16.7; RII, 0.3). Subgroup analysis revealed inequalities in obesity according to household income among younger women and according to urbanization among women aged 65-79 years.

CONCLUSIONS

Clear educational inequalities in obesity existed in Korean women. Reverse inequalities in urbanization were also apparent in older women. Developing strategies to address the multiple observed inequalities in obesity among Korean women may prove essential for effectively reducing the burden of this disease.

Summary

Korean summary
한국 성인 여성의 과체중 및 비만유병률은 서구여성에 비해 낮으며 2005년 이후 큰 변화 없이 약40%대로 일정하게 유지되어왔으나, 사회경제적불평등에 대한 연구는 체계적으로 이루어지지 않음. 경사불평등(Slope index of inequality)과 상대불평등(Relative index of inequality) 지표를 사용하여 비만유병률에서 발견되는 사회경제적불평등을 조사한 결과, 교육수준별 불평등이 유의하게 나타남. 19-44세의 젊은 여성층에서는 소득수준이 낮은 집단에, 65-79세의 노년기 여성층에서는 도시화된 지역에 사는 집단에 비만유병률이 치중되어있음.

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Is inadequate play area in schools associated with overweight among students in Addis Ababa, Ethiopia? A comparative cross-sectional study: Tsedey Moges, Bereket Gebremichael, Solomon Shiferaw, Robel Yirgu; Epidemiol Health. 2018;40:e2018017. Published online May 12, 2018; DOI: https://doi.org/10.4178/epih.e2018017

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Abstract PDF

Abstract

OBJECTIVES
The prevalence of childhood obesity has more than doubled since it was formally recognized as a global epidemic in 1997. With the increasingly dwindling space for private schools in Ethiopia, unresolved concerns exist among the public regarding the possible effect of limited play areas in schools on overweight/obesity. This study intended to determine and compare the levels of overweight/obesity among adolescents in private schools with and without adequate play area in Addis Ababa, Ethiopia.

METHODS

A school-based comparative cross-sectional study was conducted among 1,276 adolescents. Twenty private schools were grouped into 2 groups based on the size of the play area. Data were collected using a pre-tested questionnaire and anthropometric measurements and analyzed using descriptive statistical tests and logistic regression.

RESULTS

The magnitude of overweight/obesity was significantly higher in schools with inadequate play area (19.4%; 95% confidence interval [CI], 16.4 to 22.7) than in schools with adequate play area (14.6%; 95% CI, 11.9 to17.5). Inadequacy of the play area was also positively associated with overweight/obesity in the multiple logistic regression analysis (odds ratio [OR], 1.62; 95% CI, 1.05 to 2.51). Using private car transportation to and from school (OR, 2.27; 95% CI, 1.13 to 4.57), father’s educational status (secondary school and above: OR, 2.54; 95% CI, 1.14 to 5.62), and middle wealth quintile (OR, 2.54; 95% CI, 1.50 to 4.33) were other factors significantly associated with overweight/obesity.

CONCLUSIONS

Inadequate play area in schools was an important contributor to overweight/obesity. Sedentary behavior was also significantly associated with overweight/obesity.

Summary

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Review

The criteria for metabolic syndrome and the national health screening and education system in Japan: Kazumasa Yamagishi, Hiroyasu Iso; Epidemiol Health. 2017;39:e2017003. Published online January 6, 2017; DOI: https://doi.org/10.4178/epih.e2017003

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Abstract PDF

Abstract

Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.

Summary

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Original Articles

Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study: Maryam Shakiba, Hamid Soori, Mohammad Ali Mansournia, Seyed Saeed Hashemi Nazari, Yahya Salimi; Epidemiol Health. 2016;38:e2016025. Published online June 4, 2016; DOI: https://doi.org/10.4178/epih.e2016025

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Abstract PDF

Abstract

OBJECTIVES
The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality.

METHODS

Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model.

RESULTS

Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality.

CONCLUSIONS

This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.

Summary

Citations

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Hailey R Banack, Jennifer W Bea, Jay S Kaufman, Andrew Stokes, Candyce H Kroenke, Marcia L Stefanick, Shirley A Beresford, Chloe E Bird, Lorena Garcia, Robert Wallace, Robert A Wild, Bette Caan, Jean Wactawski-Wende
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Associations of smoking with overall obesity, and central obesity: a cross-sectional study from the Korea National Health and Nutrition Examination Survey (2010-2013): Yeonjung Kim, Seong Min Jeong, Bora Yoo, Bitna Oh, Hee-Cheol Kang; Epidemiol Health. 2016;38:e2016020. Published online May 19, 2016; DOI: https://doi.org/10.4178/epih.e2016020

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Abstract Summary PDF

Abstract

OBJECTIVES
The association between smoking and obesity is a significant public health concern. Both are preventable risk factors of cardiovascular disease and a range of other conditions. However, despite numerous previous studies, no consensus has emerged regarding the effect of smoking on obesity. We therefore carried out a novel study evaluating the relationship between smoking and obesity.

METHODS

A total of 5,254 subjects aged 19 years or older drawn from the 2010-2013 Korea National Health and Nutrition Examination Survey were included in this cross-sectional study. Smoking was examined both in terms of smoking status and the quantity of cigarettes smoked by current smokers. Multiple logistic regression analysis was used to assess the association between smoking and obesity. Overall obesity was defined as a body mass index (BMI) ≥25 kg/m2, and central obesity was defined as a waist circumference ≥90 cm for males and ≥85 cm for females. We adjusted for the possible confounding effects of age, sex, physical activity, alcohol consumption, and the presence of hypertension or diabetes.

RESULTS

A statistically significant difference in central obesity according to smoking status was identified. Current smokers were more likely to be centrally obese than never-smokers (adjusted odds ratio,1.30; 95% confidence interval, 1.02 to 1.67). However, no significant association was found between smoking and obesity defined by BMI. Moreover, among current smokers, no statistically significant association was found between the daily amount of smoking and obesity or central obesity.

CONCLUSIONS

Smoking was positively associated with central obesity. Current smokers should be acquainted that they may be more prone to central obesity.

Summary

Korean summary
이 연구는 국민건강영양조사(2010-2013) 자료를 이용하여 한국 성인에서 흡연과 비만의 연관성을 분석하였다. 현재 흡연자는 비흡연자와 비교하여 비만의 위험도는 유의한 차이를 보이지 않았지만 복부비만의 위험도는 유의하게 증가하였다. 흡연이 복부 비만의 위험증가와 연관성이 있음을 확인하였으며 향후 인과관계 및 기전 규명을 위한 연구가 필요할 것으로 생각된다.

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Effect change of obesity on diabetes depending on measurement: self-reported body mass index from 2012 Community Health Survey vs. directly measured from the Korea National Health and Nutrition Examination Survey: Kyuhyun Yoon, Kyungduk Min, Heeran Chun, Soong-Nang Jang, Sung-il Cho; Epidemiol Health. 2015;37:e2015001. Published online January 6, 2015; DOI: https://doi.org/10.4178/epih/e2015001

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Abstract Summary PDF

Abstract

OBJECTIVES
Obesity is a well-recognized risk factor for type 2 diabetes mellitus (DM) among young and middle-aged adults in South Korea. To elaborate on the association between obesity and DM, subjective data from self-reporting survey or objective data from health examination is generally used. This study was conducted to validate the change of association from using these different measurements.

METHODS

Community Health Survey data and Korea National Health and Nutrition Examination Survey data, as subjective and objective data respectively, were used. Population, resident in Seoul and over 45 aged, were selected for the study and the association between obesity and DM were defined by using multivariate logistic regression model.

RESULTS

In subjective data, DM prevalence was 12.4% (male, 14.7; female, 10.6) and obesity prevalence was 26.0% (male, 29.2; female, 23.4). Whereas, in objective data, DM prevalence was 15.0% (male, 17.8; female, 12.9), and obese population was 32.4% (male, 34.4; female, 30.8). Based on the effect of obesity on DM prevalence from each data, using objective data increased the impact of obesity. Difference of relative risk of obesity between from subjective data and from objective was bigger in female than male and statistically significant.

CONCLUSIONS

The differences of association pattern between subjective and objective data were found, due to higher obesity prevalence in objective data, and discrepancies of socio-economic status. These discrepancies could be inevitable Therefore we have to face them proactively, and understand the different aspect of various variables from different measurement.

Summary

Korean summary
지역사회건강조사는 각 지역의 건강관련 지표들을 제시하기 위한 기본 목적을 가지고 있으나, 자가보고를 통한 자료수집에 의존하고 있다는 면에서 연구결과의 신뢰성에 한계를 가지고 있다고 인식되어왔다. 본 연구는 실측자료와 자가보고자료에서의 분석결과차이를 파악함으로써, 이러한 인식에 대한 직접적 평가와 더불어, 자가보고자료에 대한 활용도 증진에 기여하고자 하였다. 연구 결과, 비만의 당뇨병에 대한 영향은 실측자료보다 자가보고자료에서 더 작아졌고, 이러한 차이는 남성에서보다 여성에서 더 크게 나타났다.

Citations

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Comparison of estimates and time series stability of Korea Community Health Survey and Korea National Health and Nutrition Examination Survey
Ji Son Ki, Ho Kim
Epidemiology and Health.2019; 41: e2019012. CrossRef

The effects of community environmental factors on obesity among Korean adults: a multilevel analysis: Nan-He Yoon, Soonman Kwon; Epidemiol Health. 2014;36:e2014036. Published online December 24, 2014; DOI: https://doi.org/10.4178/epih/e2014036

33,724 View
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study explored multidimensional factors related to obesity by dividing them into individual and environmental factors, and performed multilevel analysis to investigate community environmental effects.

METHODS

Data from the 2011 and 2012 Community Health Surveys were used for the analysis. Community-level variables, constructed from various regional statistics, were included in the model as environmental factors. Respondents with body mass index (BMI)≥25 were defined as obese, and a multilevel logistic regression analysis was conducted to analyze individual and environmental factors related to obesity. Moreover, a stratified analysis was conducted to compare factors related to obesity between men and women.

RESULTS

Of 337,136 samples, 82,887 (24.6%) were obese, with BMI≥25. Sociodemographic characteristics at the individual level were mostly significantly related to obesity; however, while there were more obese men subjects among those with high socioeconomic status, there were more obese women among those with low socioeconomic status. There were fewer obese respondents among those who regularly walked and more obese respondents among those who reported short sleep duration or were highly stressed. At the community level, people living in areas with high socioeconomic status, high satisfaction with safety and public transportation, and high accessibility to sports facilities in their community had lower obesity risks.

CONCLUSIONS

Community-level environmental factors affected obesity, especially perceived community environment, more significant than physical environment. Thus, it is necessary to develop effective obesity prevention and management strategies by considering potential community environmental factors that affect obesity.

Summary

Korean summary
다수준 분석을 통해 개인의 비만 발생에 영향을 미치는 다차원의 요인들을 탐색한 결과, 비만과 개인적 요인들의 관계는 성별에 따라 다르게 나타났고, 지역사회 환경에 대한 주관적 인식이 개인의 비만 발생과 유의한 관계가 있는 것으로 확인되었다. 보다 효과적인 비만 예방 및 관리를 위해 다양한 차원의 환경적 특성과 배경, 맥락을 반영한 전략의 개발이 필요하다.

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Cohort Study of Risk Factors for Breast Cancer in Post Menopausal Women: Arthur J. Hartz, Tao He; Epidemiol Health. 2013;35:e2013003. Published online April 30, 2013; DOI: https://doi.org/10.4178/epih/e2013003

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>The present study assessed more than 800 potential risk factors to identify new predictors of breast cancer and compare the independence and relative importance of established risk factors.</sec><sec><title>METHODS</title>Data were collected by the Women's Health Initiative and included 147,202 women ages 50 to 79 who were enrolled from 1993 to 1998 and followed for 8 years. Analyses performed in 2011 and 2012 used the Cox proportional hazard regression to test the association between more than 800 baseline risk factors and incident breast cancer.</sec><sec><title>RESULTS</title>Baseline factors independently associated with subsequent breast cancer at the p<0.001 level (in decreasing order of statistical significance) were breast aspiration, family history, age, weight, history of breast biopsies, estrogen and progestin use, fewer live births, greater age at menopause, history of thyroid cancer, breast tenderness, digitalis use, alcohol intake, white race, not restless, no vaginal dryness, relative with prostate cancer, colon polyps, smoking, no breast augmentation, and no osteoporosis. Risk factors previously reported that were not independently associated with breast cancer in the present study included socioeconomic status, months of breast feeding, age at first birth, adiposity measures, adult weight gain, timing of initiation of hormone therapy, and several dietary, psychological, and exercise variables. Family history was not found to alter the risk associated with other factors.</sec><sec><title>CONCLUSIONS</title>These results suggest that some risk factors not commonly studied may be important for breast cancer and some frequently cited risk factors may be relatively unimportant or secondary.</sec>

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Commentary

Persistent Organic Pollutants and Obesity-Related Metabolic Dysfunction: Focusing on Type 2 Diabetes: Duk-Hee Lee; Epidemiol Health. 2012;34:e2012002. Published online January 27, 2012; DOI: https://doi.org/10.4178/epih/e2012002

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Abstract

Even though obesity is a well-established risk factor of type 2 diabetes, there is emerging evidence that persistent organic pollutants (POPs), a variety of lipophilic chemicals accumulated in adipose tissue, may be critically involved in the pathogenesis of type 2 diabetes. Among various POPs, serum concentrations of organochlorine pesticides and polychlorinated biphenyls (PCBs) were the most strongly and consistently linked to type 2 diabetes in both cross-sectional and prospective studies. In particular, obesity did not seem to be related to type 2 diabetes among persons with very low serum concentrations of POPs, suggesting a more fundamental role of chlorinated POPs in the pathogenesis of type 2 diabetes. These POPs were also associated with obesity, insulin resistance, and adverse lipid profiles like high triglyceride and low high-density lipoprotein (HDL) cholesterol among persons without diabetes, all metabolic dysfunctions commonly observed before developing type 2 diabetes. Recent animal studies supported the findings from epidemiological studies. If all these findings on POPs are true, it suggests that any effort to reduce the external and internal exposure to POPs would be necessary to decrease the social burden of type 2 diabetes.

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Original Articles

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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ADIPOQ Gene Variants Associated with Susceptibility to Obesity and Low Serum Adiponectin Levels in Healthy Koreans: Ji Wan Park, Jungyong Park, Sun Ha Jee; Epidemiol Health. 2011;33:e2011003. Published online April 25, 2011; DOI: https://doi.org/10.4178/epih/e2011003

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Abstract

<sec><title>OBJECTIVES</title>This study aimed to measure the association between the adiponectin, C1Q and collagen domain-containing (<italic>ADIPOQ</italic>) gene variants and obesity in Koreans.</sec><sec><title>METHODS</title>Three single nucleotide polymorphisms located in the <italic>ADIPOQ</italic> gene were genotyped in a population-based cross-sectional study of 986 healthy Koreans. Three different case-control groups (i.e. G1, G2, and G3) were defined according to body mass index (BMI) and serum adiponectin levels. Allelic and genotypic associations of this gene with obesity were measured using multivariate logistic regression analyses in each group.</sec><sec><title>RESULTS</title>The G allele of -11377C>G, a polymorphism located in the promoter region of the <italic>ADIPOQ</italic> gene (odds ratio (OR), 1.48; 95% confidence interval, 1.13-1.94) and most haplotypes including this allele significantly increased the risk for obesity. However, the OR decreased from 3.98 (G1 group) to 2.90 (G2 group) and 2.30 (G3 group) when a less strict definition of obesity was used. Most haplotypes, including this allele, significantly increased the risk of obesity. The statistical evidence from the GG genotype of -11377C>G (OR, 3.98) and the GT/GT diplotype composed of -11377G>C and +45T>G (OR, 5.20) confirmed the contribution of the G allele toward a predisposition for obesity.</sec><sec><title>CONCLUSION</title>These results suggest the contribution of the <italic>ADIPOQ</italic> gene toward susceptibility to obesity in healthy Koreans. The high-risk genotypes and haplotypes identified here may provide more information for identifying individuals who are at risk of obesity.</sec>

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Association between Alcohol Intake and Abdominal Obesity among the Korean Population: Mikyung Ryu, Heejin Kimm, Jaeseong Jo, Sun Ju Lee, Sun Ha Jee; Epidemiol Health. 2010;32:e2010007. Published online May 19, 2010; DOI: https://doi.org/10.4178/epih/e2010007

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Abstract

<sec><title>OBJECTIVES</title>Although abdominal obesity has been reported to be highly related with alcohol intake, the results are still inconclusive. Therefore, this study was conducted to explore the association between alcohol and abdominal obesity among the Korean population.</sec><sec><title>METHODS</title>This study included 8,603 participants (men: 5,195, women: 3,408) aged 30 to 87 who visited the health promotion centers in Seoul for routine health examinations from April, 2006 to June, 2007. Abdominal obesity was defined as WC ≥90 cm for men and ≥85 cm for women in accordance with the Korean Society for the Study of Obesity. For ever drinkers, total alcohol consumption in grams was classified into four groups (group 1, non-drinkers; group 2, 1-10 g of alcohol per day; group 3, 11-20 g of alcohol per day; and group 4, over 20 g of alcohol per day).</sec><sec><title>RESULTS</title>The mean age of the study population was 45.4 yr old (men) and 45.3 yr (women). The average waist circumference was 85.3 cm in men and 75.3 cm in women. A high alcohol intake was associated with high waist circumference in both genders. In multivariate analysis, the group of men and women drinkers consuming >20 g in a day had a large waist circumference compared with men and women non-drinkers.</sec><sec><title>CONCLUSION</title>This study showed that a high alcohol intake was related to high waist circumference. Such association remained independently even after adjustment for smoking, which is strongly related to abdominal obesity.</sec>

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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
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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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David Chen, Alicia J Jenkins, Nicola Greenlaw, Katie Dudman, Tamsin Fernandes, David M Carty, Alun D Hughes, Andrzej S Januszewski, Coen DA Stehouwer, John R Petrie
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Sahar Sobhani, Saba Vakili, Dina Javid Jam, Reihaneh Aryan, Majid Khadem‐Rezaiyan, Saeid Eslami, Maryam Alinezhad‐Namaghi
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Metabolic syndrome is related to vascular structural alterations but not to functional ones both in hypertensives and healthy subjects
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Effect of carbohydrate restriction-induced weight loss on aortic pulse wave velocity in overweight men and women
Majid M. Syed-Abdul, Qiong Hu, Miriam Jacome-Sosa, Jaume Padilla, Camila Manrique-Acevedo, Colette Heimowitz, Elizabeth J. Parks
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Prevalence Rates and Risk Factors of Overweight and Obesity in Children and Adolescents: Using Korean National Health and Nutrition Examination Survey 2005 Data.: Shinkwan Kang, Soonduck Kim, Jesuk Lee; Korean J Epidemiol. 2008;30(2):188-197. Published online December 31, 2008; DOI: https://doi.org/10.4178/kje.2008.30.2.188

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Abstract

PURPOSE
To investigate the prevalence rates of overweight and obesty, and their associations in children and adolescents(12-18years) who were defined as normal weight, overweight , and obese.

METHODS

Korean National Health and Nutrition Examination Survey 2005 raw data was utilized. The data on the 669 subjects aged 12-18 consisted of variables from the health interview survey, health examination and nutrition survey, and health consciousness behavior survey. Overweight and obesity was evaluated by established body mass index criteria. Chi-squire and Fisher exact test were performed to analyze differences among normal, overweight and obese groups according to basic characteristics and health consciousness behavior. Logistic regression was used to analyze risk factors for the overweight and obese groups.

RESULTS

Overweight and obesity prevalence rates were 11.7% and 8.1%, respectively. Of the subjects from urban regions, 20% were overweight and 12.2% were obese. Of those from semi-urban regions, 10.2% were overweight and 3.8% were obese. Of those from rural regions, 9.0% were overweight and 10.1% were obese. The obesity rate in semi-urban regions were 0.38% times lower than the rural rate.

CONCLUSIONS

Geographical location constitutes a risk factor for overweight and obesity, which may influence preventative and education programs aimed at schools and the general community.

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Regional Adolescent Obesity and Overweight Status in Korea from 2018–2019: Comparison between Two Data Sources
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Association of obesity indices with physiological markers for cardiovascular disease among middle age and elderly in Chuncheon : Hallym Aging Study: Jin Young Jeong, Jeong Hun Kim, Young Ho Choi, Soong Nang Jang, Yong Jun Choi, Dong Hyun Kim; Korean J Epidemiol. 2008;30(1):89-99. Published online June 30, 2008; DOI: https://doi.org/10.4178/kje.2008.30.1.89

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Abstract

PURPOSE
This study was performed to evaluate association of obesity indices with physiological markers for cardiovascular disease(CVD) in community dwelling middle aged and elderly populations.

METHODS

We evaluated cross-sectional association of obesity indices with physiological markers for CVD using the data of Hallym Aging Study(HAS) conducted in 2004. Information on general characteristics and medical histories were collected by trained interviewers. Also obesity indices including waist circumference(WC), waist to hip ratio(WHR), body mass index(BMI), and body fat mass(BFM), and physiological markers of CVD including systolic blood pressure(SBP), diastolic blood pressure(DBP), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), total cholesterol(TC), and fasting blood sugar(FBS) were measured by clinical staffs. 589 out of the 922 participated in HAS were enrolled in the final analysis, excluding 333 who had been diagnosed and medicated due to obesity-related diseases. Age and gender specific correlation coefficients between obesity indices and physiological markers for CVD were calculated by partial spearman correlations using SAS ver 9.1.

RESULTS

The strength of correlation of obesity indices and physiological markers of CVD changed with age. The correlations between SBP, DBP, TG and HDL-C and obesity indices were attenuated with age, whereas those of TC, FBS and LDL-C were increased among the elderly. These patterns were similar in both gender.

CONCLUSIONS

These findings show that more appropriate obesity indices according to age are needed to evaluate the association between these indices and CVD risks.

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What is the Most Reliable Obesity Iindex in Korean Elderly Population?
June Hyung Yoon, Jongwoo Kim, Seon Yeong Lee, Kyunam Kim, In Young Cho, Young M Cho
The Korean Journal of Obesity.2012; 21(3): 140. CrossRef

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

Distribution and Correlates of Obesity in a Korean Rural People.: Jong Ku Park, Sang Baek Koh, Myung Gun Kang, Jin Baek Kim, Sook Jung Hyun, Ju Hee Hong, Jun Ho Park, Sei Jin Chang; Korean J Epidemiol. 2004;26(2):8-19.

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Abstract PDF: Abstract
OBJECTIVE: The aim of present study was to assess the distribution and correlates of obesity in a Korean rural people using both body mass index(BMI) and body fat percent.
METHODS
A total of 1,243 participants were recruited using a two-staged stratified sampling. A structured questionnaire was used to ask their sociodemographics (gender, age, marital status, educational background, and etc.) and health-related behaviors (smoking, drinking, and regular exercise etc.). The data of weight-for height, and body fat percent were also collected by physical examination. For the estimation and analysis of correlates of obesity, we used BMI(>or=25kg/m2) and body fat percent(male>or=25%, female>or=30) as a cut-point of obesity. All analyses were stratified to three age groups(>20, 20-39, 40>or=).
RESULTS
The prevalence of obesity in this study was higher than that in previous studies. This study showed that 32.6% (male: 33.7%, female: 31.7%) of participants according to BMI, and 45.6% (male: 43.8%, female: 47.4%) of them according to body fat percent were obese group. Logistic regression analysis showed that, in the criteria of BMI, while obesity was associated with female and low educational background under the age of 40, prevalence of obesity was higher in non smokers over the age of 40. In case of body fat percent crteria, single(unmarried, divorced, separated, widowed) were more likely to be obese in male aged 20 to 39 years. In the group aged 40 years and over, risk of obesity was higher in female than in male.
CONCLUSION
This result suggests that obesity is common in Korean rural areas, especially among adolescents and female aged 40 years or over, and the risk factors for obesity were different by age. It is required that health management program focusing on obesity and its adverse outcomes should be developed in a community setting.; 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

The Analysis of the Correlation of Diabetes Mellitus Incidence and Prevalence with Body Mass Index among Adults Registered in a Health Promotion Center of a University Hospital.: Sang Hoon Ahn, Jung Soon Kim; Korean J Epidemiol. 2000;22(2):159-170.

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Abstract PDF: Abstract
BACKGROUND
The prevalence and incidence of diabetes mellitus in Korea are higher than western countries. Despite the fact that obesity is an important risk factor of DM, western obesity criteria by BMI level has been used in Korea, which was based on the data derived from the western people having higher average body mass index(BMI) and lower DM incidence than Koreans. Therefore, this study was performed to find out the BMI level, at which point the risk of developing DM increases and its incidence per year.
METHODS
13,301 men and women who visited the Health Promotion Center at Seoul National University Hospital between March 1, 1995 and February 28, 1999 were studied. Factors attributable to DM including BMI were investigated. BMI was categorized in detail to find out the critical point of BMI with increased DM. The incidence of DM per year was investigated by analysing the cohort consisting of people who have visited the center more than once.
RESULTS
The risk factors of DM revealing significant statistical association were age, systolic blood pressure, total cholesterol, triglyceride and BMI. The age-sex adjusted odds ratio at BMI 24.0 was 1.950(95% CI 1.089~3.492) compared to the reference BMI(<21.0) when applying the current diagnostic criteria of DM(140mg/dl), and it was 1.635(95% CI 1.018~2.627) at BMI 22.0 by the new criteria of DM(126mg/dl). Crude incidence rate of DM was 0.9% by the current criteria and 2.1% by the new criteria.
CONCLUSIONS
Current WHO obesity criteria by BMI that we use in Korea should be readjusted(the criteria of overweight lowered from BMI 25.0 to 24.0, and obesity from 30.0 to 27.0 for Koreans), particularly in the aspect of prevention of DM for Korean people. Crude incidence rate of DM was 0.9%, much higher than that of western people, which calls for national concern on prevention and management of DM.; 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

The Association of Hyperinsulinemia with Other Cardiovascular Risk Factors.: Kang Sook Lee, Bok Rye Song; Korean J Epidemiol. 1998;20(1):167-177.

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Abstract PDF: Abstract
BACKGROUND
Hypertension, obesity, non-insulin dependent diabetes(NIDDM), and dyslipidemia are common metaolic disorders that afflict the majority of the elderly who live in Westernized societies. To explore whether the hyperinsulinemia associated with other cardiovascular risk factors in Asian populations such as Koreans.
METHODS
In this cross-sectional study we evaluated the association of hyperinsulinemia with hypertension, obesity, diabetes and hyperlipidemia. Subjects were 600 men and 396 women at least 20 years old who visited the prevention center at St. Mary's Hospital in Seoul, between March and August 1997 for a multiphasic health examination.
RESULTS
In hyperinsulinemia group( >90 percentile of fasting blood insulin 10.01uU/ml in men and 8.54 uU/mlin women), body mass index(BMI), fasting blood sugar, and triglyceride and systolic or diastolic blood pressure were significantly higher than normal insulin goup in both of men and women. The major contributable risk factor to blood insulin concentration was BMI(14% in men, 13% in women). In person with the highest tertile of insulin concentration compared with those in the lowest tertile, age adjusted odds ratio of hypertension, obesity, and hypertriglyceride were 2.22(95% Confidence Interval: 1.38-3.63), 6.96(4.31-11.51), and 4.05(1.88-9.75) in men, and 2.05(95% CI: 1.10-3.86), 4.34(2.39-8.16) and 6.84(1.18-129.40) in women. Age adjusted odds ratio for clusterin of cardiovascular risk factors in the higest tertile of insulin compared with those in lower insulin than that level were 8.74(2.82-29.27) in men and 4.91(1.19-21.79) in women.
CONCLUSION
The hyperinsulinemia was associated with hypertension, obesity, NIDDM and hypertriglyceridemia. Further prospective studies are required to investigate the effects of intervetion to improve insulin sensitivity such as calorie restriction and exercise.; Summary

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