Publications by authors named "Dong Phil Choi"

25 Publications

  • Page 1 of 1

Risk Factors Influencing the Occurrence and Severity of Symptomatic Dry Eye Syndrome: A Cross-sectional Study.

Ophthalmic Epidemiol 2021 Jan 31:1-7. Epub 2021 Jan 31.

Department of Preventive Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea.

: We aimed to investigate the prevalence and risk factors of dry eye syndrome (DES) among a population-based cohort study.: This cross-sectional study was conducted on 475 subjects (184 men and 291 women) enrolled in the Study Group for Environmental Eye Disease at July 2013. Using the ocular surface disease index (OSDI), we measured the DES severity and defined DES as OSDI score ≥13. Current symptoms of DES and possible risk factors such as body mass index, occupations, comorbidities, exercise, smoking and drinking status were assessed by multivariate logistic regression.: Prevalence of DES was significantly higher in women (52.6%) than in men (41.9%) ( < .001). Compared to white-collar workers, blue-collar workers and unemployed persons showed significantly higher DES prevalence and severity. Compared to those with low BMI (<23.0 kg/m), people with extremely high BMI (≥30.0 kg/m) had significantly higher odds ratio (OR) of having DES after fully adjusted for sex, age, hypertension, diabetes, menopausal status, hormone replacement therapy, occupation, and lifestyle factors (OR: 2.83, 95% confidence interval: 1.04-7.71).: We found some novel factors which have been unknown to the relationship with DES through the five years observation of the cohort. The positive associations of unemployment status, blue-collar work, alcohol habit, and obesity with DES suggests a person's comprehensive condition, not individual factors, contribute significantly in developing DES. Further studies will be helpful to understand the underlying mechanisms.
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http://dx.doi.org/10.1080/09286586.2021.1879172DOI Listing
January 2021

Cohort Profile: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort in Korea.

Yonsei Med J 2019 Aug;60(8):804-810

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Mortalities from cardiovascular disease in Korea have decreased markedly over the past three decades. The major cardiovascular and metabolic risk factors, however, remain prevalent, and their burden on health is large. The Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) planned a cohort study in order to identify novel risk factors and to develop evidence-based prevention strategies of cardiovascular and metabolic diseases. The CMERC deliberately designed two prospective cohorts, a community-based general population cohort (the CMERC cohort) and its sister cohort (a hospital-based high-risk patient cohort), covering a broad spectrum of cardiovascular and metabolic diseases. This paper describes the CMERC cohort study of community-dwelling adults aged 30 to 64 years. A total of 8097 adults completed baseline measurement between 2013 and 2018. Baseline measurements assessed socio-demographic factors, medical history, health-related behaviors, psychological health, social network and support, anthropometry, body composition, and resting blood pressure and comprised electrocardiography, carotid artery ultrasonography, fasting blood analysis, and urinalysis. Both active follow-up through an annual telephone survey and a 5-year on-site health examination survey and passive follow-up through secondary data linkage with national databases, such as national death records, have been applied. Researchers interested in collaborative research may contact the corresponding author.
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http://dx.doi.org/10.3349/ymj.2019.60.8.804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660443PMC
August 2019

Association between Changes in Anthropometric Indices and in Fasting Insulin Levels among Healthy Korean Adolescents: The JS High School Study.

Diabetes Metab J 2019 04 22;43(2):183-191. Epub 2019 Jan 22.

Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.

Background: This study investigated the association between changes in anthropometric indices and fasting insulin levels among healthy adolescents and whether the association differed by baseline obesity status.

Methods: This analysis was based on data collected for the JS High School study; 884 healthy adolescents aged 15 to 16 years followed up for 24 to 30 months were included. Changes in anthropometric indices and fasting insulin levels were computed as the difference between baseline and follow-up values. Multivariate linear regression models were used to determine the association between changes in anthropometric indices and fasting insulin levels. Based on body mass index (BMI)-for-age and waist circumference (WC)-for-age percentiles, participants were classified as normal weight (<85th percentile), overweight (85th percentile to <95th percentile), or obese (≥95th percentile).

Results: Changes in BMI, WC, waist-hip ratio, and waist-height ratio were significantly associated with changes in fasting insulin levels in both sexes (<0.05). In analyses stratified by baseline obesity status, the association between change in BMI and change in fasting insulin was significantly stronger in overweight (males: standardized β=1.136; females: standardized β=1.262) and obese (males: standardized β=1.817; females: standardized β=2.290) participants than in those with normal weight (males: standardized β=0.957; females: standardized β=0.976) at baseline. Results were similar for changes in WC.

Conclusion: Changes in anthropometric indices were positively associated with fasting insulin level increases. Moreover, those who were overweight or obese at baseline had a higher absolute increase in fasting insulin levels per one standard deviation unit increase in anthropometric indices than adolescents with normal weight.
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http://dx.doi.org/10.4093/dmj.2018.0034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6470103PMC
April 2019

Association between high-density lipoprotein cholesterol level and pulmonary function in healthy Korean adolescents: the JS high school study.

BMC Pulm Med 2017 Dec 11;17(1):190. Epub 2017 Dec 11.

Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, South Korea.

Background: Accumulating evidence suggests that high-density lipoprotein (HDL) cholesterol is associated with pulmonary function and pulmonary disorders. The aim of this study was to evaluate the association between HDL cholesterol and pulmonary function in healthy adolescents.

Methods: This cross-sectional study was based on data collected for the JS High School study. The analysis included 644 adolescents (318 male and 326 female) aged 15-16 years old and free from asthma or chronic obstructive pulmonary disease. Fasting blood samples were collected for hematologic and biochemical assessment. Forced vital capacity volume (FVC) and forced expiratory volume in the 1 s (FEV1) were measured using dry-rolling-seal spirometry. The associations between HDL cholesterol and pulmonary function were analyzed using multiple linear regression models.

Results: Among male adolescents, an increase of 1.0 mg/dL in HDL cholesterol was associated with 10 mL decrease in FVC (p = 0.013) and FEV1 (p = 0.013) after adjusting for age, height, weight, alcohol drinking, smoking, physical activity, systolic blood pressure, total cholesterol, triglyceride, and monthly household income. Percent predicted values of FVC (p = 0.036) and FEV1 (p = 0.017) were also inversely associated with HDL cholesterol. However, among female adolescents, HDL cholesterol level was not significantly associated with absolute or percent predictive value of FVC and FEV1.

Conclusions: Higher HDL cholesterol level may be associated with decreased pulmonary function among healthy male adolescents. The sex differences observed in the association between HDL cholesterol and pulmonary function need further investigation.
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http://dx.doi.org/10.1186/s12890-017-0548-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725943PMC
December 2017

Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) cohort: study protocol and results of the first 3 years of enrollment.

Epidemiol Health 2017 1;39:e2017016. Epub 2017 Apr 1.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Although the etiologies of cardiovascular disease (CVD) are widely understood, the goal of finding a globally effective solution for preventing CVD is unrealistic. Therefore, we aimed to conduct a community-based prospective study on the prevention and management of CVD in Korean adults. This study was designed to recruit 8,000 healthy adults over the course of 5 years. The baseline assessment includes a wide range of established CVD risk factors, including demographic characteristics, medical history, health behaviors, psychological conditions, body size and composition, blood pressure, the augmentation index, carotid ultrasonography, an electrocardiogram, and biochemical indicators, as well as some novel factors, such as social network characteristics, exposure to environmental pollutants, inflammatory markers, hemostatic markers, and immunosenescence markers. Annual telephone interviews and follow-up health examinations at 5-year intervals after the baseline assessment are planned to collect information on changes in health status and its determinants. Additionally, indirect follow-up using secondary data sources will be conducted to obtain information on health services utilization and death. So far, more than 6,000 adults have been enrolled during the first three and a half years, and almost all participants have been tracked by annual telephone follow-up surveys. The data have been uploaded to iCReaT, the clinical research information management system of the Korea National Institute of Health.
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http://dx.doi.org/10.4178/epih.e2017016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434222PMC
June 2017

Sleep duration and chronic kidney disease: The Korean Genome and Epidemiology Study (KoGES)-Kangwha study.

Korean J Intern Med 2017 Mar 15;32(2):323-334. Epub 2017 Feb 15.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background/aims: Sleep duration affects health in various ways. The objective of this study was to investigate the associations of sleep duration with chronic kidney disease (CKD) in a Korean adult population.

Methods: This cross-sectional analysis was conducted for total of 1,360 participants who completed baseline health examinations for the Korean Genome and Epidemiology Study-Kangwha study in 2010 to 2011. Sleep habits were measured by an interviewer-assisted questionnaire. Sleep duration was calculated based on the number of hours per day participants had slept over the past 1 year. CKD was defined as either proteinuria or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m. Multiple logistic regression models were applied to examine associations between sleep duration and CKD.

Results: Women with very long sleep duration (≥ 9 hours/day) were at significantly increased odds for having high serum creatinine (odds ratio [OR], 2.936; 95% confidence interval [CI], 1.176 to 7.326), low eGFR (OR, 3.320; 95% CI, 1.372 to 8.034), and CKD (OR, 3.112; 95% CI, 1.315 to 7.363), compared those with a typical sleep duration (7 to < 8 hours/day), after adjusting for sociodemographic status, socioeconomic status, health behaviors, comorbidities, and sleep quality. Among women, for every 1 hour increase in sleep duration per day, there was a 24.6% increase in the presence of CKD (OR, 1.246; 95% CI, 1.019 to 1.523). However, among men, sleep duration was not significantly associated with CKD.

Conclusions: Very long sleep duration was independently associated with a higher prevalence of CKD among Korean women. Gender may influence this association.
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http://dx.doi.org/10.3904/kjim.2015.400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339469PMC
March 2017

Secondhand Smoke Exposure and Depressive Symptoms among Korean Adolescents: JS High School Study.

PLoS One 2016 30;11(12):e0168754. Epub 2016 Dec 30.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Introduction: Increasing evidence suggests that secondhand smoke exposure (SHSE) may affect not only physical health, but also mental health. Therefore, we evaluated the association between SHSE and depressive symptoms among Korean adolescents.

Methods: The JS High School Study enrolled 1071 high school freshmen from a rural community of South Korea. The current analysis was limited to 989 adolescents (495 male and 494 female adolescents), after excluding 48 ever-smokers, 3 students with physician-diagnosed depression, and 31 students who did not complete the depression questionnaire. SHSE was assessed using a self-reported questionnaire and was classified into three groups: none, occasional exposure, and regular exposure. Depressive symptoms were assessed according to the Beck Depression Inventory (BDI) score, ranging from 0 to 63, and the presence of depressive symptoms was defined as a BDI score ≥10.

Results: Overall, adolescents with SHSE were more likely to have depressive symptoms than those without SHSE (p = 0.042).In a sex-specific analysis treating the BDI score as a continuous variable, regular SHSE was independently associated with higher BDI scores in male adolescents (β = 2.25, p = 0.026), but not in female adolescents (β = 1.11, p = 0.253). Compared to no SHSE, the odds ratio for having depressive symptoms among male adolescents with regular SHSE was 2.17 (95% confidence interval, 1.11 to 4.25) after adjusting for age, body mass index, and study year, and 3.65 (95% confidence interval, 1.52 to 8.73) after adjusting for age, body mass index, study year, exercise, and household income.

Conclusion: Regular exposure to secondhand smoke was associated with having depressive symptoms among Korean male adolescents.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168754PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201244PMC
June 2017

Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease.

Korean Circ J 2016 Sep 28;46(5):688-698. Epub 2016 Sep 28.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.

Background And Objectives: Low-density lipoprotein cholesterol (LDL-C), an established cardiovascular risk factor, can be generally determined by calculation from total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. The aim of this study was to compare LDL-C estimations using various formulas with directly measured LDL-C in a community-based group and hospital-based group among the Korean population.

Subjects And Methods: A total of 1498 participants were classified into four groups according to triglyceride concentrations as follows: <100, 100-199, 200-299, and ≥300 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, de Cordova, and Anandaraja formulas and directly measured using a homogenous enzymatic method. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Passing & Bablok regression, and Bland-Altman plots were used to evaluate the performance of six formulas.

Results: The Friedewald formula had the highest accuracy (ICC=0.977; 95% confidence interval 0.974-0.979) of all the triglyceride ranges, while the Vujovic formula had the highest accuracy (ICC=0.876; 98.75% confidence interval 0.668-0.951) in people with triglycerides ≥300 mg/dL. The mean difference was the lowest for the Friedewald formula (0.5 mg/dL) and the percentage error was the lowest for the Vujovic formula (30.2%). However, underestimation of the LDL-C formulas increased with triglyceride concentrations.

Conclusion: The accuracy of the LDL-C formulas varied considerably with differences in triglyceride concentrations. The Friedewald formula outperformed other formulas for estimating LDL-C against a direct measurement and the Vujovic formula was suitable for hypertriglyceridemic samples; it could be used as an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.
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http://dx.doi.org/10.4070/kcj.2016.46.5.688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054182PMC
September 2016

Inter-Arm Difference in Brachial Blood Pressure in the General Population of Koreans.

Korean Circ J 2016 May 3;46(3):374-83. Epub 2016 May 3.

Cardiovascular and Metabolic Disease Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.; National Academy of Agricultural Science, Rural Development Administration, Jeonju, Korea.

Background And Objectives: We investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors.

Subjects And Methods: A total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure.

Results: The mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure.

Conclusion: Large inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure.
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http://dx.doi.org/10.4070/kcj.2016.46.3.374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4891602PMC
May 2016

Association between Obesity Indices and Insulin Resistance among Healthy Korean Adolescents: The JS High School Study.

PLoS One 2015 13;10(5):e0125238. Epub 2015 May 13.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.

Objective: To investigate whether indices of obesity are associated with insulin resistance in Korean adolescents.

Methods: This study was conducted as a cross-sectional analysis of 817 healthy adolescents aged 15-16 years without diabetes. Percentiles group of weight-for-height, body mass index (BMI)-for-age, waist circumference (WC)-for-age, and skin fold thickness (SFT)-for-age were based on the 2007 Korean National Growth Charts. Percentiles of waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and percent body fat were calculated for the study population. Insulin resistance was estimated by homeostatic model assessment (HOMA-IR). Logistic regression models were used to estimate odds ratio for insulin resistance according to seven obesity indices. Generalized linear models were used to assess the associations between obesity indices and continuous HOMA-IR levels.

Results: Sex and age-adjusted odds ratios (95% confidence interval) for insulin resistance, defined as HOMA-IR>2.50, of the 75-94th and ≥95th percentiles of weight-for-height were 3.87 (2.38-6.30) and 11.37 (5.87-22.02), compared to the <50th percentile. Corresponding odds ratios were 3.27 (2.02-5.28) and 11.72 (6.05-22.73) for BMI-for-age, 4.72 (2.82-7.88) and 13.22 (6.42-27.23) for WC-for-age, 3.67 (2.27-5.94) and 13.58 (6.71-27.48) for WHR, 4.78 (2.99-7.67) and 12.84 (6.23-26.46) for WHtR, 2.62 (1.61-4.26) and 6.68 (3.46-12.90) for SFT-for-age, and 2.29 (1.33-4.26) and 10.06 (4.39-23.06) for body fat. These associations were more prominent when insulin resistance was defined as HOMA-IR>3.16 and were stronger in males than in females. Continuous measure of HOMA-IR was significantly associated with body weight, BMI, WC, WHR, WHtR, and SFT in both sexes (p<0.001), and with percent body fat in males only (p<0.001).

Conclusion: Our findings suggest that obesity indices are positively associated with insulin resistance in apparently healthy adolescents.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0125238PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429969PMC
February 2016

Cohort Profile: The JS High School study (JSHS): a cohort study of Korean adolescents.

Int J Epidemiol 2017 04;46(2):393-402

Cardiovascular and Metabolic Diseases Etiology Research Center.

Major aetiologies of atherosclerotic cardiovascular diseases begin in childhood and atherosclerotic vascular abnormalities can be observed among children and adolescents. Adolescent cohort studies have important advantages because they can observe earlier changes in vascular structure and function. The purpose of the JS High School study (JSHS) is to identify biomarkers predicting or indicating early structural and functional vascular change in adolescents. The JSHS is a prospective cohort study of a Korean adolescent population. The target population of the JSHS was first-graders (aged 14 to17 years) at a high school of South Korea. Enrolment and baseline examinations were conducted in years 2007, 2010, 2011 and 2012. Among the total eligible population of 1115 students, 1071 (96.1%) participated in the study and completed all baseline examinations. Informed consent forms were obtained from each participant and his/her parent or guardian. Baseline examinations include: questionnaires on demographics, health behaviours, medical history, and depression symptoms; fasting blood analysis; anthropometric measurement; body impedance analysis; blood pressure measurement; radial artery tonometry; bone densitometry; pulmonary function tests; and carotid ultrasonography. Participants enrolled from 2007 through 2012 were re-examined after 30 months of follow-up, and those who enrolled in 2012 were re-examined after 24 months of follow-up. The corresponding author may be contacted for potential collaboration and data access.
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http://dx.doi.org/10.1093/ije/dyv064DOI Listing
April 2017

Effects of age, sex, and menopausal status on blood cholesterol profile in the korean population.

Korean Circ J 2015 Mar 24;45(2):141-8. Epub 2015 Mar 24.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.

Background And Objectives: To investigate age-specific and sex-specific distributions of blood cholesterol in the general Korean population.

Subjects And Methods: We analyzed data for 8284 men and 9246 women aged ≥10 years who participated in the fifth (2010-2012) Korea National Health and Nutrition Examination Survey. Age-specific means, medians, and selected percentiles were calculated for men, premenopausal women, and postmenopausal women.

Results: Median total cholesterol (TC) level increased with age across all age groups, from 147 to 196 mg/dL in males and from 159 to 210 mg/dL in females. Triglyceride (TG) levels increased with age in females; however, in males, TG levels rapidly increased during young adulthood, peaked at 50-54 years, and then decreased. High density lipoprotein-cholesterol (HDL-C) levels were higher in females than in males and decreased with increasing age in both males and females. Low density lipoprotein-cholesterol (LDL-C) levels increased with age across all age groups, from 89 to 127 mg/dL in males and from 82 to 113 mg/dL in females. Lipoprotein-cholesterol fraction (TC/HDL-C, LDL-C/HDL-C, TG/HDL-C, non-HDL-C) levels increased with age in females, but increased more rapidly in males during young adulthood and decreased after middle age.

Conclusion: Blood cholesterol levels and lipoprotein-cholesterol fractions present different distributions by age, sex, and menopausal status.
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http://dx.doi.org/10.4070/kcj.2015.45.2.141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372980PMC
March 2015

Serum 25-hydroxyvitamin D and insulin resistance in apparently healthy adolescents.

PLoS One 2014 29;9(7):e103108. Epub 2014 Jul 29.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea; Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Vitamin D deficiency is a common condition that is associated with diabetes and insulin resistance. However, the association between vitamin D and insulin resistance has not been fully studied, especially in the general adolescent population. Therefore, we assessed the association between serum 25-hydroxyvitamin D [25(OH)D] level and insulin resistance among apparently healthy Korean adolescents.

Methods: A total of 260 (135 male and 125 female) adolescents in a rural high school were assessed for serum 25(OH)D, fasting plasma glucose, and insulin. All of the participants were aged 15 to 16 years old, and without known hypertension or diabetes. Serum 25(OH)D was analyzed both as a continuous and categorical variable in association with insulin resistance. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). Increased insulin resistance was operationally defined as a HOMA-IR value higher than the sex-specific 75th percentile.

Results: In male adolescents, every 10 ng/ml decrease in 25(OH)D level was associated with a 0.25 unit increase in HOMA-IR (p = 0.003) after adjusting for age and BMI. Compared to those in the highest quartile, male adolescents in the lowest 25(OH)D quartile were at significantly higher risk for insulin resistance: unadjusted odds ratio 4.06 (95% CI, 1.26 to 13.07); age and BMI adjusted odds ratio 3.59 (95% CI, 1.03 to 12.57). However, 25(OH)D level, either in continuous or categorical measure, was not significantly associated with insulin resistance among female adolescents.

Conclusions: This study suggests that serum 25(OH)D level may be inversely associated with insulin resistance in healthy male adolescents.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103108PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114462PMC
November 2015

Association between serum 25-hydroxyvitamin D level and insulin resistance in a rural population.

Yonsei Med J 2014 Jul;55(4):1036-41

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Purpose: A low serum 25-hydroxyvitamin D [25(OH)D] level in the blood has been correlated with an increased risk of diabetes mellitus; however, the association between serum 25(OH)D level and insulin resistance has not been established in a Korean rural population. The aim of this study was to investigate the independent association between serum 25(OH)D level and insulin resistance in rural Korean adults.

Materials And Methods: This study used data from the Korean Genome Epidemiology Study-Kangwha Study. In the 2011 study, 1200 adults completed health examinations. In an ancillary study, serum 25(OH)D level was measured in a subsample (n=813). After excluding those taking vitamin D supplements, a cross-sectional analysis was carried out on 807 participants (324 men and 483 women) aged 40 to 89 years old. Measured from overnight fasting blood samples, glucose and insulin levels were used to calculate the homeostasis model assessment for insulin resistance (HOMA-IR). Measures of glucose, insulin, and HOMA-IR were log-transformed for parametric tests.

Results: Serum 25(OH)D level was inversely associated with HOMA-IR (β=-0.003, p=0.039) in a univariate analysis. However, the association was not significant after adjustment for sex and age (β=-0.002, p=0.123) or after adjustment for sex, age, body mass index, smoking status, alcohol intake, and regular exercise (β=-0.003, p=0.247).

Conclusion: Our findings suggest that vitamin D is not independently associated with insulin resistance in Korean men and women.
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http://dx.doi.org/10.3349/ymj.2014.55.4.1036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075364PMC
July 2014

The Korean urban rural elderly cohort study: study design and protocol.

BMC Geriatr 2014 Mar 19;14:33. Epub 2014 Mar 19.

Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea.

Background: Korea is one of the fastest aging countries and is expected to become a super-aged society within 12 years. The Korean Urban Rural Elderly (KURE) study was developed to evaluate the epidemiological characteristics and establish the prevention and management of major disorders of the elderly in Korea.

Methods/design: The KURE study is a community-based prospective cohort study on health, aging, and common geriatric disorders of Korean elderly persons aged at least 65 years. To construct a cohort reflecting both urban and rural areas, we selected 2 representative communities in the country. To establish multidisciplinary approaches to geriatric health, this study was performed by researchers in the divisions of geriatrics, preventive medicine, endocrinology, and sociology. The baseline examinations began in 2012; the study will follow more than 4,000 elderly Koreans over 10 years. The first and second follow-up health examinations will be performed every 4 years. Every 2 years after each health examination, inter-assessment interview will be conducted to improve participant retention.

Discussion: The KURE study will provide longitudinal epidemiologic data on health, aging, and common geriatric disorders of the elderly in Korea. This is a comprehensive, multidisciplinary study of the elderly with respect to biological, physical, socio-economic, and environmental factors. The results of this study will contribute to improve public health and welfare policies for the aging society in Korea.
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http://dx.doi.org/10.1186/1471-2318-14-33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995180PMC
March 2014

Association between depressive symptoms and bone stiffness index in young adults: the Kangwha study.

PLoS One 2013 24;8(7):e69929. Epub 2013 Jul 24.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Objective: Young adulthood is an important period for both bone and mental health. This study investigated the association between depressive symptoms and bone density in apparently healthy Korean men and women aged 29-32 years.

Methods: This study is a cross-sectional analysis of data from 123 men and 133 women who completed follow-up examinations of the Kangwha study in 2010-2011. Bone stiffness index (SI) was measured at the os calcis using a quantitative ultrasound device. Depressive symptoms were evaluated using the Korean version of the Beck Depression Inventory (K-BDI) and classified as normal (K-BDI <10), mild (K-BDI 10-15), and moderate to severe (K-BDI ≥16).

Results: Moderate to severe depressive symptoms were prevalent among 11.4% of men and 19.6% of women. Higher K-BDI scores were significantly correlated to SI in men, before (ρ = -0.286, p = 0.001) and after (ρ = -0.228, p = 0.013) adjustment for covariates. Men with depressive symptoms tended to have a lower SI; multivariate-adjusted mean SI in men with normal, mild, and moderate to severe depressive symptoms was 104.1±3.1, 100.9±5.9, and 94.1±7.8, respectively (p for trend = 0.021). In contrast, no significant correlations were identified in women.

Conclusions: Depressive symptoms were significantly associated with lower SI in men, but not in women. Further studies are necessary to evaluate the impact of depression on developing osteoporosis or osteoporotic fractures later in life.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069929PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3722098PMC
February 2014

Factors Associated with a Low-sodium Diet: The Fourth Korean National Health and Nutrition Examination Survey.

Epidemiol Health 2013 20;35:e2013005. Epub 2013 Jun 20.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: The low-sodium diet is a known preventive factor for hypertension and cardiovascular disease. Factors associated with low-sodium diets should be identified to reduce sodium intake effectively. This study was conducted to identify factors correlated with a low-sodium diet.

Methods: This cross-sectional study analyzed data from a total of 14,539 Koreans aged 20 years or older, who participated in the Fourth (2007-2009) Korean National Health and Nutrition Examination Survey. A low-sodium diet was defined as having ≤2,000 mg/day based on 24-hour recalls. Multiple logistic regression models were used to assess sex, age, education, number of family members, household income, occupation, alcohol drinking, total energy intake, frequency of eating out, and hypertension management status for their associations with low-sodium diets.

Results: Among all participants, only 13.9% (n=2,016) had low-sodium diets. In the multivariate analysis, 40-49 years of age, clerical work jobs, higher total energy intake, and frequent eating out were inversely associated with low-sodium diets. And female sex and living-alone were associated with low-sodium diets. Lower frequency of eating out was significantly associated with low-sodium diets, even after adjusting for total energy intake and other potential confounders. Adjusted odds ratios (95% confidence interval) for a low-sodium diet were 1.97 (1.49-2.61), 1.47 (1.13-1.91), 1.24 (0.96-1.61), and 1.00 (reference) in people who eat out <1 time/month, 1-3 times/month, 1-6 times/week, and ≥1 time/day, respectively.

Conclusions: Our study suggests that sex, age, number of family members, occupation, total energy intake, and lower frequency of eating out were associated with a low-sodium diet in Korean adults.
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http://dx.doi.org/10.4178/epih/e2013005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691366PMC
July 2013

Association between serum uric acid level and metabolic syndrome.

J Prev Med Public Health 2012 May 31;45(3):181-7. Epub 2012 May 31.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea.

Methods: We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8-<5.6, 5.6-<6.5, ≥6.5 mg/dL in males; and <3.8, 3.8-<4.3, 4.3-<5.1, ≥5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression.

Results: The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, γ-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes).

Conclusions: Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.
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http://dx.doi.org/10.3961/jpmph.2012.45.3.181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374968PMC
May 2012

The association between serum albumin levels and metabolic syndrome in a rural population of Korea.

J Prev Med Public Health 2012 Mar 31;45(2):98-104. Epub 2012 Mar 31.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Objectives: A positive association between serum albumin levels and metabolic syndrome has been reported in observation studies, but it has not been established in the Korean population. The purpose of this study was to evaluate the association between serum albumin levels and the presence of metabolic syndrome among a sample of apparently healthy Korean adults.

Methods: This cross-sectional study analyzed data of 3189 community-dwelling people (1189 men and 2000 women) who were aged 40 to 87 years and were living in a rural area in Korea. Serum albumin levels were classified into quartile groups for each sex. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with an adjusted waist circumference cut-off value (≥90 cm for men and ≥85 cm for women). An independent association between serum albumin levels and metabolic syndrome was assessed by multiple logistic regression analysis.

Results: Higher serum albumin levels were associated with increased prevalence of metabolic syndrome. The odds ratio (95% confidence interval) of the prevalence of metabolic syndrome for the highest versus the lowest serum albumin quartiles was 2.81 (1.91 to 4.14) in men and 1.96 (1.52 to 2.52) in women, after adjusting for age, smoking status, alcohol consumption, and physical activity. When each metabolic abnormality was analyzed separately, higher serum albumin levels were significantly associated with hypertriglyceridemia and hyperglycemia in both sexes, and with abdominal obesity in men.

Conclusions: These results suggest that higher serum albumin levels are positively associated with an increased risk of metabolic syndrome in Korean adults.
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http://dx.doi.org/10.3961/jpmph.2012.45.2.98DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324721PMC
March 2012

Prevalence of Dyslipidemia among Korean Adults: Korea National Health and Nutrition Survey 1998-2005.

Diabetes Metab J 2012 Feb 17;36(1):43-55. Epub 2012 Feb 17.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: Dyslipidemia is a disorder of lipid metabolism, including elevated total cholesterol, elevated triglyceride, elevated low density lipoprotein cholesterol (LDL-C), and decreased high density lipoprotein cholesterol (HDL-C). The objective of this study was to investigate recent changes in the prevalence of dyslipidemia and also the rates of awareness, treatment, and control of dyslipidemia among Korean adults.

Methods: Dyslipidemia is defined according to the National Cholesterol Education Program-Adult Treatment Panel III as total cholesterol ≥240 mg/dL, LDL-C ≥160 mg/dL, HDL-C <40 mg/dL, and triglyceride ≥200 mg/dL. The prevalence of dyslipidemia was estimated for adults aged ≥20 years using the Korea National Health and Nutrition Survey (KNHANES) in 1998 (n=6,923), 2001 (n=4,882), and 2005 (n=5,323). Rates of awareness, treatment and control of dyslipidemia were calculated for adults aged ≥30 years using the KNHANES in 2005 (n=4,654).

Results: The prevalence of dyslipidemia (aged ≥20 years) increased from 32.4% in 1998 to 42.6% in 2001 and 44.1% in 2005. Compared with the KNHANES in 1998, the prevalence of dyslipidemia was 47% (95% confidence interval [CI], 35% to 59%) higher in 2001 and 61% (95% CI, 49% to 75%) higher in 2005. In 2005, only 9.5% of people with dyslipidemia were aware of the disease, 5.2% used lipid-lowering medication, and 33.2% of patients with treatment reached treatment goals.

Conclusion: The prevalence of dyslipidemia in Korea gradually increased between 1998 and 2005. These findings suggest that more intense efforts for the prevention and treatment of dyslipidemia may lead to further improvement in the management of dyslipidemia.
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http://dx.doi.org/10.4093/dmj.2012.36.1.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3283826PMC
February 2012

Association between body mass index and asthma symptoms among Korean children: a nation-wide study.

J Korean Med Sci 2011 Dec 29;26(12):1541-7. Epub 2011 Nov 29.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

The purpose of this study was to investigate the association between body mass index (BMI) and the prevalence of wheeze using nation-wide cross-sectional study in Korean children. Total 50,200 children from 427 elementary schools were randomly selected according to residential areas (metropolitan, provincial, rural, and industrial areas) by the cluster sampling method. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires were used to measure the prevalence of wheeze. Among 31,026 respondents, 25,322 were analyzed. BMI was classified into quartiles based on BMI-for-age percentile. In all residential areas, pets at home and visible mold or moisture were associated with an increased prevalence of wheeze in both genders. However, other living environment factors were not consistently associated among residential areas and gender. Among girls, lowest BMI was negatively associated with prevalence of wheeze and highest BMI was positively associated in all residential areas. In multilevel logistic regression analysis, environmental tobacco smoking exposure, pets at home, visible mold or moisture, and being in the lowest and highest BMI quartile were significantly associated with the prevalence of wheeze in both genders. BMI has become an important risk factor for asthma symptoms among Korean children.
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http://dx.doi.org/10.3346/jkms.2011.26.12.1541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230012PMC
December 2011

Familial concordance of metabolic syndrome in Korean population--Korean National Health and Nutrition Examination Survey 2005.

Diabetes Res Clin Pract 2011 Sep 5;93(3):430-6. Epub 2011 Jul 5.

Department of Preventive Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-Gu, Seoul 120-752, South Korea.

Aims: To investigate the familial concordance of metabolic syndrome and its components in a nationally representative survey in Korean.

Methods: We used data from the Korean National Health and Nutrition Examination Survey (KNHANES), a nationwide survey examining the general health and nutritional status of the Korean people. We enrolled 1641 married couples and 1527 parents-1342 offspring.

Results: Prevalence of the metabolic syndrome was 17.1% for husbands, 11.7% for wives, 14.3% for parents, and 7.2% for offspring. After adjustment for age, there were strong positive correlations between family members for the metabolic variables. Compared with husbands whose wives did not have metabolic syndrome, adjusted odds ratio in husbands whose wives had metabolic syndrome was 1.43 (95% CI: 1.10-1.87) for the risk of having metabolic syndrome. Similarly, wives whose husbands had metabolic syndrome had 1.41 (95% CI: 1.08-1.84) times higher risk of having metabolic syndrome. Compared with children whose parents did not have metabolic syndrome, adjusted odds ratio in children with at least one parent with the metabolic syndrome was 2.56 (95% CI: 1.09-5.98) for the metabolic syndrome.

Conclusions: Our study revealed that there is significant familial concordance for metabolic syndrome and its components in Korean families.
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http://dx.doi.org/10.1016/j.diabres.2011.06.002DOI Listing
September 2011

Gender differences in the association between smoking and dyslipidemia: 2005 Korean National Health and Nutrition Examination Survey.

Clin Chim Acta 2011 Aug 13;412(17-18):1600-5. Epub 2011 May 13.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Smoking has been reported to be associated with abnormal lipid metabolism. However, it remains uncertain whether adverse metabolic effects of smoking on dyslipidemia differ with gender. The objective of this study was to investigate the association between smoking and dyslipidemia in men and women.

Methods: We analyzed data from 2166 men and 3003 women aged ≥20 years assessed in the Third Korea National Health and Nutrition Examination Survey (2005). Dyslipidemia was defined according to the National Cholesterol Education Program-Adult Treatment Panel III.

Results: The prevalence of dyslipidemia was higher in men than in women. The odds ratios (95% confidence interval) of dyslipidemia associated with current smoking were 1.35 (0.98-1.85) in men and 1.92 (1.19-3.10) in women (p for interaction with gender <0.001). After stratification by components of dyslipidemia, women smokers showed higher odds ratios of having high triglyceride and low high-density lipoprotein cholesterol than men smokers. The association between current heavy-smoking (≥20 pack-years) and dyslipidemia was stronger in women than in men.

Conclusions: The association between smoking and dyslipidemia was significantly different between men and women. Women smokers might be more susceptible to develop dyslipidemia than men smokers.
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http://dx.doi.org/10.1016/j.cca.2011.05.013DOI Listing
August 2011

[Association between hypertension and pulmonary function in rural adults in Korea].

J Prev Med Public Health 2009 Jan;42(1):21-8

Department of Preventive Medicine, Yonsei University College of Medicine.

Objectives: Whilst hypertension exerts a negative effect on several organs there have been few studies regarding its effect on pulmonary function. The objective of this study was to examine the relationship between hypertension and pulmonary function in rural Korean adults.

Methods: In 2006, 2534 people were recruited, aged 40 to 70, in Kangwha County. We selected 1454 (male: 624, female: 830) participants whose pulmonary function results were repeatable. Blood pressure (BP) was measured twice and the average calculated. Participants were divided into two groups (hypertensive group and non-hypertensive group) in accordance with The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Pulmonary function was measured by dry rolling seal spirometry. Forced expiratory volume in the one second and forced vital capacity were converted into percent-predicted values based on average pulmonary function amongst Koreans.

Results: The number of hypertensive participants in the present study was 460 (male: 205, female: 255) and the number of non-hypertensive participants was 994 (male: 419, female: 575). Our findings have shown that the mean values for expiratory volume in the one second and forced vital capacity were significantly lower for hypertensive people than for non-hypertensive people, among women (P=0.002 for forced expiratory volume in the one second, P<0.001 for forced vital capacity volume). Odds ratio analysis revealed that hypertensive participants were more likely to have lower pulmonary function than non-hypertensive participants, again significantly among women.

Conclusions: The pulmonary function of hypertensive women was significantly lower than that of non-hypertensive women aged 40-70.
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http://dx.doi.org/10.3961/jpmph.2009.42.1.21DOI Listing
January 2009

Six-year survival and causes of death among stroke patients in Korea.

Neuroepidemiology 2009 27;32(2):94-100. Epub 2008 Nov 27.

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: Stroke is the second leading cause of death in Korea but long-term survival of Korean stroke patients has not been studied. Thus, we examined 6-year survival and causes of death in a nationally representative inpatient sample.

Methods: Between January 2000 and March 2000 in 152 sample hospitals, 4,299 first-ever stroke patients were identified and followed-up for vital status until December 2005. Mortality and mortality-related factors were evaluated by the Kaplan-Meier method and Cox proportional hazard regression analysis.

Results: Ischemic stroke was the most common subtype (62.9%), followed by intracerebral hemorrhage (ICH, 21.2%), and subarachnoid hemorrhage (SAH, 6.4%). Six-year mortality was estimated at 37.1% for all strokes, 37.2% for ischemic, 41.0% for ICH, and 29.2% for SAH. Common causes of death were stroke (58.2%), malignancies (10.3%), other cardiovascular diseases (7.7%), and diabetes (6.8%). Six-year mortality was associated with old age (hazard ratio 1.70 per 10 years, 95% CI 1.62-1.78), male sex (1.29, 1.16-1.43), subtypes of ICH (1.30, 1.15-1.48) and SAH (1.43, 1.14-1.80), longer hospital admission (1.01 per 10 days, 1.00-1.03), and loss of consciousness (1.32, 1.13-1.55).

Conclusions: More than 60% of Korean patients with first-ever stroke survived to 6 years. Major causes of death were stroke, cancer, cardiovascular diseases, and diabetes.
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http://dx.doi.org/10.1159/000177034DOI Listing
December 2009