Publications by authors named "Eun-Hee Nah"

25 Publications

  • Page 1 of 1

Comparison of diagnostic performance between FIB-4 and NFS in metabolic-associated fatty liver disease era.

Hepatol Res 2021 Nov 29. Epub 2021 Nov 29.

Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, Korea.

Aims: Fibrosis-4 index (FIB-4) and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) are the two most widely used non-invasive tools for screening of advanced fibrosis in subjects with NAFLD. Since metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed as a new category of fatty liver disease, we aimed to compare the diagnostic performance of FIB-4 and NFS in subjects with MAFLD and in various subgroups.

Methods: This study was designed as cross-sectional study. Data from 6,775 subjects who underwent magnetic resonance elastography (MRE) and abdominal ultrasonography at the same time during a health check-up at 13 various health check-up centers were retrospectively reviewed. Advanced fibrosis was defined as an MRE value of ≥3.6 kPa.

Results: The area under the receiver operating characteristic curves (AUROCs) of FIB-4 and NFS for diagnosing advanced fibrosis were similar in subjects with MAFLD. However, the AUROC of NFS was lower than that of FIB-4 in the diabetic subgroup of MAFLD (0.809 in FIB-4 vs. 0.717 in NFS, P = 0.002). The performances of both FIB-4 and NFS were poor in the subgroup of MAFLD with significant alcohol intake.

Conclusions: The overall diagnostic performance of FIB-4 and NFS for diagnosing advanced fibrosis did not differ among subjects with MAFLD. However, the performance of NFS was lower in the diabetes subgroup of MAFLD. The diagnostic performance of FIB-4 was better for fibrosis in various subgroups of MAFLD. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/hepr.13737DOI Listing
November 2021

Subclinical steatohepatitis and advanced liver fibrosis in health examinees with nonalcoholic fatty liver disease (NAFLD) in 10 South Korean cities: A retrospective cross-sectional study.

PLoS One 2021 24;16(11):e0260477. Epub 2021 Nov 24.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Korea.

Background: Nonalcoholic steatohepatitis (NASH) has a risk of progressing to cirrhosis. The prevalence of NASH and its associated risk factors in community populations are relatively unknown. This study aimed to determine the prevalence of NASH and advanced liver fibrosis using magnetic resonance elastography (MRE), and determine those risk factors in health examinees with asymptomatic fatty liver.

Methods: This study consecutively selected subjects who underwent health checkups at 13 health-promotion centers in 10 Korean cities between 2018 and 2020. Hepatic steatosis and stiffness were assessed using ultrasonography and MRE, respectively. Stages of liver stiffness were estimated using MRE with cutoff values for NASH and advanced liver fibrosis of 2.91 and 3.60 kPa, respectively.

Results: The overall prevalence of NASH and advanced liver fibrosis in the subjects with fatty liver were 8.35% and 2.04%, respectively. Multivariate logistic regression analysis indicated that central obesity (OR = 5.12, 95% CI = 2.70-9.71), increased triglyceride (OR = 3.29, 95% CI = 1.72-6.29), abnormal liver function test (OR = 3.09, 95% CI = 1.66-5.76) (all P<0.001), and decreased high-density lipoprotein cholesterol (OR = 5.18, 95% CI = 1.78-15.05) (P = 0.003) were associated with NASH. The main risk factor for advanced liver fibrosis was diabetes (OR = 4.46, 95% CI = 1.14-17.48) (P = 0.032).

Conclusion: NASH or advanced liver fibrosis is found in one-tenth of health examinees with asymptomatic fatty liver. This suggests that early detection of NASH should be considered to allow early interventions such as lifestyle changes to prevent the adverse effects of NASH and its progression in health examinees with asymptomatic fatty liver.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260477PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612540PMC
November 2021

Fibrosis Burden of Missed and Added Populations According to the New Definition of Metabolic Dysfunction-Associated Fatty Liver.

J Clin Med 2021 Oct 8;10(19). Epub 2021 Oct 8.

Department of Laboratory Medicine, Health Promotion Research Institute, Seoul 07572, Korea.

Recently, the classification of fatty liver and the definition for non-alcoholic fatty liver disease (NAFLD) have been challenged. Herein, we aim to evaluate the burden of hepatic fibrosis in the missed and added populations following the proposal of the new definition of metabolic dysfunction-associated fatty liver (MAFLD) in a health check-up cohort. A total of 6775 subjects underwent both magnetic resonance elastography (MRE) and an abdominal ultrasound at 13 nationwide health check-up centers in Korea. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of sonographic fatty liver (FL) was 47.4%. Among the subjects with sonographic FL, 77.3% and 94% are compatible with NAFLD and with the new MAFLD definitions, respectively. Moreover, 72% of FL cases belong to both the NAFLD and MAFLD definitions, whereas 1.4% is compatible with neither. The population compatible with the MAFLD definition has the following coexisting liver diseases: alcohol-related (71.9%), hepatitis B (23.9%), hepatitis C (0.4%), and both alcohol and viral hepatitis (2.8%). The prevalence of significant and advanced hepatic fibrosis is considerable in the MAFLD-only group. However, the prevalence of significant and advanced hepatic fibrosis is similar in the NAFLD-only group, and neither the NAFLD nor MAFLD group compared to healthy controls. The added population (MAFLD-only group), according to the new MAFLD definition, has a higher metabolic and fibrosis burden when compared to those in the missed population (NAFLD-only group).
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http://dx.doi.org/10.3390/jcm10194625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509136PMC
October 2021

Reference interval and the role of plasma oligomeric beta amyloid in screening of risk groups for cognitive dysfunction at health checkups.

J Clin Lab Anal 2021 Sep 3;35(9):e23933. Epub 2021 Aug 3.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Korea.

Background: Alzheimer's disease (AD) has a prolonged preclinical stage characterized by cognitive dysfunction. Simple, reliable, and noninvasive biomarkers reflecting the pathogenesis of AD are needed for screening cognitive dysfunction in primary health care. The aims of this study were to determine (1) the potential utility of the Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) value in cognitive assessments and (2) the reference interval (RI) of plasma MDS-OAβ values in the general population.

Methods: This prospective study consecutively recruited 1,594 participants who underwent health checkups including cognitive function examination at 16 health-promotion centers in Korea between December 2020 and January 2021. The inBlood OAβ test (PeopleBio, Gyeonggi-do, Republic of Korea) was utilized to quantify MDS-OAβ values in plasma. The reference subjects were obtained among those with normal general cognition on cognitive screening tools. RIs were established according to the CLSI C28-A3 guidelines.

Results: The median MDS-OAβ value was higher in subjects with Korean Dementia Screening Questionnaire-Cognition (KDSQ-C) scores ≥8 than in those with KDSQ-C scores of 6-7 (P = 0.013). The median MDS-OAβ value was higher in subjects with Mini-Mental State Examination for Dementia Screening (MMSE-DS) scores of 21-26 than in those with MMSE-DS scores ≥27 (P = 0.011). The RI (one-side upper 95th percentile) of the MDS-OAβ value was 0.80 ng/mL (95% confidence interval = 0.78-0.82) in those aged ≥50 years.

Conclusions: The plasma MDS-OAβ value reflects cognitive function as assessed using the KDSQ-C and MMSE-DS. RIs obtained from a large and cognitively healthy community-based sample are presented.
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http://dx.doi.org/10.1002/jcla.23933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418474PMC
September 2021

Diabetes is the strongest risk factor of hepatic fibrosis in lean patients with non-alcoholic fatty liver disease.

Gut 2021 Jun 14. Epub 2021 Jun 14.

Department of Laboratory Medicine, Health Promotion Research Institute, Seoul, Korea (the Republic of)

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http://dx.doi.org/10.1136/gutjnl-2021-325102DOI Listing
June 2021

Do we need a new cut-off for FIB-4 in the metabolic dysfunction-associated fatty liver disease era?

J Hepatol 2021 09 9;75(3):725-726. Epub 2021 Jun 9.

Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Republic of Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jhep.2021.05.035DOI Listing
September 2021

Nationwide seroprevalence of antibodies to SARS-CoV-2 in asymptomatic population in South Korea: a cross-sectional study.

BMJ Open 2021 04 24;11(4):e049837. Epub 2021 Apr 24.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, Republic of Korea.

Objective: Asymptomatic active infection might be an important contributor to the COVID-19 outbreak. Serological tests can assess the extent of exposure and herd immunity to COVID-19 in general populations. This study aimed to estimate the nationwide seroprevalence of SARS-CoV-2 antibodies according to age, sex and clinical status in South Korea.

Design, Setting And Participants: This cross-sectional study randomly selected health examinees who underwent health check-up at 16 health promotion centres in 13 Korean cities across the country between late September and early December 2020. Residual serum samples were obtained from 4085 subjects (2014 men and 2071 women). Antibodies to SARS-CoV-2 were measured by electrochemiluminescence immunoassay using Elecsys Anti-SARS-CoV-2 (Roche Elecsys, Mannheim, Germany).

Primary And Secondary Outcome Measures: Fisher's exact test was used to compare the seroprevalence according to sex, age group and region. The relative risks of being seropositive according to the characteristics of the study subjects were analysed using logistic regression analysis.

Results: The overall seroprevalence of anti-SARS-CoV-2 was 0.39% (95% CI=0.20% to 0.58%): 0.30% (95% CI=0.06% to 0.54%) for men and 0.48% (95% CI=0.18% to 0.78%) for women. The rate of anti-SARS-CoV-2 positivity varied significantly between different regions of Korea (p=0.003), but not with age group, sex, or the statuses of obesity, diabetes, hypertension or smoking.

Conclusions: Most of the Korean population is still immunologically vulnerable to SARS-CoV-2, but the seroprevalence has increased relative to that found in studies performed prior to September 2020 in Korea.
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http://dx.doi.org/10.1136/bmjopen-2021-049837DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076630PMC
April 2021

Prevalence of liver fibrosis and associated risk factors in the Korean general population: a retrospective cross-sectional study.

BMJ Open 2021 03 24;11(3):e046529. Epub 2021 Mar 24.

MEDIcheck LAB, Korea Association of Health Promotion, Seoul, South Korea.

Objectives: The health burden of chronic liver disease is increasing worldwide. Its main histological consequence is liver fibrosis, and eventually cirrhosis. This process is rarely diagnosed at the pre-cirrhotic stage due to it being asymptomatic. Little is known about the prevalence of liver fibrosis and associated risk factors in the general population. The aims of this study were to determine the prevalence and distribution of liver fibrosis using magnetic resonance elastography (MRE), as well as the risk factors associated with liver fibrosis in the asymptomatic general population.

Design, Setting And Participants: This cross-sectional retrospective study consecutively selected subjects who underwent health check-ups including MRE at 13 health promotion centres in Korea between 2018 and 2020. Liver fibrosis was estimated using MRE with cut-off values for significant and advanced liver fibrosis of 2.90 and 3.60 kPa, respectively.

Primary And Secondary Outcome Measures: The Χ test was used to compare the prevalence of liver fibrosis according to sex and age groups. Multivariable logistic regression analyses were performed to identify the factors for significant and advanced liver fibrosis.

Results: Among the 8183 subjects, 778 (9.5%) had ≥significant fibrosis (≥2.9 kPa), which included 214 (2.6%) subjects with ≥advanced fibrosis (≥3.6 kPa). Multivariable analysis revealed that liver fibrosis was associated with age (OR=1.34, 95% CI=1.18 to 1.51), male sex (OR=3.18, 95% CI=1.97 to 5.13), diabetes (OR=2.43, 95% CI=1.8 to 3.28), HBsAg positivity (OR=3.49, 95% CI=2.55 to 4.79), abnormal liver function test (OR=1.9, 95% CI=1.49 to 2.42) and obesity (OR=1.77, 95% CI=1.35 to 2.32) (all p<0.001), as well as metabolic syndrome (OR=1.4, 95% CI=1.05 to 1.87) (p=0.024).

Conclusions: The prevalence of significant or more liver fibrosis was high in the Korean general population and much higher among individuals with risk factors. This suggests that screening of liver fibrosis should be considered in general population, especially among high-risk groups.
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http://dx.doi.org/10.1136/bmjopen-2020-046529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993338PMC
March 2021

The patterns of lifestyle, metabolic status, and obesity among hypertensive Korean patients: a latent class analysis.

Epidemiol Health 2020 31;42:e2020061. Epub 2020 Aug 31.

Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.

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.
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http://dx.doi.org/10.4178/epih.e2020061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871153PMC
January 2021

Reference interval and the role of soluble suppression of tumorigenicity 2 (sST2) in subclinical cardiac dysfunction at health checkups.

J Clin Lab Anal 2020 Nov 7;34(11):e23461. Epub 2020 Jul 7.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Soluble ST2 (sST2) is known to predict adverse outcomes and death in individuals with established heart failure. However, the role of sST2 testing in the general population has not been established. The aims of this study were to determine the reference interval (RI) and the clinical utility of sST2 in subclinical cardiac dysfunction in general population.

Methods: This cross-sectional study consecutively selected 41,806 general subjects at health checkups who underwent echocardiography and sST2 testing at 16 health promotion centers in 13 Korean cities. The reference subjects were obtained among those with normal findings in echocardiography. Sex-specific RIs were established according to the CLSI C28-A3 guidelines. sST2 was measured using immunoassay with the Presage ST2 assay (Critical Diagnostics).

Results: In the general subjects, age, sex, BMI, systolic blood pressure, blood glucose, creatinine, liver function, and triglycerides were associated with the sST2 levels. The RI for sST2 was higher in males (≤49.6 ng/mL, 95% CI = 48.5-51.5) than in females (≤44.5 ng/mL, 95% CI = 43.5-45.6) and higher in subjects aged < 40 years than ≥ 40 years in both sexes. The sST2 levels were 29.1 ± 10.7 (mean ± SD) and 29.1 ± 14.4 ng/mL in the groups with normal cardiac function and subclinical cardiac dysfunction, respectively. The sST2 level was not associated with subclinical cardiac dysfunction (odd ratio = 1.002, P = .13).

Conclusions: RIs obtained from a large and echocardiography-proven healthy community-based sample are presented. Subclinical cardiac dysfunction was associated with older age, male sex, and metabolic factors but not with the sST2 level.
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http://dx.doi.org/10.1002/jcla.23461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676181PMC
November 2020

Diagnostic performance of Mac-2 binding protein glycosylation isomer (M2BPGi) in screening liver fibrosis in health checkups.

J Clin Lab Anal 2020 Aug 29;34(8):e23316. Epub 2020 Mar 29.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Mild-to-moderate fibrosis is rarely diagnosed because the disease is asymptomatic in the early stage. The serum level of Mac-2 binding protein glycosylation isomer (M2BPGi) has been found to increase with the severity of liver fibrosis. The aim of this study was to determine the diagnostic performance of M2BPGi in screening liver fibrosis using magnetic resonance elastography (MRE) as a reference standard and to compare it with using the aspartate aminotransferase-to-platelet ratio (APRI) and the Fibrosis-4 index (FIB-4) in health checkups.

Methods: This cross-sectional study consecutively selected subjects at health examinations who underwent MRE and M2BPGi testing at eight health promotion centers in Korea between January and September 2019. The serum M2BPGi level was measured using the chemiluminescence enzyme immunoassay method. The measured levels were indexed using the cutoff index (COI). COI values of M2BPGi were compared with the MRE results.

Results: The median (interquartile) values of COI for fibrosis stages F0 (normal liver stiffness), F1 (mild fibrosis), F2 (significant fibrosis), and ≥F3 (advanced fibrosis) were 0.49 (0.34-0.61), 0.48 (0.38-0.68), 0.64 (0.43-1.03), and 1.01 (0.75-1.77), respectively (P < .0001). The AUCs of the COI for the screening of fibrosis stage ≥F1, ≥F2, and ≥F3 were 0.591, 0.698, and 0.853, respectively. Using a threshold of 0.75 for COI to exclude advanced fibrosis had a sensitivity, specificity, and negative predictive value of 80.0%, 77.9%, and 98.9%, respectively. The AUC for excluding advanced fibrosis was better for M2BPGi than for FIB-4 and APRI.

Conclusion: Serum M2BPGi was useful for screening significant and advanced fibrosis in health checkups.
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http://dx.doi.org/10.1002/jcla.23316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439422PMC
August 2020

Distribution of hemoglobin levels and prevalence of anemia according to sex, age group, and region in 13 Korean cities.

Int J Lab Hematol 2020 Apr 12;42(2):223-229. Epub 2020 Feb 12.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Introduction: The distribution of hemoglobin (Hb) levels and the prevalence of anemia are significant public health indicators. The aims of this study were to determine the distribution of Hb levels and the prevalence of anemia according to sex, age group, and region throughout Korea.

Methods: The study analyzed data on 1 159 298 subjects who received health checkups at 16 health-promotion centers in 13 Korean cities during 2018. Anemia and its severity were defined according to the World Health Organization classification for Hb levels as follows: mild anemia (11-12.9 g/dL in males and 11-11.9 g/dL in females), moderate anemia (10-10.9 g/dL in both sexes), and severe anemia (<10.0 g/dL in both sexes).

Results: The Hb level in the general sample was lower in females (13.25 ± 1.13 g/dL, mean ± SD) than in males (15.29 ± 1.22 g/dL). The overall prevalence of anemia was 6.0% (2.98% in males and 8.56% in females), and the prevalence of severe anemia was 0.92% (0.23% in males and 1.51% in females). While the prevalence of anemia increased monotonically with age in males, it was bimodal in females with two peaks at 40-49 years and ≥80 years. The highest prevalence of anemia in females aged 40-49 years was attributed to microcytic anemia, while increases in anemia prevalence in males aged ≥50 years and females aged ≥70 years were attributed to macrocytic anemia.

Conclusion: The distribution of Hb levels and the prevalence of anemia overall and by severity differ according to sex, age group, and region throughout Korea.
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http://dx.doi.org/10.1111/ijlh.13160DOI Listing
April 2020

The Multi-Institutional Health Screening Records Database of South Korea: Description and Evaluation of Its Characteristics.

Yonsei Med J 2019 Dec;60(12):1216-1222

School of Pharmacy, Sungkyunkwan University, Suwon, Korea.

This study sought to describe and to evaluate the characteristics of the Health Screening Records Database (HSRD) of the Korea Association of Health Promotion as a data source for epidemiologic studies. The HSRD was compared to a National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) database for 2015. Common variables between the databases were selected, and sex-based analyses were conducted. The HSRD showed statistical concordance when NHIS-HEALS estimates fell within the HSRD estimate's 95% confidence interval. The HSRD and NHIS-HEALS included 946461 and 111690 participants in health screening programs, respectively. Compared to the NHIS-HEALS, the HSRD had more female (55.2% vs. 42.6%) but fewer older adult participants (34.4% vs. 51.2%). Virtually all variables had clinical concordance, with some having statistical concordance as well, among both general and life-transition program participants. The HSRD comprised more clinical information over a wider age range in contrast to the NHIS-HEALS, while showing clinical concordance. Providing more comprehensive clinical data, the HSRD may serve as an alternative resource for epidemiologic studies.
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http://dx.doi.org/10.3349/ymj.2019.60.12.1216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881703PMC
December 2019

Subclinical Iron Deficiency in Non-Anemic Individuals: A Retrospective Analysis of Korean Health Examinees.

Acta Haematol 2020 12;143(1):26-32. Epub 2019 Jul 12.

Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Republic of Korea.

Objectives: Non-anemic individuals may have undetected subclinical iron deficiency (SID). The aims of this study were to determine the prevalence of SID and identify the associated factors for SID. In addition, the screening performance of red blood cell (RBC) indices for SID in health check-ups was assessed.

Methods: This study was conducted with 16,485 non-anemic health examinees (3,567 males and 12,918 females) who underwent tests for iron variables (serum iron, total iron-binding capacity, ferritin, and iron saturation) at 16 health-promotion centers in 13 cities in Korea between January 2017 and June 2018. SID was defined as a decreased ferritin level (<24 µg/L in males and <15 µg/L in females) and either a decreased serum iron level (<44 µg/dL in males and <29 µg/dL in females) or a transferrin saturation of <20%.

Results: The prevalence rates of SID were 0.6 and 3.3% in males and females, respectively. In terms of age and sex, SID was most prevalent in males aged ≥70 years (7.8%) and females aged 15-49 years (7.6%). There were significant differences in the hemoglobin (Hb) level, white blood cell count, platelet count, mean corpuscular volume, mean corpuscular Hb (MCH), and RBC distribution width (RDW) between the SID and non-SID groups (p < 0.001). The factors associated with SID in males were older age (odds ratio, OR, 1.069, 95% confidence interval, CI, 1.03-1.109, p = 0.004), lower Hb (OR 0.58, 95% CI 0.345-0.976, p = 0.04), lower MCH (OR 0.433, 95% CI 0.298-0.629, p < 0.001), and higher RDW (OR 1.374, 95% CI 1.001-1.887, p = 0.049), while in females they were lower body mass index (BMI; OR 0.929, 95% CI 0.895-0.963, p < 0.001) and younger age (OR 0.954, 95% CI 0.945-0.963, p < 0.001), as well as lower Hb, lower MCH, and higher RDW. The AUC for the MCH (0.877, 95% CI 0.793-0.960 in males; 0.872, 95% CI 0.853-0.890 in females) indicates that the MCH at cut-offs of 29.2 and 29.3 pg are the best discriminators of SID in males and females, respectively (p < 0.001).

Conclusions: Reproductive-age females with a lower BMI and elderly males are high-risk groups for SID. MCH is a reliable RBC index for the screening of SID. For the population with defined risk factors, including females with lower BMI and elderly males, screening for SID is needed to prevent the development of anemia.
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http://dx.doi.org/10.1159/000500630DOI Listing
April 2020

Plasma NT-proBNP levels associated with cardiac structural abnormalities in asymptomatic health examinees with preserved ejection fraction: a retrospective cross-sectional study.

BMJ Open 2019 04 20;9(4):e026030. Epub 2019 Apr 20.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, South Korea.

Objectives: Stage B heart failure (HF) is defined as an asymptomatic abnormality of the heart structure or function. The circulating level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in symptomatic patients with left ventricular (LV) dysfunction caused by a structural or functional abnormality. This study investigated the association of the NT-proBNP level with echocardiography-detected cardiac structural or diastolic abnormalities in asymptomatic subjects with preserved LV systolic function (ejection fraction >50%).

Methods: We retrospectively studied 652 health examinees who underwent echocardiography and an NT-proBNP test at a health-promotion centre in Seoul, between January 2016 and September 2018. The left ventricular mass index (LVMI) and the left atrial dimension (LAD) were used as markers for structural abnormalities, and the mean e' velocity and mitral early flow velocity/early diastolic tissue velocity (E/e') ratio were used as markers for diastolic dysfunction. The plasma NT-proBNP level was measured using electrochemiluminescence immunoassay (DPC Immulite 2000 XPi, Siemens Healthcare Diagnostics, Tarrytown, New York, USA).

Results: Subjects with preclinical structural abnormalities were older and had a higher body mass index (BMI), higher blood pressure, lower high-density lipoprotein cholesterol level, higher NT-proBNP level, and higher E/e' (p<0.05). Multivariate regression analysis indicated that the factors associated with a higher NT-proBNP level were older age, female sex, lower BMI, higher creatinine level, higher LVMI and higher LAD (p<0.01).

Conclusion: Diastolic dysfunction is not associated with higher NT-proBNP levels, whereas preclinical cardiac structural abnormalities, as well as older age, female sex, lower BMI, and higher creatinine level, are associated with higher NT-proBNP levels.
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http://dx.doi.org/10.1136/bmjopen-2018-026030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500281PMC
April 2019

Efficacy of lifestyle interventions in the reversion to normoglycemia in Korean prediabetics: One-year results from a randomised controlled trial.

Prim Care Diabetes 2019 06 21;13(3):212-220. Epub 2018 Dec 21.

Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.

Aim: This study aimed to determine the efficacy of personalized lifestyle interventions on the reversion of a prediabetic state to normoglycemia compared with regular blood glucose testing alone in prediabetes.

Methods: A randomized, multicenter trial was conducted in prediabetes aged 30-70 with fasting blood glucose level of 5.6-6.9mmol/L (100-125mg/dL) and/or HbA1c level of 39-46mmol/mol (5.7-6.4%) recruited from health checkups at 16 health-promotion centers in Korea. The 799 recruited individuals were randomized to either the personalized lifestyle intervention group (LIG) or the control group (CG) by a computer generated random number list prepared by an independent statistician. The CG was provided with fasting blood glucose and HbA1c tests alone every 3months during the first year. The LIG was provided not only blood glucose test but five sessions of personalized lifestyle counseling by nutritionists every 3months during the first year aimed at improving the diet, alcohol and exercise behaviors. Data from lifestyle assesments and laboratory measurements were analyzed at 1-year after baseline. The primary outcome was the reversion rate from prediabetes to normoglycemia. Additional outcome include the effect of the lifestyle intervention program on lifestyle changes in the LIG to support primary outcome.

Results: The 799 participants randomly allocated to the LIG (n=398) or the CG (n=401). For the analyses of outcomes, 629 participants (313 men and 316 women; mean age, 53.7±9.4years; mean body mass index (BMI), 24.7kg/m) were included: 325 in the LIG; 304 in the CG. Diet (7.03, 95% CI=4.56-10.86, P<0.001), alcohol (2.24, 95% CI=1.48-3.41, P<0.001), and exercise behaviors (1.85, 95% CI=1.31-2.63, P<0.001) were improved relative to baseline by the personalized lifestyle intervention in the LIG after adjusting age, sex, and family history of diabetes. In terms of main outcome, the cumulative incidence of reversion from prediabetes to normoglycemia at the first year was 37.9% (123/325) [95% CI=32.6-43.1%] in the LIG and 29.6% (90/304) (95% CI=24.5-34.7%) in the CG. After adjustment for age, sex, family history of diabetes, BMI, blood pressure, and lipids, the hazard ratio for reverting to normoglycemia remained significantly higher in the LIG (1.40, 95% CI=1.06-1.83, P=0.017) than in the CG.

Conclusion: Personalized lifestyle intervention could be more effective compared with regular blood glucose testing alone in the reversion of a prediabetic state to normoglycemia in Korean prediabetics. This finding suggests that diabetes prevention care would be benefited by incorporating personalized lifestyle counseling. This study was registered at cris.nih.go.kr (KCT0001580).
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http://dx.doi.org/10.1016/j.pcd.2018.11.017DOI Listing
June 2019

Complete Blood Count Reference Intervals and Patterns of Changes Across Pediatric, Adult, and Geriatric Ages in Korea.

Ann Lab Med 2018 Nov;38(6):503-511

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Sampling a healthy reference population to generate reference intervals (RIs) for complete blood count (CBC) parameters is not common for pediatric and geriatric ages. We established age- and sex-specific RIs for CBC parameters across pediatric, adult, and geriatric ages using secondary data, evaluating patterns of changes in CBC parameters.

Methods: The reference population comprised 804,623 health examinees (66,611 aged 3-17 years; 564,280 aged 18-59 years; 173,732 aged 60-99 years), and, we excluded 22,766 examinees after outlier testing. The CBC parameters (red blood cell [RBC], white blood cell [WBC], and platelet parameters) from 781,857 examinees were studied. We determined statistically significant partitions of age and sex, and calculated RIs according to the CLSI C28-A3 guidelines.

Results: RBC parameters increased with age until adulthood and decreased with age in males, but increased before puberty and then decreased with age in females. WBC and platelet counts were the highest in early childhood and decreased with age. Sex differences in each age group were noted: WBC count was higher in males than in females during adulthood, but platelet count was higher in females than in males from puberty onwards (P<0.001). Neutrophil count was the lowest in early childhood and increased with age. Lymphocyte count decreased with age after peaking in early childhood. Eosinophil count was the highest in childhood and higher in males than in females. Monocyte count was higher in males than in females (P<0.001).

Conclusions: We provide comprehensive age- and sex-specific RIs for CBC parameters, which show dynamic changes with both age and sex.
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http://dx.doi.org/10.3343/alm.2018.38.6.503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056383PMC
November 2018

Evaluation of the LC-1000 Flow Cytometry Screening System for Cervical Cancer Screening in Routine Health Checkups.

Acta Cytol 2018 29;62(4):279-287. Epub 2018 May 29.

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Republic of Korea.

Objective: This study evaluated the performance of a flow cytometry system (LC-1000) in screening cervical precancerous lesions at routine health checkups.

Study Design: In total, 928 health examinees were enrolled at 16 health promotion centers in 13 Korean cities between 2016 and 2017. All participants underwent liquid-based cervical cytology and flow cytometry testing to determine the cell proliferation index (CPIx).

Results: The positivity rate of the LC-1000 system increased with the severity of the cervical cytology findings (p for trend < 0.001). When low-grade squamous intraepithelial lesion (LSIL) or higher (including LSIL, high-grade squamous intraepithelial lesion [HSIL], and atypical squamous cells without excluding HSIL [ASC-H]) was defined as gold-standard positivity, the sensitivity, specificity, PPV, and NPV of LC-1000 were 75.3% (95% confidence interval [CI], 66.8-83.7), 58.5% (95% CI, 55.2-61.9), 18.1% (95% CI, 14.5-21.8), and 95.1% [95% CI, 93.2-97.0], respectively. The median CPIx increased significantly from normal cytology to HSIL (p < 0.001). The median CPIx was higher in high-risk human papillomavirus (HR-HPV)-positive cases than in HR-HPV-negative cases (0.23 vs. 0.17, p < 0.001), while it did not differ between HR-HPV-positive and HR-HPV-negative cases with normal cytology findings (0.16 vs. 0.16, p = 0.700).

Conclusion: The LC-1000 system is potentially useful for screening cervical precancer and cancer, especially when excluding normal or ASC of undetermined significance cases in routinely screened populations.
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http://dx.doi.org/10.1159/000489079DOI Listing
August 2018

Comparison of Traditional and Reverse Syphilis Screening Algorithms in Medical Health Checkups.

Ann Lab Med 2017 Nov;37(6):511-515

Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul, Korea.

Background: The syphilis diagnostic algorithms applied in different countries vary significantly depending on the local syphilis epidemiology and other considerations, including the expected workload, the need for automation in the laboratory and budget factors. This study was performed to investigate the efficacy of traditional and reverse syphilis diagnostic algorithms during general health checkups.

Methods: In total, 1,000 blood specimens were obtained from 908 men and 92 women during their regular health checkups. Traditional screening and reverse screening were applied to the same specimens using automatic rapid plasma regain (RPR) and Treponema pallidum latex agglutination (TPLA) tests, respectively. Specimens that were reverse algorithm (TPLA) reactive, were subjected to a second treponemal test performed by using the chemiluminescent microparticle immunoassay (CMIA).

Results: Of the 1,000 specimens tested, 68 (6.8%) were reactive by reverse screening (TPLA) compared with 11 (1.1%) by traditional screening (RPR). The traditional algorithm failed to detect 48 specimens [TPLA(+)/RPR(-)/CMIA(+)]. The median TPLA cutoff index (COI) was higher in CMIA-reactive cases than in CMIA-nonreactive cases (90.5 vs 12.5 U).

Conclusions: The reverse screening algorithm could detect the subjects with possible latent syphilis who were not detected by the traditional algorithm. Those individuals could be provided with opportunities for evaluating syphilis during their health checkups. The COI values of the initial TPLA test may be helpful in excluding false-positive TPLA test results in the reverse algorithm.
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http://dx.doi.org/10.3343/alm.2017.37.6.511DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587824PMC
November 2017

Human Papillomavirus Genotype Distribution Among 18,815 Women in 13 Korean Cities and Relationship With Cervical Cytology Findings.

Ann Lab Med 2017 Sep;37(5):426-433

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: The prevalence and genotype distribution of Human papillomavirus (HPV) infection vary depending on geographical region and the immunity provided by vaccines. This study aimed to clarify the recent prevalence and genotype distribution of HPV according to age and cervical cytology findings in Korea.

Methods: This study included 18,815 health examinees that underwent cervical cytology and HPV genotyping tests at 16 centers of Korean Association of Health Promotion in 13 cities in Korea, between January 2014 and October 2015. HPV was genotyped by using multiplex PCR (Anyplex II HPV 28, Seegene, Korea), which detects 19 high-risk HPVs (HR-HPV) and nine low-risk HPVs (LR-HPV).

Results: Overall HPV prevalence was 27.8%, with 22.2% HR-HPV and 11.4% LR-HPV. The five most common carcinogens were HPV 52 (3.2%), 58 (2.7%), 16 (2.0%), 56 (1.9%), and 51 (1.8%). The five most common HR-HPVs in normal cytology samples were HPV 53, 68, 70, 52, and 58, while HPV 16, 52, 58, 33, and 31 were prevalent in high grade squamous intraepithelial lesions (HSIL). In atypical squamous cells of undetermined significance (ASCUS), the prevalence of HR-HPV varied with age; it was highest in those aged <30 yr, declining to a minimum at age 50-59 yr, and then increasing in older women (P<0.05).

Conclusions: The prevalence and distribution of HR-HPV varied with age and cervical cytology findings. This information would be helpful in the development of cervical cancer prevention policies.
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http://dx.doi.org/10.3343/alm.2017.37.5.426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500742PMC
September 2017

Comparison of Urine Albumin-to-Creatinine Ratio (ACR) Between ACR Strip Test and Quantitative Test in Prediabetes and Diabetes.

Ann Lab Med 2017 Jan;37(1):28-33

MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea.

Background: Albuminuria is generally known as a sensitive marker of renal and cardiovascular dysfunction. It can be used to help predict the occurrence of nephropathy and cardiovascular disorders in diabetes. Individuals with prediabetes have a tendency to develop macrovascular and microvascular pathology, resulting in an increased risk of retinopathy, cardiovascular diseases, and chronic renal diseases. We evaluated the clinical value of a strip test for measuring the urinary albumin-to-creatinine ratio (ACR) in prediabetes and diabetes.

Methods: Spot urine samples were obtained from 226 prediabetic and 275 diabetic subjects during regular health checkups. Urinary ACR was measured by using strip and laboratory quantitative tests.

Results: The positive rates of albuminuria measured by using the ACR strip test were 15.5% (microalbuminuria, 14.6%; macroalbuminuria, 0.9%) and 30.5% (microalbuminuria, 25.1%; macroalbuminuria, 5.5%) in prediabetes and diabetes, respectively. In the prediabetic population, the sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the ACR strip method were 92.0%, 94.0%, 65.7%, 99.0%, and 93.8%, respectively; the corresponding values in the diabetic population were 80.0%, 91.6%, 81.0%, 91.1%, and 88.0%, respectively. The median [interquartile range] ACR values in the strip tests for measurement ranges of <30, 30-300, and >300 mg/g were 9.4 [6.3-15.4], 46.9 [26.5-87.7], and 368.8 [296.2-575.2] mg/g, respectively, using the laboratory method.

Conclusions: The ACR strip test showed high sensitivity, specificity, and negative predictive value, suggesting that the test can be used to screen for albuminuria in cases of prediabetes and diabetes.
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http://dx.doi.org/10.3343/alm.2017.37.1.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5107614PMC
January 2017

[The relationship between thyroid function and the risk factors of cardiovascular disease at female medical checkups].

Korean J Lab Med 2009 Aug;29(4):286-92

Korea Association of Health Promotion, Seoul, Korea.

Background: Thyroid hormones play an important role in regulating lipid and glucose metabolism. Thus this study was conducted to investigate the relationship between the thyroid hormone (FT4) or thyroid stimulating hormone (TSH) and the cardiovascular risk factors and metabolic syndrome in the individuals with subclinical thyroid dysfunction.

Methods: The female health examinee with normal range of FT4 were classified into three groups according to the level of TSH; euthyroid group (n=4,410), subclinical hypothyroidism group (n=438) and subclinical hyperthyroidism group (n=66). Age, blood pressure, BMI, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lipoprotein(a), and high-sensitivity C-reactive protein (hsCRP) levels of serum specimens were compared among the groups and association of FT4 or TSH with these parameters.

Results: Fasting glucose was significantly higher in subclinical hyperthyroidism than in euthyroid and subclinical hypothyroidism groups (P=0.031), and total cholesterol was higher in subclinical hypothyroidism than in subclinical hyperthyroidism (P=0.011). But the other factors showed no difference among the groups. The level of TSH increased as triglyceride increased, while FT4 decreased as BMI or triglyceride increased. The FT4 also lowered when fasting glucose was above 126 mg/dL. TSH was not related with the metabolic syndrome, but the possibility of the syndrome was 1.3 times higher in the lowest quartile of the normal range of FT4 than in its highest quartile.

Conclusions: For the interpretation of FT4, its reference interval needs to be divided into 4 quartiles, which can be used as one of the predicting factors of the metabolic syndrome.
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http://dx.doi.org/10.3343/kjlm.2009.29.4.286DOI Listing
August 2009

[Metabolic characteristics and associated factors of nonalcoholic fatty liver disease diagnosed at medical checkups].

Korean J Lab Med 2008 Jun;28(3):244-50

Korea Association of Health Promotion, Seoul, Korea.

Background: Nonalcoholic fatty liver disease (NAFLD) has been reported to be related with metabolic disorder and frequently accompanied by abnormal liver function. This study was performed to investigate the metabolic characteristics of NAFLD and its associated factors.

Methods: We analysed 7,150 subjects diagnosed with NAFLD (n=2,381) or normal liver (n=4,769) and classified them into four groups based on ultrasonography and ALT levels as follows: 1) Control (normal liver and ALT), 2) increased ALT (normal liver with increased ALT), 3) NAFLD I (fatty liver with normal ALT), and 4) NAFLD II (fatty liver with increased ALT). Age, blood pressure, body mass index (BMI), fasting glucose, blood lipids, and high sensitivity C-reactive protein (hsCRP) were compared, and the incidence of metabolic syndrome was also determined in each group.

Results: The diastolic blood pressure, BMI, fasting glucose, total cholesterol, triglyceride, hsCRP, and the incidence of metabolic syndrome, were the highest in the NAFLD II group, followed by the NAFLD I group, the increased ALT group, and the control group in descending order. Meanwhile, HDL cholesterol (HDL-C) was the lowest in the NAFLD II group. Male sex, age, systolic blood pressure, BMI, fasting glucose, triglyceride, LDL cholesterol (LDL-C), and hsCRP were associated with NAFLD (P<0.001). An increased level of ALT in NAFLD was significantly related with male sex, increased BMI, fasting glucose, triglyceride, and LDL-C, younger age and decreased HDL-C (P<0.001).

Conclusions: NAFLD was related with metabolic syndrome and the risk factors of cardiovascular disease in Koreans. The correlation was more prominent in NAFLD with increased ALT. Thus, a more intensive management is required for the individuals in the NAFLD with increased ALT.
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http://dx.doi.org/10.3343/kjlm.2008.28.3.244DOI Listing
June 2008

[The Relationship between High Sensitivity C-Reactive Protein and Metabolic Syndrome according to the Fasting Glucose Level at Medical Checkups.].

Korean J Lab Med 2006 Dec;26(6):454-9

Korea Association of Health Promotion, Seoul, Korea.

Background: This study was performed to investigate the difference in high sensitivity C-reactive protein (hsCRP) and metabolic syndrome according to the fasting glucose level, especially between the groups of less than 100 mg/dL and 100-109 mg/dL, which were conventionally categorized into normal levels.

Methods: Those who underwent routine medical checkups aged above 20 (male, 3,221; female, 3,334) at a Health Promotion Center (Seoul, Korea) were divided into normal fasting glucose group I (glucose <100 mg/dL), normal fasting glucose group II (glucose, 100-109 mg/dL), impaired fasting glucose group, and diabetes mellitus group. The hsCRP, obesity index, blood pressure, total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] were compared among the groups. The hsCRP and the components of metabolic syndrome were compared.

Results: The hsCRP level, age, obesity index, blood pressure, total cholesterol and triglyceride significantly increased along with the increment in fasting glucose level in the 4 groups. The hsCRP had a positive correlation with the fasting glucose level, age, and systolic blood pressure, while it had a negative correlation with HDL-C. The metabolic syndrome was more common in the group with a higher level of glucose.

Conclusions: The group with glucose level of less than 110 mg/dL, conventionally categorized into normal range, needs to be subdivided into a group of 100-109 mg/dL and a group of less than 100 mg/dL. The former group seems to require more efforts to have the glucose level to be maintained under the level of 100 mg/dL.
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http://dx.doi.org/10.3343/kjlm.2006.26.6.454DOI Listing
December 2006

[Comparison of cardiovascular risk factors between normotension and prehypertension].

Korean J Lab Med 2007 Oct;27(5):377-81

Korea Association of Health Promotion, Seoul, Korea.

Background: The individuals with prehypertension are known to progress to hypertension, one of the risk factors of cardiovascular disease, more readily than the group of normal blood pressure. This study was performed to investigate the differences in the risk factors of cardiovascular disease between normotensive and prehypertensive groups, and to identify the determinants of prehypertension.

Methods: Normotensive (N=3,732) and prehypertensive individuals (N=676) were selected from the people who underwent routine medical checkups at the Health Promotion Center (Seoul, Korea). The age, body mass index (BMI), fasting blood glucose, total cholesterol, triglyceride, LDL-cholesterol (C), HDL-C, high sensitivity C-reactive protein (hsCRP), lipoprotein(a) [Lp(a)], and the number of white blood cell were compared between the normotensive and prehypertensive groups.

Results: The age, BMI, fasting blood glucose, triglyceride, and total cholesterol were higher in the males and females in the prehypertensive group than in the normotensive group. LDL-C, however, was higher and HDL-C was lower in the females in the prehypertensive group than in the normotensive group. The determinants of prehypertension were found to be age, BMI, and triglyceride.

Conclusions: There were differences in the risk factors of cardiovascular disease between the prehypertensive and normotensive groups.
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http://dx.doi.org/10.3343/kjlm.2007.27.5.377DOI Listing
October 2007
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