Epidemiology and Health

Original Articles

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

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Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

Citations

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

The association between glaucoma and all-cause mortality in middle-aged and elderly Chinese people: results from the China Health and Retirement Longitudinal Study: Xiaoxu Huang, Mengqiao Xu, Minwen Zhou, Wenjia Liu, Xiaohuan Zhao, Xiaodong Sun; Epidemiol Health. 2023;45:e2023066. Published online July 21, 2023; DOI: https://doi.org/10.4178/epih.e2023066

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This population-based, prospective cohort study investigated the association between glaucoma and mortality in older adults.
METHODS
Participants aged 45 years or older at baseline (47.9% male) were enrolled in 2011 for the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was observed during 7 years of follow-up. The baseline data were collected in the 2011 CHARLS, and participants were followed up for 7 years (until 2018). The risk of all-cause mortality was investigated using Cox proportional-hazards regression with age as the time scale, adjusting for significant risk factors and comorbid conditions.
RESULTS
Among the 14,803 participants included, the risk of all-cause death was significantly higher among people with glaucoma than among those without glaucoma, after adjustment for other confounders (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.04 to 2.03). In a subgroup analysis based on the mean age of death, among those who were 75 years and older (n=1,231), the risk of all-cause death was significantly higher in patients with glaucoma than in those without glaucoma (HR, 1.89; 95% CI, 1.24 to 1.89).
CONCLUSIONS
Participants with glaucoma had a higher risk of all-cause mortality, especially those aged 75 years and above. Our findings revealed potential mechanisms underlying an association between glaucoma and all-cause mortality. They also highlighted the importance of glaucoma management to prevent premature death in middle-aged and older adults.; Summary

Key Message
The present study suggests that glaucoma is associated with a higher rate of mortality in middle-aged and elderly people in China, especially for those aged 75 years and older. This study provides an important reference for the design and evaluation of clinical glaucoma treatment and the management of patients of different ages.

Direct indicators of social distancing effectiveness in COVID-19 outbreak stages: a correlational analysis of case contacts and population mobility in Korea: Sojin Choi, Chanhee Kim, Kun-Hee Park, Jong-Hun Kim; Epidemiol Health. 2023;45:e2023065. Published online July 10, 2023; DOI: https://doi.org/10.4178/epih.e2023065

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OBJECTIVES
The effectiveness of social distancing during the coronavirus disease 2019 (COVID-19) pandemic has been evaluated using the magnitude of changes in population mobility. This study aimed to investigate a direct indicator—namely, the number of close contacts per patient with confirmed COVID-19.
METHODS
From week 7, 2020 to week 43, 2021, population movement changes were calculated from the data of two Korean telecommunication companies and Google in accordance with social distancing stringency levels. Data on confirmed cases and their close contacts among residents of Gyeonggi Province, Korea were combined at each stage. Pearson correlation analysis was conducted to compare the movement data with the change in the number of contacts for each confirmed case calculated by stratification according to age group. The reference value of the population movement data was set using the value before mid-February 2020, considering each data’s characteristics.
RESULTS
In the age group of 18 or younger, the number of close contacts per confirmed case decreased or increased when the stringency level was strengthened or relaxed, respectively. In adults, the correlation was relatively low, with no correlation between the change in the number of close contacts per confirmed case and the change in population movement after the commencement of vaccination for adults.
CONCLUSIONS
The effectiveness of governmental social distancing policies against COVID-19 can be evaluated using the number of close contacts per confirmed case as a direct indicator, especially for each age group. Such an analysis can facilitate policy changes for specific groups.; Summary

Korean summary
1. 사회적 거리두기의 효과를 간접적인 자료인 이동통신사와 구글데이터를 이용하여 인구 이동성 변화의 크기를 평가하였고, 직접적인 자료인 역학조사서의 확진자 1인당 밀접 접촉자 수를 산출하여 비교 평가하였다. 2. 18세 이하 연령대는 사회적 거리두기의 강화 또는 완화 단계에 따라 확진자 1인당 밀접 접촉자 수가 민감하게 변동되었으나, 성인의 경우에는 덜 민감하게 변동되었다. 3. 역학조사서에 기반하여 시계열 자료로 재가공한 확진자 1인당 밀접 접촉자 수는 사회적 거리두기 정책의 효과를 평가하는 직접적인 평가 지표로 사용될 수 있기에 충분히 검토되어야 한다.

Key Message
1. The study assessed social distancing's effectiveness by analyzing population mobility changes through mobile operator and Google data. And it was also compared with the number of close contacts per confirmed COVID-19 case based on the epidemiological survey report. 2. Younger age groups were more influenced by the social distancing policy in close contacts per confirmed COVID-19 case than adults. 3. The study suggests using close contacts per confirmed COVID-19 case from the epidemiological survey report as a direct measure of social distancing policy effectiveness.

Exploring cognitive trajectories and their association with physical performance: evidence from the China Health and Retirement Longitudinal Study: Jingdong Suo, Xianlei Shen, Jinyu He, Haoran Sun, Yu Shi, Rongxin He, Xiao Zhang, Xijie Wang, Yuandi Xi, Wannian Liang; Epidemiol Health. 2023;45:e2023064. Published online July 9, 2023; DOI: https://doi.org/10.4178/epih.e2023064

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Abstract

OBJECTIVES
The long-term trends of cognitive function and its associations with physical performance remain unclear, particularly in Asian populations. The study objectives were to determine cognitive trajectories in middle-aged and elderly Chinese individuals, as well as to examine differences in physical performance across cognitive trajectory groups.

METHODS

Data were extracted from the China Health and Retirement Longitudinal Study. A total of 5,701 participants (47.7% male) with a mean age of 57.8 (standard deviation, 8.4) years at enrollment were included. A group-based trajectory model was used to identify cognitive trajectory groups for each sex. Grip strength, repeated chair stand, and standing balance tests were used to evaluate physical performance. An ordered logistic regression model was employed to analyze differences in physical performance across cognitive trajectory groups.

RESULTS

Three cognitive trajectory groups were identified for each sex: low, middle, and high. For both sexes, higher cognitive trajectory groups exhibited smaller declines with age. In the fully adjusted model, relative to the low trajectory group, the odds ratios (ORs) of better physical performance in the middle cognitive group were 1.37 (95% confidence interval [CI], 1.17 to 1.59; p<0.001) during follow-up and 1.40 (95% CI, 1.20 to 1.64; p<0.001) at the endpoint. The ORs in the high trajectory group were 1.94 (95% CI, 1.61 to 2.32; p<0.001) during follow-up and 2.04 (95% CI, 1.69 to 2.45; p<0.001) at the endpoint.

CONCLUSIONS

Cognitive function was better preserved in male participants and individuals with higher baseline cognitive function. A higher cognitive trajectory was associated with better physical performance over time.

Summary

Key Message
Three cognitive trajectory groups were identified for each sex in middle-aged and elderly Chinese people. Cognitive function was found to be better preserved in male participants and individuals with higher baseline cognitive function. Better cognitive trajectory was associated with better physical performance over time.

Citations

Citations to this article as recorded by

Mediation role of DNA methylation in association between handgrip strength and cognitive function in monozygotic twins
Jin Liu, Weijing Wang, Jia Luo, Haiping Duan, Chunsheng Xu, Xiaocao Tian, Shumin Chen, Lin Ge, Dongfeng Zhang
Journal of Human Genetics.2024;[Epub] CrossRef
Longitudinal trajectories of cognitive aging
Elena Lobo, Patricia Gracia-García, Antonio Lobo
Current Opinion in Psychiatry.2023;[Epub] CrossRef

Effects of multigrain rice and white rice on periodontitis: an analysis using data from the Korea National Health and Nutrition Examination Survey 2012-2015: Seung-Hee Ryu, Zi-lan Wang, Seon-Jip Kim, Hyun-Jae Cho; Epidemiol Health. 2023;45:e2023063. Published online July 3, 2023; DOI: https://doi.org/10.4178/epih.e2023063

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Abstract

OBJECTIVES
Numerous studies have investigated the efficacy of whole grains; however, research on multigrain remains limited. Grains exhibit combined positive effects against various diseases. The purpose of this study was to examine the impact of multigrain and white rice consumption on periodontitis.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Survey V-3 and VI, collected between 2012 and 2015, which included 12,450 patients (4,859 male and 7,591 female) aged 19-64 years. The World Health Organization’s Community Periodontal Index (CPI) was utilized to assess the presence of periodontitis, with periodontitis defined as a CPI index score of ≥3. Multivariable logistic regression analysis was performed after adjusting for potential confounding variables.

RESULTS

The group that consumed only multigrain rice was less likely to have periodontitis than the group that consumed only white rice (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.69 to 0.93). When stratified by sex, the risk of periodontitis demonstrated a 24% decrease in female who consumed only multigrain rice (OR, 0.76; 95% CI, 0.62 to 0.93). A similar result was observed in the age group of 40-64 years (OR, 0.84; 95% CI, 0.71 to 0.99). In the diabetes stratification model, the normal group that consumed only multigrain rice exhibited a 25% decrease in the odds of periodontitis (OR, 0.75; 95% CI, 0.62 to 0.91).

CONCLUSIONS

Our findings suggest that the prevalence of periodontitis may vary depending on the type of rice consumed.

Summary

Korean summary
본 연구에서는 우리나라의 대규모 자료를 이용하여 쌀 섭취 종류가 치주염 위험에 미치는 영향을 살펴보았다. 우리의 연구 결과는 잡곡밥을 매일 2회 이상 섭취하는 것이 흰쌀밥을 먹는 것보다 치주염 예방에 더 효과적이라는 것을 보여준다. 이러한 결과는 당뇨병이 있는 사람에 비해 건강한 사람, 남성보다는 여성, 40~64세에서 더 큰 예방 효과를 시사한다.

Key Message
In this study, we examined the impact of different types of rice consumption on the risk of periodontitis using large-scale data from Korea. The group that consumed only multigrain rice was less likely to have periodontitis than the group that consumed only white rice (odds ratio [OR]=0.80; 95% confidence interval [CI], 0.69–0.93). The risk of periodontitis was reduced by 24% in female who consumed only multigrain rice, 16% decrease in the 40–64 age group, and in the diabetic stratification model, the normal group who consumed only multigrain rice had a 25% decrease in periodontitis risk.

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Trends and Characteristics of Brown Rice Consumption among Adults in Japan: An Analysis of the National Health and Nutrition Surveys, 2012–2019
Nayu Ikeda, Miwa Yamaguchi, Nobuo Nishi
Nutrients.2024; 16(10): 1473. CrossRef

Food literacy and its relationship with food intake: a comparison between adults and older adults using 2021 Seoul Food Survey data: Seulgi Lee, Sohyun Park, Kirang Kim; Epidemiol Health. 2023;45:e2023062. Published online July 3, 2023; DOI: https://doi.org/10.4178/epih.e2023062

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Abstract

OBJECTIVES
This study was conducted to examine the differences in food literacy between adults and older adults and the association of food literacy with food group intake.

METHODS

In total, 4,039 participants from the 2021 Survey for Food Consumption in Seoul were included in this study. The intake of whole grains, high-protein foods, total vegetables, vegetables excluding kimchi and pickles, fresh fruits, and milk and dairy products was assessed using a simple food frequency questionnaire. Food literacy was measured using a food literacy measurement questionnaire.

RESULTS

With the exception of milk and dairy, adults had a significantly higher proportion of insufficient food intake than older adults (p<0.001). Both adults and older adults with sufficient food group consumption had higher food literacy scores. Notably, the difference in food literacy scores by level of food intake was highest for fresh fruits (p<0.001). After adjusting for confounding factors affecting food literacy scores, a higher score was associated with a lower probability of having insufficient food intake in all food groups for both adults and older adults. Specifically, those in the highest food literacy score quartile were less likely to have insufficient intake of vegetables (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.28 to 0.43) and fresh fruits (OR, 0.32; 95% CI, 0.24 to 0.43), compared to the lowest quartile.

CONCLUSIONS

Improving food literacy is an important factor for promoting healthy food intake in older adults as well as adults. Therefore, it is necessary to develop intervention programs to work toward this goal.

Summary

Korean summary
건강정보 이해능력(health literacy)은 노인에서 만성질환이나 인지능력과의 관련성이 보고되고 있으나 영양정보 이해능력(food literacy)에 대한 연구는 미비하다. 급변하는 식이 환경에서 식사 및 영양과 관련된 정보를 올바르게 이해하고 판단할 수 있는 영양정보 이해능력은 노인성 질환 예방에 중요하다. 본 연구에서 영양정보 이해능력과 식품군 섭취와의 상관성을 분석한 결과 영양정보 이해능력이 높은 노인이 건강한 식품 섭취 부족 위험이 낮았다. 특히 과일 섭취 부족 위험은 영양정보 이해능력이 높은 노인에서 뚜렷하게 낮았다. 국내 영양정보 이해능력 연구는 초기 단계로 주로 성인 대상으로 연구가 이루어져서 본 연구에서의 결과는 그 의의가 크며, 영양정보 이해능력 향상은 성인과 마찬가지로 노인에서도 건강한 식품 섭취를 위한 중요한 요인으로서 이를 위한 프로그램 개발이 필요할 것으로 사료된다.

Key Message
The study on food literacy among older adults in Korea is significant as previous research has mostly focused on adults. The results showed that older adults with higher food literacy score had lower risk of insufficient food intake as compared with those with lower food literacy score. Specifically, the risk of insufficient fresh fruits intake was the lowest among older adults with higher food literacy score. Therefore, improving food literacy is an important factor for promoting healthy food consumption among older adults.

Citations

Citations to this article as recorded by

Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults
Kentaro Murakami, Nana Shinozaki, Tsuyoshi Okuhara, Tracy A. McCaffrey, M. Barbara E. Livingstone
Appetite.2024; 196: 107281. CrossRef

Non-linear relationship between body mass index and self-rated health in older Korean adults: body image and sex considerations: Seok-Joon Yoon, Jin-Gyu Jung, Soon-Ki Ahn, Jong-Sung Kim, Jang-Hee Hong; Epidemiol Health. 2023;45:e2023061. Published online June 20, 2023; DOI: https://doi.org/10.4178/epih.e2023061

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The purpose of this study was to investigate the association between body mass index (BMI) and self-rated health (SRH) in older adults aged over 65 years while examining the influence of self-perceived body image (SBI) and sex.
METHODS
Raw data were obtained from the Korea Community Health Survey, which included BMI measurements of Koreans aged over 65 years (n=59,628). Non-linear relationships between BMI and SRH were analyzed separately for each sex using restricted cubic splines while controlling for SBI and other confounding variables.
RESULTS
Men showed a reverse J-shaped association, while women showed a J-shaped association between BMI and poor SRH. However, including SBI in the model changed this association for men to an inverted U-shape showing a negative direction, with the highest risk of poor SRH observed in the underweight to overweight range. For women, a nearly linear positive relationship was observed. Regardless of BMI, those who perceived their weight as not “exactly the right weight” had a higher risk of poor SRH than those who perceived their weight as “exactly the right weight” in both men and women. Older men who thought they were much too fat or too thin had similar highest risks of poor SRH, whereas older women who thought they were too thin had the highest risk of poor SRH.
CONCLUSIONS
The findings of this study emphasize the importance of considering sex and body image perceptions when assessing the relationship between BMI and SRH in older adults, especially in men.; Summary

Korean summary
자가 평가 건강 상태 (self-rated health, SRH)와 체질량지수는 각각 건강에 많은 관련이 있는 것으로 밝혀져 있다. 하지만 둘 사이의 관계는 연구마다 다양하게 나타나 있고, 노인들을 대상으로 한 연구도 많지 않다. 노인들은 본인들의 체중을 낮게 평가하는 경향이 있어 둘 사이 관계를 살펴볼 때 자기 인지 체형에 대한 고려가 필요하며, 성별에 따른 영향도 역시 고려해봐야 한다. 본 연구에서는 체질량지수로 파악한 비만의 정도에 관계없이 남성과 여성 모두에서 자기 인지 체형이 정상인 경우에 좋지 않은 SRH를 가질 위험성이 낮았다. 남성에서는 체질량지수와 SRH의 관계가 불분명하게 나타났고 자기 인지 체형이 더 중요한 요인으로 보인다. 한편 여성에서는 체질량지수가 증가함에 따라 SRH도 나빠지는 경향을 보였다. 이에 노인들의 비만과 관련된 교육에 있어서는 자가 인지 체형과 체질량지수를 이용한 비만의 기준에 대해 포함하는 것이 중요하다.

Key Message
Previous research has not fully explored the relationship between BMI, SBI, and SRH in older adults. Our study, using big data, found that the relationships differed between men and women. Those who perceived their weight as ‘exactly the right weight’ had the lowest risk of poor SRH. In men, BMI had a weak effect on SRH, while in women, the risk of poor SRH increased as BMI increased. We recommend that healthcare providers should educate older adults about BMI standards and help them identify their SBI for effective obesity counseling.

Cancer incidence among male construction workers in Korea: a standardized incidence ratio analysis, 2009-2015: Soonsu Shin, Woo-Ri Lee, Jin-Ha Yoon, Wanhyung Lee; Epidemiol Health. 2023;45:e2023060. Published online June 19, 2023; DOI: https://doi.org/10.4178/epih.e2023060

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Construction workers face an elevated risk for several types of cancer. Nevertheless, there is a lack of large-scale epidemiological studies examining the risk of all cancers in construction workers. This study aimed to investigate the risk of various cancers in male construction workers using the Korean National Health Insurance Service (NHIS) database.
METHODS
We used data from the NHIS database from 2009 to 2015. Construction workers were identified using the Korean Standard Industrial Classification code. We calculated the age-standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for cancer occurrence in male construction workers compared to all male workers.
RESULTS
Compared to all male workers, the SIRs for esophageal cancer (SIR, 1.24; 95% CI, 1.07 to 1.42) and malignant neoplasms of the liver and intrahepatic bile ducts (SIR, 1.18; 95% CI, 1.13 to 1.24) were significantly higher in male construction workers. The SIRs for malignant neoplasms of the urinary tract (SIR, 1.19; 95% CI, 1.05 to 1.35) and non-Hodgkin lymphoma (SIR, 1.21; 95% CI, 1.02 to 1.43) were significantly elevated in building construction workers. The SIR for malignant neoplasms of the trachea, bronchus, and lung (SIR, 1.16; 95% CI, 1.03 to 1.29) was significantly higher in heavy and civil engineering workers.
CONCLUSIONS
Male construction workers have an increased risk for esophageal cancer, liver cancer, lung cancer, and non-Hodgkin’s cancer. Our results indicate that tailored strategies for cancer prevention should be developed for construction workers.; Summary

Korean summary
건설 노동자는 작업환경에서 수많은 유해 인자에 노출되지만, 건설 노동자에서 암의 연령 표준화 발생비를 조사한 역학 연구는 부족하다. 이번 연구에서 식도암과 간담도암의 연령 표준화 발생비는 전체 남성 근로자에 비해 남성 건설 근로자에게서 증가하였다. 이러한 결과는 건설 근로자에서 암 위험이 증가했음을 나타내며, 이 직업군에서 암 예방을 위한 추가 연구와 정책이 필요함을 의미한다.

Key Message
Despite the exposure of construction workers to numerous hazardous substances at workplace, epidemiological studies investigating the risk of all cancers in this occupational group are lacking. In this study, the age-standardized incidence ratio of esophageal cancer and hepatobiliary cancers increased in male construction workers compared to all male workers. Our results underscore the increased several cancer risks faced by male construction workers, necessitating the development of tailored strategies for cancer prevention in this occupational group.

Regional differences in the associations of diet quality, obesity, and possible sarcopenia using the seventh Korea National Health and Nutrition Examination Survey (2016-2018): Hyeongyeong Lee, Sohyun Park; Epidemiol Health. 2023;45:e2023059. Published online June 19, 2023; DOI: https://doi.org/10.4178/epih.e2023059

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Abstract PDF

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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Association of Dietary Protein Sources and Their Adequacy, Body Composition and Risk of Sarcopenic Obesity in South Korean Populations: A Cross-Sectional Study
Jieun Kim, Kyoungsik Jeong, Sueun Lim, Siwoo Lee, Younghwa Baek
Metabolites.2024; 14(2): 130. CrossRef
Association of Combining Diet and Physical Activity on Sarcopenia and Obesity in Elderly Koreans with Diabetes
Sohye Kim, Soojeong Kim, Kyung Hee Hong
Nutrients.2024; 16(7): 964. CrossRef
Longitudinal association between soft drink consumption and handgrip strength in adults: a prospective analysis from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort study
Tongfeng Liu, Shengxin Quan, Ge Meng, Hongmei Wu, Yeqing Gu, Shunming Zhang, Xuena Wang, Juanjuan Zhang, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Zhongze Fang, Kaijun Niu
British Journal of Nutrition.2024; 131(12): 1997. CrossRef
Sex-Specific Effects of Dietary Factors on Sarcopenic Obesity in Korean Elderly: A Nationwide Cross-Sectional Study
Soojeong Kim, Kyung Hee Hong
Nutrients.2024; 16(8): 1175. CrossRef

Lack of compensation for COVID-19-related overtime work and its association with burnout among EMS providers in Korea: Ji-Hwan Kim, Jaehong Yoon, Soo Jin Kim, Ja Young Kim, Jinwook Bahk, Seung-Sup Kim; Epidemiol Health. 2023;45:e2023058. Published online June 15, 2023; DOI: https://doi.org/10.4178/epih.e2023058

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout among emergency medical service (EMS) providers in Seoul, Korea.

METHODS

We conducted a cross-sectional survey of 693 EMS providers in Seoul, Korea. Participants were classified into 3 groups according to their experience of coronavirus disease 2019 (COVID-19)-related overtime work and LCCOW: (1) “did not experience,” (2) “experienced and was compensated,” and (3) “experienced and was not compensated.” Burnout was measured using the Korean version of the Copenhagen Burnout Inventory, which has 3 subdomains: personal burnout (PB), work-related burnout (WRB), and citizen-related burnout (CRB). Multiple linear regression was applied to examine whether LCCOW was associated with burnout after adjusting for potential confounders.

RESULTS

In total, 74.2% of participants experienced COVID-19-related overtime work, and 14.6% of those who worked overtime experienced LCCOW. COVID-19-related overtime work showed a statistically non-significant association with burnout. However, the association differed by LCCOW. Compared to the “did not experience” group, the “experienced and was not compensated” group was associated with PB (β=10.519; 95% confidence interval [CI], 3.455 to 17.584), WRB (β=10.339; 95% CI, 3.398 to 17.280), and CRB (β=12.290; 95% CI, 6.900 to 17.680), whereas no association was observed for the “experienced and was compensated” group. Furthermore, an analysis restricted to EMS providers who worked overtime due to COVID-19 showed that LCCOW was associated with PB (β=7.970; 95% CI, 1.064 to 14.876), WRB (β=7.276; 95% CI, 0.270 to 14.283), and CRB (β=10.000; 95% CI, 3.435 to 16.565).

CONCLUSIONS

This study suggests that LCCOW could be critical in worsening burnout among EMS providers who worked overtime due to COVID-19.

Summary

Korean summary
본 연구는 2021년에 진행된 서울시 구급대원 693 명의 설문조사 자료를 이용해서 COVID-19으로 인한 초과근무 경험에 대한 보상 부족과 번아웃의 연관성을 살펴보았다. 초과근무 경험이 없었던 구급대원의 번아웃 점수와 비교할 때, 초과근무 경험이 있고 항상 적절한 보상을 받은 구급대원의 번아웃 점수는 통계적으로 유의한 차이가 관찰되지 않았지만, 초과근무 경험이 있고 적절한 보상을 받지 못한 적이 있는 구급대원의 번아웃 점수는 통계적으로 유의하게 높게 나타났다. 초과근무를 경험한 구급대원으로 한정한 분석에서는 적절한 보상을 항상 받은 구급대원에 비해서 적절한 보상을 받지 못한 적이 있는 구급대원의 번아웃 점수가 통계적으로 유의하게 높았다.

Key Message
Using a survey of 693 EMS providers in Seoul, Korea, we examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout. Higher scores of burnouts were observed among those with LCCOW, but not among those without LCCOW, compared to the EMS providers who did not experience overtime work due to COVID-19. Furthermore, in the analysis restricted to EMS providers who had worked overtime due to COVID-19, LCCOW was associated with burnout.

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Effects of Post-COVID-19 Syndrome on Quality of Life Among Airline Crew
Jung-Ha Kim, Seunghye Choi
Workplace Health & Safety.2024;[Epub] CrossRef

Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies: Yoojin Park, Euncheol Son, Young June Choe, Cho Ryok Kang, Sangmi Roh, Young Ok Hwang, Sung-il Cho, Jihwan Bang; Epidemiol Health. 2023;45:e2023057. Published online June 9, 2023; DOI: https://doi.org/10.4178/epih.e2023057

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Abstract Summary PDF

Abstract

OBJECTIVES
Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea.

METHODS

The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022).

RESULTS

We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF’s isolation wards.

CONCLUSIONS

This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Summary

Korean summary
서울시 CRE 감시체계를 통해 2022년 한 요양병원의 집단발생을 인지하였다. 현장역학조사를 실시하여 18명의 집단발생 사례(1명 간병인, 17명 입원환자)와 12명의 산발적인 사례를 확인하였고 감염관리 컨설팅을 통해 유행을 확산을 방지하는 중재를 시행하였다.

Key Message
The Seoul Metropolitan Government surveillance system identified an outbreak of carbapenem-resistant Enterobacterales (CRE) in a long-term care facility (LTCF) in 2022. We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE. In the current study, we could demonstrate that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

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Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study
Jung-Hwan Lee, Jongbeom Shin, Soo-Hyun Park, Boram Cha, Ji-Taek Hong, Don-Haeng Lee, Kye Sook Kwon
Microorganisms.2023; 11(12): 2970. CrossRef

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020): Jeong Min Yang, Jae Hyun Kim; Epidemiol Health. 2023;45:e2023056. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023056

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).
METHODS
After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.
RESULTS
The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.
CONCLUSIONS
There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.; Summary

Korean summary
본 연구는 제 1차~8차 한국고령화연구패널을 활용하여 중고령층의 근로활동 궤적과 사망 간의 연관성을 분석하였다. 근로활동 궤적을 파악하기 위하여 집단중심추세모형을 활용하였으며, 총 5가지의 근로활동 궤적을 도출하였다. 도출된 궤적을 바탕으로 카이제곱 검정과 콕스 비례위험모형을 통해 근로활동 궤적과 사망률 간의 연관성을 분석하였다. 연구 결과 화이트칼라에서 실업으로 변화하는 집단과 블루칼라에서 실업으로 변화하는 두 집단에서 사망 간의 유의한 결과를 발견하였으며, 특히, 65세 이상 집단과 남성 집단에서 강한 연관성이 존재하였다. 본 연구 결과를 바탕으로 근로활동 변화로 인해 사망 위험이 증가하는 취약 집단을 위한 정책적, 제도적 방안의 기초자료로서 활용되기를 기대한다.

Key Message
Compared with the sustained White Collar (WC) trajectory group, changed WC to job loss trajectory group and changed BC to job loss trajectory had higher mortality. The over 65 years group and the male group, a strong association between change in employment status and mortality was observed. This study emphasizes the need for policy and institutional measures to reduce mortality for vulnerable groups who are at increased risk of death due to changes in employment status.

Association of blood pressure measurements in sitting, supine, and standing positions with the 10-year risk of mortality in Korean adults: Inkyung Baik, Nan Hee Kim, Seong Hwan Kim, Chol Shin; Epidemiol Health. 2023;45:e2023055. Published online June 8, 2023; DOI: https://doi.org/10.4178/epih.e2023055

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk.

METHODS

This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: (1) normal, SBP <120 mmHg and DBP <80 mmHg; (2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; (3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and (4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression.

RESULTS

Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals, [CIs]) were 1.36 (95% CI, 1.06 to 1.75) and 1.59 (95% CI, 1.06 to 2.39) for grade 1 HTN and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years.

CONCLUSIONS

BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.

Summary

Korean summary
본 역학 연구는 한국 성인 8,901명을 연구대상자로 하여 기초조사에서 세가지 자세, 즉 앉은 자세, 누운 자세, 일어선 자세에서 혈압을 측정하고, 이후 10년 동안의 사망 여부를 추적조사하여, 측정 자세에 따른 혈압과 사망 위험과의 관련성을 분석하였다. 그 결과, 누운 자세에서 측정된 고혈압(기준: 수축기 혈압이 140 mmHg 이상 혹은 이완기 혈압이 90 mmHg 이상)인 사람은 정상 혈압(기준: 수축기 혈압이 120 mmHg 미만이고 이완기 혈압이 80 mmHg 미만)인 사람에 비해 36%(1단계 고혈압) 혹은 59%(2단계 고혈압) 가량 총 사망 위험이 유의적으로 증가하는 것으로 나타났다. 이에 비해, 앉은 자세 및 일어선 자세에서 측정, 정의된 고혈압은 총 사망 위험을 증가시켰지만 유의적인 결과를 나타내지 못했다. 추후 연구에서 재확인이 필요하지만, 본 연구 결과가 시사하는 바는 앉은 자세나 일어선 자세보다 누운 자세에서 측정하는 혈압이 총 사망 위험을 더 잘 예측하므로, 고혈압 진단 외의 추가적인 활용 가능성이 있는 것으로 평가된다.

Key Message
The current epidemiological study revealed that blood pressure measured in a supine position could predict all-cause mortality and cardiovascular mortality better than blood pressure measured in a sitting or standing position. As a result, blood pressure measurements in a supine position may be useful in assessing mortality risk.

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Safety of midodrine in patients with heart failure with reduced ejection fraction: a retrospective cohort study
Ming-Ju Wu, Cheng-Hsu Chen, Shang-Feng Tsai
Frontiers in Pharmacology.2024;[Epub] CrossRef

Barriers to COVID-19 vaccine surveillance: the issue of under-reporting adverse events: Yunha Noh, Hwa Yeon Ko, Ju Hwan Kim, Dongwon Yoon, Young June Choe, Seung-Ah Choe, Jaehun Jung, Ju-Young Shin; Epidemiol Health. 2023;45:e2023054. Published online June 7, 2023; DOI: https://doi.org/10.4178/epih.e2023054

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study investigated the reporting rates of adverse events following immunization (AEFIs) to the spontaneous reporting system (SRS) and its predictors among individuals with AEFIs after coronavirus disease 2019 (COVID-19) vaccination.

METHODS

A cross-sectional, web-based survey was conducted from December 2, 2021 to December 20, 2021, recruiting participants >14 days after completion of a primary COVID-19 vaccination series. Reporting rates were calculated by dividing the number of participants who reported AEFIs to the SRS by the total number of participants who experienced AEFIs. We estimated adjusted odds ratios (aORs) using multivariate logistic regression to determine factors associated with spontaneous AEFIs reporting.

RESULTS

Among 2,993 participants, 90.9% and 88.7% experienced AEFIs after the first and second vaccine doses, respectively (reporting rates, 11.6 and 12.7%). Furthermore, 3.3% and 4.2% suffered moderate to severe AEFIs, respectively (reporting rates, 50.5 and 50.0%). Spontaneous reporting was more prevalent in female (aOR, 1.54; 95% confidence interval [CI], 1.31 to 1.81); those with moderate to severe AEFIs (aOR, 5.47; 95% CI, 4.45 to 6.73), comorbidities (aOR, 1.31; 95% CI, 1.09 to 1.57), a history of severe allergic reactions (aOR, 2.02; 95% CI, 1.47 to 2.77); and those who had received mRNA-1273 (aOR, 1.25; 95% CI, 1.05 to 1.49) or ChAdOx1 (aOR, 1.62; 95% CI, 1.15 to 2.30) vaccines versus BNT162b2. Reporting was less likely in older individuals (aOR, 0.98; 95% CI, 0.98 to 0.99 per 1-year age increment).

CONCLUSIONS

Spontaneous reporting of AEFIs after COVID-19 vaccination was associated with younger age, female sex, moderate to severe AEFIs, comorbidities, history of allergic reactions, and vaccine type. AEFIs under-reporting should be considered when delivering information to the community and in public health decision-making.

Summary

Korean summary
본 연구는 국내 19-49세 성인을 대상으로, 코로나19 예방 백신 접종 후 이상반응 경험에 대한 자발적 보고율을 조사하고, 자발적 보고와 관련된 요인을 파악하고자 하였다. 2021년 12월 2일부터 20일까지 온라인 설문조사를 통하여 자료를 수집하였으며, 연구대상자는 코로나19 예방 백신의 기초접종을 완료한 후 2주 경과한 19-49세 성인으로, 전국 대표성을 확보하기 위해 성별, 연령, 지역별로 층화하여 모집하였다. 이상반응 자발적 보고율은 1차 접종과 2차 접종 후 각각 약 11.6%, 12.7%로 나타났으며, 중등도에서 중증의 이상반응에 대한 자발적 보고율은 약 50.5%, 50.0%로 나타났다. 이상반응 자발적 보고율 관련 영향요인으로는 젊은 연령층, 여성, 이상반응의 중증도, 동반질환, 알러지 반응 이력, 기초접종 백신 종류가 포함되었다.

Key Message
Spontaneous reporting rates of adverse events following immunization (AEFIs) against coronavirus disease 2019 (COVID-19) were low, at around 12 % of any AEFIs and 50 % of moderate-to-severe AEFIs. Younger age, female sex, severe AEFIs, comorbidities, history of allergic reactions, and the type of COVID-19 vaccine were associated with the AEFIs reporting.

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The effect of covid vaccination on menstruation and attitude to the vaccine among Indian women – Results of a prospective survey
Anbukkani Subbian, Jeevithan Shanmugam, Uma Ram
Indian Journal of Obstetrics and Gynecology Research.2024; 11(1): 70. CrossRef

Prediction of the 10-year risk of atherosclerotic cardiovascular disease in the Korean population: Sangwoo Park, Yong-Giun Kim, Soe Hee Ann, Young-Rak Cho, Shin-Jae Kim, Seungbong Han, Gyung-Min Park; Epidemiol Health. 2023;45:e2023052. Published online May 12, 2023; DOI: https://doi.org/10.4178/epih.e2023052

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Proper risk assessment is important for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, no validated risk prediction tools are currently in use in Korea. This study sought to develop a 10-year risk prediction model for incident ASCVD.
METHODS
Using the National Sample Cohort of Korea, 325,934 subjects aged 20-80 years without previous ASCVD were enrolled. ASCVD was defined as a composite of cardiovascular death, myocardial infarction, and stroke. The Korean atherosclerotic cardiovas cular disease risk prediction (K-CVD) model was developed separately for men and women using the development dataset and validated in the validation dataset. Furthermore, the model performance was compared with the Framingham risk score (FRS) and pooled cohort equation (PCE).
RESULTS
Over 10 years of follow-up, 4,367 ASCVD events occurred in the overall population. The predictors of ASCVD included in the model were age, smoking status, diabetes, systolic blood pressure, lipid profiles, urine protein, and lipid-lowering and blood pressure-lowering treatment. The K-CVD model had good discrimination and strong calibration in the validation dataset (time-dependent area under the curve=0.846; 95% confidence interval, 0.828 to 0.864; calibration χ<sup>2</sup>=4.73, goodness-of-fit p=0.32). Compared with our model, both FRS and PCE showed worse calibration, overestimating ASCVD risk in the Korean population.
CONCLUSIONS
Through a nationwide cohort, we developed a model for 10-year ASCVD risk prediction in a contemporary Korean population. The K-CVD model showed excellent discrimination and calibration in Koreans. This population-based risk prediction tool would help to appropriately identify high-risk individuals and provide preventive interventions in the Korean population.; Summary

Korean summary
국민건강보험공단 표본 코호트를 이용하여, 한국인 인구에서 10년 죽상경화성 심혈관질환 위험 예측 (K-CVD) 모델을 개발하였다. 한국인 인구집단을 기반으로 개발된 K-CVD 모델은 한국 인구집단에서 판별력과 교정력 측면에서 우수한 성능을 보여주었다. K-CVD 모델은 한국인 집단에서 심혈관질환의 고위험군을 적절하게 식별하고, 예방적 중재를 시행하는데 있어 도움이 될 것으로 생각된다.

Key Message
Using a nationwide cohort, the Korean ASCVD risk prediction (K-CVD) model was developed for 10-year ASCVD risk prediction. The K-CVD model showed excellent discrimination and calibration in a contemporary Korean population. This population-based risk prediction tool would help to appropriately identify high-risk individuals and provide preventive interventions in the Korean population.

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