Epidemiology and Health

Volume 46; 2024

Original Articles

Association of healthy lifestyle factors with the risk of hypertension, dyslipidemia, and their comorbidity in Korea: results from the Korea National Health and Nutrition Examination Survey 2019-2021: Ji-Sook Kong, Mi Kyung Kim; Epidemiol Health. 2024;46:e2024049. Published online May 1, 2024; DOI: https://doi.org/10.4178/epih.e2024049

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Abstract Summary PDF: Abstract
OBJECTIVES
We investigated the association of individual healthy lifestyle factors (HLFs) and their combined healthy lifestyle score (HLS) with hypertension and/or dyslipidemia.
METHODS
We analyzed data from 10,693 adults aged ≥19 from the 2019 to 2021 Korea National Health and Nutrition Examination Survey. HLS was evaluated based on smoking status, alcohol consumption, body mass index (BMI), diet, and physical activity. Using logistic regression models, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) to evaluate the associations of HLFs and HLS with hypertension, dyslipidemia, and their comorbidity.
RESULTS
The prevalence of hypertension alone, dyslipidemia alone, and their comorbidity was 8.7%, 24.6%, and 15.0%, respectively. Multivariable models showed an inverse association of hypertension (OR, 0.37; 95% CI, 0.30 to 0.46) and dyslipidemia (OR, 0.36; 95% CI, 0.32 to 0.41) with healthy BMI. Hypertension was inversely associated with healthy alcohol consumption (OR, 0.46; 95% CI, 0.35 to 0.61) and diet (OR, 0.79; 95% CI, 0.63 to 0.99), whereas dyslipidemia was inversely associated with non-smoking (OR, 0.51; 95% CI, 0.43 to 0.60). Physical activity was inversely associated with their comorbidity (OR, 0.69; 95% CI, 0.56 to 0.85). Adherence to HLS was associated with significantly lower odds of hypertension (81%), dyslipidemia (66%), and their conditions (89%) (all ptrend<0.001). Stratified analyses consistently showed inverse associations between HLS and hypertension and/or dyslipidemia independently of demographic factors (pinteractions>0.05).
CONCLUSIONS
HLFs were associated with lower risk for hypertension and/or dyslipidemia. Obesity may contribute significantly to the risk of these conditions, while relevant HLFs for individual chronic diseases may vary significantly.; Summary

Korean summary
건강한 생활 습관 요인(HLFs)의 개별 구성 요인들은 고혈압 및 이상지질혈증의 동반 위험과 각각의 상태와 음의 연관성을 보였다. 다양한 HLFs 중에서 BMI 상태가 중요한 요인으로 확인되었지만, 개별 만성 질환에 대한 관련 HLFs는 상당히 다를 수 있다. 또한, 명확한 용량-반응 관계가 관찰되어, 더 HLFs를 준수할수록 고혈압, 이상지질혈증 및 그들의 동반 가능성이 유의미하게 감소하는 것으로 나타났다.

Key Message
Individual components of healthy lifestyle factors (HLFs) were inversely associated with the risk of comorbid hypertension and dyslipidemia, as well as with each condition. Among the various HLFs, BMI status was identified as a significant factor, while relevant HLFs for individual chronic diseases may vary significantly. Additionally, clear dose-response associations were observed, indicating that adherence to more HLFs was significantly associated with decreasing odds of hypertension, dyslipidemia, and their comorbidity.

Causal effect of serum matrix metalloproteinase levels on venous thromboembolism: a Mendelian randomization study: Deheng Han, Fangcong Yu, Liangrong Zheng; Epidemiol Health. 2024;46:e2024046. Published online April 24, 2024; DOI: https://doi.org/10.4178/epih.e2024046

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Abstract PDF: Abstract
OBJECTIVES
Serum matrix metalloproteinase (MMP) levels are associated with cardiovascular diseases. However, the causal associations between serum levels of specific MMPs and venous thromboembolism (VTE) remain unclear. The present study sought to explore the causal relationship between serum MMP levels and VTE by using the Mendelian randomization (MR) method.
METHODS
In this study 2-sample MR study, the exposure data on serum MMP levels were derived from genome-wide association studies involving 21,758 individuals from 13 cohorts of European descent. The outcome data on VTE, including deep vein thrombosis and pulmonary embolism, were derived from the FinnGen research project. The primary method used was the inverse-variance weighting method. The MR-Egger intercept test and the Cochran Q test were used to evaluate pleiotropy and heterogeneity.
RESULTS
Using the inverse-variance weighting method, higher serum MMP-12 levels were found to be associated with an increased risk of VTE (odds ratio, 1.04; 95% confidence interval, 1.01 to 1.07; p=0.001). Moreover, there was a weak association between the levels of certain MMPs and VTE. Sensitivity analyses revealed no significant heterogeneity and pleiotropy in our study, and the Steiger directionality test did not reveal a significant reverse causation association.
CONCLUSIONS
There is a causal association between MMP-12 levels and VTE, which may have substantial implications for the diagnostic and therapeutic strategies used for VTE.; Summary

Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey: Sarang Jeong, Jin-Young Jeong, Sohyun Park; Epidemiol Health. 2024;46:e2024045. Published online April 16, 2024; DOI: https://doi.org/10.4178/epih.e2024045

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Abstract Summary PDF: Abstract
OBJECTIVES
Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to socio-demographic factors.
METHODS
This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th-8th Korea National Health and Nutrition Examination Survey (2018-2021).
RESULTS
In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among female, with an odds ratio of 1.42 (95% confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various socio-demographic factors regarding changes in food sufficiency during the COVID-19 period.
CONCLUSIONS
During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.; Summary

Korean summary
- 본 연구는 COVID-19 팬데믹 동안 도시와 농촌 지역의 성인들 사이에서 식품 충분성의 변화를 조사하고, 이 변화를 사회인구학적 요인에 따라 분석하였다. - 연구 결과, 코로나19 기간 동안 도시 지역의 다양한 인구통계학적 하위 그룹에서 식품 충분성이 크게 증가했으며, 농촌 지역에서는 여성들을 제외하고는 유의미한 변화가 나타나지 않았다. - 본 연구는 향후 팬데믹 대비를 위한 식품 충분성 정책을 개발할 때 인구통계학적 요인과 지역적 차이를 고려하는 것이 중요하며, 특히 농촌 지역에서의 필요성을 강조한다.

Key Message
- This study examined changes in food sufficiency among adults in urban and rural areas during the COVID-19 pandemic, focusing on socio-demographic factors. - Findings revealed that food sufficiency significantly increased in urban areas across various demographic subgroups during the COVID-19 period, while rural areas showed no significant overall change, except for an increase among women. - The study highlights the importance of considering socio-demographic factors and regional differences, particularly the need for targeted food assistance programs in rural areas, for future pandemic preparedness.

Special Article

Nutrition survey methods and food composition database update of the Korean Genome and Epidemiology Study: Seon-Joo Park, Jieun Lyu, Kyoungho Lee, Hae-Jeung Lee, Hyun-Young Park; Epidemiol Health. 2024;46:e2024042. Published online April 2, 2024; DOI: https://doi.org/10.4178/epih.e2024042

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Abstract Summary PDF: Abstract
This study presents the nutrition survey methods and the updated food composition database for the Korean Genome and Epidemiology Study (KoGES). The KoGES, which is the largest and longest cohort study in Korea, aims to identify genetic and environmental factors associated with chronic diseases. This study has collected dietary data using a validated semi-quantitative food frequency questionnaire and/or the 24-hour recall method. However, these dietary survey methods use different food composition databases, and their nutritional values are out of date. Therefore, it became necessary to update the food composition database by revising nutrient analysis values to reflect improvements in the performance of food ingredient analysis equipment, revising international values to analysis values of Korean agricultural products, adjusting nutrient units, and adding newly reported nutrients related to chronic diseases. For this purpose, we integrated the different food composition databases used in each nutrition survey, updated 23 nutrients, and expanded 48 new nutrients for 3,648 food items using the latest reliable food composition databases published by national and international institutions. This revised food composition database may help to clarify the relationship between various nutrients and chronic diseases. It could serve as a valuable resource for nutritional, epidemiological, and genomic research and provide a basis for determining public health policies.; Summary

Korean summary
한국인유전체역학조사사업은 우리나라에서 가장 크고 오래된 코호트로 만성질환과 영양과의 관련성을 밝히기 위하여 사용되고 있다. 이 논문에서는 영양조사에 대한 자세한 방법론과 현재 공개하고 있는 23개 영양소의 업데이트 및 48개 새로운 영양소의 확대에 대한 내용을 소개하였다. 이러한 개선을 통해 KoGES 영양 데이터의 활용도가 더욱 높아질 것으로 기대된다.

Key Message
The Korean Genome and Epidemiology Study (KoGES) is the largest and longest-running cohort study in South Korea aimed at identifying the relationship between chronic diseases and nutrient intake. This paper provides a detailed methods of the nutritional surveys and introduces updates to the existing 23 nutrients and the addition of 48 new nutrients. These enhancements are expected to significantly increase the utility of the KoGES nutritional data.

Original Articles

Association of decreased estimated glomerular filtration rate with lung cancer risk in the Korean population: Soonsu Shin, Min-Ho Kim, Chang-Mo Oh, Hyejin Chun, Eunhee Ha, Hyo Choon Lee, Seong Ho Moon, Dong-Young Lee, Dosang Cho, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo; Epidemiol Health. 2024;46:e2024041. Published online March 20, 2024; DOI: https://doi.org/10.4178/epih.e2024041

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Abstract Summary PDF: Abstract
OBJECTIVES
Inconsistent results are available regarding the association between low estimated glomerular filtration rate (eGFR) and lung cancer risk. We aimed to explore the risk of lung cancer according to eGFR category in the Korean population.
METHODS
We included 358,293 adults who underwent health checkups between 2009 and 2010, utilizing data from the National Health Insurance Service-National Sample Cohort. Participants were categorized into 3 groups based on their baseline eGFR, as determined using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR ≥90 mL/min/1.73 m2), group 2 (eGFR ≥60 to <90 mL/min/1.73 m2), and group 3 (eGFR <60 mL/min/1.73 m2). Incidences of lung cancer were identified using the corresponding codes from the International Classification of Diseases, 10th revision. Multivariate Cox proportional hazard models were employed to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence up to 2019.
RESULTS
In multivariate analysis, group 2 exhibited a 26% higher risk of developing lung cancer than group 1 (HR, 1.26; 95% CI, 1.19 to 1.35). Furthermore, group 3 demonstrated a 72% elevated risk of lung cancer relative to group 1 (HR, 1.72; 95% CI, 1.58 to 1.89). Among participants with dipstick proteinuria of 2+ or greater, group 3 faced a significantly higher risk of lung cancer than group 1 (HR, 2.93; 95% CI, 1.37 to 6.24).
CONCLUSIONS
Low eGFR was significantly associated with increased lung cancer risk within the Korean population. A particularly robust association was observed in individuals with severe proteinuria, emphasizing the need for further investigation.; Summary

Korean summary
이번 연구에서는 한국인 인구집단에서 단백뇨와 동반된 낮은 사구체 여과율이 페암의 발생 위험을 증가시켰다. 이는 신장기능의 저하가 폐암의 위험을 증가시킬 수 있음을 시사한다. 신장기능이 저하된 환자들의 면밀한 추적관찰이 필요할 수 있다.

Key Message
Our research found that lower estimated glomerular filtration rate with proteinuria increased the risk of lung cancer in a Korean population. These findings suggest that decreased kidney function may increase the risk of lung cancer, indicating the need for careful observation of patients with impaired kidney function.

Effect of the human papillomavirus vaccine on the risk of genital warts: a nationwide cohort study of Korean adolescent girls: Jaeyoung Cho, Eun Mi Kim, Jihye Kim, Ju-Young Shin, Eui Hyeok Kim, Jong Heon Park, Seunghyun Lewis Kwon, Geun-Yong Kwon, Soon-Ae Shin, Jaiyong Kim; Epidemiol Health. 2024;46:e2024040. Published online March 18, 2024; DOI: https://doi.org/10.4178/epih.e2024040

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Abstract Summary PDF: Abstract
OBJECTIVES
The purpose of this study was to assess the effectiveness of human papillomavirus (HPV) vaccination administered to adolescent girls through Korea’s National Immunization Program.
METHODS
This retrospective cohort study included patients who were 12-13 years old, whether vaccinated or unvaccinated, between July 2016 and December 2017. The incidence of genital warts (GWs) was monitored through 2021. Time-stratified hazard ratios (HRs) were estimated, adjusting for birth year, socioeconomic status, and the level of urbanization of the region, and were presented with 95% confidence intervals (CIs). Data were sourced from the Immunization Registry Integration System, linked with the National Health Information Database.
RESULTS
The study included 332,062 adolescent girls, with an average follow-up period of approximately 4.6 years. Except for the first year, the HRs for the vaccinated group were lower than those for the unvaccinated group. The HRs for specific cut-off years were as follows: year 2, 0.62 (95% CI, 0.31 to 1.13); year 3, 0.58 (95% CI, 0.35 to 0.96); and year 4 and beyond, 0.39 (95% CI, 0.28 to 0.52).
CONCLUSIONS
Our findings indicate that HPV vaccination was associated with a reduction in the risk of GWs among adolescent girls. Notably, this reduction became significant as the incidence of GWs increased with age.; Summary

Korean summary
이 연구는 후향적 코호트 연구로써, HPV 예방접종이 한국의 여자 청소년에서 생식기사마귀 질환의 위험을 감소시키는 것과 연관성이 있다는 것을 보여주었다. 따라서 단기적으로 한국의 국가예방접종 사업은 생식기사마귀 질환에 있어 효과가 있었다고 볼 수 있다. 향후에는 전암성 병변 또는 암 등과 같은 심각한 질환에 대한 백신의 영향을 확인할 필요가 있다.

Key Message
In this retrospective cohort study, our results demonstrated that HPV vaccination is associated with a reduction in the risk of GWs among adolescent girls. In the short term, the NIP of Korea can be considered effective in providing protection against GWs. Future studies need to analyze the impact of vaccines on more serious diseases such as precancerous lesions or cancer.

Unraveling trends in schistosomiasis: deep learning insights into national control programs in China: Qing Su, Cici Xi Chen Bauer, Robert Bergquist, Zhiguo Cao, Fenghua Gao, Zhijie Zhang, Yi Hu; Epidemiol Health. 2024;46:e2024039. Published online March 13, 2024; DOI: https://doi.org/10.4178/epih.e2024039

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Abstract PDF: Abstract
OBJECTIVES
To achieve the ambitious goal of eliminating schistosome infections, the Chinese government has implemented diverse control strategies. This study explored the progress of the 2 most recent national schistosomiasis control programs in an endemic area along the Yangtze River in China.
METHODS
We obtained village-level parasitological data from cross-sectional surveys combined with environmental data in Anhui Province, China from 1997 to 2015. A convolutional neural network (CNN) based on a hierarchical integro-difference equation (IDE) framework (i.e., CNN-IDE) was used to model spatio-temporal variations in schistosomiasis. Two traditional models were also constructed for comparison with 2 evaluation indicators: the mean-squared prediction error (MSPE) and continuous ranked probability score (CRPS).
RESULTS
The CNN-IDE model was the optimal model, with the lowest overall average MSPE of 0.04 and the CRPS of 0.19. From 1997 to 2011, the prevalence exhibited a notable trend: it increased steadily until peaking at 1.6 per 1,000 in 2005, then gradually declined, stabilizing at a lower rate of approximately 0.6 per 1,000 in 2006, and approaching zero by 2011. During this period, noticeable geographic disparities in schistosomiasis prevalence were observed; high-risk areas were initially dispersed, followed by contraction. Predictions for the period 2012 to 2015 demonstrated a consistent and uniform decrease.
CONCLUSIONS
The proposed CNN-IDE model captured the intricate and evolving dynamics of schistosomiasis prevalence, offering a promising alternative for future risk modeling of the disease. The comprehensive strategy is expected to help diminish schistosomiasis infection, emphasizing the necessity to continue implementing this strategy.; Summary

Worsening of health disparities across COVID-19 pandemic stages in Korea: Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee; Epidemiol Health. 2024;46:e2024038. Published online March 13, 2024; DOI: https://doi.org/10.4178/epih.e2024038

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Abstract Summary PDF: Abstract
OBJECTIVES
With the end of the coronavirus disease 2019 (COVID-19) pandemic, the health outcomes of this disease in Korea must be examined. We aimed to investigate health outcomes and disparities linked to socioeconomic status during the COVID-19 pandemic in Korea and to identify risk factors for hospitalization and mortality.
METHODS
This nationwide retrospective study incorporated an analysis of individuals with and without COVID-19 in Korea between January 1, 2020 and December 31, 2022. The study period was divided into 4 stages. Prevalence, hospitalization, mortality, and case-fatality rates were calculated per 100,000 population. Multivariate logistic regression was performed to identify risk factors for COVID-19 hospitalization and mortality.
RESULTS
Overall, the incidence rate was 40,601 per 100,000 population, the mortality rate was 105 per 100,000 population, and the case-fatality rate was 259 per 100,000 cases. A total of 12,577,367 new cases (24.5%) were recorded in stage 3 and 8,979,635 cases (17.5%) in stage 4. Medical Aid recipients displayed the lowest 3-year cumulative incidence rate (32,737 per 100,000) but the highest hospitalization (5,663 cases per 100,000), mortality (498 per 100,000), and case-fatality (1,521 per 100,000) rates. Male sex, older age, lower economic status, non-metropolitan area of residence, high Charlson comorbidity index, and disability were associated with higher risk of hospitalization and death. Vaccination was found to reduce mortality risk.
CONCLUSIONS
As the pandemic progressed, surges were observed in incidence, hospitalization, and mortality, exacerbating disparities associated with economic status and disability. Nevertheless, Korea has maintained a low case-fatality rate across all economic groups.; Summary

Korean summary
국민건강보험공단 자료를 이용하여 2020-2022년 후향적 코호트를 구축하여 시기별 코로나19 유병률, 입원률, 사망률, 치명률과 장애, 소득에 따른 건강격차를 확인하였을 때, 코로나19 대유행이 진행됨에 따라 발병률, 입원률, 사망률이 급증하고 건강 격차가 확대되었다. 그러나 이러한 격차에도 불구하고 한국은 다른 국가들과 비교하여 모든 소득수준에서 낮은 치명률을 유지하였다.

Key Message
Using data from the National Health Insurance Service, a retrospective cohort for the years 2020-2022 was established. By examining the COVID-19 prevalence rate, hospitalisation rate, mortality rate, and case-fatality rate, along with health disparities based on disability and economic status, as the pandemic progressed, there was a surge in incidence, hospitalisation, and mortality, widening disparities related to economic status and disability. Despite these disparities, Korea has maintained a low case-fatality rate across all economic groups.

Interactions between vitamin B₂, the MTRR rs1801394 and MTR rs1805087 genetic polymorphisms, and colorectal cancer risk in a Korean population: Madhawa Gunathilake, Minji Kim, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim; Epidemiol Health. 2024;46:e2024037. Published online March 11, 2024; DOI: https://doi.org/10.4178/epih.e2024037

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Abstract Summary PDF: Abstract
OBJECTIVES
We explored whether the association between vitamin B2 and colorectal cancer (CRC) risk could be modified by the MTRR rs1801394 and MTR rs1805087 genetic polymorphisms and examined whether the interaction effects are sex-specific.
METHODS
We performed a case-control study involving 1,420 CRC patients and 2,840 controls from the Korea National Cancer Center. Dietary vitamin B2 intake was assessed using a semiquantitative food frequency questionnaire, and the association with CRC was evaluated. Genotyping was performed using an Illumina MEGA-Expanded Array. For gene-nutrient interaction analysis, pre-matched (1,081 patients and 2,025 controls) and matched (1,081 patients and 1,081 controls) subsets were included. Unconditional and conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS
A higher intake of vitamin B2 was associated with a significantly lower CRC risk (OR, 0.65; 95% CI, 0.51 to 0.82; p<0.001). Carriers of at least 1 minor allele of MTRR rs1801394 showed a significantly higher CRC risk (OR, 1.43; 95% CI, 1.12 to 1.83). Males homozygous for the major allele (A) of MTRR rs1801394 and who had a higher intake of vitamin B2 had a significantly lower CRC risk (OR, 0.31; 95% CI, 0.18 to 0.54; p-interaction=0.02). In MTR rs1805087, males homozygous for the major allele (A) and who had a higher vitamin B2 intake had a significantly lower CRC risk (OR, 0.38; 95% CI, 0.25 to 0.60; p-interaction<0.001).
CONCLUSIONS
The MTRR rs1801394 and MTR rs1805087 genetic polymorphisms may modify the association between vitamin B2 and CRC risk, particularly in males. However, further studies are warranted to confirm these interaction results.; Summary

Korean summary
본 연구는 환자-대조군 연구를 통해 비타민 B2 섭취와 대장암 발생의 관련성을 조사하고, 대장암 발생에 있어 methionine synthase (MTRR) rs1801394 및 methionine synthase reductase (MTR) rs1805087의 유전적 다형성과 식이 요인간에 상호작용을 알아보고자 한다. 비타민 B2 의 섭취는 대장암 발생의 위험도를 낮추는 것으로 나타났으며 특히, 남성의 경우 대장암 발생의 위험도가 MTRR rs1801394 및 MTR rs1805087의 유전자형과 식이 섭취에 따른 상호 관련성에 의해 영향을 받는 것으로 나타났다.

Key Message
We conducted a case-control study to observe the association between vitamin B₂ intake and the risk of colorectal cancer (CRC), and to determine whether this association could be modified by the methionine synthase (MTRR) rs1801394 and methionine synthase reductase (MTR) rs1805087 genetic polymorphisms. Higher intake of vitamin B₂ is a protective factor in lowering CRC risk, and rs1801394 of MTRR and rs1805087 of MTR may particularly modify this association in males.

Epidemiologic Investigation

Salmonellosis outbreaks linked to eggs at 2 gimbap restaurants in Korea: Jun Suk Eun, Joohyun Han, Ji-Hyun Lim, Eunkyung Shin, Junyoung Kim, Da-Jung Ko, Jaeil Yoo, Sungil Kim, Jin Sook Kim, Jung Sub Park, Ji-Hyuk Park; Epidemiol Health. 2024;46:e2024036. Published online March 7, 2024; DOI: https://doi.org/10.4178/epih.e2024036

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Salmonellosis outbreaks occurred at 2 restaurants 2 days apart, and an epidemiological investigation was conducted to determine whether the outbreaks were connected.
METHODS
Case studies were conducted for both outbreaks. Stool samples were collected from individuals, and food samples were collected from the restaurants. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing analyses were performed on outbreak-related Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) isolates. Traceback investigations were also conducted for the ingredients from gimbap restaurants A and B.
RESULTS
In total, 106 people from gimbap restaurant A and 5 from gimbap restaurant B met the case definition. Salmonella Enteritidis was detected in samples from 2 food handlers, 22 patients, and 1 food (iceberg lettuce) at gimbap restaurant A and from 1 patient at gimbap restaurant B. According to PFGE, all isolates were identified as SEGX01.089. The molecular typing of all isolates showed the same pattern, and the genetic distance was close according to phylogenetic analysis. Eggs were the only food ingredient that was supplied to both gimbap restaurants.
CONCLUSIONS
The outbreaks were caused by Salmonella Enteritidis, and the source of infections was suspected to be contaminated eggs. To prevent foodborne outbreaks of Salmonella, restaurants should heat eggs sufficiently, and egg farms need to establish management systems that prevent Salmonella infections.; Summary

Korean summary
동일한 도시의 두 식당에서 2일 간격으로 살모넬라감염증 유행이 발생하여, 원인을 확인하고 두 유행 간에 연관이 있는지를 규명하기 위해 역학조사를 시행하였다. 병원체에 대한 유전자형 분석과 식재료 역추적조사 결과를 바탕으로 두 유행은 Salmonella Enteritidis에 의해 발생하였고, 감염원은 동일한 농장에서 공급된 오염된 계란으로 추적하였다.

Key Message
Salmonellosis outbreaks occurred at 2 restaurants in the same city 2 days apart, and epidemiological investigations were conducted to identify the causes and determine whether the outbreaks were connected. Based on the genetic characterization of the pathogens and traceback investigation of the food ingredients, the outbreaks were caused by Salmonella Enteritidis and the source of infection was traced to contaminated eggs, which were supplied from the same farm.

Original Articles

Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study: Khongorzul Ganbat, Bayarmaa Nasan Ulzii, Sangah Shin; Epidemiol Health. 2024;46:e2024035. Published online February 28, 2024; DOI: https://doi.org/10.4178/epih.e2024035

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score.
METHODS
The study included 12,356 men participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD.
RESULTS
The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3: HR, 0.80; 95% CI, 0.69 to 0.93; p for trend=0.010). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR, 0.74; 95% CI, 0.59 to 0.93; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m2 and a waist circumference ≥90 cm.
CONCLUSIONS
This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.; Summary

Korean summary
본 연구는 한국 남성의 관상 동맥 심장 질환(CHD) 위험을 줄이는데 있어서 식이 패턴, 특히 건강한 식물성 식이 지수의 역할이 중요함을 강조한다. 높은 hPDI지수를 가진 사람이 CHD 위험이 유의미하게 19% 감소하는 것은 건강한 식물성 기반 식단 선택이 심혈관 건강에 미칠 수 있는 잠재된 영향력을 강조한다.

Key Message
The study highlights the important role of dietary patterns, especially healthy plant-based diet index (hPDI), in reducing the risk of coronary heart disease (CHD) among Korean men. A significant 19% reduction in CHD risk associated with the highest hPDI underscores the potential impact of dietary choices on cardiovascular health.

Predictive ability of the Chinese visceral adiposity index for incident hypertension in working-aged Koreans: Ju Young Jung, Chang-Mo Oh, Hyun chul Jo, Sung Keun Park; Epidemiol Health. 2024;46:e2024034. Published online February 27, 2024; DOI: https://doi.org/10.4178/epih.e2024034

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1 Crossref

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The Chinese visceral adiposity index (CVAI) was developed to assess visceral adipose tissue in the Asian population. This study evaluated the predictive ability of the CVAI for incident hypertension in Korean adults.

METHODS

The study participants included 128,577 Koreans without hypertension. They were grouped in quartiles according to body mass index (BMI), waist circumference (WC), visceral adipose index (VAI), and CVAI values. The Cox proportional hazard assumption was used to evaluate the hazard ratio (HR) and 95% confidence interval (CI) for incident hypertension (adjusted HR [95% CI]) according to quartile level across a follow-up period of 6.9 years. Subgroup analyses were conducted by gender and obesity. The area under the curve was calculated to compare the predictive abilities of all indices (BMI, WC, VAI, and CVAI) for incident hypertension.

RESULTS

The CVAI was proportionally associated with the risk of hypertension in all participants (quartile 1: reference; quartile 2: 1.71 [95% CI, 1.59 to 1.82]; quartile 3: 2.41 [95% CI, 2.25 to 2.58]; and quartile 4: 3.46 [95% CI, 3.23 to 3.71]). Time dependent receiver operating characteristic curve analysis indicated that the CVAI was superior to BMI, WC, and VAI in predicting hypertension at the 2-year, 4-year, 6-year, and 8-year follow-ups. This finding was also observed in the gender and obesity subgroups. The predictive ability of the CVAI was greater in the women and non-obese subgroups than in the men and obese subgroups.

CONCLUSIONS

The CVAI was a stronger predictor of hypertension than BMI, WC, and VAI.

Summary

Korean summary
고혈압은 심혈관 질환의 주요 원인이다. 내장 지방은 비만에서 고혈압의 병태 생리에 중요한 역할을 한다. 최근의 연구는 Chinese visceral adiposity index (CVAI)가 다른 비만 지표 보다 아시아 인에서 심혈관 질환의 고 위험군을 더욱 잘 구분해 낸다는 것을 보고하였다. 우리는 체질량 지수, 허리 둘레, visceral adiposity index, CVAI의 고혈압에 대한 예측력을 비교 하였다. 우리의 연구는 CVAI가 고혈압을 예측하는데 있어 다른 지표 보다 우월하다는 것을 보여주었다.

Key Message
Hypertension is a leading risk factor for cardiovascular disease. It is known that visceral adiposity has an important role in the pathogenesis of hypertension in obesity. Recent studies have demonstrated that Chinese visceral adiposity index (CVAI) is more discriminative the high risk group for cardiovascular disease in Asians than other obesity indices. We compared the predictive ability for the development hypertension among body mass index, waist circumference, visceral adiposity index, and CVAI. Our study showed that CVAI is superior to predict hypertension than other indices.

Citations

Citations to this article as recorded by

Association of traditional and novel obesity indicators with stroke risk: Findings from the Rural Chinese cohort study
Dongdong Zhang, Weifeng Huo, Weiling Chen, Xi Li, Pei Qin, Ming Zhang, Jing Li, Xizhuo Sun, Yu Liu, Dongsheng Hu
Nutrition, Metabolism and Cardiovascular Diseases.2024;[Epub] CrossRef

Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic: Jan Bělobrádek, Luděk Šídlo, Tom Philipp; Epidemiol Health. 2024;46:e2024033. Published online February 23, 2024; DOI: https://doi.org/10.4178/epih.e2024033

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.
METHODS
We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.
RESULTS
We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).
CONCLUSIONS
Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.; Summary

Key Message
Primary care in Czechia has effectively adapted to the changes brought about by the COVID-19 pandemic. Minimal impact was observed in prescribtions and diabetic patient care. There was a significant decline in colorectal cancer screening, with a slow restitution after the pandemic subsided. Rural GPs consistently provided in-house treatment and have higher shares of both prescribing and diabetes care, as well as performing more COVID-19 specific procedures.

Brief Communication

Assessing the impact and implications of the revised Act on the Aggravated Punishment of Specific Crimes in preventing child traffic injuries in school zones in Korea: an interrupted time series analysis: Hong Jin Ku, Jin-Hwan Kim, Young June Choe, Seung Ah Choe, Mark R. Zonfrillo; Epidemiol Health. 2024;46:e2024032. Published online February 21, 2024; DOI: https://doi.org/10.4178/epih.e2024032

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Abstract Summary PDF: Abstract
In 2019, a child’s death in Korea led to legislation that imposed stricter penalties for school zone traffic violations. We assessed the impact of that legislation using 2017-2022 Traffic Accident Analysis System data. Adjusted analyses revealed a significant decline in severe injuries in school zones, decreasing from 11 cases to 8 cases per month (p=0.017). The legislation correlated with a reduced risk of all child traffic injuries (risk ratio, 0.987; 95% confidence interval, 0.977 to 0.997; p=0.002), indicating its efficacy in curbing accidents.; Summary

Korean summary
2019년 민식이법 도입 후 소아 교통사고에 미치는 영향을 평가하고자 하였다. 2017-2022 교통사고 분석 시스템 데이터를 통해 그 효과를 평가했고, 학군지역에서 심각한 부상이 월 평균 11건에서 8건으로 감소했다(p=0.017). 또한, 모든 어린이 교통사고 위험 비율도 감소했고(risk ratio, 0.987, 95% CI, 0.977-0.997; p=0.002), 사고 예방에 효과적임을 입증했다. 이 연구는 학군지역 어린이 안전에 법 조치의 긍정적 영향을 강조하며, 지속적인 도로 안전 강화의 중요성을 강조한다.

Key Message
Revised legislation in Korea, following a child’s tragic death, enforced stricter penalties for school zone traffic violations. Analysis of 2017-2022 data showed a significant decrease in severe injuries from 11 to 8 cases monthly (p=0.017). The legislation also reduced the risk of all child traffic injuries (risk ratio, 0.987; 95% CI, 0.977 to 0.997; p=0.002), demonstrating its effectiveness in preventing accidents. This study underscores the legislation’s positive impact on child safety in school zones, emphasizing the importance of ongoing enforcement efforts for road safety.

Original Article

Association of insomnia and daytime napping with metabolic syndrome and its components in a Korean population: an analysis of data from the Korean Genome and Epidemiology Study: Da-Been Lee, Dae-Wui Yoon, Inkyung Baik; Epidemiol Health. 2024;46:e2024031. Published online February 20, 2024; DOI: https://doi.org/10.4178/epih.e2024031

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Abstract Summary PDF: Abstract
OBJECTIVES
We investigated the association between metabolic syndrome (MetS) and the coexistence of insomnia and daytime napping, because limited data have been reported regarding this association.
METHODS
The study population was 8,440 participants aged 40-65 years, who were from the Korean Genome and Epidemiology Study. Self-reported information on insomnia symptoms and nap duration was used to define exposure variables. Data on waist circumference (WC), blood pressure (BP), and fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein cholesterol levels in blood were used to define MetS. Multivariate logistic regression analysis was performed to obtain odds ratio (OR) and 95% confidence interval (CI).
RESULTS
In multivariate logistic regression analysis, the coexistence of insomnia and napping was not significantly associated with MetS. However, the insomnia and non-napping group showed higher ORs of high TG (OR, 1.19; 95% CI, 1.02 to 1.39) and high BP (OR, 1.28; 95% CI, 1.10 to 1.49) than the non-insomnia and non-napping group. The combination of non-insomnia and napping and that of insomnia and napping showed higher ORs of high TG (OR, 1.13; 95% CI, 1.00 to 1.29) and high FBG (OR, 1.59; 95% CI, 1.14 to 2.21), respectively. In analyses of insomnia symptoms, only the combination of difficulty in maintaining sleep (DMS) and non-napping showed a higher OR for MetS (OR, 1.25; 95% CI, 1.03 to 1.52) than the non-DMS and non-napping group.
CONCLUSIONS
Individuals with insomnia, particularly those who do not take naps, were disproportionately likely to have MetS components, especially TG or BP. Information on these variables may help predict individuals’ vulnerability to specific MetS components.; Summary

Korean summary
- 불면증과 대사증후군 구성요소와의 유의한 연관성은 낮잠의 유무에 따라 달라진다. - 낮잠을 자지 않는 불면증 환자는 대사증후군의 구성요소 중 특히 고중성지방이나 고혈압의 위험성이 높아진다.

Key Message
• The significant association of insomnia with MetS components varies with the presence or absence of napping. • Individuals with insomnia who do not take naps were likely to have MetS components, especially TG or BP.

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