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Original article
Causal effect of fasting serum glucose on atherosclerotic cardiovascular disease: a multivariable Mendelian randomization
Su Hyun Lee, Heejin Kimm, Byung-Wan Lee, Chung Mo Nam, So Young Kim, Sunmi Lee, Sun Ha Jee
Epidemiol Health. 2024;e2024096.   Published online December 6, 2024
DOI: https://doi.org/10.4178/epih.e2024096    [Accepted]
  • 188 View
  • 4 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
Observational studies have reported that diabetes is a risk factor that increases the risk of atherosclerotic cardiovascular disease (ASCVD). However, the causal relationship remains a matter of debate. This study aimed to analyze the relationship between fasting serum glucose (FSG) and ASCVD.
METHODS
This study used data from the Korean Cancer Prevention Study (KCPS)-II Biobank, consisting of 159,844 people recruited with consent from 18 health examination centers from 2004 to 2013. Outcomes were confirmed based on diagnoses on hospital discharge summaries from National Health Insurance System. We used linear and non-linear Mendelian randomization (MR) methods. The outcome data were obtained from KCPS-II, and the exposure data were derived from the Korean Genome Epidemiology Study.
RESULTS
First, a prospective cohort study estimated that for each 10 mg/dL increase in FSG level, the risk of ASCVD increased by 5% (hazard ratio [HR]=1.05; 95% confidence interval [CI]=1.04-1.06). Second, the 2-sample MR study showed that every 10 mg/dL increase in FSG influenced the risk of ASCVD (HR=1.11; 95% CI=1.04-1.18). Third, the multivariable MR study showed that the odds ratio per 10 mg/dL increase in FSG on ASCVD was 1.14 (p<0.001). Similar results were found for a 10 mg/dL increase in FSG and ischemic heart disease (IHD), but a significant relationship with stroke was not found. When performing non-linear MR, a linear relationship was observed between fasting blood sugar and ASCVD, including IHD and stroke.
CONCLUSIONS
FSG showed a linear and causal association with IHD, but not with stroke.
Summary
Original Articles
Distribution of dense breasts using screening mammography in Korean women: a retrospective observational study
Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim, Yoon-Nam Kim, Chung Mo Nam
Epidemiol Health. 2014;36:e2014027.   Published online November 4, 2014
DOI: https://doi.org/10.4178/epih/e2014027
  • 19,148 View
  • 144 Download
  • 16 Web of Science
  • 13 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
This retrospective observational study evaluated the distribution of dense breasts by age group among healthy Korean women.
METHODS
Participants were women aged 30 years and older who voluntarily underwent screening mammography between January 2007 and December 2011. Women who received the Breast Imaging Reporting and Data System for mammographic density of 3 or 4 were defined as having dense breasts. The proportion of women with dense breasts (PDB, %) was calculated by dividing the number of participants with dense breasts by the total number of participants.
RESULTS
Among the 231,058 women who participated, 78.15% were classified as having dense breasts. PDB was highest in the youngest age group (PDB=94.87%) and lowest in the oldest age group. The greatest difference in PDB between adjacent age groups was observed in the group aged 60-64 years.
CONCLUSIONS
The results show that the proportion of dense breasts by age group increased in all age groups, except in those aged 35-39 years. These findings suggest an association between the age distribution of dense breasts and trends in breast cancer incidence. Further studies are needed to estimate the change in breast cancer incidence rate by age and the accumulation of fatty breast tissue in Korean women.
Summary

Citations

Citations to this article as recorded by  
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Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population
Soo Jeong Kim, Jakyoung Lee, Sun Ha Jee, Chung Mo Nam, Kihong Chun, Il Soo Park, Soon Young Lee
Epidemiol Health. 2010;32:e2010003.   Published online May 1, 2010
DOI: https://doi.org/10.4178/epih/e2010003
  • 20,526 View
  • 133 Download
  • 20 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>The aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea.</p></sec><sec><title>METHODS</title><p>A total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN.</p></sec><sec><title>RESULTS</title><p>With regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial.</p></sec><sec><title>CONCLUSION</title><p>Improvements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.</p></sec>
Summary

Citations

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Green Tea Consumption and Stomach Cancer Risk: A Meta-Analysis
Hyunseok Kang, Sun Young Rha, Kyung Won Oh, Chung Mo Nam
Epidemiol Health. 2010;32:e2010001.   Published online April 26, 2010
DOI: https://doi.org/10.4178/epih/e2010001
  • 21,025 View
  • 130 Download
  • 30 Crossref
AbstractAbstract PDF
Abstract
<sec><title>OBJECTIVES</title><p>Green tea has been suggested to have a chemopreventive effect against various cancers including stomach cancer. The aim of this study is to elucidate the relationship between green tea consumption and stomach cancer risk by meta-analysis.</p></sec><sec><title>METHODS</title><p>Eighteen observational studies were identified using MEDLINE, THE COCHRANE LIBRARY, RISS, and a manual search. Summary relative risks/odds ratios (RR/ORs) for the highest versus non/lowest green tea consumption levels were calculated on the basis of fixed and random effect models. Subgroup analyses were used to examine heterogeneity across the studies.</p></sec><sec><title>RESULTS</title><p>The combined results indicate a reduced risk of stomach cancer with intake of green tea (RR/OR=0.86, 95% CI=0.74-1.00). Subgroup analysis with six studies that reported differences between the highest and lowest consumption levels equal to or greater than five cups/day revealed a statistically significant protective effect (RR/OR=0.68, 95% CI=0.53-0.87).</p></sec><sec><title>CONCLUSION</title><p>Green tea appears to play a protective role against the development of stomach cancer. The results also suggest that a higher level of green tea consumption might be needed for a clear preventive effect to appear. This conclusion, however, should be interpreted with caution because various biases can affect the results of a meta-analysis.</p></sec>
Summary

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A study on the nondifferential misclassification-a mathematical approach for correcting the estimates-.
Chung Mo Nam, Hee Choul Ohrr
Korean J Epidemiol. ;15(1):85-95.
  • 5,281 View
  • 13 Download
AbstractAbstract PDF
Abstract
This study is conducted to suggest a method for correcting the biased estimates due to nondifferential misclassification of polytomous exposure and confounder. The basic idea for correcting the bias is a rearrangement of misclassified data structure using misclassification probability matrices. We present here a linear relationship between the misclassified and true date. Simulation studies were also tried to investigate the magnitude and direction of the bias mentioned above. In simulation studies, we focused on the misclassification patterns in three circumstances, misclassification of exposure, misclassification of confounder, and joint misclassification of both exposure and confounding variables. The simulation results show that the direction of exposure or confounder misclassification biases are heavily dependant on the misclassification patterns. The proposed mehod is applied to an empirical data on the presence of medical utilization and smoking history where corrected odds ratios are examplified considering plausible ranges of misclassification probaility patterns.
Summary
A study on statistics used to test the tracking phenomenon of bloodpressure in childhood.
Chung Mo Nam, Soon Young Lee, Il Suh, Chong Yon Park
Korean J Epidemiol. 1992;14(2):117-127.
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  • 11 Download
AbstractAbstract PDF
Abstract
This study was conducted to investigate the behavior of statistics, correlation analysis and 2X2 contingency table analysis, which were used to test the tracking phenomenon of blood pressure in childhood. Data were randomly generated by Blomqvist's model. The results of this study were as follows； 1. The correlation coefficients and probabilities of remaining in the upper quartile increased by the degree of tracking index θ, and decreased by the degree of within individual variation σe2. 2. The estimates of test statistics at θ=0.1, and σe2=82 were lower than those at θ= 0.0, and σe2=62 The results indicate that within individual variation must be considered to study the tracking phenomenon of blood pressure.
Summary
Framingham Equation Model Overestimates Risk of Ischemic Heart Disease in Korean Men and Women.
Kyung A Ahn, Ji Eun Yun, Eo Rin Cho, Chung Mo Nam, Yangsu Jang, Sun Ha Jee
Korean J Epidemiol. 2006;28(2):162-170.
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Abstract
BACKGROUND
The prediction of the absolute risk of ischemic heart disease (IHD) is commonly based on the risk prediction equations, originated from the Framingham Heart Study.
METHOD
Framingham equation model was applied to participants from 2001 Korean National Health and Nutrition Examination Survey (KNHNES) to estimate the 5 year risk of IHD among Koreans ranging from 30 to 74 year-olds. The estimated risks were compared to the incidence and admission rates from two statistical reports among Koreans. Five year admission rate was estimated by the annual report from National Health Insurance Corporation (NHIC).
RESULTS
The average ages (standard deviation) were 34.31(27.23) year-old for KNHNES and 48.26(12.87) year-old for Framingham population used in this study. The risk of IHD predicted by the Framingham equation model substantially exceeded the risks actually reported in Korea. Five-year predicted risks by Framingham equation model were 4.86% for men and 1.93% for women; whereas from incidence data in Korea, five-year risks for acute myocardial infarction (AMI) were for 0.47% for men and 0.18% for women. These AMI incidence was similar to the admission rate (0.34 for men and 0.15 for women) estimated by NHIC. Also, 5-year admission rate of IHD were 1.16 for men and 0.78 for women. The magnitude of risk overestimation by Framingham mode is approximately at least 150 to 320%.
CONCLUSION
Korean guidelines for the management for high risk group of IHD need to develop and correct for overestimation to avoid inflation of costs in primary prevention.
Summary
Heritability and segregation analysis of the level of HDL-cholesterol.
Ji Eun Yun, Chung Mo Nam, Il Suh, Sun Ha Jee
Korean J Epidemiol. 2004;26(2):43-53.
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Abstract
OBJECTIVES
The purpose of this study was to investigate the familial correlation and heritability in HDL cholesterol through segregation analysis.
METHODS
This study, based on data from 11,117 Korean individuals ascertained pedigrees who had participated in 1998 and 2001 Korean National Health & Nutrition Examination Survey. The subjects of segregation analysis were 4,688 Korean who had more than five members in their family.
RESULTS
Serum lipid levels revealed strong familial correlation among spouses, parent-offspring and siblings with low correlation of spouse. The heritability of HDL cholesterol was 54.8% after controlling for age, age2, gender, agexgender, waist circumference, smoking, alcohol drinking, exercise and education. Two models of inheritance, the Mendelian dominant model and the Mendelian codominant model were found in HDL cholesterol. In the codominant model, the predicted HDL-cholesterol for genotype AA, AB, and BB were 44.96, 49.13, and 69.67 mg/dl, respectively. However the Mendelian codominant model only was found in high risk families.
CONCLUSIONS
In conclusion, randomly ascertained Korean families of this study showed strong familial aggregation in HDL cholesterol. The results suggested that the variations in HDL cholesterol may be influencing by major effect of gene.
Summary
Development of the Individualized Health Risk Appraisal Model of Breast Cancer Risk in Korean Women.
Sun Ha Jee, Ji Won Song, Chung Mo Nam
Korean J Epidemiol. 2004;26(1):50-58.
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Abstract
OBJECTIVES
The objectives of this study were to develop a health risk appraisal (HRA) model of breast cancer and to evaluate the model's ability to accurately predict ndividual breast cancer risk.
METHOD
The sample data were from a prospective cohort study in Korea with a follow-up period of 8 years in Korea (1995-2002). The cohort was composed of 108,708 Korean women, aged 30 to 64 years, who received health insurance from the Korea Medical Insurance Corporation and who underwent a medical evaluation in 1994. Between 1995 and 2002 (1,138,349 person-year), there were 772 incident cases of breast cancer (67.8/100,000 person-years). First, we developed the HRA based on the Cox proportional hazard models using a prospective cohort data with half-split data (50% random sample). Second, using Cox proportional hazard models, we compared the probability of breast cancer predicted by the model to the actual number of cases observed in the other 50% of the random sample of the study population.
RESULTS
The HRA Cox proportional hazard model of breast cancer developed in the study included age, age2, age at menarche, and lactation. Multivariate Cox proportional hazards models were used to test the HRA model validation. Compared with women in the lowest 10 percentile of subjects, women in the highest 10 percentile had an increased risk of breast cancer (relative risk, 3.701; 95% confidence interval, 2.554 to 5.364).
CONCLUSION
The model's performance was satisfactory for estimating breast cancer risk for individual women aged 30-64 years.
Summary
A study on Statistical Method for Controlling the Effect of Intermediate Events: Application to the Control of the Healthy Worker Effect.
Chung Mo Nam, Jinheum Kim, Dae Ryong Kang, Yeon Soon Ahn, Hoo Yeon Lee, Dae Hee Lee
Korean J Epidemiol. 2002;24(1):7-16.
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Abstract
PURPOSE
The healthy worker effect is an important issue in occupational epidemiology. This study was conducted to propose a new method to test the relation between exposure and mortality in the presence of the healthy worker effect.
METHODS
In this study, the healthy worker hire effect was assumed to operate as a confounding variable of health status at the beginning of employment and healthy worker survival effect as a confounding and intermediate variable of employment status. In addition, the proposed method reflects the length bias sampling caused by changing of an employment status. Simulation studies were also carried out to compare the proposed method with Cox's time dependent covariates models .
RESULTS
The theoretical development of the healthy worker survival effect is based on the result that an observation with change of an employment status requires that the survival time without intermediate event exceeds the waiting time for the intermediate event. According to our simulation studies, both the proposed method and Cox's time dependent covariates model which includes the change of employment status as time dependent covariates seem to be satisfactory at 5% significance level. However, Cox's time dependent covariates models without or with the change of employment status as time fixed covariate are unsatisfactory. The proposed test is superior in power to tests based on Cox's model.
CONCLUSIONS
The healthy worker effect may not be controlled by classical Cox's proportional hazards models. The proposed method performed well in the presence of healthy worker effect in terms of level and power
Summary
A Case-Control Study on Risk Factors of CHD: Vegetable consumption and risk for CHD in Korean men.
Kyung Won Oh, Il Suh, Kang Hee lee, Chung Mo Nam, Suk Il Kim, Hyung Gon Kang, Sun Ha Jee, Seung Yun Cho, Won Heum Shim
Korean J Epidemiol. 1998;20(2):234-245.
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Abstract
The purpose of this study was to investigate the association of vegetable consumption with the incidence of CHD in Korean men by a case-control study. The case group consisted of 108 patients with EKG-confirmed myocardial infarct or angiographically-confirmed(>or=50% stenosis) angina pectoris admitted to a university teaching hospital in Seoul, Korea. Controls were 142 age-matched patients admitted to the departments of ophthalmology and orthopedic surgery at the same hospital. Dietary intake was assessed by a nutritionist using a semiquantitative food frequency method, while body mass index (BMI), tobacco use, and past history of cardiovascular disease were determined during an interview and examination. The consumption of vegetables was classified by the average frequency of intake(less than 3 times/week, 3~4 times/week, 5~6 times/week, more than once/day). The percentage of subjects who consumed vegetables less than 3 times per week was 29.6% for cases and 17.6% for controls; while men who consumed vegetavle more than once per day were 16.7% for cases and 32.4% for controls. After the adjustment for age, body mass index, and tobacco use, the odds ratio of men who consumed vegetables at least once per day was 0.38(95% confidence interval, 0.18-0.85) compared with men who consumed vegetables less than three times per week. These results suggested that in a population with a relatively low fat intake, consumption of vegetables at least once per day may reduce the risk of CHD in men.
Summary
A Study on Tracking by Using Random Coefficient Model.
Hyung Gon Kang, Byung Soo Kim, Chung Mo Nam
Korean J Epidemiol. 1997;19(1):58-66.
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Abstract
There are many epidemiologic studies to find the tracking phenomenon. In repeated measurement data, a population is said to have tracking phenomenon with respect to particular chracteristic if, for each individual, the relative rank of observed value maintained over time. Understanding tracking phenomena in epidemiologic study is quite important. If the risk factors of chronic disease have tracking phenomenon, early detection of these risk factors can lead to the possibility of early treatment. In this study, we defined tracking as relative maintenance and proposed new measure of tracking by using random coefficient model. We compared our measure with McMahan's using simulation study. And we applied ours to real data. We may conclude that our new measure of tracking is adequate in explaining and dectecting the tracking phenomenon.
Summary
Effects of Exposure-Confounder Misclassification and Criteria of Model Choice in Ecologic Studies.
Sun Hee Lee, Chung Mo Nam, Hung Wok Park
Korean J Epidemiol. 1996;18(2):142-150.
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Abstract
Ecologic studies are widely used in all fields of public health on account of accesibility of data. However, two problems related to these studies have been brought up. The first is ecological fallacy occurred in the course of interpreting the ecologic level of exposure-disease associations into individual level. The second is exposure isclassification which leads to serious bias. Nevertheless there is few methodologic study dealing joint effects of the two problems in ecologic study. This study was conducted to suggest an ecologic model not having an ecologic fallacy due to model linkage failure and a methodology for correcting the misclassification bias due to exposure-confounder misclassification. Finally, we suggest a criteria for the ecologic model selection. Main results are as follows: 1. A linear ecologic regression model has a serious ecological fallacy due to model linkage failure and the misclassification bias due to the exposure-confounder misclassification. 2. An interaction ecologic regression model has no ecological fallacy due to model linkage failure, but it is affected seriously by the exposure misclassification. However misclassification bias could be removed mathematically if the information related to the misclassification was known. 3. A log-linear ecologic regression model has an ecological fallacy due to model linkage failure. It is seriously biased as the individual risk ratio are increased, but relatively less affected by the exposure misclassification than interaction ecologic regression model. 4. One of the two ecologic regression model-interaction ecologic regression model and log-linear ecologic regression model- would be selected according to the information of individual risk ratio and exposure misclassification. But using a linear ecologic regression model should be avoided in any circumstance. The above results are only valid in case that there is no other source of ecological fallacy except model linkage failure. Also exposure and confounder are independent each other, measured binary, and having nondifferential misclassification. Since the above assumptions are somewhat strong in considering the real situations of ecologic studies, it is necessary to extend the scope of this study.
Summary
A Study on Misclassification Arising from Random Error in Exposure Measurement.
Il Suh, Chung Mo Nam, Hyung Gon Kang
Korean J Epidemiol. 1996;18(1):108-118.
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Abstract
There are many epidemiologic studies to find the relationship between disease occurrence and categorized exposure variables which are measured in continuous scales. Recently, it has been found that the differential misclassification can arise when exposure variables are observed with measurement errors and categorized for the analysis. Even though the differential misclassification leads to serious misclassification bias, there is no theoretical attempt to correct the misclassification bias occuring in these circumstances. In this paper, we propose a new statistical method to reduce the misclassification bias due to dichotomizing continuous exposure variables. Since the exposure values are more likely to be misclassified when the true exposure values are close to the cutoff point, the method proposed here gives smaller weights in these case and more weights when these values are far from cutoff point. Simulation studies are performed to compare the bias and the power of the proposed method compared to other methods. Main results are as follows: 1. The proposed method produces the smaller bias and the higher power than the simple method which modifies misclassified data using sensitivity and specificity of exposure misclassification. 2. When the standard deviation of the measurement error are moderately large, the bias and the power of the proposed estimate are somewhat better than those of the modified estimate which excluding the misclassified observations in the analysis. In conclusion, the method proposed here is found to be useful in epidemiologic studies when continuous exposure variables are obtained with measurement error and categorized in the analysis.
Summary
Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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