Epidemiology and Health

Systematic review

Handgrip strength thresholds associated with metabolic syndrome risk in children and adolescents: a systematic review and meta-analysis: Hye Ah Lee, Seunghee Jun, Hyesook Park; Epidemiol Health. 2024;e2024047. Published online April 24, 2024; DOI: https://doi.org/10.4178/epih.e2024047 [Accepted]

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Abstract PDF: Abstract
OBJECTIVES
Certain studies have reported that handgrip strength (HGS) is associated with metabolic health risks in children and adolescents, and some studies have suggested HGS thresholds for identifying poor metabolic health. Therefore, we aimed to determine the HGS thresholds associated with metabolic syndrome (MetS) in children and adolescents through a systematic review.
METHODS
We searched 3 electronic databases from their inception until October 2023 to identify original papers that focused on children and adolescents and assessed their risks of MetS according to specific HGS values. Studies were selected for inclusion through a planned screening process based on specific criteria. The Quality Assessment Tool for Diagnostic Accuracy Studies v2 (QUADAS-2) was used to evaluate quality, and a meta-analysis was performed using the diagmeta R package to suggest the optimal thresholds.
RESULTS
From the search, 8 studies were selected for this systematic review. For detecting MetS risk, the optimal threshold for HGS (defined as relative HGS by adjusting for body mass) was found to be 0.422, with a sensitivity of 76.7% (95% confidence interval [CI], 64.0% to 85.8%) and a specificity of 62.9% (95% CI, 56.9% to 68.5%). The stratification analysis by sex resulted in optimal thresholds of 0.416 for boys and 0.376 for girls. Additionally, when the data were stratified by age, the thresholds were 0.356 for children and 0.416 for adolescents.
CONCLUSIONS
Our results provide practical information for detecting high-risk groups and encouraging strength-related activities that may reduce the risk of MetS in children and adolescents.; Summary

Special Article

Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis: Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park; Epidemiol Health. 2023;45:e2023092. Published online October 16, 2023; DOI: https://doi.org/10.4178/epih.e2023092

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Abstract

OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.

METHODS

Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.

RESULTS

Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.

CONCLUSIONS

Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.

Summary

Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.

Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

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Exploring genetic associations of Crohn’s disease and ulcerative colitis with extraintestinal cancers in European and East Asian populations
Chengdong Yu, Jiawei Xu, Siyi Xu, Lei Tang, Qinyuan Han, Xiaoqiang Zeng, Yanxiao Huang, Tenghua Yu, Zhengkui Sun
Frontiers in Immunology.2024;[Epub] CrossRef

COVID-19: Original Article

Changes in eating behaviors according to household income in adolescents during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey: Hye Ah Lee, Ho Jung Lee, Bomi Park, Yoonhee Shin, Hyunjin Park, Hyesook Park; Epidemiol Health. 2022;44:e2022102. Published online November 9, 2022; DOI: https://doi.org/10.4178/epih.e2022102

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Abstract

OBJECTIVES
To assess social inequalities in changes in dietary behaviors among adolescents during the coronavirus disease 2019 (COVID-19) pandemic, we compared changes in dietary behavior indicators by household income.

METHODS

Using cross-sectional data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, the prevalence of dietary behaviors in adolescents (12-18 years old) was estimated and changes in dietary behaviors during the COVID-19 pandemic were evaluated. We assessed changes in dietary behaviors with a household income (as a measure of socioeconomic status, SES) disparity.

RESULTS

During the COVID-19 pandemic, the average consumption of vegetables decreased and food insecurity worsened. Adolescents were more likely to skip breakfast than before COVID-19 (33.1 and 37.4%). Soft drink consumption also increased in 2020 from 2019 (7.6 and 14.8%), especially among boys. Average sugar intake and sodium intake showed a tendency to decrease only in girls, but there was no significant difference according to SES level. Skipping breakfast was particularly evident in the low-SES group, and the difference according to household income level (high vs. low) was greater during COVID-19 than before. The prevalence of soft drink consumption increased significantly in the low-SES group, but the rate of increase did not differ by SES level.

CONCLUSIONS

We found that the social disparity in skipping breakfast was further aggravated during the COVID-19 pandemic. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Summary

Korean summary
국민건강영양조사 자료를 활용하여, COVID-19 팬데믹 전후 청소년의 식생활 변화 및 가구소득 수준에 따른 차이를 평가하였다. 대체로, 평균 채소 섭취량은 감소하고 탄산음료 소비는 증가한 것으로 나타났으며, 아침식사 결식율도 약간 증가한 것으로 나타났다. 게다가, 가구소득 수준에 따라 평가하였을 때, 아침식사 결식율 증가는 가구소득이 높은 군에 비해 가구소득 수준이 낮은 군에서 두드러진 것으로 나타났다. COVID-19 팬데믹이 장기화됨에 따라, 청소년의 식생활 변화에 대해서는 지속적인 모니터링이 필요하다.

Key Message
Using data from the 2019 and 2020 Korea National Health and Nutrition Examination Survey, changes in dietary behaviors of adolescents (12-18 years old) during the COVID-19 pandemic were evaluated. During the COVID-19 pandemic, average consumption of vegetables decreased and consumption of soft drinks increased in 2020 from 2019 (7.6% and 14.8%). In addition, the social disparity in skipping breakfast among adolescents was further aggravated. To reach a better understanding of the dietary behaviors of adolescents, continuous monitoring is necessary.

Citations

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Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review
Nicolas Woods, Jamie A Seabrook, Holly Schaafsma, Shauna Burke, Trish Tucker, Jason Gilliland
The Journal of Nutrition.2024; 154(4): 1376. CrossRef
Analysis of health behavior, mental health, and nutritional status among Korean adolescents before and after COVID-19 outbreak: based on the 2019–2020 Korea National Health and Nutrition Examination Survey
Misun Lee, Sarang Jeong, Chong-Su Kim, Yoon Jung Yang
Journal of Nutrition and Health.2023; 56(6): 667. CrossRef

Original Articles

Multimorbidity adjusted years lost to disability rates calculated through Monte-Carlo simulation in Korea: Yoonhee Shin, Eun Jeong Choi, Bomi Park, Hye Ah Lee, Eun-Kyung Lee, Hyesook Park; Epidemiol Health. 2022;44:e2022090. Published online October 17, 2022; DOI: https://doi.org/10.4178/epih.e2022090

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To efficiently utilize limited health and medical resources, it is necessary to accurately measure the level of health, which requires estimating the multimorbidity-corrected burden of disease.
METHODS
This study used 2015 and 2016 data from the National Health Insurance Service, and employed the list of diseases defined in a Korean study of the burden of disease, the criteria for prevalence, and the “cause–sequelae–health state” disease system. When calculating the years lost to disability (YLD), multimorbidity was corrected using Monte-Carlo simulation.
RESULTS
Correcting for multimorbidity changed YLD at all ages in Korea by -1.2% (95% confidence interval [CI], -24.1 to 3.6) in males and -12.4% (95% CI, -23.0 to 0.3) in females in 2015, and by -10.8% (95% CI, -24.1 to 4.6) in males and -11.1% (95% CI, -22.8 to 1.7) in females in 2016. The YLD rate for non-communicable diseases in males decreased more than that of other disease groups in both years, by -11.8% (95% CI, -19.5 to 3.6) and -11.5% (95% CI, -19.3 to -3.0), respectively. The overall YLD rate changed by -1.3% in the 5-year to 9-year age group, and the magnitude of this change remained similar until the 10-19-year age group, gradually decreased after 20 years of age, and steeply increased to more than 10% in those aged 60 and older.
CONCLUSIONS
Calculations of YLD should adjust for multimorbidity, as the disease burden can otherwise be overestimated for the elderly, who tend to exhibit a high prevalence of multimorbidity.; Summary

Korean summary
복합질환 유병률이 증가됨에 따라 인구의 건강수준 측정 시 복합질환을 고려하는 것은 중요하다. 이에 본 연구에서는 복합질환 유병상태를 고려한 YLD(장애로 인한 손실년수)를 산출하고, 복합질환 유병상태를 고려하지 않고 산출한 YLD값과 비교하여 질병부담 산출 시 복합질환 유병상태를 보정하는 것의 효과 크기를 추정하였다. 복합질환의 유병률이 높은 노령층에서 복합질환을 고려하지 않고 YLD를 계산 할 경우 질병부담이 과대 추정될 수 있어, 복합질환을 보정하여 YLD를 산출하는 것이 필요하다.

Key Message
For the elderly whose disease burden can be overestimated, the multimorbidity should be adjusted during YLD calculations.

Employment status and mortality among Korean men over a 13-year period: Dohee Lim, Kyoung Ae Kong, Hyesook Park, Kyunghee Jung-Choi; Epidemiol Health. 2021;43:e2021055. Published online August 18, 2021; DOI: https://doi.org/10.4178/epih.e2021055

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study explored the effect of employment status on mortality over a 13-year period in Korean men.
METHODS
Data were used from the Korean Labor and Income Panel Study from 1999 to 2012. This study started with 2,737 subjects and included employed men in good health, aged 30-69 years. Deaths were tracked for 13 years from 2000 to 2012. Employment status classifications were: (1) regular employees, (2) precarious employees, (3) petty bourgeoisie, and (4) employers. Hazard ratios (HRs) were calculated using a Cox proportional hazards model, and were adjusted for age, education, income, and occupation, with regular employees as the reference category. To examine the effect of employment status and include employment history, the risk ratios of mortality were measured using the Poisson regression model, considering the duration of each employment and using 0 years as the reference category.
RESULTS
Over the course of the 13-year study, being a precarious employee (HR, 1.84) or petty bourgeoisie (HR, 1.87) at a particular point in time had a negative effect on mortality when compared with regular employees. Furthermore, working as precarious employees or petty bourgeoisie had no positive effect on mortality. A positive effect was observed, however, on the overall mortality risk for regular employees.
CONCLUSIONS
These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.; Summary

Korean summary
13년간 추적한 결과, 비정규직 노동자와 고용원이 없는 자영업자가 정규직 노동자에 비해 사망위험이 유의하게 높았다. 정규직 노동자에서는 일하는 것이 사망위험을 낮추는 긍정적인 효과를 관찰할 수 있었으나, 비정규직 노동자나 고용원이 없는 자영업자에서는 일하는 것의 긍정적인 효과를 관찰할 수 없었다. 이는 비정규직 노동자와 고용원이 없는 자영업자에 대한 건강한 사회 정책이 필요함을 시사한다.

Key Message
Over the course of the 13-year study, being a precarious employee or petty bourgeoisie had a negative effect on mortality when compared with regular employees. No positive effect of working was found for precarious employees or petty bourgeoisie, whereas cumulative work as a regular employee was observed to have a positive effect on mortality. These results suggest that a healthy social policy is needed for precarious employees and petty bourgeoisie to avoid disadvantages in the workplace and the social safety net.

Trends in the prevalence and management of major metabolic risk factors for chronic disease over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Yoonjung Kim, Sun Jin Nho, Gyeongji Woo, Hyejin Kim, Suyeon Park, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021028. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021028

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to explore trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from 1998 to 2018 using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The study participants included 79,753 individuals aged ≥ 30 years who had participated in the health examination and health interview of the first (1998) to the seventh (2016-2018) KNHANES. The prevalence and management as well as annual percent change (APC) in chronic diseases were analyzed using SAS and the Joinpoint software program.

RESULTS

The prevalence of obesity in men significantly increased from 26.8% in 1998 to 44.7% in 2018 (APC= 1.9, p< 0.001), whereas that in women decreased slightly from 30.5% in 1998 to 28.3% in 2018 (APC= -0.5, p< 0.001). The prevalence of hypertension in men was 33.2% in 2018, with no significant change, whereas that in women slightly decreased to 23.1% in 2018 (APC= -0.9, p< 0.001). The prevalence of diabetes in men increased slightly from 10.5% in 2005 to 12.9% in 2018 (APC= 1.6, p< 0.001), whereas that in women remained at approximately 8%, with no significant change. The prevalence of hypercholesterolemia in both men and women increased 3-fold in 2018 (20.9% in men [APC = 8.2, p < 0.001] and 21.4% in women [APC= 7.1, p< 0.001]) compared to that in 2005. The awareness rate, treatment rate, and control rate of hypertension and hypercholesterolemia increased 2-3 fold. Regarding diabetes, the treatment rate increased, but the control rate did not change.

CONCLUSIONS

Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리나라 성인의 비만, 고혈압, 당뇨병, 고콜레스테롤혈증 유병률 및 관리수준을 분석한 결과, 20년 동안 비만(남자), 당뇨병, 고콜레스테롤혈증 만성질환의 유병 수준은 악화되고 있는 반면, 만성질환의 인지율, 치료율, 치료자 중 조절률 등 관리지표는 지속적으로 개선되고 있었다.

Key Message
We examined trends in the prevalence and management of obesity, hypertension, diabetes, and hypercholesterolemia in Korean adults from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, the prevalence of obesity (in men), diabetes, and hypercholesterolemia has increased and management indicators, such as the awareness rate, treatment rate, and control rate of chronic diseases, have improved continuously.

Citations

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Adherence to Cancer Prevention Guidelines and Cancer Incidence and Mortality: A Population-Based Cohort Study
Jin-Kyoung Oh, Minji Han, Byungmi Kim, Eun Young Park
Cancer Research and Treatment.2023; 55(1): 15. CrossRef
Deaths and disability-adjusted life years of hypertension in China, South Korea, and Japan: A trend over the past 29 years
Yan Qiu, Junzhuang Ma, Jiahong Zhu, Ying Liu, Wen Ren, Shuaishuai Zhang, Jingjing Ren
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Lifestyle and dietary changes related to weight gain in college students during the COVID-19 pandemic
Jihyun Kim, Seunghee Kye
Journal of Nutrition and Health.2023; 56(3): 288. CrossRef
Ultra-Processed Food Consumption and Obesity in Korean Adults
Jee-Seon Shim, Kyoung Hwa Ha, Dae Jung Kim, Hyeon Chang Kim
Diabetes & Metabolism Journal.2023; 47(4): 547. CrossRef
Changes in metabolic syndrome and the risk of breast and endometrial cancer according to menopause in Korean women
Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park
Epidemiology and Health.2023; 45: e2023049. CrossRef
Diet quality partially mediates the association between ultraprocessed food consumption and adiposity indicators
Jee‐Seon Shim, Kyoung Hwa Ha, Dae Jung Kim, Hyeon Chang Kim
Obesity.2023; 31(9): 2430. CrossRef
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Yoonjung Kim, Suyeon Park, Kyungwon Oh, Hongseok Choi, Eun Kyeong Jeong
Epidemiology and Health.2023; 45: e2023014. CrossRef
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Clinical Hypertension.2022;[Epub] CrossRef
Sex-Specific Trends in the Prevalence of Hypertension and the Number of People With Hypertension: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 1998–2018
Eunsun Seo, Sunjae Jung, Hokyou Lee, Hyeon Chang Kim
Korean Circulation Journal.2022; 52(5): 382. CrossRef
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Sun A Choi, Sung Suk Chung, Jeong Ok Rho
Journal of Nutrition and Health.2022; 55(1): 120. CrossRef
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Ga Bin Lee, Yoonjung Kim, Suyeon Park, Hyeon Chang Kim, Kyungwon Oh
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Taiyue Jin, Eun Young Park, Byungmi Kim, Jin-Kyoung Oh
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Hyeon Chang Kim
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Trends in food and nutrient intake over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Sanghui Kweon, Jin Young Park, Myungsook Park, Yangha Kim, So Yeong Yeon, Leena Yoon, Sungha Yun, Suyeon Park, Ji Eun Yang, Youngtaek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021027. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021027

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to examine the current status and trends of food and nutrient intake in the Korean population over the past 20 years using the data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

We conducted a survey of 116,284 subjects over the age of one year in Korea, who participated in the KNHANES between 1998 and 2018. We collected data on the subjects’ intake for the day before using the 24-hour recall method. The annual percent change (APC) in the food groups and nutrient intake were calculated using SAS and Joinpoint software.

RESULTS

The intake of grains (APC=-0.4, p<0.05) and vegetables (APC=-0.8, p<0.05) was observed to decrease. In contrast, the intake of beverages, meat, dairy, and eggs increased. In particular, beverage intake increased by more than four times (APC=9.2, p<0.05). There was no significant change in energy intake. However, the proportion of energy intake from carbohydrates decreased by approximately 5%p (APC=-0.3, p<0.05), whereas that from fat increased by approximately 5%p (APC= 1.1, p<0.05). Additionally, there were decreases in the proportion of energy intake from breakfast and homemade meals and increases in the energy intake from snacks, dining out, and convenience food. The intake of vitamin C (APC=-3.2, p<0.05) and sodium (APC=-2.3, p<0.05) significantly decreased.

CONCLUSIONS

Over the past 20 years, there has been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat. Since nutritional status is an important factor in the prevention and management of chronic diseases, it should be continuously monitored.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 우리 국민의 지난 20년간의 식품 및 영양소 섭취 현황 및 추이를 분석한 결과, 곡류, 채소류, 탄수화물, 나트륨, 비타민 C 섭취 감소, 음료류, 우유류, 육류, 난류, 지방 섭취 증가 등 식품 및 영양소 섭취에 변화가 있었다.

Key Message
We examined the current status and trends of food and nutrient intake in the Korean population using the data from the 1998-2018 Korea National Health and Nutrition Examination Survey. Over the past 20 years, there have been decreases in the intake of grains, vegetables, carbohydrates, sodium, and vitamin C and increases in the intake of beverages, dairy, meat, eggs, and fat.

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Trends in health behaviors over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey: Soyeon Kim, Sunhye Choi, Jihee Kim, Suyeon Park, Young-Taek Kim, Ok Park, Kyungwon Oh; Epidemiol Health. 2021;43:e2021026. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021026

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to examine the trends in health behaviors in Korean population using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

The subjects were 96,408 adults aged 19 years or older who participated in the first (1998) through seventh (2016-2018) KNHANES health interview. The prevalence of health behaviors (cigarette smoking, alcohol drinking, and physical activity) and annual percent change (APC) were estimated using SAS and the Joinpoint program.

RESULTS

The prevalence of current cigarette smoking in men decreased by 2.8%p (APC= -2.8, p< 0.001) annually over the 20-year period, and the prevalence of exposure to secondhand smoke at home substantially decreased compared to 2005 (APC= -8.8, p< 0.001). Compared to 2005, the prevalence of current alcohol drinking in women, but not men, increased (APC= 2.0, p< 0.001), and the prevalence of binge drinking decreased in men (APC= -0.7, p< 0.001) and increased in women (APC= 2.4, p< 0.001). The prevalence of aerobic physical activity decreased from 2014 in both gendersd (p< 0.001). The prevalence of healthy behaviors practice (non-smoking, alcohol abstinence, and aerobic physical activity) was down-trending (APC= -5.3, p< 0.001), especially among women (APC= -6.4, p< 0.001).

CONCLUSIONS

Over the past 20 years, smoking behaviors improved. However, drinking behavior was unchanged and physical activity indicators markedly decreased. More active programs are necessary for improving health behaviors, which are major risk factors linked to chronic diseases.

Summary

Korean summary
국민건강영양조사(1998-2018) 자료를 활용하여 지난 20년간 성인의 건강행태를 분석한 결과 흡연율과 간접흡연 노출률은 지속적으로 감소하였고, 신체활동 실천율 또한 감소하였다. 월간음주율과 폭음률의 경우 남자는 큰 변화가 없었던 반면 여자는 모두 증가하였다.

Key Message
This study aimed to examine the trends in health behaviors in Korean population using data from the 1998-2018 Korea National Health and Nutrition Examination Survey (KNHANES). Over the past 20 years, the prevalence of cigarette smoking and exposure to secondhand smoke in Korean adults consistently decreased, as well as the prevalence of physical activity. There was no considerable change in men, whereas in women, the prevalence of alcohol drinking and binge drinking both increased.

Citations

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Methods

Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions: Kyungwon Oh, Yoonjung Kim, Sanghui Kweon, Soyeon Kim, Sungha Yun, Suyeon Park, Yeon-Kyeng Lee, Youngtaek Kim, Ok Park, Eun Kyeong Jeong; Epidemiol Health. 2021;43:e2021025. Published online April 19, 2021; DOI: https://doi.org/10.4178/epih.e2021025

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575 Download
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Abstract Summary PDF Supplementary Material

Abstract

The Korea National Health and Nutrition Examination Survey (KNHANES) was initiated in 1998 to provide evidence for the development and evaluation of health policies and programs. The Korea Disease Control and Prevention Agency is responsible for the KNHANES and has conducted it as a series of surveys. Over the past 20 years, efforts to produce accurate, timely, and nationwide health statistics have been refined by establishing a continuous annual survey system with full-time field staff, incrementally expanding survey components, collaborating with relevant academic societies for quality control, and revising the survey methods. Additionally, the utility of the collected data was increased by linking the KNHANES data with related data from other government agencies or institutions and making the overall data publicly available on the official website of KNHANES (https://knhanes.kdca.go.kr). Additional long-term plans are being developed, including plans to continue producing nationwide health indicators and invigorating the utilization of the KNHANES data.

Summary

Korean summary
국민건강영양조사는 국민건강증진법제16조에 근거하여 1998년부터 우리 국민의 건강수준, 건강행태, 식품 및 영양소 섭취 실태에 대한 국가단위 통계를 산출하는 조사사업이다. 본 연구에서는 건강지표 생산 확대, 조사 자료 활용도 향상 등 20년간의 성과를 요약하고 사회환경과 조사여건 변화를 반영한 건강통계 생산의 발전 방안을 제시하였다.

Key Message
The Korea National Health and Nutrition Examination Survey (KNHANES) is an ongoing surveillance system that was initiated in 1998 based on Ar¬ticle 16 of the National Health Promotion Act to produce nationwide statistics regarding the health status, health behaviors, and food and nutrient consumption of the Korean population. In this study, the 20-year accomplishments of the KNHANES including vigorous production of health indicators and improvement of data utilization are summarized, and future plans are presented to improve the health statistics to reflect changes in the social and survey environments.

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Original Article

Comorbidity network analysis related to obesity in middle-aged and older adults: findings from Korean population-based survey data: Hye Ah Lee, Hyesook Park; Epidemiol Health. 2021;43:e2021018. Published online March 5, 2021; DOI: https://doi.org/10.4178/epih.e2021018

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Abstract Summary PDF

Abstract

OBJECTIVES
We conducted a comorbidity network analysis using data from the seventh Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities.

METHODS

The study included 11,712 subjects aged 45 to 80 (5,075 male and 6,637 female). A prevalent disease was defined as a specific disease for which a subject had been diagnosed by a doctor and was being treated. Comorbidity network analysis was performed for diseases with a prevalence of 1% or more, including overweight and obesity. We estimated the observed-to-expected ratio of all possible disease pairs with comorbidity strength and visualized the network of obesity-related comorbidities.

RESULTS

In subjects over 45 years old, 37.3% of people had a body mass index over 25.0 kg/m2. The most common prevalent disease was hypertension (42.3%), followed by dyslipidemia (17.4%) and diabetes (17.0%). Overweight and obese subjects were 2.1 times (95% confidence interval, 1.9 to 2.3) more likely to have a comorbidity (i.e., 2 or more diseases) than normal-weight subjects. Metabolic diseases such as hypertension, dyslipidemia, diabetes, and osteoarthritis were directly associated with overweight and obesity. The probability of coexistence for each of those 4 diseases was 1.3 times higher than expected. In addition, hypertension and dyslipidemia frequently coexisted in overweight and obese female along with other diseases. In obese male, dyslipidemia and diabetes were the major diseases in the comorbidity network.

CONCLUSIONS

Our results provide evidence justifying the management of metabolic components in obese individuals. In addition, our results will help prioritize interventions for comorbidity reduction as a public health goal.

Summary

Korean summary
본 연구는 비만 관련 동반질환을 체계적으로 정량화하기 위해, 제7차 (2016-2018) 국민건강영양조사 자료를 이용하여 동반질환 네트워크 분석을 수행하였습니다. 45세 이상 성인에서 비만(체질량지수≥25.0 kg/m²)은 정상체중에 비해 동반질환에 대한 위험이 2.1배 높은 것으로 나타났습니다. 동반질환 네트워크에서는 고혈압과 이상지질혈증이 비만 여성의 주요 질환 이였으며, 이상지질혈증과 당뇨병은 비만 남성의 주요 질환인 것으로 나타났습니다. 본 연구결과는 비만 관련 동반질환 감소를 위한 중재의 우선 순위를 정하는데 도움이 될 것이라고 생각됩니다.

Key Message
We conducted a comorbidity network analysis using data from the seventh (2016-2018) Korea National Health and Nutrition Examination Survey to systematically quantify obesity-related comorbidities. In subjects over 45 years old, obese (body mass index ≥ 25.0 kg/m²) subjects were 2.1 times more likely to have a comorbidity than normal-weight subjects. In the comorbidity network, hypertension and dyslipi¬demia were the major diseases in obese females, and dyslipidemia and diabetes were the major diseases in obese males. Our results will help prioritize interventions for reducing obesity-related comorbidities.

Citations

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Cohort Profile

Cohort profile: the Ewha Birth and Growth Study: Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Jeong Choi, Ui Jeong Kim, Hyun Jin Park, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eui-Jung Kim, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2021;43:e2021016. Published online February 22, 2021; DOI: https://doi.org/10.4178/epih.e2021016

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Abstract

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child’s growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

Summary

Korean summary
이화영아성장코호트는 만성질환 예방을 위한 생애초기 위험인자에 대한 근거를 제공하기 위해 2001년에 시작되었습니다. 이화영아성장코호트는 국내에서 선도적인 장기 추적관찰 연구로, 소아기 건강과 관련된 산전 및 출생 시 특징, 소아기 대사와 관련된 유전적 혹은 후성학적 특성, 내분비 장애물질 노출에 따른 영향, 소아기의 식이패턴과 같은 다양한 연구결과들을 발표하였습니다. 추후 청년기의 자료 수집을 계획하고 있으며, 우리의 연구결과는 만성질환 예방을 위한 중재 개발에 기여할 것으로 기대됩니다.

Key Message
To provide evidence of early life risk factors for the prevention of chronic diseases, the Ewha Birth and Growth Study was started in 2001. The Ewha Birth and Growth cohort is a leading long-term follow-up study in Korea, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. We are planning to collect data for early adulthood, and our findings will contribute to the development of interventions to prevent chronic diseases.

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Prospective association between phthalate exposure in childhood and liver function in adolescence: the Ewha Birth and Growth Cohort Study
Seonhwa Lee, Hye Ah Lee, Bohyun Park, Hyejin Han, Young Sun Hong, Eun Hee Ha, Hyesook Park
Environmental Health.2023;[Epub] CrossRef
BMI trajectory and inflammatory effects on metabolic syndrome in adolescents
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Synergistic effect of serum uric acid and body mass index trajectories during middle to late childhood on elevation of liver enzymes in early adolescence: Findings from the Ewha Birth and Growth Study
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Brief Communication

Evaluation report on the causal association between humidifier disinfectants and lung injury: Mina Ha, Soon Young Lee, Seung-sik Hwang, Hyesook Park, Seungsoo Sheen, Hae Kwan Cheong, Bo Youl Choi; Epidemiol Health. 2016;38:e2016037. Published online August 18, 2016; DOI: https://doi.org/10.4178/epih.e2016037

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.

METHODS

A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.

RESULTS

We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.

CONCLUSIONS

Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

Summary

Korean summary
본 논문에서는 Hill의 기준과 US Surgeon General 전문위원회에서 제시하는 기준에 근거하여 가습기살균제와 폐손상과의 인과성을 검토하였다. 검토결과, 11개 조건(관련성의 강도, 일관성, 특이성, 시간적 선후관계, 생물학적 용량-반응 관계, 개연성, 기존 지식과의 일치성, 실험, 유사성, 다른 가능한 해석에 대한 고려 및 노출의 중단) 을 모두 충족함을 확인하므로 써, 2011년 발생한 원인미상 폐손상의 원인이 가습기살균제 노출로 인한 것임을 알 수 있었다. 무엇보다도 가습기살균제 시판 전에는 원인미상 폐손상이 보고된 바가 없었고, 2011년 11월 가습기살균제 판매중지 이후 폐손상이 한 건도 발생하지 않은 것은 원인미상의 폐손상이 가습기살균제로 인한 것임을 강력하게 지지하는 것으로 판단된다.

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Original Articles

The effect of community-level smoke-free ordinances on smoking rates in men based on Community Health Surveys: Hye Ah Lee, Hyesook Park, Ho Kim, Kyunghee Jung-Choi; Epidemiol Health. 2014;36:e2014037. Published online December 26, 2014; DOI: https://doi.org/10.4178/epih/e2014037

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152 Download
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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
As one of smoke-free policies, communities have established the smoke-free ordinances since August 2010. Thus, this study aimed to evaluate the effects of community-level smoke-free ordinances (SFO) on smoking rates in men using multiyear Community Health Survey (CHS) data.

METHODS

Data on community-level SFO were collected from a website on Enhanced Local Laws and Regulation Information System. Regional smoking-related data were obtained from CHS data from 2008 to 2012 and the age-standardized rates of current smoking in men, attempts to quit smoking, and smoke-free campaign experiences including the mean number of cigarettes smoked (smoking amount) were calculated. Repeated measures analysis of variance was performed to evaluate the effects of regional implementation of SFO and the duration on change of smoking rates.

RESULTS

Overall current smoking rates and daily mean cigarettes smoked were lower in community where SFO had been implemented compared to those without implementation, and there was a significant difference in smoking rates between 2010 and 2008. Cross-sectional analysis of the effects of regional SFO revealed clear difference in rate of current smoking, but longitudinal analysis showed no significant differences. Stratifying by age groups, however, showed that groups less than 30 years of age had low smoking rates in community with ordinance compared to those without SFO since 2010. Yearly surveys measuring the number of cigarettes smoked, attempts to quit smoking, and experiences of smoke-free campaigns showed regional differences in the duration of implementation, but these differences were not significant in longitudinal analysis. Furthermore, there was a difference in regional socioeconomic characteristics between community with and without SFO implementation.

CONCLUSIONS

For effective smoking control, it is necessary to evaluate current policies and develop indices to evaluate the practical implementation of ordinances. As more communities to pass the SFO, long-term observation and assessments required.

Summary

Korean summary
2008년부터 2012년까지 조사된 지역사회건강조사 자료를 이용하여, 지역별 금연 조례 시행에 대한 효과를 평가한 연구 결과로, 종단적 분석을 통해 접근하였을 때 시간에 따른 흡연율 감소 폭은 조례 시행/미시행 지역간에 차이를 보이지 않았으며, 지역의 사회경제적 특성 요인에 차이가 존재하는 것으로 나타났다. 효과적인 흡연 규제를 위해, 현 시행중인 정책에 대한 효과 평가 및 장기적인 평가가 필요하다.

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Li-Yuan Sun, Hae-Kwan Cheong, Eun-Whan Lee, Kyeong-Jin Kang, Jae-Hyun Park
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The Associations between Social Support, Health-Related Behaviors, Socioeconomic Status and Depression in Medical Students: Yoolwon Jeong, Jin Young Kim, Jae Seon Ryu, Ko eun Lee, Eun Hee Ha, Hyesook Park; Epidemiol Health. 2010;32:e2010009. Published online November 24, 2010; DOI: https://doi.org/10.4178/epih/e2010009

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Abstract

<sec><title>OBJECTIVES</title>The objective of this study was to estimate the prevalence of depression in medical students and to evaluate whether interpersonal social support, health-related behaviors, and socio-economic factors were associated with depression in medical students.</sec><sec><title>METHODS</title>The subjects in this study were 120 medical students in Seoul, Korea who were surveyed in September, 2008. The subjects were all women and over the age of 20. Their age, body mass index (BMI), quality of sleep, diet, household income, smoking, alcohol consumption, exercise levels, and self-reported health status were surveyed. The degree of perceived social support was measured using the interpersonal support evaluation list (ISEL). Depression was evaluated using the center for epidemiology studies depression scale (CES-D).</sec><sec><title>RESULTS</title>The mean CES-D score was 14.1±8.6 and 37.1% of the participants appeared to suffer from depression. Low levels of perceived interpersonal support increased the risk of depression by more than 10 times and having higher household income did not necessarily decrease the risk of depression.</sec><sec><title>CONCLUSION</title>Medical students have a relatively high level of depression. Efforts should be made to encourage social support in order to promote mental health in medical students.</sec>

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The association between insulin resistance and Framingham risk score among type 2 diabetes.: Hee Sook Park, Ji Eun Yun, Soo Jin Yoon, Eurin Cho, Kyung A Ahn, Seok Won Park, Chul Woo Ahn, Dae Jung Kim, Young Duk Song, Young Ju Choi, Mi Ae Cho, Eun Jig Lee, Kap Bum Huh, Sun Ha Jee; Korean J Epidemiol. 2007;29(1):46-58.

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Abstract PDF: Abstract
BACKGROUND
AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea.
METHODS
We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD.
RESULTS
Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women).
CONCLUSION
Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.; Summary

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