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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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AbstractAbstract AbstractSummary 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.
Higher energy consumption in the evening is associated with increased odds of obesity and metabolic syndrome: findings from the 2016-2018 Korea National Health and Nutrition Examination Survey (7th KNHANES)
Sarang Jeong, Hajoung Lee, Sukyoung Jung, Jee Young Kim, Sohyun Park
Epidemiol Health. 2023;45:e2023087.   Published online September 19, 2023
DOI: https://doi.org/10.4178/epih.e2023087
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  • 163 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Chrono-nutrition emphasizes meal timing in preventing obesity and metabolic disorders. This study explores the impact of temporal dietary patterns (TDPs) on obesity and metabolic syndrome (MetS) in Korean adults aged 20 years to 65 years.
METHODS
We utilized dynamic time warping method and Kernel k-means clustering to investigate diet quality and the odds ratios (ORs) of obesity and MetS with different TDPs using data from the 7th Korea National Health and Nutrition Examination Survey.
RESULTS
Participants were divided into three groups based on relative energy intake over 24 hours. After adjusting for age and gender, Cluster 3 (with the highest proportion of energy intake in the evening) had the lowest Healthy Eating Index scores compared to other clusters. Following adjustment for key covariates, Cluster 3 showed the highest values for body mass index, waist circumference, blood pressure, total cholesterol, and triglycerides. Compared to Cluster 1 (with a lower proportion of energy intake in the evening), Cluster 2 and Cluster 3 had ORs for obesity of 1.12 (95% confidence interval [CI], 0.97 to 1.30) and 1.19 (95% CI, 1.03 to 1.37), respectively. For MetS, the ORs were 1.26 (95% CI, 1.08 to 1.48) and 1.37 (95% CI, 1.17 to 1.61) when comparing Cluster 2 and Cluster 3 to Cluster 1.
CONCLUSIONS
This study reveals that individuals with higher energy intake in the evening have increased odds of obesity and MetS, even after adjusting for major covariates, including age and total energy intake.
Summary
Korean summary
본 연구는 하루 중 주요 에너지 섭취 사간에 따른 인구사회학적 특징과 건강지표의 상관성을 분석하였다. 제 7기 국민건강영양조사의 20~65세의 한국 성인을 대상으로 Dynamic Time Warping 방법을 이용하여 군집을 나누어 분석한 결과, 하루 중 저녁시간에 에너지 섭취가 높은 그룹이 그렇지 않은 그룹에 비해 연령이 낮고, 흡연자, 음주자, 스트레스를 느끼는 대상자의 비율이 높았다. 또한, 저녁에 에너지 섭취 비율이 높은 그룹이 그렇지 않은 그룹에 비해 체질량지수, 허리둘레, 혈압, 총 콜레스테롤, 중성지방이 높았으며, 식생활 평가 지수가 가장 낮았다. 마지막으로 하루 섭취하는 총 에너지 양과 생활습관 변수를 보정하고도 저녁에 섭취하는 에너지가 많은 그룹은 그렇지 않은 그룹에 비해 비만 및 대사 증후군 유병이 더 높은 것으로 나타났다.
Key Message
• This study examined the relationship between sociodemographic characteristics and health indicators based on the timing of major energy intake during the day. • Using the Dynamic Time Warping method, the analysis revealed that the group with higher evening energy intake was younger and had a higher proportion of smokers, alcohol consumers, and individuals experiencing stress. • Additionally, the group with higher evening energy intake exhibited higher levels of obesity and metabolic syndrome, even after adjusting for total daily energy intake and lifestyle variables.

Citations

Citations to this article as recorded by  
  • Association of Dietary Fiber and Measures of Physical Fitness with High-Sensitivity C-Reactive Protein
    Ming-Zhen Su, Suyeon Lee, Dayeon Shin
    Nutrients.2024; 16(6): 888.     CrossRef
  • Advances in Gut Microbiota-Targeted Therapeutics for Metabolic Syndrome
    Yu Gao, Wujuan Li, Xiaoyu Huang, Yuhong Lyu, Changwu Yue
    Microorganisms.2024; 12(5): 851.     CrossRef
Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults
Pardis Mohammadzadeh, Farhad Moradpour, Bijan Nouri, Farideh Mostafavi, Farid Najafi, Ghobad Moradi
Epidemiol Health. 2023;45:e2023083.   Published online September 3, 2023
DOI: https://doi.org/10.4178/epih.e2023083
  • 4,072 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population.
METHODS
We used data from 3,996 participants, aged 35 years to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components.
RESULTS
The prevalence of MetS was 34.44% (95% confidence interval [CI], 32.97 to 35.93). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components.
CONCLUSIONS
This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.
Summary
Key Message
This study sheds light on the presence of socioeconomic inequalities in metabolic syndrome (MetS) among Iranian Kurds. Lower socioeconomic status (SES) is associated with a higher prevalence of MetS and its components. Addressing these socioeconomic factors is crucial to reduce health inequalities. Recognizing this association helps us understand the social determinants of health and design targeted interventions. Policymakers and health managers should prioritize developing strategies to reduce these inequalities in MetS across different age groups, genders, and educational levels, with a particular focus on vulnerable populations like women and the elderly.
Body mass index and prevalence of metabolic syndrome among Korean adults before and after the COVID-19 outbreak: a retrospective longitudinal study
Joo-Eun Jeong, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park, Myoung-Hye Lee, Seon-Hi Shin, Nayeon Choi
Epidemiol Health. 2023;45:e2023081.   Published online August 29, 2023
DOI: https://doi.org/10.4178/epih.e2023081
  • 6,153 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Studies evaluating weight changes during the coronavirus disease 2019 (COVID-19) pandemic have yielded inconsistent results, and most of those studies were based on self-reported anthropometric measures. We investigated changes in body mass index (BMI), professionally measured waist circumference (WC), and metabolic syndrome components from before to during the pandemic in a sample of the adult population in Korea.
METHODS
This retrospective study included 1,118 male and female (age≥18 years) who underwent health checkups at a university medical center between January 1, 2016 and March 31, 2022. Changes in BMI, lifestyles, and metabolic syndrome components during the pandemic were analyzed using the paired t-test, McNemar test, generalized estimating equations, and repeated-measures analysis of variance.
RESULTS
Changes in body weight, BMI, and body fat percentage during the pandemic were not clinically significant. However, statistically significant results were found for decreased physical activity (p<0.001) and WC (p<0.001), and exacerbation of all metabolic syndrome components (except serum triglyceride levels). Moreover, the metabolic syndrome prevalence increased significantly from 20.2% to 31.2% during the pandemic (p<0.001). The prevalence of abdominal obesity and high fasting blood glucose levels also significantly increased from 2019 to 2021.
CONCLUSIONS
Metabolic syndrome, its components, and fat distribution worsened significantly after the implementation of social distancing and lockdowns, despite no clinically significant changes in body weight and BMI. Further studies on the post- pandemic period should investigate the long-term impact of social lockdowns on BMI and the prevalence of metabolic syndrome.
Summary
Korean summary
본 연구에서는 한국인 성인들의 코로나 팬대믹으로 인한 사회적 거리 두기, 봉쇄 정책 전 후의 체질량지수, 생활습관, 그리고 대사증후군과 그 구성 요소들의 변화를 건강검진을 통해 측정한 객관적인 지표의 변화를 통해 알아보고자 하였다. 연구 결과, 사회적 거리 두기 및 봉쇄 전후의 체질량지수와 체중은 유의미한 변화가 없었으나, 신체 활동량은 유의미하게 감소하였고, 체지방률, 허리둘레가 늘어났다. 그리고 중성지방을 제외하고 다른 대사증후군의 구성 요소인 혈압, 고밀도지단백 콜레스테롤, 공복혈당 지표는 악화되었다. 하위 그룹 분석에서 매년 검진을 시행 받은 대상자들 및 고혈압, 당뇨병, 이상지질혈증 약을 복용하지 않는 대상자들의 코로나-19 전후 연도별 대사 지표의 변화를 분석한 결과, 복부비만 유병률과 공복 혈당의 증가 양상이 뚜렷하였다.
Key Message
Although there was no significant change in BMI and weight, the prevalence of metabolic syndrome, abdominal obesity, and fasting blood glucose level prominently worsened after the implementation of social distancing and lockdowns. Such findings may indicate deterioration of insulin resistance during the COVID-19 pandemic. This study provides valuable information for healthcare professionals, policymakers, and the general public towards mitigating the negative consequences of the pandemic on metabolic health, regardless of weight gain.
Associations of cumulative average dietary total antioxidant capacity and intake of antioxidants with metabolic syndrome risk in Korean adults aged 40 years and older: a prospective cohort study (KoGES_CAVAS)
Ji-Sook Kong, Jiseon Lee, Youngjun Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim
Epidemiol Health. 2023;45:e2023067.   Published online July 28, 2023
DOI: https://doi.org/10.4178/epih.e2023067
  • 4,554 View
  • 122 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Limited and inconsistent prospective evidence exists regarding the relationship of dietary total antioxidant capacity (dTAC) and antioxidant intake with metabolic syndrome (MetS) risk. We evaluated the associations of the cumulative averages of dTAC and antioxidant intake (in 5 classes: retinol, vitamin C, vitamin E, carotenoids, and flavonoids, as well as 7 flavonoid subclasses) with the risk of MetS.
METHODS
This study included 11,379 participants without MetS, drawn from the Korean Genome and Epidemiology Study_CArdioVascular disease Association Study (KoGES_CAVAS). The cumulative average consumption was calculated using repeated food frequency questionnaires. Incidence rate ratios were estimated using a modified Poisson regression model with a robust error estimator.
RESULTS
The median follow-up period was 5.16 years, and 2,416 cases of MetS were recorded over 58,750 person-years. In men, significant inverse associations were observed in all 5 antioxidant classes, except for the highest quartile of dTAC. In women, dTAC and total flavonoids were not significantly associated with MetS; however, significant L-shaped associations were found for the remaining 4 antioxidant classes. Of the 7 flavonoid subclasses, only flavones in the highest quartile for men and flavan-3-ols in women lacked significant associations with MetS. The inverse associations were not sex-specific, but they were particularly pronounced among participants with a body mass index (BMI) of 23 kg/m<sup>2</sup> or higher.
CONCLUSIONS
The findings suggest that most antioxidant classes and flavonoid subclasses, unlike dTAC, exhibit a clear beneficial association with MetS in an L-shaped pattern in both men and women, particularly those with a high BMI.
Summary
Korean summary
농촌코호트 조사 참여자를 대상으로 식이 총항산화능, 총항산화능 하위분류, 플라보노이드 하위분류와 대사증후군 발생 위험의 전향적 연관성을 평가한 결과, 대부분의 항산화물(5개항산화물 분류:4개 항산화 비타민과 플라보노이드; 플라보노이드 7개 하부분류)에서 대사증후군과 음의 상관성을 확인할 수 있었으며 총항산화능(남자와 여자)과 플라보노이드(여자)에서 약한 연관성을 보였다. 남녀간 유의한 상호작용은 없었고 특히 BMI가 높은 집단에서 두드러졌다. 이 연구의 결과는 특히 식이 총항산화능을 구성하는 하위 유형을 적절히 섭취하는 것이 특히 비만한 성인에서 대사증후군 위험을 낮추는 예방전략으로 효과가 있을 수 있음을 시사한다.
Key Message
We observed that the cumulative average of dietary antioxidant vitamins and most flavonoids may be have pivotal roles in prevention of MetS, although there may be weak associations of dTAC and flavonoids in women. Moreover, these inverse associations were more pronounced in high BMI individuals. Our results suggest that the consumption of antioxidants and flavonoid may mitigate the MetS risk, particularly in overweight/obese individuals at high risk of developing chronic diseases.

Citations

Citations to this article as recorded by  
  • The association of dietary total flavonoids and their subclasses with the risk of type 2 diabetes: a prospective cohort study
    Hye Won Woo, Mi Kyung Kim, Kong Ji-Sook, Jiseon Lee, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim
    European Journal of Nutrition.2024;[Epub]     CrossRef
  • A Systematized Review of the Relationship Between Obesity and Vitamin C Requirements
    Julia K Bird, Edith JM Feskens, Alida Melse-Boonstra
    Current Developments in Nutrition.2024; 8(5): 102152.     CrossRef
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
Epidemiol Health. 2023;45:e2023049.   Published online May 1, 2023
DOI: https://doi.org/10.4178/epih.e2023049
  • 5,258 View
  • 136 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated how changes in metabolic syndrome (MetS) are associated with the subsequent risk of breast and endometrial cancer according to menopausal status.
METHODS
This cohort study, using data from the National Health Insurance Service database, included women aged ≥40 years who underwent 2 biennial cancer screenings (2009-2010 and 2011-2012) and were followed up until 2020. Participants were grouped into MetS-free, MetS-recovery, MetS-development, and MetS-persistent groups. Menopausal status (premenopausal, perimenopausal, and postmenopausal) was assessed at 2 screenings. Cox proportional hazard regression was used to assess the association between MetS changes and cancer risk.
RESULTS
In 3,031,980 women, breast and endometrial cancers were detected in 39,184 and 4,298, respectively. Compared with the MetS-free group, those who recovered, developed, or had persistent MetS showed an increased risk of breast cancer, with adjusted hazard ratios (aHRs) of 1.05, 1.05, and 1.11, respectively (p<0.005). MetS persistence was associated with an increased risk of breast cancer in postmenopausal women (aHR, 1.12, 95% confidence interval [CI], 1.08 to 1.16) but not in premenopausal or perimenopausal women. MetS persistence was associated with an increased risk of endometrial cancer in premenopausal, perimenopausal, and postmenopausal women, with aHRs of 1.41 (95% CI, 1.17 to 1.70), 1.59 (95% CI, 1.19 to 2.12), and 1.47 (95% CI, 1.32 to 1.63), respectively.
CONCLUSIONS
Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. Meanwhile, increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.
Summary
Korean summary
- 폐경후 여성에서 대사증후군이 회복되었거나, 지속적으로 대사증후군을 앓고 있거나, 대사증후군이 발병한 여성은 유방암 위험과 관련이 있었습니다. - 한편, 폐경 상태와 관계없이 대사증후군에서 회복되었거나 지속적으로 대사증후군를 앓고 있는 비만 여성은 대사증후군이 없는 여성에 비해 자궁내막암 위험이 증가하는 것으로 나타났습니다.
Key Message
- Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. - Increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.

Citations

Citations to this article as recorded by  
  • Metabolic Syndrome and Survival Outcomes in Endometrial Cancer
    Alina-Gabriela Marin, Alexandru Filipescu, Radu Vladareanu, Aida Petca
    Cureus.2024;[Epub]     CrossRef
  • Melatonin, BAG-1 and cortisol circadian interactions in tumor pathogenesis and patterned immune responses
    George Anderson
    Exploration of Targeted Anti-tumor Therapy.2023; : 962.     CrossRef
  • Changed Endocrinology in Postmenopausal Women: A Comprehensive View
    Vidhi Motlani, Gunjan Motlani, Soumya Pamnani, Akshat Sahu, Neema Acharya
    Cureus.2023;[Epub]     CrossRef
Changes in the prevalence of metabolic syndrome in Korean adults after the COVID-19 outbreak
Ji-Young Kwon, Sang-Wook Song
Epidemiol Health. 2022;44:e2022101.   Published online November 5, 2022
DOI: https://doi.org/10.4178/epih.e2022101
  • 3,866 View
  • 95 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
This study sought to reveal changes in the prevalence of metabolic syndrome (MetS) after the start of the coronavirus disease 2019 (COVID-19) pandemic and to identify the groups showing the greatest changes.
METHODS
We compared the prevalence of MetS between 2017–2019 (i.e., the 3-year period before the COVID-19 pandemic) and soon after the initial outbreak of COVID-19 in 2020 among 24,564 adults ≥ 19 years of age using data from the Korea National Health and Nutrition Examination Survey.
RESULTS
The prevalence of MetS increased steadily between 2017 and 2020 (29.4 to 35.3%, p for trend < 0.001), with annual percent changes of 2.0%p, 2.2%p, and 1.7%p, respectively. Compared to 3 years before the COVID-19 pandemic, the prevalence of MetS significantly increased during the COVID-19 pandemic in males (6.2%p; 95% confidence interval [CI], 3.5 to 8.9) compared to females (1.5%p; 95% CI, -1.2 to 4.1). The age groups with the greatest increases in MetS prevalence after the COVID-19 pandemic were those in their 40s (4.6%p; 95% CI, 0.9 to 8.4) and 50s (5.8%p; 95% CI, 2.2 to 9.4). By educational background, the increase in MetS prevalence was greatest among those with a college degree or higher (5.1%p). The prevalence of MetS in high-income (5.3%p) and low-income (4.6%p) groups significantly increased.
CONCLUSIONS
The increasing trend in the overall prevalence of MetS continued during the COVID-19 pandemic. In particular, the prevalence of MetS among adult males in their 40s and 50s increased significantly after the COVID-19 outbreak in Korea.
Summary

Citations

Citations to this article as recorded by  
  • Deep autoencoders and multivariate analysis for enhanced hypertension detection during the COVID-19 era
    Khongorzul Dashdondov, Mi-Hye Kim, Mi-Hwa Song
    Electronic Research Archive.2024; 32(5): 3202.     CrossRef
  • Increasing incidence and prevalence of metabolic syndrome in people living with HIV during the COVID-19 pandemic
    Rebecka Papaioannu Borjesson, Laura Galli, Camilla Muccini, Andrea Poli, Tommaso Clemente, Martina Bottanelli, Nicola Gianotti, Silvia Nozza, Antonella Castagna, Vincenzo Spagnuolo
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Body mass index and prevalence of metabolic syndrome among Korean adults before and after the COVID-19 outbreak: a retrospective longitudinal study
    Joo-Eun Jeong, Hoon-Ki Park, Hwan-Sik Hwang, Kye-Yeung Park, Myoung-Hye Lee, Seon-Hi Shin, Nayeon Choi
    Epidemiology and Health.2023; 45: e2023081.     CrossRef
The association between metabolic syndrome and heart failure in middle-aged male and female: Korean population-based study of 2 million individuals
Tae-Eun Kim, Hyeongsu Kim, JiDong Sung, Duk-Kyung Kim, Myoung-Soon Lee, Seong Woo Han, Hyun-Joong Kim, Sung Hea Kim, Kyu-Hyung Ryu
Epidemiol Health. 2022;44:e2022078.   Published online September 21, 2022
DOI: https://doi.org/10.4178/epih.e2022078
  • 4,067 View
  • 68 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Although an association is known to exist between metabolic syndrome (MetS) and heart failure (HF) risk, large longitudinal studies are limited. We investigated metabolic status as a risk factor for HF in middle-aged male and female and considered sex differences in various risk factors for HF using nationwide real-world data.
METHODS
Data obtained from the Korean National Health Insurance Service from 2009 to 2016 were analyzed. A total of 2,151,597 middle-aged subjects (between 50 and 59 years old) were enrolled. Subjects were divided into 3 groups (normal, pre‐ MetS, and MetS). Cox proportional hazard models were used to estimate the association between MetS and incident HF after adjusting for clinical risk factors.
RESULTS
At baseline, MetS existed in 23.77% of male and 10.58% of female. Pre-MetS and MetS increased the risk of HF: the hazard ratios of pre-MetS for incident HF were 1.508 (95% confidence interval [CI], 1.287 to 1.767) in male and 1.395 (95% CI, 1.158 to 1.681) in female, and those of MetS were 1.711 (95% CI, 1.433 to 2.044) in male and 2.144 (95% CI, 1.674 to 2.747) in female. Current smoking, a low hemoglobin level, underweight (body mass index < 18.5 kg/m2), a high creatinine level, and acute myocardial infarction were also predictors of HF in both sexes.
CONCLUSIONS
Pre-MetS and MetS were identified as risk factors for HF in middle-aged male and female. The effect of MetS on the occurrence of HF was stronger in female than in male. Pre-MetS was also a predictor of HF, but was associated with a lower risk than MetS.
Summary

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  • Integrating machine learning and nontargeted plasma lipidomics to explore lipid characteristics of premetabolic syndrome and metabolic syndrome
    Xinfeng Huang, Qing He, Haiping Hu, Huanhuan Shi, Xiaoyang Zhang, Youqiong Xu
    Frontiers in Endocrinology.2024;[Epub]     CrossRef
  • 17-year follow-up of association between telomere length and all-cause mortality, cardiovascular mortality in individuals with metabolic syndrome: results from the NHANES database prospective cohort study
    Lijiao Xiong, Guangyan Yang, Tianting Guo, Zhaohao Zeng, Tingfeng Liao, Yanchun Li, Ying Li, Fujuan Chen, Shu Yang, Lin Kang, Zhen Liang
    Diabetology & Metabolic Syndrome.2023;[Epub]     CrossRef
  • Modifications of long-term heart rate variability produced in an experimental model of diet-induced metabolic syndrome
    W. M. Lozano, J. E. Ortiz-Guzmán, O. Arias-Mutis, A. Bizy, P. Genovés, L. Such-Miquel, A. Alberola, F. J. Chorro, M. Zarzoso, C. J. Calvo
    Interface Focus.2023;[Epub]     CrossRef
Systematic Review
The relationship between metabolic syndrome and its components with bladder cancer: a systematic review and meta-analysis of cohort studies
Mozhgan Ahmadinezhad, Maedeh Arshadi, Elahe Hesari, Maedeh Sharafoddin, Hosein Azizi, Farzad Khodamoradi
Epidemiol Health. 2022;44:e2022050.   Published online May 30, 2022
DOI: https://doi.org/10.4178/epih.e2022050
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
A previous meta-analysis, entitled “The association between metabolic syndrome and bladder cancer susceptibility and prognosis: an updated comprehensive evidence synthesis of 95 observational studies involving 97,795,299 subjects,” focused on all observational studies, whereas in the present meta-analysis, we focused on cohort studies to obtain more accurate and stronger evidence to evaluate the association between metabolic syndrome and its components with bladder cancer. PubMed, Embase, Scopus, and Web of Science were searched to identify studies on the association between metabolic syndrome and its components with bladder cancer from January 1, 2000 through May 23, 2021. The pooled relative risk (RR) and 95% confidence intervals (CI) were used to measure this relationship using a random-effects meta-analytic model. Quality appraisal was undertaken using the Newcastle-Ottawa Scale. In total, 56 studies were included. A statistically significant relationship was found between metabolic syndrome and bladder cancer 1.09 (95% CI, 1.02 to 1.17), and there was evidence of moderate heterogeneity among these studies. Our findings also indicated statistically significant relationships between diabetes (RR, 1.23; 95% CI, 1.16 to 1.31) and hypertension (RR, 1.07; 95% CI, 1.01 to 1.13) with bladder cancer, but obesity and overweight did not present a statistically significant relationship with bladder cancer. We found no evidence of publication bias. Our analysis demonstrated statistically significant relationships between metabolic syndrome and the risk of bladder cancer. Furthermore, diabetes and hypertension were associated with the risk of bladder cancer.
Summary
Key Message
In this meta-analysis study, an attempt was made to investigate the relationship between metabolic syndrome and its components with bladder cancer, and as a result of this study, the relationship between metabolic syndrome and its components such as diabetes, high blood pressure, and bladder cancer was observed. Metabolic syndrome is more common among middle-aged and elderly people, and the elderly population is increasing worldwide, so the prevalence of this disease shortly may affect the healthcare system. Therefore, with correct health policies in all societies, the exorbitant costs that this disease brings can be avoided.

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  • The causal relationship between osteoarthritis and bladder cancer: A Mendelian randomization study
    Xi Zhang, Zengjin Wen, Zixuan Xing, Xiaoyu Zhou, Zhiluo Yang, Ruijun Dong, Jiao Yang
    Cancer Medicine.2024;[Epub]     CrossRef
  • Machine learning algorithms predicting bladder cancer associated with diabetes and hypertension: NHANES 2009 to 2018
    Siying Xu, Jing Huang
    Medicine.2024; 103(4): e36587.     CrossRef
  • Epidemiology of Bladder Cancer in 2023: A Systematic Review of Risk Factors
    Ibrahim Jubber, Sean Ong, Laura Bukavina, Peter C. Black, Eva Compérat, Ashish M. Kamat, Lambertus Kiemeney, Nathan Lawrentschuk, Seth P. Lerner, Joshua J. Meeks, Holger Moch, Andrea Necchi, Valeria Panebianco, Srikala S. Sridhar, Ariana Znaor, James W.F.
    European Urology.2023; 84(2): 176.     CrossRef
  • The Characterization of Non-oncologic Chronic Drug Therapy in Bladder Cancer Patients and the Impact on Recurrence-Free and Cancer-Specific Survival: A Prospective Study
    Dorothea Strobach, Lisa Haimerl, Hanna Mannell, Christian G. Stief, Alexander Karl, Tobias Grimm, Alexander Buchner
    Journal of Clinical Medicine.2023; 12(21): 6749.     CrossRef
Original Articles
The association between fruit and vegetable consumption and metabolic syndrome in Korean adults: does multivitamin use matter?
Jihae Kim, Li-Juan Tan, Hyein Jung, Yumi Roh, Kyungjoon Lim, Sangah Shin
Epidemiol Health. 2022;44:e2022039.   Published online April 19, 2022
DOI: https://doi.org/10.4178/epih.e2022039
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Metabolic syndrome (MetS) is closely associated with dietary intake; however, few studies have investigated whether the consumption of fruits and vegetables and multivitamin use affect MetS in the Korean population. This study aimed to examine these effects in Korean adults.
METHODS
This was a cross-sectional study of 89,548 participants aged between 40 years and 69 years selected from the baseline data of the Health Examinees study conducted in Korea. Fresh vegetable and fruit consumption was assessed using a validated 106-item food frequency questionnaire. MetS and its components were defined using the National Cholesterol Education Program, Adult Treatment Panel III criteria. Multivariate logistic regression analyses were conducted to identify associations of fresh vegetable, fruit, and fresh vegetable+fruit consumption and multivitamin use with the prevalence of MetS.
RESULTS
Female in the highest quartile of fresh vegetable, fruit, and fresh vegetable + fruit consumption exhibited a lower prevalence of MetS than those in the lowest quartile. An inverse association with the prevalence of MetS was observed among male with only fresh vegetable consumption. The interaction between the 3 categories and multivitamin intake on the prevalence of MetS was not significant (all p<sub>interaction</sub>>0.05), regardless of sex.
CONCLUSIONS
Multivitamin use and consumption of fresh vegetables and fruits had no significant synergistic effects. Although fresh vegetable and fruit consumption showed an inverse association with the prevalence of MetS, this relationship was not altered by multivitamin use.
Summary
Korean summary
본 연구는 한국인 유전체역학조사사업의 도시코호트 조사에 참여한 40-69세 한국 성인 89 548명의 과일과 채소의 섭취와 종합비타민 섭취가 대사증후군에 미치는 영향을 분석하였다. 본 연구에서는 매일 다양한 과일과 채소를 섭취하면, 종합비타민의 섭취와 상관없이 대사증후군 유병 위험도를 낮추는 것을 확인하였다. 따라서, 대사증후군 예방을 위해서는 일상적인 식사에서 충분한 과일과 채소를 섭취하는 것이 권장된다.
Key Message
This study aimed to examine whether the consumption of fruits and vegetables and multivitamin use affect MetS among Korean middle-aged adults. Data was from the Health Examinees Study among 89 548 subjects. Results suggested that fruits and vegetables consumption was related with a decreased prevalence of MetS. However, there was no significant synergistic effect between the consumption of fruits and vegetables and multivitamin use in further reducing MetS prevalence.

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  • Association of serum water-soluble vitamin exposures with the risk of metabolic syndrome: results from NHANES 2003-2006
    Xun Pei, Junjie Yao, Simiao Ran, Haifei Lu, Shuo Yang, Yini Zhang, Miyuan Wang, Heyuan Shi, Aihua Tan
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
Joint association of aerobic physical activity and muscle-strengthening activities with metabolic syndrome : the Korean National Health and Nutrition Examination Survey 2014-2015
Jungjun Lim, Soyoung Park, Joon-Sik Kim
Epidemiol Health. 2021;43:e2021096.   Published online November 6, 2021
DOI: https://doi.org/10.4178/epih.e2021096
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The study aimed to examine whether simultaneously meeting the combined guidelines of accelerometer-assessed moderate to vigorous physical activity (MVPA) and self-reported muscle-strengthening activity (MSA) was associated with lower odds of metabolic syndrome (MetS) than meeting neither or 1 of the guidelines among the Koreans.
METHODS
This cross-sectional analysis included 1,355 participants from the Korea National Health and Nutrition Examination Survey (2014-2015). Logistic regression was used to analyze the associations across groups of MVPA-MSA guideline adherence (meeting neither [reference]; meeting MVPA only; meeting MSA only; meeting both MVPS and MSA) with MetS components (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol [HDL-C], hypertension, and hyperglycemia). The odds ratios (ORs) were adjusted for covariates (e.g., sex, age, body mass index, and accelerometer wearing time).
RESULTS
MSA only significantly reduced the OR for abdominal obesity (OR, 0.34; 95% confidence interval [CI], 0.13 to 0.91). Meeting both MVPA and MSA reduced the OR for hypertriglyceridemia (OR, 0.59; 95% CI, 0.39 to 0.88) and low HDL-C (OR, 0.46; 95% CI, 0.31 to 0.68). Compared to meeting neither, MVPA only (OR, 0.63; 95% CI, 0.44 to 0.89) and both MVPA and MSA (OR, 0.46; 95% CI, 0.28 to 0.76) significantly reduced the OR for MetS.
CONCLUSIONS
Combined MVPA-MSA was more beneficially associated with MetS prevalence than MVPA only and MSA only. Considering that more than 85% of Korean adults do not meet both the MVPA and MSA guidelines, public health actions to promote adherence should be supported.
Summary
Korean summary
본 연구는 2014-2015 국민건강영양조사 자료의 가속도계 자료와 신체활동 설문지를 활용하여 한국 성인의 유산소 신체활동과 근력강화운동 지침 충족 여부에 따른 대사증후군의 오즈비를 확인하였다. 그 결과, 유산소 신체활동과 근력강화운동 지침을 모두 충족한 한국 성인은 둘 중 하나의 지침만을 충족하거나, 모두 충족하지 않는 성인에 비해 더 낮은 오즈비를 나타내었다.
Key Message
In this study, the 2014-2015 Korean National Health and Nutrition Examination Survey data, the odds ratio of metabolic syndrome was confirmed according to the guidelines for aerobic physical activities and muscle-strengthening activities were met in Korean adults. As a result, Korean adults who met both the guidelines for aerobic physical activity and muscle-strengthening activities showed a lower odds ratio than adults who met only one of the guidelines or did not meet both guidelines.

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  • Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study
    Hao Wang, Huaidong Du, Yunqi Guan, Jieming Zhong, Na Li, Jin Pan, Min Yu
    JMIR Public Health and Surveillance.2024; 10: e50996.     CrossRef
  • The effect of Tabata-style functional high-intensity interval training on cardiometabolic health and physical activity in female university students
    Yining Lu, Huw D. Wiltshire, Julien Steven Baker, Qiaojun Wang, Shanshan Ying
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  • Association of Aerobic and Muscle-strengthening Activities with AIP in Korean Adults: Korea National Health and Nutrition Examination Survey 2014-2019
    Jungjun Lim, Yang Hei, Yeonsoo Kim
    Journal of Korean Association of Physical Education and Sport for Girls and Women.2022; 36(3): 245.     CrossRef
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    Soo Young Kim
    Journal of the Korean Medical Association.2022; 65(12): 776.     CrossRef
  • Aerobic or Muscle-Strengthening Physical Activity: Which Is Better for Health?
    Angelique G. Brellenthin, Jason A. Bennie, Duck-chul Lee
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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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AbstractAbstract AbstractSummary PDFSupplementary Material
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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    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
    Ui-Jeong Kim, Eun Jeong Choi, Hyunjin Park, Hye Ah Lee, Bohyun Park, Jungwon Min, Eun Ae Park, Su Jin Cho, Hae Soon Kim, Hwayoung Lee, Young Ju Kim, Young Sun Hong, Eun Hee Ha, Seungyoun Jung, Hyesook Park
    Pediatric Research.2023; 94(1): 153.     CrossRef
  • The Effect of Childhood Obesity or Sarcopenic Obesity on Metabolic Syndrome Risk in Adolescence: The Ewha Birth and Growth Study
    Hyunjin Park, Seunghee Jun, Hye-Ah Lee, Hae Soon Kim, Young Sun Hong, Hyesook Park
    Metabolites.2023; 13(1): 133.     CrossRef
  • 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
    Sung Hee Lee, Eun Jeong Choi, Ui Jeong Kim, Hyunjin Park, Bomi Park, Hye Ah Lee, Hyesook Park, Linglin Xie
    PLOS ONE.2023; 18(4): e0282830.     CrossRef
  • The association between urinary cotinine level and metabolic syndrome profiles among adolescents: findings from the Ewha Birth and growth study
    Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Seunghee Jun, Bomi Park, Hye Ah Lee, Hae Soon Kim, Hyesook Park
    BMC Public Health.2023;[Epub]     CrossRef
  • The Mediating Effect of Inflammation between the Dietary and Health-Related Behaviors and Metabolic Syndrome in Adolescence
    Ui-Jeong Kim, Eun-Jeong Choi, Hyunjin Park, Hye-Ah Lee, Bomi Park, Haesoon Kim, Youngsun Hong, Seungyoun Jung, Hyesook Park
    Nutrients.2022; 14(11): 2339.     CrossRef
  • Precision medicine via the integration of phenotype-genotype information in neonatal genome project
    Xinran Dong, Tiantian Xiao, Bin Chen, Yulan Lu, Wenhao Zhou
    Fundamental Research.2022; 2(6): 873.     CrossRef
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    Martta Kerkelä, Mika Gissler, Juha Veijola
    Epidemiology and Health.2022; 44: e2022005.     CrossRef
  • Trajectory patterns for continuous metabolic syndrome score in childhood and the cardiovascular risk in adolescence
    Eun Jeong Choi, Hye Ah Lee, Bomi Park, Bohyun Park, Hae Soon Kim, Young Sun Hong, Hyesook Park
    Scientific Reports.2021;[Epub]     CrossRef
Original Article
Comparison between walking and moderate-to-vigorous physical activity: associations with metabolic syndrome components in Korean older adults
Ki-Yong An
Epidemiol Health. 2020;42:e2020066.   Published online October 28, 2020
DOI: https://doi.org/10.4178/epih.e2020066
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The purpose of this study was to compare moderate-to-vigorous physical activity (MVPA) with walking in terms of associations with metabolic syndrome components in Korean older adults.
METHODS
Data on 1,388 older adults (age ≥65 years) from the Korea National Health and Nutrition Examination Survey 2018 were analyzed in this study. MVPA time and walking time per week were used as physical activity variables and blood pressure, waist circumference, glucose, high-density lipoprotein cholesterol, and triglyceride levels were analyzed as metabolic syndrome components. Partial correlations, analysis of covariance, and multinomial logistic regression were used for statistical analysis after adjusting for age, sex, smoking, and alcohol consumption.
RESULTS
High-density lipoprotein cholesterol levels were significantly higher in the low MVPA/high walking and high MVPA/ high walking groups than in the low MVPA/low walking group. Triglyceride levels were significantly lower in the high MVPA/ high walking group than in the low MVPA/low walking and low MVPA/high walking groups. Engaging in <150 min/wk of MVPA increased the likelihood of abnormal blood pressure and metabolic syndrome by 1.81 times and 1.89 times, respectively, compared to ≥150 min/wk of MVPA. Engaging in <180 min/wk of walking raised the likelihood of having abnormal highdensity lipoprotein levels by 1.32 times compared to ≥180 min/wk of walking.
CONCLUSIONS
Not only MVPA but also walking was significantly associated with metabolic syndrome components in Korean older adults. Considering older adults’ preferences and exercise barriers, walking should be considered as an essential component of physical activity guidelines to prevent chronic diseases in older adults.
Summary
Korean summary
현재까지 저강도 신체활동 (걷기)은 중고강도 신체활동에 비해 상대적으로 그 중요성이 간과되어 왔다. 하지만 본 연구는 저강도 신체활동도 중고강도 신체활동 못지 않게 노인들에게서 대사증후군을 예방할 수 있는 중요한 역할을 할 수 있음을 보여준다. 게다가 노인들의 신체적 제약, 부상의 위험, 운동 선호도 등을 감안하면 걷기와 같은 저강도 신체활동은 노인들의 건강유지를 위한 신체활동 권고사항의 필수요소로 고려되어야 함을 제안한다.

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    Yeon Soo Kim, Geonhui Kim, Hoyong Sung, Byung-Cheol Kim, Jeh-Kwang Ryu, Sowon Hahn
    The Korean Journal of Sports Medicine.2024; 42(2): 126.     CrossRef
  • Interactive associations of smoking and physical activity with metabolic syndrome in adult men in Korea
    Minjun Kim, Joonwoong Kim, Inhwan Lee
    Frontiers in Public Health.2023;[Epub]     CrossRef
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    Peng Zang, Fei Xian, Hualong Qiu, Shifa Ma, Hongxu Guo, Mengrui Wang, Linchuan Yang
    International Journal of Environmental Research and Public Health.2022; 19(3): 1894.     CrossRef
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Brief Communication
Testosterone levels and cause-specific mortality in the older French men without metabolic syndrome
Nasser Laouali, Sylvie Brailly-Tabard, Catherine Helmer, Marie-Laure Ancelin, Christophe Tzourio, Alexis Elbaz, Anne Guiochon-Mantel, Marianne Canonico
Epidemiol Health. 2020;42:e2020036.   Published online June 1, 2020
DOI: https://doi.org/10.4178/epih.e2020036
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AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Previous studies have reported controversial findings regarding the association of testosterone with mortality in older men. This heterogeneity might be partially explained by comorbidities and the presence of metabolic syndrome, as well as differential associations according to causes of death.
METHODS
We used data from a random subsample of the Three-City study, in which hormone levels were measured in 338 men ≥65 years without metabolic syndrome who were followed-up for 12 years. Vital status was determined for all participants from different sources. We used inverse-probability-weighted Cox regression to estimate the hazard ratios (HRs) of cause-specific mortality and 95% confidence intervals (CIs).
RESULTS
Over the follow-up period, 130 men died (30 from cardiovascular disease, 45 from cancer, 55 from other causes). The association of testosterone with mortality showed significant heterogeneity across causes of death (p=0.027 and p=0.022 for total and bioavailable testosterone, respectively). Higher testosterone levels were associated with increased cardiovascular mortality (HR for 1-standard deviation increase, 1.86; 95% CI, 1.28 to 2.71 and 1.50; 95% CI, 1.04 to 2.17 for total and bioavailable testosterone, respectively). By contrast, there were no significant associations of testosterone with mortality from cancer and other causes.
CONCLUSIONS
Our data suggest that the association of testosterone with mortality in men without metabolic syndrome might be differential according to the cause of death. These findings may partially explain the heterogeneity across studies on the relationship between testosterone levels and mortality.
Summary

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Review
The criteria for metabolic syndrome and the national health screening and education system in Japan
Kazumasa Yamagishi, Hiroyasu Iso
Epidemiol Health. 2017;39:e2017003.   Published online January 6, 2017
DOI: https://doi.org/10.4178/epih.e2017003
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AbstractAbstract PDF
Abstract
Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.
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