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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
  • 1,779 View
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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.
Associations of cumulative average dietary total antioxidant capacity and intake of antioxidants with metabolic syndrome risk in Korean adults aged 40 years and older: a prospective cohort study (KoGES_CAVAS)
Ji-Sook Kong, Jiseon Lee, Youngjun Kim, Hye Won Woo, Min-Ho Shin, Sang Baek Koh, Hyeon Chang Kim, Yu-Mi Kim, Mi Kyung Kim
Epidemiol Health. 2023;45:e2023067.   Published online July 28, 2023
DOI: https://doi.org/10.4178/epih.e2023067
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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.
Regional differences in the associations of diet quality, obesity, and possible sarcopenia using the seventh Korea National Health and Nutrition Examination Survey (2016-2018)
Hyeongyeong Lee, Sohyun Park
Epidemiol Health. 2023;45:e2023059.   Published online June 19, 2023
DOI: https://doi.org/10.4178/epih.e2023059
  • 2,875 View
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AbstractAbstract PDF
Abstract
OBJECTIVES
Sarcopenic obesity is closely related to aging and the prevalence of various chronic diseases and frailty. The purpose of this study was to analyze whether diet quality is related to obesity, sarcopenia, and sarcopenic obesity, and if so, to explore the difference in that relationship between urban and rural settings.
METHODS
Using data from the Korea National Health and Nutrition Examination Survey of 2016-2018, a total of 7,151 participants aged 40 years or older were analyzed. Sarcopenia was diagnosed using handgrip strength. Diet quality was assessed using Korea Healthy Eating Index (KHEI) scores, and obesity was determined based on participants’ abdominal circumference. Multinomial logistic analysis was used for testing statistical significance.
RESULTS
Rural participants had significantly lower KHEI scores and a higher prevalence of sarcopenic obesity than urban participants. The study findings demonstrate that participants without obesity, sarcopenia, or sarcopenic obesity had significantly higher KHEI scores in both rural and urban settings. Multinomial regression analysis further revealed that a higher KHEI score was associated with a lower risk of sarcopenia and sarcopenic obesity among urban residents, while only the risk of obesity was lower with higher diet quality scores among rural residents.
CONCLUSIONS
Since diet quality and health status were lower in rural areas, it is important to address this regional disparity with appropriate policy measures. To mitigate urban health disparities, urban residents in poor health with few resources should also be supported.
Summary
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
  • 3,590 View
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  • 1 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  
  • 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
The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults
Ziyue Sheng, Shang Lou, Jin Cao, Weidi Sun, Yaojia Shen, Yunhan Xu, Ziyang Ren, Wen Liu, Qian Yi, Peige Song
Epidemiol Health. 2023;45:e2023043.   Published online April 10, 2023
DOI: https://doi.org/10.4178/epih.e2023043
  • 3,138 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese.
METHODS
Using the 2011-2015 waves of the China Health and Retirement Longitudinal Study, we conducted a cross-sectional analysis included 9,015 subjects and a longitudinal analysis included 4,961 subjects, with 4,872 having full data on the hypertension stage and 4,784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex.
RESULTS
NWCO was associated with normal→stage 2 (odds ratio [OR], 1.95; 95% confidence interval [CI], 1.11 to 3.42), maintained stage 1 (OR, 1.62; 95% CI, 1.14 to 2.29), and normal→ISH (OR, 1.39; 95% CI, 1.05 to 1.85). AWCO was associated with normal→stage 1 (OR, 1.75; 95% CI, 1.40 to 2.19), maintained stage 1 (OR, 2.77; 95% CI, 2.06 to 3.72), maintained stage 2 (OR, 2.80; 95% CI, 1.50 to 5.25), normal→ISH (OR, 1.56; 95% CI, 1.20 to 2.02), and normal→SDH (OR, 2.54; 95% CI, 1.72 to 3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages.
CONCLUSIONS
This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.
Summary
Key Message
This study elucidates the distinct associations between obesity phenotypes and various hypertension stages and phenotypes. Furthermore, it reveals significant sex differences in the risk for hypertension stages, phenotypes, and transitions, providing essential insights for targeted interventions and personalized medicine.
The association between obesity and glaucoma in older adults: evidence from the China Health and Retirement Longitudinal Study
Xiaohuan Zhao, Qiyu Bo, Junran Sun, Jieqiong Chen, Tong Li, Xiaoxu Huang, Minwen Zhou, Jing Wang, Wenjia Liu, Xiaodong Sun
Epidemiol Health. 2023;45:e2023034.   Published online March 9, 2023
DOI: https://doi.org/10.4178/epih.e2023034
  • 2,466 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study evaluated the association between obesity and glaucoma in middle-aged and older people. A population-based retrospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study.
METHODS
Glaucoma was assessed via self-reports. Multivariate logistic regression analysis and a Cox proportional hazards model were used to assess the relationship between obesity and glaucoma risk.
RESULTS
Older males living in urban areas who were single, smokers, and non-drinkers were found to have a significantly higher incidence of glaucoma (all p<0.05). Diabetes, hypertension, and kidney disease were also associated with higher glaucoma risk, while dyslipidemia was associated with lower risk (all p<0.05). After the model was adjusted for demographic, socioeconomic, and health-related variables, obesity was significantly associated with a 10.2% decrease in glaucoma risk according to the Cox proportional hazards model (hazard ratio, 0.90; 95% confidence interval [CI], 0.83 to 0.97) and an 11.8% risk reduction in the multivariate logistic regression analysis (odds ratio, 0.88; 95% CI, 0.80 to 0.97). A further subgroup analysis showed that obesity was associated with a reduced risk of glaucoma in people living in rural areas, in smokers, and in those with kidney disease (all p<0.05). Obesity also reduced glaucoma risk in people with diabetes, hypertension, or dyslipidemia more than in healthy controls (all p<0.05).
CONCLUSIONS
This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease. Obesity exerted a stronger protective effect in people with diabetes, hypertension, or dyslipidemia than in healthy people.
Summary
Key Message
Glaucoma is a neurodegenerative disease and the leading cause of irreversible vision loss worldwide. The diagnosis of glaucoma is frequently delayed, as it may be asymptomatic until a relatively late stage. Thus, there is a need to identify protective and risk factors for glaucoma. Glaucoma is a multifactorial disease, and the impact of obesity on glaucoma risk remains uncertain. This study evaluated the association between obesity and glaucoma in middle-aged and older people. This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease.
Trends in socioeconomic inequalities in obesity among Korean adolescents: the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2006 to 2020
Eunji Kim, Ga Bin Lee, Dong Keon Yon, Hyeon Chang Kim
Epidemiol Health. 2023;45:e2023033.   Published online March 7, 2023
DOI: https://doi.org/10.4178/epih.e2023033
  • 4,298 View
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  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity.
METHODS
This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father’s educational attainment, mother’s educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII).
RESULTS
The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father’s education, and 1.45 for the mother’s education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively.
CONCLUSIONS
These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.
Summary
Korean summary
2006년부터 2020년까지 청소년 비만의 유병은 증가 추세에 있을 뿐 아니라, 가정의 경제상태, 부모의 학력수준에 따른 비만의 위험 격차도 점점 심해지는 추세를 보였다. 특히, 남학생과 고등학생의 비만 유병률이 높게 나타났으나, 사회경제적 지표에 따른 비만의 불평등 격차는 여학생과 중학생에서 높게 나타났다.
Key Message
Not only the prevalence but also socioeconomic inequality in adolescent obesity increased between 2006 and 2020. The potential impact of socioeconomic disparity on obesity was greater in girls and middle school students than their counterparts.

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  • A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study
    Mi-Sun Lee, Hooyeon Lee
    Psychiatry Investigation.2023; 20(11): 1086.     CrossRef
COVID-19: Special Article
Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey
Chang-Mo Oh, Yangha Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh
Epidemiol Health. 2023;45:e2023018.   Published online February 14, 2023
DOI: https://doi.org/10.4178/epih.e2023018
  • 5,633 View
  • 323 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to investigate changes in health behaviors, including cigarette smoking, alcohol drinking, physical activity, dietary behaviors, and obesity, before and during the coronavirus disease 2019 (COVID-19) pandemic using the Korea Youth Risk Behavior Survey (KYRBS) database.
METHODS
KYRBS data from 2015 to 2021 were used in this study. Differences in health behaviors between before (pre-pandemic period: 2018-2019) and during (pandemic period: 2020-2021) the pandemic were examined. Differences were compared using linear regression and the chi-square test considering the complex survey design after adjusting for grade level.
RESULTS
The prevalence of current cigarette smoking and current alcohol drinking significantly decreased in both male and female students during the pandemic compared to the pre-pandemic period. However, the prevalence of obesity significantly increased in both male and female students during the same period. When examining physical activity and dietary behaviors closely related to obesity, fast food consumption increased and fruit consumption decreased during the pandemic in both male and female students, whereas no significant changes in physical activity were observed in either male or female students.
CONCLUSIONS
The deterioration of adolescent dietary behaviors and an increase in the prevalence of obesity can increase the future disease burden, and concerted efforts at the individual and national levels are needed to reduce obesity and promote healthy dietary behaviors.
Summary
Korean summary
이 연구는 한국 청소년건강행태조사자료(KYRBS)를 사용하여 코로나19 유행 전후의 우리나라 청소년들의 흡연, 음주, 신체활동, 식습관, 비만 등의 건강행태의 변화에 대하여 살펴보고자 하였다. 이 연구에서는 2015년부터 2021년까지의 청소년건강행태조사자료를 사용하여, 코로나19 유행 이전 (2018-2019년)과 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화에 대하여 조사하였다. 학년레벨을 보정한 후, 복합표본설계를 고려하여 로지스틱 회귀분석과 카이제곱검정을 이용하여 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나 유행 이후 (2020-2021년) 기간의 건강행태의 변화가 있었는지에 대하여 확인하였다. 그 결과, 코로나19 유행 이전 (2018-2019년)과 비교하여, 코로나19 유행 기간(2020-2021년) 동안에 현재흡연율과 현재음주율이 유의하게 감소하였다. 그러나 동일한 기간 동안에 남학생과 여학생 모두에서 비만율이 유의하게 증가하였는데, 비만율과 관련된 신체활동 및 식습관에 대하여 살펴보았을 때, 신체활동에서는 유의한 변화가 없었던 반면, 남학생과 여학생 모두에서 패스트푸드 섭취는 증가하고 과일섭취가 감소한 것으로 나타났다. 따라서 코로나19 유행기간 동안 흡연율 및 음주율 등의 청소년 건강에 유익한 변화도 있었으나, 비만율도 같이 증가한 것을 확인할 수 있었다. 청소년기의 식습관의 악화 및 비만율의 증가는 미래 우리나라의 질병부담을 증가시킬 수 있기 때문에, 청소년의 비만율을 낮추고 건강한 식습관을 증진시키기 위한 개인 및 사회 차원의 노력이 필요하다.
Key Message
-The current cigarette smoking and current alcohol drinking rates significantly decreased among Korean adolescents during the pandemic period compared to the pre-pandemic period. -On the other hand, the obesity rate increased significantly especially among Korean male adolescents, which is accompanied by changes in dietary habits such as an increase in fast food intake and a decrease in fruit intake.

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  • A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study
    Mi-Sun Lee, Hooyeon Lee
    Psychiatry Investigation.2023; 20(11): 1086.     CrossRef
Original Articles
Long-term association of pericardial adipose tissue with incident diabetes and prediabetes: the Coronary Artery Risk Development in Young Adults Study
Minsuk Oh, Wonhee Cho, Dong Hoon Lee, Kara M. Whitaker, Pamela J. Schreiner, James G. Terry, Joon Young Kim
Epidemiol Health. 2023;45:e2023001.   Published online December 3, 2022
DOI: https://doi.org/10.4178/epih.e2023001
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We examined whether pericardial adipose tissue (PAT) is predictive of prediabetes and type 2 diabetes over time.
METHODS
In total, 2,570 adults without prediabetes/diabetes from the Coronary Artery Risk Development in Young Adults Study were followed up over 15 years. PAT volume was measured by computed tomography scans, and the new onset of prediabetes/diabetes was examined 5 years, 10 years, and 15 years after the PAT measurements. Multivariable Cox regression models were used to examine the association between the tertile of PAT and incident prediabetes/diabetes up to 15 years later. The predictive ability of PAT (vs. waist circumference [WC], body mass index [BMI], waist-to-height ratio [WHtR]) for prediabetes/diabetes was examined by comparing the area under the receiver operating characteristic curve (AUC).
RESULTS
The highest tertile of PAT was associated with a 1.56 times (95% confidence interval [CI], 1.03 to 2.34) higher rate of diabetes than the lowest tertile; however, no association was found between the highest tertile of PAT and prediabetes in the fully adjusted models, including additional adjustment for BMI or WC. In the fully adjusted models, the AUCs of WC, BMI, WHtR, and PAT for predicting diabetes were not significantly different, whereas the AUC of WC for predicting prediabetes was higher than that of PAT.
CONCLUSIONS
PAT may be a significant predictor of hyperglycemia, but this association might depend on the effect of BMI or WC. Additional work is warranted to examine whether novel adiposity indicators can suggest advanced and optimal information to supplement the established diagnosis for prediabetes/diabetes.
Summary
Korean summary
본 연구는 심장 내 축적되는 내장지방과 5년에서 15년 뒤의 당뇨병 전조 단계 및 당뇨병의 발생률과 연관성이 있음을 제안한다. 또한, 본 연구는 심장 내 내장지방과 당뇨병 발생률의 관계는 체질량 지수 또는 허리둘레의 영향에 따라 상이할 수 있음을 제안한다.
Key Message
Pericardial adipose tissue may be a significant predictor of future hyperglycemia in adults, but this association might depend on the effect of body mass index or waist circumference.
Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets
Sukyoung Jung, Sohyun Park
Epidemiol Health. 2022;44:e2022063.   Published online August 2, 2022
DOI: https://doi.org/10.4178/epih.e2022063
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years.
METHODS
This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity.
RESULTS
During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women.
CONCLUSIONS
Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.
Summary
Korean summary
본 연구는 한국인 유전체역학조사사업의 안성안산코호트 조사에 참여한 40-69세 한국 성인 6,054명을 대상으로 식물성 기반의 식이 지수와 복부비만 간 연관성이 식이 노출 기간(기반, 최근, 누적 노출)에 따라 어떻게 다른지 비교 분석하였다. 건강하지 않은 식물성 기반의 식이 지수 점수가 높을수록 복부비만 발생 위험이 증가하였고, 식이 노출 기간에 관계없이 일관된 결과를 보였다. 식물성 기반의 식이가 반드시 건강에 유익한 것은 아니며, 정제된 곡물, 탄산음료, 사탕 등 간식류를 많이 먹는 식이 패턴은 식물성 기반 식이라 할지라도 복부비만 위험을 증가시킬 수 있으므로 주의가 필요하다.
Key Message
Unhealthy plant-based diets, including refined grains, sugar-sweetened beverages, sweets and desserts, and salty plant foods, can have a negative effect on abdominal obesity in Korean adults regardless of its exposure duration.

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  • Plant-based diets and the gut microbiome: findings from the Baltimore Longitudinal Study of Aging
    Xinyi Shen, Curtis Tilves, Hyunju Kim, Toshiko Tanaka, Adam P Spira, Chee W Chia, Sameera A. Talegawkar, Luigi Ferrucci, Noel T Mueller
    The American Journal of Clinical Nutrition.2024;[Epub]     CrossRef
  • Scoping review of the association of plant-based diet quality with health outcomes
    Richard M. Rosenfeld, Hailey M. Juszczak, Michele A. Wong
    Frontiers in Nutrition.2023;[Epub]     CrossRef
Differences in accuracy of height, weight, and body mass index between self-reported and measured using the 2018 Korea Community Health Survey data
Yoonsil Ko, Sunhye Choi, Jisoo Won, Yeon-Kyeng Lee, Dong-Hyun Kim, Seon Kui Lee
Epidemiol Health. 2022;44:e2022024.   Published online February 19, 2022
DOI: https://doi.org/10.4178/epih.e2022024
  • 8,512 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to determine an effective survey method for the accurate calculation of obesity prevalence by comparing the self-reported and measured height, weight, and body mass index (BMI) using the 2018 Korea Community Healthy Survey (CHS) data.
METHODS
Raw data from the 2018 CHS were used to analyze the differences, correlation, and agreement between self-reported and measured height, weight, and BMI.
RESULTS
The self-reported height was over-reported than the measured height (0.59 cm greater for men and 0.71 cm greater for women), while the self-reported weight was under-reported than the measured weight (0.55 kg less for men and 0.67 kg less for women). Subsequently, the self-reported BMI was under-estimated (0.35 kg/m<sup>2</sup> lower for men and 0.49 kg/m<sup>2</sup> lower for women) compared with the measured BMI. The kappa statistic and agreement between measured and self-reported values per BMI category (underweight, normal, overweight, and obesity) were 0.82 and 79.6%, respectively.
CONCLUSIONS
The prevalence of obesity should be calculated using the measured values provided in the CHS in order to promote local health projects based on accurate evidence.
Summary
Korean summary
본 연구는 2018년 지역사회건강조사 원시자료를 이용하여, 자가보고된 신장, 체중, 그리고 체질량지수 값과 실제 측정한 값 간에 차이를 분석하고 상관성과 일치도를 확인하고자 하였으며, 확인결과 자가보고값 체질량지수는 측정값보다 과소측정(남자의 경우 측정값보다 자가보고값이 0.35kg/m2 낮게, 여자는 0.49kg/m2 낮게 측정)된것을 확인하였다.
Key Message
This study aimed to determine an effective survey method for the accurate calculation of obesity prevalence by comparing the self-reported and measured height, weight, and body mass index (BMI) using the 2018 Community Healthy Survey (CHS) data.

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  • Consistency between self-reported disease diagnosis and clinical assessment and under-reporting for chronic conditions: data from a community-based study in Xi’an, China
    Haobiao Liu, Yanru Zhao, Lichun Qiao, Congying Yang, Ying Yang, Tianxiao Zhang, Qian Wu, Jing Han
    Frontiers in Public Health.2024;[Epub]     CrossRef
  • Comparison of self-reported and measured height and weight in patients with psoriasis
    Simona Mastroeni, Francesca Sampogna, Claudia Uras, Mara De Angelis, Roberta Fusari, Nidia Melo Salcedo, Sabatino Pallotta, Damiano Abeni
    Archives of Dermatological Research.2023; 315(7): 2023.     CrossRef
  • Accuracy of Assessing Weight Status in Adults by Structured Observation
    Tânia Jorge, Sofia Sousa, Isabel do Carmo, Nuno Lunet, Patrícia Padrão
    Applied Sciences.2023; 13(14): 8185.     CrossRef
  • Changes in health behaviors and obesity of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey
    Chang-Mo Oh, Yangha Kim, Jieun Yang, Sunhye Choi, Kyungwon Oh
    Epidemiology and Health.2023; 45: e2023018.     CrossRef
  • Tobacco consumption, sales, and output as monitoring indicators in the era of the tobacco endgame: a Korean example
    Hana Kim, Hee-kyoung Nam, Heewon Kang
    Epidemiology and Health.2023; 45: e2023030.     CrossRef
Methods
Development and validation of the Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome
Sung Yoon Cho, Danbee Kang, Minji Im, Aram Yang, Min-Sun Kim, Jiyeon Kim, Eu-Seon Noh, Eun Kyung Kwon, Eujin Choi, Sunju Han, Young Ah Park, Min Jung Kwak, Youngha Kim, Juhee Cho, Dong-Kyu Jin
Epidemiol Health. 2022;44:e2022014.   Published online January 10, 2022
DOI: https://doi.org/10.4178/epih.e2022014
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Hyperphagia is a highly stressful, life-threatening feature of Prader-Willi syndrome (PWS). It is important to assess this complex behavior accurately over time. This study aimed to develop and validate the Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome (PYHAP) as a tool targeting children and adolescents.
METHODS
After an extensive literature review and qualitative interviews, the final version of the PYHAP with 14 questions in 3 domains (verbal [5], behavior [4], and social [5]) was developed and tested at Samsung Medical Center in Seoul, Korea from July 2018 to September 2019. Exploratory factor analysis and confirmatory factor analysis (CFA) were performed to confirm construct validity. The correlations between the PYHAP and the Korean Children’s Eating Behavior Questionnaire (K-CEBQ) were calculated to evaluate convergent and discriminant validity. Criterion validity and the validity of the response categories were also tested.
RESULTS
Cronbach’s alpha coefficient of the PYHAP was 0.91. The fit indices for CFA were good (comparative fit index, 0.87; standardized root mean squared residual, 0.08). The domains of the PYHAP were closely correlated with the relevant domains of the K-CEBQ. The accuracy of the PYHAP score for predicting uncontrolled hyperphagia was good (area under the curve, 0.75; 95% confidence interval, 0.65 to 0.85).
CONCLUSIONS
The PYHAP was confirmed to be a reliable and valid tool to evaluate hyperphagia in children and adolescents with PWS via caregivers’ assessments. It is recommended to use the PYHAP to communicate with parents or caregivers about patients’ hyperphagia or to monitor and manage extreme behaviors in children with PWS.
Summary
Korean summary
프래더 윌리 증후군에서 '조절되지 않는 식욕'은 환자의 수명과 삶의 질에 매우 중요한 문제로, 최근 식욕 억제제 개발을 위한 연구가 활발히 이뤄지고 있으나 약제의 유효성을 객관적으로 평가하는 도구는 부족한 상황입니다. 본 연구는 주부양자를 통하여 평가가 가능한 프래더윌리 증후군 소아청소년 환자들의 식욕심각도 평가도구를 개발하였고, 그것의 신뢰성과 타당성을 입증하였습니다.
Key Message
Pediatric-Youth Hyperphagia Assessment for Prader-Willi syndrome (PYHAP) is a reliable and valid tool to evaluate hyperphagia in children and adolescents with PWS via caregivers’ assessments.
Original Articles
Association between body temperature and leukocyte telomere length in Korean middle-aged and older adults
Carolina García-García, Chol Shin, Inkyung Baik
Epidemiol Health. 2021;43:e2021063.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021063
  • 8,409 View
  • 209 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Data on associations between body temperature (BT) and leukocyte telomere length (LTL), which has been widely used as a biomarker of cellular senescence in recent epidemiological studies, are limited. Therefore, this study aimed to explore the associations between a normal BT range (35.0-37.5°C) and LTL via 6-year longitudinal observations of 2,004 male and female adults aged 50 or older.
METHODS
BT was obtained by measuring the tympanic temperature, and relative LTL was determined by real-time polymerase chain reaction. Robust regression analysis was used to evaluate the association between the baseline and follow-up LTL values and their differences.
RESULTS
A significant inverse association was found between BT and LTL at baseline. The regression coefficient estimate was -0.03 (95% confidence interval, -0.07 to -0.001; p<0.05). This association was stronger in participants with a body mass index >25 kg/m<sup>2</sup> and males (p<0.01). However, there were no associations between BT and LTL at follow-up or BT and 6-year longitudinal differences in LTL.
CONCLUSIONS
These findings suggest that having a high BT between 35°C and 37.5°C (95°F and 99°F) may be detrimental for obese individuals in terms of biological aging.
Summary
Korean summary
본 역학 연구는 한국 성인 2,004명을 연구대상자로 하여 2011-2012년에 고막 체온을 측정하고 전혈을 채취하여 백혈구 텔로미어 길이를 분석하였으며 이러한 분석을 2017-2018년에 반복하여 6년 동안의 백혈구 텔로미어 길이 변화를 계산하였다. 고막 체온과 초기 텔로미어 길이의 관련성을 분석한 결과, 정상 체온 범위 내 체온이 높을수록 텔로미어 길이가 유의적으로 짧아지는 생리적 노화 상태와 관련된 것으로 나타났으며, 이러한 결과는 비만할 경우 더욱 분명하게 나타났다. 본 연구 결과를 통해 비만 시 체내 열발생과 관련된 노화 진행이 체중 감소를 통해 지연될 수 있는 가능성이 제시되었다.
Key Message
In an epidemiological study including Korean adults, a relatively higher normal body temperature between 35°C to 37.5°C was found to be associated with shorter leukocyte telomere length, a cellular senescence biomarker. In particular, this association was observed to be stronger among obese participants, suggesting that attaining normal body weight may be beneficial for anti-aging.

Citations

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  • Higher Daily Air Temperature Is Associated with Shorter Leukocyte Telomere Length: KORA F3 and KORA F4
    Wenli Ni, Kathrin Wolf, Susanne Breitner, Siqi Zhang, Nikolaos Nikolaou, Cavin K. Ward-Caviness, Melanie Waldenberger, Christian Gieger, Annette Peters, Alexandra Schneider
    Environmental Science & Technology.2022; 56(24): 17815.     CrossRef
Obesity parameters in relation to lung function levels in a large Chinese rural adult population
Xiang Zeng, Dongling Liu, Zhen An, Huijun Li, Jie Song, Weidong Wu
Epidemiol Health. 2021;43:e2021047.   Published online August 3, 2021
DOI: https://doi.org/10.4178/epih.e2021047
  • 9,361 View
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  • 7 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The association between obesity parameters and lung function indicators in the general Chinese rural adult population remains unclear.
METHODS
In total, 8,284 Chinese adults aged 20 years to 80 years old from Xinxiang were recruited. Obesity-related parameters, including body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waistto-height ratio (WHtR), body fat percentage (BFP), basal metabolism, and visceral fat index, and lung function parameters such as forced vital capacity and forced expiratory volume in first second were measured.
RESULTS
The total prevalence of obesity defined by BMI, WC, WHR, WHtR, and BFP was 23.2%, 58.2%, 66.7%, 69.2%, and 56.5%, respectively. Spearman correlation analyses showed significant correlations between all obesity-related parameters and lung function. Linear regression analyses further demonstrated that BMI, WHtR, BFP, and general obesity defined using those indicators were negatively associated with lung function, while WC, WHR, and central obesity defined accordingly were positively associated with lung function. The relationship between general obesity and lung function was more evident in women than in men, while the link between central obesity and lung function was more obvious in men than in women.
CONCLUSIONS
Obesity is closely related to lung function in the general Chinese adult population. Weight control and loss are important strategies to improve lung function and respiratory health.
Summary
Key Message
This cross-sectional sduty clarify the relationship between several obesity parameters and lung function indicators on rural adult population in central China using big data and stratified analyses. Specifically, the obesity group has a lower level of lung function than the non-obesity group, and there is an opposite effect of general obesity and central obesity on lung function.

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    Yu-Yun Zhang, Wei Li, Yu Sheng, Qun Wang, Fang Zhao, Ying Wei
    Patient Preference and Adherence.2024; Volume 18: 111.     CrossRef
  • Air pollution associated acute respiratory inflammation and modification by GSTM1 and GSTT1 gene polymorphisms: a panel study of healthy undergraduates
    Xiang Zeng, Ge Tian, Jingfang Zhu, Fuyun Yang, Rui Zhang, Huijun Li, Zhen An, Juan Li, Jie Song, Jing Jiang, Dongling Liu, Weidong Wu
    Environmental Health.2023;[Epub]     CrossRef
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    Gaili Wang, Huizi Tian, Kai Kang, Shixian Feng, Weihao Shao, Xiaorui Chen, Caifang Zheng, Bowen Zhang, Pei Pei, Weidong Zhang
    Clinical Epidemiology.2023; Volume 15: 289.     CrossRef
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    Fang Jia, Jingyu Zhang, Yongcheng Hu, Ping Li
    International Journal of General Medicine.2023; Volume 16: 1061.     CrossRef
  • BMI, sex and outcomes in hospitalised patients in western Sweden during the COVID-19 pandemic
    Martin Lindgren, Triantafyllia Toska, Christian Alex, Christina E. Lundberg, Ottmar Cronie, Annika Rosengren, Martin Adiels, Helen Sjöland
    Scientific Reports.2022;[Epub]     CrossRef
  • The Relationship Between BMI and Lung Function in Populations with Different Characteristics: A Cross-Sectional Study Based on the Enjoying Breathing Program in China
    Xingyao Tang, Jieping Lei, Wei Li, Yaodie Peng, Chen Wang, Ke Huang, Ting Yang
    International Journal of Chronic Obstructive Pulmonary Disease.2022; Volume 17: 2677.     CrossRef
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    Yu-Yun Zhang, Wei Li, Yu Sheng
    International Journal of Nursing Sciences.2022; 9(2): 243.     CrossRef
  • Sex Differences in Spirometric Measures and its Association with Basal Metabolic Rate in Obese and Healthy Normal Weight Middle-Aged Subjects
    Afreen Begum H. Itagi, G. Y. Yunus, Ambrish Kalaskar, Pasang Tshering Dukpa, Dhruba Hari Chandi
    Indian Journal of Respiratory Care.2022; 11(1): 14.     CrossRef
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    AfreenBegum H Itagi, Ambrish Kalaskar, PasangTshering Dukpa, DhrubaHari Chandi, GY Yunus
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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
  • 11,798 View
  • 367 Download
  • 12 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary 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.

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    Jihyun Kim, Seunghee Kye
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    Epidemiology and Health.2023; : e2023049.     CrossRef
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