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The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) has not yet been fully elucidated. Therefore, the objective of this study was to evaluate the connection between OSA risk and CRS by investigating associations between the STOP-Bang questionnaire and presence of CRS in a nationwide, population-based study. This is a cross-sectional study based on the Korean National Health and Nutrition Examination Survey (KNHANES). We evaluated 10,081 subjects who completed both the STOP-Bang and CRS-related questionnaires. Among the total subjects, 390 (3.9%) were CRS patients. The median STOP-Bang score was 3.0 [2.0; 4.0] in CRS patients, compared to 2.0 [1.0; 3.0] in subjects without CRS. In a low-risk group according to the STOP-Bang questionnaire, 3.1% of subjects were CRS patients. However, a gradual increase was observed among different risk groups. In the higher risk group, CRS patients accounted for 5.3% (P < 0.001). Among the four main symptoms of CRS (nasal obstruction, nasal discharge, facial pain/pressure, and decreased sense of smell), nasal obstruction (4.1 to 7.3%) and a decreased sense of smell (1.9 to 3.3%) increased with higher STOP-Bang scores. This study found that the proportion of patients with CRS was significantly higher in the group at a higher STOP-Bang score in the general population. Among symptoms of CRS, nasal obstruction and anosmia were found to be associated with an increased STOP-Bang score. [ABSTRACT FROM AUTHOR]

Background: This study investigated the association between handgrip strength (HGS) and physical activity (PA) at different levels in Korean adults for the purpose of providing direction for increasing HGS, which represents muscular strength, and increasing understanding of PA and HGS. Methods: This study targeted adults aged ≥30 years from the Korean National Health and Nutrition Examination Survey (2014–2019), including 31,888 participants for analysis. HGS was defined as the maximum value of the three measurements of the dominant hand. PA was defined as an activity that causes shortness of breath or a fast heartbeat. Data were weighted according to survey district and household data; p <.05 was considered statistically significant. Results: In men, HGS in those aged 30–64 years was significantly associated with high‐intensity PA and in those aged ≥65 years was associated with moderate‐intensity PA. In women, HGS in those aged 30–64 years was also significantly associated with high‐intensity PA, and in those aged ≥65 years, it was significantly associated with both moderate‐ and high‐intensity PA. Moreover, compared to participants who did not participate in weight training, those who participated showed higher HGS in both sexes. Conclusions: This study demonstrated age‐ and sex‐specific characteristics of the association between HGS and PA in Koreans. The findings suggest the importance of managing health by considering differences in age‐ and sex‐related PA. In particular, this study suggests that adequate PA is necessary despite its importance of PA for elderly individuals. [ABSTRACT FROM AUTHOR]

Bisphenol A (BPA) exposure primarily occurs through dietary intake. This study aimed to estimate the extent of dietary BPA exposure among Koreans. A thorough literature search was conducted to establish a BPA content database encompassing common foods consumed in Korea, including various food raw materials and processed food products. Dietary exposure levels were estimated by integrating the constructed BPA database with comprehensive nationwide 24 h-dietary recall datasets. The finding revealed that dietary BPA exposure was low for most Koreans, with a mean of 14.5 ng/kg bw/day, but was higher for preschool-age children (over 23 ng). Canned foods accounted for 9–36% of the total dietary exposure of the highest dietary exposure groups; while across all age groups, a considerable amount was derived from canned tuna, contribution of canned fruits and canned coffee (milk-containing) was high for preschool-age children and adults, respectively. Notably, for adults, a substantial proportion also stemmed from beer packaged in cans. While diet contributed over 80% of aggregate exposure for most age groups, preschool-age children experienced 60% exposure through diet due to additional exposure from indoor dust. Even at the high exposure scenario, aggregate BPA exposure levels remained lower than the current tolerable daily intake (TDI) set by the Korean agency (20 μg/kg bw/day). Nevertheless, most Koreans were exposed to BPA levels surpassing the strictest TDI (0.2 ng/kg bw/day) set by the European Food Safety Authority. [ABSTRACT FROM AUTHOR]

• Among Korean adults ≥65y, 25% of men and 36% of women had low muscle strength. • Only 16% of Korean adults met the recommended nutrient intake of dietary vitamin C. • Dietary vitamin C intake was correlated with handgrip strength in Korean women. • Korean women ≥65y with low dietary vitamin C had a higher risk of possible sarcopenia. Although vitamin C is one of the most important antioxidants, its effect on muscle quality is not fully understood. Therefore, we hypothesized that low dietary vitamin C intake is associated with low muscle strength. To test the hypothesis, a single 24-h dietary recall and handgrip strength test of 10,883 younger adults 19-64 y and 3,961 older adults ≥65 y from the seventh Korea National Health and Examination Survey (KNHANES VII 2016-2018) was analyzed by multivariable linear and logistic regression models, and low muscle strength was defined as handgrip strength <28 kg for men and <18 kg for women. Approximately 15.5% of Korean adults met the recommended intake of dietary vitamin C, and those with higher dietary vitamin C intake had higher total energy and protein intake. After adjusting for confounding variables, including age, body mass index, total energy intake, household income, alcohol consumption, smoking, resistance exercise, medical condition, and dietary intake of protein, vitamin E, and β-carotene, dietary vitamin C was correlated with maximal handgrip strength in younger women 19-64 y (β = 0.002; SE = 0.001; P -value =.026) and older women ≥65 y (β = 0.005; SE = 0.002; P -value =.013). Among older women ≥65 y, those in the lowest quartile of dietary vitamin C intake had a higher risk of low muscle strength compared to those in the highest quartile after adjustment of confounding factors (odds ratio, 2.16; 95% confidence interval, 1.49-3.15). These results imply that adequate dietary vitamin C intake may reduce the risk of sarcopenia in older Korean women. Dietary vitamin C was shown to be inversely associated with the risk of low muscle strength in older Korean women. Although no association between the two variables among younger men 19-64 y, older men ≥65 y, and women 19-64 y was observed, older Korean women ≥65 y in the lowest quartile of vitamin C intake had significantly higher odds of low muscle strength compared to those in the highest quartile with adjustment for confounding variables (OR, 2.16; 95% CI, 1.49-3.15). [Display omitted] [ABSTRACT FROM AUTHOR]

Objective Low-density lipoprotein cholesterol (LDL-C) has been commonly calculated by equations, but their performance has not been entirely satisfactory. This study aimed to develop a more accurate LDL-C prediction model using machine learning methods. Methods The study involved predicting directly measured LDL-C, using individual characteristics, lipid profiles, and other laboratory results as predictors. The models applied to predict LDL-C values were multiple regression, penalized regression, random forest, and XGBoost. Additionally, a novel 2-step prediction model was developed and introduced. The machine learning methods were evaluated against the Friedewald, Martin, and Sampson equations. Results The Friedewald, Martin, and Sampson equations had root mean squared error (RMSE) values of 12.112, 8.084, and 8.492, respectively, whereas the 2-step prediction model showed the highest accuracy, with an RMSE of 7.015. The LDL-C levels were also classified as a categorical variable according to the diagnostic criteria of the dyslipidemia treatment guideline, and concordance rates were calculated between the predictive values obtained from each method and the directly measured ones. The 2-step prediction model had the highest concordance rate (85.1%). Conclusion The machine learning method can calculate LDL-C more accurately than existing equations. The proposed 2-step prediction model, in particular, outperformed the other machine learning methods. [ABSTRACT FROM AUTHOR]

The incidence of hypertension has increased dramatically in both elderly and young populations. The incidence of hypertension also increased with the outbreak of the COVID-19 pandemic. To enhance hypertension detection accuracy, we proposed a multivariate outlier removal method based on the deep autoencoder (DAE) technique. The method was applied to the Korean National Health and Nutrition Examination Survey (KNHANES) database. Several studies have identified various risk factors for chronic hypertension. Chronic diseases are often multifactorial rather than isolated and have been associated with COVID-19. Therefore, it is necessary to study disease detection by considering complex factors. This study was divided into two main parts. The first module, data preprocessing, integrated external features for COVID-19 patients merged by region, age, and gender for the KHNANE-2020 and Kaggle datasets. We then performed multicollinearity (MC)-based feature selection for the KNHANES and integrated datasets. Notably, our MC analysis revealed that the "COVID-19 statement" feature, with a variance inflation factor (VIF) of 1.023 and a p-value < 0.01, is significant in predicting hypertension, underscoring the interrelation between COVID-19 and hypertension risk. The next module used a predictive analysis step to detect and predict hypertension based on an ordinal encoder (OE) transformation and multivariate outlier removal using a DAE from the KNHANES data. We compared each classification model's accuracy, F1 score, and area under the curve (AUC). The experimental results showed that the proposed XGBoost model achieved the best results, with an accuracy rate of 87.78% (86.49%–88.1%, 95% CI), an F1 score of 89.95%, and an AUC of 92.28% for the COVID-19 cases, and an accuracy rate of 87.72% (85.86%–89.69%, 95% CI), an F1 score of 89.94%, and an AUC of 92.23% for the non-COVID-19 cases with the DAE_OE model. We improved the prediction performance of the classifiers used in all experiments by developing a high-quality training dataset implementing the DAE and OE in our method. Moreover, we experimentally demonstrated how the steps of the proposed method improved performance. Our approach has potential applications beyond hypertension detection, including other diseases such as stroke and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate predictive value of the myopia growth chart based on population-based health survey data using longitudinal cohorts. Methods: Patients aged from 5 to 18 years and underwent two or more cycloplegic refraction (CR) exams with at least one year of interval were included. Percentile deviation was calculated by subtracting percentile at final exam from the percentile at initial exam based on the chart. Spherical equivalent (SE) deviation was calculated by SE at final CR subtracted from predicted SE based on initial CR using the chart. Results: 2310 eyes from 1155 subjects were included. There were 1344 eyes (58.2%) categorized as inliers, where both initial and final CR were within the 2nd to 99th percentile. Mean percentile and SE deviations were + 11.0 ± 22.9 percentiles and -0.60 ± 1.33 diopters, each. Outliers, those except the inliers, were 966 eyes (41.8%). Most outliers (709 eyes, 73.4%) were outside the chart for both initial and final exam. The rest of the outliers (257 eyes, 26.2%) were within the 2 to 99 percentile range on the chart at least once, either at initial or final exams; most of those (202 eyes, 78.6%) progressed toward myopia more than predicted. Conclusions: In our large cohorts, both inliers and outliers tended to progress toward more myopia than predicted from the chart. This suggests the chart predicts childhood myopia rather conservatively. The myopia growth chart may be useful as a screening tool in detecting children at high risk of developing high myopia. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the association between handgrip strength (HGS) and health-related quality of life (HRQoL), demonstrating HGS as an effective indicator for evaluating HRQoL of patients with cancer. Analyzing 1657 Korean adult cancer patients (644 males, 1013 females) aged ≥ 20 years from the Korea National Health and Nutrition Examination Survey (2014–2019), HGS was standardized based on body mass index and categorized by sex. HRQoL was assessed using the Euro Quality of Life-5-Dimension 3-Level version (EQ-5D-3L) Index. Lower relative HGS was associated with decreased HRQoL in female patients, while no significant association was found in male patients. The lowest quartile of relative HGS exhibited a 2.5-fold decrease in HRQoL compared to the highest quartile (OR 2.50, 95% CI 1.59–3.95, p < 0.001). Both male and female patients with cancer were affected by age, subjective health perception, and stress recognition regarding HRQoL. This study suggests that HGS may be associated with the HRQoL of female patients with cancer, emphasizing that the HGS measurement can be effectively utilized as a pivotal tool for evaluating HRQoL in female patients with cancer. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether children's attention-deficit hyperactivity disorder (ADHD) is associated with parental mental health, using data from the Korean National Health and Nutrition Examination Survey (KNHANES). This cross-sectional study included 14,428 samples from KNHANES of parents with children younger than 19 years between 2011 and 2020. Mental health problems, measured as perceived stress, depressive symptoms, and suicidality, were assessed. Sociodemographic and health-related characteristics were collected as potential confounding factors. The association between children with ADHD and parental mental health problems was expressed as odds ratio and 95 % confidence interval with multivariate logistic regression using PROC SURVEYLOGISTIC. Among the 14,428 participants, 202 (1.4 %) were classified as parents of children with ADHD. Mothers of children with ADHD reported higher perceived stress (aOR = 1.67, 95 % CI 1.09–2.56), depressive symptoms (aOR = 2.93, 95 % CI 1.59–5.40), and suicidality (aOR = 2.63, 95 % CI 1.29–5.38) than those of children without ADHD after adjusting for parents' age, gender, and parental education level, employment status, cohabitation status, drinking, smoking, and number of children. However, fathers' mental health problems were not significantly associated with having a child with ADHD. Because it was conducted the analysis using cross-sectional data, findings on causality are unclear. The current findings suggest that parenting children with ADHD is associated with parental mental health problems. Parents of children with ADHD, especially mothers, need community support and public health attention to help alleviate their mental health problems. • Parenting children with ADHD was associated with parental mental health problems. • ADHD mothers likely face more mental health issues than non-ADHD mothers. • ADHD child-rearing impacts mothers more than fathers within a family. [ABSTRACT FROM AUTHOR]

Excessive alcohol consumption has been consistently linked to depression. This study, utilizing nationwide samples from the Korea National Health and Nutrition Examination Survey (n = 21,440) examined the association between drinking behaviors and depressive symptoms while also exploring the influence of sleep duration on this relationship. Demographic, socioeconomic, and health-related factors were included as covariates in the multivariable logistic regression analysis to assess their relationships with depressive symptoms. Based on their sleep duration, the participants were divided into subgroups to explore how sleep duration affects the relationship between drinking behaviors and depressive symptoms. Moderate alcohol consumption (1–4 times a month) was associated with reduced likelihood of experiencing depressive symptoms in women (p = 0.024), with a similar trend observed among men (p = 0.001). Men who started consuming alcohol before the age of 19 had a higher likelihood of experiencing depressive symptoms (p = 0.048). Only women who consumed more alcohol per occasion (≥ 7 drinks) had higher odds of depressive symptoms (p = 0.001). This study revealed complex factors that influence depressive symptoms, including alcohol consumption and sleep duration. This highlights the importance of tailored interventions based on sleep duration and sociodemographic characteristics for preventing and treating depression. [ABSTRACT FROM AUTHOR]

This study investigated associations between healthy dietary practices and the odds of prediabetes among Korean adolescents. The data of 1,624 adolescents aged 12 to 18 who participated in the 2017-2021 Korea National Health and Nutrition Examination Survey were analyzed. Healthy dietary practices were defined according to Health Plan 2030 criteria, and prediabetes was defined as a fasting blood glucose level of 100-125 mg/dL. After controlling for confounders, adjusting odds ratios and 95% confidence intervals (CIs) for prediabetes were determined for different healthy dietary practices using multivariable logistic regression analysis. Compared with adolescents who engaged in healthy dietary practices, those who did not had a 1.63-fold (95% CI: 1.12-2.37) higher odds of prediabetes. In addition, adolescents who did not consume ≥500 g of fruit and vegetables daily and those who refrained from reading nutritional fact labels, which are both subindicators of healthy dietary practices, had a 1.66 (95% CI: 1.05-2.62) and 1.58-fold (95% CI: 1.06-2.37) higher odds of prediabetes, respectively, than those who did. Increasing the proportion of adolescents engaging in healthy dietary practices, such as consuming ≥500 g of fruit and vegetables daily and reading nutritional fact labels when selecting food, is imperative. [ABSTRACT FROM AUTHOR]

Background: Depression is a leading cause of disability and mortality, with estimated number of deaths exceeding 2.2 million worldwide. We examined depression in relation to anemia and physical activity, both of which have an impact on depression mechanisms. Methods: This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey, including 18,622 participants. Depression was measured by The Patient Health Questionnaire-9, and physical activity was assessed by the Global Physical Activity Questionnaire. Anemia was defined by World Health Organization criteria for blood hemoglobin levels. Isotemporal substitution model for physical activity was used to assess the effect of replacing sedentary behavior to each intensity level of physical activity. Logistic regression was applied to estimate the association on depression. Results: Replacing sedentary behavior with moderate or vigorous physical activity was associated with a lower risk of depression in the anemic (OR: 0.875, 95% CI: 0.782–0.978) and non-anemic groups (OR: 0.943, 95% CI: 0.919–0.967). Depression risk was significantly reduced by replacing walking with moderate to vigorous physical activity in both anemic (OR: 0.877, 95% CI: 0.784–0.982) and non-anemic groups (OR: 0.951, 95% CI: 0.927–0.976). Conclusions: Moderate to vigorous physical activity had a protective association against depression in both anemic and non-anemic groups. Anemic patients are recommended to perform physical activity for any duration acceptable to them to prevent depression. [ABSTRACT FROM AUTHOR]

Aim: Adult women experience several changes in physiological status, such as pregnancy and childbirth, during their life cycle. This study analyses the association between birth‐related factors (the number of childbirths, abortions and miscarriages) and periodontitis using data from the Korea National Health and Nutrition Examination Survey, which represents Korean adults. Materials and Methods: The study used data from Korea National Health and Nutrition Examination Survey VI and VII (2013–2018) and included 10,072 women 19 years or older, with no missing data on the variables assessed. Periodontitis was defined according to the Community Periodontal Index (CPI) criteria. Multiple logistic regression analysis, adjusting for age, household income, education, alcohol consumption, smoking, stress, body mass index, waist circumference, hypertension, diabetes mellitus, an oral examination within 1 year, daily tooth brushing frequency, hygiene products and self‐perceived oral health as identified via logistic regression analyses, was performed to determine the association between birth‐related variables and periodontitis. Results: In the crude model, the odds ratio (OR) showed a significantly increased risk of periodontitis (CPI ≥ 3) and severe periodontitis (CPI = 4) based on the number of childbirths, abortions and miscarriages (p <.05). After covariate adjustment, periodontitis (CPI ≥ 3) was associated with the number of childbirths (1: OR = 1.92; 95% confidence interval [CI]: 1.47–2.50; 2: OR = 2.03; 95% CI: 1.57–2.61; ≥3: OR = 2.11; 95% CI: 1.60–2.78). Furthermore, severe periodontitis (CPI = 4) was also associated with the number of childbirths (1: OR = 2.33; 95% CI: 1.24–4.38; 2: OR = 2.99; 95% CI: 1.62–5.52; ≥3: OR = 3.34; 95% CI: 1.79–6.21). Conclusions: The findings of this large‐scale, nationally representative study suggest that the number of childbirths is associated with the severity of periodontitis. However, the relationship between the number of abortions and miscarriages and periodontitis (CPI ≥ 3) or severe periodontitis (CPI = 4) is not significant. [ABSTRACT FROM AUTHOR]

This study aimed to determine the association between household types and healthy dietary practices among Korean adults. A cross-sectional analysis was performed using nationwide data on 23,488 participants from the 2017-2021 Korea National Health and Nutrition Examination Survey (KNHANES). Based on self-reported data, the participant household types were classified into single- and multi-person households. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for healthy dietary practices according to household types were calculated by applying multivariable logistic regression analysis after adjusting for confounders. Of total, 11.21% and 88.79% were single- and multi-person households, respectively. Compared with individuals living in multi-person households, those in single-person households had lower odds of adhering to healthy dietary practices (AOR: 0.88, 95% CI: 0.79-0.98) and consuming adequate saturated fatty acids (<7% of energy) (AOR: 0.78, 95% CI: 0.69-0.88). In addition, men and individuals aged 65 years living in single-person households exhibited lower odds of consuming adequate saturated fatty acids and 500 g of fruit and vegetables per day than those in multi-person households. Single-person households often find it a challenge to practice a healthy diet. Hence, nutritional policies and educational support that help individuals living alone consume healthier diets are warranted. [ABSTRACT FROM AUTHOR]

Background: Uric acid is known for its antioxidant capacity; however, whether uric acid is independently associated with depression in the older population remains controversial. The current study aimed to investigate the association between uric acid and depressive symptoms in older adults according to sex, using a large national sample population. Methods: Data from the 2016, 2018, and 2020 Korean National Health and Nutrition Examination Surveys were analyzed, and 5609 participants older than 60 years were included in this study. We defined a Patient Health Questionnaire‐9 score ≥5 as indicating the presence of depressive symptoms. Results: The prevalence of depressive symptoms was higher in women with lower uric acid levels than in those with higher uric acid levels. In women, the lower levels of uric acid were significantly associated with depressive symptoms in the multivariable logistic regression analysis (odds ratio, 1.36; 95% confidence interval, 1.10–1.68; p = 0.005). However, no significant association between uric acid levels and depressive symptoms was observed in men. Conclusion: The findings of this study suggest that uric acid is associated with depressive symptoms in older women, but not in men. Relatively lower serum uric acid levels in women compared to men and sex differences in oxidative stress may explain the significant association of uric acid levels and depressive symptoms in older women. Further research is needed on sex differences in the relationship between serum uric acid levels and depressive symptoms. Key points: Uric acid is known for its antioxidant capacity and may have neuroprotective effects.Low serum uric acid levels are associated with a higher prevalence of depressive symptoms in women aged over 60 years, but not in men.Women's lower total serum uric acid levels and greater susceptibility to oxidative stress compared to men may explain the sex differences. [ABSTRACT FROM AUTHOR]

Background: Reduced meal frequency can increase the risk of metabolic syndrome (MetS). However, limited studies have examined the association between meal frequency and skipping meals with MetS. This study aims to analyze the association between main meal frequency and meal skipping with MetS in Korean adults aged ≥ 19 years. Methods: In this study, we included data from 22,699 Korean adult participants from the 2016–2020 Korea National Health and Nutrition Examination Survey (KNHANES). The 24-h dietary recall method was used to classify the participants into three groups based on main meal frequency (one, two, or three meals per day) and seven groups based on the type of main meal they skipped. Multivariable logistic regression analysis was conducted to determine the association between main meal frequency and the types of main meals skipped with the odds of MetS and its associated components. Appropriate estimates were accounted for using sampling weights, stratification, and clustering. Results: The prevalence of MetS in the study population was 33.8%. The average age of the participants was 47.2 years with 42.6% being men, and 57.4% being women. Men who consumed two meals per day had higher odds of MetS than those who consumed three meals per day (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01–1.33). Women who consumed two meals per day, and skipped breakfast had increased odds of having elevated fasting blood glucose levels (OR 1.18, 95% CI 1.02–1.35), and elevated triglycerides (OR 1.19, 95% CI 1.02–1.39). However, women who skipped dinner had reduced odds of having elevated fasting blood glucose levels (OR 0.74, 95% CI 0.58–0.94). Conclusions: Our findings suggest that meal frequency and the type of main meal skipped may be associated with MetS and emphasize the importance of consuming breakfast to prevent MetS. [ABSTRACT FROM AUTHOR]

Evidence on the association between serum 25-hydroxyvitamin D (25(OH)D) concentration and all-cause and cause-specific mortality in Asians, especially Koreans, is limited. We hypothesized that high concentrations of 25(OH)D are associated with lower all-cause and cause-specific mortality in the general Korean population. This study included 27,846 adults participating in the Fourth and Fifth Korean National Health and Nutrition Examination Survey 2008–2012, followed up through December 31, 2019. Hazard ratios (HR) and 95% confidence intervals (CIs) for mortality from all causes, cardiovascular disease (CVD), and cancer were estimated using multivariable-adjusted Cox proportional hazards regression. The weighted mean serum 25(OH)D of study participants was 17.77 ng/mL; 66.5% had vitamin D deficiency (<20 ng/mL) and 94.2% had insufficient vitamin D (<30 ng/mL). During a median follow-up of 9.4 years (interquartile range, 8.1–10.6 years), 1680 deaths were documented, including 362 CVD deaths and 570 cancer deaths. Serum 25(OH)D levels ≥30 ng/mL were inversely associated with all-cause mortality (HR, 0.57; 95% CI, 0.43–0.75) compared with serum 25(OH)D levels <10 ng/mL. Based on the quartile cutoffs of serum 25(OH)D concentration, the highest quartile of serum 25(OH)D concentration (≥21.8 ng/mL) was associated with the lowest all-cause mortality (HR, 0.72; 95% CI, 0.60–0.85; P trend <.001), and CVD mortality (HR, 0.60; 95% CI, 0.42–0.85; P trend =.006). No association with cancer mortality outcome was found. In conclusion, higher serum 25(OH)D levels were associated with lower all-cause mortality in the general Korean population. An additional association was found between higher quartile of serum 25(OH)D and lower CVD mortality. In this nationally representative sample of Korean adults, we found that higher serum 25-hydroxyvitamin D (25(OH)D) levels were associated with lower all-cause mortality but not with cancer mortality. Quartile analysis of serum 25(OH)D levels revealed an additional significantly inverse relationship with cardiovascular mortality. Maintaining the proper level of serum 25(OH)D through vitamin D supplementation in the general Korean population may have potential benefits in altering mortality risk. [Display omitted] [ABSTRACT FROM AUTHOR]

Hypertriglyceridemia is a well‐known risk factor of various chronic diseases including diabetes mellitus, metabolic syndrome, obesity, and cardiovascular diseases. This study aimed to determine dietary patterns and explore the relationship between dietary patterns and hypertriglyceridemia in the Korean adult population. We utilized a cross‐sectional and nationally representative survey, the Korea National Health and Nutrition Examination Survey 2013–2018 database. From 47,217 subjects who participated in the survey between 2013 and 2018, only subjects over 40 years old were included. Subjects lacking 24‐h recall data and data on hypertriglyceridemia and body mass index, and who had implausible energy intake were excluded. A total of 19,806 participants' data were analyzed. Dietary data were based on 24‐h recall data, and dietary patterns were derived using factor analysis. Triglyceride levels greater than 200 mg/dl were considered hypertriglyceridemia, according to the Korean Society of Lipid and Atherosclerosis. Three dietary patterns— "oil and fats & seasoning", "soybean paste and vegetable", and "fruit and whole‐grain"— explained 7.9%, 6.3%, and 5.8% of variation in food intake, respectively. Comparing the lowest and highest dietary pattern score groups after adjusting for potential confounders revealed an inverse relationship between "fruit and whole‐grain" dietary pattern and hypertriglyceridemia in men (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.45–0.82, p for trend <.0001); which was only marginal in women (OR: 0.78, 95% CI: 0.58–1.07, p for trend:.628). A diet containing high proportions of fruit and whole‐grain may have preventive effects on hypertriglyceridemia in middle and older aged Korean adults. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the prevalence, trends, and risk factors of early chronic obstructive pulmonary disease (COPD) by using a nationally representative sample. The datasets of the Korea National Health and Nutrition Examination Survey 2010–2019 were used, where 80,860 individuals were identified; of these, 9,045 participants aged 40–49 years who underwent spirometry with no missing data were analyzed. Early COPD was defined as forced expiratory volume in 1 s /forced vital capacity ratio < the lower limit of normal (2.5th percentile) in individuals aged <50 years without a history of asthma, inhaler therapy, or persistent respiratory symptoms. The prevalence and trend of early COPD were estimated according to features such as smoking status and pack-years. Joinpoint regression analysis was used to analyze the significant annual change in the trend according to sex, smoking status, and pack-years. A complex sample multivariable-adjusted regression model was used to identify factors affecting early COPD. The estimated population size during 2010–2019 was 82,326,178. Early COPD was present in 4.5% of patients (6.5% of men and 2.3% of women). It was present in 7.7% of current smokers, followed by former and never smokers. Among smokers with ≥ 10 pack-years, early COPD was present in 8.2%, whereas it was present in 2.6% of smokers with < 10 pack-years. Joinpoint regression analyses found a recent decrease in the trend of prevalence in males who were former and current smokers. The multivariable-adjusted logistic regression model showed that being male, lower educational level, smoking status, and pack-years were factors that affected the presence of early COPD. Continued surveillance of this pre-disease condition is required, and further research are warrant. [ABSTRACT FROM AUTHOR]

Background: Many factors associated with chronic low back pain (CLBP) have been proposed, including individual, psychosocial, and physical factors. However, these associated factors are still controversial. Purpose: (1) To determine the prevalence of CLBP and (2) to analyze factors associated with CLBP in the general population using a nationally representative sample of South Koreans. Study design: Cross-sectional study. Patient sample: Data from versions IV-1, -2, and -3 of the Korea National Health and Nutrition Examination Survey (KNHANES), which were performed in 2007, 2008, and 2009, respectively (n = 24,871). Outcome measures: Multiple logistic regression analysis was performed to determine the association between several factors (age, gender, alcohol consumption, household income, education level, mid-intensity physical activity, depressive symptoms, vitamin D level, and comorbidities [stroke, ischemic heart disease, knee osteoarthritis, asthma, COPD, cancer history]) and CLBP. Methods: CLBP status was surveyed using a self-reported questionnaire. Demographic, socioeconomic status, comorbidities, and other factors were evaluated from health questionnaires, health and physical examinations, and laboratory tests. To analyze the association between these factors and CLBP, we used multiple logistic regression analysis. Results: Data from 17,038 participants were included in the final analysis, including 2,693 with CLBP and 14,345 without. The prevalence of CLBP was 15.8% in South Korean subjects, with a prevalence of 11.8% in men and 24.5% in women. After regression analysis, we found advanced age, female gender, mid-intensity physical activity, depressive symptoms, stroke, ischemic heart disease, knee arthritis, asthma, COPD, and cancer history were positively associated with CLBP. In contrast, alcohol consumption ≥ 1 drink per month, increased household income, higher education level, and vitamin D insufficiency were negatively associated with CLBP. Conclusions: Our study showed that CLBP was most common in the elderly and women in the general South Korean population. Several individual, socioeconomic, lifestyle, and health-related factors were associated with CLBP. These results demonstrate the influence of these factors on CLBP in the general population and suggest that consideration of these factors may improve the management of CLBP. [ABSTRACT FROM AUTHOR]

Purpose: National big data pertaining to the status of common respiratory diseases is essential to devising appropriate policies to promote proper treatment and prevention of respiratory diseases amid the prolonged coronavirus disease 2019 (COVID‐19) pandemic. The aim of this study is to investigate the prevalence of common respiratory diseases and their association with sociodemographic characteristics, comorbidities, and medical history using 11 years (2008–2018) of the Korea National Health and Nutrition Examination Survey (KNHANES) data, ultimately to present foundational data for policy decision making and disease prevention measures. Methods: Among the participants of the KNHANES survey (2008–2018), 93 028 adults aged ≥40 years who underwent a lung function test were included in this cross‐sectional study. The participants were divided into four groups: Asthma, chronic obstructive pulmonary disease (COPD), asthma + COPD, and no respiratory disease. Their data were analyzed for demographic factors, health behavior, and disease‐related factors. Multiple logistic regression was used to calculate the odds ratio (OR) adjusted for sex, age, household income, educational level, occupation, body mass index (BMI), smoking status, alcohol consumption, physical activity, and comorbidities. Results: Of all participants, 1.83%, 12.63%, and 1.27% had only asthma, only COPD, and asthma + COPD, respectively. With respect to the patients with asthma who also had asthma + COPD, the OR of asthma + COPD was 5.272 in underweight patients and 6.479 in patients aged ≥70 years. Meanwhile, a high association between COPD and asthma + COPD was found in female patients, whereas asthma was more highly associated with asthma + COPD in male patients. Conclusion: The study confirmed that old age, sex, smoking status, BMI, previous history of atopic dermatitis, and lung cancer were independent risk factors for asthma, COPD, and asthma + COPD. The present study demonstrated the need for a multidisciplinary integrative approach to respiratory diseases, and the findings could be used for developing policies for the treatment of COVID‐19 and respiratory diseases and the prevention of infectious diseases. [ABSTRACT FROM AUTHOR]

This study investigated the potential role of dietary factors associated with obesity and metabolic syndrome (MetS) in Koreans. The scoping review method was used to evaluate the studies that utilized the secondary data sets comprising the Korean National Health and Nutrition Examination Survey (KNHANES) and the Korean Genome and Epidemiology Study (KoGES). Articles published between 2012 and 2022 were identified using RISS, KISS, DBpia, PubMed, and ScienceDirect databases. In all, there were 32 published articles on obesity and 119 on MetS. Obesity research included eight articles on nutrients, 12 on food items/food groups, two on dietary patterns, nine on dietary behavior/eating habits, and one on the dietary index. MetS studies comprised 34 articles on nutrients, 43 on food items/food groups, seven on dietary patterns, 25 on dietary behavior/eating habits, and 10 on the dietary index. Carbohydrates, alcohol, and coffee consumption were the most frequently studied dietary factors for obesity and MetS. The primary areas of study were largely focused on nutrients and food items/food groups. Thus, to overcome the paucity of information on the relationship of dietary patterns and dietary indexes with obesity and MetS, there is a need for further research using the KNHANES and KoGES data sets. [ABSTRACT FROM AUTHOR]

Background: Several studies have reported an association between anemia and depression. However, whether anemia is independently associated with depression remains controversial. The current study aimed to investigate the association between anemia and depression according to sex in a large national sample population.Methods: Data from the 2014, 2016, and 2018 Korean National Health and Nutrition Examination Survey were analyzed, and 15,472 participants were included in this study. Anemia was defined as a hemoglobin level <13 g/dL in men and <12 g/dL in women. We defined a Patient Health Questionnaire-9 score ≥10 as depression and ≥5 as mild depressive symptoms.Results: The prevalence of depression was significantly higher in women with anemia than in women without anemia (8.9 % vs. 7.0 %, P = 0.036). In women, anemia was significantly associated with depression after adjusting all covariates in multilevel logistic regression analysis (odds ratio, 1.37; 95 % confidence interval, 1.08-1.75; P = 0.011). However, no significant association was observed in men.Limitations: There is a limit to explaining the causal direction, and several factors may not have been considered as confounders. Also, patients with severe diseases were excluded from data acquisition. A structured diagnostic interview, other than the self-report method, was not conducted.Conclusions: The findings of this study suggest that anemia is associated with depression in women but not in men. A decrease in tissue oxygenation, deterioration of physical performance due to anemia, and altered monoamine synthesis due to malnutrition may have an effect on depression. [ABSTRACT FROM AUTHOR]

Background and Aim: The association between thyroid autoimmunity and nonalcoholic fatty liver disease (NAFLD) remains unclear. In this study, we aimed to investigate the relationship between thyroid autoimmunity and NAFLD in a large cohort of euthyroid subjects. Methods: We analyzed clinical and biochemical data from a nationwide, population‐based, cross‐sectional survey (KNHANES VI). A total of 1589 middle‐aged participants aged 45–65 years, with normal thyroid function, were included in this study. NAFLD was defined as a hepatic steatosis index of > 36. We estimated the odds ratios (ORs) for NAFLD according to anti‐thyroid peroxidase antibody (TPOAb) positivity by using logistic regression models, and adjusted for potential confounders. Results: Overall, 24% (n = 378) of the subjects had NAFLD. Subjects with NAFLD showed a higher positivity for TPOAb (11% vs 7%, P = 0.014) compared with those without NAFLD. TPOAb positivity was a significant risk factor for NAFLD [OR 1.668, 95% confidence interval (CI) 1.019–2.730, P = 0.042] even after adjusting for confounding variables, including age, sex, household income, education, smoking, alcohol consumption, walking activity, abdominal obesity, elevated blood pressure, dyslipidemia and hyperglycemia. In addition, TPOAb positivity predicted the risk of advanced liver fibrosis (OR 3.112, 95% CI 1.256–7.713, P = 0.014) in subjects with NAFLD, independent of the confounding variables. Conclusion: In euthyroid subjects, thyroid autoimmunity is associated with NAFLD and advanced liver fibrosis, independent of known metabolic risk factors. Large longitudinal studies in the future will help clarify the causality. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health‐related quality of life on a national level. Objective: We aimed to investigate the associations of TMDs, tinnitus and quality of life among the Korean population, aged 19 years or older. Methods: Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5786). TMDs, tinnitus and health‐related quality of life were assessed using self‐report data from EuroQol‐5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present and both TMD and tinnitus present. Results: Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort and anxiety/depression dimensions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% confidence interval [CI]: 1.014–2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570–2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034–2.767), EQ‐5D score (OR = 1.651, 95% CI: 1.121–2.431) and EQ‐VAS (OR = 1.682, 95% CI: 1.246–2.269). Conclusion: The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasise the need for a multilateral and comprehensive approach to address these disorders and provide baseline data for developing appropriate interventions. [ABSTRACT FROM AUTHOR]

This study examined the nutrient intake of Korean adults by considering the lunch type, categorized as home meals (HM), eating out (EO), and institutional meals (IM). Data was obtained from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES). Totally, 3,786 adults (1,643 men, and 2,143 women) aged between 19-64 years were included in the study. Subjects with daily energy intake of less than 500 kcal or over 5,000 kcal, and those who skipped lunch, were excluded. The percentage of subjects in the HM, EO, and IM were 31.9, 53.6, and 14.4%, respectively. The daily energy intakes of the HM, EO, and IM groups were determined to be 2,185, 2,360, and 2,339 kcal, respectively, in men, and 1,622, 1,731, and 1,741 kcal, respectively, in women. Among the three groups, men in the EO group had more intake of fat, saturated fat, cholesterol, sodium, and riboflavin, and less dietary fiber, and whereas women consumed more fat and less dietary fiber and potassium. In the IM group, the men consumed more dietary fiber, potassium, and thiamine, whereas consumption of carbohydrate, unsaturated fatty acid, sodium, potassium, and thiamine was more in women. Energy contributions of carbohydrate, protein, and fat were all within the AMDR (acceptable macronutrient distribution ranges) for all lunch types, except for the percent of energy provided from saturated fat in EO (7.4% in men, and 8.2% in women). Our results indicate that the dietary habit of frequently eating out increases the fat intake, thereby resulting in increased health risks for adults. Thus, implementation of a nutritional education program to encourage balanced dietary habits is required to improve the nutritional status of individuals eating out. [ABSTRACT FROM AUTHOR]

Unhealthy dietary behavior such as insufficient calcium intake can be one of risk factors of osteoporosis and chronic diseases in older people. This study evaluated the recent trends in dietary calcium intake and the food source in Korean adults aged 50 years or older using the Korea National Health and Nutrition Examination Survey (KNHANES, 2015-2019) data. This study used 24-hour recall survey data to investigate the calcium intake, the major food groups and main dishes contributing to the calcium intake. The mean calcium intake was 479.55-506.81 mg/day. The major food groups that contribute to calcium intake were vegetables, milks and fishes. Dairy and frozen desserts and kimchi were the major dish groups that contributed to the calcium intake. Calcium intake from milk in dairy and frozen dessert group has been high in last 5 years (50-64 years old: 34.71-47.68 mg, 65-74 years old: 29.72-43.65 mg, over 75 years old: 22.91-42.93 mg). In addition, baechu-kimchi is the most contributed to the calcium intake in kimchi group (50-64 years old: 35.10-41.47 mg, 65-74 years old: 29.62-34.96 mg, over 75 years old: 23.79-29.13 mg). In conclusion, various source of calcium needs to be recommended to increase intake calcium in over 50 years, which may reduce chronic diseases and improve quality of life. [ABSTRACT FROM AUTHOR]

This study was conducted to examine the status of food consumption and nutrition intake of young adults according to food security using data from the Korea National Health and Nutrition Examination Survey (KNHANES) (2008~2018). A total of 10,655 young adults aged 19~34 years participated in the study. The subjects in the moderately/severely food insecure group consumed less fruits, vegetables, meat, nuts and seeds than those in food secure/mildly food insecure group after adjusting for confounding factors. The moderately/severely food insecure group significantly decreased mean adequacy ratio (MAR) and nutrient adequacy ratio (NAR) for protein, vitamin A, riboflavin, niacin, vitamin C, calcium, phosphorus and iron compared to the food secure/ mildly food insecure group. The percentages of the participants consuming a daily diet with carbohydrate, protein, vitamin A, thiamin, riboflavin, niacin, vitamin C, phosphorus and iron less than the estimated average requirement (EAR) increased in the moderately/severely food insecure group compared with the food secure group. This study suggested that the nutrition intake of young adults was related to food security status. These findings can be used as basic data for developing nutritional policies for young adults. [ABSTRACT FROM AUTHOR]

Background: Although physical activity (PA) benefits cancer survivors physically and psychosocially, health inequality may limit these benefits in a subset of cancer survivors, and its association with PA in cancer survivors has not been investigated. Therefore, the purpose of this study is to explore PA levels with regard to health inequality factors (i.e., demographic and socioeconomic profiles) in Korean cancer survivors using the Korean National Health and Nutrition Examination Survey (KNHANES). Methods: Data of 900 cancer survivors from the KNHANES in 2014–2017 were used. ANCOVA was used to determine differences in PA and sedentary behavior by healthy inequality factors. Logistic regression was used to estimate the associations of the health inequality factors with meeting the aerobic PA guidelines. Results: Higher PA was reported in participants who were male (p = 0.004), younger (p = 0.006), and with higher education (p = 0.003). In adjusted logistic regression models, females were 37% less likely to meet the guideline compared to males (p = 0.045). Participants who were ≥ 70 years were 78% less likely to meet the guideline compared to < 50 years (p < 0.001). Compared to participants who graduated from college/university, participants who graduated from high-, middle-, or elementary-school were 50% (p = 0.005), 53% (p = 0.023), and 71% (p < 0.001) less likely to meet the guideline, respectively. Conclusions: Lower PA was prevalent in cancer survivors who were female, older, and less educated. Systematic efforts to promote PA are required for targeted cancer subgroups. [ABSTRACT FROM AUTHOR]

The present study aimed to determine thiamine intake levels and the association between thiamine intake, diabetes, cardiovascular diseases and mental health. Participants were interviewed to obtain data on socio-demographic characteristics, lifestyle, current medications, medical and family history. The daily intake of thiamine was assessed by a 24-h recall. The mean age of the 34 700 study subjects was 42⋅9 years (sd 22⋅8, min–max: 1–80) and 19 342 (55⋅7 %) were women. The levels of thiamine intake were 1⋅126 mg (2016), 1⋅115 mg (2017) and 1⋅087 mg (2018) for women, which were equal to or only slightly above the recommended intake of 1⋅10 mg/d for women. The levels of thiamine intake from 2014–15 and 2016–18 significantly decreased. The estimated percentage of insufficient thiamine intake was 37⋅8 % (95 % CI 37⋅3, 38⋅4). Multivariable regression analysis adjusted for potential confounders showed that thiamine intake was critically associated with lower risks of hypertension, MI or angina, type 2 diabetes, depression and dyslipidemia. The daily thiamine intake from food can reversal the risks of hypertension (OR 0⋅95; 95 % CI 0⋅90, 0⋅99), MI or angina (OR 0⋅84; 95 % CI 0⋅74, 0⋅95), type 2 diabetes (OR 0⋅86; 95 % CI 0⋅81, 0⋅93), depression (OR 0⋅90; 95 % CI 0⋅83, 0⋅97) and dyslipidemia (OR 0⋅90; 95 % CI 0⋅86, 0⋅95), respectively. Further works are needed to identify the effects of thiamine and non-communicable diseases (NCDs) and mental health. A preventive thiamine supplementation strategy should be adopted to target NCDs and mental health and risk factors associated with thiamine deficiency. The optimisation of NCD control and mental health protection is also a vital integral part of Korea's public health system. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking status based solely on self-reporting is unreliable and might be inaccurate, particularly among women. This study investigated the association between urinary cotinine-verified smoking status and hyperuricemia in a nationwide Korean population. METHODS This study included 5329 participants aged ≥19 years with information on smoking status, urine cotinine levels and serum uric acid. We determined smoking status according to self-reports and urinary cotinine levels. Multivariate linear regression analysis was used to measure the association between smoking exposure and serum uric acid levels. The effects of smoking on hyperuricemia were evaluated by multivariate logistic regression analysis. RESULTS Biochemically verified active and passive smokers comprised 22% (38.7% of men and 8.8% of women) and 12.3% (11.9% of men and 12.6% of women) of the study population, respectively. While reclassification rate of active smokers was 1.4% in men, 31.8% of cotinine-verified female active smokers were self-reported never smokers. Higher uric acid levels were observed with increased tobacco exposure among women (p-trend=0.007) but not among men. After adjusting for confounders, the risk of hyperuricemia increased with tobacco exposure only in women (p-trend=0.016). CONCLUSIONS Cotinine-verified smoking status was associated with increased serum uric acid and hyperuricemia in a dose-response manner only in women. This study might provide evidence to support the importance of smoking cessation in women with gout and further studies are necessary to elucidate the underlying mechanism of the observed association. [ABSTRACT FROM AUTHOR]

Introduction: Ferritin regulates iron homeostasis, and is involved in the inflammation in the lung, especially in smokers; however, its associations on pulmonary function in nonsmokers remain unclear. Objectives: The present study aimed to evaluate the association between serum ferritin and lung function in a tobacco‐naïve postmenopausal women. Methods: In this study, 25 534 individuals were enrolled, among who 5338 tobacco‐naïve individuals were identified; of those, 342 men and 2879 women (742 pre‐ and 2137 postmenopausal) with data of serum ferritin, lung function and covariates were included. To evaluate the association of ferritin and lung function, multivariable‐adjusted linear regression analyses was used including the factors of predicted value of forced expiratory volume in 1 second (FEV1%) and forced vital capacity (FVC%). Logistic regression analyses were used to measure the relationship between ferritin and restrictive and obstructive lung disease. Results: In premenopausal women, FEV1%/FVC was weakly but positively associated with serum ferritin, and after adjusting for covariates, the association was without statistical significance. No significant association between ferritin and obstructive lung disease was observed. In postmenopausal women, predicted FVC% was negatively associated with serum ferritin, and ferritin was dose‐dependently related with risk for restrictive lung disease. The odds ratio for restrictive lung disease in postmenopausal women was 2.285 at T3 and 1.560 at T2 relative to that at T1. Conclusions: High serum ferritin level was significantly associated with lower FVC% and increased risk of restrictive lung disease in tobacco‐naïve postmenopausal women. Further study is needed to determine the mechanism underlying the current findings. [ABSTRACT FROM AUTHOR]

Several nutrients have been suggested to protect against airway destruction via antioxidant activity. The present study aimed to evaluate the association between disease severity and dietary nutrient intake in chronic obstructive pulmonary disease (COPD) patients using the Korea National Health and Nutrition Examination Survey. Of the 22,948 participants, 702 patients (418 men and 284 women) with COPD, who were defined as the fifth percentile from a reference population were selected. The severity of airflow limitation was measured by the predicted percentage of forced expiratory volume in 1 second (FEV1%). The Jonckheere–Terpstra test was used to evaluate the dose-dependent association between nutrient intake and disease severity. Multivariate linear regression analysis was used to evaluate the relationship between dietary nutrient intake and predicted FEV1%. Vitamin A intake showed a positive association with FEV1% in men in a model adjusted for covariates. Carbohydrate, protein, fiber, thiamin, riboflavin, niacin, and vitamin C intake were significantly associated with decreased disease severity in elderly men (aged ≥60 years). On the contrary, statistical significance was not observed for all the nutrients in women. In conclusion, intake of carbohydrate, protein, fiber, thiamin, riboflavin, niacin, and vitamin C was associated with decreased severity of airway impairment in elderly men with COPD. Our results are in line with those of previous studies into the importance of nutritional status in airway disease. A longitudinal study is required to clarify the mechanisms underlying the association between dietary nutrient intake and COPD severity. [ABSTRACT FROM AUTHOR]

The traditional Korean diet is relatively high in carbohydrate and low in fat and protein compared with diets of non-Asian populations. In recent decades, the rapid economic growth in Korea has led to lifestyle and dietary changes, with an increase in the prevalence of dyslipidemia, a risk factor for chronic diseases. To examine the association between a low carbohydrate diet (LCD) score and dyslipidemia in Korean adults. The Korea National Health and Nutrition Examination Survey is an ongoing nationally representative population-based cross-sectional survey that is conducted annually. A total of 12,199 Korea National Health and Nutrition Examination Survey participants aged ≥20 years from 2010 to 2016 were included in this study. Individual components of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol levels, were defined based on fasting blood test results. Participants were classified by sex into quintiles of LCD scores calculated using 1-day 24-hour dietary recall data. A multivariable logistic regression model was used to examine the association between LCD score and each dyslipidemia component after adjusting for potential confounders. A higher LCD score was significantly associated with higher odds of hypercholesterolemia (odds ratio 1.36, 95% CI, 1.05 to 1.78; P for trend=0.031) and lower odds of low high-density lipoprotein cholesterol levels (odds ratio 0.72, 95% CI 0.55 to 0.94; P for trend=0.002) in women. However, in men, higher LCD scores were significantly associated with lower odds of hypertriglyceridemia (odds ratio 0.70, 95% CI 0.52 to 0.95; P for trend=0.012). More specifically, animal-based LCD scores were negatively associated with the odds of hypertriglyceridemia (odds ratio 0.65, 95% CI 0.48 to 0.87; P for trend=0.010) in men. These results suggest that the complicated and integrated effects of macronutrient composition on individual lipid components should be considered for preventing dyslipidemia in Korean adults. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between age at menarche and adult height [and body mass index (BMI)] in young Korean females and also to investigate whether early menarche (<12 years) is a risk factor for short stature and obesity in young Korean females. Methods: Data on 1148 females aged 18-30 years and 612 mother (612 pairs of mothers and daughters) from the 6th Korea National Health and Nutrition Examination Survey (2013-2015) were analyzed. Results: Among 1148 females, 256 (22.3%) had early menarche. Their stature was approximately 0.445 cm shorter when menarche had occurred one year earlier. The prevalence of short stature (≤153 cm) and obesity (BMI ≥25) was higher in females with early menarche compared to those with later menarche (short stature: 10.5% vs 6.4%, obesity; 20.7% vs 13.1%, all p<0.001). In multivariate regression, the odds ratio (OR) for short stature was 2.62 [95% confidence interval (CI): 1.26-5.44] after adjusting for current age and mother's height. OR for obesity was 1.74 (95% CI: 0.98-3.07) after adjusting for age and maternal BMI. Conclusion: Final height in girls is influenced by age of menarche. Early menarche increased the risk for adult short stature in young Korean females. [ABSTRACT FROM AUTHOR]

Aim: An elevated serum uric acid level is associated with various diseases, such as gout, hypertension, renal impairment, and diabetes. Heavy metals, including lead and cadmium, are suspected to increase serum uric acid levels, but evidence regarding this is not sufficient, particularly in the Asian population. Therefore, this study aimed to evaluate the association between lead, cadmium and mercury exposure and hyperuricemia in the Korean general population. Methods: We enrolled 2682 participants (1124 men and 1528 women) aged ≥19 years from The Korean National Health and Nutrition Examination Survey. Sex‐ and hyperuricemic state‐stratified general characteristics of study participants were compared using the Chi‐square test, Student's t test, and Mann–Whitney U test for categorical, continuous, and non‐normally distributed continuous variables, respectively. Multivariate logistic regression analysis was performed to evaluate the association between blood lead and cadmium levels and hyperuricemia. Results: Subjects with hyperuricemia had higher blood lead and cadmium levels than those without hyperuricemia. Lead and cadmium exposure had a positive association with serum uric acid levels in a dose–response manner in the nationally representative Korean population. In logistic analysis, blood cadmium levels had a positive association with increasing risk for hyperuricemia only in men, and this association was more evident in cotinine‐verified non‐smokers. Although an incremental trend of hyperuricemia in relation to lead exposure was observed, it was not statistically significant. Conclusion: Further studies are necessary to clarify the observed association, and public health strategies to reduce heavy metal exposure may be necessary for decreasing the potential harmful effects of hyperuricemia. [ABSTRACT FROM AUTHOR]

Background Context: Physical activity, such as muscle strengthening and aerobic exercise, has been found to be effective for low back pain (LBP). However, the association between weekly walking duration and LBP in the general population remains poorly understood.Object: This study aimed (1) to analyze the association between walking and LBP and (2) to examine this association according to walking duration and overall walking days per week in a general population over 50years of age using a representative sample of Korean adults.Study Design: Cross-sectional study.Patient Sample: Data from the Korea National Health and Nutrition Examination Surveys V and VI, performed from 2010 to 2015.Outcome Measures: Multiple logistic regression analysis was performed to determine the association between walking days and duration and LBP. Analysis was restricted to participants aged over 50years who responded to surveys on LBP and walking activity.Methods: National health and nutrition examination surveys were performed in the Korean general population (N=48,482) from 2010 to 2015. LBP status was surveyed using a self-reported questionnaire form ("Have you complained of LBP for more than 30days during the past 3 months?"). Daily walking activity (low-intensity activity) was evaluated using the following two questions: (1) "During the last 7days, on how many days did you walk for at least 10 minutes at a time? This includes at work and at home, walking to travel from place to place, and any other walking that you have done solely for recreation, sport, exercise, or leisure." (2) "How much time did you usually spend walking on each of those days?" Walking duration per day was classified into two categories: over 30min/day and over 1h/day. Overall walking days per week were categorized into <3, 3-4, and ≥5days/week. Basic characteristics, comorbidities, socioeconomic status, and other variables were used to create multiple logistic regression models. No sources of funding and no conflicts of interest were associated with this study.Results: Walking for more than 3days per week for over 30 minutes at a time was negatively associated with LBP in the unadjusted (adjusted odds ratio [aOR]: 0.65, p<.001) and fully adjusted logistic regression models (aOR: 0.79, p<.001). Similarly, walking for more than 5days per week for over 1 hour at a time was negatively associated with LBP in the unadjusted (aOR: 0.62, p<.001) and fully adjusted logistic regression models (aOR: 0.76, p<.001). The risk of LBP decreased with increasing walking days and duration.Conclusions: Our study showed that longer walking duration was associated with a lower risk of LBP using a cross-sectional health survey in the Korean general population. Regular walking with a longer duration for more than 3days/week is significantly associated with a lower risk of LBP in the general population aged over 50years. [ABSTRACT FROM AUTHOR]

Purpose: Glaucoma affects millions of people globally, and socioeconomic status is known to be associated with glaucoma. This study expands the understanding of the relationship between socioeconomic factors and glaucoma. Methods: This study used Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2012, with 24,664 persons who did not have missing records on the key variables. The combined relationship between levels of income and education and the prevalence of glaucoma was examined, as well as the occupational difference in the prevalence of glaucoma. Logistic regression models were constructed to generate odds ratios with 95% confidence intervals for predictors of glaucoma. All analyses were adjusted for strata, cluster, and weight. Results: The prevalence of glaucoma generally decreased with increasing levels of education and income, but this trend did not hold at the top two levels of education and income, wherein the prevalence was either the same or somewhat higher. Occupation types were shown to be significantly associated with glaucoma (p < 0.0001), and among all the occupations in the survey, farming/forestry/fishing showed the highest percentage of those with glaucoma (4.9%), and service/retail showed the lowest percentage (1.3%). In the multivariable adjusted model, the odds of glaucoma decreased with increasing income level, and increased at the highest income quartile, though the odds were significant only for the top two quartiles. The odds of glaucoma showed neither a nonlinear relationship nor statistical significance with education level when adjusted for other factors. In contrast, age and gender remained significant even after adjusting for other factors. Conclusions: There exists a nonlinear relationship between key socioeconomic factors and the prevalence of glaucoma, though the exact nature of the relationship requires further investigation. These findings merit attention in studies that relate disease prevalence to education and income. [ABSTRACT FROM AUTHOR]

Objective: We investigated whether, in the Korean population, the risk of premature ovarian insufficiency (POI) and early menopause varies with a woman's socioeconomic status, evaluated in relation to income, education, and occupation.Methods: This cross-sectional, population-based study involved 31,508 women aged >19 years registered in the Korea National Health and Nutrition Examination Survey (KNHANES) (2007-2016). Menopausal status and socioeconomic status were obtained from self-reported KNHANES data. A logistic regression model was applied to test whether POI and early menopause varied with socioeconomic status.Results: The prevalence of POI was 2.41% and of early menopause was 5.89%. The annual incidence of POI during the investigation period plateaued, while that of early menopause showed a linear trend. The risk of POI was significantly higher among participants with lower household incomes (odds ratio [OR], 95% confidence interval [CI]; 1.44, 1.16-1.78) and lower levels of education (OR, 95% CI: 1.75, 1.16-2.65) after adjustment for age.Conclusion: The prevalence of POI in the Korean population was almost twice that reported in a previous study. Lower socioeconomic status was associated with an increased risk of POI and early menopause. Further studies are warranted to investigate this association. [ABSTRACT FROM AUTHOR]

Objective/background: Sleep plays a vital role in maintaining homeostasis and promoting individual health. This study aimed to investigate the trends of sleep duration in Korean adults.Patients/methods: We collected data from individuals who were adults (≥18 years) and participated in three cycles (2007-2009, 2010-2012, and 2013-2015) of the Korea National Health and Nutrition Examination Survey (KNHANES) for the analysis of self-reported sleep duration pattern. A total of 51,545 adults (21,937 men and 29,608 women) were included.Results: Sleep duration decreased among both men and women from 2007 to 2009 KNHANES to 2013-2015 KNHANES. Sleep duration differed by age group and sex. Moreover, sleep duration declined among middle-aged (30-49 years old) and older (50-64 years old) men and young (18-29 years old) and middle-aged (30-49 years old) women, although not among older and elderly women.Conclusions: The young and middle-aged adult groups (18-49 years old) showed a significant decline in sleep duration in the KNHANES 2007-2015. [ABSTRACT FROM AUTHOR]

Several studies have reported an increased prevalence of depressive symptoms during the coronavirus disease 2019 (COVID-19) pandemic. However, the prevalence of significant depressive symptoms and its associated factors in younger adults remain uncertain. We aimed to investigate this association during the COVID-19 pandemic and make a comparison with the pre-pandemic period. Cross-sectional data from the 2018 and 2020 Korea National Health and Nutrition Examination Surveys were analyzed, and 3281 respondents aged 19–40 years were included. We defined a Patient Health Questionnaire-9 score ≥ 10 as significant depressive symptoms and the categories of depressive symptoms were also classified as none, mild, moderate, and severe. The prevalence of significant depressive symptoms was higher in the pandemic group (7.4% vs. 4.7%). Furthermore, the prevalence in the pandemic group was higher for all degrees: mild, moderate, and severe depressive symptoms. A multivariable logistic regression indicated that significant depressive symptoms during the pandemic was significantly associated with female sex, low educational attainment, unemployment, chronic medical disease, and being overweight. Our findings suggest an increase in depressive symptoms in younger adults during the pandemic. It is necessary to develop policies to provide younger adults with resources to cope with depressive symptoms related to COVID-19 and potential global outbreak of infectious disease. • Depressive symptoms were more prevalent during the COVID-19 pandemic than before. • Moderate and severe depressive symptoms were more prominent during the pandemic. • Female sex was associated with significant depressive symptoms in the pandemic. • Low education and unemployment were linked to depressive symptoms in the pandemic. • Medical comorbidities and being overweight were also linked to depressive symptoms. [ABSTRACT FROM AUTHOR]

Background Context: There is increasing evidence supporting an association between sitting time and low back pain (LBP). However, the degree of the association between the total daily sitting time and LBP in the general population is poorly understood.Purpose: The present study aimed (1) to analyze the association between the duration of sitting time and LBP, and (2) to examine this association according to the degree of physical activity in population over 50 years of age with a nationally representative sample of Korean adults.Study Design: This is a cross-sectional study.Patient Sample: Data from version VI-2, 3 of the Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2014 and 2015 were analyzed.Outcome Measures: Multiple logistic regression was performed to find the rates of association between chronic LBP, level of sitting time, and physical activity.Methods: Nationwide health surveys and examinations were conducted in general Korean representative populations (n=7,550 in 2014, n=7,380 in 2015). Chronic LBP was defined as self-reported LBP lasting for more than 30 days during the past 3 months in a health survey. Sitting time and daily physical activity were evaluated using the long version of the International Physical Activity Questionnaires (IPAQ). The duration of sitting time was divided into two categories according to the median value (7 hours) and further divided into four categories using quartiles. Physical activity was also divided into low and high physical activity according to duration of mid- to high-intensity activities. There were no sources of funding and no conflicts of interest associated with the present study.Results: On multiple logistic regression analysis, sitting time more than 7 hours/day was significantly associated with LBP (adjusted odds ratio 1.33, p<.001). The risk of LBP increased with increasing duration of sitting time. In participants with low levels of physical activity, the duration of sitting time showed more positive association with LBP than that in all the participants and participants with high levels of physical activity.Conclusions: Longer duration of sitting time is a risk factor for LBP. Furthermore, long duration of sitting time with low physical activity further increases the risk of LBP. [ABSTRACT FROM AUTHOR]

Abstract: Background: Dietary carbohydrate quality may play an important role in disease development. We evaluated the association between carbohydrate quality index (CQI) and the prevalence of obesity and metabolic disorders among adults in South Korea. Methods: We analysed 12 027 adults aged 19–64 years from the fifth Korea National Health and Nutrition Examination Survey (KNHANES). CQI was based on four criteria: crude fibre intake, dietary glycaemic index (DGI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Results: Participants with a lower CQI were younger, had a lower income and were more likely to be smokers and to drink alcohol. The highest quintile CQI group showed the lowest DGI and the lowest consumption of liquid carbohydrates and refined grains, as well as the highest consumption of solid carbohydrates, crude fibre and whole grains (P < 0.05). A higher CQI was negatively associated with the prevalence of obesity (odds ratio = 0.83; 95% confidence interval = 0.69–0.99) and hypertension (odds ratio = 0.78; 95% confidence interval = 0.61–0.99) but was not associated with other metabolic disorders. Conclusions: These results suggest that the quality of carbohydrates consumed is associated with the risk of obesity and hypertension. However, the cross‐sectional design does not preclude reverse causality. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the association between age at asthma diagnosis and tooth loss due to caries using data obtained from the Korean National Health and Nutrition Examination Survey.Materials and Methods: A complex sample multivariable linear regression was used, and the results were analysed. Age at diagnosis and the number of teeth lost were set as independent and dependent variables, respectively. Among the total 65,973 subjects, 10,056 aged <12 years and 11,714 with missing values in dependent and independent variables were excluded. Asthmatic subjects were divided into the following age groups based on the age at diagnosis: 0-6 years, 7-12 years, 13-18 years, 19-28 years, and 29-64 years. In each analysis, the calibration was performed by adding covariates to each model.Results: Compared with the no asthma group (β = 0), the values of β in asthmatic subjects belonging to the age groups 0-6 years (β = 0.794, 0.521, 0.560) and 7-12 years (β = 0.527, 0.407, 0.437) were high in all models.Conclusions: Our findings revealed significant increase in tooth loss due to caries after early asthma diagnosis at 0-6 years (β = 0.560, p < .001) and 7-12 years (β = 0.437, p < .001). Clinicians need to shift their perception of dental risks in young asthmatic patients and provide active oral health care to them. [ABSTRACT FROM AUTHOR]

Hyperuricemia is not only a risk factor for gout but also an independent determinant of hypertension, diabetes, and chronic kidney diseases. Although the incidence of gout in Korean adults is increasing, epidemiologic studies on hyperuricemia in the general Korean population are limited. Thus, this study aimed at evaluating the prevalence of hyperuricemia and its associated factors among non-institutionalized Korean adults. The present study included 5548 participants (2403 men and 3145 women) aged ≥ 19 years from The Korea National Health and Nutrition Examination Survey. Based on the new 2016 census data, the age-standardized prevalence and mean uric acid level were calculated using the chi-square test and t test, respectively. A multivariate logistic regression analysis was performed to evaluate the risk factors associated with hyperuricemia. The age-standardized prevalence of hyperuricemia and mean uric acid level in the general Korean population was 11.4% (17.0% in men and 5.9% in women) and 5.1 mg/dL (5.83 mg/dL in men and 4.36 mg/dL in women), respectively. The prevalence of hyperuricemia was high in young Korean adults, and a U-shaped association was observed between hyperuricemia and age. While obesity, metabolic syndrome, renal impairment, and low-grade inflammation were positively associated with hyperuricemia in both sexes, alcohol consumption, education, and current smoking status had a positive association with hyperuricemia only in women. Hyperuricemia is prevalent in the young population in Korea, and special efforts are necessary to reduce the potential harmful effects of hyperuricemia on the health of adults, particularly the younger-generation adults, in Korea. [ABSTRACT FROM AUTHOR]

Background and Objectives: We conducted this cross-sectional study to identify the association between coffee consumption and risk of metabolic syndrome (MetS) in the Korean population.Methods and Study Design: Subjects aged 30-79 years in the Fifth Korea National Health and Nutrition Examination Survey conducted in 2010 and 2011 were included (n=8,246). The self-reported frequency of coffee consumption was classified as non-drinker, <1, 1, 2, and >=3 cups/day.Results: The MetS prevalence was 33.6% in men (n=1,149) and 26.1% in women (n=1,388). Among women, the level of coffee consumption was inversely associated with MetS and each component (p for trend 0.002 for abdominal obesity and <0.001 for others). The dose-response inverse association remained significant between coffee consumption and MetS, high triglyceride, and low high-density lipoprotein cholesterol (p for trend 0.001, 0.009, and <0.001, respectively; adjusted for age and body mass index). Compared with women who did not consume coffee, the adjusted odds ratio (OR) for MetS was 0.57 (95% CI, 0.38- 0.86) for women who consumed >=3 cups per day (p for trend 0.002). Among women, excluding those receiving medical treatments for hypertension, diabetes, and dyslipidemia, a significantly lower OR for MetS (0.53, 95% CI 0.31-0.93) was observed with coffee consumption >=3 cups, and the dose-response inverse association remained significant (p for trend 0.008). In men, there were no significant associations between coffee consumption and MetS.Conclusion: In conclusion, coffee consumption is associated with a lower risk of MetS among Korean women. There was a dose-response inverse relationship between coffee consumption and the prevalence of MetS in Korean women. [ABSTRACT FROM AUTHOR]

Background There has been a consistent decrease in age at menarche in South Korea. A potential risk factor for early menarche is exposure to particulate matter (PM), because endocrine-disrupting compounds emitted into air from anthropogenic sources may be incorporated into PM. The objective of this study was to examine the association between pre-menarcheal exposure to PM ≤ 10 μm in diameter (PM 10 ) and age at menarche in adolescents of South Korea using Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012 data. Methods We used self-reported age at menarche of 639 girls aged 13–17 years in this study. The cut-off age for early menarche was set to 12 years. Based on each subject's address, 1-year, 2-year, and 3-year averages of annual mean PM 10 concentrations (models 1–3) were linked to KNHANES. Models were adjusted for body mass index (BMI), city size, household income level, maternal age at menarche, and second-hand smoke exposure at home. SURVEYREG and SURVEYLOGISTIC procedures were used to address the complex survey design of KNHANES. Results Overall analysis showed that exposure to PM 10 has a significant effect on decreasing age at menarche. Multiple linear regression results suggested that each 1 μg/m 3 increase in 1-year, 2-year, 3-year averages of annual mean PM 10 concentrations accelerated age at menarche by 0.046 years (95% CI: −0.064, −0.027; p  < .0001), 0.038 years (95% CI: −0.059, −0.018; p  = 0.0003),and 0.031 years (95% CI: −0.047, −0.015; p  = 0.0002), respectively. Adjusted ORs for a 1 μg/m 3 increase in PM 10 concentration were 1.08 (95% CI: 1.04 −1.12) for model 1, 1.06 (95% CI: 1.02 −1.10) for model 2, and 1.05 (95% CI: 1.01 −1.09) for model 3. Conclusion Our findings suggest that elevated PM 10 concentration can decrease age at menarche. This is the first study that investigates the association between exposure to PM 10 and age at menarche using a nationally representative sample of Koreans. [ABSTRACT FROM AUTHOR]

Objectives: Decreased muscle mass is known to be associated with several serious medical conditions. We analyzed the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V, 2010-2011) to estimate the heritability of muscle mass in Korean parent-offspring pairs.Study Design: Cross-sectional.Main Outcome Measures: A total of 1233 parents (average age 57.67 ± 8.50 years) and 917 offspring (average age 29.10 ± 7.57 years) from 743 families were included in the analysis. Muscle mass was estimated based on three different indices: appendicular skeletal muscle mass (ASM) measured with a dual-energy X-ray absorptiometry (DXA), weight-adjusted ASM (SMI), and height-adjusted ASM (RASM). The heritability was estimated by employing the maximum-likelihood variance components implemented in Sequential Oligogenic Linkage Analysis Routines (SOLAR). The best-fitting model was determined out of four polygenic models. Pearson's partial correlation coefficient was also calculated using the muscle mass indices to further study the association between father or mother and son or daughter pairs.Results: The heritability estimates of the muscle mass indices ranged from 55% to 80% (all p < 0.01). The correlation coefficient of father and offspring ranged from 0.11 to 0.40, while that of mother and offspring ranged from 0.23 to 0.43 (all p < 0.01).Conclusions: The heritability estimates of muscle mass in Koreans are large and significant, suggesting that parental muscle mass is an important predictor of the offspring's muscle mass. The result implies that there may be a genetic factor partly determining muscle mass. [ABSTRACT FROM AUTHOR]

Purpose: Dietary total antioxidant capacity (TAC) has been reported to be inversely associated with the risk of chronic diseases. However, little is known about dietary TAC among the Korean population. Therefore, we aimed to estimate the dietary TAC of Korean adults and to document the major food sources.Methods: We studied 33,581 Korean adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey 2007-2012. Dietary TAC was estimated from 1-day 24-h dietary recall data using a TAC database comprising antioxidant capacities of 42 dietary antioxidants, developed for common Korean foods.Results: The average dietary TAC of Korean adults was 384.7 mg VCE/d, and the major contributors were flavonoids, followed by vitamin C and E. The energy-adjusted daily TAC level was higher in women, middle-aged adults, non-regular alcohol consumers, current non-smokers, supplement users, and in those with a higher income and education level than in their counterparts (P < 0.001). Fruits (47.3%), vegetables (28.4%), beverages and alcohols (11.2%), and legumes and legume products (5.5%), in particular, grapes, persimmons, mandarins, apples, and green tea, were major food sources of dietary TAC. In addition, the consumption of nutrient-dense foods, such as fruits and vegetables, increased, whereas the intake of energy and fat decreased across quartiles of energy-adjusted dietary TAC.Conclusions: The present study documented the baseline dietary TAC of Korean adults and the major food sources thereof using nationally representative data. Further research on the health effects of dietary TAC among Korean adults is warranted. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study analyzed the intake of fruits and vegetables by cooking location and daily meals for Korean children and adolescents.Methods and Study Design: For this study, 2,538 Korean children and adolescents aged 7-18 years, who participated in the 2010 and 2011 Korea National Health and Nutrition Examination Survey dietary intake survey (24-hour recall methods), were sampled.Results: The total unsalted fruit and vegetable intake for all subjects was 300 g (aged 7-12 years, 280 g; aged 13-18 years, 316 g). Regarding meal serving location, the combined unsalted fruit and vegetable intake was 159 g at home, 206 g at commercial locations, and 104 g at institutions. The combined unsalted fruit and vegetable intake in snack form was 128 g, which was higher than that during daily meals. In total, 24.9% of subjects satisfied the recommended fruit and vegetable intake (>=400 g), according to the guidelines created by the World Health Organization/World Cancer Research Fund. Logistic regression analysis results revealed that the fruit and vegetable intake of girls was 1.4 times higher than that of boys, and the number of people who ate more than 400 g of fruits and vegetables was 1.7 times higher in the group with higher education.Conclusions: Based on the above results, in-depth measures to continuously increase intake of fruits and vegetables in children and adolescents are needed. This study can be used as basic data for the development of educational programs for dietary improvements. [ABSTRACT FROM AUTHOR]