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Background: The age‐standardised incidence ratio of gastrointestinal cancers in type 1 diabetes (T1D) patients has been reported to be higher than that in the general population. After adjusting for shared risk factors, we aimed to explore the association between T1D and gastrointestinal cancer and examine how this relationship varies by age and sex. Materials and Methods: This retrospective cohort study included 268,179 participants from the Korean National Health Insurance Service‐National Sample Cohort. The primary outcome is the incident of gastrointestinal cancers, based on diagnostic codes. Multivariate Cox regression analyses were performed to assess the association between T1D and gastrointestinal cancers. Results: Of the 268,179 participants, 2681 had T1D at baseline and were followed for 12.98 (± 2.92) years. Compared with non‐T1D, T1D patients had a significantly increased risk of all gastrointestinal cancer (adjusted hazard ratio [aHR]: 1.403, 95% confidence interval [CI]: 1.253–1.573). T1D patients increased risks of oesophageal cancer (aHR: 1.864, 95% CI: 1.038–3.349), gastric cancer (aHR: 1.313, 95% CI: 1.066–1.616), colon cancer (aHR: 1.365, 95% CI: 1.110–1.678), liver cancer (aHR: 1.388, 95% CI: 1.115–1.727), and pancreatic cancer (aHR: 1.716, 95% CI: 1.182–2.492). The consistency of this association persisted among both male and female, with its strength increasing with older age. Conclusions: The risk of gastrointestinal cancer was significantly increased in T1D patients. Older male T1D patients exhibit a higher risk, suggesting the need for targeted attention in their care. [ABSTRACT FROM AUTHOR]

Background and Aim: Decreased kidney function is a putative risk factor for various cancers. However, few studies have investigated the association between a decreased estimated glomerular filtration rate (eGFR) and incident pancreatic cancer. We aimed to investigate the risk of incident pancreatic cancer according to eGFR categories. Methods: In this retrospective cohort study, we included 359 721 adults who underwent health checkups in 2009 or 2010 by using the Korean National Health Insurance Database. The study population was categorized into four groups by eGFR (mL/min/1.73 m2) using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR < 45), group 2 (eGFR ≥ 45 to < 60), group 3 (eGFR ≥ 60 to < 90), and group 4 (eGFR ≥ 90). Multivariate Cox proportional hazards models were used to determine the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of pancreatic cancer until 2019 by comparing the eGFR groups. Results: During the 3 493 589.05 person‐years of follow‐up, 1702 pancreatic cancer cases were identified. Compared with group 4 (eGFR ≥ 90), HRs and 95% CIs for the incidence of pancreatic cancer were 1.39 (1.24–1.56) for group 3 (eGFR ≥ 60 to < 90), 1.79 (1.47–2.16) for group 2 (eGFR ≥ 45 to < 60), and 2.05 (1.62–2.60) for group 1 (eGFR < 45) in the multivariate adjusted model. Conclusions: Decreased eGFR was significantly associated with an increased risk of pancreatic cancer in Korean population. Further studies are needed to investigate the relationship between a decreased eGFR and the risk of pancreatic cancer in other ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Smoking is a definite risk factor for macrovascular complications in diabetes mellitus (DM). However, the effect of smoking on microvascular complications is inconclusive. Method: Study participants were 26,673 diabetic men who received health check‐up both in 2003–2004 and 2009, excluding women. Assessing smoking status (never, quitting and current) at 2003–2004 and 2009, changes in smoking status were categorised into 7 groups (never ‐ never, never ‐ quitting, never ‐ current, quitting—quitting, quitting—current, current—quitting and current—current). Smoking amount was categorised into never, light (0–10 pack years), moderate (10–20 pack years), and heavy smoking (>20 pack years) based on 2009 data. They were followed‐up until 2013 to identify incident microvascular complications. We calculated the adjusted hazard ratios (HR) and 95% confidence interval (CI) (adjusted HR [95% CI]) for incident microvascular complications according to changes in smoking status and smoking amount. Results: Current‐quitting (1.271 [1.050–1.538]), current‐current (1.243 [1.070–1.444]) and heavy smoking (1.238 [1.078–1.422]) were associated with an increased risk of overall microvascular complications. The risk of nephropathy increased in current‐current smoking (1.429 [1.098–1.860]) and heavy smoking (1.357 [1.061–1.734]). An increased risk of neuropathy was observed in current‐quitting smoking (1.360 [1.076–1.719]), current‐current smoking (1.237 [1.025–1.492]) and heavy smoking (1.246 [1.048–1.481]). However, we couldn't see the interpretable findings for the association between smoking and retinopathy. Conclusions: Lasting and heavy smoking increases the risk of microvascular complications, including nephropathy and neuropathy. Quitting smoking and reducing smoking amount are imperative in preventing microvascular complications in DM patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Smoking is associated with the increased risk of gastroduodenal ulcer. However, although smoking status can vary over time, most of studies have analyzed this association with smoking status at a single point of time. We analyzed the risk of gastroduodenal ulcer according to change in smoking status for more than 5 years. Methods: Study participants were 43 380 Korean adults free of gastroduodenal ulcer who received health check‐up between 2002 and 2013. Through evaluating their smoking status (never, quitter, and current) at 2003–2004 and 2009, they were categorized them into seven groups (never‐never, never‐quitter, never‐current, quitter‐quitter, quitter‐current, current‐quitter, and current‐current) and monitored until 2013 to identify incident gastroduodenal ulcer. Cox‐proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% confidence interval (CI) for incident gastroduodenal ulcer according to changes in smoking status and smoking amount. Results: Compared with never‐never group (reference), other groups had the significantly increased adjusted HRs and 95% CI for gastroduodenal ulcer. In particular, participants with current smoking (never‐current, quitter‐current, and current‐current) had the relatively higher HRs than other groups (never‐quitter: 1.200 [1.070–1.346], never‐current: 1.375 [1.156–1.636], quitter‐quitter: 1.149 [1.010–1.306], quitter‐current: 1.325 [1.058–1.660], current‐quitter: 1.344 [1.188–1.519], and current‐current: 1.379 [1.256–1.513]). Heavy smoker had the highest risk for gastroduodenal ulcer, followed by moderate and light smoker. Conclusion: People who ever experienced smoking had increased risk of gastroduodenal ulcer. Out of smoking status, current smoking is more associated with the increased risk of gastroduodenal ulcer than past smoking. [ABSTRACT FROM AUTHOR]

There are reports that nut consumption provides potential benefit for gastric pathologies including stomach cancer and Helicobacter pylori infection. However, there are no studies investigating the effect of nut consumption on gastric intestinal metaplasia (GIM). In a Korean cohort of 53 424 men (average age 38.7 ± 7.0 years) and 33 024 women (average age 38.0 ± 7.0 years), we analysed the risk of GIM according to the frequency of nut consumption (peanuts, pine nuts and almonds only) as the following: rare (<1 serving/month), ≤1 serving/month and <1 serving/week, ≤1 serving/week and <3 serving/week, ≤3 serving/week and <5 serving/week and ≥5 serving/week where one serving is 15 g. Cox proportional hazards model was used to calculate the multivariable‐adjusted hazard ratio (HR) for GIM and their 95% confidence intervals (CI) in each group (adjusted HR [95% CI]). Subgroup analysis was conducted by body mass index (BMI, non‐obesity <25 and obesity ≥25). The models were adjusted for age, regular exercise, BMI, smoking, alcohol intake (g/day), diabetes mellitus, hypertension, dietary fibre intake, sodium intake and total calorie intake. After 5.3 years (median 5.9 years) of follow‐up, GIM was observed in 5073 subjects. In men, compared with rare nuts consumption, greater nuts consumption was associated with a lower risk of GIM (rare consumption: reference, 1/month–1/week: 0.85 [0.79–0.91], 1–3/week: 0.81 [0.72–0.91], 3–5/week: 0.70 [0.57–0.86] and ≥5/week: 0.59 [0.48–0.73]). Subgroup analysis indicated that the inverse relationship between nuts consumption and the risk of GIM is more distinct in men without obesity (rare consumption: reference, 1/month–1/week: 0.83 [0.76–0.91], 1–3/week: 0.78 [0.67–0.91], 3–5/week: 0.68 [0.51–0.89] and ≥5/week: 0.51 [0.37–0.69]). However, this association was not observed in women. In conclusion, increased nuts consumption was associated with a decreased risk of GIM in working aged Korean men. [ABSTRACT FROM AUTHOR]

Background and Aim: Cholelithiasis is one of the most common gastrointestinal diseases worldwide. The metabolic syndrome (MetS), a combination of various metabolic abnormalities, is also common with a continually increasing prevalence. These diseases are associated with several risk factors. However, data on the association between MetS components and cholelithiasis are insufficient. This study aimed to analyze the association of MetS and its components with the incidence of cholelithiasis using national data from the Korean population. Methods: Data were obtained from the National Health Insurance Corporation of Korea, and 207 850 individuals without cholelithiasis in 2009 were enrolled and followed up until 2013. A multivariate Cox proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of cholelithiasis according to the presence of MetS and the number of MetS components. Furthermore, the risk of cholelithiasis was evaluated in individuals with a single metabolic component. Results: The multivariate adjusted HRs and 95% CIs for incident cholelithiasis according to 1, 2, 3, and 4–5 MetS components were 1.08 (0.93–1.24), 1.22 (1.06–1.41), 1.35 (1.17–1.57), and 1.35 (1.15–1.57), respectively (P < 0.001). This increasing trend was observed in both sexes. Compared with participants with no metabolic components, those with low high‐density lipoprotein (HDL) cholesterol had a significantly increased risk for cholelithiasis (adjusted HR, 1.39 [95% CI, 1.05–1.85]). Conclusions: Metabolic syndrome is a potential risk factor for cholelithiasis. Low HDL cholesterol level is the most relevant factor among MetS components for incident cholelithiasis. [ABSTRACT FROM AUTHOR]

Studies have indicated that increased body fat is associated with cardiovascular risk factors including hypertension. However, there is only limited information about the influence of body fat percentage (BF%) on incident hypertension. In a cohort of Korean genome epidemiology study (KoGES), 4864 non-hypertensive participants were divided into 5 quintile groups, and followed-up for 10 years to monitor incident hypertension. Cox proportional hazard model was used to evaluate the hazard ratio (HRs) and 95% confidence interval (CI) for hypertension (adjusted HRs [95% CI]) according to BF% quintile groups. Subgroup analysis was conducted by low or high level of BF% (cutoff: 22.5% in men and 32.5% in women) and low or high level of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). In adjusted model, compared with BF% quintile 1, the risk of incident hypertension significantly increased over BF% quintile 3 (BF% ≥19.9%) in men (quintile 3:1.42 [1.10-1.85], quintile 4:1.58 [1.22-2.05], quintile 5:1.82 [1.40-2.36]), and quintile 4 (BF% ≥32.5%) in women (quintile 4:1.48 [1.12-1.94], quintile 5:1.56 [1.20-2.04]). Subgroup analysis showed that individuals with high BF% were significantly associated with the increased risk of hypertension even in individuals with low BMI, WC, and WHR. The risk of hypertension increased proportionally to BF% over the specific level of BF% in Koreans. Even in non-obese individuals, increase in BF% was significantly associated with the increased risk of hypertension. [ABSTRACT FROM AUTHOR]

Background: Components of the metabolic syndrome (MetS), such as elevated fasting glucose levels and abdominal obesity, have been suggested as potential risk factors for pancreatic cancer. However, data are still insufficient to assure the influence of MetS on incident pancreatic cancer. The objective of the current study was to investigate the association between MetS, metabolic components, and the risk of pancreatic cancer. Methods: In the Korea National Health Information Database, 223,138 individuals who were without pancreatic cancer in 2009 were enrolled and followed until 2013. They were categorized into 4 groups according to the number of baseline metabolic components (0, 1, 2, 3, and 4‐5). A multivariate Cox proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% CIs for incident pancreatic cancer according to the presence of MetS and the number of metabolic components. In addition, the risk of pancreatic cancer was evaluated in individuals who had a single metabolic component. Results: The presence of MetS was significantly associated with incident pancreatic cancer (adjusted HR, 1.47; 95% CI, 1.19‐1.81). The group with 4 or 5 baseline metabolic components had a higher risk of pancreatic cancer than the other groups (0 components: reference category; 1 component: adjusted HR, 0.94 [95% CI, 0.61‐1.45]; 2 components: adjusted HR, 1.03 [95% CI, 0.68‐1.56]; 3 components: adjusted HR, 1.35 [95% CI, 0.89‐2.04]; 4‐5 components: adjusted HR, 1.64 [95% CI, 1.06‐2.51]). Regarding associations between the individual metabolic components and pancreatic cancer, no metabolic component alone had a statistically significant association with pancreatic cancer. Conclusions: MetS is a potential risk factor for pancreatic cancer. The presence of ≥4 metabolic components leads to a higher risk of pancreatic cancer even within categories of the MetS. The metabolic syndrome (MetS) is a potential risk factor for incident pancreatic cancer. The presence of abnormalities in more components of the MetS leads to a higher risk of pancreatic cancer even within categories of the MetS. [ABSTRACT FROM AUTHOR]

Aim Previous studies showed that non-alcoholic fatty liver disease (NALFD) could be related to subclinical left ventricular (LV) diastolic dysfunction and remodeling. However, this association is still equivocal in the general population. Thus, this study was carried out to examine whether NAFLD is associated with the risk for LV diastolic dysfunction and remodeling. Methods A cross-sectional study was carried out for 20 821 Korean men and women who received a health checkup including echocardiography from 2011 to 2012. The study population was divided into three groups of normal, mild and moderate-to-severe NAFLD detected by ultrasonography. Using multivariable logistic regression analysis, the odd ratios of abnormal LV relaxation and remodeling were analyzed according to the degree of NAFLD. Additionally, adjusted mean values of LV diastolic functional and structural parameters were evaluated in the three groups. Results Compared with the normal group, the mild and moderate-to-severe NAFLD groups had higher odd ratios for abnormal LV relaxation (mild group 1.29, 95% confidence interval 1.15-1.46; moderate-to-severe group 1.95, 95% confidence interval 1.61-2.35) and increased relative wall thickness (>0.42; mild group 1.26, 95% confidence interval 1.05-1.52; moderate-to-severe group 1.46, 95% confidence interval 1.08-1.95). Analyzing adjusted mean values of LV parameters also showed the significant association between the degree of NAFLD and impaired LV diastolic function and concentric LV remodeling. Conclusions The risk for LV diastolic dysfunction and remodeling proportionally increased according to the degree of NAFLD. NAFLD is significantly associated with LV functional and structural alteration. [ABSTRACT FROM AUTHOR]

Objective Although serum apolipoprotein measurement is known to be associated with coronary heart disease (CHD) risk, there is only limited information about the clinical significance of lipid profiles such as ApoA, ApoB and A/B ratio in predicting CHD risk in Asians. Therefore, this cohort study was conducted to evaluate the longitudinal effects of baseline serum apolipoprotein measurements on CHD risk in Korean men. Design Initially, an intermediate and high Framingham risk score (FRS)-free cohort of 23 918 healthy Korean men was followed until 2010. FRS was calculated for each man and divided into three levels of risk <10% (low), 10-19% (intermediate) and ≥20% (high). More-than-a-moderate CHD risk group (participants with FRS ≥ 10%) and high CHD risk group (participants with FRS ≥ 20%) were defined as our two dependent variables. Cox proportional hazards models were performed. Results In the more-than-a-moderate CHD risk group, the total and average follow-up periods were 83340.2 and 3.48 personyears, respectively, and 3763 (15.7%) incident cases developed between 2006 and 2010. In the high CHD risk group, the total and average follow-up periods were 87868.8 and 3.67 personyears, respectively, and 344 (1.4%) incident cases developed between 2006 and 2010. Multivariate-adjusted analyses showed a strong statistically significant relationship between the quintile groups of apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1) and apolipoprotein B/apolipoprotein A-1 (ApoB/A-1) ratio and both the more-than-a-moderate CHD risk and high CHD risk. Conclusions Serum ApoB, ApoA-1 and ApoB/A-1 ratio levels are independently associated with CHD risk in Korean men. [ABSTRACT FROM AUTHOR]

Background and Aim Non-alcoholic fatty liver disease ( NAFLD) is getting an increasing attention for its clinical implications on cardiovascular disease ( CVD). However, epidemiologic data are not so evident to sustain the causative association between NAFLD and hypertension, the major cause of CVD. Accordingly, we designed this study to investigate the clinical association between NAFLD and the development of hypertension. Methods To assess the natural course of blood pressure according to degree of NAFLD (normal, mild, and moderate to severe), we conducted a prospective cohort study on the 22 090 Korean men without hypertension for 5 years. We serially checked the various metabolic factors including systolic and diastolic blood pressure in order to monitor the development of hypertension. Results The incidence rate of hypertension increased according to the degree of NAFLD (normal: 14.4%, mild: 21.8%, moderate to severe: 30.1%, P < 0.001). Even after adjusting for other multiple covariates, the hazard ratios (95% confidence intervals) for hypertension were higher in the mild group (1.07; 1.00-1.15) and moderate to severe group (1.14; 1.00-1.30), compared with normal group, respectively ( P for trend < 0.001). Conclusion Development of hypertension is more potentially associated with the more progressive NAFLD than normal or milder state. In addition, NAFLD was an independent risk factor for hypertension. [ABSTRACT FROM AUTHOR]

Background Elevated serum uric acid (UA) could be a risk factor for hypertension, type 2 diabetes mellitus and cardiovascular disease. In addition, elevated serum UA may be associated with impaired renal function. However, it is unclear whether elevated serum UA is a cause of microalbuminuria or not. Therefore, we performed a prospective cohort study of the temporal relationship between baseline elevated serum UA and the development of microalbuminuria in Korean men. Design and methods A microalbuminuria-free cohort of 1743 healthy Korean men, who had their urine albumin-creatinine ratio (UACR) calculated for a medical check-up programme in 2005, was followed until 2010. Microalbuminuria was defined as a urine albumin-creatinine ratio between 30 and 300 μg/mg. Cox proportional hazards model was performed. Results During 5884·6 person-years of follow-up, 96 incident cases of microalbuminuria developed between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence intervals) for incident microalbuminuria when comparing the second tertile to the third tertile of serum UA levels vs. the first tertile were 1·52 (0·86-2·70) and 2·27 (1·30-3·98), respectively ( P for trend = 0.005). Conclusion Elevated serum UA level was independent risk factor for the development of microalbuminuria during a 5-year follow-up in Korean men. [ABSTRACT FROM AUTHOR]

Background and objective Elevated serum ferritin levels have been reported to be associated with several metabolic disorders. We investigated the relationship between serum ferritin level and metabolic syndrome and its components in healthy Korean men. Methods In this cross-sectional study, serum ferritin level and metabolic syndrome and its components were measured from 18 581 men from January to December in 2008. The presence of metabolic syndrome was determined according to the most recent consensus report of the National Cholesterol Education Program's Third Adult Treatment Panel. Logistic regression models were applied to examine the relationship between the serum ferritin level and the metabolic syndrome and its components. Results After adjusting for clinical covariates, the odds ratio and 95% confidence intervals of metabolic syndrome with respect to Q2, Q3 and Q4 were 1.34 (1.14-1.57), 1.49 (1.24-1.70) and 1.99 (1.70-2.33), respectively ( p for trend < 0.001). The multivariable-adjusted model also showed a significantly graded relationship between individual components of metabolic syndrome and the quartile groups of serum ferritin. Conclusions In this study, elevated ferritin concentration is independently associated with metabolic syndrome and its components among healthy Korean men. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]