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Background/objectives: The aim of this study was to estimate average total fat and fatty acid intakes as well as identify major food sources using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-1 (2013)., Subjects/methods: Total fat and fatty acid intakes were estimated using 24-hour dietary recall data on 7,048 participants aged ≥ 3 years from the KNHANES VI-1 (2013). Data included total fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) levels. Population means and standard errors of the mean were weighted in order to produce national estimates and separated based on sex, age, income, as well as residential region. Major food sources of fat, SFA, MUFA, PUFA, n-3 FA, and n-6 FA were identified based on mean consumption amounts of fat and fatty acids in each food., Results: The mean intake of total fat was 48.0 g while mean intakes of SFA, MUFA, PUFA, n-3 FA, and n-6 FA were 14.4 g, 15.3 g, 11.6 g, 1.6 g, and 10.1 g, respectively. Intakes of MUFA and SFA were each higher than that of PUFA in all age groups. Pork was the major source of total fat, SFA, and MUFA, and soybean oil was the major source of PUFA. Milk and pork were major sources of SFA in subjects aged 3-11 years and ≥ 12 years, respectively. Perilla seed oil and soybean oil were main sources of n-3 FA in subjects aged ≥ 50 years and aged < 50 years, respectively., Conclusions: Estimation of mean fatty acid intakes of this study using nationally represented samples of the Korean population could be useful for developing and evaluating national nutritional policies.

Objectives: The prevalence of aged individuals in the Korean workforce continues to increase. This research determined the health and working conditions of Korean older wage workers and confirmed the effects of factors on the health-related quality of life of Korean older workers., Methods: Of the 25,534 persons surveyed in the fifth Korea National Health and Nutrition Examination Survey, 1368 older (>55 years of age) wage workers without missing variables were selected. Their general characteristics, health status (cardiovascular disease, musculoskeletal disease, and mental health), working conditions (type of occupation, employment status, full- or part-time work, weekly average working hours, and shift work), and health-related quality of life assessed by the EQ-5D questionnaire were examined., Results: The mean values of the EQ-5D index of the male and female older workers were 0.956 ± 0.087 and 0.917 ± 0.124, respectively (p < 0.001). The factors that caused statistically significant differences in the EQ-5D index for all subjects were age, education, household income, cerebro-cardiovascular event, osteoarthritis, musculoskeletal pain, stress, occupation type, employment status, and working hours. In logistic regression analysis, the factors that associated with perceived problems in each EQ-5D dimensions were age, musculoskeletal pain, stress, diabetes, smoking, occupation type, employment status, and working hours., Conclusions: To eventually raise the quality of life of older workers through health maintenance and management, it is necessary to manage related factors that include of musculoskeletal pain and diseases, stress, diabetes, smoking, occupation, employment status, and working hours.

Aim: To evaluate the association of hypertension and high systolic and diastolic blood pressure (SBP and DBP) with periodontitis in a nationally representative Korean adult population., Materials and Methods: Total of 14,625 participants of Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) aged over 19 years were cross-sectionally surveyed. Periodontitis was defined as CPI score of 3 or 4. Hypertension was categorized as: normotensive (SBP < 120 mmHg and DBP < 80 mmHg), pre-hypertensive (120 < SBP < 140 mmHg or 80 < DBP < 90 mmHg) and hypertensive (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or taking antihypertensive medication). Multivariate Poisson regression analyses were performed controlling for age, sex, household income, drinking, smoking, physical activity, obesity, hypercholesterolaemia and diabetes mellitus. Stratified analyses were performed to identify specific risk groups., Results: Hypertension showed a significant positive association with periodontitis in the fully adjusted model in female adults with a dose-response relationship. This association was highlighted in females aged 30-59 years (prevalence ratio = 1.25; 95% confidence interval: 1.11-1.40). The strength of the association was highest in females aged 30-39 years and decreased with increasing age. Among females aged 30-59 years, high-risk groups of this link were lower middle income quartile, never drinker and non-diabetes groups for both pre-hypertension and hypertension., Conclusion: Our data showed that hypertension was associated with periodontitis in Korean female adults independent of known confounders., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background/objectives: Women's bone health status is closely related with environmental factors and lifestyle factors. The purpose of this study is to evaluate the dietary risks of osteoporosis and osteopenia for Korean postmenopausal women., Subjects/methods: The data from 1,433 subjects from the 2010 KNHANES were used and divided into three groups: normal, osteopenia, and osteoporosis group using bone mineral density (BMD). Nutrient intakes and food intake frequency were evaluated. Logistic regression analysis was applied to determine the odds ratios for osteoporosis and osteopenia., Results: The RNI percentage of each nutrient and food intake frequency from 12 food groups decreased as bone mineral density status deteriorated. Risk for osteoporosis of low calcium (Ca) intake, under the EAR, showed an odds ratio of 2.13(95% CI; 1.26-3.61, P < 0.05). Higher intake frequency showed preventive effect from osteoporosis compared to lower intake frequency in such food group as dairy products (ORs 0.40, CI 0.21-0.75), beans (ORs 0.49, CI 0.29-0.83), seaweeds (ORs 0.55, CI 0.32-0.94), fish (ORs 0.56, CI 0.32-0.98), and fruits (ORs 0.42, CI 0.23-0.79) after adjusting for age., Conclusion: To prevent osteoporosis in later life, sufficient Ca intake and more frequent intakes of foods containing Ca such as dairy products, beans, fish, seaweeds, and fruits, which help in Ca absorption, should be stressed for Korean postmenopausal women.

Backgrounds/objectives: The effects of malnutrition on growth of toddlers and preschoolers by socioeconomic status are not well known. This study aimed to examine the effects of dietary intake on growth outcomes in toddlers and preschoolers by household income level., Subjects/methods: The study population was a total of 1,687 children aged 1 to 5 years that participated in the KNHANES from 2009 to 2011. Growth of children was assessed by height for age (HFA) and weight for height (WFH). Children were classified into three groups according to children's HFA and WFH compared to the 10(th) and 90(th) percentiles of the 2007 Korean Children and Adolescent Growth Standard. Average monthly household income was divided into quartile groups. Dietary intake data were obtained by using the one day 24-hr recall method. Risks of inadequate intake of nutrients and unfavorable growth were estimated by using a multiple logistic regression model adjusted for sex, age, region, and energy intake., Results: The low HFA group (< 10(th) percentile) had significantly lower intakes of energy, carbohydrate, and thiamin as compared with the high group (≥ 90(th) percentile). For WFH status, vitamin C intake was lower in the low group than in the high group. Household income level was related to WFH status but not HFA. Children from lower income households were more likely to have high WFH than those from higher income households (P for trend = 0.038). Household income status was also significantly related with risk of inadequate intake of micronutrients such as thiamin (P for trend = 0.032) and vitamin C (P for trend = 0.002), showing higher odds of inadequate intakes in children from lower income households., Conclusions: Children from lower income households were prone to be overweight and to have inadequate intakes of micronutrients such as thiamin and vitamin C. To reduce nutritional and health disparities, collective action in the public sector is required from early life.

Objectives: The importance of the prediction of coronary heart disease (CHD) has been recognized in Korea; however, few studies have been conducted in this area. Therefore, it is necessary to develop a method for the prediction and classification of CHD in Koreans., Methods: A model for CHD prediction must be designed according to rule-based guidelines. In this study, a fuzzy logic and decision tree (classification and regression tree [CART])-driven CHD prediction model was developed for Koreans. Datasets derived from the Korean National Health and Nutrition Examination Survey VI (KNHANES-VI) were utilized to generate the proposed model., Results: The rules were generated using a decision tree technique, and fuzzy logic was applied to overcome problems associated with uncertainty in CHD prediction., Conclusions: The accuracy and receiver operating characteristic (ROC) curve values of the propose systems were 69.51% and 0.594, proving that the proposed methods were more efficient than other models.

Study Objectives: Sleep can affect quality of life (QOL). We examined the association between self-reported sleep time and QOL independent of perceived health status and depressive disorder using the EuroQol-5 Dimension (EQ-5D) and a visual analog scale (VAS)., Methods: We used the nationwide cross-sectional survey data of 28,178 subjects from the Korea National Health and Nutrition Examination Survey (KNHANES) IV-V. Self-reported sleep time was assessed by average hours of sleep per day. QOL was measured using the EQ-5D and VAS. A generalized additive model and multiple linear regression analysis were used to estimate the effect of sleep time on the QOL while adjusting for potential confounding variables., Results: We found a significant inverted U-shaped relationship between sleep time and QOL using both the EQ-5D and VAS indices. Compared with subjects who slept 7 h/day, Korean men whose sleep time was very short (≤ 4 h/ day) or very long (≥ 10 h/day) had substantially worse QOL (-3.125 in EQ-5D, p < 0.001 and -4.387 on the VAS, p = 0.000 for ≤ 4 h/day; -1.763 in EQ-5D, p = 0.001 and -1.944 on the VAS for ≥ 10 h/day, all p = 0.038). A similar inverted U-shape was observed between sleep time and QOL in Korean women., Conclusions: Inappropriate sleep time (either short or long) in both men and women was significantly associated with lower QOL. In particular, such an association was more apparent among persons whose perceived health status was poor., (© 2015 American Academy of Sleep Medicine.)

Objective: We aimed to evaluate the reproducibility and validity of the newly developed FFQ for the Korean National Health and Nutrition Examination Survey (KNHANES) and to estimate the measure's calibration factors., Design: The 109-item FFQ was administered twice, approximately 9 months apart. We also collected four seasonal 3 d dietary records (DR) as a reference method. Correlation coefficients and joint classification were computed to compare intakes of energy, thirteen nutrients and eleven food groups between the two FFQ to evaluate reproducibility. For validity, de-attenuated and energy-adjusted correlation, joint classification and Bland-Altman statistics were calculated for energy and nutrients between the first FFQ and the DR. To calibrate the FFQ, we performed a linear regression analysis in which the DR were the dependent variables and FFQ, age and sex were the independent variables., Setting: Seoul metropolitan area, Republic of Korea., Subjects: A total of 126 adults aged 20-65 years., Results: The average correlation coefficients measuring reproducibility were 0·54 for nutrients and 0·57 for food groups. The mean correlation coefficient measuring validity was 0·40 for all nutrients between the first FFQ and the DR. On average, 75 % of the participants were classified into the same or adjacent quartiles, while 5 % of the participants were grossly misclassified. The mean energy and nutrient intakes estimated by the calibrated FFQ were similar to the means estimated by the DR., Conclusions: The newly developed FFQ for assessing dietary intake in the KNHANES has acceptable reproducibility and modest validity compared with a 12 d DR collected over a 9-month period.

Using data from 2007 to 2011 of the Korea National Health and Nutrition Examination Survey, we evaluated the influence of coronary heart disease (CHD) on health-related quality of life (HRQoL) as measured by the EQ-5D in comparison with the general population and the predictors of HRQoL in CHD. Compared with the general population, HRQoL was impaired in the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression. The impairment of HRQoL was much greater in the older age group and in females. In subjects with CHD, the predictors for a low EQ-5D index were old age, female sex, low education, stroke, and noncardiovascular comorbidities, and the predictors for a low EQ Visual Analogue Scale were low income and noncardiovascular comorbidities. For the improvement in HRQoL, preventing stroke and noncardiovascular comorbidities is important, especially among female and older Asian patients with CHD., (© The Author(s) 2014.)

This study was conducted to assess the association between sarcopenic obesity and cardiovascular disease (CVD) risk in Korean adults (n=3,320; ≥40 yr) who participated in the 5th Korean National Health and Nutrition Examination Survey in 2010. The appendicular skeletal muscle mass divided by body weight was calculated for each participant; participants with values <1 standard deviation below the mean reference value (i.e., aged 20-39 yr) were considered sarcopenic. Subjects were further classified into 4 groups according to their obesity (i.e., body mass index ≥25 kg/m(2)) and sarcopenic status. Individuals' 10-yr CVD risk was determined using the Framingham risk model. The sarcopenic obese group had more participants (43.8% men, 14.6% women) with a high risk of CVD (≥20%). The sarcopenic obese group was associated with an increased 10-yr CVD risk than the non-sarcopenic, non-obese group (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.53-4.06, P<0.001 in men; OR, 1.87; 95% CI, 1.02-3.41, P=0.041 in women). Sarcopenic non-obese and non-sarcopenic obese subjects were not associated with an increased 10-yr CVD risk. Sarcopenic obesity, but not non-sarcopenic obesity, was closely associated with an increased CVD risk in Korean adults.

Background: We investigated the association between flavonoid intake and type 2 diabetes mellitus (T2DM) risk factors including serum fasting glucose, insulin level, and insulin resistance., Methods: A total of 4186 participants who were involved in the 2007-2009 Korean National Health and Nutrition Examination Survey were examined. The participants were divided into 2 groups by fasting plasma glucose (FPG) as follows: normal fasting glucose (NFG; FPG <100 mg/dl) and impaired fasting glucose (IFG) groups (FPG ≥100 mg/dl)., Results: In the IFG group, body weight, body mass index, and waist circumference were increased. Fasting insulin level and homeostasis model assessment estimate of insulin resistance as markers of insulin resistance were higher in the IFG group. Intakes of energy and nutrients, including protein, fat, carbohydrate, crude fiber, vitamin C, calcium, phosphorus, and iron, did not differ between the 2 groups. For the male subjects, the energy-adjusted flavanone intake was lower in the IFG group than in the NFG group. Insulin and insulin resistance were inversely correlated with intakes of flavones and flavonols among the male subjects., Conclusion: These findings can provide valuable information for further development of appropriate strategies for diabetes prevention in Korea., (Copyright © 2014 Elsevier B.V. All rights reserved.)

It is not clear whether the inverse relationship between bone mineral density (BMD) and blood pressure (BP) could be generalizable to the general elderly population. We used data from the fourth and fifth Korea National Health and Nutrition Examination Survey. The study sample consisted of 8439 men and postmenopausal women aged 50 years and older. We evaluated the relationship between BMD and BP. When adjusted for covariates, femur neck T-score [coefficient = -0.391, 95% confidence interval (CI) -0.766 to -0.016, p = 0.041] had an inverse relationship with diastolic BP (DBP), whereas lumbar spine BMD (coefficient = 0.395, 95% CI 0.058-7.752, p = 0.047) and T-score (coefficient = 0.458, 95% CI 0.005-0.911, p = 0.047) had a positive relationship with systolic BP (SBP). When adjusted for confounding factors, SBP (128.67 ± 0.979 mmHg versus 126.36 ± 0.545 mmHg, p = 0.026) and DBP (78.8 ± 0.622 mmHg versus 77.27 ± 0.283 mmHg, p = 0.016) were significantly higher in femur neck osteoporosis subjects than non-osteoporosis subjects. However, there were no differences in BP in relation to lumbar spine osteoporosis. Femur neck osteoporosis (odds ratio = 1.422, 95% CI 1.107-1.827, p = 0.006) had a significant and positive relationship with hypertension, whereas the other parameters of BMD were not significantly related to hypertension. In conclusion, higher BP and hypertension were significantly and positively correlated with femur neck osteoporosis in men and postmenopausal women aged 50 years and older.

Background: Multiple comorbidities related to chronic obstructive pulmonary disease (COPD) make it a difficult disease to treat. The relationship between these comorbidities and COPD has not been fully investigated. We aimed to determine whether COPD was independently associated with various comorbidities., Methods: This was a cross-sectional study, which used data from the Korean National Health and Nutrition Examination Survey (KNHANES) V conducted between 2010 and 2012. Survey design analysis was employed to determine the association between COPD and 15 comorbidities. A COPD patient was defined as a smoker with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7 and comorbidities were defined based on objective laboratory findings and questionnaires., Results: Of a total of 9488 patient who underwent spirometry, 744 (7.84%) COPD cases and 3313 non-COPD controls were included in the analyses. Although the prevalence rates of the majority of the comorbidities were high among the COPD patients, only hypertension (adjusted odds ratio [aOR], 1.63; 95% CI, 1.13-2.33 in Stage 1 COPD group; aOR, 1.92; 95% CI, 1.36-2.72 in Stage 2-4 COPD group) and a history of pulmonary tuberculosis (aOR, 3.38; 95% CI, 1.90-5.99 in Stage 2-4 COPD group) were independently associated with COPD after adjustment for age, smoking status, and confounders., Conclusions: Only hypertension and a history of pulmonary tuberculosis were independently associated with COPD after adjustment for confounders among 15 comorbidities. The results suggest that majority of COPD patients might have similar risk factors with its comorbidities, including age and smoking status., (Copyright © 2014. Published by Elsevier Ltd.)

Limited epidemiologic data is available regarding the cardiovascular effects of mercury exposure. The purpose of this study was to determine the relationship between mercury exposure from fish consumption and cardiovascular disease in a nationally representative sample of Korean adults using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV 2008~2009). Survey logistic regression models accounting for the complex sampling were used to estimate the odds ratios (OR) adjusted for fish consumption frequency, age, education, individual annual income, household annual income, body mass index (BMI), waist circumference (WC), alcohol consumption status, and smoking status. The mean blood mercury level in the population was 5.44 μg/L. Trends toward increased blood mercury levels were seen for increased education level (P=0.0011), BMI (P<0.0001), WC (P<0.0001), and fish (i.e., anchovy) consumption frequency (P=0.0007). The unadjusted OR for hypertension in the highest blood mercury quartile was 1.450 [95% confidential interval (CI): 1.106~1.901] times higher than that of the lowest quartile. The fish consumption-adjusted OR for hypertension in the highest blood mercury quartile was 1.550 (95% CI: 1.131~2.123) times higher than that of the lowest quartile, and the OR for myocardial infarction or angina in the highest blood mercury quartile was 3.334 (95% CI: 1.338~8.308) times higher than that of the lowest quartile. No associations were observed between blood mercury levels and stroke. These findings suggest that mercury in the blood may be associated with an increased risk of hypertension and myocardial infarction or angina in the general Korean population.

Background/objectives: Osteoporosis and osteoporosis-related disease are drawing a lot of attention in Korea as one of the serious health problems. Bone health status may be influenced by the general dietary quality and dietary pattern., Subjects/methods: To determine the relationship between dietary quality and intake patterns and bone health status, the %RNI, NAR, DDS, and food group intake patterns were assessed according to their bone health status for 847 postmenopausal women using the 2010 KNHANES data after eliminating those of likely changing their diet under the advice of doctors or those taking estrogen., Results: Bone health became worse as dietary quality deteriorated. All NAR and %RNI values were highly associated with bone health levels and the consumption frequency of Ca sources, DDS and the food group intake patterns also confirmed the findings., Conclusions: This study confirmed that dietary quality and dietary patterns were important for bone health. Nutritional education on eating foods from the five basic food groups has to be emphasized to prevent osteoporosis among older women.

Background/objectives: Turmeric and its active component curcumin have received considerable attention due to their many recognized biological activities. Turmeric has been commonly used in food preparation and herbal remedies in South Asia, leading to a high consumption rate of curcumin in this region. However, the amount of curcumin in the Korean diet has not yet been estimated, where turmeric is not a common ingredient., Subjects/methods: This study utilized the combined data sets obtained from the Korea National Health and Nutrition Examination Survey conducted from 2008 to 2012 in order to estimate the curcumin intake in the Korean diet. The mean intake of curcumin was estimated from the amount of curcumin-containing foods (curry powder and ready-made curry) consumed using reported curcumin content in commercial turmeric and curry powders., Results: Only 0.06% of Koreans responded that they consumed foods containing curcumin in a given day, and 40% of them were younger than 20 years of age. Curcumin-containing foods were largely prepared at home (72.9%) and a significant proportion (20.4%, nearly twice that of all other foods) was consumed as school and workplace meals. The estimated mean turmeric intake was about 0.47 g/day corresponding to 2.7-14.8 mg curcumin, while the average curry powder consumption was about 16.4 g, which gave rise to curcumin intake in the range of 8.2-95.0 mg among individuals who consumed curcumin. The difference in estimated curcumin intake by using the curcumin content in curry powder and turmeric may reflect that curry powder manufactured in Korea might contain higher amounts of other ingredients such as flour, and an estimation based on the curcumin content in the turmeric might be more acceptable., Conclusions: Thus, the amount of curcumin that can be obtained from the Korean diet in a day is 2.7-14.8 mg, corresponding to nearly one fourth of the daily curcumin intake in South Asia, although curcumin is rarely consumed in Korea.

Background/objectives: The objective of the study was to provide useful insights into plain water intake of Korean adults according to life style, anthropometric, and dietary characteristics., Subjects/methods: The data from the 2008-2010 Korea National Health and Nutrition Examination Survey were used. The subjects were 14,428 aged 20-64 years. Water intake was estimated by asking the question "How much water do you usually consume per day?". Dietary intake was estimated by 24-hour dietary recall. A qualitative food frequency questionnaire including 63 food items was also administered., Results: The mean plain water intake for men and women were 6.3 cup/day and 4.6 cup/day, respectively. Plain water intake increased as lean body mass, waist circumference, and body mass index levels increased, except for percentage of body fat. As energy and alcohol intakes increased, plain water intake increased. As total weight of food intake and total volume of food intake increased, plain water intake increased. Plain water intake increased as consumption of vegetables increased. Plain water intake increased as frequencies of green tea, alcoholic drink, and all beverages were increased in men. Plain water intake increased with increased frequencies of green tea, milk, soy milk, and alcoholic drink and decreased frequencies of coffee and soda in women., Conclusions: Our results suggest that persons who had a higher waist circumference or lean body mass and women with higher BMI consumed more plain water. The persons eating high quality diet, or the persons who had more vegetables, green tea, milk, soy milk, or alcoholic drink consumed more plain water.

Objectives: Vitamin D deficiency is increasing worldwide. However, few studies have attempted to examine the vitamin D status of wage workers and the correlation between vitamin D deficiency and working conditions. Hence, we aimed to evaluate the prevalence of vitamin D deficiency and the association between occupational conditions and vitamin D deficiency among Korean wage workers., Methods: Wage workers aged 20-65 years from the 5th Korea National Health and Nutrition Examination Survey (KNHANES 2010-2012; n = 5409) were included in our analysis. We measured the prevalence of vitamin D deficiency and identified the correlations with the working conditions of these subjects., Results: The prevalence of vitamin D deficiency in male and female subjects was 69.5% and 83.1%, respectively. Among the male subjects, a significant correlation between vitamin D deficiency and working conditions was observed among shift workers, office workers, and permanent workers. No significant correlation with any type of working conditions was observed among female subjects., Conclusion: The prevalence of vitamin D deficiency among Korean wage workers was very high and was found to correlate significantly with working conditions, likely because of insufficient exposure to sunlight associated with certain types of work. Wage workers require more frequent outdoor activity and nutrition management to maintain sufficient vitamin D level.

Background: Patients with either diabetes mellitus (DM) or metabolic syndrome (MS) are recognized as a high risk group for cardiovascular disease (CVD). Several studies have demonstrated the clinical value of MS for predicting additional CVD risk in the DM population, although the clinical significance remains debatable., Methods: We used the Korea National Health and Nutrition Examination Survey (KNHANES) 2008, which is the national representative database. We classified the KNHANES subjects based on MS and glucose tolerance status, and compared clinical characteristics and future CVD risk among the subgroups., Results: A total of 796 of the 4314 subjects were diagnosed with MS. Their clinical characteristics were significantly different from patients without MS. Prevalence of DM was 9.5% in subjects with MS, but only 1.1% in subjects without MS. In addition, there was no MS in 30.9% of total DM patients who were enrolled in this study. For the normal and impaired fasting glucose subgroups, the prevalence of moderate (5-10%) and high (>10%) CVD risk was significantly higher in patients with MS than in patients without MS (p < 0.001). However, in the DM subgroup, even after multiple adjustments, there were no differences in clinical characteristics or in the prevalence of moderate to high CVD risk according to MS status. That said, LDL cholesterol in the DM group without MS was significantly higher than in the DM group with MS (p = 0.010)., Conclusions: The efficacy of MS as a screening tool for high CVD risk may be limited in DM patients, and conventional risk factors such as LDL may be more important.

Purpose: To determine the risk factors for and relationship between diabetic retinopathy (DR) and diabetic nephropathy (DN), including microalbuminuria and overt nephropathy, in a population-based study of diabetes mellitus (DM) patients in Korea., Methods: This was a population-based, cross-sectional study. From the fifth (2011, 2012) Korea National Health and Nutrition Examination Survey (KNHANES), 971 participants with type 2 DM were included. The prevalence of DR and DN was determined. Multivariate logistic regression was performed to determine risk factors, including DR, associated with DN in the Korean population., Results: In DM patients, we observed a prevalence of 20.0% for any DR and 3.8% for proliferative diabetic retinopathy (PDR). Microalbuminuria prevalence was 19.3% and overt nephropathy prevalence was 5.5%. The risk factors of microalbuminuria were presence of hypertension; higher systolic blood pressure, serum hemoglobin A1c (HbA1c), and serum blood urea nitrogen level; as well as the presence of PDR. The risk factors of overt nephropathy were long duration of DM; high levels of HbA1c, systolic blood pressure, total cholesterol, and serum creatinine; as well as the presence of DR CONCLUSIONS: Proliferative diabetic retinopathy is associated with microalbuminuria and DR is associated with overt nephropathy in Korean DM patients. Our findings suggest that when an ophthalmologist finds the presence of DR or PDR, timely evaluation of the patient's renal status should be recommended., (Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.)

The relationship between salt intake and adequate blood pressure control is not well investigated in Korea populations, especially in patients with cardiovascular disease. This cross-sectional study enrolled 19,083 subjects who participated in the Korea National Health and Nutrition Examination Survey conducted from 2009-2011. The amount of salt intake was estimated using the Tanaka equations based on spot urine samples. Comparing patients with and without cardiovascular disease, systolic blood pressure (129.1±18.1 mmHg vs. 120.0±18.1 mmHg, P<0.001) and the amount of urinary sodium excretion (149.4±37.5 mM/day vs. 144.1±36.2 mM/day, P<0.001) were higher in patients with cardiovascular diseases. Among patients with cardiovascular disease, the high blood pressure group showed an increased amount of urinary sodium excretion compared to the normal blood pressure group (155.5±38.2 vs. 146.6±36.9 mM/day, P<0.001). The odds ratio (OR) of high blood pressure was higher (OR, 1.825; 95% CI, 1.187-2.807; P-for-trend 0.003, highest quartile of urinary sodium excretion vs. lowest quartile) in patients with cardiovascular disease. A higher amount of urinary sodium excretion was associated with a lower rate of adequate blood pressure control in Korean population, especially with cardiovascular disease.

Objective: To examine the relationship between socioeconomic status (SES) and type 2 diabetes using the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012., Design: A pooled sample cross-sectional study., Setting: A nationally representative population survey data., Participants: A total of 14,330 individuals who participated in the KNHANES 2010-2012 were included in our analysis., Primary Outcome: Prevalence of type 2 diabetes., Results: The relationship between SES and type 2 diabetes was assessed using logistic regression after adjusting for covariates including age, gender, marital status, region, body mass index, physical activity, smoking and high-risk drinking behaviour. After adjustment for covariates, our results indicated that individuals with the lowest income were more likely to have type 2 diabetes than those with the highest income (OR 1.35; 95% CI 1.08 to 1.72). In addition, lower educational attainment was an independent factor for a higher prevalence of type 2 diabetes in Korea., Conclusions: These findings suggest the need for developing a health policy to ameliorate socioeconomic inequalities, in particular income and education-related disparities in type 2 diabetes, along with risk factors at the individual level. In addition, future investigations of type 2 diabetes among Koreans should pay more attention to the social determinants of diabetes in order to understand the various causes of the condition., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The purpose of this study was to predict osteoporosis risk as decreasing muscle mass and to declare the cut-off value of low muscle mass in an elderly Korean population. This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys (KNHANES). The subjects included 1,308 men and 1,171 women over 65 yr. Bone mineral density (BMD) and appendicular skeletal muscle (ASM) were measured by dual energy X-ray absorptiometry (DXA), and appendicular skeletal muscle was adjusted by height as a marker of sarcopenia. After confirming the correlation between low muscle mass and BMD, the best cut-off value of muscle mass to estimate osteoporosis was suggested through the receiver operating characteristic (ROC) curve. For both men and women, BMD correlated positively with low muscle mass when ASM/Ht(2) was used as a marker for sarcopenia. The ROC curve showed that ASM/Ht(2) was the best marker for osteoporosis at a cut-off value of 6.85 kg/m(2) for men and 5.96 kg/m(2) for women. When these cut-off values were used to determine sarcopenia, the risk of osteoporosis increased 4.14 times in men and 1.88 times in women. In particular, men (OR 2.12) with sarcopenia were more greatly affected than women (OR 1.15), even after adjusting for osteoporosis risk factors. In elderly Korean people, sarcopenia is positively correlated with BMD and there is a strong correlation between sarcopenia and osteoporosis with risk of bone fracture.

Background: The purpose of this study was to examine the relationship of physical activity levels with sleep duration (SD), and self-rated health (SRH) using the fifth Korean National Health and Nutrition Examination Survey data from 2010 and 2011., Method: Overall, 12,188 Korean people were evaluated in relation to meeting guidelines for vigorous PA (MVPA), moderate PA (MMPA), and low PA (MLPA) associated with SD and SRH., Results: The adjusted odds ratio (AOR) of males who slept seven hours with MMPA (AOR=0.84) and MLPA (AOR=0.85) and eight hours with MMPA (AOR=0.76) and MLPA (AOR=0.78) significantly decreased compared to subjects who sleep 6 hours/day. In females, an AOR of less than 5 (AOR=1.40) and 6 hours (AOR=1.12) with MVPA was significantly increased compared to 7 hours sleep/day, while sleeping more than 8 hours/day was significantly decreased with MLPA (AOR=0.73). Compared to the very good SHR, the AORs of more negative SHR status with MVPA, MMPA, and MLPA in males and with MMVP and MLVP in females decreased significantly., Conclusions: Sleeping 6-8 hours/day for MMPA and MLPA in males and 7-8 hours/day for MVPA and MLPA in females, and a very good SRH for MVPA, MMPA, and MLPA in males and for MMPA and MLPA in females are recommended to participate physical activity for the Korean population. We therefore, the independent association between PA levels and SD or SRH according to gender supports public health program to participate physical activity for the Korean population.

Background: The effect of vitamin D on allergic conditions is unclear. In particular, large-scale, population-based studies examining this relationship in adult Asian populations are lacking., Objective: To evaluate the association between serum vitamin D levels and allergic conditions in the general adult Korean population., Methods: A cross-sectional study was performed by using data collected from 15,212 individuals 19 years or older who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2010. The confounder-adjusted mean serum 25-hydroxyvitamin D (25[OH]D) levels of participants with and without allergic conditions (including atopic dermatitis, asthma, allergic rhinitis, and increased total and allergen-specific serum IgE) were compared by using multiple linear regression analyses. Multiple logistic regression analyses with confounder adjustment estimated the odds ratios (ORs) for developing each condition according to adequate, inadequate, or deficient serum 25(OH)D levels., Results: After adjusting for potential confounders, mean serum 25(OH)D levels were significantly lower in participants diagnosed with atopic dermatitis than in those without this diagnosis (mean ± SE, 18.58 ± 0.29 ng/mL vs 19.20 ± 0.15 ng/mL; P = .02). Compared with participants with adequate vitamin D levels (≥20 ng/mL), confounder-adjusted ORs of atopic dermatitis were significantly higher in those with inadequate (12-19.99 ng/mL) or deficient (<12 ng/mL) levels (OR [95% CI], 1.50 [1.10-2.06] and 1.48 [1.04-2.12], respectively; P = .02). This relationship was not observed in participants with the other allergic conditions., Conclusion: Vitamin D-insufficient adult individuals within the general Korean population have an increased likelihood of atopic dermatitis, but not asthma, allergic rhinitis, or IgE sensitization., (Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

Study Objectives: Sleep duration is recognized as one of the most common issues in modern society. Self-rated health is a commonly used subjective health measure based on a single question asking individuals to rate their general health on a four- or five-point scale. However, few studies have examined the relationship between sleep duration and self-rated health. Here, we examined the association between sleep duration and poor self-rated health, using a large representative sample of the general Korean adult population., Design: We conducted a cross-sectional study of 15,252 participants in the Korea National Health and Nutrition Examination Survey IV (2007-2009) who were aged 19 years and older. Sleep duration was categorized as ≤ 5, 6, 7, 8, or ≥ 9 hours. The main outcome of interest was poor self-rated health (n = 3,705, 19.7%). Multiple logistic regression analysis was performed to examine the association between sleep duration and self-rated health., Results: We found both short (≤ 5 h) and long (≥ 9 h) sleep duration to be associated with poor self-rated health independent of sociodemographic, health risk, and health status variables. Compared with 7-h sleep duration, the multivariate odds of poor self-rated health were 1.358 times higher (95% CI 1.167-1.580) with short sleep duration and 1.322 times higher (95% CI 1.091-1.601) with long sleep duration. This association persisted in subgroup analyses of gender, body mass index, and age by gender., Conclusions: In a large representative sample of the Korean general adult population, compared with sleep duration of 7 hours, we found a positive association between short and long sleep duration and poor self-rated health in Korean adults. Furthermore, the association between sleep duration and poor self-rated health was consistently present in subgroups divided by gender, age, and BMI.

Objectives: This study examined the relationship between dietary patterns and disability in the Korean elderly., Study Design: We used data from a cross-sectional study of 327 men and 460 women aged ≥65 years who completed the 2005 Korea National Health and Nutrition Examination Survey., Main Outcome Measures: A single 24-h dietary recall method was used to assess dietary intake and dietary patterns were identified by cluster analysis. Functional disability was assessed by the activities of daily living (ADL) and instrumental ADL (IADL) scales. The association of dietary patterns with ADL and IADL disability was analyzed by logistic regression adjusting for age, marital status, education, household income, region, chronic conditions, body mass index, smoking, alcohol drinking, physical activity, and energy intake., Results: Two dietary patterns were identified in both men and women: the modified traditional dietary pattern, characterized by a relatively lower consumption of white rice, but higher consumption of fruits, dairy products, and legumes, and the traditional dietary pattern, characterized by high consumption of white rice. After controlling for covariates, in men, those who engaged in modified traditional dietary pattern, compared with traditional dietary pattern, showed a lower likelihood of ADL disability (odds ratio [OR]=0.17, 95% confidence interval [CI]: 0.05-0.56). In women, the modified traditional dietary pattern compared with the traditional pattern was associated with a significantly decreased risk of ADL (OR=0.45, 95% CI: 0.23-0.90) and IADL disability (OR=0.45, 95% CI: 0.28-0.72)., Conclusions: The modified traditional dietary pattern is associated with a decreased risk of functional disability in older Korean adults., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Whether the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) guidelines can be applied to the Asian population remains unclear. We aim to test the hypothesis that adherence to the JNC-7 guidelines is associated with hypertension in a representative sample of the Korean population in the fourth Korea National Health and Nutrition Examination Survey. Participants completed a non-quantitative food frequency questionnaire and 24-hour diet recall through interviews. Blood pressure, height, and weight were directly measured, and questions about physical activity and other lifestyle factors were administered. A total of 500 hypertensive and 4567 normotensive participants were identified. We estimated the odds ratio and 95% confidence intervals using a multivariate logistic regression. The following components of the JNC-7 guidelines were considered: dietary approaches to stop a hypertension style diet, moderate consumption of alcohol, adequate physical activity, and a normal body mass index. Those individuals who fell in the low-risk category for all 4 lifestyle components had an odds ratio of 0.48 (95% confidence interval, 0.30-0.78) compared with the remainder of the participants. In conclusion, we found an inverse association between adherence to the JNC-7 guidelines and hypertension prevalence among Korean adults, suggesting the importance of lifestyle modification for the prevention and management of hypertension., (© 2013 Elsevier Inc. All rights reserved.)

Purpose: A population-based study was conducted in order to examine the characteristics of family members of cancer patients in comparison with the general population and also to evaluate the psychosocial impact of cancer patients on their family members., Materials and Methods: From the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) (2007-2009) dataset, we identified 460 cancer patients and then selected family members of these patients who were aged 20 years or older (n=565). The control group was sampled from members of families without a cancer patient with matching for sex and age (n=2,260). Serial conditional logistic regression models were used for comparison of characteristics between family members of cancer patients and subjects in the control group., Results: Family members of cancer patients were less employed (57.9% vs. 63.0%, p<0.001), more functionally limited (20.2% vs. 16.5%, p=0.032), and had lower self-rated health (p=0.023) compared with sex and age-matched control subjects. They also had a significantly higher level of stress (79.7% vs. 76.1%, p=0.008), history of depression (12.9% vs. 10.2%, p=0.035), and current depressive symptoms (5.5% vs. 3.5%, p=0.038). However, higher physical activity was reported in family members of cancer patients (13.6% vs. 9.6%, p=0.003) than in control subjects. The presence of a cancer patient in the family showed an association with current depressive symptoms (odds ratio, 1.62; 95% confidence interval, 1.05 to 2.48; p=0.028), however, the association was no longer significant after adjustment for household income, education level, and employment status (p=0.304)., Conclusion: Family members of cancer patients are more susceptible to depression, probably due to adverse change in socioeconomic status. Use of multidisciplinary approaches for promotion of psychological health and well-being is essential.

This cross-sectional study was done to identify and determine the socio-demographic and health-related factors associated with diabetic retinopathy and nephropathy screening in Korea. Participants included 2,660 adults, aged 40 or older, with diabetes. Of the 2,660 adults, 998 (37%) and 1,226 (46.1%) had received a diabetic retinopathy and a nephropathy screening within one year, respectively. Regarding retinopathy, subjects older than 65, living in urban areas, with high educational levels, and with self-reported "unhealthy" status were likely to receive annual screening. Subjects living in urban areas, with higher educational levels, with self-reported "fair" or "unhealthy" status, and with 1 to 2 co-morbidities were likely to receive annual nephropathy screening. The Korea Composite Stock Price Index (KOSPI) continued to rise until 2007 when it started to decline over the subsequent years, following the same curve as the diabetic retinopathy and nephropathy screening rates during that time. Together with the financial matter, lack of patient education proved to be a hindrance to diabetes-related screening. The relatively low screening rates in Korea compared to the Western countries are likely to be due to the difference in the health system, economic situations and national demographics.

The relationship between smoking and nutrient intake has been widely investigated in several countries. However, Korea presents a population with a smoking rate of approximately 50% and dietary consumption of unique foods. Thus, the aim of this study was to evaluate the association of dietary patterns with smoking in Korean men using a nationally representative sample. The study subjects were comprised of 4,851 Korean men over 19 yr of age who participated in the fourth Korean National Health and Nutrition Examination Survey. Dietary data were assessed by the 24-hr recall method. The smoking group comprised 2,136 men (46.6%). Five dietary patterns were derived using factor analysis: 'sugar & fat', 'vegetables & seafood', 'meat & drinks', 'grains & eggs', and 'potatoes, fruits and dairy products.' Current smokers showed a more significant 'sugar & fat' pattern (P = 0.001) while significantly less of the 'vegetables & seafood' and 'potatoes, fruits and dairy products' patterns (P = 0.011, P < 0.001, respectively). As found in similar results from Western studies, Korean male smokers showed less healthy dietary patterns than nonsmokers. Thus, the result of this study underlines the need for health professionals to also provide advice on dietary patterns when counseling patients on smoking cessation.

It has been suggested that there is an association between environmental, low-level arsenic exposure and the risk of diabetes mellitus (DM), but little research has been conducted. Here, the glucose tolerance status and urinary creatinine adjusted total arsenic concentrations were analyzed in 3,602 subjects ≥ 20 yr of age who were registered for the Korea National Health and Nutrition Examination Survey, 2008-2009. Various demographic parameters were associated with urinary arsenic concentrations. After adjusting for these variables, urinary arsenic concentrations in subjects with DM were significantly higher than those in subjects with normal glucose tolerance and those with impaired fasting glucose (P < 0.001). Compared with the lowest quartile ( < 70.7 µg/g creatinine), the odds ratios and 95% confidence intervals for DM were 1.11 (0.73-1.68), 1.42 (0.94-2.13), and 1.56 (1.03-2.36) for urinary arsenic concentrations of 70.7 to < 117.7, 117.7 to < 193.4, and ≥ 193.4 µg/g creatinine, respectively, following multivariate adjustment. Furthermore, the urinary total arsenic concentration was inversely associated with the insulin secretion index, HOMA2 %B (β = -0.033, P = 0.032). These findings suggest that arsenic exposure, possibly involving beta cell dysfunction, is associated with an increased risk of DM in the Korean population.

Recent studies in Western countries have reported a significant association between glomerular filtration rate (GFR) and bone mineral density (BMD) in the absence of dialysis among the general population. However, there have been few studies regarding renal function and BMD among Korean or Asian subjects with moderate to severe (stage 3 or 4) chronic kidney disease (MS-CKD). The aim of the present study was to investigate the association between MS-CKD and BMD in the general Korean population. BMD, serum creatinine and other measures were obtained from 3,190 subjects (1,428 males and 1,762 females; the fourth Korean National Health and Nutrition Examination Survey). GFR was estimated using the Cockcroft-Gault formula, with adjustment for body surface area. After adjustment for all variables, multiple regression analysis showed that BMD in the femur neck, total femur and lumbar spine were positively associated with eGFR in both males and females. Additional analysis showed that MS-CKD was also significantly associated with osteoporosis in both males and females (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.15-4.20 in males; and OR 1.96, 95% CI 1.33-2.88 in females). Individuals with MS-CKD may be at higher risk of osteoporosis even among Asians.

A valid assessment of obesity in children and adolescents is important due to significant change in body composition during growth. This study aimed to develop percentile curves of body fat and fat free mass using the Lambda, Mu, and Sigma method, and to examine the relationship among body mass index (BMI), fat mass and fat free mass in Korean children and adolescents, using the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010. The study subjects were 834 for boys and 745 for girls aged between 10 and 18 yr. Fat mass and fat free mass were measured by dual-energy x-ray absorptiometry. The patterns of development in body fat percentage, fat mass and fat free mass differed for boys and girls, showing a decreased fat mass with an increased fat free mass in boys but gradual increases with age in girls. The considerable proportion of boys and girls with relatively normal fat mass appeared to be misclassified to be at risk of overweight based on the BMI criteria. Therefore, the information on the percentiles of body fat and fat free mass with their patterns would be helpful to complement assessment of overweight and obesity based on BMI for Korean children and adolescents.

The most critical point in the assessment of adherence to dietary guidelines is the development of a practical definition for adherence, such as a dietary pattern score. The purpose of this study was to develop the Korean Diet Score (KDS) based on the Korean Food Balance Wheel and to examine the association of KDS with various lifestyle characteristics and biochemical factors. The dietary data of 5,320 subjects from the 4th Korean National Health and Nutritional Examination Survey were used for the final analysis. The food guide was composed of six food group categories; 'grain dishes', 'fish and meat dishes', 'vegetable dishes', 'fruits', 'milk' and 'oils and sugars'. Based on the recommended serving numbers for each group, the scores measuring adherence to this food guide were calculated from the dietary information from the 24-hour dietary recall questionnaire, and then its correlation with various characteristics was assessed. KDS was significantly associated with several clinical, lifestyle and socioeconomic factors as well as diagnosed disease history. The higher quintile group of KDS showed a significantly lower level in fasting blood glucose, systolic blood pressure, triglycerides, current smoking and drinking as well as higher leisure time activity, house income and education. Furthermore, the KDS quintile group of women was inversely associated with hypertension, osteoporosis and diabetes. A higher KDS quintile was characterized with a higher intake of several critical nutrients, such as Ca, Fe and vitamins as well as a desirable nutrition balance such as the ratio of macronutrients. Our results demonstrate that KDS is a beneficial tool in assessing the adherence to a healthy diet based on the Korean dietary guidelines. We suggest that KDS could be a useful indicator for evaluating the dietary balance of the Korean population.

The objective of this study was to provide information regarding trends of rice consumption of Korean adults based on different meal types. Respondent reports 24-hour recall data from the Korean National Health and Nutrition Examination Survey were used to assess daily rice consumption and intake ratios of rice for different meal types and places of preparation. Rice intake had gradually decreased from 224.6 g in 1998 to 190 g in 2001 and to 179.4 g in 2005. The rice consumption of Korean adults decreased every year in all ages for all places of meal preparation in 2001 and 2005 compare to 1998. Analysis for each meal type showed that rice intake at breakfast had not considerably changed, but rice intake had decreased at lunch and dinner. While the rice consumption ratio at lunch and dinner decreased, it also decreased or did not change at snack times except for the 19-29 age groups. All the age groups revealed comparable change in the analysis for meal types. There was some diversity between all age divisions in daily rice intake depending on place of meal preparation. The rice consumption by place of meal preparation was generally highest at home, lowest at other places, but it decreased in all places. The rice consumption at home was highest in the over 50 age group, lowest in the 20-30 age group. These changes seem to be related to food intake patterns of rice and substitutional foods in the diets and development regarding socio-economic status. So the need for further study on differences in rice intake based on socioeconomic levels and age group are indicated.

Purpose: Unbalanced diets and decreased physical activity have contributed to increased prevalence of obesity and metabolic syndrome in adolescents. We have performed a systematic review and data analysis to examine the association between dietary pattern and metabolic syndrome risk factors in adolescents., Methods: We searched the PubMed and BioMedLib databases for appropriate articles published during the past 10 years and selected 6 articles. The studies reviewed applied factor analysis or cluster analysis to extract dietary patterns. For data analysis, we examined the association between dietary patterns and the prevalence of metabolic syndrome risk factors using data of 3,168 adolescents (13 to 18 years) obtained from 4 consecutive Korean Nutrition Health and Nutrition Examination Surveys (1998, 2001, 2005, and 2007 to 2009)., Results: Our systematic review confirmed that western dietary patterns are positively associated with metabolic syndrome risk factors such as obesity and elevated triglycerides, while traditional dietary patterns were negatively associated. Data analysis found that the number of adolescents aged 16 to 18 years who had "Rice & Kimchi" dietary pattern decreased, while the number having western dietary patterns increased during the 1998 to 2009 time frame. There were no changes in the dietary patterns in adolescents aged 13 to 15 years. The risk of elevated serum triglycerides and reduced serum high density lipoprotein cholesterol was high in the "Rice & Kimchi" dietary pattern compared to the other dietary pattern groups., Conclusion: Because adolescents' dietary patterns are changing continuously and have long-term effects, further studies on the dietary patterns of adolescents and their health effects into adulthood are necessary.

The purposes of this study were to: 1) describe the patterns of screen-based sedentary behaviors, and 2) examine the association between screen-based sedentary behavior and cardiovascular disease (CVD) risk factors in representative Korean children and adolescents, aged 12 to 18 yr, in the Korean National Health and Nutrition Examination Survey. Screen-based sedentary behavior was measured using self-report questionnaires that included items for time spent watching TV and playing PC/video games. Physical activity was measured using items for frequency and duration of moderate-to-vigorous physical activity (MVPA). CVD risk factors such as body mass index (BMI), waist circumference, LDL cholesterol, HDL cholesterol, total cholesterol, triglycerides, glucose, systolic blood pressure, and diastolic blood pressure were measured. Boys spent more time playing PC/video games, and girls spent more time watching TV. After adjusting for age, gender, annual household income, and MVPA, an additional hour of watching TV was significantly associated with the risk of overweight (OR 1.17 [95% CI 1.03-1.33]), high abdominal adiposity (OR 1.27 [1.06-1.51]), and low HDL cholesterol (OR 1.27 [1.10-1.47]). An additional hour spent playing PC/video games also increased the risk of high abdominal adiposity (OR 1.20 [1.03-1.40]). Prospective observations and interventions are needed to determine causal relationships between screen-based sedentary behavior and CVD risk profiles in Korean youth.

There are conflicting data as to whether general or abdominal obesity is a better predictor of cardiovascular risk. This cross-sectional study involved 4,573 subjects aged 30 to 74 yr who participated in the Fourth Korea National Health and Nutrition Examination Survey conducted in 2008. Obesity phenotype was classified by means of body mass index (BMI) and waist circumference (WC), and participants were categorized into 4 groups. Individuals' 10-yr risk of coronary heart diseases (CHD) was determined from the Framingham risk score. Subjects with obese WC had a higher proportion of high risk for CHD compared to the normal WC group, irrespective of BMI level. Relative to subjects with normal BMI/normal WC, the adjusted odds ratios (ORs) of normal BMI/obese WC group (OR 2.93 [1.70, 5.04] and OR 3.10 [1.49, 6.46]) for CHD risk in male were higher than obese BMI/obese WC group (OR 1.91 [1.40, 2.61] and OR 1.70 [1.16, 2.47]), whereas the adjusted ORs of obese BMI/obese WC group (OR 1.94 [1.24, 3.04] and OR 3.92 [1.75, 8.78]) were higher than the others in female. Subjects with obese BMI/normal WC were not significantly associated with 10-yr CHD risk in men (P = 0.449 and P = 0.067) and women (P = 0.702 and P = 0.658). WC is associated with increased CHD risk regardless of the level of BMI. Men with normal BMI and obese WC tend to be associated with CHD risk than those with obese BMI and obese WC.

Objectives: The present study investigated associations between income and intake of nutrients and food in adults (n = 11,063) from the fourth Korea National Health and Nutrition Examination Survey 2007-2009., Methods: To examine relationships between individual dietary intake and anthropometric measures and family income, multiple linear regression models were constructed for each outcome variable. All models were adjusted for age, education, energy intake, smoking, body mass index, and physical activity., Results: For men, intakes of protein, calcium, phosphorus, potassium, and vitamin C were lower in low-income compared to high-income groups. For women, intakes of protein and niacin were lower in low-income groups. Lowest income group ate less dairy products in men and less fruits and fishes or shellfishes in women., Conclusion: Low-income groups had severe food insecurity and low diet quality compared to high-income groups. The study results will provide direction for public health efforts regarding dietary intakes according to economic status among Korean men and women.