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Data regarding plant extracts with antiaging properties, particularly via the biological process involving telomeres and telomerase, are limited. Thus, the present study aimed to investigate the effects of Acanthopanax senticosus extract (ASE) supplementation on leukocyte telomere length (LTL), telomerase, and inflammatory and metabolic markers in adult animal models. A freeze-dried product of ethanol extracts was prepared using a mixture product of stem and root ASE. In a 24-week experiment that included 24-week-old Sprague Dawley male rats, experimental rats (n = 10) were administrated with 7 mg/day of ASE dissolved in saline and control rats (n = 10) with saline. All rats had access to chow and tap water ad libitum. Their LTL and plasma levels of telomerase and inflammatory and metabolic markers were assayed and compared between the two groups. The experimental rats showed significantly longer LTL (P-value0.05) and lower plasma levels of alanine aminotransferase (P-value0.05) and aspartate aminotransferase (P-value = 0.08) compared with the control. In addition, LTL was correlated with the aforementioned biochemical parameters of liver function test among experimental rats only. No significant differences in plasma levels of telomerase and inflammatory and metabolic markers were observed. These findings indicate that ASE supplementation may attenuate LTL shortening and reduce liver biochemical parameters, indicating its potential anti-aging and hepatoprotective effects without any adverse metabolic response.

Summary Background & aims Coronavirus disease 2019 (COVID-19) is an ongoing pandemic outbreak leading to more than 1 million deaths worldwide as reported in 2020. Several risk assessment tools, including individual vulnerability to COVID-19, have been developed. The present study aimed to characterize a high-risk population using such a tool and examine risk factors and nutritional status in the national survey data and estimate the region-specific population size. Methods The study included 17,540 Korean adults who participated in the Korea National Health and Nutrition Examination Survey (KNHANES). The risk scores for individual vulnerability to COVID-19 were calculated based on age, sex, smoking status, and comorbidities, and a high-risk population was defined as having risk scores ≥11. Nutritional status was compared between the high-risk population and the remaining participants in the KNHANES data. The region-specific population size was estimated using national statistics. Results The proportion of the high-risk population was estimated to be 10.5%, which corresponds to approximately 4.6 million adults in South Korea. About 20% of them had inadequate intake of all of vitamins A, B1, B2, B3, and C below the estimated average requirement. The high-risk population showed 1.65 [95% confidence interval: 1.39, 1.96] higher odds of inadequate intake of multiple vitamins than the remaining participants. In the ecological analysis, the region-specific numbers of the high-risk population correlated significantly with the actual numbers of deaths due to COVID-19 (P value = 0.013). Conclusions These results suggest that individuals vulnerable to COVID-19, in particular those are living in densely populated regions, should pay particular attention to the protection against this pandemic and have adequate nutritional status, which may support optimal immune function.

Background and Objective There are few studies assessing diagnostic accuracy of the STOP-BANG questionnaire, which is a screening tool for detecting obstructive sleep apnea (OSA), in the general population. Our study aimed to develop a modified version of this screening questionnaire and compare its diagnostic accuracy to the standard version in general Korean adults. Methods A cross-sectional polysomnographic study was conducted among 2065 male and female participants aged 48–79 years, who were members of a population-based cohort study. Half of them were assigned to the exploratory sample and the other half to the validation sample. Results In this study, 958 individuals (487 in an exploratory sample) were identified to have OSA. To develop a model in an exploratory sample, stepwise analysis was used with information from the standard version and additional variables; snoring, witnessed breathing cessation, hypertension, body mass index > 25 kg/m2, age groups, male, diabetes, and waist circumference > 85 cm were included in a final modified model. In the evaluation of diagnostic accuracy in a validation sample, the modified model showed higher sensitivity [79.1%, 95% confidence interval (CI): 77.3, 80.9] in detecting severe OSA than that of the standard version model (66.0%, 95% CI: 64.0, 68.0). Overall accuracy indicated as area under the receiver-operating characteristic curve for the modified model was greater (p = 0.001) than that of the standard version model. Conclusions These findings suggest that the modified version of the STOP-BANG questionnaire may be useful in detecting severe OSA in general adults.

There is an increasing need for portable sleep monitoring in clinical practice, but there is no comparative study that used the same device for home and in-laboratory sleep monitoring and device close to full polysomnography (PSG) to evaluate the feasibility and preference of home unattended sleep monitoring. Twenty male participants with high risk for moderate to severe OSA based on the STOP-BANG questionnaire were included. The participants were randomly assigned to group A (home unattended monitoring after in-laboratory monitoring) or group B (in-laboratory monitoring after home unattended monitoring). A 2-week washout period was implemented between the sleep tests. All hook-up procedures were performed in laboratory. Participants were asked to complete a questionnaire after finishing each sleep test. There was no difference in sleep efficiency, arousal index, or time spent in each sleep stage between the two monitoring modes using Nox-A1. Additionally, other respiratory parameters such as apnea–hypopnea index (AHI), supine AHI, and snoring time did not differ. A high and similar sensor quality for airflow, oxygen, and respiratory effort was observed in both monitoring groups. Patient’s feelings and satisfaction with the test were similar between in-laboratory and home monitoring, but preference rate for the in-laboratory test was higher than that for home monitoring (70% vs. 30%, respectively). These data suggest that home unattended monitoring with Nox-A1 type 2 ambulatory device is a feasible alternative diagnostic mode for high risk of moderate to severe OSA, yielding reliable quality recordings and high patient satisfaction.

Introduction Mounting evidence indicates a significant relationship between Sasang constitutional types (SCTs) and metabolic syndrome (MetS), and between metabolic hormones and risk of MetS. However, studies have not yet examined whether the impact of metabolic hormones on MetS differs according to SCT. The aim of this study was to investigate whether the association of adiponectin, ghrelin, leptin with MetS and metabolic components is affected by SCTs. Methods A total of 2370 subjects (1201 men and 1169 women) who participated in the Korean Genome and Epidemiology Study-Ansan cohort between 2007 and 2008 and completed the health-related questionnaire, anthropometric evaluation, and biochemical measurements were included in the analysis. Each constitutional type was defined using an integrated diagnostic method. Total adiponectin, ghrelin, and leptin levels were determined by enzyme-linked immunosorbent assay or radioimmunoassay. Results Tae-eum (TE) type had the highest frequency of MetS (29.9%). In multivariate logistic regression analysis adjusted for possible confounders, adiponectin (OR = 0.88, 95% CI: 0.84–0.92; P Conclusions This population-based study showed different association of adiponectin, ghrelin, and leptin with MetS and its components according to SCT.

BACKGROUND There are limited data on the association between obstructive sleep apnea (OSA), which is characterized by intermittent hypoxia, and male-pattern baldness (MPB). Low blood iron levels are reportedly associated with hypoxia and hair loss. This study explored a possible link among OSA, iron status, and MPB. METHODS Polysomnography (PSG) and hair assessments were conducted in a cross-sectional study including 932 men aged 46-76 years. OSA was defined as an apnea-hypopnea index ≥5 by PSG evaluation and MPB as scales from IV to VII according to the Norwood-Hamilton scale classification. Serum transferrin saturation (TSA) levels were assessed. RESULTS A total of 224 men (24%) were identified as MPB cases and 495 men (53%) as having OSA. After considering potential risk factors, OSA and other sleep-related variables were not associated with MPB. In joint analysis of OSA and family history of hair loss, men with these two factors showed a sevenfold higher multivariate odds ratio (95% confidence interval: 3.70, 12.56) for MPB than those without both of them (P

To evaluate the effects of poly-gamma-glutamic acid (γ-PGA) administration on inflammatory and metabolic biomarkers in sleep-restricted rats, we conducted an experimental study with 30 Wistar male rats aged 10 weeks. These animals were evenly and randomly assigned to each of three groups including a normal control (NC) group, a sleep-restricted control (SRC) group, and a sleep-restricted experimental (SRE) group. During the 1-week period of experiments, saline for the NC group, caffeine (20 mg/kg) for the SRC group, and caffeine (20 mg/kg) and γ-PGA (25 mg/kg) for the SRE group were administered orally using a sonde attached to a syringe. At the end of the experiments, the rats were killed and their serum samples were collected to analyze levels of high-sensitivity C-reactive protein (hs-CRP), as an inflammatory biomarker, and biomarkers of glucose and lipid metabolism including lipoprotein cholesterol fractions, adiponectin, and leptin. The SRE group showed significantly lower hs-CRP levels than the SRC group (p = 0.03), whereas the SRC group tended to have higher levels of total cholesterol than the NC group and the SRE group. In the SRE group, no correlation of serum hs-CRP levels with weight and adiponectin and leptin levels was observed, although a reduction in weight was observed during the experimental period. No significant differences in other biomarkers were observed between groups. Based on these results, we suggest that γ-PGA administration may relieve pro-inflammation directly, not mediated by weight change or metabolic alteration, in sleep-restricted rats.

BACKGROUND/OBJECTIVES There are limited studies investigating the eating patterns of children's favorite foods. The present study aimed to evaluate a wide range of children's favorite foods, derive its eating patterns, and identify factors related to the patterns. SUBJECTS/METHODS A nationwide cross-sectional study included 5,458 students in elementary, middle, and high schools. The survey was conducted at each school to evaluate children's favorite food intake, including the intake frequency of 31 food items or food groups, and its related factors, such as demographic, economic, and environmental characteristics and awareness of policies on children's favorite foods. Factor analysis using varimax rotation method and logistic regression analysis were conducted. RESULTS Two factors were derived as major eating patterns from data of children's favorite foods: the 'unhealthy eating pattern' which mainly involves confectionery, chocolate, ramen, fried food, etc.; and the 'healthy eating pattern' which mainly involves soybean milk, vegetables, fruit juice, and nuts. A stepwise selection procedure through the regression analysis revealed that allowance, use of screen media, less awareness of policies on children's favorite foods, and less interest in health were positively related to the tendency of unhealthy or less-healthy eating patterns (P < 0.05). CONCLUSIONS This study examined that the eating patterns of children's favorite foods were associated with certain environmental characteristics and awareness about the related policies. These findings suggest that a nutrition education program regarding children's favorite foods needs to be conducted according to the characteristics of students to develop their healthy eating habits and proper choice of favorite foods.

There are limited data on the association between Fe overload and leucocyte telomere length (LTL), known as a useful biomarker of the replicative ageing of cells. The aim of the study was to evaluate associations between Fe-status biomarkers and LTL. A cross-sectional study included 1174 men and women aged 50–79 years who provided blood samples for assays of Fe-status biomarkers including ferritin, transferrin saturation (TSAT), total Fe-binding capacity (TIBC) and relative LTL. They were free of hepatitis, potential infection or Fe deficiency. In multiple linear regression analysis adjusted for potential confounding variables, log-transformed LTL was positively associated with TIBC (adjusted coefficient estimate for its highest quartile: 0·17 (se 0·03), Pse 0·03), P45 %) but also with high-normal concentrations (35–45 %) of TSAT had shorter LTL compared with those with low-normal concentrations (P

The present study investigated caffeinated beverage consumption and screen time in the association with excessive daytime sleepiness (EDS) and sleep duration. We conducted a cross-sectional study including 249 Korean male high school students. These participants responded to a questionnaire inquiring the information on lifestyle factors, consumption of caffeinated beverages, time spent for screen media, and sleep duration as well as to the Epworth Sleepiness Scale (ESS) questionnaire. EDS was defined as ESS scores of 9 or greater. Students with EDS consumed greater amount of chocolate/cocoa drinks and spent longer time for a TV and a mobile phone than those without EDS (p < 0.05). In addition, students with short sleep (≤ 6 hours) consumed greater amount of coffee than others whereas students with long sleep (> 8 hours) consumed greater amount of chocolate/cocoa drinks than others (p < 0.05). Screen time did not differ according to the categories of sleep duration. Although these findings do not support causal relationships, they suggest that screen time is associated with EDS, but not with sleep duration, and that consumption of certain types of caffeinated beverages is associated with EDS and sleep duration. Adolescents may need to reduce screen time and caffeine consumption to improve sleep quality and avoid daytime sleepiness.

BACKGROUND/OBJECTIVES A number of studies examined secular trends in blood lipid profiles using time series data of national surveys whereas few studies investigated individual-level factors contributing to such trends. The present study aimed to examine secular trends in dietary and modifiable factors and hyper-LDL-cholesterolemia (HC) prevalence and evaluate their associations using time series data of nationwide surveys. SUBJECTS/METHODS The study included 41,073 Korean adults aged ≥ 30 years from the 2005, 2007-2009, 2010-2012, 2013-2015, and 2016 Korea National Health and Nutrition Examination Surveys. Stepwise logistic regression analysis was performed to select significant factors associated with HC, which was defined as serum LDL cholesterol levels ≥130 mg/dL. RESULTS The following factors showed a positive association with HC (P < 0.05): for men having higher body mass index (BMI), being married, having an office job, and consuming higher dairy and vegetable oil products; for women having higher age or BMI, having no job or a non-office job, not in a low-income household, and consuming higher dairy products. In the given model, the 2016 survey data showed that a 2 kg/m2 reduction in BMI of obese persons resulted in a decreased HC prevalence from 30.8% to 29.3% among men and from 33.6% to 32.5% among women. CONCLUSIONS Based on these findings, it is suggested that primary prevention programs should advocate having proper BMI for Korean adults with a high-risk of HC. However, whether discouraging consumption of dairy and vegetable oil products can reduce HC prevalence warrants further studies with a prospective longitudinal design.

BACKGROUD/OBJECTIVES Data regarding the effects of poly-γ-glutamic acid (γ-PGA) on sleep status are limited. This study aimed to test whether γ-PGA and vitamin B6 (VitB6) supplements improve sleep duration and quality. SUBJECTS/METHODS A factorial randomized, double-blinded, placebo-controlled crossover study included 47 adults (25 men and 22 women) who were free of chronic disease. Stratified randomized allocation considered age and gender for three interventions, group A (supplementation with γ-PGA 600 mg; n = 16), group B (supplementation with VitB6 100 mg; n = 14), and group C (dual supplementation of both γ-PGA 600 mg and VitB6 100 mg; n = 17). Participants underwent a 1-mon intervention period, followed by a 1-mon washout period, and then a second 1-mon intervention period. Differences (mean ± SD) in nighttime sleep status before and after supplementation were compared between the placebo and intervention groups using nonparametric tests. RESULTS Significant changes in sleep duration (0.27 ± 0.98 h, P < 0.05) and the Pittsburgh Sleep Quality Index global score (-0.52 ± 1.58, P < 0.05) indicating improved sleep status were observed in the intervention compared with the placebo of group C while no significant changes were observed in groups A and B. No statistical significance was detected between the intervention and the placebo; however, there was a greater increase in the group C intervention (4.59 ± 38.5 ng/mL) in serum serotonin concentrations than the groups A and B interventions. No side effects were observed. CONCLUSIONS On the basis of these findings, the dual supplementation of γ-PGA and VitB6 may be effective as functional food components to improve nighttime sleep status. Trial Registration Clinical Research Information Service Identifier: KCT0005083.

Study objectives Age-related brain white matter changes (WMC) have been associated separately with obstructive sleep apnea (OSA) and short telomere length (TL). No studies have examined their interaction effect on WMC. Methods This is a cross-sectional study with a community-based sample of 420 participants (mean age, 61.3 ± 7.2) from the Korean Genome and Epidemiology Study during 2011-2012. An overnight fasted blood sample was taken to determine glucose and blood lipid levels at the sleep laboratory of Korea University Ansan Hospital. The status of brain WMC was determined using structural magnetic resonance imaging at 1.5 Tesla. Overnight polysomnography was performed, and leukocyte TL was measured. OSA was determined based on apnea-hypopnea index, and short TL was defined as the lowest quartile of the study participants. Results Adjusting for age, sex, BMI, smoking, drinking, snoring, and hypertension, odds ratio (OR) of brain WMC was estimated using multivariate logistic regression. The odds ratio was significant for cardiovascular disease (OR, 4.5; 95% CI, 1.2-16.3) and OSA (OR, 4.0; 95% CI, 1.0-15.2) among those with short TL; and for diabetes (OR, 3.0; 95% CI, 1.3-13.0) and age (OR, 1.1; 95% CI, 1.0-1.1) among those with longer TL. Interaction effect of OSA and short TL (OR, 4.3; 95% CI, 1.4-13.8) was significant, compared to those with neither OSA nor short TL. Conclusions This study provides a first evidence of mediated interaction of short TL with OSA on brain WMC in a community-based sample. The results generate new hypotheses regarding mechanisms of impaired brain health in sleep apnea.

Background Data on the association between alcohol consumption and telomere length, a marker of biological aging, are inconsistent. Moreover, the genetic modification of this association has been reported only rarely. To evaluate the association between alcohol consumption and leukocyte telomere length (LTL), and the effect modification of this association by a common polymorphism of the aldehyde dehydrogenase 2 (ALDH2) gene, we conducted a cross-sectional study in a general population including 1,771 middle-aged and elderly Koreans, aged 49 to 79 years. Methods Study participants provided blood samples between 2011 and 2012 for the LTL assay, and between 2001 and 2002 for genomewide genotyping. Between 2011 and 2012, they also completed a questionnaire-based interview regarding their alcohol consumption. We examined effect modification by rs2074356, a surrogate marker of the ALDH2 polymorphism. Results Heavy alcohol consumption (average daily alcohol consumption of >30 g) was inversely associated with LTL only among carriers of the mutant alleles (CT and TT) of rs2074356 (p

Folate, vitamin B12, and homocysteine (HCY) are involved in the metabolism of nucleic acid precursors and it has been hypothesized that they also influence telomere length, a biomarker of aging. However, previous studies have reported inconsistent findings, and data for older adults are limited. Our study aimed to evaluate associations between leukocyte telomere length (LTL) and serum folate, vitamin B12, and HCY levels among adults aged 55 years and over. In a cross-sectional study in 798 men and women aged 55-79 years, serum folate, vitamin B12, and HCY levels were measured using chemiluminescent immunometric assays, and relative LTL was assessed using quantitative real-time polymerase chain reaction. To evaluate associations between LTL and serum folate, vitamin B12, and HCY levels, multiple linear regression models were used. In multiple models adjusted for age, sex, serum high sensitive C-reactive protein (hs-CRP) levels, and other potential confounding factors, we found no association between LTL and serum folate, vitamin B12, and HCY levels. However, we did find a significant inverse association between HCY levels and LTL in participants with serum hs-CRP levels of ≥ 2 mg/L (p < 0.05). Moreover, there was a trend toward an association between HCY and vitamin B12 levels in these individuals (p = 0.08). In those with serum hs-CRP levels of < 2 mg/L, HCY was inversely associated with vitamin B12 levels (p < 0.001) and had no association with LTL. Our findings suggest that increased serum HCY levels, when combined with the presence of systemic inflammation, may play a role in accelerating biological aging.

STUDY OBJECTIVE There are few studies on gene-environment interactions with obstructive sleep apnea (OSA). Our study aimed to explore genetic polymorphisms associated with OSA using genome-wide association (GWA) data and evaluate the effects of relevant polymorphisms on the association between risk factors, including obesity and alcohol consumption, and OSA. We also investigated on these associations in relation to cerebral white matter hyperintensities (WMH) on magnetic resonance images. DESIGN A cross-sectional design. SETTING A polysomnography study embedded in a population-based cohort from the Korean Genome Epidemiology Study was conducted in 2011-2013. PARTICIPANTS 1,763 participants aged 48-78 years. RESULTS 251 individuals were identified to have OSA with an apnea-hypopnea index ≥ 15. A common polymorphism of neuregulin-1 gene (NRG1), rs10097555, was selected as the most suggestive locus associated with OSA (P value < 10(-5)) based on the results of GWA analysis in a matched case-control subsample (n = 470). Among 1,763 participants, we found that the presence of the NRG1 polymorphism is inversely associated with OSA (P value < 0.01) even after taking into account potential risk factors; the multivariate odds ratio (95% confidence interval) for the mutant alleles was 0.57 (0.39-0.82) compared with the wild-type. We observed that this association is modified by alcohol consumption (P < 0.05), not by obesity. We also observed that WMH are positively associated with OSA independent of the NRG1 polymorphism and alcohol consumption (P < 0.05). CONCLUSIONS These findings suggest that the neuregulin-1 gene (NRG1) may be involved in the etiological mechanisms of obstructive sleep apnea (OSA) and that carriers of a particular NRG1 mutation may be less likely to have OSA if they do not drink alcoholic beverages.

BACKGROUND/OBJECTIVES: It is well-known that alcohol consumption is associated with stroke risk as well as with aldehyde dehydrogenase 2 gene (ALDH2) polymorphisms. However, it is unclear whether ALDH2 polymorphisms are associated with stroke risk independent of alcohol consumption and whether such association is modified by sex. We evaluated sex-specific associations of a common ALDH2 polymorphism and alcohol consumption with stroke risk in a Korean population. SUBJECTS/METHODS: We conducted a prospective cohort study involving 8,465 men and women, aged 40-69 years and free of stroke between June, 2001 and January, 2003, and followed for the development of stroke. We identified new cases of stroke, which were self-reported or ascertained from vital registration data. Based on genome-wide association data, we selected a single-nucleotide polymorphism (rs2074356), which shows high linkage disequilibrium with the functional polymorphism of ALDH2. We conducted Cox proportional hazards regression analysis considering potential risk factors collected from a baseline questionnaire. RESULTS: Over the median follow-up of 8 years, 121 cases of stroke were identified. Carrying the wild-type allele of the ALDH2 polymorphism increased stroke risk among men. The multivariate hazard ratio [95% confidence interval] of stroke was 2.02 [1.03-3.99] for the wild-type allele compared with the mutant alleles, but the association was attenuated after controlling for alcohol consumption. Combinations of the wild-type allele and other risk factors of stroke, such as old age, diabetes mellitus, and habitual snoring, synergistically increased the risk among men. Among women, however, the ALDH2 polymorphism was not associated with stroke risk. CONCLUSIONS: The prospective cohort study showed a significant association between a common ALDH2 polymorphism and stroke risk in Korean men, but not in Korean women, and also demonstrated that men with genetic disadvantages gain more risk when having risk factors of stroke. Thus, these men may need to make more concerted efforts to control modifiable risk factors of stroke.

Supplemental Digital Content is available in the text, The fat mass and obesity-associated (FTO) rs9939609 polymorphism have been associated with the increased metabolic risk and mortality, irrespective of obesity. The mechanism underlying this association is not known. We aimed to evaluate whether the FTO rs9939609 risk variant is independently associated with metabolic risk factors and/or leukocyte telomere length (LTL). We further aimed to investigate whether this relationship is modified by obesity status. A total of 2133 participants were recruited from the Korean Genome and Epidemiology Study. LTL was measured using the real-time quantitative polymerase chain reaction methodology. The FTO rs9939609 polymorphism was genotyped using DNA samples collected at baseline. The proportions of the TT, TA, and AA genotypes were 76.7%, 21.5%, and 1.8%, respectively, and obese subjects comprised 44.5% of the total subjects. Among the 1184 nonobese subjects, body mass index, waist circumference, and visceral fat area were higher in subjects with the FTO risk allele than in noncarriers. In contrast, only high-sensitive C-reactive protein level was associated with the FTO risk allele in the obese subjects. LTL was significantly shorter in carriers of the FTO risk allele compared with noncarriers after controlling for several confounding factors (P

BACKGROUND/OBJECTIVES Telomere length is a useful biomarker for determining general aging status. Some studies have reported an association between alcohol consumption and telomere length in a general population; however, it is unclear whether the alcohol flush reaction, which is an alcohol-related trait predominantly due to acetaldehyde dehydrogenase deficiency, is associated with telomere length. This cross-sectional study aimed to evaluate the associations of alcohol consumption and alcohol flush reaction with leukocyte telomere length (LTL). SUBJECTS/METHODS The study included 1,803 Korean adults. Participants provided blood specimens for LTL measurement assay and reported their alcohol drinking status and the presence of an alcohol flush reaction via a questionnaire-based interview. Relative LTL was determined by using a quantitative polymerase chain reaction. Statistical analysis used multiple linear regression models stratified by sex and age groups, and potential confounding factors were considered. RESULTS Age-specific analyses showed that heavy alcohol consumption (> 30 g/day) was strongly associated with a reduced LTL in participants aged ≥ 65 years (P < 0.001) but not in younger participants. Similarly, the alcohol flush reaction was associated with a reduced LTL only in older participants who consumed > 15 g/day of alcohol (P < 0.01). No significant alcohol consumption or alcohol flush reaction associations with LTL were observed in the sex-specific analyses. CONCLUSIONS The results suggest that older alcohol drinkers, particularly those with the alcohol flush reaction, may have an accelerated aging process.

Background Subclinical left ventricular (LV) diastolic dysfunction in type 2 diabetes (T2D) is a common finding and represents an early sign of diabetic cardiomyopathy. However, the relationship between LV diastolic dysfunction and the incident T2D has not been previously studied. Methods A total of 1817 non-diabetic participants (mean age, 54 years; 48% men) from the Korean Genome and Epidemiology Study who were free of cardiovascular disease were studied. LV structure and function were assessed by conventional echocardiography and tissue Doppler imaging. Subclinical LV diastolic dysfunction was defined using age-specific cutoff limits for early diastolic (Em) velocity, mitral E/Em ratio, and left atrial volume index. Results During the 6-year follow-up period, 273 participants (15%) developed T2D. Participants with incident T2D had greater LV mass index (86.7 ± 16.4 vs. 91.2 ± 17.0 g/m2), worse diastolic function, reflected by lower Em velocity (7.67 ± 1.80 vs. 7.47 ± 1.70) and higher E/Em ratio (9.19 ± 2.55 vs. 10.23 ± 3.00), and higher prevalence of LV diastolic dysfunction (34.6 vs. 54.2%), compared with those who did not develop T2D (all P

Obesity and low muscle mass may coexist as age-related changes in body composition. We aimed to investigate the effect of visceral adiposity and skeletal muscle mass on left ventricular (LV) structure and function in the general population.A total of 1941 participants without known cardiovascular disease were enrolled from the Korean Genome and Epidemiology Study. Visceral fat area (VFA) was assessed by computed tomography. Appendicular skeletal muscle mass (ASM) was estimated by dual-energy X-ray absorptiometry and was used as a percentage of body weight (ASM/Wt). LV structure and function were assessed by tissue Doppler imaging (TDI) echocardiography.Across VFA tertiles, ASM increased, but ASM/Wt decreased (all P0.001). In multivariate models adjusted for conventional cardiovascular risk factors, LV mass index and LV diastolic parameters, such as left atrial dimension, TDI Ea velocity, and E/Ea ratio, were significantly impaired as VFA increased. On the other hand, an increase in ASM/Wt was associated with a decrease in LV mass index and improvement of LV diastolic parameters. With regard to LV mass index and TDI Ea velocity, VFA and ASM/Wt showed synergistic effects (all P interaction0.05). When both VFA and ASM/Wt were simultaneously included in the same model, both remained independent predictors of LV mass index and TDI Ea velocity.More visceral fat and less muscle mass are independently and synergistically associated with an increase in LV mass index and impairment of LV diastolic parameters. Further research is needed to explore the complex mechanisms underlying these associations.

To explore biological mechanisms underlying the association between sleep fragmentation and hypercholesterolemia, we conducted an experimental study with 36 Wistar male rats aged 7 weeks. An experimental model for 4-day subchronic sleep fragmentation was applied to rats which were fed ad libitum or were given 50% restricted amount of standard chow. Sleep fragmentation was induced by a treadmill which moved intermittently for 3 s with 30-second pauses between moves. Blood lipid and lipoprotein profiles and adiponectin, leptin, ghrelin, cortisol, epinephrine, and norepinephrine levels were compared among four groups including rats with ad libitum sleep and ad libitum intake (Control), those exposed to sleep fragmentation with ad libitum intake (SF), those with ad libitum sleep and diet restriction (DR), and those exposed to sleep fragmentation and diet restriction (SF+DR). SF and SF+DR showed a higher ratio of LDL and HDL cholesterol (184% and 132% increase, P-value for SF effects

Background There are few studies on the association between nutrient intake and telomere length, which may reflect cumulative oxidative stress and indicate biological ageing. In the present study, we evaluated longitudinal associations between the consumption of micronutrients, including antioxidant nutrients and B vitamins involved in one-carbon transfer pathways, and leukocyte telomere length (LTL). Methods The study included 1958 middle-aged and older Korean men and women (age range at baseline: 40–69 years) from a population-based cohort. We collected dietary information at baseline using a semiquantitative food frequency questionnaire (June 2001 to January 2003) and assessed the consumption of micronutrients, including vitamins A, B1, B2, B3, B6, B9 (folate), C and E, as well as calcium, phosphorus, potassium, iron and zinc. We measured LTL using a real-time polymerase chain reaction at the 10-year follow-up examination (February 2011 to November 2012). Results In the multiple regression model adjusted for potential confounders, LTL was positively associated with the consumption of vitamin C (P < 0.05), folate (P = 0.05) and potassium (P = 0.05) in all participants. In the age-stratified analysis, the association between the consumption of vitamin C (P < 0.01), folate (P < 0.05) and potassium (P < 0.05) with LTL was significant only among participants aged

Hypertension is associated with cardiovascular organ damage. However, data are scanty on whether individual forms or combinations of subclinical target organ damage (TOD) increase the risk of incident hypertension in nonhypertensive study participants.A total of 1785 nonhypertensive participants from the fourth biennial examination (2007-2008) of the Korean Genome and Epidemiology Study were followed-up for four years. Echocardiographic left ventricular (LV) hypertrophy, LV diastolic dysfunction, increased carotid intima-media thickness (cIMT), and brachial-ankle pulse wave velocity (baPWV) were defined according to the current guidelines.During 4-year follow-up, 19.9% of participants developed hypertension. In multivariate Cox proportional hazards models, the adjusted hazard ratios for developing hypertension were 1.39, 1.66, 1.48, and 0.78 for higher values of the LV mass index, cIMT, baPWV, and tissue Doppler e' velocity, respectively (all P 0.01). The hazard ratios for LV hypertrophy, LV diastolic dysfunction, cIMT75th percentile, and baPWV ≥ 1400 cm/s were 1.61, 1.30, 1.86, and 2.07, respectively (all P 0.05). Compared with participants without any TOD, those with combinations of TOD types had significantly greater risk for developing hypertension (hazard ratio = 2.12 and 3.98 for 1-2 and 3-4 TOD sites, respectively, all P 0.001).In the nonhypertensive population, each subclinical form of TOD independently predicts incident hypertension. In addition, the combinations of various forms of TOD are associated with stepwise increases in the risk for developing hypertension. The results suggest that asymptomatic TOD does not always exist in an intermediate stage in the cardiovascular continuum.

Data are limited on cardiovascular disease (CVD) risk prediction models that include dietary predictors. Using known risk factors and dietary information, we constructed and evaluated CVD risk prediction models. Data for modeling were from population-based prospective cohort studies comprised of 9026 men and women aged 40–69 years. At baseline, all were free of known CVD and cancer, and were followed up for CVD incidence during an 8-year period. We used Cox proportional hazard regression analysis to construct a traditional risk factor model, an office-based model, and two diet-containing models and evaluated these models by calculating Akaike information criterion (AIC), C-statistics, integrated discrimination improvement (IDI), net reclassification improvement (NRI) and calibration statistic. We constructed diet-containing models with significant dietary predictors such as poultry, legumes, carbonated soft drinks or green tea consumption. Adding dietary predictors to the traditional model yielded a decrease in AIC (delta AIC=15), a 53% increase in relative IDI (P-value for IDI

Background and Objective Many attempts have sought to devise an animal model of sleep fragmentation (SF) to understand the clinical effects of sleep loss, but no study has investigated the usefulness of the walking wheel method to interrupt sleep in rats. Methods Seven-week-old male Wistar rats were divided into a SF group and an exercise control (EC) group, with five rats in each. SF was achieved with a walking wheel using a 30 s on, 90 s off interval (total walking time 6 h/day). The EC group walked the same distance. Rat multiple sleep latency test was performed to measure sleepiness in rats. Sleep data were collected at baseline, and 4, 12, and 18 days after treatment. Percent (%) time spent awake and in non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, NREM and wake bout number, NREM bout length, and mean sleep latency were analyzed. Results Numbers of NREM and wake bout were higher in the SF group, whereas the NREM bout length was smaller than in the baseline group. Unlike NREM, REM sleep (%) in the SF group was significantly lower than in the baseline and EC groups. Mean sleep latency was shortened in the SF group compared to the baseline and EC groups. EC did not differ significantly with respect to the amount of sleep time (%), bout number of NREM and wakefulness, NREM bout length, and mean sleep latency, compared to its own baseline. Conclusions Use of a walking wheel is an effective means of interrupting sleep in rats during a long-term period.

OBJECTIVE Healthy obese phenotype with favorable metabolic profiles is proposed. However, whether healthy obesity leads to target organ changes is controversial. We investigated the impact of a healthy obesity on cardiovascular structure and function. METHODS A total of 2540 participants without known cardiovascular disease were enrolled. According to BMI and the metabolic syndrome (MetS) component, the participants were divided into six groups: healthy (none of five MetS components) normal weight (BMI

Background and Objective Reportedly, snoring is associated with chronic bronchitis. This association warrants further studies including polysomnographic evaluations because of few epidemiologic studies on the association. Via a polysomnography study, we evaluated the associations of snoring, obstructive sleep apnea, and systemic inflammation with chronic bronchitis among 442 participants from a population-based cohort. Methods At baseline, we assessed participants’ serum levels of C-reactive protein, a biomarker of systemic inflammation. Over a 5-year period, we conducted overnight polysomnography and identified any new cases of chronic bronchitis. Results After taking into account age, smoking, and other potential risk factors, the multivariate odds ratio (95% CI) for chronic bronchitis was 2.9 (95% CI, 1.3–6.4) for snorers with cumulative duration of snoring episodes ≥ 1 hour as compared with those snoring < 1 hour. This association did not change after further adjustment for the presence of apnea. Obstructive sleep apnea had no association with chronic bronchitis. A higher level of serum C-reactive protein was associated with chronic bronchitis (p value for trend < 0.05). In a joint analysis of snoring and C-reactive protein, longer cumulative duration of snoring episodes accompanied by systemic inflammation was associated with a 10-fold (95% CI, 2.9 to 37.4) increase in the multivariate odds of chronic bronchitis. Conclusions This polysomnography study provides additional data supporting the hypothesis that snoring is associated with chronic bronchitis implying that snoring-related local and systemic inflammation may play roles in the development of chronic bronchitis.

Adiponectin is associated with obesity and insulin resistance. To date, there has been no genome-wide association study (GWAS) of adiponectin levels in Asians. Here we present a GWAS of a cohort of Korean volunteers. A total of 4,001 subjects were genotyped by using a genome-wide marker panel in a two-stage design (979 subjects initially and 3,022 in a second stage). Another 2,304 subjects were used for follow-up replication studies with selected markers. In the discovery phase, the top SNP associated with mean log adiponectin was rs3865188 in CDH13 on chromosome 16 (p = 1.69 × 10(-15) in the initial sample, p = 6.58 × 10(-39) in the second genome-wide sample, and p = 2.12 × 10(-32) in the replication sample). The meta-analysis p value for rs3865188 in all 6,305 individuals was 2.82 × 10(-83). The association of rs3865188 with high-molecular-weight adiponectin (p = 7.36 × 10(-58)) was even stronger in the third sample. A reporter assay that evaluated the effects of a CDH13 promoter SNP in complete linkage disequilibrium with rs3865188 revealed that the major allele increased expression 2.2-fold. This study clearly shows that genetic variants in CDH13 influence adiponectin levels in Korean adults.

Background Whether or not fish and n-3 fatty acid intake is associated with the metabolic syndrome risk has not been carefully evaluated. This study investigated the effect of fish and n-3 fatty acid intake on the incidence of metabolic syndrome and on the individual risk factors for the syndrome. Methods A population-based prospective cohort study included 3,504 male and female Koreans aged 40 to 69 years from the Korean Genome Epidemiology Study. At the beginning of follow-up, all individuals were free of metabolic syndrome and known cardiovascular disease. Each participant completed a food frequency questionnaire. Incident cases of metabolic syndrome were identified by biennial health examinations during a follow-up period between April 17, 2003, and November 17, 2006. Pooled logistic regression analysis was applied to obtain an odds ratio (OR) of metabolic syndrome with its 95% confidence interval (CI) for fish or n-3 fatty acid intake. Results After controlling for potential cardiovascular risk factors, multivariate OR for metabolic syndrome was 0.43 (95% CI 0.23 to 0.83) for men who ate fish daily when compared with those eating fish less than once a week. Similarly, metabolic syndrome risk was halved for men in the top decile of n-3 fatty acid intake when compared with those in the bottom decile (OR 0.53, 95% CI 0.28 to 0.99). In particular, fish intake was significantly associated with triglyceride level and high-density lipoprotein cholesterol level among the metabolic syndrome components. For women, apparent associations were not observed between fish intake or n-3 fatty acid intake and metabolic syndrome risk. Conclusions In a prospective study, high consumption of fish and n-3 fatty acids was significantly associated with a lower risk of metabolic syndrome among men, but not among women. Whether or not encouraging fish intake can help prevent the development of metabolic syndrome warrants further studies.

Obesity is consistently reported to have a positive association with the development of habitual snoring. Whether lifestyle factors modify the association between body weight and the future risk of snoring has not been examined. In a prospective cohort study, we evaluated the association of lifestyle factors and body mass index (BMI) with the development of snoring. The study population (497 men and 670 women aged 40–69 years) were drawn from an ongoing population-based cohort. At baseline, all participants were free of cardiovascular disease and snoring at night. Information on lifestyle factors and snoring frequencies was obtained from interviewer-based questionnaires. During the 4-year follow-up, 533 participants reported new onset snoring. After adjusting for age, sex, and other potential risk factors, overweight persons with a BMI of _25 kg/m2 were found to have a 48% excess (95% confidence interval, 10% to 100%) in the odds of developing snoring compared with those with a BMI of ?23 kg/m2. In particular, we found that alcohol drinking and frequent exercise modify the association between BMI and the development of snoring; alcohol drinkers showed a stronger association than abstainers and persons who did not frequently exercise showed a stronger association than those exercising 4 days per week. We observed that even overweight persons who drink alcohol or do not exercise frequently had a higher chance of becoming snorers. Further evaluations are warranted to confirm whether abstaining from alcohol and frequent exercise can help prevent future snoring.