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Background: Uric acid has antioxidant properties, and several studies have suggested its neuroprotective effects. Despite reports of increased oxidative damage and decreased antioxidants in anxiety disorders, findings remain inconclusive. This study investigated the association between serum uric acid levels and anxiety symptoms, stratified by sex, using nationwide data from South Korea. Methods: Data were derived from the Korea National Health and Nutrition Examination Survey, which included 2,228 males and 2,805 females. Presence of anxiety symptoms was defined as a Generalized Anxiety Disorder 7-item scale (GAD-7) score of ≥ 10. Study participants were categorized into three groups based on serum uric acid levels: 1 (lowest) to 3 (highest). Multivariable logistic regression analyzed the association between uric acid levels and anxiety symptoms, stratified by sex. Results: Compared to reference group 2, females in group 1 had increased anxiety symptoms (odds ratio (OR) 2.28, 95% confidence interval (CI) 1.48–3.49). When anxiety symptoms were defined as a GAD-7 score of ≥ 5, females in groups 1 (OR 1.68, 95% CI 1.30–2.16) and 3 (OR 1.35, 95% CI 1.04–1.74) both showed more anxiety symptoms than group 2, with a U-shaped relationship between uric acid levels and anxiety symptoms. In males, uric acid levels weren't significantly linked to anxiety symptoms. Conclusions: This study indicates that low serum uric acid levels are associated with a higher prevalence of anxiety symptoms only in females, suggesting involvement of oxidative stress in anxiety disorders and its sex-based variation. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is linked to various health conditions, including cardiovascular diseases and metabolic disorders. Hyperuricemia and gout may be associated with OSA, but large-scale studies on this are limited. This study aimed to investigate the association between hyperuricemia/gout and OSA using data from the Korea National Health and Nutrition Survey (KNHANES). Methods: Using the 2019–2021 KNHANES data, 11,728 participants were selected. OSA risk was assessed using the STOP-BANG questionnaire score, which is as follows: (1) high-risk (5–8), (2) intermediate-risk (3–4), and (3) low-risk (0–2). Anthropometric, socioeconomic, health-related variables, and biochemical measurements, including serum uric acid (SUA) levels, were included in the analysis. Multiple regression analyses examined the association between the STOP-BANG score and hyperuricemia/gout. Results: After assigning weights, among 25,354,276 individuals, 3,114,119 (12.2%) had a high OSA risk. The high OSA risk group exhibited higher SUA levels (5.9 mg/dL) than those of the intermediate (5.6 mg/dL) and low OSA risk groups (4.7 mg/dL) (P < 0.001). Additionally, it had a higher incidence of physician-diagnosed gout than the other groups (6.6% vs. 3.8% vs. 0.8%, respectively, P < 0.001). The STOP-BANG questionnaire scores and SUA levels were positively correlated (r = 0.383; P < 0.001). When adjusted for confounding factors, the high OSA risk group demonstrated an association with hyperuricemia (SUA ≥ 6.8 mg/d) (adjusted Odds Ratio [OR]: 1.462, 95% Confidence interval [CI]: 1.108–1.929). High and intermediate OSA risk was associated with severe hyperuricemia (SUA ≥ 9.0 mg/dL) and gout; however, the significant association between OSA and severe hyperuricemia and gout attenuated to null after adjusting for confounding factors. Conclusions: High OSA risk was independently associated with hyperuricemia but not severe hyperuricemia or gout. Screening and management of OSA may help prevent hyperuricemia. [ABSTRACT FROM AUTHOR]

Abstract The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) has not yet been fully elucidated. Therefore, the objective of this study was to evaluate the connection between OSA risk and CRS by investigating associations between the STOP-Bang questionnaire and presence of CRS in a nationwide, population-based study. This is a cross-sectional study based on the Korean National Health and Nutrition Examination Survey (KNHANES). We evaluated 10,081 subjects who completed both the STOP-Bang and CRS-related questionnaires. Among the total subjects, 390 (3.9%) were CRS patients. The median STOP-Bang score was 3.0 [2.0; 4.0] in CRS patients, compared to 2.0 [1.0; 3.0] in subjects without CRS. In a low-risk group according to the STOP-Bang questionnaire, 3.1% of subjects were CRS patients. However, a gradual increase was observed among different risk groups. In the higher risk group, CRS patients accounted for 5.3% (P

Background: This study evaluated the relationship between aging and tympanometric changes, specifically the incidence of type C tympanograms, using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: We analyzed data from the 2019–2022 KNHANES, including 26,738 ears from individuals aged 40 and older. Tympanometry at 226 Hz identified type C tympanograms based on peak pressure below −100 daPa. Multiple logistic regression evaluated the association between age and type C tympanograms, adjusting for confounders such as sex, smoking status, allergic rhinitis, chronic sinusitis, and lifestyle disease markers. Results: The incidence of type C tympanograms increased significantly with age (R2 = 0.953, p < 0.001). Age was the most significant factor associated with type C tympanograms (p < 0.001, odds ratio 1.052), while other factors were not statistically significant. Ears with type C tympanograms had significantly poorer hearing thresholds compared to those with type A tympanograms (p < 0.001). Conclusions: Aging is significantly associated with an increased incidence of type C tympanograms, indicating possible middle ear dysfunction in older adults. The correlation between type C tympanograms and poorer hearing thresholds suggests that age-related changes in middle ear function may contribute to hearing impairment. Tympanometric screening in older adults may facilitate early detection and management of middle ear dysfunction, potentially improving hearing outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background and Objectives: Respiratory and periodontal diseases are among the most common diseases affecting humans worldwide. Periodontal disease is a risk factor for aspiration pneumonia and other respiratory diseases. However, the evidence supporting the link between respiratory and periodontal disease is inconclusive and insufficient. Therefore, this study aimed to investigate the relationship between oral disease symptoms and respiratory diseases. Materials and Methods: Adults who underwent oral examinations and lung disease tests were recruited from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 14,956 individuals participated in the 2019 KNHANES. Among the 6846 participants who underwent oral examinations, 1320 children and adolescents were excluded. Additionally, of the 4119 adults aged ≥40 years who underwent dual lung function tests, those who did not respond to key independent confounding variables were excluded. The final sample consisted of 2988 adults. Results: Complex sample multivariate logistic regression analysis revealed that the risk of restrictive ventilation disorder was lower in individuals without chewing discomfort compared to individuals with chewing discomfort (odds ratio, 0.68; 95% confidence interval, 0.479–0.996), and the difference was statistically significant. Only one significant difference was observed between the two groups. Conclusions: Chewing discomfort is a major periodontal health-related factor associated with chronic obstructive pulmonary disease (COPD). Although the exact mechanism underlying the relationship between masticatory discomfort and COPD remains unclear, masticatory discomfort is an early symptom of oral diseases. The findings from this study provide additional basic data for the prevention of oral diseases and COPD in Korea. [ABSTRACT FROM AUTHOR]

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

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

Insulin resistance is closely associated with metabolic diseases such as type 2 diabetes and cardiovascular disease, and the resting heart rate (RHR) is an important marker of the autonomic nervous system's status. This study aimed to investigate the association between the RHR and the homeostatic model assessment of insulin resistance (HOMA-IR) in Korean adults. Using data from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES 2019), we analyzed 6118 adults and classified the participants into four groups based on their RHR (≤67, 68–71, 72–79, and ≥80 beats/min [bpm]). Logistic regression analysis considering demographic, lifestyle, and biochemical factors revealed that the odds of having a HOMA-IR of 2.5 or higher were significantly increased in the higher RHR groups. Specifically, compared to the ≤67 bpm group, the 68–71, 72–79, and ≥80 bpm groups had increased odds of 1.277, 1.599, and 1.919 times, respectively. These results are expected to contribute to the development of strategies for the early diagnosis and management of metabolic diseases through the RHR, and further research is needed to deepen the understanding of the physiological mechanisms of this relationship, including the management of the RHR through lifestyle modification and regular exercise and the effect of reducing insulin resistance. [ABSTRACT FROM AUTHOR]

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

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

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

BackgroundPatients with low back pain (LBP) often suffer from sleep disorder, and insufficient sleep duration was recognized as a potential risk factor for LBP. Our aim was to explore the exact effect of sleep duration on LBP and the optimal sleep duration to reduce the risk of LBP.MethodsAnalyzing data from the Korean National Health and Nutrition Examination Survey (KNHANES), we investigated the association between sleep duration and LBP in individuals aged 50 years and older. We used logistic regression models, interaction stratification analysis, and threshold effect assessment to analyze the relationship between sleep duration and LBP.ResultsA total of 6,285 participants, comprising 3,056 males and 3,229 females with a median age of 63.1 years, were enrolled in the study. The association between sleep duration and LBP risk exhibited an L-shaped curve (p < 0.015) in RCS analysis. In the threshold analysis, the OR of developing risk of LBP was 0.864 (95% CI:0.78–0.957, p = 0.005) in participants with sleep duration

Objectives: This study aimed to compare the distinct socio-ecological characteristics, nutritional status, and nutrient intake quality of the older adults based on breakfast skipping (EBF, eating breakfast vs. SBF, skipping breakfast). This study also investigated the association between breakfast skipping, socioecological features, and quality of nutrient consumption. Method: From the 8th Korea National Health and Nutrition Examination Survey (KNHANES, 2020), data of 92,093 subjects aged ≥ 65 years old (male: 43,910 and female: 48,183) having data with eating habits, such as nutrient intake and skipping breakfast were analyzed. Results: The average age of SBF was markedly lower than EBF. EBF had a lower employed status, education level, heavy alcohol intake frequency, smoking, and eating out regularly than SBF. Compared to EBF, SBF showed a significantly higher BMI and waist circumference. Moreover, EBF showed a markedly higher average intake in energy, protein, fiber, calcium, and iron compared with SBF, while SBF had a noticeably higher mean intake in fat, saturated fat, and sugar. In addition, SBF had a significantly reduced mean adequacy ratio (MAR, adjusted OR: 0.260 [95% CI: 0.245−0.276]) and the value of index nutritional quality (INQ, adjusted OR: 0.847 [95% CI: 0.799−0.898]) compared with EBF. Discussion: There were distinct socioecological features and nutritional conditions of older adults relying on breakfast skipping; and a strong association between breakfast skipping, socioecological parameters, and nutrient intake quality. These observations provide the significance of breakfast skipping in the nutritional status of older adults and offer fundamental information for nutritional education and implications for older adults.

This study examined the association between achieving the recommended physical activity level and quality of life after controlling for depression. Health information from adults aged 65 years and older, who had participated in the seventh 2018 Korea National Health and Nutrition Examination Survey, was used. Five covariate adjustment models were used to derive robust estimates of the association between physical activity practice levels, depression, and older adults' quality of life. A total of 1,336 older adults was extracted from the seventh 2018 Korea National Health and Nutrition Examination Survey, and 31% of the older adults achieved the recommended physical activity level, whereas 69% did not. We found that the achievement of physical activity practice levels is significantly associated with the quality of life of the older adults (β = 0.024–0.031, all p <.05). Our results could be used for advocating for welfare policy changes that promote physical activity to prepare for the upcoming super-aging society. [ABSTRACT FROM AUTHOR]

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

Abstract The purpose of this study is to investigate the association between handgrip strength (HGS) and health-related quality of life (HRQoL), demonstrating HGS as an effective indicator for evaluating HRQoL of patients with cancer. Analyzing 1657 Korean adult cancer patients (644 males, 1013 females) aged ≥ 20 years from the Korea National Health and Nutrition Examination Survey (2014–2019), HGS was standardized based on body mass index and categorized by sex. HRQoL was assessed using the Euro Quality of Life-5-Dimension 3-Level version (EQ-5D-3L) Index. Lower relative HGS was associated with decreased HRQoL in female patients, while no significant association was found in male patients. The lowest quartile of relative HGS exhibited a 2.5-fold decrease in HRQoL compared to the highest quartile (OR 2.50, 95% CI 1.59–3.95, p

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

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

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

Objectives: This study aimed to investigate the association between multimorbidity, which refers to the presence of two or more chronic diseases, and periodontal disease in Korean adults using national survey data. Methods: A total of 12,440 Korean adults aged ≥19 years were selected from the seventh Korea National Health and Nutrition Examination Survey (KNHANES). We investigated periodontal disease status based on various variables, including the gender, age, educational level, income level, smoking and alcohol drinking status, frequency of daily toothbrushing, and unmet dental treatment needs. Furthermore, periodontal status according to diagnosed chronic diseases, including hypertension, dyslipidaemia, stroke, myocardial infarction, angina pectoris, and diabetes, was investigated, and the association between multimorbidity and periodontal disease was analysed through multiple logistic regression using SAS 9.4. Results: According to the general characteristics of the study participants, the prevalence of periodontal disease was higher in males, smokers, older age, and lower educational and income levels (p < 0.001). Moreover, as the frequency of daily toothbrushing increased, the distribution of periodontal disease decreased (p < 0.001). The prevalence of periodontal disease was higher in those with chronic diseases than in those without chronic diseases and was statistically significantly higher as the number of diagnosed chronic diseases increased (p < 0.001). Additionally, an increase in the number of chronic diseases was observed to increase the prevalence and risk of periodontal disease. Conclusion: These results suggest that multimorbidity significantly affects the prevalence of periodontal disease. [ABSTRACT FROM AUTHOR]

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

This study aimed to compare the dietary factors related to sarcopenia and obesity status in 5458 elderly individuals (2391 men and 3076 women) aged ≥65 years from the Korean National Health and Nutrition Examination Survey (2016–2019). Participants were categorized into normal, sarcopenia, obesity, and sarcopenic obesity groups. Sarcopenic obesity showed a higher prevalence of diabetes and lower HDL cholesterol levels compared to obesity. Sarcopenic obesity exhibited a lower total KHEI score and lower adequacy, including meat/fish/eggs/beans, than normal or obesity. In women, sarcopenic obesity scored lower than obesity on the total KHEI, adequacy for most foods, and balance of energy intake, and lower than sarcopenia on the adequacy of breakfast and milk/milk products. Sarcopenic obesity showed no significant difference in energy intake compared to sarcopenia, and less physical activity compared to sarcopenia and obesity, with a BMI/waist circumference comparable to that of obesity. Low total KHEI scores and scores for meat/fish/eggs/beans were most closely associated with sarcopenia in men and with sarcopenic obesity in women. In conclusion, low dietary quality and inadequate protein-rich foods are possibly associated with the prevalence of sarcopenic obesity in elderly Koreans, especially in women. Adequate energy intake and dietary diversity may be effective in managing sarcopenic obesity. [ABSTRACT FROM AUTHOR]

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

Cancer screening is pivotal for early detection and improved survival rates. While socio-ecological factors are known to influence screening uptake, the role of lifestyle, dietary habits, and general health in shaping these decisions remains underexplored. Utilizing the 2019 Korea National Health and Nutrition Examination Survey (KNHANES), this study examined the myriad of factors impacting cancer screening utilization. Data from 274,872 adults aged 40 years or older were scrutinized, highlighting demographics, income, lifestyle behaviors, health-related variables, nutrient intake, and dietary quality. A combination of descriptive statistics and logistic regression helped us ascertain influential determinants. Higher educational attainment and income quartiles were positively correlated with cancer screening rates. Regular walkers, those engaged in moderate physical activity, and individuals with a previous cancer diagnosis were more likely to get screened. High-risk drinkers and smokers were less inclined towards screening. Dietary habits also influenced screening decisions. Notably, participants with healthier eating behaviors, indicated by factors such as regular breakfasts and fewer meals out, were more likely to undergo screening. Additionally, nutrient intake analysis revealed that those who had undergone screening consumed greater quantities of most nutrients, bar a few exceptions. For individuals aged 50–64, nutritional assessment indicators highlighted a higher mean adequacy ratio (MAR) and index of nutritional quality (INQ) value among those who participated in screening, suggesting better nutritional quality. This study elucidates the complex socio-ecological and nutritional landscape influencing cancer screening decisions. The results underscore the importance of a holistic approach, emphasizing lifestyle, dietary habits, and socio-economic considerations. It provides a roadmap for policymakers to craft more inclusive screening programs, ensuring equal access and promoting early detection. [ABSTRACT FROM AUTHOR]

The increased life expectancy and the occurrence of premature menopause prolong the mean postmenopausal phase in women's lifespans. Although the roles of poor socioeconomic status (SES), anthropometric characteristics, and nutritional status in premature menopause and the health of postmenopausal women are well understood, the differences in nutritional status and metabolic syndrome (MetS) prevalence in postmenopausal women depending on their menopause age are less explored. Furthermore, the association between SES and MetS risk in postmenopausal women is not studied. Thus, this study aimed to compare distinct nutritional status and MetS risk between women with premature menopause and natural menopause. Additionally, the association among SES, health-related lifestyle behaviors (HLBs), and MetS risk in postmenopausal women was studied. This study included 31,799 postmenopausal women from the 8th National Health and Nutrition Examination Survey (KNHANES). The relationship between disease prevalence and nutrient intake of the subjects was analyzed using analysis of variance (GLM), and Scheffé test was performed. Multiple logistic regression analysis was used to evaluate the association among SES, HLBs, and MetS as well as premature menopause. Women with premature menopause showed poor SES, anthropometric characteristics, and HLBs compared with women with natural menopause. Additionally, premature menopausal women had markedly lower intakes of protein, polyunsaturated fatty acid, n-3 fatty acid, and β-carotene, but higher intakes of energy, carbohydrate, saturated fatty acid, and sugar than women with natural menopause (p < 0.0001). Premature menopausal women showed significantly higher MetS prevalence by having hypertriglyceridemia (p < 0.0001), hypertension (p = 0.0145), and reduced HDL cholesterol levels (p < 0.0001) relative to natural menopausal women. Furthermore, our findings indicate a substantial link among SES, HLBs, and the risk of premature menopause. In postmenopausal women, deteriorating SES and HLBs appear to influence the prevalence of MetS. Notably, our study reveals that higher intakes of protein, calcium, phosphate, and iron are correlated with a lower risk of developing MetS. These observations suggest that proactive nutritional education for premature menopausal women is necessary to improve MetS risk and their nutritional status. Also, SES-dependent interventions regarding nutrition and HLBs in postmenopausal women will be significant to lower MetS risk, MetS-derived chronic disease, and mortality in postmenopausal women. [ABSTRACT FROM AUTHOR]

This study aimed to identify the combined factors of physical activity and diet associated with non-sarcopenic non-obese status in 1586 diabetic patients aged ≥65 years from the Korean National Health and Nutrition Examination Survey (2016 to 2019). Participants were categorized into non-sarcopenic non-obesity (NSNO), sarcopenia non-obesity (SNO), non-sarcopenic obesity (NSO), and sarcopenic obesity (SO) groups. NSNO had lower insulin, HOMA-IR, and triglycerides compared to NSO and SO. NSNO had lower perceived stress, higher nutrition education and dietary supplement intake. As assessed by the Korean Healthy Eating Index, NSNO scored higher total than SNO and SO, in breakfast and energy balance compared to SO, and in the adequacy of vegetables and meat/fish/egg/bean compared to SNO. NSNO had significantly higher energy and protein intake and physical activity, with BMI/waist circumference lower than NSO, SO, and comparable to SNO. Physical activity was positively associated with NSNO. Low Total KHEI score and protein intake level reduced the odds ratio (OR) of NSNO, particularly when physical activity was insufficient, with OR = 0.38 for KHEI Q1 and OR = 0.32 for protein T1. In conclusion, physical activity, diet quality, and protein intake are associated with NSNO prevalence in Korean elderly with diabetes, and energy balance through active intake and expenditure may be effective. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate the relationship between dietary polyamine intake and all-cause and cardiovascular disease (CVD)-related mortality in Korean population. Methods: A total of 37,715 participants were included in a population-based cohort study. Dietary polyamine intake (µmol/d) were calculated using the average spermidine and spermine content (µmol/g) and daily consumed food components (mg/d) from 12 food groups. Cox proportional hazards examined associations between dietary polyamine and all-cause and CVD-related mortality. Results: Among the participants, 2,080 all-cause and 483 CVD-related deaths occurred. The lowest risk of all-cause and CVD-related mortality was found in the highest tertile of fruit, vegetables, legume, nut and seafood-derived spermidine and spermine intake, after adjusting covariates. The relationship between dietary polyamine intake and all-cause and CVD-related mortality was more pronounced in men and older individuals than in their counterparts. Conclusions: Higher intake of mediterranean-like diet derived polyamine was associated with lower CVD-related and all-cause mortality in Korean adults.

This study aimed to evaluate the prevalence, trends, and risk factors of early chronic obstructive pulmonary disease (COPD) by using a nationally representative sample. The datasets of the Korea National Health and Nutrition Examination Survey 2010–2019 were used, where 80,860 individuals were identified; of these, 9,045 participants aged 40–49 years who underwent spirometry with no missing data were analyzed. Early COPD was defined as forced expiratory volume in 1 s /forced vital capacity ratio

Background and Objectives: Respiratory and periodontal diseases are among the most common diseases affecting humans worldwide. Periodontal disease is a risk factor for aspiration pneumonia and other respiratory diseases. However, the evidence supporting the link between respiratory and periodontal disease is inconclusive and insufficient. Therefore, this study aimed to investigate the relationship between oral disease symptoms and respiratory diseases. Materials and Methods: Adults who underwent oral examinations and lung disease tests were recruited from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 14,956 individuals participated in the 2019 KNHANES. Among the 6846 participants who underwent oral examinations, 1320 children and adolescents were excluded. Additionally, of the 4119 adults aged ≥40 years who underwent dual lung function tests, those who did not respond to key independent confounding variables were excluded. The final sample consisted of 2988 adults. Results: Complex sample multivariate logistic regression analysis revealed that the risk of restrictive ventilation disorder was lower in individuals without chewing discomfort compared to individuals with chewing discomfort (odds ratio, 0.68; 95% confidence interval, 0.479–0.996), and the difference was statistically significant. Only one significant difference was observed between the two groups. Conclusions: Chewing discomfort is a major periodontal health-related factor associated with chronic obstructive pulmonary disease (COPD). Although the exact mechanism underlying the relationship between masticatory discomfort and COPD remains unclear, masticatory discomfort is an early symptom of oral diseases. The findings from this study provide additional basic data for the prevention of oral diseases and COPD in Korea.

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

Objectives: This study evaluated usual dietary intakes of total fat and fatty acids among the Korean population based on the revised Dietary Reference Intakes for Koreans 2020 (2020 KDRIs). Methods: This study utilized data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES 2019–2021). We included 18,895 individuals aged 1 year and above whose 1-day 24-hour dietary recall data were available. To calculate the external variability using the National Cancer Institute 1-day method, data from the U.S. NHANES 2017-March 2020 Pre-pandemic dataset were employed. The total fat and fatty acid intake were evaluated based on the Acceptable Macronutrient Distribution Ranges (AMDRs) and Adequate intake (AI) of 2020 KDRIs for each sex and age groups. Results: Approximately 86% of the Korean population obtained an adequate amount of energy from total fat consumption (within the AMDRs), indicating an appropriate level of intake. However, the percentage of individuals consuming saturated fatty acids below the AMDR was low, with only 12% among those under 19 years of age and 52% aged 19 years and older. On a positive note, approximately 70% of the population showed adequate consumption of essential fatty acids, exceeding the AI. Nevertheless, monitoring the intake ratio of omega 3 (n-3) to omega 6 (n-6) fatty acids is essential to ensure an optimum balance. Conclusions: This study explored the possibility of estimating the distribution of nutrient intake in a population by applying the external variability ratio. Therefore, if future KNHANES conduct multiple 24-hour recalls every few years-similar to the U.S. NHANES-even for a subset of participants, this may aid in the accurate assessment of the nutritional status of the population.

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

Insulin resistance is closely associated with metabolic diseases such as type 2 diabetes and cardiovascular disease, and the resting heart rate (RHR) is an important marker of the autonomic nervous system’s status. This study aimed to investigate the association between the RHR and the homeostatic model assessment of insulin resistance (HOMA-IR) in Korean adults. Using data from the 2019 Korea National Health and Nutrition Examination Survey (KNHANES 2019), we analyzed 6118 adults and classified the participants into four groups based on their RHR (≤67, 68–71, 72–79, and ≥80 beats/min [bpm]). Logistic regression analysis considering demographic, lifestyle, and biochemical factors revealed that the odds of having a HOMA-IR of 2.5 or higher were significantly increased in the higher RHR groups. Specifically, compared to the ≤67 bpm group, the 68–71, 72–79, and ≥80 bpm groups had increased odds of 1.277, 1.599, and 1.919 times, respectively. These results are expected to contribute to the development of strategies for the early diagnosis and management of metabolic diseases through the RHR, and further research is needed to deepen the understanding of the physiological mechanisms of this relationship, including the management of the RHR through lifestyle modification and regular exercise and the effect of reducing insulin resistance.

BackgroundThe rise in myopia prevalence, particularly among adolescents in East Asia, is a cause for concern. While a combination of environmental and genetic factors is understood to contribute to this trend, the role of dietary nutrients is not yet fully clarified.ObjectiveTo assess the potential association between the intake of specific nutrients and the prevalence of myopia in a large, population-based sample of Korean adolescents.MethodsData from 18,077 adolescents (average age: 15.05 ± 1.67 years; 51.7% male, 48.3% female) who participated in the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016) were analyzed. Refractive error was measured using an auto-refractor-keratometer (KR-8800) without cycloplegia. Dietary intake of 14 nutrients was assessed through a 24-h personalized dietary recall method.ResultsThe study revealed a myopia prevalence of 87.6% among the adolescents. Multivariable models adjusted for age, gender, BMI, and other confounding factors indicated that higher intakes of carbohydrates, proteins, cholesterol, sodium, and vitamin B2 were associated with an increased risk of myopia. Conversely, higher intake of vitamin C was found to be associated with a decreased risk.ConclusionThe findings suggested a potential association between dietary nutrient intake and myopia prevalence in Korean adolescents. While the study did not establish a causal link, the differences in nutrient intake between the myopic and non-myopic groups could indicate that diet plays a role in the development or progression of myopia. Further research is warranted to corroborate these findings and explore the underlying mechanisms.

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

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

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

A high prevalence of dyslipidemia has recently been shown not only in adults, but also in adolescents. When occurring in adolescence, dyslipidemia is a risk factor for cardiovascular disease in adulthood. This study aimed to identify significant factors affecting dyslipidemia in South Korean adolescents. We used data from the third year of the 8th Korea National Health and Nutrition Examination Survey (KNHANES VIII-3) on 381 Korean adolescents aged 12–18 years. The data were analyzed using frequency analysis, descriptive statistics, the Rao–Scott χ test, the t-test, and univariate and multivariate logistic regression using complex sample analysis. On a weighted population basis, 28.1% of the adolescents among the participants were identified as the group with dyslipidemia. Obesity, waist circumference, serum uric acid, and alanine aminotransferase (ALT) were significantly related to the prevalence of dyslipidemia. Physical activity 4–7 days a week was related to a decrease in the prevalence of dyslipidemia only in male adolescents. The results of this study can be used as evidence for the risk assessment of adolescent dyslipidemia and the establishment of systematic health management guidelines according to risk factors for the prevention of adolescent dyslipidemia. [ABSTRACT FROM AUTHOR]

We investigated whether cigarette smoking and dietary acid load (DAL) are associated with a risk of chronic obstructive pulmonary disease (COPD) in healthy, middle-aged Korean men. Healthy men without diagnosed chronic disease (aged 40–64 years) from the KNHANES-VI (2013–2015) were included in the analysis (n = 774) and were subdivided by smoking status and DAL levels, as estimated using the quartile of net endogenous acid production (NEAP). The current smokers tended to have a higher risk of COPD than the never-smokers before and after adjustment. When divided by the DAL quartile, the Q4 group tended to have a higher risk of COPD than the Q1 group. Additionally, the current smokers with lower (Q2), modest (Q3), and the highest NEAP scores (Q4) showed risks of COPD that were more than fourfold higher than those of the never-smokers with the lowest NEAP scores (Q1). The ex-smokers with higher NEAP scores (Q3 and Q4) showed risks of COPD that were more than fourfold higher than those of the Q1 group. Interestingly, the risk of COPD was also more than sixfold higher in the never-smokers with the highest NEAP scores compared to that in the Q1 group. The NEAP scores and smoking status synergistically increased the risk of COPD in healthy, middle-aged Korean men. This suggests that DAL levels are an important factor in the prevention and management of COPD. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction-associated steatotic liver disease (MASLD) is distinguished by the buildup of excessive liver fat unrelated to alcohol consumption. However, the role of alcohol consumption on disease progression is debatable. Recently, alcohol flushing syndrome in Asian populations has gained interest, and its role in the risk of developing MASLD is unknown. Therefore, in this cross-sectional study, we investigated the association between alcohol consumption and MASLD in Korean men, considering their alcohol flushing response and utilizing the lipid accumulation product (LAP) score. Data from the Korean National Health and Nutrition Examination Survey (2019–2021) were analyzed. Participants were categorized into non-or-infrequent drinkers and light-to-heavy drinkers and further sub-classified based on alcohol flushing response as non-flushers and flushers. Multivariate logistic regression analysis showed a significant association between alcohol consumption and MASLD risk in both non-flushers (aHR 1.90, 95% CI 1.51–2.40, p < 0.001) and flushers (aHR 2.35, 95% CI 1.94–2.84, p < 0.001) after adjusting for potential confounding factors such as age, exercise, smoking, body mass index, systolic blood pressure, total cholesterol, and fasting plasma glucose. There was a significant interaction between alcohol consumption and alcohol flushing response for MASLD risk (p for interaction < 0.001). These findings emphasize the importance of alcohol flushing as a potential indicator of MASLD risk in Korean men and highlight the need for further research to understand the underlying mechanisms and develop targeted preventive strategies. [ABSTRACT FROM AUTHOR]

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

Abstract Background Chronic kidney disease (CKD) has a significant impact on global health. Studies have shown that subclinical thyroid dysfunction may be related to CKD, but the association between subclinical thyroid dysfunction and CKD in the general population is unclear. We aimed to evaluate the risk of CKD according to thyroid function status in a large cohort. Methods We analyzed data from a nationwide, population-based, cross-sectional survey (KNHANES VI). A total of 3,257 participants aged ≥ 19 years who underwent thyroid and kidney function assessments were included in this study. CKD was defined as an estimated glomerular filtration rate

Objectives: The purpose of this study was to compare the sex-associated differences in the dietary intake of gastric cancer patients in Korea. Methods: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) the 7th (2016-2018) were analyzed in the present study. The subjects included 122 gastric cancer patients aged over 40 years (75 male, 47 female). General characteristics (age, marital status, household income, education, food security, comorbidities, alcohol drinking, and smoking), anthropometric characteristics (height, weight, body mass index, and blood pressure), blood biochemical characteristics [fasting plasma glucose (FPG), blood urea nitrogen (BUN), creatinine, triglyceride, total cholesterol, and HDL-cholesterol)], and quantity and quality of dietary intake were compared between male and female participants. Results: Males had higher rates of having a spouse, prevalence of hypertension, alcohol drinking, and smoking than females. The proportion of males with a normal range of FPG, BUN, and HDL-cholesterol was lower than that in females. The total cholesterol levels above the normal range were higher in females than in males. We also found that females had a higher percentage of intakes below the estimated energy requirement (EER) and intakes below the estimated average requirement (EAR) for carbohydrates, niacin, phosphorus, and iron than males. The index of nutritional quality (INQ) for phosphorus and folate, nutrient adequacy ratio (NAR) for vitamin C, thiamine, niacin, folate, calcium, and phosphorus, and the mean adequacy ratio (MAR) were lower in females than males. Conclusions: In Korean gastric cancer patients, management of comorbidities such as diabetes and hypertriglyceridemia, lowering FPG, and raising HDL-cholesterol level management is required for males, whereas management of lowering total cholesterol and raising hematocrit is required for females. The quantitative and qualitative nutritional intakes were poor in gastric cancer patients, especially in females, who had a lower nutritional intake than males. We suggest that nutritional interventions are needed to improve the overall nutritional intake in both male and female gastric cancer patients. In particular, we propose that support is urgently needed for females whose nutritional intake is lower than that of males. In addition, family, social, and national support for nutritional management of female gastric cancer patients is highly necessary.

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

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

Background and Objectives: Grip strength is a measure of general health and is associated with oral health. This study aimed to investigate the relationship between the number of teeth and grip strength in Korean adults. Methods and Materials: We recruited adult participants who underwent oral examinations in the Korean National Health and Nutrition Examination Survey (KNHANES) between 2016–2018. When performing the KNHANES oral examination, an experienced dentist performed it according to the oral examination guidelines and recorded the results. A total of 24,269 participants from the 2016–2018 KNHANES were included in this study. Of these, only 16,489 participants underwent oral screening. A total of 3209 were non-adult children and adolescents, and 1781 did not respond to the grip strength test; those who did not respond to the main independent confounder were excluded. The relationships between grip strength, general characteristics, general health, oral health, and the number of remaining teeth were analyzed. There were 11,499 subjects in total in this study, with 4839 males and 6660 females. The age groups were 19–65 years of age, with 8387 subjects, and 65 years and older, with 3112 subjects, and the number of remaining teeth was 0–9 for 936 subjects, 10–19 for 1015 subjects, and 20–28 for 9548 subjects. Results: The probability that the higher the grip strength, the higher the residual number of gingiva was estimated by multinomial logistic regression analysis using complex sampling. The higher the grip strength, the higher the probability of having 20–28 teeth remaining (adjusted odds ratio, 1.59; 95% confidence interval, 1.19–2.13). Conclusions: Maintaining general health is related to maintaining teeth; the higher the grip strength, the higher the number of remaining teeth. [ABSTRACT FROM AUTHOR]

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