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Background:Increasing evidence suggests that obesity is associated with a reduction in health-related quality of life (HRQL). HRQL is a widely used measure for assessing the degree of impairment in psychosocial and physical functions associated with disease states. This study aimed to examinethe association between weight control behaviors and HRQL in Korean adults without diabetes. Methods: This study used data from the 2017 Korea National Health and Nutrition Examination Survey. A total of 3,575 adults without diabetes were selected and divided into four groups according to their weight control behavior: trying to lose weight, trying to maintain weight, trying to gain weight, and not trying to control weight. HRQL was evaluated using the EuroQol five-dimensional (EQ-5D) questionnaire. The EQ-5D consists of five multiple-choice questions and one subjective health level. Health status was determined with respect to the following five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The participants were asked to choose one of the following three responses: “No problem at all,” “There are some problems,” or “There are many problems.” Results:A statistically significant difference in the EQ-5D index score was observed among the four groups before and after controlling for age, sex, and body mass index (BMI). ANOVA and Tukey’s post-hoc test showed that the “trying to maintain weight” group had the highest EQ-5D index score. The “trying to lose weight” group had the second highest EQ-5D index score, followed by the “not trying to control weight” group, whereas the “trying to gain weight” group had the lowest EQ-5D index score(p-value compared with the “trying to maintain weight” group = 0.053, 0.001, and 0.002, respectively). Conclusions: Participants trying to maintain their weight had the best quality of life. Individuals who are interested in their health tend to have a high quality of life. Conversely, individuals who are not interested in their health, such as those who are not trying to control their weight, tend to have a low quality of life. Furthermore, underweight individuals are against health promotion.

Psoriasis is a chronic autoimmune condition characterized by patches of abnormal skin. Currently, there is no cure for psoriasis, and treatment strategies aim to reduce the severity of symptoms. We report the case of a 71-year-old female with severe psoriasis under treatment with topical steroids, ultraviolet light, and immunosuppressants for 13 years. After receiving intravenous nutritional therapy, antihistamines, and adrenal extract, the patient experienced almost complete resolution of psoriatic patches on her body.

Metabolic syndrome is well known to increase the risk of cardiovascular diseases. We have reported that phytochemicals rich black rice with giant embryo reduced fat mass and metabolic disorders in an animal model. However, such effects have not been evaluated in humans. Subjects with metabolic syndrome (n = 49, 38 male, 44.3 ± 6.1 years) were randomly assigned into two groups and ingested roasted black-rice with giant embryo (BR, n = 26, 20 male) or white-rice (WR, n = 23, 18 male) powders mixed with water for breakfast for three months. Subjects were evaluated for various metabolic parameters before and after intervention. All parameters were not significantly different between groups before starting the intervention. After three months of consumption of either BR or WR, changes of body weight in BR vs WR groups (-1.54 kg vs -1.29 kg, p = 0.649) as well as waist circumference (-1.63 cm vs -1.02 cm, p = 0.365) were not significantly different between groups. However, changes in highly-sensitive C reactive proteins in BR vs WR groups (-0.110 mg/dl vs 0.017 mg/dl, p = 0.003) had significant differences. Three months of meal replacement with BR had a significant reduction of highly-sensitive C reactive protein compared to those with WR in adults with metabolic syndrome.

Background Obesity causes several changes in the body and is associated with both inflammation and oxidative stress. However, the relationship between abdominal obesity, diacron-reactive oxygen metabolites (d-ROMs), and biological antioxidant potential (BAP) levels in Korean adults has not yet been proved. The aim of this study was to evaluate the association between d-ROMs, BAP levels, and abdominal obesity in the Korean adult population using clinical data. Methods A total of 2,367 individuals, aged 18–86 years, were identified from health check-up examination records at a university hospital, between January 2015 and August 2016. Clinical and biochemical parameters, including waist circumference, lipid profile, alcohol drinking status, and smoking status, were investigated. Oxidative stress levels, viz., d-ROM concentration and antioxidant capacity, viz., BAP, were measured. Results Subjects with abdominal obesity presented significantly higher levels of d-ROMs compared to those with a normal waist circumference (P

Purpose. High sensitivity C-reactive protein (hs-CRP) has been used as a biomarker to assess the risk of cardiovascular accidents (CVA) and to measure general inflammation in the body. This study investigated the relationship and extent of correlation between serum glucose level markers and hs-CRP as a means to assess CVA risk through hemoglobin A1c (HbA1c) and fasting glucose levels. Methods. This cross-sectional, population-based study used data from the 2017 Korea National Health and Nutrition Examination Survey (KNHANES). From the total sample of 8,127 people, 4,590 subjects were excluded due to age ( n = 1,505 ), diabetes mellitus (DM) diagnosis or medication ( n = 596 ), inactivity ( n = 424 ), pregnancy ( n = 17 ), hypoglycemia ( n = 8 ), smoking history ( n = 1,077 ), and missing data ( n = 963 ). In total, 3,537 adults not diagnosed with diabetes were selected. Their hs-CRP levels were compared with the glucose level markers using a complex sample general linear regression analysis. Results. We adjusted for sedentary hours, smoking, binge drinking frequency, age, sex, mean SBP, triglycerides, and waist circumference. Increases in HbA1c correlated with hs-CRP levels ( B coefficient 95 % CI = 0.185 , p = 0.001 , and R 2 = 0.087 ). Changes in the fasting glucose levels were also associated with the hs-CRP levels ( B coefficient 95 % CI = 0.005 , p = 0.006 , and R 2 = 0.086 ). Conclusion. This study showed a linear association between HbA1c and fasting glucose levels and hs-CRP. It also showed that changes in the hs-CRP level were better correlated with those in the HbA1c levels than in the fasting glucose levels.

Summary Aim The aim of this study was to assess the effects of ursodeoxycholic acid composite (URSA-S) on fatigue in patients with elevated liver function tests and/or fatty liver disease. Methods In this multi-centre randomised double-blinded placebo-controlled trial, 168 adults who were diagnosed with fatigue based on our criteria and had elevated liver function tests (but not > 5 times the normal level) and/or fatty liver on ultrasonography, were randomised to either the placebo or URSA-S administration group. The rate of improvement of checklist individual strength (CIS) using a cut-off of 76 points at the end of the study (8 weeks), the change in fatigue scale [CIS score and visual analogue scale (VAS)] were evaluated. The adverse effects of URSA-S were also recorded. Results The rate of CIS improvement at the end-point was 79.76% and 45.68% in the therapy and placebo groups, respectively (p < 0.05). The fatigue recovery rate of the CIS score and VAS were higher in the therapy (−25.44 ± 18.57, −27.84 ± 2.70) than in the placebo group (−16.59 ± 17.29, −19.46 ± 2.81) (p < 0.05). The difference in fatigue recovery rate between the therapy and placebo groups was significant after 8 weeks. When analysed separately in patients with abnormal liver function tests and fatty liver disease, the fatigue recovery rate of the CIS score and VAS at 8 weeks was higher in the therapy than in the placebo group (p < 0.05). The frequency of adverse events in the therapy group was not significantly higher than that in the placebo group. Conclusion URSA-S is effective for alleviating fatigue in patients with liver dysfunction and/or fatty liver. The adverse effects of URSA-S are not significant. This study is registered at https://clinicaltrials.gov/ct2/show/NCT02415777.

Chronic fatigue (CF) is a common reason for consulting a physician due to affecting quality of life, but only a few effective treatments are available. The aim of this study was to examine the effectiveness of subcutaneous injection of the human placental extract (HPE) on medically indescribable cases of CF and safety in a randomized, double-blind, placebo-controlled clinical trial. A total of 78 subjects with CF were randomly assigned to either a HPE group or a placebo group. Subjects in the HPE group were treated with HPE three times a week subcutaneously for 6 weeks, whereas those in the placebo group with normal saline. Then, the fatigue severity scale (FSS), visual analog scale (VAS) and multidimensional fatigue inventory (MFI) were measured in both CF group and chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF) subgroup. The FSS, VAS and MFI score at baseline were not different between the HPE and placebo group in total subjects with CF. In CFS group, the FSS (p=0.0242), VAS (p=0.0009) and MFI (p=0.0159) scores measured at the end of the study period decreased more in the HPE group than in the placebo group when compared with those at the baseline. There were no significant differences between the HPE group and placebo group in the mean change from baseline in FSS, VAS, and MFI in subjects with ICF during the study period. The subcutaneous injection of HPE was effective in the improvement of CFS.

BACKGROUND Oxidative stress is implicated in the pathogenesis and development of lifestyle-related diseases. In the present study, we evaluated the correlation between the serum uric acid (UA) levels and oxidative status in Korean adults. METHODS The subjects were 5,093 individuals (2,041 women and 3,052 men) who underwent a health checkup between June 2012 and December 2016. Oxidative stress levels (derivatives of reactive oxygen metabolites [d-ROMs]) and antioxidant potential (biological antioxidant potential [BAP]) were measured. Metabolic markers, including UA, were also examined. RESULTS Higher serum UA levels were associated with decreased levels of d-ROMs (P

SETTING Emphysema without airway obstruction or airway obstruction without emphysema are often detected clinically, although they are commonly co-existent. We therefore tested the hypothesis that non-obstructive emphysema and pure airway obstruction have unique features. METHODS A case-control observation study was undertaken retrospectively in a patient cohort at a single centre. Among 2662 subjects who underwent chest computed tomography and pulmonary function tests, we enrolled 90 patients with non-obstructive emphysema, 119 with pure airway obstruction, 81 with obstructive emphysema and 2031 subjects as normal controls. The features of the four groups were analysed and compared. RESULTS Higher serum homocysteine (13.4 ± 7.4 vs. 11.6 ± 4.6 mol/l), higher rate of osteoporosis (15.8% vs. 4.5%), higher leukocyte count, higher male ratio, lower serum albumin and lower body mass index were observed in subjects with non-obstructive emphysema than in controls (P < 0.05). In multiple logistic regression analysis of groups without airway obstruction, osteoporosis, hyperhomocysteinaemia, hypoalbuminaemia and higher leukocyte count were independent factors associated with non-obstructive emphysema (P < 0.05). CONCLUSION Hyperhomocysteinaemia, hypoalbuminaemia, osteoporosis and higher leukocyte count were independent predictors of non-obstructive emphysema.

Objectives Stress is recognized as an important factor in the etiology of rheumatoid arthritis (RA). Therefore, we explored multiple aspects of stress in RA patients. Methods Salivary cortisol and α-amylase levels were measured as markers of the hypothalamic–pituitary–adrenal axis activity and sympatho-adrenomedullary system activity, respectively. Depression was assessed by the Beck Depression Inventory (BDI) and short-term analysis of the heart rate variability (HRV) was performed to evaluate the autonomic nervous system. Results The salivary cortisol levels of the RA patients were significantly higher than those of the normal controls (NC; 0.12 ± 0.162 μg/dL vs. 0.068 ± 0.052 μg/dL, P = 0.006). There was no difference in salivary α-amylase levels between the RA and the NC. The BDI levels of the RA patients were significantly higher than the NC (13.7 ± 8.9 vs. 6.4 ± 6.9, P

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

To describe the rationale, objectives, protocol, and preliminary results for a new prospective cohort study of cardiovascular disease (CVD) risk factors in South Korea.Study members were recruited from participants in routine health assessments at health promotion centres across South Korea. Established and emerging CVD risk factors were measured. Eighteen centres holding electronic health records agreed to linkage of participants' records to future health insurance claims for monitoring of disease events. The recruitment of 430,920 participants (266,782 men, 164,138 women), aged 30-74 years, provides broad geographical reach across South Korea.Risk factor prevalence was more favourable in women than men, and, in general, in the younger rather than older study members. There was also close similarity between the characteristics of the present sample and the Korean National Health and Nutrition Examination Survey. The expected associations between risk factors and both CVD and death were also apparent.Data from the present sample, based on data linkage, show close agreement with South Korea-wide surveys (for risk factor prevalence) and the extant literature (for risk factor associations). These findings gives confidence in future results anticipated from this cohort study of east Asians - a group that has been traditionally under-researched.

Compelling evidence suggests that bilirubin, via its antioxidant potential, has anti-atherogenic properties, and that serum bilirubin concentrations within the reference range for the general population may provide some protection against coronary artery disease (CAD). This study examined the association between serum total bilirubin concentration and Framingham risk score (FRS) in the Korean population.This cross-sectional study was performed on 19,792 Koreans. In addition to FRS, data on body mass index, fasting blood glucose, liver enzymes, lipid profile, uric acid, gamma glutamyltransferase, high-sensitive C-reactive protein and total bilirubin were used.Negative correlations were established between log-transformed total bilirubin concentration and FRS (females; r = -0.067, p0.001, males; r = -0.128, p0.001). Analyses relating total bilirubin to FRS ≥10% utilized multiple confounder adjusted logistic regression. Unadjusted odd ratios for FRS ≥10% were 0.325 (95% CI: 0.160-0.659, p = 0.002) and 0.342 (95% CI: 0.281-0.417, p0.001) for log-transformed total bilirubin in females and males, respectively. These inverse relationships remained significant after adjustments for multiple confounders in both genders.Increased total bilirubin concentrations are associated with the decrease in FRS. Serum total bilirubin may be helpful to decrease the future risk of CAD.

Introduction. Fatigue is a common symptom, but only a few effective treatments are available. This study was conducted to assess the efficacy and safety of the human placental extract solution, which has been known to have a fatigue recovery effect.Methods. A total of 315 subjects were randomly assigned to three groups: group 1 (with Unicenta solution administration), group 2 (with exclusively human placental extract administration, excluding other ingredients from the Unicenta solution), and the placebo group. Subsequently, solutions were administered for four weeks.Results. The fatigue recovery rate was 71.00% in group 1, 71.72% in group 2, and 44.21% in the placebo group, which show statistically significant differences between the group 1 and the placebo group (Pvalue = 0.0002), and between group 2 and the placebo group (Pvalue = 0.0001).Conclusion. The human placental extract solution was effective in the improvement of fatigue.

Purpose: Changes in human body composition can affect the accuracy of spine bone mineral density (BMD) measurements. The purpose of this study was to evaluate whether fat and water in the soft tissue of the abdomen influence lumbar spine BMD measurements obtained using dual energy X-ray absorptiometry (DXA). Materials and Methods: Duplicate BMD measurements were carried out on healthy volunteers (10 men and 10 women) and the Hologic anthropomorphic spine phantom had on the same day before and after placement of following 3 materials in the abdominal area: lard 900 g, 1.5 cm thick; oil 1.4 liters in a vinyl bag; and water 1.2 liters in a vinyl bag. Results: In the case of human participants, following the placement of exogenous water to mimic extracellular fluid (ECF), there was a significant decrease in lumbar spine BMD (-0.012 g/cm 2 , p=0.006), whereas the placement of exogenous lard and oil to mimic abdominal fat produced a slight increase in lumbar spine BMD (0.006 g/cm 2 , p=0.301; 0.008 g/cm 2 , p=0.250, respectively). The average percentage of lumbar spine BMD change with and without exogenous lard, oil, and water showed increase of 0.51%, and 0.67%, and decrease of 1.02%, respectively. Using the phantom, BMD decreased with the placement of both lard (-0.002 g/cm 2 , p=0.699) and water (-0.006 g/cm 2 , p=0.153); however, there was no difference in BMD after oil placement. Conclusion: These results suggest that in cases where changes in fat and ECF volume are similar, ECF exerts a greater influence than fat on DXA lumbar BMD measurements.

Testosterone deficiency is associated with late-onset hypogonadism. Micronutrients including copper (Cu) and zinc (Zn) influence testosterone synthesis. The association between micronutrient concentrations in hair tissue and serum testosterone was studied in Korean men. The subjects were 88 men 40-60 years of age who visited the health promotion center and an outpatient clinic of family medicine at a university hospital from March 2006 to February 2008. Population sociological features of the subjects were acquired by self-administered surveys and interview, height and weight were measured, serum total testosterone was determined in the morning, and Cu and Zn were quantified from hair tissue collected in the morning. Subjects with normal testosterone group had a significantly higher Zn level compared to low testosterone group (P = 0.003). Significant negative correlations were evident between total testosterone and Cu level (r = -0.252, P = 0.022), and the Cu/Zn ratio (r = -0.288, P = 0.008). Normal testosterone is associated with a higher Zn level. Decreased serum testosterone is significantly associated with a high level of Cu and elevated Cu/Zn ratio in hair tissue.

Objective: After menopause, women are at an increased risk of cardiovascular disease. The present study assessed cardiovascular hemodynamics in premenopausal versus postmenopausal women, with a focus on systemic vascular resistance (SVR) at rest and during stress. Sympathetic nervous system activity and cardiovascular adrenergic receptor (AR) function were also examined. Methods: A total of 90 women (45 premenopausal and 45 postmenopausal) completed a laboratory protocol composed of a resting baseline and four mental stress tasks. Measurements included blood pressure, cardiac output, SVR, and plasma catecholamine level. In addition, > -a ndA-AR responsiveness to the infusion of selective pharmacological agonists was assessed. Results: Compared with premenopausal women, postmenopausal women were characterized by similar blood pressure but lower cardiac output and higher SVR, both at rest and during stress (Ps G 0.05). Postmenopausal women also had higher baseline plasma norepinephrine levels (P = 0.007) and reduced A-AR responsiveness (P = 0.02), although differences in A-AR responsiveness may have been confounded by aging effects. Conclusions: After menopause, women exhibit altered sympathetic nervous system activity and a sustained increase in hemodynamic load that may contribute to pathological structural and functional changes in the heart and blood vessels.

Deficiency of minerals causes functional abnormality of enzymes, frequently resulting in metabolic disturbance. We investigated possible relationship between minerals and metabolic syndrome by analysis of hair tissue minerals. We selected 848 subjects older than 20 years of age at Ajou University Hospital from May 2004 to February 2007. We excluded the subjects who had cancers, steroid and thyroid medication, and incomplete record from the study. Finally, 343 subjects were eligible. We performed cross-sectional analysis for the relationship between minerals and metabolic syndrome. The contents of calcium, magnesium, and copper in the metabolic syndrome group were significantly lower than those of the normal group, whereas the amounts of sodium, potassium, and mercury in the metabolic syndrome group were significantly higher than those of the normal group. By dividing the subjects into quartile with the level of calcium, magnesium, and mercury concentrations, we carried out logistic regression analysis to study the subjects and found that the subjects in the third quartile of calcium and magnesium concentrations had significantly lower odds ratio (OR) of the metabolic syndrome compared with that of the lowest quartile group [OR = 0.30, confidence interval (CI) = 0.10-0.89; OR = 0.189, CI = 0.063-0.566] and that the subjects in the highest mercury quartile had significantly higher OR of the metabolic syndrome compared with that of the lowest mercury quartile group (OR = 7.35, CI = 1.73-31.1). As part of the metabolic syndrome, the optimal calcium and magnesium concentrations in hair tissue may reflect decreased risk of metabolic syndrome, whereas high mercury concentration in hair tissue may indicate increased risk of metabolic syndrome.

Objective In Korea, human placental extract (HPE) has recently been used to treat various diseases (chronic liver diseases, menopause syndrome, chronic fatigue, skin pigment diseases, etc.), but evidence-based studies are not yet sufficient. The aim of this study was to examine the effects of HPE on menopausal symptoms, fatigue, and risk factors for cardiovascular disease in middle-aged Korean women in a randomized controlled trial. Design Korean women, aged 40 to 64 years, with menopausal symptoms and fatigue were recruited as participants. The women were randomly assigned to a placebo group or an HPE group. The HPE group received subcutaneous injections of HPE in the abdomen for 8 weeks, whereas the placebo group received normal saline. Then, the Menopause Rating Scale, and Fatigue Severity Scale, and Visual Analog Scale were administered, and risk factors for cardiovascular disease were assessed. Results The Menopause Rating Scale total baseline score was not different between the two groups; however, the score of the HPE group decreased significantly at 8 weeks compared with that of the placebo group (P = 0.033). Fatigue Severity Scale and Visual Analog Scale scores of the placebo group did not change, whereas the scores of the HPE group decreased significantly during the study period (Fatigue Severity Scale, P = 0.002; Visual Analog Scale, P = 0.001). The baseline 17beta-estradiol level was not significantly different between the two groups, but the 17beta-estradiol level of the HPE group was significantly increased at 8 weeks compared with that of the placebo group (P = 0.031). No changes in risk factors for cardiovascular disease were observed in either group. Conclusions Menopausal symptoms and fatigue in middle-aged Korean women improved after 8 weeks of HPE treatment, whereas risk factors for cardiovascular disease did not change during the study period.

Objective: We investigated the difference in metabolic parameters by waist circumference (WC) and body mass index (BMI) in a population of Korean men and women. Method: We collected data on 69,535 Korean men and women and performed a cross-sectional analysis of the data. Study subjects were grouped by BMI and WC. We measured metabolic parameters for each group and compared the differences in the metabolic abnormalities. Subjects were grouped as follows: normal group (NG; normal WC and normal BMI); centrally obese group (COG; high WC and normal BMI); generally obese group (GOG; normal WC and high BMI); and combined obese group (COM; high WC and high BMI). Results: Subjects in the COM group showed more metabolic parameter abnormalities in comparison to the other groups. In men, triglyceride (TG) and fasting blood glucose (FBG) levels were higher in the COG than in the GOG. Correspondingly, total cholesterol (TC), TG, and FBG levels were higher in the female COG than in the female GOG. In addition, the mean numbers of abnormal metabolic parameters in the COG were higher than in the GOG for both men and women. More men and women developed metabolic syndrome in the COG (39.1% in men, 33.0% in women) than in the GOG (9.7% in men, 7.8% in women). Conclusion: Among Koreans, the COG had more metabolic abnormalities and metabolic syndrome than the GOG. (J Am Board Fam Med 2007;20:258 –265.)

Objective Gamma-glutamyltransferase (GGT) is a novel cardiovascular disease (CVD) risk factor, but its use as an independent factor for general CVD risk prediction remains unclear in general population. This study examined the association between serum GGT concentration and 10-year CVD risk in Koreans. Methods This cross-sectional study was performed on 27,270 Koreans. Besides individual components of 10-year CVD risk, body mass index, fasting blood glucose, liver enzymes, lipid profile, uric acid and high sensitive C-reactive protein data were used. The study subjects were grouped into quartiles according to the levels of GGT. Analyses relating GGT to 10-year CVD risk greater than 20% used multiple confounders-adjusted logistic regression. Results Positive correlations were established between log-transformed GGT concentration and 10-year CVD risk (Spearman's rho = 0.51; P < 0.001). Compared to the lowest baseline GGT category, unadjusted odds ratios for 10-year CVD risk greater than 20% were significantly increased from the lowest to the highest GGT quartiles; these results remained significant after adjustments for multiple confounders. Conclusion Increased GGT concentration is associated with the increase in 10-year CVD risk. Serum GGT may be helpful to predict the future risk of general CVD.

Smoking is a major risk factor for the development and progression of cardiovascular disease and cigarettes contain a slight amount of mercury. Mercury has been causally linked to cardiovascular diseases. This study evaluated the mercury content in hair according to smoking exposure status and the influence of the mercury level on blood pressure and lipid metabolism.We examined mercury concentration in the hair samples from 236 healthy people 16-75-years-of-age who had visited the health promotion center of a university hospital from January 2004 to January 2007. Self-reported cigarette smoking status and baseline health information were obtained using a questionnaire. Blood pressure and serum lipid level according to the mercury concentration were assessed.The mean systolic blood pressure in the smoking exposure group and non-exposure group were 123.2±15.4mmHg and 117.2±15.9mmHg, respectively (p=0.005). The mean diastolic pressure in the smoking exposure group and non-exposed group were 80.2±10.9mmHg and 75.1±11.3mmHg, respectively (p0.001). Mercury concentration had a positive relationship with systolic and diastolic blood pressure. Compared with the normal and high mercury groups, the normal mercury group demonstrated lower blood pressure, lower triglyceride, and lower smoking amount, but higher high density lipoprotein cholesterol than the high mercury group. There was an increase of mercury concentration in the smoking exposure group. The 20-29 packyear group showed significantly increased odds ratio of mercury content, compared with the non-exposure group (14.00, 95% confidence interval, 5.03-38.96).Smoking is positively associated with mercury accumulation, and high mercury concentration is associated with increased blood pressure and abnormal lipid metabolism.

Erosive esophagitis (EE) may be related to small intestinal bacterial overgrowth (SIBO) because gastro-esophageal reflux disease has been a comorbid condition of irritable bowel syndrome (IBS), which has been associated with SIBO. We conducted a pilot study to investigate whether EE was associated with SIBO.Twenty-eight patients with EE according to the Los Angeles classification criteria and 29 sex- and age-matched subjects without EE were enrolled. All subjects underwent esophagogastroduodenoscopy and a lactulose hydrogen breath test. A peak of H₂ values20 ppm above the basal value after 10 g of lactulose ingestion was considered abnormal and suggestive of SIBO.Abnormal lactulose hydrogen breath test results were found in 67% of EE patients, as compared with 37% in the control group; the difference was statistically significant (p = 0.024). Among the subjects without IBS, subjects with EE and controls had 65% and 31% abnormal lactulose hydrogen breath test results, respectively; the difference was also statistically significant (p = 0.032).Subjects with EE had a higher prevalence of SIBO, as assessed by the lactulose hydrogen breath test, with respect to a control group. These findings may suggest that EE is associated with SIBO.

Cardiovascular disease (CVD) is the primary cause of death in Korea. Hyperhomocysteinemia confers an independent risk for CVD comparable to the risk of smoking and hyperlipidemia. The purpose of this study was to assess the effect of cardiovascular risk factors and body composition change on homocysteine (Hcy) levels in Korean men and women. The association between body composition and Hcy levels was investigated in a 2-yr prospective cohort study of 2,590 Koreans (mean age 45.5±9.6 yr). There were 293 cases of hyperhomocysteinemia (>14 µM/L) at follow-up. Increases in total body fat proportion and decreases in lean body mass (LBM) were significantly associated with increases in Hcy concentration after controlling for confounding factors. Further adjustments for behavioral factors showed that decreases in LBM were associated with Hcy increase. Decrease in LBM also predicted hyperhomocysteinemia at follow-up, after controlling for confounding factors. There was no significant association between change in body mass index (BMI) and Hcy concentrations over time. Hcy changes over time were related to change in LBM and body fat content, whereas BMI or weight change did not predict change in Hcy levels. Changes in ratio of LBM to total fat mass may contribute to hyperhomocysteinemia.

Background Combined therapy with alendronate and calcitriol may have additive effects on bone density. An observational study was performed to evaluate the efficacy and safety of Maxmarvil, a combinative agent of alendronate (5 mg) and calcitriol (0.5 µg), and to identify factors associated with efficacy. Methods A total of 568 postmenopausal women with osteoporosis were enrolled by family physicians in 12 hospitals. The study subjects took Maxmarvil daily for 12 months. Questionnaires about baseline characteristics, socioeconomic status, and daily calcium intake were completed at the first visit. Adverse events were recorded every 3 months and bone mineral density (BMD) in the lumbar spine was measured using dual-energy X-ray absorptiometry at baseline and after 12 months. We evaluated the efficacy and safety of Maxmarvil, and the factors related to BMD improvement. Results A total of 370 patients were included in final analysis. The median BMD was 0.81 ± 0.12 g/cm2 at pre-treatment and 0.84 ± 0.13 g/cm2 after one year. The average BMD improvement was 3.4% ± 6.4% (P < 0.05), and 167 (45.1%) patients showed improvement. Factors associated with improved BMD were continuation of treatment (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.15 to 5.07) and good compliance (OR, 2.54; 95% CI, 1.29 to 5.00). Adverse events were reported by 35 of the 568 patients, with the most common being abdominal pain and dyspepsia. Conclusion Maxmarvil was found to be safe, well tolerated and effective in osteoporosis treatment. Continuation of treatment and good compliance were the factors associated with efficacy.

Objectives. Human placental extract (HPE) has begun to be used in Korea in various ways to improve health, even though evidence-based data is insufficient. This study investigated the effects of HPE on health status in elderly Koreans. Design. Randomized, single-blind, and case-control study design. Setting and Participants. Thirty-nine community-dwelling healthy Koreans ≥65 years of age. Intervention. The participants were randomly categorized into a placebo group ( 𝑛 = 1 7 ) and HPE group ( 𝑛 = 2 2 ). The HPE group received abdominal subcutaneous injections of HPE for 8 weeks. The placebo group was injected with normal saline. Measurements. The degree of health status was surveyed by the Korean health status measure for the elderly (KoHSME V1.0) at baseline and the end of the study. Results. In the HPE group, the scores of physical function, sexual life, and general heath perception at the end of the study period were significantly improved from baseline ( 𝑃 = . 0 0 7 , .020, and .005, resp.), while the health status of the placebo group remained unchanged during the study period. There was a significant difference over the study period between the two groups in the mean change of the physical function score ( 𝑃 = . 0 3 6 ). Conclusion. A HPE injection regimen can improve the health status in elderly Koreans.

Little is known about hair mineral status in fibromyalgia patients. This study evaluated the characteristics of hair minerals in female patients with fibromyalgia compared with a healthy reference group. Forty-four female patients diagnosed with fibromyalgia according to the American College of Rheumatology criteria were enrolled as the case group. Age and body mass index-matched data were obtained from 122 control subjects enrolled during visit for a regular health check-up. Hair minerals were analyzed and compared between the two groups. The mean age was 43.7 yr. General characteristics were not different between the two groups. Fibromyalgia patients showed a significantly lower level of calcium (775 µg/g vs 1,093 µg/g), magnesium (52 µg/g vs 72 µg/g), iron (5.9 µg/g vs 7.1 µg/g), copper (28.3 µg/g vs 40.2 µg/g) and manganese (140 ng/g vs 190 ng/g). Calcium, magnesium, iron, and manganese were loaded in the same factor using factor analysis; the mean of this factor was significantly lower in fibromyalgia group in multivariate analysis with adjustment for potential confounders. In conclusion, the concentrations of calcium, magnesium, iron, and manganese in the hair of female patients with fibromyalgia are lower than of controls, even after adjustment of potential confounders.

There are inconsistent findings on the effects of vitamin K on bone mineral density (BMD) and undercarboxylated osteocalcin (UcOC). The present intervention study evaluated the effect in subjects over 60-yr-old. The vitamin K group (vitamin K + vitamin D + calcium supplement; 15 mg of vitamin K2 [menatetrenone] three times daily, 400 IU of vitamin D once a day, and 315 mg of calcium twice daily) and the control group (vitamin D + calcium supplement) were randomly assigned. During the six months of treatment, seventy eight women participated (38 in the vitamin K group and 40 in the control group) and 45 women completed the study. The baseline characteristics of study participants did not differ between the vitamin K and the control groups. In a per protocol analysis after 6 months, L3 bone mineral density has increased statistically significantly in the vitamin K group compared to the control group (0.01 ± 0.03 g/cm(2) vs -0.008 ± 0.04 g/cm(2), P = 0.049). UcOC concentration was also significantly decreased in the vitamin K group (-1.6 ± 1.6 ng/dL vs -0.4 ± 1.1 ng/dL, P = 0.008). In conclusion, addition of vitamin K to vitamin D and calcium supplements in the postmenopausal Korean women increase the L3 BMD and reduce the UcOC concentration.

Carcinoembryonic antigen (CEA) levels can be affected by many factors and metabolic syndrome is also a candidate. This study examined the relationship between CEA levels and metabolic syndrome using the data of 32,897 healthy Koreans. Fecal occult blood tests were also performed. Subjects with colorectal carcinoma were excluded. Subjects were classified by their smoking status, metabolic syndrome and its components. Prevalence of metabolic syndrome and its all components showed a significant increase according to the quartile of serum CEA concentration (P < 0.001). Increased numbers of metabolic syndrome components showed a positive association with CEA levels (P-trend < 0.001). The odds ratios for the highest CEA quartile vs the lowest serum CEA quartile significantly increased in the presence of metabolic syndrome and its components. After adjusting for age, gender and smoking status, metabolic syndrome, low high density lipoprotein cholesterol and elevated blood pressure had higher odds ratios (OR) of the highest CEA quartile compared with the lowest serum CEA quartile (OR = 1.125, 95% CI = 1.030 to 1.222, P = 0.009; OR = 1.296, 95% CI = 1.195 to 1.405, P < 0.001; OR = 1.334, 95% CI = 1.229 to 1.448, P < 0.001, respectively). These results indicate that metabolic syndrome is associated with CEA value, which may lead to a misunderstanding of the CEA levels.

This study was to assess the relation of thyroid dysfunction to metabolic syndrome (MetS) at an earlier stage in Korean population. Metabolic parameters such as body composition, blood pressure (BP), fasting glucose, total cholesterol, triglyceride (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), thyroid-stimulating hormone (TSH) and free thyroxine 4 (fT(4)) were measured. During a mean follow-up of 3 yr, 5,998 Koreans ages over 18 yr were assessed. There were 694 cases of MetS at follow-up. The mean age of the subjects was 45.6 ± 9.5 yr. Mean level of TSH was 2.02 ± 1.50 mIU/L, mean level of fT(4) was 1.23 ± 0.20 ρM/L. At baseline, TSH levels and fT(4) levels were associated to waist circumference, BP, glucose and lipids in the subjects. Increase in systolic blood pressure, diastolic blood pressure (DBP), total cholesterol and TG were significantly associated with changes in TSH levels after adjustment. Changes in DBP, TG, HDL-C and fasting glucose were significantly associated with changes in fT(4) levels after adjustment. Increase in TSH levels even after further controlling for baseline TSH level predicted the MetS over the study period. In conclusion, there is a relationship between thyroid function and cardiovascular risk factors, such as BP, total cholesterol, TG, HDL-C and fasting glucose. Also, higher levels of TSH may predict the MetS in Korean.

Objective: Obesity and cardiovascular disease (CVD) are closely related and have become increasingly prevalent in Korea. Asians are more prone to obesity-related co-morbidities than Caucasians, even at lower body mass index (BMI) and/or smaller waist circumference (WC) values. Nevertheless, little is known regarding the association of WC with the risk of CVD in non-Caucasian populations. The authors conducted a prospective cohort study of WC and the risk of CVD in the Korean Heart Study. Methods: We examined the association of WC to CVD incidence among 53,026 Korean adults (30,152 men, 22,874 women) with no history of CVD and/or cancer. During a mean follow-up of 8.6 years, 2,722 incident cases of atherosclerotic cardiovascular disease (ASCVD) including 1,383 cases of ischemic heart disease (IHD) and 1,012 cases of stroke were documented. Results: Average WC at baseline was 84.0&177;8.2 cm in men and 75.2&177;8.9 cm in women. After adjustment for age and BMI, WC was significantly associated with cardiovascular risk factors (P Conclusions: Central obesity significantly and independently contributes to cardiovascular outcomes in Korean men and women.

Heart rate variability (HRV) is a noninvasive measure of autonomic input to heart rate that has been successfully used to estimate modulation of autonomic tone. The authors investigated to determine the normal ranges as a standardized tests of heart rate variability (HRV) for autonomic function tests in a large sample of healthy Koreans. The study also evaluated the effects of age, sex, and heart rate (HR) on the results of HRV and the values of HRV in hypertension, diabetes, and obesity group. Six hundred and thirty-seven healthy subjects who visited the health improvement center for medical examination were evaluated. A standardized 5-min resting study, including spectral analysis of HR, was used to all participants after an overnight fast. HRV (SA-2000E, Medicore, Korea) was spectrally determined by three components: total-frequency (TF) component (0.01 to 0.5 Hz), low-frequency (LF) component (0.04 to 0.15 Hz), and high-frequency (HF) component (0.15 to 0.5 Hz). Also two component ratio (LF/HF) was calculated. Routine laboratory and physical examinations were used to eliminate cardiovascular diseases and neurological disorders. The determinants of short-period HRV in a random sample of 366 men and 271 women from healthy subjects were assessed. The mean age of these subjects was 45.1 +/- 10.7 years. The mean value of total power was 1106.9 +/- 1109.1 ms(2); SDNN was 35.9 +/- 15.5 ms; rMSSD was 27.3 +/- 15.6 ms for time domain analysis. The mean value of LF was 287.5 +/- 384.1 ms(2); HF was 227.0 +/- 284.4 ms(2); LF/HF was 2.2 +/- 3.4 for frequency domain analysis. Additionally, men showed that their TP, LF, and LF/HF values were significantly higher than women whereas SDNN, rMSSD, HF showed no significant differences between sexes. With increasing age, there was no significant decrease in HR. TP, SDNN, LF, and HF were significantly decreased when getting older. On the contrary, LF/HF had no significant difference related to age. The study confirmed that SDNN and rMSSD were significantly lower in hypertension and diabetes group. In conclusion, middle-aged men had more pronounced sympathetic influence than women in cardiac regulation, and HRV declined linearly with age. In addition, HRV reflecting the function of autonomic nervous system was decreased in hypertension and diabetes group.

Objective The objectives of this study were to develop a coronary heart disease (CHD) risk model among the Korean Heart Study (KHS) population and compare it with the Framingham CHD risk score. Design A prospective cohort study within a national insurance system. Setting 18 health promotion centres nationwide between 1996 and 2001 in Korea. Participants 268 315 Koreans between the ages of 30 and 74 years without CHD at baseline. Outcome measure Non-fatal or fatal CHD events between 1997 and 2011. During an 11.6-year median follow-up, 2596 CHD events (1903 non-fatal and 693 fatal) occurred in the cohort. The optimal CHD model was created by adding high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides to the basic CHD model, evaluating using the area under the receiver operating characteristic curve (ROC) and continuous net reclassification index (NRI). Results The optimal CHD models for men and women included HDL-cholesterol (NRI=0.284) and triglycerides (NRI=0.207) from the basic CHD model, respectively. The discrimination using the CHD model in the Korean cohort was high: the areas under ROC were 0.764 (95% CI 0.752 to 0.774) for men and 0.815 (95% CI 0.795 to 0.835) for women. The Framingham risk function predicted 3–6 times as many CHD events than observed. Recalibration of the Framingham function using the mean values of risk factors and mean CHD incidence rates of the KHS cohort substantially improved the performance of the Framingham functions in the KHS cohort. Conclusions The present study provides the first evidence that the Framingham risk function overestimates the risk of CHD in the Korean population where CHD incidence is low. The Korean CHD risk model is well-calculated alternations which can be used to predict an individual9s risk of CHD and provides a useful guide to identify the groups at high risk for CHD among Koreans.

Obesity and the metabolic syndrome are closely related and have become increasingly prevalent in Korea. The cardiovascular disease (CVD) risk factors comprising the metabolic syndrome have previously been associated with increased hypothalamic-pituitary-adrenal axis (HPAA) activity, but the associations have not been extensively examined in non-Caucasian populations. The aim of the present study was to investigate the relationships between cortisol, adiposity and the metabolic syndrome in a Korean population. A total of 1,881 adults participated in the study between January 2001 and February 2008. Sociodemographic data were assessed by questionnaires. Body composition, clinic blood pressures as well as metabolic variables including glucose, insulin, and lipid profile were assessed and analyzed in relation to cortisol levels. Mean age of the participants was 58.7 ± 10.8 yr. Higher levels of cortisol was associated with elevated blood pressure, fasting glucose and total cholesterol in men, and between cortisol and systolic blood pressure, fasting glucose and total cholesterol in women. There was an increased risk for the metabolic syndrome associated with higher cortisol levels in both men (P < 0.001) and women (P = 0.040) adjusting for age and body mass index. Higher cortisol levels are associated with several CVD risk factors and the metabolic syndrome, independent of overall of adiposity level, in Korean men and women.

Background: The social problems of cigarette smoking and obesity are increasing and they threaten the health and daily life of the both the young and old adults. Therefore, we evaluated the relationship between cigarette smoking and obesity. Methods: The study subjects were recruited from the middle and high school located in Ansan city. We used the selfquestionnaire to evaluate their general information including cigarette smoking at enrollment and 8,589 students informations were gathered. Data were classified into three groups (normal body weight, over weight and obesity). Smoking status was classified into past, current, and non smoker and analyzed the relationship with obesity and some life-style patterns. Results: Body weight and body mass index of the girls were significantly higher in the current smokers (52.4 ± 12.2 kg, 19.8 ± 3.5 kg/m 2 ) than in the non-smokers (49.5 ± 7.7 kg, 19.3 ± 2.6 kg/m 2 ) and in the boys, body weight was higher in the current smokers (60.3 ± 10.7 kg, 20.4 ± 3.1 kg/m 2 ) than in the non-smokers (57.5 ± 12.1 kg, 20.3 ± 3.3 kg/m 2 ), which was not significant. The odds ratios of having obesity were 2.33 (P < 0.001; 95% confidence interval [CI], 1.24 to 3.34) in the current smokers and 2.04 (P < 0.001; 95% CI, 1.36 to 4.0) in the past smokers compared with the non-smokers in the girls. In the boys, there were no significance. Also, all students of the dietary pattern (breakfast, fast food, instant noodle, snack, soft drink) were associated with smoking status significantly. Conclusion: The current smokers showed higher prevalence of obesity and obesity-related dietary pattern than in the nonsmokers. Cigarette smoking may be associated with obesity in the school girls.

Background: Elevated plasma total homocysteine causes the risk of cardiovascular diseases. By reducing plasma total homocysteine may prevent cardiovascular diseases. Many studies showed that vitamin B12 and folic acid decrease homocysteine level when taken with calcium fortified drinking water. Our aim of this study was to demonstrate the association between plasma homocysteine concentrations and daily calcium intake. Methods: Among 636 adults aged 40-69 years who visited a health promotion center of a university hospital from May 2006 to April 2007, the study subjects were 567 who completed self-reported questionnaire. Self-reported calcium intake amount and their baseline health questionnaire were obtained. We measured height and weight by physical examination. Through blood test, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, plasma creatinine and homocysteine level were evaluated. Results: The mean daily calcium intake of entire subjects was 770.1 ± 266.3 mg. The mean plasma homocysteine concentration was 10.6 ± 4.3 μmol/L. The multiple regression analysis showed significant correlations between plasma homocysteine level and body mass index, plasma creatinine level and calcium intake. Plasma homocysteine level was inversely associated with dietary calcium intake. Conclusion: We found the calcium was inversely associated and homocysteine level an independent risk factor of cardiovascular diseases. However, further studies should be established to confirm if greater calcium intake may lower plasma homocysteine level.

Methods: The study randomly selected 640 students either majoring in medicine or engineering from two universities in Kyung-Gi province, Korea. Each of 320 students majoring in either of the two majors from each university was recruited. Among 640 students, 360 students, who were composed of 172 medical students and 188 engineering students was fi nally chosen for the analysis. The Zung Self-Rating Depression Scale was used to measure the depression state. Results: The average Zung depression score of university students was 49.2 ± 9.8. Medical students had a higher score of 52.4 ± 9.3 as compared to engineering students, who scored 46.3 ± 9.4. Overall depression rate was 42.8%. Medical students had a higher depression rate (52.3%) than engineering students (34.0%). The logistic analysis showed that infl uencing factors on depression state were sex, grade, major, stress and satisfactory sleep. The main source of stress for medical students was the grades from classes whereas job search was for engineering students. There were differences between the two groups in managing the stress. Medical students chose alcohol drinking or smoking for stress management whereas engineering students playing selected video games as their outlet. Conclusion: Medical students from urban areas seemed to be depressed more than engineering students. Their stress management methods among the subjects were drinking, smoking, and playing video games which may cause further physical and psychological problems in the future.