Sex differences in the relationship between serum total bilirubin and risk of incident metabolic syndrome in community-dwelling adults: Propensity score analysis using longitudinal cohort data over 16 years.

BACKGROUND: Research on identifiable risks for metabolic syndrome (MetS) is ongoing, and growing evidence suggests that bilirubin is a potent antioxidant and cytoprotective agent against MetS. However, there have been conflicting results on the association between bilirubin and MetS. Our study aimed to validate the association by separately stratifying data for men and women in a longitudinal prospective study. METHODS: Data were derived from the Korean Genome Epidemiology Study provided by the Korea Centers for Disease Control and Prevention. Data from 5,185 adults aged 40-69 years (3,089 men and 2,096 women) without MetS were analyzed. The participants were divided according to sex-specific quartiles of serum total bilirubin levels and followed up biennially for 16 years (until 2018). The log-rank test was used for obtaining the Kaplan-Meier curves of cumulative incidence of MetS according to sex-specific serum total bilirubin quartiles, and the hazard ratios (HRs) with 95% confidence intervals (CIs) for incident metabolic syndrome were analyzed with a multiple Cox proportional hazard regression analysis model, after propensity score matching for removing differences at baseline. RESULTS: With increasing serum total bilirubin quartiles, the incidence rate per 1000 person-years proportionally decreased in both men and women. After propensity score matching and adjusting for confounding variables, the HRs (95% CIs) for MetS of the highest quartile in reference to the lowest quartile were 1.00 (0.80-1.24) for men and 0.80 (0.65-0.99) for women. Higher quartiles of serum total bilirubin showed significantly lower cumulative incidence of MetS in women (log-rank test p = 0.009), but not in men (log-rank test p = 0.285). CONCLUSION: Serum total bilirubin levels were significantly inversely associated with MetS in women, but there was no significant association observed in men. Sex differences in the effects of serum total bilirubin should be noted when predicting incident MetS by sex in clinical settings.

Comparison of triglyceride-glucose index and HOMA-IR for predicting prevalence and incidence of metabolic syndrome.

BACKGROUND AND AIMS: Insulin resistance is related closely to metabolic syndrome (MetS). The homeostasis model assessment of insulin resistance (HOMA-IR) is the most commonly used insulin resistance index, but the triglyceride-glucose (TyG) index has been suggested as a reliable alternative insulin resistance index. This study aims to compare the predictive powers of TyG index and HOMA-IR for the prevalence and incidence of MetS in a large, community-based, prospective cohort over 12 years of follow-up. METHODS AND RESULTS: Data from 9730 adults with or without MetS at baseline, 6091 adults without MetS who were followed as part of the Korean Genome and Epidemiology Study were analyzed. Receiver-operating-characteristic (ROC) curves and time-dependent ROC curves were performed to compare the areas under the ROC curve (AUROC) of the TyG index and HOMA-IR for predicting the prevalence and incidence of MetS. The optimal cut-off points were calculated. Cox proportional hazard spline curves were used to verify dose-response relationship between TyG index/HOMA-IR and incident MetS. TyG index showed higher predictive power for prevalent MetS than HOMA-IR (0.837 vs. 0.680, p < 0.001). The AUROC for incident MetS of TyG index and HOMA-IR was 0.654 (0.644-0.664) and 0.556 (0.531-0.581), respectively (p < 0.001). Cut-off points of TyG index and HOMA-IR for predicting the prevalence of MetS were 8.718 and 1.8 and for predicting incident MetS were 8.518 and 1.5, respectively. Both TyG index and HOMA-IR had a linear relationship with incident MetS. CONCLUSIONS: TyG index is superior to HOMA-IR for predicting MetS.

Association of the new visceral adiposity index with coronary artery calcification and arterial stiffness in Korean population.

BACKGROUND AND AIMS: The new visceral adiposity index (NVAI) is an indirect marker of visceral adipose tissue recently developed using a Korean population. Here we examined the association of NVAI with coronary artery calcification and arterial stiffness in asymptomatic Korean patients. METHODS AND RESULTS: We analyzed data from 60,938 asymptomatic Korean adults. Odds ratios and 95% confidence intervals (CIs) for coronary artery calcification score (CACS) > 100 and brachial-ankle pulse wave velocity (baPWV) ≥14 m/s were calculated across NVAI tertiles using multiple logistic regression analysis. Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to assess the ability of NVAI to predict moderate to high risk of cardiovascular disease. The prevalence of moderate and high risk of cardiovascular disease increased significantly as the NVAI tertile increased. The odds ratio (95% CI) of the highest NVAI tertile for CACS >100 was 5.840 (5.101-6.686) for men and 18.916 (11.232-31.855) for women, after adjusting for confounders. All NVAI AUC values were significantly higher than the AUC values for other visceral adiposity markers. CONCLUSIONS: This study provides the evidence that NVAI is independently and positively associated with coronary calcification and arterial stiffness in asymptomatic Korean adults.

Derivation and validation of a new nutritional index for predicting 90 days mortality after ICU admission in a Korean population.

BACKGROUND/PURPOSE: Predicting the mortality in patients admitted to the ICU is important for determining a treatment strategy and public health policy. Although many scores have been developed to predict the mortality, these scores were based on Caucasian population. We aimed to develop a new prognostic index, the New nutritional index (NNI), to predict 90-days mortality after ICU admission based on Korean population. METHODS: Patients (1453) who admitted intensive care unit (ICU) of the Gangnam Severance hospital were analyzed. After exclusion, 984 patients were randomly divided into internal (n = 702) and external validation (n = 282) data set. The new nutritional index (NNI) was developed using univariate and multivariate logistic regression with backward selection of predictors. Receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC) verified the better predictor of 90 days-mortality after ICU admission. RESULTS: The NNI better predicted 90 days-mortality compared to modified NUTRIC score, APACHE II scores, SOFA scores, CRP, glucose, total protein, and albumin level in internal and external data sets, with AUC of 0.862 (SE: 0.017, 95% CI: 0.829-0.895) and 0.858 (SE: 0.015, 95% CI: 0.829-0.887), respectively. The calibration plots using external data set for validation showed a close approximation to the logistic calibration of each nomogram, and p-value of Hosmer and Lemeshow test was 0.1804. CONCLUSION: The NNI has advantages as a predictor of 90 days mortality based on nutritional status in the Korean population.

Computed tomography findings for a gastric lymphoepithelioma-like carcinoma: How often does it present as a submucosal mass?

OBJECTIVES: To describe the anatomical location, size, tumour characteristics and morphology on CT of gastric lymphoepithelioma-like carcinoma (LELC) in order to determine the proportion of lesions that present as submucosal masses, and to review the clinicopathological findings. METHODS: This retrospective study reviewed CT images of 186 lesions from 178 patients with LELC. CT morphologies and other findings were also analyzed. Pathology and medical records were reviewed. A pathology slide review of the lesions that presented with submucosal masses was performed. RESULTS: Gastric LELC presenting as a submucosal mass was found in 9.1 %. The most common CT morphology was eccentric wall thickening (67.7 %). On the pathology review, 14/17 submucosal mass lesions (82.4 %) had a central ulceration. 105 lesions were T1/T2 stage (94.1 %), and N0 stage was diagnosed in 66.1 %. Fifty-six of 63 metastatic lymph nodes (LNs) (88.9 %) demonstrated homogeneous enhancement, regardless of size. Male predominance (85.4 %), upper stomach location (45.7 %) and multiplicity (4.5 %) were found. CONCLUSIONS: Gastric LELC presenting as a submucosal mass is only detected in a small portion of all patients, and the most common finding is eccentric wall thickening. Central ulceration and enlarged LNs with homogeneous enhancement are occasionally other features on CT. KEY POINTS: • LELCs as submucosal masses on CT were detected in only 9.1 %. • The most common CT finding was eccentric wall thickening (67.7 %). • Central ulceration and enlarged LNs with homogeneous enhancement might be seen.

Features of Gastric Carcinoma With Lymphoid Stroma Associated With Epstein-Barr Virus.

BACKGROUND & AIMS: Gastric carcinoma with lymphoid stroma (GCLS) is a distinct histologic subtype of gastric cancer that is characterized by undifferentiated carcinoma mixed with prominent lymphoid infiltration. More than 80% of GCLS cases are associated with Epstein-Barr virus (EBV) infection, but it is unclear if the virus affects disease progression. We investigated how EBV infection affects the clinical and pathologic features of GCLS, as well as patients' outcomes. METHODS: We performed a retrospective analysis of 274 patients (mean age, 56.8 y; 85.4% male) diagnosed with GCLS, based on pathology findings, from March 1998 through December 2012 at the Asan Medical Center in Seoul, South Korea. Their data were compared with those from 822 age- and sex-matched patients who underwent resection for gastric adenocarcinoma. EBV was detected in tumor samples by in situ hybridization. RESULTS: Of the 274 patients with GCLS, 236 had EBV-positive tumors (86.1%) and 38 had EBV-negative tumors (13.9%). EBV-positive GCLS was more prevalent than EBV-negative GCLS in younger patients, tended to be located proximally, and was more frequently of an early stage macroscopic type. The 10-year, disease-specific rates of survival were 89.1% for patients with EBV-positive GCLS and 66.9% for patients with EBV-negative GCLS (P = .009). Patients with EBV-negative GCLS had clinical and pathologic features and survival times similar to those of patients with conventional adenocarcinoma. By multivariate analysis, longer survival time was associated with EBV-positive tumors (P = .007), younger patient age (P = .002), smaller tumor size (P = .046), lower stage (based on American Joint Committee on Cancer classification; P < .001), and lack of lymphovascular invasion (P = .012). The proportion of undifferentiated tumor cells was not associated significantly with patient survival time. CONCLUSIONS: Clinical and pathologic features of GCLS differ based on EBV infection status. EBV-negative GCLS is similar to conventional adenocarcinoma, and patients have similar survival times. EBV status may be more important than the proportion of undifferentiated tumor cells in the diagnosis of GCLS and management of patients.

Identifying predictors of lymph node metastasis after endoscopic resection in patients with minute submucosal cancer of the stomach.

BACKGROUND: The use of endoscopic submucosal dissection (ESD) for the treatment of minute submucosal (SM) invasive cancer that fulfills the current expanded criteria remains controversial. This study investigated the clinicopathological parameters of patients with sm1 gastric cancers to predict lymph node metastasis (LNM) and evaluate the feasibility of ESD as a curative treatment. METHODS: Data from 278 patients who underwent surgical resection of sm1 gastric cancer between 2006 and 2010 were retrospectively collected, and their clinicopathological parameters were analyzed to identify predictive factors of LNM. RESULTS: Of 278 patients, 28 patients (10.1 %) had LNM. Multivariate analysis identified multiple lesions (p = 0.018), lymphovascular invasion (LVI) (p < 0.001), SM invasion depth >500 µm (p = 0.007), undifferentiated histology (p = 0.012), and ulceration (p = 0.024) as factors significantly associated with LNM in patients with sm1 gastric cancer. Additionally, SM invasion width/superficial tumor size ratio >0.04 (p = 0.036) demonstrated a significant association with LNM in patients with sm1 gastric cancer falling within the current expanded criteria for ESD. LNM was not identified among 35 patients who met the absence of ulceration, SM invasion depth ≤ 500 µm, and SM invasion width/superficial tumor size ratio ≤ 0.04 besides the current expanded indications. CONCLUSIONS: Endoscopic resection can be performed on patients with minute SM invasive, differentiated cancers of ≤ 3 cm without LNM on pretreatment examination. In addition, if histological assessment shows the absence of LVI and ulceration, SM invasion depth ≤ 500 µm, and SM invasion width/superficial tumor size ratio ≤ 0.04, the patient can be carefully observed without additional treatment.

Neoplasms arising in large gastric hyperplastic polyps: endoscopic and pathologic features.

BACKGROUND: Little is known about gastric neoplasms arising from hyperplastic polyps (HPs). OBJECTIVE: To investigate the risk factors associated with neoplasms within HPs and to evaluate the role of alterations of the p16-cyclin D1-pRb pathway in the malignant transformation of HPs. DESIGN: Retrospective, case-control study. SETTING: Tertiary-care center. PATIENTS: Between May 1995 and January 2011, a total of 809 HPs >1 cm were investigated. Associated neoplasms were present in 30 HPs (case group); 30 HPs without neoplasms were selected as a control group. INTERVENTIONS: Gastric polypectomy. MAIN OUTCOME MEASUREMENTS: The risk factors associated with neoplasms within HPs and immunohistochemical expression of p16, cyclin D1, p53, and Ki-67 between case and control groups. RESULTS: Of the 809 HPs, 15 had associated dysplasia, and 15 had carcinoma. Multivariate analysis showed that neoplasm was associated with patient age (odds ratio [OR] 1.159; 95% confidence interval [CI], 1.243-2.044; P < .001), polyp size (OR 1.103; 95% CI, 1.055-1.152; P < .001), and polyp lobulation (OR 4.549; 95% CI, 1.759-11.0766; P < .001) but not with location, multiplicity, intestinal metaplasia, growth pattern, or Helicobacter pylori infection. Loss of p16 expression and high Ki-67 expression were observed in dysplastic areas of HPs compared with the control group (p16 = 14.3% vs 60%; P = .001, Ki-67 = 60.7% vs 36.7%; P < .001). However, no significant differences were found in nondysplastic areas in both groups. LIMITATIONS: Single-center, retrospective study. CONCLUSION: HPs >1 cm may indicate the presence of neoplasms. Loss of p16 and high Ki-67 expression may be markers of HP-associated dysplasia.

Sex difference in skeletal muscle mass in relation to metabolic dysfunction-associated steatotic liver disease: a propensity score matching study.

BACKGROUND: While low muscle mass is considered a risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD), whether the relationship is independent of fat mass remains unclear. OBJECTIVES: This study aims to clarify the association between the sex-specific height-adjusted low skeletal muscle mass index (LSMI) and MASLD. METHODS: Data from the 2008-2010 Korean National Health and Nutrition Examination Survey were analyzed. LSMI was defined using the 2019 Asian Working Group for Sarcopenia. The non-alcoholic fatty liver disease-liver fat score was used to assess MASLD. Gender-specific 1:1 propensity score matching (PSM) was performed to mitigate the confounding effects of anthropometric variables and lifestyles. Conditional logistic analysis was used on the dataset after PSM to estimate the odds ratio (OR) with a 95% confidence interval (CI). RESULTS: After PSM, the prevalence of MASLD was significantly higher in men with LSMI than in those without LSMI (37.4% vs. 29.6%). No significant difference was observed in the prevalence of MASLD between groups after PSM in women (20.4% vs. 20.3%). Conditional logistic analysis revealed that the odds of having MASLD were significantly higher in men with LSMI compared to those without LSMI (OR = 1.38, 95% CI: 1.09-1.75), while no significant association was found in women with LSMI (OR = 1.10, 95% CI: 0.87-1.40). CONCLUSION: Height-adjusted LSMI is an independent factor associated with MASLD in the condition of the same level of fat mass in men. Further prospective studies in diverse populations are needed to confirm our findings.

Neck Circumference as a Predictor of Insulin Resistance in People with Non-alcoholic Fatty Liver Disease.

Background: Insulin resistance is common in individuals with non-alcoholic fatty liver disease (NAFLD). Because insulin resistance is a predictive factor for advanced liver diseases in people with NAFLD, efforts have been made to predict it through anthropometric variables. Recently, neck circumference (NC) has been regarded as a reliable alternative marker for metabolic disorders. This study verified the association between NC and insulin resistance in patients with NAFLD. Methods: We analyzed data from 847 people with NAFLD who participated in the 2019 Korean National Health and Nutrition Examination Survey. NAFLD was defined by a hepatic steatosis index score of ≥36 points, and insulin resistance was defined by a homeostatic model assessment of insulin resistance score of ≥2.5 points. Participants were divided according to sex-specific NC tertiles (T1, lowest; T2, middle; T3, highest). Results: In the analysis of the area under the receiver operating characteristic curve (AUC), NC displayed a greater predictive power than body mass index (BMI) for insulin resistance in women (AUC of NC=0.625 vs. AUC of BMI=0.573, P=0.035). NC and the odds ratio (OR) for insulin resistance showed a cubic relationship in both men and women. In the weighted multiple logistic regression analysis, the ORs with 95% confidence intervals for insulin resistance in people with NAFLD in T2 and T3 compared to the reference tertile (T1) were 1.06 (0.47-2.41) and 1.13 (0.41-3.11), respectively, in men and 1.12 (0.64-1.97) and 2.54 (1.19-5.39), respectively, in women, after adjusting for confounding factors. Conclusion: NC was positively correlated with insulin resistance in women with NAFLD.

Modified triglyceride-glucose index indices are reliable markers for predicting risk of metabolic dysfunction-associated fatty liver disease: a cross-sectional study.

Introduction: Metabolic dysfunction-associated fatty liver disease (MAFLD) is newly proposed nomenclature, and its diagnosis involves an algorithm that can be complicated and impractical for clinicians in real-world clinical settings. Thus, we investigated the association between MAFLD and modified triglyceride-glucose index (TyG) indices to find a more concise, feasible method for predicting MAFLD in everyday clinical care. Methods: Data were obtained from people who voluntarily underwent health check-ups at the Health Promotion Centre of Gangnam Severance Hospital, Yonsei University College of Medicine, from January 2017 to October 2020. Four indices were analyzed: TyG-body to mass index (BMI), TyG-waist circumference (WC), TyG, and the fatty liver index (FLI). The odds ratios for MAFLD according to each index were calculated using multiple logistic regression analyses, and the receiver operating characteristics curve (ROC) and area under the ROC were obtained to find the predictive powers of each index. Results: The final number of study participants was 22,391, 8,246 with MAFLD and 14,145 without MAFLD. The odds ratios (95% confidence intervals) from TyG-WC and TyG-BMI after adjusting for confounding variables were 12.484 (9.962-15.644) and 12.494 (9.790-15.946), respectively, for quartile 2, 54.332 (43.131-68.442) and 51.580 (40.495-65.699) for quartile 3, and 165.804 (130.243-211.076) and 128.592 (100.601-164.371) for quartile 4. The area under the ROC curve values for TyG-WC and TyG-BMI were 0.862 (0.857-0.867) and 0.867 (0.862-0.872), respectively. Conclusion: The modified TyG indices are highly reliable markers for predicting MAFLD that clinicians can easily and practically apply in everyday, real-world, clinical care settings.

Association between the Oxidative Balance Score and Incident Chronic Kidney Disease in Adults.

Oxidative stress is a novel risk factor for chronic kidney disease (CKD). The oxidative balance score (OBS) was developed to represent the overall oxidative balance based on dietary and lifestyle pro-oxidant and antioxidant components. The aim of this study is to verify the relationship between the OBS and the incidence of CKD. Data from 5795 participants without CKD at the baseline survey of the Korean Genome and Epidemiology Study were analyzed. Participants were classified into sex-specific OBS tertiles. During the mean follow-up period of 13.6 years, 286 men and 382 women newly developed CKD. The Cox proportional hazard spline curve revealed an inverse dose-response association between the OBS and incident CKD in both men and women. Multiple Cox proportional hazard regression analysis revealed that the adjusted hazard ratios (95% confidence intervals) for sex-specific highest (T3) and middle (T2) OBS tertile groups were 0.80 (0.59-1.08) and 0.70 (0.51-0.95), respectively, in men and 0.76 (0.59-0.98) and 0.73 (0.55-0.96), respectively, in women, with the sex-specific lowest OBS tertile group (T1) as the reference. These results suggest that a healthy diet and lifestyle that increases the OBS may help prevent CKD in both men and women.

Combined Effect of Body Mass Index and Waist Circumference in Predicting Nonalcoholic Fatty Liver Disease.

Background: Body mass index (BMI) and waist circumference (WC) are the most widely used anthropometric indices for identifying obesity. This study aimed to compare and clarify the usefulness of BMI, WC, and the combination of these two indicators in predicting nonalcoholic fatty liver disease (NAFLD). Methods: This cross-sectional study included 15,267 Korean adults. We defined four obesity categories using BMI and WC as follows: BMI nonobese and WC nonobese (BNWN); BMI obese and WC nonobese (BOWN); BMI nonobese and WC obese (BNWO); and BMI obese and WC obese (BOWO). Analysis of variance was used to compare fatty liver severity across each category. The odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using multiple logistic regression. Results: Compared with BNWN, participants with BNWO were 3.235 (95% CI: 2.774-3.773) times more likely and participants with BOWN were 2.344 (95% CI: 2.045-2.687) times more likely to have NAFLD. Participants with BNWO had higher OR for NAFLD than those with BOWN. Moreover, BOWO participants had the highest OR of 4.788 (95% CI: 4.350-5.270) for NAFLD among all obesity categories. Conclusion: Combined obesity classification by BOWO is the most reliable indicator for NAFLD presence in Korean adults.

Histology and distribution of prostatic tissue on prostatic urethral margins: evaluation of radical prostatectomy specimens and implications on frozen section analysis.

The identification of prostate-specific antigen (PSA)-producing glands in prostatic urethral margins is often challenging, especially when examined as intraoperative frozen sections. To assess the histology of periurethral prostatic urethral glands and their expression of PSA and cytokeratins 7 and 20, we examined prostatic urethras of frozen and permanent sections of radical prostatectomy specimens. We observed 3 types of prostatic urethral glands: urethral mucosal, prostatic acinar, and mixed. The urethral mucosal type consisted of a single layer of surface cuboidal to columnar cells with densely eosinophilic luminal cytoplasm and underlying urothelial cells. The prostatic acinar type was lined by prostatic-type secretory cells and basal cells. The mixed type showed luminal secretory cells and underlying urothelial cells. The gland types were correctly assigned in most frozen section slides. The proximal segment of the prostatic urethra and the bladder neck consisted mostly of the urethral mucosal type, whereas the distal segment and apical margins consisted mostly of the prostatic acinar type. Prostate-specific antigen was expressed in secretory cells in prostatic acinar and mixed types, whereas cytokeratin 7 was expressed by urothelial cells and surface cells of the urethral mucosal type. Cytokeratin 20 was not expressed in any of these cells. These results indicate that PSA-expressing cells are abundant in the distal segment of the prostatic urethra and apical margin and share histologic features of prostatic secretory cells. These PSA-expressing prostatic acinar and mixed-type glands should be reported as a potential source of PSA-secreting benign glands.

Association between oxidative balance score and new-onset hypertension in adults: A community-based prospective cohort study.

Introduction: Oxidative stress plays a key role in the pathophysiology of hypertension development. The oxidative balance score (OBS) comprises dietary and lifestyle pro- and anti-oxidant components and reflects the overall oxidative stress burden. We aimed to evaluate the association between the OBS and new-onset hypertension (HTN) using large, community-based, prospective Korean cohort data. Methods: Among 10,030 participants aged 40-69 years included in the Korean Genome and Epidemiology Study, the data of 5,181 participants were analyzed. The hazard ratio (HR) and 95% confidence interval (CI) for new-onset HTN according to sex-specific OBS quartile groups were calculated using univariable and multivariable Cox proportional hazard regression analyses. Results: During the mean 13.6-year follow-up period, 1,157 men and 1,196 women developed new-onset HTN. Compared to the Q1 group, the adjusted HRs (95%CI) for new-onset HTN in the Q2, Q3, and Q4 groups were 0.96 (0.82-1.16), 0.85 (0.72-0.99), and 0.71 (0.59-0.86) in men and 0.81 (0.69-0.95), 0.81(0.68-0.95), and 0.70 (0.57-0.84) in women, respectively. Discussion: Individuals with high OBS are at lower risk of developing HTN. This study suggests that a healthy lifestyle and antioxidant rich diet could be a preventive strategy for HTN.

Association between Relative Handgrip Strength and Insulin Resistance in Korean Elderly Men without Diabetes: Findings of the 2015 Korea National Health Nutrition Examination Survey.

BACKGROUND: Evidence regarding the association between handgrip strength (HGS) and insulin resistance in a non-diabetic population is scarce. This study aimed to investigate the association between relative HGS and insulin resistance in older men without diabetes, using a representative sample of the Korean male population. METHODS: The study population comprised 206 participants aged 65-80 years, selected from the 2015 Korea National Health and Nutrition Examination Survey. Insulin resistance was defined as the upper tertile of the homeostatic model assessment of insulin resistance (HOMA-IR). Odds ratios and 95% confidence intervals for insulin resistance were assessed using multiple logistic regression analyses after adjusting for confounding variables. RESULTS: The prevalence of insulin resistance decreased with increasing relative HGS. The prevalence in the T1, T2, and T3 groups was 46.0%, 32.2%, and 26.4%, respectively. Compared with the individuals in the highest tertile of relative HGS, the odds ratio (95% confidence interval) for insulin resistance in individuals in the lowest quartile was 2.82 (1.10-7.21) after adjusting for age, smoking, alcohol consumption, aerobic exercise, resistance exercise, systolic blood pressure, total cholesterol, residential area, household income, and education level. CONCLUSION: Lower relative HGS was inversely associated with an increased risk of insulin resistance in older Korean men without diabetes. In clinical practice, relative HGS, which is a simple and inexpensive tool, could be a useful measure for identifying older men with insulin resistance. Moreover, these findings suggest that muscle strengthening exercises should be considered to reduce insulin resistance and increase insulin sensitivity.

Association Between C-Reactive Protein and Relative Handgrip Strength in Postmenopausal Korean Women Aged 45-80 Years: A Cross-Sectional Study.

Background: Chronic inflammation plays a key role in the pathophysiology of frailty and loss of physical performance, which are closely associated with sarcopenia. In women, the decline in muscle mass and strength is accelerated after menopause. Thus, we examined the association between high sensitivity C-reactive protein (hs-CRP) and relative handgrip strength (HGS) in postmenopausal women. Methods: This cross-sectional study included 2171 postmenopausal women aged ≥45 years who participated in the Korean National Health and Nutrition Survey (KNHNES) between 2015 and 2018. Relative HGS was categorized into quartiles as follows: Q1, <0.810 (kg/BMI); Q2, 0.810-0.968 (kg/BMI); Q3, 0.969-1.119 (kg/BMI); Q4, >1.119 (kg/BMI). The odds ratios (ORs) and 95% confidence intervals (95% CIs) for high hs-CRP (>1.0 mg/L, 75 percentile of the current samples) were calculated across relative HGS quartiles using multiple logistic regression analysis. Results: The prevalence of high hs-CRP decreased with relative HGS quartiles. Compared to the highest quartile, the OR (95% CI) of the lowest relative HGS quartile for high hs-CRP was 3.266 (2.227-4.789) after adjusting for age, hypertension, diabetes mellitus, dyslipidemia, education, household income, physical activity, strength exercise, smoking, and alcohol ingestion. Conclusion: Serum hs-CRP level was inversely and independently associated with relative HGS. Our findings indicate that low-grade inflammation is inversely associated with muscle strength in postmenopausal women.

Non-HDL cholesterol as a predictor for incident type 2 diabetes in community-dwelling adults: longitudinal findings over 12 years.

Non-HDL cholesterol is a simple measure to analyze the total amount of proatherogenic lipoproteins in the blood and to predict development of cardiovascular disease. However, it is unclear whether non-HDL cholesterol has a relationship with incident type 2 diabetes. This study aimed to evaluate the association between non-HDL cholesterol and incident type 2 diabetes with a large-sample, community-based Korean cohort over a 12-year period. Among the 10,038 total participants, 7608 (3662 men and 3946 women) without diabetes were selected from the Korean Genome and Epidemiology Study (KoGES). Their non-HDL cholesterol level was divided into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for incident type 2 diabetes were calculated using multivariate Cox proportional hazards regression models after adjusting for potentially confounding variables. In total, 1442 individuals (18.9%: 1442 of 7608) developed type 2 diabetes during the 12-year follow up period, with an incident rate of 3.0-5.0. Compared to the reference first quartile, the HRs (95% CIs) of incident type 2 diabetes for the second, third, and fourth quartiles increased in a dose-response manner after adjusting for potentially confounding variables, including the HOMA-IR marker. Non-HDL cholesterol level at baseline could be a future predictor of type 2 diabetes even when prior glucose or insulin (HOMA-IR) levels are normal.

New markers in metabolic syndrome.

Metabolic syndrome (MetS) is increasing globally and is clinically significant due to its association with cardiovascular disease, type 2 diabetes and cancer. Although the pathogenesis of MetS has not been clearly elucidated, insulin resistance and chronic low-grade inflammation derived from central obesity are the most widely accepted as underlying pathophysiology. Accordingly, insulin resistance indices, adipokines and various inflammatory markers have been suggested as reliable biomarkers for MetS. Others, such as uric acid, alkaline phosphatase, γ-glutamyl transferase, are also known to positively correlate with MetS and could be diagnostically useful. In this review, we provide a comprehensive overview of MetS biomarkers and the development of a systematic approach to laboratory analysis.

Triglyceride Glucose-Waist Circumference (TyG-WC) Is a Reliable Marker to Predict Non-Alcoholic Fatty Liver Disease.

The triglyceride and glucose index (TyG index), a marker of insulin resistance, is positively associated with NAFLD. Modified TyG indices, combining body composition markers including body-mass index (BMI) or waist circumference (WC) with the TyG index, are reported to enhance predictability of insulin resistance. This study aimed to compare the usefulness of modified TyG indices for predicting NAFLD with the TyG index and fatty liver index (FLI). This cross-sectional study included 12,757 Korean adults. The TyG index and FLI were calculated using established formulas, and TyG-BMI and TyG-WC were calculated as TyG × BMI and TyG × WC, respectively. All measures were divided into quartiles. NAFLD severity (grade 0-3) was compared using ANOVA by quartiles of each index. Odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated using a multiple logistic regression analysis. ROC and AUROC analyses were performed to compare the predictability of NAFLD using WC, BMI, TyG, TyG-BMI, TyG-WC, and FLI. A higher TyG index, TyG-BMI, TyG-WC, and FLI were associated with a higher grade of NAFLD. ORs (CIs) for NAFLD increased in all indices, especially in TyG-WC (39.251 (31.304-49.215)) and FLI (38.937 (31.145-48.678)). AUROC was 0.848 (0.840-0.855) for TyG-WC and 0.850 (0.842-0.857) for FLI. TyG-WC is a reliable indicator for the presence of NAFLD in Korean adults.