Associations of minimally processed and ultra-processed food intakes with cardiovascular health in Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES VI), 2013-2015.

BACKGROUND: Although recent studies have suggested the adverse effects of processed foods on cardiovascular disease, few studies have been conducted on the effects of food processing on cardiovascular health (CVH) in Koreans. OBJECTIVE: This study aimed to investigate the associations of minimally processed foods (MPF) and ultra-processed foods (UPF) intakes with CVH. METHODS: We used the data of 6945 adults (≥19) from the sixth Korea National Health and Nutrition Examination Survey. MPF and UPF intakes were based on the NOVA food classification. Using Life's simple 7 (LS7) proposed by the American Heart Association, the CVH indicator was estimated as the sum (0-12) of the scores of six components. Multiple linear and multinomial logistic regressions were used to estimate the associations between processed food intakes and CVH. RESULTS: The mean (standard error) of MPF and UPF intake was 61.28 (0.28) and 20.27 (0.24) %kcal/day, respectively. After adjusting for sex, age, household income, educational attainment, family history of CVD, and stress, we found significant positive associations between MPF intake and CVH (p value < 0.001), while associations between UPF intake and CVH were significantly negative (p value < 0.001). Moreover, the magnitude of the observed association was more distinctive in females (p-interaction < 0.01) and with increasing age (p-interaction < 0.001). CONCLUSIONS: A high intake of MPF is associated with improved CVH, while a high intake of UPF is associated with poorer CVH in Korean adults. Therefore, public health policies should be established to promote the choice of less processed foods to improve CVH among South Korean adults. IMPACT STATEMENT: In modern society, processed foods have become ubiquitous and South Korea's consumption of processed foods is very high. This study had shown that the more processed a food is, the more negative impact it can have on cardiovascular health. Therefore, researching the effects of processed foods on the human body can increase understanding of population health and aid in the development of prevention and treatment strategies.

Association between environmental mercury exposure and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) cycles 3-4 (2015-2020).

Although previous studies have suggested potential adverse effects of mercury on a child's immune system, the associations have been inconsistent. We aimed to determine the association between urinary mercury levels and allergic diseases in Korean children with high mercury exposure. Data from 853 and 710 children aged 6-11 years in the Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017) and cycle 4 (2018-2020) were analyzed. We examined the association between mercury exposure and the prevalence of atopic dermatitis (AD), asthma, allergic rhinitis (AR), and allergic multimorbidity. After adjusting for all covariates, the urinary mercury level was positively associated with AD in the 2015-2017 study (OR = 1.34, 95% CI = 1.01, 1.79) and AR in 2018-2020 study (OR = 1.46, 95% CI = 1.01, 2.10). Pooled effects showed OR of 1.34 (95% CI = 1.01, 1.79) for AD and 1.47 (95% CI = 1.01, 2.12) for allergic multimorbidity. The association with allergic multimorbidity was greater in boys (OR = 1.88, 95% CI = 1.01, 3.49) than in girls (OR = 1.25, 95% CI = 0.73, 2.14). These results suggest that environmental mercury exposure may exacerbate symptoms of atopic dermatitis and allergic multimorbidity in children.

Exposure to biocides and its association with atopic dermatitis among children and adolescents: A population-based cross-sectional study in South Korea.

BACKGROUND: Biocides have emerged as a contributor to the rising cases of atopic dermatitis among children and adolescents. Previous animal studies suggested that phenols, parabens, and pyrethroid insecticides present in these products might play a role in atopic dermatitis. However, there's limited epidemiological evidence confirming the individual or combined effects of exposure to these chemicals on atopic dermatitis in young populations. This study aimed to investigate the association between phenol, paraben, and pyrethroid metabolite levels in urine and atopic dermatitis among Korean children and adolescents METHODS: We analyzed 556 preschool children (3-5 years), 701 schoolchildren (6-11 years), and 731 adolescents (12-17 years) enrolled in the 4th Korean National Environmental Health Survey (KoNEHS) (2018-2020). We used logistic regression and Bayesian kernel machine regression to evaluate the association between atopic dermatitis and individual or mixed exposure to urinary triclosan (TCS), parabens (methylparaben, ethylparaben, propylparaben, and butylparaben), and 3-phenoxybenzoic acid (3-PBA) levels. RESULTS: Urinary TCS levels were positively associated with atopic dermatitis in schoolchildren. When stratified by sex, male schoolchildren exhibited an increasing prevalence of atopic dermatitis as their urinary TCS and 3-PBA levels increased. The combined effect of biocide mixtures on atopic dermatitis was also significantly increased in male schoolchildren, with TCS as the main contributor. CONCLUSIONS: These study findings suggest that biocides at levels found in Korean children and adolescents affect atopic dermatitis.

Association between oil spill clean-up work and thyroid cancer: Nine years of follow-up after the Hebei Spirit oil spill accident.

In 2007, an unprecedented oil spill occurred in Taean, Korea. Although crude oil contains chemicals that could increase thyroid cancer risk, few studies have examined the long-term effects of oil exposure during clean-up and thyroid cancer incidence. We investigated the long-term thyroid cancer incidence among participants involved in clean-up work. 1798 participants engaged in at least two surveys since the baseline was tracked from 2008 to 2018. Participants reported the days they participated in oil clean-up works and cancer diagnoses. Cox proportional hazard models were used to estimate the hazard ratios between clean-up work duration and thyroid cancer. Over the 9-year follow-up, 30 thyroid cancer cases were diagnosed. A positive association was observed between clean-up duration and thyroid cancer risk. This effect was more pronounced among residents living <50 m from traffic roads. Our results indicate that crude oil clean-up work participation may increase the thyroid cancer risk.

Long-term effects of the Hebei Spirit oil spill on the prevalence and incidence of allergic disorders.

The Hebei Spirit oil spill accident occurred in December 2007, approximately 10 km off the coast of Taean, South Korea, a location notably close to residential areas. Crude oil substances have been detected in various environmental mediums since the accident, yet previous studies have primarily focused on the acute effects of oil exposure due to the short latency period of allergic diseases. Therefore, this study evaluated the long-term effects of oil spill exposure on allergic disorders. Our study included adult residents who had participated in the Health Effects Research on Hebei Spirit Oil Spill (HEROS) study up to five years post-incident, which was a prospective cohort to monitor the health status of Taean residents. We used two indicators to assess oil spill exposure, namely the distance from the initial contaminated coastline to each participant's residence and the number of days participants had engaged in oil clean-up work. Current symptoms such as asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and multimorbidity were considered allergic disorders. In the baseline survey, the prevalence of asthma, allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and allergic multimorbidity symptoms was associated with both exposure indicators; however, these associations were not observed in the two consecutive surveys. Significant longitudinal associations between oil spill exposure indicators and the four allergic disorders, as well as multimorbidity incidences, were observed during a five-year follow-up period. Our results suggest that oil spill exposure can affect acute and long-term allergic symptoms in residents near the accident site.

Health risks of pest control and disinfection workers after the COVID-19 outbreak in South Korea.

The exposure patterns of pest control and disinfection workers have changed after the coronavirus disease 2019 (COVID-19) outbreak, but the health risks of chemical exposure have not been assessed. We identified these workers' chemical exposure patterns and risks before and after the COVID-19 outbreak. We used data conducted between 2018 (pre-pandemic) and 2021 (post-pandemic) from three-year cross-sectional surveys on pest control and disinfection workers. Inhalation and dermal exposure concentrations were estimated using equations based on a biocidal product risk assessment model from the Korean National Institute of Environmental Research. The non-carcinogenic and carcinogenic risks of chemicals were calculated using the United States Environmental Protection Agency risk assessment model. We found that the annual work frequency (50th percentile) of foggers using disinfectants increased the most among all the work types, from 140 uses/year to 176 uses/year after the COVID-19 outbreak. Moreover, all chemicals' non-carcinogenic and carcinogenic risks increased regardless of exposure routes. In the worst scenario (95th percentile), the margin of exposure for citric acid, benzethonium chloride, benzyl-C12-16-alkyldimethyl chlorides, and sodium chlorite of inhalation exposure, and isopropyl alcohol and benzyl-C12-16-alkyldimethyl chlorides of dermal exposure were acceptable (>100) before the COVID-19 outbreak but became unacceptable (<100) after the COVID-19 outbreak. Carcinogenic risks of dichlorvos from inhalation and dermal exposure were above acceptable levels (>10-6) before and after the COVID-19 outbreak but comparatively high after the COVID-19 outbreak. Additionally, significantly more workers experienced health symptoms after the COVID-19 outbreak (p<0.05), with the most common being muscle lethargy (31%), skin/face stinging (28.7%), and breath shortness/neck pain (24.1%).

Evaluation of effectiveness and improvement factors of occupational health and safety management system in the Republic of Korea Navy based on AHP-entropy and IPA.

The Republic of Korea Navy (ROKN) has applied Occupational Health and Safety Management System (OHSMS), but the effectiveness of OHSMS is being questioned due to continuous industrial accidents that continue to occur. Although OHSMS, which has been generally applied in enterprises, has more potential for improper implementation in the military, there are few studies on OHSMS in the military. Therefore, this study verified the effectiveness of OHSMS in the ROKN and derived improvement factors. This study was conducted in a two-step process. First, we surveyed 629 workers at the ROKN workplaces to confirm the effectiveness of OHSMS by comparing occupational health and safety (OHS) efforts according to whether OHSMS was applied and the period of application. Second, 29 naval OHSMS experts evaluated the factors for improving OHSMS using two decision-making tools: Analytic Hierarchy Process (AHP)-entropy and Importance-Performance Analysis (IPA). The study results indicate that the OHS efforts of OHSMS-applied workplaces were similar to that of unapplied. Also, no better OHS efforts were identified in workplaces with more extended OHSMS application periods. There were five improvement factors of OHSMS applied to the ROKN workplaces, with the highest weight in the following order: consultation and participation of workers; resources; competence; hazard identification and risk assessment; and organizational roles, responsibilities, and authorities. The effectiveness of OHSMS in the ROKN was insufficient. Therefore, the ROKN needs focused improvement efforts on the five requirements to implement OHSMS practically. These results can be helpful information for the ROKN to apply OHSMS more effectively for industrial safety.

Evaluating the feasibility of air environment management system for VOCs through 'VOCs specification' of petroleum refining industry.

The chemical industry releases various types of volatile organic compounds (VOCs) into the atmosphere, and the concentration of VOCs emitted from chimneys is regulated worldwide. However, some VOCs such as benzene are highly carcinogenic, while others such as ethylene and propylene may cause secondary air pollution, owing to their high ozone-generating ability. Accordingly, the US EPA(United State, Environment Protect Agency) introduced a fenceline monitoring system that regulates the concentration of VOCs at the boundary of a facility, away from the chimney source. This system was first introduced in the petroleum refining industry, which simultaneously emits benzene, affecting the local community because of its high carcinogenicity, and ethylene, propylene, xylene, and toluene, which have a high photochemical ozone creation potential (POCP). These emissions contribute to air pollution. In Korea, the concentration at the chimney is regulated; however, the concentration at the plant boundary is not considered. In accordance with the EPA regulations, Korea's petroleum refining industries were identified and the limitations of the Clean Air Conservation Act were studied. The average concentration of benzene at the research facility examined in this study was 8.53 µg/m3, which complied with the benzene action level of 9 µg/m3. However, this value was exceeded at some points along the fenceline, in proximity to the benzene-toluene-xylene (BTX) manufacturing process. The composition ratios of toluene and xylene were 27% and 16%, respectively, which were higher than those of ethylene or propylene. These results suggest that reduction measures in the BTX manufacturing process are necessary. This study shows that legal regulations should enforce reduction measures through continuous monitoring at the fenceline of petroleum refineries in Korea.Implications: Although volatile organic compounds(VOCs) are essential in various industrial sites, they adversely affect the health of people in the near community. Benzene is highly carcinogenic, so it is dangerous if exposed continuously. In addition, there are various types of VOCs, which combine with atmospheric ozone to generate smog. Globally, VOCs are managed as Total VOCs. However, through this study, VOCs have priority, and in the case of the petroleum refining industry, it is suggested that VOCs should be preemptively measured and analyzed to be regulated. In addition, it is necessary to minimize the impact on the local community by regulating the concentration at the fenceline beyond the chimney measurement.

Exposure to volatile organic compounds and polycyclic aromatic hydrocarbons is associated with the risk of non-alcoholic fatty liver disease in Korean adolescents: Korea National Environmental Health Survey (KoNEHS) 2015-2017.

Non-alcoholic fatty liver disease (NAFLD) is one of the most frequent liver diseases among adolescents. Several animal studies have suggested that volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) increase NAFLD risk. However, few epidemiological studies have confirmed the association between VOCs, PAHs and NAFLD in the general adolescent population. Therefore, we analyzed 798 adolescents from the Korean National Environmental Health Survey (KoNEHS), 2015-2017, to examine the associations of urinary metabolites of VOCs and PAHs with serum alanine aminotransferase (ALT) activity and NAFLD prevalence. We performed linear regression, logistic regression, and Bayesian kernel machine regression (BKMR) to evaluate the association of urinary VOCs and PAHs metabolites with ALT levels and NAFLD prevalence. After adjusting for all covariates, urinary benzylmercapturic acid and 2-hydroxyfluorene levels were found to increase ALT activity and NAFLD prevalence. Additionally, the BKMR analyses showed a significantly positive overall effect on ALT activity and NAFLD prevalence with urinary concentrations of VOCs and PAHs metabolites, with 2-hydroxyfluorene as the biggest contributor. Our study suggests that exposure to low-level VOCs and PAHs may have a detrimental effect on NAFLD risk in adolescents. Given the increasing prevalence of NAFLD in adolescents, future cohort studies are confirmed to comprehend the effect of these chemicals on NAFLD risk.

Occupational and Environmental Asbestos Exposure and Survival of Patients with Asbestos-Related Cancer: A Follow-Up Study on Patients with Malignant Mesothelioma and Asbestos-Related Lung Cancer in Korea.

Malignant mesothelioma and asbestos-related lung cancer are typically associated with a poor prognosis. However, it has been observed that some patients with these cancers survive significantly longer than the average survival period. While many preliminary studies have investigated factors influencing patient survival, the specific impact of asbestos exposure has not been thoroughly explored. We followed up with 546 patients with malignant mesothelioma and 902 patients with asbestos-related lung cancer, all identified as asbestos victims between 2009 and 2021. In both malignant mesothelioma and asbestos-related lung cancer, patients with occupational asbestos exposure exhibited not only shorter median survival times but also lower 3- and 5-year survival rates compared to those with environmental exposure. Additionally, a longer duration of occupational exposure and closer proximity to the source of asbestos were linked to shorter survival times and lower survival rates. Among the patients with occupational asbestos exposure, the highest hazard ratios (HRs) were observed in those who worked in the production of asbestos-containing products across both cancer types. In contrast, significant HRs were only noted in mesothelioma patients who lived near asbestos industries, slate houses, and redevelopment areas, within the environmentally exposed group.

Disease Latency according to Asbestos Exposure Characteristics among Malignant Mesothelioma and Asbestos-Related Lung Cancer Cases in South Korea.

Korea was one of the major consumers of asbestos in the late 1900s, and asbestos-related disease patients have been reported continuously to date, owing to long disease latency. Several studies have been conducted to predict the future incidence of malignant mesothelioma and lung cancer in Korea, but little is understood about the latency time. Therefore, the aim of this study is to estimate the latency period of malignant mesothelioma and asbestos-related lung cancer in Korea and its determinants. We obtained information from the Environmental Health Centers for Asbestos in Korea on the history of asbestos exposure and demographic characteristics of 1933 patients with malignant mesothelioma and asbestos-related lung cancer. In our study, the latency periods for malignant mesothelioma and lung cancer were 33.7 and 40.1 years, respectively. Regardless of the disease type, those with a history of exposure related to the production of asbestos-containing products or asbestos factories had the shortest latency period. In addition, we observed that those who worked in or lived near asbestos mines tended to have a relatively long disease latency. Smoking was associated with shorter latency, but no linear relationship between the lifetime smoking amount (expressed in pack years) and latent time was observed. In addition, the age of initial exposure showed a negative linear association with the latency period for mesothelioma and lung cancer.

Urinary 3-phenoxybenzoic acid (3-PBA) levels and changes in hematological parameters in Korean adult population: A Korean National Environmental Health Survey (KoNEHS) 2012-2014 analysis.

Pyrethroid insecticides have been broadly used as pest control in agriculture and residential spaces, exerting high effectiveness of insecticidal property and relatively low toxicity to humans. Several animal studies suggested that exposure to pyrethroids may induce hematological abnormalities, thereby altering the number of blood cells and resulting in blood disorders. However, no epidemiologic study has reported on the effect of pyrethroid insecticide exposure on hematological changes, except for occupational exposure. This study aimed to investigate the effect of urinary 3-phenoxybenzoic acid (3-PBA) concentrations on hematological parameters in a representative South Korean adult population. We analyzed data from 6296 adults enrolled in the Korean National Environmental Health Survey (2012-2014). We employed multiple linear regression analysis to evaluate the association of urinary 3-PBA levels with eight hematological profiles: white blood cells (WBCs), red blood cells (RBCs), hemoglobin, hematocrit, platelets, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). The urinary 3-PBA levels were negatively associated with WBC, RBC, and hemoglobin levels and positively associated with MCV levels. The direction and magnitude of the association between the 3-PBA and hematological parameters varied according to sex and age. The adverse effects of 3-PBA on hematological parameters were distinctive among males aged 60 years and older. In this age group, 3-PBA levels were negatively associated with the WBC, RBC, hemoglobin, hematocrit, and MCHC levels among males. This study is the first to verify that urinary 3-PBA concentrations at the levels found in a Korean population are associated with blood parameters. This finding merits further investigation to understand the impact of 3-PBA on human blood function and public health.

Association between Heavy Metal Exposure and Dyslipidemia among Korean Adults: From the Korean National Environmental Health Survey, 2015-2017.

Cardiovascular disease (CVD) is a leading cause of death in Korea. Dyslipidemia, characterized by the presence of abnormal lipid levels, has been suggested as an early diagnostic and preventable factor for CVD. Recent studies have shown that exposure to lead (Pb), cadmium (Cd), and mercury (Hg) affects lipid metabolism. This study aimed to verify the association between heavy metal concentrations and serum lipid profiles in the general population. A representative sample of 2591 Korean adults from the Korean National Environmental Health Survey (2015−2017) was analyzed. The associations between heavy metals [Blood Pb (BPb), blood Hg (BHg), urinary Hg (UHg), urinary Cd (UCd)] and serum lipid profiles [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), non-low level of high-density lipoprotein cholesterol (Non-HDL-C)] were assessed using regression analysis. After adjusting for demographic and socioeconomic factors, the proportional changes in serum lipid levels were significantly associated with increases in BPb, BHg, and UHg levels (p for trend < 0.05). Overall, BPb, BHg, and Uhg levels positively correlated with dyslipidemia, whereas UCd levels did not show a significant association. Our results suggest that heavy metal exposure, at low levels, may contribute to an increased prevalence of dyslipidemia in Korean adults.

Urinary bisphenol concentrations and its association with metabolic disorders in the US and Korean populations.

Bisphenol A (BPA) is a representative endocrine disrupting compound used in a vast array of consumer products, and are being frequently substituted by its analogues, bisphenol S (BPS) and bisphenol F (BPF). We aimed to examine the association between urinary bisphenol levels with obesity and lipid profiles in the general population to comprehensively evaluate its potential of metabolic disturbance. A representative sample of 1046 US adults from the National Health and Nutrition Examination Survey (2013-2016) and 3268 Korean adults from the Korean National Environmental Health Survey (2015-2017) was analyzed. We examined the exposure levels of bisphenols and determined their associations with obesity, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels, and hypercholesterolemia prevalence through multiple linear, and binary/ordinal logistic regression models. In both populations, high BPA levels (lowest tertile vs. 2nd, 3rd tertiles) showed corresponding associations with lipid profile and obesity. BPA levels were associated with decreased HDL-C levels (Q3: ß = -0.053, p = 0.08 (US); Q2: ß = -0.030, p-0.03), increased TG levels (Q3: ß = 0.121, p = 0.029 (US); Q3: ß = 0.089, p = 0.021, and higher odds for obesity (Q3: OR = 1.58, 95% CI: 1.06, 2.35 (US); Q3: OR = 1.41, 95% CI: 1.11, 1.78). Higher BPS levels were positively associated with obesity status, especially in US men (Q2: OR = 1.84, 95% CI: 1.15, 2.96) and Korean women (Q3: OR = 1.27, 95% CI: 0.99, 1.64). A significant decrease in HDL-C (Q3: ß = -0.088, p = 0.01) and elevated odds for obesity at higher BPF levels (Q3: OR = 1.60, 95% CI: 1.00, 2.56) was observed in US women. The findings of our study indicate that BPA and its analogues, BPS and BPF, are associated with lipid metabolism disorders in addition to obesity in adults. Given the increase in exposure to BPA alternatives, continuous biomonitoring, and further investigation of their health effects through prospective cohort studies are warranted.

Changes in Risk in Medium Business Plating and Paint Manufacturing Plants following the Revision of the Korean Chemical Accident Prevention System.

Chemical accidents can occur anywhere. The need for chemical management in Korea was realized following the 2012 Gumi hydrofluoric acid accident in 2012. The Chemicals Control Act was enacted in 2015. This system evaluates the risks (high, medium, low) and consequent safety management at all plants that handle hazardous chemical substances. However, the system was criticized as excessive when most plants were designated high-risk without considering their size. Thus, laboratories and hospitals handling very small quantities were subject to regulation. Accordingly, in 2021 Korea revised the system to include off-site consequence analyses and a Korean-style risk analysis. Plants handling very small quantities, such as laboratories and hospitals, were exempt from regulation. In this study, changes in risk were examined for four medium-sized plating and paint manufacturing plants. Under the previous system, all four factories were judged as high-risk groups. In particular, the paint manufacturing plant A, which has an underground storage tank, received a medium risk like the plating plant C, although the possibility of a chemical accident was lower than that of other plants. However, in the changed system, all plants were changed to the low-risk group. In the Korean-style risk analysis, it is possible to see at a glance what is lacking in the plants, such as cooperation between local residents and local governments and the construction of safety facilities according to the type of accident scenario. The revised system is a reasonable regulation for medium business plants.

Association between environmental exposure to phthalates and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) 2015-2017.

BACKGROUND: Phthalates are common industrial chemicals that are used as plasticizers in plastics, personal care products, and building materials. Although these chemicals have been suspected as risk factors for allergic outcomes among children, inconsistent associations between environmental exposure to phthalates and allergic disorders have been found across different populations. Therefore, this study aimed to assess whether environmental phthalate exposure was associated with parent-reported current allergic symptoms (atopic dermatitis, AD; asthma; and allergic rhinitis, AR) and the index of allergic response (levels of serum total immunoglobulin E, IgE) in a nationally representative sample of children. METHODS: In this study, children aged 3-17 years (n = 2208) were recruited from the Korean National Environmental Health Survey (KoNEHS) 2015-2017 to conduct an analysis of their current allergic symptoms. Among this number of children, the total IgE analysis included 806 participants because total IgE levels were only measured in children aged 12-17 years. RESULTS: After adjusting for all covariates, mono-benzyl phthalate (MBzP) [OR (95% CI) = 1.15 (1.01, 1.30)], mono-(carboxyoctyl) phthalate (MCOP) [OR (95% CI) = 1.35 (1.02, 1.78)], and the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) [OR (95% CI) = 1.39 (1.09, 1.79)] were associated with increased odds of current AD. MCOP [OR (95% CI) = 1.19 (1.01, 1.40)], mono-(carboxynonyl) phthalate (MCNP) [OR (95% CI) = 1.24 (1.05, 1.45)], and ∑DEHP [OR (95% CI) = 1.22 (1.02, 1.44)] were also associated with increased odds of current AR. Individual DEHP metabolites showed similar associations with current AD and AR. In addition, MCNP was positively related to IgE levels [ß (95% CI) = 0.26 (0.12, 0.40)]. MBzP [OR (95% CI) = 1.17 (1.01, 1.35)], MCOP [OR (95% CI) = 1.62 (1.12, 2.32)], and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) [OR (95% CI) = 1.36 (1.06, 1.76)] showed positive relationships with allergic multimorbidity. Moreover, higher concentrations of MCNP were related to increased odds of experiencing both current AR and total IgE levels [OR (95% CI) = 1.98 (1.29, 3.04)], and children with elevated IgE levels (>100IU/mL) were more likely to have current AR associated with MCNP than those without elevated IgE levels (p = 0.007). Specifically, the relationship between MCNP and current AR was significantly mediated through alterations in IgE levels (14.7%), and MCNP also showed the positive association with current AR, independent of IgE (85.3%). CONCLUSION: These results suggest that environmental exposure to phthalates may affect the immune system and increase the occurrence of allergic symptoms in children.

Association between Pb, Cd, and Hg Exposure and Liver Injury among Korean Adults.

BACKGROUND: Exposure to lead (Pb), cadmium (Cd), and mercury (Hg) has been reported to be associated with liver-related diseases. However, studies examining the association between heavy metal exposure and liver injury in a large population are scant and characterized by inconsistent results. This study aimed to evaluate the association between levels of heavy metal exposure and liver injury in the general population. METHODS: Data for 2953 participants aged 19 years or more obtained from the Korean National Environmental Health Survey (KoNEHS) Cycle 3 (2015-2017) were used. The associations between levels of blood or urine heavy metals (Pb, Cd, and Hg) and liver function biomarkers [aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT)] were evaluated using multiple linear regression analysis. RESULTS: Regarding the blood Pb (BPb), AST was higher in those of the 4th quartile, ALT was higher in those of the 2nd and 4th quartiles, and GGT was higher in those of the 3rd and 4th quartiles than in the 1st quartile. For urinary Cd (UCd), AST was higher in those of the 4th quartile; ALT was higher in those of the 2nd, 3rd, and 4th quartiles; and GGT was higher in the 4th quartile than in the 1st quartile. For the blood Hg (BHg), AST was higher in those of the 2nd and 4th quartile, ALT was higher in those of the 2nd, 3rd, and 4th quartiles; and GGT was higher in those of the 3rd and 4th quartiles than in the 1st quartile. There was no significant difference between urinary Hg (UHg) and liver function markers. CONCLUSION: Heavy metal exposure showed an association with liver injury among the general adult population in Korea. Further studies are required to clarify the relationship between heavy metals and liver injury.

Occupational and environmental asbestos exposure and the risk of lung cancer in Korea: A case-control study in South Chungcheong Province of Korea.

Despite the use of large amounts of asbestos in the 1990s, few studies have been conducted in Korea on occupational and environmental asbestos exposure and lung cancer risk. The main aim of this study was to estimate the risk of lung cancer development caused by occupational and environmental asbestos exposures in residents of South Chungcheong Province, where about half of the asbestos mines in Korea operated. We conducted a case-control study, for which the information on asbestos exposure history and demographic characteristics was provided by the Environmental Health Center for asbestos of Soonchunhyang University Cheonan Hospital. After adjusting for all covariates, the odds ratios for lung cancer tended to increase with higher exposure probability for both occupational as well as environmental asbestos. The relative risk of occupational asbestos exposure was higher than that of environmental exposure; the interaction of co-exposure was not statistically significant. The estimated means of the latency period were significantly shorter in participants who were engaged in the production of asbestos-containing products and in those who lived near asbestos industries as compared to other groups.

Joint Effect of Alcohol Drinking and Environmental Cadmium Exposure on Hypertension in Korean Adults: Analysis of Data from the Korea National Health and Nutrition Examination Survey, 2008 to 2013.

BACKGROUND: Hypertension is a common disease found in 1.13 billion adults worldwide. Several animal studies have provided evidence of the joint effect of alcohol drinking and cadmium exposure on hypertension. However, no epidemiologic study has examined the association between these 2 risk factors and hypertension. Therefore, we examined the individual effects of alcohol drinking and cadmium and the joint effect of their coexposure on hypertension in the general population. METHODS: We analyzed data from 8,403 South Korean adults who had been randomly assigned to the Korea National Health and Nutrition Examination Survey from 2008 to 2013. Multiple linear and logistic regression analyses were conducted to estimate the association of alcohol drinking and blood cadmium concentration with blood pressure and the odds ratio (OR) for hypertension. RESULTS: The weighted prevalence of hypertension and high-risk drinking was 25.7 and 13.6%, respectively. The weighted geometric mean of blood cadmium levels was 0.94 µg/L (95% confidence interval [CI]: 0.93 to 0.96). After adjusting for demographic characteristics, anthropometric measurements, health-related behaviors, and dietary and disease variables, the OR for hypertension in the group with the high-risk alcohol drinking was 1.67 (95% CI: 1.34 to 2.06) compared with the group without high-risk alcohol drinking. When the highest and the lowest blood cadmium quartiles were compared, the OR for hypertension was 1.46 (95% CI: 1.15 to 1.86). The positive joint effect of high-risk drinking and blood cadmium levels was statistically significant for systolic blood pressure (SBP; p = 0.037) and diastolic blood pressure (DBP; p < 0.001). CONCLUSIONS: Our results show that heavy alcohol drinking had a joint effect with cadmium exposure to increase the risk of hypertension. Future efforts are needed to reduce alcohol drinking and environmental cadmium exposure to prevent hypertension in the general population.

Association between blood lead levels and metabolic syndrome considering the effect of the thyroid-stimulating hormone based on the 2013 Korea National health and nutrition examination survey.

Imbalances in thyroid-stimulating hormone (TSH) levels are associated with metabolic syndrome (MetS), and the underlying mechanism is partly in alignment with that of lead exposure causing MetS. Many studies have reported the association between lead exposure and MetS, but no study has considered the possibility of TSH mediating lead's effect on MetS. Therefore, we aimed to examine the association between lead exposure and MetS considering TSH as a partial mediator. The data of 1,688 adults (age ≥19 years) from the Korea National Health and Nutrition Examination Survey in 2013 were analyzed. The prevalence of MetS in the Korean population was 21.9%, and the geometric mean of blood lead and serum TSH levels were 1.96 µg/dL and 2.17 µIU/mL, respectively. The associations between blood lead levels, serum TSH levels, and MetS were determined through a multiple logistic regression analysis. Blood lead levels were positively associated with high TSH levels (upper 25%) with an odds ratio (OR) and 95% confidence interval (CI) of 1.79 (1.24, 2.58) per doubled lead levels. The increase in blood lead and serum TSH levels both positively increased the odds of developing MetS. The OR of MetS per doubling of blood lead level was 1.53 (1.00, 2.35), and was not attenuated after adjusting for TSH levels. These findings suggest that higher levels of blood lead are positively associated with serum TSH levels and MetS. By exploring the role of TSH as a partial mediator between lead and MetS, we verified that lead exposure has an independent relationship with MetS, regardless of TSH levels.