Adolescent overweight and obesity and the risk of papillary thyroid cancer in adulthood: a large-scale case-control study.

This study aimed to investigate the association between adolescent overweight and obesity and PTC risk in adulthood. We conducted a case-control study in the Republic of Korea with 1,549 PTC patients and 15,490 controls individually matched for age and sex. We estimated body mass index (BMI) at age 18 years from self-reported weight at this age. Compared with BMI < 23.0 at age 18 years, BMI ≥ 25.0 at age 18 years was associated with higher PTC risk (odds ratio [OR] = 4.31, 95% confidence interval [CI]: 3.57, 5.22). The association between BMI ≥ 25.0 at age 18 years and PTC risk was stronger among men (OR = 6.65, 95% CI: 4.78, 9.27) than among women (OR = 3.49, 95% CI: 2.74, 4.43), and stronger among individuals with current BMI ≥ 25.0 (OR = 8.21, 95% CI: 6.34, 10.62) than among those with current BMI < 25.0 (OR = 2.21, 95% CI: 1.49, 3.27). Among PTC patients, BMI ≥ 25.0 at age 18 years was associated with extra-thyroidal extension and T stage ≥2, but not with N stage ≥1 or BRAFV600E mutation. Adolescent overweight and obesity was associated with higher risk of PTC in adulthood. Our results emphasise the importance of weight management in adolescence to decrease the PTC risk.

Impact of number of medications and age on adherence to antihypertensive medications: A nationwide population-based study.

This study tried to investigate the effects of number of medications and age on antihypertensive medication adherence in a real-world setting using a nationwide representative cohort.We obtained data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea, which is a sample of 2.2% (N = 1,048,061) of total population (N = 46,605,433). Patients aged 20 years or older (N = 150,550) who took antihypertensive medications for at least 1 year were selected. Medication possession ratio (MPR) was used for measuring adherence. The subjects were divided into 5 subgroups according to total number of medications: 1-2, 3-4, 5-6, 7-8, and 9 or more. The mean age and the mean number of medications were 60.3 ±â€Š12.6 years and 4.1 ±â€Š2.2, respectively. The mean MPR was 80.4 ±â€Š23.9%, and 66.9% (N = 100,645) of total subjects were adherent (MPR ≥ 80%). The overall tendency of antihypertensive medication adherence according to the total number of medications displayed an inverted U-shape with a peak at 3-4 drugs. Adherence consistently increased as the age increased until age 69 and started to decrease from age 70. The proportion of adherent patients (MPR ≥ 80%) according to the total number of medications also showed an inverted U-shape with a peak at 3-4 drugs. When the same number of drugs was taken, the proportion of adherent patients according to age featured an inverted U- shape with a peak at 60 to 69 years. Patients taking 9 or more total drugs had the overall odds ratio (95% CI) of non-adherence (MPR < 80%) with 1.17 (1.11-1.24) compared with those taking 1 to 8 total drugs and the odds ratios in the age subgroups of 40 to 49, 50 to 59, 60 to 69 years were 1.57 (1.31-1.87), 1.21 (1.08-1.36), and 1.14 (1.04-1.25), respectively (P < .05).Association between age, total number of medications, and antihypertensive adherence displayed an inverted U-shape with a peak at 3 to 4 total medications and at age 60 to 69 years. When the total number of drugs was 9 or more, adherence decreased prominently, regardless of age.

The Relationship between Electronic Cigarette Use with or without Cigarette Smoking and Alcohol Use among Adolescents: Finding from the 11th Korea Youth Risk Behavior Web-based Survey.

BACKGROUND: Electronic cigarette (EC) consumption ('vaping') is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking. METHODS: We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products). RESULTS: EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink. CONCLUSION: Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.

The Association between Type 2 Diabetes Mellitus and Thyroid Cancer.

AIM: The incidence of thyroid cancer is increasing worldwide. The prevalence of type 2 diabetes mellitus (T2DM) is also increasing. Therefore, we aimed to analyze the effect of T2DM on thyroid cancer. METHODS: A case-control study was performed. A total of 415 healthy controls with thyroid ultrasound screening and physician consultation were selected from the Thyroid Cancer Longitudinal Study (T-CALOS). Among patients with thyroid cancer who were enrolled in T-CALOS, 415 patients were matched to the control group according to age and sex. We assessed the effects of T2DM, T2DM duration, and T2DM medication on thyroid cancer. RESULTS: Women with T2DM had lower odds of thyroid cancer than women without T2DM (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.20-0.81). Individuals receiving T2DM medication had higher odds of thyroid cancer compared to those without T2DM medication (OR: 5.21, 95% CI: 1.58-17.15). Individuals with T2DM duration <6 years had lower odds of thyroid cancer compared to those without T2DM (OR: 0.58, 95% CI: 0.34-0.97). CONCLUSIONS: Individuals with early T2DM are presumed to have a low incidence of thyroid cancer, and this effect seems to last up to 6 years after diagnosis of T2DM.

Weight Change and Associated Factors in Long-Term Breast Cancer Survivors.

PURPOSE: Weight gain often occurs after breast cancer diagnosis and significantly impacts the general health of cancer survivors. While the number of breast cancer survivors is increasing, few studies have reported data on weight change beyond 5 years post-diagnosis. We investigated weight change and associated factors in long-term survivors of breast cancer. PATIENTS AND METHODS: Medical records were reviewed on 1363 breast cancer patients and a total of 822 women who had survived beyond 5 years since diagnosis were included in the final analysis. The association between demographic, anthropometric, lifestyle, cancer related factors (including time since diagnosis, treatment modality, pathologic stage, and hormone receptor status), and weight-change over 5 years were examined. RESULTS: During an average 8.2 years of follow-up time, mean weight gain was 0.32kg (p = 0.017). 175 (21.3%) patients had gained more than 5% of their weight at diagnosis and their average gain was 5.55kg. Body mass index (BMI) at diagnosis, age at diagnosis, aromatase inhibitor (AI) use, heavy drinking, and type of surgery were associated with relative weight gain (≥5%) in univariate analysis (all p-values<0.05). Patients who were non-obese at diagnosis showed weight gain, while those who were obese at diagnosis lost weight (0.78kg,-1.11kg, respectively, p<0.001). In multivariate analysis, the non-obese group showed odds ratio of 2.7 (p = 0.001) relative to the obese group. Younger age group (age 18-54 years) showed odds ratio of 1.9 (p = 0.021) relative to the older age group (age 55-75 years), and patients who did not use AI showed odds ratio of 2.2 (p = 0.006) relative to women who did. CONCLUSION: Long-term breast cancer survivors who were non-obese at diagnosis are more likely to gain weight than obese survivors. Younger survivors and survivors who have never used AI are also likely to gain weight.

Acute High-Dose and Chronic Lifetime Exposure to Alcohol Consumption and Differentiated Thyroid Cancer: T-CALOS Korea.

BACKGROUND: This study evaluated the effects of acute high-dose and chronic lifetime exposure to alcohol and exposure patterns on the development of differentiated thyroid cancer (DTC). METHODS: The Thyroid Cancer Longitudinal Study (T-CALOS) included 2,258 DTC patients (449 men and 1,809 women) and 22,580 healthy participants (4,490 men and 18,090 women) who were individually matched by age, gender, and enrollment year. In-person interviews were conducted with a structured questionnaire to obtain epidemiologic data. Clinicopathologic features of the patients were obtained by chart reviews. Odds ratios (ORs) and 95% confidence intervals (95%CI) were estimated using conditional regression models. RESULTS: While light or moderate drinking behavior was related to a reduced risk of DTC, acute heavy alcohol consumption (151 g or more per event or on a single occasion) was associated with increased risks in men (OR = 2.22, 95%CI = 1.27-3.87) and women (OR = 3.61, 95%CI = 1.52-8.58) compared with never-drinkers. The consumption of alcohol for 31 or more years was a significant risk factor for DTC for both men (31-40 years: OR = 1.58, 95%CI = 1.10-2.28; 41+ years: OR = 3.46, 95%CI = 2.06-5.80) and women (31-40 years: OR = 2.18, 95%CI = 1.62-2.92; 41+ years: OR = 2.71, 95%CI = 1.36-5.05) compared with never-drinkers. The consumption of a large amount of alcohol on a single occasion was also a significant risk factor, even after restricting DTC outcomes to tumor size, lymph node metastasis, extrathyroidal extension and TNM stage. CONCLUSION: The findings of this study suggest that the threshold effects of acute high-dose alcohol consumption and long-term alcohol consumption are linked to an increased risk of DTC.

Annual Average Changes in Adult Obesity as a Risk Factor for Papillary Thyroid Cancer: A Large-Scale Case-Control Study.

We evaluated the association between weight change in middle-aged adults and papillary thyroid cancer (PTC) based on a large-scale case-control study. Our study included data from 1551 PTC patients (19.3% men and 80.7% women) who underwent thyroidectomy at the 3 general hospitals in Korea and 15,510 individually matched control subjects. The subjects' weight history, epidemiologic information, and tumor characteristics confirmed after thyroidectomy were analyzed. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined for the annual average changes in weight and obesity indicators (body mass index (BMI), body surface area, and body fat percentage (BF%) in subjects since the age of 35 years. Subjects with a total weight gain ≥10 kg after age 35 years were more likely to have PTC (men, OR, 5.39, 95% CI, 3.88-7.49; women, OR, 3.36, 95% CI, 2.87-3.93) compared with subjects with a stable weight (loss or gain <5 kg). A marked increase in BMI since age 35 years (annual average change of BMI ≥0.3 kg/m/yr) was related to an elevated PTC risk, and the association was more pronounced for large-sized PTC risks (<1 cm, OR, 2.34, 95% CI, 1.92-2.85; ≥1 cm, OR, 4.00, 95% CI, 2.91-5.49, P heterogeneity = 0.005) compared with low PTC risks. Weight gain and annual increases in obesity indicators in middle-aged adults may increase the risk of developing PTC.

Physical Activity Level of Korean Adults with Chronic Diseases: The Korean National Health and Nutritional Examination Survey, 2010-2012.

BACKGROUND: Proper physical activities are known to be helpful in the prevention and management of chronic diseases. However, the physical activity level of patients with chronic diseases is low. Therefore, this study aimed to investigate the physical activity compliance of patients with hypertension, diabetes, and dyslipidemia in Korea. METHODS: This study analyzed the 2010-2012 Fifth Korean National Health and Nutrition Examination Survey data. We included 13,873 individuals in the analysis. The level of physical activity compliance was measured by performing multivariate logistic regression analyses. RESULTS: In the univariate analysis, the subjects with hypertension or diabetes tended to comply with the physical activity guidelines less faithfully than their healthy counterparts. The proportion of subjects with hypertension who were insufficiently physically active was 65.4% among the men and 75.8% among the women. For diabetes, the proportions were 66.7% and 76.8%, respectively. No significant difference was found between the subjects with dyslipidemia and their healthy counterparts. In the multivariate logistic regression analysis, no significant difference in physical activity compliance was observed between the subjects with hypertension, diabetes, or dyslipidemia and their healthy counterparts for both sexes. CONCLUSION: The patients with hypertension or diabetes tended to have lower physical activity prevlaence than their healthy counterparts. However, for dyslipidemia, no significant difference was found between the two groups. Given the significance of physical activities in the management of chronic diseases, the physical activities of these patients need to be improved.

Protocol of a thyroid cancer longitudinal study (T-CALOS): a prospective, clinical and epidemiological study in Korea.

INTRODUCTION: Thyroid cancer incidence in Korea is the highest in the world and has recently increased steeply. However, factors contributing to this sudden increase have not been fully elucidated, and few studies have explored the postoperative prognosis. The Thyroid Cancer Longitudinal Study (T-CALOS) was initiated with three aims: (1) to identify factors predicting quality of life, recurrence, and incidence of other diseases after thyroid cancer treatments; (2) to investigate environmental exposure to radiation, toxicants and molecular factors in relation to tumour aggressiveness; and (3) to evaluate gene-environment interactions that increase thyroid cancer in comparison with healthy participants from a pool of nationwide population-based healthy examinees. METHODS AND ANALYSIS: T-CALOS enrols patients with incident thyroid cancer from three general hospitals, Seoul National University Hospital, Seoul National University Bundang Hospital and National Medical Center, Korea. The study is an ongoing project expecting to investigate 5000 patients with thyroid cancer up until 2017. Healthy examinees with a normal thyroid confirmed by sonography have been enrolled at the Healthy Examination Center at Seoul National University Hospital. We are also performing individual matching using two nationwide databases that are open to the public. Follow-up information is obtained at patients' clinical visits and by linkage to the national database. For statistical analysis, we will use conditional logistic regression models and a Cox proportional hazard regression model. A number of stratifications and sensitivity analyses will be performed to confirm the results. ETHICS AND DISSEMINATION: Based on a large sample size, a prospective study design, comprehensive data collection and biobank, T-CALOS has been independently peer-reviewed and approved by the three hospitals and two funding sources (National Research Foundation of Korea and Korean Foundation for Cancer Research). The results of T-CALOS will be published according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.

Shared decision-making on the use of hormone therapy: a nationwide survey in the Republic of Korea.

OBJECTIVE: This study aims to assess the current status of shared decision-making on instituting postmenopausal hormone therapy (HT). METHODS: Two cross-sectional nationwide surveys of postmenopausal women and primary care physicians in the Republic of Korea were conducted in 2012 via face-to-face interviews. A total of 685 women (aged 50-69 y) who with natural menopause and 250 primary care physicians were included. RESULTS: Only 56.8% of primary care physicians reported that they explain the benefits and risks of HT and leave the decision to postmenopausal women. The others usually recommended using or not using HT. Of those postmenopausal women who had discussed such therapy with physicians (147 of 685; 21.5%), not all were aware of breast cancer or cardiovascular risks (only 65.3% and 38.8% were informed, respectively). Although most physicians perceived HT as beneficial for menopausal symptom control (99.6%) and acknowledged the related risk of breast cancer (84.8%), nearly half had the impression that HT was preventive of cardiovascular diseases. The interviewed women were less informed of the benefits and risks of HT than were the physician respondents. The awareness levels of the treated and untreated women did not differ. CONCLUSIONS: Participation of postmenopausal women in deciding whether to use HT is not prevalent. Physician-woman information transfer is suboptimal, and treatment decisions often are not based on the best available evidence. The current status of shared decision-making in this setting is clearly in need of improvement.

Preferences for the "screen and treat" strategy of Helicobacter pylori to prevent gastric cancer in healthy Korean populations.

BACKGROUND: Helicobacter pylori (HP) eradication may reduce the risk of gastric cancer, and professional guidelines recommend eradication based on patients' preference. However, little data exist regarding individual's preference for HP eradication to prevent gastric cancer. We explored healthy Korean populations' preference for HP "screen and treat" strategy and its associated factors. METHODS: We conducted a cross-sectional survey with 604 healthy adults expected to undergo screening esophagogastroduodenoscopy during routine health checkups. Survey packages-including a decision aid about "screen and treat" strategy for the HP eradication-were sent to the eligible people 1-3 weeks before the health checkup. Within the survey package, we first assessed people's knowledge and experience with HP test and treatment, provided the decision aid, and evaluated participants' preference for screening and treatment for HP to prevent gastric cancer. RESULTS: With the provision of the decision aid, most participants (73.7%) opted for the "screen and treat" strategy. Having family member(s) with gastric cancer (adjusted odds ratio (aOR) = 2.28; 95% confidence interval (CI), 1.16-4.47), previous treatment history of HP (aOR = 2.70; 95% CI, 1.38-5.29), and higher baseline knowledge (aOR = 1.16; 95% CI, 1.07-1.26) were significantly associated with accepting the strategy. Most participants (71.4%)-and even individuals who did not choose "screen and treat" strategy-agreed with the provision with the decision aid. CONCLUSIONS: Individuals preferred to take the "screen and treat" strategy for the prevention of gastric cancer. Further intervention study is warranted to see if implementation of decisional support would improve decision quality and patient outcomes.

Protective effects of vitamin E on chemotherapy-induced peripheral neuropathy: a meta-analysis of randomized controlled trials.

PURPOSE: This study aimed to investigate the neuroprotective effects of vitamin E for preventing chemotherapy-induced peripheral neuropathy (CIPN). METHODS: A comprehensive search from 1973 through July 2011 identified randomized controlled trials (RCTs) that reported the preventive effects of vitamin E on CIPN. The relative risk (RR) of CIPN with vitamin E supplementation, compared with placebo, was assessed with the Bayesian random effect model and expressed as RR with a 95 % credible-interval (CrI). Bayesian outcome probabilities were calculated as the probability (P) of RR < 1. RESULTS: Five RCTs, involving 319 patients, were identified. Upon pooling these RCTs, vitamin E supplementation (300 - 600 mg/day) had a significant effect on CIPN prevention (RR 0.43; 95 % CrI 0.10 - 1.00, P = 97.5 %). Subgroup analysis by chemotherapeutic agent type was only available for cisplatin and showed that vitamin E supplementation significantly reduced the incidence of CIPN (RR 0.26; 95 % CrI 0.06 - 0.89, P = 98.1 %). Furthermore, there were no adverse effects caused by vitamin E supplementation in any of the RCTs. CONCLUSION: Available data included in this meta-analysis show that vitamin E supplementation might significantly prevent CIPN. Currently, however, the data are insufficient to confidently conclude the true value. Large-scale, rigorously designed RCTs are needed to confirm the role of vitamin E supplementation in CIPN prevention.

High-sensitivity C-reactive protein levels and cancer mortality.

BACKGROUND: High-sensitivity C-reactive protein (hs-CRP) is an important inflammatory marker, and inflammation is known to be involved in the initiation and progression of cancer. We investigated the association between serum hs-CRP levels and all-cause mortality, cancer mortality, and site-specific cancer mortality in apparently cancer-free Koreans. METHODS: A total of 33,567 participants who underwent routine check-ups at a single tertiary hospital health-screening center between May 1995 and December 2006, and whose serum hs-CRP level data were available, were included in the study. Baseline serum hs-CRP levels were obtained and subjects were followed up for mortality from baseline examination until December 31, 2008. RESULTS: During an average follow-up of 9.4 years, 1,054 deaths, including 506 cancer deaths, were recorded. The adjusted HRs (aHR; 95% confidence interval [CI]) of subjects with hs-CRP ≥3 mg/L for all-cause and cancer-related mortality were 1.38 (1.15-1.66) and 1.61 (1.25-2.07) in men, and 1.29 (0.94-1.77) and 1.24 (0.75-2.06) in women, respectively, compared with subjects with hs-CRP ≤1 mg/L. Elevated hs-CRP was also associated with an increased risk of site-specific mortality from lung cancer for sexes combined (2.53 [1.57-4.06]). CONCLUSIONS: This study suggests that elevated levels of hs-CRP in apparently cancer-free individuals may be associated with increased mortality from all-causes and cancer, in particular, lung cancer in men, but not in women. IMPACT: As a marker for chronic inflammation, hs-CRP assists in the identification of subjects with an increased risk of cancer death.

Association between metabolic syndrome and Helicobacter pylori infection diagnosed by histologic status and serological status.

GOALS: We aimed to simultaneously evaluate the association between metabolic syndrome and Helicobacter pylori (HP) infection diagnosed histologically and serologically in a large number of healthy Korean adults. BACKGROUND: Serological positivity for HP does not necessarily indicate current infection. No study to date has compared the association between metabolic syndrome and HP infection diagnosed by histologic and serological status. STUDY: HP status was ascertained histologically and serologically in healthy Korean adults who underwent comprehensive health screening in a private health screening center in Korea. Metabolic syndrome was defined according to the International Diabetes Federation definition. Multivariate logistic analyses were performed, after adjusting for potential confounders, including age, sex, smoking, alcohol consumption, and income level. RESULTS: A total of 5889 subjects were included in the analysis. The metabolic syndrome was more strongly associated with histologic positivity for HP [adjusted odds ratio (aOR)=1.26; 95% confidence interval (CI), 1.08-1.48] than serologic positivity (aOR=1.12, 95% CI, 0.95-1.32), after adjusting for age, sex, smoking status, alcohol consumption, and economic status. CONCLUSIONS: The stronger association between metabolic syndrome and histologic positivity than serological positivity suggests that the effects of HP infection on the pathogenesis of cardiometabolic outcomes may be reversible. Further prospective studies are needed.

A low level of serum total testosterone is independently associated with nonalcoholic fatty liver disease.

BACKGROUND: The association between low serum testosterone levels, visceral adipose tissue (VAT), and metabolic syndrome is now well known. However, the relationship between hepatic steatosis and serum testosterone levels has not been extensively studied. Our aim was to investigate the association of serum total testosterone levels with nonalcoholic fatty liver disease (NAFLD), adjusting for the influence of VAT and insulin resistance. METHODS: This study is a retrospective observational cross-sectional one of healthy Korean men and was conducted at the Seoul National University Hospital Healthcare System Gangnam Center. We used data obtained from 495 men who were at least 20 years of age and who had undergone blood testing, abdominal computed tomography, and ultrasonography. Multiple logistic regression analysis was used to explore the association of serum total testosterone levels with NAFLD. RESULTS: Men in the low serum testosterone quintile were at a higher risk for NAFLD than men in the highest serum testosterone quintile. After adjusting for age, smoking, diabetes, exercise, BMI, triglycerides, and high-density-lipoprotein cholesterol, subjects with serum testosterone levels in the lowest quintile had an odds ratio (OR) (95% confidence interval (CI)) of 5.12 (2.43-10.77) for NAFLD (p value, 0.0004). The inverse association between serum testosterone and NAFLD was attenuated by further adjustment for variables including VAT; however, it remained statistically significant (OR (95% CI): 4.52 (2.09-9.80) in the lowest quintile; p value=0.004). CONCLUSIONS: A low serum total testosterone level was independently associated with NAFLD. This report is the first one suggesting the association remains unchanged even after controlling for VAT and insulin resistance.

Effect of central obesity on prostate specific antigen measured by computerized tomography: related markers and prostate volume.

PURPOSE: We assessed the effects of central adiposity represented by visceral adipose tissue on prostate volume, prostate specific antigen, and prostate specific antigen mass and mass ratio. MATERIALS AND METHODS: This cross-sectional study included 6,389 Asian men 30 to 79 years old. Prostate volume was estimated by transrectal ultrasound. Visceral and subcutaneous adipose tissue was measured by computerized tomography. Multivariate linear regression analysis was done between prostate specific antigen related variables and obesity indexes such as body mass index, waist circumference, and visceral and subcutaneous adipose tissue after adjusting for age. RESULTS: Body mass index, waist circumference and subcutaneous adipose tissue were inversely associated with prostate specific antigen (p for trend <0.001) but visceral adipose tissue showed no associations with prostate specific antigen (p for trend = 0.740). Waist circumference, and visceral and subcutaneous adipose tissue were positively associated with prostate specific antigen mass (p for trend = 0.014, <0.001 and 0.036, respectively). However, body mass index did not show this association (p for trend = 0.372). Body mass index, waist circumference and subcutaneous adipose tissue negatively affected the prostate specific antigen mass ratio (each p for trend <0.05) but there was no such significant correlation for visceral adipose tissue (p for trend = 0.187). When adjusted for visceral adipose tissue body mass index was not associated with prostate volume (p for trend = 0.152) but visceral adipose tissue remained positively associated with prostate volume even after adjusting for body mass index (p for trend = 0.005). CONCLUSIONS: Visceral adiposity is the main determining factor of the prostate volume increase and prostate specific antigen production.

Alcohol consumption shows a J-shaped association with lower urinary tract symptoms in the general screening population.

PURPOSE: Controversial and contradictory data on the association between alcohol consumption and lower urinary tract symptoms are currently available in the literature. In this study we determined the association between alcohol consumption and lower urinary tract symptoms, including voiding and storage symptoms, in a large general screening population. MATERIALS AND METHODS: This cross-sectional study included 30,196 men 30 years old or older participating in a comprehensive health evaluation at the Seoul National University Hospital Healthcare System Gangnam Center. Men with a history of prostate related medical problems such as prostate cancer, prostate surgery or prostatitis were excluded from study. Using the International Prostate Symptom Score, lower urinary tract symptoms were defined as a score of 8 or greater, indicating moderate to severe symptoms. We used logistic regression analysis to determine the association between alcohol consumption and lower urinary tract symptoms. RESULTS: After adjustment for eligible covariates, graphing of the association between alcohol consumption and the risk of moderate to severe lower urinary tract symptoms showed a J-shaped curve. Compared with nondrinkers, the odds ratios of moderate to severe lower urinary tract symptoms were 0.91 (95% CI 0.84-0.98) in men who drank 0 to 10 gm daily and 1.19 (95% CI 1.07-1.33) in those who drank 40 or more gm daily. This is a cross-sectional study with data from self-reported alcohol consumption and, therefore, the reported amounts of alcohol consumption might be underestimated. CONCLUSIONS: To the best of our knowledge this is the largest population based study to evaluate the relationship between alcohol consumption and moderate to severe lower urinary tract symptoms, including voiding and storage symptoms. In men alcohol consumption shows a J-shaped curve relationship with the risk of moderate to severe lower urinary tract symptoms.

An implication of the short physical performance battery (SPPB) as a predictor of abnormal pulmonary function in aging people.

If association between the decline in physical performance and the decline in pulmonary function is confirmed, the SPPB could be used as a predictor for pulmonary functional declines in aging people because of its convenient use. This study aimed to elucidate the association of the SPPB with the pulmonary function test (PFT) to determine the usefulness of the SPPB as a predictor of PFT decline. The SPPB and PFT were performed on random sample nested in the Korean Longitudinal Study of Aging (KLoSA) panel, a national representative sample of aging people in Korea. Comparisons of adjusted means of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory ratio (FER) defined as FEV1/FVC between normal and abnormal SPPB groups were performed using the t-test. The association between PFT and SPPB abnormality was examined using multiple logistic regression analysis. Additionally, the associations of gait speed and chair stand time with FEV1 and FVC were examined using multiple linear regression analysis. Five hundred and eighteen subjects were included in analysis. Approximately 43% (222/518) of the subjects were male and 65% (338/518) were 60 years or older. Adjusted means of FEV1 and FER were significantly or marginally lower when SPPB score was abnormal in both overall and non-smoking men (p=0.009 and 0.053 for overall, p<0.001 and p<0.080 for non-smokers), but FVC was lower only in non-smoking men (p=0.024). Abnormal SPPB score was significantly associated with abnormal PFT regardless of sex. (adjusted odds ratio=OR=3.76, 95%CI=1.96-7.22 for men, adjusted OR=2.11, 95%CI 1.28-3.47 for women). Gait speed was significantly or marginally associated with FEV1 and FVC in participants 60 years or older, regardless of sex. We conclude that abnormal SPPB score was associated with abnormal pulmonary function. Thus, the SPPB has the potential to be used as an early predictor of abnormal pulmonary function in clinical settings and epidemiological study.

Lower urinary tract symptoms have negative associations with glomerular filtration rate irrespective of prostate volume in Korean men.

OBJECTIVE: To understand the relationship between lower urinary tract symptoms (LUTS) and renal function by prostate volume (PV) in Korean men. LUTS can be related to early renal dysfunction, irrespective of bladder outlet obstructive lesions, few studies have been conducted. METHODS: We conducted a cross-sectional survey of 3713 men, aged≥40 years, who received routine comprehensive health evaluations, including transrectal ultrasonography and the International Prostate Symptom Score questionnaire. We used the estimated glomerular filtration rate (GFR) for the assessment of renal function and the IPSS for LUTS severity. We compared LUTS and GFR using multivariate regression analysis after adjusting for age and/or PV. RESULTS: An increasing severity of LUTS, especially voiding LUTS, was associated with a decreasing GFR in the older age group (≥55 years). In a stratified analysis by PV of 30 cm3, voiding LUTS showed a negative association with GFR, irrespective of the PV (P for trend<.01 and P for trend<.02), but total LUTS did so only in the small PV group. CONCLUSION: In men without known urinary tract disease, LUTS and renal function had a negative association, especially in older men with a normal PV. Although the underlying mechanism is uncertain, physicians who treat patients with moderate or severe LUTS should monitor renal function, even in patients with a normal PV.

The illusion of prostate-specific antigen decline in patients with metabolic syndrome and insulin resistance.

UNLABELLED: What's known on the subject? and What does the study add? Studies have shown that PSA is negatively associated with obesity as a result of hemodilution or metabolic effect. Hemodilution could be the main reason for low PSA levels in obese men. However, the intrinsic metabolic effects such as insulin resistance (IR) or metabolic syndrome (MS) on PSA level have not been clearly evaluated although obesity is closely tied to MS and IR. We regarded MS and IR as the pathophysiological cornerstone of metabolic disorder in obesity and analyzed the relationships among MS, IR, and PSA levels, and plasma volume by using the concept of PSA mass, the total circulating PSA protein. PSA mass did not change depending on the severity of the obesity, MS or IR. Even the group with both MS and IR, which could be the most metabolically disturbed in this study, did not have different PSA mass, comparing with the group without any MS or IR. Thus, the decline in PSA level in men with MS or IR can be also explained by increased plasma volume other than any intrinsic metabolic effects. OBJECTIVE: • To investigate the detailed mechanism of prostate-specific antigen (PSA) decline in metabolic syndrome (MS) and insulin resistance (IR), which lowers the predictive value of the PSA test, we examined the effect of haemodilution and the possibility of an intrinsic metabolic effect. PATIENTS AND METHODS: • We analysed 28,315 men who underwent routine check-ups. We compared the age-adjusted mean PSA levels in subjects with and without MS before and after adjusting or stratifying the plasma volume. We analysed changes in PSA level, plasma volume and PSA mass according to obesity grade, number of MS components, IR severity and diagnosis of MS, IR or both using an analysis of covariance. RESULTS: • The PSA levels were lower in the group with MS than in the group without MS (P= 0.001), but this difference disappeared after adjusting or stratifying the plasma volume (P > 0.05 for all). The PSA levels decreased, plasma volume increased, and PSA mass did not change as the number of MS components increased (P= 0.002, P < 0.001, P= 0.55, respectively) or the IR severity increased (P= 0.001, P < 0.001, P= 0.34, respectively). • Similarly, PSA levels were lower, plasma volumes were higher and PSA masses were the same in subjects with MS (P= 0.002, P < 0.001, P= 0.10, respectively), IR (P= 0.018, P < 0.001, P= 0.94, respectively), or both (P= 0.003, P < 0.001, P= 0.86, respectively) than in subjects without those conditions. CONCLUSION: • The PSA decline in MS and IR may result simply from a haemodilution effect and be unrelated to intrinsic metabolic disturbances. For this reason, PSA levels could be underestimated in patients with MS or IR because of haemodilution.