Concordance of Characteristics and Metabolic Syndrome in Couples: Insights from a National Survey.

Background and Objective: There is insufficient evidence on whether the concordance of sociodemographic, behavioral, and nutritional characteristics between spouses correlates with the concordance of metabolic syndrome (MetS) between spouses, or if a spouse's characteristics are directly linked to their own MetS. This study seeks to evaluate the association between the concordance of characteristics and the concordance of MetS in couples and investigate whether a spouse's attributes are linked to their partner's MetS. Methods: Analyzing data from the Korea National Health and Nutrition Examination Survey 2019-2021, 1824 couples with complete data, including MetS parameters, sociodemographic details, health behaviors, and dietary information, were included. General linear model and logistic regression were employed. Results: Among couples, 10.7% exhibited concordant MetS, with spousal concordance ranging from 1.3% to 81.5% for nonoptimal characteristics. Multivariate analysis revealed that the odds of both partners having MetS increased by 1.04-1.61 times with a higher mean age of the couple and higher concordance in lower education, poor subjective health, insufficient strength exercise, and excessive carbohydrate consumption. When accounting for both individual and spousal factors, the odds of MetS rose with the higher mean age of the couple, having a spouse with MetS, their own characteristics (lower education, poor subjective health, insufficient strength exercise, and sedentary behavior for husbands and wives; alcohol consumption and insufficient walking for husbands; and excessive carbohydrate intake for wives), and spousal factors such as smoking (in husbands) and lower education, lower economic status, and excessive carbohydrate intake (in wives). In wives, spousal sedentary behavior and poor subjective health were linked to decreased odds. Conclusions: The findings suggest a connection between MetS concordance and shared characteristics in couples, as well as an association between both spousal MetS status and characteristics and their own MetS.

Rejuvenating aged microglia by p16ink4a-siRNA-loaded nanoparticles increases amyloid-ß clearance in animal models of Alzheimer's disease.

Age-dependent accumulation of amyloid plaques in patients with sporadic Alzheimer's disease (AD) is associated with reduced amyloid clearance. Older microglia have a reduced ability to phagocytose amyloid, so phagocytosis of amyloid plaques by microglia could be regulated to prevent amyloid accumulation. Furthermore, considering the aging-related disruption of cell cycle machinery in old microglia, we hypothesize that regulating their cell cycle could rejuvenate them and enhance their ability to promote more efficient amyloid clearance. First, we used gene ontology analysis of microglia from young and old mice to identify differential expression of cyclin-dependent kinase inhibitor 2A (p16ink4a), a cell cycle factor related to aging. We found that p16ink4a expression was increased in microglia near amyloid plaques in brain tissue from patients with AD and 5XFAD mice, a model of AD. In BV2 microglia, small interfering RNA (siRNA)-mediated p16ink4a downregulation transformed microglia with enhanced amyloid phagocytic capacity through regulated the cell cycle and increased cell proliferation. To regulate microglial phagocytosis by gene transduction, we used poly (D,L-lactic-co-glycolic acid) (PLGA) nanoparticles, which predominantly target microglia, to deliver the siRNA and to control microglial reactivity. Nanoparticle-based delivery of p16ink4a siRNA reduced amyloid plaque formation and the number of aged microglia surrounding the plaque and reversed learning deterioration and spatial memory deficits. We propose that downregulation of p16ink4a in microglia is a promising strategy for the treatment of Alzheimer's disease.

Exercise interventions for frail older adults with cancer.

PURPOSE OF REVIEW: Frailty is prevalent in older adults with cancer and can lead to complications during cancer treatment and poor health outcomes. Exercise has been shown to be a promising strategy to mitigate frailty and slow the accumulation of functional impairment in the general geriatric population. In this review, we present a discussion on the state of the science of exercise interventions for frail older adults with cancer. This review is timely and relevant given the aging of the population and corresponding increase in proportion of older adults living with cancer. RECENT FINDINGS: Existing research related to exercise interventions for frail older adults with cancer appear to show some promise in feasibility and efficacy in both surgical and systemic treatment settings. SUMMARY: More research on this topic and testing rigorously structured exercise interventions for older adults with cancer may help inform cancer-specific guidelines and create a foundation of evidence to enable implementation of exercise interventions. These interventions can support cancer care to attenuate frailty-related outcomes while extending its benefit to overall health of this population.

Self-perceived Weight and Mortality in Korean Adults Based on the Korea National Health and Nutrition Examination Survey Data Linked to Cause of Death Statistics.

Background: This study aimed to determine the associations between self-perceived weight, weight perception, and mortality risk among Korean adults. Methods: Data from the 2007 to 2015 Korea National Health and Nutrition Examination Survey and the 2007 to 2019 Cause of Death Statistics were linked for this cohort study. A complex samples Cox regression analysis involving 42,453 participants (17,056 male; 25,397 female) was performed after excluding those who died within 1 year of the follow-up period, those with a history of cancer, those with cardiovascular diseases, those without body mass index (BMI) data, and those without self-perceived weight data. Results: During 7.85 years of follow-up, the overall mortality rate was 3.8% (4.5% for male and 3.1% for female). Self-perceived thin weight status was associated with a 43% to 68% higher risk of all-cause mortality and a 2.48-times higher risk of cardiovascular mortality compared to self-perceived just right weight status after controlling for sociodemographic characteristics, health-related behaviors, underlying health status, BMI, and metabolic syndrome. After adjusting for the confounding factors, those who underestimated their weight had a 27% reduced risk of all-cause mortality than those who correctly estimated their weight. The risks of all-cause mortality and cardiovascular mortality were 2.14-times higher and 2.32-times higher, respectively, in the underweight group with an accurate weight estimation than in the normal weight group with an accurate weight estimation. However, all-cause mortality was 47% lower among participants with obesity who overestimated their weight. Conclusion: Self-perceived thinness and accurately perceived underweight status were associated with increased risks of all-cause mortality and cardiovascular mortality among Korean adults.

Weight perception and self-rated health: are there differences between cancer survivors and non-cancer survivors?

PURPOSE: To compare relationships between self-perceived weight and self-rated health (SRH) between cancer survivors and non-cancer survivors. METHODS: A cross-sectional study based on the 2014-2019 Korea National Health and Nutrition Examination Survey was conducted for the associations of self-perceived weight status, measured BMI categories, and combined categories by self-perceived weight and measured BMI with SRH in 1622 cancer survivors and 29,903 non-cancer survivors using complex samples ordinal regression analysis after adjusting for sociodemographic factors, health behaviors, and concurrent diseases. RESULTS: Compared to the comparison group (those who were normal weight and self-perceived as average weight in non-cancer survivors), adjusted odds for poorer SRH were higher in cancer survivors and non-cancer survivors who were underweight and self-perceived as underweight (adjusted odds ratios[aORs], 2.69 for non-cancer survivors; 2.62 for cancer survivors), those who were normal weight but self-perceived as underweight or overweight (aORs, 1.69-2.38 for non-cancer survivors; 2.34-3.78 for cancer survivors), and those who were overweight and self-perceived as overweight (aORs, 1.52 for non-cancer survivors; 2.42 for cancer survivors). In cancer survivors, the odds for poorer SRH were greater for those who were normal weight and self-perceived as average weight (aOR = 1.84), whereas the odds were not significant for those who were underweight or overweight and self-perceived as average weight. In non-cancer survivors who self-perceived as average weight, the odds for poorer SRH were significant in those with underweight (aOR = 1.35) or overweight (aOR = 0.84). CONCLUSION: According to actual weight status, the association between self-perceived weight and SRH may differ between cancer survivors and non-cancer survivors.

Relationships of food security with skeletal muscle mass and handgrip strength by sex.

OBJECTIVES: This study aimed to evaluate sex differences in the relationships of food security level with skeletal muscle mass and handgrip strength. METHODS: Skeletal muscle mass (appendicular skeletal muscle mass [ASM] adjusted for squared height [ASM/height2] or body mass index [ASM/BMI]), handgrip strength, food security level (high, marginally, and low secure), and covariates (age, education, household income, chronic diseases, smoking status, alcohol use, and physical activity) were assessed in participants aged 19 to 80 y using Korea National Health and Nutrition Examination Survey data (4481 men and 6320 women from the 2008-2011 data, 9588 men and 12 981 women from the 2014-2018 data). A complex sample design general linear model was performed. RESULTS: After adjusting for covariates, the interaction between food security and sex was significant for associations with ASM/height2 (P = 0.001) and handgrip strength (P < 0.001), but not with ASM/BMI. After adjusting for covariates, ASM/height2 and ASM/BMI were significantly lower in men aged <60 y from lower food-security households than those from high food-security households, but not in men aged ≥60 y or women of all ages. After adjusting for covariates, men and women aged <60 y and ≥60 y from lower food-security households had significantly weaker handgrip strength than those from high food-security households. CONCLUSIONS: Low food security was associated with lower muscle mass and strength in men aged <60 y and weaker muscle strength in men aged ≥60 y and women of all ages. These results suggest sex differences in the relationships of food security with muscle mass and strength in individuals aged <60 y.

Food Security Moderates the Relationships of Muscle Mass with Metabolic Syndrome and Insulin Resistance.

BACKGROUND: This study aimed to determine whether food security moderates the relationship of skeletal muscle mass with metabolic syndrome (MetS) and insulin resistance (IR). METHODS: This study analyzed the data of 10,680 adults using the Korea National Health and Nutrition Examination Survey from 2008 to 2011. The food security reported by households, appendicular skeletal muscle mass (ASM) divided by body mass index (BMI) (ASM/BMI), weight (ASM/weight), or height squared (ASM/height2) as muscle mass indicators, MetS (defined as presence of at least 3 components of MetS), and IR (defined as sex-specific highest quintile of homeostatic model assessment for IR) were assessed. The association between the muscle mass indicators and food security as well as their interaction with MetS and IR was analyzed for all participants and each sex using complex sample logistic regression and general linear model analyses. RESULTS: When the ASM/BMI increased by 0.1 kg/BMI, the odds for MetS and IR decreased by 36% and 29%, respectively, after adjusting for age, sex, education, economic level, smoking, alcohol consumption, physical activity, chronic diseases, and intake of fats and protein. There was a significant interaction between ASM/BMI and food security in their relationship with MetS and its components. In the low food security group, the inverse relationship of ASM/BMI with MetS and IR was stronger than in the food security group. These findings were more pronounced in men than in women, and similar findings were observed in the association with ASM/weight. CONCLUSIONS: The associations of skeletal muscle mass with MetS and IR may be influenced by household food security in Korean adults.

The association between occupational categories and grip strength in Korean male workers.

PURPOSE: This study explored the association between occupational categories and muscle strength using handgrip strength (HGS) while considering sociodemographic and health-related factors in Korean men using a national survey. METHODS: Using cross-sectional data of 8380 men (59.9 ± 16.6 years of age), the occupational categories held the longest duration and HGS levels (normal vs. weak) were determined. Logistic regression was applied with adjustment for sociodemographic factors, work-related factors (working hours and schedule), and health-related factors (physical activity, sedentary time, resistance exercise, alcohol consumption, smoking status, chronic illness, subjective health status, weight category, metabolic syndrome, and protein intake). RESULTS: Weak HGS prevalence was lowest in male managerial or professional workers (1.5%) and highest in male skilled agricultural, forestry, fishery, or craft and the related trades workers (16.4%). Compared to male managerial or professional workers, the odds for weak HGS increased in male service/sales workers (OR 2.41; 95% CI 1.45-3.99) and male manual workers [agricultural/forestry/fishery/craft and related trades workers, OR 2.94 (95% CI 1.78-4.83); equipment/machine operating/assembling workers, OR 1.68 (95% CI 1.05-2.71); and elementary workers, OR 3.43 (95% CI 1.95-6.05)] in the fully adjusted model. Regardless of age groups, income, working hours, strength exercise, and sedentary time levels, and chronic illness and metabolic syndrome status, male manual workers were more likely to have weak HGS compared to male non-manual workers. CONCLUSION: Male manual workers may have a higher risk for weak muscle strength compared to male non-manual workers regardless of sociodemographic, work-related, and health-related factors.

Sarcopenic obesity and 10-year cardiovascular disease risk scores in cancer survivors and non-cancer participants using a nationwide survey.

OBJECTIVE: To evaluate the associations of combinations of sarcopenia and adiposity phenotypes with 10-year cardiovascular disease (CVD) risk scores in cancer survivors and non-cancer participants. METHODS: In 19,019 individuals including 1023 cancer survivors free of CVD who were aged ≥30 years from the Korea National Health and Nutrition Examination Survey, combination groups of sarcopenia, obesity and abdominal obesity based on handgrip strength, BMI and waist circumference, respectively, were generated and 10-year CVD risk scores based on Framingham risk model were determined. RESULTS AND CONCLUSION: After adjusting for socio-demographic factors, health behaviours, dietary intake of nutrients and time since cancer diagnosis and current cancer therapy (in cancer survivors), cancer survivors with sarcopenic non-obesity, non-sarcopenic abdominal obesity or sarcopenic abdominal obesity had, respectively, 84%, 85% and 3.61-fold higher odds for ≥10% CVD risk scores compared with cancer survivors without those phenotypes. In non-cancer participants, sarcopenia, obesity, abdominal obesity and combinations of those phenotypes had higher odds from 1.37 (in those with obesity) to 4.24 (in those with sarcopenic abdominal obesity) for ≥10% CVD risk scores compared with reference phenotypes. In conclusion, cancer survivors and non-cancer participants with sarcopenia, obesity, abdominal obesity or combination of those phenotypes had increased 10-year CVD risk scores.

Sex and Region-Specific Associations of Bone Mineral Content, Muscle Mass, and Fat Mass with Insulin Resistance.

Background: To compare the strengths of the associations between total and region-specific body composition and insulin resistance (IR) considering sex and menopausal status and to compare body composition indicators for discriminating high IR. Materials and Methods: Among 5380 men, 3652 premenopausal women, and 3207 postmenopausal women in the Korean National Health and Nutrition Examination Survey, high IR was defined as the sex-specific highest quintiles of homeostasis model assessment IR and metabolic syndrome. Percentages of bone mineral content (BMC%), muscle mass (MM%), and fat mass (FM%) were measured for the whole body, trunk, and upper/lower extremities by dual-energy X-ray absorptiometry. Results: After adjusting for body mass, age, education, smoking status, alcohol use, and physical activity, one-standard deviation increases in whole-body FM%, MM%, and BMC% were associated with 50%-63%, 19%-26%, and 14%-22% higher odds of high IR in men and pre- and postmenopausal women, 31%-36%, 12%-17%, and 10%-15% lower odds, and 27%-36%, 31%-40%, and 19%-23% lower odds, respectively. Those associations for FM% in men and BMC% in premenopausal women tended to be stronger in the upper body than in lower extremities. In receiver operating characteristic curve analysis, FM% in men and BMC% in women had superior discriminatory abilities for high IR. Conclusions: IR may have a stronger association with FM% in men and BMC% in premenopausal women in upper body, while the association strength in postmenopausal women may be similar across body composition. These findings reveal differences in the strengths of region-, sex, and menopausal status-specific relationships between body composition and IR.

Genetic and environmental relationships between eating behavior and symptoms of anxiety and depression.

PURPOSE: To assess gender-specific genetic and environmental correlations between depressive and anxiety symptoms, and concurrent and follow-up eating behavior in Korean twins and their family members. METHODS: Center for Epidemiological Studies Depression Scale and State-Trait Anxiety Inventory were used to measure depressive and anxiety symptoms in subjects. To assess concurrent and follow-up relationships of the symptoms with eating behavior domains (restrained, emotional, and external eating), the Dutch Eating Behavior Questionnaire was administered to 2359 subjects at baseline (men, 48.5%; 42.0 ± 12.7 years; monozygotic twins, 33.7%) and to 1169 subjects at follow-up (men, 45.9%; 44.9 ± 11.6 years; monozygotic twins, 41.0%). A mixed linear model and bivariate analysis were applied. RESULTS: After adjusting for age, twin and family effects, income, education, smoking status, alcohol use, exercise, and body mass index, depressive and anxiety symptoms were positively associated with concurrent and follow-up emotional and external eating, but not with restrained eating. The effect size of association with emotional eating increased in men in men over time, but decreased in women. Common genetic and environmental correlations showed a difference between genders, and their strength changed with time. Nevertheless, common genetic correlations were found between depressive and anxiety symptoms, and concurrent emotional eating, in both genders. There were common environmental correlations between anxiety symptoms, and concurrent restrained and emotional as well as follow-up emotional eating, in both genders. CONCLUSIONS: There are similarities and differences in genetic and environmental relationships between depressive and anxiety symptoms and eating behaviors, based on gender and time of assessment. LEVEL OF EVIDENCE: Level III, cohort study.

Relative handgrip strength in relation to depressive mood and suicidal ideation in Koreans using the 2015 KNHANES data.

OBJECTIVES: This study aimed to examine the association of relative handgrip strength (RHGS) with depressive mood and suicidal ideation. METHODS: A cross-sectional study was conducted among 2167 men and 2643 women (aged 50.9 years ± 16.7 years) who participated in the 2015 Korean National Health and Nutrition Examination Survey. RHGS was defined by the handgrip strength/body mass index (BMI) ratio. Depressive mood and suicidal ideation were assessed using self-reported questionnaires. Logistic regression analysis was conducted after adjusting for sex, concurrent illness, age, education, income, smoking status, alcohol use, physical activity, and depressive mood (in the analysis for suicidal ideation). RESULTS: Among participants, 4.0% men and 5.7% women reported serious suicidal ideation while 9.5% men and 16.0% women reported serious depressive mood. After adjusting for confounding factors, RHGS was associated with depressive mood (odds ratio [95% confidence interval] per RHGS [kg/BMI], 0.82 [0.69-0.99]) and suicidal ideation (0.73 [0.54-0.99]). In sex-specific relationship, RHGS was associated with depressive mood and suicidal ideation in women (0.71 [0.55-0.93] and 0.54 [0.34-0.85], respectively) but not in men. CONCLUSIONS: Poorer RHGS indicates higher risk of depressive mood as well as suicidal ideation regardless of depressive mood among women.

Relationship Between Handgrip Strength and Nonalcoholic Fatty Liver Disease: Nationwide Surveys.

BACKGROUND: The association of handgrip strength with nonalcoholic fatty liver disease (NAFLD) has not been studied yet. This study investigated the relationship between handgrip strength and NAFLD in South Korean adults. METHODS: Referring to the Korea National Health and Nutrition Examination Survey 2014 and 2015 database, South Korean adults (n = 8001, women: 55.5%) aged 19-80 years having complete data were considered for this study. Relative handgrip strength (RHGS) [average handgrip strength of both hands divided by body mass index (BMI)], hepatic steatosis index (HSI), BMI, and components of metabolic syndrome were measured. Demographics, treatment of concurrent illnesses, and health-related behaviors were assessed by using standardized questionnaires. NAFLD was defined by the HSI >36.0, alcohol consumption <20 grams/day, and negative biomarkers for chronic hepatitis B and C. RESULTS: The prevalence of NAFLD was 30.3% ± 0.7%. Complex sample logistic regression analysis revealed that individuals with lower RHGS [per 1 standard deviation (SD) decrease] manifested higher odds of suffering from NAFLD (adjusted odds ratio: 1.47, 95% confidence interval: 1.35-1.60). Furthermore, lower RHGS was associated with higher odds for NAFLD throughout the strata of sex, age group, education, BMI category, metabolic syndrome, treatment history of illnesses, smoking status, alcohol consumption, or physical activity. The odds for NAFLD increased in the range of 1.40-1.63 with 1 SD decrease in RHGS according to the strata. CONCLUSIONS: This study of South Korean adults suggests that lower handgrip strength is associated with NAFLD regardless of sociodemographic characteristics, weight status, metabolic syndrome, concurrent illnesses, and lifestyle.

Mammographic Density and Circulating Sex Hormones: a Cross-Sectional Study in Postmenopausal Korean Women.

Mammographic density (MD) is a strong independent risk factor for breast cancer. It has been suggested that breast cancer is related to the exposure to circulating sex hormones. However, relations between MD and hormones have been inconsistent. In addition, such relations are mainly evaluated in Western populations. Therefore, we conducted a cross-sectional study in 396 cancer-free postmenopausal Korean women who had never used hormone replacement therapy. We assayed estradiol, testosterone, and sex hormone-binding globulin (SHBG) levels. We then calculated free testosterone (cFT) levels. Total and dense areas of digital mammogram were measured using a computer-assisted thresholding method, and non-dense area and percent dense area were calculated. Linear mixed model was used for analyses. Estradiol and testosterone levels were not associated with any MD measures after adjusting for reproductive factors and body mass index. However, cFT was persistently associated with non-dense area even after adjusting for covariates, with non-dense area increased by 3.5% per 1 standard deviation increase of cFT. SHBG showed an inverse association with non-dense area, although it showed a positive association with dense area and percent dense area regardless of adjustment for covariates. Non-dense area was decreased by 5.6% while percent dense area was increased by 13.4% per 1 standard deviation increase of SHBG. These findings suggest that SHBG might be related with breast cancer risk, probably through its association with breast density.

Sex-Specific Associations of Risk-Based Alcohol Drinking Level with Cardiovascular Risk Factors and the 10-Year Cardiovascular Disease Risk Scores.

BACKGROUND: To assess sex-specific associations between risk-based alcohol drinking levels and the 10-year cardiovascular disease (CVD) risk scores and cardiovascular (CV) risk factors. METHODS: Data from 9,995 Koreans (4,249 men, 5,746 women), aged 40 to 79 years who did not have CVD and participated in the 2011 to 2013 Korea National Health and Nutrition Examination Survey, were used to assess risk-based alcohol drinking levels in the past year (no drinking, drinking at low risk, and drinking at risk) categorized by the National Institute on Alcohol Abuse and Alcoholism, components of the 10-year CVD risk scores using the Adult Treatment Panel III risk score and the 10-year hard atherosclerotic CVD risk score, CV risk factors, and confounding factors (age, smoking status, body mass index, educational attainment, income level, and physical activity). RESULTS: Drinking levels had positive associations with blood pressure and levels of glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C) and inverse associations with levels of low-density lipoprotein cholesterol and non-HDL-C and ratio of total cholesterol (TC) to HDL-C in men, while higher drinking levels were associated with higher HDL-C levels and lower ratio of TC to HDL-C in women after adjusting for confounding factors (p for trend < 0.001). With respect to the 10-year CVD risk scores, higher drinking levels were associated with lower scores in both sexes (p for trend < 0.001). CONCLUSIONS: Risk-based drinking levels were more likely to have dose-dependent associations with CV risk factors in men than in women and had inverse relationships with 10-year CVD risk in both men and women.

Blood mercury concentration in relation to metabolic and weight phenotypes using the KNHANES 2011-2013 data.

PURPOSE: We assessed the association of blood mercury concentration with metabolic and weight phenotypes. METHODS: Blood mercury concentration, metabolic syndrome components, and body mass index (BMI) were measured in 6006 Korean adults (2963 men, 3043 women, mean age 44.7 ± 14.7 years), using the 2011-2013 Korean National Health and Nutrition Examination Survey data. Metabolic and weight phenotypes were classified based on BMI and metabolic syndrome (MetS) presence as metabolically healthy and normal weight (MHNW), metabolically unhealthy and normal weight (MUNW), metabolically healthy and obese (MHO), and metabolically unhealthy and obese (MUO). RESULTS: The geometric mean of blood mercury concentration was 3.37 µg/L (95% CI 3.32-3.43). A higher quartile of blood mercury concentration was associated with older age, male sex, higher education, alcohol use, current smoking, low physical activity, greater energy intake, and hypertension history. After adjusting for confounding factors (age, sex, education, income, health behaviors, and energy intake), blood mercury concentration tended to increase across the MHNW, MUNW, MHO, and MUO groups in all subjects and each sex (P for trend < 0.01). Compared to the lowest mercury quartile group, adjusted odds ratios (95% CI) for MHO and MUO in those with the highest mercury quartile were, respectively, 1.67 (1.34, 2.09) and 2.02 (1.59, 2.56) in all subjects: 1.58 (1.25, 1.99) and 1.72 (1.37, 2.16) for men; 1.33 (0.94, 1.88) and 1.90 (1.34, 2.70) for women. CONCLUSIONS: Blood mercury concentration was associated with both metabolic syndrome and obesity, and the association was dose dependent across metabolic and weight phenotypes.

The Effect of Lifestyle Changes on Blood Pressure Control among Hypertensive Patients.

BACKGROUND: Hypertension is highly prevalent among patients who visit primary care clinics. Various factors and lifestyle behaviors are associated with effective blood pressure control. We aimed to identify factors and lifestyle modifications associated with blood pressure control among patients prescribed antihypertensive agents. METHODS: This survey was conducted at 15 hospital-based family practices in Korea from July 2008 to June 2010. We prospectively recruited and retrospectively assessed 1,453 patients prescribed candesartan. An initial evaluation of patients' lifestyles was performed using individual questions. Follow-up questionnaires were administered at 4, 8, and 12 weeks. We defined successful blood pressure control as blood pressure <140 mm Hg systolic and <90 mm Hg diastolic. RESULTS: Of the 1,453 patients, 1,139 patients with available data for initial and final blood pressures were included. In the univariate analysis of the change in performance index, weight gain (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.52 to 3.11; P<0.001), physical inactivity (OR, 1.195; 95% CI, 1.175 to 3.387; P=0.011), and increased salt intake (OR, 1.461; 95% CI, 1.029 to 2.075; P=0.034) were related to inadequate blood pressure control. Salt intake also showed a significant association. Multivariate ORs were calculated for age, sex, body mass index, education, income, alcohol consumption, smoking status, salt intake, comorbidity, and family history of hypertension. In the multivariate analysis, sex (OR, 3.55; 95% CI, 2.02 to 6.26; P<0.001), salt intake (OR, 0.64; 95% CI 0.43 to 0.97; P=0.034), and comorbidity (OR, 1.82; 95% CI, 1.23 to 2.69; P=0.003) were associated with successful blood pressure control. CONCLUSION: Weight gain, physical inactivity, and high salt intake were associated with inadequate blood pressure control.

Cross-sectional association between testosterone, sex hormone-binding globulin and metabolic syndrome: The Healthy Twin Study.

OBJECTIVES: This study evaluated an association between testosterone, sex hormone-binding globulin (SHBG) and metabolic syndrome (MetS).We also evaluated the genetic and environmental influences on the association. DESIGN: Cross-sectional. SETTING: Community-based study. PARTICIPANTS: A total of 1098 Korean adult men including 139 monozygotic twin pairs. MAIN OUTCOME MEASURE: MetS was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP ATP III) and International Diabetes Federation (IDF) criteria. The associations between MetS and sex hormones were evaluated using linear mixed model and generalized estimating equation model. RESULTS: After considering covariates such as smoking, alcohol consumption and physical exercises as well as SHBG or testosterone, the risk of MetS defined by NCEP ATP III criteria decreased by 31%, 29%, and 48%, respectively, with 1-standard deviation increase in total testosterone (TT), free testosterone (cFT) and SHBG. Similar findings were revealed with IDF criteria. Metabolic component specific analysis showed that sex hormones were inversely associated with several components of MetS: TT with abdominal obesity, low high-density lipoprotein cholesterol (HDL-C) and high blood pressure; cFT with abdominal obesity and high blood pressure; SHBG with all components except high blood pressure. Cotwin control analysis found an inverse correlation between within-pair differences in testosterone and SHBG levels and within-pair differences in waist circumference only. CONCLUSION: Both testosterone and SHBG were inversely associated with MetS although the inverse associations with the sex hormones were not consistently found across individual metabolic components. Findings from cotwin analysis suggest a significant contribution of unshared unique environmental effect to the association between testosterone and SHBG and abdominal obesity.

Lung function and impaired kidney function in relation to metabolic syndrome.

PURPOSE: This study aimed to assess the relationships between abnormal lung function and indicators of chronic kidney disease in relation to metabolic syndrome (MetS) by using data from the 2011-2013 Korea National Health and Nutrition Examination Survey. METHODS: Using the data of 8551 Korean adults (3798 men, 4753 women, ≥40 years), lung function categories [obstructive lung disease (OLD), restrictive lung disease (RLD), and non-obstructive/non-restrictive lung disease (reference group)] were defined for each gender. Albuminuria and low estimated glomerular filtration rate (eGFR) were defined as urine albumin-to-creatinine ratio ≥30 mg/g and eGFR < 60 mL/min/1.73 m2. Gender-specific logistic regression analysis was performed after adjusting for age, educational level, smoking, alcohol use, physical activity, and medication use for chronic diseases. RESULTS: Compared to the reference group, low eGFR was associated with higher odds for RLD in men and RLD or OLD in women when they did not have MetS. In those with MetS, low eGFR was associated with higher odds for OLD in men and RLD or OLD in women. Albuminuria was associated with higher odds for RLD in men who did not have MetS, while it was associated with higher odds for RLD or OLD in men and women who had MetS. CONCLUSIONS: Abnormal lung function was associated with increased odds for chronic kidney disease indicators, when combined with MetS in both gender. Even in those without MetS, RLD in men was associated with increased odds for low eGFR or albuminuria, while RLD or OLD in women was associated with increased odds for low eGFR.

Genetic and environmental influences on the associations between change in kidney function and changes in cardiometabolic factors in Koreans.

BACKGROUND: This study aimed to evaluate genetic and environmental relations between change in estimated glomerular filtration rate (eGFR) and changes in cardiometabolic factors. METHODS: In 1772 Korean adults without diabetes and chronic kidney disease at baseline, changes in eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation, blood pressure (BP), fasting serum glucose (FSG), insulin, homeostasis model assessment of insulin resistance index (HOMA-IR), hemoglobin A1c, triglycerides, high and low density lipoprotein cholesterol (HDL and LDL), uric acid, white blood cell (WBC) count, and body mass index (BMI) were calculated as follows: (value at follow-up - value at baseline) × 100/[value at baseline × follow-up interval (years)]. RESULTS: eGFR change was associated with 10 % changes in FSG (Odds ratio, OR = 1.36), uric acid (OR = 2.49), HDL (OR = 0.69), LDL (OR = 1.26), and WBC (OR = 1.15) after adjusting for age, sex, intra-familial and twin correlations, smoking, alcohol use, and physical activity at baseline, and BMI change using a generalized estimating equation. In bivariate variance-component analysis, eGFR change had additive genetic correlations ([Formula: see text]) with changes in insulin (-0.26), HOMA-IR (-0.24), diastolic BP (-0.15), uric acid (-0.45), triglycerides (-0.30), WBC (-0.46), and HDL (0.41), and environmental correlations ([Formula: see text]) with changes in FSG (-0.11), uric acid (-0.32), LDL (-0.14), and WBC (0.10). In co-twin control analyses in 319 monozygotic twin pairs, the ORs for having a greater eGFR decline with a 1 % increase in diastolic BP, uric acid, and LDL were 1.04, 1.09, and 1.03, respectively after adjusting for change in BMI and health behaviors at baseline. CONCLUSIONS: In these Korean twins and families, additive genetic influences and environmental effects play significant roles in the associations between eGFR change and changes in cardiometabolic factors.