Long-term impact of weight loss in people with class II obesity on the overall burden of disease: Evidence from the National Health Screening Cohort in Korea.

BACKGROUND: Obesity is known to increase overall disease burden but does obesity management actually help reduce disease burden? OBJECTIVES: To investigate the effects of weight loss on disease burden in people with obesity using the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in Korea. SETTING: Pure longitudinal observational study using Nationwide cohort database. METHODS: Out of 514,866 NHIS-HEALS cohort, participants with class II obesity in Asia-Pacific region (30 ≤ body mass index [BMI] < 35) who underwent health check-up provided by NHIS during 2003-2004 (index date) were included. All final participants continued to receive a total of 5 biennial health check-ups over the next 10 years without missing. A group-based trajectory model (GBTM) was used to categorize subjects based on 10-year BMI change patterns. The changes of co-morbidities, healthcare resource utilization, and medical cost were analyzed. RESULTS: The final study subjects (9857) were categorized into 3 trajectory clusters based on the pattern of BMI (kg/m2) change: maintenance (57.35%) with an average change of -.02 ± .06, loss (38.65%) with -.04 ± .08, and substantial loss (4.0%) with -.10 ± .18. The annual increases in the number of co-morbidities per subject in each cluster were .18, .18, and .16 (all P < .001), respectively. The increase of healthcare resource utilization over time was lowest for the substantial loss compared to maintenance and loss. With each passing year, the average annual total healthcare cost increased by ₩21,200 ($16.48, P = .034) and ₩10,500 ($8.16, P = .498) in the maintenance and loss, respectively, but decreased by ₩62,500 ($48.59, P = .032) in the substantial loss. CONCLUSIONS: Weight loss in people with obesity was associated with a reduced burden of disease, as evidenced by lower co-morbidity, healthcare resource utilization rate, and decreased medical costs. This study highlights the potential positive long-term impact on Korean society when actively managing weight in individuals with obesity.

Value of cardiopulmonary exercise testing in the assessment of symptoms and quality of life in Asian patients with chronic obstructive pulmonary disease.

Background: The natural course of chronic obstructive pulmonary disease (COPD) is characterized by symptom exacerbation and quality-of-life reduction. Therefore, symptoms should be properly assessed. Some studies have demonstrated a weak correlation between cardiopulmonary exercise testing (CPET) parameters and symptoms in patients with COPD; however, data on Asian patients are lacking. We investigated the value of CPET parameters in assessing symptoms and quality of life in Asian patients with COPD. Methods: Of 681 patients who underwent CPET at Asan Medical Center between January 2020 and June 2022, we analyzed 195 patients with COPD in this retrospective study. A cycle ergometer was used for the incremental protocol. The modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) were administered to assess the patients' symptoms. Results: The mMRC grade was related to maximal oxygen uptake (VO2 max, L/min) (Spearman's correlation coefficient ρ=-0.295, P<0.001) and physiological dead space/tidal volume ratio at peak exercise (VD/VT peak) (ρ=0.256, P<0.001). The CAT score was significantly correlated with VO2 max (L/min) (Spearman's correlation coefficient ρ=-0.297, P<0.001) and VD/VT peak (ρ=0.271, P<0.001), but had no correlation with breathing reserve (ρ=-0.122, P=0.089). The optimal cut-off values of VO2 max and VD/VT peak for predicting the onset of clinically significant dyspnea were 1.099 L/min and 0.295, respectively. Conclusions: VO2 max and VD/VT peak comprehensively reflect the symptoms and health-related quality of life of patients with COPD.

Twelve-Year Trajectory of Disease Burden and Mortality by Obesity Level in Korea: Analysis of the National Health Insurance Service Database.

INTRODUCTION: Despite increases in obesity prevalence, awareness of obesity as a disease requiring active treatment remains lacking in Korea. We investigated differences in medical problems and expenditures and mortality across obesity categories using 12-year data from the National Health Insurance Service. MATERIALS AND METHODS: Individuals aged 40-79 years who underwent medical examinations during 2003-2004 (n = 415,201) were divided based on Asian body mass index (kg/m2) criteria: normal weight (18.5 to < 23.0, 36.4%), overweight (23.0 to < 25.0, 28.3%), obesity (25.0 to < 30.0, 32.5%), and severe obesity (≥ 30.0, 2.8%). Medical problems and expenditures were fitted to linear mixed models. Mortality was analyzed via Cox proportional-hazards model. RESULTS: More severe obesity was associated with a higher rate of medical problems, relative to normal weight: coefficient = 0.31 (95% confidence interval [CI], 0.30-0.32) for overweight, 0.61 (0.60-0.61) for obesity, and 1.07 (1.04-1.09) for severe obesity. A similar association was observed for medical expenditure: coefficient = 8.85 (95%CI, 6.80-10.89) for overweight, 20.04 (18.07-22.01) for obesity, and 48.76 (43.66-53.86) for severe obesity. Relative to overweight participants, those with normal weight and severe obesity exhibited a higher mortality risk (hazard ratio [HR] 1.21 [95%CI, 1.18-1.25] for normal; 1.27 [1.19-1.36] for severe obesity). In age-specific analyses, mortality risk was the highest for participants with severe obesity, aged < 60 years (HR, 1.58 [95%CI, 1.41-1.77]). CONCLUSION: Disease burden including medical problems and expenditure, and mortality in middle-aged adults, increased proportionally to the degrees of obesity. Health policies and medical systems aimed at reducing the burden of obesity may help reduce the burden of disease on society.

Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer.

BACKGROUND: Nationwide research about the clinical and economic burden caused by anastomotic leakage (AL) has not been published yet in Korea. This study assessed the AL rate and quantified the economic burden using the nationwide database. METHODS: This real world evidence study used health claims data provided by the Korean Health Insurance Review and Assessment Service (HIRA, which showed that 156,545 patients underwent anterior resection (AR), low anterior resection (LAR), or ultra-low anterior resection (uLAR) for colorectal cancer (CRC) between January 1, 2007 and January 31, 2020. The incidence of AL was identified using a composite operational definition, a composite of imaging study, antibacterial drug use, reoperation, or image-guided percutaneous drainage. Total hospital costs and length of stay (LOS) were evaluated in patients with AL versus those without AL during index hospitalization and within 30 days after the surgery. RESULTS: Among 120,245 patients who met the eligibility criteria, 7,194 (5.98%) patients had AL within 30 days after surgery. Male gender, comorbidities (diabetes, metastatic disease, ischemic heart disease, ischemic stroke), protective ostomy, and multiple linear stapler use, blood transfusion, and urinary tract injury were associated with the higher odds of AL. Older age, rectosigmoid junction cancer, AR, LAR, and laparoscopic approach were related with the reduced odds of AL. Patients with AL incurred higher costs for index hospitalization compared to those without AL (8,991 vs. 7,153 USD; p<0.0001). Patients with AL also required longer LOS (16.78 vs. 14.22 days; p<0.0001) and readmissions (20.83 vs. 13.93 days; p<0.0001). CONCLUSION: Among patients requiring resection for CRC, the occurrence of AL was associated with significantly increased costs and LOS. Preventing AL could not only produce superior clinical outcomes, but also reduce the economic burden for patients and payers.

Deep learning image reconstruction algorithm for abdominal multidetector CT at different tube voltages: assessment of image quality and radiation dose in a phantom study.

OBJECTIVES: To compare the image quality and radiation dose of a deep learning image reconstruction (DLIR) algorithm compared with iterative reconstruction (IR) and filtered back projection (FBP) at different tube voltages and tube currents. MATERIALS AND METHODS: A customized body phantom was scanned at different tube voltages (120, 100, and 80 kVp) with different tube currents (200, 100, and 60 mA). The CT datasets were reconstructed with FBP, hybrid IR (30% and 50%), and DLIR (low, medium, and high levels). The reference image was set as an image taken with FBP at 120 kVp/200 mA. The image noise, contrast-to-noise ratio (CNR), sharpness, artifacts, and overall image quality were assessed in each scan both qualitatively and quantitatively. The radiation dose was also evaluated with the volume CT dose index (CTDIvol) for each dose scan. RESULTS: In qualitative and quantitative analyses, compared with reference images, low-dose CT with DLIR significantly reduced the noise and artifacts and improved the overall image quality, even with decreased sharpness (p < 0.05). Despite the reduction of image sharpness, low-dose CT with DLIR could maintain the image quality comparable to routine-dose CT with FBP, especially when using the medium strength level. CONCLUSION: The new DLIR algorithm reduced noise and artifacts and improved overall image quality, compared to FBP and hybrid IR. Despite reduced image sharpness in CT images of DLIR algorithms, low-dose CT with DLIR seems to have an overall greater potential for dose optimization. KEY POINTS: • Using deep learning image reconstruction (DLIR) algorithms, image quality was maintained even with a radiation dose reduced by approximately 70%. • DLIR algorithms yielded lower image noise, higher contrast-to-noise ratios, and higher overall image quality than FBP and hybrid IR, both subjectively and objectively. • DLIR algorithms can provide a better image quality, much better than FBP and even better than hybrid IR, while facilitating a reduction in radiation dose.

Community Assessment of the Predictability of Cancer Protein and Phosphoprotein Levels from Genomics and Transcriptomics.

Cancer is driven by genomic alterations, but the processes causing this disease are largely performed by proteins. However, proteins are harder and more expensive to measure than genes and transcripts. To catalyze developments of methods to infer protein levels from other omics measurements, we leveraged crowdsourcing via the NCI-CPTAC DREAM proteogenomic challenge. We asked for methods to predict protein and phosphorylation levels from genomic and transcriptomic data in cancer patients. The best performance was achieved by an ensemble of models, including as predictors transcript level of the corresponding genes, interaction between genes, conservation across tumor types, and phosphosite proximity for phosphorylation prediction. Proteins from metabolic pathways and complexes were the best and worst predicted, respectively. The performance of even the best-performing model was modest, suggesting that many proteins are strongly regulated through translational control and degradation. Our results set a reference for the limitations of computational inference in proteogenomics. A record of this paper's transparent peer review process is included in the Supplemental Information.

Socioeconomic Status, Vocational Aspirations, School Tracks, and Occupational Attainment in South Korea.

Adults' career choice is not an abrupt event, but an outcome of continuous development throughout childhood and adolescence. In the developmental process of one's career, personal characteristics and contextual resources come into play. The goal of the present study is to examine how family socioeconomic status, adolescents' vocational aspirations, and high school contexts affect their occupational attainment in young adulthood, using two cohorts of data from the Korean Education and Employment Panel. Cohort 1 consisted of 1535 individuals (49.3% female), and cohort 2 consisted of 1473 individuals (53.5% female). Both cohorts were surveyed during their senior year of high school (Time 1; Mage = 17.8) and followed up until young adulthood (Time 2; Mage = 25.8). The results reveal that having high vocational aspirations and attending academic high school predict attaining higher-status occupations for both cohorts. Family background has positive direct and indirect effects on occupational attainment for cohort 2, while it only has an indirect effect on occupational attainment via types of high school for cohort 1. Implications in the context of constructing social systems to support adolescents' career development are discussed.

Assessment of red onion on antioxidant activity in rat.

Oxidative stress related to the aging process can increase the risk of degenerative disease. Red onions contain antioxidative compounds. This study was designed to investigate the effect of dietary red onion peel and/or flesh on antioxidative activity in rats. Twenty Sprague-Dawley male rats (18 weeks old) were divided into four groups. Each group was raised for 4 weeks on a red onion free control diet (ND), red onion diet containing 5% red onion peel (RP), 5% red onion flesh (RF), or 5% red onion peel+flesh (RPF). The results demonstrated that serum SOD activity was significantly increased in the RP and RPF groups, whereas glutathione peroxidase (GPx) activity was significantly higher in the RF group than in the ND group. Catalase activity and ORAC activity in liver showed upward tendency in the RP, RF, and RPF groups although the differences were not statistically significant. Liver malondialdehyde levels in the RPF group were significantly lower than those in the ND group were. In conclusion, red onion may enhance antioxidant defense mechanism through the induction of plasma SOD and GPx activities and inhibited liver lipid peroxidation. Therefore, red onion may exert important protective effects against oxidative stress related diseases.