Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial.

BACKGROUND: Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. OBJECTIVE: We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. METHODS: In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. RESULTS: Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean -10.95, SD 2.09 mmHg; app only: mean -7.29, SD 1.83 mmHg; app with personalized coaching: mean -7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean -0.12, SD 0.30 kg; app only: mean -0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean -0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean -0.13, SD 0.34 kg; app only: mean -0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean -0.79, SD 0.38 kg; P=.08). CONCLUSIONS: Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. TRIAL REGISTRATION: ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271.

Triglyceride to high density lipoprotein cholesterol ratio among adolescents is associated with adult hypertension: the Kangwha study.

BACKGROUND: The triglyceride to high density lipoprotein cholesterol (TG/HDL-C) ratio associated with hypertension in adults. However, whether the TG/HDL-C ratio in adolescents predicts future hypertension remains unclear. Here, we evaluated the prospective association between the TG/HDL-C ratio in adolescents and hypertension in early adulthood. METHODS: The Kangwha Study is an ongoing prospective cohort study that has tracked the blood pressure of first grade elementary school students since 1986. We followed up 272 participants who completed health examinations at the age of 16 and 35 years. We excluded 27 participants with adolescent hypertension, defined as those whose blood pressures were above the age- and sex-specific 95th percentiles of the Korean population, and finally analysed 245 participants. We defined high and low TG/HDL-C ratio groups according to the age- and sex-specific 75th percentile of the TG/HDL-C ratio (1.04 for boys and 0.81 for girls) of the Korean population. Adult hypertension was defined by a systolic/diastolic blood pressure ≥ 140/90 mmHg or by taking antihypertensive medication at the age of 35 years. Logistic regression analysis was performed to evaluate the association between adolescent TG/HDL-C ratio and adult hypertension after adjusting for age at follow-up, sex, baseline systolic blood pressure, waist circumference, and total cholesterol and fasting glucose levels. RESULTS: During the 20-year follow-up, 11 (18.3%) individuals developed hypertension in the high TG/HDL-C ratio group and 10 (5.4%) individuals developed hypertension in the low TG/HDL-C ratio group. The adjusted odds ratio for incident hypertension in the high TG/HDL-C ratio group, compared with the low TG/HDL-C ratio group, was 3.40 (95% confidence interval 1.24-9.31). CONCLUSIONS: High TG/HDL-C ratio in adolescence is associated with hypertension in early adulthood.

Metabolic outcomes of workers according to the International Standard Classification of Occupations in Korea.

BACKGROUND: Occupation influences the risk for developing chronic metabolic diseases. METHODS: We compared the prevalence of MetS by International Standard Classification of Occupations using the nationally representative data in Korea (KNHANES). We enrolled 16,763 workers (9,175 males; 7,588 females) who had measurements for the National Cholesterol Education Program criteria III and other variables. OR and 95%CIs for MetS and its components were estimated according to occupation using the multiple logistic regression models. RESULTS: The occupational groups with the highest age-standardized prevalence of MetS were lower skilled white-collar men (31.1 ± 2.4%) and green-collar women (24.2 ± 2.9%). Compared with the unskilled male blue-collar group, which had the lowest prevalence of MetS, the OR (95%CIs) of MetS in men were 1.77 (1.45-2.15) in higher skilled white-collar, 1.82 (1.47-2.26) in lower-skilled white-collar, 1.63 (1.32-2.01) in pink-collar and 1.37 (1.13-1.66) in skilled blue-collar workers in final logistic regression model. CONCLUSIONS: MetS and its components vary by occupational category and gender in ways that may guide health interventions. Am. J. Ind. Med. 59:685-694, 2016. © 2016 Wiley Periodicals, Inc.

The novel myokine irisin: clinical implications and potential role as a biomarker for sarcopenia in postmenopausal women.

PURPOSE: To clarify the association of circulating irisin with muscle, liver and bone, and to evaluate irisin as a biomarker for sarcopenia in postmenopausal women. METHODS: Quadriceps cross-sectional area (QcCSA), bone mineral density (BMD), liver attenuation (measured in Hounsfield units (HU)) were assessed using quantitative computed tomography in 153 postmenopausal women, mean age of 72.20 ± 5.96 years. Muscle strength and physical performance were evaluated by handgrip test and short physical performance battery, respectively. Serum irisin was measured by an enzyme-linked immunosorbent assay kit. In addition, 147 young women were recruited as a reference group to define cut-off values for sarcopenia. RESULTS: Circulating irisin was positively correlated with QcCSA/body weight (BW) and liver HU even after adjusting for multiple covariates, and the serum level was significantly lower in the sarcopenia group (QcCSA/BW<-2SD of the mean values for young women) than in the presarcopenia (-2SD≤QcCSA/BW<-1SD) or control groups (1SD≤QcCSA/BW<2SD). Logistic regression models showed that the relationship between circulating irisin and prevalence of sarcopenia remained significant after adjusting for confounding factors (per 1.0 ng/mL decrease of irisin, odds-ratio = 1.95, 95% confidence interval 1.33-2.87, p-value = 0.001). CONCLUSIONS: In postmenopausal women, serum irisin may be used as a biomarker for sarcopenia, and we showed the potential for the development of irisin-based early screening and staging tool for sarcopenia.

Association between dry eye symptoms and suicidal ideation in a Korean adult population.

PURPOSE: This study assessed the association of dry eyes with depression and suicidal ideation in a Korean adult population. METHODS: Data from 16408 participants (6972 men and 9436 women) aged ≥ 19 years included in the fifth Korea National Health and Nutrition Examination Survey, conducted from 2010-2012, were analyzed. For dry eyes, surveys of previous diagnosis of dry eye disease (DED) by an ophthalmologist and experience of subjective dry eye symptoms were separately used. Diagnosis of depression and suicidal ideation were obtained via responses to an interviewer-assisted questionnaire, and questions were asked in a closed-ended response format. Logistic regression was used to examine the associations between dry eyes, depression, and suicidal ideation. RESULTS: DED diagnosis exhibited an odds ratio (OR) of 1.32 (95% confidence interval [CI] 1.11-1.57) for depression and 1.24 (95% CI 1.05-1.48) for suicidal ideation compared to those without DED, after adjusting for sex, age, education, occupation, household income, body mass index, smoking behavior, alcohol consumption, physical activity, hypertension, diabetes, dyslipidemia, thyroid diseases, major cardiovascular disease, and cancer. Similarly, the adjusted OR (95% CI) of dry eye symptoms was 1.50 (95% CI 1.30-1.73) for depression and 1.47 (95% CI 1.27-1.70) for suicidal ideation. CONCLUSION: Our findings suggest that dry eyes (either DED diagnosis or dry eye symptoms) may be associated with the prevalence of depression and suicidal ideation in the Korean adult population.

Are Serum Vitamin D Levels Associated With Dry Eye Disease? Results From the Study Group for Environmental Eye Disease.

OBJECTIVES: Dry eye disease (DED) is an increasingly important public health problem in Korea. Previous studies conducted in Korea have reported inconsistent results regarding the protective effects of vitamin D on DED, and these discrepancies may be related to the relatively simple questionnaire that has been used. Thus, we evaluated the association of serum vitamin D levels with DED using the ocular surface disease index (OSDI). METHODS: The present study evaluated data from participants in the Study Group for Environmental Eye Disease (2014-2015). This group included data from 752 participants, and data from 740 participants (253 men and 487 women) were analyzed in the present study. DED severity was evaluated using the OSDI. RESULTS: Higher serum vitamin D levels were associated with a non-significantly reduced risk of DED in the crude analysis (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.971 to 1.011) and in the adjusted analysis (OR, 0.988; 95% CI, 0.966 to 1.010). In the crude analysis of no/mild DED vs. moderate/severe DED, men exhibited a decreased risk with increasing serum vitamin D levels (OR, 0.999; 95% CI, 0.950 to 1.051), while women exhibited an increased risk (OR, 1.003; 95% CI, 0.979 to 1.027). In these analyses, we found no significant associations. CONCLUSIONS: The findings of the present study support previous reports that serum vitamin D levels are not associated with DED.

Association between vitamin D status and asymmetric dimethylarginine (ADMA) concentration in the Korean elderly population.

OBJECTIVES: Vitamin D deficiency has been reported to be associated with the risk of cardiovascular disease. We investigated the relationship between vitamin D status and asymmetric dimethylarginine (ADMA) concentration, a marker of endothelial dysfunction, in the Korean elderly population. STUDY DESIGN: A cross-sectional study was conducted on 269 men and 382 women (mean age, 71.6 years) enrolled in the Korean Social Life, Health, and Aging Project (KSHAP), a population-based longitudinal study of health determinants in elderly Koreans. We stratified patients by vitamin D status into three groups according to serum 25-hydroxyvitamin D [25(OH)D] level: sufficient (≥30ng/mL, n=25), insufficient (10-<30ng/mL, n=516), and deficient (<10ng/mL, n=110). To measure endothelial dysfunction, ADMA concentration was assayed by high-performance liquid chromatography. The association between 25(OH)D status and ADMA concentration was analyzed by multiple linear regression models. RESULTS: The mean ADMA concentration was significantly higher in the insufficient 25(OH)D group (0.665µmol/L, p=0.001) and the deficient 25(OH)D group (0.734µmol/L, p<0.001) compared with the sufficient 25(OH)D group (0.589µmol/L). Even after adjusting for sex, age, body mass index, blood pressure, diabetes mellitus, total and HDL cholesterol, estimated glomerular filtration rate (eGFR), smoking status, and drinking status, ADMA concentrations were higher in the insufficient group (ß=0.0742µmol/L, p=0.001) and the deficient group (ß=0.1417µmol/L, p<0.001) compared than in the sufficient group. In a sex-stratified analysis, 25(OH)D deficiency was associated with higher ADMA levels in both women (p<0.001) and men (p=0.007), while 25(OH)D deficiency was associated with higher ADMA levels in women (p<0.001) but not in men (p=0.631). CONCLUSION: Our findings suggest that low serum 25(OH)D level may be associated with endothelial dysfunction in elderly Korean people.

The Association Between Smoking Tobacco After a Diagnosis of Diabetes and the Prevalence of Diabetic Nephropathy in the Korean Male Population.

OBJECTIVES: Smoking is known to be associated with nephropathy in patients with diabetes. The distinct effects of smoking before and after diabetes has been diagnosed, however, are not well characterized. We evaluated the association of cigarette smoking before and after a diagnosis of diabetes with the presence of diabetic nephropathy. METHODS: We analyzed data from the 2011-2013 editions of the Korea National Health and Nutrition Examination Survey. A total of 629 male patients diagnosed with diabetes were classified as non-smokers (90 patients), former smokers (225 patients), or continuing smokers (314 patients). A "former smoker" was a patient who smoked only before receiving his diagnosis of diabetes. A "continuing smoker" was a patient who smoked at any time after his diabetes had been diagnosed. Diabetic nephropathy was defined as the presence of albuminuria (spot urine albumin/creatinine ratio ≥30 mg/g) or low estimated glomerular filtration rate (<60 mL/min/1.73 m(2)). Multiple logistic regression models were used to assess the independent association after adjusting for age, duration of diabetes, hemoglobin A1c, body mass index, systolic blood pressure, medication for hypertension, and medication for dyslipidemia. Female patients were excluded from the study due to the small proportion of females in the survey who smoked. RESULTS: Compared to non-smokers, continuing smokers had significantly higher odds ratio ([OR], 2.17; 95% confidence interval [CI], 1.23 to 3.83) of suffering from diabetic nephropathy. The corresponding OR (95% CI) for former smokers was 1.26 (0.70 to 2.29). CONCLUSIONS: Smoking after diagnosis of diabetes is significantly associated with the presence of diabetic nephropathy in the Korean male population.

Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013.

BACKGROUND AND OBJECTIVES: Joint National Committee guidelines attempt to vary treatment recommendations for patients based on considerations of their comorbidities. The aim of the present study is to estimate the age-standardized prevalence of common comorbidities among Korean hypertension patients. SUBJECTS AND METHODS: We analyzed the Korea National Health and Nutrition Examination Survey from 2007 to 2013. Among the 58423 participants, 30092 adults, aged ≥30 yrs who completed a health examination and interview survey, were selected. The survey procedures were used to estimate weighted prevalence and odds ratios for 8 comorbidities, including obesity, diabetes mellitus, dyslipidemia, cardiovascular disease, chronic kidney disease, and thyroid disease. RESULTS: Most chronic conditions were more prevalent in adults with hypertension than in those without hypertension. Common comorbidities were obesity (60.1%), dyslipidemia (57.6%), and impaired fasting glucose (45.1%). Hypertensive patients with two or more comorbid diseases were 42.2% and those with three or more diseases were 17.7%. The age- and sex-specific prevalence of three or more comorbid diseases among male hypertension patients was significantly higher than those patients in the 30-59 (p<0.05) age group. CONCLUSION: Comorbidity is highly prevalent in Korean patients with hypertension.

Cross-sectional and longitudinal association between hemoglobin concentration and hypertension: A population-based cohort study.

We investigated the cross-sectional and longitudinal associations between hemoglobin concentration and hypertension in a Korean population.Between 2006 and 2013, we examined 4899 participants with mean age of 56.6 years (range 35-88 years) from a rural community. We excluded 298 participants with a history of myocardial infarction or stroke and 264 participants with very low hemoglobin levels (men: <13.3 g/dL; women: <11.6 g/dL). Finally, we performed a cross-sectional analysis on 1629 men and 2708 women. Longitudinal associations were evaluated in 654 men and 1099 women, after excluding 2584 people with hypertension at baseline and those who did not participate in follow-up examinations. Hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive treatment.The mean hemoglobin level was significantly higher in people with hypertension than in those without hypertension (P = 0.002 for men, P = 0.006 for women). On cross-sectional analysis, the odds ratio (95% confidence interval) for hypertension per 1 standard deviation increase in hemoglobin concentration (1.2 g/dL) was 1.11 (1.05-1.18) before adjustment and 1.20 (1.09-1.32) after adjusting for age, sex, body mass index, kidney markers, lifestyle factors, and comorbidities. On longitudinal analysis, the relative risk (95% confidence interval) for incident hypertension per 1 standard deviation increase in hemoglobin concentration was 1.09 (0.96-1.23) before adjustment and 0.91 (0.78-1.08) after adjusting for age, sex, body mass index, lifestyle factors, baseline blood pressure, baseline comorbidities, and baseline kidney markers.This study suggests that hemoglobin per se does not cause hypertension development.

C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population.

OBJECTIVES: C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea. METHODS: A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant's vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors. RESULTS: The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality. CONCLUSIONS: Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.

Effects of Offspring-Related Characteristics on Depressive Disorder among Cancer Patients and Survivors.

OBJECTIVE: To investigate the influence of offspring-related characteristics on the prevalence of depressive disorders among cancer patients and those who survived cancer for at least 45 years. MATERIALS AND METHODS: Data were obtained from the Korean Longitudinal Study of Aging (KLoSA). To investigate the association between offspring and depressive disorder among cancer patients and survivors, we analyzed data from 292 cancer patients and survivors drawn from a total subject pool of 16,613 individuals at baseline. RESULTS: According to our results, the odds ratio (OR) for subjects with five or more offspring developing depressive disorder was -0.794 (p-value: 0.039, SE: 0.329) compared with that of those with two offspring. In addition, the adjusted effect of the number of male and female offspring on the presence of depressive disorder showed that the OR for those with three or more female offspring for developing depressive disorder was -0.958 lower (SE: 0.305, p-value: 0.012) than it was for those with no female offspring. CONCLUSIONS: This article provides evidence for an association between offspring-related characteristics and depressive disorders among cancer patients and survivors. Therefore, offspring may be important contributors to the emotional status of cancer patients and survivors. Further study should precisely need to measure depressive disorders because of self-reported data.

Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database.

OBJECTIVES: The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea. METHODS: The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database. RESULTS: Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%). CONCLUSIONS: The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.