Association of Participation in Health Check-ups with Risk Factors for Cardiovascular Diseases.

BACKGROUND: We compared the risk factors for cardiovascular diseases (CVDs) among Koreans who did and did not participate in national periodic health check-ups, after adjustment for demographic factors, socioeconomic status, and lifestyle factors. METHODS: This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2018. Study subjects were classified as participants or non-participants in health check-ups, based on attendance at national periodic health check-ups during the previous two years. RESULTS: Comparison of participants and non-participants in health check-ups indicated statistically significant differences in age, gender, region, education level, monthly income, employment status, obesity, smoking, alcohol consumption, exercise, and marital status. After adjustment for demographic, socioeconomic factors, and health-related behaviors, woman non-participants were more likely to have metabolic syndrome, pre-hypertension, hypertension, prediabetes, and diabetes, and man non-participants were more likely to have pre-diabetes and diabetes. CONCLUSION: Subjects who participated in periodic health check-ups had fewer CVD-related risk factors than non-participants. Thus, health care providers should encourage non-participants to attend periodic health check-ups so that appropriate interventions can be implemented and decrease the risk for CVDs in these individuals.

Public Interest in Acne on the Internet: Comparison of Search Information From Google Trends and Naver.

BACKGROUND: Acne vulgaris is a common skin disease primarily affecting young adults. Given that the internet has become a major source of health information, especially among the young, the internet is a powerful tool of communication and has a significant influence on patients. OBJECTIVE: This study aimed to clarify the features of patients' interest in and evaluate the quality of information about acne vulgaris on the internet. METHODS: We compared the search volumes on acne vulgaris with those of other dermatological diseases using Google Trends from January 2004 to August 2019. We also determined the search volumes for relevant keywords of acne vulgaris on Google and Naver and evaluated the quality of answers to the queries in KnowledgeiN. RESULTS: The regression analysis of Google Trends data demonstrated that the patients' interest in acne vulgaris was higher than that for other dermatological diseases, such as atopic dermatitis (ß=-20.33, 95% CI -22.27 to -18.39, P<.001) and urticaria (ß=-27.09, 95% CI -29.03 to -25.15, P<.001) and has increased yearly (ß=2.38, 95% CI 2.05 to 2.71, P<.001). The search volume for acne vulgaris was significantly higher in the summer than in the spring (ß=-5.04, 95% CI -9.21 to -0.88, P=.018) and on weekends than on weekdays (ß=-6.68, 95% CI -13.18 to -0.18, P=.044). The most frequently searched relevant keywords with "acne vulgaris" and "cause" were "stress," "food," and "cosmetics." Among food, the 2 highest acne vulgaris-related keywords were milk and wheat in Naver and coffee and ramen in Google. The queries in Naver KnowledgeiN were mostly answered by a Korean traditional medicine doctor (53.4%) or the public (33.6%), but only 12.0% by dermatologists. CONCLUSIONS: Physicians should be aware of patients' interest in and beliefs about acne vulgaris to provide the best patient education and care, both online and in the clinic.

Association of Blood Pressure with Blood Lead and Cadmium Levels in Korean Adolescents: Analysis of Data from the 2010-2016 Korean National Health and Nutrition Examination Survey.

BACKGROUND: We evaluated the association of blood pressure (BP) with blood levels of cadmium, lead, and cadmium and lead together (cadmium + lead) in a representative sample of adolescents from Korea. METHODS: We used 2010-2016 data from the Korean National Health and Nutrition Examination Survey. This cross-sectional study enrolled adolescents aged at 10-18 years-old who completed a health examination survey and had blood measurements of lead and cadmium. The association of adjusted mean differences in diastolic and systolic BP with doubling of blood lead and cadmium were estimated by regression of BP against log2-transformed blood metals and their quartiles after covariate adjustment. Adjusted odds ratio for prehypertension were calculated for log2-transformed blood levels of lead and cadmium and their quartiles. RESULTS: Our analysis of adolescents in Korea indicated that blood levels of lead and cadmium were not significantly associated with increased BP or risk of prehypertension. However, the cadmium + lead level was associated with prehypertension. Previous studies showed that blood levels of lead and cadmium were associated with increased BP and risk of hypertension in adult populations. We found no such association in Korean adolescents. CONCLUSION: We found that the cadmium + lead level was associated with prehypertension. The differences between adults and adolescents are because adolescents generally have lower levels of these blood metals or because adolescents only rarely have hypertension.

Environmental exposures to lead, mercury, and cadmium among South Korean teenagers (KNHANES 2010-2013): Body burden and risk factors.

INTRODUCTION: Limited information is available on the association of age and sex with blood concentrations of heavy metals in teenagers. In addition, factors such as a shared family environment may have an association. We analyzed data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2010-2013) to determine whether blood levels of heavy metals differ by risk factors such as age, sex, and shared family environment in a representative sample of teenagers. METHODS: This study used data obtained in the KNHANES 2010-2013, which had a rolling sampling design that involved a complex, stratified, multistage, probability-cluster survey of a representative sample of the non-institutionalized civilian population in South Korea. Our cross-sectional analysis was restricted to teenagers and their parents who completed the health examination survey, and for whom blood measurements of cadmium, lead, and mercury were available. The final analytical sample consisted of 1585 teenagers, and 376 fathers and 399 mothers who provided measurements of blood heavy metal concentrations. RESULTS: Male teenagers had greater blood levels of lead and mercury, but sex had no association with blood cadmium level. There were age-related increases in blood cadmium, but blood lead decreased with age, and age had little association with blood mercury. The concentrations of cadmium and mercury declined from 2010 to 2013. The blood concentrations of lead, cadmium, and mercury in teenagers were positively associated with the levels in their parents after adjustment for covariates. CONCLUSION: Our results show that blood heavy metal concentrations differ by risk factors such as age, sex, and shared family environment in teenagers.

Carbohydrate Intake Exhibited a Positive Association with the Risk of Metabolic Syndrome in Both Semi-Quantitative Food Frequency Questionnaires and 24-Hour Recall in Women.

We compared the usual nutrient intake in both the semi-quantitative food frequency questionnaire (SQFFQ) and 24-hour recall methods and determined the association between metabolic syndrome (MetS) risk and nutrient intake calculated by both methods in Korea National Health and Nutrition Examination Survey (KNHANES; 2012-2014) data. Adjusted odds ratios for MetS were calculated according to the intake of macronutrients, measured by the 2 methods in 10,286 adults, while controlling for covariates associated with MetS. Fat and carbohydrate intake (energy percent) calculated by 24-hour recall and SQFFQ was significantly different between the MetS and non-MetS groups, particularly in women. The differences in other nutrient intakes determined by both methods were mainly non-significant. The correlation coefficients between the 2 methods were about 0.4 for most nutrients except total vitamin A and iron (Fe). Energy intake according to gender and MetS presence was similar between the 2 methods. Carbohydrate intake exhibited a positive association with the MetS risk, while fat intake showed a negative association in both methods. The association exhibited a gender interaction with carbohydrate and fat intake calculated by 24-hour recall: women exhibited a significant association. However, for the SQFFQ a gender interaction was evident only for carbohydrate intake. In diet quality index of SQFFQ the adequacy of vegetables and total fat intake was higher in the non-MetS than the MetS. In conclusion, the MetS prevalence exhibited a positive association with carbohydrate intake only in women, as assessed by 24-hour recall and SQFFQ. The SQFFQ can be used to assess the association between usual food intake and MetS risk in large population studies.

High carbohydrate diets are positively associated with the risk of metabolic syndrome irrespective to fatty acid composition in women: the KNHANES 2007-2014.

We evaluated that carbohydrates and fatty acids intake modifies the prevalence of metabolic syndrome (MetS) and we also determined gender-nutrient interaction in 38,766 adults in KNHANES (2007-2014). Carbohydrate intake was positively associated, and fat intake inversely associated, with the incidence of MetS. The association exhibited a gender interaction with the macronutrient intake; this association was significant in females. Furthermore, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) intakes were inversely associated with MetS risk and only females showed the positive association. Both n-3 and n-6 fatty acids intake showed inverse associations with MetS risk, similar to PUFA intake. Among the MetS components, serum triglyceride levels and blood pressure had significant inverse associations with fatty acid intake irrespective of fatty acid types and exhibited a gender interaction. In conclusions, high carbohydrate intakes (≥74.2 En%) may increase the MetS risk and moderate fat intakes (≥20.7 En%), irrespective of fat types, may decrease it. These associations were significant only in women.

Self-rated Subjective Health Status Is Strongly Associated with Sociodemographic Factors, Lifestyle, Nutrient Intakes, and Biochemical Indices, but Not Smoking Status: KNHANES 2007-2012.

Despite advertised health warnings regarding the deadly hazards of smoking, many people have not heeded recommendations to quit smoking. We examined factors that affect self-rated subjective health status (SRH) scores among lifestyle, nutrient intake and biochemical parameters, and the association of SRH scores and smoking status in a large Korean adult population. Adjusted odd ratios for SRH were calculated for smoking status, selected biochemical data, and food and nutrient intake obtained using the 24-hr recall method after covariate adjustment in the 2007-2012 Korean National Health and Nutrition Examination Survey (27,534 men and women aged ≥ 20 yr). Age, sex, income, education, drinking, exercise and stress levels were associated with SRH scores, regardless of smoking status (P < 0.001). Interestingly, people in any smoking status groups considered the well-known indicators for metabolic diseases (HDL cholesterol, glucose, aspartate aminotransferase, and alanine aminotransferase in the circulation), and the intake of fiber, total vitamins A, and vitamin C as indicators of SRH. Especially in current smokers, higher intake of nutritious food groups such as grains (OR = 1.227), vegetables (OR = 1.944), and milk (OR = 2.26) significantly increased the adjusted odds ratio of SRH. However, smoking status was not associated with SRH scores. In conclusion, SRH is affected by the indices related to health but not smoking status in Korean adults. The development of a new indicator of the direct adverse effects of smoking at regular health check-ups might be required to modulate the SRH in smokers and a nutritional education should not include the possible attenuation of adverse effects of smoking by good nutrition.

Risk factors for fatigue and stress among Korean police officers.

[Purpose] This study investigated factors that affect the health of police officers by analyzing job stress, psychosocial stress, and fatigue faced by police officers in order to provide basic data for the efficient management of police officers and future comparative research. [Subjects and Methods] Police officers admitted to the National Police Hospital from March to May 2013 were surveyed to investigate their degree of stress. The questionnaire consisted of 4 areas related to patient characteristics: general and demographic characteristics factors, job stress, psychosocial stress, and fatigue. [Results] The analysis of the relationships among job stress, psychosocial health, and fatigue showed the 0%, 44.7%, and 82% of those with healthy, potential, and high risks of stress had high job stress, respectively. Meanwhile, 40.8% and 77.9% of subjects with normal and high risks of fatigue had high job stress. [Conclusion] The studies can be used as basic and comparative data for the prevention and early control of job-related diseases for police officers.

Blood levels related to the Z-score of bone mineral density in young males and females.

[Purpose] The purpose of this study was to investigate the blood levels related to the bone mineral density by using the dual energy X-ray absorption for females before menopause and males younger than 50 years old. [Subjects and Methods] Between August 1, and September 15, 2013, the Z-score was measured in females before menopause and males younger than 50 years old using a bone mineral density measuring instrument. After the measurement, the subjects were classified into two groups, that is, the below expectations and within expectations groups. Next, we analyzed and compared the differences in age, body mass index, and blood levels between the 2 groups. [Results] The results showed a correlation of 0.212 for total protein, -0.317 for alanine aminotransferase, -0.199 for gamma-glutamyl transferase, -0.358 for alkaline phosphatase, 0.266 for uric acid, -0.313 for lactate dehydrogenase, 0.244 for creatinine, -0.234 for the red blood cell count, and -0.230 for the red cell distribution width in patients with less than expected level for their age. [Conclusion] In conclusion, osteoporosis may occur in females before menopause and males younger than 50 years old, and aggressive attention is required for prevention and treatment.

Serum cystatin C during 30 postnatal days is dependent on the postconceptional age in neonates.

BACKGROUND: Cystatin C (CysC) is a promising endogenous marker for renal function. However, the reference serum CysC level is not sufficiently studied in neonates. This study was conducted to investigate the reference level of serum CysC for neonates, including very low birth weight infants according to the postconceptional age (PCA). METHODS: Serum CysC levels were measured in 883 blood samples (246 neonates including 127 premature infants). Infants with symptoms or signs of acute kidney injury, systemic illness, congenital anomaly, or renal pathology were excluded. CysC levels were analyzed for association between subgroups dichotomized by postnatal age and PCA. RESULTS: Reference ranges of serum CysC were determined and a decreasing trend of CysC levels was observed as PCA increased, except for the first 3 postnatal days. CysC levels were negatively correlated with gestational age at birth, and PCA (P < 0.001), while positively correlated with postnatal age and serum creatinine (P < 0.001). CONCLUSION: The reference level of serum CysC was determined according to postnatal age and PCA. As the reference CysC level was dependent on gestational age and PCA, consideration of these parameters is warranted when assessing CysC levels in neonates.

Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety.

PURPOSE: To evaluate the clinical and radiological risk factors for exiting root injuries during transforaminal endoscopic discectomy. METHODS: We retrospectively examined cohort data from 233 patients who underwent percutaneous endoscopic lumbar discectomy for lumbar disc herniation between January 1st, 2010 and December 31st, 2011. We divided the patients into the two groups: those who presented a postoperative exiting root injury, such as postoperative dysesthesia or motor weakness (Group A, n = 20), and those who did not suffer from a root injury (Group B, n = 213). We examined the clinical and radiological factors relating exiting root injuries. We measured the active working zone with the exiting root to the upper facet distance (Distance A), the exiting root to disc surface distance at the lower facet line (Distance B) and the exiting root to the lower facet distance (Distance C) in magnetic resonance imaging (MRI). RESULTS: Group A exhibited a shorter Distance C (6.4 ± 1.5 versus 4.4 ± 0.8 mm, p < 0.001) and a longer operation time (67.9 ± 21.8 versus 80.3 ± 23.7 min, p = 0.017) relative to Group B. The complication rate decreased by 23% per each 1-mm increase in Distance C (p = 0.000). In addition, the complication rate increased 1.027-fold per each 1-min increase in the operation time (p = 0.027). CONCLUSION: We recommend measuring the distance from the exiting root to the facet at the lower disc level according to a preoperative MRI scan. If the distance is narrow, an alternative surgical method, such as microdiscectomy or conventional open discectomy, should be considered.

Cardiovascular age of workers with different employment categories.

INTRODUCTION: We compared the cardiovascular age (an indicator of cardiovascular disease risk) in workers with different employment status after adjustment for demographic and socioeconomic factors. METHODS: This cross-sectional study used data collected from 2007 to 2017 for the Korea National Health and Nutrition Examination Survey (KNHANES). Study participants were placed into different employment categories based on employment status and work schedule: regular full-time, regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time. RESULTS: Analysis of women indicated that regular part-time, temporary full-time, temporary part-time, daily full-time, and daily part-time workers were more likely to have an older cardiovascular age (OR = 1.180, 1.238, 1.297, 1.493, and 1.408, respectively) after adjustment for age, marriage, education, income, residence, region, and drinking status. Analysis of men indicated employment status was unrelated to cardiovascular age. CONCLUSION: Female nonstandard Korean workers were more likely to have an increased cardiovascular age. However, most of these workers, especially daily workers, are not currently protected by the Occupational Safety and Health Act (OSHA) of Korea. Collaboration or networking with community-based health care services in Korea is essential to better manage the health of these vulnerable female workers.

A Healthy Diet Rich in Calcium and Vitamin C Is Inversely Associated with Metabolic Syndrome Risk in Korean Adults from the KNHANES 2013-2017.

The association between metabolic syndrome and eating patterns remains unclear. We hypothesized that Korean Healthy Eating Index (KHEI) scores were related to metabolic syndrome (MetS) risk in adults in a gender-dependent manner. We aimed to examine the hypothesis using the Korea National Health and Nutrition Examination Survey-VI (2013-2017) data with a complex sample survey design. Adjusted means and 95% confidence intervals of KHEI scores and nutrient intake estimated by the 24-h recall were calculated according to MetS status after adjusting for age, residence area, region, education, obesity, income, drinking status, smoking status, marriage, and exercise. Adjusted odds ratios for MetS were measured according to KHEI quartiles using logistic regression analysis while controlling for covariates. MetS incidence was significantly higher in females than in males. Those who were older, less educated, earning less income, more obese, living in rural areas, drinking severely, non-exercising, and married had higher MetS incidence than those with the opposite state. Total KHEI scores of all components KHEI scores were lower for those with MetS (MetS group) than those without MetS (Non-MetS group) in both genders. For KHEI components, having breakfast and milk and fat intake had lower scores for the MetS group than for the Non-MetS group in women, whereas fruits and milk and milk product intake had lower scores for the MetS group in men. Nutrient intake influenced the MetS risk in females more than in males. Fat, calcium, and vitamin C intakes from 24-h recall were lower in the MetS group than in the Non-MetS group in women. KHEI scores had an inverse association with MetS risk by 0.98-fold in both genders after adjusting for covariates. In conclusion, a healthy diet that includes adequate calcium and vitamin C is associated with a lower the risk of MetS in both men and women.

Comparison of the physical and mental health problems of unemployed with employees in South Korea.

This study compared the physical and mental health problems of adults with standard and nonstandard employment with those who were unemployed. We used data from the Korean National Health and Nutrition Examination Survey to compare adult males and females with standard and nonstandard employment with those who were unemployed. Relative to adults with standard employment, higher proportions of unemployed individuals were women, older, had low monthly incomes, and had mental health problems. Compared to men and women with standard employment, unemployed men and women had greater risk of reporting depressive feelings (OR = 1.683, 95% CI = 1.298-2.183; OR = 1.419, 95% CI = 1.179-1.709) and suicidal ideation (OR = 2.218, 95% CI = 1.682-2.928; OR = 1.250, 95% CI = 1.020-1.530). Among workers with nonstandard employment, there were gender differences in the risk for arthritis. Unemployed individuals also had a higher risk of mental health problems than nonstandard workers. In conclusion, the unemployed were more vulnerable to mental health problems.

Association of the Healthy Eating Index with Estimated Cardiovascular Age in Adults from the KNHANES 2013-2017.

In this paper, we hypothesized that the gap between estimated cardiovascular age (eCV-age) and chronological age had a gender-wise correlation with the Korean Healthy Eating Index (KHEI). We tested the hypothesis in adults aged 20-64 years old using the KNHANES 2013-2017 data. eCV-age was estimated based on the designated risk factors of cardiovascular disease (CVD) and age-gap was calculated by subtracting the eCV-age from the chronological age in 12,317 adults. Adjusted odds ratios for the age-gap were measured according to KHEI, while controlling for covariates to influence risk factors of CVD, using logistic regression analysis with the complex sample survey design. Age-gaps were divided into four groups: >4 (High), 0-4 (Moderate), -4-0 (Mild), and <-4 years (Low). The higher the age-gap, the lower the cardiovascular risk. Persons included in the following categories belonged to the high and moderate age-gap groups: young (<40 years), women, urban living, better than high school education, higher income, lean, mild drinking, and exercising regularly. KHEI scores were overall higher in women than men (p < 0.01). Having breakfast and saturated fat intake were primary factors that influenced the age-gap for men, whereas fresh fruit intake and carbohydrate intake influenced the age-gap in women. The KHEI scores positively correlated with nutrient intake, especially fiber and vitamin C intake in women (p < 0.05). Participants with high KHEI scores increased their chances of belonging to the high age-gap group by 2.16 times for men and 2.10 for women after adjusting for covariates of sex, age, and residence. However, after adding the covariates of education, income, marriage, and obesity, in conjunction with smoking, alcohol, and regular exercise, this reduced to 1.34 times in women. In conclusion, both genders had a positive correlation between age-gap and overall KHEI scores.

Trends in the Intake of Fatty Acids and Their Food Source According to Obese Status Among Korean Adult Population Using KNHANES 2007-2017.

BACKGROUND: Increasing obesity rates are related to energy intake with carbohydrate and fat ratio. Using Korean National Health and Nutrition Examination Survey 2007-2017 data, we examined the hypothesis that the fat intake and food sources of dietary fats had changed over the last 10 years according to gender and obesity status in adult population ≥19 years. METHODS: The food intake of each participant was collected by the 24-hour recall method, and nutrient intake including different fatty acids was calculated. The fatty acid intakes from 7 food groups were determined according to gender and obesity status. RESULTS: Body mass index increased in both genders of the obese group over the decade, but it decreased in the normal-weight group. In men, energy intake was higher in the obese group than in the lean group, but the opposite trend was shown in women. Total fat intake including various fatty acids continuously and sharply increased in both men and women until 2016, then slightly declined only in men. The source of saturated fatty acid (SFA) intake was mainly from the animal food group in men and women regardless of obese status, and SFA and monounsaturated fatty acid from the animal food group gradually increased over time in both genders. N-3 fatty acid intake markedly decreased from fish and crabs and increased from sauces and nuts regardless of genders and the obese status from 2008 to 2017. Polyunsaturated fatty acid and N-6 fatty acid intake increased from bread, cookies, sauces, and nuts regardless of genders and obesity status. CONCLUSION: Fat intake was higher in obese men, but this was opposite in women. The N-3 fatty acid intake from seafood should increase, and the fat composition in sauce needs to be modulated to increase N-3 fatty acids.

Non-Standard Workers Have Poorer Physical and Mental Health Than Standard Workers.

OBJECTIVES: To compare the health status of workers who had non-standard and standard employment in Korea. METHODS: Data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2007 to 2017) were used to compare the health of workers with standard and non-standard employment. RESULTS: Workers with non-standard employment (rather than standard employment) were more likely to be women, older, have less education, have lower monthly income, perform manual work, and work fewer hours per week. Men with non-standard employment were more likely to have physician-diagnosed cardiovascular disease, arthritis, and to report depressive and suicidal ideation. Women with non-standard employment were more likely to have physician-diagnosed cardiovascular disease and to report depressive feelings. CONCLUSION: Workers with daily employment were most vulnerable to physical and mental health problems. Health problems differed among individuals who had different types of non-standard employment.

Relationship of Occupational Category With Risk of Physical and Mental Health Problems.

OBJECTIVES: We evaluated the physical and mental health problems of waged workers in Korea who had different classes of occupation. METHODS: We used data from the Korean National Health and Nutrition Examination Survey (2007-2017) to examine 22,788 workers who were waged employees and categorized these workers into 5 occupational classes. RESULTS: "Unskilled manual workers" were more likely to be older, less educated, have lower monthly income, and work fewer hours per week. Among men and relative to "managers and professionals" (reference group), "skilled manual workers" were more likely to have physician-diagnosed osteoarthritis, "clerks" were less likely to report suicidal ideation, and "unskilled manual workers" were more likely to report suicidal ideation. Among women and relative to "managers and professionals" (reference group), "service and sales workers" and "unskilled manual workers" were more likely to report physician-diagnosed osteoarthritis, depressive feelings, and suicidal ideation. However, hypertension, hyperlipidemia, diabetes, and cardiovascular diseases did not differ among the occupational classes for men and women. CONCLUSION: We identified differences between men and women and among those in different occupational classes regarding employment status, physical health, and mental health. "Unskilled manual workers" of both genders were more likely to be older, less educated, have less monthly income, work fewer hours per week, and have suicidal ideation. Female "service and sales workers" were more likely to have osteoarthritis, depressive feelings, and suicidal ideation.

Changes of Atmospheric and Blood Concentrations of Lead and Cadmium in the General Population of South Korea from 2008 to 2017.

We measured changes in atmospheric and blood levels of lead and cadmium in the South Korean general population during the past decade. Blood data of 16,873 adults were taken from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2017). Atmospheric data were taken from 66 air quality monitoring sites in 16 different regions in South Korea. From 2008 to 2017, the geometric mean (GM) blood lead level decreased from 2.37 to 1.46 µg/dL (38.4% decrease), and the atmospheric lead concentration decreased by 61.0% in the overall population. During this time, the GM blood cadmium level decreased from 0.88 to 0.72 µg/L (18.2% decrease), and the atmospheric cadmium concentration decreased by 63.6%. Multiple linear regression analysis indicated that a half reduction in air lead was associated with a 0.09 µg/dL decrease in blood lead (95% CI: 0.03 to 0.15) in a subgroup of the metropolitan city population. However, a half reduction in air cadmium had no significant effect on blood cadmium. Multiple linear regression analyses indicated that the decrease in blood lead level over 10 years in Korea was related to the decrease in atmospheric lead concentration. However, the decrease in blood cadmium level during this time was not significantly associated with the decrease in atmospheric cadmium concentration. Our findings suggest that inhalation is a major source of lead exposure, but not of cadmium exposure. Ingestion of dietary cadmium presumably has a stronger impact on blood cadmium levels.

Very-low-fat diets may be associated with increased risk of metabolic syndrome in the adult population.

BACKGROUND & AIMS: Although fat intake has often been targeted to decrease the prevalence of metabolic syndrome; however decreasing dietary fat intake has not had this result. We studied the association between fat intake and the prevalence of metabolic syndrome in adults using KNHANES 2007-2013 data, a representative sample of the non-institutionalized civilian population. METHODS: This cross-sectional study included 34,003 Korean adults aged ≥19 years. Adjusted odds ratios (OR) for the components of metabolic syndrome were measured according to fat intake (≤15, 15-25, ≥25% of daily energy intake) while controlling for covariates that affect metabolic syndrome using linear and logistic regression analysis while incorporating the sample weights for the complex sample design of the survey. RESULTS: Surprisingly, the prevalence of metabolic syndrome was significantly higher in the ≤15% fat intake group (OR = 1.277), accompanied by lower daily energy intake compared to the reference group (≥25% fat intake). Higher daily fat intake was associated with significantly lower ORs for four components of metabolic syndrome, except diabetes mellitus, using continuous variable analysis, whereas only three serum components (serum HDL, serum triglyceride, and blood pressure) exhibited significantly higher ORs in the lowest tertile of dietary fat intake (≤15%) compared with the reference group (≥25% fat-intake tertile). Subjects in a low-fat intake group had about 6.0 g polyunsaturated fatty acid/day that did not meet the recommended intake. Consumption of grain groups was a significant predictor of low fat intake, whereas milk food groups were significant predictors of not having low fat intake. Subjects in the low-fat group (≤15%) had much lower daily energy intake, by 500 kcal, compared with subjects who consumed high-fat diets (≥25%). All nutrients except carbohydrates had significantly lower mean values in the low-fat-intake group as compared to the high-fat-intake group. CONCLUSIONS: Low fat intake, <15%, was associated with a higher incidence of metabolic syndrome in the adult population, despite the daily energy intakes being lower by 500 kcal and the intakes with proper ratio (1:1.03:1.01) of saturate, monounsaturated and polyunsaturated fatty acid; this may be related to lower intake of various nutrients other than carbohydrates.