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Cigarette smoking is the leading preventable cause of death, with smoking cessation representing the most effective strategy to reduce the risk of smoking-related diseases. Pharmacotherapeutic interventions for smoking cessation such as nicotine replacement therapy, bupropion, and varenicline aim to manage the symptoms of nicotine cravings and withdrawal. Evidence-based practice guidelines for pharmacotherapy in smoking cessation have been recently developed in Korea.Current Concepts: Among the general population, varenicline is the recommended first-line therapy for smoking cessation, surpassing nicotine patches and bupropion therapy. Although varenicline is commonly effective, combination therapy with varenicline and a nicotine patches may be considered when varenicline monotherapy is insufficient for managing nicotine cravings and withdrawal symptoms. Extended-duration therapy (>12 weeks) has demonstrated greater efficacy compared to standard therapy (6-12 weeks). Varenicline can promote attempts to quit smoking in smokers who are not yet prepared to quit. In cases of smokers with comorbid psychiatric conditions, varenicline is preferred over nicotine patches. The efficacy and safety profiles of smoking cessation medications have been well established in patients with cardiovascular diseases.Discussion and Conclusion: Smoking is a chronic condition associated with a high risk of relapse, emphasizing the crucial role of pharmacotherapy in increasing the success rates of smoking cessation. In accordance with evidence-based smoking cessation guidelines, the careful selection of pharmacotherapeutic agents tailored to individual smokers is pivotal.
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The incidence of giant gastric perforation occurring during upper gastrointestinal endoscopy is exceedingly rare. Gastric perforation can arise from excessive air insufflation and is more prevalent in elderly patients with atrophic gastritis. Although giant gastric mucosal lacerations during diagnostic endoscopy have occasionally been reported, there are few reports of giant gastric perforation. The authors experienced a giant gastric perforation occurring in the normal mucosa during endoscopy in an 81-year-old woman with advanced gastric cancer. The patient had reduced gastric extensibility due to the advanced gastric cancer surrounding the entire lower part of her stomach. During continuous air insufflation, only the upper part of the stomach became overdistended, resulting in mucosal rupture and perforation. In addition, old age and the presence of atrophic gastritis contributed to the increased risk of mucosal rupture. The patient was treated successfully with endoscopic clips. This paper reports this case with a review of the relevant literature.
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Background and Objectives@#To evaluate the impact of smoking in young adults on the risk of cardiovascular disease (CVD) and the clustering effect of behavioral risk factors such as smoking, obesity, and depression. @*Methods@#A Korean nationwide population-based cohort of a total of 3,280,826 participants aged 20–39 years old who underwent 2 consecutive health examinations were included. They were followed up until the date of CVD (myocardial infarction [MI] or stroke), or December 2018 (median, 6 years). @*Results@#Current smoking, early age of smoking initiation, and smoking intensity were associated with an increased risk of CVD incidence. Even after quitting smoking, the risk of MI was still high in quitters compared with non-smokers. Cigarette smoking, obesity, and depression were independently associated with a 1.3–1.7 times increased risk of CVD, and clustering of 2 or more of these behavioral risk factors was associated with a 2–3 times increased risk of CVD in young adults. @*Conclusions@#In young adults, cigarette smoking was associated with the risk of CVD, and the clustering of 2 or more behavioral risk factors showed an additive risk of CVD.
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Tobacco use is a leading cause of countless deaths and disabilities worldwide. An estimated 11 million Korean adults were still using tobacco in 2020, according to the Korea National Health and Nutrition Examination Survey. This review aims to explain the current trends in tobacco use, sales, cessation, and control policies in South Korea.Current Concepts: Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Advertisements stating that HTPs are odorless, tar-free, and less harmful to health have caused sales of HTPs to grow quickly over the past 5 years, such that they account for about 15% of the total tobacco market. According to national smoking rate statistics and tobacco sales trends, declines in current smoking rates have slowed and even risen in some groups, and declines in total tobacco sales have slowed but also risen again during the coronavirus 19 pandemic. In addition, the number of visitors to smoking cessation clinics decreased just after the advent of HTPs and social distancing policies triggered by the coronavirus. Nicotine replacement therapy can serve as a drug therapy for smoking cessation, or bupropion and varenicline can be prescribed. Korea’s representative tobacco control policies include the tax increase policy, non-smoking area policy, cigarette pack warning picture policy, and support policy for visiting smoking cessation clinics.Discussion and Conclusion: There is a pressing need to reflect tobacco control policies in line with changes in tobacco user behaviors and tobacco company marketing strategies.
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Background@#After the advent of heated tobacco products (HTPs) in 2017, domestic cigarette sales declined until 2019, but have increased in South Korea since 2020. This study aimed to analyze tobacco use and cessation behavior among HTP users compared with conventional cigarette (CC) users. @*Methods@#We analyzed data from the eighth Korea National Health and Nutrition Examination Survey (2019). Of 6,188 study participants, 1,181 were current tobacco product users (single, dual, and triple), including all combinations of CCs, HTPs, and electronic cigarettes (ECs). Tobacco use and cessation behaviors among single and dual users of CCs and HTPs were assessed using various categorical methods. @*Results@#In 2019, proportions of HTP use in men and women aged ≥19 years in South Korea were 8.8% and 1.5%, respectively, and those of single, dual, and triple users were 23.6%, 58.0%, and 18.4%, respectively. Dual users had more tobacco use than CC only and HTP only users (all P<0.001). Each daily user accounted for a lower percentage of attempt and preparation stages for cessation than intermittent users (all P<0.001, except for dual users). @*Conclusion@#In this study, we analyzed the differences in tobacco use and cessation behavior among CC and HTP users in various populations in South Korea. Additionally, we found that all novel tobacco product users had already experienced CCs in adulthood. Further studies that address HTP’s harmful effects in humans are necessary.
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Objectives@#This study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers. @*Methods@#This rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity. @*Results@#Following screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I2=40.71%), depending on prior abstinence duration and the drug type. Conclusions: The results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.
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Background@#Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. @*Methods@#Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. @*Results@#Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). @*Conclusion@#In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.
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Objectives@#This study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers. @*Methods@#This rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity. @*Results@#Following screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I2=40.71%), depending on prior abstinence duration and the drug type. Conclusions: The results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.
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Background@#Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. @*Methods@#Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. @*Results@#Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). @*Conclusion@#In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.
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This document provides a description of country-level laws that regulate electronic cigarettes and heated tobacco products. The mechanisms used to regulate e-cigarettes were classified as either new/amended laws or existing laws. The policy domains identified include restrictions or prohibitions related to the product (sale, manufacturing, importation, distribution, use, product design including e-liquid ingredients, advertising/ promotion/ sponsorship, and trademarks) and regulatory requirements (taxation, health warning labels, and child-safety standards). A range of regulatory approaches are currently being applied to e-cigarettes globally; however, many countries still regulate e-cigarettes using legislation not tailored specifically for e-cigarettes. Only a handful of countries levy a tax on e-cigarettes. Evidence on the harmful effects and benefits of e-cigarettes usage has not been clearly established yet. The regulatory treatment of heated tobacco products varies from country to country, with some classifying e-cigarettes and cigarettes under the same legislation, other countries treating e-cigarettes more favorably, and some jurisdictions banning them altogether. As the evidence base grows, we expect additional activity in the regulatory arena.
Subject(s)
Electronic Nicotine Delivery Systems , Hand , Hot Temperature , Jurisprudence , Nicotine , Taxes , Tobacco Products , NicotianaABSTRACT
Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Owing to advertisements stating that HTPs are odorless, tar-free, and less harmful to health, the sales of HTPs have grown quickly enough to account for about 10% of the total tobacco market in a year. HTP use by young, highly educated, and high-income groups had a significant impact on both the overall tobacco market over the past 3 years and the smoking and quitting behaviors of smokers. Based on national smoking rate statistics, tobacco sales trends, and the number of visitors to smoking cessation clinics, the following changes have been identified: (1) The decline in current smoking rates has slowed or rose in some groups. (2) The decline in total cigarette sales has slowed but rose again in the first quarter of 2020. (3) The number of visitors to smoking cessation clinics decreased just after the advent of HTPs. These results may be due to the insufficient support of tobacco regulation policies but also coincide chronologically with the appearance of HTPs in South Korea. It is necessary to investigate the usage rate of various tobacco products, including HTPs and e-cigarettes, to examine the health risks of novel tobacco products and provide accurate information to users and policymakers. Finally, tobacco companies are continuously developing new product concepts to escape the regulation of existing cigarettes; thus, comprehensive management measures for all nicotine-containing products are needed.
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This document provides a description of country-level laws that regulate electronic cigarettes and heated tobacco products. The mechanisms used to regulate e-cigarettes were classified as either new/amended laws or existing laws. The policy domains identified include restrictions or prohibitions related to the product (sale, manufacturing, importation, distribution, use, product design including e-liquid ingredients, advertising/ promotion/ sponsorship, and trademarks) and regulatory requirements (taxation, health warning labels, and child-safety standards). A range of regulatory approaches are currently being applied to e-cigarettes globally; however, many countries still regulate e-cigarettes using legislation not tailored specifically for e-cigarettes. Only a handful of countries levy a tax on e-cigarettes. Evidence on the harmful effects and benefits of e-cigarettes usage has not been clearly established yet. The regulatory treatment of heated tobacco products varies from country to country, with some classifying e-cigarettes and cigarettes under the same legislation, other countries treating e-cigarettes more favorably, and some jurisdictions banning them altogether. As the evidence base grows, we expect additional activity in the regulatory arena.
ABSTRACT
This document provides a description of country-level laws that regulate electronic cigarettes and heated tobacco products. The mechanisms used to regulate e-cigarettes were classified as either new/amended laws or existing laws. The policy domains identified include restrictions or prohibitions related to the product (sale, manufacturing, importation, distribution, use, product design including e-liquid ingredients, advertising/ promotion/ sponsorship, and trademarks) and regulatory requirements (taxation, health warning labels, and child-safety standards). A range of regulatory approaches are currently being applied to e-cigarettes globally; however, many countries still regulate e-cigarettes using legislation not tailored specifically for e-cigarettes. Only a handful of countries levy a tax on e-cigarettes. Evidence on the harmful effects and benefits of e-cigarettes usage has not been clearly established yet. The regulatory treatment of heated tobacco products varies from country to country, with some classifying e-cigarettes and cigarettes under the same legislation, other countries treating e-cigarettes more favorably, and some jurisdictions banning them altogether. As the evidence base grows, we expect additional activity in the regulatory arena.
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Based on epidemiological studies, an International Agency for Research on Cancer Working Group determined that strong inorganic acid mists containing sulfuric acid are carcinogenic to human even though, sulfuric acid, per se, is not. Accumulative studies indicate that there is a link between chronic occupational exposure to sulfuric acid mists and an increased risk of laryngeal cancer. Unintended, acute exposure to sulfuric acid mists can cause corrosive damage to target tissues depending on the route of exposure. This review compares the toxicity and carcinogenicity of sulfuric acid mists compared to other strong inorganic acid mists. It also examines the routes and duration of exposure (short-term, prolonged, and long-term). In vivo evidence does not support or refute the carcinogenicity of sulfuric inorganic mists even though its co-carcinogenic or promoting potential has been considered. On the basis of existing evidence on sulfuric acid mist toxicity, we suggested a putative adverse outcome pathway (AOP) relevant to carcinogenicity caused by mists containing sulfuric acid. A possible key factor involved in sulfuric acid mist carcinogenesis is the genotoxic effects of low pH since it can increase instability in chromosomes and DNA. A putative AOP for sulfuric acid mist carcinogenicity would help generate better risk assessments and more accurate predictions regarding the risk of developing cancer due to prolonged exposure. Establishing an AOP would also be useful for future studies examining the carcinogenicity of other strong inorganic mists.
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Humans , Carcinogenesis , Chemical Hazard Release , DNA , Epidemiologic Studies , Hydrogen-Ion Concentration , International Agencies , Laryngeal Neoplasms , Occupational Exposure , Risk Assessment , Sulfur , Sulfuric AcidsABSTRACT
BACKGROUND: Electronic cigarette (EC) consumption (‘vaping’) is rapidly increasing, not only in adults but also in adolescents. Little is known about the association between vaping and problem behaviors such as drinking. METHODS: We used data from the 11th Korea Youth Risk Behavior Web-based Survey, which was conducted in 2015 and included 68,043 participants who were Korean middle and high school students. The survey assessed EC, cigarette, and alcohol use. Multiple regression analysis was used to examine risk of current drinking and problem drinking across the following categories of users: never user (never used either product), former user (use of EC or cigarettes in the past, but not currently), vaping only, smoking only, and dual user (current use of both products). RESULTS: EC only users were 1.2% in males, and 0.3% in females. Dual user of both conventional cigarettes and ECs were 5.1% in males, and 1.2% in females. Drinking frequency, drinking quantity per once, and problem drinking were higher among vapers than non-vapers and former-vapers, moreover, were higher among daily vapers than intermittent vapers. Compared to never users, EC only users were higher on risk of current drink and problem drink. The dual users were highest on risk of current drink. CONCLUSION: Vaping is independently associated with alcohol use problems in Korean students, even those not currently smoking. Moreover, dual use of cigarettes and ECs is strongly associated with alcohol use problems. Therefore, vaping students should be concerned about their hidden alcohol use problems.
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Adolescent , Adult , Female , Humans , Male , Adolescent Behavior , Alcohol Drinking , Drinking , Electronic Nicotine Delivery Systems , Korea , Problem Behavior , Risk-Taking , Smoke , Smoking , Tobacco ProductsABSTRACT
Radon, the primary constituent of natural radiation, is the second leading environmental cause of lung cancer after smoking. To confirm a relationship between indoor radon exposure and lung cancer, estimating cumulative levels of exposure to indoor radon for an individual or population is necessary. This study sought to develop a model for estimate indoor radon concentrations in Korea. Especially, our model and method may have wider application to other residences, not to specific site, and can be used in situations where actual measurements for input variables are lacking. In order to develop a model, indoor radon concentrations were measured at 196 ground floor residences using passive alpha-track detectors between January and April 2016. The arithmetic mean (AM) and geometric mean (GM) means of indoor radon concentrations were 117.86±72.03 and 95.13±2.02 Bq/m³, respectively. Questionnaires were administered to assess the characteristics of each residence, the environment around the measuring equipment, and lifestyles of the residents. Also, national data on indoor radon concentrations at 7643 detached houses for 2011-2014 were reviewed to determine radon concentrations in the soil, and meteorological data on temperature and wind speed were utilized to approximate ventilation rates. The estimated ventilation rates and radon exhalation rates from the soil varied from 0.18 to 0.98/hr (AM, 0.59±0.17/hr) and 326.33 to 1392.77 Bq/m²/hr (AM, 777.45±257.39; GM, 735.67±1.40 Bq/m²/hr), respectively. With these results, the developed model was applied to estimate indoor radon concentrations for 157 residences (80% of all 196 residences), which were randomly sampled. The results were in better agreement for Gyeonggi and Seoul than for other regions of Korea. Overall, the actual and estimated radon concentrations were in better agreement, except for a few low-concentration residences.
Subject(s)
Background Radiation , Exhalation , Korea , Life Style , Lung Neoplasms , Methods , Models, Theoretical , Radon , Seoul , Smoke , Smoking , Soil , Ventilation , WindABSTRACT
PURPOSE: Exposure to indoor radon is associated with lung cancer. This study aimed to estimate the number of lung cancer deaths attributable to indoor radon exposure, its burden of disease, and the effects of radon mitigation in Korea in 2010. MATERIALS AND METHODS: Lung cancer deaths due to indoor radon exposure were estimated using exposure-response relations reported in previous studies. Years of life lost (YLLs) were calculated to quantify disease burden in relation to premature deaths. Mitigation effects were examined under scenarios in which all homes with indoor radon concentrations above a specified level were remediated below the level. RESULTS: The estimated number of lung cancer deaths attributable to indoor radon exposure ranged from 1946 to 3863, accounting for 12.5–24.7% of 15623 total lung cancer deaths in 2010. YLLs due to premature deaths were estimated at 43140–101855 years (90–212 years per 100000 population). If all homes with radon levels above 148 Bq/m3 are effectively remediated, 502–732 lung cancer deaths and 10972–18479 YLLs could be prevented. CONCLUSION: These findings suggest that indoor radon exposure contributes considerably to lung cancer, and that reducing indoor radon concentration would be helpful for decreasing the disease burden from lung cancer deaths.
Subject(s)
Korea , Lung Neoplasms , Lung , Mortality, Premature , RadonABSTRACT
Radon, the primary constituent of natural radiation, is the second leading environmental cause of lung cancer after smoking. To confirm a relationship between indoor radon exposure and lung cancer, estimating cumulative levels of exposure to indoor radon for an individual or population is necessary. This study sought to develop a model for estimate indoor radon concentrations in Korea. Especially, our model and method may have wider application to other residences, not to specific site, and can be used in situations where actual measurements for input variables are lacking. In order to develop a model, indoor radon concentrations were measured at 196 ground floor residences using passive alpha-track detectors between January and April 2016. The arithmetic mean (AM) and geometric mean (GM) means of indoor radon concentrations were 117.86±72.03 and 95.13±2.02 Bq/m³, respectively. Questionnaires were administered to assess the characteristics of each residence, the environment around the measuring equipment, and lifestyles of the residents. Also, national data on indoor radon concentrations at 7643 detached houses for 2011-2014 were reviewed to determine radon concentrations in the soil, and meteorological data on temperature and wind speed were utilized to approximate ventilation rates. The estimated ventilation rates and radon exhalation rates from the soil varied from 0.18 to 0.98/hr (AM, 0.59±0.17/hr) and 326.33 to 1392.77 Bq/m²/hr (AM, 777.45±257.39; GM, 735.67±1.40 Bq/m²/hr), respectively. With these results, the developed model was applied to estimate indoor radon concentrations for 157 residences (80% of all 196 residences), which were randomly sampled. The results were in better agreement for Gyeonggi and Seoul than for other regions of Korea. Overall, the actual and estimated radon concentrations were in better agreement, except for a few low-concentration residences.
Subject(s)
Background Radiation , Exhalation , Korea , Life Style , Lung Neoplasms , Methods , Models, Theoretical , Radon , Seoul , Smoke , Smoking , Soil , Ventilation , WindABSTRACT
BACKGROUND: Cut-off values for visceral fat area (VFA) measured by computed tomography (CT) for identifying individuals at risk of metabolic syndrome (MetS) have not been clearly established in Korean adults, particularly for large populations. We aimed to identify optimal VFA and waist circumference (WC) cut-off values and compare the ability of VFA and WC to predict the presence of ≥2 metabolic risk factors. METHODS: We included 36,783 subjects aged 19–79 years undergoing abdominal fat CT during regular health checkups between January 2007 and February 2015 in Seoul. The risk factors for MetS except WC were based on the International Diabetes Federation criteria. Receiver operating characteristic curve analyses were used to determine the appropriate VFA and WC cut-off values for MetS. RESULTS: VFA was a more significant predictor of metabolic risk factors than WC and body mass index (BMI). The optimal cut-off values for VFA and WC were 134.6 cm2 and 88 cm for men and 91.1 cm2 and 81 cm for women, respectively. We estimated age-specific cut-off values for VFA, WC, and BMI. VFA cut-off values increased with age, particularly among women. CONCLUSION: This large population study proposed the cut-off values for VFA and WC for identifying subjects at risk of MetS among Korean adults. For more accurate diagnosis, different age-specific cut-off values for VFA and WC may be considered.
Subject(s)
Adult , Female , Humans , Male , Abdominal Fat , Body Mass Index , Diagnosis , Intra-Abdominal Fat , Obesity, Abdominal , Risk Factors , ROC Curve , Seoul , Waist CircumferenceABSTRACT
BACKGROUND: We investigated the association between body composition, especially truncal or non-truncal fat mass (FM), and bone mineral density (BMD) in premenopausal women in Korea. METHODS: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey IV and V (2008–2011). Total lean mass (LM), total FM (TFM), truncal FM, and non-truncal FM, and BMD of the total femur, femoral neck (FN), and lumbar spine were measured using dual-energy X-ray absorptiometry. The association between body composition and BMD was analyzed using multiple linear regression. The risk of low BMD according to quartiles of TFM, truncal FM, and non-truncal FM was calculated using logistic regression. Subgroup analysis according to body mass index was also performed. RESULTS: In 4,343 premenopausal women, total LM was positively associated with BMD regardless of weight adjustment. TFM, truncal FM, and non-truncal FM were inversely associated with BMD after adjusting for weight. Odds ratios (ORs) for low BMD and 95% confidence intervals (CIs) of the highest quartile of TFM, truncal FM, and non-truncal FM compared with the lowest quartile were calculated. The risk of low BMD of the FN was higher in the highest quartile of TFM (OR, 4.48; 95% CI, 1.11–18.01) and truncal FM (OR, 5.48; 95% CI, 1.75–17.20). Truncal FM and not-truncal FM had an inverse association with BMD in the non-obese and obese subgroups of women. CONCLUSION: Total LM has a protective effect on BMD and FM can have a detrimental effect on BMD besides its skeletal loading effect.