Changes in smoking status, amount of smoking and their relation to the risk of microvascular complications in men with diabetes mellitus.

BACKGROUND: Smoking is a definite risk factor for macrovascular complications in diabetes mellitus (DM). However, the effect of smoking on microvascular complications is inconclusive. METHOD: Study participants were 26,673 diabetic men who received health check-up both in 2003-2004 and 2009, excluding women. Assessing smoking status (never, quitting and current) at 2003-2004 and 2009, changes in smoking status were categorised into 7 groups (never - never, never - quitting, never - current, quitting-quitting, quitting-current, current-quitting and current-current). Smoking amount was categorised into never, light (0-10 pack years), moderate (10-20 pack years), and heavy smoking (>20 pack years) based on 2009 data. They were followed-up until 2013 to identify incident microvascular complications. We calculated the adjusted hazard ratios (HR) and 95% confidence interval (CI) (adjusted HR [95% CI]) for incident microvascular complications according to changes in smoking status and smoking amount. RESULTS: Current-quitting (1.271 [1.050-1.538]), current-current (1.243 [1.070-1.444]) and heavy smoking (1.238 [1.078-1.422]) were associated with an increased risk of overall microvascular complications. The risk of nephropathy increased in current-current smoking (1.429 [1.098-1.860]) and heavy smoking (1.357 [1.061-1.734]). An increased risk of neuropathy was observed in current-quitting smoking (1.360 [1.076-1.719]), current-current smoking (1.237 [1.025-1.492]) and heavy smoking (1.246 [1.048-1.481]). However, we couldn't see the interpretable findings for the association between smoking and retinopathy. CONCLUSIONS: Lasting and heavy smoking increases the risk of microvascular complications, including nephropathy and neuropathy. Quitting smoking and reducing smoking amount are imperative in preventing microvascular complications in DM patients.

Daily Vigorous Intensity Physical Activity and Its Preventive Effect on Pancreatic Cancer.

PURPOSE: There has been accumulating evidence for the preventive effect of high physical activity on cancer. However, it is still unclear which level of physical activity is associated with the decreased risk of pancreatic cancer. The purpose of current study is to assess the association between the frequency of vigorous intensity physical activity and the risk of pancreatic cancer. MATERIALS AND METHODS: The nationwide retrospective cohort study was conducted using the National Health Information Database. Study participants were 220,357 Koreans who received health check-up in 2009. They were divided into four groups by the weekly frequency of vigorous intensity physical activity longer than 20 minutes (group 1, no vigorous intensity physical activity (reference); group 2, 1-3 days; group 3, 4-5 days and group 4, 6-7 days). Cox proportional hazard model was used to calculate the adjusted hazard ratios (HRs) and 95% confidence interval (CI) for incident pancreatic cancer (adjusted HRs [95% CI]) according to the weekly frequency of vigorous intensity physical activity. RESULTS: For 4.38 years' follow-up on average, 377 cases of pancreatic cancer developed. Subjects without incident pancreatic cancer had more favorable metabolic condition and higher physical activity than subjects with incident pancreatic cancer. Adjusted HRs and 95% CI indicated that only group 4 was significantly associated with the decreased risk of pancreatic cancer (group 1, reference; group 2, 1.10 [0.86-1.40]; group 3, 0.75 [0.45-1.25] and group 4, 0.47 [0.25-0.89]). CONCLUSION: In this nationwide representative cohort study, near daily vigorous intensity physical activity showed the preventive effect on pancreatic cancer.

The association of pancreatic cancer incidence with smoking status and smoking amount in Korean men.

OBJECTIVES: Our study examined the dose-response relationship between smoking amounts (pack-years) and the risk of developing pancreatic cancer in Korean men. METHODS: Of 125,743 participants who underwent medical health checkups in 2009, 121,408 were included in the final analysis and observed for the development of pancreatic cancer. We evaluated the associations between smoking amounts and incident pancreatic cancer in 4 groups classified by pack-year amounts. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident pancreatic cancer by comparing groups 2 (<20 pack-year smokers), 3 (20-≤40 pack-year smokers), and 4 (>40 pack-year smokers) with group 1 (never smokers). RESULTS: During 527,974.5 person-years of follow-up, 245 incident cases of pancreatic cancer developed between 2009 and 2013. The multivariate-adjusted HRs (95% CIs) for incident pancreatic cancer in groups 2, 3, and 4 were 1.05 (0.76 to 1.45), 1.28 (0.91 to 1.80), and 1.57 (1.00 to 2.46), respectively (p for trend=0.025). The HR (95% CI) of former smokers showed a dose-response relationship in the unadjusted model, but did not show a statistically significant association in the multivariate-adjusted model. The HR (95% CI) of current smokers showed a dose-response relationship in both the unadjusted (p for trend=0.020) and multivariate-adjusted models (p for trend=0.050). CONCLUSIONS: The risk of developing pancreatic cancer was higher in current smokers status than in former smokers among Korean men, indicating that smoking cessation may have a protective effect.

Fasting blood glucose and risk of incident pancreatic cancer.

BACKGROUND: The number of patients with diabetes and impaired fasting blood glucose in Korea is rapidly increasing compared to the past, and other metabolic indicators of population are also changed in recent years. To clarify the mechanism more clearly, we investigated the association between fasting blood glucose and incidence of pancreatic cancer in this retrospective cohort study. METHODS: In Korea National Health Information Database, 19,050 participants without pancreatic cancer in 2009 were enrolled, and followed up until 2013. We assessed the risk of incident pancreatic cancer according to the quartile groups of fasting blood glucose level (quartile 1: <88 mg/dL, quartile 2: 88-97 mg/dL, quartile 3: 97-109 mg/dL and quartile 4: ≥109 mg/dL). Multivariate Cox-proportional hazard model was used in calculating hazard ratios (HRs) and 95% confidence interval (CI) for incident pancreatic cancer. RESULTS: Compared with quartile1 (reference), unadjusted HRs and 95% CI for incident pancreatic cancer significantly increased in order of quartile2 (1.39 [1.01-1.92]), quartile3 (1.50 [1.09-2.07]) and quartile4 (2.18 [1.62-2.95]), and fully adjusted HRs and 95% CI significantly increased from quartile2 (1.47 [1.05-2.04]), quartile3 (1.61 [1.05-2.04]) to quartile4 (2.31 [1.68-3.17]). CONCLUSION: Fasting blood glucose even with pre-diabetic range was significantly associated with the incident pancreatic cancer in Korean.

Association between urinary trans,trans-muconic acid and diabetes: a cross-sectional analysis of data from Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017).

BACKGROUND: Benzene is a ubiquitous air pollutant that is well known to cause hematopoietic effects in humans including leukemia. Recently, several studies have discussed its non-carcinogenic effects such as diabetes. This study aimed to investigate the association between diabetes and urinary trans,trans-muconic acid (t,t-MA), one of benzene metabolite, using adult data from Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017). METHODS: This study analyzed 3,777 adults (1,645 men and 2,132 women) from the KoNEHS cycle 3 (2015-2017). The distribution and fraction of each independent variable were presented separately according to the urinary benzene metabolite levels (t,t-MA quartiles) and diabetes to determine the general characteristics of the subjects. Odds ratios (ORs) were calculated using logistic regression after stratification by gender and smoking status to identify the association between urinary t,t-MA and diabetes. RESULTS: Compared with the first quartile (reference), the risk of diabetes significantly increased above the 4th (1.834 [1.107-3.039]) quartile in men and above the 3rd (1.826 [1.095-3.044]) and 4th (2.243 [1.332-3.776]) quartiles in women after adjustment. Stratified analysis based on smoking revealed that the ORs for the 3rd (1.847 [1.146-2.976]) and 4th (1.862 [1.136-3.052]) quartiles in non-smokers and those for the 2nd (1.721 [1.046-2.832]), 3rd (1.797 [1.059-3.050]), and 4th (2.546 [1.509-4.293]) quartiles in smokers were significantly higher. CONCLUSIONS: We confirmed that urinary t,t-MA is significantly associated with diabetes regardless of gender and smoking status. And further studies are necessary to access the clinical impacts of this findings.

Relationship between urinary phthalate metabolites and diabetes: Korean National Environmental Health Survey (KoNEHS) cycle 3 (2015-2017).

BACKGROUND: We aimed to determine relationship diabetes according to urinary phthalate metabolites using adult data from Korean National Environmental Health Survey cycle 3 (2015-2017). METHOD: This study was conducted on 3,781 adults aged 19 years and older (1,648 men and 2,133 women) based on KoNEHS cycle 3. Participants' data were analyzed by gender; Relationship between phthalate metabolites in the urine and diabetes was analyzed by dividing the sociodemographic variables, health behavior-related variables, and urinary phthalate metabolite concentrations into quartiles. To determine the relationship between urinary phthalate metabolites and the prevalence of diabetes, the odds ratio (OR) was calculated using logistic regression analysis. RESULTS: Based on the 1st quartile of each metabolite, the ORs for di-2-ethylhexyl phthalate (DEHP) (4th quartile), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (2nd quartile, 3rd quartile and 4th quartile), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) (4th quartile), mono-(2-ethyl-5-carboxypentyl) phthalate (MECCP) (4th quartile), mono-n-butyl phthalate (MnBP) (3rd quartile and 4th quartile), mono-benzyl phthalate (MBzP) (2nd quartile) and 4th quartile), and mono (3-carboxypropyl) phthalate (MCPP) (3rd quartile and 4th quartile) were significantly higher after the adjustment in men. The ORs for DEHP (2nd quartile, 3rd quartile and 4th quartile), MEHHP (2nd quartile, 3rd quartile and 4th quartile), MEOHP (4th quartile), MECCP (4th quartile), MBzP (4th quartile), and MCPP (4th quartile) were significantly higher after the adjustment in women. CONCLUSION: This study investigated relationship between urinary phthalate metabolites and diabetes. The higher urinary phthalate metabolites, the higher the prevalence of diabetes. Further regulation of phthalate may be needed, and further studies are warranted to confirm the association between phthalate concentration and other chronic diseases (such as hypertension, hyperlipidemia, and cardiovascular disease).

Relationship between seafood consumption and bisphenol A exposure: the Second Korean National Environmental Health Survey (KoNEHS 2012-2014).

BACKGROUND: This study aimed to identify the relationship between exposure to bisphenol A (BPA) and seafood consumption using a nationally representative data of the general Korean population. METHODS: This study was conducted on 5,402 adults aged 19 years and older (2,488 men, 2,914 women) based on the second Korean National Environmental Health Survey (2012-2014). We stratified the data according to gender and analyzed urinary BPA concentrations in terms of sociodemographic characteristics, health behavior, dietary factor, and seafood consumption. In the high and low BPA exposure groups, the odds ratios (ORs) were calculated using logistic regression analysis according to the top 75th percentile concentration. RESULTS: In men, large fish and tuna and other seafood categories had significantly higher ORs before and after adjustment in the group who consumed seafood more than once a week than in the group who rarely consumed seafood, with an adjusted value of 1.97 (95% confidence interval [CI]: 1.12-3.48) and 1.74 (95% CI: 1.10-2.75), respectively. In the shellfish category, the unadjusted OR was 1.61 (95% CI: 1.00-2.59), which was significantly higher in the group who consumed seafood more than once a week than in the group who rarely consumed seafood. However, the OR after adjusting for the variables was not statistically significant. In women, the frequency of seafood consumption and the concentration of urinary BPA were not significantly associated. CONCLUSIONS: BPA concentration was higher in men who frequently consumed large fish and tuna, shellfish and other seafood in this study.

Relationship between personal care products usage and triclosan exposure: the second Korean National Environmental Health Survey (KoNEHS 2012-2014).

BACKGROUND: We aimed to find the exposure level of triclosan (TCS), a known endocrine disruptor, related to the use of personal care products using a nationally representative data of the general population in Korea. METHODS: This study included data of 6288 adults aged 19 years and older (2692 men, 3596 women), based on the Second Korean National Environmental Health Survey (KoNEHS 2012-2014). The data were divided according to gender. The frequency and proportion of each variable were determined by dividing participants into two groups based on the top 75th percentile concentration of urinary TCS (male: 1.096 µg/g creatinine, female: 1.329 µg/g creatinine). Odds ratios (ORs) were calculated using logistic regression analysis for the high TCS exposure and low TCS exposure groups. RESULTS: Overall, the proportion of participants using personal care products was higher in women than in men. There was a significantly higher proportion of participants in the high TCS exposure group with younger age, higher education and income levels and with more frequent use of fragrance products, hair care products, body cleansers, cosmetics, and antimicrobial agents. In both men and women, ORs tended to increase with increased frequency of use of hair care products, body cleansers, and cosmetics before and after adjustment. CONCLUSIONS: Our findings demonstrate that as the frequency of use of personal care products increases, urine TCS concentration increases. Because TCS is a well-known endocrine disruptor, further studies are needed and explore other health effects with exposure to TCS in general population in Korea.