Engineering Rhodosporidium toruloides for production of 3-hydroxypropionic acid from lignocellulosic hydrolysate.

Microbial production of valuable bioproducts is a promising route towards green and sustainable manufacturing. The oleaginous yeast, Rhodosporidium toruloides, has emerged as an attractive host for the production of biofuels and bioproducts from lignocellulosic hydrolysates. 3-hydroxypropionic acid (3HP) is an attractive platform molecule that can be used to produce a wide range of commodity chemicals. This study focuses on establishing and optimizing the production of 3HP in R. toruloides. As R. toruloides naturally has a high metabolic flux towards malonyl-CoA, we exploited this pathway to produce 3HP. Upon finding the yeast capable of catabolizing 3HP, we then implemented functional genomics and metabolomic analysis to identify the catabolic pathways. Deletion of a putative malonate semialdehyde dehydrogenase gene encoding an oxidative 3HP pathway was found to significantly reduce 3HP degradation. We further explored monocarboxylate transporters to promote 3HP transport and identified a novel 3HP transporter in Aspergillus pseudoterreus by RNA-seq and proteomics. Combining these engineering efforts with media optimization in a fed-batch fermentation resulted in 45.4 g/L 3HP production. This represents one of the highest 3HP titers reported in yeast from lignocellulosic feedstocks. This work establishes R. toruloides as a host for 3HP production from lignocellulosic hydrolysate at high titers, and paves the way for further strain and process optimization towards enabling industrial production of 3HP in the future.

Engineering Bacillus subtilis for production of 3-hydroxypropanoic acid.

3-Hydroxypropionic acid (3-HP) is a valuable platform chemical that is used as a precursor for several higher value-added chemical products. There is an increased interest in development of cell factories as a means for the synthesis of 3-HP and various other platform chemicals. For more than a decade, concentrated effort has been invested by the scientific community towards developing bio-based approaches for the production of 3-HP using primarily Escherichia coli and Klebsiella pneumoniae as production hosts. These hosts however might not be optimal for applications in e.g., food industry due primarily to endotoxin production and the pathogenic origin of particularly the K. pneumoniae. We have previously demonstrated that the generally recognized as safe organism Bacillus subtilis can be engineered to produce 3-HP using glycerol, an abundant by-product of the biodiesel industry, as substrate. For commercial exploitation, there is a need to substantially increase the titer. In the present study, we optimized the bioprocess conditions and further engineered the B. subtilis 3-HP production strain. Thereby, using glycerol as substrate, we were able to improve 3-HP production in a 1-L bioreactor to a final titer of 22.9 g/L 3-HP.

Potentially inappropriate prescribing of cardiovascular system and antiplatelet/anticoagulant drugs among elderly patients: a Korean population-based national study.

OBJECTIVES: To investigate the prevalence of potentially inappropriate prescribing (PIP) for cardiovascular system (CVS) and antiplatelet/anticoagulant (AP/AC) drugs among Korean elderly patients, using the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2 and to identify the risk factors related to PIP. METHODS: The 2016 National Aged Patient Sample data, comprising National Health Insurance claim records for a random sample of 20% of patients aged ≥ 65 years, were used to calculate PIP prevalence of outpatient prescriptions. For criteria including drug-disease interactions, PIP prevalence per indication was estimated. RESULTS: Among 1,274,148 elderly patients and 27,062,307 outpatient prescription claims, 100,085 patients (7.85%) and 341,664 claims (1.27%) had one or more PIP. The most frequent PIP was "non-steroidal anti-inflammatory drug with concurrent antiplatelet agent (s) without proton-pump inhibitor prophylaxis" in the claim-level (0.97%) and patient-level (6.33%) analyses. "Beta-blocker with bradycardia" (16.47% of claims) and "angiotensin receptor blockers in patients with hyperkalaemia" (23.89% of claims) showed the highest PIP prevalence per indication. Logistic regression analysis revealed that, among the patient and health care provider characteristics, female, older age, more severe comorbidities, polypharmacy, higher level of healthcare organization, and specialty of prescriber were significantly associated with a higher risk of PIP. CONCLUSIONS: Our findings of a high prevalence of PIP for CVS and AP/AC drugs among the elderly suggest that an effective strategy is urgently needed to improve the prescription practices of these drugs.

Differences in the Fatty Acid Profile, Morphology, and Tetraacetylphytosphingosine-Forming Capability Between Wild-Type and Mutant Wickerhamomyces ciferrii.

One tetraacetylphytosphingosine (TAPS)-producing Wickerhamomyces ciferrii mutant was obtained by exposing wild-type W. ciferrii to γ-ray irradiation. The mutant named 736 produced up to 9.1 g/L of TAPS (218.7 mg-TAPS/g-DCW) during batch fermentation in comparison with 1.7 g/L of TAPS (52.2 mg-TAPS/g-DCW) for the wild type. The highest production, 17.7 g/L of TAPS (259.6 mg-TAPS/g-DCW), was obtained during fed-batch fermentation by mutant 736. Fatty acid (FA) analysis revealed an altered cellular FA profile of mutant 736: decrease in C16:0 and C16:1 FA levels, and increase in C18:1 and C18:2 FA levels. Although a significant change in the cellular FA profile was observed, scanning electron micrographs showed that morphology of wild-type and mutant 736 cells was similar. Genetic alteration analysis of eight TAPS biosynthesis-related genes revealed that there are no mutations in these genes in mutant 736; however, mRNA expression analysis indicated 30% higher mRNA expression of TCS10 among the eight genes in mutant 736 than that in the wild-type. Collectively, these results imply that the enhancement of TAPS biosynthesis in mutant 736 may be a consequence of system-level genetic and physiological alterations of a complicated metabolic network. Reverse metabolic engineering based on system-level omics analysis of mutant 736 can make the mutant more suitable for commercial production of TAPS.

Microbial Production of Retinyl Palmitate and Its Application as a Cosmeceutical.

Chemically synthesized retinyl palmitate has been widely used in the cosmetic and biotechnology industry. In this study, we aimed to demonstrate the microbial production of retinyl palmitate and the benefits of microbial retinyl palmitate in skin physiology. A heterologous retinyl palmitate biosynthesis pathway was reconstructed in metabolically engineered Escherichia coli using synthetic expression modules from Pantoea agglomerans, Salinibacter ruber, and Homo sapiens. High production of retinyl palmitate (69.96 ± 2.64 mg/L) was obtained using a fed-batch fermentation process. Moreover, application of purified microbial retinyl palmitate to human foreskin HS68 fibroblasts led to increased cellular retinoic acid-binding protein 2 (CRABP2) mRNA level [1.7-fold (p = 0.001) at 100 µg/mL], acceleration of cell proliferation, and enhancement of procollagen synthesis [111% (p < 0.05) at 100 µg/mL], strongly indicating an anti-ageing-related effect of this substance. These results would pave the way for large-scale production of retinyl palmitate in microbial systems and represent the first evidence for the application of microbial retinyl palmitate as a cosmeceutical.

Altered subcallosal and posterior cingulate cortex-based functional connectivity during smoking cue and mental simulation processing in smokers.

BACKGROUND: Long-term cigarette smoking induces sensitization of incentive salience and conditioning of contextual cues which involves brain function alteration across multiple regions. Understanding how nicotine affects hub-based functional connectivities involved in affective and cognitive function can help us determine the treatment strategy for nicotine dependence. METHOD: Functional MRI was conducted on 30 smokers and 30 non-smokers while mentally simulating neutral and smoking hand movements. Smoking cue and mental simulation processing-related changes in functional connectivity strengths of the subcallosal and posterior cingulate cortex (SCC and PCC) with major brain network nodes were examined. RESULTS: Compared to non-smokers, smokers showed cue-induced SCC functional connectivities which were enhanced with the intraparietal sulcus and reduced with the medial prefrontal cortex. The PCC activation and functional connectivity enhancements with the anterior insula cortex and rostro-lateral prefrontal cortex was found during smoking mental simulation. The PCC-lateral prefrontal cortex functional connectivity correlated with nicotine dependence severity. CONCLUSION: The present results demonstrate that smokers can be identified by cue-induced SCC functional connectivity strength decline and increment in the default mode and dorsal attention network nodes. However, nicotine dependence was associated with smoking mental simulation-related PCC-lateral prefrontal cortex functional connectivity strength, suggesting that the development of nicotine dependence may depend on the strength of coupling between the default mode network and the central executive network at the cognitive level.

Engineering and application of synthetic nar promoter for fine-tuning the expression of metabolic pathway genes in Escherichia coli.

BACKGROUND: Promoters regulate the expression of metabolic pathway genes to control the flux of metabolism. Therefore, fine-tuning of metabolic pathway gene expression requires an applicable promoter system. In this study, a dissolved oxygen-dependent nar promoter was engineered for fine-tuning the expression levels of biosynthetic pathway enzymes in Escherichia coli. To demonstrate the feasibility of using the synthetic nar promoters in production of biochemicals in E. coli, the d-lactate pathway consisting of one enzyme and the 2,3-butanediol (BDO) pathway consisting of three enzymes were investigated. RESULTS: The spacer sequence of 15 bp between the - 35 and - 10 elements of the upstream region of the wild-type nar promoter was randomized, fused to the GFP gene, transduced into E. coli, and screened by flow cytometry. The sorted synthetic nar promoters were divided into three groups according to fluorescence intensity levels: strong, intermediate, and weak. The selected three representative nar promoters of strong, intermediate, and weak intensities were used to control the expression level of the d-lactate and 2,3-BDO biosynthetic pathway enzymes in E. coli. When the ldhD gene encoding d-lactate dehydrogenase was expressed under the control of the strong synthetic nar promoter in fed-batch cultures of E. coli, the d-lactate titers were 105.6 g/L, 34% higher than those using the wild-type promoter (79.0 g/L). When the three 2,3-BDO pathway genes (ilvBN, aldB, and bdh1) were expressed under the control of combinational synthetic nar promoters (strong-weak-strong) in fed-batch cultures of E. coli, the titers of 2,3-BDO were 88.0 g/L, 72% higher than those using the wild-type promoter (51.1 g/L). CONCLUSIONS: The synthetic nar promoters, which were engineered to have strong, intermediate, and weak intensities, were successfully applied to metabolic engineering of d-lactate and 2,3-BDO pathways in E. coli. By controlling expression levels of d-lactate and 2,3-BDO pathway enzymes using the synthetic nar promoters, the production of d-lactate and 2,3-BDO was increased over that using the wild-type promoter by 34 and 72%, respectively. Thus, this synthetic promoter module system will support the improved production of biochemicals and biofuels through fine-tuning of gene expression levels.

Prevalence and predictors of potentially inappropriate prescribing of central nervous system and psychotropic drugs among elderly patients: A national population study in Korea.

OBJECTIVES: To investigate the prevalence of potentially inappropriate prescribing (PIP) of central nervous system and psychotropic (CNS-PS) drugs to the Korean elderly population, and to identify PIP-associated factors. METHODS: Ambulatory care visits were identified from the 2013 National Aged Patient Sample (HIRA-APS-2013) data, composed of 20% random samples of all enrollees in the universal health security program aged ≥65 years. The CNS-PS section of Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria version 2 was used to identify PIP at these visits. RESULTS: A total of 24,427,069 prescription claims records and 1,122,080 patients were included in the study; 10.73% of the claims and 53.64% of the patients satisfied at least one STOPP criterion in the prescription of CNS-PS drugs. The highest prevalence of PIP was observed for the criteria of "first-generation antihistamines" (FGAH), followed by tricyclic antidepressants (TCA) in patients with prostatism and TCA in patients with dementia. The generalized estimating equation logistic regression analysis showed that the PIP of FGAH was significantly associated with polypharmacy (5-9 drugs: odds ratio (OR) 4.965, 95% confidence interval (CI) 4.936-4.994; ≥10 drugs: OR 5.704, 95% CI 5.604-5.807), less severe health conditions (Charlson Comorbidity Index (CCI)=2: OR 0.852, 95% CI 0.842-0.862; CCI=1: OR 0.975, 95% CI 0.964-0.986), prescriptions from clinics (OR>1.0), and outpatient care by general practitioners (OR>1.0). CONCLUSIONS: Appropriate interventions to reduce PIP should be made, especially for the criteria that indicate a high PIP prevalence. Targeted strategies are necessary to modify the risk factors of PIP identified from this study.

Factors influencing on influenza vaccination and its trends of coverage in patients with diabetes in Korea: A population-based cross-sectional study.

BACKGROUND: Influenza infection is a contagious disease and annual influenza vaccination is recommended to the patients with chronic diseases. Although diabetes is an indication for influenza vaccination, the global rate of influenza vaccination is insufficient. Therefore, our study aimed to elucidate influenza vaccination statuses among patients with diabetes and the related factors in Korea. METHODS: A total of 32,268 subjects (4,540 with and 27,728 without diabetes) from the Korea National Health and Nutrition Examination Survey III-VI (2005-2015) were included. Socioeconomic factors and health-related factors were analyses for the relation of influenza vaccination by Student's t-test, the chi-squared test and a multivariate logistic regression analysis. RESULTS: The influenza vaccination coverage rates were 50.0% in the diabetes mellitus (DM) group and 38.2% in the non-DM group. The trends in influenza vaccination rates during KNHANES III-VI were not significant in each group (P trend  =  0.24 in the DM group, 0.30 in the non-DM group). Socioeconomic (older age, female sex, higher family income, and medical aid insurance) and health-related factors (lack of risky alcohol consumption, obesity, and recent health check-ups) were associated with influenza vaccination among patients with DM. CONCLUSIONS: The rate of influenza vaccination among patients with diabetes is insufficient in Korea. More efforts are needed to increase the influenza vaccination rates among vulnerable at-risk populations.

Factors Influencing Influenza Vaccination Among Patients With Chronic Obstructive Pulmonary Disease: A Population-Based Cross-sectional Study.

This study aimed to investigate the factors associated with vaccination coverage among chronic obstructive pulmonary disease (COPD) patients in Korea using the fourth to the sixth Korean National Health and Nutrition Examination Surveys (KNHANES IV, V, VI). A total of 16 812 subjects aged 40 years and older who underwent spirometry and had an "influenza vaccination history" were analyzed. The vaccination rate of middle-aged (40-64 years) COPD patients was only 31.9%; whereas, the vaccination rate of elderly (65 years and older) COPD patients was 80.0%. The results of a multiple regression analysis indicated that older age (odds ratio [OR], 1.12; 95% confidence interval [95% CI], 1.09-1.14), poor self-rated health status (OR, 1.45; 95% CI, 1.14-1.95), regular health check-up (OR, 2.61; 95% CI, 1.93-3.51), married marital status (OR, 0.64; 95% CI, 0.42-0.96), and household income below average (OR, 0.72; 95% CI, 0.53-0.98) were associated with influenza vaccination. More attention and targeted interventions are required to improve the influenza vaccination rate of COPD patients.

Body Misperception and Its Associated Factors among Cancer Survivors in Korea

Background: As the number of cancer survivors is increasing, the importance of their healthcare management is becoming emphasized. For this purpose, appropriate recognition of the importance of body weight is necessary. This study concerned misconceptions about body weight and related factors among cancer patients. Methods: This cross-sectional study involved 1,159 participants who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess cancer information, socioeconomic status, health behavior, and psychological factors. Results: Men had a higher rate of underestimation and a lower rate of overestimation of body weight than women (34.7% vs. 22.9%; 10.9% vs. 15.5%, respectively). Underestimation of body weight was positively associated with a self-assessment of being in poor health in men (OR 2.44, 95% CI 1.58- 3.75) and in elderly women (OR 3.70, 95% CI 2.44-5.23). Overestimation of body weight was positively associated with depression in men (OR 2.17, 95% CI 1.01-4.63) and a high educational level/high-income level and having tried to control weight in women (OR 1.92, 95% CI 1.16-3.18; OR 1.57, 95% CI 1.00-2.47; OR 3.24, 95% CI 1.82-5.77, respectively). Conclusions: Higher socioeconomic status (SES), depression, self-rated health status, age, and weight control trials were found to be associated with underestimation and overestimation of body weight in cancer survivors. From this study, it is evident that more efforts are needed to remove misperceptions and to develop healthy behavior for cancer survivors by various means.

Gamma-glutamyltransferase and cardiovascular mortality in Korean adults: A cohort study.

BACKGROUND AND AIMS: Insufficient evidence has been reported on the associations between gamma-glutamyltransferase (GGT) and cardiovascular disease (CVD) mortality from studies with an adequate number of participants. METHODS: 512,990 Korean adults who participated in routine health examinations during the period 2002-2003 were followed up until 2013. Hazard ratios (HRs) were calculated after adjusting for potential confounders. RESULTS: Each 1-unit higher natural-log-transformed GGT (LogeGGT) level was associated with approximately 30-50% higher mortality risk of CVD (HR = 1.31): hypertensive diseases (HR = 1.31), ischemic heart diseases (IHD, HR = 1.29), total stroke (HR = 1.29), acute myocardial infarction (HR = 1.30), chronic IHD (HR = 1.27), heart failure (HR = 1.48), hemorrhagic stroke (HR = 1.42), and ischemic stroke (HR = 1.27). The associations with CVD mortality did not vary by sex, or alcohol use, whereas they were stronger in younger (<60 years), non-hypertensive (systolic blood pressure [SBP] <140 mmHg), physically more active, normal-weight (body mass index<25 kg/m2), and normocholesterolemic (total cholesterol <200 mg/dL) adults than in their respective counterparts. Adding LogeGGT to prediction models for CVD mortality increased AUC value (0.0020, p < 0.001), especially in persons aged <60 years (0.0055), with SBP <140 mmHg (0.0030), and with both age <60 years and SBP <140 mmHg (0.0086). CONCLUSIONS: Higher GGT significantly increased the risk of mortality due to CVD and its subtypes. The relative risks were greater in subjects with younger age, no hypertension, more physical activity, normal weight, and normocholesterolemia than in their respective counterparts. In the general population, adding GGT to conventional CVD risk factors may improve the prediction of CVD mortality, especially in subjects younger than 60 years and in those without hypertension.

Mental Health of the People with Hearing Impairment in Korea: A Population-Based Cross-Sectional Study.

BACKGROUND: The prevalence of hearing impairment is increasing and an association between hearing impairment and mental health has been reported. Our study aimed to determine the association between hearing impairment and mental health in Korea. METHODS: This was a cross-sectional study of data from the Korean National Health and Nutrition Examination Survey 2010-2013, with a sample size of 18,563 individuals (6,395 with hearing impairment and 12,168 without hearing impairment), aged ≥20 years. RESULTS: The female group with hearing impairment tended to have a higher rate of stress (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11 to 1.56). The association between hearing impairment and depressive symptoms was higher in elderly males (OR, 1.60; 95% CI, 1.10 to 2.32), while the association of hearing impairment with suicide ideation was higher in elderly females (OR, 1.32; 95% CI, 1.00 to 1.75). CONCLUSION: Elderly individuals with hearing impairment are easily susceptible to poor mental health status. Early targeted intervention to address mental health problems is recommended for people with hearing impairment.

White blood cell counts, insulin resistance, vitamin D levels and sarcopenia in Korean elderly men.

Sarcopenia is a major determinant of frailty, disability and mortality in the elderly. Whether low-grade inflammation, insulin resistance and vitamin D are independently associated with sarcopenia remains unclear. In our study, sarcopenia was defined as an appendicular skeletal muscle mass divided by height squared (ASM/Ht2) that was <2 SD below the normal means for young adults. Insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR) index [(insulin (IU/mL) × fasting glucose (mg/dL)/18)/22.5]. Data of white blood cell counts and serum 25-hydroxyvitamin D (25-(OH)D) levels were collected in the second and third year (2008-2009) of Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). The results showed that the prevalence of sarcopenia in Korean elderly men aged more than 65 years was 11.2%. ASM/Ht2 were positively associated with vitamin D levels, but negatively associated with white blood cell counts and HOMA-IR by multiple regression analysis. After adjustment for covariables, sarcopenia was associated with the highest quartile of WBC counts (OR = 2.93, 95% CI = 1.21-7.14) and the highest quartile of serum vitamin D levels (OR = 0.38, 95% CI = 0.15-0.95). In conclusion, the study findings suggest that higher WBC counts and lower vitamin D levels are independently associated with the presence of sarcopenia in community-dwelling elderly men. They also provide a basis for further studies of the complex immune-endocrine network in sarcopenia.

Facility characteristics as independent prognostic factors of nursing home-acquired pneumonia.

BACKGROUND/AIMS: Recently, the incidence of nursing home-acquired pneumonia (NHAP) has been increasing and is now the leading cause of death among nursing home residents. This study was performed to identify risk factors associated with NHAP mortality, focusing on facility characteristics. METHODS: Data on all patients ≥ 70 years of age admitted with newly diagnosed pneumonia were reviewed. To compare the quality of care in nursing facilities, the following three groups were defined: patients who acquired pneumonia in the community, care homes, and care hospitals. In these patients, 90-day mortality was compared. RESULTS: Survival analyses were performed in 282 patients with pneumonia. In the analyses, 90-day mortality was higher in patients in care homes (12.2%, 40.3%, and 19.6% in community, care homes, and care hospitals, respectively). Among the 118 NHAP patients, residence in a care home, structural lung diseases, treatment with inappropriate antimicrobial agents for accompanying infections, and a high pneumonia severity index score were risk factors associated with higher 90-day mortality. However, infection by potentially drug-resistant pathogens was not important. CONCLUSIONS: Unfavorable institutional factors in care homes are important prognostic factors for NHAP.

Associations Between Periodontitis and Chronic Obstructive Pulmonary Disease: The 2010 to 2012 Korean National Health and Nutrition Examination Survey.

BACKGROUND: The aim of this study is to examine whether oral hygiene and self-care, particularly in periodontal health, are associated with chronic obstructive pulmonary disease (COPD) in the Korean population. METHODS: Data from the Korean National Health and Nutrition Examination Survey from 2010 to 2012 were used to assess the community periodontal index (CPI) of 5,878 participants (normal lung function: n = 5,181; obstructive spirometric pattern: n = 697) aged ≥40 years, who underwent spirometry. RESULTS: Participants with COPD brushed their teeth less frequently and used the following less frequently: 1) dental floss and/or interdental brush; 2) mouthwash; and 3) electric toothbrush (P <0.001). Prevalence of periodontitis in patients with COPD (58.1%) was significantly higher than in those without COPD (34.0%, P <0.001). Number of teeth was significantly lower in patients with COPD compared with controls. Decayed-missing-filled tooth index was significantly lower in patients with COPD. This study shows risk of COPD by periodontal severity. Periodontitis (CPI 3 and 4) was associated in males with COPD after adjustment for: 1) age; 2) income; 3) education; 4) smoking; 5) alcohol consumption; 6) exercise; 7) body mass index; 8) toothbrushing frequency; 9) diabetes mellitus; and 10) number of teeth (CPI 3: relative risk [RR] = 1.38, 95% confidence interval [CI] = 1.12 to 2.05; CPI 4: RR = 1.23, 95% CI = 1.06 to 1.56). CONCLUSION: Findings of this cross-sectional study suggest that COPD in males may be associated with severe periodontitis and indicates the importance of promoting dental care in patients with COPD.

Association between Sarcopenic Obesity and Bone Mineral Density in Middle-Aged and Elderly Korean.

OBJECTIVES: To identify the prevalence of osteosarcopenic obesity and to evaluate the association between sarcopenic obesity and bone mineral density in middle-aged and elderly Korean. METHODS: This study included 3,385 males and 4,064 females (age ≥50 years and in the stage of menopause) who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011. The cutoff value for sarcopenia was 7.26 kg/m2 for men and 5.45 kg/m2 for female. The fat mass was >30% for men and 40% for female; these values were used to define obesity. Based on the combination of sarcopenia and obesity status, all subjects were classified as sarcopenic obese (SO), sarcopenic nonobese (SNO), nonsarcopenic obese (NSO), or nonsarcopenic nonobese. RESULTS: The incidence rates of sarcopenia, sarcopenic obesity, and osteosarcopenic obesity were 31.5, 5.1, and 4.1%, respectively. Following adjustment, the ORs for osteoporosis were 8.67 in the SO group (95% CI 4.19-17.94), 3.85 in the SNO group (95% CI 2.61-5.67), and 1.88 in the NSO group (95% CI 0.72-4.91) in men and 2.93 in the SO group (95% CI 1.99-4.32), 1.71 in the SNO group (95% CI 1.31-2.23), and 0.58 in the NSO group (95% CI 0.43-0.78) in women. CONCLUSIONS: Sarcopenic obesity is associated with the development of osteoporosis among the middle-aged and elderly Korean population.

The association among three aspects of physical fitness and metabolic syndrome in a Korean elderly population.

BACKGROUND: The purpose of current study is to evaluate the association between physical fitness level and the prevalence of metabolic syndrome (MS) in a Korean elderly population. METHODS: A cross-sectional study measuring physical fitness and components of MS in a health promotion center of a general hospital for routine health check-ups. A total of 227 subjects >60 years old agreed to participate. A lifestyle questionnaire that included cigarette smoking, alcohol consumption, and physical activity was checked. Body weight, height, blood pressure, fasting glucose, total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, C-reactive protein, and glycated hemoglobin were measured. Muscular strength was assessed by measuring grasping power. Muscular endurance was evaluated using a sit-up test. Cardiopulmonary fitness was assessed via the Tecumseh step test (measuring hear rates at 1 min post-exercise). RESULTS: The highest tertile muscular endurance group (sit-ups >15 in men, >10 in women) was 0.37 times less likely to have MS [95 % confidence interval (CI) 0.17-0.84; p = 0.036] compared to that in the lowest tertile group (<11 in men, 0 in women), and the highest tertile in the cardiopulmonary fitness group (heart rate at rest >91/min in men, >92/min in women) was 2.81 times more likely to have MS (95 % CI 1.27-6.18; p = 0.038) compared to that in the lowest tertile group (<81/min in men, <80/min in women). CONCLUSIONS: Cardiopulmonary fitness and muscular endurance were related to MS in a Korean elderly population after adjusting for age, sex, current smoker, current alcohol drinking, and physical activity. Older adults should be encouraged to increase their cardiopulmonary fitness and muscular endurance.

Behavioral and Psychological Symptoms of Dementia and Antipsychotic Drug Use in the Elderly with Dementia in Korean Long-Term Care Facilities.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are known predictors of institutionalization, lower quality of life, and caregiver distress. Guidelines recommend initial management with non-pharmacological means, but antipsychotic drugs are widely used for the treatment of certain BPSD. OBJECTIVES: The objective of the current study is to analyze the prevalence of BPSD and antipsychotic drug use in long-term care facilities in Korea. METHODS: Retrospective chart review and cross-sectional analysis was conducted with 529 residents diagnosed with dementia out of a total 835 residents in 20 long-term care facilities from October 2011 to April 2012. Basic characteristics of residents such as prevalence of BPSD and antipsychotic prescriptions were analyzed. BPSD was determined using the Neuropsychiatric Inventory-Questionnaire (NPI-Q) assessment tool, and associations with the use of antipsychotic drugs were investigated. RESULTS: The mean age of the 529 residents was 81.16 ± 8.73 years; 410 (77.5 %) were female. The mean length of stay in long-term care facilities was 24.19 ± 23.06 months. The primary outcome was a prescription rate of antipsychotic medications. Of the 529 dementia residents, 143 (27 %) were prescribed antipsychotic medications (quetiapine, risperidone, and olanzapine). Agitation was the most common symptom of BPSD. Disinhibition and irritability were associated with the use of antipsychotics in a multiple logistic regression analysis [respectively P = 0.007 and 0.016 and adjusted odds ratio (range) = 0.51 (0.31-0.83) and 0.57 (0.36-0.90)]. CONCLUSION: BPSD are common in long-term care facilities in Korea. Twenty-seven percent of dementia residents in long-term care facilities in Korea were prescribed antipsychotic medications. Furthermore, antipsychotic drug use was significantly associated with disinhibition and irritability in those patients.

Potentially Inappropriate Medications in the Elderly in Korean Long-Term Care Facilities.

BACKGROUND: Elderly residents of long-term care facilities are more vulnerable to being prescribed inappropriate medications because of the high incidence of co-medication in this population resulting from the presence of multiple chronic diseases and also age-related changes in pharmacokinetics and pharmacodynamics. OBJECTIVE: We evaluated the frequency of potentially inappropriate medications and factors influencing their frequency. METHODS: A retrospective cross-sectional study was conducted in 20 long-term care facilities located in the northwest regions of South Korea for 824 patients aged 65 years and older who were assessed between January and February of 2012. Potentially inappropriate medications were identified using the 2012 American Geriatric Society's Beers Criteria. We assessed the relationship between the frequency of potentially inappropriate medications prescribed and patient age, sex, co-medications, comorbidity, activities of daily living, length of stay, grade of long-term care insurance for seniors, and the bed size and business type of the long-term care facility. RESULTS: Of the 529 participants who satisfied our inclusion criteria, 308 (58.2 %) had received at least one inappropriate medication according to the 2012 Beers Criteria. The most frequently prescribed classes of inappropriate medications were central nervous system drugs (58.7 %), anti-cholinergics (21.2 %), and cardiovascular medications (10.8 %). The most commonly used drugs were quetiapine (28.4 %), chlorpheniramine (15.8 %), risperidone (6.5 %), and zolpidem (5.8 %). Inappropriate medication use was associated with the number of co-medications and long-term care insurance grade 3, which means less dependence and a requirement of low-level care. CONCLUSIONS: Central nervous system drugs (58.7 %) were the most prescribed class of inappropriate medications. Quetiapine was the drug most often given inappropriately (28.4 %). There was a relationship between inappropriate medication use and the number of co-medications. The frequency of inappropriate medication prescriptions was higher among patients whose long-term care insurance for seniors was grade 3, which means less dependence and a requirement of low-level care.