Angiotensin Receptor Blockers and the Risk of Suspected Drug-Induced Liver Injury: A Retrospective Cohort Study Using Electronic Health Record-Based Common Data Model in South Korea.

INTRODUCTION: Angiotensin receptor blockers are widely used antihypertensive drugs in South Korea. In 2021, the Korea Ministry of Food and Drug Safety acknowledged the need for national compensation for a drug-induced liver injury (DILI) after azilsartan use. However, little is known regarding the association between angiotensin receptor blockers and DILI. OBJECTIVE: We conducted a retrospective cohort study in incident users of angiotensin receptor blockers from a common data model database (1 January, 2017-31 December, 2021) to compare the risk of DILI among specific angiotensin receptor blockers against valsartan. METHODS: Patients were assigned to treatment groups at cohort entry based on prescribed angiotensin receptor blockers. Drug-induced liver injury was operationally defined using the International DILI Expert Working Group criteria. Cox regression analyses were conducted to derive hazard ratios and the inverse probability of treatment weighting method was applied. All analyses were performed using R. RESULTS: In total, 229,881 angiotensin receptor blocker users from 20 university hospitals were included. Crude DILI incidence ranged from 15.6 to 82.8 per 1000 person-years in treatment groups, most were cholestatic and of mild severity. Overall, the risk of DILI was significantly lower in olmesartan users than in valsartan users (hazard ratio: 0.73 [95% confidence interval 0.55-0.96]). In monotherapy patients, the risk was significantly higher in azilsartan users than in valsartan users (hazard ratio: 6.55 [95% confidence interval 5.28-8.12]). CONCLUSIONS: We found a significantly higher risk of suspected DILI in patients receiving azilsartan monotherapy compared with valsartan monotherapy. Our findings emphasize the utility of real-world evidence in advancing our understanding of adverse drug reactions in clinical practice.

Relationship between Eating Alone and Handgrip Strength in Korean Older Adults.

Sarcopenia is defined as an age-related decline in muscle mass, muscle strength, and physical performance. Eating alone has been linked to various health issues in older adults. This study investigated the relationship between eating alone and handgrip strength (HGS) in older adults using data from 7278 individuals (≥65 years) who participated in the 2014-2019 Korea National Health and Nutrition Examination Survey. HGS was measured using a digital grip strength dynamometer, relative HGS was calculated by dividing HGS by body mass index, and dynapenia was defined as an HGS < 28 kg for men and <18 kg for women. Multivariable logistic regression analysis showed that women who ate two meals alone were more likely to exhibit dynapenia than those who never ate alone (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.03-1.77). If the groups that never ate alone or ate one meal alone were combined as the reference group, the probability of dynapenia was higher in the combined groups that ate two or three meals alone (OR, 1.25; 95% CI, 1.04-1.50). No association was observed between eating alone and dynapenia in men. This suggests that eating alone is a modifiable related factor of dynapenia in older women.

The Relationship between Breakfast and Sleep and Cardiovascular Risk Factors.

Despite extensive research on the individual effects of breakfast and sleep on health outcomes, there has been limited investigation into their combined effects. We aimed to evaluate the relationship between breakfast-eating behavior and sleep timing on cardiovascular disease (CVD) risk factors. A total of 16,121 participants (6744 men and 9377 women) aged 19 years or older were selected from the Korea National Health and Nutrition Examination Surveys (2016-2018, 2021). We classified participants into four groups: early sleep + regular breakfast eaters (group 1), late sleep + regular breakfast eaters (group 2), early sleep + infrequent breakfast eaters (group 3), and late sleep + infrequent breakfast eaters (group 4). In men, group 4 had a lower prevalence of obesity than group 1 (OR 0.78, 95%CI 0.62-0.97), and groups 2, 3, and 4 had a higher prevalence of metabolic syndrome (MetS) than group 1 (OR 1.43, 1.62, and 1.47, respectively). In women, group 4 had a lower prevalence of dyslipidemia than group 1 (OR 0.59, 95%CI 0.44-0.80), and group 2 had a higher prevalence of MetS than group 1 (OR 1.24, 95%CI 1.03-1.50). The combination of skipping breakfast and late sleep timing was associated with the higher prevalence of MetS particularly in men. Moreover, the relationship between breakfast and sleep timing on CVD risk factors differed by sex and age group.

Association of age-related hearing loss, tinnitus, and chronic low back pain in middle-aged and older Korean adults.

This was a cross-sectional study conducted to evaluate the association between hearing impairment and low back pain (LBP) using data from the Korean National Health and Nutrition Examination Survey. A total of 5,504 middle-aged and older Korean adults (aged ≥50 years old) who underwent plain radiography of the lumbar spine and pure tone audiometry were included. The presence of LBP was evaluated using a questionnaire, which included a question on whether the patient had experienced LBP that lasted for more than 30 days during the past three months. Patients with age-related hearing loss (ARHL) were defined as those with bilateral hearing impairment who met the following criteria: 1) normal otologic examination results, 2) average pure-tone hearing thresholds of ≤15 dB in both ears, and 3) no occupational noise exposure. Multivariable logistic regression analysis showed that ARHL was not associated with LBP (odds ratio, 1.33; 95% CI, 0.94-1.89) after adjusting for potential confounders in the final model. However, when participants without both ARHL and tinnitus were defined as the reference group, the results showed that the participants with both ARHL and tinnitus were more likely to have LBP (OR, 1.86; 95% CI, 1.11-3.11). These results indicate that ARHL with tinnitus is significantly associated with LBP. We recommend that elderly patients with ARHL and tinnitus increase their daily physical activities and engage in more muscle-strengthening exercises to prevent LBP.

Optimal cutoffs of sleep timing and sleep duration for cardiovascular risk factors.

AIM: We aimed to establish the optimal cutoffs of sleep timing and duration to assess obesity, hypertension (HTN), diabetes mellitus (DM), dyslipidemia (DL), and metabolic syndrome (MetS) using data from the Korea National Health and Nutrition Examination Surveys. METHODS: In this cross-sectional study, data from 18,677 participants (8,107 men and 10,570 women) aged 19 or over were used. A receiver operating characteristic (ROC) curve adjusted for potential confounding variables was constructed to calculate the cutoff of sleep-related variables (bedtime, mid-sleep on free days corrected for sleep debt on workdays (MSFsc), and sleep duration) for assessing cardiovascular disease (CVD) risk factors according to sex. RESULTS: Bedtime between 9:00 PM to 0:30 AM for men and 10:00 PM to 11:00 PM for women is appropriate for assessing obesity, HTN, DM, DL, and MetS. The cutoff range was 9:00 PM to 11:00 PM for men ≥65 years and 9:00 PM to 12:00 AM for women ≥65 years, which was slightly earlier than that for participants <65 years. The optimal MSFsc cutoff points were established between 12:00 AM to 3:00 AM and sleep durations around 6 h were associated with the optimal cutoffs for assessing CVD risk factors. CONCLUSIONS: Bedtime between 10:00 PM to 11:00 PM, early MSFsc, and short sleep durations were appropriate for assessing CVD risk factors.

Relationship between Coffee, Tea, and Carbonated Beverages and Cardiovascular Risk Factors.

We aimed to analyze the relationship between coffee, tea, and carbonated beverages and cardiovascular risk factors. We used data from the fourth to eighth Korea National Health and Nutrition Examination Surveys (2007-2016, 2019-2020). We categorized the frequency of intake into three groups (<1 time/week, 1 time/week to <1 time/day, and ≥1 time/day). Subsequently, logistic regression analyses by sex were performed to assess cardiovascular risk factors (hypertension (HTN), diabetes mellitus (DM), dyslipidemia (DL), or metabolic syndrome (MetS)) according to the frequency of coffee, tea, and carbonated beverage intake. For HTN, coffee intake showed an inverse relationship and tea intake showed a direct relationship. For DM, coffee intake showed an inverse relationship, and tea and carbonated beverage intake showed a direct relationship. For DL, coffee intake showed an inverse relationship, whereas tea intake demonstrated a direct relationship. In addition, carbonated beverage intake showed a direct relationship with MetS. Coffee intake showed an inverse relationship with HTN, DM, and DL. However, tea intake showed a direct relationship with HTN, DM, and DL, whereas carbonated beverage intake showed a direct relationship with DM and MetS.

Differences in Fat-Free Mass According to Serum Vitamin D Level and Calcium Intake: Korea National Health and Nutrition Examination Survey 2008-2011.

We analyzed the differences in fat-free mass (FFM) according to serum vitamin D level (VitD) and daily calcium intake (Ca) in 14,444 adults aged over 19 years. We used data from the 4th and 5th Korea National Health and Nutrition Examination Surveys (2008-2011). FFM was measured using dual-energy X-ray absorptiometry. VitD was classified as insufficient or sufficient (cutoff: 20 ng/mL). Ca was classified as unsatisfactory or satisfactory (recommended daily intake: 700 mg). In men, the FFM of group 2 (VitD ≥ 20 ng/mL; Ca < 700 mg), group 3 (VitD < 20 ng/mL; Ca ≥ 700 mg) and group 4 (VitD ≥ 20 ng/mL; Ca ≥ 700 mg) was 0.50 kg (95% confidence interval (CI), 0.084-0.92), 0.78 kg (95% CI, 0.26-1.29) and 1.58 kg (95% CI, 0.95-2.21) higher than that of group 1 (VitD < 20 ng/mL; Ca < 700 mg), respectively. In women, a 1 ng/mL increase in VitD was associated with a 0.023 kg increase in FFM (95% CI, 0.003-0.043) and a 1 g increase in Ca was associated with a 0.62 kg increase in FFM (95% CI, 0.067-1.16). High VitD and Ca were associated with a high FFM.