Primary results of STRONG: An open-label, multicenter, phase 3b study of fixed-dose durvalumab monotherapy in previously treated patients with urinary tract carcinoma.

BACKGROUND: Prior durvalumab (anti-PD-L1 agent) studies in platinum-refractory metastatic urothelial carcinoma evaluated a dose of 10 mg/kg administered every two weeks. The nonrandomised phase 3b STRONG study (NCT03084471) evaluated the safety and efficacy of fixed-dose durvalumab at a more convenient dosing schedule in a previously treated patient population, more similar to a real-world clinical setting. PATIENTS AND METHODS: 867 patients with urothelial or nonurothelial urinary tract carcinoma (UTC) who progressed on or after platinum or nonplatinum chemotherapy were treated with durvalumab 1500 mg every four weeks; 87% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1, and 13% had an ECOG PS of 2. The primary end-point was the incidence of adverse events of special interest (AESIs), including immune-mediated AEs (imAEs). Secondary and exploratory end-points included overall survival (OS), objective response rate (ORR) and disease control rate (at six and 12 months) (DCR). RESULTS: AESIs of any grade were reported in 51% of patients (8% grade ≥ 3). The incidence of imAEs was 11% (2% grade ≥ 3). The median OS was 7.0 months (95% confidence interval [CI]: 6.4-8.2) and ORR was 18% (95% CI: 14.8-20.6), with complete responses in 5% of patients and a DCR at six months of 19% (95% CI: 16.1-22.1). CONCLUSION: Fixed-dose durvalumab monotherapy every four weeks has an acceptable safety profile and yields durable clinical activity in previously chemotherapy-treated patients with UTC. Safety and efficacy are consistent with previous durvalumab studies and other anti-PD-1/PD-L1 agents in this setting. CLINICALTRIALS. GOV IDENTIFIER: NCT03084471https://clinicaltrials.gov/ct2/show/NCT03084471.

Development and Validation of Osteoporosis Risk-Assessment Model for Korean Men.

PURPOSE: The aim of the present study was to develop an osteoporosis risk-assessment model to identify high-risk individuals among Korean men. MATERIALS AND METHODS: The study used data from 1340 and 1110 men ≥50 years who participated in the 2009 and 2010 Korean National Health and Nutrition Examination Survey, respectively, for development and validation of an osteoporosis risk-assessment model. Osteoporosis was defined as T score ≤-2.5 at either the femoral neck or lumbar spine. Performance of the candidate models and the Osteoporosis Self-assessment Tool for Asian (OSTA) was compared with sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). A net reclassification improvement was further calculated to compare the developed Korean Osteoporosis Risk-Assessment Model for Men (KORAM-M) with OSTA. RESULTS: In the development dataset, the prevalence of osteoporosis was 8.1%. KORAM-M, consisting of age and body weight, had a sensitivity of 90.8%, a specificity of 42.4%, and an AUC of 0.666 with a cut-off score of -9. In the validation dataset, similar results were shown: sensitivity 87.9%, specificity 39.7%, and AUC 0.638. Additionally, risk categorization with KORAM-M showed improved reclassification over that of OSTA up to 22.8%. CONCLUSION: KORAM-M can be simply used as a pre-screening tool to identify candidates for dual energy X-ray absorptiometry tests.

Association between Fibrinogen and Carotid Atherosclerosis According to Smoking Status in a Korean Male Population.

PURPOSE: Although inconsistent, reports have shown fibrinogen levels to be associated with atherosclerosis. Accordingly, since cigarette smoking is associated with increased levels of fibrinogen and atherosclerosis, it may also affect the association between fibrinogen and atherosclerosis. We investigated the associations between fibrinogen and carotid intima-media thickness (IMT) according to smoking status in a Korean male population. MATERIALS AND METHODS: Plasma fibrinogen levels were measured in 277 men aged 40-87 years without a history of myocardial infarction or stroke. High-resolution B-mode ultrasonography was used to examine the common carotid arteries. IMT level was analyzed both as a continuous (IMT-max, maximum value; IMT-tpm, 3-point mean value) and categorical variable (higher IMT; presence of plaque). Serial linear and logistic regression models were employed to examine the association between fibrinogen and IMT according to smoking status. RESULTS: Fibrinogen levels were positively associated with IMT-max (standardized ß=0.25, p=0.021) and IMT-tpm (standardized ß=0.21, p=0.038), even after adjusting for age, body mass index, systolic blood pressure, fasting glucose, and total cholesterol to high-density lipoprotein cholesterol ratio in current smokers (n=75). No significant association between fibrinogen and IMT, however, was noted in former smokers (n=80) or nonsmokers (n=122). Adjusted odds ratios (95% confidence interval) for having plaque per one standard deviation higher fibrinogen level were 2.06 (1.09-3.89) for current smokers, 0.68 (0.43-1.10) for former smokers, and 1.06 (0.60-1.87) for nonsmokers. CONCLUSION: Our findings suggest that cigarette smoking may modify the association between fibrinogen and carotid atherosclerosis. Further studies are required to confirm this finding in different populations.

Serum 25-hydroxyvitamin D and insulin resistance in apparently healthy adolescents.

PURPOSE: Vitamin D deficiency is a common condition that is associated with diabetes and insulin resistance. However, the association between vitamin D and insulin resistance has not been fully studied, especially in the general adolescent population. Therefore, we assessed the association between serum 25-hydroxyvitamin D [25(OH)D] level and insulin resistance among apparently healthy Korean adolescents. METHODS: A total of 260 (135 male and 125 female) adolescents in a rural high school were assessed for serum 25(OH)D, fasting plasma glucose, and insulin. All of the participants were aged 15 to 16 years old, and without known hypertension or diabetes. Serum 25(OH)D was analyzed both as a continuous and categorical variable in association with insulin resistance. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). Increased insulin resistance was operationally defined as a HOMA-IR value higher than the sex-specific 75th percentile. RESULTS: In male adolescents, every 10 ng/ml decrease in 25(OH)D level was associated with a 0.25 unit increase in HOMA-IR (p = 0.003) after adjusting for age and BMI. Compared to those in the highest quartile, male adolescents in the lowest 25(OH)D quartile were at significantly higher risk for insulin resistance: unadjusted odds ratio 4.06 (95% CI, 1.26 to 13.07); age and BMI adjusted odds ratio 3.59 (95% CI, 1.03 to 12.57). However, 25(OH)D level, either in continuous or categorical measure, was not significantly associated with insulin resistance among female adolescents. CONCLUSIONS: This study suggests that serum 25(OH)D level may be inversely associated with insulin resistance in healthy male adolescents.

Development and application of chronic disease risk prediction models.

Currently, non-communicable chronic diseases are a major cause of morbidity and mortality worldwide, and a large proportion of chronic diseases are preventable through risk factor management. However, the prevention efficacy at the individual level is not yet satisfactory. Chronic disease prediction models have been developed to assist physicians and individuals in clinical decision-making. A chronic disease prediction model assesses multiple risk factors together and estimates an absolute disease risk for the individual. Accurate prediction of an individual's future risk for a certain disease enables the comparison of benefits and risks of treatment, the costs of alternative prevention strategies, and selection of the most efficient strategy for the individual. A large number of chronic disease prediction models, especially targeting cardiovascular diseases and cancers, have been suggested, and some of them have been adopted in the clinical practice guidelines and recommendations of many countries. Although few chronic disease prediction tools have been suggested in the Korean population, their clinical utility is not as high as expected. This article reviews methodologies that are commonly used for developing and evaluating a chronic disease prediction model and discusses the current status of chronic disease prediction in Korea.

Association between serum 25-hydroxyvitamin D level and insulin resistance in a rural population.

PURPOSE: A low serum 25-hydroxyvitamin D [25(OH)D] level in the blood has been correlated with an increased risk of diabetes mellitus; however, the association between serum 25(OH)D level and insulin resistance has not been established in a Korean rural population. The aim of this study was to investigate the independent association between serum 25(OH)D level and insulin resistance in rural Korean adults. MATERIALS AND METHODS: This study used data from the Korean Genome Epidemiology Study-Kangwha Study. In the 2011 study, 1200 adults completed health examinations. In an ancillary study, serum 25(OH)D level was measured in a subsample (n=813). After excluding those taking vitamin D supplements, a cross-sectional analysis was carried out on 807 participants (324 men and 483 women) aged 40 to 89 years old. Measured from overnight fasting blood samples, glucose and insulin levels were used to calculate the homeostasis model assessment for insulin resistance (HOMA-IR). Measures of glucose, insulin, and HOMA-IR were log-transformed for parametric tests. RESULTS: Serum 25(OH)D level was inversely associated with HOMA-IR (ß=-0.003, p=0.039) in a univariate analysis. However, the association was not significant after adjustment for sex and age (ß=-0.002, p=0.123) or after adjustment for sex, age, body mass index, smoking status, alcohol intake, and regular exercise (ß=-0.003, p=0.247). CONCLUSION: Our findings suggest that vitamin D is not independently associated with insulin resistance in Korean men and women.

Longitudinal standards for height and height velocity in Korean children and adolescents: the Kangwha study. [corrected].

Longitudinal standards for height and height velocity are essential to monitor for appropriate linear growth. We aimed to construct standards in Korean children and adolescents through the population-based longitudinal Kangwha study. Our study was a part of a community-based prospective cohort study from 1986 to 1999 with 800 school children. Height and height velocity were recorded annually from age 6 until final height. Results were compared with cross-sectional data from the 2007 Korean National Growth Charts. Final height was 173.5 cm in boys and 160.5 cm in girls. Although final height was similar between longitudinal and cross-sectional standards, the mean height for age was higher in the longitudinal standard by 1-4 cm from age 6 until the completion of puberty. Using the longitudinal standard, age at peak height velocity (PHV) was 12 in boys and 10 in girls; height velocity at PHV was 8.62 cm/yr in boys and 7.07 cm/yr in girls. The mean height velocity was less than 1 cm/yr at age 17 in boys and 15 in girls. Thus, we have presented the first report of longitudinal standards for height and height velocity in Korean children and adolescents by analyzing longitudinal data from the Kangwha cohort.

Noncommunicable diseases: current status of major modifiable risk factors in Korea.

A noncommunicable disease (NCD) is a medical condition or disease that is by definition non-infectious and non-transmissible among people. Currently, NCDs are the leading causes of death and disease burden worldwide. The four main types of NCDs, including cardiovascular disease, cancer, chronic lung disease, and diabetes, result in more than 30 million deaths annually. To reduce the burden of NCDs on global health, current public health actions stress the importance of preventing, detecting, and correcting modifiable risk factors; controlling major modifiable risk factors has been shown to effectively reduce NCD mortality. The World Health Organization's World Health Report 2002 identified tobacco use, alcohol consumption, overweight, physical inactivity, high blood pressure, and high cholesterol as the most important risk factors for NCDs. Accordingly, the present report set out to review the prevalence and trends of these modifiable risk factors in the Korean population. Over the past few decades, we observed significant risk factor modifications of improved blood pressure control and decreased smoking rate. However, hypertension and cigarette smoking remained the most contributable factors of NCDs in the Korean population. Moreover, other major modifiable risk factors show no improvement or even worsened. The current status and trends in major modifiable risk factors reinforce the importance of prevention, detection, and treatment of risk factors in reducing the burden of NCDs on individuals and society.

Association between alanine aminotransferase and intracerebral hemorrhage in East Asian populations.

BACKGROUND: Intracerebral hemorrhage (ICH) and chronic liver disease are relatively common in East Asian countries. However, the relationship between the two diseases is unclear. Thus, we investigated the association between serum alanine aminotransferase (ALT) levels and ICH risk in East Asian populations. METHODS: The East Asian Network for Stroke Prevention enrolled 279,982 participants with ALT measurements from four cohort studies in Korea, Taiwan, Japan and mainland China. Among them, 1,324 ICH events and 493 ICH deaths were observed. Cox's proportional hazard regression analysis was performed in each cohort to estimate the hazard ratio (HR) after adjusting for age, blood pressure, diabetes, total cholesterol, smoking and alcohol intake. Combined HRs were then estimated using pooled analyses with fixed-effects models. RESULTS: The multivariate-adjusted pooled HRs (with 95% confidence interval, CI) for ICH incidence per 10 IU/l increments of ALT were 1.04 (1.03-1.04) in men and 1.01 (0.98-1.04) in women. Corresponding HRs for ICH mortality were 1.04 (1.02-1.05) in men and 1.04 (1.00-1.08) in women. The pooled HRs for ICH incidence in participants with ALT levels greater than or equal to 50 IU/l compared to those with levels less than 20 IU/l were 1.74 (1.41-2.16) in men and 1.60 (1.06-2.40) in women. The corresponding HRs for ICH mortality were 1.72 (1.21-2.44) in men and 1.63 (0.79-3.36) in women. CONCLUSIONS: An elevated ALT level was independently and significantly associated with an increased risk of ICH in East Asian men, but the association was less prominent in women.

Association between depressive symptoms and bone stiffness index in young adults: the Kangwha study.

OBJECTIVE: Young adulthood is an important period for both bone and mental health. This study investigated the association between depressive symptoms and bone density in apparently healthy Korean men and women aged 29-32 years. METHODS: This study is a cross-sectional analysis of data from 123 men and 133 women who completed follow-up examinations of the Kangwha study in 2010-2011. Bone stiffness index (SI) was measured at the os calcis using a quantitative ultrasound device. Depressive symptoms were evaluated using the Korean version of the Beck Depression Inventory (K-BDI) and classified as normal (K-BDI <10), mild (K-BDI 10-15), and moderate to severe (K-BDI ≥16). RESULTS: Moderate to severe depressive symptoms were prevalent among 11.4% of men and 19.6% of women. Higher K-BDI scores were significantly correlated to SI in men, before (ρ = -0.286, p = 0.001) and after (ρ = -0.228, p = 0.013) adjustment for covariates. Men with depressive symptoms tended to have a lower SI; multivariate-adjusted mean SI in men with normal, mild, and moderate to severe depressive symptoms was 104.1±3.1, 100.9±5.9, and 94.1±7.8, respectively (p for trend = 0.021). In contrast, no significant correlations were identified in women. CONCLUSIONS: Depressive symptoms were significantly associated with lower SI in men, but not in women. Further studies are necessary to evaluate the impact of depression on developing osteoporosis or osteoporotic fractures later in life.

Factors Associated with a Low-sodium Diet: The Fourth Korean National Health and Nutrition Examination Survey.

OBJECTIVES: The low-sodium diet is a known preventive factor for hypertension and cardiovascular disease. Factors associated with low-sodium diets should be identified to reduce sodium intake effectively. This study was conducted to identify factors correlated with a low-sodium diet. METHODS: This cross-sectional study analyzed data from a total of 14,539 Koreans aged 20 years or older, who participated in the Fourth (2007-2009) Korean National Health and Nutrition Examination Survey. A low-sodium diet was defined as having ≤2,000 mg/day based on 24-hour recalls. Multiple logistic regression models were used to assess sex, age, education, number of family members, household income, occupation, alcohol drinking, total energy intake, frequency of eating out, and hypertension management status for their associations with low-sodium diets. RESULTS: Among all participants, only 13.9% (n=2,016) had low-sodium diets. In the multivariate analysis, 40-49 years of age, clerical work jobs, higher total energy intake, and frequent eating out were inversely associated with low-sodium diets. And female sex and living-alone were associated with low-sodium diets. Lower frequency of eating out was significantly associated with low-sodium diets, even after adjusting for total energy intake and other potential confounders. Adjusted odds ratios (95% confidence interval) for a low-sodium diet were 1.97 (1.49-2.61), 1.47 (1.13-1.91), 1.24 (0.96-1.61), and 1.00 (reference) in people who eat out <1 time/month, 1-3 times/month, 1-6 times/week, and ≥1 time/day, respectively. CONCLUSIONS: Our study suggests that sex, age, number of family members, occupation, total energy intake, and lower frequency of eating out were associated with a low-sodium diet in Korean adults.

The association between disturbed eating behavior and socioeconomic status: the Online Korean Adolescent Panel Survey (OnKAPS).

BACKGROUND: A limited amount of research, primarily conducted in Western countries, has suggested that higher socioeconomic status (SES) is associated with higher risk of eating disorders (EDs). However, little is known about this association in Asian countries. We examined the association of SES with disturbed eating behavior (DEB) and related factors in Korean adolescents. SUBJECTS: A nationwide online panel survey was conducted in a sample of adolescents (n = 6,943, 49.9% girls). DEB was measured with the 26-item Eating Attitudes Test (EAT-26). Participants who scored ≥20 on the EAT-26 were considered to have DEB. Participants' SES was determined based on self-reported household economic status. RESULTS: The prevalence of DEB was 12.7%: 10.5% among boys and 14.8% among girls. Both boys and girls with DEB were more likely to perceive themselves as obese, experience higher levels of stress, and have lower academic achievement. The risk for DEB was significantly higher in boys of higher SES than in those of middle SES (OR = 1.45, 95%CI = 1.05-1.99 for high SES; OR = 5.16, 95%CI: 3.50-7.61 for highest SES). Among girls, higher risk of DEB was associated with the highest and lowest SES (OR = 1.52, 95%CI: 1.13-2.06 for lowest SES; OR = 2.22, 95%CI: 1.34-3.68 for highest SES). CONCLUSIONS: Despite the lower prevalence of obesity in Korea compared with Western countries, the prevalence of DEB in Korean adolescents was high, especially among girls. Moreover, the association between SES and DEB followed a U-shaped curve for girls and a J-shaped curve for boys.

Development and validation of osteoporosis risk-assessment model for Korean postmenopausal women.

Currently, dual-energy X-ray absorptiometry (DXA) is the gold standard for detecting osteoporosis, but is not recommended for general population screening. Therefore, this study aims to develop an osteoporosis risk-assessment model to identify high-risk individuals among Korean postmenopausal women. Data from 1,209 and 1,046 postmenopausal women who participated in the 2009 and 2010 Korean National Health and Nutrition Examination Survey, respectively, were used for development and validation of an osteoporosis risk-assessment model. Osteoporosis was defined as T score less than or equal to -2.5 at either the femoral neck or lumbar spine. Performance of the candidate models and the Osteoporosis Self assessment Tool for Asians (OSTA) were compared with respect to sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). To compare the developed Korean Osteoporosis Risk-Assessment Model (KORAM) with OSTA, a net reclassification improvement was further calculated. In the development dataset, the prevalence of osteoporosis was 33.9 %. KORAM, consisting of age, weight, and hormone therapy, had a sensitivity of 91.2 %, a specificity of 50.6 %, and an AUC of 0.709 with a specific cut-off score of -9. Comparable results were shown in the validation dataset: sensitivity 84.8 %, specificity 51.6 %, and AUC 0.682. Additionally, risk categorization with KORAM showed improved reclassification over that of OSTA from 7.4 to 41.7 %. KORAM can be easily used as a pre-screening tool to identify candidates for DXA tests. Further studies investigating cost-effectiveness and replicability in other datasets are required to establish the clinical utility of KORAM.

Dietary protein in relation to bone stiffness index and fat-free mass in a population consuming relatively low protein diets.

Dietary protein has a mixed effect on skeletal health and the effect may differ by amount or source of protein. The purpose of this study was to investigate dietary protein in relation to bone density and fat-free mass in rural Korean residents consuming relatively low protein diets. Between 2008 and 2010, 3,330 participants were recruited for a baseline examination of a community-based study in Kangwha. Of those, 1,182 men and 1,393 postmenopausal women were eligible for the present study. Diet was assessed using a food-frequency questionnaire developed for Korean adults. Calcaneal bone density measured by ultrasound was expressed as the stiffness index (SI). Fat-free mass index (FFMI) was defined as fat-free mass in kilograms divided by the height in meters squared. The mean ages of men and women were 59.5 and 60.0 years, respectively. The median daily intakes of total and meat protein were 52.3 and 6.7 g in men and 45.0 and 3.0 g in women, respectively. After controlling for potential confounders, SI and FFMI showed an increasing trend with a higher meat protein intake in men (P for trend = 0.017 and 0.033, respectively), but not in women. No positive association was observed for other food sources of protein. In conclusion, our findings suggest that meat protein contributes to skeletal health in men consuming relatively low protein diets.

Factors associated with long-stay status in patients with schizophrenia: an analysis of national databases covering the entire Korean population.

BACKGROUND: Admissions lasting over six months (long-stay) occur frequently among patients with schizophrenia in South Korea. AIMS: To identify some patient-level and institution-level factors associated with long-stay status of patients with schizophrenia. METHODS: This is a retrospective cross-sectional study. We analysed a nationwide population-based reimbursement claims data set consisting of 496,338 claims for 58,287 patients with schizophrenia between 1 January 2005 and 30 June 2006. A two-level random effects logistic regression model was used to identify those factors. RESULTS: Age (<20 years (ref), 60-69 (OR 2.000, 95% CI: 1.640-2.438), ≥ 70 (2.068, 1.682-2.543)), male gender (1.192, 1.144-1.242), type of national health insurance plan (national health insurance (ref), Medical Care Aid Type 1 (4.299, 4.024-4.593)), secondary diagnosis (none (ref), psychiatric diagnosis (0.719, 0.666-0.777), non-psychiatric diagnosis (0.918, 0.850-0.991)) and type of institution (clinic (ref), psychiatric hospital (2.769, 1.507-5.087)) were associated with likelihood of long-stay status. Institutional variable associated with long-stay status included a higher number of beds (1.073, 1.013-1.137). The number of professionals (0.752, 0.646-0.876) showed negative association with long-stay status. CONCLUSIONS: Researchers could improve their assessment of long-stay status of patients with schizophrenia by using a two-level analysis including patient-level and institution-level factors. This study suggests that mental health interventions to reduce the long stay of patients with schizophrenia focus on older male patients, those enrolled in a national medical care aid programme and those admitted to psychiatric hospitals.

Aortic calcification and bone metabolism: the relationship between aortic calcification, BMD, vertebral fracture, 25-hydroxyvitamin D, and osteocalcin.

The aim of this study was to investigate the relationship between aortic calcification (AC) and low bone mineral density (BMD), 25(OH)D, C-terminal telopeptide (CTx), and osteocalcin levels in Asian women. We also tried to find the association between AC and the risk of vertebral fracture. We included 769 patients in this study. All patients underwent QCT. Aortic calcium score (ACS) was quantified by the Agatston scoring method. Spinal fracture was defined by lumbar spine radiography. Among 769 subjects, 96 had at least one vertebral fracture and 345 had AC. ACS positively correlated with age. Osteocalcin, CTx, 25(OH)D, total-hip trabecular BMD (tBMD), femoral neck tBMD, and vertebral tBMD were inversely related with ACS. However, cortical BMD (cBMD) did not correlate with ACS. Among these parameters, only osteocalcin significantly correlated with ACS, even after adjusting for age. We divided the subjects into two groups based on the presence of AC to determine the association between AC and vertebral fracture. Multivariate logistic regression analysis showed that age, tBMD of each site, and AC were associated with vertebral fractures. After adjusting for confounding factors, patients with AC had more than a threefold increased risk of vertebral fracture (OR = 3.29-3.57, P < 0.05 according to site). This study suggests that high ACS is related to low tBMD but not cBMD. Furthermore, our findings indicate that this relationship is definitely age-dependent. Finally, we found that AC is significantly associated with the prevalence of vertebral fracture in Asian women.

Association between serum uric acid level and metabolic syndrome.

OBJECTIVES: Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea. METHODS: We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8-<5.6, 5.6-<6.5, ≥6.5 mg/dL in males; and <3.8, 3.8-<4.3, 4.3-<5.1, ≥5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression. RESULTS: The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, γ-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes). CONCLUSIONS: Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.

The association between serum albumin levels and metabolic syndrome in a rural population of Korea.

OBJECTIVES: A positive association between serum albumin levels and metabolic syndrome has been reported in observation studies, but it has not been established in the Korean population. The purpose of this study was to evaluate the association between serum albumin levels and the presence of metabolic syndrome among a sample of apparently healthy Korean adults. METHODS: This cross-sectional study analyzed data of 3189 community-dwelling people (1189 men and 2000 women) who were aged 40 to 87 years and were living in a rural area in Korea. Serum albumin levels were classified into quartile groups for each sex. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines with an adjusted waist circumference cut-off value (≥90 cm for men and ≥85 cm for women). An independent association between serum albumin levels and metabolic syndrome was assessed by multiple logistic regression analysis. RESULTS: Higher serum albumin levels were associated with increased prevalence of metabolic syndrome. The odds ratio (95% confidence interval) of the prevalence of metabolic syndrome for the highest versus the lowest serum albumin quartiles was 2.81 (1.91 to 4.14) in men and 1.96 (1.52 to 2.52) in women, after adjusting for age, smoking status, alcohol consumption, and physical activity. When each metabolic abnormality was analyzed separately, higher serum albumin levels were significantly associated with hypertriglyceridemia and hyperglycemia in both sexes, and with abdominal obesity in men. CONCLUSIONS: These results suggest that higher serum albumin levels are positively associated with an increased risk of metabolic syndrome in Korean adults.

Association between depression and bone mineral density in community-dwelling older men and women in Korea.

OBJECTIVES: Previous research suggested a significant correlation between depression and osteoporosis, but little is known for the elderly Asian population. We investigated an association between depression and bone mineral density (BMD) in the Korean elderly. STUDY DESIGN: Cross-sectional data analysis of a community-based study, Kangwha Island, South Korea. MAIN OUTCOME MEASURES: BMD, measured at the os calcis using a quantitative ultrasound device, was expressed as stiffness index and T-score. Depressive symptoms were evaluated by the Korean version of Beck Depression Inventory (K-BDI). Depression was defined as a K-BDI score of 16 or higher. Participants also completed a questionnaire, including demographic factors, metabolic abnormalities, and health-related lifestyle factors. RESULTS: A total of 932 local residents (422 men and 510 women) aged 60-80 years completed the questionnaires and baseline BMD evaluation. Men with depression had a significantly lower stiffness index compared to those without depression in an age-adjusted (77.2±5.2 vs. 86.0±1.5, p=0.002) and a multivariate-adjusted model (78.5±5.2 vs. 85. 9±1.5, p=0.007). Correspondingly, men with depression had an increased probability of having an osteoporosis (T-score≤-2.5) compared to those without depression; the age-adjusted odds ratio was 2.86 (95% CI, 1.36-6.01) and the multivariate-adjusted odds ratio was 2.69 (95% CI, 1.26-5.76). However, no significant association was observed in older women. CONCLUSIONS: Depression was significantly associated with lower BMD in Korean older men, but not in women.

Association between meat consumption and carotid intima-media thickness in Korean adults with metabolic syndrome.

OBJECTIVES: The effect of meat consumption on cardiometabolic risk has been continuously studied, but their associations are not conclusive. The aim of this study is to examine the association between the consumption of meat or red meat and carotid intima-media thickness (IMT) in healthy Korean adults. METHODS: This study evaluated 2374 community-dwelling adults (933 men and 1441 women) who were free of cardiovascular disease or cancer, living in a rural area in Korea. Total meat and red meat intakes were assessed with a validated 103 item-food frequency questionnaire. Carotid IMT was evaluated ultrasonographically, IMTmax was defined as the highest value among IMT of bilateral common carotid arteries. RESULTS: After adjustment for potential confounding factors, the mean IMTmax tended to increase in higher meat consumption groups in both men and women with metabolic syndrome (p for trend= 0.027 and 0.049, respectively), but not in participants without metabolic syndrome. Frequent meat consumption (≥5 servings/week) was significantly associated with higher IMTmax in men with metabolic syndrome (by 0.08 mm, p=0.015). Whereas, the association was not significant in women (by 0.05 mm, p=0.115). Similar but attenuated findings were shown with red meat intake. CONCLUSIONS: Our findings suggest that a higher meat consumption may be associated with a higher carotid IMT in Korean adults with metabolic syndrome. The frequent meat consumption (≥5 servings/week), compared with the others, was associated with a higher carotid IMTmax only in men with metabolic syndrome. Further research is required to explore optimal meat consumption in people with specific medical conditions.