Factors Associated with Non-Adherence to Glaucoma Treatment in a Korean Nationwide Survey.

Background: Glaucoma is a main cause of blindness despite the effectiveness of treatments, and adherence to treatment is a critical aspect of glaucoma management. We aimed to identify the factors associated with non-adherence to treatment among Korean glaucoma patients. Methods: Data were collected from 4,833 glaucoma patients during the Korea Community Health Survey (KCHS) in 2008 and 2011 regarding current treatment for glaucoma, demographics, comorbidities, perceived health status, and health-related behaviors were subjected to analysis. A multivariable regression model was applied to identify factors related to non-treatment for glaucoma. Results: Approximately, half of the 4,883 patients failed to adhere to treatment. Compared to the treatment group, the non-treatment group had lower social status, fewer comorbid conditions, were more optimistic about their health statuses, and more likely to adopt unhealthy behaviors. Stepwise regression analysis showed that poor social status (low level of education and unmarried), self-perception of a satisfactory health status, and unhealthy behaviors (smoking and no flu-vaccination) were significantly associated with non-adherent to treatment. Conclusion: More attention should be paid to glaucoma patients with low social status or that are overconfident about their health. Future prospective studies that more comprehensively assess treatment compliance, are needed to confirm our findings.

Suicidal Ideation in Long-Term Adult Cancer Survivors: Findings of a Nationwide Cross-Sectional Study.

BACKGROUND: Cancer survivors suffer substantial psychologic distress, but little is known about their vulnerabilities to suicidal ideation more than 5 years after diagnosis. METHODS: We compared suicidal ideation among 1,033 adult cancer survivors, who had received a diagnosis of cancer more than 5 years previously, with that among individuals without a cancer history using nationwide survey data. Logistic regression models were used to evaluate suicidal ideation in cancer survivors. RESULTS: Cancer survivors did not have a significantly higher suicidal ideation rate than those without a cancer history, regardless of depressive mood. CONCLUSIONS: A cancer history of 5 years or greater is not associated with suicidal ideation. IMPACT: A large Korean study considering depressive mood affirm no association between long-term cancer survivorship and suicidal ideation.

The Relationship between Age-Related Macular Degeneration and Cardiovascular Disease: A Meta-Analysis.

BACKGROUND: Age-related macular degeneration (AMD) and cardiovascular disease (CVD) share pathogenic mechanisms, and their lead-lag relationship remains unclear. We performed a meta-analysis of data from longitudinal studies to evaluate the interactive association between age-related macular degeneration (AMD) and cardiovascular disease (CVD). METHODS: A literature search was performed in PubMed, Embase, and Cochrane Library up to Feb 2019. Estimates were pooled by study quality and type of AMD and CVD. Publication bias was assessed by Begg's test. RESULTS: We identified nine studies for the risk of AMD in CVD and ten studies for the risk of CVD in AMD. Overall, evidence for the risk of CVD in AMD patients was most robust. Both early and late AMD preceded CVD, but more solid significance existed in late AMD. Among the types of CVD, stroke was more tightly associated with AMD than coronary heart disease. Publication bias was not significant in either direction. CONCLUSION: AMD is a risk factor for CVD, which is primarily driven by the increased risk of stroke in patients with late AMD. Moreover, these results suggested that AMD treatment and screening for CVD in AMD patients may have unexplored clinical benefits.

Associations between Dietary Fiber Intake and Bone Mineral Density in Adult Korean Population: Analysis of National Health and Nutrition Examination Survey in 2011.

BACKGROUND: The correlations between the amount of daily fiber intake and bone mineral densities (BMDs) in Korean adult population were investigated in our study. METHODS: Utilizing the Korean National Health and Nutrition Examination Survey in 2011, multivariable linear regression was performed to explore the association between fiber consumption and BMD of lumbar vertebrae 1 to 4 (L1-4 total), L1, L2, L3, and L4 vertebrae, femur neck, femur total, and trochanter. All models were adjusted for age, body mass index, vitamin D level, smoking, physical activity, alcohol use, contraceptive use, hormonal replacement therapy, consumption of carbohydrate, protein, fat, calcium, phosphate, iron, thiamine, riboflavin, niacin, and vitamin C. RESULTS: In males aged between 18 and 45, fiber intake significantly increased BMDs of L1 (coefficient ß=0.004, P=0.040) and L2 (ß=0.004, P=0.038) while daily protein consumption significantly lowered BMDs of femur neck (ß=-0.001, P=0.009), femur total (ß=-0.001, P=0.008), and trochanter (ß=-0.001, P=0.008). In males aged 65 and older, nutrient intake shows no significant correlations with BMDs except fat consumption was inversely associated with BMD of trochanter (ß=-0.001, P=0.017). In females aged between 18 and 45, fiber intake shows no significant relationship with BMDs while daily fat consumption significantly increased BMDs of L1 (ß=0.001, P=0.028), L2 (ß=0.001, P=0.024), L3 (ß=0.001, P=0.033), and L1-4 total (ß=0.001, P=0.017). CONCLUSIONS: Fiber intake was a protective factor of lumbar spine (L1 and L2) BMD in male aged between 18 and 45 but not in female participants of any age groups.

Association between shift work and suicidal ideation: data from the Korea National Health and Nutrition Examination Survey (2008-2016).

Objective Studies on the relationship between shift work and suicidal ideation are scarce. This study aimed to investigate the impact of shift work on suicidal ideation using a nationwide representative sample from the Korean working population. Methods The association between shift work and suicidal ideation was determined using data in 17 756 Korean workers over 19 years of age with fixed work schedules. These data were collected from the nationwide cross-sectional Korean National Health and Nutrition Examination Survey (2008-2016). The odds ratios (OR) and 95% confidence intervals (CI) for suicidal ideation were calculated by sex and age using multiple logistic regression models. Results Approximately 14% of included participants were classified as shift workers. Among male workers, evening and night shift workers had a significantly increased risk of suicidal ideation compared to day workers after adjusting for demographics, lifestyle factors, comorbidities, number of work hours, and occupational type (OR 1.89, 95% CI 1.25-2.88 for evening-fixed workers and OR 1.38, 95% CI 1.03-1.86) for night-fixed workers]. Age-stratified analyses indicated that shift workers were more likely to report suicidal ideation than day workers in young and middle-aged groups. Conclusion Evening and night shift work is associated with higher suicidal ideation among male workers.

A Possible Case of Statin-Induced Ichthyosis in an Elderly Woman.

Ichthyosis is a heterogeneous group of hereditary or acquired skin disorders, characterized by increased stratum corneum production. Several systemic diseases and many drugs can occasionally cause acquired ichthyosis. We report a case of statin-induced ichthyosis in which the causality between statin and ichthyosis was found possible by using the Naranjo scale. A 79-year-old woman presented with pruritic skin lesions on both legs that appeared erythematous, scaly, and cracked. A clinical diagnosis of acquired ichthyosis was made and the statin was suspected as the cause. The skin lesions improved after 6 weeks of dose reduction of the statin.

Effect of Influenza Vaccination on Risk of Stroke: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite the presence of a strong association between influenza infection and stroke, whether influenza vaccination reduces the risk of stroke is yet a matter of controversy. We conducted a meta-analysis to determine whether influenza vaccination protects against stroke. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from database inception date to November 18, 2016, without language restrictions, to identify studies investigating the effect of influenza vaccination on subsequent risk of stroke. We conducted a meta-analysis to quantify the risk of stroke in overall and subgroup analyses and calculated a pooled OR for developing stroke with a 95% CI. Publication bias was assessed by Begg's rank correlation test. RESULTS: Eleven studies fulfilled our inclusion criteria. In a random-effects model, vaccinated individuals had a decreased risk of stroke compared with unvaccinated individuals (OR 0.82; 95% CI 0.75-0.91; p < 0.001). The relationship between influenza vaccination and stroke risk remained robust in subgroup analyses. The significant effect of influenza vaccination was associated with ascertainment of vaccination status and stage of prevention. CONCLUSION: Vaccination against influenza is associated with a lower risk of stroke. Well-designed prospective studies are needed to provide stronger evidence of the protective effect of influenza vaccination against stroke.

Association of Serum 25-hydroxy-vitamin D Concentration and Arterial Stiffness among Korean Adults in Single Center.

BACKGROUND: There are growing concerns about the role of vitamin D deficiency in cardiovascular diseases. Therefore, we investigated the correlation between serum 25-hydroxy-vitamin D (25[OH]D) and arterial stiffness among Korean adults. METHODS: We retrospectively reviewed the medical charts of 302 people (115 women and 187 men) who visited a tertiary hospital from January 2015 to December 2016. Serum 25(OH)D was measured using the radioimmunoassay technique, and brachial-ankle pulse wave velocity (baPWV) was measured using an automatic wave analyzer. We obtained the doctor's report on the medical history of the participants, their alcohol consumption and smoking habits, and their exercise status. Metabolic syndrome was diagnosed based on guidelines from the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP III) and the International Diabetes Federation (IDF). Results of basic blood tests and physical assessment were also collected. RESULTS: In the Pearson correlation analysis, serum 25(OH)D and baPWV showed a statistically significant inverse relationship (r=-0.279, P<0.001). Using multiple regression analysis, and after adjusting for possible confounders, serum 25(OH)D concentration was found to be significantly associated with baPWV (ß=-0.121, P=0.011). CONCLUSIONS: We observed an association between serum 25(OH)D concentration and arterial stiffness. Further studies involving larger sample sizes will be needed to confirm this associations.

Association between blood lead levels and blood pressures in a non-smoking healthy Korean population.

OBJECTIVE: The Korea National Health and Nutrition Examination Survey (KNHANES) has been performed every 3 years in Korea to help prevent cardiovascular mortality in the general population. Previous studies showed an association between blood lead levels and cardiovascular mortality. In order to assess the relationship between blood lead concentration and blood pressure in the healthy general population, we investigated whether blood lead levels were related to blood pressure in a non-smoking healthy population without any known medical diseases in the 2013 KNHANES. METHODS: 896 (mean age 40.55±13.83 years; body mass index 23.06±3.33 kg/m2) subjects who had no known diseases were included among 8018 subjects. Exclusion criteria were: hypertension, diabetes, hyperlipidaemia, cerebrovascular events, renal insufficiency, liver cirrhosis, thyroid dysfunction, any cardiovascular or renal disease, and any malignancy. Blood pressures were measured three times by sphygmomanometers, 5 min apart. Blood pressures were then expressed as the average between the second and third values. Height, weight, waist circumferences and blood pressure, as well as total cholesterol, high density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell count and blood lead levels were measured. In addition, dietary components were analysed by 24 hour recall. RESULTS: The association between log blood lead levels and systolic/diastolic pressure was stronger after it was controlled for age, sex, education, body mass index (BMI), waist circumference and fasting plasma glucose (FPG) (p=0.048, 0.002). Furthermore, the association between log blood lead levels and systolic pressure (p=0.048) and diastolic pressure (p=0.002) was more evident when controlled for age, sex, education, BMI, waist circumference, FPG, AST and ALT. CONCLUSIONS: Blood lead levels are significant determinants of systolic and diastolic blood pressure in a healthy Korean population, irrespective of sociodemographic factors and metabolic derangements.

Correlation of Arterial Stiffness and Bone Mineral Density by Measuring Brachial-Ankle Pulse Wave Velocity in Healthy Korean Women.

BACKGROUND: An association between arterial stiffness and osteoporosis has previously been reported. Therefore, we investigated the relationship between arterial stiffness, measured by brachial-ankle pulse wave velocity, and bone mineral density in a sample of healthy women undergoing routine medical checkup. METHODS: We retrospectively reviewed the medical charts of 135 women who had visited the Health Promotion Center (between May 2009 and December 2012). Brachial-ankle pulse wave velocity was measured using an automatic wave analyzer. Bone mineral density of the lumbar spine (L1-L4) and femur was measured by dual-energy X-ray absorptiometry. Metabolic syndrome was defined according to National Cholesterol Education Program-Adult Treatment Panel III criteria, using body mass index >25 kg/m(2) instead of waist circumference >88.9 cm. RESULTS: Pearson's correlation analysis revealed significant inverse relationships between pulse wave velocity and bone mineral density of the lumbar spine (r=-0.335, P<0.001), femur neck (r=-0.335, P<0.001), and total femur (r=-0.181, P=0.04). Pulse wave velocity showed the strongest association with age (r=0.586, P<0.001). Multiple regression analysis identified an independent relationship between pulse wave velocity and lumbar spine bone mineral density in women after adjusting for age, metabolic syndrome, body mass index, smoking status, alcohol intake, and exercise (r=-0.229, P=0.01). CONCLUSION: This study confirmed an association between arterial stiffness and bone mineral density in women.

HEPATIC VISCERAL LARVA MIGRANS DUE TO TOXOCARA CANIS IN A 72-YEAR-OLD MAN.

Hepatic toxocariasis is visceral larva migrans caused by Toxocara. We report a case of hepatic toxocariasis detected incidentally during a health checkup. The patient had elevated levels of eosinophils, total IgE, and anti-Toxocara IgG antibodies. On contrast-enhanced computed tomography (CT) imaging he had a single, 2.16 cm, oval, ill-defined, low-attenuation hepatic nodule which was best appreciated during the portal venous phase of the scan. Clinicians should consider hepatic toxocariasis as a possible diagnosis in any individual who presents with eosinophilia of unknown etiology and an ill-defined hepatic lesion on CT imaging.

Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: The Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV and V, 2008-2011).

BACKGROUND: Body mass index (BMI), waist circumference (WC), and even dual-energy X-ray absorptiometry (DXA) are used for obesity diagnosis. However, it is not known which DXA-derived index of obesity correlates best with BMI and/or WC and it is not clear whether such an index is accurate or not. OBJECTIVES: The aim of this study is to show the relationship between anthropometric measurements (BMI, WC) and body fat indices from DXA and to determine which DXA indices are strongly related to BMI and WC. SUBJECTS: This study was based on data obtained from the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V). DXA measurements were performed on survey subjects over 10 years old from July 2008 through to May 2011. Of these, 18 198 individuals, aged 19 years and older for whom DXA data were available, were included. METHODS: Weighted Pearson's correlated coefficients (r) were calculated among indices, according to sex, age group and menopause, and the coefficients were compared with each other. RESULTS: BMI correlates most with trunk body fat mass in kg (r=0.831) and then with total body fat in kg (r=0.774, P<0.00043 for difference of r). In the older age group, BMI correlates with total body fat mass (r=0.822) better than with trunk fat mass (r=0.817, P<0.00043). WC correlates with trunk body fat mass most in both genders and all age groups (0.804≤r≤0.906). Correlations of BMI (r=0.645 for men, 0.689 for women) and WC (r=0.678 for men, 0.634 for women) to body fat percentages (%) were less robust than those to body fat mass. CONCLUSIONS: BMI and WC reflect trunk and total body fat in kg more than body fat percentage derived by DXA.

Association of arterial stiffness and osteoporosis in healthy men undergoing screening medical examination.

BACKGROUND: Association of arterial stiffness and osteoporosis has been previously reported in women. However, this association is still controversial for men. Therefore, we investigated correlation of arterial stiffness and osteoporosis by measuring brachial-ankle (ba) pulse wave velocity (PWV) and bone mineral density (BMD). METHODS: We reviewed medical charts of 239 people (women: 128, men: 111) who visited the Health Promotion Center, retrospectively. ba-PWV was measured by automatic wave analyzer. Lumbar spine (L1-L4) BMD and femur BMD were measured by dual energy X-ray absorptiometry. Metabolic syndrome was based on the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATPIII) definition. Body mass index (BMI)>25 kg/m(2) was used instead of waist circumference. RESULTS: In Pearson's correlation analysis, PWV and femur BMD (Neck, total) had a significant inverse relationship in men (r=-0.254, P=0.007; r=-0.202, P=0.034). In women, PWV and the L-spine, femur (Neck, total) had a significant inverse relationship. (r=-0.321, P<0.001; r=-0.189, P=0.032; r=-0.177, P=0.046) Age and PWV showed the greatest association in both men and women (r=0.46 P<0.001; r=0.525, P<0.001) In multiple regression analysis, the L-spine BMD and PWV had an independent relationship in women after adjusting for age, metabolic syndrome, BMI, smoking, drinking and exercise. (r=-0.229, P=0.015). No independent association was found between PWV and BMD in men. CONCLUSIONS: The association between arterial stiffness and BMD was confirmed in women. However, this association was not statistically significant for men.

Influence of eating behaviors on short-term weight loss by orlistat and anorectic agent.

Little data exists concerning whether eating behaviors determine the response to orlistat treatment, especially with added anorectic agents. This study was a sub-investigation of a 12-week randomized controlled trial for the additive effect of orlistat on sibutramine treatment. The analysis presented here was restricted to 98 women who had fulfilled the protocol. The Dutch eating behavior questionnaire and three-factor eating questionnaire were used to assess eating behaviors. Scores of emotional eating, external eating, disinhibition and hunger are significantly interrelated. Using multiple logistic analysis with adjustment for potential confounders, such as age, initial BMI and the other 2 eating behavior scores, traits of emotional eating (OR 0.30, 95% CI 0.13-0.74) and disinhibition (OR 0.61, 95% CI 0.40-0.82) have a significant influence on prediction for additional 5% weight loss in the treatment with orlistat and sibutramine. Subjects with less vulnerability to emotional cues had significantly more weight loss with orlistat treatment and anorectic agents.

Effects of CYP3A5, CYP2C19, and CYP2B6 on the clinical efficacy and adverse outcomes of sibutramine therapy: a crucial role for the CYP2B6*6 allele.

BACKGROUND: Various cytochrome P450 isoforms modulate sibutramine activity and influence sibutramine plasma levels and pharmacokinetics. However, there are no available data to demonstrate the association of these polymorphisms with the clinical outcomes of sibutramine administration. METHODS: This study was a sub-investigation of a 12-week, double-blind, placebo-controlled trial examining the additive effect of orlistat on sibutramine. The final analysis was restricted to 101 women who had fulfilled the protocol. We evaluated the effects of genetic polymorphisms of CYP3A5, CYP2C19 and CYP2B6 on the % weight loss and the occurrence of adverse events. RESULTS: The change of pulse rate from baseline value was affected by both CYP2B6 and CYP3A5 genetic polymorphisms (P<.01 for CYP3A5 and P=.01 for CYP2B6). Both CYP2B6 and CYP3A5 showed gene-gene interactions (P<.01). After adjusting for significant variables in the backward stepwise regression model, the change of pulse rate and time-dependent weight reduction were significant only among the CYP2B6 genotypes (P=.027 and P<.01, respectively). CONCLUSION: The CYP2B6*6 allele influences the extent of weight reduction and pulse rate changes in patients undergoing sibutramine treatment.

Relationships between serum osteocalcin, leptin and the effect of weight loss by pharmacological treatment in healthy, nonsmoking Korean obese adults.

BACKGROUND: Recent studies have reported a relationship between osteocalcin (OC) levels and factors associated with energy metabolism and insulin resistance. As any detailed understanding of OC mechanisms still remains elusive, this study aimed at revealing a correlation between serum OC levels and obesity in healthy, nonsmoking, Korean obese adults who had undergone weight loss through pharmacological treatment. METHODS: 119 healthy, nonsmoking, Korean obese adults were investigated at 3 months following weight loss through pharmacological treatment. Serum OC, leptin, HOMA score, ghrelin, visceral fat mass, total body fat, and BMI were measured. RESULTS: Increase in serum OC was significantly associated with decreases in: BMI (and weight change %) (r=-0.209, p=0.023), visceral fat mass (r=-0.189, p=0.049), HOMA (r=-0.203 p=0.027), and leptin (r=-0.253 p=0.006), but not with changes in adiponectin (r=+0.029, p=NS), and Ghrelin (r=+0.019, p=NS). Decrease in leptin (ß=-0.280, p=0.002) was significantly associated with an increase in serum OC, after pharmacological weight loss treatment was adjusted for age, sex, drug type, and BMI (or visceral fat mass). CONCLUSIONS: Serum OC was significantly increased at 3 months after pharmacological weight loss. We further found that leptin levels were associated with changes in serum OC. These findings suggest a relationship between bone and adipose tissue.