Trends in prevalence of overweight and obesity, self-perceived overweight or obesity, and weight loss efforts among older adults in South Korea, 2005-2021.

OBJECTIVE: We assessed trends in prevalence of overweight and obesity, self-perceived overweight or obesity, and efforts to lose weight among Korean older adults from 2005 to 2021. METHODS: Using Korea National Health and Nutrition Examination Survey data from 2005 to 2021, we assessed prevalence of overweight and obesity (body mass index≥25 kg/m2), self-perceived overweight or obesity, and self-reported weight loss efforts among Korean adults aged ≥60 years (11,936 men, 15,966 women). Complex sample frequency and linear by linear association analyses were conducted. RESULTS: The prevalence of overweight and obesity tended to increase only in men, from 28.9% to 37.2% (P for trend<0.001). The prevalence of self-perceived overweight or obesity increased from 18.9% to 35.3% in men and 32.5% to 48.6% in women (P for trend<0.001) and tended to increase regardless of their actual weight (P for trend<0.001). The prevalence of weight loss efforts increased from 17.9% to 28.8% in men and 19.2% to 38.2% in women (P for trend<0.001) and increased in men and women who were not overweight or obese and in women who were overweight or obese (P for trend<0.001). The prevalence of weight loss efforts increased in women who self-perceived themselves as overweight or obese regardless of their actual weight, and in men who self-perceived themselves as overweight or obese even though they were not (P for trend<0.05). CONCLUSIONS: There were increasing trends in the prevalence of overweight and obesity in older Korean men, self-perceived overweight or obesity, and weight loss efforts in older Korean men and women.

Evaluation of weekend catch-up sleep and weekday sleep duration in relation to metabolic syndrome in Korean adults.

PURPOSE: This study aimed to evaluate whether or not the relationship between weekday sleep duration and prevalence of metabolic syndrome (MetS) differs according to weekend catch-up sleep (CUS) in Korean adults. METHODS: Data from the Korea National Health and Nutrition Examination Survey 2016-2020, including that regarding weekday sleep duration, weekend CUS, MetS components, and confounding factors such as sociodemographic factors, health behaviors, and illness-related factors, were evaluated in Korean adults aged 19 to 80 years. Complex-sample logistic regression was applied after adjusting for confounding factors. RESULTS: Among 24,313 adults, the prevalence of MetS was lowest in individuals with 6-7 h of sleep on weekdays and CUS ≥ 2 h (17.7%, reference group). The interaction between weekday sleep duration and weekend CUS for MetS was significant. Compared to the reference group, the prevalence of MetS was higher in those who slept < 7 h and had a maximum CUS of 1 h (aORs, 1.42-1.66), and in those who slept ≥ 9 h and had a maximum CUS of 2 h (aORs, 1.28-1.82). In subjects with no CUS or CUS ≥ 2 h, the prevalence of MetS was greater even in those with adequate weekday sleep duration (7- 9 h) than in the reference group (aORs, 1.37 and 1.64, respectively). CONCLUSION: Weekend CUS may help individuals with short weekday sleep duration reduce their odds of developing MetS, but it may worsen the condition in individuals with a long weekday sleep length.

Moderation of Weight Misperception on the Associations Between Obesity Indices and Estimated Cardiovascular Disease Risk.

BACKGROUND: This study aimed to investigate the gender-specific association between weight misperception and estimated cardiovascular disease (CVD) risk and gender-specific moderation of weight misperception in the associations between obesity indices and CVD risk. METHODS: In 7836 men and 10,299 women aged 40-79 years without CVD history from the 2014-2018 Korea National Health and Nutrition Examination Survey, the risk of 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using Pooled Cohort Equations. Weight misperception was defined as accurate estimation, overestimation, or underestimation by comparing perceived weight to actual weight category. Obesity indices were BMI and waist circumference (WC). RESULTS: In fully adjusted models, odds of 10-year ASCVD risk of ≥ 7.5% were lower in men with overestimating weight (odd ratio [95% confidence interval], 0.85 [0.73, 0.99] after adjusting for BMI;0.79 [0.68, 0.92] after adjusting for WC), but higher in women with underestimating weight (1.44 [1.27, 1.63] after adjusting for BMI;1.42 [1.26, 1.61] after adjusting for WC) compared to those with accurate weight estimates. Compared to women with accurate weight estimates, the ASCVD risk associated with obesity indices was higher in those who underestimated weight (ß [95% CI], 0.33 [0.23, 0.43] for BMI;0.16 [0.13, 0.20] for WC), whereas it was lower in those who overestimated weight (-0.15 [-0.28, -0.02] for BMI; -0.07 [-0.11, -0.03] for WC). In men, weight misperception did not moderate the association between obesity indices and the ASCVD risk. CONCLUSIONS: These findings suggest that weight misperception was associated with estimated CVD risk independently across gender and moderates the association between obesity indices and estimated CVD risk in women.

Weight perception and self-rated health: are there differences between cancer survivors and non-cancer survivors?

PURPOSE: To compare relationships between self-perceived weight and self-rated health (SRH) between cancer survivors and non-cancer survivors. METHODS: A cross-sectional study based on the 2014-2019 Korea National Health and Nutrition Examination Survey was conducted for the associations of self-perceived weight status, measured BMI categories, and combined categories by self-perceived weight and measured BMI with SRH in 1622 cancer survivors and 29,903 non-cancer survivors using complex samples ordinal regression analysis after adjusting for sociodemographic factors, health behaviors, and concurrent diseases. RESULTS: Compared to the comparison group (those who were normal weight and self-perceived as average weight in non-cancer survivors), adjusted odds for poorer SRH were higher in cancer survivors and non-cancer survivors who were underweight and self-perceived as underweight (adjusted odds ratios[aORs], 2.69 for non-cancer survivors; 2.62 for cancer survivors), those who were normal weight but self-perceived as underweight or overweight (aORs, 1.69-2.38 for non-cancer survivors; 2.34-3.78 for cancer survivors), and those who were overweight and self-perceived as overweight (aORs, 1.52 for non-cancer survivors; 2.42 for cancer survivors). In cancer survivors, the odds for poorer SRH were greater for those who were normal weight and self-perceived as average weight (aOR = 1.84), whereas the odds were not significant for those who were underweight or overweight and self-perceived as average weight. In non-cancer survivors who self-perceived as average weight, the odds for poorer SRH were significant in those with underweight (aOR = 1.35) or overweight (aOR = 0.84). CONCLUSION: According to actual weight status, the association between self-perceived weight and SRH may differ between cancer survivors and non-cancer survivors.

IgGs from patients with amyotrophic lateral sclerosis and diabetes target CaVα2δ1 subunits impairing islet cell function and survival.

Patients with amyotrophic lateral sclerosis (ALS) often show hallmarks of type 2 diabetes mellitus (T2DM). However, the causal link between ALS and T2DM has remained a mystery. We now demonstrate that 60% of ALS patients with T2DM (ALS-T2DM) have sera that exaggerated K+-induced increases in cytosolic free Ca2+ concentration ([Ca2+]i) in mouse islet cells. The effect was attributed to the presence of pathogenic immunoglobulin Gs (IgGs) in ALS-T2DM sera. The pathogenic IgGs immunocaptured the voltage-dependent Ca2+ (CaV) channel subunit CaVα2δ1 in the plasma membrane enhancing CaV1 channel-mediated Ca2+ influx and [Ca2+]i, resulting in impaired mitochondrial function. Consequently, impairments in [Ca2+]i dynamics, insulin secretion, and cell viability occurred. These data reveal that patients with ALS-T2DM carry cytotoxic ALS-T2DM-IgG autoantibodies that serve as a causal link between ALS and T2DM by immunoattacking CaVα2δ1 subunits. Our findings may lay the foundation for a pharmacological treatment strategy for patients suffering from a combination of these diseases.

Bone Mediated and Moderated the Associations Between Sarcopenic Obesity Indices and Cardiovascular Disease Risk Scores.

To evaluate mediation and moderation of bone on the association of sarcopenic obesity (SO) indices using the metabolic load-capacity model with the 10-year cardiovascular disease risk scores (CVDR). In 2905 men and 3622 women (age ≥ 30 years), dual-energy X-ray absorptiometry was used to measure bone indicators [total bone mineral content percentage(TBM%), bone mineral density of femur neck (BMD_FN) and lumbar spines(BMD_LS)], total muscle (TMM) and fat mass (TFM), appendicular skeletal muscle mass (ASM), and truncal fat mass (TrFM). Two SO indices were TMM/TFM and ASM/TrFM. The Framingham model was used to calculate CVDR. Sex-specific mediation and moderation effects of bone indicators in the associations between the SO indices and the CVDR were analyzed. After adjusting for age, education, income, alcohol use, and physical activity, the SO indices inversely associated with the CVDR and TBM% inversely mediated those associations in both sexes. BMD inversely mediated those associations in men, while the mediation effects of BMD in women were non-significant or positive. In those aged ≥ 60, the mediation effects were found in TBM% and BMD_LS , but not in BMD_FN. The moderation analysis shows stronger inverse associations between the SO indices and the CVDR in those with low bone indicators in women and in men (for the relationship between ASM/TrFM and TBM%), while bone indicators did not moderate these associations in those aged ≥ 60. Bone mass mediated the associations between the SO indices and the CVDR in Korean men and women and moderated these associations in women.

The association between occupational categories and grip strength in Korean male workers.

PURPOSE: This study explored the association between occupational categories and muscle strength using handgrip strength (HGS) while considering sociodemographic and health-related factors in Korean men using a national survey. METHODS: Using cross-sectional data of 8380 men (59.9 ± 16.6 years of age), the occupational categories held the longest duration and HGS levels (normal vs. weak) were determined. Logistic regression was applied with adjustment for sociodemographic factors, work-related factors (working hours and schedule), and health-related factors (physical activity, sedentary time, resistance exercise, alcohol consumption, smoking status, chronic illness, subjective health status, weight category, metabolic syndrome, and protein intake). RESULTS: Weak HGS prevalence was lowest in male managerial or professional workers (1.5%) and highest in male skilled agricultural, forestry, fishery, or craft and the related trades workers (16.4%). Compared to male managerial or professional workers, the odds for weak HGS increased in male service/sales workers (OR 2.41; 95% CI 1.45-3.99) and male manual workers [agricultural/forestry/fishery/craft and related trades workers, OR 2.94 (95% CI 1.78-4.83); equipment/machine operating/assembling workers, OR 1.68 (95% CI 1.05-2.71); and elementary workers, OR 3.43 (95% CI 1.95-6.05)] in the fully adjusted model. Regardless of age groups, income, working hours, strength exercise, and sedentary time levels, and chronic illness and metabolic syndrome status, male manual workers were more likely to have weak HGS compared to male non-manual workers. CONCLUSION: Male manual workers may have a higher risk for weak muscle strength compared to male non-manual workers regardless of sociodemographic, work-related, and health-related factors.

Sarcopenic obesity and 10-year cardiovascular disease risk scores in cancer survivors and non-cancer participants using a nationwide survey.

OBJECTIVE: To evaluate the associations of combinations of sarcopenia and adiposity phenotypes with 10-year cardiovascular disease (CVD) risk scores in cancer survivors and non-cancer participants. METHODS: In 19,019 individuals including 1023 cancer survivors free of CVD who were aged ≥30 years from the Korea National Health and Nutrition Examination Survey, combination groups of sarcopenia, obesity and abdominal obesity based on handgrip strength, BMI and waist circumference, respectively, were generated and 10-year CVD risk scores based on Framingham risk model were determined. RESULTS AND CONCLUSION: After adjusting for socio-demographic factors, health behaviours, dietary intake of nutrients and time since cancer diagnosis and current cancer therapy (in cancer survivors), cancer survivors with sarcopenic non-obesity, non-sarcopenic abdominal obesity or sarcopenic abdominal obesity had, respectively, 84%, 85% and 3.61-fold higher odds for ≥10% CVD risk scores compared with cancer survivors without those phenotypes. In non-cancer participants, sarcopenia, obesity, abdominal obesity and combinations of those phenotypes had higher odds from 1.37 (in those with obesity) to 4.24 (in those with sarcopenic abdominal obesity) for ≥10% CVD risk scores compared with reference phenotypes. In conclusion, cancer survivors and non-cancer participants with sarcopenia, obesity, abdominal obesity or combination of those phenotypes had increased 10-year CVD risk scores.

Nurses' post-traumatic stress symptoms and growth by perceived workplace bullying: An online cross-sectional study.

AIM: The aim of this study was to explore the relationship between workplace bullying and mental health, focusing on the indirect effect of post-traumatic stress responses and moderation of nurses' perception of workplace bullying. BACKGROUND: Post-traumatic stress symptoms frequently result from workplace bullying, but how nurses' individual appraisals relate to negative consequences is unclear. METHOD: A cross-sectional online survey was conducted with 319 Korean nurses; participants were divided into the perceived and non-perceived workplace bullying groups. Moderated mediation models were tested using structural equation modelling with Stata version 16. RESULTS: Regardless of nurses' appraisals, higher levels of workplace bullying were associated with poor mental health. Post-traumatic stress symptoms indirectly impacted the relationship in both groups, but post-traumatic growth did not. The perceived group showed a partial negative association between post-traumatic growth and mental health. CONCLUSION: It is necessary to develop systems for early detection of mental health problems to create safe work environments not only for nurses who perceive workplace bullying but also for those who do not. IMPLICATIONS FOR NURSING MANAGEMENT: Staff education and institutional support that consider PTSS are recommended for all nurses.

Association of osteosarcopenic obesity and its components: osteoporosis, sarcopenia and obesity with insulin resistance.

INTRODUCTION: To evaluate the differences in the associations of combinations of co-existent osteopenia, obesity, and/or sarcopenia with insulin resistance (IR) according to different criteria of obesity. MATERIALS AND METHODS: Among 4500 Korean men and postmenopausal women who were aged ≥ 50 years and did not have diabetes mellitus, osteopenia, sarcopenia, and obesity were defined using bone mineral density, skeletal mass index, and body fat % (or BMI). Body composition groups were generated based on the combinations of these components. IR was defined using the HOMA-IR ≥ 2.5. RESULTS: When obesity was defined by body fat % and the relationships were adjusted for age, sex, education, and health behaviors, the odds ratios (ORs) for IR was highest in the groups with obesity and osteopenic obesity, followed by sarcopenic obesity and osteosarcopenic obesity, followed by osteopenia and sarcopenia, and followed by osteosarcopenia. When BMI was additionally adjusted, the ORs for IR were not significantly different between body composition groups except for osteopenia: those groups had higher ORs for IR compared to osteopenia. When obesity was defined by BMI, obesity co-existent groups had higher ORs for IR than the obesity non-coexistent groups. The ORs for IR were not significantly different within obesity co-existent groups or obesity non-coexistent groups. CONCLUSIONS: Combinations of co-existent osteopenia, obesity, and/or sarcopenia had different associations with IR according to obesity classification methods and consideration of BMI adjustment. Osteosarcopenic obesity may not have a stronger association with IR compared to obesity only and obesity co-existent other conditions.

Comparison of the associations between appendicular lean mass adjustment methods and cardiometabolic factors.

BACKGROUND AND AIMS: To compare the cross-sectional and longitudinal associations between appendicular lean mass (ALM) and cardiometabolic risk factors according to body-size adjustment methods and the contributions of genetic and/or environmental factors to the correlations between those traits. METHODS AND RESULTS: Regression coefficients per sex-specific 1 standard deviation in bodyweight (wt), body mass index (BMI), or height-squared (ht2) adjusted ALM (assessed using a dual-energy X-ray absorptiometer (DXA) and a bioelectrical impedance analyzer (BIA) at baseline)/changes in these indices (assessed using BIA) were compared in terms of their associations with blood pressure (BP), lipid profiles, and insulin resistance profiles in 2655 participants for cross-sectional analysis and 332 participants for longitudinal analysis (follow-up time, 32.2 ± 7.9 months). A bivariate genetic analysis of the genetic/environmental cross-trait correlations was conducted to determine their cross-sectional relationships. After adjusting for sociodemographic factors, health behaviors, and BMI in the analysis for ALM/ht2, ALM/wt and ALM/BMI had favorable associations with all cardiometabolic risk factors, while ALM/ht2 had favorable associations with some risk factors. In longitudinal associations, changes in ALM/wt and ALM/BMI had inverse associations with increments of lipid profiles, insulin, and homeostasis model assessment of insulin resistance (HOMA), while change in ALM/ht2 did not have associations with increments of cardiometabolic risk factors. ALM/ht2 had genetic correlations with seven of nine risk factors; ALM/wt and ALM/BMI had correlations with three and one risk factors, respectively. CONCLUSION: ALM/wt and ALM/BMI are better indicators for cardiometabolic risk factors; genetic factors may contribute more to the correlations between ALM/ht2 and those traits.

Moderation Effect of Handgrip Strength on the Associations of Obesity and Metabolic Syndrome With Fatty Liver in Adolescents.

INTRODUCTION/BACKGROUND: This study aimed to evaluate the effect of handgrip strength on the associations of body mass index and metabolic syndrome with an indicator of nonalcoholic fatty liver disease in adolescents. METHODOLOGY: In data of 1690 adolescents aged 10-18 yr from the Korea National Health and Nutrition Examination Survey 2014-2016, alanine amino-transferase levels, age, sex, bodyweight-, sex-, and age-standardized handgrip strength, age- and sex-specific body mass index Z-scores, and metabolic syndrome severity scores were assessed. Nonalcoholic fatty liver disease was defined based on alanine amino-transferase levels (boys ≥52U/L, girls ≥44U/L) in adolescents who were overweight. Moderation analysis via the PROCESS procedure was performed. RESULTS: The prevalence of nonalcoholic fatty liver disease was 1.5% among all adolescents and 6.7% among those who were overweight. In all adolescents and adolescents who were overweight, age- and sex-specific body mass index Z-scores and metabolic syndrome scores had positive associations with nonalcoholic fatty liver disease after adjusting for bodyweight-, sex-, and age-standardized handgrip strength. Bodyweight-, sex-, and age-standardized handgrip strength had an inverse association with nonalcoholic fatty liver disease after adjusting for metabolic syndrome scores, and this association became nonsignificant after adjusting for age- and sex-specific body mass index Z-scores. There were positive associations between age- and sex-specific body mass index Z-scores and alanine amino-transferase levels when bodyweight-, sex-, and age-standardized handgrip strength values were ≤-0.13 in overweight adolescents and ≤0.74 in all adolescents, whereas these associations were nonsignificant or negative above those cut-off values. These cut-off values of bodyweight-, sex-, and age-standardized handgrip strength for the relationship between metabolic syndrome scores and alanine amino-transferase levels were -0.15 in overweight adolescents and 0.55 in all adolescents. CONCLUSIONS: A higher bodyweight-, sex-, and age-standardized handgrip strength may attenuate the risk of obesity and metabolic syndrome for an indicator of nonalcoholic fatty liver disease in adolescents.

Association between urinary urgency and falls among rural dwelling older women.

AIM: To examine the association between urinary urgency and falls in older women living in rural areas in South Korea. DESIGN: A secondary analysis was conducted using cross-sectional data. METHODS: This study used dataset obtained from 246 women aged 65 years or older living in 15 rural mountain communities in South Korea between February 2016-March 2016. Falls were measured by self-reports including the number, location, reasons of falls during the past year. Frequency of urinary urgency and nocturia were assessed by self-reports. Covariates included age, body mass index, self-reported health problems. Mixed-effects negative binomial regression was used to analyse the association between urinary urgency and the number of falls. RESULTS: The mean age of the 246 women was 77.3 years. Among the sample, 30.1% experienced at least one fall in the past year and 16% had required hospital treatments. The analysis showed that urinary urgency and osteoporosis were significantly associated with a greater number of falls after adjusting for other covariates. Among those who had experienced falls, nearly 60% reported that the reasons for falls were environmental factors, such as slippery floors or uneven sidewalks/thresholds. CONCLUSION: Improving urinary urgency may be a strategy to decrease the fall risk in older women. Accordingly, community nurses can provide intervention programs on lifestyle and behavioural changes such as bladder training, dietary modification and pelvic floor muscle training. Interventions for fall prevention need to be developed while considering the unique features of indoor and outdoor environments. IMPACT: The findings have implications for healthcare providers and policy makers with regard to the development of safer indoor and outdoor environments for older women living in rural areas by remodelling their residential spaces and neighbourhoods. In addition, more prospective studies using larger samples are needed to investigate the causal mechanism between urinary urgency and falls.

Eating behavior and metabolic syndrome over time.

PURPOSE: We evaluated the longitudinal associations between eating behaviors (EB) and risk of metabolic syndrome (MetS). METHODS: We obtained complete data on EB, assessed using the Dutch Eating Behavior Questionnaire, and MetS components at baseline and follow-up. Participants included 1876 individuals (704 men, 1172 women; mean age, 45.0 ± 12.8 years) from those participating in the Korean Healthy Twin study. A generalized estimating equation model was applied, with sociodemographic factors, health-related factors, follow-up interval, and EB (baseline and changes over time) as independent factors. RESULTS: MetS at baseline was 21.5%, while incident MetS and persistent MetS were 12.0% and 66.6%, respectively, at the 3.13 ± 1.38 years follow-up period. In men, baseline restrained EB had positive associations with concurrent MetS (odds ratio [95% confidence interval] per 1 point increase in the score, 1.55 [1.33-1.81]) and persistent MetS (1.53 [1.16-2.01]); baseline external EB and change in external EB had positive associations with persistent MetS (1.56 [1.04-2.33], 1.37 [1.01-2.22], respectively). In women, baseline restrained EB had a positive association with concurrent MetS (1.14 [1.01-1.30]); baseline external EB had an inverse association with persistent MetS (0.71[0.52-0.98]); baseline emotional EB had positive associations with concurrent, incident, and persistent MetS (1.23 [1.01-1.50], 2.14 [1.50-3.06], and 1.92 [1.40-2.64], respectively); and change in emotional EB had positive associations with incident and persistent MetS (1.50 [1.05-2.15], 1.62 [1.14-2.29], respectively). CONCLUSION: Higher restrained and external EB, and an increase in external EB in men; and higher restrained and emotional EB, and an increase in emotional EB in women may be associated with increased risk of concurrent, incident, or persistent MetS. LEVEL OF EVIDENCE: III, cohort study.

Estimation of weight status and weight-loss efforts in Korean adults with non-obesity considering metabolic syndrome.

PURPOSE: To examine whether metabolic syndrome (MetS) is related to estimation of weight status and weight-loss efforts in Korean adults with non-obesity. METHODS: In 4345 men and 6387 women in non-obese Koreans (age 49.2 ± 16.7 years, BMI < 25 kg/m2) participating in the 2011-2013 Korean National Health and Nutrition Examination Survey, the presence/absence of MetS using the harmonized criteria, and weight perception and weight-loss efforts using questionnaires were assessed. Estimation of weight status was determined as underestimation, correct estimation, and overestimation based on differences between perceived weight categories and BMI-based categories. RESULTS: 15.7% in men and 12.6% in women with BMI < 25 kg/m2 had the MetS. After adjusting for sociodemographic factors, health-related behaviors, treatment of cardiovascular diseases and cardiovascular risk factors, and BMI-based categories, correct estimation and overestimation of weight status in men [odds ratio (95% CI), 1.58 (1.29-1.92); 2.82 (1.48-5.38)], and women [1.53 (1.26-1.86); 1.59 (1.09-2.31)] were positively associated with the presence of MetS compared to those with underestimation of weight status. After adjusting for weight estimation, sociodemographic factors, health-related behaviors, and treatment of cardiovascular diseases and cardiovascular risk factors, weight-loss efforts were positively associated with the presence of MetS [1.66 (1.33-2.08) in men, 1.31 (1.07-1.61) in women] in all subjects, and number of MetS components [1.28 (1.02-1.62) per 1 more component] in those with MetS. CONCLUSIONS: In non-obese individuals, correct estimation and overestimation of weight status may be more likely to identify individuals with MetS and concurrent MetS may increase weight-loss efforts regardless of weight estimation. LEVEL OF EVIDENCE: Level III, evidence obtained from a case-control observational study.

Genetic and environmental relationships between eating behavior and symptoms of anxiety and depression.

PURPOSE: To assess gender-specific genetic and environmental correlations between depressive and anxiety symptoms, and concurrent and follow-up eating behavior in Korean twins and their family members. METHODS: Center for Epidemiological Studies Depression Scale and State-Trait Anxiety Inventory were used to measure depressive and anxiety symptoms in subjects. To assess concurrent and follow-up relationships of the symptoms with eating behavior domains (restrained, emotional, and external eating), the Dutch Eating Behavior Questionnaire was administered to 2359 subjects at baseline (men, 48.5%; 42.0 ± 12.7 years; monozygotic twins, 33.7%) and to 1169 subjects at follow-up (men, 45.9%; 44.9 ± 11.6 years; monozygotic twins, 41.0%). A mixed linear model and bivariate analysis were applied. RESULTS: After adjusting for age, twin and family effects, income, education, smoking status, alcohol use, exercise, and body mass index, depressive and anxiety symptoms were positively associated with concurrent and follow-up emotional and external eating, but not with restrained eating. The effect size of association with emotional eating increased in men in men over time, but decreased in women. Common genetic and environmental correlations showed a difference between genders, and their strength changed with time. Nevertheless, common genetic correlations were found between depressive and anxiety symptoms, and concurrent emotional eating, in both genders. There were common environmental correlations between anxiety symptoms, and concurrent restrained and emotional as well as follow-up emotional eating, in both genders. CONCLUSIONS: There are similarities and differences in genetic and environmental relationships between depressive and anxiety symptoms and eating behaviors, based on gender and time of assessment. LEVEL OF EVIDENCE: Level III, cohort study.

Sex-Specific Associations of Risk-Based Alcohol Drinking Level with Cardiovascular Risk Factors and the 10-Year Cardiovascular Disease Risk Scores.

BACKGROUND: To assess sex-specific associations between risk-based alcohol drinking levels and the 10-year cardiovascular disease (CVD) risk scores and cardiovascular (CV) risk factors. METHODS: Data from 9,995 Koreans (4,249 men, 5,746 women), aged 40 to 79 years who did not have CVD and participated in the 2011 to 2013 Korea National Health and Nutrition Examination Survey, were used to assess risk-based alcohol drinking levels in the past year (no drinking, drinking at low risk, and drinking at risk) categorized by the National Institute on Alcohol Abuse and Alcoholism, components of the 10-year CVD risk scores using the Adult Treatment Panel III risk score and the 10-year hard atherosclerotic CVD risk score, CV risk factors, and confounding factors (age, smoking status, body mass index, educational attainment, income level, and physical activity). RESULTS: Drinking levels had positive associations with blood pressure and levels of glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C) and inverse associations with levels of low-density lipoprotein cholesterol and non-HDL-C and ratio of total cholesterol (TC) to HDL-C in men, while higher drinking levels were associated with higher HDL-C levels and lower ratio of TC to HDL-C in women after adjusting for confounding factors (p for trend < 0.001). With respect to the 10-year CVD risk scores, higher drinking levels were associated with lower scores in both sexes (p for trend < 0.001). CONCLUSIONS: Risk-based drinking levels were more likely to have dose-dependent associations with CV risk factors in men than in women and had inverse relationships with 10-year CVD risk in both men and women.

Association Between Excessive Alcohol Consumption and Echocardiographic Parameters According to the Presence of Flushing Reaction in Korean Men: A Community-Based Study.

BACKGROUND: The objective of this study was to investigate the effect of excessive alcohol consumption on heart reflected by various echocardiographic parameters according to the presence or absence of flushing reaction that might reflect acetaldehyde metabolism. METHODS: A total of 854 Korean men without significant cardiovascular diseases who underwent echocardiography and participated in the Korean Healthy Twin Study were used as subjects of this study. These subjects were classified into 3 categories: nondrinker, moderate drinker (≤196 g/wk), and heavy drinker (>196 g/wk) within 2 strata of flushing reaction to alcohol drinking. Association between echocardiographic measurements and categories of the amount of alcohol consumption considering flushing reaction were evaluated using mixed linear regression model. RESULTS: The proportion of flushers among drinkers was 39.5% (278 of 703). In stratified analysis by flushing reaction, nonflushers showed significantly higher left ventricular mass index (ß: 4.605; 95% CI: 0.966, 8.243) and significantly lower ratio of peak early diastolic velocities (E peak) over peak late diastolic velocities of mitral inflow (ß: -0.103; 95% CI: -0.198, -0.008) in heavy drinkers compared to nondrinkers. Flushers showed significantly higher left atrial (LA) volume index (ß: 2.712; 95% CI: 0.456, 4.968) in heavy drinkers and significantly lower ratio of E peak over the peak early diastolic mitral annular velocities (ß: -0.493; 95% CI: -0.902, -0.085) in moderate drinkers compared to nondrinkers. However, the interaction according to flushing reaction was only statistically significant for the association between alcohol consumption and LA volume index (p for interaction = 0.004). CONCLUSIONS: Alcohol consumption is associated with changes in cardiac structure and function. Such association might be influenced by acetaldehyde metabolism.

Relative handgrip strength in relation to depressive mood and suicidal ideation in Koreans using the 2015 KNHANES data.

OBJECTIVES: This study aimed to examine the association of relative handgrip strength (RHGS) with depressive mood and suicidal ideation. METHODS: A cross-sectional study was conducted among 2167 men and 2643 women (aged 50.9 years ± 16.7 years) who participated in the 2015 Korean National Health and Nutrition Examination Survey. RHGS was defined by the handgrip strength/body mass index (BMI) ratio. Depressive mood and suicidal ideation were assessed using self-reported questionnaires. Logistic regression analysis was conducted after adjusting for sex, concurrent illness, age, education, income, smoking status, alcohol use, physical activity, and depressive mood (in the analysis for suicidal ideation). RESULTS: Among participants, 4.0% men and 5.7% women reported serious suicidal ideation while 9.5% men and 16.0% women reported serious depressive mood. After adjusting for confounding factors, RHGS was associated with depressive mood (odds ratio [95% confidence interval] per RHGS [kg/BMI], 0.82 [0.69-0.99]) and suicidal ideation (0.73 [0.54-0.99]). In sex-specific relationship, RHGS was associated with depressive mood and suicidal ideation in women (0.71 [0.55-0.93] and 0.54 [0.34-0.85], respectively) but not in men. CONCLUSIONS: Poorer RHGS indicates higher risk of depressive mood as well as suicidal ideation regardless of depressive mood among women.

Blood mercury concentration in relation to metabolic and weight phenotypes using the KNHANES 2011-2013 data.

PURPOSE: We assessed the association of blood mercury concentration with metabolic and weight phenotypes. METHODS: Blood mercury concentration, metabolic syndrome components, and body mass index (BMI) were measured in 6006 Korean adults (2963 men, 3043 women, mean age 44.7 ± 14.7 years), using the 2011-2013 Korean National Health and Nutrition Examination Survey data. Metabolic and weight phenotypes were classified based on BMI and metabolic syndrome (MetS) presence as metabolically healthy and normal weight (MHNW), metabolically unhealthy and normal weight (MUNW), metabolically healthy and obese (MHO), and metabolically unhealthy and obese (MUO). RESULTS: The geometric mean of blood mercury concentration was 3.37 µg/L (95% CI 3.32-3.43). A higher quartile of blood mercury concentration was associated with older age, male sex, higher education, alcohol use, current smoking, low physical activity, greater energy intake, and hypertension history. After adjusting for confounding factors (age, sex, education, income, health behaviors, and energy intake), blood mercury concentration tended to increase across the MHNW, MUNW, MHO, and MUO groups in all subjects and each sex (P for trend < 0.01). Compared to the lowest mercury quartile group, adjusted odds ratios (95% CI) for MHO and MUO in those with the highest mercury quartile were, respectively, 1.67 (1.34, 2.09) and 2.02 (1.59, 2.56) in all subjects: 1.58 (1.25, 1.99) and 1.72 (1.37, 2.16) for men; 1.33 (0.94, 1.88) and 1.90 (1.34, 2.70) for women. CONCLUSIONS: Blood mercury concentration was associated with both metabolic syndrome and obesity, and the association was dose dependent across metabolic and weight phenotypes.