A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study

Yeo, Yohwan,Ma, Seung Hyun,Park, Sue Kyung,Chang, Soung-Hoon,Shin, Hai-Rim,Kang, Daehee,Yoo, Keun-Young The Korean Society for Preventive Medicine 2013 Journal of Preventive Medicine and Public Health Vol.46 No.5

Objectives: Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea. Methods: The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines. Results: The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ${\leq}5$ hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ${\geq}10$ hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ${\geq}60$ years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ${\leq}5$ hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (${\leq}5$ and ${\geq}10$ hours). Conclusions: Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

Viral Hepatitis and Liver Cancer in Korea: an Epidemiological Perspective

Yeo, Yohwan,Gwack, Jin,Kang, Seokin,Koo, Boyeon,Jung, Sun Jae,Dhamala, Prakash,Ko, Kwang-Pil,Lim, Young-Khi,Yoo, Keun-Young Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

In the past, hepatitis B virus (HBV) infection was endemic in the general Korean population. The association of HBV infection with the occurrence of liver cancer has been well demonstrated in several epidemiologic studies. While the mortality rates of liver cancer in Korea have decreased steadily over the last decade, the presence of hepatitis B surface antigen (HBsAg) in mothers remains high at 3-4%, and 25.5% of these HBsAg positive mothers are positive for hepatitis B e antigen (HBeAg). HBV infection caused almost a quarter of hepatocellular carcinoma (HCC) cases and one-third of deaths from HCC. These aspects of HBV infection prompted the Korean government to create a vaccination program against HBV in the early 1980s. In 1995, the Communicable Disease Prevention Act (CDPA) was reformed, and the government increased the number of HBV vaccines in the National Immunization Program (NIP), driving the vaccination rate up to 95%. In 2000, the National Health Insurance Act (NHIA) was enacted, which provided increased resources for the prevention of perinatal HBV infection. Then in 2002, the Korean government, in conjunction with the Korean Medical Association (KMA), launched an HBV perinatal transmission prevention program. The prevalence of HBsAg in children had been high (4-5%) in the early 1980s, but had dropped to below 1% in 1995, and finally reached 0.2% in 2006 after the NIP had been implemented. After the success of the NIP, Korea finally obtained its first certification of achievement from the Western Pacific Regional Office of the World Health Organization (WPRO-WHO) for reaching its goal for HBV control. An age-period-cohort analysis showed a significant reduction in the liver cancer mortality rate in children and adolescents after the NIP had been implemented. In addition to its vaccination efforts, Korea launched the National Cancer Screening Program (NCSP) for 5 leading sites of cancer, including the liver, in 1999. As a consequence of this program, the 5-year liver cancer survival rate increased from 13.2% (1996-2000) to 23.3% (2003-2008). The development of both the primary and secondary prevention for liver cancer including HBV immunization and cancer screening has been of critical importance.

Relationship between Serum Testosterone Level and Carotid Intima-Media Thickness among Korean Men and Postmenopausal Women

Miso Kim,Yohwan Yeo,Yun-Mi Song 대한가정의학회 2022 Korean Journal of Family Medicine Vol.43 No.6

Background: Given that the role of serum testosterone on incident cardiovascular disease has been uncertain, it is necessary to find out the relationship between serum testosterone and carotid atherosclerosis.Methods: The study participants included 1,302 Korean adults (873 men and 429 postmenopausal women) who participated in the Healthy Twin Study and were not receiving androgen deprivation therapy. The participants were classified into three groups: men aged <40 and ≥40 years and postmenopausal women. Total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations were measured using electrochemiluminescence immunoassays, and free testosterone (cFT) levels were calculated using Vermeulen’s method. Carotid intima-me-dia thickness (IMT) was measured at three levels using a high-resolution B-mode ultrasound equipped with a 7-MHz linear transducer. The associations between sex hormone concentrations and carotid IMT were evaluated using a mixed linear regression analysis.Results: After adjusting for cardiovascular risk factors, TT was found to be inversely associated with common carot-id IMT in men aged ≥40 years, with a 4.5% decrease in common carotid IMT for every one-standard deviation in-crease in TT concentration (P=0.0063). In contrast, TT was not significantly associated with carotid IMT in all seg-ments in men aged <40 years and postmenopausal women. Additionally, SHBG and cFT were not associated with carotid IMT in any segment.Conclusion: The significant association between TT level and common carotid IMT in men aged ≥40 years sug-gests that decreased testosterone levels are involved in the development of atherosclerosis in men.

Dietary Intake and Nutritional Status in Young and Middle-Aged Adults according to the Meal Frequency from the Korea National Health and Nutritional Survey

Junhee Park,Yohwan Yeo,Jun Hyun Yoo 대한가정의학회 2022 Korean Journal of Family Medicine Vol.43 No.5

Background: Previous studies have shown a close relationship between skipping breakfast and nutritional defi-ciency. However, the impact of regular eating, including lunch and dinner, has not been studied well. We explored the correlation between regularity and frequency of daily meals and nutritional status.Methods: We analyzed Korea National Health and Nutrition Examination Surveys between 2016 and 2018. A total of 7,725 adults aged 19–49 years were classified into four groups according to the regularity of meal intake: three-meal regular diet (3MRD), two-meal regular diet, one-meal regular diet, and irregular diet (IRD). Food and nutrient intake was assessed using the 24-hour recall method and estimated by a generalized linear model in complex sam-ple weight variables.Results: In IRD, there were relatively more females who were not married, lived alone, or reported low levels of ed-ucation. As subjects ate more meals, more people felt thinner and healthier by themselves. Dietary intake of cereal, vegetables, seaweed, and fiber was directly proportional to the number of regular meals as well as essential compo-nents such as water, carbohydrates, protein, fat, and micronutrients. Contrarily, alcohol and beverage consumption was inversely proportional to the number of regular meals. Intake level of legumes, fish, fruits, seasonings, milk, oils, sugars, and cholesterol was consistent regardless of meal frequency.Conclusion: Our findings suggest that 3MRD showed nutrient adequacy and a healthier profile on body weight, body mass index, waist circumference, blood pressure, serum fasting glucose, total cholesterol, and triglyceride.

Plasma phytoestrogens concentration and risk of colorectal cancer in two different Asian populations

Ko, Kwang-Pil,Yeo, Yohwan,Yoon, Ji-Hye,Kim, Cheong-Sik,Tokudome, Shinkan,Ngoan, Le Tran,Koriyama, Chihaya,Lim, Young-Khi,Chang, Soung-Hoon,Shin, Hai-Rim,Kang, Daehee,Park, Sue K.,Kang, Chul Hwan,Yoo, Elsevier 2018 Clinical nutrition Vol.37 No.5

<P><B>Summary</B></P> <P><B>Background & aims</B></P> <P>To evaluate the relationship between phytoestrogen and colon cancer risk, we quantified plasma isoflavones (Genistein and Daidzein) and lignan (enterolactone) in a Korean nested case-control study and conducted replication study in a Vietnamese case-control study.</P> <P><B>Methods</B></P> <P>Study populations of 101 cases and 391 controls were selected from the Korean Multicenter Cancer Cohort which was constructed from 1993 to 2004. For replication study, Vietnamese hospital-based case-control subjects of 222 cases and 206 controls were selected from 2003 to 2007. The concentrations of plasma genistein, daidzein, and enterolactone were quantified by liquid chromatography-mass spectrometry. Logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CIs), and meta-analysis was conducted to estimate combined ORs (CORs) and 95% Cis of Korean and Vietnamese population in 2014.</P> <P><B>Results</B></P> <P>Genistein showed a continual decrease in colorectal cancer risk according to level up of the concentration categories in Korean and Vietnamese population (<I>P</I> for trend = 0.032, and 0.001, respectively) and a significantly decreased risk was found at the highest concentration of genistein and daidzein (for the highest category compared to the lowest: COR (95% CI) = 0.46 (0.30–0.69), and COR (95% CI) = 0.54 (0.36–0.82)). When the study population was stratified, the beneficial relationship of genistein with colorectal cancer was observed regardless of sex and anatomical subtype. However, enterolacton level was not associated with colorectal cancer risk.</P> <P><B>Conclusions</B></P> <P>High plasma levels of isoflavones had relationship with a decreased risk of colorectal cancer, regardless of different ethnic background.</P>

Current Status and Physicians’ Perspectives of Childhood Cancer Survivorship in Korea: A Nationwide Survey of Pediatric Hematologists/Oncologists

Lee Ji Won,Yeo Yohwan,Ju Hee Young,Cho Hee Won,Yoo Keon Hee,Sung Ki Woong,Koo Hong Hoe,Jeong Su-Min,Shin Dong Wook,Baek Hee Jo,Kook Hoon,Chung Nack-Gyun,Cho Bin,Kim Young Ae,Park Hyeon Jin,Song Yun-Mi 대한의학회 2023 Journal of Korean medical science Vol.38 No.29

Background: Data on the status of long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) in Korea is lacking. This study was conducted to evaluate the current status of LTFU care for CCSs and relevant physicians’ perspectives. Methods: A nationwide online survey of pediatric hematologists/oncologists in the Republic of Korea was undertaken. Results: Overall, 47 of the 74 board-certified Korean pediatric hematologists/oncologists currently providing pediatric hematology/oncology care participated in the survey (response rate = 63.5%). Forty-five of the 47 respondents provided LTFU care for CCSs five years after the completion of primary cancer treatment. However, some of the 45 respondents provided LTFU care only for CCS with late complications or CCSs who requested LTFU care. Twenty of the 45 respondents oversaw LTFU care for adult CCSs, although pediatric hematologists/ oncologists experienced more difficulties managing adult CCSs. Many pediatric hematologists/oncologists did not perform the necessary screening test, although CCSs had risk factors for late complications, mostly because of insurance coverage issues and the lack of Korean LTFU guidelines. Regarding a desirable LTFU care system for CCSs in Korea, 27 of the 46 respondents (58.7%) answered that it is desirable to establish a multidisciplinary CCSs care system in which pediatric hematologists/oncologists and adult physicians cooperate. Conclusion: The LTFU care system for CCS is underdeveloped in the Republic of Korea. It is urgent to establish an LTFU care system to meet the growing needs of Korean CCSs, which should include Korean CCSs care guidelines, provider education plans, the establishment of multidisciplinary care systems, and a supportive national healthcare policy.

Relationship between Metabolic Syndrome and Hearing Loss: Korea National Health and Nutritional Survey

Ji-Young Kim,In Young Cho,Yohwan Yeo,Yun-Mi Song 대한가정의학회 2021 Korean Journal of Family Medicine Vol.42 No.1

Background: We aimed to evaluate the association between metabolic syndrome (MetS) and hearing loss (HL) in light of noise exposure in Korean middle-aged adults. Methods: Subjects were 10,356 adults (4,509 males, 5,847 females) aged 40–80 years, who completed audiometric tests and laboratory examinations as part of the Korea National Health and Nutrition Examination Survey between 2010 and 2012. MetS was defined according to the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP III) and International Diabetes Federation (IDF). Low-frequency HL was defined as pure tone averages >25 decibels (dB) at low frequencies (0.5, 1, and 2 kilohertz [kHz]). High-frequency HL was defined as pure tone averages >25 dB at high frequencies (3, 4, and 6 kHz). Odd ratios (OR) and 95% confidence intervals (CI) of MetS associated with each HL type were estimated using multiple logistic regression analysis after adjusting for covariates and taking into consideration sampling weight. Results: Thirty eight point one percent and 28.6% met the MetS by NCEP III and IDF criteria, respectively. Prevalence of HL was 29.3% and 63.9% for low- and high-frequency HL, respectively. MetS defined by NCEP III was associated with higher risk of high-frequency HL (OR, 1.35; 95% CI, 1.05–1.73), while MetS by IDF criteria was not. The interaction by the noise exposure on the MetS and high-frequency HL was not significant (P-interaction= 0.100). There was no association between MetS and low-frequency HL, regardless of applied diagnostic criteria for MetS. Conclusion: Our findings suggest MetS is associated with high-frequency HL in people with exposure to noise.

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea

Mun Young Yoo,이정권,Ji In Chung,Yohwan Yeo,In Young Cho 대한가정의학회 2021 Korean Journal of Family Medicine Vol.42 No.4

Background: As indoor activity increases with modern lifestyles changes, reduced exposure to sunlight may lead to reduced vitamin D synthesis. Previous studies demonstrated that increased vitamin D level is associated with decreased risk of colon cancer; therefore, this study attempted to determine the association between vitamin D and colon polyps, which may be precancerous lesions, in participants who underwent colonoscopy exams. Methods: A total of 31,004 participants who underwent routine health checkups, including vitamin D level and colonoscopy, at Samsung Medical Center in South Korea from 2010 to 2018 were included in the study. Colorectal polyps were diagnosed through biopsy after performing colonoscopy exams. Participants were categorized into three groups according to level of vitamin D (deficient: <20 ng/mL), insufficient: 20≤ vitamin D <30 ng/mL, and sufficient: ≥30 ng/mL). We analyzed the presence of colorectal polyps according to vitamin D level, and performed multiple logistic regression analyses for the association between vitamin D level and colorectal polyps. Results: About 50% of participants had colorectal polyps (hyperplastic polyp, n=4,864; adenomatous polyp, n=10,470; adenocarcinoma, n=24). There were no significant associations between vitamin D categories and colorectal polyp and colorectal cancer. However, when further analyzing by type of polyp, the risk of hyperplastic polyps significantly decreased with increasing vitamin D levels (P for trend=0.006). Conclusion: We did not find evidence for an association between vitamin D and overall colorectal polyps; however, we observed a trend for decreased odds of hyperplastic polyps with increased vitamin D levels in comparison to vitamin D deficient subjects.

Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study

마승현,박보영,양재정,En-Joo Jung,Yohwan Yeo,황윤지,장성훈,신해림,강대희,유근영,박수경 대한예방의학회 2012 Journal of Preventive Medicine and Public Health Vol.45 No.6

Objectives: Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). Methods: Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. Results: Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI ≥25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. Conclusions: This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.

Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study

Ma, Seung Hyun,Park, Bo-Young,Yang, Jae Jeong,Jung, En-Joo,Yeo, Yohwan,Whang, Yungi,Chang, Soung-Hoon,Shin, Hai-Rim,Kang, Daehee,Yoo, Keun-Young,Park, Sue Kyung The Korean Society for Preventive Medicine 2012 예방의학회지 Vol.45 No.6

Objectives: Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). Methods: Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. Results: Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 $kg/m^2$), lean subjects with diabetes (BMI <21 $kg/m^2$) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI ${\geq}25kg/m^2$) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. Conclusions: This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.