Development and validation of prediction equations for the assessment of muscle or fat mass using anthropometric measurements, serum creatinine level, and lifestyle factors among Korean adults

Lee Gyeongsil,Chang Jooyoung,Hwang Seung-sik,Son Joung Sik,Park Sang Min 한국영양학회 2021 Nutrition Research and Practice Vol.15 No.1

BACKGROUND/OBJECTIVES: The measurement of body composition, including muscle and fat mass, remains challenging in large epidemiological studies due to time constraint and cost when using accurate modalities. Therefore, this study aimed to develop and validate prediction equations according to sex to measure lean body mass (LBM), appendicular skeletal muscle mass (ASM), and body fat mass (BFM) using anthropometric measurement, serum creatinine level, and lifestyle factors as independent variables and dual-energy X-ray absorptiometry as the reference method. SUBJECTS/METHODS: A sample of the Korean general adult population (men: 7,599; women: 10,009) from the Korean National Health and Nutrition Examination Survey 2008–2011 was included in this study. The participants were divided into the derivation and validation groups via a random number generator (with a ratio of 70:30). The prediction equations were developed using a series of multivariable linear regressions and validated using the Bland–Altman plot and intraclass correlation coefficient (ICC). RESULTS: The initial and practical equations that included age, height, weight, and waist circumference had a different predictive ability for LBM (men: R2 = 0.85, standard error of estimate [SEE] = 2.7 kg; women: R2 = 0.78, SEE = 2.2 kg), ASM (men: R2 = 0.81, SEE = 1.6 kg; women: R2 = 0.71, SEE = 1.2 kg), and BFM (men: R2 = 0.74, SEE = 2.7 kg; women: R2 = 0.83, SEE = 2.2 kg) according to sex. Compared with the first prediction equation, the addition of other factors, including serum creatinine level, physical activity, smoking status, and alcohol use, resulted in an R2 that is higher by 0.01 and SEE that is lower by 0.1. CONCLUSIONS: All equations had low bias, moderate agreement based on the Bland–Altman plot, and high ICC, and this result showed that these equations can be further applied to other epidemiologic studies.

Risk of Osteoporotic Fractures Among Obese Women Based on Body Mass Index and Waist Circumference: A Nationwide Cohort in South Korea

( Gyeongsil Lee ),( Seulggie Choi ),( Yoosun Cho ),( Sang Min Park ) 한국임상영양학회 2022 Clinical Nutrition Research Vol.11 No.1

We evaluated the association between obesity status by body mass index (BMI) or waist circumference (WC) and osteoporotic fracture risk. We collected data of 143,673 women with a mean age of 58.5 years without history of osteoporotic fracture from the Korean National Health Insurance Service Cohort. Participants were divided into four groups according to obesity by BMI and WC, normal BMI/WC (BMI 18.5-24.9 kg/㎡ and WC < 85 cm, reference), obese BMI/normal WC (BMI ≥ 25 kg/㎡ and WC < 85 cm), normal BMI/obese WC (BMI < 25 kg/㎡ and WC ≥ 85 cm), and obese BMI/WC (BMI ≥ 25 kg/㎡ and WC < 85cm). Cox proportional hazards regression analyses were performed to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for the subsequent median 6.0 years, which were adjusted for age, socioeconomic status, lifestyle, morbidity index, and osteoporosis medication. Compared with the normal group, normal BMI/obese WC was associated with a higher osteoporotic fracture risk after multivariable adjustment (HRs [95% CI], 1.13 [1.05-1.21]), and obese BMI/normal WC was associated with a lower osteoporotic fracture risk (0.89 [0.84-0.94]). Obese BMI/normal WC was associated with a lower risk for hip fractures (0.75 [0.57-0.99]). Obese BMI/normal WC was associated with decreased risk of osteoporotic fracture, whereas normal BMI/obese WC was associated with increased risk of osteoporotic fracture compared with the normal group among East Asian women in their late 40s or more.

Association between Suicidal Ideation and Causes of Primary Care Visits: A Cross-Sectional Study to Identify Patients with Suspected Suicidal Ideation

Lee Gyeongsil,Kim Jung-Ha 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.7

Objective Suicide victims are likely to visit a primary care provider within 1 month of the suicide attempt. However, it is impossible for primary care providers to screen all patients for suicidal ideation or attempts. We, therefore, aimed to investigate potential differences in the chief diagnoses received by primary care patients with and without suicidal ideation, as this information may provide clues and predict patients at risk of suicide.Methods This cross-sectional study included 1,211 Korean adults aged ≥20 years who had participated in the Korea National Health and Nutrition Examination Survey during 2014 and provided information about their histories of suicidal ideation and visits to primary care providers. Multiple logistic regression analyses were used to examine whether suicidal ideation was associated with specific diseases after controlling for age, sex, household income, education, occupation, marital status, smoking, alcohol consumption, and physical activity.Results Among primary care patients, the sample-weighted percentage of suicidal ideation was approximately 12%. The diagnoses of neoplasm and mental disorder were associated with a higher likelihood of suicidal ideation {odds ratio (OR) [95% confidence interval (CI)] 8.32 (1.01–68.56) and 6.19 (1.72–22.33), respectively}. Notably, diseases of the musculoskeletal system and connective tissue were also associated with suicidal ideation [OR (95% CI): 1.93 (1.09–3.43)].Conclusion The observed visit patterns and correlations of certain diagnoses with suicidal ideation suggest that primary care physicians should pay attention to patients with relevant disorders, consider screening suicidal ideation, and properly consult to a psychiatrist.

Association of waist circumference with muscle and fat mass in adults with a normal body mass index

Gyeongsil Lee,Seulggie Choi,Sang Min Park 한국영양학회 2021 Nutrition Research and Practice Vol.15 No.5

BACKGROUND/OBJECTIVES: We aimed to investigate the association of waist circumference (WC) with body composition among individuals with a normal body mass index (BMI) to distinguish muscle and fat mass, as both affect health differently. SUBJECTS/METHODS: We analyzed dual-energy X-ray absorptiometry data (derived from the Korean National Health and Nutrition Survey, which includes information on fat and lean mass) of 7,493 adults with a normal BMI. Subjects were categorized into four groups of increasing WC. The fourth group was defined as being centrally obese. Each number of subjects are as follows: 1,870, 695, 231, and 39 among men and 3,054, 1,100, 406, and 98 among women. We conducted a sex-stratified linear regression analysis of body composition according to WC group after adjustments for covariates. RESULTS: We observed a positive association of body fat with increasing WC in both men and women (all P for trend: < 0.001). The adjusted mean values for percent body fat with 95% confidence intervals (CIs) according to the four WC groups in ascending order were 17.8 (17.5-18.3), 21.0 (20.6-21.5), 22.1 (21.5-22.8), and 25.1 (24.2-26.1) in men and 29.7 (29.4-30.0), 32.0 (31.6-32.3), 32.9 (32.4-33.4), and 34.7 (33.2-36.1) in women. However, there was an inverted J-shaped association between muscle mass and WC. The fourth group had a higher percent body fat and lower muscle mass than other groups. The adjusted mean values for appendicular skeletal muscle mass index (kg/m2) with 95% CIs according to the four WC groups in ascending order were 7.55 (7.51-7.59), 7.62 (7.56-7.68), 7.65 (7.56-7.74), and 7.22 (7.04-7.41) in men and 5.83 (5.80-5.85), 5.96 (5.92-6.00), 6.03 (5.96-6.10), and 5.88 (5.73-6.03). CONCLUSIONS: There was a positive association between body fat and WC among individuals with normal BMI; conversely there was an inverted J-shaped association between lean body mass and WC. Our findings support the WC measurement should be included in obesity evaluations for adults with a normal BMI.

The development of a community-based medical education program in Korea

Jung Eun Yoo,Seo Eun Hwang,Gyeongsil Lee,Seung Jae Kim,Sang Min Park,Jong-Koo Lee,Seung-Hee Lee,Hyun Bae Yoon,Ji Eun Lee 한국의학교육학회 2018 Korean journal of medical education Vol.30 No.4

Purpose: The introduction of community-based medical education would help improve the quality of primary care. This paper suggests learning objectives and an educational program for community-based medical education. Methods: The educational program was developed in a 1-day consensus workshop. Twenty experts, including faculty members from family medicine department of a college of medicine in Seoul and community-based preceptors, participated in the program. A needs-assessment survey was conducted among community-based preceptors before the workshop. Through this workshop, we derived learning objectives and a standardized curriculum for community-based medical education. Results: In the questionnaire before the workshop, community-based preceptors voiced concerns over the program’s potential costs and the time required for teaching. The learning objectives and educational programs derived from the workshop’s consensus were consistent with the characteristics of the primary care. Based on the results of this workshop, the joint expert team developed a standard educational program on two core topics: clinical teaching and mentoring. Conclusion: From this curriculum development process, participants could construct a more standardized curriculum for community-based medical education. Future studies are needed to evaluate the long-term outcomes of these educational programs, such as the learners’ satisfaction and achievement.

Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis

김지수,Gyeongsil Lee,박경일,오성원 대한당뇨병학회 2024 Diabetes and Metabolism Journal Vol.48 No.2

Background: There is still a lack of research on which diabetic drugs are more effective in preventing stroke. Our network metaanalysis aimed to compare cerebrovascular benefits among glucose-lowering treatments.Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry for clinical trials from inception through May 25, 2021. We included both prespecified cerebrovascular outcomes and cerebrovascular events reported as severe adverse events. Subgroup analyses were conducted by stroke subtype, publication type, age of patients, baseline glycosylated hemoglobin (HbA1c), duration of type 2 diabetes mellitus, and cardiovascular risks.Results: Of 2,861 reports and 1,779 trials screened, 79 randomized controlled trials comprising 206,387 patients fulfilled the inclusion criteria. In the pairwise meta-analysis, the use of glucagon-like peptide-1 (GLP-1) agonist was associated with a lower risk of total stroke compared with placebo (relative risk [RR], –0.17; 95% confidence interval [CI], –0.27 to –0.07). In the network meta- analysis, only the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitor was associated with a reduction of total stroke, compared with placebo (RR, 0.81; 95% CI, 0.67 to 0.98). In the subgroup analyses, the use of SGLT-2 inhibitor and GLP-1 agonist was associated with a lower risk of stroke in those with high HbA1c (≥8.0) and low-risk of cardiovascular disease, respectively.Conclusion: SGLT-2 inhibitors and GLP-1 agonists were shown to be beneficial for stroke prevention in patients with type 2 diabetes mellitus.

Association of Eating Alone with Depressive Symptoms and Suicidal Ideation among Korean Adults

Joonyoung Park,Gyeongsil Lee 대한가정의학회 2021 Korean Journal of Family Medicine Vol.42 No.3

Background: In recent years, eating dinner alone has become a rising social issue in Korea. Depression is one of the primary health problems that can lead to numerous negative consequences. However, few studies have focused on people who eat alone and the effect of eating alone on depression. We investigated the association between eating dinner alone and depression. Methods: Our cross-sectional study included data from 14,093 Korean adults aged above 19 years old; data were sourced from the Korea National Health and Nutrition Examination Survey in 2014, 2016, and 2018, when the Patient Health Questionnaire (PHQ-9) was used. We classified participants based on their dinner habits: eating alone or social eating. Depression and suicidal ideation among participants were measured using the PHQ-9. Multivariate logistic regression analysis was used to investigate whether eating alone was related to depression or suicidal ideation after adjusting for age, sex, household income, education, alcohol, smoking, exercise, frequency of eating out, and living arrangement. Results: Individuals who ate dinner alone (22.9%) had higher depression and suicidal ideation rates than those who ate with others. Those who ate alone had greater odds ratios (ORs) of depressive symptoms (depression: OR, 1.42; 95% confidence interval [CI], 1.27–1.58; suicidal ideation: OR, 1.49; 95% CI, 1.25–1.78) after adjustment for covariates. The subgroup analysis shows that the odds of suicidal ideation among individuals who eat alone were nonexistent among those who performed regular aerobic exercise. Conclusion: Eating dinner alone is closely associated with depressive symptoms, particularly suicidal ideation. Therefore, providing opportunities to eat with others may be effective for maintaining the mental health of adults.

Effects of the 2008 Global Economic Crisis on National Health Indicators: Results from the Korean National Health and Nutrition Examination Survey

Jung-Hyun Shin,Gyeongsil Lee,Jun-Suk Kim,오형석,Keun-Seung Lee,Yong Hur,Belong Cho 대한가정의학회 2015 Korean Journal of Family Medicine Vol.36 No.4

Background: The relationship between economics and health has been of great interest throughout the years. The accumulated data is not sufficient enough to carry out long-term studies from the viewpoint of morbidity, although Korea National Health and Nutrition Examination Survey (KNHANES) was carried out yearly since 1998 in Korea. Thus, we investigated the effect of the 2008 global economic crisis on health indicators of Korea. Methods: Health indicators were selected by paired t-test based on 2007 and 2009 KNHANES data. Age, gender, body mass index (BMI), smoking, drinking, exercise, education, income, working status, and stress were used as confounding factors, which were analyzed with logistic and probit analyses. Validation was done by comparing gross domestic product (GDP) growth rates and probit analyses results of 2007–2012 KNHANES data. Results: Among several health indicators, the prevalence of hypertension and stress perception was higher after the economic crisis. Factors related with higher hypertension prevalence include older age, male gender, higher BMI, no current tobacco use, recent drinking, lower education levels, and stress perception. Factors related with more stress perception were younger age, female gender, current smoking, lower education levels, and lower income. GDP growth rates, a macroeconomic indicator, are inversely associated with hypertension prevalence with a one-year lag, and also inversely associated with stress perception without time lag. Conclusion: The economic crisis increased the prevalence of hypertension and stress perception. In the case of GDP growth rate change, hypertension was an inversely lagging indicator and stress perception was an inverselyrelated coincident indicator.

Weight Gain After Smoking Cessation and Cardiovascular Events in Young Adults

Kim, Kyuwoong,Choi, Seulggie,Lee, Gyeongsil,Jeong, Su-Min,Kim, Sung Min,Son, Joung Sik,Yun, Jae Moon,Kim, Yeon-Yong,Park, Seong Yong,Park, Sang Min Elsevier Inc. 2019 Journal of the American College of Cardiology Vol.73 No.25

Association between sugar-sweetened beverage consumption and depression and suicidal ideation among Korean adults: a cross-sectional study from the 2014 and 2016 Korean National Health and Nutrition Examination Survey (KNHANES)

Jiyeong Kim,Changbin Hong,Gyeongsil Lee 한국영양학회 2022 Nutrition Research and Practice Vol.16 No.2

BACKGROUND/OBJECTIVES: Sugar-sweetened beverages (SSBs) are regarded as modifiable risk factors for mental health in several populations. Although the consumption of SSBs is steadily increasing in Korea, there is scant evidence regarding the impact of SSB consumption on depression and suicidal ideation. The aim of this study was to investigate the association of SSB consumption with depression and suicidal ideation among adults in Korea. SUBJECTS/METHODS: We used the data for 5,465 participants (2,170 men and 3,295 women) aged ≥ 20 years from the 2014 and 2016 Korea National Health and Nutrition Examination Survey. The subjects were divided into four groups according to SSB consumption using a food frequency questionnaire. Logistic regression analyses were conducted to examine the association of SSB consumption with depression and suicidal ideation, adjusting for sociodemographic, health behavior, and dietary variables. RESULTS: Participants consuming ≥ 1 SSB/day had a significantly higher risk of depression (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.08–2.18; P < 0.001) and suicidal ideation (OR, 2.20; 95% CI, 1.13–4.28; P < 0.001) compared with those in the non-SSB group after adjusting for potential confounding factors. CONCLUSIONS: Our results suggest that SSB consumption is positively associated with depression and suicidal ideation in Korean adults.