Journal of Preventive Medicine and Public Health

Original Articles

The Diabetogenic Effect of Statin Use May Interact With Polygenic Risk Scores for Type 2 Diabetes: Evidence From the UK Biobank: Jong Hyun Park, Kyu-Taek Lim, Jooyeon Lee, Yongjin Gil, Joohon Sung; J Prev Med Public Health. 2025;58(1):92-102. Published online December 11, 2024; DOI: https://doi.org/10.3961/jpmph.24.671

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Abstract Summary PDF Supplementary Material: Objectives
Statins are essential in the prevention of cardiovascular disease; however, their association with type 2 diabetes mellitus (T2DM) risk is concerning. We examined whether genetic susceptibility to T2DM modifies the association between regular statin use and T2DM risk.
Methods
This study included 447 176 individuals from the UK Biobank without baseline diabetes or major cardiovascular disease. Statin use was recorded at baseline, and T2DM incidence was determined using clinical records. Polygenic risk scores (PRS) for T2DM risk were provided by the UK Biobank. Using propensity scores adjusted for age, sex, body mass index, and comorbidities, 14 831 statin users were matched with 37 060 non-users. Cox proportional hazards models were used to estimate the interaction effect of statin use and PRS on T2DM incidence, adjusting for key confounders.
Results
In the propensity-matched cohort, 3675 of 51 891 participants developed T2DM over a mean follow-up period of 13.7 years. Within the top 5% of the PRS distribution, per 1000 person-years, the incidence of T2DM was 15.42 for statin users versus 12.18 for non-users. Among the lowest 5%, the incidence was 1.90 for statin users and 1.65 for non-users. Based on the Cox proportional hazards model, regular statin use was associated with a 1.24-fold increased T2DM risk (95% confidence interval [CI], 1.15 to 1.33). Furthermore, PRS exhibited a significant multiplicative interaction with regular statin use (odds ratio, 1.10; 95% CI, 1.02 to 1.19).
Conclusions
PRS may help identify individuals particularly susceptible to the diabetogenic effects of statins, providing a potential path for personalized cardiovascular disease management.; Summary

Korean summary
스타틴은 심혈관 질환 예방에 필수적이지만, 제2형 당뇨병 발생 위험을 높인다고 알려져 있습니다. 본 연구는 영국 바이오뱅크 데이터를 활용하여, 스타틴 사용과 제2형 당뇨병 다유전자 위험 점수(Polygenic Risk Score, PRS)의 상호작용이 당뇨병 발생 위험에 미치는 영향을 분석했습니다. 연구 결과, PRS가 높은 집단에서는 스타틴 사용이 제2형 당뇨병 발생 위험을 유의하게 증가시켰으나, PRS가 낮은 집단에서는 스타틴 사용이 오히려 당뇨병 위험을 낮추는 경향을 보였습니다. 이러한 결과는 유전적 요인을 고려한 맞춤형 심혈관 질환 예방 전략의 중요성을 시사합니다.

Key Message
This study highlights that the diabetogenic effect of statins interacts significantly with genetic predisposition, as quantified by polygenic risk scores (PRS) for type 2 diabetes mellitus (T2DM). Individuals with high PRS are at a significantly increased risk of developing T2DM with statin use, while those with low PRS may experience a reduced risk. These findings underscore the potential of integrating genetic risk stratification into clinical decision-making to optimize the balance between cardiovascular benefits and T2DM risk in statin therapy.

Discrete-time Survival Analysis of Risk Factors for Early Menarche in Korean Schoolgirls: Yong Jin Gil, Jong Hyun Park, Joohon Sung; J Prev Med Public Health. 2023;56(1):59-66. Published online December 29, 2022; DOI: https://doi.org/10.3961/jpmph.22.428

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Objectives
The aim of this study was to evaluate the effect of body weight status and sleep duration on the discrete-time hazard of menarche in Korean schoolgirls using multiple-point prospective panel data.
Methods
The study included 914 girls in the 2010 Korean Children and Youth Panel Study who were in the elementary first-grader panel from 2010 until 2016. We used a Gompertz regression model to estimate the effects of weight status based on age-specific and sex-specific body mass index (BMI) percentile and sleep duration on an early schoolchild’s conditional probability of menarche during a given time interval using general health condition and annual household income as covariates.
Results
Gompertz regression of time to menarche data collected from the Korean Children and Youth Panel Study 2010 suggested that being overweight or sleeping less than the recommended duration was related to an increased hazard of menarche compared to being average weight and sleeping 9 hours to 11 hours, by 1.63 times and 1.38 times, respectively, while other covariates were fixed. In contrast, being underweight was associated with a 66% lower discrete-time hazard of menarche.
Conclusions
Weight status based on BMI percentiles and sleep duration in the early school years affect the hazard of menarche.

Summary

Korean summary
초경연령의 조기화는 세계적인 현상이나 유독 우리나라에서는 그 단축속도가 매우 빠르나. 그 위험요인은 비만 이외에 확립되어 있지 못하다. 본 연구는 한국아동청소년패널의 2010-16년도까지 추적관찰된 914 명의 여아 자료를 Gompetz 회귀모형 (다중 분절형 생존분석모형)을 통해 분석하였며, 그 결과 과체중은 1년의 초경연령 단축을 유발할 위험도가 정상체중 여아에 비해 1.63배, 수면시간이 충분하지 못한 여아는 충분한 수면을 취하는 여아에 비해 1년의 초경연령 단축이 발생할 위험도가 1.38배 높은 것으로 나타났다.

Citations

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Neighbourhood environment and early menarche among adolescent girls of five countries
Erdenetuya Bolormaa, Taemi Kim, Eunson Gwak, Seung-Ah Choe, Adriane Martin Hilber
The European Journal of Contraception & Reproductive Health Care.2024; 29(6): 263. CrossRef

Blood Triglycerides Levels and Dietary Carbohydrate Indices in Healthy Koreans: Hye Sook Min, Ji Yeon Kang, Joohon Sung, Mi Kyung Kim; J Prev Med Public Health. 2016;49(3):153-164. Published online May 17, 2016; DOI: https://doi.org/10.3961/jpmph.16.014

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Abstract PDF

Objectives
Previous studies have obtained conflicting findings regarding possible associations between indices measuring carbohydrate intake and dyslipidemia, which is an established risk factor of coronary heart disease. In the present study, we examined cross-sectional associations between carbohydrate indices, including the dietary glycemic index (GI), glycemic load (GL), total amount of carbohydrates, and the percentage of energy from carbohydrates, and a range of blood lipid parameters.
Methods
This study included 1530 participants (554 men and 976 women) from 246 families within the Healthy Twin Study. We analyzed the associations using a generalized linear mixed model to control for familial relationships.
Results
Levels of the Apo B were inversely associated with dietary GI, GL, and the amount of carbohydrate intake for men, but these relationships were not significant when fat-adjusted values of the carbohydrate indices were used. Triglyceride levels were positively associated with dietary GI and GL in women, and this pattern was more notable in overweight participants (body mass index [BMI] ≥25 kg/m²). However, total, low-density lipoprotein and high-density lipoprotein cholesterol levels were not significantly related with carbohydrate intake overall.
Conclusions
Of the blood lipid parameters we investigated, only triglyceride levels were positively related with dietary carbohydrate indices among women participants in the Healthy Twin Study, with an interactive role observed for BMI. However, these associations were not observed in men, suggesting that the association between blood lipid levels and carbohydrate intake depends on the type of lipid, specific carbohydrate indices, gender, and BMI.

Summary

Citations

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Zainab Shateri, Irodakhon Rasulova, Milad Rajabzadeh-dehkordi, Moein Askarpour, Abbas Rezaianzadeh, Masoumeh Ghoddusi Johari, Mehran Nouri, Shiva Faghih
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Dietary glycemic load and its association with glucose metabolism and lipid profile in young adults
Ana Campos Fernandes, Ana Rita Marinho, Carla Lopes, Elisabete Ramos
Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(1): 125. CrossRef
Effect of grape juice, red wine and resveratrol solution on antioxidant, anti-inflammatory, hepactic function and lipid profile in rats feds with high-fat diet
Teresa Palmisciano Bedê, Vanessa de Jesus, Vanessa Rosse de Souza, Vânia Mattoso, Joel Pimentel Abreu, Juliana Furtado Dias, Anderson Junger Teodoro, Vilma Blondet de Azeredo
Natural Product Research.2021; 35(23): 5255. CrossRef
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Li Cao, Yan Du, Mo Zhang, Feng Wang, Jian‐Yuan Zhao, Yun‐Yun Ren, Yong‐Hao Gui
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Francesca Solmi, Arlinda B. Moreno, Glyn Lewis, Maria Angélica Nunes, Maria de Jesus Mendes da Fonseca, Rosane Harter Griep
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Minjuan Li, Zhixin Cui, Shuangli Meng, Ting Li, Tong Kang, Qi Ye, Mengting Cao, Yuxin Bi, Huicui Meng
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Glenn Dallérac, Julien Moulard, Jean-François Benoist, Stefan Rouach, Stéphane Auvin, Angèle Guilbot, Loïc Lenoir, Nathalie Rouach
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Socioeconomic Status and Number of Children Among Korean Women: The Healthy Twin Study: Jinseob Kim, Joohon Sung; J Prev Med Public Health. 2013;46(1):50-60. Published online January 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.1.50

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Abstract PDF

Objectives

This study aimed to evaluate whether the birth rate is associated with socioeconomic status in the women of the Republic of Korea, where the birth rate is rapidly decreasing.

Methods

This study included 732 females from the Healthy Twin Study, a family-twin cohort. The participants were classified into 3 socioeconomic groups according to their average income, education, and occupation. The association between socioeconomic status and number of children was assessed using gamma regression analysis with a generalized linear mixed model, adjusting for the age group, smoking/alcohol status, and family relationships.

Results

The group with the highest education level had significantly fewer children compared with the group with the lowest education level (p=0.004). However, no significant associations were found according to household income level. The non-manual labor group had significantly fewer children compared with those working as homemakers (p=0.008).

Conclusions

This study aimed to explain the causal relationship between socioeconomic status and number of children. Associations between some socioeconomic status and number of children were found in Korea.

Summary

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Social Determinants of Smoking Behavior: The Healthy Twin Study, Korea: Youn Sik Kim, Hansoo Ko, Changgyo Yoon, Dong-Hun Lee, Joohon Sung; J Prev Med Public Health. 2012;45(1):29-36. Published online January 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.1.29

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Abstract PDF

Objectives

The purpose of this study was to identify any influence of socioeconomic status on smoking and smoking cessation in a situation where genetic factors are controlled.

Methods

The sample for this study was 2502 members of the twins and families cohort who participated in the Korean Healthy Twins Study from 2005 to 2009. Groups of brothers or sisters, including twins and fraternal twins, were compared in terms of smoking and smoking cessation behaviors according to differences in socioeconomic status and gender.

Results

In a situation with complete control of genetic factors, results showed that the daily smoking amount, cumulative smoking amount, and dependence on nicotine decreased with higher-status occupations, and the rate of smoking and amount of cumulative smoking decreased with higher levels of education. Regarding smoking cessation behavior, a higher level of education was associated with a lower smoking cessation rate, and no significant gender differences were found.

Conclusions

Environmental factors had a stronger influence on smoking behavior than did genetic factors. Genetic factors had greater influence on smoking cessation than did environmental factors; however, this requires verification in further studies.

Summary

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Brief Report

Fifteen Years After the Gozan-Dong Glass Fiber Outbreak, Incheon in 1995: Soo-Hun Cho, Joohon Sung, Jonghoon Kim, Young-Su Ju, Minji Han, Kyu-Won Jung; J Prev Med Public Health. 2011;44(4):185-189. Published online July 29, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.4.185

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Abstract PDF: Objectives
In 1995, an outbreak survey in Gozan-dong concluded that an association between fiberglass exposure in drinking water and cancer outbreak cannot be established. This study follows the subjects from a study in 1995 using a data linkage method to examine whether an association existed. The authors will address the potential benefits and methodological issues following outbreak surveys using data linkage, particularly when informed consent is absent.
Methods
This is a follow-up study of 697 (30 exposed) individuals out of the original 888 (31 exposed) participants (78.5%) from 1995 to 2007 assessing the cancer outcomes and deaths of these individuals. The National Cancer Registry (KNCR) and death certificate data were linked using the ID numbers of the participants. The standardized incidence ratio (SIR) and standardized mortality ratio (SMR) from cancers were calculated by the KNCR.
Results
The SIR values for all cancer or gastrointestinal cancer (GI) occurrences were the lowest in the exposed group (SIR, 0.73; 95% CI, 0.10 to 5.21; 0.00 for GI), while the two control groups (control 1: external, control 2: internal) showed slight increases in their SIR values (SIR, 1.18 and 1.27 for all cancers; 1.62 and 1.46 for GI). All lacked statistical significance. All-cause mortality levels for the three groups showed the same pattern (SMR 0.37, 1.29, and 1.11).
Conclusions
This study did not refute a finding of non-association with a 13-year follow-up. Considering that many outbreak surveys are associated with a small sample size and a cross-sectional design, follow-up studies that utilize data linkage should become standard procedure.; Summary

English Abstracts

High Risk Groups in Health Behavior Defined by Clustering of Smoking, Alcohol, and Exercise Habits: National Heath and Nutrition Examination Survey.: Kiwon Kang, Joohon Sung, Chang yup Kim; J Prev Med Public Health. 2010;43(1):73-83.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.73

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Abstract PDF

OBJECTIVES
We investigated the clustering of selected lifestyle factors (cigarette smoking, heavy alcohol consumption, lack of physical exercise) and identified the population characteristics associated with increasing lifestyle risks. METHODS: Data on lifestyle risk factors, sociodemographic characteristics, and history of chronic diseases were obtained from 7,694 individuals > or =20 years of age who participated in the 2005 Korea National Health and Nutrition Examination Survey (KNHANES). Clustering of lifestyle risks involved the observed prevalence of multiple risks and those expected from marginal exposure prevalence of the three selected risk factors. Prevalence odds ratio was adopted as a measurement of clustering. Multiple correspondence analysis, Kendall tau correlation, Man-Whitney analysis, and ordinal logistic regression analysis were conducted to identify variables increasing lifestyle risks. RESULTS: In both men and women, increased lifestyle risks were associated with clustering of: (1) cigarette smoking and excessive alcohol consumption, and (2) smoking, excessive alcohol consumption, and lack of physical exercise. Patterns of clustering for physical exercise were different from those for cigarette smoking and alcohol consumption. The increased unhealthy clustering was found among men 20-64 years of age with mild or moderate stress, and among women 35-49 years of age who were never-married, with mild stress, and increased body mass index (>30 kg/m2). CONCLUSIONS: Addressing a lack of physical exercise considering individual characteristics including gender, age, employment activity, and stress levels should be a focus of health promotion efforts.

Summary

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Strategy Considerations in Genome Cohort Construction in Korea.: Joohon Sung, Sung Il Cho; J Prev Med Public Health. 2007;40(2):95-101.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.95

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Abstract PDF: Focusing on complex diseases of public health significance, strategic issues regarding the on-going Korean Genome Cohort were reviewed: target size and diseases, measurements, study design issues, and followup strategy of the cohort. Considering the epidemiologic characteristics of Korean population as well as strengths and drawbacks of current research environment, we tried to tailor the experience of other existing cohorts into proposals for this Korean study. Currently 100,000 individuals have been participating the new Genome Cohort in Korea. Target size of de novo collection is recommended to be set as between 300,000 to 500,000. This target size would allow acceptable power to detect genetic and environmental factors of moderate effect size and possible interactions between them. Family units and/or special subgroups are recommended to parallel main body of adult individuals to increase the overall efficiency of the study. Given that response rate to the conventional re-contact method may not be satisfactory, successful follow-up is the main key to the achievement of the Korean Genome Cohort. Access to the central database such as National Health Insurance data can provide enormous potential for near-complete case detection. Efforts to build consensus amongst scientists from broad fields and stakeholders are crucial to unleash the centralized database as well as to refine the commitment of this national project.; Summary

Original Articles

Summertime Heat Waves and Ozone : an Interaction on Cardiopulmonary Mortality? - Based on the 1994 Heat Wave in Korea -.: Joohon Sung, Ho Kim, Soo Hun Cho; Korean J Prev Med. 2001;34(4):316-322.

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Abstract PDF: OBJECTIVES
To explore the possible effect of an interaction between summertime heat waves and ozone on cardiopulmonary mortality during the 1994 heat wave in Korea. METHODS: The unusually hot summer of 1994 in Korea was defined as the heat wave in this study. We examined the associations of air pollutants with daily cardiopulmonary deaths between 1991-1995, considering the product term of the heat wave and each pollutant, weather and time trends. RESULTS: During the heat wave, while temperatures were uniformly higher than those of other summers, the within-heat-wave difference in mortality paralleled that in the regional ozone levels. In terms of the influence of the heat wave, the results of ozone were different to those of total suspended particles (TSP) and sulfur dioxide (SO2). The ozone association (relative risk (RR) =1.036; 95% confidence interval (CI) = 1.018-1.054) was observed only under heat wave conditions, while the TSP (RR =1.006, 95% CI = 0.999-1.012) and the SO2 (RR =1.018, 95% CI = 1.011-1.024) associations were found under normal weather conditions (per interquartile increase of each pollutant; results of three pollutants model). The ozone association under heat wave was attributable to the statistical interaction between the heat wave and ozone. CONCLUSIONS: These results support the possibility of a biological synergy between the heat wave and ozone, one that is not evident between the heat wave and other major pollutants like particles or SO2.; Summary

Development of Work-related Musculoskeletal Disorder Questionnaire Using Receiver Operating Characteristic Analysis.: Jaiyong Kim, Ho Jang Kwon, Yeongsu Ju, Soo Hun Cho, Daehee Kang, Joohon Sung, Seong Woo Choi, Jae Wook Choi, Jae Young Kim, Don Gyu Kim; Korean J Prev Med. 1999;32(3):361-373.

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Abstract PDF: OBJECTIVES
Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. METHODS: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. RESULTS: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. CONCLUSION: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance tool through quantitative validation of the measures, would serve for the systematic disease prevention activities.; Summary

Prediction Equations for FVC and FEV1 among Korean Children Aged 12 Years.: Jong Won Kang, Yeong Su Ju, Joohon Sung, Soo Hun Cho; Korean J Prev Med. 1999;32(1):60-64.

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Abstract PDF: OBJECTIVES
Changes in lung function are frequently used as biological markers to assess the health effects of criteria air pollutants. We tried to formulate the prediction models of pulmonary functions based on height, weight, age and gender, especially for children aged 12 years who are commonly selected for the study of health effects of the air pollution. METHODS: The target pulmonary function parameters were forced vital capacity(FVC) and forced expiratory volume in one second(FEV1). Two hundreds and fifity-eight male and 301 female 12-year old children were included in the analysis after excluding unsatisfactory tests to the criteria recommended by American Thoracic Sosiety and excluding more or less than 20% predicted value by previous prediction equations. The weight prediction equation using height as a independent variable was calculated, and then the difference of observed weight and predicted weight (i.e. residual) was used as the independent variable of pulmonary function prediction equations with height. RESULTS: The prediction equations of FVC and FEV1 for male are FVC(ml) = 50.84 x height(cm) + 7.06 x weight residual - 4838.86, FEV1(ml) = 43.57 x height(cm) + 3.16 x weight residual - 4156.66, respectively. The prediction equations of FVC and FEV1 for female are FVC(ml) = 42.57 x height(cm) + 12.50 x weight residual - 3862.39, FEV1(ml) = 36.29 x height(cm) + 7.74 x weight residual - 3200.94, respectively.; Summary

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