Journal of Preventive Medicine and Public Health

Original Articles

Sex-specific Associations Between Serum Hemoglobin Levels and the Risk of Cause-specific Death in Korea Using the National Health Insurance Service-National Health Screening Cohort (NHIS HEALS): Yoonsuk An, Jieun Jang, Sangjun Lee, Sungji Moon, Sue K. Park; J Prev Med Public Health. 2019;52(6):393-404. Published online November 1, 2019; DOI: https://doi.org/10.3961/jpmph.19.146

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Abstract Summary PDF Supplementary Material

Objectives
The purpose of this study was to determine the associations between blood hemoglobin (Hgb) levels and the risk of death by specific causes.
Methods
Using the National Health Insurance Services-National Health Screening Cohort (n=487 643), we classified serum Hgb levels into 6 sex-specific groups. Cox regression analysis was used to analyze the associations between Hgb levels and the risk of cause-specific death.
Results
Hgb levels in male population showed a U-shaped, J-shaped, or inverse J-shaped association with the risk of death from ischemic heart disease, acute myocardial infarction, liver cancer, cirrhosis and chronic obstructive pulmonary disease (COPD) (all non-linear p<0.05; hazard ratio [HR]; 95% confidence interval [CI]) for the lowest and the highest Hgb levels for the risk of each cause of death in male population: HR, 1.14; 95% CI, 0.98 to 1.34; HR, 2.87; 95% CI, 1.48 to 5.57; HR, 1.16; 95% CI, 0.96 to 1.40; HR, 3.05; 95% CI, 1.44 to 6.48; HR, 1.36; 95% CI, 1.18 to 1.56; HR, 2.11; 95% CI, 1.05 to 4.26; HR, 3.64; 95% CI, 2.49 to 5.33; HR, 5.97; 95% CI, 1.44 to 24.82; HR, 1.62; 95% CI, 1.14 to 2.30; HR, 3.84; 95% CI, 1.22 to 12.13, respectively), while in female population, high Hgb levels were associated with a lower risk of death from hypertension and a higher risk of death from COPD (overall p<0.05; HR, 1.86; 95% CI, 1.29 to 2.67 for the lowest Hgb levels for hypertension; overall p<0.01, HR, 6.60; 95% CI, 2.37 to 18.14 for the highest Hgb levels for COPD). For the risk of lung cancer death by Hgb levels, a linear negative association was found in male population (overall p<0.01; the lowest Hgb levels, HR, 1.17; 95% CI, 1.05 to 1.33) but an inverse J-shaped association was found in female population (non-linear p=0.01; HR, 1.25; 95% CI, 0.96 to 1.63; HR, 2.58; 95% CI, 1.21 to 5.50).
Conclusions
Both low and high Hgb levels were associated with an increased risk of death from various causes, and some diseases showed different patterns according to sex.

Summary

Korean summary
본 연구는 2002년 및 2003년 한국 국민건강보험공단 건강검진 수검자 코호트(NHIS-HEALS)를 이용하여 총 487,643명을 대상으로 2013년 말일까지의 통계청 사망자료 추적관찰 기반 혈중 헤모글로빈과 전체, 심뇌혈관, 암, 기타 질환의 (만성 폐쇄성 폐질환, 간경화증) 사망위험 간 상관관계를 성별 층화하여 콕스회귀모형으로 분석하였음. 연구 결과 남성에서는 낮은 헤모글로빈 및 높은 헤모글로빈 농도와 허혈성 심질환, 심근경색, 간암, 간경화증, 그리고 만성 폐쇄성 폐질환 사망위험이 통계적으로 유의하게 증가함을 보인 반면, 여성에서는 낮은 헤모글로빈 농도에서는 고혈압, 높은 헤모글로빈 농도에서는 만성 폐쇄성 폐질환 사망위험도가 통계적으로 유의하게 증가하였음.결과적으로 낮은 그리고 높은 헤모글로빈 농도가 기존에 알려져 있던 심혈관질환의 사망위험에 영향을 주었을 뿐만 아니라 암 질환 및 기타 다른 질환들의 사망위험에도 영향을 주는 것으로 나타났기에 혈중 헤모글로빈 농도가 사망위험도의 잠재적인 예측인자로써의 가능성을 보였음. 주요 단어: 헤모글로빈, 빈혈, 사망, 성별, 한국인

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Cigarette Smoking and Serum Bilirubin Subtypes in Healthy Korean Men: The Korea Medical Institute Study: Jaeseong Jo, Heejin Kimm, Ji Eun Yun, Kyu Jang Lee, Sun Ha Jee; J Prev Med Public Health. 2012;45(2):105-112. Published online March 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.2.105

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Abstract PDF

Objectives

Cigarette smoking is a modifiable risk factor for cardiovascular disease. Bilirubin is a potent antioxidant and its concentration decreases in smokers. However, studies about the association between cigarette smoking and bilirubin are scarce and most are limited to total bilirubin. Additionally, bilirubin is highly related to hemoglobin. Therefore, this study evaluates the association between bilirubin subtypes and cigarette smoking in healthy Korean men independently of hemoglobin.

Methods

This study included 48 040 Korean men aged 30 to 87 years who visited the Korea Medical Institute for routine health examinations from January to December, 2007. The association of smoking with total, direct, and indirect bilirubin was assessed by logistic regression analysis taking into consideration differences in subjects and smoking characteristics.

Results

Current smokers had lower bilirubin concentrations than never-smokers and ex-smokers. Smoking amount and duration were inversely significantly associated with total, direct, and indirect bilirubin. In a multivariable adjusted model, compared to never-smokers, the odds ratios (ORs) and 95% confidence intervals (CIs) of current smokers with the highest number of pack-years were 1.7 (1.6 to 1.9) for total, 1.5 (1.4 to 1.6) for direct, and 1.7 (1.6 to 1.9) for indirect bilirubin. After further adjustment for hemoglobin, this association became stronger (OR [95% CI], 2.1 [1.9 to 2.2] for total; 1.9 [1.8 to 2.0] for direct; 2.0 [1.9 to 2.2] for indirect bilirubin).

Conclusions

In this study, bilirubin subtypes are inversely associated with smoking status, smoking amount, and smoking duration in healthy Korean men independently of hemoglobin. Further studies are needed to investigate this association in healthy Korean women.

Summary

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Direct Bilirubin Levels and Risk of Metabolic Syndrome in Healthy Chinese Men
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Active and Passive Smoking and Serum Total Bilirubin in a Rural Korean Population
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Fangyi Gu, Andriy Derkach, Neal D Freedman, Maria Teresa Landi, Demetrius Albanes, Stephanie J Weinstein, Alison M Mondul, Charles E Matthews, Kristin A Guertin, Qian Xiao, Wei Zheng, Xiao-ou Shu, Joshua N Sampson, Steven C Moore, Neil E Caporaso
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Cigarette Smoking Habit and Subjective Quality of Sleep
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Hiroyuki Moriya, Katsuhiko Saito, Nuala Helsby, Shigekazu Sugino, Michiaki Yamakage, Masahiko Takasaki, Hidenori Kato, Nahoko Kurosawa
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Brief Communication

A Comparison of Fasting Glucose and HbA1c for the Diagnosis of Diabetes Mellitus Among Korean Adults.: Woo Jun Yun, Min Ho Shin, Sun Seong Kweon, Kyeong Soo Park, Young Hoon Lee, Hae Sung Nam, Seul Ki Jeong, Yong Woon Yun, Jin Su Choi; J Prev Med Public Health. 2010;43(5):451-454.; DOI: https://doi.org/10.3961/jpmph.2010.43.5.451

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Abstract PDF

OBJECTIVES
The American Diabetes Association (ADA) has recently recommended the HbA1c assay as one of four options for making the diagnosis of diabetes mellitus, with a cut-point of > or =6.5%. We compared the HbA1c assay and the fasting plasma glucose level for making the diagnosis of diabetes among Korean adults. METHODS: We analyzed 8710 adults (age 45-74 years), who were not diagnosed as having diabetes mellitus, from the Namwon study population. A fasting plasma glucose level of > or =126 mg/dL and an A1c of > or =6.5% were used for the diagnosis of diabetes. The kappa index of agreement was calculated to measure the agreement between the diagnosis based on the fasting plasma glucose level and the HbA1c. RESULTS: The kappa index of agreement between the fasting plasma glucose level and HbA1c was 0.50. CONCLUSIONS: The agreement between the fasting plasma glucose and HbA1c for the diagnosis of diabetes was moderate for Korean adults.

Summary

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Original Articles

Effects of Ethanol and Phenobarbital on Hemoglobin Adducts Formation in Rats Exposed to Direct Black 38.: Chi Nyon Kim, Se Hoon Lee, Jaehoon Roh; Korean J Prev Med. 2002;35(3):229-235.

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Abstract PDF: OBJECTIVES
To evaluate the effects on the formation of benzidine-hemoglobin, and benzidine metabolite-hemoglobin adducts, caused by pretreatment with the known xenobiotic metabolism effectors, ethanol and phenobarbital, in rats administered Direct Black 38 dye. METHODS: The experimental rats were divided into three groups: a control group, an ethanol group and a phenobarbital group. Rats were pretreated with ethanol (1g/kg) or phenobarbital (80mg/kg) 24 hours prior to the oral administration of Direct Black 38 (0.5mmol/kg), with the control group being administered the same amount of distilled water. Blood samples were obtained from the vena cava of 5 rats from each group prior to, and at 30 min, 3 h, 6 h, 9 h, 12 h, 24 h, 48 h, 72 h, 96 h, and 144 h following the oral administration of Direct Black 38. Directly after sampling the blood was separated into hemoglobin and plasma, with the adducts being converted into aromatic amines by basic hydrolysis. Hydrolyzed benzidiene, monoacetylbenzidine and 4-aminobiphenyl were analyzed by reverse-phase liquid chromatography with an electrochemical detector. The quantitative amount of the metabolites was expressed by the hemoglobin binding index (HBI). RESULTS: In the ethanol group, benzidine-, monoacetylben-zidine-, and 4-aminobiphenyl-HBI were increased to a greater extent than those in the control group. These results were attributed to the ethanol inducing N-hydroxylation, which is related to the formation of the hemoglobin adduct. In the phenobarbital group, all the HBIs, with the exception of the benzidine-HBI, were increased to a greater extent than those of the control group. These results were attributed to the phenobarbital inducing N-hydroxylation related to the formation of the hemoglobin adduct. The N-acetylation ratio was only increased with the phenobarbital pretreatment due to the lower benzidine-HBI of the phenobarbital group compared to those of the control and ethanol groups. The N-acetylation ratios for all groups were higher than 1 for the duration of the experimental period. Although the azo reduction was unaffected by the ethanol, it was inhibited by the phenobarbital. The ratio of the benzidine-HBI in the phenobarbital group was lower than those of the ethanol the control groups for the entire experiment. CONCLUSION: Our results indicate that both ethanol and phenobarbital increase the formation of adducts by the induction of N-hydroxylation, but also induced N-acetylation. Phenobarbital decreased the formation of benzidine-HBI due to the decrease of the azo reduction. These results suggest that the effects of ethanol and phenobarbital need to be considered in the biochemical monitoring of Direct Black 38.; Summary

Epidemiologic investigation to identify the cause of an infant methemoglobinemia.: young Yeul Kim, Bo Youl Choi, Hung Bae Park, Min Young Kim, In Hak Yeo; Korean J Prev Med. 1993;26(2):192-201.

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Abstract PDF: Epidemiologic investigation was conducted on January, 1993 in Seoul to identify the cause of an infant methemoglobinemia. Field investigation of the area of outbreak, survey of household and family members, analysis of ground water, and blood tests of involved family members were performed. Following results were obtained. On analyzing the quality of the ground water on patients's household high levels of nitrate was found indicating contamination of water as the cause of a methemoglobinemia outbreak. On analyzing the quality of the ground waters on seven other places within the neighborhood five were contaminated by nitrate in concentration that exceeded the permissible limit implying presence nearby source of contamination. Sources of contamination were thought to be originating from human waste in conventional bathroom facilities, chicken manure used in nearby orchards and plant fields or fertilizers. But the results of water analysis with presence of bacteria or E.coli, concentration of potassium, phosphate and the past history of diarrhea among family members, chicken manure suggested the most possible source of contamination. To evaluate the health status of members in the neighborhood past history was reviewed revealing no prior existence of patient with cyanosis and 65 people in the neighborhood had normal levels of methemoglobin concentration in their blood. Conclusively, the ground water on patient's household was contaminated with nitrate and despite provision of adequate water supply, family members of the patient along with distrust in the water supply system had used ground water as their source of drinking water resulting of methemoglobinemia. Many suburban area of Seoul and country side thought to be having similar problems concerning contaminated ground water supply and dormant outbreak of patients as a result of the drinking of the contaminated water. Epidemiologic investigation and water analysis of ground waters are advised.; Summary

The levels of blood lead and zinc protoporphyrin for healthy urban population in Korea.: Dong Il Kim, Yong Kyu Kim, Jung Man Kim, Kap Yull Jung, Joon Youn Kim; Korean J Prev Med. 1992;25(3):287-302.

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Abstract PDF: Hemoglobin(Hb), zinc protoporphyrin(ZPP) and blood lead(PbB) levels were determined for 1,851 blood samples collected from healthy urban population to establish reliable baselines for Hb, ZPP and PbB levels by age and sex. ZPP values were analyzed with a Hmatofluorometer and PbB determinations were concurrently carried out using flameless atomic absorption spectrophotometry. The blood sampling period was about 6 months from May, 1991 and the summarized results were as follows; 1. The mean value of Hb in male female were 14.55+/-1.81 g/dl and 12.61+/-1.81 g/dl respectively and there was statistically significant difference(p<0.05). 2. The mean value of ZPP in pre-schoolchildren was 37.49+/-13.31 microgram/dl for male, 35.77+/-11.85 microgram/dl for female and that of ZPP in after 7 years groups was 31.91+/-8.23 microgram/dl for male, 30.11+/-9.11 microgram/dl for female and there was statistically significant difference(p<0.05). 3. The mean value of PbB in pre-schoolchildren was 25.10+/-5.21 microgram/dl for male, 24.45+/-4.18 microgram/dl for female and that of PbB in after 7 years groups was 24.28+/-3.00 microgram/dl for male, 21.99+/-5.05 microgram/dl for female and there was statistically significant difference(p<0.05).; Summary

Carboxyhemoglobin Dissociation Pattern by Age in the Rat.: Sun Min Kim, Heon Kim, Soo Hum Cho; Korean J Prev Med. 1991;24(4):507-515.

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Abstract PDF: One, two, six and ten week old Sprague-Dawley rats were exposed to carbon monoxide at 3,700 ppm for 30 minutes, and carboxyhemoglobin was measured immediateley, 5, 30, 60, 90, 120 minutes after the exposure. In each time after the exposure, the means of the carboxyhemoglobin levels were "compared among the week age groups. The regression analysis was done using the natural logarithm. of the carboxyhemoglobin concentration as a dependent variable and the time after the exposure. as an independent vaiable. From the regression equation, the half lives of the carboxyhemoglobin were calculated. The one week old rats showed significantly higher carboxyhemoglobin level than other week age rats in the entire time after the exposure. The corrected carboxyhemoglobin concentration calculated by subtracting the normal carboxyhemoglobin level from the me cured carboxyhemoglobin at each age group, showed no uniform differences.; Summary

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