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Original Articles
Association Between Cadmium Exposure and Liver Function in Adults in the United States: A Cross-sectional Study
Dongui Hong, Jin-Young Min, Kyoung-Bok Min
J Prev Med Public Health. 2021;54(6):471-480.   Published online November 30, 2021
DOI: https://doi.org/10.3961/jpmph.21.435
  • 3,918 View
  • 146 Download
  • 21 Web of Science
  • 21 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Cadmium is widely used, leading to extensive environmental and occupational exposure. Unlike other organs, for which the harmful and carcinogenic effects of cadmium have been established, the hepatotoxicity of cadmium remains unclear. Some studies detected correlations between cadmium exposure and hepatotoxicity, but others concluded that they were not associated. Thus, we investigated the relationship between cadmium and liver damage in the general population.
Methods
In total, 11 838 adult participants from National Health and Nutrition Examination Survey 1999-2015 were included. Urinary cadmium levels and the following liver function parameters were measured: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transferase (GGT), total bilirubin (TB), and alkaline phosphatase (ALP). Linear and logistic regression analyses were performed to assess the associations between urinary cadmium concentrations and each liver function parameter after adjusting for age, sex, race/ethnicity, annual family income, smoking status, alcohol consumption status, physical activity, and body mass index.
Results
The covariate-adjusted results of the linear regression analyses showed significant positive relationships between log-transformed urinary cadmium levels and each log-transformed liver function parameter, where beta±standard error of ALT, AST, GGT, TB, and ALP were 0.049±0.008 (p<0.001), 0.030±0.006 (p<0.001), 0.093±0.011 (p<0.001), 0.034±0.009 (p<0.001), and 0.040±0.005 (p<0.001), respectively. Logistic regression also revealed statistically significant results. The odds ratios (95% confidence intervals) of elevated ALT, AST, GGT, TB, and ALP per unit increase in log-transformed urinary cadmium concentration were 1.360 (1.210 to 1.528), 1.307 (1.149 to 1.486), 1.520 (1.357 to 1.704), 1.201 (1.003 to 1.438), and 1.568 (1.277 to 1.926), respectively.
Conclusions
Chronic exposure to cadmium showed positive associations with liver damage.
Summary
Korean summary
카드뮴은 사회 전반에서 널리 쓰이고 있어 직업적인 노출은 물론 환경적인 노출이 빈번히 일어나고 있다. 본 연구는 미국 국민건강영양조사 데이터를 이용하였으며 소변 내 카드뮴의 증가는 알라닌 아미노전이효소 (ALT), 아스파테이트 아미노전이효소 (AST), 감마 글루타밀전이효소 (GGT), 총 빌리루빈, 알칼리 인산분해효소 (ALP)의 상승과 관련이 있었다. 따라서 만성적인 카드뮴 노출은 간 손상과 연관이 있다고 할 수 있다.

Citations

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  • Cadmium-associated protein changes in residents of contaminated areas: Abandoned mine and smelter
    Sora Mun, You-Rim Lee, Jiyeong Lee, Seungyeon Lee, Yeeun Yun, Jeeyoung Kim, Jung-Yeon Kwon, Woo Jin Kim, Yong Min Cho, Young-Seoub Hong, Hee-Gyoo Kang
    Environmental Pollution.2024; 345: 123512.     CrossRef
  • Toxicity Tolerance in the Carcinogenesis of Environmental Cadmium
    Aleksandar Cirovic, Soisungwan Satarug
    International Journal of Molecular Sciences.2024; 25(3): 1851.     CrossRef
  • Cross-talk between Vimentin and autophagy regulates blood-testis barrier disruption induced by cadmium
    Na Chen, Xiaoyan Wan, Mei Wang, Yamin Li, Xiaofei Wang, Ling Zeng, Jinzhao Zhou, Yanwei Zhang, Shun Cheng, Yi Shen
    Environmental Pollution.2024; 346: 123625.     CrossRef
  • Correlation between urinary rare earth elements and liver function in a Zhuang population aged 35–74 years in Nanning
    Xingxi Luo, Liling Wei, Shun Liu, Kaili Wu, Dongping Huang, Suyang Xiao, Erna Guo, Lei Lei, Xiaoqiang Qiu, Xiaoyun Zeng
    Journal of Trace Elements in Medicine and Biology.2024; 84: 127426.     CrossRef
  • Changes in Endogenous Essential Metal Homeostasis in the Liver and Kidneys during a Six-Month Follow-Up Period after Subchronic Cadmium Exposure
    Rafał Kusak, Marzenna Nasiadek, Joanna Stragierowicz, Wojciech Hanke, Anna Kilanowicz
    International Journal of Molecular Sciences.2024; 25(7): 3829.     CrossRef
  • The Effect of Smoking Habits on Blood Cadmium and Lead Levels in Residents Living Near a Mining and Smelting Area in Northwest China: a Cross-Sectional Study
    Hui Dai, Honglong Zhang, Haiping Wang, Jingping Niu, Bin Luo, Jun Yan, Xun Li
    Biological Trace Element Research.2023; 201(3): 1101.     CrossRef
  • Bloodlettings in Hemochromatosis Result in Increased Blood Lead (Pb) Concentrations
    Mazyar Yazdani, Sonia Distante, Lars Mørkrid, Rune J. Ulvik, Bjørn J. Bolann
    Biological Trace Element Research.2023; 201(7): 3193.     CrossRef
  • Associations of blood metals with liver function: Analysis of NHANES from 2011 to 2018
    Wenjie Li, Xinyan Li, Jing Su, Han Chen, Ping Zhao, Haisheng Qian, Xin Gao, Qiang Ye, Guoxin Zhang, Xuan Li
    Chemosphere.2023; 317: 137854.     CrossRef
  • MCU Upregulation Overactivates Mitophagy by Promoting VDAC1 Dimerization and Ubiquitination in the Hepatotoxicity of Cadmium
    Cong Liu, Hui‐Juan Li, Wei‐Xia Duan, Yu Duan, Qin Yu, Tian Zhang, Ya‐Pei Sun, Yuan‐Yuan Li, Yong‐Sheng Liu, Shang‐Cheng Xu
    Advanced Science.2023;[Epub]     CrossRef
  • Effects of Environmental Cadmium Exposure on the Liver in Korean Adults: Cross-Sectional and Longitudinal Studies
    Mi-Na Seo, Sang-Yong Eom, Ji-Ae Lim, Jung-Eum Lee, Byung-Sun Choi, Ho-Jang Kwon, Young-Seoub Hong, Heon Kim, Jung-Duck Park
    Archives of Environmental Contamination and Toxicology.2023; 84(2): 237.     CrossRef
  • Estimation of health risks associated with dietary cadmium exposure
    Soisungwan Satarug, David A. Vesey, Glenda C. Gobe, Kenneth R. Phelps
    Archives of Toxicology.2023; 97(2): 329.     CrossRef
  • Sex, Nutrition, and NAFLD: Relevance of Environmental Pollution
    Arianna Dolce, Sara Della Torre
    Nutrients.2023; 15(10): 2335.     CrossRef
  • ROS‐mediated PERK‐CHOP pathway plays an important role in cadmium‐induced HepG2 cells apoptosis
    Cao Zhaohui, Tang Cifei, Huang Di, Zeng Weijia, Han Cairui, Li Zecong, Hu Xiaobo
    Environmental Toxicology.2023; 38(9): 2271.     CrossRef
  • Association between mixed urinary metal exposure and liver function: analysis of NHANES data
    Bowen Zha, Huanchang Xu, Yuqi Liu, Xiaqin Zha
    Environmental Science and Pollution Research.2023; 30(52): 112564.     CrossRef
  • Association of urinary bisphenols with oxidative stress and inflammatory markers and their role in obesity
    Ren Zhou, Lei Zhang, Yu Sun, Jia Yan, Hong Jiang
    Ecotoxicology and Environmental Safety.2023; 266: 115546.     CrossRef
  • Is Environmental Cadmium Exposure Causally Related to Diabetes and Obesity?
    Soisungwan Satarug
    Cells.2023; 13(1): 83.     CrossRef
  • Gut microbiota–bile acid–intestinal Farnesoid X receptor signaling axis orchestrates cadmium-induced liver injury
    Yunhuan Liu, Weili Kang, Shuiping Liu, Jinyan Li, Jinyan Liu, Xingxiang Chen, Fang Gan, Kehe Huang
    Science of The Total Environment.2022; 849: 157861.     CrossRef
  • Multiple Targets of Toxicity in Environmental Exposure to Low-Dose Cadmium
    Soisungwan Satarug, Glenda C. Gobe, David A. Vesey
    Toxics.2022; 10(8): 472.     CrossRef
  • The function of omega-3 polyunsaturated fatty acids in response to cadmium exposure
    Zhi Chen, Qinyue Lu, Jiacheng Wang, Xiang Cao, Kun Wang, Yuhao Wang, Yanni Wu, Zhangping Yang
    Frontiers in Immunology.2022;[Epub]     CrossRef
  • Mitigation of Cadmium Toxicity through Modulation of the Frontline Cellular Stress Response
    Soisungwan Satarug, David A. Vesey, Glenda C. Gobe
    Stresses.2022; 2(3): 355.     CrossRef
  • Oligochaeta ramosa (Roxb.) Extract Regulates Lipid Metabolism and Exerts Hepatoprotective Effects in Cadmium-Induced Hepatic Injury in Rats
    Saira Aslam, Fiaz-ud-Din Ahmad, Waseem Hassan, Manal Ali Buabeid, Imran Mukhtar, Muhammad Ihtisham Umar, Nihal Abdallah Ibrahim, Daniel Dias Rufino Arcanjo
    Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1.     CrossRef
Association Between Low Muscle Mass and Non-alcoholic Fatty Liver Disease Diagnosed Using Ultrasonography, Magnetic Resonance Imaging Derived Proton Density Fat Fraction, and Comprehensive NAFLD Score in Korea
Hun Ju Lee, Jae Seung Chang, Jhii Hyun Ahn, Moon Young Kim, Kyu-Sang Park, Yeon-Soon Ahn, Sang Baek Koh
J Prev Med Public Health. 2021;54(6):412-421.   Published online October 22, 2021
DOI: https://doi.org/10.3961/jpmph.21.387
  • 4,052 View
  • 124 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Non-alcoholic fatty liver disease (NAFLD) is an increasingly prevalent metabolic disease. Muscle is known to influence NAFLD development. Therefore, this study aimed to determine the relationships among low muscle mass, NAFLD, and hepatic fibrosis using various definitions of low muscle mass and NAFLD diagnostic methods, including magnetic resonance imaging-based proton density fat fraction (MRI-PDFF).
Methods
This cross-sectional study included 320 participants (107 males, 213 females) from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population cohort. Muscle mass was assessed using whole-body dual-energy X-ray absorptiometry and adjusted for the height squared, body weight, and body mass index (BMI). NAFLD was diagnosed using ultrasonography (US), MRI-PDFF, and the comprehensive NAFLD score (CNS). Hepatic fibrosis was assessed using magnetic resonance elastography. Multivariable logistic and linear regression analyses were performed to determine the aforementioned associations.
Results
According to US, 183 participants (57.2%) had NAFLD. Muscle mass adjusted for body weight was associated with NAFLD diagnosed using US (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.70 to 5.31), MRI-PDFF (OR, 2.00; 95% CI, 1.13 to 3.53), and CNS (OR, 3.39; 95% CI, 1.73 to 6.65) and hepatic fibrosis (males: β=-0.070, p<0.01; females: β=-0.037, p<0.04). Muscle mass adjusted for BMI was associated with NAFLD diagnosed by US (OR, 1.71; 95% CI, 1.02 to 2.86) and CNS (OR, 1.95; 95% CI, 1.04 to 3.65), whereas muscle mass adjusted for height was not associated with NAFLD.
Conclusions
Low muscle mass was associated with NAFLD and liver fibrosis; therefore, maintaining sufficient muscle mass is important to prevent NAFLD. A prospective study and additional consideration of muscle quality are needed to strengthen the findings regarding this association.
Summary
Korean summary
비알콜성 간질환은 대사질환 중 하나로 적은 근육양과의 연관성이 지속적으로 제시되었으나, 기존 연구들에서 일관되지 않은 결과를 보여주었다. KoGES-ARIRANG 코호트의 320명을 대상으로 초음파·MRI-PDFF·CNS 진단기준을 사용하여 단면연구를 수행한 결과, 세 진단기준에서 모두 적은 근육량과 비알콜성 간질환 사이에 연관성이 나타났다.

Citations

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  • Association between Regional Body Muscle Mass and Non-Alcoholic Fatty Liver Disease: An Observational Study Using Data from the REACTION Study
    Jing Du, Shizhan Ma, Li Fang, Meng Zhao, Zhongshang Yuan, Yiping Cheng, Jiajun Zhao, Xiude Fan, Qingling Guo, Zhongming Wu
    Journal of Personalized Medicine.2023; 13(2): 209.     CrossRef
  • Predicting Habitual Use of Wearable Health Devices Among Middle-aged Individuals With Metabolic Syndrome Risk Factors in South Korea: Cross-sectional Study
    Jaeyoung Ha, Jungmi Park, Sangyi Lee, Jeong Lee, Jin-Young Choi, Junhyoung Kim, Sung-il Cho, Gyeong-Suk Jeon
    JMIR Formative Research.2023; 7: e42087.     CrossRef
  • Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease
    Alessandra Musio, Federica Perazza, Laura Leoni, Bernardo Stefanini, Elton Dajti, Renata Menozzi, Maria Letizia Petroni, Antonio Colecchia, Federico Ravaioli
    International Journal of Molecular Sciences.2023; 24(8): 7517.     CrossRef
COVID-19: Perspective
Unconventional Answers to Unprecedented Challenges: The Swedish Experience During the COVID-19 Outbreak
Giuseppe Valeriani, Iris Sarajlic Vukovic, Richard Mollica
J Prev Med Public Health. 2020;53(4):233-235.   Published online July 22, 2020
DOI: https://doi.org/10.3961/jpmph.20.235
  • 4,983 View
  • 214 Download
  • 11 Crossref
AbstractAbstract PDF
Since its early stages, the coronavirus disease 2019 (COVID-19) pandemic has posed immense challenges in meeting the public health and healthcare and social care needs of migrants. In line with other reports from United Kingdom and United States, data from Sweden’s health authority show that migrants have been disproportionately affected by COVID-19. Following the World Health Organization’s statements, as well as the European Public Health Association’s call for action, several centres in Sweden’s most populated areas have activated tools to implement national plans for community outreach through initiatives targeting migrants and ethnic minority groups. Unconventional means should be promoted to mitigate the impact of COVID-19 on migrants and the health of the public at large.
Summary

Citations

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    Kevin Morisod, Marie-Anne Durand, Kevin Selby, Marie-Annick Le Pogam, Véronique S. Grazioli, Javier Sanchis Zozaya, Patrick Bodenmann, Christian von Plessen
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  • Addressing Healthcare Gaps in Sweden during the COVID-19 Outbreak: On Community Outreach and Empowering Ethnic Minority Groups in a Digitalized Context
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    Healthcare.2020; 8(4): 445.     CrossRef
Original Articles
Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea
Jisun Sung, Seungho Ryu, Yun-Mi Song, Hae-Kwan Cheong
J Prev Med Public Health. 2020;53(5):342-352.   Published online July 17, 2020
DOI: https://doi.org/10.3961/jpmph.20.089
  • 3,598 View
  • 140 Download
  • 9 Crossref
AbstractAbstract PDF
Objectives
The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease.
Methods
This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors.
Results
Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant.
Conclusions
NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.
Summary

Citations

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  • Anti-osteoporotic treatments in the era of non-alcoholic fatty liver disease: friend or foe
    Maria Eleni Chondrogianni, Ioannis Kyrou, Theodoros Androutsakos, Christina-Maria Flessa, Evangelos Menenakos, Kamaljit Kaur Chatha, Yekaterina Aranan, Athanasios G. Papavassiliou, Eva Kassi, Harpal S. Randeva
    Frontiers in Endocrinology.2024;[Epub]     CrossRef
  • Association between body fat and bone mineral density in Korean adults: a cohort study
    Hyunjung Yoon, Eunju Sung, Jae-Heon Kang, Cheol-Hwan Kim, Hocheol Shin, Eunsol Yoo, Minyoung Kim, Mi Yeon Lee, Sujeong Shin
    Scientific Reports.2023;[Epub]     CrossRef
  • Liver fibrosis is associated with impaired bone mineralization and microstructure in obese individuals with non-alcoholic fatty liver disease
    Ilaria Barchetta, Carla Lubrano, Flavia Agata Cimini, Sara Dule, Giulia Passarella, Arianna Dellanno, Alberto Di Biasio, Frida Leonetti, Gianfranco Silecchia, Andrea Lenzi, Maria Gisella Cavallo
    Hepatology International.2023; 17(2): 357.     CrossRef
  • Non-Alcoholic Fatty Liver Disease and Bone Tissue Metabolism: Current Findings and Future Perspectives
    Oxana M. Drapkina, Anastasia Yu. Elkina, Anna F. Sheptulina, Anton R. Kiselev
    International Journal of Molecular Sciences.2023; 24(9): 8445.     CrossRef
  • Nonalcoholic Fatty Liver Disease Is Associated With Decreased Bone Mineral Density in Adults: A Systematic Review and Meta‐Analysis
    Ying‐Hao Su, Kuo‐Liong Chien, Shu‐Hua Yang, Wei‐Tso Chia, Jen‐Hau Chen, Yen‐Ching Chen
    Journal of Bone and Mineral Research.2023; 38(8): 1092.     CrossRef
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    Marina V. Maevskaya, Yulia V. Kotovskaya, Vladimir T. Ivashkin, Olga N. Tkacheva, Ekaterina A. Troshina, Marina V. Shestakova, Valeriy V. Breder, Natalia I. Geyvandova, Vladimir L. Doshchitsin, Ekaterina N. Dudinskaya, Ekaterina V. Ershova, Khava B. Kodzo
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    Ilias D. Vachliotis, Athanasios D. Anastasilakis, Antonis Goulas, Dimitrios G. Goulis, Stergios A. Polyzos
    Diabetes, Obesity and Metabolism.2022; 24(9): 1702.     CrossRef
  • Hepatic fibrosis is associated with an increased rate of decline in bone mineral density in men with nonalcoholic fatty liver disease
    Ji Won Yoon, Min Joo Kim, Goh-Eun Chung, Jong In Yang, Jeong Yoon Yim, Jin Ju Kim, Sun Mie Kim, Min-Sun Kwak
    Hepatology International.2021; 15(6): 1347.     CrossRef
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    L. B. Lazebnik, S. V. Turkina
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Comparison of Computed Tomography-based Abdominal Adiposity Indexes as Predictors of Non-alcoholic Fatty Liver Disease Among Middle-aged Korean Men and Women
Jongmin Baek, Sun Jae Jung, Jee-Seon Shim, Yong Woo Jeon, Eunsun Seo, Hyeon Chang Kim
J Prev Med Public Health. 2020;53(4):256-265.   Published online June 18, 2020
DOI: https://doi.org/10.3961/jpmph.20.140
  • 4,800 View
  • 163 Download
  • 3 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
We compared the associations of 3 computed tomography (CT)-based abdominal adiposity indexes with non-alcoholic fatty liver disease (NAFLD) among middle-aged Korean men and women.
Methods
The participants were 1366 men and 2480 women community-dwellers aged 30-64 years. Three abdominal adiposity indexes—visceral fat area (VFA), subcutaneous fat area (SFA), and visceral-to-subcutaneous fat ratio (VSR)—were calculated from abdominal CT scans. NAFLD was determined by calculating the Liver Fat Score from comorbidities and blood tests. An NAFLD prediction model that included waist circumference (WC) as a measure of abdominal adiposity was designated as the base model, to which VFA, SFA, and VSR were added in turn. The area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were calculated to quantify the additional predictive value of VFA, SFA, and VSR relative to WC.
Results
VFA and VSR were positively associated with NAFLD in both genders. SFA was not significantly associated with NAFLD in men, but it was negatively associated in women. When VFA, SFA, and VSR were added to the WC-based NAFLD prediction model, the AUC improved by 0.013 (p<0.001), 0.001 (p=0.434), and 0.009 (p=0.007) in men and by 0.044 (p<0.001), 0.017 (p<0.001), and 0.046 (p<0.001) in women, respectively. The IDI and NRI were increased the most by VFA in men and VSR in women.
Conclusions
Using CT-based abdominal adiposity indexes in addition to WC may improve the detection of NAFLD. The best predictive indicators were VFA in men and VSR in women.
Summary

Citations

Citations to this article as recorded by  
  • Relationship between Non-Alcoholic Fatty Liver Disease and Visceral Fat Measured by Imaging-Based Body Composition Analysis: A Systematic Review
    Ker Ming Seaw, Christiani Jeyakumar Henry, Xinyan Bi
    Livers.2023; 3(3): 463.     CrossRef
  • Stratifying the risk of ovarian cancer incidence by histologic subtypes in the Korean Epithelial Ovarian Cancer Study (Ko‐EVE)
    Soseul Sung, Youjin Hong, Byoung‐Gie Kim, Ji‐Yeob Choi, Jae Weon Kim, Sang‐Yoon Park, Jae‐Hoon Kim, Yong‐man Kim, Jong‐Min Lee, Tae Jin Kim, Sue K. Park
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  • Correlation between CT Abdominal Anthropometric Measurements and Liver Density in Individuals with Non-Alcoholic Fatty Liver Disease
    Dragoș Constantin Cucoranu, Marian Pop, Raluca Niculescu, Vlad Vunvulea, Irina-Bianca Kosovski, Radu-Ovidiu Togănel, Eliza Russu, Adrian Vasile Mureșan, Răzvan-Andrei Licu, Anca Bacârea
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Impact of Regional Cardiocerebrovascular Centers on Myocardial Infarction Patients in Korea: A Fixed-effects Model
Sang Guen Cho, Youngsoo Kim, Youngeun Choi, Wankyo Chung
J Prev Med Public Health. 2019;52(1):21-29.   Published online November 28, 2018
DOI: https://doi.org/10.3961/jpmph.18.154
  • 6,497 View
  • 163 Download
  • 7 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality.
Methods
We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes.
Results
We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality.
Conclusions
The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.
Summary
Korean summary
권역심뇌혈관질환센터 설립 사업은 지역별로 심뇌혈관센터를 지정/육성하여, 심뇌혈관질환 발생시 3시간 이내 진료체계를 구축함으로써 급성심근경색과 뇌졸중의 급성기 응급상황에 대한 대응을 강화하고자 시행되었다. 본 연구는 권역심뇌혈관질환센터 설립 정책으로 인해 시술 건수와 30일 내 사망 등과 같은 치료 성과가 지역 수준에서 향상되었는지 살펴보기 위해 건강보험 청구자료로 지역 수준 패널자료를 구축하여 권역심뇌혈관질환센터 설립의 효과를 추정하였다. 분석 결과, 시계열적 효과와 관련 변수를 통제하였을 때 권역심뇌혈관질환센터 설립 이후 설립 지역에서 여성의 치료 사례 수가 통계적으로 유의하게 증가하였고, 사망률은 유의미한 변화가 관찰되지 않았다. 따라서 권역심뇌혈관질환센터 설립은 대비성 향상과 치료 사례 수 증가를 통해 추가적인 치료를 받은 급성심근경색 환자의 잠재적인 원외 사망을 방지하는 효과가 있는 것으로 판단된다.

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The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim
J Prev Med Public Health. 2016;49(4):230-239.   Published online July 14, 2016
DOI: https://doi.org/10.3961/jpmph.16.034
  • 10,570 View
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  • 17 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.
Summary

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Perspective
Implementation of Quaternary Prevention in the Korean Healthcare System: Lessons From the 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea
Jong-Myon Bae
J Prev Med Public Health. 2015;48(6):271-273.   Published online November 24, 2015
DOI: https://doi.org/10.3961/jpmph.15.059
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AbstractAbstract PDF
Quaternary prevention should be implemented to minimize harm to patients because the ultimate goal of medicine is to prevent disease and promote health. Primary care physicians have a major responsibility in quaternary prevention, and the establishment of clinical epidemiology as a distinct field of study would create a role charged with minimizing patient harm arising from over-medicalization.
Summary

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Original Articles
Physical Activity- and Alcohol-dependent Association Between Air Pollution Exposure and Elevated Liver Enzyme Levels: An Elderly Panel Study
Kyoung-Nam Kim, Hyemi Lee, Jin Hee Kim, Kweon Jung, Youn-Hee Lim, Yun-Chul Hong
J Prev Med Public Health. 2015;48(3):151-169.   Published online May 15, 2015
DOI: https://doi.org/10.3961/jpmph.15.014
  • 9,721 View
  • 125 Download
  • 43 Crossref
AbstractAbstract PDFSupplementary Material
Objectives
The deleterious effects of air pollution on various health outcomes have been demonstrated. However, few studies have examined the effects of air pollution on liver enzyme levels.
Methods
Blood samples were drawn up to three times between 2008 and 2010 from 545 elderly individuals who regularly visited a community welfare center in Seoul, Korea. Data regarding ambient air pollutants (particulate matter ≤2.5 μm [PM2.5], nitrogen dioxide [NO2], ozone [O3], carbon monoxide, and sulfur dioxide) from monitoring stations were used to estimate air pollution exposure. The effects of the air pollutants on the concentrations of three liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and γ-glutamyltranspeptidase [γ-GTP)]) were evaluated using generalized additive and linear mixed models.
Results
Interquartile range increases in the concentrations of the pollutants showed significant associations of PM2.5 with AST (3.0% increase, p=0.0052), ALT (3.2% increase, p=0.0313), and γ-GTP (5.0% increase, p=0.0051) levels; NO2 with AST (3.5% increase, p=0.0060) and ALT (3.8% increase, p=0.0179) levels; and O3 with γ-GTP (5.3% increase, p=0.0324) levels. Significant modification of these effects by exercise and alcohol consumption was found (p for interaction <0.05). The effects of air pollutants were greater in non-exercisers and heavy drinkers.
Conclusions
Short-term exposure to air pollutants such as PM2.5, NO2, and O3 is associated with increased liver enzyme levels in the elderly. These adverse effects can be reduced by exercising regularly and abstinence from alcohol.
Summary

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Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010
Eunkyoung Kim, Soonman Kwon, Ke Xu
J Prev Med Public Health. 2013;46(5):237-248.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.237
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AbstractAbstract PDF
Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Summary

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Special Articles
A Strategy Toward Reconstructing the Healthcare System of a Unified Korea
Yo Han Lee, Seok-Jun Yoon, Seok Hyang Kim, Hyun-Woung Shin, Jin Yong Lee, Beomsoo Kim, Young Ae Kim, Jangho Yoon, Young Seok Shin
J Prev Med Public Health. 2013;46(3):134-138.   Published online May 31, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.3.134
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AbstractAbstract PDF

This road map aims to establish a stable and integrated healthcare system for the Korean Peninsula by improving health conditions and building a foundation for healthcare in North Korea through a series of effective healthcare programs. With a basic time frame extending from the present in stages towards unification, the roadmap is composed of four successive phases. The first and second phases, each expected to last five years, respectively, focus on disease treatment and nutritional treatment. These phases would thereby safeguard the health of the most vulnerable populations in North Korea, while fulfilling the basic health needs of other groups by modernizing existing medical facilities. Based on the gains of the first two phases, the third phase, for ten years, would prepare for unification of the Koreas by promoting the health of all the North Korean people and improving basic infrastructural elements such as health workforce capacity and medical institutions. The fourth phase, assuming that unification will take place, provides fundamental principles and directions for establishing an integrated healthcare system across the Korean Peninsula. We are hoping to increase the consistency of the program and overcome several existing concerns of the current program with this roadmap.

Summary

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Public Health Challenges of Electronic Cigarettes in South Korea
Sungkyu Lee, Heejin Kimm, Ji Eun Yun, Sun Ha Jee
J Prev Med Public Health. 2011;44(6):235-241.   Published online November 14, 2011
DOI: https://doi.org/10.3961/jpmph.2011.44.6.235
  • 44,717 View
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AbstractAbstract PDF

Electronic cigarettes (e-cigarrettes) were recently introduced and advertised as a smoking cession device in South Korea. As the social norm to quit smoking has gained hold in the country, the number of e-cigarette users is growing rapidly. This phenomenon should be urgently considered, because of the lack of research that has been conducted to examine the safety of e-cigarettes and its efficacy as a smoking cessation aid.

This paper raises several public health concerns on e-cigarettes in South Korea. Uncertain regulations of the government on e-cigarettes are contributing to an increase of e-cigarette users and allowing the e-cigarette industry to circumvent existing regulations. The aggressive marketing activity of this industry is also a core factor that is responsible for the rapid increase of e-cigarette use, in particular among the youth. Following the enforcement of tobacco control, some cigarette smokers may be encouraged to purchase e-cigarettes in order to circumvent the regulations, even though the dual use of e-cigarette and cigarette may be more harmful.

Until there is clear evidence of the e-cigarette's safety, it is recommended that the industry's marketing and promotional activities be banned and closely monitored, and public campaigns be initiated to educate the public regarding e-cigarettes.

Summary

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English Abstracts
The Association of Cardiovascular Risk Factors with Nonalcoholic Fatty Liver Disease in Health Checkup Examinees.
Jae Hee Yu, Kang Sook Lee, Seon Young Lee, A Rum Hong, Yong Sang Park
J Prev Med Public Health. 2008;41(6):407-412.
DOI: https://doi.org/10.3961/jpmph.2008.41.6.407
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AbstractAbstract PDF
OBJECTIVES
The purpose of this study was to evaluate the relationship of nonalcoholic fatty liver and cardiovascular risk factors. METHODS: This study was conducted to investigate the association of nonalcoholic fatty liver and cardiovascular risk factors for adult men (n=2976) and women (n=2442) who were over 19 years old, after excluding the HBsAg(+) or anti-HCV(+) patients and the men and women with increased alcohol intake (men: 40 g/week, women: 20 g/week). RESULTS: Compared with the normal liver subjects, the nonalcoholic fatty liver subjects showed a significantly increased frequency of abnormal systolic blood pressure (> or =120 mmHg), fasting blood sugar (> or =100 mg/dL), total cholesterol (> or =200 mg/dL), triglyceride (> or =150 mg/dL), high density lipoprotein cholesterol (<40 mg/dL), low density lipoprotein cholesterol (> or =130g m/dL) and abdominal obesity in men, and all these measures were significantly increased in the women except for abnormal HDL cholesterol. After adjusting for the body mass index, age, smoking, exercise and a nonalcoholic liver, the odds ratios of an abnormal waist hip ratio were 1.35(95% Confidence Interval=1.05-4.72) in the mild fatty liver, 1.61(1.19-2.18) in the moderate fatty liver, 2.77(1.57-4.92) in the severe fatty liver compared with a normal liver. The adjusted odds ratios for abnormal fasting blood sugar were 1.26(1.03-1.53) in the mild fatty liver, 1.62(1.27-2.06) in the moderate fatty lliver and 1.77(1.12-2.78) in the severe fatty liver. The adjusted odds ratios for abnormal triglyceride were 1.38(1.11-1.72) in the mild fatty liver, 1.73(0.33-2.24) in the moderate fatty liver and 1.91(1.17-3.10) in the severe fatty liver of men. Adjusted odds ratios for abnormal triglyceride were 1.50(1.04-2.15) in mild, 1.71(1.07-2.68) in moderate, 1.81(0.69-4.38) in severe fatty liver of women. CONCLUSIONS: The nonalcoholic fatty liver subjects had more cardiovascular risk factors compared with the normal liver subjects. Thus, prevention and treatment of the nonalcoholic fatty liver is necessary by lifestyle modifications such as restriction of alcohol intake, no smoking, exercise and adequate eating habits.
Summary

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    Zeynel Abidin Ozturk
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Associations of Non Alcoholic Fatty Liver with the Metabolic Syndrome and Serum Carotenoids.
Sun kyun Park, Hyun Jung Lee, Duk Hee Lee, Sung Kook Lee, Byung Yeol Chun, Sung Ae Kim, Hye Sung Lee, Hyo Kyung Son, Sung Hi Kim
J Prev Med Public Health. 2008;41(1):39-44.
DOI: https://doi.org/10.3961/jpmph.2008.41.1.39
  • 5,545 View
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AbstractAbstract PDF
OBJECTIVES
This study was conducted to investigate the associations of non alcoholic fatty liver with metabolic syndrome and the serum carotenoids. METHODS: This study was conducted in a general hospital in South Korea from November, 2004 to August, 2005. The study subjects were 350 sampled persons who were aged from 40 years and older (males: 180, females: 170). They were grouped into the normal, mild and severe groups according to fat accumulation in their livers, as determined by ultrasonography. We analyzed the association between non alcoholic fatty liver and metabolic syndrome by multiple logistic regression analysis and we analyzed the association between non alcoholic fatty liver and the serum carotenoids by a general linear model(ANCOVA). RESULTS: After adjustment for the effect of potential covariates, the prevalence of metabolic syndrome was associated with fat accumulation in the liver (p trend <0.001). If the odds ratio of normal group is 1.00, then that of the mild group is 2.80 (95% C.I=1.17-6.71) and that of the severe group is 7.29 (95% C.I=2.76-19.30). The prevalence of metabolic alterations fitting the criteria of metabolic syndrome, according to the class of fat accumulation in the liver, was significantly increased, except for criteria of high blood pressure, a large waist circumference and low HDL (high density lipoprotein) cholesterol level (p trend <0.001). The level of serum beta-carotene was decreased according to the class of fat accumulation in the liver (p trend=0.036), but the levels of serum alpha-carotene, lycopene, bata-cryptoxanthin and lutein were not decreased. CONCLSIONS: This study shows that non alcoholic fatty liver was associated with metabolic syndrome and with the serum beta-carotene level.
Summary

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Fasting Serum Glucose and Subsequent Liver Cancer Risk in a Korean Prospective Cohort.
Jin Gwack, Seung Sik Hwang, Kwang Pil Ko, Jae Kwan Jun, Sue Kyung Park, Soung Hoon Chang, Hai Rim Shin, Keun Young Yoo
J Prev Med Public Health. 2007;40(1):23-28.
DOI: https://doi.org/10.3961/jpmph.2007.40.1.23
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OBJECTIVES
Chronic infections with hepatitis B or C and alcoholic cirrhosis are three well-known major risk factors for liver cancer. Diabetes has also been suggested as a potential risk factor. However, the findings of previous studies have been controversial in terms of the causal association. Therefore, the aim of this study was to evaluate the association between serum glucose levels and liver cancer development in a Korean cohort. METHODS: Thirty-six liver cancer cases were identified in the Korean Multi-Center Cancer Cohort (KMCC). Baseline information on lifestyle characteristics was obtained via questionnaire. Serum glucose levels were measured at the study's enrollment. Relative risks (RRs) were estimated using a Cox proportional hazard regression model. The adjusting variables included age, gender, smoking history, alcohol consumption, body mass index, and hepatitis B surface antigen (HBsAg) seropositivity. RESULTS: The RRs of serum glucose for liver caner were 1.20 (95% CI=0.48-2.99) for the category of 100 to 125 mg/dL of serum glucose and 2.77 (95% CI=1.24-6.18) for the >126 mg/dL serum glucose category (both compared to the <100 mg/dL category). In a subgroup analysis, the RR of serum glucose among those who were both HBsAg seronegative and non-drinkers was 4.46 (95% CI=1.09-18.28) for those with glucose levels >100 mg/dL. CONCLUSIONS: The results of this study suggest that a high level of serum glucose can increase liver cancer risk independently of hepatitis infection and drinking history in Koreans. This study implies that glucose intolerance may be an independent risk factor for liver cancer.
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