Hwi-Won Lee

What Are the Major Determinants in the Success of Smoking Cessation: Results from the Health Examinees Study

Understanding mechanisms underlying smoking-related factors should be prioritized in establishing smoking prevention and cessation policy. The aim of this study was to identify factors significantly associated with smoking initiation and/or smoking cessation as well as the most important determinants of successful smoking cessation in a developed non-Western setting. Based on multiple logistic regression models, the odds ratios (ORs) for smoking initiation and cessation were estimated among males (N = 24,490) who had participated in the Health Examinees (HEXA) study. The Cox proportional hazards regression model was used to assess the association between selected predictors of smoking cessation and the likelihood of reaching this goal. Finally, Kaplan–Meier curves were constructed to illustrate the distribution of time from age at smoking initiation to age at smoking cessation. We found that the ORs for successfully quitting smoking increased with age, married status, educational achievement, having a non-manual job, drinking cessation and disease morbidity. Those exposed to secondhand smoking showed less likelihood of quitting smoking. A continual decrease in the ORs for successfully quitting smoking was observed according to increased smoking duration, smoking dose per day and lifetime tobacco exposure (p trend <0.001). Among the selected predictors, lifetime tobacco exposure, educational attainment, alcohol drinking status and birth cohort were the major determinants in the success of smoking cessation. Our findings suggest that lifetime tobacco exposure, educational attainment, alcohol drinking status and birth cohort can determine success in smoking cessation. Public interventions promoting a smoke-free environment are needed to reinforce discouraging the initiation of, reducing, and quitting cigarette smoking.

Egg Consumption and Risk of Metabolic Syndrome in Korean Adults: Results from the Health Examinees Study

Metabolic syndrome (MetS) is defined as a cluster of metabolic alterations such as abdominal obesity, dyslipidemias, elevated fasting glucose, and hypertension. Studies on the association between egg consumption and MetS are limited and inconsistent. A cross-sectional analysis was conducted to examine the association of egg consumption with MetS among Korean adults aged 40–69 years. A total of 130,420 subjects (43,682 men and 86,738 women) from the Health Examinees Study were selected for the final analysis. Egg consumption was estimated using a validated 106-item food frequency questionnaire. MetS was defined using the National Cholesterol Education Program, Adult Treatment Panel III. Logistic regression analyses were performed to identify the association of egg consumption with MetS via odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for potential variables. Among 130,420 subjects, 34,039 (26.1%) people had MetS. Consumption of more than 7 eggs/week was associated with a lower odds of MetS risk compared to those who consumed less than one egg/week in women (OR: 0.77, 95%CI: 0.70–0.84, p trend < 0.0001). Higher egg consumption was inversely associated with the MetS components: elevated waist circumference (OR: 0.80, 0.75–0.86), elevated triglyceride (OR: 0.78, 0.72–0.85), reduced high-density lipoprotein cholesterol (HDL-C) (OR: 0.82, 0.77–0.88), elevated blood pressure (OR: 0.86, 0.80–0.92), and elevated fasting glucose (OR: 0.94, 0.83–0.99) in women; reduced HDL-C (OR: 0.89, 0.80–1.00) in men. Our results suggest that higher egg consumption may be associated with a reduction in the odds for MetS and all five metabolic components in women, and the risk of reduced HDL-C in men.

Determinants of Poor Self-rated Health in Korean Adults With Diabetes

Objectives: Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes. Methods: A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance. Results: We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]Frequent stress events, 5.40; 95% confidence interval [CI], 4.63 to 6.29; ORSevere distress, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A1clevels of 6.5% or more, and comorbidities, were other correlates of poor reported health. Conclusions: Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

Short Sleep Duration and Its Correlates among Cancer Survivors in Korea: the Korea National Health and Nutrition Examination Surveys.

BACKGROUND Though a large proportion of cancer survivors are assumed to be commonly affected by sleep disturbance, few studies have focused on short sleep problems and its correlates among Korean cancer survivors. The purpose of this study was to evaluate the prevalence of short sleep in adult cancer survivors from a nationwide population-based sample and to identify risk factors for short sleep duration. MATERIALS AND METHODS Based on the fourth and fifth Korea National Health and Nutrition Examination Surveys (2007-2012), 1,045 cancer survivors and 33,929 non-cancer controls were analyzed. The prevalence of short sleep was compared between these two groups. Associations between short sleep and its correlates were evaluated using multiple logistic regression among cancer survivors: odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated after adjusting for sociodemographic factors, lifestyle factors, psychological conditions, and cancer-related factors. RESULTS About 8.1% of cancer survivors slept for less than 5 hours per day (6.2% men and 9.3% women), whereas this was the case for only 3.7% of non-cancer controls. Cancer survivors who had the lowest household income level showed a significantly higher likelihood for short sleep (adjusted OR 2.82, 95%CI 1.06-7.54). Self-reported poor health and depressive symptoms were found to be associated with significantly increased likelihood for short sleep in cancer survivors (adjusted OR 3.60, 95%CI 1.40-9.26 and adjusted OR 2.00, 95%CI 1.17-3.42). Gastric cancer survivors had a 3.97-fold increased risk for short sleep (95%CI 1.60-9.90). CONCLUSIONS The prevalence of short sleep occurs at a high rate among the Korean cancer survivors, which may indicate a poorer quality of life and a higher risk of future complications in survivorship. Targeted interventions that can assist cancer survivors to cope with sleep disturbances as well as ensuring psychological stability are warranted to reduce the latent disease burden.

The Potential Application of Personalized Preventive Research

With increases in life expectancy, the focus has shifted to living a healthier, longer life. By concentrating on preventing diseases before occurrence, researchers aim to diminish the increasing gap in medical costs and health inequalities prevalent across many nations. Although we have entered an era of post-genomics, we are still in infancy in terms of personalized preventive research. Personalized preventive research has and will continue to improve with advancements in the use of biomarkers and risk assessment. More evidence based on well-designed epidemiologic studies is required to provide comprehensive preventive medical care based on genetic and non-genetic profile data. The realization of personalized preventive research requires building of evidence through appropriate methodology, verification of results through translational studies as well as development and application of prediction models.

An association between diet quality index for Koreans (DQI-K) and total mortality in Health Examinees Gem (HEXA-G) study

BACKGROUND/OBJECTIVES Diet quality scores or indices, based on dietary guidelines, are used to summarize dietary intake into a single numeric variable. The aim of this study was to examine the association between the modified diet quality index for Koreans (DQI-K) and mortality among Health Examinees-Gem (HEXA-G) study participants. SUBJECTS/METHODS The DQI-K was modified from the original diet quality index. A total of 134,547 participants (45,207 men and 89,340 women) from the HEXA-G study (2004 and 2013) were included. The DQI-K is based on eight components: 1) daily protein intake, 2) percent of energy from fat, 3) percent of energy from saturated fat, 4) daily cholesterol intake, 5) daily whole-grain intake, 6) daily fruit intake, 7) daily vegetable intake, and 8) daily sodium intake. The association between all-cause mortality and the DQI-K was examined using Cox proportional hazard regression models. Hazard ratios and confidence intervals were estimated after adjusting for age, gender, income, smoking status, alcohol drinking, body mass index, and total energy intake. RESULTS The total DQI-K score was calculated by summing the scores of the eight components (range 0–9). In the multivariable adjusted models, with good diet quality (score 0–4) as a reference, poor diet quality (score 5–9) was associated with an increased risk of all-cause mortality (hazard ratios = 1.23, 95% confidence intervals = 1.06–1.43). Moreover, a one-unit increase in DQI-K score resulted in a 6% higher mortality risk. CONCLUSIONS A poor diet quality DQI-K score was associated with an increased risk of mortality. The DQI-K in the present study may be used to assess the diet quality of Korean adults.

Frequency of Loud Snoring and Metabolic Syndrome among Korean Adults: Results from the Health Examinees (HEXA) Study

Studies regarding the association between snoring and metabolic abnormalities have been inconsistent. We examine whether snoring frequency and obstructive sleep apnea markers are associated with metabolic syndrome (MetS) among Koreans aged 40–69 years. A total of 72,885 subjects (24,856 men, 48,029 women) from the Health Examinees Gem study between 2009 and 2013 were included. Snoring frequency was grouped into five categories (never, 1–3/month, 1–3/week, 4–5/week, 6+/week). Obstructive sleep apnea markers included breathing interruptions and awakenings. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated through logistic regression. Compared with non-snorers, those who snore 6+/week were associated with increased odds for MetS (OR: 2.07, 95% CI: 1.91–2.25, p-trend < 0.0001 among men; OR: 1.45, CI: 1.33–1.58, p-trend < 0.0001 among women). Snoring frequency is associated with MetS and its components in both men and women. Snoring and obstructive sleep apnea markers are important indicators of sleep quality, which may facilitate early detection of sleep disorders and further complications such as MetS.

Association between Milk Consumption and Metabolic Syndrome among Korean Adults: Results from the Health Examinees Study

It has been suggested that a greater dairy consumption, particularly of milk, may have contributed in lowering the prevalence of metabolic syndrome (MetS). A cross-sectional analysis was conducted to examine the association between milk consumption and MetS, and its components among Korean adults aged 40–69. A total of 130,420 subjects (43,682 men and 86,738 women) from the Health Examinees Study were selected for the final analysis. Milk consumption was estimated using a validated 106-item food frequency questionnaire. MetS was defined using the National Cholesterol Education Program, Adult Treatment Panel III (NCEP III). Logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) between milk consumption and MetS after adjusting for potential confounders. In this study, the average milk consumption was 77.9 g/day, with the overall prevalence of MetS being 26.1% (29.1% in men and 24.6% in women). We found that the prevalence of the MetS was significantly lower in subjects with higher milk consumption (p < 0.0001). Adjusted OR for MetS was significantly lower in the highest milk consumption category (≥1 serving/day among men; ≥2 serving/day among women) than those in the lowest milk consumption category (OR: 0.92 95%CI: 0.86–0.99, p trend = 0.0160 in men; OR: 0.68, 95%CI: 0.60–0.76, p trend < 0.0001 in women). Overall, higher milk consumption was inversely associated with the MetS components: elevated waist circumference, elevated triglyceride, and reduced high-density lipoprotein cholesterol (HDL-C) (all p trend < 0.05). This study concludes that higher milk consumption is associated with the lower odds of MetS in Korean adults.

Association of Short Sleep Duration with Psychological Conditions inCancer Survivors: From the Korea National Health and NutritionExamination Survey

Background: Cancer survivors experience various psychological complications. This study aims to explore the concurrent association between short sleep duration and poor psychological conditions among adult cancer survivors in Korea. Methods: Cross-sectional study using data from the fourth and fifth Korea National Health and Nutrition Examination Surveys (2007-2012) included 1,042 cancer survivors and 33,867 non-cancer controls. Psychological conditions (i.e., severe distress, depression, suicidal ideation and suicide attempt) were compared between cancer survivors and non-cancer controls. Based on logistic regression models controlling for age and sex, associations between short sleep duration and psychological status were evaluated among cancer survivors. Results: Cancer survivors exhibited higher estimated proportions of depression, suicidal ideation, and suicide attempt than non-cancer controls. Short sleep duration was found to have a significantly increased likelihood for poor psychological outcomes such as severe distress, depression, and suicidal ideation in cancer survivors (OR=2.21, 95% CI 1.28-3.81; OR=3.14, 95% CI 1.47-6.72, and OR=2.32, 95% CI 1.70-3.78, respectively). Conclusions: Our findings indicate that short sleep duration can place cancer survivors at a higher risk of adverse psychological conditions. Interventions focused on improving both sleep behavior and psychological stability among cancer survivors are needed.