Jungun Lee

Association between low pulmonary function and metabolic risk factors in Korean adults: the Korean National Health and Nutrition Survey.

Impaired lung function is a risk factor for cardiovascular events and mortality. In addition, lung function impairment is also associated with insulin resistance and type 2 diabetes mellitus. It is well known that a common mechanism, such as insulin resistance and obesity, underlies metabolic syndrome. Our aim was to evaluate the association between impaired lung function and metabolic risk factors using data from a nationwide survey of chronic obstructive pulmonary disease prevalence in Korea and the Korean National Health and Nutrition Survey in 2001. The study population included 4001 subjects (aged > or =18 years) who underwent spirometry at least twice. We analyzed the association of low pulmonary function with metabolic syndrome components using multiple linear regression and also analyzed the association of metabolic syndrome with restrictive lung disease and obstructive lung disease using multiple logistic regression adjusted for waist to height ratio, sex, age, smoking, and the other covariates. Waist girth, systolic blood pressure, and triglyceride were associated with forced vital capacity (FVC); and only triglyceride was so with forced expiratory volume in 1 second (FEV(1)), but not with FEV(1)/FVC ratio. The odds ratio of metabolic syndrome for restrictive lung disease (FVC <80%, FEV(1)/FVC >0.7) was 1.40 (95% confidence interval, 1.01-1.98), and that for obstructive lung disease (FEV(1)/FVC <0.7) was 0.93 (95% confidence interval, 0.67-1.28) after adjustment for covariates. These results indicate that low pulmonary function in the general population is associated with clustering of metabolic syndrome risk factors and, furthermore, that restrictive lung disease is also related to metabolic syndrome.

Efficacy of low‐calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: a double‐blind, randomised controlled trial of two diet plans – one high in protein and one nutritionally balanced

Background:  Little is known about the relative efficacy of high‐protein vs. conventional diet plans that include partial meal replacements on body fat loss in obese subjects with metabolic syndrome.

Influence of Maternal Environmental Tobacco Smoke Exposure Assessed by Hair Nicotine Levels on Birth Weight

BACKGROUND While the perinatal outcomes of active maternal smoking are well documented, results of the effects of environmental tobacco smoke (ETS) exposure during pregnancy are inconsistent. We aimed to examine the effect of ETS exposure, assessed by maternal hair nicotine levels at 35th week of gestation, on birth weight and the risk of small for gestational age (SGA) and low birth weight (LBW). MATERIALS AND METHODS A total of 871 non-smoking healthy pregnant women were recruited by one Korean hospital between 1 October 2006 and 31 July 2007. Hair samples were collected and anthropometric questionnaires administered at 35th week of gestation. The primary outcome was birth weight and secondary outcomes were the risk of babies being SGA and LBW. RESULTS Log-transformed hair nicotine concentrations were inversely related with birth weight after adjusting for confounding variables (β=-0.077, p=0.037). After stratifying hair nicotine levels by tertiles (T1, low [0.0-0.28 ng/mg]; T2, medium [0.29-0.62 ng/mg]; and T3, high [0.63-5.99 ng/mg]), the mean birth weight in each groups were 3,342 g (T1) 3,296 g (T2) and 3,290 g (T3), respectively. However the difference between groups was not statistically significant by analysis of co-variance (ANCOVA) adjusting for covariates (p=0.062). In logistic regression analysis, the risk of SGA was higher in the T3 (OR=1.59, 95%CI 1.05-2.42) than in the reference group (T1), after controlling for confounding variables. The risk of low birth weight (<2,500 g, LBW) was not significantly higher (OR=1.44, 95%CI 0.95-2.19), but the risk of babies being below 3,000g birth weight was increased in the T3 group (OR=1.53, 95%CI 1.00-2.36) compared with that in the T1 group. CONCLUSIONS Maternal ETS exposure during pregnancy was inversely related with birth weight. The risk of SGA increased in the highest ETS exposure group compared with in the low exposure group. To prevent ETS exposure during pregnancy, more comprehensive tobacco control policies are needed.

The Characteristics of False Respondents on a Self-reported Smoking Survey of Korean Women: Korean National Health and Nutrition Examination Survey, 2008

Background Previous studies have shown that self-reports tend to underestimate smoking status, especially among women in Korea. We therefore assessed the characteristics of Korean women smokers who falsely described themselves as non-smokers. Methods The subjects were 4,135 adult women aged ≥19 years who participated in the 2008 Korean National Health and Nutrition Examination Survey. Of these, 3,151 subjects answered questions about their smoking status on self-reported questionnaires and underwent assays of urinary cotinine concentration. Subgroups of false respondents (n = 131) and true respondents (n = 198) regarding smoking were determined by comparing their responses on questionnaires with their urinary cotinine levels. Results Among adult Korean women, the self-reported smoking rate was 7.4% (95% confidence interval [CI], 6.4% to 8.4%); however, using urinary cotinine >100 ng/mL as a marker of smoking, the smoking rate was 11.8% (95% CI, 10.5% to 13.3%). In multivariate analysis, after adjusting for type of household, family income, and suicidal ideation, the odds ratios (ORs) of false respondents were 3.49 (95% CI, 1.41 to 8.63) for college-educated women and 2.47 (95% CI, 1.22 to 5.01) for women with high school education, relative to women with elementary school education. Married women with living spouses (OR, 2.80; 95% CI, 1.33 to 5.90) were more likely to respond falsely than unmarried women. Women who reported trying to reduce weight within 1 year (OR, 2.70; 95% CI, 1.47 to 4.93) and those who reported being less stressed (OR, 1.82; 95% CI, 1.08 to 3.07) were more likely to be false respondents. Conclusion The smoking rate determined using urinary cotinine concentration was higher than the self-reported rate among Korean women. Among smokers, those who were more educated, married, living with a husband, trying to reduce weight, and less stressed tended to describe themselves falsely as non-smokers.

Knowledge, Current Status, and Barriers toward Healthcare Worker Vaccination among Family Medicine Resident Participants in a Web-Based Survey in Korea

Background We investigated the knowledge, status, and barriers toward healthcare workers receiving vaccinations among Korean family medicine residents. To date, a systematic study has not been conducted among medical practitioners examining these variables. Methods A web-based, anonymous, self-administered questionnaire was distributed to all 942 family medicine residents working in 123 training hospitals in Korea. A multiple logistic regression analysis was performed to investigate factors affecting vaccination completion. Results Korean family medicine residents (N=242, 25.7%) from 54 training hospitals (43.9%) participated in the survey. Only 24 respondents (9.9%) had correct knowledge on all the recommended vaccinations by the Korean Society of Infectious Diseases. The complete vaccination rates against hepatitis B virus and influenza were relatively high (69.4% and 83.0%, respectively), whereas they were relatively low against other infections (e.g., 16.5%– 53.1%). The most common reason for not receiving a vaccination was the belief that there was little possibility of infection from the vaccine-preventable diseases. Conclusion Knowledge and vaccination coverage were poor among family medicine residents in Korea. Medical schools should provide vaccination information to healthcare workers as part of their mandatory curriculum. Further research should confirm these findings among primary care physicians and other healthcare workers.

Health Inequality in Health Checkups

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. *Corresponding Author: Jungun Lee https://orcid.org/0000-0001-8580-1445 Tel: +82-31-390-2416, Fax: +82-31-390-2416, E-mail: trachea@naver.com https://doi.org/10.4082/kjfm.2018.39.2.65 • Korean J Fam Med 2018;39:65-66

Effect of Fenofibrate Medication on Renal Function

Background Fibrates are widely used to treat hypertriglyceridemia, a risk factor for arteriosclerosis, but these compounds have been associated with renal dysfunction. This study aimed to investigate the effects of fibrates on renal function in relatively healthy adult subjects with no cardiovascular diseases. Methods This retrospective study included 558 outpatients who were prescribed 160 mg fenofibrate (fenofibrate group) or 10 mg atorvastatin (control group) between August 2007 and October 2015. The groups were randomly matched using propensity scores at a 1:1 ratio. Serum creatinine levels and estimated glomerular filtration rates before and after treatment were compared between the two groups. Results Patients in the fenofibrate group showed greater changes in serum creatinine levels than those in the control group (9.73%±9.83% versus −0.89%±7.37%, P<0.001). Furthermore, 55.1% of patients in the fenofibrate group, but only 6.1% of those in the control group, exhibited a serum creatinine level increase ≥0.1 mg/dL (P<0.001). The fenofibrate group showed significantly greater declines in the estimated glomerular filtration rate than the control group (−10.1%±9.48% versus 1.42%±9.42%, P<0.001). Moreover, 34.7% of the fenofibrate group, but only 4.1% of the control group, exhibited an estimated glomerular filtration rate decrease ≥10 mL/min·1.73 m2 (P<0.001). Conclusion Fenofibrate treatment resulted in increased serum creatinine levels and reduced estimated glomerular filtration rates in a primary care setting. Therefore, regular renal function monitoring should be considered essential during fibrate administration.

False Replies on Smoking Rate Surveys and an In-Hospital Smoking Cessation Clinic

Cigarette smoking is a leading risk factor for cancer and cardiovascular and pulmonary disorders. It has been recommended that primary care physicians inquire about a patients smoking status and recommend smoking cessation during every medical consultation.1) Thus, smoking rates and smoking cessation have been major topics in papers published in the Korean Journal of Family Medicine. In this issue, Kim et al.2) report a discrepancy between self-reporting and urine cotinine-verified smoking status in South Korea. Among 3,477 men, urine cotinine-verified smoking rates were 11.1% higher than the self-reported smoking rate. About 1 in 3 participants did not complete a smoking questionnaire or gave false replies. Age greater than 60 years, an educational level of high school graduation or lower, multiple health check-ups, and urine cotinine levels <500 ng/mL were associated with a discrepancy between the smoking rates in the self-reported and cotinine-verified groups. This study was performed in a single hospital unit. However, the results were similar to those of previous studies, which showed that, compared to smoking rates determined by counter-verification with biomarkers, smoking rates in self-reports are lower in populations that are pressured to abstain from cigarette smoking for medical or social reasons, such as pregnant women,3,4) teenagers,5) those undergoing treatment for smoking cessation,6) and those with pulmonary disorders.7) Another study by Shin et al.8) presented the results of compliance and effectiveness of a smoking cessation program started in hospitalized patients. Of these, 74.5% were cardiovascular disease patients who were referred from neurology and cardiology and who needed to stop smoking for secondary prevention. However, only 67.9% of the referred patients actually had a consultation and prescription. Moreover, even those patients who were prescribed a medicine to quit smoking through a consultation rarely revisited the outpatient clinic after discharge from the hospital. This study indicated that there were various obstacles to treatment in terms of referring hospitalized patients to the smoking cessation clinic. The authors state that it is imperative to introduce a systematic smoking cessation program, which emphasizes the relationship between smoking and disease, for hospitalized patients and to encourage cooperation to improve the smoking cessation rate. After the implementation of a new tax policy that raised the cigarette price in South Korea, smoking cessation treatment gained support from the National Health Insurance Program. Under these circumstances, primary care physicians are likely to encounter more patients with tobacco addiction problems. Therefore, they should be familiar with smoking cessation counseling and treatment regimens.