- A Cohort Study on Risk Factors for Chronic Liver Disease: Analytic Strategies Excluding Potentially Incident Subjects.
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Moo Song Lee, Dae Sung Kim, Dong Hyun Kim, Jong Myun Bae, Myung Hee Shin, Yoon Ok Ahn
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Korean J Prev Med. 1999;32(4):452-458.
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 Abstract
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- OBJECTIVES
The authors conducted the study to evaluate bias when potentially diseased subjects were included in cohort members while analyzing risk factors of chronic liver diseases. METHODS: Total of 14,529 subjects were followed up for the incidence of liver diseases from January 1993 to June 1997. We have used databases of insurance company with medical records, cancer registry, and death certificate data to identify 102 incident cases. The cohort members were classified into potentially diseased group(n=2,217) when they were HBsAg positive, serum GPT levels higher than 40 units, or had or has liver diseases in baseline surveys. Cox' model were used for potentially diseased group, other members, and total subjects, respectively. RESULTS: The risk factors profiles were similar for total and potentially diseased subjects: HBsAg positivity, history of acute liver disease, and recent quittance of smoking or drinking increased the risk, while intake of pork and coffee decreased it. For the potentially diseased, obesity showed marginally significant protective effect. Analysis of subjects excluding the potentially diseased showed distinct profiles: obesity increased the risk, while quitting smoking or drinking had no association. For these intake of raw liver or processed fish or soybean paste stew increased risk; HBsAg positivity, higher levels of liver enzymes and history of acute liver diseases increased the risk. CONCLUSIONS: The results suggested the potential bias in risk ratio estimates when potentially diseased subjects were included in cohort study on chronic liver diseases, especially for lifestyles possibly modified after disease onset. The analytic strategy excluding potentially diseased subjects was considered appropriate for identifying risk factors for chronic liver diseases.
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Summary
- The Effect of Coffee Consumption on Serum Total Cholesterol Level in Healthy Middle-Aged Men.
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Myung Hee Shin, Dong Hyun Kim, Jong Myun Bae, Hyung Ki Lee, Moo Song Lee, Joon Yang Noh, Yoon Ok Ahn
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Korean J Prev Med. 1994;27(2):200-216.
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- In present study, the authors investigated the possible effect of coffee consumption on serum cholesterol level in 1017 men between the ages of 40 and 59 years, who were randomly selected from the members of Seoul Cohort Study. Serum total cholesterol data was collected with other serologic indices(e.g. systolic blood pressure, diastolic blood pressure, hight, weight, etc.)through the program of biennial health check-up offered by Korean Medical Insurance Corporation(KMIC). The amount of coffee consumption was assessed by a self-administered questionnaire through mailing. Other confounding factors, such as age, body mass index, cigarette smoking, alcohol consumption, physical activity, and other dietary intake pattern were also determined by the questionnaire. The differences in means of serum total cholesterol in compared to non consumers were -0.4+/-3.56mg/dl for those drinking less than 1 cup a day, -0.6+/-3.60mg/dl for those drinking 1 cup a day, and 7.1+/-3.41mg/dl for those drinking more than 2 cups a day. Since smoking interacted the relationship between coffee consumption and serum total cholesterol, we re-analyzed those relationship in smokers and non-smokers separately. Other atherogenic behaviors were well correlated with total cholesterol, so we adjusted the mean values of serum total cholesterol through multivariate model selection with age(r=0.12), total cigarette index(cigarette-years; r=0.10), Quetelet's index(kg/m2, r=0.16), daily calory expenditure(kcal/day, r=0.06), weekly meat and poultry consumption(g/week, r=0.05), weekly fish consumption(g/week, r=0.08), other caffeinated beverage intake(cups/week), and the amount of sugar and prim added to the coffee. Among those variables only age, Quetelet's index, fish consumption, and total cigarette index(in smokers)were remained in the models. After adjustment, the corresponding differences of total cholesterol in smokers were changed to 0.4+/-5.24mg/dl, -0.5+/-4.97mg/dl, and 8.9+/-4.78mg/dl, which were significantly different among themselves(P=0.011). In non-smokers, however, the differences were not statistically significant(P=0.76). Adjusted mean values of systolic blood pressure and diastolic blood pressure were also determined to evaluate the direct effect of coffee to cardiovascular system, but their means were not significantly different by coffee consumption(p=0.18 for SBP, P=0.48 for DBP). Assuming instant coffee on the most popular type of coffee in Korea, the association observed in our study between coffee and serum total cholesterol, especially in smokers , is very interesting finding for the connection between coffee and serum total cholesterol, because only 'boiled coffee' tend to show significant lipid raising effect rather than to other types of coffee, like filtered or espresso, in most of the western countries. We concluded that people who drink coffee more than 2 cups a day have significantly higher serum total cholesterol level than those who never drink coffee, especially in smokers.
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