Journal of Preventive Medicine and Public Health

Original Articles

Effect Modification of Kidney Function on the Non-linear Association Between Serum Calcium Levels and Cardiovascular Mortality in Korean Adults: Jung-Ho Yang, Sun-Seog Kweon, Young-Hoon Lee, Seong-Woo Choi, So-Yeon Ryu, Hae-Sung Nam, Hye-Yeon Kim, Min-Ho Shin; J Prev Med Public Health. 2023;56(3):282-290. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.068

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Abstract Summary PDF Supplementary Material: Objectives
This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality.
Methods
This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: <2.5th, 2.5-25.0th, 25.0-50.0th, 50.0-75.0th, 75.0-97.5th, and >97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate.
Results
Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (<2.5th: HR, 6.23; 95% confidence interval [CI], 1.16 to 33.56; >97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (<2.5th: HR, 1.37; 95% CI, 0.58 to 3.27; >97.5th: HR, 1.65; 95% CI, 0.70 to 3.93).
Conclusions
We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.; Summary

Korean summary
- 혈중 칼슘 농도와 심혈관 질환에 의한 사망은 U자형의 비선형 연관성을 보였다. - 혈중 칼슘 농도와 심혈관 질환에 의한 사망의 비선형 연관성은 신기능이 정상인 그룹보다 신기능이 낮은 그룹에서 더 유의하게 나타났다.

The Korea Cohort Consortium: The Future of Pooling Cohort Studies: Sangjun Lee, Kwang-Pil Ko, Jung Eun Lee, Inah Kim, Sun Ha Jee, Aesun Shin, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Daehee Kang, Keun-Young Yoo, Sue K. Park; J Prev Med Public Health. 2022;55(5):464-474. Published online September 12, 2022; DOI: https://doi.org/10.3961/jpmph.22.299

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Abstract Summary PDF Supplementary Material

Objectives
We introduced the cohort studies included in the Korea Cohort Consortium (KCC), focusing on large-scale cohort studies established in Korea with a prolonged follow-up period. Moreover, we also provided projections of the follow-up and estimates of the sample size that would be necessary for big-data analyses based on pooling established cohort studies, including population-based genomic studies.
Methods
We mainly focused on the characteristics of individual cohort studies from the KCC. We developed “PROFAN”, a Shiny application for projecting the follow-up period to achieve a certain number of cases when pooling established cohort studies. As examples, we projected the follow-up periods for 5000 cases of gastric cancer, 2500 cases of prostate and breast cancer, and 500 cases of non-Hodgkin lymphoma. The sample sizes for sequencing-based analyses based on a 1:1 case-control study were also calculated.
Results
The KCC consisted of 8 individual cohort studies, of which 3 were community-based and 5 were health screening-based cohorts. The population-based cohort studies were mainly organized by Korean government agencies and research institutes. The projected follow-up period was at least 10 years to achieve 5000 cases based on a cohort of 0.5 million participants. The mean of the minimum to maximum sample sizes for performing sequencing analyses was 5917-72 102.
Conclusions
We propose an approach to establish a large-scale consortium based on the standardization and harmonization of existing cohort studies to obtain adequate statistical power with a sufficient sample size to analyze high-risk groups or rare cancer subtypes.

Summary

Korean summary
한국 코호트 컨소시엄(KCC)은 “2015년 한국의 생활 습관 및 환경 요인에 따른 암 기여분율” 프로젝트의 3단계 과업으로써, 본 프로젝트에 참여한 기존의 구축된 개인 코호트 연구의 연구자들을 주도로 다수의 대규모 한국 코호트 연구를 기반으로 구성되었다. 따라서 본 연구는 KCC에 포함된 한국 코호트 연구를 소개하는 것을 목표로 하였다. 또한 여러 기 확립된 국제 컨소시엄을 기반으로 빅데이터 기반 코호트 풀링 연구의 중요성을 제시하였다.

Citations

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The relationship between regional inequalities in the provision of emergency health services and other health services
Erkan Boğa
Medicine.2023; 102(45): e35930. CrossRef

Non-linear Relationship Between Body Mass Index and Lower Urinary Tract Symptoms in Korean Males: Chang Kyun Choi, Sun A Kim, Ji-An Jeong, Sun-Seog Kweon, Min-Ho Shin; J Prev Med Public Health. 2019;52(3):147-153. Published online March 29, 2019; DOI: https://doi.org/10.3961/jpmph.18.259

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Abstract Summary PDF

Objectives
The purpose of this study was to evaluate the association between body mass index (BMI) and severe lower urinary tract symptoms (LUTS) in Korean males.
Methods
This study was conducted on males aged ≥50 years who participated in the 2011 Korean Community Health Survey. LUTS severity was assessed using the Korean version of the International Prostate Symptom Score (IPSS) questionnaire, and was dichotomized as severe (IPSS >19) and non-severe (IPSS ≤19). BMI was divided into 6 categories: <18.5, 18.5-22.9, 23.0-24.9, 25.0-27.4, 27.5-29.9, and ≥30.0 kg/m2. To evaluate the relationship between BMI and LUTS, a survey-weighted multivariate Poisson regression analysis was performed to estimate prevalence rate ratios (PRRs). Age, smoking status, alcohol intake, physical activity, educational level, household income, and comorbidities were adjusted for in the multivariate model.
Results
A U-shaped relationship was detected between BMI and severe LUTS. Compared with a BMI of 23.0-24.9 kg/m2, the PRR for a BMI <18.5 kg/m2 was 1.65 (95% confidence interval [CI], 1.35 to 2.02), that for a BMI of 18.5-22.9 kg/m2 was 1.25 (95% CI, 1.09 to 1.44), that for a BMI of 25.0-27.4 kg/m2 was 1.20 (95% CI, 1.00 to 1.45), that for a BMI of 27.5-29.9 kg/m2 was 1.11 (95% CI, 0.83 to 1.47), and that for a BMI ≥30.0 kg/m2 was 1.85 (95% CI, 1.18 to 2.88).
Conclusions
This study showed that both high and low BMI were associated with severe LUTS.

Summary

Korean summary
이 연구는 2011 지역사회건강조사를 기반으로 하였다. 한국인 남성에서 체질량지수와 하부요로증상 간에는 U자형 관련성이 있었으며, 저체중과 비만 모두 높은 하부요로증상 유병률을 보였다. 따라서 전립선 질환의 건강서비스 제공에 있어서 비만 뿐만 아니라 저체중 또한 위험인자로 함께 고려할 필요가 있다.

Citations

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Metabolic syndrome and male lower urinary tract symptoms
Gallus B. INEICHEN, Fiona C. BURKHARD
Panminerva Medica.2022;[Epub] CrossRef

Effect of Uric Acid on the Development of Chronic Kidney Disease: The Korean Multi-Rural Communities Cohort Study: Kwang Ho Mun, Gyeong Im Yu, Bo Youl Choi, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin; J Prev Med Public Health. 2018;51(5):248-256. Published online September 7, 2018; DOI: https://doi.org/10.3961/jpmph.18.112

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Abstract PDF

Objectives
Several studies have investigated the effects of serum uric acid (SUA) levels on chronic kidney disease (CKD), with discrepant results. The effect of SUA levels on CKD development was studied in the Korean rural population.
Methods
A total of 9695 participants aged ≥40 years were recruited from 3 rural communities in Korea between 2005 and 2009. Of those participants, 5577 who participated in the follow-up and did not have cerebrovascular disease, myocardial infarction, cancer, or CKD at baseline were studied. The participants, of whom 2133 were men and 3444 were women, were grouped into 5 categories according to their quintile of SUA levels. An estimated glomerular filtration rate of <60 mL/min/1.73 m2 at the time of follow-up was considered to indicate newly developed CKD. The effects of SUA levels on CKD development after adjusting for potential confounders were assessed using Cox proportional hazard models.
Results
Among the 5577 participants, 9.4 and 11.0% of men and women developed CKD. The hazard ratio (HR) of CKD was higher in the highest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.60; 95% confidence interval [CI], 1.02 to 2.51) and women (adjusted HR, 1.56; 95% CI, 1.14 to 2.15). Furthermore, CKD development was also more common in the lowest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.83; 95% CI, 1.15 to 2.90). The effect of SUA was consistent in younger, obese, and hypertensive men.
Conclusions
Both high and low SUA levels were risk factors for CKD development in rural Korean men, while only high levels were a risk factor in their women counterparts.

Summary

Citations

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Serum Uric Acid Levels and Nephrosclerosis in a Population-Based Autopsy Study: The Hisayama Study
Kenji Maki, Jun Hata, Satoko Sakata, Emi Oishi, Yoshihiko Furuta, Toshiaki Nakano, Yoshinao Oda, Takanari Kitazono, Toshiharu Ninomiya
American Journal of Nephrology.2022; 53(1): 69. CrossRef
Clinical features suggesting renal hypouricemia as the cause of acute kidney injury: a case report and review of the literature
Tommaso Mazzierli, Luigi Cirillo, Viviana Palazzo, Fiammetta Ravaglia, Francesca Becherucci
Journal of Nephrology.2022; 36(3): 651. CrossRef
U-shaped relationship between serum uric acid level and decline in renal function during a 10-year period in female subjects: BOREAS-CKD2
Kazuma Mori, Masato Furuhashi, Marenao Tanaka, Keita Numata, Takashi Hisasue, Nagisa Hanawa, Masayuki Koyama, Arata Osanami, Yukimura Higashiura, Masafumi Inyaku, Megumi Matsumoto, Norihito Moniwa, Hirofumi Ohnishi, Tetsuji Miura
Hypertension Research.2021; 44(1): 107. CrossRef
Sex-Specific Association of Uric Acid and Kidney Function Decline in Taiwan
Po-Ya Chang, Yu-Wei Chang, Yuh-Feng Lin, Hueng-Chuen Fan
Journal of Personalized Medicine.2021; 11(5): 415. CrossRef
Detailed association between serum uric acid levels and the incidence of chronic kidney disease stratified by sex in middle-aged adults
Shingo Nakayama, Michihiro Satoh, Yukako Tatsumi, Takahisa Murakami, Tomoko Muroya, Takuo Hirose, Takayoshi Ohkubo, Takefumi Mori, Atsushi Hozawa, Hirohito Metoki
Atherosclerosis.2021; 330: 107. CrossRef
Association between Serum Uric Acid Level and ESRD or Death in a Korean Population
Kipyo Kim, Suryeong Go, Hyung Eun Son, Ji Young Ryu, Hajeong Lee, Nam Ju Heo, Ho Jun Chin, Jung Hwan Park
Journal of Korean Medical Science.2020;[Epub] CrossRef
Renal effects of uric acid: hyperuricemia and hypouricemia
Jung Hwan Park, Yong-Il Jo, Jong-Ho Lee
The Korean Journal of Internal Medicine.2020; 35(6): 1291. CrossRef
Hyperuricemia Predicts Residual Diuresis Decline in Peritoneal Dialysis Patients
Natalia Stapanova, Lyudmyla Snisar, Larysa Lebid
Electronic Journal of General Medicine.2020; 18(1): em270. CrossRef
Genetically Elevated Serum Uric Acid and Renal Function in an Apparently Healthy Population
Ji-Yong Ge, Yuan Ji, Zhen-Yan Zhu, Xun Li
Urologia Internationalis.2020; 104(3-4): 277. CrossRef
Threshold Effects of Serum Uric Acid on Chronic Kidney Disease in US Women without Hypertension and Diabetes: A Cross-Sectional Study
Guiping Hu, Yi Bai, Tian Chen, Shichuan Tang, Lihua Hu
Kidney and Blood Pressure Research.2019; 44(5): 1036. CrossRef

C-reactive Protein Concentration Is Associated With a Higher Risk of Mortality in a Rural Korean Population: Jung Hyun Lee, Hyungseon Yeom, Hyeon Chang Kim, Il Suh, Mi Kyung Kim, Min-Ho Shin, Dong Hoon Shin, Sang-Baek Koh, Song Vogue Ahn, Tae-Yong Lee, So Yeon Ryu, Jae-Sok Song, Hong-Soon Choe, Young-Hoon Lee, Bo Youl Choi; J Prev Med Public Health. 2016;49(5):275-287. Published online August 23, 2016; DOI: https://doi.org/10.3961/jpmph.16.025

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Abstract PDF Supplementary Material

Objectives
C-reactive protein (CRP), an inflammatory biomarker, has been widely used as a preclinical marker predictive of morbidity and mortality. Although many studies have reported a positive association between CRP and mortality, uncertainty still remains about this association in various populations, especially in rural Korea.
Methods
A total of 23 233 middle-aged participants (8862 men and 14 371 women) who were free from cardiovascular disease, cancer, and acute inflammation (defined by a CRP level ≥10 mg/L) were drawn from 11 rural communities in Korea between 2005 and 2011. Blood CRP concentration was analyzed as a categorical variable (low: 0.0-0.9 mg/L; intermediate: 1.0-3.0 mg/L; high: 3.1-9.9 mg/L) as well as a continuous variable. Each participant’s vital status through December 2013 was confirmed by death statistics from the National Statistical Office. Cox proportional hazard models were used to assess the independent association between CRP and mortality after adjusting for other risk factors.
Results
The total quantity of observed person-years was 57 975 for men and 95 146 for women, and the number of deaths was 649 among men and 367 among women. Compared to the low-CRP group, the adjusted hazard ratio for all-cause mortality of the intermediate group was 1.17 (95% confidence interval [CI], 0.98 to 1.40) for men and 1.27 (95% CI, 1.01 to 1.61) for women, and the corresponding values for the high-CRP group were 1.98 (95% CI, 1.61 to 2.42) for men and 1.41 (95% CI, 1.03 to 1.95) for women. Similar trends were found for CRP evaluated as a continuous variable and for cardiovascular mortality.
Conclusions
Higher CRP concentrations were associated with higher mortality in a rural Korean population, and this association was more prominent in men than in women.

Summary

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Letter to the Editor

Ankle-brachial Index, Peripheral Arterial Disease, and Diabetic Retinopathy: Hasan Kutsi Kabul, Aydogan Aydogdu, Ilker Tasci, Young-Hoon Lee, Min-Ho Shin; J Prev Med Public Health. 2012;45(2):122-124. Published online March 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.2.122

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Summary

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Brian Luong, Christina M. Brown, Misty D. Humphries, Steven Maximus, Mimmie Kwong
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Original Article

Arterial Stiffness is Associated With Diabetic Retinopathy in Korean Type 2 Diabetic Patients: Yong-Woon Yun, Min-Ho Shin, Young-Hoon Lee, Jung-Ae Rhee, Jin-Su Choi; J Prev Med Public Health. 2011;44(6):260-266. Published online November 14, 2011; DOI: https://doi.org/10.3961/jpmph.2011.44.6.260

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Abstract PDF

Objectives

We evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachial-ankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients.

Methods

We analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s.

Results

The association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT.

Conclusions

BaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.

Summary

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Chenghui Zhang, Suyuan Wang, Mingxia Li, Yunhong Wu
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Author Response
Young-Hoon Lee, Min-Ho Shin
Journal of Preventive Medicine and Public Health.2012; 45(2): 123. CrossRef
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