• Nutrition Research and Practice
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• v.15 no.5
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• pp.604-612
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• 2021

BACKGROUND/OBJECTIVES: We aimed to investigate the association of waist circumference (WC) with body composition among individuals with a normal body mass index (BMI) to distinguish muscle and fat mass, as both affect health differently. SUBJECTS/METHODS: We analyzed dual-energy X-ray absorptiometry data (derived from the Korean National Health and Nutrition Survey, which includes information on fat and lean mass) of 7,493 adults with a normal BMI. Subjects were categorized into four groups of increasing WC. The fourth group was defined as being centrally obese. Each number of subjects are as follows: 1,870, 695, 231, and 39 among men and 3,054, 1,100, 406, and 98 among women. We conducted a sex-stratified linear regression analysis of body composition according to WC group after adjustments for covariates. RESULTS: We observed a positive association of body fat with increasing WC in both men and women (all P for trend: < 0.001). The adjusted mean values for percent body fat with 95% confidence intervals (CIs) according to the four WC groups in ascending order were 17.8 (17.5-18.3), 21.0 (20.6-21.5), 22.1 (21.5-22.8), and 25.1 (24.2-26.1) in men and 29.7 (29.4-30.0), 32.0 (31.6-32.3), 32.9 (32.4-33.4), and 34.7 (33.2-36.1) in women. However, there was an inverted J-shaped association between muscle mass and WC. The fourth group had a higher percent body fat and lower muscle mass than other groups. The adjusted mean values for appendicular skeletal muscle mass index (kg/m²) with 95% CIs according to the four WC groups in ascending order were 7.55 (7.51-7.59), 7.62 (7.56-7.68), 7.65 (7.56-7.74), and 7.22 (7.04-7.41) in men and 5.83 (5.80-5.85), 5.96 (5.92-6.00), 6.03 (5.96-6.10), and 5.88 (5.73-6.03). CONCLUSIONS: There was a positive association between body fat and WC among individuals with normal BMI; conversely there was an inverted J-shaped association between lean body mass and WC. Our findings support the WC measurement should be included in obesity evaluations for adults with a normal BMI.

• The Korean Journal of Applied Statistics
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• v.34 no.3
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• pp.309-327
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• 2021

Dynamic treatment regimes (DTRs) are decision-making rules designed to provide personalized treatment to individuals in multi-stage randomized trials. Unlike classical methods, in which all individuals are prescribed the same type of treatment, DTRs prescribe patient-tailored treatments which take into account individual characteristics that may change over time. The Q-learning method, one of regression-based algorithms to figure out optimal treatment rules, becomes more popular as it can be easily implemented. However, the performance of the Q-learning algorithm heavily relies on the correct specification of the Q-function for response, especially in observational studies. In this article, we examine a number of double-robust weighted least-squares estimating methods for Q-learning in high-dimensional settings, where treatment models for propensity score and penalization for sparse estimation are also investigated. We further consider flexible ensemble machine learning methods for the treatment model to achieve double-robustness, so that optimal decision rule can be correctly estimated as long as at least one of the outcome model or treatment model is correct. Extensive simulation studies show that the proposed methods work well with practical sample sizes. The practical utility of the proposed methods is proven with real data example.

• Journal of Nutrition and Health
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• v.54 no.6
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• pp.631-643
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• 2021

Purpose: Frailty is a clinical syndrome in older adults, and adequate nutrition is a modifiable factor in preventing the condition. The current study aims to investigate the association between frailty and dietary intake in the Korean elderly. Methods: This cross-sectional study included data from the 2018 Korean National Health and Nutrition Examination Survey of 1,268 subjects (535 men and 733 women) aged 65 years or older. Frailty was defined as having more than three of the following 5 modified Fried frailty phenotype criteria: unintentional weight loss, exhaustion, walking difficulties, weakness, and low physical activity. Dietary intake was assessed by applying the one-day 24-hour dietary recall. The association between frailty and dietary intakes were analyzed by multiple logistic regression. Results: Totally, 9.7% men and 21.9% women were classified as the frail group. Increasing levels of frailty were proportional to a decreased mean nutrient adequacy ratio in both genders. Moreover, the total food intake was significantly low in the frail elderly. In male subjects, multiple logistic regression analyses after adjusting covariates showed that the odds ratio (OR) of frailty in the highest tertile of the consumption of fruits (OR [95% confidence interval, CI] = 0.34 [0.13-0.93], p-trend = 0.021) were significantly lower than values obtained in the lowest tertile. In females, the highest tertile of fish and shellfish intake showed a significantly lower OR for frailty (OR [95% CI] = 0.55 [0.30-0.99], p-trend = 0.045), as compared with the lowest tertile. Conclusion: The present study indicates that high intake of fruits for men, and fish and shellfish for women, are probably linked with lowering the risk of frailty in the elderly.

• 한국노년학
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• v.40 no.1
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• pp.91-109
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• 2020

This study aims to investigate the interdependence of Korean middle and old-aged couples in the association between exercise and life satisfaction through grip strength trajectory. Data were drawn from the nationally representative Korea Longitudinal Study of Aging (KLoSA) collected from 2006 to 2016. The sample included couples over 45 years of age in the first wave and participated in all six waves of the survey (Ncouple=1,997). There were three steps for analyses: correlation, parallel latent growth curve model, tests of indirect effects of the mediation paths. Covariates included in the models were husbands and wives' characteristics (age, education, work status, chronic diseases, marital satisfaction, contact frequency with friends or neighbors) and couple's household income. Results showed husbands' and wives' life satisfaction and grip strength were interdependent upon each other. Also, exercise participation of both husbands and wives was associated with both husbands' and wives' life satisfaction via the initial level of grip strength of husbands. Moreover, exercise participation of only husbands was associated with wives' life satisfaction through the initial grip strength of husbands. These results suggest the aging processes of middle and old-aged couples need to be understood in the context of gender dynamics and couple interdependence.

• Korean Journal of Community Nutrition
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• v.26 no.6
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• pp.441-454
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• 2021

Objectives: This study investigated the association between the frequency and pattern of eating alone and the mental health status according to region in Korean adults. Methods: The data of 10,040 Korean adults aged ≥ 19 years from the Korea National Health and Nutrition Examination Survey (KNHANES) 2017 and 2019 were used. Participants were divided into 4 groups based on their frequency of eating alone: none (all meals together), 1, 2, and 3 meals/day alone. The regions were divided into urban and rural areas. Mental health status was assessed by stress recognition, depressive symptoms, and suicidal ideation. Multivariable logistic regressions were conducted to estimate the adjusted odds ratios (AORs) with 95% confidence intervals (CIs) on the association of the frequency and pattern of eating alone with poor mental health after controlling for covariates. Results: Among Korean adults, 74.1% ate more than one meal a day alone. Individuals having 3 meals a day alone tended to be less educated, single, single person households, or living in urban areas (all P < 0.05). In rural areas, those having 3 meals/day alone had higher odds of stress recognition (AOR: 1.55, 95% CI: 1.02-2.35) than those having all meals together. In urban areas, individuals eating alone 3 times/day had higher odds of stress recognition (AOR: 1.60, 95% CI: 1.31-1.96), depressive symptoms (AOR: 1.61, 95% CI: 1.23-2.12), and suicidal ideation (AOR: 2.14, 95% CI: 1.42-3.22) compared to those having all meals together. Urban residents having dinner alone had higher odds of depressive symptoms (AOR: 1.29, 95% CI: 1.05-1.58) and suicidal ideation (AOR: 1.66, 95% CI: 1.19-2.33) than those having dinner with others. Conclusions: Our findings showed that the frequency and patterns of eating alone were differentially associated with increased odds of poor mental health according to region of residence. Nutrition education is needed for those frequently eating alone, particularly those living in urban areas, to highlight the advantages of eating together and to ensure that they have balanced and healthy meals even if they eat alone.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.69-76
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• 2022

Background: While the use of bioprosthetic valves for mitral valve replacement (MVR) is increasing, very few studies have compared bovine pericardial and porcine valves in the mitral position to help guide bioprosthetic selection. Methods: In the present study, patients who underwent MVR using bovine pericardial valves were compared with those who underwent MVR with porcine bioprostheses between January 1996 and July 2018. Those with prior MVR, infective endocarditis, congenital mitral valve disease, or ischemic mitral regurgitation were excluded. The primary outcomes were structural valve deterioration (SVD) and mitral valve reoperation from any cause, and death was regarded as a competing risk. Competing risk analysis and propensity score-matching were used for comparisons. Results: Among the 388 patients enrolled, pericardial and porcine bioprostheses were implanted in 217 (55.9%) and 171 (44.1%), respectively. Propensity score-matching yielded 122 pairs of patients that were well-balanced for all baseline covariates. No significant differences were observed between the groups in unadjusted (p=0.09) and adjusted overall survival (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.72-1.76; p=0.60). Competing risk analysis revealed no significant differences in the risks of mitral reoperation (HR, 1.07; 95% CI, 0.50-2.27; p=0.86) and development of SVD (HR, 1.57; 95% CI, 0.56-4.36; p=0.39) between the groups. Matched population analysis confirmed similar results regarding reoperation (HR, 0.99; 95% CI, 0.40-3.22; p=0.98) and SVD (HR, 1.39; 95% CI, 0.41-4.73; p=0.60). Conclusion: No significant differences in survival or valve durability were observed between bovine pericardial and porcine bioprosthetic MVR. These findings require further validation through studies with larger sample sizes.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.480-486
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• 2021

Background: Although various methods are already used to calculate predicted postoperative forced expiratory volume in 1 second (FEV₁) based on preoperative FEV₁ in lung surgery, the predicted postoperative FEV₁ is not always the same as the actual postoperative FEV₁. Observed postoperative FEV₁ values are usually the same or higher than the predicted postoperative FEV₁. To overcome this issue, we investigated the relationship between the number of resected lung segments and the discordance of preoperative and postoperative FEV₁ values. Methods: From September 2014 to May 2020, the data of all patients who underwent anatomical lung resection by video-assisted thoracoscopic surgery (VATS) were gathered and analyzed retrospectively. We investigated the association between the number of resected segments and the differential FEV₁ (a measure of the discrepancy between the predicted and observed postoperative FEV₁) using the t-test and linear regression. Results: Information on 238 patients who underwent VATS anatomical lung resection at Kyung Hee University Hospital at Gangdong and by DH. Kim for benign and malignant disease was collected. After applying the exclusion criteria, 114 patients were included in the final analysis. In the multiple linear regression model, the number of resected segments showed a positive correlation with the differential FEV₁ (Pearson r=0.384, p<0.001). After adjusting for multiple covariates, the differential FEV₁ increased by 0.048 (95% confidence interval, 0.023-0.073) with an increasing number of resected lung segments (R²=0.271, p<0.001). Conclusion: In this study, after pulmonary resection, the number of resected segments showed a positive correlation with the differential FEV₁.

• Journal of Korea Entertainment Industry Association
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• v.13 no.5
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• pp.139-143
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• 2019

The aim of this study was to assess the association of vitamin D and urine microalbumin/creatinine (uACR) and obesity. The study subjects were Korean adults 20 years or older (n = 4,948) who participated in the Korea National Health and Nutrition Examination Survey 2012. Analysis of covariance test adjusted for covariates were performed for uACR levels in relation to vitamin D status [vitamin D deficient, 25(OH)D < 10 ng/dL; vitamin D insufficient, 25(OH)D ≥ 10, < 20 ng/dL; vitamin D sufficient, 25(OH)D ≥ 20 ng/dL]. The key study results were as follows: First, in the populations without obesity (BMI < 25 kg/m²), uACR levels were decreased with the increasing of vitamin D status (p < 0.001) after adjusting for relevant variables. Second, in the populations with obesity (BMI ≥ 25 kg/m²), the association between uACR levels and vitamin D status was not significant (p = 0.659). In conclusion, urine microalbumin/creatinine levels were inversely associated with vitamin D status in Korean adults without obesity, but not in Korean adults with obesity.

• Journal of muscle and joint health
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• v.16 no.2
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• pp.174-183
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• 2009

Purpose: The purposes of this study were to develop and examine the self-help and Tai Chi program for arthritis, and to identify the effect when combined with a supportive follow up phone-calls. Method: The design for this study was a 3*2 quasi-experimental design. Sixty-six participants were recruited in W-city, and assigned to Exp 1 group (n=21) or Exp 2 group (n=24) according to supportive follow-up phone call method, or to the control group (n=21). Fifty-two subjects (17 and 20 in Exp 1 and 2, and 15 in the control group) completed pretest and posttest. Both experimental groups participated in the self-help and Tai Chi program for arthritis once a week for 8 weeks. Exp 1 received automated follow up phone-calls made up in KT-SHUT program, and Exp 2 received follow up phone-calls made up by researchers. The control group received no education and no phone call. Measures used to examine the effect self-help and Tai Chi program for arthritis were joint flexibility, hand muscle strength, balance with closed eyes and self-efficacy. The final analysis of the post-test measures was conducted by ANCOVA with age and self efficacy as covariates. Results: Both experimental group had significantly increased right shoulder flexibility (p=.002), left shoulder flexibility (p=.000), right hand grip (p=.024), and self efficacy (p=.008) compared with the control group. But there were no significant differences between two experimental groups in any physical indicators and self efficacy. Conclusion: Automated follow up phone-call would be helpful in managing the self-help and Tai Chi program for arthritis as well as researcher's phone call. The automated follow up phone-call program which was a new method could be recommended for use to encourage home exercise practice and the program participation.

• Journal of Industrial Convergence
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• v.21 no.5
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• pp.77-85
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• 2023

Suicide is the leading cause of death among Korean adolescents. There is a growing interest in the role of loneliness as a risk factor for suicide ideation and depressive symptoms. However, little is known in the Korean context. This study analyzed a total of 109,796 respondents from the Korea Youth Health Behavior Survey in 2020 and 2021. Multiple logistic regression models were implemented to test the association between loneliness and either of suicidal ideation and depressive mood. Covariates included demographic characteristics, school enrolled, household income, living arrangement, self-rated health, and the number of times treated for violence. Adjusted odd ratio (OR) and 95% confidence intervals (CI) were computed. 12.0% of adolescents reported to have felt lonely frequently and 3.0% always. 11.8% and 26.0% had suicidal ideation and depressive mood, respectively. The prevalence of suicidal ideation was higher in the always-lonely adolescents (52.6%) than in the frequently-lonely adolescents (35.1%). The always-lonely adolescents were nearly 30 times more likely to have suicidal ideation (OR=30.7; 95% CI, 27.1 - 34.8) and to feel depressed (OR=32.5; 95% CI, 29.2 - 36.4) than adolescents who felt never lonely. In conclusion, Loneliness was a major risk factor for suicidal ideation and depressive mood among Korean adolescents. Monitoring and addressing the condition of loneliness may help reduce suicidal ideation and depressive mood.