Chronic diseases are a significant burden on the healthcare system. Nutrition counseling plays a pivotal role in the management and prevention of chronic diseases. Despite its importance, primary healthcare clinicians face practical challenges in providing effective nutritional guidance owing to time limitations, lack of information, and resistance of patients.Current Concepts: This review identifies the main barriers to nutrition counseling that are encountered by primary healthcare clinicians. We propose general strategies to overcome these obstacles, emphasizing the need for simple and easy approaches in clinical settings. In addition, specific one-point counseling methods according to gender and age that can be applied in various situations, techniques related to behavior change for motivating and guiding patients, and practical tips to cope with common conditions such as diabetes, hypertension, and obesity are also discussed. Additionally, utilization of education materials, apps, and websites as convenient resources for patients is highlighted.Discussion and Conclusion: Real-life cases demonstrated successful application of nutrition counseling in clinical practice that benefitted both the patients and clinicians. This review suggests enhancing nutrition education in medical schools and residency programs, along with activating nutrition counseling fees to motivate and support clinicians. In conclusion, this review reaffirms the importance of nutrition counseling and stresses the need for continuous learning and practice by clinicians. In the future, nutrition counseling is envisioned as a more integrated and patient-centered approach, necessitating active engagement and adaptation by primary healthcare providers.

Background: In recent years, eating dinner alone has become a rising social issue in Korea. Depression is one of the primary health problems that can lead to numerous negative consequences. However, few studies have focused on people who eat alone and the effect of eating alone on depression. We investigated the association between eating dinner alone and depression. Methods: Our cross-sectional study included data from 14,093 Korean adults aged above 19 years old; data were sourced from the Korea National Health and Nutrition Examination Survey in 2014, 2016, and 2018, when the Patient Health Questionnaire (PHQ-9) was used. We classified participants based on their dinner habits: eating alone or social eating. Depression and suicidal ideation among participants were measured using the PHQ-9. Multivariate logistic regression analysis was used to investigate whether eating alone was related to depression or suicidal ideation after adjusting for age, sex, household income, education, alcohol, smoking, exercise, frequency of eating out, and living arrangement. Results: Individuals who ate dinner alone (22.9%) had higher depression and suicidal ideation rates than those who ate with others. Those who ate alone had greater odds ratios (ORs) of depressive symptoms (depression: OR, 1.42; 95% confidence interval [CI], 1.27–1.58; suicidal ideation: OR, 1.49; 95% CI, 1.25–1.78) after adjustment for covariates. The subgroup analysis shows that the odds of suicidal ideation among individuals who eat alone were nonexistent among those who performed regular aerobic exercise. Conclusion Eating dinner alone is closely associated with depressive symptoms, particularly suicidal ideation. Therefore, providing opportunities to eat with others may be effective for maintaining the mental health of adults.

Background: In recent years, eating dinner alone has become a rising social issue in Korea. Depression is one of the primary health problems that can lead to numerous negative consequences. However, few studies have focused on people who eat alone and the effect of eating alone on depression. We investigated the association between eating dinner alone and depression. Methods: Our cross-sectional study included data from 14,093 Korean adults aged above 19 years old; data were sourced from the Korea National Health and Nutrition Examination Survey in 2014, 2016, and 2018, when the Patient Health Questionnaire (PHQ-9) was used. We classified participants based on their dinner habits: eating alone or social eating. Depression and suicidal ideation among participants were measured using the PHQ-9. Multivariate logistic regression analysis was used to investigate whether eating alone was related to depression or suicidal ideation after adjusting for age, sex, household income, education, alcohol, smoking, exercise, frequency of eating out, and living arrangement. Results: Individuals who ate dinner alone (22.9%) had higher depression and suicidal ideation rates than those who ate with others. Those who ate alone had greater odds ratios (ORs) of depressive symptoms (depression: OR, 1.42; 95% confidence interval [CI], 1.27–1.58; suicidal ideation: OR, 1.49; 95% CI, 1.25–1.78) after adjustment for covariates. The subgroup analysis shows that the odds of suicidal ideation among individuals who eat alone were nonexistent among those who performed regular aerobic exercise. Conclusion Eating dinner alone is closely associated with depressive symptoms, particularly suicidal ideation. Therefore, providing opportunities to eat with others may be effective for maintaining the mental health of adults.

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.

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.

Objective: Suicide victims are likely to visit a primary care provider within 1 month of the suicide attempt. However, it is impossible for primary care providers to screen all patients for suicidal ideation or attempts. We, therefore, aimed to investigate potential differences in the chief diagnoses received by primary care patients with and without suicidal ideation, as this information may provide clues and predict patients at risk of suicide. Methods: This cross-sectional study included 1,211 Korean adults aged ≥20 years who had participated in the Korea National Health and Nutrition Examination Survey during 2014 and provided information about their histories of suicidal ideation and visits to primary care providers. Multiple logistic regression analyses were used to examine whether suicidal ideation was associated with specific diseases after controlling for age, sex, household income, education, occupation, marital status, smoking, alcohol consumption, and physical activity. Results: Among primary care patients, the sample-weighted percentage of suicidal ideation was approximately 12%. The diagnoses of neoplasm and mental disorder were associated with a higher likelihood of suicidal ideation {odds ratio (OR) [95% confidence interval (CI)] 8.32 (1.01–68.56) and 6.19 (1.72–22.33), respectively}. Notably, diseases of the musculoskeletal system and connective tissue were also associated with suicidal ideation [OR (95% CI): 1.93 (1.09–3.43)]. Conclusion The observed visit patterns and correlations of certain diagnoses with suicidal ideation suggest that primary care physicians should pay attention to patients with relevant disorders, consider screening suicidal ideation, and properly consult to a psychiatrist.

BACKGROUND/OBJECTIVES: Sugar-sweetened beverages (SSBs) are regarded as modifiable risk factors for mental health in several populations. Although the consumption of SSBs is steadily increasing in Korea, there is scant evidence regarding the impact of SSB consumption on depression and suicidal ideation. The aim of this study was to investigate the association of SSB consumption with depression and suicidal ideation among adults in Korea. SUBJECTS/METHODS: We used the data for 5,465 participants (2,170 men and 3,295 women) aged ≥ 20 years from the 2014 and 2016 Korea National Health and Nutrition Examination Survey. The subjects were divided into four groups according to SSB consumption using a food frequency questionnaire. Logistic regression analyses were conducted to examine the association of SSB consumption with depression and suicidal ideation, adjusting for sociodemographic, health behavior, and dietary variables. RESULTS: Participants consuming ≥ 1 SSB/day had a significantly higher risk of depression (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.08–2.18; P < 0.001) and suicidal ideation (OR, 2.20; 95% CI, 1.13–4.28; P < 0.001) compared with those in the non-SSB group after adjusting for potential confounding factors. CONCLUSIONS Our results suggest that SSB consumption is positively associated with depression and suicidal ideation in Korean adults.

BACKGROUND: The Korean population is aging rapidly and the number of health threats is increasing. The elderly obese population is also increasing and this study aimed to evaluate the association between body mass index (BMI) and health-related quality of life in the elderly Korean population. METHODS: The Korean version Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to elderly subjects (≥60 years) selected from welfare and health centers, and university hospitals. Sociodemographic information and subjects' height and weight were also recorded. RESULTS: The study population's mean age was 74.2±7.1 years, and the average BMI was 24.5±3.2 kg/m². The 542 participants were segregated based on BMI quartiles. The SF-36 scores were compared among the sex-stratified quartile groups after adjusting for age, education level, income, smoking, alcohol, and arthritis diagnosis. The SF-36 scores were compared for four BMI quartiles stratified by sex, after adjusting for age, education level, income, smoking, alcohol consumption, and arthritis diagnosis. Men in the Q3 and Q4 groups had higher mental health scores than men in Q2 group. Additionally, men in the Q3 group had higher social function scores than those in the Q2 and Q4 groups. No differences were observed for the remaining six domains; no significant score differences were observed in any of the survey domains for the female subjects. CONCLUSION: There was no significant association between a high BMI and a low quality of life in the elderly Korean population selected from hospitals and welfare centers, as assessed using the SF-36 scores.
Aged* ; Aging ; Alcohol Drinking ; Arthritis ; Body Mass Index* ; Diagnosis ; Education ; Female ; Health Surveys ; Hospitals, University ; Humans ; Male ; Mental Health ; Obesity ; Quality of Life* ; Smoke ; Smoking

Muscle strength and physical function decrease in older men, as do testosterone levels. Nonetheless, the effects of testosterone replacement therapy on muscle strength and physical function remain inconclusive and equivocal. We conducted a rapid systematic review, the results of which showed that testosterone replacement does not affect muscle strength (measured by hand grip strength and leg muscle strength), although it may increase physical function (measured by the 6-minute walk test, Physical Activity Scale for the Elderly score, and other physical performance tests). However, most of the studies were conducted in the United States or Europe and did not include participants from Asian or other ethnic backgrounds; therefore, further studies are needed to evaluate the effects of testosterone replacement in a broader population.
Aged ; Asian Continental Ancestry Group ; Europe ; Hand ; Hand Strength ; Humans ; Leg ; Male ; Motor Activity ; Muscle Strength* ; Testosterone* ; United States

BACKGROUND/OBJECTIVES: The measurement of body composition, including muscle and fat mass, remains challenging in large epidemiological studies due to time constraint and cost when using accurate modalities. Therefore, this study aimed to develop and validate prediction equations according to sex to measure lean body mass (LBM), appendicular skeletal muscle mass (ASM), and body fat mass (BFM) using anthropometric measurement, serum creatinine level, and lifestyle factors as independent variables and dual-energy X-ray absorptiometry as the reference method. SUBJECTS/METHODS: A sample of the Korean general adult population (men:7,599; women:10,009) from the Korean National Health and Nutrition Examination Survey 2008–2011 was included in this study. The participants were divided into the derivation and validation groups via a random number generator (with a ratio of 70:30). The prediction equations were developed using a series of multivariable linear regressions and validated using the Bland– Altman plot and intraclass correlation coefficient (ICC). RESULTS: The initial and practical equations that included age, height, weight, and waist circumference had a different predictive ability for LBM (men: R2 = 0.85, standard error of estimate [SEE] = 2.7 kg; women: R2 = 0.78, SEE = 2.2 kg), ASM (men: R2= 0.81, SEE = 1.6 kg; women: R2 = 0.71, SEE = 1.2 kg), and BFM (men: R2 = 0.74, SEE = 2.7 kg; women: R2 = 0.83, SEE = 2.2 kg) according to sex. Compared with the first prediction equation, the addition of other factors, including serum creatinine level, physical activity, smoking status, and alcohol use, resulted in an R2 that is higher by 0.01 and SEE that is lower by 0.1. CONCLUSIONS All equations had low bias, moderate agreement based on the Bland–Altman plot, and high ICC, and this result showed that these equations can be further applied to other epidemiologic studies.