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Association between Sarcopenia and Dipstick Proteinuria in the Elderly Population: The Korea National Health and Nutrition Examination Surveys 2009–2011.

Duna HWANG ; Mi Ryung CHO ; Minyong CHOI ; Sang Hyun LEE ; Youngmin PARK

Korean Journal of Family Medicine.2017;38(6):372-379. doi:10.4082/kjfm.2017.38.6.372

BACKGROUND: Sarcopenia and proteinuria are significant health difficulties in the elderly; however, few studies have investigated their relationship. In this study, we investigated the association between sarcopenia and proteinuria in Korean subjects over 60 years old. METHODS: We included data from the Korean National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey conducted from 2009 to 2011 (n=4,008). Sarcopenia was defined using appendicular skeletal muscle mass as a percentage of body weight. Proteinuria was defined by a urine dipstick test result above trace levels. RESULTS: The overall proteinuria prevalence was 7.2%. The incidence of sarcopenia was significantly higher in subjects with proteinuria. The prevalence of proteinuria was significantly higher in the sarcopenic group (5.5% vs. 14.5% in the non-chronic kidney disease (CKD) group; 17.2% vs. 23.2% in the CKD group) than in the non-sarcopenic group. Furthermore, sarcopenic participants had worse metabolic parameters, such as higher body mass indexes, waist circumferences, and fasting glucose levels, and lower high-density lipoprotein cholesterol levels than those in the non-CKD group. After adjustment for confounders, the odds ratios (95% confidence interval) for proteinuria were 2.84 (1.92–4.18) in the sarcopenic non-CKD group, 3.70 (2.59–5.30) in the non-sarcopenic CKD group, and 5.19 (2.64–10.18) in the sarcopenic CKD group, compared to the non-sarcopenic, non-CKD group. Sarcopenia increased the proteinuria risk in elderly participants without CKD, even after adjustment for obesity, hypertension, diabetes, and metabolic syndrome. CONCLUSION: These findings showed that sarcopenia was associated with dipstick proteinuria, especially in elderly participants without CKD, regardless of comorbidities.
Aged* ; Body Mass Index ; Body Weight ; Cholesterol ; Comorbidity ; Fasting ; Glucose ; Humans ; Hypertension ; Incidence ; Kidney Diseases ; Korea* ; Lipoproteins ; Muscle, Skeletal ; Nutrition Surveys ; Obesity ; Odds Ratio ; Prevalence ; Proteinuria* ; Renal Insufficiency, Chronic ; Sarcopenia* ; Waist Circumference

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Osteoarthritis Affects Health-Related Quality of Life in Korean Adults with Chronic Diseases: The Korea National Health and Nutritional Examination Surveys 2009–2013.

Ji Hye YANG ; Kiheon LEE ; Se Young JUNG ; Woo Kyung BAE ; Hye Jin JU ; In Young CHO ; Jae Kyeong SONG ; Hwa Yeon PARK ; Jong Soo HAN ; Ga Hye LEE ; Ye Seul BAE

Korean Journal of Family Medicine.2017;38(6):358-364. doi:10.4082/kjfm.2017.38.6.358

BACKGROUND: Osteoarthritis (OA) is a chronic disease that commonly afflicts the elderly. This disease reduces the health-related quality of life (HRQoL) and causes a significant social burden. Whether the effect of coexisting chronic conditions on HRQoL varies according to the presence of OA remains unclear. Therefore, this study aimed to investigate this notion. METHODS: A total of 13,395 participants were identified from the 2009–2013 Korean National Health and Nutrition Examination Survey for analysis. HRQoL was assessed using the European quality of life-5 dimensions (EQ-5D) index. Patients with OA were defined as those diagnosed by a physician or those who displayed both, symptoms and radiological findings consistent with OA at the time of the survey. Associations between OA and 8 chronic conditions were tested using regression analysis. RESULTS: The EQ-5D index was lower in patients with OA than in those without (mean difference, −0.145; 95% confidence interval [CI], −0.138 to −0.151; P<0.001). Most patients with OA and chronic conditions showed a lower score than those without. EQ-5D was particularly lower in OA patients with hypertension, dyslipidemia, stroke, and renal failure. The estimated β coefficient for the interaction term was significant in renal failure (−0.034; 95% CI, −0.055 to −0.012), after adjusting for demographic and socio-economic variables. CONCLUSION: OA significantly affects HRQoL of Korean elderly individuals alone or when combined with other conditions. OA combined with renal failure is particularly detrimental. These results indicate the importance of managing OA, which is an underestimated disease in public health surveys.
Adult* ; Aged ; Chronic Disease* ; Comorbidity ; Dyslipidemias ; Humans ; Hypertension ; Korea* ; Nutrition Surveys ; Osteoarthritis* ; Public Health ; Quality of Life* ; Renal Insufficiency ; Stroke

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Relationship between Coffee Consumption and Metabolic Syndrome in Korean Adults: Data from the 2013–2014 Korea National Health and Nutrition Examination Survey.

Hyekyung SHIN ; John A LINTON ; Yujin KWON ; Yohan JUNG ; Bitna OH ; Sinae OH

Korean Journal of Family Medicine.2017;38(6):346-351. doi:10.4082/kjfm.2017.38.6.346

BACKGROUND: The gradually increasing demand for coffee worldwide has prompted increased interest in the relationship between coffee and health issues as well as a need for research on metabolic syndrome in adults. METHODS: Data from 3,321 subjects (1,268 men and 2,053 women) enrolled in the 2013–2014 Korean National Health and Nutrition Examination Survey were analyzed. The subjects were divided into three groups according to their daily coffee consumption. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for metabolic syndrome in the coffee-drinking groups were calculated using multiple logistic regression analysis by adjusting for confounding variables. RESULTS: The prevalence of metabolic syndrome was 15.5%, 10.7%, and 9.7% in men and 3.0%, 7.1%, and 6.5% in women according to their coffee consumption (less than one, one or two, or more than three cups of coffee per day), respectively. Compared with the non-coffee consumption group, the ORs (95% CIs) for metabolic syndrome in the group that consumed more than three cups of coffee was 0.638 (0.328–1.244) for men and 1.344 (0.627–2.881) for women after adjusting for age, body mass index, household income, education, smoking, alcohol, regular exercise, and daily caloric intake. CONCLUSION: The OR of metabolic syndrome was not statistically significant in both men and women.
Adult* ; Body Mass Index ; Coffee* ; Confounding Factors (Epidemiology) ; Education ; Energy Intake ; Family Characteristics ; Female ; Humans ; Korea* ; Logistic Models ; Male ; Nutrition Surveys* ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Waist Circumference

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Correlation of Cardiovascular Risk Factors with Central Obesity and Multiple Body Mass Index in Korea.

Bora YOO ; Hosuk NAM ; In Cheol HWANG ; Youngmin PARK

Korean Journal of Family Medicine.2017;38(6):338-345. doi:10.4082/kjfm.2017.38.6.338

BACKGROUND: Body mass index (BMI) and waist circumference (WC) are associated with cardiovascular (CV) risk factors. The aim of this study was to investigate the correlation of CV risk factors by cross-tabulating central obesity with multiple BMI categories in Korea. METHODS: A total of 328,789 adults aged 30–84 years who completed health assessments for National Health Insurance in 2012–2013 in Korea were examined. The participants were divided into two WC and five BMI groups to investigate CV risk factors, including metabolic syndrome (MetS), hypertension, diabetes, and dyslipidemia. RESULTS: The proportions of central obesity and obesity were 24.2% and 39.5% in men and 19.4% and 28.1% in women, respectively, according to the Korean Society for the Study of Obesity and World Health Organization Asia-Pacific Guideline criteria. The odds ratios (ORs) of CV risk factors in all sexes increased with increases in BMI and WC. Compared to the group with a normal WC and BMI, the adjusted ORs (95% confidence intervals) for having MetS and diabetes in the centrally obese and highest BMI group (BMI ≥30.0 kg/m²) were 35.95 (33.75–38.30) and 3.51 (3.26–3.77) in men and 29.22 (27.36–31.20) and 4.35 (4.02–4.70) in women, respectively. Participants who were centrally obese and obese (BMI ≥25.0 kg/m²) had the strongest correlation with all CV risk factors compared with those who were not centrally obese or obese. CONCLUSION: The presence of central obesity in multiple BMI categories may significantly identify individuals at increased risk of CV risk factors.
Adult ; Body Mass Index* ; Cardiovascular Diseases ; Diabetes Mellitus ; Dyslipidemias ; Female ; Humans ; Hypertension ; Korea* ; Male ; National Health Programs ; Obesity ; Obesity, Abdominal* ; Odds Ratio ; Risk Factors* ; Waist Circumference ; World Health Organization

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Uric Acid Level Has a J-Shaped Association with Arterial Stiffness in Korean Postmenopausal Women.

Hyungbin LEE ; Young Hyo JUNG ; Yu Jin KWON ; Byoungjin PARK

Korean Journal of Family Medicine.2017;38(6):333-337. doi:10.4082/kjfm.2017.38.6.333

BACKGROUND: Uric acid has been reported to function both as an oxidant or antioxidant depending on the context. A previous study in the Korean population reported a positive linear association between serum uric acid level and arterial stiffness in men, but little is known about how serum uric acid level is related to the risk of increased arterial stiffness in Korean postmenopausal women. METHODS: We performed a cross-sectional study of 293 subjects who participated in a health examination program run by the health promotion center of Gangnam Severance Hospital between October 2007 and July 2010. High brachial-ankle pulse wave velocity was defined as a brachial-ankle pulse wave velocity of more than 1,450 cm/s. The odds ratios (ORs) for high brachial-ankle pulse wave velocity were calculated using multivariate logistic regression analysis across uric acid quartiles after adjusting for other indicators of cardiovascular risk. RESULTS: The 293 postmenopausal women were divided into quartiles according to uric acid level. The mean brachial-ankle pulse wave velocity values of each quartile were as follows: Q1, 1,474 cm/s; Q2, 1,375 cm/s; Q3, 1,422 cm/s; Q4, 1,528 cm/s. The second quartile was designated as the control group based on mean brachial-ankle pulse wave velocity value. Multivariate adjusted ORs (95% confidence intervals) for brachial-ankle pulse wave velocity across the uric acid quartiles were 2.642 (Q1, 1.095–6.3373), 1.00, 4.305 (Q3, 1.798–10.307), and 4.375 (Q4, 1.923–9.949), after adjusting for confounding variables. CONCLUSION: Serum uric acid level has a J-shaped association with arterial stiffness in Korean postmenopausal women.
Cardiovascular Diseases ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Female ; Health Promotion ; Humans ; Logistic Models ; Male ; Menopause ; Odds Ratio ; Pulse Wave Analysis ; Uric Acid* ; Vascular Stiffness*

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General Practitioners' Perceptions on Clinical Management and Training Needs regarding the Healthcare of Community-Dwelling People with Intellectual Disability: A Preliminary Survey in Singapore.

Sreedharan Geetha SAJITH ; Yen Li GOH ; Joshua Marcus WEE

Korean Journal of Family Medicine.2017;38(6):327-332. doi:10.4082/kjfm.2017.38.6.327

BACKGROUND: Studies worldwide indicate that people with intellectual disability have high risks of physical and mental morbidities, and poor quality of health care. This study was aimed at determining general practitioners' perceptions on barriers in clinical assessment and training needs with regard to the healthcare of community-dwelling people with intellectual disability. METHODS: A survey questionnaire was developed specifically for the study through focus group discussions and a literature review. The study was conducted as a cross-sectional anonymous survey of private general practitioners practicing in Singapore. The survey contained questions on their experience and training needs in assessing and treating patients with intellectual disability. RESULTS: Forty-nine of the 272 questionnaires sent out were returned. The respondents were predominantly male general practitioners working in “solo” practices. For most general practitioners, the proportion of patients with intellectual disability ranged from 1% to 5%. Nearly 90% of general practitioners identified problems in communicating with such patients as an important barrier that affected the quality of assessment of their health conditions. Other barriers identified were behavioral issues and sensory impairments. Only one-third of the general practitioners were confident that they had sufficient knowledge of physical and mental health conditions related to patients with intellectual disability. Three-fourths of the general practitioners believed that further training in this area would be beneficial. CONCLUSION: Appropriate interventions to address barriers in assessment and management of patients with intellectual disability with further training for general practitioners may improve the standard of healthcare provided to this population group.
Anonyms and Pseudonyms ; Delivery of Health Care* ; Focus Groups ; General Practitioners ; Humans ; Intellectual Disability* ; Male ; Mental Health ; Population Groups ; Primary Health Care ; Quality of Health Care ; Singapore* ; Surveys and Questionnaires

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The Effect of Having a Regular Doctor as a Primary Care Provider on Emergency Room Utilization in South Korea.

Su Young LEE ; Hyeong Seok LIM

Korean Journal of Family Medicine.2017;38(6):322-326. doi:10.4082/kjfm.2017.38.6.322

BACKGROUND: Because primary care is the cornerstone of an effective health care system, many developed countries have striven to establish and strengthen their primary care systems. However, the primary care system in South Korea is not well established, and primary care research is still in its infancy. This study aimed to show the benefits of regular doctors as primary care providers in South Korea by analyzing the effect of regular doctor visits on emergency room (ER) visits. METHODS: We analyzed cross-sectional data on 11,293 adults aged 18 years and over collected from the 2013 Korea Health Panel Survey (beta version 1.0). We classified those participants with and without regular doctors into the treatment and control groups, respectively, and estimated the average treatment effect (ATE) of having a regular doctor on ER visits. We used counterfactual framework and propensity score analysis to adjust for unevenly distributed confounding covariates between treatments and control groups. RESULTS: The estimated conditional ATE of a regular doctor on ER visits was statistically insignificant in the general population (-0.4%; 95% confidence interval [CI], -2.0 to 1.2) and in the subgroup of patients with hypertension (-1.8%; 95% CI, -4.5 to 0.9). However, in patients with diabetes mellitus (DM), the estimated ATE was statistically significant (-5.0; 95% CI, -9.2 to -0.7). CONCLUSION: In the total study population, having a regular doctor did not result in a significant difference in ER visits. However, there was a decrease in ER visits in patients with DM in South Korea.
Adult ; Delivery of Health Care ; Developed Countries ; Diabetes Mellitus ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypertension ; Korea* ; Primary Health Care* ; Propensity Score ; Treatment Outcome

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Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

Yogarabindranath Swarna NANTHA

Korean Journal of Family Medicine.2017;38(6):315-321. doi:10.4082/kjfm.2017.38.6.315

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.
Clinical Decision-Making ; Decision Making ; Diagnosis ; Heuristics ; Problem Solving ; Psychology ; Thinking*

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Cardiovascular Risk Assessment Based on Combined Body Mass Index and Waist Circumference in Korean Adults.

Young Gyu CHO

Korean Journal of Family Medicine.2017;38(6):313-314. doi:10.4082/kjfm.2017.38.6.313

No abstract available.
Adult* ; Body Mass Index* ; Humans ; Risk Assessment* ; Waist Circumference*

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A Case of Co-infection of Salmonella typhi and Viral Hepatitis A after Traveling Abroad.

Young Hye CHO ; Dong Wook JEONG ; Sang Yeoup LEE ; Son Ki PARK ; Ah Ra CHO ; Su Jin LEE ; Hee Kyoung CHOI ; Yun Jin KIM ; Jeong Ku LEE ; Yu Hyun LEE

Korean Journal of Family Medicine.2010;31(12):937-940. doi:10.4082/kjfm.2010.31.12.937

Infectious diseases imported from other countries have increased. Feco-oral route is the most common mode of transmission for both typhoid fever and hepatitis A, and thus infection by these agents have an association with poor sanitation. A 30-year-old male was visited to the hospital because of high fever after traveling in Thailand. The level of hepatic transaminases were mildly elevated and viral serological marker for hepatitis was negative. The blood culture was reported positive for Salmonella typhi. After a few days, the level of hepatic transaminases rapidly increased and viral serological marker for hepatitis became positive with anti-hepatitis A viral IgM at follow-up. Therefore we report a case of co-infection of S. typhi and viral hepatitis A after traveling abroad.
Adult ; Coinfection ; Communicable Diseases ; Fever ; Follow-Up Studies ; Hepatitis ; Hepatitis A ; Humans ; Immunoglobulin M ; Male ; Salmonella ; Salmonella typhi ; Sanitation ; Thailand ; Transaminases ; Typhoid Fever

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