Background: This study aimed to investigate real-world data of C-terminal telopeptide (CTX), propeptide of type I collagen (P1NP), and osteocalcin through present multicenter clinical study, and retrospectively analyze the usefulness of bone turnover markers (BTMs) in Koreans. Methods: The study focused on pre- and post-menopausal patients diagnosed with osteoporosis and excluded patients without certain test results or with test intervals of over 1 year. The demographic data and 3 BTMs (CTX, P1NP, and osteocalcin) were collected. The patients were classified by demographic characteristics and the BTM concentrations were analyzed by the group. Results: Among women with no history of fractures, the levels of P1NP (N=2,100) were 43.544±36.902, CTX (N=1,855) were 0.373 ±0.927, and osteocalcin (N=219) were 10.81 ±20.631. Among men with no history of fractures, the levels of P1NP (N=221) were 48.498±52.892, CTX (N=201) were 0.370±0.351, and osteocalcin (N=15) were 7.868 ±10.674. Treatment with teriparatide increased the P1NP levels after 3 months in both men and women, with a 50% increase observed in women. Similarly, treatment with denosumab decreased the CTX levels after 3 months in both men and women, with a reduction of 50% observed in women. Conclusions The results of this study can contribute to the accurate assessment of bone replacement status in Koreans. We also provide the P1NP level in the Korean population for future comparative studies with other populations.

Thyroid hormones have an important physiological role in maintaining adult bone structure and strength. Therefore, thyroid dysfunction is inevitably associated with various degrees of skeletal consequences. Endogenous overt hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, resulting in osteoporosis and an increased risk of fractures. Hyperthyroidism induced by thyroid stimulating hormone suppression therapy in patients with differentiated thyroid cancer also has emerged as a contributing factor to osteoporosis and fragility fractures. While, there is lack of evidence that hypothyroidism negatively affects bone health. Although there is growing clinical evidence of the importance of bone health in hyperthyroidism, clinical guidelines on how to evaluate and manage bone health in these diseases have not yet been published worldwide. The Task Force from the Korean Thyroid Association Committee of Clinical Practice Guideline has developed this position statement for the evaluation and management of bone health in patients with thyroid diseases, particularly focused on endogenous hyperthyroidism and thyroid stimulating hormone suppression therapyassociated hyperthyroidism in patients with differentiated thyroid cancer.

Purpose: Skeletal muscles display significant heterogeneity in metabolic responses, owing to the composition of metabolically distinct fiber types. Recently, numerous studies have reported that in skeletal muscles, suppression of genes related to fatty acid channeling alters the triacylglycerol (TAG) synthesis and switches the energy substrates. However, such responses may differ, depending on the type of muscle fiber. Hence, we conducted in vitro and animal studies to compare the metabolic responses of different types of skeletal muscle fibers to the deficiency of fatty acyl-CoA synthetase (Acsl)6, one of the main fatty acidactivating enzymes. Methods: Differentiated skeletal myotubes were transfected with selected Acsl6 short interfering RNA (siRNA), and C57BL/6J mice were subjected to siRNA to induce Acsl6 deficiency. TAG accumulation and expression levels of insulin signaling proteins in response to acute glucose supplementation were measured in immortalized cell-based skeletal myotubes, oxidative muscles (OM), and glycolytic muscles (GM) derived from the animals. Results: Under conditions of high glucose supplementation, suppression of the Acsl6 gene resulted in decreased TAG and glycogen synthesis in the C2C12 skeletal myotubes. The expression of Glut4, a glucose transporter, was similarly downregulated. In the animal study, the level of TAG accumulation in OM was higher than levels determined in GM. However, a similar decrease in TAG accumulation was obtained in the two muscle types in response to Acsl6suppression. Moreover, Acsl6 suppression enhanced the phosphorylation of insulin signaling proteins (Foxo-1, mTORc-1) only in GM, while no such changes were observed in OM. In addition, the induction ratio of phosphorylated proteins in response to glucose or Acsl6 suppression was significantly higher in GM than in OM. Conclusion The results of this study demonstrate that Acsl6 differentially regulates the energy metabolism of skeletal muscles in response to glucose supplementation, thereby indicating that the fiber type or fiber composition of mixed muscles may skew the results of metabolic studies.

An accurate assessment of the recommended calcium (Ca) intake may contribute to reducing the risk of fractures and chronic diseases, ultimately improving quality of life.This review was performed to summarize key findings of Ca studies, investigate the effect of Ca intake on health outcomes, and determine the adequacy of evidence to revise the 2015 Dietary Reference Intakes for Koreans (KDRIs) for Ca in 2020. Databases were searched for intervention studies that assessed health outcomes by providing Ca in diets or as supplements. The framework of the systematic review comprised conducting literature searches, data extraction, quality assessment of the literature, and summarizing key findings relevant to set the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) for Ca for the 2020 KDRI. The final search was performed in June 2019. A total of 13,309 studies were identified through databases and manual search. Sixtyfive studies were included in the final quality assessment and were summarized according to health indicators. As bone health was used as an indicator of the EAR for Ca, literature reports on bone health were further categorized by the life-cycle stage of the participants. This systematic review did not find new evidence that could be applied to the general Korean adult population, including postmenopausal women, for defining a new EAR for Ca in the 2020 KDRIs. Evidence in most of the reviewed literature was considered weak; however, some evidence was found that could improve the criteria on how the EAR for Ca was determined in children and adolescents. A review of the literature for the 2020 KDRIs for Ca did not find strong evidence in order to change the recommended values of the 2015 KDRIs. More clinical interventions are required among Koreans to strengthen the body of evidence to warrant the revision of the KDRIs.

Purpose: Recent studies have reported a significant association between skeletal muscle, muscle strength and non-alcoholic fatty liver disease (NAFLD). The effect of nutrient intake on the prediction of skeletal muscle mass and strength or its suggested correlation with metabolic diseases has been primarily reported in healthy individuals. The current study explores the association between energy intake and handgrip strength (HGS) in individuals with NAFLD. Methods: Data were obtained from the Korea National Health and Nutrition Examination Surveys 2016-2018. Data from 12,469 participants were extracted and 1,293 men and 1,401 women aged 20 years and older were included in the analyses of patients with NAFLD. The presence of NAFLD was determined using the hepatic steatosis index. To estimate relative skeletal muscle strength, HGS was measured using a digital dynamometer and calculated by adjusting the body mass index of the dominant arm. Study subjects in the NAFLD and nonNAFLD groups were separately categorized according to quartiles of the calculated HGS. Results: We found that individuals with low (EQ1) energy intake had lower odds of HGS compared to subjects with high (EQ4) energy intake, irrespective of their NAFLD status (p < 0.0001). However, the HGS did not differ based on the level of protein or fat intake ratio.Additionally, the effect of energy intake on HGS was more pronounced in men than in women. Conclusion Energy intake was associated with the risk of weak HGS in men with NAFLD.The results indicate that energy intake may be a key factor in nutrition care for NAFLD patients with low muscle function.

OBJECTIVE: Previous studies have separately reported the contributions of dietary factors to the risk of cardiovascular disease (CVD) and its markers, including blood pressure (BP) and lipid profile. This study systematically reviewed the current evidence on this issue in the Korean population. METHODS: Sixty-two studies from PubMed and Embase were included in this meta-analysis. We performed a random-effects model to analyze pooled odds ratios (ORs) and hazard ratios (HRs) and their 95% confidence intervals (CIs) for the consumption of 14 food items, three macro- and eight micro-nutrients, two dietary patterns, and three dietary indices. RESULTS: An analysis of pooled effect sizes from at least four individual study populations showed significant associations between coffee consumption and CVD (OR/HR, 0.71; 95% CI, 0.52–0.97) and elevated/high triglycerides (TG) (OR, 0.84; 95% CI, 0.78–0.90), sugar-sweetened beverage intake and elevated BP (OR/HR, 1.20; 95% CI, 1.09–1.33), and milk and dairy intake and elevated/high TG and low high-density lipoprotein cholesterol (HDL-C) (OR/HR, 0.82; 95% CI, 0.76–0.89 for both). Carbohydrate consumption and the low-carbohydrate-diet score were consistently related to an approximately 25% risk reduction for elevated TG and low HDL-C. A lower risk of elevated total cholesterol, but not low-density lipoprotein, was additionally observed for those with a higher low-carbohydrate-diet score. A healthy dietary pattern was only associated with a reduced risk of elevated TG in the Korea National Cancer Screenee Cohort (OR, 0.81; 95% CI, 0.67–0.98). CONCLUSION This study showed that milk and dairy and coffee had protective effects for CVD and its risk factors, such as BP and lipid profile, while sugar-sweetened beverages exerted harmful effects.

Isolating the effects of a single nutrient or food in relation to health outcomes including increased skeletal muscle mass is a challenging task because dietary constituents are highly correlated and synergistic. Hence, diet pattern analysis may be used to investigate the role of certain diets in health outcomes. The present study investigated the dietary patterns and their relationship to skeletal muscle mass in Korean adults. Data were extracted from the 2008–2011 Korea National Health and Nutrition Examination Surveys. To explore the dietary patterns of the study subjects, factor analysis was performed using data obtained from a 24-hour recall. The skeletal muscle index according to dietary pattern scores was then investigated to estimate the changes in skeletal muscle mass. Three patterns were initially identified from the factor analysis. Of these vegetables and fish (VF) pattern was the primary factor with high reliability and was a common factor in sex-separated analyses. The VF pattern scores were positively associated with increased skeletal muscle mass in both men and women. Further analysis according to quartile levels of VF pattern scores showed a positive association between skeletal muscle mass and VF pattern in men but not in women. These results suggest that dietary patterns focused on vegetables and seafoods may contribute to increased skeletal muscle mass in Korean men but that sex difference should be considered in nutrition care for skeletal muscle health.
Adult ; Diet ; Factor Analysis, Statistical ; Female ; Fishes ; Food Habits ; Humans ; Korea ; Male ; Muscle, Skeletal* ; Seafood ; Sex Characteristics ; Vegetables*

PURPOSE: This study investigated major dietary patterns among healthy Korean adults using cluster analysis and analyzed the relationship between energy intake and skeletal muscle mass.METHODS: This study was conducted using the data from the 2008 ~ 2010 Korea National Health and Nutrition Survey. The data of 7,922 subjects aged 30 years and over, without any missing values, were included in the final analysis. K-means cluster analyses were conducted to identify the dietary patterns of the study subjects, which were based on the energy intake from 21 food groups using a 24-h recall method. The changes in energy intake with each dietary pattern, according to quartiles of skeletal muscle mass, were investigated.RESULTS: Three dietary patterns were identified for both men and women: ‘Flour, Animal fat’, ‘White rice’ and ‘Healthy mixed diet’. The association between energy intake and skeletal muscle mass for both men and women was significant only in the ‘White rice’ dietary pattern. In the ‘White rice’ pattern, the energy intake increased up to > 300 kcal from the lowest to the highest quartile of skeletal muscle mass after adjustment for covariates. Within the ‘White rice’ pattern, skeletal muscle mass was linearly associated with energy intake in all the age groups in men.CONCLUSION: Energy intake was significantly associated with changes in skeletal muscle mass only in the ‘White rice’ pattern. Furthermore, the degree of association between the change in skeletal muscle mass and energy intake differed according to gender. These results indicate that the association between skeletal muscle mass and energy intake may be specific to Korean people who are accustomed to a traditional Korean diet.
Adult ; Animals ; Cluster Analysis ; Diet ; Energy Intake ; Female ; Humans ; Korea ; Male ; Methods ; Muscle, Skeletal ; Nutrition Surveys

After publication of the article (Jang & Bu, 2019), the authors recognized clerical errors on page 3 and 4.