The association between sarcopenia and cardiovascular disease (CVD) in elderly people has not been adequately assessed. The aim of this study was to investigate whether CVD is more prevalent in ...subjects with sarcopenia independent of other well-established cardiovascular risk factors in older Korean adults.
This study utilized the representative Korean population data from the Korea National Health and Nutrition Examination Survey (KNHANES) which was conducted in 2009. Subjects older than 65 years of age with appendicular skeletal muscle mass (ASM) determined by dual energy X-ray absorptiometry were selected. The prevalence of sarcopenia in the older Korean adults was investigated, and it was determined whether sarcopenia is associated with CVD independent of other well-known risk factors.
1,578 subjects aged 65 years and older with the data for ASM were selected, and the overall prevalence of sarcopenia was 30.3% in men and 29.3% in women. Most of the risk factors for CVD such as age, waist circumference, body mass index, fasting plasma glucose and total cholesterol showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with CVD independent of other well-documented risk factors, renal function and medications (OR, 1.768; 95% CI, 1.075-2.909, P = 0.025).
Sarcopenia was associated with the presence of CVD independent of other cardiovascular risk factors after adjusting renal function and medications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
It was hypothesized that the presence of nonalcoholic fatty liver disease (NAFLD) at baseline predicts future conversion from the metabolically healthy (MH) to the metabolically unhealthy ...(MU) phenotype according to body fat mass.
Methods
A total of 22,551 Korean participants (13,601 men and 8,950 women) aged 18 to 78 years in the Kangbuk Samsung Health Study cohort were enrolled from 2007 to 2013.
Results
During a median of 5.1 years of follow‐up (interquartile range 2.1‐9.8 years), 23.5% (n = 5,298) of MH individuals converted to the MU phenotype. NAFLD at baseline predicted conversion independent of age, sex, BMI, lifestyle factors, individual components of metabolic syndrome, and insulin resistance (HR, 1.29; 95% CI: 1.19‐1.39; P < 0.0001). In participants with lower BMI and fat mass, NAFLD was strongly associated with conversion; however, as BMI and fat mass increased, the risk decreased, and there was no association in participants with higher BMI and fat mass (P < 0.0001 for trend).
Conclusions
NAFLD at baseline was independently associated with future conversion from the MH to the MU phenotype.
Objective
The aim of this study was to evaluate the relationship between the triglyceride and glucose (TyG) index and nonalcoholic fatty liver disease (NAFLD) using a large, population‐based cohort ...study database.
Methods
A total of 52,575 participants were enrolled from 2007 to 2013 in the Kangbuk Samsung Health Study cohort. The presence of NAFLD was ascertained by ultrasonography in the absence of other known liver diseases.
Results
Over a median 5.1 years of follow‐up, 7,292 participants (13.87%) were diagnosed with NAFLD. In a multivariate‐adjusted model, the hazard ratio for NAFLD of the TyG index was 1.413 (95% CI: 1.349‐1.480) in the first 6 months, 1.480 (95% CI: 1.408‐1.556) in months 6 to 12, 1.427 (95% CI: 1.370‐1.485) in months 12 to 18, and 1.246 (95% CI: 1.159‐1.339) in months >18. The hazard ratios of triglycerides, glucose, fatty liver index, and homeostatic model assessment of insulin resistance for NAFLD in months >18 were 1.124 (95% CI: 1.061‐1.190), 1.037 (95% CI: 0.970‐1.109), 1.508 (95% CI: 1.417‐1.605), and 1.177 (95% CI: 1.116‐1.242), respectively. The NAFLD‐free rate decreased with increasing TyG index quartile (p < 0.001). The TyG index level from which the risk of NAFLD increased appeared to be 8.24.
Conclusions
This study found that the TyG index is a simple and easy‐to‐calculate marker associated with NAFLD.
Our aim was to systematically review prospective studies of the association of plasma adiponectin levels with the risk of coronary heart disease (CHD) events, cardiovascular mortality and all-cause ...mortality.
We searched Medline, EMBASE, the Cochrane Library and CINAHL for reports published through October 2011. Search terms included 'adiponectin' AND 'cardiovascular disease' OR 'mortality'. We included prospective studies lasting more than 1 year with plasma adiponectin levels at baseline and all-cause mortality and/or major cardiovascular morbidity and mortality as outcomes. We used a random-effects model to pool the data and conducted additional subgroup meta-analyses according to the pre-existence of CHD. Pooled relative risk (RR) was estimated by a 1-SD increase in the logarithmically transformed circulating adiponectin levels.
A total of 24 prospective studies were included in the meta-analysis. The pooled RR of adiponectin for CHD events (23 studies) was 1.03 95% confidence interval (CI): 1.00, 1.06. In subgroup analyses, the RR of adiponectin was 0.99 (95% CI: 0.94, 1.03) for new-onset CHD (17 studies), but there was an increased risk (RR = 1.12, 95% CI: 1.04, 1.22) for CHD recurrence (seven studies). A 10% increased risk (RR = 1.10, 95% CI: 1.04, 1.16) of all-cause mortality (six studies) and a 14% increased risk (RR = 1.14, 95% CI: 1.05, 1.23) of cardiovascular disease mortality (five studies) were observed.
No association was observed between adiponectin levels and CHD events. Our results suggest that higher circulating adiponectin levels may be associated with an increased risk of CHD recurrence and all-cause/CVD mortality.
Background: Modification of health-related behaviors may improve clinical outcomes after acute myocardial infarction (AMI), but the need for systematic efforts to modify such behaviors and the ...estimated effect have not been investigated, especially in Asian populations. The aim of the study was to investigate changes in smoking and physical activity after AMI and their associations with death and recurrent revascularization. Methods and Results: Using the Korean National Insurance Health Service database, we included 13,452 patients with AMI in 2011, who were stable until 1.5 years on average after onset. Patients were grouped according to their smoking status and physical activity before and after AMI. After AMI, 44.6% of smokers continued smoking and only 11.0% of inactive patients increased their physical activity to a sufficient level. The ‘smoker/smoker’ group and ‘non-smoker/smoker’ group showed higher mortality (hazard ratio (HR): 1.566, 95% confidence interval (CI): 1.192–2.035; HR: 1.785, 95% CI: 1.061–2.815, respectively). On the other hand, the ‘active/active’ group and ‘inactive/active’ group showed less mortality (HR: 0.625, 95% CI: 0.460–0.832; HR: 0.681, 95% CI: 0.438–1.009, respectively) and the ‘inactive/active’ group showed less recurrent revascularization (HR: 0.761, 95% CI: 0.599–0.952). Conclusions: Smoking cessation and maintaining sufficient physical activity after AMI remain challenging for many Korean patients, and are associated with higher rates of mortality and recurrent revascularization. Systematic nationwide efforts such as cardiac rehabilitation (CR) to change health-related behaviors after AMI are required in Korea.
We investigated whether metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with an elevated risk of all-cause and cardiovascular mortality using a large-scale health ...examination cohort.
A total of 394,835 subjects in the Kangbuk Samsung Health Study cohort were enrolled from 2002 to 2012. Participants were categorized by the presence of nonalcoholic fatty liver disease (NAFLD) and MAFLD as follows: normal subjects; patients with both NAFLD and MAFLD; patients with NAFLD only; and patients with MAFLD only. Cox proportional hazards models were used to analyze the risk of mortality.
During a median 5.7 years of follow-up, 20.69% was patients with both NAFLD and MAFLD, 1.51% was patients with NAFLD only, and 4.29% was patients with MAFLD only. All-cause and cardiovascular death was higher in patients with MAFLD than those without MAFLD (P<0.001, respectively). In patients with MAFLD only, the hazard ratio (HR) of all-cause and cardiovascular death was 1.35 (95% confidence interval CI, 1.13 to 1.60) and 1.90 (95% CI, 1.26 to 2.88) after adjusting for age, which lost its statistical significance by multivariable adjustments. Compared to patients with less than two components of metabolic dysfunction, patients with more than two components of metabolic dysfunction were a higher risk of cardiovascular death (HR, 2.05; 95% CI, 1.25 to 3.38) and only women with more than two components of metabolic dysfunction were a higher risk of all-cause death (HR, 1.44; 95% CI, 1.02 to 2.03).
MAFLD criteria could identify a high-risk group for all-cause and cardiovascular death.
Objective
The triglyceride and glucose (TyG) index is a useful marker of insulin resistance and is a predictor of several metabolic diseases. The aim of this study was to evaluate the association ...between the TyG index and all-cause or cardiovascular mortality using a large population-based cohort study database.
Methods
A total of 255,508 subjects in the Kangbuk Samsung Health Study cohort were enrolled. Cox proportional hazards models were used to analyze the risk of mortality.
Results
During a median 5.7-year follow-up, the cumulative all-cause and cardiovascular mortality was 0.47% and 0.07%. There was a nonlinear relationship between the TyG index and death, and moving from moderate to high, the TyG index levels were associated with an increase in the risk of death. The hazard ratio (HR) for all-cause and cardiovascular mortality of the TyG index was 1.21 95% confidence interval (CI) 1.14–1.28 and 1.45 (95% CI 1.26–1.66) in the unadjusted model, respectively. After adjustment for covariates, the association between the TyG index and all-cause and cardiovascular mortality was attenuated. In the multivariable-adjusted model, the TyG index was associated with an elevated risk of all-cause mortality in women (HR 1.13, 95% CI 1.02–1.26) and a decreased risk in men (HR 0.92, 95% CI 0.85–0.99). The association between cardiovascular mortality and the TyG index was not statistically significant among either men or women in the multivariable-adjusted model.
Conclusions
The TyG index in a young, relatively healthy, population is associated with an elevated risk of all-cause and cardiovascular mortality. This association between the TyG index and all-cause mortality persists in women after multivariable adjustment.
Little is known about the subtypes of type 2 diabetes (T2D) and their association with clinical outcomes in Asians.
We performed data-driven cluster analysis in patients with newly diagnosed ...drug-naive T2D (n = 756) from the Korean Genome and Epidemiology Study. Clusters were based on five variables (age at diagnosis, BMI, HbA1c, and HOMA2 β-cell function, and insulin resistance).
We identified four clusters of patients with T2D according to k-means clustering: cluster 1 (22.4 %, severe insulin-resistant diabetes SIRD), cluster 2 (32.7 %, mild age-related diabetes MARD), cluster 3 (32.7 %, mild obesity-related diabetes MOD), and cluster 4 (12.3 %, severe insulin-deficient diabetes SIDD). During 14 years of follow-up, individuals in the SIDD cluster had the highest risk of initiation of glucose-lowering therapy compared to individuals in the other three clusters. Individuals in the MARD and SIDD clusters showed the highest risk of chronic kidney disease and cardiovascular disease, and individuals in the MOD clusters showed the lowest risk after adjusting for other risk factors (P < 0.05).
Patients with T2D can be categorized into four subgroups with different glycemic deterioration and risks of diabetes complications. Individualized management might be helpful for better clinical outcomes in Asian patients with different T2D subgroups.
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•Patients with type 2 diabetes can be categorized into four clusters with different diabetes-related outcomes.•Glycemic deterioration needed to initiate anti-diabetic therapy was earlier in severe insulin-deficient diabetes patients.•Patients with mild age-related diabetes and severe insulin-deficient diabetes showed the highest risk of complications.
We aimed to investigate the performance of clinician prediction of survival (CPS) and the association between CPS and the prognostic confidence of clinicians in ambulatory medical oncology ...outpatients.
Eight medical oncologists estimated the expected survival of their patients in a prospective cohort study. They were asked to provide a temporal type of CPS in weeks, together with their level of confidence for each prediction (0-100%). We analyzed the accuracy of CPS, the association between CPS and the prognostic confidence, and the characteristics of patients showing inaccurate CPS.
A total of 200 advanced cancer patients were enrolled and the median overall survival was 7.6 months. CPS was accurate in 67 (33.5%) patients, underestimated in 87 (43.5%), and overestimated in 46 (23.0%). The overall accuracy of CPS for 12-week, 24-week, 36-week, and 48-week survival was 83.0%, 72.0%, 75.5%, and 74.0%, respectively. The specificity was highest for 12-week survival (90.2%) and the sensitivity was highest for 48-week survival (96.1%). The sensitivity of 12-week CPS was 51.4% and the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% confidence interval CI 0.71-0.87). The prognostic confidence of clinicians was not significantly associated with the accuracy of prediction (P = 0.359). Patients with overestimated survival had significantly poorer global health status and physical/role/emotional functioning in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Additionally, they showed significantly higher levels of fatigue, nausea/vomiting, pain, dyspnea, and loss of appetite.
The overall accuracy of CPS in predicting 12-week to 48-week survival was high in medical oncology outpatients. However the sensitivity of 12-week CPS was low and prognostic confidence was not associated with the accuracy of CPS. Patients with overestimated CPS showed poorer quality of life and higher symptom burden.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between ...malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition.
A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated.
The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001).
Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.
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