The relationship between anemia and pulse pressure and hypertension: The Korea National Health and Nutrition Examination Survey 2010–2012

The present study was conducted to assess the relationship between anemia and pulse pressure (PP) and hypertension (HTN). Data from 16,060 adults (aged ≥20 years) in the fifth Korean National Health and Nutrition Examination Survey (2010–2012) were analyzed. Several key findings were identified. First, after adjusting for related variables, the odds ratio (OR) of anemia (hemoglobin <13 and <12 g/dL, in men and women, respectively), using the normal PP group (PP ≤61 mmHg) as a reference, was significant for the high PP cohort (PP >61 mmHg; OR, 1.517; 95% confidence interval [CI], 1.270–1.812). Second, after adjusting for related variables (except body mass index [BMI] and waist measurement [WM]), the OR of anemia, with a normal blood pressure group as a reference, was significant for the HTN group (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or use of HTN medications; OR, 0.835; 95% CI, 0.709–0.983). However, when further adjusted for BMI and WM, anemia was not associated with HTN (OR, 0.884; 95% CI, 0.750–1.042). In conclusion, anemia was positively associated with high PP, but was not associated with HTN.     

Association Between Hearing Impairment and Albuminuria in the Korean Adults: The 2011–2012 Korea National Health and Nutrition Examination Survey

Although the associations between albuminuria and renal and cardiovascular diseases, including diabetes and hypertension, have been extensively studied, few studies have investigated the association between albuminuria and hearing impairment. In this study, we assessed the relationship between albuminuria and hearing impairment in 9786 adult Korean subjects, using data from the Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2011–2012. The range of urinary albumin-to-creatinine ratio (UACR) was divided into 4 grades: grade 1 (first tertile of low-grade albuminuria [LGA]), 0.00 to 1.99 mg/g Cr; grade 2 (second tertile of LGA), 2.00 to 5.49 mg/g Cr; grade 3 (third tertile of LGA), 5.50 to 29.99 mg/g Cr; grade 4 (albuminuria), ≥30.00 mg/g Cr.The age- and sex-adjusted weighted UACR was higher in subjects with hearing impairment compared with those without hearing impairment (26.2 ± 4.7 mg/g Cr vs 14.1 ± 1.5 mg/g Cr, P = 0.020). The age- and sex-adjusted weighted prevalence of albuminuria was also higher in subjects with hearing impairment compared with subjects without hearing impairment. (8.3 ± 0.9% vs 5.8 ± 0.4%, P = 0.013) The age- and sex-adjusted weighted percentage of hearing impairment increased as UACR increased (18.0% ± 0.6%, 20.0% ± 0.8%, 22.2% ± 0.9%, 25.3% ± 2.0%, respectively; P < 0.001). Logistic regression analyses were performed for hearing impairment by albuminuria, with age, sex, tobacco use, heavy alcohol use, educational background, occupational noise exposure, obesity, hypertension, diabetes, total serum cholesterol, and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² as covariates. Using grade 1 of UACR as the control, grade 3 (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.05–1.53, P = 0.005) and grade 4 (OR 1.41, 95% CI 1.04–1.90, P = 0.026) of UACR were correlated with hearing impairment, respectively. When the level of hearing impairment (dB) was analyzed as a continuous variable, it was positively correlated with log UACR (Spearman correlation, unadjusted r = 0.226, adjusted r = 0.076, P < 0.001).In conclusion, we are the first to demonstrate that albuminuria is associated with hearing impairment in the Korean general population, using nationally representative data. Screening for albuminuria would allow for interventions for the prevention of hearing impairment.     

Prevalence and factors associated with diabetic retinopathy in a Korean adult population: The 2008–2009 Korea National Health and Nutrition Examination Survey

Aim

We examined the prevalence and factors associated with diabetic retinopathy (DR) in a Korean adult population.

Methods

Fundus examination data from 10,345 people in the fourth Korea National Health and Nutrition Examination Survey from 2008 to 2009 were examined. For each participant, one 45° nonmydriatic digital retinal image, centered on the fovea, was taken per eye. DR was defined as the presence of one or more retinal microaneurysms or retinal blot hemorrhages with or without more severe lesions.

Results

The weighted prevalence of DR was 0.9% (95% CI, 0.7–1.1) in a Korean adult population and 11.0% (95% CI, 8.9–13.6) in Korean adults with diabetes. In a logistic regression analysis, only HbA1c and diabetes duration were independently associated with DR; the other variables examined, including age, gender, exercise, current smoking, heavy alcohol drinking, presence of hypertension, total cholesterol, triglycerides, high-density lipoprotein cholesterol, anti-lipid medication, oral anti-diabetes treatment, and insulin treatment, were not associated with DR.

Conclusions

According to these national survey data, 1 in 10 people with diabetes has diabetic retinopathy. Glycemic control is the most important factor for preventing retinopathy in patients with diabetes.     

Risk Factors for Pterygium in Korea: The Korean National Health and Nutrition Examination Survey V, 2010–2012

The aim of this study is to report general and age-specific risk factors for pterygium prevalence in the Korean population.This in an observational case series study.Data from total 24,812 participants (age 40 years or older) from the Korean National Health and Nutrition Examination Surveys conducted from 2010 to 2012 were retrieved. After applying exclusion criteria, data from 13,204 participants (821 with pterygium and 12,383 without) were used for univariate and multivariate analyses. General risk factors were identified and participants were grouped by decade: 40 s, 50 s, 60 s, 70 s, and 80+. Age-specific risk factors were investigated for each group.After univariate analysis, 2 multiple regression models were constructed. Model 1: age + sex + spherical equivalent (SE) + sun exposure hours + occupation (indoor vs outdoor) + residency area (rural vs urban) + education level; model 2: age + sex + SE + sun exposure hours. In model 1, older age (odds ratio [OR]: 1.05 95% confidence interval [CI]: 1.05–1.06), male gender (OR: 1.28, 95% CI: 1.01–1.61), and longer sun exposure hours (OR: 1.47, 95% CI: 1.11–1.94) were significant risk factors for pterygium prevalence whereas higher level of education (elementary school vs college, OR: 3.98, 95% CI: 2.24–7.06) and urban residency (vs rural residency, OR: 0.56, 95% CI: 0.45–0.70) were protective factors. Higher SE (OR 1.11, 95% CI: 1.03–1.19) refractive error was considered a risk factor when using model 2 for the analysis. Age-specific risk factors were different in each age group. Male gender was associated with higher pterygium prevalence in younger age groups while longer sun exposure (5+ hours/day) increased pterygium prevalence in older age groups.Previously characterized risk factors were also found in this large population study. However, we found that risk factors may vary according to the age group. Myopic eyes were found to have lower prevalence than hyperopic eyes.     

Sarcopenia is associated with Framingham risk score in the Korean population: Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2011

Background Sarcopenia is a risk factor for metabolic disorders and cardiovascular disease, but the association between sarcopenia and cardiovascular risk factors according to age and obesity status in the general population remains unknown. We thus investigated these associations in the Korean population. Methods We included 8,958 and 8,518 subjects from the fifth Korean National Health and Nutrition Examination Survey (KNHANES) (from 2010 and 2011, respectively). The study was restricted to participants ≥ 20 years old who had completed the health examination survey, including whole body dual-energy X-ray absorptiometry scans. After exclusion, 7,366 subjects (3,188 men, 4,178 women) were included in our final analysis. Age was categorized according to three age groups (20–39, 40–59, and ≥ 60 years), and subjects were categorized according to their sarcopenic and obesity status. Cardiovascular risk was assessed with Framingham risk score (FRS). Results The sarcopenic obese group had a higher FRS than the non-sarcopenic obese group, which had a higher FRS than the non-sarcopenic non-obese group. Age-wise, the 20–39 year-old group showed a non-significant association between sarcopenia and FRS. In the 40–59 year-old group, regardless of obesity status, sarcopenic subjects had a higher FRS than non-sarcopenic subjects. In the ≥ 60 year-old group, sarcopenic subjects had a higher FRS than non-sarcopenic subjects for the non-obese group. Conclusions Sarcopenia was associated with cardiovascular disease and may be an early predictor of its susceptibility in both elderly and middle-aged subjects. Thus, management of sarcopenia is necessary to prevent cardiovascular disease.     

Prediabetes is not independently associated with microalbuminuria in Korean general population: The Korea National Health and Nutrition Examination Survey 2011–2012 (KNHANES V-2,3)

We investigated the association between microalbuminuria and prediabetes in Korean population using data from the KNHANES 2011–2012. Prevalence of microalbuminuria was significantly increased in prediabetes group. However, the odds ratio became insignificant after adjustment for blood pressure, and the prevalence of microalbuminuria was not increased in prediabetic subjects without hypertension.     

Association Between the Presence of Iron Deficiency Anemia and Hemoglobin A1c in Korean Adults: The 2011–2012 Korea National Health and Nutrition Examination Survey

Few studies have investigated the clinical effect of iron deficiency anemia (IDA) on the use of the Hemoglobin A1c (HbA1c) as a screening parameter for diabetes or prediabetes. We investigated the association between IDA and HbA1c levels in Korean adults.Among the 11,472 adults (≥19 years of age) who participated in the 2011–2012 Korea National Health and Nutrition Examination Survey (a cross-sectional and nationally representative survey conducted by the Korean Center for Disease Control for Health Statistics), 807 patients with diabetes currently taking anti-diabetes medications were excluded from this study. We compared the weighted HbA1c levels and weighted proportion (%) of HbA1c levels of ≥5.7%, ≥6.1%, and ≥6.5% according to the range of fasting plasma glucose (FPG) levels and the presence of IDA.Among 10,665 participants (weighted n = 35,229,108), the prevalence of anemia and IDA was 7.3% and 4.3%, respectively. The HbA1c levels were higher in participants with IDA (5.70% ± 0.02%) than in normal participants (5.59% ± 0.01%; P < 0.001), whereas there was no significant difference in FPG levels. In participants with an FPG level of <100 mg/dL and 100 to 125 mg/dL, the weighted HbA1c level was higher in those with IDA (5.59% ± 0.02% and 6.00% ± 0.05%) than in normal participants (5.44% ± 0.01% and 5.82% ± 0.01%) after adjusting for confounders such as age, sex, FPG level, heavy alcohol drinking, waist circumference, and smoking status as well as after exclusion of an estimated glomerular filtration rate of <60 mL/min/1.73 m² (P < 0.001, <0.01). The weighted proportions (%) of an HbA1c level of ≥5.7% and ≥6.1% were also higher in participants with IDA than in normal participants (P < 0.001, <0.05). However, the weighted HbA1c levels in individuals with an FPG level ≥126 mg/dL and a weighted proportion (%) of an HbA1c level of ≥6.5% showed no significant differences according to the presence of IDA.In conclusion, the presence of IDA shifted the HbA1c level upward only in the normoglycemic and prediabetic ranges, not in the diabetic range. Therefore, IDA should be considered before using HbA1c as a screening test for prediabetes.     

Males seropositive for hepatitis B surface antigen are at risk of lower bone mineral density: the 2008–2010 Korea National Health and Nutrition Examination Surveys

Background

Hepatic osteodystrophy has been reported in patients with various chronic liver diseases, including liver cirrhosis. However, it has not been well investigated in patients with hepatitis B virus infection. The aim of this study was to investigate the association between hepatitis B surface antigen (HBsAg) seropositivity and bone mineral density (BMD) in a population representative of normal Koreans.

Methods

Subjects with both HBsAg and BMD levels examined during the 2008–2010 Korea National Health and Nutrition Examination Surveys were included. HBsAg-seropositive (+) subjects were compared with those who were HBsAg-seronegative (?). BMD was measured at the lumbar spine and femur by dual-energy X-ray absorptiometry. Multivariable logistic regression was performed for BMD.

Results

In total, 11,306 participants were included in this study, among which 423 (3.7 %) were HBsAg(+): 153 premenopausal female (3.4 %), 83 postmenopausal female (3.5 %), and 187 male (4.2 %). Multivariable logistic regression analysis adjusted for age and body mass index showed that HBsAg(+) male had significantly lower BMD of the femoral neck than HBsAg(?) male (0.810 ± 0.009 vs. 0.827 ± 0.002 g/cm², p = 0.035). Further adjustment for waist circumference, smoking, drinking, exercise, income, occupation, and vitamin D levels showed that HBsAg(+) male had significantly lower BMD of the femur neck (0.810 ± 0.010 vs. 0.831 ± 0.002 g/cm², p = 0.032) and lumbar spine (0.953 ± 0.011 vs. 0.974 ± 0.003 g/cm², p = 0.049) than HBsAg(?) male.

Conclusions

HBsAg seropositivity was significantly associated with lower BMD in male. Future long-term prospective studies investigating bone turnover markers and hormones are needed to better understand the pathophysiology and clinical significance of chronic hepatitis B virus-related hepatic osteodystrophy.

     

The Prevalence and Factors Associated with Hearing Impairment in the Korean Adults: The 2010–2012 Korea National Health and Nutrition Examination Survey (Observational Study)

There are few studies that have used audiometric testing to gauge the demographic characteristics and associated risk factors for hearing loss at the national-level. Here, we investigated the weighted prevalence and associated factors of hearing impairment in 16,040 Korean adult population. Subjects completed audiometric test and laboratory examination as part of the data from The 2010–2012 Korea National Health and Nutrition Examination Survey (KNHANES). In our respective study, the overall weighted (n = 33,762,584) prevalence of mild hearing impairment among the Korean adult population was 20.5% (95% clearance [CI], 19.6–21.6), whereas moderate-to-profound hearing impairment was 9.2% (95% CI, 8.6–9.9). The weighted prevalence of mild hearing impairment in younger adults (19–39 years’ old) was 4.4% (3.5–5.5), in middle-age adults (40–64 years), it was 21.1% (19.8–22.5), and in older adults (≥65 years’ old), it was 69.7% (67.8–71.6). Logistic regression analyses were performed for low/mid frequency or high-frequency mild hearing impairment with age, sex, tobacco use, heavy alcohol use, educational background, occupational noise exposure, obesity, hypertension, diabetes, total serum cholesterol, and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² as covariates. The analyses revealed independent correlations between increased age, tobacco use, education, hypertension, and eGFR <60 mL/min/1.73m², and low/mid frequency and high frequency mild hearing impairment. High frequency mild hearing impairment was positively correlated with male sex, diabetes, and an increase in total serum cholesterol. Taken together, hearing impairment in Korea is highly prevalent with approximately one-fifth of Korean adult reporting mild hearing impairment. This study suggests that individuals with cardiovascular risk factors such as hypertension, diabetes, smoking, increased serum cholesterol, or decreased eGFR are at particular risk of developing hearing impairment. As such, these groups may benefit from hearing loss screening in addition to those groups typically considered to be of elevated risk including geriatrics, those of low socioeconomic status, and those with considerable occupational noise exposure.     

Trends in the prevalence of major cardiovascular disease risk factors among Korean adults: Results from the Korea National Health and Nutrition Examination Survey, 1998–2012

Background

Mortality from coronary heart disease in Korea has increased continuously, but there are few comprehensive national data on trend in the prevalence of risk factors for cardiovascular disease in this population. We examined the trends in the prevalence of major risk factors for cardiovascular disease, including smoking, obesity, hypertension, diabetes, and hypercholesterolemia, from 1998 through 2012 in a representative Korean population.

Methods

Using data from the Korea National Health and Nutrition Examination Survey I (1998) to V (2010–2012), we selected the adults aged ≥ 30 yr who participated in both a health examination and health interview survey.

Results

From 1998 to 2012, significant decrease in the prevalence of hypertension was observed in both men (32.5 to 31.5%) and women (26.9 to 24.3%). Smoking rates decreased only in men (65.1 to 47.0%), whereas the prevalence of diabetes did not change over time. Conversely, the prevalence of hypercholesterolemia significantly increased from 7.2% to 12.6% for men and from 8.4% to 14.9% for women, whereas the rates of awareness and treatment for hypercholesterolemia were relatively lower than that of hypertension and diabetes. During the period, prevalence of obesity significantly increased from 26.8% to 38.1% only in men.

Conclusions

The increased prevalence of hypercholesterolemia and obesity may have contributed to the increasing trend in the mortality from coronary heart disease in Korea. Further population-based surveillance of blood cholesterol levels and obesity needs to be performed, and national strategies for improvement of these factors should be established in Korea.     

Association of serum 25-hydroxyvitamin D and diabetes-related factors in Korean adults without diabetes: The Fifth Korea National Health and Nutrition Examination Survey 2010–2012

Aims

Vitamin D is associated with diabetes mellitus (DM) occurrence by affecting insulin secretion and resistance. However, variations exist due to differences in vitamin D sensitivity among individuals. We investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] status and various indices of DM in a Korean population without DM.

Metabolic Health,Obesity, and Cardiovascular Disease: 2015–2016 National Health and Nutrition Examination Survey

BackgroundThe metabolically unhealthy normal weight (MUN) and metabolically healthy obese (MHO) phenotypes are abnormal metabolic states. The purpose of this study was to report the frequency of the strictly defined MHO and MUN phenotypes and the association between metabolic phenotype and 10-year Framingham cardiovascular disease (CVD) risk score using a sample taken from the 2015–2016 National Health and Nutrition Examination Survey.MethodsA cross-sectional sample of 2,316 participants age 18–79 years with complete metabolic health information were selected from the 2015–2016 dataset and included in the present analysis. Metabolic health was defined as the absence of all metabolic abnormalities as outlined by the National Cholesterol Education Program Adult Treatment Panel III criteria, excluding waist circumference. Obesity was defined as body mass index ≥30 kg/m² or waist > 88.9 cm for females or > 101.6 cm for males.ResultsFrequency of the MHO phenotype was 5.5% and the MUN was 44.3%. After adjustment for all covariates, Framingham CVD risk score was higher in the MUN (b = 1.74,p < 0.001) and metabolically unhealthy obese (b = 3.32,p < 0.001) phenotypes that used BMI to define obesity, and the MHO phenotype had a slight protective effect (b = -2.25,p < 0.001) when waist circumference was used as the measure of obesity.ConclusionsMetabolically unhealthy phenotypes had higher CVD risk, while the MHO phenotype was not at any greater risk than the metabolically healthy normal weight.     

Prognostic value of resting heart rate in predicting undiagnosed diabetes in adults: Korean National Health and Nutrition Examination Survey 2008–2018

Background and aimAlthough resting heart rate (RHR) is associated with prevalence and incidence of diabetes, whether it is associated with undiagnosed diabetes is still unclear. We aimed to investigate whether the RHR is associated with the prevalence of undiagnosed diabetes in a large Korean national dataset.Methods and resultsThe Korean National Health and Nutrition Examination Survey data from 2008 to 2018 were used. After screening, 51,637 participants were included in this study. The odds ratios and 95% confidence intervals (CIs) for undiagnosed diabetes were calculated using multivariable-adjusted logistic regression analyses.Analyses showed that participants with a RHR of ≥90 bpm showed a 4.00- (95% CI: 2.77–5.77) and 3.21-times (95% CI: 2.01–5.14) higher prevalence of undiagnosed diabetes for men and women, respectively, than those with a RHR of <60 bpm. The linear dose-response analyses showed that each 10-bpm increment in RHR was associated with a 1.39- (95% CI: 1.32–1.48) and 1.28-times (95% CI: 1.19–1.37) higher prevalence of undiagnosed diabetes for men and women, respectively. In the stratified analyses, the positive association between RHR and the prevalence of undiagnosed diabetes was tended to be stronger among those who were younger (age: <40 years) and lean (BMI: <23 kg/m²).ConclusionsElevated RHR was significantly associated with a higher prevalence of undiagnosed diabetes in Korean men and women, independent of demographic, lifestyle, and medical factors. Accordingly, the value of RHR as a clinical indicator and health marker, especially in reducing the prevalence of undiagnosed diabetes, is suggestible.     

Associations Between the Periodontal Disease in Women Before Menopause and Menstrual Cycle Irregularity: The 2010–2012 Korea National Health and Nutrition Examination Survey

The association between menstrual cycle irregularities and system disease has been evaluated in previous studies. However, the association between periodontal disease and menstrual cycle irregularity has not been fully investigated. The study aimed to evaluate the relationship between periodontal disease and tooth loss in women before menopause and menstrual cycle irregularity using nationally representative data.This study performed a cross-sectional analysis and used hierarchical multivariable logistic regression analysis models. Data from Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2012 were analyzed. The analysis in this study was confined to a total of 1553 respondents over 19 years old who had not gone through menopause and had no missing values for the reproductive factors and outcome variables. A community periodontal index was greater than or equal to code 3 was used to define periodontal treatment needs.The risk of periodontal treatment needs tended to increase in the presence of menstrual cycle irregularity after adjustment for potential confounders (P for trend in the odds ratios = .0481 in model 1; 0.0613 in model 2; 0.0369 in model 3; 0.0456 in model 4). The number of natural teeth of 28 did not reach statistically significant differences (P for trend in the odds ratios = 0.2204 in model 1; 0.2373 in model 2; 0.2814 in model 3; 0.2609 in model 4).Menstrual cycle irregularity was positively associated with the risk of periodontal treatment needs in Korean women before menopause. However, there was no significant association between tooth loss and menstrual cycle irregularity. Menstrual cycle irregularity may be considered to be a potential risk indicator for periodontal treatment needs in Korean women before menopause.     

Relationship between serum gamma-glutamyltransferase and chronic kidney disease in the United States adult population. Findings from the National Health and Nutrition Examination Survey 2001–2006

Background and aimsElevated serum levels of gamma-glutamyltransferase (GGT) are a marker of liver injury, but may also be associated with other diseases and death. Currently, the association of serum GGT concentrations with chronic kidney disease has not been established in the U.S. general population.Methods and resultsWe performed a cross-sectional analysis of data from the National Health and Nutrition Examination Survey 2001 through 2006 and examined the association between serum GGT concentrations and chronic kidney disease in a nationally representative sample of 13,188 adults aged 20 years or older. Glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease formula. The prevalence of chronic kidney disease defined as eGFR <60 ml/min/1.73 m² or abnormal albuminuria in those with eGFR ≥ 60 ml/min/1.73 m² was 13.9% (n = 1842). Serum GGT elevation was associated with an increased odds of chronic kidney disease (odds ratio 2.38, 95% confidence intervals 2.02–2.80, p < 0.0001). After adjustment for demographics, comorbidities, daily alcohol consumption, lipid-lowering medications, viral hepatitis status and laboratory measures, the odds ratio of chronic kidney disease per log serum GGT increase was 1.79 (1.41, 2.27; p < 0.0001).ConclusionsThese results show a strong, independent, relationship of increased serum GGT concentrations with chronic kidney disease in the US adult population.     

National Patterns in Diabetes Screening: Data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012

BACKGROUND

There are few current population-based estimates of the patterns of diabetes screening in the United States. The American Diabetes Association (ADA) recommends universal screening of adults ≥ 45 years, and high-risk adults < 45 years, but there is no current assessment of ADA guideline performance in detecting diabetes and prediabetes. Furthermore, data on racial/ethnic patterns of screening are limited.

OBJECTIVE

Our aim was to estimate diabetes screening prevalence for the US adult population and specifically for those who meet ADA criteria; to report the prevalence of prediabetes and diabetes among these groups; and to determine if high-risk race/ethnicity was associated with reported screening.

DESIGN

This was a Cross-sectional survey.

PARTICIPANTS

Non-pregnant adults (≥ 21 years) without diabetes or prediabetes who participated in the National Health and Nutrition Examination Survey (NHANES) in 2005–2012 (n = 17,572) were included in the study. “Screening-recommended” participants, classified by ADA criteria, included (1) adults ≥ 45 years and (2) “high-risk” adults < 45 years. “Screening-not-recommended” participants were adults < 45 years who did not meet criteria.

MAIN MEASURES

Diabetes screening status was obtained by self-report. We used calibrated HbA_1c and/or fasting glucose levels to define undiagnosed diabetes and prediabetes.

KEY RESULTS

Seventy-six percent of the study population (approximately 136 million US adults) met ADA criteria. Among them, less than half (46.2 %) reported screening; undiagnosed diabetes affected 3.7 % (5 million individuals), and undiagnosed prediabetes affected 36.3 % (49 million people.) African Americans were more likely to report screening, both among adults ≥ 45 years and among “high risk” younger adults (OR 1.27 and 1.36, respectively.) Hispanic participants were also more likely to report screening (OR 1.31 for older adults, 1.42 for younger adults.) The screening rate among “screening-not-recommended” adults was 29.6 %; the prevalence of diabetes and prediabetes were 0.4 and 10.2 %, respectively.

CONCLUSIONS

In a nationally representative sample, 76 % of adults met ADA screening criteria, of whom fewer than half reported screening. Limitations include cross-sectional design and screening self-report.KEY WORDS: diabetes screening, prediabetes, NHANES, ADA, disparities     

Low skeletal muscle mass is associated with non-alcoholic fatty liver disease in Korean adults：the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND: Sarcopenia and non-alcoholic fatty liver disease(NAFLD) share similar pathophysiological mechanisms, and the relationship between sarcopenia and NAFLD has been recently investigated. The study investigated whether low skeletal muscle mass is differentially associated with NAFLD by gender in Korean adults.METHODS: We conducted a cross-sectional analysis of the data from the Fifth Korea National Health and Nutrition Examination Survey. The skeletal muscle index(SMI) was obtained by the appendicular skeletal muscle mass divided by the weight. NAFLD was defined as a fatty liver index(FLI) ≥60 in the absence of other chronic liver disease.RESULTS: Among the included subjects, 18.3%(SE: 1.4%) in men and 7.0%(SE: 0.7%) in women were classified as having FLI-defined NAFLD. Most of the risk factors for FLI-defined NAFLD showed a significant negative correlation with the SMI in both genders. Multiple logistic regression analysis showed that low SMI was associated with FLI-defined NAFLD, independent of other metabolic and lifestyle parameters in both genders [males: odds ratio(OR)=1.35; 95% confidence interval(CI): 1.17-1.54; females: OR=1.36; 95% CI: 1.18-1.55]. The magnitude of the association between FLI-defined NAFLD and low SMI was higher in middle aged to elderly males(OR=1.50; 95% CI: 1.22-1.84) than in males less than 45 years of age(OR=1.25; 95% CI: 1.02-1.52) and in premenopausal females(OR=1.50; 95% CI: 1.12-2.03) than in postmenopausal females(OR=1.36; 95% CI: 1.20-1.54).CONCLUSIONS: Low SMI is associated with the risk of FLIdefined NAFLD independent of other well-known metabolic risk factors in both genders. This association may differ according to age group or menopausal status. Further studies are warranted to confirm this relationship.