Korean Longitudinal Study On Health And Aging Research Articles

Differences in sarcopenia status and mortality according to physical activity: results from the Korean Longitudinal Study on Health and Aging (KLoSHA).

There is increasing evidence that promoting physical activity can prevent sarcopenia. However, physical activity (PA) decreases with age, and the impact of PA intensity on health is unclear. This study investigated the relationship between the level of PA and sarcopenia, and the association between PA levels and mortality in patients with and without sarcopenia. Data were derived from the Korean Longitudinal Study on Health and Aging. PA was classified as sedentary behavior, light PA, or moderate-to-vigorous PA. Each PA level was subdivided based on the median time spent engaged in that activity, yielding eight PA profiles. Logistic regression and Cox proportional hazard models were used to investigate the association between PA level and sarcopenia, and between PA profiles and mortality. This study included 620 participants (50.2% women; mean age 75.7 ± 7.5years), of whom 130 (21.0%) participants were identified sarcopenia. During follow-up (mean 10.9 ± 4.1years), 264 (42.6%) participants died. Overall, sarcopenic participants were less physically active than non-sarcopenic participants. After multivariate adjustment, more sedentary behavior and less moderate-to-vigorous PA were associated with sarcopenia and all related variables, except muscle mass. Compared with the reference, non-sarcopenic participants with lower sedentary behavior and concomitantly higher moderate-to-vigorous PA had significantly lower hazard ratios for mortality, while higher light PA reduced mortality in sarcopenic participants regardless of time spent engaged in sedentary behavior or moderate-to-vigorous PA. PA, especially sedentary behavior and moderate-to-vigorous PA, was associated with sarcopenia and related variables, but the level of PA that prevented death differed according to sarcopenia status. Our findings may help determine the optimal intensity and amount of PA.

Musculoskeletal Pain, Physical Activity, Muscle Mass, and Mortality in Older Adults: Results from the Korean Longitudinal Study on Health and Aging (KLoSHA).

Background and objectives: Musculoskeletal (MSK) pain significantly impacts physical activity and quality of life in older adults, potentially influencing mortality. This study explored the relationship between MSK pain, physical activity, muscle mass, and mortality among older adults. Material and Methods: We studied 1000 participants in the Korean Longitudinal Study on Health and Aging (KLoSHA), a prospective, population-based cohort study of people aged 65 years or older. Survival status was tracked over a 5-year period. Correlations between low back pain (LBP), knee pain, regular exercise, appendicular skeletal muscle mass (ASM), and other variables were analyzed. Logistic regression analyses were used to identify independent risk factors for mortality. Results: Of the total participants, 829 (82.9%) survived over a 5-year period. Survivors tended to be younger, had a higher BMI, and were more active in regular exercise. In contrast, non-survivors exhibited a higher prevalence of both LBP and knee pain, along with increased instances of multiple MSK pains. Lower ASM correlated moderately with LBP and knee pain, whereas higher ASM was associated with regular exercise. There was a moderate correlation between LBP and knee pain, both of which were associated with a lack of regular exercise. Age, sex, ASM, and regular exercise were significant predictors, even though MSK pain itself did not directly predict all-cause mortality. Conclusions: This study demonstrated the independent association between ASM, regular exercise, and mortality. Although MSK pain did not directly correlate with all-cause mortality, the non-survivor group had higher levels of both single and multiple MSK pains. Recognizing the interplay of MSK pain, physical activity, and muscle mass for older adults, the research underscores the need for holistic strategies to enhance health outcomes in older individuals with MSK pain.

Quality of life and disease burden in patients with MCI and dementia

AbstractBackgroundUnderstanding of Health Related Quality of Life (HRQoL) and disease burden from Mild Cognitive Impairment (MCI) and dementia is critical to properly manage growing clinical and social burden of cognitive disorder. While each type of cognitive disorders requires different management strategy, studies separately evaluating HRQoL and disease burden of different types of dementia are sparse. Particularly, there is no study estimating disease burden from MCI. Therefore, we investigated 1) the loss of HRQoL from each of MCI, Alzheimer’s Dementia (AD), Vascular Dementia (VD), and dementia total, 2) the disease burden of each disorder in Disability Adjusted Life Year (DALY) with population representative cohort data.MethodEuro‐QoL‐5D index scores and clinical data of 6,520 elderlies are derived from Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) cohort. We built a multiple linear regression model to estimate the adjusted impact of cognitive disorder on HRQoL. For calculation of DALY, disease specific prevalence, mortality, remission rate are obtained from Korean Longitudinal Study on Health and Aging (KLOSHA) and KLOSCAD cohort. The current and future DALY from MCI, AD, VD and total dementia is calculated by standardized method according to the World Health Organization’s guideline.ResultAfter adjustment of covariates, VD causes the most substantial HRQoL loss of ‐0.309, followed by AD (‐0.143) and MCI (‐0.017). Patients with CDR ≥2 experience significantly higher loss of HRQoL (‐0.498) than patient with CDR 1 (‐0.151) or CDR <1 (‐0.096). In 2015, DALY per 100,000 attributed to AD, VD and dementia total is 417, 237, and 931 respectively. The DALY from MCI (412 per 100,000) is almost same with that of AD. The projected DALY from MCI and dementia in 2065 (9,543 per 100,000) is more than seven times bigger than 2015 (1,343 per 100,000).ConclusionCognitive disorders, especially VD, cause significant loss of HRQoL in elderlies. The disease burden from MCI as well as dementia is substantial at present and rapidly grows. From MCI stage, the early efforts should be made to prevent HRQoL loss and to manage increasing disease burden. (Supported by Korean Health Technology R&D Project, Ministry of Health and Welfare, grant number HI15C3206.)

Long-Term Prognostic Value of Coronary Computed Tomography Angiography in an Asymptomatic Elderly Population.

BackgroundThe prognostic value of coronary computed tomographic angiography (CCTA) for evaluating coronary artery disease in asymptomatic older adults is controversial. We investigated the prognostic value of CCTA in community‐dwelling elderly Koreans.Methods and ResultsParticipants (n=470; mean age: 75.1±7.3 years) who underwent CCTA were enrolled from KLoSHA (Korean Longitudinal Study on Health and Aging), a community‐based prospective cohort. Using CCTA, coronary artery disease was classified as normal, nonobstructive, or obstructive according to the presence of 0%, <50%, or ≥50% stenosis, respectively. Coronary artery calcium scores were investigated together with Framingham risk score, atherosclerotic cardiovascular disease score, and individual risk factors. Major adverse cardiac events (MACE) were defined as a composite of cardiac event–related death or nonfatal myocardial infarction. During a median follow‐up of 8.2 years (interquartile range: 7.7–10.1 years), MACE occurred in 24 participants (5.1%). Compared with the normal group, participants in the obstructive group showed higher incidence of MACE (hazard ratio: 5.65; 95% CI, 1.22–26.16; P=0.027), whereas there were no significant differences in MACE between the normal and nonobstructive groups. The 8‐year event‐free survival rates were 98.1±1.1%, 94.9±1.6%, and 81.7±4.8% in the normal, nonobstructive, and obstructive groups, respectively. Compared with the Framingham risk score and coronary artery calcium score model, CCTA improved risk prediction by C‐index (from 0.698 to 0.749) and category‐free net reclassification index (0.478; P=0.022).Conclusions CCTA showed better long‐term prognostic value for MACE than coronary artery calcium score in this asymptomatic older population.

Sarcopenia is an Independent Risk Factor for Dysphagia in Community-Dwelling Older Adults.

Dysphagia is common in older adults and associated with increased socioeconomic burdens. Recently, sarcopenia is considered to be a possible contributor for dysphagia. The purpose of this study is to investigate theassociation of dysphagia with sarcopenia in a geriatric population in Korea. This is a cross-sectional study using data from the Korean Longitudinal Study on Health and Aging (KLoSHA). Community-dwelling men and women aged 65years and older without common causes of dysphagia in Seongnam City, Korea were included (N = 236). Dysphagia was screened using Standardized Swallowing Assessment. Appendicular skeletal muscle mass was calculated by dual-energy X-ray absorptiometry. Grip strength and long-distance corridor walk were assessed. Of 236 subjects, 54 (22.9%) showed dysphagia and 38 (16.1%) showed sarcopenia. Fourteen (5.9%) participants were diagnosed with sarcopenic dysphagia. In multiple logistic regression analysis for dysphagia, sarcopenia was the only significant variable with odds ratio of 2.738 (95% confidence interval 1.160-6.466). Sarcopenia was associated with increased risk of dysphagia in community-dwelling older adults having no common causes of dysphagia even after adjusting for possible confounders. A prospective study with a larger sample size is needed to reveal their causal relationship in the future.

Thickness of retina and choroid in the elderly population and its association with Complement Factor H polymorphism: KLoSHA Eye study.

PurposeTo analyze the associations of retinal and choroidal thickness on enhanced-depth imaging optical coherence tomography (EDI-OCT) with clinical, ophthalmic and genetic factors in the normal elderly population (aged 65 years or older).MethodsIn this prospective, population-based cohort study, people aged 65 years or older were enrolled in the baseline study of the Korean Longitudinal Study on Health and Aging (KLoSHA) Eye Study. All participants underwent spectral domain-OCT scan using the EDI technique. A topographic map of the retina was obtained and subfoveal choroidal thickness (SFCT) was measured manually. Blood samples from all subjects were genotyped for major age-related macular degeneration (AMD)-associated single nucleotide polymorphisms (SNPs) the major AMD-associated SNPs; CFH Y402H rs1061170, CFH I62V rs800292, ARMS2 A69S rs10490924. A statistical analysis was conducted to compare the retinal thickness, choroidal thickness, and AMD risk genotypes.ResultsAmong the three hundred eighty people enrolled, the mean age was 76.6 years (range 65–99 years). Factors that showed correlation with either tomographic retinal parameters, retinal nerve fiber layer, or SFCT, were age and gender. Significant age-related decrease in thickness was observed in the RNFL, mean central thickness (MCT) and SFCT. Gender differences existed in central foveolar thickness (CFT) and MCT, where it was thicker in men. While chorioretinal parameters were not related with other genotypes, CFH rs1061170 risk genotype was significantly associated with thin SFCT. The group containing the AMD- risk allele (CT) had a 14.7% reduction in the SFCT compared to the non-risk TT group.ConclusionsIn addition to the well-known association with AMD, CFH rs1061170 is a significant genetic risk factor associated with choroidal thinning in normal eyes of the elderly population. Such findings may provide further insight into the pathogenesis of age-related macular degeneration as well as normal aging. In addition, our study provides the first normative data on retinal and choroidal thickness in population-based aged groups with a mean age over seventy-five.

Respiratory allergies in the elderly: findings from the Korean Longitudinal Study on Health and Aging phase I study (2005-2006).

Population aging is a global issue, but is estimated to be more rapid and dramatic in Asian countries. In the past, allergy might have been a minor concern in the elderly (usually defined as ≥65 years). However, recent series of epidemiologic studies indicate that allergic diseases are more prevalent than expected in the aged population. Furthermore, they pose significant impact on quality of life and socioeconomic costs. The burden may also increase in the elderly, due to frequent comorbidities and treatment-related complications. The Korean Longitudinal Study on Health and Aging (KLoSHA) cohort study is one of major research projects on the epidemiology of common geriatric disease conditions in Korea. In this review, we summarized the baseline findings on the prevalence, risk factors, comorbidities and impact of geriatric respiratory allergic conditions in the phase I KLoSHA cohort study.

Multidimensional Geriatric Prognostic Index, Based on a Geriatric Assessment, for Long-Term Survival in Older Adults in Korea.

The patient´s survival estimate is important for clinical decision-making, especially in frail patients with multimorbidities. We aimed to develop a multidimensional geriatric prognosis index (GPI) for 3- and 5-year mortality in community-dwelling elderly and to validate the GPI in a separate hospital-based population. The GPI was constructed using data for 988 participants in the Korean Longitudinal Study on Health and Aging (KLoSHA) and cross-validated with 1109 patients who underwent a geriatric assessment at the Seoul National University Bundang Hospital (SNUBH). The GPI, with a total possible score of 8, included age, gender, activities of daily living, instrumental activities of daily living, comorbidities, mood, cognitive function, and nutritional status. During the 5-year observation period, 179 KLoSHA participants (18.1%) and 340 SNUBH patients (30.7%) died. The c-indices for 3- and 5-year mortality were 0.78 and 0.80, respectively, in the KLoSHA group and 0.73 and 0.80, respectively, in the SNUBH group. Positive linear trends were observed for GPI scores and both 3- and 5-year mortality in both groups. In conclusions, using common components of a geriatric assessment, the GPI can stratify the risk of 3- and 5-year mortality in Korean elderly people both in the community and hospital.

Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

High serum adiponectin concentration and low body mass index are significantly associated with increased all-cause and cardiovascular mortality in an elderly cohort, “adiponectin paradox”: The Korean Longitudinal Study on Health and Aging (KLoSHA)

BackgroundThe relationship between adiponectin concentration and mortality is unclear. We examined whether serum adiponectin concentration is associated with all-cause and cardiovascular mortality in elderly Asians. MethodsWe analyzed the data for community-dwelling adults ≥65years of age (439 men and 561 women) who were enrolled in the Korean Longitudinal Study on Health and Aging (KLoSHA) cohort in prospective manner. The baseline serum total and high molecular weight adiponectin were measured using an enzyme-linked immunosorbent assay. Using Cox regression, we determined the associations between serum adiponectin concentration and all-cause and cardiovascular mortality after adjusting for well-known cardiovascular risk factors. ResultsOver a mean follow-up time of 6.2years, 222 individuals died, and 52 deaths (23.4%) were by cardiovascular disease. After adjusting confounding factors, elevated baseline serum adiponectin concentration was independently associated with all-cause mortality (adjusted hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.17–1.64) and cardiovascular mortality (HR 1.50; 1.06–2.14). We evaluated the effect modification by baseline body mass index (BMI). High serum adiponectin and low BMI were synergistically associated with increased all-cause mortality (HR 6.25; 3.08–12.71) and cardiovascular mortality (HR 13.94; 1.82–106.58). ConclusionsHigher serum adiponectin concentration was associated with increased all-cause and cardiovascular mortality in community-dwelling elderly Asian population. Our data supported the recent theory so called “adiponectin paradox”. This relationship was strengthened when combined with low BMI. We suggest that measurement of adiponectin concentration and BMI together could be an additional predictive marker of survival among elderly adults.

Counterintuitive relationship between visceral fat and all-cause mortality in an elderly Asian population.

Abdominal obesity is considered to be a risk factor for mortality. However, recent studies indicate that overweight may be negatively associated with mortality ("obesity paradox"). The relationships between mortality and various obesity markers in an elderly Asian cohort were evaluated. Subjects of the Korean Longitudinal Study on Health and Aging (KLoSHA) (n = 1000, age ≥65 years) were included. The visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using computed tomography. A total of 222 deaths occurred during the 6-year follow-up (median = 5.2 [range 0.1-6.3] years). Body mass index (BMI), VFA, SFA, and total fat mass were negatively associated with all-cause mortality in the univariable analyses (hazard ratio [HR] 0.67 per 1 SD [95% CI 0.57-0.77], 0.66 [0.55-0.79], 0.73 [0.61-0.86], and 0.74 [0.63-0.87], respectively). BMI and VFA were significantly associated with all-cause mortality in the multivariable analyses (HR 0.85 per 1 SD [95% CI 0.73-0.99] and 0.64 [0.47-0.87], respectively). When stratified by quartiles, the HR associated with VFA was the lowest in the third quartile. In this observational study with a short follow-up of elderly Asian people, higher amounts of visceral fat, a marker for central obesity, were associated with decreased all-cause mortality.

Prevalence and Outcomes of Frailty in Korean Elderly Population: Comparisons of a Multidimensional Frailty Index with Two Phenotype Models

BackgroundFrailty is related to adverse outcomes in the elderly. However, current status and clinical significance of frailty have not been evaluated for the Korean elderly population. We aimed to investigate the usefulness of established frailty criteria for community-dwelling Korean elderly. We also tried to develop and validate a new frailty index based on a multidimensional model.MethodsWe studied 693 participants of the Korean Longitudinal Study on Health and Aging (KLoSHA). We developed a new frailty index (KLoSHA Frailty Index, KFI) and compared predictability of it with the established frailty indexes from the Cardiovascular Health Study (CHS) and Study of Osteoporotic Fracture (SOF). Mortality, hospitalization, and functional decline were evaluated.ResultsThe prevalence of frailty was 9.2% (SOF index), 13.2% (CHS index), and 15.6% (KFI). The criteria from CHS and KFI correlated with each other, but SOF did not correlate with KFI. During the follow-up period (5.6±0.9 years), 97 participants (14.0%) died. Frailty defined by KFI predicted mortality better than CHS index (c-index: 0.713 and 0.596, respectively; p<0.001, better for KFI). In contrast, frailty by SOF index was not related to mortality. The KFI showed better predictability for following functional decline than CHS index (area under the receiver-operating characteristic curve was 0.937 for KFI and 0.704 for CHS index, p = 0.001). However, the SOF index could not predict subsequent functional decline. Frailty by the KFI (OR = 2.13, 95% CI 1.04–4.35) and CHS index (OR = 2.24, 95% CI 1.05–4.76) were associated with hospitalization. In contrast, frailty by the SOF index was not correlated with hospitalization (OR = 1.43, 95% CI 0.68–3.01).ConclusionPrevalence of frailty was higher in Korea compared to previous studies in other countries. A novel frailty index (KFI), which includes domains of comprehensive geriatric assessment, is a valid criterion for the evaluation and prediction of frailty in the Korean elderly population.

Lower-But-Normal Serum TSH level Is Associated With the Development or Progression of Cognitive Impairment in Elderly: Korean Longitudinal Study on Health and Aging (KLoSHA)

The association between subclinical hyperthyroidism and the risk of dementia has been validated in several studies. However, the effect of thyroid function within reference range on the risk of cognitive dysfunction including mild cognitive impairment (MCI) and dementia is still unclear. Our aim was to investigate the association between thyroid function and the risk of MCI and dementia in euthyroid elderly subjects. We conducted a population-based prospective study as a part of the Korean Longitudinal Study on Health and Aging. A total of 313 participants who were euthyroid and nondemented at baseline and completed cognitive function tests at a 5-year follow-up evaluation (mean age 72.5 ± 6.9 y) were analyzed in the present study. Baseline thyroid function was compared according to the development of MCI or dementia during the study period. Binary logistic regression analysis was performed to investigate the independent association between thyroid function and cognitive impairment. At baseline evaluation, 237 subjects were cognitively normal, and 76 subjects had MCI. Diagnoses of cognitive function in 259 subjects remained unchanged or improved during the study period (nonprogression group), whereas 54 subjects showed progression of cognitive impairment to MCI or dementia (progression group). In the progression group, baseline serum TSH levels were lower than those in nonprogression group. Baseline serum free T₄ levels were not significantly different between these two groups. The association between lower baseline serum TSH levels and the development of MCI or dementia was maintained after adjustment for conventional baseline risk factors. Lower serum TSH level within the reference range was independently associated with the risk of cognitive impairment including MCI and dementia in elderly subjects.

Associations of physical activity, insomnia and cognitive impairment in older adults

primary neurodegenerative dementia, and vascular mild cognitive impairment (vMCI). We investigated the prevalence of VCI and its subtypes in a Korean elderly population.Methods: This study was a part of the Korean Longitudinal Study on Health and Aging (KLoSHA) which had been conducted on the residents aged 65 years or older in Seongnam, Korea from September 2005 to August 2006. A simple random sample (N1⁄41118) was drawn from the roster of 61,730 persons aged 65 years or older. Standardized clinical interviews, neurological and physical examinations and comprehensive neuropsychological assessments were administered. Diagnosis of vascular dementia was made according to NINDS-AIREN criteria. Diagnosis of mixed dementia was made according to DSM-IV-TR criteria. And, diagnosis of vMCI was made according to the MCI criteria proposed by the InternationalWorking Groupwith vascular risk factors (Modified Hachinski ischemic scale 4). Results: Ageand sex-standardized prevalence rate of VCI was 4.4% (95% CI1⁄42.9%-5.9%). Ageand sex-standardized prevalence of VD or mixed dementia was 1.4% (95% CI1⁄40.6%-2.3%), and that of vMCI was 3.0% (95% CI1⁄41.8%-4.3%). The prevalence of VCI increased with advancing age (2.3% in 65-69, 5.1% in 70-74, and 6.8% in 75 or older). Gender and educational level had no significant influence on the prevalence of VCI. Conclusions: The prevalence of VCI in Korean elders was comparable to other western countries (5% in Canada, 6.6% inUK) and older age was significantly associated with an increased risk of developing VCI. As operational criteria of VCI is still variable between studies, it is warranted to establish uniform operational criteria for VCI for ensuring validity and comparability in future researches.

Poster 144 Anemia is Associated Differently With Physical Function in Community-Dwelling Korean Women Elders: Results From the Korean Longitudinal Study on Health and Aging (KLoSHA)

Poster 144 Anemia is Associated Differently With Physical Function in Community-Dwelling Korean Women Elders: Results From the Korean Longitudinal Study on Health and Aging (KLoSHA)

Anemia and activities of daily living in the Korean urban elderly population: Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

This study was planned to investigate the prevalence and risk factors of anemia and its impact on health-related quality of life and activities of daily living (ADL) in elderly Koreans. Of the 1,118 randomly sampled elderly Koreans aged 65years or older living in Seongnam, Korea, on Aug. 1, 2005, we estimated the prevalence of anemia from 695 responders. We investigated the risk factors of anemia using a merged sample of this random sample and 270 volunteers enrolled from Seongnam residents aged 85years or older. We diagnosed anemia according to the World Health Organization criteria. The estimated age- and gender-standardized prevalence of anemia was 8.33% for the overall random sample (95% confidence intervals (CI) 6.28-10.39), 10.58% in men (95% CI 7.09-14.07), and 6.85% in women (95% CI 4.37-9.34). The identified risk factors were age ≥80years, male, iron deficiency, history of stroke, renal dysfunction, and metabolic syndrome. Anemia was associated with impairment in physical functioning (p = 0.031) and instrumental ADL (p < 0.001). This is the first report about anemia's prevalence in community-dwelling Korean elders, adjusted and standardized according to the city's and nation's population. Timely diagnosis of anemia and correction of its treatable cause may improve QOL and ADL in elderly individuals.

P3‐396: Anhedonia is associated with the risk of Alzheimer's disease in elders with mild cognitive impairment: Results from the Korean Longitudinal Study on Health and Aging (KLOSHA)

P3‐396: Anhedonia is associated with the risk of Alzheimer's disease in elders with mild cognitive impairment: Results from the Korean Longitudinal Study on Health and Aging (KLOSHA)

Evaluation of Factors Influencing Grip Strength in Elderly Koreans

ObjectivesGrip strength has been used as a measure of function in various health-related conditions. Although grip strength is known to be affected by both physical and psychological factors, few studies have looked at those factors comprehensively in a population-based cohort regarding elderly Koreans. The aim of this study was to evaluate potential factors influencing grip strength in elderly Koreans.MethodsWe evaluated dominant hand grip strengths in 143 men and 123 women older than 65 years who participated in a population-based cohort study, the Korean Longitudinal Study on Health and Aging (KLoSHA). Individuals who had a history of surgery for musculoskeletal disease or trauma in the upper extremity were excluded. Factors assessed for potential association with grip strength were; 1) demographics such as age and gender, 2) body constructs such as height, body mass index (BMI), and bone mineral density (BMD), 3) upper extremity functional status using disabilities of the arm, shoulder and hand (DASH) scores, and 4) mental health status using a depression scale and the short form-36 (SF36) mental health score. Multivariate analyses were performed in order to identify factors independently associated with grip strength.ResultsGrip strengths of dominant hands in elderly Koreans were found to generally decrease with aging, and were significantly different between men and women, as expected. Multivariate analyses indicated that grip strength was independently associated with age, height and BMI in men (R2 = 21.3%), and age and height (R2 = 19.7%) in women. BMD, upper extremity functional status, or mental health status were not found to be associated with grip strength.ConclusionsThis study demonstrates that in elderly Koreans, grip strength is mainly influenced by age and height in both men and women, and additionally by BMI in men. BMD or self-reported physical or mental health status was not found to influence grip strength in elderly Koreans. This information may be helpful in future studies using grip strength as a measure of function in elderly Koreans.

Vitamin D Inadequacy Is Associated with Significant Coronary Artery Stenosis in a Community-Based Elderly Cohort: The Korean Longitudinal Study on Health and Aging

Recent studies suggest an association between vitamin D activity and cardiometabolic risk. We investigated vitamin D status and its association with subclinical atherosclerosis in a population-based cohort study, the Korean Longitudinal Study on Health and Aging (KLoSHA). Participants were 439 men and 561 women aged 65 yr or older who were recruited by random stratified sampling for KLoSHA. Anthropometric and biochemical parameters, the concentration of 25-hydroxyvitamin D (25-OHD), and intact PTH were measured. We evaluated the coronary artery calcium score and stenosis using multidetector-row cardiac computed tomography, the intima-media thickness using carotid sonography, pulse wave velocity, and the ankle-brachial index. Among the participants, 49.8, 44.2, and 6.0% had 25-OHD deficiency (<15 ng/ml), insufficiency (15-29.9 ng/ml), and adequacy (≥30 ng/ml), respectively. The frequency of coronary artery stenosis (>50%) differed between 25-OHD categories: 18.5, 12.9, and 1.9% in the 25-OHD-deficient, -insufficient, and -adequate groups, respectively (P < 0.05). After adjusting for cardiometabolic risks and intact PTH concentration, multivariate regression analysis showed that participants with a low 25-OHD concentration had a higher risk of significant coronary artery stenosis; the odds ratios were 2.08 for 25-OHD concentration of 15-29.9 ng/ml vs. at least 30 ng/ml and 3.12 for 25-OHD concentration below 15 ng/ml vs. at least 30 ng/ml (both P < 0.05). The association between 25-OHD inadequacy and subclinical atherosclerosis underscores the clinical implications of vitamin D status. An intervention strategy to increase vitamin D level through vitamin D-fortified diet and adequate sun exposure may mitigate the consequences of vitamin D deficiency.

Optimal cut points of waist circumference (WC) and visceral fat area (VFA) predicting for metabolic syndrome (MetS) in elderly population in the Korean Longitudinal Study on Health and Aging (KLoSHA)

Optimal cut points of central obesity identifying subjects at risk for MetS were proposed ethnic-specifically, but have not been established yet. Of particular interest are the values for elderly persons, which have not been identified previously. We investigated the appropriate cut points of WC and VFA for elderly in a community-based cohort in Korea. We recruited 294 men and 313 women aged 65 or over who participated in the KLoSHA. A receiver operating characteristic (ROC) curve analysis was used to estimate the optimal cut points of WC and VFA indicative of MetS. The optimal cut points for predicting MetS were 87cm for WC, 140cm2 for VFA in men, and 85cm for WC, 100cm2 for VFA in women with the Youden index. Similar cut points were obtained with the closest-to-(0, 1) criterion except for VFA in men, which was 122cm2. When adjusted for age, exercise, smoking, and alcohol consumption, men with ≥122cm2 and women with ≥100cm2 of VFA had a higher risk of MetS than subjects with lower values. The cut points of VFA and WC at risk for MetS were higher in men than women. In this community-based elderly cohort, the optimal cut points of WC at risk for MetS were lower than the Western criteria. Compared with the cut points in middle-aged Koreans, the cut points for elderly were lower in men and similar in women.