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Volume 46(3); May 2025

Editorial

Cumulative circadian disruption factors and metabolic syndrome
Jungun Lee
Korean J Fam Med 2025;46(3):125-126.   Published online May 20, 2025
DOI: https://doi.org/10.4082/kjfm.46.3E
  • 75 View
  • 8 Download

Review Articles

Systemic aging delay and anti-aging therapy using allogeneic stem cells
Seongho Han, Sung-Whan Kim
Korean J Fam Med 2025;46(3):127-136.   Published online May 20, 2025
DOI: https://doi.org/10.4082/kjfm.25.0080
Allogeneic stem cells derived from umbilical cord tissue, placenta, and umbilical cord blood have shown potential in treating delayed systemic aging and aging-related diseases. Aging induces cellular senescence, oxidative stress, chronic inflammation, and stem cell depletion, all of which contribute to tissue damage and functional decline. Recent advances in regenerative medicine suggest that allogeneic stem cells can mitigate these aging processes through immunomodulation and tissue regeneration. In particular, umbilical cord-derived mesenchymal stem cells have gained attention for clinical applications owing to their strong immunomodulatory properties and low immunogenicity. These cells can repair damaged tissues and enhance metabolic and cognitive function by secreting various cytokines, growth factors, and exosomes, offering potential treatment for aging-related conditions such as osteoporosis and neurodegenerative disorders. Both clinical and preclinical studies indicate that allogeneic stem cells play a critical role in alleviating these diseases, including osteoporosis, osteoarthritis, cardiovascular diseases, and neurodegenerative disorders. Despite their therapeutic potential, challenges remain, such as immune compatibility, long-term safety, and the lack of standardized protocols for large-scale production. This review outlines the biological mechanisms by which allogeneic stem cells contribute to delayed aging, summarizes current clinical research, and explores future prospects. Allogeneic stem cells may offer novel strategies for delaying aging and extending lifespan.
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Exercise, environmental conditions, and diet are integral to athletes’ health and performance. Understanding how these factors interact to influence appetite-regulating hormones is a growing area of interest in sports science. This knowledge facilitates the development of personalized strategies for precisely monitoring and improving dietary intake, enhancing well-being, and improving athletic performance. For this narrative review, databases like “PubMed,” “SportDiscus,” “Scopus,” “ProQuest,” and “Google Scholar” were referred to using Boolean operators (AND, OR) to combine keywords related to exercise, environmental conditions, diet, and appetite-regulating hormones. High-intensity interval training, sprint interval training, resistance exercises, and high-intensity aerobic exercises were found to enhance satiety and suppress appetite by increasing appetite-suppressing hormones while reducing ghrelin levels. Greater exercise intensity prolonged appetite suppression by sustaining elevated levels of satiety hormones. Environmental factors such as high altitude, hypoxia, and extreme heat were associated with increased satiety, reduced appetite, and lower energy intake. Conversely, exposure to cold temperatures and participation in cold water exercises stimulated appetite. Dietary interventions, particularly ketogenic and high-protein diets, promoted satiety by increasing glucagon-like peptide-1 levels and decreasing ghrelin levels. Calorie restriction, especially when meals were infrequent but included breakfast, helped maintain satiety for extended periods by elevating satiety hormones. Integrating personalized exercise routines with dietary strategies while considering environmental adaptations is essential for optimizing appetite regulation, athletic performance, and overall health.
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Original Articles

Comparing Mobile-Based to Group-Based Education for Weight Reduction in a Developing Country: A Randomized Study
Hourvash Haghighinejad, Forough Sedaghat, Marzieh Akbarzadeh, Mahtab Jafari
Korean J Fam Med 2025;46(3):152-161.   Published online May 21, 2024
DOI: https://doi.org/10.4082/kjfm.23.0144
Background
This study compared the impact of Short Message Service (SMS)-based education with traditional group-based education and the control group on body mass index, weight, and lifestyle in obese and overweight patients in a limited-resource country. It also compared the direct financial costs between the two intervention groups.
Methods
In this controlled randomized educational study, 90 overweight or obese adults from four family physician clinics in Shiraz, Iran were randomly allocated to three training groups: SMS-based education, group-based education, and a control group. The participants’ weight, body mass index (BMI), and waist circumference were measured at baseline, and the Physical Activity Scale questionnaire was completed. Group-based training was conducted in 1-hour weekly sessions. The SMS group received a text message each morning. The control group received routine care from a family physician. The intervention lasted 12 weeks. All participants were re-examined for the studied variables. Additionally, the direct costs were estimated, calculated, and compared.
Results
The mean weight, BMI, and waist circumference changed significantly after 3 months compared to baseline in each group. The mean weight change differed significantly among the three groups (P-value=0.04), and the mean BMI changes were near significant (P-value=0.06). A post hoc comparison of changes in weight and BMI showed a significant difference between the control and SMS groups. SMS education incurred much lower costs for patients and healthcare services than group-based education.
Conclusion
The study showed that SMS is an effective and cost-saving educational method for weight loss compared to group-based education, especially in developing countries.
  • 1,482 View
  • 26 Download
Background
Circadian misalignment is associated with metabolic syndrome. This study aimed to examine the association between circadian rhythm-disturbing factors and metabolic syndrome.
Methods
We used data from the 7th and 8th Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020, which surveyed 16,253 individuals. Circadian rhythm-disturbing factors were defined as follows: sleep duration outside the reference group (6–8 hours), irregular breakfast, shift work, and physical inactivity. The adjusted odds ratio (aOR) for metabolic syndrome was calculated based on the number of circadian rhythm-disturbing factors present in adults over the age of 19 years.
Results
Among a total of 16,253 participants (mean age 48.2±15 years), metabolic syndrome was found in 5,237 participants (29.3 %). The participants were classified into three categories based on the number of circadian rhythm-disturbing factors as follows: 2,627 (15.6%) did not have any factors, 6,406 (38.13%) had one factor, and 7,220 (46.3%) had two or more factors. Participants with a single circadian rhythm-disturbing factor were 21% more likely to have metabolic syndrome (aOR, 1.21; 95% confidence interval [CI], 1.08–1.36), and participants with two or more factors were 27% more likely to have metabolic syndrome (aOR, 1.27; 95% CI, 1.12–1.43).
Conclusion
Circadian rhythm-disturbing factors were significantly associated with the prevalence of metabolic syndrome in Korean adults. This finding has potential clinical implications for maintaining circadian rhythms by avoiding certain factors to prevent metabolic syndrome. Further studies are required to confirm these findings.
  • 1,388 View
  • 44 Download
Relationship between Social Participation and Cognitive Impairment in Low-Educated Older Adults Based on Indonesian Family Life Survey-5
Jayanto Nanda Putra, Yuda Turana, Yvonne Suzy Handajani
Korean J Fam Med 2025;46(3):170-175.   Published online May 21, 2024
DOI: https://doi.org/10.4082/kjfm.23.0134
Background
The increasing older adult population requires attention in terms of education and health, as higher education levels contribute to cognitive reserve and may protect against age-related cognitive impairment. Cognitive reserve is an individual’s cognitive flexibility in using cognitive functions affected by brain aging, neurological diseases, and injury. Indonesia has a high prevalence of low-educated older adults, which strongly correlates with progressive cognitive impairment. Identifying risk factors for cognitive decline in this population is crucial. This study determines the factors affecting cognitive impairment in low-educated older adults using cross-sectional data from the Indonesian Family Life Survey-5.
Methods
This descriptive study analyzed 2,313 low-educated older adults ≥60 years old. Univariate and bivariate analyses were used to describe the sample and identify the relationships between categorical variables. Logistic regression identified the most significant factor affecting cognitive impairment.
Results
The prevalence of cognitive impairment in low-educated older adults is 22.6%. The chi-square test revealed significant relationships between those who are aged 75 years, a status other than married, female, living in rural areas, and not participating in social activities. Age is the most prominent factor affecting cognitive impairment in such adults (P<0.001; adjusted odds ratio, 3.232; 95% confidence interval, 2.500–4.180).
Conclusion
Cognitive impairment in the aforementioned adults is associated with being ≥75 years old, being a status other than married, being female, living in rural areas, and not participating in social activities. After controlling other variables, low-educated older adults who participated in at least ≥1 social activity in the last 12 months experienced cognitive impairment 0.64 times compared to those who did not participate in social activities.

Citations

Citations to this article as recorded by  
  • Impact of social wellbeing on tooth loss and cognition: A scoping review
    Charlotte Cheuk Kwan Chan, Huimin Chen, Colman McGrath, Iven Klineberg, Gloria Hoi Yan Wong, Hui Chen
    Journal of Dentistry.2024; 150: 105376.     CrossRef
  • 1,420 View
  • 42 Download
  • 1 Crossref
Association of Lipoprotein(a) with Progression of Coronary Artery Calcification: Retrospective Longitudinal Study
Anna Lee, Hyun-Min Koh, Ji-Yong Jang, Hye-Rang Bak, Hye-Jin Jang, Jun-Young Huh, Nak-Gyeong Ko
Korean J Fam Med 2025;46(3):176-184.   Published online May 22, 2024
DOI: https://doi.org/10.4082/kjfm.23.0108
Background
Atherosclerotic cardiovascular disease (ASCVD) is a major health concern, and lipoprotein(a) (Lp(a)) is an independent risk factor. However, there is limited evidence regarding Lp(a) and the risk of ASCVD in Asian populations. This study aimed to assess the predictive value of changes in coronary artery calcification (CAC) for ASCVD risk associated with Lp(a) level.
Methods
Participants (n=2,750) were grouped according to their Lp(a) levels, and the association between Lp(a) and CAC progression was examined. CAC progression was defined as the occurrence of incident CAC or a difference ≥2.5 between the square root (√) of baseline and follow-up coronary artery calcium scores (CACSs) (Δ√transformed CACS). To adjust for differences in follow-up periods, Δ√transformed CACS was divided by the follow- up period (in years).
Results
Over an average follow-up of 3.07 years, 18.98% of participants experienced CAC progression. Those with disease progression had notably higher Lp(a) levels. Higher Lp(a) tertiles correlated with increased baseline and follow-up CACS, CAC progression (%), and Δ√transformed CACS. Even after adjustment, higher Lp(a) levels were associated with CAC progression. However, annualized Δ√transformed CACS analysis yielded no significant results.
Conclusion
This study demonstrated an association between elevated Lp(a) levels and CAC progression in a general population without ASCVD. However, longer-term follow-up studies are needed to obtain meaningful results regarding CAC progression. Further research is necessary to utilize Lp(a) level as a predictor of cardiovascular disease and to establish clinically relevant thresholds specific to the Korean population.
  • 1,629 View
  • 47 Download
Effectiveness of an Informal Home Care Support Intervention Program to Reduce Loneliness and Improve Quality of Life among Lonely Community-Dwelling Older Adults: A Feasibility Study
Ahmad Kousha, Elham Lotfalinezhad, Haidar Nadrian, Karen Andersen-Ranberg, Shannon Freeman, Fatemeh Barati, Hasan Mosazadeh, Mina Hashemiparast, Mohamed Asghari Jafarabadi, Ahmad Sohrabi, Mohammad Reza Honarvar
Korean J Fam Med 2025;46(3):185-194.   Published online June 7, 2024
DOI: https://doi.org/10.4082/kjfm.23.0269
Background
Establishing cost-effective informal care services for lonely older adults living at home in developing countries can be an innovative approach for improving their well-being. This study investigated the effectiveness of an informal home care support intervention program (HoSIP) reducing the loneliness and improving quality of life of lonely community-dwelling older adults.
Methods
This quasi-experimental pre-post study employed a non-randomized control group design with a 12-week intervention period and three follow-up points at the end of the HoSIP. Questionnaires were used to measure feelings of loneliness (20-item UCLA Loneliness Scale), quality of life (Control, Autonomy, Self‐Realization and Pleasure Scale), general health (12-item General Health Questionnaire), social network (six-item Lubben Social Network Scale), social support (12-item Multidimensional Scale of Perceived Social Support), and self-care ability (17-item Self-care Ability Scale for the Elderly). Repeated-measures analysis of variance was used to gauge the effect of the intervention program over time and in comparison to the control group. Data analyses were performed using the IBM SPSS Statistics software (IBM Corp., USA).
Results
We found a significant relationship between the outcome variables, including feelings of loneliness (P<0.001) and quality of life (P<0.001), at different stages of measurement. Despite the positive feasibility results, the implementation of the HoSIP faced challenges due to a lack of facilities (e.g., place restriction for holding educational classes, educational facilities like computers, video projector, and whiteboard at daycare center) and the absence of supporting organizations.
Conclusion
Utilizing the existing capabilities of older adults to provide online and face-to-face care services can be a cost-effective way to improve their quality of life and reduce loneliness. The process of facilitating such informal care services for lonely older adults should be managed by either governmental or non-governmental organizations to reduce the rate of social isolation among this vulnerable population.
  • 1,668 View
  • 93 Download
Background
Obesity, sarcopenia, and sarcopenic obesity are increasingly prevalent in older adults and negatively affect health-related quality of life (HRQOL). While EuroQol-5 Dimension and Short Form-36 Health Survey are widely used HRQOL measures, they have limitations in sensitivity and cultural relevance. In contrast, the Health-related Quality of Life Instrument with 8 Items (HINT-8) is a preference-based instrument developed specifically for the Korean population, offering finer discrimination of physical, emotional, and social health domains.
Methods
This study analyzed data from 1,387 older adults (≥65 years) from the 2023 Korea National Health and Nutrition Examination Survey. Obesity was defined as body mass index ≥25 kg/m 2 , sarcopenia by Asian Working Group for Sarcopenia 2019 criteria, and sarcopenic obesity as having both conditions. Multiple linear regression was used to examine their independent effects on HRQOL, adjusting for potential confounders.
Results
Of the participants, 54.2% were classified as normal, 34.9% as obese, 9.8% with sarcopenia, and 1.1% with sarcopenic obesity. All three conditions were significantly associated with greater difficulty in stair climbing: obesity (B=0.223, P<0.001), sarcopenia (B=0.242, P<0.001), and sarcopenic obesity (B=0.338, P=0.048). Sarcopenia was also linked to impaired working ability and higher total HINT-8 scores. Sarcopenic obesity was associated with greater pain. And obesity was linked to slightly lower depression scores.
Conclusion
Obesity, sarcopenia, and sarcopenic obesity negatively impact HRQOL in older adults. Early detection and intervention are essential to improve quality of life and extend health-adjusted life expectancy.
  • 135 View
  • 11 Download

Case Report

Fasting is not always good: perioperative fasting leads to pronounced ketone body production in patients treated with SGLT2 inhibitors: a case report
Jae Chan Choi, Yo Nam Jang, Jong Hoon Lee, Sang Wook Park, Jeong A Park, Hye Sook Kim, Jae Won Choi, Joo Hyung Lee, Yong Jae Lee
Korean J Fam Med 2025;46(3):204-209.   Published online March 7, 2025
DOI: https://doi.org/10.4082/kjfm.24.0210
Ketone bodies produced by sodium-glucose cotransporter 2 (SGLT2) inhibitors can be advantageous, providing an efficient and stable energy source for the brain and muscles. However, in patients with diabetes, ketogenesis induced by SGLT2 inhibitors may be harmful, potentially resulting in severe diabetic ketoacidosis (DKA). During fasting, ketone body production serves as an alternative and efficient energy source for the brain by utilizing stored fat, promoting mental clarity, and reducing dependence on glucose. The concurrent use of SGLT2 inhibitors during perioperative fasting may further elevate the risk of euglycemic DKA. We describe a case of DKA that occurred during perioperative fasting in a patient receiving empagliflozin, an SGLT2 inhibitor. This case underscores the importance of recognizing the potential risk of DKA in patients with diabetes using SGLT2 inhibitors during perioperative fasting.
  • 880 View
  • 46 Download
Letters
Beyond numbers: a sustainable approach to physician workforce planning in the Philippines
Jose Eric Mella Lacsa
Korean J Fam Med 2025;46(3):210-211.   Published online March 24, 2025
DOI: https://doi.org/10.4082/kjfm.25.0043
  • 262 View
  • 17 Download
Artificial intelligence integration and human interaction in detecting depression in tuberculosis patients
Mylene Icamina Maravilla
Korean J Fam Med 2025;46(3):212-213.   Published online March 24, 2025
DOI: https://doi.org/10.4082/kjfm.25.0047
  • 265 View
  • 19 Download
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