Korean Journal of Family Medicine

"Sang Wha Lee"

Original Articles

The Association between Urinary Sodium Excretion and Metabolic Syndrome in Korean Adults from the 2010–2011 Korean National Health and Nutrition Examination Survey: Jeong Eun Seo, Hong Soo Lee, Sang Wha Lee, Kyung Won Shim, A Ri Byun, Jung Hwa Kim, Hee Jeong An, Hyejin Chun; Korean J Fam Med 2017;38(4):199-205. Published online July 20, 2017; DOI: https://doi.org/10.4082/kjfm.2017.38.4.199

Abstract
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Background

The sodium intake of Koreans was higher than that recommended by the World Health Organization. Urinary sodium, which is correlated with sodium intake, can be easily calculated by the Tanaka's equation. This study aimed to evaluate the association between urinary sodium and metabolic syndrome in Korean adults using the 2010–2011 Korean National Health and Nutrition Examination Survey (KNHANES).

Methods

A total of 5,870 participants from the 2010–2011 KNHANES were included in this study. Twenty-four hour urinary sodium was calculated by the Tanaka's equation using spot urine. Participants were divided into tertiles based on urinary sodium levels. The association between urinary sodium and metabolic syndrome was analyzed using multivariate logistic regression analysis.

Results

The odds ratios (ORs) and 95% confidence intervals (CIs) of metabolic syndrome for the 2nd and 3rd tertile of urinary sodium levels was 1.51 (1.16–1.97) and 1.56 (1.23–1.97) compared to the lowest tertile of urinary sodium in men. The ORs and 95% CIs of metabolic syndrome in women were 1.20 (0.95–1.51) for the 2nd tertile and 2.16 (1.68–2.78) for the 3rd tertile. These associations remained statistically significant, even after adjusting for multiple covariates such as age, education, regular exercise, smoking, and alcohol consumption.

Conclusion

These findings indicate that urinary sodium is significantly associated with metabolic syndrome in Korean adults.

Citations

Citations to this article as recorded by

Associations of heavy metals and urinary sodium excretion with obesity in adults: A cross-sectional study from Korean Health Examination and Nutritional Survey
Juyeon Lee, Sue K. Park, Iman Al-Saleh
PLOS ONE.2025; 20(1): e0317190. CrossRef
The relationship between excess sodium intake and metabolic syndrome: Worth consideration?
Baris Afsar, Rengin Elsurer Afsar, Said Mowaffaq, Geetha Maddukuri, Krista L. Lentine
European Journal of Clinical Investigation.2025;[Epub] CrossRef
Impact of urinary sodium excretion on the prevalence and incidence of metabolic syndrome: a population-based study
Lu Yin, Sidong Li, Yongmei He, Lin Yang, Li Wang, Chao Li, Yaqin Wang, Jing Wang, Pingting Yang, Jiangang Wang, Zhiheng Chen, Ying Li
BMJ Open.2023; 13(4): e065402. CrossRef
Association between childhood obesity and familial salt intake: analysis of data from Korean National Health and Nutrition Examination Survey, 2014–2017
Byung Min Yoo, Mijin Kim, Min Jae Kang
Endocrine Journal.2021; 68(9): 1127. CrossRef
Association of rheumatoid arthritis and high sodium intake with major adverse cardiovascular events: a cross-sectional study from the seventh Korean National Health and Nutrition Examination Survey
Jeong-Hyeon Bae, Min-Young Shin, Eun Ha Kang, Yun Jong Lee, You-Jung Ha
BMJ Open.2021; 11(12): e056255. CrossRef
Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)
Kristina S. Petersen, Sarah Rae, Erik Venos, Daniela Malta, Kathy Trieu, Joseph Alvin Santos, Sudhir Raj Thout, Jacqui Webster, Norm R. C. Campbell, JoAnne Arcand
The Journal of Clinical Hypertension.2019; 21(2): 307. CrossRef
Evaluation and implications of salt intake and excretion
Decio Armanini, Luciana Bordin, Gabriella Donà, Alessandra Andrisani, Guido Ambrosini, Marco Boscaro, Chiara Sabbadin
The Journal of Clinical Hypertension.2019; 21(7): 950. CrossRef
Associations of urinary sodium levels with overweight and central obesity in a population with a sodium intake
Juyeon Lee, Yunji Hwang, Kyoung-Nam Kim, Choonghyun Ahn, Ho Kyung Sung, Kwang-Pil Ko, Kook-Hwan Oh, Curie Ahn, Young Joo Park, Suhnggwon Kim, Young-Khi Lim, Sue K. Park
BMC Nutrition.2018;[Epub] CrossRef
Sodium Intake Estimated from Spot Urine Samples and the Prevalence of Metabolic Syndrome in the Korea National Health and Nutrition Examination Survey
Young Gyu Cho
Korean Journal of Family Medicine.2017; 38(4): 171. CrossRef

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Cancer Prevalence among Physicians in Korea: A Single Center Study: Hye Lin Kim, Hae Jin Park, Yun Hye Sim, Eun Young Choi, Kyung Won Shim, Sang Wha Lee, Hong Soo Lee, Hyejin Chun; Korean J Fam Med 2016;37(2):91-96. Published online March 25, 2016; DOI: https://doi.org/10.4082/kjfm.2016.37.2.91

Abstract
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Background

There is little research regarding whether working as a physician affects cancer risk. Moreover, there is no research on cancer prevalence among physicians in Korea. This study utilized the Korea National Cancer Incidence Database to determine whether the prevalence of cancer among physicians differs from the prevalence of cancer within the general population.

Methods

We analyzed the medical records of a representative sample of 382 doctors who underwent a health examination between 2010 and 2013 at a health examination center in a Ewha Womans University Medical Center.Cancer incidence was measured as cases that were eventually diagnosed as cancer according to a biopsy.

Results

We collected medical records from 382 physicians (mean age, 51.9±8.1 years) and calculated the standardized prevalence ratios compared to the general population. Thirty physicians (9 male and 21 female) were identified as having cancer. Physicians had a significantly higher prevalence of cancer compared to the general population.Cancer prevalence in male physicians was found to be 2.47 times higher than the prevalence expected within the general population (P=0.006). Among female physicians, cancer prevalence was 3.94 times higher than that in the general population (P<0.001).

Conclusion

This study revealed that physicians had a higher prevalence of cancer compared to the general population in Korea, which suggests that there may be a problem present in the health care of physicians. Changes to the working environment of physicians will be needed to reduce the high prevalence of cancer among physicians.

Citations

Citations to this article as recorded by

Analysis of Cancers in A University Hospital Employees between 2006 and 2022
Serkan ÇELİKGÜN, Tülay KOÇ, Reyhan UÇKU
Journal of Basic and Clinical Health Sciences.2023; 7(3): 174. CrossRef
Health and Mortality in Korean Healthcare Workers
Yoonhee Shin, Ui Jeong Kim, Hye Ah Lee, Eun Jeong Choi, Hyun Jin Park, Hyeong Sik Ahn, Hyesook Park
Journal of Korean Medical Science.2022;[Epub] CrossRef
Importance of lifestyle, stress, and chronic diseases in self-rated health of Korean doctors
Su Hyun Oh, Jin Suk Kim
Journal of the Korean Medical Association.2020; 63(9): 566. CrossRef
Cancer Incidence among Healthcare Workers in Cancer Centers: A 14-Year Retrospective Cohort Study in Thailand
Chatchai Ekpanyaskul, Suleeporn Sangrajrang
Annals of Global Health.2018; 84(3): 429. CrossRef
Comparison of Cancer Prevalence in Physicians with That of the General Population, and Important Considerations
Yousef Veisani, Ali Delpisheh
Korean Journal of Family Medicine.2016; 37(5): 308. CrossRef

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The Association of Lung Age with Smoking Status in Korean Men: Hye Young Oh, Hong Soo Lee, Sang Wha Lee, Kyung Won Shim, Hyejin Chun, Joo Yeon Kim; Korean J Fam Med 2014;35(1):35-41. Published online January 23, 2014; DOI: https://doi.org/10.4082/kjfm.2014.35.1.35

Abstract
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Background

Lung age, calculated from sex, forced expiratory volume in one second (FEV₁), and height, was developed to illustrate premature changes to the lungs and could be used to motivate smoking cessation. However, this method has not been tested in association with smoking in Korea. The purpose of this study was to investigate the association of lung age with smoking and other factors in Korean males.

Methods

We reviewed the records of 1,100 healthy men who visited a health promotion center at Ewha Womans University Medical Center from January 2008 to June 2009. Lung age was calculated from FEV₁ and normal predictive values of spirometry according to age in the Korean population. The difference between lung age and chronological age was evaluated in relation to smoking status, weight, body mass index, waist, muscle mass, fat mass, and exercise.

Results

The age difference was significantly higher in current smokers than in non-smokers (12.47 ± 19.90 vs. 7.30 ± 19.52, P < 0.001). Additionally, the age difference was positively correlated with life time pack-year (β = 0.223; P < 0.001) and fat mass (β = 0.462; P < 0.001). Lung age increased 1 year for 4.48 pack-year increase or for 2.16% increase in fat mass.

Conclusion

We found a significant relationship between lung age and both smoking status and fat mass in healthy Korean males. Lung age may be a useful tool for motivating cessation of cigarette smoking and management of risk factors related to obesity.

Citations

Citations to this article as recorded by

Developing a predictive equation of muscular age to evaluate muscle health in Chinese community-dwelling older women
Xiaoguang Zhao, Jiabin Yu, Nan Liu
Health Care for Women International.2023; 44(12): 1587. CrossRef
Effect of smoking status on spirometric lung age in adult Chinese Men
Xiaoguang Zhao, Chenya Du
Health & Social Care in the Community.2022; 30(4): 1384. CrossRef
Comparison of periodontal status and salivary IL-15 and -18 levels in cigarette-smokers and individuals using electronic nicotine delivery systems
Dena Ali, Isaac Kuyunov, Jagan Kumar Baskaradoss, Toshinari Mikami
BMC Oral Health.2022;[Epub] CrossRef
A pilot randomized controlled trial on the effectiveness of a ‘lung age’ intervention on smoking cessation: study protocol
Imran Muhammad, Wenqi Mok, Hai Moy Toh, Daniel Sii, Wenru Wang
Journal of Advanced Nursing.2015; 71(10): 2426. CrossRef

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The Relationship of Serum Homocysteine Levels with Lumbar and Femoral Bone Mineral Density.: Yoen Jung Lee, Sang Wha Lee, Hong Soo Lee, Kyung Won Shim, Sooa Kim, Eui Jeong Woo, Na Yeon Kim; J Korean Acad Fam Med 2008;29(3):175-181. Published online March 10, 2008

Abstract
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Background
Recently, an elevated serum homocysteine level has been reported to be associated with increased fracture risk and reduced bone mineral density (BMD). So far, little research has been done to evaluate such association in Korean population. Therefore, we investigated the association between serum homocysteine levels and BMD in Korean adults. Methods: The subjects consisted of 2,750 adults who visited a health promotion center at a university hospital from January 2005 to March 2006. Self-administered questionnaires provided information about lifestyle and medical history. Fasting plasma samples were collected and BMD of the lumbar spine and femoral neck were obtained by dual energy X-ray absorptiometry. To adjust for menopausal state, the female subjects were divided into three groups according to age (≤45 yrs, 46∼55 yrs, 55 yrs ＜). Multiple linear regression analysis was used to evaluate the association between serum homocysteine levels and BMD in each gender and age group. Results: The results adjusted for alcohol and smoking history showed significant association between serum homocysteine levels and BMD in women (Lumbar spine: Ղ=-0.006, P=0.015, Femoral neck: Ղ=-0.065, P=0.012) but not in men (Lumbar spine: Ղ=0.001, P=0.240, Femoral neck: Ղ=0.001, P=0.242). With analyses by three age groups, plasma homocysteine level was associated with both lumbar and femoral BMD in age 46∼55 women (Lumbar spine: Ղ=-0.014, P=0.024, Femoral neck: Ղ= -0.007, P=0.019). Conclusion: Our study suggests that increased serum homocysteine level is an independent risk factor for low BMD among women, especially perimenopausal women. Further studies about the sexual differences and the mechanisms linking serum homocysteine level to BMD are needed. (J Korean Acad Fam Med 2008;29:175-181)

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The Relation of Nonalcoholic Fatty Liver Disease to Metabolic Syndrome.: Jee Hyun Kang, Sang Wha Lee, Hong Soo Lee, Choo Yon Cho, Byung Yeon Yu; J Korean Acad Fam Med 2004;25(10):746-753. Published online October 10, 2004

Abstract
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Background
: The aim of this study was to elucidate the relationship between nonalcoholic fatty liver disease diagnosed by ultrasonography and the metabolic syndrome defined by NCEP-ATP III criteria.

Methods : Sixty-nine adult male subjects with negligible alcohol consumption underwent an anthropometric and laboratory investigation. The ultrasound scan of the liver was performed to determine the presence and the severity of nonalcoholic fatty liver disease.

Results : Nonalcoholic fatty liver disease was diagnosed in 36 cases by ultrasound scan. According to the severity of nonalcoholic fatty liver, triglyceride, HDL- cholesterol, alanine aminotransferase, aspartate aminotrasnferase, fasting insulin level, HOMA-IR, and obesity related variables (body mass index, percent body fat, waist circumference) showed a significant difference. The independent variables which account for the severity of nonalcoholic fatty liver disease was waist circumference, and alanine aminotransferase which is a predictor of nonalcoholic steatohepatitis. The prevalence of metabolic syndrome was 41% vs 6.1% in nonalcoholic fatty liver group vs control group, respectively, and the odds ratio was 11.1 (95% CI 2.29∼53.6). The prevalence of nonalcoholic fatty liver was increased with increasing the number of features of metabolic syndrome.

Conclusion : Nonalcoholic fatty liver disease was closely related to the metabolic syndrome and the severity classification of nonalcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance, and the risk of nonalcoholic steatohepatitis.

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The usefulness of wrist/height ratio as a predictor for the risk factors of coronary artery disease.: Ji Young Ko, Hyo Ley Lee, Shin Ai Park, Wol Mi Park, Sang Wha Lee, Hong Soo Lee; J Korean Acad Fam Med 1998;19(9):719-727. Published online September 1, 1998

Abstract
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Background
: The waist/hip ratio is an useful index of abdominal obesity, but it includes two variables which may result in a false interpretation. The purpose of this study is to evaluate the usefulness of waist/height ratio as a predictor for the risk factors of coronary artery disease(CAD).

Methods : 1395 persons(818 men & 577 women) were selected as subjects who visited the Health Examination Center at Ewha Mokdong Hospital from October 1996 to March 1997. Waist circumference was measured at the level of umbilicus with standing position. Hip circumference was measured at the level of the largest circumference of the hip. We set the criteria of the risk factors as hypertension(systolic BP≥140mmHg and/or diastolic BP≥90mmHg), glucose intolerance(fasting blood glucose≥115mg/dl), hypertriglyceridemia(>160mg/dl), hypercholesterolemia(≥200mg/dl), and low HDL-cholesterol level(<35mg/dl). The morbidity index of CAD was calculated by the sum of the risk factor scores(one point per item if present).

Results : There was significant correlation between waist/height ratio, waist/hip ratio and body mass index(BMI)(p=0.0001). BMI had more strong correlation with waist/height ratio(r=0.81) than waist/hip ratio(r=0.48). According to the simple regression analysis, BMI, waist/hip ratio and waist/height ratio had significant correlation with all of the risk factors and the morbidity index. According to the multiple regression analysis, waist/height ratio had significant correlation with age, weight, height, systolic BP, triglyceride, cholesterol and HDL-cholesterol. The risk factor morbidity index of the groups with waist/height ratio over 0.45 was significantly more higher than the group of the lowest risk factor morbidity index(waist/height ratio under 0.4) in men(p=0.01). For women, 0.46 was the level which the risk factor morbidity index increased significantly(p<0.01).

Conclusion : Waist/height ratio can be a useful index of abdominal obesity. And it may be used as a more easier and better predictor of multiple CAD risk factors than waist/hip ratio. We can predict that waist/height ratio over 0.45 in men and over 0.46 in women may have more higher coronary artery disease risk.

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The risk factors of the nonresponders after hepatitis B vaceinatio and the immunogenecity after a double-dose revaccination in the nonresponders.: Hee Jeong Koh, Kie Jung Lee, Kyeng Won Sim, Wol Mi Park, Sang Wha Lee, Hong Soo Lee; J Korean Acad Fam Med 1998;19(8):652-661. Published online August 1, 1998

Abstract
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Background
: Korea is an endemic area of viral hepatitis B with a rate of 5~10% carrier state. Therefore, hepatitis B vaccination is performed nationwide. But 5~15% of health individuals fail to respond adequately to the vaccine and an approved guideline for the nonresponders has not been developed yet. This study is designed to identify risk factors for those who lack anti-HBs after hepatitis B vaccination and to document the results of a double-dose revaccination in such nonresponders to the primary vaccination.

Methods : From Feb. 1996 to Aug. 1997, we assessed 51 healthy subjects(HBs Ag negative, anti-HBs negative, anti-HBs negative and a normal LFT). All subjects were vaccinated with Hepavax-B® 1.0ml, 24 by a rapid schedule(0, 1, and 2 months) and and 27 by a standard schedule(0, 1, and 6 months). Anti-HBs titers were evaluated 3 months after the third vaccine and assessed the nonresponders(anti-HBsTiter < 2mIU/ml) and the hyporesponders(2~10 mIU/ml). All 13 nonresponders were revaccinated with 2 ml of Hepavax-B 3 months after the primary vaccination. Anti-HBs titers were evaluated 1 month later.

Results : The difference in age(p<0.01) and smoking amount(p<0.05) between the responders andhe hypo and the nonresponders were statistically significant. There were more males and higher body mass index in the hypo and the nonresponders but not statistically significant. The seroconversion rate after the double-dose vaccination was 92.3%(12/13) with an average titer of 58.08 mIU/ml(1~132.4 mIU/ml).

Conclusion : Increase in age and smoking amount were the risk factors of the nonresponders after the primary vaccination. Most of the hypo and the nonresponders to the primary vaccination responded adequately to the double-dose revaccination.

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Ettects of including smoking status in Medical Record On Doctors Counselling to Quit Smoking.: Young Ok Lee, Wol Mi Park, Sang Wha Lee, Hong Soo Lee, Kie Jung Lee, Hyeon Ju Yu, Yu Mi Lee, Ja Young Kim; J Korean Acad Fam Med 1996;17(9):810-815. Published online September 1, 1996

Abstract
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Background
: It is well known fact that smoking is hazardous and fatal to health. Recently, physician's counselling about smoking cessation is carried out sucessfully and its importance is emerging. If phsicians can easily identify the current smoking status of the patient, the frequency of counselling will increase dramatically. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physicians advice to quit smoking. Its purpose is to utilize this to practical practice.

Methods : From September 1 to October 31 in 1995, we analyzed 99 first-visit male patients(over age 20) who finished questionnaires which is composed of 7 questions during visiting family practice clinic in Ewha Womans University Mokdong Hospital in Seoul. Simple institutional change in clinical practice involved training the nurse how to use progress notepaper with a vital sign stamp that included smoking status(current, former, of never) along with the traditional visit signs from October, 1 1995 to October, 31, 1995 and just the traditional vital sign(blood pressure, body temperature, pulse rate) from September, 1, 1995 to September, 30, 1995. The contents of the survey were questions about whether the patient smoked, whether the patient was asked about smoking status by a doctor and, for smokers, whether they were urged to quit smoking.

Results : From September 1, 1995 to September 30, 1995, 52 patients participated and from October 1, 1995 to October 31, 1995, 47 patients did and the current smokers were 30 and 34 patients respectively. After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit(an increase from approximately 53.3% at baseline to 82.4% at intervention ; P<0.05). The vital sign intervention was associated with significant increase in the percentage of smokers who reported that their clinician advised them to quit smoking (from approximately 36.7% at baseline to 61.7% during the intervention ; P<0.05). Age, age at which smoking was started, the number of cigarettes currently being smoked daily and number of previous quit attempts were not statistically significant.

Conclusion : Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist smoking cessation. This simple, low-cost intervention may effectively prompt family physicians to inquire about use of tobacco and offer recommendations to smokers.

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A survey on the knowledge, attitude and behavior about familymedicine of the people living in certain apartment, Seoul.: Jun Kag Lee, Sung Kon Park, Sang Wha Lee, Dong Young Cho; J Korean Acad Fam Med 1991;12(8):50-57. Published online August 1, 1991

Abstract
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To know the knowledge, attitude and behavior about family medicine among the people living in certain apartment in Seoul, a questionnaire survey was carried out.
Among 500 persons setected randomly, 206 persons answered the questionnaire.
The results of this survey were as follows:
1. Among 296 persons, male was in 41.6%, and female was in 58.4%.
2. The rate of knowledge of family medicine was 70.9% and most of them heard of it via mass media.
3. 87.5% of the subject answered that the family medicine is really necessary for the health delivery system in Korea.
4. 6.8% of the subjects were registered at family medicine department and 78.7% of 196 answers were interested in participating family practice program whenever it is available.

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An analysis of the results of periodic health examination.: Hyung Yune Kang, Moon Jeong Kim, Sang Wha Lee, Hye Ree Lee, Bang Bu Youn; J Korean Acad Fam Med 1991;12(7):46-51. Published online July 1, 1991

Abstract
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The results of 2674 case with periodic health examination which were performed at hospitals located in were reviewed.
1. 544 cases(20.3%) were abnormal in the primary check-up, including hypercholesterolemia(24.4%), positive HBsAg(22.4%), high BP(17.3%), hyperglycemia(10.1%), elevated SGOT/SGPT(10.0%), abnormal finding of the chest x-ray(5.1%), low blood Hb(5.0%), positive VDRL test(2.0%), abnormal urine analysis(1.3%), hemorrhoid, skin lesion, lymphadenopathy, conjunctivitis.
2. Secondary check-up were applied to these 544 cases with the results of the followings ; Hepatitis B virus-related liver disease(34.2%), hypertriglyceridemia(22.7%), other liver disease(10.3%), diabetes mellitus(9.5%), hypertension(7.6%), anemia(7.65), serology-positive syphilis(3.1%), renal disease(0.85), pulmonary disease(0.65).
3. 37 cases among 54 cases with elevated SGOT/SGPT have abnormal LFT. (68.5%)
4. 34 cases among 55 cases with hyperglycemia are proven to have DM.(61.8%)
5. 81 cases among 133 cases with hypercholesterolemia are proven to have hypertriglyceridemia or abnormal HDL-cholesterol(60.9%)
6. 27 cases among 94 cases with high BP have abnormal EKG(28.7%)
7. 28 cases among 122 HBs Ag(+) cases have abnormal LFT.(23.0%)

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Clinical analysis of the 1,253 traffic accident victims.: Jong Wook Park, Woo Chul Jeong, Eung Soo Kim, Sang Wha Lee, Bang Bu Youn; J Korean Acad Fam Med 1991;12(4):51-57. Published online April 1, 1991

Abstract
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A retrospective study has been made of 1,253 cases of traffic accidents which had been treated at the H hospital in Seoul from May 1989 to April 1990.
This study was conducted to find out the nature and pattern of the traffic accident from the clinical and epidemiologic standpoint. The aims of this study were not to indicate direct preventive measures but focus attention on fields in which best results should be given by the preventive measures.

The following results were obtained;
1. Accidents occurred most frequently from 6 p.m. to midnight, 54.2%.
Although there was no significant difference, the descending order of monthly incidence was January(12.3%), March(9.6%), and August(9.6%).
2. Male to female ratio was 2.63:1.
The highest incidence was in age group between 20-29 year(34.7%).
3. The majority of trauma was from taxi and passengers' car (64.1%).
Pedestrians were most commonly injured(43.4%).
4. The types of injury were almost neurosurgical and orthopedic injury(88.1%).
5. Abrasion and contusion were most frequent(25.0%) and cerebral concussion was 21.7%.
6. In abdominal trauma, small bowel (33.3%), spleen(25.0%), liver(12.5%), kidney(8.3%) was the descending order of frequency.
7. Brain damages were responsible for the majority of cause of death (53.6%) and mortality rate was 4.1% in the admitted patients.