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"Incidence"

Original Article

Background
In addition to its antidiabetic effects, metformin has pleiotropic effects, such as the inhibition of carcinogenesis. This study aimed to investigate the association between metformin use and pancreatic cancer risk in the Korean National Health Insurance Service (NHIS)-National Health Screening Cohort (HEALS).
Methods
Of the individuals in the Korean NHIS-HEALS, 29,271 men and 19,091 women were included in the final analysis after propensity score matching based on age, body mass index, and smoking status. The study population was categorized into three groups: metformin non-users with diabetes mellitus (DM), metformin users with DM, and non-diabetic users. A Cox proportional hazards regression model was used to examine the association between metformin use and pancreatic cancer.
Results
The median follow-up period was 12.9 years. The estimated pancreatic cancer incidence was highest in metformin users with DM, regardless of sex (P<0.001), and lowest in non-diabetic men and female metformin non-users (P=0.053). The hazard ratios (95% confidence interval) for pancreatic cancer incidence in metformin users and non-diabetic individuals were 1.116 (0.648–1.923) and 0.447 (0.259–0.771) in men and 2.769 (1.003–7.642) and 1.451 (0.529–3.984) in women, respectively, after full adjustment.
Conclusion
Women with diabetes using metformin are at a higher risk of pancreatic cancer than women with diabetes not using metformin. Meanwhile, men with DM using metformin have a similar risk of pancreatic cancer as men with DM not using metformin.

Citations

Citations to this article as recorded by  
  • Rising Pancreatic Adenocarcinoma and Type 2 Diabetes Mellitus-Related Mortality in the United States, 2000 to 2024, With Forecasts to 2034
    Arkadeep Dhali, Rick Maity, Abdul R. Faisal, Muhammad U. Saeed, Ali S. Hafeez, Asad Zaman, Jyotirmoy Biswas, Adnan Bhat
    American Journal of Clinical Oncology.2026;[Epub]     CrossRef
  • Preventive and Therapeutic effects of Metformin in Cancer: A Meta- Analysis of RCT and Cohort Studies
    Mikiyas Amare Getu, Xianbin Zhang, Jia Wang, Kunpeng Xu, Ying Ying, Li Ma, Peng Gong
    Current Cancer Drug Targets.2026; 26(3): 379.     CrossRef
  • Metformin: A Dual-Role Player in Cancer Treatment and Prevention: A Comprehensive Systematic Review and Meta-Analysis
    Imran Rangraze, Adil Farooq Wali, Mohamed El-Tanani, Mohamed Anas Patni, Syed Arman Rabbani, Rasha Babiker, Shakta Mani Satyam, Yahia El-Tanani, Manfredi Rizzo
    Medicina.2025; 61(6): 1021.     CrossRef
  • Unusual Manifestations of Primary Pancreatic Neoplasia
    Emilia Włoszek, Kamila Krupa, Marta Fudalej, Hanna Miski, Anna M. Badowska-Kozakiewicz, Andrzej Deptała
    Cancers.2025; 17(19): 3240.     CrossRef
  • A survey of the use of EHR as real-world evidence for discovering and validating new drug indications
    Nabasmita Talukdar, Xiaodan Zhang, Shreya Paithankar, Hui Wang, Bin Chen
    Drug Discovery Today.2025; 30(12): 104552.     CrossRef
  • Metformin adverse event profile: a pharmacovigilance study based on the FDA Adverse Event Reporting System (FAERS) from 2004 to 2022
    Yikuan Du, Jinfeng Zhu, Zhuoming Guo, Zhenjie Wang, Yuni Wang, Mianda Hu, Lingzhi Zhang, Yurong Yang, Jinjin Wang, Yixing Huang, Peiying Huang, Mianhai Chen, Bo Chen, Chun Yang
    Expert Review of Clinical Pharmacology.2024; 17(2): 189.     CrossRef
  • Metformin: A Dual-Role Player in Cancer Treatment and Prevention
    Mariam Ahmed Galal, Mohammed Al-Rimawi, Abdurrahman Hajeer, Huda Dahman, Samhar Alouch, Ahmad Aljada
    International Journal of Molecular Sciences.2024; 25(7): 4083.     CrossRef
  • Anti-Diabetic Therapies and Cancer: From Bench to Bedside
    Dimitris Kounatidis, Natalia G. Vallianou, Irene Karampela, Eleni Rebelos, Marina Kouveletsou, Vasileios Dalopoulos, Petros Koufopoulos, Evanthia Diakoumopoulou, Nikolaos Tentolouris, Maria Dalamaga
    Biomolecules.2024; 14(11): 1479.     CrossRef
  • Exploring the Basic Molecular Pathways: Metformin as a Potential Treatment Option for Pancreatic Cancer
    Sepehr Ramezani, Dariush Moslemi, Faezeh Firuzpour, Hamidreza Didar, Seyedamirmohammad Mazloumi, Narjes rezaeiroushan
    Iranian Journal of Blood and Cancer.2024; 16(4): 56.     CrossRef
  • Diabetes Mellitus in Pancreatic Cancer: A Distinct Approach to Older Subjects with New-Onset Diabetes Mellitus
    Jan Bures, Darina Kohoutova, Jan Skrha, Bohus Bunganic, Ondrej Ngo, Stepan Suchanek, Pavel Skrha, Miroslav Zavoral
    Cancers.2023; 15(14): 3669.     CrossRef
  • 7,515 View
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  • 8 Web of Science
  • 10 Crossref

Brief Communications

Serum Cadmium Level Is Positively Associated with Unruptured Intracranial Aneurysm Incidence
Bich Nae Ri Yoon, Jun Beom Lee, Ga Heon Jin, Won Yong Kim
Korean J Fam Med 2019;40(4):273-277.   Published online February 7, 2019
DOI: https://doi.org/10.4082/kjfm.17.0140
Background
Cadmium is a toxic element in cigarette smoke associated with ischemic vascular disease. Its association with cerebral aneurysm is unknown.
Methods
We retrospectively analyzed the medical records of patients with headache who underwent imaging studies between March 2014 and August 2016. An unruptured intracranial aneurysm (UIA) was confirmed by brain magnetic resonance angiography or computed tomography angiography. A control group included age- and sexmatched patients without an UIA. Whole blood and random urine tests were used for detection of cadmium and arsenic levels, respectively. Student t-test was used to compare subject characteristics, mean cadmium and arsenic levels between groups, and differences between groups with small (<4-mm) and large (≥4-mm) UIAs. Multivariate regression analysis was used to identify risk factors for aneurysm incidence.
Results
Of 238 patients, 25 had an UIA. Those with an UIA had more pack-years of smoking (19.5±3.8 vs. 12.5±6.8, P=0.044) and higher mean serum cadmium levels (1.77±0.19 vs. 0.87±0.21 µg/L, P=0.027). Arsenic levels showed no difference between groups. (67.4±23.5 vs. 62.2±18.3 µg/L, P=0.458). There were no significantly different demographic, clinical, or laboratory characteristics between small and large aneurysm groups. According to multivariate analysis, smoking (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.06–2.33; P=0.047) and serum cadmium >2.0 mcg/L (OR, 1.39; 95% CI, 1.15–1.84; P=0.043) were associated with aneurysm incidence.
Conclusion
UIA incidence was associated with pack-years of smoking and serum cadmium level, but aneurysm size was not associated with serum cadmium level.

Citations

Citations to this article as recorded by  
  • Risk factors for saccular unruptured intracranial aneurysms: a systematic review and meta-analysis
    Maaike J A van Eldik, Mariam Ali, Stijn Rietkerken, Jan W Schoones, Sanne A E Peters, Hester M den Ruijter, Ynte M Ruigrok
    European Stroke Journal.2026;[Epub]     CrossRef
  • Impact of lifetime and current smoking exposure on the rupture status, number, and size of intracranial aneurysms
    Ramazan Jabbarli, Marvin Darkwah Oppong, Meltem Gümüs, Mehdi Chihi, Thiemo Florin Dinger, Laurèl Rauschenbach, Yahya Ahmadipour, Philipp Dammann, Yan Li, Nika Guberina, Karsten H. Wrede, Ulrich Sure
    Clinical Neurology and Neurosurgery.2025; 254: 108924.     CrossRef
  • Underreporting of Sex-Specific Findings in Risk Factors for Unruptured Intracranial Aneurysms
    Maaike J.A. van Eldik, Mariam Ali, Stijn Rietkerken, Sanne A.E. Peters, Hester M. den Ruijter, Ynte M. Ruigrok
    Cerebrovascular Diseases.2025; 55(2): 302.     CrossRef
  • Cigarette Smoking and Observed Growth of Unruptured Intracranial Aneurysms: A Systematic Literature Review and Meta-Analysis
    Maria José Pachón-Londoño, Maged T. Ghoche, Brandon A. Nguyen, Seyed Farzad Maroufi, Vita Olson, Devi P. Patra, Evelyn L. Turcotte, Zhen Wang, Brooke S. Halpin, Chandan Krishna, Ali Turkmani, Fredric B. Meyer, Bernard R. Bendok
    Stroke.2024; 55(10): 2420.     CrossRef
  • Hemodynamic Analysis of Pipeline Embolization Device Stent for Treatment of Giant Intracranial Aneurysm under Unsupervised Learning Algorithm
    Haibin Gao, Wei You, Jian Lv, Youxiang Li, Le Sun
    Journal of Healthcare Engineering.2022; 2022: 1.     CrossRef
  • Urinary cadmium and stroke - a case-cohort study in Danish never-smokers
    Aslak Harbo Poulsen, Clara G. Sears, James Harrington, Chanelle J. Howe, Katherine A. James, Nina Roswall, Kim Overvad, Anne Tjønneland, Gregory A. Wellenius, Jaymie Meliker, Ole Raaschou-Nielsen
    Environmental Research.2021; 200: 111394.     CrossRef
  • Blood cadmium concentration and risk of subarachnoid haemorrhage
    Martin Söderholm, Yan Borné, Bo Hedblad, Margaretha Persson, Lars Barregard, Gunnar Engström
    Environmental Research.2020; 180: 108826.     CrossRef
  • Chemical Composition and Microbial Contaminants of Poha Beer: A Local Nonalcoholic Beverage in the Bolgatanga Municipality, Ghana
    Julius T. Dongdem, James Abugri, Clement A. Asakedola, Todd R. Callaway
    International Journal of Microbiology.2020; 2020: 1.     CrossRef
  • 7,896 View
  • 71 Download
  • 8 Web of Science
  • 8 Crossref
Incidence of Type 2 Diabetes Mellitus among Emirati Residents in Ajman, United Arab Emirates
Jayadevan Sreedharan, Jayakumary Muttappallymyalil, Shatha al Sharbatti, Sana Hassoun, Rawda Safadi, Iehab Abderahman, Wathib Abdulsamad Hameed, Abdul Mohsen Ibrahim, Mohamed Tahir Takana, Ahmad Mohammad Fouda
Korean J Fam Med 2015;36(5):253-257.   Published online September 18, 2015
DOI: https://doi.org/10.4082/kjfm.2015.36.5.253
Background

Diabetes mellitus (DM), particularly type-2 is a major public health concern worldwide. Not much information is available with regard to the incidence of DM in United Arab Emirates (UAE). This study aimed at determining the incidence rate of diabetes mellitus among Emirati population in Ajman, UAE. This is a retrospective cohort study.

Methods

This study was conducted in all primary health care centers and Shaikh Khalifa and GMC Hospitals, Ajman, UAE where the Emirati population primarily go for diagnosis and treatment. The incident cases of diabetes mellitus were collected during the period 2010 January to December.

Results

A total of 158 cases newly detected in 2010, 54 were among non-Emiratis and one was type-1 diabetes. Eliminating these, the remaining 101 were included in the analysis. The age of the patients ranged from 23 years to 78 years; 35 (34.7%) males and 66 (65.3%) were females. The overall incidence observed was 4.8/1,000 person-years (PY) with a female predominance of 6.3/1,000 PY against incidence among males of 3.3/1,000 PY. With regard to age specific incidence rate among males, it increases with age till 60 years and then showed a decreasing trend. Among females also the same trend was observed but not as similar to males.

Conclusion

The highest incidence rate was observed in the 55-59 age group among males, 23.4/1,000 PY and females, 32.4/1,000 PY. Among males the incidence rate was much less compared to females in-the age groups older than 59 years.

Citations

Citations to this article as recorded by  
  • Type 3c Diabetes Mellitus: Epidemiology, Diagnosis, Management, and Research Imperatives With Insights From the United Arab Emirates and Global Contexts
    Mathew Vadukoot Lazar, Arun C.S. Menon, Jibu Thomas
    Cureus.2026;[Epub]     CrossRef
  • Epidemiology, Technology, and Professional Perspectives on Diabetes in the United Arab Emirate: A Focused Review
    Khaled M. Al. Dahmani, Mohamed Suliman, Khadija Hafidh, Salem A. Beshyah
    Journal of Diabetes and Endocrine Practice.2024; 07(02): 093.     CrossRef
  • Prevalence of associated renal risk in type 2 diabetes mellitus in the United Arab Emirates
    Mustafa Jamal Ahmed, Omer Ali, Saf Naqvi, Aisha Ahmed, Waseem Omar
    Journal of Diabetes.2024;[Epub]     CrossRef
  • A hybrid super ensemble learning model for the early-stage prediction of diabetes risk
    Ayşe Doğru, Selim Buyrukoğlu, Murat Arı
    Medical & Biological Engineering & Computing.2023; 61(3): 785.     CrossRef
  • Correlation between Glycated Hemoglobin Levels and Knowledge, Attitude, and Practice of Type 2 Diabetic Patients Attending Primary Health Care Centers in Dubai Health Authority
    Hind Al Razooqi, Bashayer AlNajjar, Ebrahim AlShamsi, Kaltham Ibrahim, Wadeia Sharief, Hamda Khansaheb, Marwan Zidan
    Dubai Medical Journal.2023; 6(2): 107.     CrossRef
  • Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses
    Aus Alzaid, Patricia Ladrón de Guevara, Maud Beillat, Valérie Lehner Martin, Petar Atanasov
    Expert Review of Pharmacoeconomics & Outcomes Research.2021; 21(4): 785.     CrossRef
  • Incidence and risk factors of type 2 diabetes mellitus in an overweight and obese population: a long-term retrospective cohort study from a Gulf state
    Dybesh Regmi, Saif Al-Shamsi, Romona D. Govender, Juma Al Kaabi
    BMJ Open.2020; 10(7): e035813.     CrossRef
  • The Prediabetes Outcome at National Guard Primary Health Care Centers in Riyadh, Saudi Arabia: Retrospective Chart Review
    Mohammed A Alateeq, Moath Aljohani, Sondos S Kinani, Ibrahim A Aljabr , Abdullah A Alduayji , Abdulrhman Aloud , Elham Alzahrani, Khalid Alharbi
    Cureus.2020;[Epub]     CrossRef
  • Prediabetes and diabetes prevalence and risk factors comparison between ethnic groups in the United Arab Emirates
    Rifat Hamoudi, Narjes Saheb Sharif-Askari, Fatemeh Saheb Sharif-Askari, Salah Abusnana, Hayat Aljaibeji, Jalal Taneera, Nabil Sulaiman
    Scientific Reports.2019;[Epub]     CrossRef
  • Challenges in the management of Type 2 Diabetes among native women in the United Arab Emirates
    Walaa Abuelmagd, Bachar Afandi, Helle Håkonsen, Seham Khmidi, Else-Lydia Toverud
    Diabetes Research and Clinical Practice.2018; 142: 56.     CrossRef
  • Prevalence of type 2 diabetes mellitus in a sample of the adult population of Alexandria, Egypt
    Samir H. Assaad Khalil, Magdy H. Megallaa, Kamel H. Rohoma, Hanaa Ismael, Myriam AbouSeif, Ibrahim Kharboush, Dalal Elkaffash, Mohamed Hassanein, Moataza M. Abdel Wahab, Amin Malaty, Hassan Sallam
    Diabetes Research and Clinical Practice.2018; 144: 63.     CrossRef
  • The Epidemiology and Economic Burden of Obesity and Related Cardiometabolic Disorders in the United Arab Emirates: A Systematic Review and Qualitative Synthesis
    Hadia Radwan, Rami A. Ballout, Hayder Hasan, Nader Lessan, Mirey Karavetian, Rana Rizk
    Journal of Obesity.2018; 2018: 1.     CrossRef
  • Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study
    Segundo Nicolas Seclen, Moises Ernesto Rosas, Arturo Jaime Arias, Cecilia Alexandra Medina
    BMJ Open Diabetes Research & Care.2017; 5(1): e000401.     CrossRef
  • 10,056 View
  • 40 Download
  • 14 Web of Science
  • 13 Crossref
Original Articles
Background

Serum gamma-glutamyltransferase (GGT) has been suggested as a predictor for development of the metabolic syndrome in non-Korean population, but studies in Korean population are scarce. Therefore, we examined the association between serum GGT levels and the incidence of the metabolic syndrome in Korean male office workers.

Methods

The study population consisted of 32,692 office workers who underwent health checkups in both 2005 and 2009. A total of 17,583 with elevated GGT levels, the presence of metabolic syndrome, medication history at baseline, and female office workers were excluded. Finally, 15,109 subjects were included in the final analysis. We measured serum GGT levels and individual metabolic components.

Results

As a quartile of serum GGT increased, 4-year follow-up incidence of the metabolic syndrome increased. After adjustment for age, alcohol drinking status and smoking status in 2005, logistic regression analysis showed that the odds ratios (95% confidence interval) for incident metabolic syndrome in 2009 compared to the lowest quartile and upper quartiles were 1.00 (reference), 1.57 (1.24-2.00), 2.73 (2.17-3.43), 3.78 (3.02-4.74), and statistically significant (P < 0.001), respectively.

Conclusion

These results showed that the higher serum GGT predicted the future development of metabolic syndrome. In Korean male office workers without the metabolic syndrome, the serum GGT levels despite normal levels were associated with an increased risk of incident metabolic syndrome.

Citations

Citations to this article as recorded by  
  • Serum gamma-glutamyl transferase level is associated with the risk of pancreatic cystic neoplasms: A nationwide retrospective cohort study
    Min Woo Lee, Jin Myung Park, In Rae Cho, Kwang Hyun Chung, Bong Seong Kim, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Kyungdo Han, Sang Hyub Lee
    World Journal of Gastroenterology.2025;[Epub]     CrossRef
  • Higher gamma-glutamyl transferase levels are associated with an increased risk of incident systemic sclerosis: a nationwide population-based study
    Oh Chan Kwon, Kyungdo Han, Min-Chan Park
    Scientific Reports.2023;[Epub]     CrossRef
  • Can Gamma-glutamyl Transferase Predict Unhealthy Metabolic Phenotypes Among Healthcare Workers in Azar Cohort Study?
    Mohammadhossein Somi, Seyed Sina Zakavi, Alireza Ostadrahimi, Negin Frounchi, Neda Gilani, Sarvin Sanaie, Elnaz Faramarzi
    Hepatitis Monthly.2022;[Epub]     CrossRef
  • Association between γ-Glutamyltransferase and Head and Neck Cancer in Korean Population: A National Population-Based Study
    Dong-Hyun Lee, Choung-Soo Kim, Jun-Ook Park, Inn-Chul Nam, Sung Joon Park, Hyun-Bum Kim, Kyungdo Han, Young-Hoon Joo
    Cancer Epidemiology, Biomarkers & Prevention.2022; 31(10): 1975.     CrossRef
  • Prospective Evaluation of Cardiovascular, Cardiorespiratory, and Metabolic Risk of German Office Workers in Comparison to International Data
    Markus Strauss, Peter Foshag, Roman Leischik
    International Journal of Environmental Research and Public Health.2020; 17(5): 1590.     CrossRef
  • Combined Effect of Initial and Longitudinal Increases in γ-Glutamyltransferase on Incident Metabolic Syndrome: ARIRANG Study
    Dhananjay Yadav, Mi Young Lee, Jang Young Kim, Hoon Ryu, Ji Hye Huh, Keum Seok Bae, Song Vogue Ahn, Choon Hee Chung, Jong Taek Park, Sang Baek Koh
    Yonsei Medical Journal.2017; 58(4): 763.     CrossRef
  • Nonalcoholic fatty liver disease is associated with an almost twofold increased risk of incident type 2 diabetes and metabolic syndrome. Evidence from a systematic review and meta‐analysis
    Stefano Ballestri, Stefano Zona, Giovanni Targher, Dante Romagnoli, Enrica Baldelli, Fabio Nascimbeni, Alberto Roverato, Giovanni Guaraldi, Amedeo Lonardo
    Journal of Gastroenterology and Hepatology.2016; 31(5): 936.     CrossRef
  • Occupation and metabolic syndrome: is there correlation? A cross sectional study in different work activity occupations of German firefighters and office workers
    Markus Strauß, Peter Foshag, Bianca Przybylek, Marc Horlitz, Alejandro Lucia, Fabian Sanchis-Gomar, Roman Leischik
    Diabetology & Metabolic Syndrome.2016;[Epub]     CrossRef
  • Cut-Off Values of Blood Mercury Concentration in Relation to Increased Body Mass Index and Waist Circumference in Koreans
    Suhyun Bae, Soo-Jung Park, Kyung-Jin Yeum, Beomhee Choi, Young-Sang Kim, Nam-Seok Joo
    Journal of Investigative Medicine.2016; 64(4): 867.     CrossRef
  • Gamma-Glutamyltransferase: A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk
    Gerald Koenig, Stephanie Seneff
    Disease Markers.2015; 2015: 1.     CrossRef
  • Serum Gamma-glutamyl Transferase Concentration Within the Reference Range is Related to the Coronary Heart Disease Risk Prediction in Korean Men
    Kyung-Sun Han, Doo-Yeoun Cho, Young-Sang Kim, Kyu-Nam Kim
    Chinese Medical Journal.2015; 128(15): 2006.     CrossRef
  • Gamma‐glutamyltransferase, insulin resistance and cardiometabolic risk profile in a middle‐aged African population
    Tandi Edith Matsha, Muiruri Macharia, Yandiswa Yolanda Yako, Rajiv Timothy Erasmus, Mogamat Shafick Hassan, Andre Pascal Kengne
    European Journal of Preventive Cardiology.2014; 21(12): 1541.     CrossRef
  • Association between γ-Glutamyl Transferase and Metabolic Syndrome: A Cross-Sectional Study of an Adult Population in Beijing
    Lixin Tao, Xia Li, Huiping Zhu, Yue Gao, Yanxia Luo, Wei Wang, Zhaoping Wang, Dongning Chen, Lijuan Wu, Xiuhua Guo
    International Journal of Environmental Research and Public Health.2013; 10(11): 5523.     CrossRef
  • 6,433 View
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  • 13 Crossref
Relations of Serum gamma-glutamyltransferase Levels to Incidence of the Metabolic Syndrome.
Shin Woong Oh, Jeong Gyu Lee, Min Seok Kim, Dong Wook Jung, Young Joo Kim, Sangyeoup Lee, Yun Jin Kim
J Korean Acad Fam Med 2008;29(11):838-843.   Published online November 10, 2008
Background: The metabolic syndrome is a cluster of risk factors for cardiovascular diseases. Recently, serum gamma-glutamyltransferase (GGT) has been suggested as a predictor for development of the metabolic syndrome. Therefore, we investigated the association between serum GGT levels and the incidence of the metabolic syndrome in the Korean healthy adults with normal serum GGT with a 3 year follow-up. Methods: The study subjects consisted of 741 individuals who visited the Center for Health Promotion in Pusan National University Hospital for a medical checkup in 2002 to 2005. Among 741 subjects, 312 were excluded: 71 were positive for HBsAg, 17 were positive for Anti-HCV Ab, 40 showed GGT higher levels than limit of reference range, and 224 had metabolic syndrome. The final subjects were 429 individuals. We measured serum GGT levels, lipid profiles, fasting glucose, blood pressure and their metabolic components. Results: As the quartile of serum GGT increased, 3 year follow-up incidence of the metabolic syndrome was increased. Logistic regression analysis adjusting for sex, age, and alcohol drinking status showed that the odds ratio (95% confidence Interval, P-value) of each GGT quartile was 2.28 (0.58∼9.01, P=0.240), 1.53 (0.36∼6.66, P=0.564), 4.56 (1.08∼19.32, P=0.040), respectively. Conclusion: These results showed that the serum GGT was closely related to the metabolic syndrome. In Korean adults without the metabolic syndrome, the serum GGT levels within normal limit were associated with an increased risk of incident, metabolic syndrome. (J Korean Acad Fam Med 2008;29:838-843)
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