Background: Despite differences in body shape and adiposity characteristics according to sex and age, a single range of healthy weight [body mass index (BMI, kg/m2) of 18.5–24.9) regardless of sex and age has been recommended. The aim of the study is to examine whether the association between BMI and all-cause mortality varies by sex and age, and, if relevant, to estimate sex-age-specific optimal BMIs associated with a minimal risk of death.Methods: A total of 12 832 637 Korean adults aged 18–99 years who participated in health examinations during 2001–04 were followed up until 2013. Hazard ratios of death in sex-age groups were calculated using Cox regression models after adjustment for age, smoking status and known pre-existing illness.Results: During follow-up, 456 175 men and 241 208 women died. Among men, the age-specific optimal BMI was 23.0–25.9 (kg/m2) at 18–34 years, 24.0–27.9 at 45–54 year, and 25.0–28.9 at 65–74 years. Among women, it was 15.5–24.9 at 18–34 years, 21.0–26.9 at 45–54 years and 24.0–28.9 at 65–74 years. Patterns of sex-age-specific association generally did not differ between never-smokers with no known illness and all participants. Progressively increased risks above and below sex-age-specific optimums were observed (reverse J-curve). Smoking had a limited impact on the observed associations.Conclusions: Women had a lower optimal BMI than men, especially at younger ages. The optimal BMI increased with age. Change in optimal BMI with age, however, was more profound in women than in men. Sex-age-specific optimums were generally higher than the current normal weight (BMI of 18.5–24.9), except in women below 50 years. Sex-age-specific guidelines related to body weight may be needed to guide people for better health.

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up, 694,423 individuals died. U-curve associations were found. In the TC ranges of 50–199 and 200–449 mg/dL, each 39 mg/dL (1 mmol/L) increase in TC was associated with 23% lower (95% CI:23%,24%) and 7% higher (6%,7%) mortality, respectively. In the age groups of 18–34, 35–44, 45–54, 55–64, 65–74, and 75–99 years, each 1 mmol/L higher TC increased mortality by 14%, 13%, 8%, 7%, 6%, and 3%, respectively (P < 0.001 for each age group), for TC ≥ 200 mg/dL, while the corresponding TC changes decreased mortality by 13%, 27%, 34%, 31%, 20%, and 13%, respectively, in the range < 200 mg/dL (P < 0.001 for each age group). TC had U-curve associations with mortality in each age-sex group. TC levels associated with lowest mortality were 210–249 mg/dL, except for men aged 18–34 years (180–219 mg/dL) and women aged 18–34 years (160–199 mg/dL) and 35–44 years (180–219 mg/dL). The inverse associations for TC < 200 mg/dL were stronger than the positive associations in the upper range.

With advancing age, the effects of alcohol use and HCV on the development of HCC become stronger, whereas the effect of male sex weakens. Lifetime moderate alcohol consumption may cause HCC in the elderly. Smoking increases the risk of HCC irrespective of viral hepatitis, and diabetes increases the risk of HCC independent of cirrhosis. Cancer 2018;124:2748-2757. © 2018 American Cancer Society.

ObjectivesThe aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans.MethodsA postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model.ResultsThe prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis.ConclusionsKorean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

U-curve relationships existed regardless of diabetes status. Optimal BMI for lowest mortality became gradually higher with worsening diabetes for each sex and each age-group.

The association of fasting glucose with the risk of death according to sex and age remains unclear, and insufficient information is available on sex- and age-specific glucose concentrations within ethnic groups. This study analyzed a sample of 12,455,361 Korean adults who participated in health examinations during 2001–2004, and were followed up until 2013. Men had 3.0 mg/dL (0.167 mmol/L) higher mean glucose concentrations than women (94.7 vs. 91.7 mg/dL), although women over 73 years had higher levels. For glucose levels of 100–199 mg/dL, each 18 mg/dL (1 mmol/L) increase in fasting glucose increased mortality by 13% (HR = 1.13, [95% CI 1.12 to 1.13], p < 0.001). In individuals with fasting glucose levels of 100–125 mg/dL, each 18 mg/dL increase in fasting glucose was associated with a 30% increase in the risk for mortality (1.30, [1.18 to 1.43]) in those aged 18–34 years, a 32% increase (1.32, [1.26 to 1.39]) in those aged 35–44 years, and a 10% increase (1.10, [1.02 to 1.19]) in those aged 75–99 years. The fasting glucose levels associated with the lowest mortality were 80–94 mg/dL regardless of sex and age. Prediabetes (100–125 mg/dL) was associated with higher mortality. The associations of hyperglycemia with mortality were stronger at younger ages.

No abstract

Blood pressure (BP) has been reported to be directly related to mortality from vascular disease down to at least 115/75 mm Hg with no clear threshold level.1 Evidence from previous research suggests that low BP is a predictor of mortality in various clinical settings, and J-or U-curve associations between BP and vascular mortality have been reported among the elderly and those with vascular or other diseases.2-9 Low BP, even a single incidence of isolated hypotensive BP in certain situations, can predict mortality, 10 but despite the evidence, physicians often ignore low BP. 10,11 There is no doubt, however, that a J-curve association between BP and mortality exists, even in the general population with no known comorbid diseases, because adequate perfusion to vital organs is difficult to sustain below a certain BP. In nonclinical populations, a few studies have found that low BP was associated with a higher mortality from vascular disease.12-14 However, it is unclear whether and in what range of BP a J-curve occurs. We conducted a large prospective cohort study with >1 million participants to demonstrate whether a J-curve association exists between systolic BP (SBP) and mortality from vascular disease in a nonclinical population. We focused on SBP, because SBP has been shown to be a better predictor of mortality from vascular disease than diastolic BP (DBP) or pulse pressure in prospective studies among the general population. 1,15,16 Clinical Perspective on p 2390 Methods Study ParticipantsThe Korean Cancer Prevention Study comprises 1 329 525 individuals (482 618 women) aged 30 to 95 years who underwent at least 1 routine medical examination by the Korean Medical Insurance CorporationBackground-The association between low systolic blood pressure (SBP) and vascular disease is unclear, especially in nonclinical populations. Methods and Results-We studied 1 235 246 individuals who participated in routine medical examinations between 1992 and 1995. The hazard ratios (HRs) were adjusted for potential confounders. During 22.7 million person-years of follow-up, 34 816 individuals died of atherosclerotic vascular diseases. An increase in SBP was directly related to an increase in vascular mortality at SBP above ≈100 mmHg. The group with the lowest SBP (<90 mm Hg) had a higher HR for mortality from atherosclerotic vascular disease (HR, 1.53; 95% confidence interval, 1.15-2.03) in comparison with those with an SBP of 90 to 99 mm Hg. The HR associated with the lowest SBP was 2.54 (95% confidence interval, 1.51-4.29) for ischemic heart disease and 1.21 (95% confidence interval, 0.79-1.85) for stroke. Regarding stroke subtype, mortality from hemorrhagic stroke (HR per 10 mm Hg increase, 0.53; 95% confidence interval, 0.29-0.96), rather than mortality from ischemic stroke (HR per 10 mm Hg increase, 1.00; 95% confidence interval, 0.51-1.97), was inversely associated with SBP when SBP fell to <100 mm Hg. Even when excluding the first 5 years of follow-up, the HRs associated with the lowest SBP did not decrease. The invers...