Individual lifestyle risk factors have been associated with an increased risk of mortality. However, limited evidence is available on the combined association of lifestyle risk factors with mortality in non-Western populations. The analysis included 37,472 participants (aged ≥19 years) in the Korea National Health and Nutrition Examination Surveys (2007-2014) for whom the data were linked to death certificates/medical records through December 2016. A lifestyle risk score was created using five unhealthy behaviors: current smoking, high-risk alcohol drinking, unhealthy weight, physical inactivity, and insufficient/prolonged sleep. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (CI). During up to 9 years of follow-up, we documented 1,057 total deaths. Compared to individuals with zero lifestyle risk factor, those with 4-5 lifestyle risk factors had 2.01 times (HR = 2.01, 95% CI = 1.43-2.82) and 2.59 times (HR = 2.59, 95% CI = 1.24-5.40) higher risk of all-cause and cardiovascular mortality, respectively. However, higher lifestyle risk score was not significantly associated with cancer mortality (p-trend >0.05). In stratified analyses, the positive associations tended to be stronger in adults aged <65 years, unemployed, and those with lower levels of education. In conclusion, combined unhealthy lifestyle behaviors were associated with substantially increased risk of total and cardiovascular mortality in Korean adults. Individual lifestyle risk factors such as obesity, physical inactivity, smoking, heavy alcohol use and poor diet have been associated with increased risk of various chronic diseases and premature death 1-4. More recently, insufficient or prolonged sleep has been identified as a predictor of adverse health outcomes 5,6. Generally, lifestyle behaviors have complex relationships and they tend to cluster in specific combinations within populations 7,8. Moreover, having multiple lifestyle risk factors can have synergistic effects on diseases. Thus, it is important to evaluate the combined effects of lifestyle factors on health outcomes to quantify disease burden and provide valuable public health messages for disease prevention. A number of epidemiological studies have examined the combined association of major lifestyle factors including obesity, smoking, alcohol, and physical activity in relation to mortality. A systematic review and meta-analysis of 15 cohort studies showed that adherence to at least four healthy lifestyle behaviors was associated with a 66% reduced risk of all-cause mortality, although high heterogeneity (I 2 = 94%) was observed between study populations 9. Subsequent studies consistently suggested the importance of healthy lifestyle behaviors for the prevention of diseases 10-18. However, majority of the studies were conducted in Western populations (e.g., US and Europe). Limited data are available for non-Caucasians, especially Asians 16,19-21 including Koreans 10,12,18 whose lifestyle patterns are different from Western populations...

Background Increasing evidence suggests that sleep duration is associated with risks of various diseases including type 2 diabetes, cardiovascular disease (CVD), and certain types of cancer. However, the relationship with mortality is not clear, particularly in non-European populations. In this study, we investigated the association between sleep duration and mortality in a population-based prospective cohort of Korean adults. Methods This analysis included 34,264 participants (14,704 men and 19,560 women) of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2013 who agreed to mortality follow-up through December 31, 2016. Sleep duration was self-reported at baseline and was categorized into four groups: ≤4, 5–6, 7–8, and ≥ 9 h/day. Cox proportional hazards models were performed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations with mortality (all-cause as well as CVD- and cancer-specific), adjusting for potential confounders. Results During up to 9.5 years of follow-up, we identified a total of 1028 deaths. We observed the lowest mortality at 5–6 h/day sleep. Compared with 7–8 h/day of sleep, short (≤4 h/day) and long (≥9 h/day) sleep were associated with a 1.05-fold (95% CI = 0.79–1.39) and 1.47-fold (95% CI = 1.15–1.87) higher all-cause mortality, respectively. After additional adjustment for self-rated health, the positive association with short sleep disappeared (HR = 0.99, 95% CI = 0.75–1.32) and the association with long sleep was slightly attenuated (HR = 1.38, 95% CI = 1.08–1.76). Long sleep was also nonsignificantly positively associated with both cancer-mortality (HR = 1.30, 95% CI = 0.86–1.98) and CVD-mortality (HR = 1.27, 95% CI = 0.73–2.21). There was no statistically significant evidence for nonlinearity in the relationships between sleep duration and mortality (all-cause as well as CVD- and cancer-specific). Effect modification by age, sex, education, and occupation were not statistically significant. Conclusions Our findings suggest that long sleep duration is associated with an increased all-cause mortality in Korean adults.

IMPORTANCEDespite high use of smartphones among adolescents, little is known about the association of smartphone use with body image and related behaviors. OBJECTIVE To examine the associations of duration of smartphone use and types of content most frequently accessed via smartphone with body image distortion and weight loss behaviors in adolescents. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the populationbased Korea Youth Risk Behavior Web-Based Survey 2017. Participants comprised a nationally representative sample of 53 133 Korean adolescents aged 12 to 18 years. Data were collected from

Background Studies have shown that aerobic and muscle-strengthening physical activities reduce mortality risk. However, little is known about the joint associations of the two activity types and whether other type of physical activity, such as flexibility activity, can provide similar mortality risk reduction. Objectives We examined the independent associations of aerobic, muscle-strengthening, and flexibility physical activities with all-cause and cause-specific mortality in a population-based prospective cohort of Korean men and women. We also examined the joint associations of aerobic and muscle-strengthening activities, the two physical activity types that are recommended by the current World Health Organization physical activity guidelines. Design This analysis included 34,379 Korea National Health and Nutrition Examination Survey 2007–2013 participants (aged 20–79 years) with mortality data linkage through December 31, 2019. Engagement in walking, aerobic, muscle-strengthening, and flexibility physical activities was self-reported at baseline. Cox proportional hazards model was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Results Flexibility physical activity (≥ 5 vs. 0 d/wk) was inversely associated with all-cause (HR [95% CI] = 0.80 [0.70–0.92]; P-trend < 0.001) and cardiovascular mortality (0.75 [0.55–1.03], P-trend = 0.02). Moderate- to vigorous-intensity aerobic physical activity (≥ 50.0 vs. 0 MET-h/wk) was also associated with lower all-cause (HR [95% CI] = 0.82 [0.70–0.95]; P-trend < 0.001) and cardiovascular mortality (0.55 [0.37–0.80]; P-trend < 0.001). Similar inverse associations were observed with total aerobic physical activity, including walking. Muscle-strengthening activity (≥ 5 vs. 0 d/wk) was inversely associated with all-cause mortality (HR [95% CI] = 0.83 [0.68–1.02]; P-trend = 0.01) but was not associated with cancer or cardiovascular mortality. Compared to participants meeting the highest guidelines for both moderate- to vigorous-intensity aerobic and muscle-strengthening physical activities, those not meeting in any guideline were associated with higher all-cause (1.34 [1.09–1.64]) and cardiovascular mortality (1.68 [1.00-2.82]). Conclusions Our data suggest that aerobic, muscle-strengthening, and flexibility activities are associated with lower risk of mortality.