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The “Fast track” protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD.
We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled “Fast track” protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays.
The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0–169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031).
Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.
Blood carotenoid concentration measurement is considered the gold standard for fruit and vegetable (F&V) intake estimation; however, this method is invasive and expensive. Recently, skin carotenoid status (SCS) measured by optical sensors has been evaluated as a promising parameter for F&V intake estimation. In this cross-sectional study, we aimed to validate the utility of resonance Raman spectroscopy (RRS)-assessed SCS as a biomarker of F&V intake in Korean adults. We used data from 108 participants aged 20–69 years who completed SCS measurements, blood collection and 3-d dietary recordings. Serum carotenoid concentrations were quantified using HPLC, and dietary carotenoid and F&V intakes were estimated via 3-d dietary records using a carotenoid database for common Korean foods. The correlations of the SCS with serum carotenoid concentrations, dietary carotenoid intake and F&V intake were examined to assess SCS validity. SCS was positively correlated with total serum carotenoid concentration (r = 0·52, 95 % CI = 0·36, 0·64, P < 0·001), serum β-carotene concentration (r = 0·60, 95 % CI = 0·47, 0·71, P < 0·001), total carotenoid intake (r = 0·20, 95 % CI = 0·01, 0·37, P = 0·04), β-carotene intake (r = 0·30, 95 % CI = 0·11, 0·46, P = 0·002) and F&V intake (r = 0·40, 95 % CI = 0·23, 0·55, P < 0·001). These results suggest that SCS can be a valid biomarker of F&V intake in Korean adults.
Birds in flight are prone to collide with various transparent or reflective structures. While bird–window collision has been recognised as a critical conservation issue, collision with other transparent structures has been less understood. Noise barriers made of transparent materials are considered critical hazards for birds; however, little is known about the bird mortality they cause. We conducted the first nationwide-scale estimates of bird-collision mortality caused by transparent noise barriers (TNBs) along roads in the Republic of Korea. The total length of existing roadside transparent noise barriers was estimated at 1,416 km nationwide (as of 2018), and it had been increasing exponentially. Based on carcass surveys at 25 sites, daily mortality at the observed barriers was 0.335 ± 1.132 birds/km on average, and no difference in observed mortality was detected between both sides of a single barrier and between road types (i.e. local roads and motorways). Finally, we estimated that approximately 186,000 birds (95% confidence interval: 162,465–204,812 birds) are killed annually by collisions with roadside TNBs. As privately installed barriers were not considered in this study, the actual mortality is likely be higher than our estimates. Thus, collision with TNBs could become an emerging threat to avian conservation, especially in developing and urbanising regions around the world. As such structures are not formally recognised as conservation issues of importance, more systematic surveys aided by citizen science, both for the status of TNBs and bird-collision mortality, are needed in addition to management and mitigation policies.
This study investigated the effect of the flavonoid-based compound isorhamnetin (ISO) on maturation and developmental competence in oxidative stress-exposed porcine oocytes in vitro. Treatment with 2 μM ISO (2 ISO) increases the developmental rate of oxidative stress-exposed porcine oocytes during in vitro maturation (IVM). The glutathione level and mRNA expression of antioxidant-related genes (NFE2L2 and SOD2) were increased in the 2 ISO-treated group, whereas the reactive oxygen species level was decreased. Treatment with 2 ISO increased mRNA expression of a cumulus cell expansion-related gene (SHAS2) and improved chromosomal alignment. mRNA expression of maternal genes (CCNB1, MOS, BMP15 and GDF9) and mitogen activated protein kinase (MAPK) activity were increased in the 2 ISO-treated group. The total cell number per blastocyst and percentage of apoptotic cells were increased and decreased in the 2 ISO-treated group, respectively. Treatment with 2 ISO increased mRNA expression of development-related genes (SOX2, NANOG, and POU5F1) and anti-apoptotic genes (BCL2L1 and BIRC5) and decreased that of pro-apoptotic genes (CASP3 and FAS). These results demonstrate that 2 ISO improves the quality of porcine oocytes by protecting them against oxidative stress during IVM and enhances subsequent embryo development in vitro. Therefore, we propose that ISO is a useful supplement for IVM of porcine oocytes.
The COVID-19 pandemic poses a major threat to mental health and is associated with an increased risk of suicide. An understanding of suicidal behaviours during the pandemic is necessary for establishing policies to prevent suicides in such social conditions.
We aimed to investigate vulnerable individuals and the characteristics of changes in suicidal behaviour during the COVID-19 pandemic.
We retrospectively reviewed the medical records of patients with suicide attempts who visited the emergency department from February 2019 to January 2021. We analysed the demographic and clinical characteristics, risk factors and rescue factors of patients, and compared the findings between the pre-pandemic and pandemic periods.
In total, 519 patients were included. During the pre-pandemic and pandemic periods, 303 and 270 patients visited the emergency department after a suicide attempt, respectively. The proportion of suicide attempts by women (60.1% v. 69.3%, P = 0.035) and patients with a previous psychiatric illness (63.4% v. 72.9%, P = 0.006) increased during the COVID-19 pandemic. In addition, patients’ rescue scores during the pandemic were lower than those during the pre-pandemic period (12 (interquartile range: 11–13) v. 13 (interquartile range: 12–14), P < 0.001).
Women and people with previous psychiatric illnesses were more vulnerable to suicide attempts during the COVID-19 pandemic. Suicide prevention policies, such as continuous monitoring and staying in touch with vulnerable individuals, are necessary to cope with suicide risk.
In this review, we introduce our recent applications of deep learning to solar and space weather data. We have successfully applied novel deep learning methods to the following applications: (1) generation of solar farside/backside magnetograms and global field extrapolation based on them, (2) generation of solar UV/EUV images from other UV/EUV images and magnetograms, (3) denoising solar magnetograms using supervised learning, (4) generation of UV/EUV images and magnetograms from Galileo sunspot drawings, (5) improvement of global IRI TEC maps using IGS TEC ones, (6) one-day forecasting of global TEC maps through image translation, (7) generation of high-resolution magnetograms from Ca II K images, (8) super-resolution of solar magnetograms, (9) flare classification by CNN and visual explanation by attribution methods, and (10) forecasting GOES solar X-ray profiles. We present major results and discuss them. We also present future plans for integrated space weather models based on deep learning.
Background: SARS-CoV-2 infection of healthcare workers (HCWs) occasionally occurs via acquisition from their colleagues. Data regarding the infection rates of HCWs with close contact and non–close contacts of HCWs are limited. In addition, the protective effect of COVID-19 vaccination against transmission between HCWs is unknown. We evaluated the infection rates of HCWs with close contact and non–close contact of infected HCWs and the effect of COVID-19 vaccination on transmission among HCWs in a tertiary-care hospital in South Korea. Methods: This study was performed in a tertiary-care hospital in Korea. We analyzed the COVID-19 cases and contacts among HCWs from January to December 2021. We reviewed the vaccination status of confirmed and exposed HCWs, the type of vaccination, and the infection rate according to the contact. We performed subgroup analyses in individuals who had been diagnosed since July 2021 when the δ (delta) variant became the dominant strain in South Korea. Transmission was defined based on their spatiotemporal epidemiologic association. Results: During the study period, 173 HCWs had COVID-19, and 2,693 HCWs were exposed to them. Among them, 18 (1.52%) of 1,186 close contacts and 13 (0.86%) of 1,507 non–close contacts had a positive SARS-CoV-2 test (P = .11). When the index cases had been fully vaccinated, the infection rate of close contacts was 0.85% (7 of 820), whereas the infection rate of close contacts was 3.01% (11 of 366) when the index had not been fully vaccinated (P = .005). However, the infection rate of non–close contacts was not different according to the vaccination status of index (0.83% vs 0.89%; P = .90). During the period of δ (delta) variant being dominant, the infection rate of close contacts was significantly lower when the index case had been fully vaccinated index than in cases with a non–fully vaccinated index case (0.85% vs 5.88%; P < .001). Conclusions: Transmission to colleagues was significantly lower from vaccinated HCWs than from nonvaccinated HCWs, and this finding was more significant in the era of the δ (delta) variant. Our findings support the importance of vaccination in HCWs.
Our previous studies have already revealed that β-cryptoxanthin (BCX), hesperetin (HES), and icariin (ICA) antioxidants are effective for in vitro maturation (IVM) of porcine oocytes. In this study, we investigated which of BCX, HES, or ICA was more effective for IVM of porcine oocytes. The antioxidant properties were assessed with aged porcine oocytes and embryos by comparing 2,2-diphenyl-1-(2,4,6-trinitrophenyl)hydrazyl (DPPH), reducing power, and H2O2 scavenging activity assays. The chemical assay results demonstrated that BCX had a greater DPPH scavenging activity and reducing power than HES and ICA, compared with controls. However, the H2O2 scavenging activity of the antioxidants was similar when tested at the optimal concentrations of 1 μM BCX (BCX-1), 100 μM HES (HES-100), and 5 μM ICA (ICA-5). The biological assay results showed that BCX-1 treatment was more effective in inducing a significant reduction in reactive oxygen species (ROS), improving glutathione levels, and increasing the expression of antioxidant genes. In addition, BCX-1 inhibited apoptosis by increasing the expression of anti-apoptotic genes and decreasing pro-apoptotic genes in porcine parthenogenetic blastocysts. BCX-1 also significantly increased the blastocyst formation rate compared with the ageing control group, HES-100 and ICA-5. This study demonstrates that damage from ROS produced during oocyte ageing can be prevented by supplementing antioxidants into the IVM medium, and BCX may be a potential candidate to improve assisted reproductive technologies.
Firefighters are frequently exposed to stressful situations and are at high risk of developing post-traumatic stress disorder (PTSD). Hyperresponsiveness to threatening and emotional stimuli and diminishment of executive control have been suggested as manifestations of PTSD.
To examine brain activation in firefighters with PTSD by conducting an executive control-related behavioural task with trauma-related interferences.
Twelve firefighters with PTSD and 14 healthy firefighters underwent functional magnetic resonance imaging (fMRI) while performing a Stroop match-to-sample task using trauma-related photographic stimuli. Seed-based functional connectivity analysis was conducted using regions identified in fMRI contrast analysis.
Compared with the controls, the participants with PTSD had longer reaction times when the trauma-related interferences were presented. They showed significantly stronger brain activation to interfering trauma-related stimuli in the left insula, and had weaker insular functional connectivity in the supplementary motor area and the anterior cingulate cortex than the controls. They also showed a significant correlation between left insula–supplementary motor area connectivity strength and the hyperarousal subscale of the Clinician-Administered PTSD Scale.
Our findings indicate that trauma-related stimuli elicit excessive brain activation in the left insula among firefighters with PTSD. Firefighters with PTSD also appear to have weak left insular functional connectivity with executive control-related brain regions. This aberrant insular activation and functional connectivity could be related to the development and maintenance of PTSD symptoms in firefighters.
This study aimed to determine the effect of donor-transmitted atherosclerosis on the late aggravation of cardiac allograft vasculopathy in paediatric heart recipients aged ≥7 years.
In total, 48 patients were included and 23 had donor-transmitted atherosclerosis (baseline maximal intimal thickness of >0.5 mm on intravascular ultrasonography). Logistic regression analyses were performed to identify risk factors for donor-transmitted atherosclerosis. Rates of survival free from the late aggravation of cardiac allograft vasculopathy (new or worsening cardiac allograft vasculopathy on following angiograms, starting 1 year after transplantation) in each patient group were estimated using the Kaplan–Meier method and compared using the log-rank test. The effect of the results of intravascular ultrasonography at 1 year after transplantation on the late aggravation of cardiac allograft vasculopathy, correcting for possible covariates including donor-transmitted atherosclerosis, was examined using the Cox proportional hazards model.
The mean follow-up duration after transplantation was 5.97 ± 3.58 years. The log-rank test showed that patients with donor-transmitted atherosclerosis had worse survival outcomes than those without (p = 0.008). Per the multivariate model considering the difference of maximal intimal thickness between baseline and 1 year following transplantation (hazard ratio, 22.985; 95% confidence interval, 1.948–271.250; p = 0.013), donor-transmitted atherosclerosis was a significant covariate (hazard ratio, 4.013; 95% confidence interval, 1.047–15.376; p = 0.043).
Paediatric heart transplantation recipients with donor-transmitted atherosclerosis aged ≥7 years had worse late cardiac allograft vasculopathy aggravation-free survival outcomes.
Two aphid-transmitted RNA viruses, broad bean wilt virus 2 (BBWV2) and cucumber mosaic virus (CMV), are the most prevalent viruses in Korean pepper fields and cause chronic damage in pepper production. In this study, we employed a screening system for pathotype-specific resistance of pepper germplasm to BBWV2 and CMV by utilizing infectious cDNA clones of different pathotypes of the viruses (two BBWV2 strains and three CMV strains). We first examined pathogenic characteristics of the BBWV2 and CMV strains in various plant species and their phylogenetic positions in the virus population structures. We then screened 34 commercial pepper cultivars and seven accessions for resistance. While 21 pepper cultivars were resistant to CMV Fny strain, only two cultivars were resistant to CMV P1 strain. We also found only one cultivar partially resistant to BBWV2 RP1 strain. However, all tested commercial pepper cultivars were susceptible to the resistance-breaking CMV strain GTN (CMV-GTN) and BBWV2 severe strain PAP1 (BBWV2-PAP1), suggesting that breeding new cultivars resistant to these virus strains is necessary. Fortunately, we identified several pepper accessions that were resistant or partially resistant to CMV-GTN and one symptomless accession despite systemic infection with BBWV2-PAP1. These genetic resources will be useful in pepper breeding programs to deploy resistance to BBWV2 and CMV.
We quantitatively assessed the fit failure rate of N95 respirators according to the number of donning/doffing and hours worn.
A tertiary-care referral center in South Korea.
In total, 10 infection control practitioners participated in the fit test.
The first experiment comprised 4 consecutive 1-hour donnings and fit tests between each donning. The second experiment comprised 2 consecutive 3-hour donnings and fit tests between each donning. The final experiment comprised fit tests after an 1-hour donning or a 2-hour donning.
For 1-hour donnings, 60%, 70%, and 90% of the participants had fit failures after 2, 3, and 4 consecutive donnings, respectively. For 3-hour donnings, 50% had fit failure after the first donning and 70% had failures after 2 consecutive donnings. All participants passed the fit test after refitting whenever fit failure occurred. The final experiment showed that 50% had fit failure after a single use of 1 hour, and 30% had fit failure after a single use of 2 hours.
High fit-failure rates were recorded after repeated donning and extended use of N95 respirators. Caution is needed for reuse (≥1 time) and extended use (≥1 hour) of N95 respirators in high-risk settings such as those involving aerosol-generating procedures. Although adequate refitting may recover the fit factor, the use of clean gloves and strict hand hygiene afterward should be ensured when touching the outer surfaces of N95 respirators for refitting.
Background: After the Middle East respiratory syndrome coronavirus outbreak in Korea in 2015, the government newly established the additional reimbursement for infection prevention to encourage infection control activities in the hospitals. The new policy was announced in December 2015 and was implemented in September 2016. We evaluated how infection control activities improved in hospitals after the change of government policy in Korea. Methods: Three cross-sectional surveys using the WHO Hand Hygiene Self-Assessment Framework (HHSAF) were conducted in 2013, 2015, and 2017. Using multivariable linear regression model including hospital characteristics, we analyzed the changes in total HHSAF scores according to the survey time. Results: In total, 32 hospitals participated in the survey in 2013, 52 in 2015, and 101 in 2017. The number of inpatient beds per infection control professionals decreased from 324 in 2013 to 303 in 2015 and 179 in 2017. Most hospitals were at intermediate or advanced levels of progress (90.6% in 2013, 86.6% in 2015, and 94.1% in 2017). In a multivariable linear regression model, the total HHSAF scores were significantly associated with hospital teaching status (β coefficient of major teaching hospital, 52.6; 95% CI, 8.9–96.4; P = .018), bed size (β coefficient of 100-bed increase, 5.1; 95% CI, 0.3–9.8; P = .038), and survey time (β coefficient of 2017 survey, 45.1; 95% CI, 19.3–70.9; P = .001). Conclusions: After the national policy implementation, the number of infection control professionals increased, and the promotion of hand hygiene activities was strengthened in Korean hospitals.
Background: Recently, healthcare-associated infections (HAIs) in long-term care hospitals (LTCHs) have markedly increased, but no infection control policy has been established in South Korea. We investigated the current HAI surveillance system and executed a point-prevalence pilot study in LTCHs. Methods: HAIs were defined by newly established surveillance manual based on McGeer criteria revised in 2012. Three LTCHs in Seoul and Gyeonggi province were voluntarily recruited, and data were collected from up to 50 patients who were hospitalized on August 1. The medical records from September to November 2018 were retrospectively reviewed by a charge nurse for infection control per each hospitals after 1 day of training specific for LTCH surveillance. All data were reviewed by a senior researcher visiting onsite. Results: The participating hospitals had 272.33 ± 111.01 beds. Only 1 hospital had an onsite microbiological laboratory. In total, 156 patients were enrolled and 5 HAIs were detected, for a prevalence rate of 3.2%. The average patient age was 79.04 ± 9.92 years. The HAIs included 2 urinary tract infections, skin and soft-tissue infection, low respiratory infection, and conjunctivitis. Conclusions: This is the first survey of HAI in LTCHs in South Korea. The 3.2% prevalence rate is lower than those from previous reports from the European Union or the United States. This study supports the development of a national HAI surveillance and infection control system in LTCHs, although implementation may be limited due to the lack of laboratory support and infection control infrastructure in Korea.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
A 635-bed, tertiary-care hospital in Daegu, South Korea.
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
Mee-Soo was a good student in North Korea. She came to South Korea in her early teens, and South Korean state policy for North Korean defectors enabled her to gain entry into a decent university in Seoul. She majored in Business Management and, when she had to choose her sub-major, she chose Accounting over Marketing and Human Resources because she thought she could avoid English. Achieving CPA (Certified Public Accountant) status was the goal for Accounting majors. Passing a score of 700 in the Test of English for International Communication (TOEIC) was a requirement to take the CPA exam. Mee-Soo worked hard studying for TOEIC and took the test ten times. Her score rose from the 400s to the 600s, but she could not pass the 700 threshold and was left behind while other South Korean students passed the English requirement. She could not even begin to study for the CPA exam itself. She once sighed and told me (one of the authors), ‘I wish I could have a life without English.’ I responded, ‘I didn't think English would be so important to North Koreans in South Korea.’ To this, Mee-Soo exclaimed, ‘It is a matter of survival.’
Given there have now been over 70 years of separation between North and South Korea since the Korean War, it is unquestionable that North Korean migrants face and struggle with a variety of troubles in their attempts to settle into South Korean society. In this context, why does English constitute a ‘matter of survival’ for North Koreans when there are so many other critical issues for these individuals, who crossed several borders at the risk of their lives? This phenomena, that ‘English’ represents a major difficulty for North Korean defectors in their process of settling in South Korea (Jung & Lim, 2009), constitutes an interesting linguistic phenomena in an intra-ethnic contact. However, by itself, this statement somewhat simplifies how English actually affects the migrant group. Instead, its influence works in a surprisingly diverse number of ways across different ranges and layers within the North Korean population, depending on their regional and social background, age, time of migration, and possibly many other factors. A meaningful pattern we discuss here is the changing relations between English and North Korean migrants according to age; it is the North Korean young adults who seem to be particularly affected by English and disproportionately in need of English teaching. We also note, though, that this pattern itself is changing, as we are seeing the recent increase of children of North Korean migrants born and educated in South Korea or in China.
Korea is probably one of the few countries, if not the only one, that observes a holiday in honor of the national language's alphabet. Hangulnal, which falls on October 9, is the Korean Alphabet Day. Each year, the government hosts events to celebrate one of the most prized possessions of the country, Hangul – the writing system of the national language. Created by King Sejong and his Royal Academy Scholars in the 15th century, Hangul is recognized as one of ‘the world's most scientific writing systems ever created by man’ (Sohn, 2001: 13). To outsiders, such pride may appear somewhat overblown, but Koreans do take great pride in Hangul.
To propose a new anthropometric index that can be employed to better predict percent body fat (PBF) among young adults and to compare with current anthropometric indices.
All measurements were taken in a controlled laboratory setting in Seoul (South Korea), between 1 December 2015 and 30 June 2016.
Eighty-seven young adults (18–35 years) who underwent dual-energy x-ray absorptiometry (DXA) were used for analysis. Multiple regression analyses were conducted to develop a body fat index (BFI) using simple demographic and anthropometric information. Correlations of DXA measured PBF (DXA_PBF) with previously developed anthropometric indices and the BFI were analysed. Receiver operating characteristic curve analyses were conducted to compare the ability of anthropometric indices to identify obese individuals.
BFI showed a strong correlation with DXA_PBF (r = 0·84), which was higher than the correlations of DXA_PBF with the traditional (waist circumference, r = 0·49; waist to height ratio, r = 0·68; BMI, r = 0·36) and alternate anthropometric indices (a body shape index, r = 0·47; body roundness index, r = 0·68; body adiposity index, r = 0·70). Moreover, the BFI showed higher accuracy at identifying obese individuals (area under the curve (AUC) = 0·91), compared with the other anthropometric indices (AUC = 0·71–0·86).
The BFI can accurately predict DXA_PBF in young adults, using simple demographic and anthropometric information that are commonly available in research and clinical settings. However, larger representative studies are required to build on our findings.
Body weight is a major risk determinant of frailty, but the effect of obesity on frailty is controversial. The present study aimed to confirm the hypothesis that the risk of frailty is positively associated with obesity (BMI ≥ 30 kg/m2), but the association is mediated by the waist:height ratio (WHtR) in older women and men. A total of 2862 community-dwelling older individuals aged 70–84 years were assessed for frailty using the Korean version of Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight index. Obesity (BMI ≥ 30 kg/m2) was associated with a higher risk of frailty compared with BMI 18·5–<23 kg/m2 in all the older individuals (OR 1·88; 95 % CI 1·11, 3·17; P = 0·018) and in older women (OR 1·86; 95 % CI 1·01, 3·42; P = 0·047) before adjusting for WHtR but was not associated with BMI after adjusting for WHtR. Additionally, obesity was not significantly associated with the risk of frailty before and after adjusting for WHtR in older men. Mediation analysis revealed that the association between BMI and frailty score was mediated by WHtR. Moreover, the mediating effect of WHtR on frailty score was positive in both women and men, but the frailty score was associated with BMI positively in women and negatively in men. The present study suggests that the risk of frailty is higher in obese women, which is mediated by WHtR, but not in obese men.