Endocrinology and Metabolism

Original Articles

Calcium & bone metabolism Big Data Articles (National Health Insurance Service Database)
Association between Smoking Status and the Risk of Hip Fracture in Patients with Type 2 Diabetes: A Nationwide Population-Based Study: Se-Won Lee, Jun-Young Heu, Ju-Yeong Kim, Jinyoung Kim, Kyungdo Han, Hyuk-Sang Kwon; Endocrinol Metab. 2023;38(6):679-689. Published online December 6, 2023; DOI: https://doi.org/10.3803/EnM.2023.1760

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Abstract PDF Supplementary Material PubReader ePub: Background
Limited longitudinal evidence exists regarding the potential association between smoking status and hip fracture among individuals with type 2 diabetes. We investigated this association using large-scale, nationwide cohort data for the Korean population.
Methods
This nationwide cohort study included 1,414,635 adults aged 40 and older who received Korean National Health Insurance Service health examinations between 2009 and 2012. Subjects with type 2 diabetes were categorized according to their smoking status, amount smoked (pack-years), number of cigarettes smoked per day, and duration of smoking. The results are presented as hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between smoking status parameters and risk of hip fracture in multivariable Cox proportional hazard regression analysis.
Results
Compared with never-smokers, an increased adjusted HR (aHR) for hip fracture was observed in current smokers (1.681; 95% CI, 1.578 to 1.791), and a comparable aHR for hip fracture was found in former smokers (1.065; 95% CI, 0.999 to 1.136). For former smokers who had smoked 20 pack-years or more, the risk was slightly higher than that for never-smokers (aHR, 1.107; 95% CI, 1.024 to 1.196). The hip fracture risk of female former smokers was similar to that of female current smokers, but the hip fracture risk in male former smokers was similar to that of male never-smokers.
Conclusion
Smoking is associated with an increased risk of hip fracture in patients with type 2 diabetes. Current smokers with diabetes should be encouraged to quit smoking because the risk of hip fracture is greatly reduced in former smokers.

Diabetes, Obesity and Metabolism Big Data Articles (National Health Insurance Service Database)
Association among Current Smoking, Alcohol Consumption, Regular Exercise, and Lower Extremity Amputation in Patients with Diabetic Foot: Nationwide Population-Based Study: Yoon Jae Lee, Kyung-Do Han, Jun Hyeok Kim; Endocrinol Metab. 2022;37(5):770-780. Published online October 12, 2022; DOI: https://doi.org/10.3803/EnM.2022.1519

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Background
The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients.
Methods
A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders.
Results
The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors.
Conclusion
Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.

Citations

Citations to this article as recorded by

Adjuvant effect of antimicrobial photodynamic therapy (aPDT) in the treatment of diabetic foot ulcers: A case series
Rita de Cassia Ferreira, Rebeca Boltes Cecatto, Silvana Torres Perez, Raquel Agnelli Mesquita‐Ferrari, Sandra Kalil Bussadori, Cinthya Cosme Duran, Anna Carolina Tempestini Horliana, Kristianne Porta Santos Fernandes
Journal of Biophotonics.2024;[Epub] CrossRef
Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real‐world data from the German/Austrian DPV registry
Alexander J. Eckert, Stefan Zimny, Marcus Altmeier, Ana Dugic, Anton Gillessen, Latife Bozkurt, Gabriele Götz, Wolfram Karges, Frank J. Wosch, Stephan Kress, Reinhard W. Holl
Journal of Diabetes.2024;[Epub] CrossRef
Investigating Diabetic Foot Pathophysiology and Amputation Prevention Strategies through Behavioral Modification
Jun Hyeok Kim
Journal of Wound Management and Research.2023; 19(3): 167. CrossRef

Thyroid
Effect of Cigarette Smoking on Thyroid Cancer: Meta-Analysis: Joon-Hyop Lee, Young Jun Chai, Ka Hee Yi; Endocrinol Metab. 2021;36(3):590-598. Published online May 26, 2021; DOI: https://doi.org/10.3803/EnM.2021.954

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Background
Although smoking is generally carcinogenic, its effect on thyroid cancers is still subject to controversy. The purpose of this study was to summarize the role of smoking in relation to thyroid cancer occurrence.
Methods
We performed a meta-analysis of 24 eligible studies: 21 case-control studies and three prospective cohort studies. The summary odds ratio (OR) and 95% confidence interval (CI) of all studies were acquired based on random effect model. Further subgroup analyses were conducted according to gender, histological type of thyroid cancer, and smoking status of patients for the case-control studies.
Results
The summary effect size indicated a negative association of smoking for thyroid cancer (OR, 0.798; 95% CI, 0.681 to 0.935). From the subgroup analyses for the case-control studies, reduced risk of thyroid cancer was observed in both men (OR, 0.734; 95% CI, 0.553 to 0.974) and women (OR, 0.792; 95% CI, 0.700 to 0.897). The protective effect of smoking was observed in studies in which thyroid cancer was limited to differentiated thyroid cancers (DTCs) (OR, 0.798; 95% CI, 0.706 to 0.902).
Conclusion
Our results suggests that smoking may have a protective effect on thyroid cancer, especially on DTCs. Further studies with larger sample sizes should be conducted in elucidating the dose and time dependent effect of smoking on thyroid cancer with specific focus on the types of thyroid cancers.

Citations

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Tobacco smoking, e-cigarette and thyroid: what are the risks of thyroid disorders
I. M. Belovalova, E. S. Shugurova, M. O. Korchagina, T. N. Borkhoeva, M. S. Sheremeta
Clinical and experimental thyroidology.2024; 19(2): 11. CrossRef
Relationship between Serum Levels of Selenium and Thyroid Cancer: A Systematic Review and Meta-Analysis
Runhua Hao, Ping Yu, Lanlan Gui, Niannian Wang, Da Pan, Shaokang Wang
Nutrition and Cancer.2023; 75(1): 14. CrossRef
Potentially inappropriate medication and frailty in older adults: A systematic review and meta-analysis
Wenlian Ma, Hongyan Wang, Zhifei Wen, Linfeng Liu, Xiangeng Zhang
Archives of Gerontology and Geriatrics.2023; 114: 105087. CrossRef
Inflammation biomarkers are associated with the incidence of cardiovascular disease: a meta-analysis
Yifei Liu, Suzhen Guan, Haiming Xu, Na Zhang, Min Huang, Zhihong Liu
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Maternal gestational weight gain and offspring’s neurodevelopmental outcomes: A systematic review and meta-analysis
Dan Wu, Yicheng Li, Lingyan Chen, Marieke Klein, Barbara Franke, Jinjin Chen, Jan Buitelaar
Neuroscience & Biobehavioral Reviews.2023; 153: 105360. CrossRef
Association of preoperative hypoprotein malnutrition with spinal postoperative complications and other conditions: A systematic review and meta-analysis
Yongrong Hu, Liping Wang, Hao Liu, Kunhai Yang, Song Wang, Xiang Zhang, Bo Qu, Hongsheng Yang
Clinical Nutrition ESPEN.2023; 57: 448. CrossRef
Metabolic syndrome and risk of ovarian cancer: a systematic review and meta-analysis
Ziyu Chen, Zesi Liu, Hongxia Yang, Chaosheng Liu, Fandou Kong
Frontiers in Endocrinology.2023;[Epub] CrossRef
Cigarette smoking and thyroid cancer risk: A Mendelian randomization study
Hongzhan Jiang, Yi Li, Jiali Shen, Huihui Lin, Siyue Fan, Rongliang Qiu, Jiaxi He, Ende Lin, Lijuan Chen
Cancer Medicine.2023; 12(19): 19866. CrossRef
Longitudinal Changes in Smoking Habits in Women and Subsequent Risk of Cancer
Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park
American Journal of Preventive Medicine.2022; 63(6): 894. CrossRef

Clinical Study
Gender-Dependent Reference Range of Serum Calcitonin Levels in Healthy Korean Adults: Eyun Song, Min Ji Jeon, Hye Jin Yoo, Sung Jin Bae, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Hong-Kyu Kim, Won Gu Kim; Endocrinol Metab. 2021;36(2):365-373. Published online April 7, 2021; DOI: https://doi.org/10.3803/EnM.2020.939

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Background
Serum calcitonin measurement contains various clinical and methodological aspects. Its reference level is wide and unclear despite sensitive calcitonin kits are available. This study aimed to identify the specific reference range in the healthy Korean adults.
Methods
Subjects were ≥20 years with available calcitonin (measured by a two-site immunoradiometric assay) data by a routine health checkup. Three groups were defined as all eligible subjects (group 1, n=10,566); subjects without self or family history of thyroid disease (group 2, n=5,152); and subjects without chronic kidney disease, autoimmune thyroid disease, medication of proton pump inhibitor/H2 blocker/steroid, or other malignancies (group 3, n=4,638).
Results
This study included 6,341 male and 4,225 female subjects. Males had higher mean calcitonin than females (2.3 pg/mL vs. 1.9 pg/mL, P<0.001) in group 1. This gender difference remained similar in groups 2 and 3. Calcitonin according to age or body mass index was not significant in both genders. Higher calcitonin in smoking than nonsmoking men was observed but not in women. Sixty-nine subjects had calcitonin higher than the upper reference limit (10 pg/mL) and 64 of them had factors associated with hypercalcitoninemia besides medullary thyroid cancer. Our study suggests the reference intervals for men who were non, ex-, current smokers, and women (irrespective of smoking status) as <5.7, <7.1, <7.9, and <3.6 pg/mL, respectively.
Conclusion
Specific calcitonin reference range should be provided considering for sex and smoking status. Taking account for several factors known to induce hypercalcitoninemia can help interpret the gray zone of moderately elevated calcitonin.

Citations

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Determinants of circulating calcitonin value: analysis of thyroid features, demographic data, anthropometric characteristics, comorbidities, medications, and smoking habits in a population with histological full exclusion of medullary thyroid carcinoma
Pierpaolo Trimboli, Giuseppe Peloni, Dorotea Confalonieri, Elena Gamarra, Tommaso Piticchio, Francesco Frasca, Petra Makovac, Arnoldo Piccardo, Lorenzo Ruinelli
Frontiers in Oncology.2024;[Epub] CrossRef
Surgical treatment of solid variant of papillary thyroid carcinoma: Fifteen-year experience of a tertiary center
Katarina Tausanović, Marina Stojanović, Milan Jovanović, Boban Stepanović, Jovan Ilić, Sara Ivaniš, Vladan Živaljević
Medicinska istrazivanja.2024; 57(1): 121. CrossRef
Some genetic differences in patients with rheumatoid arthritis
Hosam M. Ahmad, Zaki M. Zaki, Asmaa S. Mohamed, Amr E. Ahmed
BMC Research Notes.2023;[Epub] CrossRef
Presence or severity of Hashimoto’s thyroiditis does not influence basal calcitonin levels: observations from CROHT biobank
M. Cvek, A. Punda, M. Brekalo, M. Plosnić, A. Barić, D. Kaličanin, L. Brčić, M. Vuletić, I. Gunjača, V. Torlak Lovrić, V. Škrabić, V. Boraska Perica
Journal of Endocrinological Investigation.2022; 45(3): 597. CrossRef
Environmental Factors That Affect Parathyroid Hormone and Calcitonin Levels
Mirjana Babić Leko, Nikolina Pleić, Ivana Gunjača, Tatijana Zemunik
International Journal of Molecular Sciences.2021; 23(1): 44. CrossRef

Clinical Study
Association between Secondhand Smoke Exposure and Metabolic Syndrome in 118,609 Korean Never Smokers Verified by Self-Reported Questionnaire and Urine Cotinine: Ji Hye Kim, Byung Jin Kim, Young Youl Hyun, Jin Ho Kang; Endocrinol Metab. 2020;35(4):892-900. Published online December 23, 2020; DOI: https://doi.org/10.3803/EnM.2020.847

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Background
No study has reported the association between secondhand smoke (SHS) exposure and metabolic syndrome (MetS) in self-reported never smokers verified by both self-reported questionnaire and urine cotinine.
Methods
A total of 118,609 self-reported and cotinine-verified never smokers (38,385 male; age 34.8±7.1 years) who participated in the Kangbuk Samsung Health Study between 2011 and 2016 were included. Cotinine-verified never smokers were defined as individuals with urinary cotinine <50 ng/mL. SHS exposure was defined as current exposure to passive smoking indoors at home or workplace.
Results
Prevalence of SHS exposure in the overall population was 22.6% (27.4% for males and 20.3% for females (P<0.001). The overall prevalence of MetS was 6.8% and was higher in males than in females (10.7% vs. 4.9%, P<0.001). In both genders, MetS prevalence was higher in the SHS exposure group than the non-SHS exposure group (11.3% vs. 10.4%, P=0.010 for males; 5.8% vs. 4.6%, P<0.001 for females). However, there was significant gender interaction for the association between SHS exposure and MetS (P for interaction=0.010). In the multivariate regression analyses, SHS exposure was associated with increased MetS odds only in females (odds ratio [95% confidence interval], 1.02 [0.94 to 1.11] in male vs. 1.17 [1.06 to 1.29] in female). In particular, females with SHS exposure of ≥1 hour/day and ≥3 times showed increased odds of MetS compared with those without SHS exposure (1.22 [1.02 to 1.45], 1.30 [1.14 to 1.49]).
Conclusion
This cross-sectional study showed that SHS exposure was significantly associated with prevalence of MetS in self-reported and cotinine-verified female never smokers.

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Combined Influence of Eight Lifestyle Factors on Metabolic Syndrome Incidence: A Prospective Cohort Study from the MECH-HK Study
Yun-Yang Deng, Fei-Wan Ngai, Jing Qin, Lin Yang, Ka-Po Wong, Harry-Haoxiang Wang, Yao-Jie Xie
Nutrients.2024; 16(4): 547. CrossRef
Association of Zinc Intake, Tobacco Smoke Exposure, With Metabolic Syndrome: Evidence from NHANES 2007–2018
Shengxiang Yang, Qian Chen, Lin Wang
Biological Trace Element Research.2024;[Epub] CrossRef
The association between urinary cotinine level and metabolic syndrome profiles among adolescents: findings from the Ewha Birth and growth study
Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Seunghee Jun, Bomi Park, Hye Ah Lee, Hae Soon Kim, Hyesook Park
BMC Public Health.2023;[Epub] CrossRef
Association of environmental tobacco smoke exposure with metabolic syndrome: A longitudinal Cohort Study of 71,055 never smokers
Hyo-In Choi, Seung Jae Lee, Jeong Gyu Kang, Sung Ho Lee, Bum Soo Kim, Byung Jin Kim
Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(11): 2534. CrossRef

Review Article

Thyroid
Clinical Relevance of Environmental Factors in the Pathogenesis of Autoimmune Thyroid Disease: Wilmar M. Wiersinga; Endocrinol Metab. 2016;31(2):213-222. Published online May 13, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.213

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Genetic factors contribute for about 70% to 80% and environmental factors for about 20% to 30% to the pathogenesis of autoimmune thyroid disease (AITD). Relatives of AITD patients carry a risk to contract AITD themselves. The 5-year risk can be quantified by the so-called Thyroid Events Amsterdam-score, based on serum thyroid-stimulating hormone, thyroid peroxidase (TPO)-antibodies and family history. Subjects at risk may ask what they can do to prevent development of AITD. This review summarizes what is known about modulation of exposure to environmental factors in terms of AITD prevention. To stop smoking decreases the risk on Graves disease but increases the risk on Hashimoto disease. Moderate alcohol intake provides some protection against both Graves and Hashimoto disease. Low selenium intake is associated with a higher prevalence of thyroid autoimmunity, but evidence that selenium supplementation may lower TPO antibodies and prevent subclinical hypothyroidism remains inconclusive. Low serum vitamin D levels are associated with a higher prevalence of TPO antibodies, but intervention studies with extra vitamin D have not been done yet. Stress may provoke Graves hyperthyroidism but not Hashimoto thyroiditis. Estrogen use have been linked to a lower prevalence of Graves disease. The postpartum period is associated with an increased risk of AITD. Taking together, preventive interventions to diminish the risk of AITD are few, not always feasible, and probably of limited efficacy.

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Original Articles

Association between Cigarette Smoking and Thyroid Function in Adults without Previous History of Thyroid Disease.: Bo Hyun Kim, Won Bae Kim, Tae Yong Kim, Hong Kyu Kim, Seong Hoon Jeon, Chang Won Lee, Young Kee Shong; J Korean Endocr Soc. 2008;23(2):123-128. Published online April 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.2.123

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Abstract PDF

BACKGROUND
Cigarette smoking has a significant impact on thyroid function. However, the association between smoking and thyroid function is incompletely understood. METHODS: We conducted a cross-sectional study that included 90,970 adults (age range: 20 to 79) who had visited the health promotion center at Asan Medical Center between January 1, 2001, and December 31, 2003. Those subjects with previous known thyroid disease, a history of thyroid operation, a history of thyroid function altering medication (herb, estrogen or digestive) or a family history of thyroid disease were excluded. Finally, 47,577 subjects (males: 30,726, females: 16,851) were included in this study. We calculated the age-adjusted geometric mean of the serum TSH and the age-adjusted mean of the serum free T4 among the current, former and never smokers. We also analyzed the age-adjusted prevalence of hypothyroidism and hyperthyroidism among each group. RESULTS: Among men, the geometric mean TSH level was significantly low in the current (1.40 mIU/L, 95% confidence interval [CI]: 1.38-1.41) and former smokers (1.59 mIU/L, 95% CI: 1.57-1.61) compared with the never smokers (1.65 mIU/L, 95% CI: 1.63-1.68). The mean free T4 level was high in the current smokers (1.236 ng/dL, 95% CI: 1.234-1.239) compared with the never smokers (1.234 ng/dL, 95% CI: 1.230-1.238). Similarly, among women, the geometric mean TSH level was low in the current smokers (1.75 mIU/L, 95% CI: 1.67-1.87) compared with the never smokers (1.85 mIU/L, 95% CI: 1.83-1.87). The mean free T4 level was high in the current smokers (1.149 ng/dL, 95% CI: 1.139-1.159) compared with the never smokers (1.138 ng/dL, 95% CI: 1.135-1.140). Among the current male smokers, heavy daily smoking (over 2 packs per day) was more associated with low TSH levels than moderate smoking (less than 1 pack per day). In men, the prevalence of subclinical hypothyroidism was low in the current smokers compared with the never smokers (odds ratio: 0.53, 95% CI: 0.43-0.66). CONCLUSION: We found that current smokers had lower TSH levels and higher free T4 levels than never smokers in both men and women and smoking was associated with a low prevalence of subclinical hypothyroidism in men, which may be of importance when evaluating subjects with subclinical hypothyroidism in Korea.

Citations

Citations to this article as recorded by

Reference interval for thyrotropin in a ultrasonography screened Korean population
Mijin Kim, Tae Yong Kim, Soo Han Kim, Yunkyoung Lee, Su-yeon Park, Hyung-don Kim, Hyemi Kwon, Yun Mi Choi, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
The Korean Journal of Internal Medicine.2015; 30(3): 335. CrossRef
Clinical Review of Thyroid Dysfunction in the Subjects for Health Check-up
Ji Eun Park, Ho Chan Cho
Journal of Korean Thyroid Association.2012; 5(1): 52. CrossRef
Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism
Joo Hyung Kim, Sol Ah Park, Nam Hoon Kim, Jae Hee Ahn, Yoon Jung Kim, Myongjin Cho, Yoon Jung Lee, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim
Endocrinology and Metabolism.2012; 27(3): 200. CrossRef

Relationship between Plasma Leptin Levels and Carotid Intima-Medial Thickness in Korean Adults.: Hyejin Lee, Eunsoon Hong, Youngsun Hong, Yeon Ah Sung; J Korean Endocr Soc. 2002;17(1):87-94. Published online February 1, 2002

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Abstract PDF: BACKGROUND
Many studies have recently shown that leptin can promote angiogenesis via endothelial leptin receptors and induce oxidative stress in endothelial cells; These findings suggest the relationship between cardiovascular risk and blood leptin concentration. In the present study, we investigated the relationship between leptin concentration and carotid intima-medial thickness (CIMT) as an indicator of early atherosclerosis in adults. METHEODS: The study subjects comprised 138 (45 men and 93 women; mean age 42.4+/-7.5 years; mean BMI 24.0+/-2.7 kg/m2) without history of diabetes, hypertension or cardiovascular disease. We measured CIMT by high resolution ultrasonography and plasma leptin levels by radioimmunoassay. RESULTS: 1) No significant differences in age, BMI or CIMT between male and female subjects were noted, but the leptin levels in female were significantly higher than those in males. (8.42+/-5.90 ng/mL vs. 3.08+/-1.00 ng/mL, p<0.001) 2) CIMT showed a significant positive correlation with age (r=0.31, p< 0.001), BMI (r=0.25, p<0.01) and level (r=0.42, p<0.05) in simple regression analysis. 3) When male and female subjects were each divided into 3 groups by leptin concentration, no significant difference in CIMT among female subjects was found. In male subjects, CIMT was significantly higher in the highest tertile of leptin level than in the other 2 groups (0.65+/-0.03 mm vs. 0.56+/-0.07 mm and 0.53+/-0.07 mm, p<0.01) after adjustment for BMI and age. However, this difference was not significant after adjustment for smoking. 4) CIMT (0.61+/-0.05 mm vs. 0.53+/-0.07 mm, p<0.01) and leptin concentrations (3.57+/-2.13 ng/mL vs. 2.20+/-1.39 ng/mL, p<0.05) were significantly higher in male smokers than in male non-smokers. CONCLUSION: Our results demonstrated significant correlation of CIMT to plasma leptin level before adjustment for smoking. A possible explanation is the permissive action of smoking on the atherogenic effect of leptin. However, further studies to elucidate the relationships and interactions among smoking, leptin level and the development of atherosclerosis will be needed.

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