Insulin resistance (IR) can be optimally assessed using the euglycemic clamp, but practical clinical limitations necessitate surrogate markers. This study leveraged the Bayesian network analysis to evaluate three established IR markers: the Homeostatic Model Assessment of IR (HOMA-IR) using insulin level and fasting blood glucose (FBG), TG-Glucose (TyG) index using triglycerides (TG) and FBG, and TG-to-HDL ratio (TG/HDL ratio) using TG and high-density lipoprotein (HDL), based on the Korean National Health and Nutrition Examination Survey data (2019–2021). Our analysis revealed a sequential association pattern (TG/HDL ratio → TyG index → HOMA-IR), positioning the TyG index as a central connecting marker. The HOMA-IR exhibited strong predictive power for diabetes, while the TG/HDL ratio was most effective for assessing dyslipidemia. However, both had limited crossover utility. In contrast, the TyG index bridged this gap, demonstrating robust predictive capability for both conditions. The Markov blanket analysis illuminated the distinctive metabolic signatures of each marker: The TyG index displayed balanced glucose-lipid metabolic contributions, the HOMA-IR predominantly reflected glucose metabolism and obesity characteristics, and the TG/HDL ratio emphasized lipid metabolism. Notably, the TyG index’s predictive performance showed significant enhancement when integrated with obesity information, contrasting with the HOMA-IR’s minimal response owing to its inherent incorporation of obesity characteristics. These findings position the TyG index as a superior clinical marker, offering both comprehensive predictive capability and enhanced performance through synergistic integration with obesity measures. While each marker demonstrated reliability, the TyG index’s unique combination of versatility and scalability establishes it as an effective tool for comprehensive metabolic risk assessment.

The object of this study was to examine the effects of domestic and work-related physical activity (DWPA) and leisure-time physical activity (LTPA) on the risk of diabetes, by categorizing fasting blood glucose (FBG) levels into normal, Impaired Fasting Glucose (IFG), and diabetes. The sample consisted of 4661 adults aged 30 years or above, and was chosen from the 2017 Korean National Health and Nutrition Examination Survey (KNHANES) data. Of all the subjects, 14.6% engaged in high-intensity DWPA and 6.25% in moderate-intensity DWPA; while 11.68% and 24.80% engaged in high- and moderate-intensity LTPA, respectively. The effects of both types of physical activities on the risk of diabetes were analyzed using a Bayesian ordered probit model. For those with high-intensity DWPA, the probability of the FBG level being normal was 5.10% (SE = 0.25) lower than for those with non-high-intensity DWPA, and the probabilities of IFG and diabetes were 3.30% (SE = 0.15) and 1.79% (SE = 0.09) higher, respectively. However, for those with high-intensity LTPA, the probability of the FBG level being normal was 2.54% (SE = 0.09) higher, and the probabilities of IFG and diabetes were 1.74% (SE = 0.07) and 0.80% (SE = 0.03) lower, respectively, than those with non-high-intensity LTPA. Likewise, for moderate-intensity DWPA and LTPA, the results were the same compared to low-intensity physical activities though the magnitude of the effects were smaller than for high-intensity. Thus, the activities related to work have a negative effect and those related to leisure have a positive effect. The criteria for physical activities to reduce the risk of diabetes should be set by separating these domains of physical activity, and new management strategies for diabetes are needed for people with moderate- or high-intensity DWPA.

We assessed the association between breast cancer and analgesic use in women of a specific working-age group. The Korean National Health Insurance Service–National Sample Cohort database (KNHIS–NSC) data were analyzed. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for patients’ cancer risk based on whether the women participated in economic activity (PEA or not PEA (NPEA) groups) and analgesic use. Additionally, breast cancer incidence variations by age group, and PEA or NPEAs, health behavior, Charlson Comorbidity Index, and analgesic use were evaluated. The PEA group had a higher cancer risk than the NPEA group (HR = 1.542, 95% CI: 1.345–1.768, p < 0.001). Breast cancer risk was high in the PEA, high income, and no history of exercise groups, but significantly reduced in the regular-use-of-analgesics group. Notably, the working age group of 40~49 years, within the PEA group, had the highest HR of breast cancer development (HR = 1.700, 95% CI = 1.361–2.124, p < 0.001); whereas regular analgesic use in those aged 25~39 years decreased breast cancer risk (HR = 0.611, 95% CI = 0.427–0.875, p < 0.05). In conclusion, our results suggest that individuals at a high-risk of comorbidity may benefit from regular use of analgesics, which may prove to be a useful strategy for breast cancer prevention in the Young-aged group.

OBJECTIVES: This study investigated the effectiveness of early medication treatment and metformin use for cancer prevention in type 2 diabetes patients.METHODS: Population-based cohort data were used from the Korean National Health Insurance Service-National Sample Cohort database (KNHIS-NSC) for 2002-2013. Patient-specific medication prescription status was defined by the landmark time (LMT; a fixed time after cohort entry), considering both pre- and post-LMT prescriptions to control methodological biases in observational research. The LMT was set to 2 years. Logistic regression analysis with multivariable adjustment was conducted to analyze cancer incidence by patient-specific medication prescription status.RESULTS: Only 33.4% of the subjects were prescribed medication early (before the LMT) with compliance. Cancer incidence in individuals with early prescription and compliance was 25% lower (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.67 to 0.84) than in those without. As early-prescribed medications, metformin monotherapy and metformin combination therapy were associated with 34% (OR, 0.66; 95% CI, 0.51 to 0.83) and 25% (OR, 0.75; 95% CI, 0.64 to 0.88) lower cancer risk than non-use, respectively. Patients who were prescribed late (post-LMT) but did not comply with the prescription had a 24% (OR, 1.24; 95% CI, 0.97 to 1.58) higher cancer incidence than non-users. Among patients who started monotherapy early without changes throughout the entire follow-up period, those who started on metformin had a 37% (OR, 0.63; 95% CI, 0.41 to 0.99) lower risk of cancer than non-metformin users.CONCLUSIONS: Doctors must prescribe antidiabetic medication early, and patient compliance is required, regardless of the prescription time, to prevent cancer. Metformin monotherapy or combination therapy is recommended as an early prescription.

Obesity is a major cause of diabetes and hypertension. Previous studies have analyzed the effects of obesity on diabetes and hypertension by comparing non-obese and obese groups. Here, we investigated the effects of obesity type through comparison between obesity types in obese adults.The sample comprised 8,914 adults, classified as obese according to body mass index criteria or waist circumference criteria, selected from the Korean National Health and Nutrition Examination Survey (2016-2020). Obesity was classified as abdominal obesity-only, general obesity-only, and abdominal and general obesity. The effects of obesity type on diabetes and hypertension were analyzed using logistic regression model.12.78% of participants exhibited abdominal obesity-only, 22.35% had general obesity-only, and 64.78% had both types. The proportion of patients aged ≥60 years was 57.52% in the abdominal obesity-only group, while 17.12% in the general obesity-only group. The general obesity-only group had a lower incidence of diabetes than the abdominal obesity-only group (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.47-0.77), and the abdominal and general obesity group had a higher incidence of hypertension than the abdominal obesity-only group (OR, 1.82; 95% CI, 1.54-2.15).Abdominal obesity has a stronger association with diabetes than general obesity, and the risk of hypertension is greatest when both obesity types coexist. Individuals with abdominal obesity-only are likely to be excluded from obesity management, especially when aged ≥60 years. The risk of hypertension is much greater when abdominal and general obesity coexist, emphasizing the need to use both body mass index and waist circumference to define obesity.

We aimed to determine the relationship between the use of analgesics prescribed for pain management and the onset and progression of mood disorders using a large-scale cohort database. We calculated hazard ratios (HR) with 95% confidence intervals (CI) for patient risk of developing mood disorders based on age, income, health-related variables, disease history, Charlson comorbidity index, and analgesics prescription behavior (Models 1–3). Additionally, we determined the risk of mood disorder occurrence by age group (Model 4) using a proportional hazards regression model. The age- and income-adjusted HR (Model 1) was 1.8275. The age-, income-, BMI-, and physical-activity-adjusted HR (Model 2) was 1.882. The fully adjusted HR (Model 3) was 1.698. Compared with no analgesic use, nonregular use (HR = 1.386) and regular use (HR = 1.698) was associated with a higher risk of mood disorders. Among patients older than 50 years, those who participated in physical activity (less than five days) had a lower risk of mood disorders than those who did not. This suggests that it may be useful for preventing mood disorders in older cancer survivors. A high risk of comorbidities and regular use of analgesics are risk factors for developing mood disorders. Therefore, our results suggest that cancer survivors with a high risk of comorbidities and a history of regular analgesic use should undergo careful psychiatric consultation.