Health screening is an important component of health promotion programs, and countries have promoted general health screening targeting the prevention and early management of common chronic diseases. In Korea, a General Health Screening Program (GHSP) began with workers in the 1950s and continuously expanded its target population, and currently includes the adult population. The main target diseases are cerebroand cardiovascular diseases, including hypertension, diabetes mellitus, dyslipidemia, obesity, and related health behaviors. Other target conditions include other diseases (e.g., anemia, liver disease, visual/auditory impairment), mental health (e.g., depression), and geriatric disease and function (osteoporosis, dementia, risk of fall, etc.). The National Health Information Database, including GHSP information, is now extensively used in clinical and public health research. The participation rate is currently 70% to 80%, but varies according to age, disability, and the socioeconomic status. There is a need for a more systematic evaluation of the screening items, reducing disparity gaps in participation, and linking GHSP to actual health promotion.

Chronic inflammation is known to be one of the main steps in carcinogenesis. Identification of those with chronic inflammation may help identify subjects at risk of cancer. Previous studies have reported low albumin-to-globulin ratio (AGR) to be associated with increased cancer mortality in cancer patients, but there has been no study based on healthy populations. Our retrospective cohort study involved 26 974 generally healthy adults aged 30 or older who visited Seoul National University Hospital Health Promotion Center for self-referred health checkup. National medical service claims data were used to determine cancer incidence, and Korean death registry data was used to determine mortality. Median follow-up time for survival was 5.9 years (interquartile range 4.1 years). Compared with subjects with AGR ≥ 1.5, subjects with 1.1 > AGR ≥ 1.0 and 1.0 > AGR showed adjusted hazard ratio (aHR) 2.69 (95% confidence interval, CI, 1.54–4.72) and aHR 6.71 (95% CI 3.56–12.66) for all-cause mortality, aHR 2.95 (95% CI 1.42–6.11) and aHR 4.38 (95% CI 1.57–12.25) for cancer mortality, and aHR 2.07 (95% CI 1.28–3.36) and aHR 3.99 (95% CI 2.10–7.58) for cancer incidence, respectively. When cancer incidence events after 2 years from baseline were separately analyzed, subjects with 1.1 > AGR ≥ 1.0 and 1.0 > AGR were associated with aHR 1.88 (95% CI 1.01–3.48) and aHR 2.55 (95% CI 1.03–7.11) for cancer incidence, respectively. Cancer events were increased in all types of cancer, but especially in liver and hematologic malignancies. Low AGR is a risk factor for cancer incidence and mortality, both short- and long terms, in a generally healthy screened population. The results of this study need to be replicated in larger studies, along with the determination of the sensitivity and other diagnostic values of low AGR.

Screening for hepatocellular carcinoma (HCC) is clinically important given that its early detection has remarkable survival benefits. We investigated the possible role of FIB‐4, a recently developed noninvasive marker for liver fibrosis based on routine laboratory tests, as a clinical indicator for predicting future HCC among hepatitis B surface antigen (HBsAg) carriers. Our retrospective cohort study involved 986 Korean HBsAg carriers 40 years of age or older who visited Seoul National University Hospital for a health checkup. National medical service claims data were used to determine HCC incidence. Median follow‐up time was 5.4 years (interquartile range: 4.4 years). Adjusted for age, sex, body mass index, smoking, alcohol, and antiviral medication for hepatitis B, compared to subjects with FIB‐4 <1.25, subjects with 1.7≤ FIB‐4 <2.4 showed an adjusted hazard ratio (aHR) of 4.57 (95% confidence interval [CI]: 1.50‐13.92) and subjects with FIB‐4 ≥2.4 showed an aHR of 21.34 (95% CI: 7.73‐58.92) for HCC incidence. FIB‐4 was shown to have incremental predictive value to ultrasonographic liver cirrhosis for HCC incidence (C‐index: 0.701 vs. 0.831; P = 0.001). FIB‐4 was also better predictive of HCC incidence, compared to that of ultrasonographic liver cirrhosis (C‐index: 0.775 vs. 0.701; P = 0.040). Conclusion: High FIB‐4 is a highly predictive risk factor for HCC incidence among Korean HBsAg carriers. FIB‐4 is a promising, easily applicable, and cost‐effective clinical tool in identifying a subpopulation of HBsAg carriers who are at heightened risk. Our study needs to be replicated in larger future studies on various ethnic groups; nonetheless, our study suggests that FIB‐4 may play a valuable role in HCC screening among HBsAg carriers. (Hepatology 2015;61:1261–1268)

Currently, more than 57 million people live with dementia worldwide, and this number is expected to increase to more than 152 million by 2050.¹ Alcohol consumption is generally considered as a potential modifiable risk factor for dementia, but the results in the literature are not completely consistent.² Several longitudinal studies^3-6 reported an association of mild to moderate alcohol consumption with a reduced risk of dementia, whereas others showed no association.^7-10 Notably, most studies assessed alcohol consumption only once at baseline. Only a few studies considered a change of alcohol consumption during the study period and its association with the incidence of dementia (eTable 1 in Supplement 1). Sabia et al⁴ examined the link between 17-year trajectories of alcohol consumption and the risk of dementia in the UK. The authors concluded that the risk of dementia was increased in those with long-term abstinence, decreased alcohol consumption, and long-term consumption greater than 14 units per week compared with participants with long-term consumption of 1 to 14 units per week.⁴ However, that study did not conduct stratified analyses considering the initial amount of alcohol consumption level (eg, mild, moderate, or heavy). Mukamal et al⁵ examined alcohol consumption in 2 separate assessments. In that study, however, the participants were simply categorized according to the average level of alcohol consumption between 2 measurements (eg, <1 drinks per week) without reflecting changes in the pattern (eg, decreased or increased) of alcohol consumption between the measurements.⁵ In addition, that study used only the abstainers, but not the sustainers, as a reference, making it difficult to accurately reflect the effect of changes in the pattern of alcohol consumption on the risk of dementia.