Yu-Jin Kwon

Aims: To evaluate the effectiveness and treatment patterns of once‐weekly semaglutide 2.4 mg in South Korean adults with overweight or obesity in real‐world practice. Materials and Methods: This multicenter retrospective study analysed electronic medical records from 17 centres in South Korea. Included were adults (≥ 19 years) with BMI ≥ 25 kg/m ² , or ≥ 23 kg/m ² with obesity‐related comorbidities. Primary endpoints were changes in body weight at 3, 6, 9, and 12 months. Secondary outcomes included body composition, categorical weight loss, cardiometabolic changes, treatment persistence, safety, and changes in liver function. Results: Among 1160 patients (40.9% with prior obesity medications), semaglutide treatment induced progressive weight reduction (−5.85%, −9.55%, −11.43%, and −13.16% at 3, 6, 9, and 12 months). Greater reduction occurred in women, younger patients, and those without T2D or prior obesity medication. By 6 months, cardiometabolic, liver function, and body composition parameters improved, with preferential loss of fat over lean mass (all p < 0.001). Starting doses varied across patients (0.25 mg, 55.9%; 0.5 mg, 30.4%; 1.0 mg, 11.9%), with rapid dose escalation reaching the maintenance dose (2.4 mg) in a mean of 3.52 months, reflecting individualised real‐world dosing. Mean treatment duration was 4.9 months. Adverse events, predominantly transient gastrointestinal symptoms, occurred in approximately 22% of patients. Conclusions: Semaglutide 2.4 mg achieved substantial weight loss in South Korean adults with overweight or obesity. Weight reduction was comparable to the STEP 6 trial despite shorter follow‐up (4.9 months), substantial prior obesity medication exposure, and accelerated dose escalation, supporting robust real‐world effectiveness.

Stratifying populations based on indicators of insulin resistance and visceral adiposity may help identify genetic associations with type 2 diabetes mellitus (T2DM) that vary across metabolic environments. This study aimed to investigate metabolic context-dependent genetic associations with T2DM using the metabolic score for insulin resistance (METS-IR) and visceral fat (METS-VF). A total of 70,583 and 70,513 participants were eligible for METS-IR and METS-VF stratification, respectively. After excluding participants with missing diabetes status, the final case–control samples comprised 40,970 and 40,944 participants, respectively. Genome-wide association studies of prevalent T2DM were conducted within metabolic tertiles, with additional evaluation of lead variants in the intermediate tertile (T2). Logistic regression under an additive genetic model was performed, followed by genotype × metabolic stratum interaction analyses and Cochran’s Q heterogeneity tests. Twelve notable loci were identified, showing both shared and varying association patterns across metabolic strata. CDKAL1 showed robust associations across metabolic strata, with progressively attenuated effect sizes from T1 to T3 and significant interaction results under both METS-VF and METS-IR stratifications. PAX4, CPEB3, and HHEX also demonstrated stronger associations in metabolically favorable groups, supported by nominally significant interaction and heterogeneity tests. CDKN2A/B showed associations across metabolic strata, with evidence of differences in genetic effects. KCNQ1 exhibited broadly consistent associations, although evidence of interaction varied by metabolic index. CNNM2, HNF1B, HNF4A, SLC30A8, and DNAJC5B–TRIM55 displayed subgroup-dependent patterns of statistical significance, which did not uniformly correspond to significant interaction effects. ALDH2 showed distinct association patterns across metabolic strata and between men and women. These findings suggest that genetic associations with T2DM may vary according to metabolic context, although subgroup-specific genome-wide significance does not necessarily establish differential genetic effects. Formal interaction and heterogeneity analyses provide additional evidence for metabolic effect modification at selected loci, suggesting that metabolic stratification may help characterize variation in genetic associations with T2DM in the Korean population.

Background: Oxidative stress is a key contributor to the pathogenesis of Alzheimer's disease and other dementias. The oxidative balance score (OBS), which reflects combined dietary and lifestyle exposure to pro-oxidant and antioxidant factors, serves as an integrated measure of oxidative stress burden. Objective: To investigate the association between OBS and predicted late-life dementia risk using the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score. Methods: We analyzed data from 5088 participants aged 40–69 years without dementia at baseline from the Korean Genome and Epidemiology Study. Participants were categorized by OBS tertiles. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for developing a high risk of late-life dementia, defined by a CAIDE score ≥8. Longitudinal changes in CAIDE scores were assessed using linear mixed-effects models. Results: During a mean follow-up of 12.8 years, 1468 participants (28.9%) progressed to CAIDE-predicted high risk for late-life dementia. Compared with the lowest OBS tertile (T1), participants in the highest tertile (T3) had a significantly lower risk for developing high-risk late-life dementia (HR 0.74, 95% CI 0.65–0.84) and exhibited the lowest CAIDE scores ( p < 0.001). Each one-point increase in the OBS was associated with a 3% reduction in CAIDE-predicted dementia risk. Conclusions: A higher OBS was significantly associated with a lower predicted risk of late-life dementia. These findings suggest that maintaining an antioxidant-rich diet and a healthy lifestyle during midlife may be effective strategies for dementia prevention.

Aims: Pancreatic cancer remains one of the most lethal malignancies due to late diagnosis and limited opportunities for prevention. Cardiovascular–kidney–metabolic (CKM) syndrome reflects the cumulative burden of metabolic, renal, and cardiovascular dysfunction, but its association with pancreatic cancer risk has not been well established. We investigated this relationship in a large prospective cohort from the UK Biobank. Materials and Methods: Participants without pancreatic cancer at baseline (2006–2010) were followed through national cancer and mortality registries until 31 December 2022. CKM syndrome was categorised into five stages (0–4) according to American Heart Association criteria. Incident pancreatic cancer was identified using ICD‐9 and ICD‐10 codes. Fine–Gray subdistribution hazard models accounting for death were used to estimate subdistribution hazard ratios (SHRs) and 95% confidence intervals (CIs), with prespecified subgroup analyses performed. Results: Among 326,148 participants, 1234 incident pancreatic cancer cases were identified over a mean follow‐up of 13.5 years (SD 2.0). Incidence rates increased progressively from 9.0 to 48.6 per 100,000 person‐years across CKM stages. Compared with CKM stage 0, multivariable‐adjusted SHRs for pancreatic cancer were 1.97 (95% CI 1.28–3.02) for stage 1, 2.02 (1.42–2.87) for stage 2, and 2.08 (1.42–3.04) for stages 3–4 ( p for trend < 0.001). Associations were generally consistent across subgroup analyses according to age, sex, smoking status, and alcohol consumption, without statistically significant interaction effects. Conclusions: Advanced CKM syndrome was independently associated with higher pancreatic cancer risk, supporting its potential role in risk stratification and early detection strategies.

Background/Objectives: The Mediterranean diet is widely recognized for its cardiovascular and metabolic benefits, including weight reduction; however, the metabolic mechanisms underlying these effects remain incompletely understood. This study investigated whether changes in circulating polyamines are associated with metabolic improvements following a Mediterranean diet intervention, particularly in breast cancer survivors. Methods: This exploratory secondary analysis used stored paired serum samples from a previously reported 8-week controlled intervention conducted in three groups: Group A (breast cancer survivors following a Mediterranean diet alone, n = 21), Group B (breast cancer survivors following a Mediterranean diet combined with naltrexone/bupropion, n = 23), and Group C (non-cancer participants receiving the combined intervention, n = 28). Paired polyamine data were available for 16, 9, and 16 participants, respectively. Breast cancer survivors were randomized to Groups A and B, whereas Group C was enrolled as a non-randomized active comparison group. Serum metabolic profiles were analyzed using liquid chromatography–mass spectrometry-based untargeted metabolomics, and nine polyamines were quantified using targeted analysis. An exploratory indirect-effect analysis examined associations between changes in serum polyamines and clinical outcomes, including body composition and lipid parameters. Results: Body weight, fat mass, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) decreased significantly within all three groups after the 8-week intervention (median changes: −1.9 to −2.8 kg, −1.9 to −2.8 kg, and −0.3 to −0.7, respectively). LDL cholesterol decreased significantly only within the two groups receiving naltrexone/bupropion (median changes: −20.6 and −10.1 mg/dL). However, between-group differences in these changes were not statistically significant. N-acetylspermine increased nominally in all groups (p < 0.01), whereas spermine increased only in the Mediterranean diet alone group (p = 0.015). Conclusions: Mediterranean diet-related metabolic improvements were accompanied by changes in circulating polyamines. Spermine and N-acetylspermine may represent candidate metabolic response markers associated with nutritional and pharmacological interventions in breast cancer survivorship.

This study examined associations between dietary habits and the risk of developing Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE)-predicted late-life dementia risk in Korean adults. A total of 5,042 participants aged 40–69 years were included. We assessed associations between dietary patterns—the Mediterranean diet, Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) diet, Korean Healthy Eating Index (KHEI), and Empirical Dietary Inflammatory Index (EDII)—and CAIDE-predicted high risk of dementia. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, and cumulative incidence was assessed using Kaplan–Meier analysis. Longitudinal trajectories of CAIDE scores over a 10-year period were analyzed using linear mixed-effects models. During follow-up of 15.83 years, 30.9% progressed to CAIDE-predicted high risk of dementia. The highest tertile of the Mediterranean diet, MIND diet, and KHEI were associated with lower cumulative incidence (P = .008, P < .001, and P < .001) and reduced risk of progression to CAIDE-predicted high risk of dementia (HR 0.78, 95% CI 0.67–0.90, HR 0.80, 95% CI 0.69–0.93, and HR 0.80, 95% CI 0.70–0.91, respectively) along with lower CAIDE score (P < .001, P < .001, P = .002). Conversely, the highest EDII tertile showed the highest cumulative incidence (P < .001), an increased risk of progression to CAIDE-predicted high risk of dementia (HR 1.15, 95% CI 1.01–1.32), and elevated CAIDE scores (P < .001). Greater adherence to the Mediterranean diet, MIND diet, and KHEI, and lower consumption of pro-inflammatory diets were associated with a lower risk of high CAIDE-predicted late-life dementia and slower accumulation of risk factors. Graphical Abstract The alternative text for this image may have been generated using AI.

Objective: Nutritional management is essential in caring for patients with chronic kidney disease (CKD), older adults at higher risk of malnutrition and comorbidities. However, data on actual dietary intake patterns in older adults with predialysis CKD, especially by diabetes mellitus (DM) status, remain limited.Methods: This cross-sectional study included 106 patients aged ≥65 years with CKD stage G3a or higher, divided into DM (n=67) and non-DM (n=39) groups. Dietary intake was assessed using a single 24-hour recall. Nutrient and food-group intakes were compared with recommended levels.Results: In both groups, energy intake was lower than recommended levels. More than half of the participants exceeded sodium limits, and approximately half consumed excess protein. Patients with DM had significantly higher protein intake and blood urea nitrogen (BUN) levels than those without DM. Most food groups, except protein foods, were consumed below recommended levels.Conclusion: Dietary patterns in older adults with predialysis CKD showed low energy intake, high sodium intake, and relatively high protein intake. Those with DM had higher protein intake and BUN levels, suggesting dietary differences by diabetes status. These findings underscore the need for age-sensitive, individualized nutritional management strategies that consider kidney function and DM status.

Aims: Cardiovascular diseases (CVD) are the leading cause of death worldwide, with excess visceral adipose tissue (VAT) being identified as an independent indicator of poor cardiovascular outcomes. We examined the association between three indices of VAT, namely, metabolic score for visceral fat (METS‐VF), visceral adiposity index (VAI), and lipid accumulation product (LAP), and the development of CVD in a large cohort of middle‐aged Korean adults. Materials and Methods: The study recruited 8192 participants without CVD at baseline from the Korean Genome and Epidemiology Study. METS‐VF, VAI, and LAP were calculated using established formulas based on anthropometric and metabolic parameters. Incident CVD was defined based on self‐reported physician diagnoses confirmed by trained interviewers. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard ratio (HR) with a 95% confidence interval (CI) for incident CVD. Heagerty's integrated areas under the receiver operating characteristic curves (iAUC) were used to compare the discriminatory performance of three indices. Results: The adjusted HRs (95% CIs) for incident CVD in the highest tertile compared with the lowest tertile were 1.62 (1.29–2.03), 1.38 (1.08–1.77), and 1.66 (1.32–2.09) for METS‐VF, VAI, and LAP, respectively. METS‐VF showed statistically higher discriminatory performance than VAI and LAP for incident CVD ( p < 0.001), although the overall discriminative ability of indices was modest. Conclusions: METS‐VF, VAI, and LAP were independently associated with an increased risk of CVD events. Among these indices, METS‐VF demonstrated relatively better discriminatory performance, suggesting its potential role as a complementary tool for cardiovascular risk stratification.

Steatotic liver disease (SLD) is a chronic condition associated with cardiometabolic risk. The body roundness index (BRI) is a novel visceral adiposity marker. We evaluate the associations between BRI and risks of SLD, major adverse liver-related outcomes (MALO), liver-related mortality, and all-cause mortality using the UK Biobank cohort. Data from 399,115 participants (aged 37–73 years) without baseline SLD or MALO were analyzed. BRI was categorized into sex-specific quartiles. Outcomes were identified via national health records. Adjusted hazard ratios (HRs) were estimated using Fine–Gray competing risk models and Cox proportional hazards models. During a median follow-up of 13.9 years, the incidence of SLD, MALO, liver-related mortality, and all-cause mortality was 1.38%, 1.25%, 0.24%, and 8.31%, respectively. Higher BRI was significantly associated with increased SLD risk (HR 6.20; 95% CI 5.28–7.28), with a more pronounced association in women (HR 9.11) than in men (HR 3.38). Significant non-linear, J-shaped associations were observed for SLD and all-cause mortality (both p for nonlinearity < 0.001). Conversely, MALO and liver-related mortality showed linear positive associations (p for nonlinearity > 0.05), with significant risks primarily observed in the highest BRI quartiles. Higher BRI is significantly associated with increased risks of SLD, MALO, and bothliver-related and all-cause mortality. These findings suggest that BRI is a valuable tool for identifying individuals at risk of adverse hepatic outcomes, potentially offering predictive utility beyond conventional anthropometric indices. The online version contains supplementary material available at 10.1186/s12876-026-04679-8.

Background: Smoking is a global health risk known to elevate hemoglobin (HB) levels through its effects on hematopoiesis. Urine cotinine, a metabolite strongly correlated with serum cotinine, serves as an effective biomarker for assessing smoking status. This study aimed to explore the relationship between urinary cotinine levels and both HB and hematocrit (HCT) levels in a Korean population.Methods: The study analyzed 4,454 healthy participants, categorized into three groups based on urine cotinine tertiles. Steiger’s Z tests were used to assess correlations between HB, HCT levels, and urine cotinine. After adjusting for clinical variables, multiple linear regression was employed to evaluate the relationship between urine cotinine levels and HB/HCT. Receiver operating characteristic curves helped determine the cut-off values for urine cotinine in relation to HB and HCT levels.Results: After adjusting for covariates, a positive correlation was found between urine cotinine and both HB and HCT levels. HB levels were 18% higher in the second tertile and 23% higher in the highest tertile than the lowest. Similarly, HCT levels increased by 44% in the second tertile and 50% in the highest tertile. The highest tertiles of HB and HCT had values of 504.650 and 202.950, respectively, with area under the curve values of 0.634 for HB and 0.616 for HCT.Conclusion: This study demonstrates a significant correlation between urine cotinine levels and elevated HB and HCT levels in a representative Korean population. Clinicians should consider urine cotinine levels when assessing anemia in smokers or individuals exposed to secondhand smoke. Further research is needed to validate these findings.