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1.  Cancer Risk in Adult Residents near Nuclear Power Plants in Korea - A Cohort Study of 1992-2010 
Journal of Korean Medical Science  2012;27(9):999-1008.
This study evaluated cancer risk for adult residents near Nuclear Power Plants (NPPs) in Korea through a valid prospective cohort study during 1992-2010. The study cohort was composed of 11,367 adults living within a five km radius from the NPPs for the exposed and 24,809 adults for the non-exposed or reference cohort set at two different levels of proximity; 5-30 km radius and more than 30 km radius away from NPPs. In 303,542.5 person-years of follow-up, a total of 2,298 cancer cases of all sites, or 1,377 radio-inducible cancers diagnosed during 1992-2008 were ascertained. Multiple adjusted hazard ratios and 95% confidence intervals were estimated using multivariate Cox proportional hazard model. There were no epidemiological evidence for increased risk of cancer due to radiation from NPPs. Radiological study results or surveillance data of radiation doses around NPPs could be well documented for risk estimation of radio-inducible cancers, instead of epidemiological study results of the long-time required. Continuous surveillance of quantitative measures of dose levels around NPPs and radiation exposures to the residents is warranted.
doi:10.3346/jkms.2012.27.9.999
PMCID: PMC3429841  PMID: 22969244
Cancer Risk; Nuclear Power Plants (NPPs); Residents near NPPs; Radiation; Cohort Studies
2.  Completeness of Cancer Case Ascertainment in Korea Radiation Effect and Epidemiology Cohort Study 
Journal of Korean Medical Science  2012;27(5):489-494.
The aim of this study was to evaluate whether the completeness of case ascertainment during the follow-up of a cohort differed between the exposed and the nonexposed groups in Korea Radiation Effect and Epidemiology Cohort (KREEC). The completeness was defined as the proportion of the number of detected cases to the number of estimated cases, in which the estimation was performed by capture-recapture method. Data were obtained from the cancer registries, death certificates, and medical records during years 2004-2007. Among 11,367 subjects in the exposed group and 24,809 subjects in the unexposed group, the completeness of cancer case ascertainment were 88.2% vs 87.2% in cancer registry, 38.2% vs 41.1% in death certificate and 57.9% vs 62.0% in medical records data, 96.9% vs 97.1% for all combined sources and were not statistically different between the two groups. In conclusion, the method of ascertaining the cases in the KREEC was not biased depending on the exposure status, and thus adds credibility to the outcomes of the KREEC study as well as confirming the incident cases in the two groups.
doi:10.3346/jkms.2012.27.5.489
PMCID: PMC3342538  PMID: 22563212
Cohort Studies; Data Collection; Neoplasms; Validity
3.  Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults 
This study was conducted to evaluate the association of single serum total cholesterol (TC) measurement with cardiovascular diseases (CVD) deaths in Korean adults. The study subjects were taken from the multi-site collaborative dynamic prospective cohort for epidemiologic investigation on cancer risk in residents nearby nuclear power plants in Korea. A total of 12,740 adults aged 40 to 69 yr who underwent a mass screening examination were followed up from 1993 to 2008. Occurring CVD deaths were confirmed by the death certificates in the National Statistical Office, Korea. Groups with the lowest group having TC < 160 mg/dL as well as the highest group having >= 240 mg/dL were associated with higher CVD mortality in Cox proportional hazards analysis adjusting for age, sex, smoking and drinking status, body mass index, level of blood pressure, triglyceride and high density lipoprotein cholesterol. The distribution of adjusted hazard ratios showed the U-shaped curve. Based on the results of this study, caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk in Korean adults.
doi:10.3346/jkms.2012.27.1.58
PMCID: PMC3247776  PMID: 22219615
Cholesterol; Cardiovascular Diseases; Mortality; Stroke; Cohort Studies
4.  Molecular Epidemiology of Colon Cancer 
Colorectal cancer appears to have rapidly increased over the past two decades in Korea. Environmental factors, characterized by a western life style, seem to be closely related to the increased risk of colorectal cancer. Higher intakes of meat, a lower vegetable intake, a lack of physical activity, obesity, and alcohol drinking have been suggested to be risk factors for colorectal cancer in the numerous epidemiologic studies. Several specific associations have also been observed between genetic polymorphisms and colorectal cancer. Moreover, it has been postulated that environmental factors and a genetic predisposition work in concert in colorectal cancer development. A stronger association between red meat intake and colorectal cancer among those with rapid acetylators at either the NAT1 or NAT2 locus was reported, particularly for colorectal cancer associated with K-ras mutations. The protective effect of the homozygous variant TT form of the MTHFR genotype on the risk of colon cancer seems to be modified by the level of methyl diets, i.e., by folate, which has a protective effect, or conversely by alcohol. The insulin-related pathway, which possibly explains at a mechanistic level the effect of physical activity and obesity on colon cancer, appears to be a common denominator in colon cancer and in other metabolic disorders, such as diabetes mellitus and dyslipidemia. Hyperinsulinemia has been proposed as an explanation for the association between a Western lifestyle and colon cancer risk. Further studies, that incorporate both genetic and environmental factors, are needed to fully explain and identify the underlying pathway of colorectal carcinogenesis.
doi:10.4143/crt.2004.36.2.93
PMCID: PMC2855094  PMID: 20396547
Colon neoplasm; Risk factors; Genetic susceptibility; Molecular epidemiology
5.  Cardiovascular Health Metrics and All-cause and Cardiovascular Disease Mortality Among Middle-aged Men in Korea: The Seoul Male Cohort Study 
Objectives
This study estimated the association of cardiovascular health behaviors with the risk of all-cause and cardiovascular disease (CVD) mortality in middle-aged men in Korea.
Methods
In total, 12 538 men aged 40 to 59 years were enrolled in 1993 and followed up through 2011. Cardiovascular health metrics defined the following lifestyle behaviors proposed by the American Heart Association: smoking, physical activity, body mass index, diet habit score, total cholesterol, blood pressure, and fasting blood glucose. The cardiovascular health metrics score was calculated as a single categorical variable, by assigning 1 point to each ideal healthy behavior. A Cox proportional hazards regression model was used to estimate the hazard ratio of cardiovascular health behavior. Population attributable risks (PARs) were calculated from the significant cardiovascular health metrics.
Results
There were 1054 total and 171 CVD deaths over 230 690 person-years of follow-up. The prevalence of meeting all 7 cardiovascular health metrics was 0.67%. Current smoking, elevated blood pressure, and high fasting blood glucose were significantly associated with all-cause and CVD mortality. The adjusted PARs for the 3 significant metrics combined were 35.2% (95% confidence interval [CI], 21.7 to 47.4) and 52.8% (95% CI, 22.0 to 74.0) for all-cause and CVD mortality, respectively. The adjusted hazard ratios of the groups with a 6-7 vs. 0-2 cardiovascular health metrics score were 0.42 (95% CI, 0.31 to 0.59) for all-cause mortality and 0.10 (95% CI, 0.03 to 0.29) for CVD mortality.
Conclusions
Among cardiovascular health behaviors, not smoking, normal blood pressure, and recommended fasting blood glucose levels were associated with reduced risks of all-cause and CVD mortality. Meeting a greater number of cardiovascular health metrics was associated with a lower risk of all-cause and CVD mortality.
doi:10.3961/jpmph.2013.46.6.319
PMCID: PMC3859853  PMID: 24349653
Cardiovascular diseases; Cohort studies; Cox proportional hazards models; Life style; Mortality
6.  Pulmonary Tuberculosis and Lung Cancer Risk in Current Smokers: The Seoul Male Cancer Cohort Study 
Journal of Korean Medical Science  2013;28(6):896-900.
Authors evaluated pulmonary tuberculosis (PTB) history as a risk factor for lung cancer in current male smokers in a prospective, population-based cohort study. The subjects were the 7,009 males among the participants in the Seoul Male Cancer Cohort Study for whom there was full information on PTB history and smoking habits. With a 16-yr follow-up, 93 cases of lung cancer occurred over the 99,965 person-years of the study. The estimated relative risk (RR) of PTB history of current smokers in lung cancer after adjusting for three confounders - intake of coffee and tomatoes, and age at entry - was 1.85 (95% CI: 1.08-3.19). The observed joint RRs and attributable risks (ARs) across strata of three confounders were greater than the expected, indicating a positive interaction. Thus a history of PTB in current smokers may be another risk factor for lung cancer. Based on a synergic interaction, a heavy male smoker with a PTB history would be expected to belong to the group at high risk of lung cancer.
doi:10.3346/jkms.2013.28.6.896
PMCID: PMC3678007  PMID: 23772155
Lung Neoplasms; Cancer Incidence; Tuberculosis, Pulmonary; Smoking; Effect Modifier; Cohort Studies
7.  Lung Cancer Incidence by Smoking Status in Korean Men: 16-Years of Observations in the Seoul Male Cancer Cohort Study 
Journal of Korean Medical Science  2013;28(4):636-637.
The relative risk (RR) of smoking and mortality of lung cancer in British doctors was previously reported to have increased throughout a 40-yr period. Here, we evaluated this RR based on the incidence of lung cancer in Korean men using a longer follow-up period. We compared our data to the RR reported in a study using a 10-yr follow-up period; the subjects and methods were identical to those of the previous paper with the exception of the follow-up period, which ended on December 31, 2008. We found that the RR of smoking habits in patients with lung cancer did not increase, and that the data showed narrowing 95% confidence intervals over a longer observation in Korean men. Estimated lung cancers attributable to smoking were 55.6%. These results highlight the need for an intervention program to help patients quit smoking in Korea.
doi:10.3346/jkms.2013.28.4.636
PMCID: PMC3617322  PMID: 23580076
Cancer Incidence; Cigarette Smoking; Cohort Study; Lung Neoplasm
8.  Prevalence Rate and Associated Factors of Sarcopenic Obesity in Korean Elderly Population 
Journal of Korean Medical Science  2012;27(7):748-755.
This study was conducted to estimate the prevalence rates and to explore associated factors of sarcopenic obesity (SO) in 2,221 Koreans over 60 yr-of age from the Fourth Korea National Health and Nutrition Examination Survey (2009). Participants were assessed by dual energy X-ray absorptiometry. Appendicular skeletal muscle mass divided by body weight was used to define sarcopenia and waist circumference was used to define obesity. We estimated the prevalence rates of SO according to age-groups, sex and region. In addition, each group was compared by demographic characteristics, metabolic status, nutrition, and physical activity. The prevalence rates of SO were 6.1% (95% confidential interval [CI] = 6.1-6.2) for men and 7.3% (95% CI = 7.3-7.3) for women, respectively. SO was positively associated with no current working and the number of combined medical conditions. High serum insulin level was positively associated with SO, whereas vitamin D was negatively associated with SO in both men and women. In conclusion, the prevalence rates of SO are 6.1% in men and 7.3% in women. SO is associated with insulin resistance, inappropriate nutrition, and low physical activity.
doi:10.3346/jkms.2012.27.7.748
PMCID: PMC3390722  PMID: 22787369
Sarcopenia; Obesity; Aging; Prevalence; Epidemiology
9.  Impact of Individual and Combined Health Behaviors on All Causes of Premature Mortality Among Middle Aged Men in Korea: The Seoul Male Cohort Study 
Objectives
The aim of this study was to evaluate and quantify the risk of both individual and combined health behaviors on premature mortality in middle aged men in Korea.
Methods
In total, 14 533 male subjects 40 to 59 years of age were recruited. At enrollment, subjects completed a baseline questionnaire, which included information about socio-demographic factors, past medical history, and life style. During the follow-up period from 1993 to 2008, we identified 990 all-cause premature deaths using national death certificates. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of each health risk behavior, which included smoking, drinking, physical inactivity, and lack of sleep hours. Using the Cox model, each health behavior was assigned a risk score proportional to its regression coefficient value. Health risk scores were calculated for each patient and the HR of all-cause premature mortality was calculated according to risk score.
Results
Current smoking and drinking, high body mass index, less sleep hours, and less education were significantly associated with all-cause premature mortality, while regular exercise was associated with a reduced risk. When combined by health risk score, there was a strong trend for increased mortality risk with increased score (p-trend < 0.01). When compared with the 1-9 score group, HRs of the 10-19 and 20-28 score groups were 2.58 (95% confidence intervals [CIs], 2.19 to 3.03) and 7.09 (95% CIs, 5.21 to 9.66), respectively.
Conclusions
Modifiable risk factors, such as smoking, drinking, and regular exercise, have considerable impact on premature mortality and should be assessed in combination.
doi:10.3961/jpmph.2012.45.1.14
PMCID: PMC3278600  PMID: 22389754
Cohort studies; Life style; Mortality; Risk factors
10.  Polymorphisms in innate immunity genes and risk of childhood leukemia 
Human immunology  2010;71(7):727-730.
Objectives
To evaluate whether candidate genes in innate immunity are associated with childhood leukemia, we conducted an association study with the 1,536 SNPs in 203 genes related to innate immunity.
Methods
Incident childhood leukemia cases (n=136) aged from 0 to 18 were recruited from three teaching hospitals in Seoul between 2003 and 2006. Non-cancer controls (n=140) were frequency-matched to cases by age and gender. The information on the characteristics of children and their parents were collected by trained interviewers using structured questionnaire. Candidate genes were selected based on SNP databases (CGAP and SNP500 database), and genotype assay was performed using GoldenGate (Illumina) oligonucleotide pool assay (OPA). False discovery rate (FDR), permutation test, and haplotype analyses were used to identify the SNP with significant association with childhood leukemia. Childhood leukemia risk was estimated as ORs and 95% CIs adjusted for age, gender and birth weight.
Results
Fourteen SNPs in 13 genes (LMAN1, TLR4, STAT4, CCR9, MBP, ZP1, C8B, XDH, C7, C1QG, FGF2, LOC390183, and STAT6) were significantly associated with childhood leukemia risk (FDR p-values <0.05). In particular, LMAN1 rs1127220, TLR4 rs11536897, STAT4 rs13020076, CCR9 rs1471962, and MBP rs10514234 were significant in 5,000 permutation tests (Permutation p-value <0.05). The most significant association with childhood leukemia risk was for the LMAN1 rs1127220 that is in the protein-coding region, this finding was also supported by haplotype analysis.
Conclusions
A number of innate immunity related genes are associated with childhood leukemia, suggesting possible links between the innate immunity system and development of the childhood leukemia.
doi:10.1016/j.humimm.2010.04.004
PMCID: PMC2967770  PMID: 20438785
Childhood Leukemia; Innate Immunity; Single Nucleotide Polymorphism
11.  Polymorphisms in the selenoprotein S and 15-kDa selenoprotein genes are associated with altered susceptibility to colorectal cancer 
Genes & Nutrition  2010;5(3):215-223.
Selenium (Se), a dietary trace metal essential for human health, is incorporated into ~25 selenoproteins including selenoprotein S (SelS) and the 15-kDa selenoprotein (Sep15) both of which have functions in the endoplasmic reticulum protein unfolding response. The aim of this study was to investigate whether genetic variants in such selenoprotein genes are associated with altered risk of colorectal cancer (CRC). A Korean population of 827 patients with CRC and 733 healthy controls was genotyped for 7 SNPs in selenoprotein genes and one SNP in the gene encoding manganese superoxide dismutase using Sequenom technology. Multivariate logistic regression analysis showed that after adjustment for lifestyle factors three SNP variants were associated with altered disease risk. There was a mean odds ratio of 2.25 [95% CI 1.13,4.48] in females homozygous TT for rs34713741 in SELS with the T variant being associated with higher risk of rectal cancer, and odds ratios of 2.47 and 2.51, respectively, for rs5845 and rs5859 in SEP15 with the minor A and T alleles being associated with increased risk of male rectal cancer. The data indicate that the minor alleles for rs5845, rs5859 and rs34713741 are associated with increased rectal cancer risk and that the effects of the three SNPs are dependent on gender. The results highlight potential links between Se, the function of two selenoproteins involved in the protein unfolding response and CRC risk. Further studies are required to investigate whether the effects of the variants on CRC risk are also modulated by dietary Se intake.
doi:10.1007/s12263-010-0176-8
PMCID: PMC2935533  PMID: 21052528
Selenium; Rectal cancer; 15-kDa selenoprotein; Selenoprotein S; SNP
12.  Paternal smoking, genetic polymorphisms in CYP1A1 and childhood leukemia risk 
Leukemia research  2008;33(2):250-258.
We conducted a case–control study to evaluate the association between paternal smoking and childhood leukemia and to evaluate potential modification by polymorphisms in CYP1A1. Histologically confirmed childhood leukemia cases (n = 164) and non-cancer controls (n = 164) were recruited from three teaching hospitals in Seoul, Korea. Five single nucleotide polymorphisms in CYP1A1 (–17961T>C, –9893G>A, I462V, 1188C>T (*2A), and 11599C>G) were genotyped and haplotypes were estimated by the expectation-maximization method. We also conducted a meta-analysis of 12 studies that have reported the association between paternal smoking and childhood leukemia risk. Paternal smoking at home was associated with all leukemias (OR = 1.8, 95% CI = 1.1–2.8) and acute lymphoblastic leukemia (ALL) (2.0, 1.2–3.4). An increasing trend in risk was observed for pack-years smoked after birth (Ptrend = 0.06 and 0.02, respectively) and the number of smokers in the home during the child's life (Ptrend = 0.05 and 0.03, respectively). Among those without the CGACC haplotype, ALL risk was significantly increased by the father's smoking at home (2.8, 1.5–5.3) and the presence of at least one smoker in the home (2.3, 1.2–4.4), and the test for interaction was significant (Pinteraction = 0.03 and 0.02, respectively). The meta-analysis showed that overall paternal smoking (1.13, 1.04–1.24) and smoking before the pregnancy of the child (1.12, 1.04–1.21) were significantly associated with childhood leukemia risk. Our results suggest that paternal smoking is a risk factor for childhood leukemia and the effect may be modified by CYP1A1 genotype.
doi:10.1016/j.leukres.2008.06.031
PMCID: PMC2787091  PMID: 18691756
Childhood leukemia; Paternal smoking; CYP1A1; Interaction; Haplotype
13.  Nationwide Cancer Incidence in Korea, 2003-2005 
Purpose
To estimate the current cancer burden in Korea, newly diagnosed cancer cases and cancer incidence rates were calculated for the years 2003~2005.
Materials and Methods
The cancer incidence cases and rates were calculated from the Korea National Cancer Incidence Database. Crude and age-standardized incidence rates were calculated by gender for specified cancer sites in 5-year age groups.
Results
From 2003 to 2005, 398,824 cases of cancer were newly diagnosed in Korea (218,856 in men and 179,968 in women). For all sites combined, the crude incidence rate (CR) was 300.0 and 248.2 for men and women and the age-standardized incidence rate (ASR) was 297.0 and 191.2 per 100,000, respectively. Among men, five leading cancers were stomach (CR 66.0, ASR 64.2), lung (CR 48.5, ASR 50.3), liver (CR 44.9, ASR 42.1), colon and rectum (CR 37.9, ASR 37.2), and prostate cancer (CR 12.7, ASR 13.8). Among women, five leading cancers were breast (CR 37.3, ASR 29.0), thyroid (CR 36.2, ASR 28.8), stomach (CR 34.1, ASR 25.4), colon and rectum (CR 28.0, ASR 21.1), and lung cancer (CR 17.9, ASR 12.8). In the 0~14-year-old group, leukemia was the most common in both sexes; in the 15~34 group, the most common cancer was stomach cancer for men and thyroid cancer for women; in the 35~64 group, stomach cancer for men and breast cancer for women; among those 65 and over, lung cancer for men and stomach cancer, for women, respectively.
Conclusion
The cancer incidence rates have increased in recent years, and more cancers are expected to develop as Korea is quickly becoming an aged society. The cancer incidence statistics in this report can be used as an important source to effectively plan and evaluate the cancer control program in Korea.
doi:10.4143/crt.2009.41.3.122
PMCID: PMC2757659  PMID: 19809561
Cancer incidence; Nationwide cancer registry; Korea
14.  Cigarette Smoking and Risk of Lung Cancer in Korean Men: The Seoul Male Cancer Cohort Study 
Journal of Korean Medical Science  2007;22(3):508-512.
Lung cancer is the leading cause of cancer deaths in Korea. The aim of this study was to estimate lung cancer risk of cigarette smoking in Korean men by a 10-yr follow-up prospective cohort study using the primary databases. The number of subjects was 14,272 men, who had full information of smoking habits among participants in the Seoul Male Cancer Cohort Study (SMCC). Total 125,053 person-years were calculated by determining the number of days from the start of follow-up, January 1, 1993, until the date of lung cancer diagnosis, death from another cause, or the end of follow-up, December 31, 2002, followed by converting the number of days to years. The information of outcome was obtained by the database of Korea Central Cancer Registry, Seoul Regional Cancer Registry, and Korea Statistical Office. The relative risk (RR) and its 95% confidence interval (CI) values of smoking were calculated using Cox proportional hazards regression stratified on potential confounders. During the follow-up periods, 78 cases of lung cancer occurred. The cigarette smoking is the major risk factor and increases the 4.18-fold risk of lung cancer in Korean men. In order to control lung cancer, intervention of quitting smoking is needed.
doi:10.3346/jkms.2007.22.3.508
PMCID: PMC2693646  PMID: 17596662
Lung Neoplasm; Cancer Incidence; Cigarette Smoking; Cohort Study
15.  A nested case-control study on the high-normal blood pressure as a risk factor of hypertension in Korean middle-aged men. 
Journal of Korean Medical Science  2002;17(3):328-336.
The aim of this study was to identify the 'high-normal blood pressure' as a risk factor of hypertension for applying primary prevention strategy in Korean people. To keep time sequence of events, and to prevent information bias, nested case control study was chosen for avoiding measurement errors because hypertension is a benign disease. Source population consisted of the 'Seoul Cohort' participants and follow-up was done by using Korea Medical Insurance Corporation's database on the utilization of health services from January 1, 1993 to June 30, 1997. Incidence cases were ascertained through the chart review, telephone contacts, and direct blood pressure measurements. Controls included the pairing of 4 individuals to each case on the basis of age. The statistically significant risk factors of hypertension were body mass index, dietary fiber, alcohol consumption, weekly activity, and history of quitting smoking as well as high-normal blood pressure (p<0.05). The multivariate odds ratio of high-normal blood pressure adjusted for all risk factors was 1.84 (95% CI, 1.31-2.56). Thus, the 'high-normal blood pressure' is considered as a risk factor for hypertension in Korean middle-aged men, which suggests that the vigorous lifestyle modification for persons with 'high-normal blood pressure' is needed.
PMCID: PMC3054892  PMID: 12068135
16.  Risk factors for hepatitis C virus infection among Koreans according to the hepatitis C virus genotype. 
Journal of Korean Medical Science  2002;17(2):187-192.
To investigate risk factors for HCV infection according to the genotype, we studied 178 patients positive for HCV-PCR and 226 controls that were negative for the anti-HCV antibody. One hundred and twenty five controls (community control) were recruited from spouses of HCV-PCR-positive patients and the other 101 from hospital visitors (hospital control). HCV genotyping was performed by PCR, and epidemiological data were obtained from all participants. The distribution of HCV genotypes was as follows -- 1a (0.6%), 1b (39.9%), 2a (38.2%), 2b (0%), 3 (1.1%), and unclassified (20.2%). By multivariate analysis, blood transfusion (OR 2.90) and endoscopy (OR 2.80) were found to be risk factors for HCV genotype 1b versus the community control. Similarly, blood transfusion (OR 3.17) was found to be risk factors for HCV genotype 1b versus the hospital control. Blood transfusion (OR 2.75) and endoscopy (OR 3.57) were risk factors for HCV genotype 2a versus the community control, and blood transfusion (OR 4.55) and endoscopy (OR 2.16) were those versus the hospital control. Our results suggest that the risk factors for HCV infection are similar among the different genotypes. Blood transfusion and endoscopy were found to be associated with HCV infection.
PMCID: PMC3054844  PMID: 11961301
17.  Association of body mass index and risk of death from pancreas cancer in Asians: findings from the Asia Cohort Consortium 
Objective
We aimed to examine the association between BMI and the risk of death from pancreas cancer in a pooled analysis of data from the Asia Cohort Consortium.
Methods
The data for this pooled-analysis included 883,529 men and women from 16 cohort studies in Asian countries. Cox proportional-hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for pancreas cancer mortality in relation to BMI. Seven predefined BMI categories (<18.5, 18.5–19.9, 20.0–22.4, 22.5–24.9, 25.0–27.4, 27.5–29.9, ≥30) were used in the analysis, with BMI of 22.5–24.9 serving as the reference group. The multivariable analyses were adjusted for known risk factors, including age, smoking, and history of diabetes.
Results
We found no statistically significant overall association between each BMI category and risk of death from pancreas cancer in all Asians, and obesity was unrelated to mortality risk in both East Asians and South Asians. Age, smoking, and history of diabetes did not modify the association between BMI and risk of death from pancreas cancer. In planned subgroup analyses among East Asians, an increased risk of death from pancreas cancer among those with a BMI<18.5 was observed for individuals with a history of diabetes; HR = 2.01(95%CI: 1.01–4.00) (p for interaction=0.07).
Conclusion
The data do not support an association between BMI and risk of death from pancreas cancer in these Asian populations.
doi:10.1097/CEJ.0b013e3283592cef
PMCID: PMC3838869  PMID: 23044748
body mass index; insulin resistance; obesity; overweight; pancreatic cancer
18.  Genome-wide association analyses in East Asians identify new susceptibility loci for colorectal cancer 
Nature genetics  2012;45(2):191-196.
To identify novel genetic factors for colorectal cancer (CRC), we conducted a genome-wide association study in East Asians. By analyzing genome-wide data in 2,098 cases and 5,749 controls, we selected 64 promising SNPs for replication in an independent set of samples including up to 5,358 cases and 5,922 controls. We identified four SNPs with a P-value of 8.58 × 10−7 to 3.77 × 10−10 in the combined analysis of all East Asian samples. Three of the four SNPs were replicated in a study conducted among 26,060 European descendants with a combined P-value of 1.22 × 10−10 for rs647161 (5q31.1), 6.64 × 10−9 for rs2423279 (20p12.3), and 3.06 × 10−8 for rs10774214 (12p13.32 near the CCND2 gene), respectively, derived from the meta-analysis of data from both East Asian and European populations. This study identified three new CRC susceptibility loci and provides additional insight into the genetics and biology of CRC.
doi:10.1038/ng.2505
PMCID: PMC3679924  PMID: 23263487
19.  Association between body mass index and cardiovascular disease mortality in east Asians and south Asians: pooled analysis of prospective data from the Asia Cohort Consortium 
Objective To evaluate the association between body mass index and mortality from overall cardiovascular disease and specific subtypes of cardiovascular disease in east and south Asians.
Design Pooled analyses of 20 prospective cohorts in Asia, including data from 835 082 east Asians and 289 815 south Asians. Cohorts were identified through a systematic search of the literature in early 2008, followed by a survey that was sent to each cohort to assess data availability.
Setting General populations in east Asia (China, Taiwan, Singapore, Japan, and Korea) and south Asia (India and Bangladesh).
Participants 1 124 897 men and women (mean age 53.4 years at baseline).
Main outcome measures Risk of death from overall cardiovascular disease, coronary heart disease, stroke, and (in east Asians only) stroke subtypes.
Results 49 184 cardiovascular deaths (40 791 in east Asians and 8393 in south Asians) were identified during a mean follow-up of 9.7 years. East Asians with a body mass index of 25 or above had a raised risk of death from overall cardiovascular disease, compared with the reference range of body mass index (values 22.5-24.9; hazard ratio 1.09 (95% confidence interval 1.03 to 1.15), 1.27 (1.20 to 1.35), 1.59 (1.43 to 1.76), 1.74 (1.47 to 2.06), and 1.97 (1.44 to 2.71) for body mass index ranges 25.0-27.4, 27.5-29.9, 30.0-32.4, 32.5-34.9, and 35.0-50.0, respectively). This association was similar for risk of death from coronary heart disease and ischaemic stroke; for haemorrhagic stroke, the risk of death was higher at body mass index values of 27.5 and above. Elevated risk of death from cardiovascular disease was also observed at lower categories of body mass index (hazard ratio 1.19 (95% confidence interval 1.02 to 1.39) and 2.16 (1.37 to 3.40) for body mass index ranges 15.0-17.4 and <15.0, respectively), compared with the reference range. In south Asians, the association between body mass index and mortality from cardiovascular disease was less pronounced than that in east Asians. South Asians had an increased risk of death observed for coronary heart disease only in individuals with a body mass index greater than 35 (hazard ratio 1.90, 95% confidence interval 1.15 to 3.12).
Conclusions Body mass index shows a U shaped association with death from overall cardiovascular disease among east Asians: increased risk of death from cardiovascular disease is observed at lower and higher ranges of body mass index. A high body mass index is a risk factor for mortality from overall cardiovascular disease and for specific diseases, including coronary heart disease, ischaemic stroke, and haemorrhagic stroke in east Asians. Higher body mass index is a weak risk factor for mortality from cardiovascular disease in south Asians.
doi:10.1136/bmj.f5446
PMCID: PMC3788174  PMID: 24473060

Results 1-19 (19)