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Background: Maternal diet quality during pregnancy may significantly influence fetal growth and birth weight. Objectives: This study aimed to assess the dietary quality of pregnant women in Korea and investigate its association with the risk of delivering a small-for-gestational-age (SGA) infant. Methods: A total of 1158 pregnant women and their newborns were recruited from the Mothers and Children’s Environmental Health (MOCEH) 2006–2010 cohort. Maternal dietary intake during gestational weeks 12–28 was assessed using a validated food frequency questionnaire. The nutrient adequacy ratio (NAR), mean adequacy ratio (MAR), and Korean Healthy Eating Index (KHEI) were employed to evaluate dietary quality. Birth outcomes were obtained from hospital records, and logistic regression analyses were performed to examine associations between maternal dietary quality and SGA risk. Results: Higher KHEI scores were significantly associated with increased nutrient intake, with the exception of fat, and demonstrated a positive association with the NAR of 15 nutrients. After adjusting for covariates, women in the highest KHEI quartile exhibited a significantly lower risk of SGA birth than those in the lowest quartile (adjusted odds ratio: 0.448; 95% confidence interval: 0.201–0.997; P-for-trend = 0.031). Conclusions: Enhanced maternal diet quality, as measured using the KHEI, is associated with improved nutrient intake and a reduced risk of SGA births among Korean pregnant women. These findings underscore the need for public health strategies that promote high-quality diets during pregnancy to improve birth outcomes.

Background Maternal diet during pregnancy might influence the development of childhood allergic disorders. There are few studies on the association between processed food intake and infant atopic dermatitis (AD) during pregnancy. The aim of the present study was to investigate the association of ultra-processed food (UPF) intake during pregnancy with infantile AD. Methods This study involved 861 pairs of pregnant women and their offspring from the Mothers’ and Children’s Environmental Health (MOCEH) study, a multi-center birth cohort project conducted in Korea. Dietary intake was estimated using a 24-h recall method at 12−28 weeks gestation. The NOVA classification was used to identify UPF, and UPF intake was calculated as the percentage of total energy consumption and categorized into quartiles. Infantile AD was assessed based on medical history and the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Associations were assessed by logistic regression with adjustment for confounding factors. Results Children born to mothers in the highest quartile of UPF consumption (15.5% or more of the total energy) compared to the lowest quartile (6.8% or less) showed a higher risk of AD within 12 months [odds ratio (OR) = 1.69; 95% confidence interval (CI): 1.07−2.66, P for trend 0.0436]. After adjustment for the confounding factors under study, the association was strengthened; the adjusted OR between extreme quartiles was 2.19 (95% CI: 1.11–4.32, P for trend = 0.0418). This association was maintained even after an additional adjustment based on the Korean Healthy Eating Index (KHEI), an indicator of diet quality. Conclusions Higher maternal consumption of UPF during pregnancy was associated with a greater risk of infantile AD within the first year of life.

We investigated the effects of particulate matter (PM) on mortality in patients diagnosed with asthma-COPD overlap (ACO) or ‘pure COPD’. Subjects from the National Health Insurance Service–National Sample Cohort of Korea, who were aged 40 years or above and had newly diagnosed COPD since 2009 were selected. Finally, 6,313 patients were enrolled and divided into ‘pure COPD’ and ACO groups. Average PM 10 exposure data were obtained using Kriging interpolation from 2001 to 2013. Hazard ratios(HR) were estimated using a time-varying Cox regression model. Exposure to PM 10 for 1, 3, and 6 months was associated with an increase in non-accidental mortality in the entire COPD group, especially the ACO group. When a stratified analysis of 3-month exposure was performed by sex, the highest HR was found in women with ACO (HR = 1.153; 95% confidence intervals [CI]: 1.121, 1.185). A stratified analysis according to smoking status showed that ACO patients had the highest HR among never smokers (HR = 1.151; 95% CI; 1.124, 1.178). Average exposure to PM 10 was associated with non-accidental mortality in patients with COPD, especially those diagnosed with ACO. In addition, the adverse effects of PM 10 exposure are more severe in women and never-smokers.

Overweight or obesity might be protective factors of tuberculosis (TB), but the evidence is inconclusive. The objective of study was to evaluate association between BMI and incident TB. The National Health Insurance database was used. Eligible participants were individuals aged 20-89 years without history of TB before 2007, and who underwent national health examinations between January 2002 and December 2006. The latest record of BMI was used as the exposure and categorized as follows: <18.5, 18.5-23, 23-25, 25-30, and ≥30 kg/m2. TB was defined as the first recorded diagnosis of TB, using ICD-10 between January 2007 and December 2013. Among 301,081 individuals, 3,772 (1.26%) incident TB cases were detected. The incidence rate of the event was 19.65 per 10,000 person-years. After adjusting age, sex, household income, smoking status, alcohol use, and diabetes, incident TB was decreased as BMI was increased in an inverse dose-response relationship. However, when stratified by age and sex, BMI >30 kg/m2 did not show protective effect of TB in female under 50 years. Additionally, BMI >30 kg/m2 did not decrease incident TB in diabetics. Our study suggests that high BMI might be associated with decreased risk of TB. However, very high BMI did not reduce the risk of TB in young females or diabetics participants with in Korean population.

The impact of COVID-19 pandemic on suicide remains unclear and might differ according to individuals’ socioeconomic characteristics. We aimed to investigate excess suicide attributable to COVID-19 in South Korea, stratified by the outbreak period and individual characteristics. We obtained daily time-series suicide mortality data for January 2017–December 2020 from the Korea National Statistics Office and performed a two-stage interrupted time-series analysis. We estimated excess suicide in 16 regions of Korea using a quasi-Poisson time-series regression model and pooled the region-specific estimates using a mixed-effects multivariate meta-analysis model in the first and second stages, respectively. From February 18 to December 31, 2020, suicide decreased by 9.5% [95% empirical confidence interval (eCI): 3.8%, 15.6%] compared to the number expected from the pre-pandemic period. The decrease in excess suicide risk from the initial pandemic was pronounced during the pandemic’s first and third waves. Further, we found that the decrease in suicide was more evident in individuals who were male [11.7% (95% eCI: 5.5%, 18.0%)], middle-aged [13.7% (95% eCI: 7.8%, 19.6%)], highly educated [12.6% (95% eCI: 6.4%, 19.4%)], and married [13.6% (95% eCI: 8.0%, 20.3%)] than in the general population, based on the point estimates. Our results provide timely evidence to establish public health policies for suicide prevention and suggest the prioritization of resource allocation for mental health of individuals based on individual characteristics.

Bisphenol A (BPA) is a type of endocrine-disrupting chemical utilized in the production of plastics like epoxy resins and polycarbonate polymers. BPA exhibits weak estrogenic and potent anti-androgenic effects, and prior research has linked it to disturbances in thyroid function. This study aims to assess the potential association between early childhood exposure to urinary bisphenol A and thyroid hormone levels in pubertal children from Korea. Participants were drawn from the Ewha Birth and Growth Cohort Study, encompassing individuals who visited Ewha Women's Mokdong Hospital between 2001 and 2005. The concentration of urinary BPA was repeatedly measured for each subject at ages 3-5 years and 7-9 years. Serum levels of free triiothyronine (T3), free thyroxine (T4), and thyroid-stimulating hormone (TSH) were measured at ages 10-12 years in a subgroup of 128 out of 164 subjects who had undergone repeated BPA concentration measurements. We utilized the SAS program to analyze possible links between childhood exposure to BPA and thyroid hormone function in adolescence. Additionally, we explored how exposure to BPA during two specific periods influenced changes in thyroid hormone levels. The study observed that urinary BPA levels at ages 3-5 years were not notably linked to thyroid hormone levels in adolescents aged 10-12 years. However, BPA levels at ages 7-9 years were significantly associated with free T3 levels in girls aged 10-12 years. Conversely, exposure to BPA did not result in significant differences in thyroid hormone levels among boys. The study did not find statistically significant connections between levels of urinary BPA and the other thyroid hormones, specifically TSH and free T4. There was a significant decrease in the concentration of free T3 in girls with higher BPA concentrations. BPA exposure in childhood affects thyroid function in adolescent girls. This relationship may contribute to an increased prevalence of thyroid disorders in adolescents due to environmental influences.

Background Although urinary tract infection (UTI) is a common and severe public health concern, and there are clear biological mechanisms between UTI and hot temperatures, few studies have addressed the association between hot temperatures and UTI. Methods We designed a time-stratified case-crossover study using a population-representative sample cohort based on the National Health Insurance System (NHIS) in South Korea. We obtained all NHIS-based hospital admissions through the emergency room (ER) due to UTI (using a primary diagnostic code) from 2006 to 2019. We assigned satellite-based reanalyzed daily summer (June to September) average temperatures as exposures, based on residential districts of beneficiaries (248 districts in South Korea). The conditional logistic regression was performed to evaluate the association between summer temperature and UTI outcome. Results A total of 4,436 ER visits due to UTI were observed during the summer between 2006 and 2019 among 1,131,714 NHIS beneficiaries. For 20% increase in summer temperatures (0–2 lag days), the odd ratio (OR) was 1.06 (95% CI: 1.02–1.10) in the total population, and the association was more prominent in the elderly (people aged 65 y or older; OR:1.11, 95% CI: 1.05–1.17), females (OR: 1.12, 95% CI: 1.05–1.19), and people with diabetes history (OR: 1.14, 95% CI: 1.07–1.23). The effect modification by household income was different in the total and elderly populations. Furthermore, the association between summer temperature and UTI increased during the study period in the total population. Conclusions Our results are consistent with the hypothesis that higher summer temperatures increase the risk of severe UTIs, and the risk might be different by sub-populations.

Inhaled corticosteroids (ICS) might lower the risk of coronary heart disease (CHD) in patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess the association of ICS with the development of CHD in COPD patients by using data from the Korean Nationwide study. Patients who were newly diagnosed with COPD between 2004 and 2013 and who were not diagnosed with coronary heart disease before their diagnosis of COPD were included. Exposure of ICS was incorporated into multivariable Cox regression models using time-dependent methods. To accurately estimate ICS-exposure accumulation, a washout period of 2 years from 2002 to 2003 was applied. Among a total of 4,400 newly diagnosed COPD patients, 771 patients were diagnosed as CHD incident cases during a median follow-up of one year (interquartile range 0.1–2.9). The cumulative dose of ICS was associated with a reduced risk of CHD (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], 0.52–0.89). When the cumulative exposure dose of ICS was divided into quartiles, the aHR for CHD incidence was 0.70 (95% CI, 0.55–0.88) in the highest quartile ICS dose use. The effect of ICS on reducing CHD incidence was pronounced in adults over 55 years, men under 55 years, and former smokers. Our findings demonstrate the role of ICS for the prevention of CHD in COPD patients without a history of CHD. Further research is needed to determine whether a certain amount of ICS exposure in COPD patients is protective against CHD.

Background Several studies have reported that climate change elevates heat exposure in pregnant women and high temperatures during pregnancy are associated with preterm births (PTBs). Although the association might be disproportionate, related evidence remains sparse. We evaluated the disproportionate risk of PTB associated with ambient temperature during pregnancy by individual and regional characteristics in South Korea. Methods We collected data on birth certificates and daily mean temperatures during the period from 2011 to 2019. A time-stratified case-crossover design was used to investigate the association between temperature and PTB and stratified analyses were conducted to examine the effect modification of individual and regional characteristics. Results A total of 160,067 singleton PTBs were recorded in Korea from 2011 to 2019. A 5℃ increase in the mean temperature during the last four weeks before delivery was associated with an increased risk of PTB with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 1.02, 1.05), and the association was more evident in mothers aged ≥35 years (OR: 1.06 [95% CI: 1.03, 1.10]) and with low education levels (OR: 1.04 [95% CI: 1.02, 1.05]). Additionally, the estimated risk was evident in districts with lower medical resources and more prominent disparities were shown by individual and regional characteristics in rural areas than in urban areas. Conclusions This study provides evidence that the risk of PTB related to ambient temperature is disproportionate by individual and regional characteristics and suggests the need for public health policies to alleviate the disparities, especially in rural areas.

Prenatal exposure to climate factors, air pollution, and green space has been linked to respiratory diseases in infants. However, the role of the combined effects of exposure to these factors on respiratory ailments remains unclear. Here we investigate the association of combined exposure to traffic-related air pollution (TRAP), climate factors, and green space during the prenatal period with respiratory diseases in infants. We enrolled 454 participants from the ongoing prospective birth cohort known as the Mothers and Children’s Environmental Health study. Data on infant respiratory diseases were collected from parents or guardians. Average exposure values of TRAP, climate factors, and green spaces for the study population were calculated based on geocoded residential addresses. Multiple logistic regression and quantile-based g-calculation models were utilized to examine the association of exposure to environmental factors and green space with respiratory diseases. The combined exposure to climate factors and TRAP during the first trimester of pregnancy was associated with an increased risk of respiratory diseases in infants. High levels of particulate matter with a diameter less than 2.5 μm (PM 2.5 ) and temperature increased the risk of respiratory diseases (adjusted odds ratio (AOR): 1.615, 95% confidence interval (CI): 1.001, 2.658). Additionally, the risk of respiratory diseases from exposure to air pollution and temperature was associated with lower tertiles of residential green spaces. The AOR was 1.064 (95% CI: 1.001, 1.133) per 1 µg/m 3 increase in PM 2.5 , 1.057 (95% CI: 1.001, 1.116) per 1 ppb increase in NO 2 , and 1.108 (95% CI: 1.001, 1.176) per 1 ℃ increase in temperature. Incorporating green space into the analysis of joint exposure to climate factors and air pollution reduced the risk of respiratory disease. This study proposes that combined exposures to climate factors, TRAP, and green spaces during pregnancy are associated with infant respiratory diseases. Fewer residential green spaces could enhance the association of climate factors and air pollution with respiratory diseases.