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Background: Whether body weight changes are associated with Parkinson's disease (PD) mortality remains uncertain. Objective: To investigate the association between changes in body mass index (BMI) and all-cause mortality in patients with PD. Methods: This nationwide cohort study enrolled 20,703 individuals with new-onset PD (ICD-10 code: G20 and a rare intractable disease registration code: V124) who underwent health screening program by the Korean National Health Insurance Service within two years from pre- and post-PD diagnosis. We identified nine BMI change groups based on three BMI status: underweight (BMI < 18.5 kg/m2), normal or overweight (18.5 kg/m2≤BMI < 25 kg/m2), and obese (BMI≥25 kg/m2). Results: Of 20,703 individuals, 3,789 (18.0%) died during the follow-up period. Excessive weight loss to underweight in the obese group (hazard ratio [HR] = 3.36, 95% CI:1.60–7.08), weight loss in the normal to overweight group (HR = 2.04, 95% CI:1.75–2.39), sustained underweight status (HR = 2.05, 95% CI:1.67–2.52), and weight gain from underweight to normal or overweight (HR = 1.52, 95% CI:1.15–2.02) were associated with increased mortality. Sustained obese status (HR = 0.80, 95% CI:0.74–0.87) and weight gain in the normal to overweight group (HR = 0.82, 95% CI:0.71–0.95) were associated with reduced mortality. Conclusions: We found that BMI change at diagnosis was associated with mortality in patients with PD. Specifically, being underweight either before or after diagnosis as well as experiencing weight loss, were associated with increased mortality. These findings provide valuable insights for weight management planning in PD, highlighting the importance of individualized approach that consider pre-diagnosis BMI. Plain Language Summary: Whether body weight changes are associated with Parkinson's disease (PD) mortality remains uncertain. This study looked at how changes in body weight affect the chances of survival in people who have recently been diagnosed with PD. We followed 20,703 individuals who were newly diagnosed with this condition and checked their weight changes before and after their diagnosis. We found that people with PD who lost a lot of weight to become underweight had a higher risk of dying during our study. Similarly, those who were already underweight and remained so also had a higher mortality risk. On the other hand, people who maintained a weight or gained a small amount of weight after their diagnosis had the lowest risk of dying. Our research found that weight changes at diagnosis were associated with mortality in PD, with underweight or weight loss being linked to increased risk of death. Each person's situation is different, so weight management should be tailored to each individual, considering their weight before they were diagnosed with PD. [ABSTRACT FROM AUTHOR]

Background: Whether bone mineral density (BMD) is related to the risk of Parkinson's disease (PD) is unclear. Objectives: The objective of this study was to examine the association between BMD status and incident PD in postmenopausal women. Methods: We retrospectively examined a nationwide cohort of 272,604 women aged 66 years who participated in the 2009–2012 Korean national health screening for transitional ages. BMD was evaluated using dual‐energy X‐ray absorptiometry of the central bones. The use of antiosteoporosis medications (AOMs) was assessed. We performed multivariable Cox proportional hazards regression to evaluate the association between BMD and PD risk by calculating hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During the median follow‐up of 7.7 years, 2,884 (1.1%) incident PD cases developed. After adjusting for confounding factors, lower BMD was associated with an increased risk of PD (P for trend <0.001). Individuals with osteoporosis had a 1.40‐fold higher HR (1.40, 95% CI: 1.25–1.56) than those with a normal BMD. Sensitivity analyses suggested the associations robust to longer lag periods and further adjustment. These associations were prominent in individuals without AOM use before or after enrollment (P for interaction = 0.031 and 0.014). Increased risks of PD in individuals with osteopenia and osteoporosis who did not use AOMs were attenuated by the medication use during the follow‐up period, regardless of previous AOM use. Conclusions: Lower postmenopausal BMD and osteoporosis were associated with an increased risk of PD. In addition, this association could be mitigated using AOMs. Proper management of BMD in postmenopausal women may help prevent PD. © 2023 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background The association of metabolic syndrome (MetS) with the development of Parkinson disease (PD) is currently unclear. We sought to determine whether MetS and its components are associated with the risk of incident PD using large-scale cohort data for the whole South Korean population. Methods and findings Health checkup data of 17,163,560 individuals aged [greater than or equal to]40 years provided by the National Health Insurance Service (NHIS) of South Korea between January 1, 2009, and December 31, 2012, were included, and participants were followed up until December 31, 2015. The mean follow-up duration was 5.3 years. The hazard ratio (HR) and 95% confidence interval (CI) of PD were estimated using a Cox proportional hazards model adjusted for potential confounders. We identified 44,205 incident PD cases during follow-up. Individuals with MetS (n = 5,848,508) showed an increased risk of PD development compared with individuals without MetS (n = 11,315,052), even after adjusting for potential confounders including age, sex, smoking, alcohol consumption, physical activity, income, body mass index, estimated glomerular filtration rate, and history of stroke (model 3; HR, 95% CI: 1.24, 1.21-1.27). Each MetS component was positively associated with PD risk (HR, 95% CI: 1.13, 1.10-1.16 for abdominal obesity; 1.13, 1.10-1.15 for hypertriglyceridemia; 1.23, 1.20-1.25 for low high-density lipoprotein cholesterol; 1.05, 1.03-1.08 for high blood pressure; 1.21, 1.18-1.23 for hyperglycemia). PD incidence positively correlated with the number of MetS components (log-rank p < 0.001), and we observed a gradual increase in the HR for incident PD with increasing number of components (p < 0.001). A significant interaction between age and MetS on the risk of incident PD was observed (p for interaction < 0.001), and people aged [greater than or equal to]65 years old with MetS showed the highest HR of incident PD of all subgroups compared to those Conclusions Our population-based large-scale cohort study suggests that MetS and its components may be risk factors of PD development., Author(s): Ga Eun Nam 1, Seon Mee Kim 2,*, Kyungdo Han 3, Nan Hee Kim 4, Hye Soo Chung 4, Jin Wook Kim 2, Byoungduck Han 1, Sung Jung Cho [...]

Aims This study aimed to examine the association of premature menopause and age at menopause with the risk of heart failure (HF) and atrial fibrillation (AF). Methods and results A total of 1 401 175 postmenopausal women, who had undergone health examination provided by the Korean National Health Insurance Service, were included, and their reproductive histories were collected. Multivariable Cox proportional hazard models were performed to determine the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident HF and AF, according to the history of premature menopause and age at menopause. At a mean follow-up of 9.1 years, there were 42 699 (3.0%) and 44 834 (3.2%) new cases of HF and AF, respectively. Women with history of premature menopause had an increased risk of HF (HR: 1.33, 95% CI: 1.26–1.40) and AF (HR: 1.09, 95% CI: 1.02–1.16), compared to women without the history. Compared with women aged ≥50 years at menopause, those aged 45−49, 40−44, and <40 years at menopause showed a significantly increased trend in HRs for the incident risk of both HF and AF (P for trend <0.001). The robustness of the results of a series of sensitivity analyses further strengthens the main findings. Conclusion Our findings suggest that postmenopausal women with a history of premature menopause or early menopausal age may have an increased risk of HF and AF. These reproductive factors need to be considered for preventing the future risk of HF and AF. [ABSTRACT FROM AUTHOR]

Introduction: The longitudinal evidence between detailed parameters of smoking status and type 2 diabetes among young adults has been limited. We evaluated this association in young Korean adults.Methods: This nationwide cohort study included 3 026 551 adults aged 20 to 39 years who underwent Korean National Health Insurance Service health examinations in 2009 and were followed up until the end of 2017. The participants were categorized according to smoking status, smoking duration, and smoking amount. The hazard ratios (HRs) and 95% CIs for type 2 diabetes were estimated using multivariable Cox proportional hazard regression analysis.Results: During 8.2 years of follow-up, 71 952 cases of type 2 diabetes newly developed. Compared with never-smokers, independently increased HRs of type 2 diabetes were observed in ex-smokers (1.06, 95% CI = 1.04-1.09) and current smokers (1.39, 1.36-1.42). In these two groups, the type 2 diabetes risk increased with greater smoking duration and amount (p for trend <.001). The HRs of type 2 diabetes were higher in current smokers than in ex-smokers at the same lifetime smoking amount. The associations between smoking status and incident type 2 diabetes were stronger in men, individuals who did not drink heavily, and those without obesity.Conclusions: Among young adults, past and current smoking was associated with an increased risk of type 2 diabetes, and there was a dose-response association of smoking amount and duration with type 2 diabetes development. Appropriate interventions to help young adults cease smoking may help reduce the incidence of type 2 diabetes.Implications: Smoking was associated with an increased risk of type 2 diabetes among young adults, and the risk was shown to increase as amount and duration of smoking increased. Ceasing smoking in young adults may help reduce the incidence of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objective: We investigated the association between interval changes in physical activity (PA) and dementia risk among patients with new-onset type 2 diabetes.Research Design and Methods: We identified 133,751 participants newly diagnosed with type 2 diabetes in a health screening (2009-2012), with a follow-up health screening within 2 years (2010-2015). PA level changes were categorized into continuous lack of PA, decreaser, increaser, and continuous PA groups. Dementia was determined using dementia diagnosis codes and antidementia drug prescriptions.Results: During the median follow-up of 4.8 years, 3,240 new cases of all-cause dementia developed. Regular PA was associated with lower risks of all-cause dementia (adjusted hazard ratio [aHR] 0.82; 95% CI 0.75-0.90), Alzheimer disease (AD) (aHR 0.85; 95% CI 0.77-0.95), and vascular dementia (VaD) (aHR 0.78; 95% CI 0.61-0.99). Increasers who started to engage in regular PA had a lower risk of all-cause dementia (aHR 0.86; 95% CI 0.77-0.96). Moreover, the risk was further reduced among those with continuous regular PA: all-cause dementia (aHR 0.73; 95% CI 0.62-0.85), AD (aHR 0.74; 95% CI 0.62-0.88), and VaD (aHR 0.62; 95% CI 0.40-0.94). Consistent results were noted in various subgroup analyses.Conclusions: Regular PA was independently associated with lower risks of all-cause dementia, AD, and VaD among individuals with new-onset type 2 diabetes. Those with continuous regular PA and, to a lesser extent, those who started to engage in regular PA had a lower risk of dementia. Regular PA should be encouraged to prevent dementia in high-risk populations and those with new-onset type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: The longitudinal association between dynamic changes in the metabolic syndrome (MS) status and Parkinson's disease (PD) has been poorly studied. Objective: We examined whether dynamic changes in MS status are associated with altered risk for PD. Methods: This study was a nationwide retrospective cohort study. We enrolled 5,522,813 individuals aged≥40 years who had undergone health examinations under the National Health Insurance Service between 2009 and 2010 (two health examinations with a 2-year interval). Participants were followed up until the end of 2017. The participants were categorized into four groups according to MS status changes over 2 years: non-MS, improved MS, incident MS, and persistent MS groups. Multivariable Cox hazard regression was performed. Results: During the 7-year median follow-up, there were 20,524 cases of newly developed PD. Compared with non-MS group, improved, incident, and persistent MS groups for 2 years were significantly associated with higher risks of PD (model 3; hazard ratio: 1.12, 95%confidence interval: 1.06–1.19 [improved MS]; 1.15, 1.09–1.22 [incident MS]; and 1.25, 1.20–1.30 [persistent MS]). Individuals with incident and persistent abdominal obesity, low levels of high-density lipoprotein cholesterol, hypertriglyceridemia, and hyperglycemia had a significantly increased risks of PD compared with those without either condition over 2 years. Conclusion: Persistent and incident MS and its components may be risk factors for incident PD. Ever exposure to MS may also be associated with PD risk. Appropriate intervention for preventing and improving MS may be crucial in decreasing the PD incidence. [ABSTRACT FROM AUTHOR]

Objective: Obesity and type 2 diabetes are risk factors for cardiovascular diseases and mortality, and they commonly result in weight variabilities. We aimed to investigate the association between body weight variability and risk of major cardiovascular outcomes and mortality in individuals with type 2 diabetes using large-scale, nationwide cohort data on the Korean population.Research Design and Methods: We enrolled 624,237 individuals with type 2 diabetes who underwent health examinations provided by the Korean National Health Insurance System between 2009 and 2010, with three or more body weight measurements within 5 years since enrollment and followed up until the end of 2017. We assessed body weight variability using four indices, including variability independent of the mean (VIM). A multivariate-adjusted Cox proportional hazards regression analysis was performed.Results: During the follow-up, 15,832, 25,038, and 44,716 cases of myocardial infarction (MI), stroke, and all-cause mortality, respectively, were recorded. Body weight variability was associated with increased risks of major cardiovascular outcomes after adjusting for confounding variables. Compared with the hazard ratios (HRs) of the lowest quartile group, the HRs (95% CIs) of the highest quartile group of VIM for body weight were 1.15 (1.10-1.20), 1.22 (1.18-1.26), and 1.58 (1.53-1.62) for MI, stroke, and all-cause mortality, respectively.Conclusions: Body weight variability was associated with increased risks of MI, stroke, and all-cause mortality in patients with type 2 diabetes and may be a predictor of cardiovascular outcomes in such patients. Appropriate interventions to maintain stable weight could positively influence health outcomes in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]