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The strength of association between the body mass index (BMI) and blood pressure (BP) varies with population and time. Therefore, identifying the trends in BMI-BP association in adolescents can help predict the upcoming metabolic and cardiovascular disease burden. For this reason, from physical examination data collected from 2003 to 2017, a total of 5,133,246 Korean men aged 19 years were assessed for the annual trends and changes in the BMI-BP association. During the 15-year period, the mean BMI increased from 22.5 to 23.5 kg/m2, and the prevalence of obesity increased from 16.7 to 21.4%. Meanwhile, the mean systolic BP (SBP) decreased from 122.8 to 122.3 mmHg in the first year and gradually increased to 125.9 mmHg afterward. The diastolic BP (DBP) decreased from 71.5 to 70.0 mmHg in the first 4 years and then rose to 74.8 mmHg in the following years. The association analysis between BMI and SBP resulted in an annual increase in the correlation coefficient (SBP: 0.257–0.495, DBP: 0.164–0.413). The regression coefficient similarly increased between 2003 and 2015 but slightly decreased between 2015 and 2017 (SBP: 0.896–1.569, DBP: 0.405–0.861). The BMI-BP association increased over time (coefficient of the interaction term > 0, P < 0.001). Moreover, as the BMI increased, the annual increase in BP and BP per unit BMI also increased. In conclusion, this study emphasized a continuous shift towards obesity in BMI distribution and intensifying BMI-BP association over time in young men. Further research on factors affecting this BMI-BP association is needed to fully validate the potential applications of this hypothesis.

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Background and Aims Patients acuity has been reported to be associated with poor outcome in hospitals. However, the effect of the patient acuity of hemodialysis center on the prognosis of individual patients is not well known. In this study, the association between the severity of illness in hemodialysis facility and major adverse cardiac and cerebrovascular event (MACCE) in patients undergoing hemodialysis was investigated. Method 15,633 participants receiving hemodialysis in the primary health care center who participated in the Periodic Hemodialysis Quality Assessment by Health Insurance Review & Assessment Service (HIRA) were examined. The main predictor was severity-to-nurse ratio, defined as a sum of Charlson comorbidity index of all patients divided by the number of nurses in each hemodialysis facility. The primary and secondary outcome were MACCE, and all-cause mortality, respectively. Results During a median follow-up of 5.5 years, MACCE and all-cause mortality occurred in 7,966 (51.0%) and 6,536 (41.8%) participants. Participants with higher severity-to-nurse ratio tended to have higher incidence rate of MACCE. The hazard ratios (HRs) of MACCE for the second, third, and highest quartiles compared with the lowest quartile of severity-to-nurse ratio were 1.05 (95% confidence intervals [CI], 0.98-1.11; P = 0.151), 1.07 (95% CI, 1.00-1.14; P = 0.053), and 1.08 (95% CI, 1.00-1.16; P = 0.040). When treating severity-to-nurse ratio as a continuous variable, MACCE risk increased by 1% per 1 increase in severity-to-nurse ratio (HR, 1.01; 95% CI, 1.00 - 1.02; P = 0.003). Compared to the lowest quartile group, the HRs of all-cause mortality for second, third and fourth quartile were 1.12 (95% CI, 1.04-1.19; P = 0.002), 1.11 (95% CI, 1.03-1.19; P = 0.005), and 1.16 (95% CI, 1.07-1.25; P&lt;0.001), respectively. Conclusion As the part of the Joint Project on Quality Assessment Research by HIRA, the present study showed that the patient acuity was strongly associated with an increased risk of poor outcomes in hemodialysis patients.

Background and Aims Dietary intake from various protein sources can affect health differently. However, the association between plant protein intake and incident chronic kidney disease (CKD) is uncertain. Method Using the UK Biobank prospective cohort, we included 117,809 participants who completed more than one dietary questionnaire and had an estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m2, urinary albumin-to-creatinine ratio (UACR) &lt;30 mg/g, and no prior history of CKD. The main predictor was the daily plant protein intake, assessed with a web-based 24-hour recall questionnaire. The primary outcome was incident CKD, based on the International Classification of Diseases, 10th Revision (ICD-10) or Office of Population Censuses and Surveys Classification of Interventions and Procedures, version 4 (OPCS-4) codes. We additionally analyzed this association in 37,955 participants with primary care-linked data for eGFR and UACR. We used strictly defined CKD based on ICD-10 and OPCS-4 codes or two consecutive measures of eGFR &lt;60 ml/min/1.73 m2 or UACR &gt;30 mg/g. Results During the median follow-up of 9.9 years, incident CKD occurred in 3745 (3.2%) participants (incidence rate, 3.2 per 1,000 person-years). In a multivariable cause-specific model, the adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for the second, third, and highest quartiles were 0.91 (0.83-0.99), 0.79 (0.71-0.87), and 0.75 (0.64-0.85), respectively, compared with the lowest quartile. In a continuous model, the aHR (95% CIs) per 0.1 g/kg/day increase in plant protein intake was 0.91 (0.88-0.94). This beneficial association was also consistent in the secondary analysis with strictly defined CKD and various sensitivity analyses. Conclusion This large prospective cohort study showed that increased dietary plant protein intake was associated with a lower risk of CKD.