title: Lower urinary cotinine level is associated with a trend toward more myopic refractive errors in Korean adolescents.
abstract: PurposeTo investigate the association between urinary cotinine levels as an objective biological marker for exposure to nicotine and refractive status.Patients and methodsThis cross-sectional study analyzed data from the Korea National Health and Nutrition Examination Survey between 2008 and 2011. A total of 1139 Korean adolescents aged 12-18 years were enrolled. Urinary cotinine concentrations and other potential risk factors for myopia were examined. Correlation analyses and multivariate regression analysis were performed to investigate the association between urinary cotinine level and refractive error.ResultsSpherical equivalent correlated significantly with urinary cotinine concentration (r=0.104, P=0.011). Lower urinary cotinine level was associated with a trend toward more myopic refractive errors (P for trend=0.003). After adjusting for age, sex, area of residence, physical activity, serum 25-hydroxyvitamin D level, parental income level, and receipt of basic livelihood security, subjects with a low urinary cotinine level had a significantly increased risk of myopia <-0.5 D (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.18-3.21), <-3.0 D (OR 2.03, 95% CI 1.29-3.2), and <-6.0 D (OR 2.2, 95% CI, 1.15-4.23) when compared with subjects with a high urinary cotinine level. As urinary cotinine level decreased, the risks of myopia <-0.5 D, <-3.0 D, and <-6.0 D increased significantly (P for trend <0.05).ConclusionA trend toward less myopic refractive error was observed among Korean adolescents with higher urinary cotinine levels. This result provides the epidemiologic evidence implying nicotine as a potential modulator related with refractive development. Further studies with full consideration for myopia-associated risk factors are required to yield clear answers on the direct effect of smoking to the refractive status.
authors.affiliation: Department of Family Medicine, Sahmyook Medical Center, Seoul, Republic of Korea.
authors.forename: G E
authors.initials: GE
authors.lastname: Nam
authors.affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: B E
authors.initials: BE
authors.lastname: Hwang
authors.affiliation: Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: J-S
authors.initials: JS
authors.lastname: Paik
authors.affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: S-W
authors.initials: SW
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chun
authors.affiliation: Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: K
authors.initials: K
authors.lastname: Han
authors.affiliation: Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Y G
authors.initials: YG
authors.lastname: Park
authors.affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Park
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000652:urine; D002648:Child; D003367:Cotinine / Q000652:urine*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D009216:Myopia / Q000453:epidemiology* / Q000209:etiology / Q000652:urine; D009749:Nutrition Surveys; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012029:Refraction, Ocular; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology / Q000652:urine
chemical_list: D015415:Biomarkers; D003367:Cotinine