Appropriate waist circumference cutoff points for central obesity in Korean adults

BACKGROUND

The International Diabetes Federation consensus recently proposed a new definition for the diagnosis of metabolic syndrome, incorporating ethnically specific waist circumference (WC) cutoff points.

OBJECTIVE

We investigated the ethnically appropriate WC cutoff values for central obesity in Korean adults to predict increased risk of elevated triacylglycerol, reduced HDL cholesterol, elevated blood pressure, elevated fasting plasma glucose, or two or more of these factors.

DESIGN

We used data from 6561 adults, aged 20-80 years, who participated in the Korean Health and Nutritional Examination Survey of 1998, a cross-sectional health survey of a nationally representative sample of Koreans.

RESULTS

Based on the receiver operating characteristic curve analysis, the WC value for predicting metabolic risk factors in Koreans was about 85 cm for men and 80 cm for women. The odds ratio for the risk of two or more metabolic risk factors increased abruptly in men with WC >or= 90 cm and women with WC >or= 85 cm. The 80th percentile for WC in the Korean population was 90 cm for men and 86.5 cm for women. Thus, the appropriate WC cutoff point for central obesity in Koreans was determined to be 90 cm for men and 85 cm for women.

CONCLUSIONS

Based on our criteria, the prevalence of central obesity was 19.8% in Korean men and 24.5% in Korean women. These findings suggest the applicability of ethnically specific cutoff points for WC in assessing central obesity.

2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.

2014 clinical practice guidelines for overweight and obesity in Korea

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index ≥25 kg/m² in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

PURPOSE OF REVIEW

As a chronic and relapsing disease, obesity impairs metabolism and causes cardiovascular diseases. Although behavioral modification is important for the treatment of obesity, it is difficult to achieve an ideal weight or sustain the process of long-term weight loss. Therefore, the obesity control guidelines strongly recommend lifestyle interventions along with medical treatment for patients who are overweight. There is sufficient evidence supporting that pharmacotherapy in combination with behavior-based interventions can result in significant weight loss and improved cardiometabolism.

RECENT FINDINGS

Recent meta-analyses of new anti-obesity drugs and their weight-loss efficacy have shown that the overall placebo-subtracted weight reduction (%) for at least 12 months ranged from 2.9 to 6.8% for the following drugs: phentermine/topiramate (6.8%), liraglutide (5.4%), naltrexone/bupropion (4.0%), orlistat (2.9%), and lorcaserin (3.1%). However, very recently, on February 13, 2020, the US Food and Drug Administration (FDA) ordered the withdrawal of lorcaserin from markets, as a clinical trial to assess drug safety showed an increased risk of cancer. Currently, the anti-obesity medications that have been approved by the FDA for chronic weight management are orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide. However, they are costly and may have adverse effects in some individuals. Therefore, drug therapy should be initiated in obese individuals after weighing its benefits and risks. One of the strategies for long-term obesity control is that anti-obesity medications should be tailored for specific patients depending on their chronic conditions, comorbidities, and preferences.

Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial

BACKGROUND

Semaglutide 2·4 mg once weekly has been investigated for weight management in global populations. Differences exist between Asian and non-Asian populations in terms of body composition and definitions of obesity. In the Semaglutide Treatment Effect in People with obesity (STEP) 6 trial, we assessed the effect of semaglutide versus placebo for weight management in adults from east Asia with obesity, with or without type 2 diabetes.

METHODS

This randomised, double-blind, double-dummy, placebo-controlled, phase 3a superiority trial was done at 28 outpatient clinics in Japan and South Korea. Eligible participants were adults (aged ≥18 years in South Korea; ≥20 years in Japan) with a BMI of at least 27·0 kg/m2 with two or more weight-related comorbidities or a BMI of 35·0 kg/m2 or more with one or more weight-related comorbidity (one comorbidity had to be either hypertension, dyslipidaemia, or, in Japan only, type 2 diabetes) who had at least one self-reported unsuccessful dietary attempt to lose bodyweight. Participants were randomly assigned (4:1:2:1) to once-weekly subcutaneous semaglutide 2·4 mg or matching placebo, or semaglutide 1·7 mg or matching placebo, plus lifestyle recommendations for 68 weeks. Data for the placebo groups were pooled in statistical analyses. The primary endpoints were percentage change in bodyweight from baseline at week 68 and the proportion of participants who had achieved a reduction of at least 5% of baseline bodyweight at week 68. Change in abdominal visceral fat area was assessed as a supportive secondary endpoint using computed tomography scanning in a subset of participants. Efficacy outcomes were assessed in the full analysis set, which included all randomly assigned participants according to the intention-to-treat principle. Safety was assessed in all participants who received at least one dose of the study drug. This trial was registered with ClinicalTrials.gov, NCT03811574.

FINDINGS

Between Jan 21, 2019 and June 4, 2019, 437 participants were screened, of whom 401 were randomly assigned to semaglutide 2·4 mg (n=199), semaglutide 1·7 mg (n=101), or placebo (n=101) and included in the intention-to-treat analysis. Estimated mean change in bodyweight from baseline to week 68 was -13·2% (SEM 0·5) in the semaglutide 2·4 mg group and -9·6% (0·8) in the semaglutide 1·7 mg group versus -2·1% (0·8) in the placebo group (estimated treatment difference [ETD] -11·1 percentage points [95% CI -12·9 to -9·2] for semaglutide 2·4 mg vs placebo; -7·5 percentage points [95% CI -9·6 to -5·4] for semaglutide 1·7 mg vs placebo; both p<0·0001). At week 68, a larger proportion of participants had achieved a 5% or higher reduction in baseline bodyweight in the semaglutide 2·4 mg group (160 [83%] of 193 participants) and semaglutide 1·7 mg group (71 [72%] of 98 participants) than in the placebo group (21 [21%] of 100 participants); odds ratio [OR] 21·7 [95% CI 11·3 to 41·9] for semaglutide 2·4 mg vs placebo; OR 11·1 [95% CI 5·5 to 22·2] for semaglutide 1·7 mg vs placebo; both p<0·0001). Abdominal visceral fat area was reduced by 40·0% (SEM 2·6) among participants in the semaglutide 2·4 mg group and 22·2% (3·7) among participants in the semaglutide 1·7 mg group versus 6·9% (3·8) in the placebo group (ETD -33·2% [95% CI -42·1 to -24·2] for semaglutide 2·4 mg vs placebo; -15·3% [95% CI -25·6 to -4·9] for semaglutide 1·7 mg vs placebo). 171 (86%) of 199 participants in the semaglutide 2·4 mg group, 82 (82%) of 100 participants in the semaglutide 1·7 mg group, and 80 (79%) of 101 participants in the placebo group reported adverse events. Gastrointestinal disorders, which were mostly mild to moderate, were reported in 118 (59%) of 199 participants in the semaglutide 2·4 mg group, 64 (64%) of 100 participants in the semaglutide 1·7 mg group, and 30 (30%) of 101 participants in the placebo group. Adverse events leading to trial product discontinuation occurred in five (3%) of 199 participants in the semaglutide 2·4 mg group, three (3%) of 100 participants in the semaglutide 1·7 mg group, and one (1%) of 101 participants in the placebo group.

INTERPRETATION

Adults from east Asia with obesity, with or without type 2 diabetes, given semaglutide 2·4 mg once a week had superior and clinically meaningful reductions in bodyweight, and greater reductions in abdominal visceral fat area compared with placebo, representing a promising treatment option for weight management in this population.

FUNDING

Novo Nordisk.

TRANSLATIONS

For the Korean and Japanese translations of the abstract see Supplementary Materials section.

Elevated intraocular pressure is associated with insulin resistance and metabolic syndrome

BACKGROUND AND AIM

Elevated intraocular pressure (IOP), a well-known risk factor for glaucoma, has recently been shown to be associated with some metabolic complications and obesity. We investigated the link between IOP and metabolic disturbances, focusing especially on metabolic syndrome and insulin resistance.

METHODS

Eye examinations, including IOP measurement, were conducted on 943 subjects (533 men and 410 women). Body mass index (BMI), percent body fat, waist circumference, systolic and diastolic pressure, fasting insulin, glucose, lipids, and other metabolic parameters were measured. The homeostasis model assessment (HOMA) score and McAuley index were calculated to assess whole-body insulin resistance.

RESULTS

Both of these insulin resistance indices showed positive associations with IOP (p < 0.05), even after statistical adjustment for other risk factors. IOP was higher in participants with metabolic syndrome, as compared to those who did not have metabolic syndrome. The mean IOP tended to increase linearly with the presence of increasing numbers of components for metabolic syndrome.

CONCLUSIONS

These results suggest that insulin resistance might contribute to an explanation that would account for many previous findings concerning the association between IOP and obesity, hypertension, and diabetes.

Cigarette smoking increases abdominal and visceral obesity but not overall fatness: an observational study

BACKGROUND

Cigarette smoking and obesity are leading public health concerns. Both increase the risk for cardiovascular disease, cancer, and metabolic abnormalities. This study was conducted to assess the association between cigarette smoking and different types of obesity.

METHODOLOGY/PRINCIPAL FINDINGS

Two hundred eighty-three visitors to university hospitals located in four main provinces of South Korea were participated. All participants were classified as either current/past or never smokers and were divided into quartiles according to the total pack-years. Body mass index, waist circumference, total body fat percentage, and area of visceral and abdominal subcutaneous fat were measured. These results of each groups were compared. Waist circumference, and visceral fat area showed a J- or U-shaped association with total smoking amount during a lifetime. After restricting the analyses to past/current smokers, we found significant dose-dependent associations of smoking pack-years with abdominal and visceral obesity. Overall obesity measured by body mass index and total body fat percentage did not show such associations. Although current smokers clearly showed significant associations, we could not demonstrate these in past smokers, possibly because of the limited sample size.

CONCLUSIONS/SIGNIFICANCE

Although smokers did not show significant difference in mean body mass index than those who never smoked, they showed more metabolically adverse fat distributions with increasing smoking amounts. This finding suggests that smoking is not beneficial for weight control. Therefore, smoking cessation and avoidance of smoking commencement should be addressed as important public health issues in preventing obesity and related complications.

Waist circumference, dual-energy X-ray absortiometrically measured abdominal adiposity, and computed tomographically derived intra-abdominal fat area on detecting metabolic risk factors in obese women

OBJECTIVES

We investigated which abdominal adiposity measurements, waist circumference (WC), dual-energy X-ray absorptiometry (DXA)-measured abdominal fat, and computed tomography (CT)-derived intra-abdominal fat areas (IAF), were the most predictive in identifying metabolic risk factors.

METHODS

Ninety-five Korean women (body mass index 27.5 +/- 3.2 kg/m(2), WC 90.2 +/- 6.8 cm, age 42 +/- 10.6 y) with abdominal obesity (WC > or = 80 cm) were examined in this study. Abdominal adiposity was assessed using DXA (absolute values and percentages of trunk and android fat, trunk-to-leg fat ratio, and android-to-gynoid fat ratio) and CT (IAF and ratio of IAF to subcutaneous abdominal fat [SAF]). Metabolic indicators were blood pressure, high-density lipoprotein cholesterol, triacylglycerol, fasting glucose, insulin, and high-sensitivity C-reactive protein. Metabolic syndrome (MS) was defined as the presence of at least two of the following: triacylglycerol level > or = 150 mg/dL, high-density lipoprotein cholesterol level <50 mg/dL, blood pressure > or = 130/85 mmHg, and/or fasting glucose level > or = 100 mg/dL.

RESULTS

The correlations between adiposity measurements and metabolic indicators were stronger in premenopausal compared with postmenopausal women. Areas under the curve for MS and all abdominal adiposity measurements (WC, DXA-measured abdominal fat, and CT-derived IAF) were significant. Areas under the curve were not significantly different among measurements. The sensitivity and specificity at the threshold value of each abdominal adiposity measurement to predict MS were 38-93% and 34-96%, respectively. Women with 1 SD higher abdominal adiposity were 1.6-3.4 times more likely to have MS.

CONCLUSION

No single abdominal adiposity measurement, i.e., WC, DXA-measured abdominal fat, and CT-assessed IAF, was a stronger predictor of metabolic risk factors than the other.

Anti-Obesity Drugs: Long-Term Efficacy and Safety: An Updated Review

As a chronic and relapsing disease, obesity negatively impacts the health of men to a greater extent than that of women, with a higher risk of cardiovascular disease. Since lifestyle modifications alone are often challenging and limited for the maintenance of weight reduction, pharmacotherapy should be considered in a timely manner for obese men or overweight patients with weight-related comorbidities. Recent advances in anti-obesity drugs have enabled the potential of achieving clinically significant weight loss. Increasing evidence has shown that behavior-based interventions with one of these medications can result in greater weight loss than that elicited by usual care conditions. Data from most recent meta-analyses showed that the overall placebo-subtracted weight reduction (%) with the use of anti-obesity drugs for at least 12 months ranges from 2.9% to 6.8%; phentermine/topiramate (-6.8%) liraglutide (-5.4%), naltrexone/bupropion (-4.0%), lorcaserin (-3.1%), and orlistat (-2.9%). However, they have a high cost and may cause adverse outcomes depending on the individual. Very recently, on February 13, 2020, the US Food and Drug Administration requested withdrawal of lorcaserin from the market because a safety clinical trial showed an increased occurrence of cancer. Therefore the decision to initiate drug therapy in obese individuals should be made after the benefits and risks are considered. Thereafter, treatment should be tailored to specific patient subpopulations depending on their chronic conditions, comorbidities, and preferences. Herein, we provide an overview of the latest developments in weight loss medications, which may serve as one of the strategies for long-term obesity control.

The new definition of metabolic syndrome by the international diabetes federation is less likely to identify metabolically abnormal but non-obese individuals than the definition by the revised national cholesterol education program: the Korea NHANES study

OBJECTIVE

The new definitions for metabolic syndrome (MS) proposed by the IDF and revised NCEP have caused some confusion because patients have emerged that have satisfied the revised NCEP but not the IDF criteria. We performed this study to compare the prevalence of these criteria and to investigate the characteristics of discrepant cases.

RESEARCH DESIGN AND METHODS

A total of 7962 individuals aged >or= 20 years (3597 men; 4365 women) who participated in the 1998 Korean NHANES were included. We assessed the agreement between the revised NCEP and IDF criteria and investigated the characteristics of cases satisfying the revised NCEP criteria but not the IDF criteria.

RESULTS

The prevalence of MS by the revised NCEP (25.7% of men and 31.9% of women) was higher than that according to the IDF (14.2% of men and 26.6% of women). The IDF criteria failed to identify 44.9% of men and 16.6% of women identified as having MS according to the revised NCEP criteria. The discrepant group showed more adverse metabolic profiles and unfavorable lifestyles despite lower waist circumference as compared with those having MS by both the IDF and revised NCEP criteria. The prevalence of discrepant cases was higher among the elderly.

CONCLUSIONS

The IDF criteria were inferior to the revised NCEP criteria in identifying the metabolically abnormal but nonobese groups known to be predisposed to type 2 diabetes and cardiovascular disease. Further research regarding the appropriateness of central obesity as an obligatory criterion proposed by the IDF seems to be warranted.

Changes in plasma ghrelin concentration immediately after gastrectomy in patients with early gastric cancer

Although the majority of circulating ghrelin originates from the stomach, no prospective study of the proportion of ghrelin derived from the stomach has been reported. Patients with early gastric cancer who underwent gastric resection were divided into three groups according to the extent and site of gastric resection: subtotal gastrectomy group (n = 24), proximal gastrectomy group (n = 4), and total gastrectomy group (n = 12). Patients with advanced gastric cancer who underwent gastrojejunostomy without gastrectomy served as the bypass group (n = 5). Blood samples were collected from all patients preoperatively, at 1 h after gastric resection or gastrojejunostomy, and on postoperative d 1, 3, and 7. The plasma ghrelin level was determined in all samples and expressed as a percentage of the preoperative level. In the bypass group, no significant drop in the ghrelin level was observed at 1 h after gastrojejunostomy, and the ghrelin level remained stable through postoperative d 7. In the subtotal gastrectomy group, the ghrelin concentration reached a nadir of 38.8 +/- 12.9% of preoperative levels at 1 h after gastric resection and then gradually increased to 88.1 +/- 13.2% by postoperative d 7. In the proximal gastrectomy group, the nadir ghrelin level was 24.5 +/- 15.4% at 1 h after gastric resection and was followed by a gradual recovery. However, the recovery rate was slower than that in the subtotal gastrectomy group, with the ghrelin level reaching only 47.6 +/- 18.8% by postoperative d 7 (P < 0.05). In the total gastrectomy group, the nadir ghrelin level was 28.6 +/- 11.1% at 1 h after gastric resection and remained at 30.0 +/- 13.2% until postoperative d 7. These results suggest that compensatory ghrelin production can occur in the remnant stomach after the surgical removal of part of the stomach and that the proximal fundus is more important than the distal antrum and body in terms of the capacity for ghrelin production. The principal site of ghrelin production is clearly the stomach, which contributes 70% of the circulating ghrelin concentration.

Central obesity as a risk factor for prostatic hyperplasia

OBJECTIVE

Obesity-related metabolic diseases may influence prostatic hyperplasia. This study examined the impact of obesity on prostate volume in men without overt obesity-related metabolic diseases.

RESEARCH METHODS AND PROCEDURES

We recruited 146 men over the age of 40 years who did not have overt obesity-related diseases, such as diabetes, impaired fasting glucose, hypertension, or dyslipidemia. Transrectal ultrasonography was performed on all subjects. The subjects were divided into three groups according to their BMI: normal (18.5 to 22.9 kg/m2), overweight (23 to 24.9 kg/m2), and obese (> or = 25 kg/m2), and two groups according to their waist circumference: normal waist (< or = 90 cm) and central obesity (> 90 cm). The classification of the subgroups was based on the Asia-Pacific criteria of obesity. We compared the prostate volume among subgroups and assessed factors related to prostatic hyperplasia.

RESULTS

Mean prostate volume was 18.8 +/- 5.0, 21.8 +/- 7.2, and 21.8 +/- 5.6 mL in the normal, overweight, and obese groups, respectively, and was 20.0 +/- 5.9 and 23.7 +/- 5.3 mL in the normal waist and central obesity group, respectively. Prostate volume was significantly greater in the obese group than in the normal group (P = 0.03) and in the central obesity group compared with the normal waist group (P = 0.002). Prostate volume was positively correlated with BMI and waist circumference after adjustment for age. After adjusting for confounding factors, central obesity was an independent factor affecting prostatic hyperplasia, which was defined as a prostate volume > 20 mL (odds ratio = 3.37, p = 0.037). Relative to men with both low BMI (18.5 to 22.9 kg/m2) and normal waist circumference, those with high BMI (> or = 25 kg/m2) and central obesity were at significantly increased risk of prostatic hyperplasia (odds ratio = 4.88, p = 0.008). However, those with high BMI (> or = 25 kg/m2) and normal waist circumference were not at significantly increased risk.

DISCUSSION

Prostate volume was greater in the obese and central obesity groups than in the normal group after patients with overt obesity-related metabolic diseases were excluded. Although both BMI and waist circumference were positively correlated with prostate volume, central obesity was the only independent factor affecting prostate hyperplasia. We suggest that central obesity is an important risk factor for prostatic hyperplasia.

Clinical usefulness of the two-site Semmes-Weinstein monofilament test for detecting diabetic peripheral neuropathy

The present study was done to validate the two-site Semmes-Weinstein (SW) monofilament test in identifying patients at risk of lower-extremity complications in clinical setting. The SW monofilament test and nerve conduction study were conducted on type 2 diabetic patients (n=37) at Pusan National University Hospital in Korea. As the duration of diabetes mellitus was longer, neuropathy identified by nerve conduction study and complications of diabetes were more severe (p<0.01). The number of sites unable to perceive SW monofilament (p<0.001) was larger in patients with lower-extremity neuropathy symptoms than those without symptoms. Sensitivity and specificity at two sites (the third and fifth metatarsal head sites) were 93% and 100%, respectively. In conclusion, the two-site SW monofilament test was a sensitive, specific, simple, and inexpensive screening tool for identifying diabetic peripheral neuropathy in clinical setting.

Prevalence and risk factors for erectile dysfunction in primary care: results of a Korean study

In order to assess the prevalence and associated factors for erectile dysfunction (ED) in primary care, a cross-sectional study was undertaken by questionnaire distributed to consecutive adult male attendees at 32 family practices. ED was assessed by the Korean five-item version of the International Index of Erectile Function (IIEF-5). In total, 3501 completed questionnaires were available for analysis. The prevalence of ED was severe (IIEF-5 score: 5-9) in 1.6% of cases, moderate (10-13) in 10.2%, mild (14-17) in 24.7%, and normal (18-25) in 63.4%. The prevalence of ED increased with age, lower educational status, heavy job-related physical activity, and lower income. ED prevalence was significantly higher in patients with chronic diseases such as diabetes, depression, and anxiety. These results suggest that the age-adjusted prevalence of ED among Korean men can be estimated as 32.2% (95% CI 30.6-33.7). Low socioeconomic status and several diseases such as diabetes, anxiety, and depression, as well as age, were associated with ED.

An association between colonic adenoma and abdominal obesity: a cross-sectional study

BACKGROUND

Colorectal adenoma is a precursor lesion of colorectal cancer and thus, it is an important target for preventing colorectal cancer. Only a few studies suggest an association between colorectal adenoma and obesity, but results show considerable heterogeneity. In this study, we investigated the association between colorectal adenoma and waist circumference.

METHODS

165 adenoma cases and 365 polyp-free controls with a normal colon were compared in this cross-sectional study. Subjects underwent screening colonoscopy by experienced endoscopists. Demographic data, including smoking habit, were obtained by interview and waist circumference and anthropometric measurements were examined. Dietary intakes were evaluated using a food frequency questionnaire, and abdominal obesity was evaluated by measuring waist circumference. Statistical analysis was performed using SPSS for 13.0.

RESULTS

Age, waist circumference, and BMI were significantly higher in cases than controls. And smokers and men were more prevalent among cases than controls.Among the abdominal obese subjects, 45.6% had 1 or more adenoma, and 9.0% of these had advanced adenoma, whereas among subjects with a normal waist circumference, only 25.7% had 1 or more adenomas. The prevalence of adenoma was higher among abdominal obese group (P < 0.05). Logistic regression analysis showed that abdominal obesity was associated with an increased risk of colorectal adenoma (OR, 2.74; 95% CI, 1.66~4.51 in men, OR, 2.58; 95% CI, 1.08~6.12 in women). These associations persisted even after adjusting for BMI. While BMI was found to be weekly associated with the risk of adenoma among men at the highest BMI levels. However, BMI was not associated with the risk for adenoma after adjusting for waist circumference.

CONCLUSION

Our data suggest that abdominal obesity is associated with an increased risk of colorectal adenoma.

Transcriptional control of the HERV-H LTR element of the GSDML gene in human tissues and cancer cells

Long terminal repeats (LTRs) of human endogenous retroviruses (HERVs) have been reported to serve as alternative promoters in functional genes. The GSDML (gasdermin-like protein) gene located on human chromosome 17q21 has been found to be an oncogenomic recombination hotspot. Here, we identified the LTR element of HERV-H with reverse orientation as an alternative promoter of the GSDML gene and analyzed its expression pattern in human tissues and cancer cells. A reporter gene assay of the promoter activity of the LTR on the GSDML gene in human cancer cell lines (HCT-116 and HeLa) and a kidney cell line (Cos7) of African green monkey indicated that the LTR promoter with reverse orientation had stronger promoter activity than forward one. The transcripts of this LTR-derived promoter were widely distributed in various human tissues and cancer cells, whereas the transcripts of the cellular promoter were found only in stomach tissues and some cancer cells (HCT116, MCF7, U937, C-33A, and PC3). These findings suggest that the LTR element on the GSDML gene was integrated into the hominoid lineage and acquired the role of transcriptional regulation of human tissues and cancer cells.

Effects of exercise-induced weight loss on acylated and unacylated ghrelin in overweight children

OBJECTIVE

Controversial data on ghrelin concentration during exercise in human subjects have been published. We tested the hypothesis that exercise could affect acylated ghrelin (AG) and unacylated ghrelin (UAG), which could partly explain the previously reported inconsistent findings on the association of exercise with changes in ghrelin.

DESIGN

A prospective randomized study.

PATIENTS AND MEASUREMENTS

We randomized 17 overweight volunteers (11-year-old boys) to a 12-week combined exercise group (EG, n = 8) or control group (CG, n = 9). At baseline, 1, 4 and 12 weeks, we measured body weight and composition, insulin, leptin, total ghrelin and acylated ghrelin.

RESULTS

Compared with the CG, body weight, percentage body fat and homeostatic model assessment (HOMA) indices were significantly lower throughout the 12 weeks in the EG. Total ghrelin and UAG levels gradually increased to 131.9 +/- 5.2% and 130.4 +/- 5.2% of baseline, respectively, at week 12 in the EG, whereas AG concentration remained unchanged throughout the 12 weeks both within each group and between the groups. At week 12, there were differences in the total ghrelin level and UAG level between the groups.

CONCLUSIONS

This study shows an increase in unacylated acylated ghrelin and unchanged acylated ghrelin after a 12-week combined exercise programme in overweight children. These findings provide evidence of favourable effects of exercise on improving energy metabolism.

Depressive mood and abdominal fat distribution in overweight premenopausal women

OBJECTIVE

There is increasing evidence that depressive mood is associated with central obesity, but little is known about the association between depression and abdominal fat distribution. This study investigated this relationship in premenopausal women.

RESEARCH METHODS AND PROCEDURES

We recruited 101 overweight premenopausal women who had no eating disorders as defined using the DSM IV criteria. Depressive mood was assessed using Zung's Self-Rating Depression Scale (SDS). Areas of visceral (VAT) and subcutaneous (SAT) adipose tissue at the level of vertebral body L(4)-L(5) were measured using computed tomography. Associations of VAT, SAT, and the ratio of VAT to SAT with natural logarithmic transformation [(ln)]SDS were evaluated using linear regression. Anthropometric indices and physical fitness were also measured. Information on socioeconomic status, education level, and alcohol and smoking habits was obtained using self-administered questionnaires. A hospital nutritionist assessed nutritional status. All of these factors were adjusted for as possible confounding factors in the analyses.

RESULTS

The (ln)SDS score showed a positive association with the area of VAT, even after adjusting for the confounders mentioned above (p < 0.01). BMI, waist circumference, maximal oxygen uptake, and age were also associated with the area of VAT (all p < 0.05). In contrast, the (ln)SDS score was not associated with SAT (p > 0.10).

DISCUSSION

We showed that depressive mood is associated with VAT, not with SAT, in overweight premenopausal women. These findings may explain some of the association between depression and coronary heart disease. More studies are needed to elucidate the causal relationship.

Serum 25-hydroxyvitamin D levels and testosterone deficiency in middle-aged Korean men: a cross-sectional study

Previous studies have demonstrated that male hypogonadism is associated with a low level of vitamin D. However, no reports have investigated the effects of vitamin D on testosterone levels in Korean men. Our aim was to investigate whether testosterone levels are associated with serum vitamin D levels and whether seasonal variation exists. This cross-sectional study analyzed serum 25-hydroxyvitamin D [25(OH)D], total testosterone (TT), and free testosterone (FT) in 652 Korean men over 40 years of age who had undergone a comprehensive medical examination. The average age of the subjects was 56.7 ± 7.9 years, and the mean serum 25(OH)D, TT and FT levels were 21.23 ± 7.9 ng ml-1 , 4.70 ± 1.6 ng ml-1 , and 8.12 ± 3.3 pg ml-1 , respectively. In the multiple linear regression model, 25(OH)D showed positive association with TT (β =0.137, P< 0.001) and FT (β =0.103, P= 0.008). 25(OH)D and FT showed similar seasonal or monthly variation after adjustment for age. A vitamin D deficiency [25(OH)D < 20 ng ml-1 ] was associated with an increased risk of deficiencies of TT (<2.30 ng ml-1 ) (odds ratio [OR]: 2.65; 95% confidence interval [CI]: 1.21-5.78, P= 0.014) and FT (<6.50 pg ml-1 ) (OR: 1.44; 95% CI: 1.01-2.06 P= 0.048) after adjusting for age, season, body mass index, body composition, chronic disease, smoking, and alcohol use. In conclusion, we demonstrated a positive correlation between 25(OH)D and testosterone, which showed similar seasonal variation in Korean men.

Effect of pumpkin seed oil on hair growth in men with androgenetic alopecia: a randomized, double-blind, placebo-controlled trial

Pumpkin seed oil (PSO) has been shown to block the action of 5-alpha reductase and to have antiandrogenic effects on rats. This randomized, placebo-controlled, double-blind study was designed to investigate the efficacy and tolerability of PSO for treatment of hair growth in male patients with mild to moderate androgenetic alopecia (AGA). 76 male patients with AGA received 400 mg of PSO per day or a placebo for 24 weeks. Change over time in scalp hair growth was evaluated by four outcomes: assessment of standardized clinical photographs by a blinded investigator; patient self-assessment scores; scalp hair thickness; and scalp hair counts. Reports of adverse events were collected throughout the study. After 24 weeks of treatment, self-rated improvement score and self-rated satisfaction scores in the PSO-treated group were higher than in the placebo group (P = 0.013, 0.003). The PSO-treated group had more hair after treatment than at baseline, compared to the placebo group (P < 0.001). Mean hair count increases of 40% were observed in PSO-treated men at 24 weeks, whereas increases of 10% were observed in placebo-treated men (P < 0.001). Adverse effects were not different in the two groups.

Association of Handgrip Strength with Dietary Intake in the Korean Population: Findings Based on the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-1), 2016

To evaluate associations between handgrip strength (HGS) and dietary nutrients, this study of a representative Korean population of 1553 adults aged ≥60 years (706 men and 847 women) analyzed data from the Korea National Health and Nutrition Examination Survey (2016). HGS was measured in both hands three times using a digital grip strength dynamometer. Dietary intake data were collected by the 24-h recall method through computer-assisted personal interviews. The study population had a mean age of 70.1 years, body mass index (BMI) of 24.2 kg/m², and HGS of 35.7 kg in men, 21.2 kg in women. Total energy (r = 0.411), protein (r = 0.217), polyunsaturated fatty acid (PUFA) (r = 0.269), fiber (r = 0.272), and vitamin C (r = 0.098) were positively correlated with HGS. In multivariable regression analysis, PUFA (β = 0.083) and vitamin C (β = 0.003) were positively associated with HGS among women. Fiber (β = 0.071) and vitamin C (β = 0.006) showed a positive association with HGS among men. Community-dwelling older men and women with higher levels of PUFA, fiber, and vitamin C in their diet were more likely to have greater HGS even after adjusting for age, total calorie intake, BMI, chronic diseases and health-related habits.

A randomized, double-blind, vehicle-controlled clinical study of hair regeneration using adipose-derived stem cell constituent extract in androgenetic alopecia

Accumulating evidence suggests that adipose-derived stem cell constituent extract (ADSC-CE) helps hair regrowth in patients with androgenetic alopecia (AGA). However, the effects of ADSC-CE have not been demonstrated in a randomized, double-blind, vehicle-controlled clinical trial. In this randomized, double-blind, vehicle-controlled clinical trial, 38 patients (29 men) with AGA were assigned to an intervention group (IG), with twice-daily self-application of the ADSC-CE topical solution over the scalp with fingers, or to a control group (CG). Changes in hair count and thickness at 16 weeks from the baseline were evaluated using a phototrichogram. Overall, 34 (89%) patients (mean age, 45.3 years) completed the study. The phototrichogram at week 8 showed more increase in hair count in the IG than in the CG, and intergroup differences in the change of hair count remained significant until week 16 with overall changes of 28.1% vs 7.1%, respectively. Similarly, a significant improvement in hair diameter was observed in the IG (14.2%) after 16 weeks when compared with hair diameter in the CG (6.3%). Our findings suggest that the application of the ADSC-CE topical solution has enormous potential as an alternative therapeutic strategy for hair regrowth in patients with AGA, by increasing both hair density and thickness while maintaining adequate treatment safety.

Effects of oral magnesium supplementation on insulin sensitivity and blood pressure in normo-magnesemic nondiabetic overweight Korean adults

BACKGROUND AND AIM

Little is known about the effect of magnesium on insulin sensitivity and BP in healthy individuals. Therefore, we investigated whether magnesium could improve insulin sensitivity and blood pressure (BP) in normo-magnesemic nondiabetic overweight adults.

METHODS AND RESULTS

In a double-blinded, placebo-controlled, randomized trial, a total of 155 participants (BMI > or = 23 kg/m(2)) received either 12.3 mmol (300 mg) of elemental magnesium in the form of magnesium oxide (n=75) or placebo (n=80) each day for 12 weeks, constituting the intent-to-treat population. A repeated-measures ANOVA was used to evaluate the between-group changes in variables during the study. The baseline characteristics between the intervention and control groups were similar. There were no significant differences between the groups in the pattern of change of the homeostasis model assessment insulin resistance index, BP over time during the 12-week study. In subgroup analysis, magnesium supplementation (n=8, 27, and 24, respectively) lowered BP much more than placebo (n=16, 29, and 25, respectively) in those subjects whose systolic BP > or = 140 mmHg, diastolic BP 80-90 mmHg, and diastolic BP > or = 90 mmHg at the start of the study (P=0.016, 0.043, and 0.023, respectively); in comparison, those subjects whose initial BP reading was low at baseline did not show a change in BP. No significant adverse events related to magnesium supplementation were recorded.

CONCLUSIONS

These results suggested that magnesium supplementation does not reduce BP and enhance insulin sensitivity in normo-magnesemic nondiabetic overweight people. However, it appears that magnesium supplementation may lower BP in healthy adults with higher BP.