Appropriate waist circumference cutoff points for central obesity in Korean adults

Effects of muscular and aqua aerobic combined exercise on metabolic indices in elderly women with metabolic syndrome

The purpose of this study was to investigate the effects of muscle strengthening exercise using elastic thera-band and aquatic aerobic combined exercise on metabolic syndrome index in elderly with metabolic syndrome. Fifty-four were assigned to muscle strengthening exercise group (n = 19), aquatic aerobic exercise group (n = 19), and combined exercise group (n = 16). The muscle strength exercise, aquatic aerobic exercise and combined exercise were provided three times a week for 12 weeks. Metabolic syndrome indices[Fasting blood glucose, triglyceride, high density lipoprotein cholesterol (HDL-C), systolic blood pressure, diastolic blood pressure and waist circumference] were measured before and after the program. One-way ANOVA, paired t-test and two-way repeated ANOVA were used with the SPSS program for data analysis. There was a significant difference in triglyceride (p < .001), HDL-C (p = .010) and waist circumference (p = .016). Triglyceride and waist circumference was significantly decreased in combined group than muscle strength exercise group and aquatic exercise group. HDL-C was significantly increased in combined group than muscle strength exercise group. The results indicate that combined exercise was more effective in the improvement of dyslipidemia and abdominal obesity.

Clinical characteristics of metabolic syndrome in Korea, and its comparison with other Asian countries

Metabolic syndrome is referred to as syndrome X or insulin resistance syndrome, and is primarily composed of abdominal obesity, diabetes, glucose intolerance, dyslipidemia and high blood pressure. Asians have a lower frequency of obesity than Caucasians, but have an increasing tendency toward metabolic syndrome. Thus, metabolic syndrome poses a major challenge for public health professionals, and is set to become a social and economic problem in Asian populations. Most data on metabolic syndrome are based on studies from Western countries with only limited information derived from Asian populations. Recently, several studies were carried out on a large scale that represents the general Korean population. The prevalence of metabolic syndrome in Korean adults has varied depending on the study designs and different criteria, but shows a distinct increasing trend of metabolic syndrome driven by an increase in abdominal obesity and dyslipidemia. Given the rapid economic progression of Korea over the past 30 years along with a rise of the aged population, it is expected that the prevalence of metabolic syndrome will further increase. Therefore, a proactive strategy at the governmental level for metabolic syndrome prevention should be implemented, reducing abdominal obesity and dyslipidemia. Healthy dietary habits and regular exercise should be emphasized as a part of such a strategy.

Gamma-glutamyl transferase is associated with sarcopenia and sarcopenic obesity in community-dwelling older adults: results from the Fifth Korea National Health and Nutrition Examination Survey, 2010-2011

Although elevated serum gamma-glutamyl transferase activity (GGT) has been linked with metabolic risk factors for sarcopenia, including non-alcoholic fatty liver disease, adiposity, and insulin resistance, whether GGT independently associated with sarcopenia and sarcopenic obesity has not yet been investigated. We analyzed cross-sectional data of 3,193 community-dwelling adults (42.2% men, age 63.4 ± 8.7) aged ≥50 years from the Fifth Korean National Health and Nutrition Examination Survey, 2010-2011. Sarcopenia was defined as a calculated value of the appendicular skeletal muscle mass divided by body weight (ASM/Wt, %) <1 standard deviation below the sex-specific mean for healthy young adults. Sarcopenic obesity was defined as sarcopenia combined with a waist circumference ≥90 cm for men and ≥85 cm for women. The prevalence of sarcopenia and sarcopenic obesity increased stepwise from the lowest to highest GGT quintiles (sarcopenia, 20.2-39.7%; sarcopenic obesity, 7.5-27.3%; P for trend, <0.001). Serum GGT activity was associated negatively with ASM and positively with waist circumference. In multivariate logistic regression analyses, participants in the highest GGT quintile had a 2.3-fold increased risk of sarcopenia and 3.4-fold risk of sarcopenic obesity versus those in the lowest quintile, whereas each single-unit increase in natural log-GGT associated independently with a 35% increased risk of sarcopenia and 62% increased risk of sarcopenic obesity after adjusting for age, sex, body mass index, and other confounders. Elevated serum GGT activity was independently associated with sarcopenia and sarcopenic obesity in community-dwelling older adults.

Obesity with metabolic abnormality is associated with the presence of carotid atherosclerosis in Korean men: a cross-sectional study

BACKGROUND

Obesity is a risk factor for cardiovascular disease, but metabolic disturbances can also lead to the development of this disease. Therefore, we investigated the associations between obesity subtype, considering both body weight and metabolic disturbances, and carotid atherosclerosis as a predictor of cardiovascular disease in Korean men.

METHODS

Data from a total of 980 men were analysed in this study. Obesity subtypes were classified as normal weight without metabolic syndrome (metabolically healthy normal weight; MHNW), obesity without metabolic syndrome (metabolically healthy, but obese; MHO), normal weight with metabolic syndrome (metabolically abnormal, but normal weight; MANW) and obesity with metabolic syndrome (metabolically abnormal obese; MAO). Carotid intima-media thickness (CIMT) and carotid plaque were assessed using a high-resolution B-mode ultrasound system. Carotid atherosclerosis was defined as a mean CIMT value >0.9 mm or the presence of carotid plaque.

RESULTS

Mean CIMT in the MAO subtype was significantly higher than that in the MHNW control group (0.790 ± 0.019 vs. 0.747 ± 0.013 mm; p < 0.001). The presence of carotid plaque was positively associated with MAO subtype [adjusted odds ratio (aOR) 1.49, 95 % confidence interval (CI) 1.02-2.16; p = 0.039], but not with MHO or MANW, compared to the MHNW control group. The MAO subtype showed a positive association with the presence of carotid atherosclerosis (aOR 1.68, 95 % CI 1.17-2.42; p = 0.006).

CONCLUSIONS

Only the MAO subtype showed a higher CIMT value and positive associations with carotid plaque and carotid atherosclerosis, but not with MHO and MANW subtypes, compared to the MHNW control. Additional prospective studies are needed to evaluate preclinical carotid atherosclerosis according to the subtypes of obesity.

Association of Metabolic Syndrome with the Cardioankle Vascular Index in Asymptomatic Korean Population

AIM

Metabolic syndrome is characterized by a cluster of atherosclerotic cardiovascular risk factors. The cardioankle vascular index (CAVI) reflects arterial stiffness and may be used as an indicator of atherosclerotic cardiovascular disease. In this study, we investigated the association of CAVI with metabolic syndrome.

METHODS

A total of 1,144 adults were included in this study. We measured CAVIs and examined blood samples to identify metabolic syndrome according to WHO Asia Pacific criteria and NCEP-ATPIII criteria. AST, ALT, r-GTP, BUN, creatinine, high sensitivity C-reactive protein, and uric acid were also measured.

RESULTS

CAVI values were significantly higher in subjects with metabolic syndrome than those without metabolic syndrome and increased according to the number of metabolic syndrome components present. Subjects with high fasting blood sugar levels or high blood pressure showed high CAVI values. Multiple regression analysis showed that age, sex, diastolic blood pressure, and uric acid were independent predictors of CAVI.

CONCLUSION

Subjects with metabolic syndrome had high CAVIs, which indicated arterial stiffness, and were closely associated with an increase in the number of metabolic risk factors. The individual risk factors for metabolic syndrome have the synergistic effect of elevating arterial stiffness in asymptomatic Korean population.

Sex differences in the relationship between blood mercury concentration and metabolic syndrome risk

BACKGROUND

Mercury exposure enhances free radical production and reduces activity of anti-oxidant enzymes, resulting in detrimental health effects. Some researchers have reported an association between blood mercury and increased risk of metabolic syndrome (MetS); however, sex differences in the relationship were not fully considered.

AIM

To examine the sex differences in the relationship between blood mercury concentration and the increased risk of MetS in Korean men and women.

MATERIALS AND METHODS

A nationwide cross-sectional study was conducted to examine the relationship between blood mercury concentration and MetS in 2,976 men and 3,074 women over 19 years of age (aged 19-87 years), using data from the 2010-2012 Korean National Health and Nutrition Examination Survey (KNHANES-V). Multiple logistic regression analysis was used to assess the relationship between blood mercury concentration and the prevalence risk of MetS after adjusting for confounding variables.

RESULTS

Compared to the lowest quartile of blood mercury concentration, the OR (95 % CI) for MetS of the highest quartile in men was 1.62 (1.15-2.28) after adjusting for age, smoking status, alcohol consumption, regular exercise, and BMI. Similarly, in multiple logistic regression analysis using log2-transformed blood mercury as a continuous variable, the OR (95 % CI) for having MetS with doubling of blood mercury was 1.20 (1.05-1.36) after adjusting for the same co-variables. However, the relationship was not observed in women after adjusting for the same co-variables.

CONCLUSIONS

Blood mercury concentration was independently associated with an increased risk of MetS in men.

Increased risk of diabetes development in subjects with the hypertriglyceridemic waist phenotype: a 4-year longitudinal study

BACKGROUND

The hypertriglyceridemic waist (HTGW) phenotype is a simple and inexpensive screening parameter to identify people at increased risk of cardiovascular disease. We evaluated whether the HTGW phenotype predicts diabetes in urban Korean adults.

METHODS

A total of 2,900 nondiabetic subjects (mean age 44.3 years), comprising 2,078 males (71.7%) and 822 females (28.3%) who underwent annual medical check-ups at our center between January 2005 and December 2009, were recruited. The subjects were divided into four groups according to baseline serum triglyceride (TG) level and waist circumference (WC): normal WC-normal TG (NWNT) level, normal WC-high TG level, enlarged WC-normal TG level, and enlarged WC-high TG (EWHT) level. High serum TG level was defined as ≥150 mg/dL and enlarged WC was defined as ≥90 cm for men and ≥85 cm for women. New cases of diabetes were determined according to questionnaires filled in by participants and the diagnostic criteria of the American Diabetes Association. Cox proportional hazards model analysis was used to assess the association of HTGW phenotype with the incidence of diabetes.

RESULTS

A total of 101 (3.5%) new diabetes cases were diagnosed during the study period. The EWHT group had a higher incidence of diabetes (8.3%) compared with the NWNT group (2.2%). The adjusted hazard ratio for diabetes for subjects with the EWHT phenotype at baseline was 4.113 (95% confidence interval [CI], 2.397 to 7.059) after adjustment for age, and 2.429 (95% CI, 1.370 to 4.307) after adjustment for age, sex, total cholesterol, systolic blood pressure, and alcohol drinking history. It was attenuated by inclusion of baseline fasting glucose level in the model.

CONCLUSION

Subjects with the HTGW phenotype showed the highest risk of incident diabetes. This tool could be useful for identifying individuals at high risk of diabetes.

Optimal waist circumference cutoff values for the diagnosis of abdominal obesity in korean adults

Abdominal obesity is associated closely with insulin resistance, diabetes, and cardiovascular disease. Waist circumference (WC) is a useful surrogate marker commonly used for abdominal adiposity. The determination of WC cutoff levels is important in the prevention and treatment of obesity, type 2 diabetes, and related cardiovascular diseases. Recent epidemiological evidence suggested that appropriate optimal cutoffs for Koreans ranged over 80 to 89.8 cm in males and 76.1 to 86.5 cm in females. We analyzed the data from two large cohorts using receiver operating characteristic curve analysis with the incidences of diabetes, hypertension, dyslipidemia, cerebrovascular disease, myocardial infarct, angina, coronary artery disease, and multiple metabolic risk factors as outcome variables. Optimal WC cutoff points for Koreans were 85 cm in males and 80 cm in females. However, considering the prevalence of abdominal obesity and the health costs for its prevention and management, 90 cm in males and 85 cm in females are probably more appropriate thresholds for abdominal obesity. These values may be modified once better research is performed through prospective studies using representative populations, common health outcomes, and proper analytical approaches.

Sex factors in the metabolic syndrome as a predictor of cardiovascular disease

BACKGROUND

Metabolic syndrome (MetS) is a condition characterized by a cluster of metabolic disorders and is associated with increased risk of cardiovascular disease (CVD). This study analyzed data from the Korean Health and Genome Study to examine the impact of MetS on CVD.

METHODS

A total of 8,898 subjects (4,241 males and 4,657 females), 40 to 69 years of age, were enrolled and evaluated for the development of new onset CVD from 2001 to 2012 (median 8.1 years of follow-up).

RESULTS

The prevalence of MetS at baseline was 22.0% (932/4,241) and 29.7% (1,383/4,657) in males and females, respectively. MetS was associated with increased risk of coronary heart disease (CHD; hazard ratio [HR], 1.818; 95% confidence interval [CI], 1.312 to 2.520 in males; HR, 1.789; 95% CI, 1.332 to 2.404 in females) and CVD (HR, 1.689; 95% CI, 1.295 to 2.204 in males; HR, 1.686; 95% CI, 1.007 to 2.192 in females). Specifically, MetS was associated with risk of future stroke in females only (HR, 1.486; 95% CI, 1.007 to 2.192). Among MetS components, abdominal obesity and hypertension were independent predictors of both CHD and CVD. In addition, a higher number of MetS components correlated with higher CVD risk.

CONCLUSION

MetS is a significant risk factor for the development of CVD although its impact varies between sexes.

Prevalence of and risk factors associated with dry eye: the Korea National Health and Nutrition Examination Survey 2010-2011

PURPOSE

To investigate the prevalence of and risk factors associated with dry eye syndrome (DES) in South Korea.

DESIGN

Cross-sectional study.

METHODS

In 2010 and 2011, 11,666 subjects, ranging in age from 19 to 95, were randomly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey (KNHANES). Subjects were divided into 2 groups: 1 with clinically diagnosed DES and 1 with symptoms of dry eye. We determined the prevalence of and risk factors for dry eyes in a Korean population. Health-related quality of life (HRQoL), measured by the EuroQoL-5 dimension (EQ-5D), was evaluated in patients with dry eyes.

RESULTS

The mean age was 49.9 years. The overall prevalence of diagnosed DES was 8.0% (95% confidence interval [CI], 7.3% to 8.7%), and of dry eye symptoms the prevalence was 14.4% (95% CI, 13.1 to 15.7). Age (adjusted odds ratio [aOR] = 1.8, 1.6), female (aOR = 2.8, 1.9); history of eye surgery (aOR = 2.6, 2.2); stress (aOR = 1.7, 1.6); thyroid disease (aOR = 1.7, 1.5); and high education level (aOR = 1.6, 1.5) were common risk factors in the groups. Subjects who had undergone ptosis, cataract or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery. Means of pain and anxiety dimensions in the EQ-5D and the Euro Quality of Life Visual Analog Scale (EQ-VAS) were significantly higher in the group with diagnosed DES than in the normal group.

CONCLUSIONS

The risk factors were mostly similar in both groups. It is thought there are more patients with DES who have not been diagnosed by doctors. Doctors should identify whether a patient has any risk factors for dry eye. Patients need to be educated about the modifiable factors of DES.

Interleukin-6 is associated with obesity, central fat distribution, and disease severity in patients with acute pancreatitis

BACKGROUND/OBJECTIVE

Acute pancreatitis (AP) is a systemic inflammatory disease, and cytokines are suggested to be related to the course of AP. Obesity and central fat distribution are considered to have been associated with severe AP. This study investigated the profile of inflammatory cytokines in AP to determine how they are related to obesity, central fat distribution, and AP severity.

METHODS

Fifty-nine patients with AP were prospectively enrolled in the study. Body mass index and waist circumference were obtained at admission. Serum levels of inflammatory cytokines, IL-Iβ, IL-1ra, IL-6, TNF-α, sTNFR-I, and sTNFR-II, were measured on day 1 and 2 of AP.

RESULTS

Of the patients included in the study, 19 (32%) were overweight, 23 (39%) had central fat distribution, and 23 (39%) had moderate AP. IL-1ra and IL-6 were significantly higher in overweight patients compared with non-overweight patients. IL-1ra, IL-6, TNF-α, and sTNFR-I were significantly higher in patients with central fat distribution compared with patients with non-central fat distribution. IL-6, sTNFR-I, and sTNFR-II were significantly higher in patients with moderate pancreatitis compared to those with mild pancreatitis. Among the six cytokines, IL-6 was commonly elevated in patients with central fat distribution, overweight, and moderate AP. The areas under the receiver operating characteristic curves of IL-6 for predicting the association with overweight, central fat distribution, and AP severity were 0.678, 0.716, and 0.801, respectively (P < 0.05).

CONCLUSIONS

IL-6 is a good marker for AP severity and is associated with obesity and central fat distribution in AP patients.

Metabolic syndrome and sex-specific socio-economic disparities in childhood and adulthood: the Korea National Health and Nutrition Examination Surveys

AIMS

To examine whether adulthood and/or childhood sex-specific socio-economic disparities are associated with metabolic syndrome and its components in a developed non-Western setting.

METHODS

Based on the Fourth Korea National Health and Nutrition Examination Surveys, 14 888 people aged ≥ 20 years were analysed to evaluate the effect of adult and childhood socio-economic status on metabolic syndrome. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III guidelines. Logistic regression analyses were conducted to calculate the odds ratios for metabolic syndrome and each component of metabolic syndrome in later life.

RESULTS

The age-standardized prevalence of metabolic syndrome was 26.6% for men and 21.3% for women. Compared with the highest level of education, men with the lowest education level were significantly less likely to have metabolic syndrome (odds ratio 0.76, 95% CI 0.60-0.96), whereas the opposite association was found in women (odds ratio 3.29, 95% CI 2.45-4.42). Men who were manual labourers and economically inactive had a lower prevalence of metabolic syndrome compared with those with non-manual jobs (odds ratio 0.82, 95% CI 0.69-0.98 and odds ratio 0.79, 95% CI 0.64-0.99, respectively), but the reverse association was observed in women (odds ratio 1.34, 95% CI 1.04-1.73 and odds ratio 1.40, 95% CI 1.09-1.81, respectively). A significant interaction between combined adulthood and childhood socio-economic status on the presence of metabolic syndrome was observed (P < 0.05).

CONCLUSIONS

Our findings suggest that sex-specific socio-economic disparities in childhood and adulthood have differential effects on the prevalence of metabolic syndrome and its individual components in Korea.

Serum HBV surface antigen positivity is associated with low prevalence of metabolic syndrome in Korean adult men

Background

Metabolic syndrome has clinical implications for chronic liver disease, but the relationship between chronic hepatitis B and metabolic syndrome remains unclear. The aim of this study was to determine whether hepatitis B surface antigen (HBsAg) positivity is associated with metabolic syndrome.

Methods

Data were obtained from the Third Korean National Health and Nutrition Examination Survey (KNHANES). Participant sera were tested for HBsAg. Metabolic syndrome was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III guidelines for Koreans.

Results

Of the 5108 participants, 209 (4.1%) tested positive for HBsAg, and 1364 (26.7%) were diagnosed with metabolic syndrome. The prevalence of metabolic syndrome was 23.4% in HBsAg-positive men, 31.5% in HBsAg-negative men, 18.6% in HBsAg-positive women, and 23.7% in HBsAg-negative women. After adjusting for multiple factors, male participants who tested positive for serum HBsAg had an odds ratio of 0.612 (95% confidence interval [CI] 0.375–0.998) for metabolic syndrome and an odds ratio of 0.631 (95% CI 0.404–0.986) for elevated triglycerides. Women who tested positive for serum HBsAg had an odds ratio of 0.343 (95% CI 0.170–0.693) for elevated triglycerides.

Conclusions

Positive results for serum HBsAg are inversely associated with metabolic syndrome in men and with elevated triglycerides in men and women. This suggests that elevated triglycerides may contribute to the inverse association between HBsAg and metabolic syndrome.

Association between metabolic syndrome, radiographic knee osteoarthritis, and intensity of knee pain: results of a national survey

CONTEXT

Although osteoarthritis (OA) has been suggested as another component of metabolic syndrome (MetS), weight-independent associations between MetS and knee OA or intensity of arthritic knee pain remain unclear.

OBJECTIVE

The objective of the study was to evaluate the above associations and suggest possible mechanisms.

DESIGN AND SETTING

This was a cross-sectional study using the fifth Korean National Health and Nutrition Examination Survey (2010).

PARTICIPANTS

A total of 2363 adults (≥50 y of age) who had completed both laboratory examinations and an evaluation for radiographic knee OA participated in the study.

MAIN OUTCOME AND MEASURES

Radiographic knee OA was defined as a Kellgren/Lawrence grade of 2 or greater, and the intensity of arthritic knee pain was assessed using a self-reported numeric rating scale. MetS was diagnosed based on National Cholesterol Education Program-Adult Treatment Panel III criteria, and insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance index.

RESULTS

In a multivariable logistic regression analysis, MetS was associated with radiographic knee OA (adjusted odds ratio 1.49; 95% confidence interval 1.23-1.79; P < .001). This association was not changed significantly after further adjusting for homeostasis model assessment-estimated insulin resistance but became nonsignificant after adjusting for weight or body mass index. Age-, sex-, and weight (or body mass index)-adjusted mean score of knee pain was significantly higher in subjects with more components of MetS (P for trend = .010 or .035, respectively).

CONCLUSIONS

The association between MetS and radiographic knee OA can be largely explained by an excessive weight but not by insulin resistance, a key pathophysiology of MetS. Because accumulation of MetS components appears to be associated with a higher intensity of knee pain, independently of weight, appropriate treatment for MetS may be helpful for subjects with knee pain.

Nut consumption has favorable effects on lipid profiles of Korean women with metabolic syndrome

Nut consumption has been studied for its cardioprotective effects. However, the findings of clinical intervention studies are inconsistent; and no intervention studies have been conducted in the Korean population. We hypothesized that nut supplementation may have favorable influence on metabolic markers. Therefore, this study aimed to investigate the effects of nut consumption on metabolic parameters and biomarkers related to inflammation, oxidative stress, and endothelial function in Korean adults with metabolic syndrome. To this end, we designed a randomized, parallel, controlled dietary intervention study (ClinicalTrials.gov NCT02023749). Subjects with metabolic syndrome and a body mass index of at least 23 kg/m(2) were randomized to the Control group and the Nut group, which received supplementation with 30 g/d of mixed nuts (walnuts, peanuts, and pine nuts) for 6 weeks. Sixty volunteers were included in the final analysis. Metabolic markers were evaluated at baseline and at the end of the study. Total cholesterol and non-high-density lipoprotein cholesterol levels significantly improved in the Nut group compared to those in the Control group (P = .023 and P = .016, respectively) in women. Biomarkers related to inflammation, oxidative stress, and endothelial function did not significantly change from baseline in either group. Thus, supplementing a usual diet with mixed nuts for 6 weeks had favorable effects on several lipid parameters in Korean women with metabolic syndrome. These findings present a possible mechanism for the cardioprotective effects of nut consumption.

The associations between serum zinc levels and metabolic syndrome in the Korean population: findings from the 2010 Korean National Health and Nutrition Examination Survey

The prevalence of metabolic syndrome has been increasing rapidly worldwide. The functions of zinc may have a potential association with metabolic syndrome, but such associations have not been investigated extensively. Therefore, we examined the relationship between serum zinc levels and metabolic syndrome or metabolic risk factors among South Korean adults ≥20 years of age. The analysis used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians, conducted from January to December 2010. A total of 1,926 participants were analyzed in this study. Serum zinc levels in men were negatively associated with elevated fasting glucose (adjusted odds ratio [aOR], 0.58; 95% confidence interval [CI], 0.36–0.93) and positively associated with elevated triglycerides (aOR, 1.47; 95% CI, 1.01–2.13). A difference in serum zinc levels was detected in women, depending on the number of metabolic syndrome components (p = 0.002). Furthermore, serum zinc levels showed a decreasing trend with increasing numbers of metabolic syndrome components in women with metabolic syndrome. These findings suggest that serum zinc levels might be associated with metabolic syndrome or metabolic risk factors. Further gender-specific studies are needed to evaluate the effect of dietary or supplemental zinc intake on metabolic syndrome.

The prevalence of general and abdominal obesity according to sasang constitution in Korea

Background

Obesity is an important risk factor for cardiovascular and metabolic diseases and could affect mortality rates. Body mass index (BMI) and waist circumference (WC) have been used to classify obesity, and waist-to-hip ratio (WHR) has recently emerged as a discriminator of cardiovascular disease. Sasang constitution (SC) is a kind of well-known traditional Korean medicine: Tae-eumin (TE), Soeumin (SE), Taeyangin (TY) and Soyangin (SY) carrying a different level of susceptibility to chronic diseases. We aimed to examine the prevalence in general and abdominal obesity (AO) using BMI, WC and WHR according to SC in the Korean population.

Methods

A total of 3,348 subjects were recruited from 24 Korean medicine clinics. Obesity was divided into three categories: general obesity by BMI, abdominal obesity by waist circumference (WC AO) and abdominal obesity by waist-to-hip ratio (WHR AO). A Chi-square test was performed to compare prevalence, and logistic regression was conducted to generate odds ratios (ORs) according to SC (p < .05).

Results

The prevalence of general obesity was significantly higher in males than in females. The highest prevalence of general obesity, WC AO and WHR AO were all observed in the TE type, and the SY and SE types were followed in order, for both males and females respectively.

The TE type was highly associated with increased risk of general obesity (OR = 20.2, 95% CI: 12.4-32.9 in males and OR = 14.3, 95% CI: 10.1-20.2 in females), of WC AO (OR = 10.7, 95% CI: 7.2-15.9 in males and OR = 7.5, 95% CI: 5.8-9.6 in females), and of WHR AO (OR = 4.6, 95% CI: 3.3-6.4 in males and OR = 3.8, 95% CI: 2.9-4.9 in females) compared with the SE type. In addition, after controlling for age, social status and eating habits, the ORs were similar to the crude model according to gender and SC.

Conclusions

This study shows that the prevalence of obesity varies according to SC in the Korean population. In particular, the TE type was highly associated with increased ORs for general obesity, WC AO and WHR AO in both genders.

Serum zinc concentration is inversely associated with insulin resistance but not related with metabolic syndrome in nondiabetic Korean adults

Although zinc was known to be associated with insulin metabolism and diabetes, the relationship of serum zinc concentration with insulin resistance (IR) and metabolic syndrome (MetS) was not well investigated in general population. The aim of this study is to evaluate the relationships of serum zinc concentration with IR and MetS in a nondiabetic adult population. This cross-sectional study included 656 men and 825 women who were nondiabetic adults from the fifth Korea National Health and Nutrition Examination Survey conducted in 2010. Serum zinc concentration and metabolic parameters were measured. IR was estimated by homeostatic model assessment (HOMA2). MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Serum zinc concentration was negatively correlated with homeostasis model assessment for insulin resistance (HOMA2-IR) in men (r = -0.104, P = 0.008), but not in women. After adjusting for conventional cardiovascular risk factors, the inverse correlation was significant in both men and women (B = -0.262, SE = 0.060 for men, and B = -0.129, SE = 0.052 for women). However, serum zinc concentration was not different between the groups with and without MetS (P = 0.752 for men and P = 0.371 for women). In conclusion, serum zinc concentration was inversely associated with IR but not related to MetS in nondiabetic adult population.

Binge drinking and its relation to metabolic syndrome in korean adult men

Background

It is reported that heavy drinking increases the risk of metabolic syndrome. But there have been few studies on the relationship between the intensity of drinking and metabolic syndrome when drinking the same amount of alcohol. This study aimed to assess the relationship between the frequency of binge drinking and metabolic syndrome in Korean adult men.

Methods

From the database of the 4th and 5th Korea National Health and Nutrition Examination Survey conducted in 2007-2010, data of 8,305 adult men (≥19 years of age) was included in this analysis. Cross-sectional relationship between the frequency of binge drinking and metabolic syndrome was investigated adjusting for pure alcohol consumed per day.

Results

Adjusting for various confounders including pure alcohol consumed per day, the adjusted odds ratio for metabolic syndrome in those in higher frequency (more than 1/wk) binge drinking group was 1.62 (95% confidence interval, 1.30 to 2.03; P for trend = <0.001) compared to those in the non-binge drinking group. Through analysis of the relationship between pure alcohol consumed per day and metabolic syndrome, it was found that pure alcohol consumed per day had a positive relation to metabolic syndrome in the higher frequency binge drinking group (P for trend = 0.041). The relationship was inverse in the non-binge drinking group (P for trend = 0.002).

Conclusion

Our study found a positive relationship between frequency of binge drinking and metabolic syndrome in adult men. And the effect of drinking on metabolic syndrome may depend on the frequency of binge drinking. Further studies are required to confirm this association.

Association between Appendicular Fat Mass and Metabolic Risk Factors

BACKGROUND

Different regional fat depots have different effects on lipid and glucose metabolism. The purpose of this study is to examine the relationship between body fat distribution as measured by dual-energy X-ray absorptiometry (DEXA) and metabolic risk factors and to disclose whether there is any difference between groups with and without metabolic syndrome (MS).

METHODS

A total of 292 participants (98 men, 194 women) over 19 years old underwent whole-body DEXA to evaluate body composition with respect to the whole body, leg, arm, and android regions. Anthropometry and blood tests for metabolic risks were measured.

RESULTS

One hundred and seven participants were diagnosed with MS. The MS group had significantly higher android fat (%) and had lower leg fat (%), arm fat (%), and appendicular (arms + legs) fat (%) than the non-MS group. Android fat (%) had a positive correlation with waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, log insulin, hemoglobin A1c (HbA1c), triglyceride (TG), and low density lipoprotein cholesterol, and had a negative correlation with high density lipoprotein (HDL) cholesterol. Appendicular fat (%) had a negative correlation with WC, SBP, DBP, glucose, log insulin, HbA1c, and TG, and had a positive correlation with HDL cholesterol. The association of appendicular fat with metabolic risk was consistently observed in non-MS, but the association was not observed except for SBP, glucose and log insulin in MS.

CONCLUSION

In contrast with the adverse effects of android fat, appendicular fat distribution was associated with decreased risks of MS. The protective effect of appendicular fat against metabolic risk factors in non-MS was less characteristic in MS.

Predicting visceral obesity based on facial characteristics

Background

Visceral obesity is associated with facial characteristics and chronic disease, but no studies on the best predictor of visceral obesity based on facial characteristics have been reported. The aims of the present study were to investigate the association of visceral obesity with facial characteristics, to determine the best predictor of normal waist and visceral obesity among these characteristics, and to compare the predictive power of individual and combined characteristics.

Methods

Cross-sectional data were obtained from 11347 adult Korean men and women ranging from 18 to 80 years old. We examined 15 facial characteristics to identify the strongest predictor of normal and viscerally obese subjects and assessed the predictive power of the combined characteristics.

Results

FD_94_194 (the distance between both inferior ear lobes) was the best indicator of the normal and viscerally obese subjects in the following groups: Men-18-50 (p ≤ 0.0001, OR = 4.610, AUC = 0.821), Men-50-80 (p ≤ 0.0001, OR = 2.624, AUC = 0.735), and Women-18-50 (p ≤ 0.0001, OR = 2.979, AUC = 0.76). In contrast, FD_43_143 (mandibular width) was the strongest predictor in Women-50-80 (p ≤ 0.0001, OR = 2.099, AUC = 0.679). In a comparison of the combined characteristics, the area under the receiver operating characteristic curve (AUC) and the kappa values of the 4 groups ranged from 0.826 to 0.702 and from 0.483 to 0.279, respectively. The model for Men-18-50 showed the strongest predictive values and the model for Women-51-80 had the lowest predictive value for both the individual and combined characteristics.

Conclusions

In both men and women, the predictive power of the young and middle-age groups was better than that of the elderly groups for predicting normal waist and viscerally obese subjects for both the individual and combined characteristics. The predictive power appeared to increase slightly with the combined characteristics.

Effects of weight management by exercise modes on markers of subclinical atherosclerosis and cardiometabolic profile among women with abdominal obesity: a randomized controlled trial

Background

Few studies have examined the differential effects of weight management by exercise mode on subclinical atherosclerosis. We hypothesized that 3 modes of aerobic, resistance, and combination exercises have differential effects on the flow-mediated dilation (FMD), carotid-femoral pulse wave velocity (PWV), and carotid intima-media thickness (IMT) as well as cardiometabolic profile in weight management.

Methods

A randomized, single-blind trial (ISRCTN46069848) was conducted in Seoul, South Korea between November 2011 and December 2012. Randomized participants were 110 women with abdominal obesity (aerobic group n = 50; resistance group n = 30; combination exercise group n = 30). The treatment period was 12 months with 3-month follow up: A diet-alone intervention for the first 3 months and a diet-plus-exercise intervention for the next 9 months according to exercise modes. The exercise training was designed with an intensity of 50-70% heart rate reserve for 3 days a week in 60-minute-long sessions for 9 months, consisting of 30-minute treadmill and 30-minute bike exercises for aerobic group; upper and lower body exercises with an intensity target of 2 sets and 8–12 repetitions for resistance group; 30-minute resistance and consecutive 30-minute aerobic exercises for combination group.

Results

Ninety-two and 49 participants were analyzed for modified intention-to-treat analysis and per-protocol (PP) analysis, respectively. The 3 exercise modes had no significant differential effects on FMD, PWV, and IMT over time; however, the combination group was found to have significantly lower levels of fasting glucose than the aerobic group (p = .034) in the PP analysis. Nevertheless, we observed significant time effects such as reductions in PWV (p = .048) and IMT (p = .018) in cubic and quadratic trends, respectively, and improvements in body weight, waist circumference, low-density and high-density lipoprotein cholesterol levels, fasting glucose levels, and cardiorespiratory fitness in linear, quadratic, or cubic trends.

Conclusions

For women with abdominal obesity, a combination of aerobic and resistance exercises may be preferable to a single exercise mode for effective glucose control. Regardless of exercise mode, exercise interventions combined with dietary interventions in weight management may be beneficial in reducing the risk of subclinical atherosclerosis and cardiometabolic risk.

Metabolic syndrome and suicidal ideation in korean based on the 2010 korean national health and nutrition examination survey

The aim of this study was to investigate the relationship between metabolic syndrome and suicidal ideation in Korean. This study was based on the 2010 Korean National Health and Nutrition Examination Survey. A questionnaire was used to measure suicidal ideation and physical examination was performed to measure waist circumference, blood pressure, fasting glucose, cholesterol and triglyceride levels. Complex samples logistic regression was performed to estimate the relationship between metabolic syndrome and suicidal ideation among adults and adolescents. Subjects with metabolic syndrome were more likely to have suicidal ideation in adult. There would be essential needs to evaluate suicidal ideation in adult with metabolic syndrome and to follow up suicidal ideation in adolescents with metabolic syndrome.

Association between markers of glucose metabolism and risk of colorectal adenoma

BACKGROUND & AIMS

Diabetes is a risk factor for colorectal cancer. We studied the association between markers of glucose metabolism and metabolic syndrome and the presence of colorectal adenomas in a large number of asymptomatic men and women attending a health screening program in South Korea. We also investigated whether these associations depend on adenoma location.

METHODS

In a cross-sectional study, we measured fasting levels of glucose, insulin, hemoglobin A1c, and C-peptide and calculated homeostatic model assessment (HOMA) values (used to quantify insulin resistance) for 19,361 asymptomatic South Korean subjects who underwent colonoscopy examinations from January 2006 to June 2009. Participants completed a standardized self-administered health questionnaire and a validated semiquantitative food frequency questionnaire. Blood samples were collected on the day of the colonoscopy; fasting blood samples were also collected. Robust Poisson regression was used to model the associations of glucose markers with the prevalence of any adenoma.

RESULTS

Using detailed multivariable-adjusted dose-response models, the prevalence ratios (aPR, 95% confidence interval [CI]) for any adenoma, comparing the 90th with the 10th percentile, were 1.08 (1.00-1.16; P = .04) for fasting glucose, 1.07 (0.99-1.15; P = .10) for insulin, 1.09 (1.02-1.18, P = .02) for HOMA, 1.09 (1.01-1.17; P = .02) for hemoglobin A1c, and 1.14 (1.05-1.24; P = .002) for C-peptide. The corresponding ratios for nonadvanced adenomas were 1.11 (0.99-1.25; P = .08), 1.10 (0.98-1.24; P = .12), 1.15 (1.02-1.29; P = .02), 1.14 (1.01-1.28; P = .03), and 1.20 (1.05-1.37; P = .007), respectively. The corresponding ratios for advanced adenomas were 1.32 (0.94-1.84; P = .11), 1.23 (0.87-1.75; P = .24), 1.30 (0.92-1.85; P = .14), 1.13 (0.79-1.61; P = .50), and 1.67 (1.15-2.42; P = .007), respectively. Metabolic syndrome was associated with the prevalence of any adenoma (aPR, 1.18; 95% CI, 1.13-1.24; P < .001), nonadvanced adenoma (aPR, 1.30; 95% CI, 1.20-1.40; P < .001), and advanced adenoma (aPR, 1.42; 95% CI, 1.14-1.78; P = .002). Associations were similar for adenomas located in the distal versus proximal colon.

CONCLUSIONS

Increasing levels of glucose, HOMA values, levels of hemoglobin A1c and C-peptide, and metabolic syndrome are significantly associated with the prevalence of adenomas. Adenomas should be added to the list of consequences of altered glucose metabolism.

Additive effect of heavy metals on metabolic syndrome in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010

There have been increasing concerns regarding health problems due to endocrine disrupting chemicals (EDCs). We investigated association of heavy metals, including lead, mercury, and cadmium, with metabolic syndrome (MS) and its individual components in the Korean population. Participants included 1,961 males and 1,989 females 20 years of age or older from the fourth and fifth Korea National Health and Nutritional Examination Surveys of the Korean population (2009 and 2010). We examined the relationship of blood lead, mercury, and cadmium levels with MS and the additive effect of three heavy metals on MS after adjustment for age, sex, body mass index (BMI), region, smoking, alcohol consumption, and regular exercise. Blood concentration of lead showed a significant but modest association with prevalence of MS (P = 0.04). Other heavy metals did not show such a relationship with MS. When the participants were classified according to the sum of category numbers of the three heavy metals, adjusted odds ratios were 1.0, 1.355, 1.638, and 1.556 (P < 0.01). Among components of MS, significant relationship of the sum of heavy metals with hypertension and elevated triglyceride was demonstrated. Blood concentration of lead was positively associated with the prevalence of MS. Of particular interest, cumulative effect of a mixture of lead, mercury, and cadmium on prevalence of MS was stronger than the sum of effect of each heavy metal. Accumulative effect of exposure to heavy metals could be more additive or synergistic than individual exposure in the general population.

Relationships of hair mineral concentrations with insulin resistance in metabolic syndrome

Mineral deficiencies can cause impaired insulin release and insulin resistance. This study was conducted to investigate the relationship between hair mineral concentrations and insulin resistance in patients with metabolic syndrome (MS). A total of 456 subjects (161 patients with MS and 295 subjects without MS) were reviewed, and fasting plasma glucose, triglycerides, HDL-cholesterol, homeostasis assessment model-insulin resistance (HOMA-IR), and hair mineral concentrations were analyzed. While hair sodium and potassium concentrations were significantly higher, the hair calcium, magnesium, and zinc concentrations were lower in the MS group than in the control group. Regarding toxic element measurements, the hair arsenic (As) and lead (Pb) concentrations were higher in the MS group than in the control group. The results of multiple regression analysis, after adjusting for age, showed significant relationships between the Na/Mg and Ca/P ratios and HOMA-IR (R (2) = 0.109, p < 0.05). The Ca, Na, K, and B concentrations were also associated with HOMA-IR (R (2) = 0.116, p < 0.05). The hair Na concentration was significantly associated with MS, even after adjusting for age, visceral adipose tissue, and HOMA-IR (OR 1.020; 95 % CI 1.001-1.040; p = 0.036). Our findings suggest that hair mineral concentrations, such as calcium, magnesium, zinc, sodium, and potassium concentrations, may play a role in the development of insulin resistance.

Waist circumference and health-related quality of life by sex in the Korean elderly

OBJECTIVE

This study aims to explore the impact of differential degrees of obesity on health-related quality of life (HRQL) by sex in the Korean elderly.

METHOD

We analyzed data on those aged between 65 and 74 years from the Korean National Health and Nutrition Examination Survey (KNHANES) using multiple regression analysis.

RESULTS

Compared with the lowest waist circumference (WC) quintile, the women in the fourth and fifth quintiles demonstrated significantly lower unadjusted HRQL but not the men in any quintiles. Whereas higher WC quintiles impaired mobility, usual activities, and pain/discomfort in women, the fourth WC quintile improved usual activities in men. After adjustment, only the women of the highest WC quintile reported impaired mobility.

DISCUSSION

Extreme obesity worsens mobility, and comorbidity in combination with obesity worsens HRQL in elderly women. Monitoring and controlling comorbidity and maintaining adequate WC decreases the risks of lowered HRQL in Korean elderly women.

Prevalence of noncommunicable diseases and their risk factors in Guangzhou, China

Introduction

This article reports on the prevalence of noncommunicable diseases (NCDs) and their risk factors in the city of Guangzhou, China, and shows a trend toward epidemic proportions when municipal data are compared with provincial data.

Methods

We conducted the Guangzhou Community Health Survey in the 12 administrative districts of Guangzhou to learn about NCDs and their risk factors. A community-based, face-to-face survey with a stratified multistage cluster sampling was used. Information was gathered on 27,743 respondents, aged 0 to 108 years, with a male to female ratio of 1 to 1. All participants completed a questionnaire, and those aged 15 years or older had a physical examination. Survey results were compared with the provincial results of the 2002 Guangdong Nutrition and Health Survey (GNHS).

Results

The data were weighted to the respondent’s probability of selection and to the age- and sex-specific population. Prevalence estimate of self-reported NCDs was 16.0%. Hypertension and diabetes were reported as the most important NCDs. Of those who responded, 6.8% reported having more than 2 chronic conditions. The adjusted prevalence of hypertension decreased by 13.3% since 2002. Awareness, treatment, and control of hypertension and diabetes were improved. The estimated prevalence of current smoking decreased, and the prevalence of former smoking increased from 2002. However, the prevalence of overweight and obesity, especially central obesity, increased.

Conclusion

Results were encouraging with regard to hypertension and diabetes. However, the unfavorable trends, especially for overweight, central obesity, and passive smoking, call for additional action.

Association between obesity and metabolic co-morbidities among children and adolescents in South Korea based on national data

Background

Childhood obesity has become a serious public health threat worldwide due to its many short- and long-term adverse health effects. We assessed the association between weight status and metabolic co-morbidities among South Korean children using nationally representative data.

Methods

Data from the 2007-2008 Korea National Health and Nutrition Examination Surveys for 1,526 children aged 10-19 years were used. Logistic regression models were fit to examine the association between weight status [overweight, 85^th percentile ≤ BMI <95^th percentile; obese, BMI ≥95^th percentile; and central obesity, waist circumference ≥90^th percentile, based on 2007 Korean National Growth Charts] and metabolic outcomes.

Results

More obese children had metabolic co-morbidities than normal-weight children (P < 0.05). Boys had higher means BMI than girls, WC, and BP, while girls had higher means of total blood cholesterol and HDL-cholesterol (P < 0.05). Attributable risk of metabolic syndrome was high due to overweight and obesity: 91.1% for central obesity and 29.6% for high TG. Obese children had increased risk of having high BP (adjusted odds ratio (OR): 1.90; 95% CI: 1.05-3.45), dyslipidemia (OR: 6.21; 95% CI: 3.59-10.75), high TG (OR: 6.87; 95% CI: 4.05-11.64), low HDL (OR: 4.46; 95% CI: 2.23-8.89), and ≥2 co-morbidities (OR: 26.97; 95% CI: 14.95-48.65) compared to normal-weight subjects, while the associations between weight status and metabolic outcomes were stronger in boys.

Conclusions

Obesity was strongly associated with metabolic co-morbidities in South Korean children.

Sarcopenia and sarcopenic obesity and their association with dyslipidemia in Korean elderly men: the 2008-2010 Korea National Health and Nutrition Examination Survey

BACKGROUND

Recently, aging has been shown to be associated with sarcopenic obesity (SO), of which decreased muscle mass and increased fat mass are features. Sarcopenia and obesity alone are known to be associated with abnormal lipid metabolism. However, it remains unclear whether SO has greater adverse effects on dyslipidemia than on sarcopenia or obesity alone.

AIM

We aimed to investigate the association between SO and dyslipidemia in elderly Koreans.

SUBJECTS AND METHODS

This study was based on data collected during the 2008-2010 Korea National Health and Nutrition Examination Survey. We included 1,466 men and 2,017 women aged 65 years and over. Sarcopenia was indicated in participants with height- or weight-adjusted appendicular skeletal muscle that was 1 standard deviation below the sex-specific mean for the young reference group, and obesity was defined as a body mass index ≥ 25 kg/m(2). Dyslipidemia was defined according to the National Cholesterol Education Program-Adult Treatment Panel III.

RESULTS

After adjusting for confounding factors, the SO group had a higher risk for dyslipidemia [odds ratio (OR) 2.82 (95 % confidence interval 1.76-4.51)] than the obese group [2.12 (1.11-4.07)] and sarcopenic group [1.46 (1.01-2.11)] (p < 0.001) only in men. Furthermore, the SO group in men had the highest OR for hypercholesterolemia, hypertriglyceridemia, hypo-high-density lipoprotein cholesterolemia, hyper-low-density lipoprotein cholesterolemia, and a high ratio of triglyceride to high-density lipoprotein cholesterol even after further adjustments.

CONCLUSIONS

In Korean elderly men, SO was associated with an increased risk for dyslipidemia compared with sarcopenia or obesity alone.

Association between waist circumference (WC) values and hypertension, heart disease (HD) and diabetes, reported by the elderly--SABE Survey: Health, Wellness and Aging, 2000 and 2006

The positive association between WC and systemic arterial hypertension (SAH), diabetes mellitus (DM) and HD calls for investigation in the elderly. The objective of the present study was to identify WC values, so as better to determine the risk of these diseases. This was a longitudinal study using the data of 405 elderly participants of the SABE Survey: Health, Well-being and Aging, undertaken in São Paulo, in 2000 and 2006. The study variables were WC, sex, age group, ethnicity, and body mass index (BMI) (2000) and SAH, DM and HD (2006). The area under the Receiver Operating Caracteristics (ROC) curve (AUC) and confidence intervals of 95% was used to estimate the performance of WC values in correctly discriminating among the elderly, according to the reference or not to diseases associated with WC. WC critical values were identified by the highest positive likelihood ratio (PLR), and negative likelihood ratio (NLR) equal to zero. The AUC showed the satisfactory performance of WC critical values in discriminating between reports of DM in individuals of 60-74 years of age. The WC critical values identified were ≥87 cm for women and ≥99 cm for men, which presented a better performance in relation to the AUC value than to the WC values commonly used. The WC critical values identified in this study showed better discriminatory power of foretelling reference to DM than did the WC values commonly used.

Eating frequency is inversely associated with blood pressure and hypertension in Korean adults: analysis of the Third Korean National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

A lower eating frequency (EF) has been suggested to be important in the development of cardiovascular risk factors such as obesity and hyperlipidemia. However, the association between EF and blood pressure (BP) remains unclear.

SUBJECTS/METHODS

The aim of this study was to explore the association of EF with BP and hypertension after adjusting for confounding variables, including body mass index (BMI) and waist circumference (WC). This cross-sectional study used data from the Third Korean National Health and Nutrition Examination Survey. A total of 4625 subjects aged ≥ 19 years were included. To explore the association of EF with BP and hypertension, we performed multiple linear regression analyses and multiple logistic regression analyses for survey design, respectively.

RESULTS

EF was inversely associated with systolic BP (SBP) and diastolic BP (DBP). As EF increased from ≤ 2 to 3, 4 and ≥ 5 times per day, estimated adjusted means of both SBP and DBP decreased, showing a significant linear trend independent of obesity (SBP: 120.66, 120.23, 119.18 and 117.92 mm Hg, respectively; P<0.001; DBP: 78.36, 77.78, 77.25 and 76.50 mm Hg, respectively; P=0.004). The inverse association between EF and hypertension was gradually attenuated and significant after adjustment for confounding variables including BMI and WC (P=0.040).

CONCLUSIONS

This study suggests that lower EF is significantly associated with higher BP, which may be partially mediated by the effect of central obesity. Further prospective studies are needed to verify this causal relationship.

Prevalence, awareness, and management of obesity in Korea: data from the Korea national health and nutrition examination survey (1998-2011)

BACKGROUND

Obesity is a risk factor for diabetes and several cardiovascular diseases. This study was to investigate the trends in the prevalence, awareness, and management status of obesity among the Korean population for recent 13 years.

METHODS

The prevalence, subjective awareness, and management of obesity were investigated in adults aged ≥19 years by using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) 1998 to 2011.

RESULTS

The number of participants was 8,117, 5,826, 5,500, 3,025, 6,756, 7,506, 6,255, and 6,155 in the KNHANES in years 1998, 2001, 2005, 2007, 2008, 2009, 2010, and 2011, respectively. The prevalence of obesity was 26.9%, 29.2%, 32.9%, 32.5%, 32.0%, 32.6%, 32.0%, and 32.0% in 1998, 2001, 2005, 2007, 2008, 2009, 2010, and 2011, respectively, while the overall prevalence of obesity and abdominal obesity increased by 1.19-fold and 1.24-fold respectively in 2011 compared against 2001. In general, a gradual increase in the prevalence of severe obesity has been observed as years go by. Furthermore, trends of improvements in obesity awareness and management rates were visible over the period of surveys.

CONCLUSION

Although the management status of obesity has improved during the recent years, more effective strategy to control obesity is needed.

The effect of insulin resistance on postprandial triglycerides in Korean type 2 diabetic patients

We hypothesized that the influence of metabolic parameters depends on metabolic syndrome (MetS) status. The clinical and metabolic implications of postprandial triglyceride (ppTG) in Korean type 2 diabetes were investigated in the presence or absence of MetS, MetS+, or MetS-. To investigate the relationship between ppTG and metabolic parameters, we analyzed plasma TG levels in 126 newly diagnosed, drug-naïve diabetic patients after ingestion of a standardized low calorie and fat (500 kcal, 17.5 g fat) liquid meal formula. We report that MetS+ patients have significantly higher BMI, waist/hip ratio, HOMA-IR, and HOMA-β, but insignificantly higher fasting TG, ppTG, and ΔTG than MetS- patients. In the MetS+ patients, ppTG correlated with fasting TG and non-HDL, but was not related to HOMA-IR. In MetS- patients, ppTG correlated with fasting TG, non-HDL, blood pressure, waist/hip ratio, fasting C-peptide and insulin levels, and HOMA-IR. Multivariate analysis showed HOMA-IR to be a predictive factor for ppTG in MetS- patients but not in MetS+ patients. ppTG correlated with IR in MetS- type 2 diabetic patients but not in MetS+. This unexpected result implies that MetS+ diabetic patients already have high fasting TG and that IR influences fasting TG more dominantly than ppTG.

Gender differences in health-related quality of life associated with abdominal obesity in a Korean population

OBJECTIVES

Overall obesity, as measured by body mass index (BMI), has been associated with a low level of health-related quality of life (HRQOL), but little is known about abdominal obesity. This cross-sectional study aimed to determine whether abdominal obesity, as measured by waist circumference (WC), would be significantly associated with HRQOL independent of overall obesity, and if so, whether the association would differ by gender among the Korean population.

DESIGN

Cross-sectional study.

SETTING

South Korea.

PARTICIPANTS

Using data from the 2007-2009 Korea National Health and Nutrition Examination Survey, a total of 13 754 men and women aged 19-65 years were selected, and information about height (cm), weight (kg), WC (cm) and the EuroQOL-5 Dimensions (EQ-5D) scores for HRQOL were taken.

RESULTS

Not only an overall obesity (as categorised into obese, overweight or non-overweight groups based on BMI) but also an abdominal obesity (defined by WC ≥90 cm for men and ≥85 cm for women) was significantly associated with lower EQ-5D scores, after adjusting for age, gender, socioeconomic variables and a number of comorbidities. Even after adjusting BMI effect, the association between abdominal obesity and lower EQ-5D scores remained significant for women, but not for men.

CONCLUSIONS

Among the Korean population aged 19-65 years, abdominal obesity was associated with impaired HRQOL, independently of overall obesity. Furthermore, this association differed by gender, being significant only for women. Therefore, primary healthcare professionals should pay attention to gender differences in the impact of obesity on HRQOL when evaluating population-based health programmes.

Cataract subtype risk factors identified from the Korea National Health and Nutrition Examination survey 2008-2010

Background

To assess the socio-demographic and health-related risk factors associated with cataract subtypes in Korea.

Methods

A total of 11,591 participants (aged ≥40 years) were selected from the Korean National Health and Nutrition Examination Survey between 2008 and 2010. The Korean Ophthalmologic Society conducted detailed ophthalmologic examinations on these participants based on the Lens Opacity Classification System III. Risk factors for developing any type of cataract, and its subtypes (nuclear, cortical, posterior subcapsular and mixed), were identified from univariate and multivariate logistic regression analysis.

Results

The prevalence of cataracts was 40.1% (95% CI, 37.8 − 42.3%) in participants over 40 years old. Older age, lower monthly household income, lower education, hypercholesterolemia, hypertension, and diabetes mellitus (DM) were independent risk factors for development of any cataract. Older age, lower monthly household income, lower education, hypercholesterolemia, and DM were independent risk factors for development of pure cortical cataracts. Older age, lower education, metabolic syndrome, and DM were independent risk factors for development of pure nuclear cataracts. Older age and DM were independent risk factors for development of pure posterior subcapsular cataracts. Older age, lower monthly household income, lower education, and DM were independent risk factors for development of mixed cataracts.

Conclusion

Although socioeconomic disparities are related to cataract development, this study identified several “modifiable” risk factors that may help to lower the incidence of cataracts and associated vision loss. Improved control of blood pressure, blood, glucose, and cholesterol may help to reduce the incidence of cataracts in the general Korean population.

Risk factors associated with pterygium and its subtypes in Korea: the Korean National Health and Nutrition Examination Survey 2008-2010

PURPOSE

To assess the sociodemographic and health-related risk factors associated with pterygium and its subtypes in Korea.

METHODS

From 2008 to 2010, a total of 14,920 randomly selected national representative participants of the Korean National Health and Nutrition Examination Survey underwent additional ophthalmologic examinations by the Korean Ophthalmologic Society. The risk factors for pterygium in general or according to subtype (atrophic, intermediate, and fleshy) were identified using multivariate logistic regression analysis.

RESULTS

The prevalence of pterygium was 6.7% (95% confidence interval, 5.9-7.5) in subjects aged 30 years or older. Older age, male sex, lower educational level, rural habitation, nonsmoking, and sun exposure were independent risk factors for pterygium. Among subjects with pterygium, older age, male sex, lower educational level, and nonsmoking were independent risk factors for all types of pterygium. Sun exposure for >5 h/d was the independent risk factor for the severe pterygium subtype.

CONCLUSIONS

Socioeconomic disparities in pterygium development exist. Proper ocular examination and education to avoid excessive sun exposure would be helpful in reducing disease risk.

Measurement of antioxidant capacity using the biological antioxidant potential test and its role as a predictive marker of metabolic syndrome

BACKGROUND/AIMS

Oxidative stress increases the risk of cardiovascular complications of metabolic syndrome (MetS). This study was conducted to examine the difference in antioxidant capacity according to the presence of MetS, and to characterize the association between antioxidant capacity and MetS-related factors.

METHODS

We used the biological antioxidant potential (BAP) test to estimate antioxidant capacity. The BAP test has recently been used as an indicator of antioxidant capacity. We measured BAP levels in 45 patients with MetS (mean age, 44.6 ± 1.1 years) and 47 age- and sex-matched controls (mean age, 42.7 ± 1.1 years). To evaluate the association between antioxidant capacity and MetS, adiponectin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6, tumor necrosis factor-α, and homeostatic model assessment for insulin resistance (HOMA-IR), linear regression and logistic analyses were performed.

RESULTS

The mean BAP of the MetS group (1,937.3 ± 36.5 µmol/L) was significantly lower than that of the non-MetS group (2,101.7 ± 29.5 µmol/L). Also, the mean BAP was low in persons having low high density lipoprotein and high triglyceride. Reduced antioxidant capacity was significantly associated with adiponectin, HOMA-IR and hs-CRP after adjusting for age and sex. The odds ratios for MetS with BAP, log adiponectin, log HOMA-IR, and log hs-CRP were 0.63 (95% confidence interval [CI], 0.49 to 0.82), 0.22 (0.10 to 0.51), 14.24 (4.35 to 46.58), and 1.93 (1.36 to 2.75), respectively.

CONCLUSIONS

Persons with MetS showed reduced antioxidant capacity. We identified relationships between antioxidant capacity measured by BAP test and MetS, as well as MetS-related factors, such as insulin resistance, hs-CRP, and adiponectin.

The cut-off values of anthropometric indices for identifying subjects at risk for metabolic syndrome in Iranian elderly men

AIM

This study aimed to investigate which anthropometric indices could be a better predictor of metabolic syndrome (MetS) and the cut-off points for these surrogates to appropriately differentiate MetS in the Iranian elderly.

METHOD

The present cross-sectional study was conducted on a sample of Isfahan Healthy Heart Program (IHHP). MetS was defined according to Third Adult Treatment Panel (ATPIII). In total, 206 elderly subjects with MetS criteria were selected. Anthropometric indices were measured and plotted using receiver operating characteristic (ROC) curves.

RESULTS

WC followed by WHtR yielded the highest area under the curve (AUC) (0.683; 95% CI 0.606-0.761 and 0.680; 95% CI 0.602-0.758, resp.) for MetS. WC at a cut of 94.5 cm resulted in the highest Youden index with sensitivity 64% and 68% specificity to predict the presence of ≥2 metabolic risk factors. BMI had the lowest sensitivity and specificity for MetS and MetS components. WC has the best ability to detect MetS which followed by WHtR and BMI had a lower discriminating value comparatively.

CONCLUSION

WC is the best predictor for predicting the presence of ≥2 metabolic risk factors among Iranian elderly population and the best value of WC is 94.5 cm. This cut-off values of WC should be advocated and used in Iranian men until larger cross-sectional studies show different results.

Low skeletal muscle mass is associated with insulin resistance, diabetes, and metabolic syndrome in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2010

Sarcopenia is an emerging risk factor for metabolic disorders. No study of the association of sarcopenia with insulin resistance, diabetes, and metabolic syndrome (MS) according to age group and obesity status in the general population has been reported. We investigated these associations in the Korean population. Participants included 4558 males and 5874 females, who were ≥20 years of age or older from the fourth and fifth Korea National Health and Nutritional Examination Surveys of the Korean population (2009 and 2010). Age was categorized according to three groups (20-39, 40-59, and ≥ 60 years). Obesity was defined according to body mass index. Sarcopenia was defined as the appendicular skeletal muscle mass (ASM) divided by weight (Wt) (%) of > 2SD below the sex-specific mean for young adults. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. After adjustment for confounding variables, sarcopenia showed a significant association with HOMA-IR in the non-obese group (P<0.001). Sarcopenia was found to be a risk factor for diabetes in the non-obese group (OR, 2.140; 95% CI, 1.549-2.956; P<0.001). Sarcopenia also showed an association with MS in the non-obese group (OR, 2.209; 95% CI, 1.679-2.906; P<0.001), but not in the obese-group. However, these results were not relevant to young age group. In conclusion, sarcopenia showed an association with insulin resistance, diabetes, and MS, in the non-obese population. Sarcopenia may be an early predictor for diabetes and MS susceptibility in the non-obese population, particularly in elderly people.

Parathyroid hormone, vitamin D levels and urine albumin excretion in older persons: the 2011 Korea National Health and Nutrition Examination Survey (KNHANES)

OBJECTIVE

Persistent elevation of urinary albumin excretion (UAE), even within normal range, is an independent predictor for cardiovascular disease. Accumulating research suggests that low levels of vitamin D and high levels of parathyroid hormone (PTH) also increase cardiovascular disease risk. This study is intended to investigate the relationship between PTH, vitamin D levels and UAE.

METHODS

We examined 2897 adults aged 50 and above, participating in the second year of the fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2). Anthropometric and laboratory measurements were performed. Elevated UAE was defined as spot urinary albumin creatinine ratio equal or above 10.

RESULTS

The proportion of elevated UAE (21·8%, 23·2%, 23·2%, 31·8%; P for trend = 0·002) rose with increasing quartiles of PTH. The odds ratio for elevated UAE in the highest quartile of PTH was 72% higher than the lowest quartile group. There was no relationship between vitamin D and elevated UAE.

CONCLUSIONS

Elevated PTH levels are associated with elevated UAE in Korean adults aged 50 and above. Additional studies are needed to clarify this relationship.

Determination of most suitable cut off point of waist circumference for diagnosis of metabolic syndrome in Kerman

OBJECTIVES

Metabolic syndrome is a determining indicator of cardiovascular diseases and diabetes. Abdominal obesity, determined by measuring waist circumference, is one of the most important criteria for diagnosing this syndrome. This criterion varies between men and women and among different races. The present study aims at the assessment of the sensitivity and specificity of the commonly used cut off point of waist circumference, and the estimation of the most suitable cut off point of waist circumference for the diagnosis of metabolic syndrome in the urban society of Kerman.

METHODS

5332 subjects consisting of 2966 women and 2366 men, 20 years old and above were studied in a population based, cross sectional study. Waist circumference, blood pressure, blood sugar, and blood lipids were measured. People with at least two of the NCEP ATP III criteria - high blood pressure (BP>130/80), high triglycerides (TG>150), high glucose (FBG>100) and low HDL (HDL<40 in men and <50 in women) - were taken as population at risk. ROC analysis was used for determining the most suitable cut off point of waist circumference. The prevalence of metabolic syndrome was then assessed based on IDF, NCEP criteria and the proposed criterion, and agreement among the three methods in diagnosing people suffering from metabolic syndrome was examined.

RESULTS

The average±standard deviation of waist circumference in women and in men was 83.90±12.55 and 87.99±11.94 cm respectively. The most suitable cut off point of waist circumference for metabolic syndrome diagnosis was 86 in women and 89 in men. These circumferences had the highest specificity and sensitivity. The prevalence of metabolic syndrome in IDF, NCPE, and the proposed criterion was 30.4%, 27.7%, and 35.2% respectively. The new criterion and the NCEP criterion achieved the highest agreement (kappa factor=83%).

CONCLUSION

The cuts off point of waist circumference in men and women are close. It is possible, then, to determine a common cut off point of waist circumference for both in Iran. Therefore, the cut point of 90-cm of waist circumference proposed by the National Obesity Committee seems to be appropriate for the Iranian society. These clinical findings should nevertheless be verified by simulation.

Relationships between visceral adipose tissue measurement site and the metabolic syndrome in the Korean population

SUMMARY

OBJECTIVE

Visceral adipose tissue (VAT) is presumed to play an important role in the development of metabolic syndrome (MS). The purpose of this study was to evaluate the influence of measurement location of VAT on the cardiometabolic risk factors and the MS in the Korean population.

METHODS

To assess abdominal fat distribution, 5 single-slice computed tomography (CT) images were obtained in 470 healthy subjects. The five CT images were obtained at the intervertebral space from L1 to S1 using known anatomical landmarks. Multiple logistic regression analysis was performed to assess the relationship between regional adipose tissue areas and MS.

RESULTS

All risk factors were more closely correlated with VAT than subcutaneous adipose tissue (SAT), except waist circumference and blood pressure. Images located at L2-L3 or L3-L4 provided high correlations between VAT area and all cardiometabolic risk factors. The highest adjusted odds (per SD) between VAT and MS were the L2-L3 image in men (OR 4.53) and the L1-L2 in women (OR 4.87), which was higher than measures at L4-L5 (OR 3.22 in men, OR 4.71 in women). However, differences in OR between L1-L2 VAT (OR 4.87) and L4-L5 (OR 4.71) were not great in women.

CONCLUSIONS

The results of this study suggest that VAT has a stronger association with MS than ASAT in Korean population regardless of measurement site, and an image located in the upper abdomen (L2-L3 or L3-L4) would be a better predictor of the relationship between VAT and MS in Korean men.

A prospective study of epicardial adipose tissue and incident metabolic syndrome: the ARIRANG study

Increased epicardial adipose tissue (EAT) may be closely associated with the development of metabolic abnormalities. We investigated whether EAT predicts the incident metabolic syndrome in a community-based, middle-aged population. The study subjects were comprised of 354 adults (134 men and 220 women) aged 40 to 70 yr without metabolic syndrome. Baseline EAT thickness, measured by echocardiography, was compared between subjects who developed new-onset metabolic syndrome at follow-up survey and those who did not. After an average of 2.2 yr of follow-up, 32 men (23.9%) and 37 women (16.8%) developed metabolic syndrome. Median EAT thickness at baseline was significantly higher in male subjects who developed metabolic syndrome than those who did not (1.52 mm vs 2.37 mm, P<0.001). The highest quartile of EAT thickness (≥2.55 mm) was associated with increased risk of progression to metabolic syndrome (Odds ratio [OR], 3.09; 95% confidence interval [CI], 1.11-8.66) after adjustment for age, smoking, alcohol intake, regular exercise, total energy intake, high sensitive C-reactive protein and homeostasis model assessment of insulin resistance in men. A significant association of EAT with incident metabolic syndrome was not seen in women (OR, 1.25; 95% CI, 0.54-2.90). In conclusion, increased EAT thickness is an independent predictor for incident metabolic syndrome in men.