In 2005, the International Diabetes Federation (IDF) presented a new, clinically accessible worldwide definition of 'metabolic syndrome' in a global consensus statement. According to the criteria, central obesity is an essential, not optional, component of metabolic syndrome, which is assessed by ethnicity- and genderspecific cut-off values as measured by waist circumference (WC). Thus we need to have a Korean population-specific WC cut-off values. For this aim, we analyzed data from the 1998 Korean National Health and Nutrition Survey from 6562 participants (2930 men and 3632 women). We determined the appropriate WC cut-offs using receiver operator characteristic (ROC) curve analysis giving the optimal sensitivity and specificity. We estimated multivariate-adjusted odds ratios (ORs) for risk (> or =2metabolic risk factors assessed by IDF) according to the WC categories.The ROC curve analysis indicated that WC was better than BMI in predicting risks. Ageadjusted ORs for having > or =2metabolic risk factors increased abruptly for WC of 90cm in men and 85cm in women, indicating ORs greater than 5.0. WC-compatible 80th percentile was 90cm for men and 86.5cm for women. This analysis demonstrated the appropriate cut-off values of WC for abdominal obesity among Korean are 90cm for men and 85cm for women. These values may be updated, as new data become available.
Consensus ; Female ; Humans ; Male ; Nutrition Surveys ; Obesity, Abdominal* ; Odds Ratio ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Waist Circumference*

This study aimed to evaluate current clinical assessments and management of obesity in the primary care setting in Korea since anti-obesity agents have become available. A questionnaire was sent to eligible primary care physicians selected from a national probability sample in two specialties: family physicians and internists. Of 939 randomly selected physicians, 452 (48.1%) replied. We found that 51.8% of physicians were aware of the definition of obesity, and 33.8% were aware of the definition of abdominal obesity proposed by Asia-Pacific guideline. When evaluating apparently obese patients, 50.0% of respondents measured body mass index (BMI) and 20.4% measured waist circumference. Fewer than 50% of physicians measured blood glucose or lipid profiles, both of which are risk factors for obesity. About 47.3% of physicians prescribed an anti-obesity medication without allowing sufficient time for nonpharmacologic therapy to take effect, and 68.8% of physicians prescribed anti-obesity medications to patients that requested them regardless of obesity status. The majority of respondents did not appropriately evaluate obesity and its risk factors, and were readily susceptible to prescribing anti-obesity medications. Our findings suggest that primary care physicians in Korea need additional education on obesity and its management.
Adult ; Age Factors ; Anti-Obesity Agents/*pharmacology ; Blood Glucose/metabolism ; Body Mass Index ; Family Practice/*methods ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Korea ; Lipids/metabolism ; Male ; Middle Aged ; Obesity/metabolism/*therapy ; Physician's Practice Patterns ; Physicians, Family ; Questionnaires ; Risk Factors ; Weight Loss

PURPOSE: Elevated circulating oxidized low density lipoprotein (Ox-LDL) levels are associated with increased risk of atherosclerosis, which may be due to high plasma homocysteine (Hcy) and low intakes of antioxidants. We investigated the contribution of dietary intakes of antioxidants to Hcy-induced LDL oxidation in atherosclerotic patients (AP) and controls. MATERIALS AND METHODS: Male AP (n = 101) who were confirmed by coronary angiography and 91 controls were evaluated by blood biochemistry and dietary intakes. To determine whether homocysteine is an independent risk factor for atherosclerosis, subjects were divided into three groups; low- (< or = 6.9 uM/L), normal- (7 uM-12 uM/L) and high- (> or = 12.1 uM/L) Hcy. RESULTS: Plasm levels of homocysteine and LDL were higher, but plasma apo A-I in HDL and folate were lower in the AP group. The odds ratio (OR) for the risk of atherosclerosis was 3.002 [95% confidence interval (CI), 1.27-7.09] for patients in the highest tertile with homocysteine > or = 12.1 uM/L. AP having high homocysteine levels had low intakes of vitamin A, beta-carotene and vitamin C. By logistic regression analysis, age, body mass index (BMI), plasma LDL, plasma folate, and low intakes of vitamin A and beta-carotene were found to be risk factors for atherosclerosis in patients with high-Hcy, but dietary B vitamins including folate were not. CONCLUSION: A high-Hcy level was a risk factor for atherosclerosis in patients with high Ox-LDL levels. High intakes of antioxidants appeared to be a protective factor for atherosclerosis, perhaps exerting a pro-oxidative effect on LDL when combined with high levels of Hcy and LDL. However, more evidence for the benefits of B vitamins as a homocysteine-lowering therapy is needed.

The Third Report of the National Cholesterol Education Program Adult Treatment Panel III emphasized the importance of management of the metabolic syndrome. However, little information is available about the effect of weight reduction on the metabolic syndrome in obese patients among Koreans. A longitudinal clinical intervention study from the 12-week of weight reduction program, including life style modification and adjuvant appetite suppressants, in 78 obese persons was performed. Anthropometry and metabolic risk factors were measured before and after weight reduction. Visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) on abdomen were determined by CT scan. Moderate decrease in weight (9.3%) induced significant reduction of waist circumference, systolic and diastolic blood pressure, and triglyceride. Weight reduction also resulted in significant decrease in total cholesterol, LDL-C, uric acid, fasting insulin, and HOMA score. The subjects with metabolic syndrome showed more improvements of metabolic components than those without metabolic syndrome through weight reduction. The reductions of visceral-subcutaneous fat ratio (VSR) and waist circumference were observed as for the predictable variables related to the improvement of metabolic component and insulin resistance in Korean obese patients.
Abdomen ; Adipose Tissue/metabolism ; Adolescent ; Adult ; Female ; Human ; Insulin Resistance ; Korea ; Lipids/blood ; Male ; Metabolic Syndrome X/*diet therapy/*epidemiology/metabolism ; Middle Aged ; Obesity/*diet therapy/*epidemiology/metabolism ; Risk Factors ; Risk Reduction Behavior ; *Weight Loss

BACKGROUND: Overweight in Korean adolescents has continuously increased over the past few years and it is recognized as a public health problem. We investigated the relationship between socioeconomic status and overweight in Korean adolescents. METHODS: The data was obtained from the 2007 Korean Youth's Risk Behavior Web-based Study. We included adolescents aged 12 to 18 yearswho were > or = 5th percentile of the BMI cut-off point based on the Korean child growth curve. Logistic regression analysis was performed to examine the association between socioeconomic status and overweight. RESULTS: The adjusted odds ratios for overweight were 1.116 (95% confidence interval [CI],1.021 to 1.220), 1.390 (95% CI, 1.242 to 1.555) in girls having middle and low grade family affluence scale (FAS), respectively, compared in girls having high grade FAS (P < 0.05). However, in boys, there was no significant relationship between FAS and overweight. In both gender, perceived household economic status and parental education level were negatively related to overweight in adolescents (P < 0.05). CONCLUSION: Lower socioeconomic status increased the risk of overweight in Korean adolescents. Efforts to reduce socioeconomic disparities in adolescents should be initiated for overweight prevention.
Adolescent ; Aged ; Child ; Family Characteristics ; Humans ; Logistic Models ; Odds Ratio ; Overweight ; Parents ; Public Health ; Risk-Taking ; Social Class ; Socioeconomic Factors

BACKGROUND: It is generally known that the principle treatment of obesity is life-style modification and behavior therapy for weight reduction. This study was carried out to investigate the effect of office-based education for weight control and behavior modification in overweight patients. METHODS: We selected 119 patients among the overweight or obese (BMI >or=23 kg/m2) patients who visited the Department of Family Medicine at Asan Medical Center. Life styles such as diet, exercise, smoking, and alcohol drinking were evaluated by self-questionnaire. Weight, height, body mass index, waist circumference, waist to hip ratio, and body fat were measured. The patients were divided randomly into two groups, the intervention (n=60) and the control (n=59) group. We educated the intervention group about the importance of weight reduction, life-style modification and provided specific guidelines. Two months later, we measured anthropometric variables and evaluated changes of behavior modification. RESULTS: After two months, 28 patients of the intervention group and 22 patients of the control group were followed up. At the follow-up time, the body weight and waist circumference decreased significantly in the intervention group compared with those of the control group. The exercise time increased significantly in the intervention group compared to the control group. The frequency of fatty meal ingestion decreased significantly in the intervention group. CONCLUSIONS: The office-based education for weight reduction in overweight or obese patients has contributed substantially in changing their life-style and reducing their waist circumference. As a result, we have found that patient education for behavior modification was essential part of comprehensive approach for weight control in overweight patients.
Adipose Tissue ; Alcohol Drinking ; Behavior Therapy* ; Body Height ; Body Weight ; Chungcheongnam-do ; Diet ; Eating ; Education ; Follow-Up Studies ; Humans ; Life Style ; Meals ; Obesity ; Overweight* ; Patient Education as Topic* ; Smoke ; Smoking ; Waist Circumference ; Waist-Hip Ratio ; Weight Loss

BACKGROUND: Metabolic syndrome (MetS), characterized by abdominal obesity, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and high fasting glucose level, is a common risk factor for cardiovascular diseases and associated complications. We examined the relationship between the metabolic syndrome and risk of chronic kidney disease (CKD) in Korean women. METHODS: We used data from 10,170 women, aged 30-89 years, who had visited a health examination center at a tertiary care hospital in 2006. The data were studied cross-sectionally. MetS was identified using the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). CKD was defined as an estimated GFR < 60 ml/min per 1.73 m2. The multivariable-adjusted (adjustment for age, education, body mass index (BMI), alcohol drinking, smoking, previous coronary heart disease, menopauses and physical inactivity) odds ratio of CKD (95% CI) associated with each component of the metabolic syndrome was calculated using the logistic regression models. RESULTS: A total of 1,039 participants have MetS. The multivariable-adjusted odds ratios (OR) of CKD in participants with MetS, hypertriglyceridemia and high blood pressure compared with participants without such factors were 2.68 (95% CI, 1.77-4.06), 1.96 (95% CI, 1.34-2.88), and 2.00 (95% CI, 1.38-2.89). Compared with the participants with no MetS traits, those with one, two, equal to or more than three traits of MetS had OR of CKD of 1.24 (95% CI, 0.75-2.06), 1.56 (95% CI, 0.89-2.75), and 2.18 (95% CI, 1.21-3.93), respectively. CONCLUSION: We found that Korean women with MetS had an increased risk for developing CKD. Finally, earlier identification and management of MetS might improve patient health and prevent progression of CKD.
Adult ; Aged ; Alcohol Drinking ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Coronary Disease ; Fasting ; Female ; Glomerular Filtration Rate ; Glucose ; Humans ; Hypertension ; Hypertriglyceridemia ; Lipoproteins ; Logistic Models ; Obesity, Abdominal ; Odds Ratio ; Renal Insufficiency, Chronic ; Risk Factors ; Smoke ; Smoking ; Tertiary Healthcare

BACKGROUND: Current guidelines for the treatment of hyperlipidemia propose lifestyle modification as a first-line intervention. The aim of this study was to identify the factors which determine responsiveness of LDL-cholesterol lowering to lifestyle modification in hypercholesterolemic patients. METHODS: A total of 109 patients aged between 30 and 70 years (52 men and 109 women) who were diagnosed with hypercholesterolemia between July 2007 and February 2008 at Asan Medical Center were enrolled in this study. The patients were educated on lifestyle modifications by trained family physicians. We measured clinical, anthropometric, lifestyle parameters and lipid profiles initially and at eight weeks after education. Stepwise multiple linear regression models were used to assess covariates and variance components. RESULTS: The serum level of LDL-cholesterol decreased in both women (8.0 +/- 15.37%, P < 0 .001) and men (4.95 +/- 9.81%, P < 0.001). In women, dietary adherence (beta = 0.267, P = 0.004), change in physical activity duration (beta = 0.196, P = 0.034) and menopausal state (beta = -0.207, P = 0.026) were significant predictors in response of percent change in LDL-cholesterol. In men, dietary adherence (beta = 0.372, P = 0.007) was a predictor in response of percent change in LDL-cholesterol. CONCLUSION: Adherence to lifestyle modification was a main factor which had influenced on response of percent change in LDL-C levels. In women, however, menopausal state was also an important factor.
Aged ; Female ; Humans ; Hypercholesterolemia ; Hyperlipidemias ; Life Style ; Linear Models ; Male ; Motor Activity ; Physicians, Family

BACKGROUND: Sarcopenia is the loss of muscle mass leading to decreased muscle strength, physical disability, and increased mortality. The genesis of both sarcopenia and osteoporosis is multifactorial, and several factors that play a role in osteoporosis are thought to contribute to sarcopenia. This study evaluated the association between sarcopenia and bone density and health-related quality of life in Korean men. METHODS: We used the data of 1,397 men over 50 years of age from the 2009 Korean National Health and Nutrition Examination Survey. Sarcopenia was defined as the appendicular skeletal muscle mass divided by height2 (kg/m2) < 2 standard deviations below the sex-specific mean for young adults. Health-related quality of life was measured by the EuroQol-5 dimension (EQ-5D) instrument. Logistic regression analysis was performed to evaluate the relationship between sarcopenia, bone density, and health-related quality of life. RESULTS: The T-score of the lumbar spine, total femur, and femur neck in bone mineral density in subjects with sarcopenia were lower than those in subjects without sarcopenia. The score of the EQ-5D index was significantly lower and the rate of having problems with individual components of health-related quality of life was higher in the sarcopenic group. After adjustment for age and body mass index, the odds ratios (ORs) (95% confidence interval [CI]) for sarcopenia were 2.06 (1.07-3.96) in osteopenic subjects and 3.49 (1.52-8.02) in osteoporotic subjects, respectively. After adjustment, the total score of the EQ-5D index was significantly lower in the sarcopenic subjects. The ORs (95% CI) for having problems of mobility and usual activity of the EQ-5D descriptive system were 1.70 (1.02-2.84) and 1.90 (1.09-3.31), respectively. CONCLUSION: Sarcopenia was associated with decreased bone mineral density in Korean men. In addition, sarcopenia was related to poor quality of life, especially with regard to mobility and usual activity. Greater attention to and evaluation for sarcopenia are needed in subjects showing low bone mineral density to prevent and manage poor quality of life.
Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Electrolytes ; Femur ; Femur Neck ; Humans ; Logistic Models ; Male ; Muscle Strength ; Muscle, Skeletal ; Muscles ; Nutrition Surveys ; Odds Ratio ; Osteoporosis ; Quality of Life ; Sarcopenia ; Spine ; Young Adult

BACKGROUND: Low high density lipoprotein-cholesterol (HDL-C) is one of the major risk factors for coronary heart disease. Using data from the Korean National Health and Nutrition Examination Survey (KNHANES), we assessed trend of the prevalence of low HDL-C and the factors which are associated with low HDL-C in Korean men. METHODS: We analyzed three serial KNHANES data which were conducted in year 1998, 2001, and 2005. Among all survey participants, we included men aged 30-79 years with laboratory data. Low HDL-C was defined by serum HDL-C < 40 mg/dL. We used multiple logistic regression analysis to assess the association between low HDL-C and related factors. We investigated trend of the prevalence of low HDL-C and associated factors among Korean men. RESULTS: The prevalence of low HDL-C in Korean men was increasing from 26.3% (1998) to 38.8% (2001) and 45.9% (2005). Low HDL-C was associated with non-alcohol drinker, current smoking, sedentary physical activity, obesity and hypertriglyceridemia. The prevalence of current smoking decreased linearly. The prevalence of sedentary physical activity and hypertriglyceridemia increased from year 1998 to year 2001, but decreased from year 2001 to year 2005. However, the prevalence of non-alcohol drinker and obesity increased continuously. The patterns of the increasing prevalence of low HDL-C were compatible to the increasing prevalence of obesity according to age in Korean men. CONCLUSION: From year 1998 to year 2005, the prevalence of low HDL-C in Korean men has increased. Obesity and non-alcohol drinking might be contributing factors of increasing prevalence of low HDL-C in Korean men. Management of obesity is needed to prevent increasing the prevalence of low HDL-C among Korean men.
Aged ; Coronary Disease ; Drinking ; Humans ; Hypertriglyceridemia ; Logistic Models ; Male ; Motor Activity ; Nutrition Surveys ; Obesity ; Prevalence ; Risk Factors ; Smoke ; Smoking