1.Intra-arterial calcium stimulation test with hepatic venous sampling for preoperative diagnosis of a large insulinoma in an obese young man.
Ya-Cheng CHEN ; Chang-Hsien LIU ; Chih-Yung YU ; Guo-Shu HUANG
Singapore medical journal 2014;55(8):e132-5
Herein, we report the case of a large benign insulinoma in an obese young man with a three-year history of asymptomatic hypoglycaemia. He presented to our outpatient department with a two-week history of dizziness and morning cold sweats. A random serum glucose test revealed hypoglycaemia. Upon admission, computed tomography and magnetic resonance imaging of the abdomen with intravenous contrast media showed an enhancing mass lesion in the uncinate process of the pancreas. To confirm the diagnosis, an intra-arterial calcium stimulation test with hepatic venous sampling was performed for preoperative localisation and to exclude the presence of occult insulinomas. The patient underwent an exploratory laparotomy, with successful resection of the pancreatic head tumour. Histology confirmed the diagnosis of insulinoma. The patient's postoperative recovery was uneventful, and he has not developed further episodes of hypoglycaemia three years post surgery.
Adult
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Blood Glucose
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analysis
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Calcium
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metabolism
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Contrast Media
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chemistry
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Hepatic Veins
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pathology
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Humans
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Insulinoma
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blood
;
complications
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diagnosis
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Magnetic Resonance Imaging
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Male
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Obesity
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blood
;
complications
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Pancreatic Neoplasms
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blood
;
complications
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diagnosis
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Tomography, X-Ray Computed
2.Ketonuria after Fasting may be Related to the Metabolic Superiority.
Nam Seok JOO ; Duck Joo LEE ; Kwang Min KIM ; Bom Taeck KIM ; Chan Won KIM ; Kyu Nam KIM ; Sang Man KIM
Journal of Korean Medical Science 2010;25(12):1771-1776
Obese individuals are less able to oxidize fat than non-obese individuals. Caloric reduction or fasting can detect ketonuria. We investigated the differences of metabolic parameters in the presence of ketonuria after a minimum 8 hr fast in a cross-sectional analysis of 16,523 Koreans (6,512 women and 10,011 men). The relationship between the presence of ketonuria of all subjects and prevalence of obesity, central obesity, metabolic syndrome, and obesity-related metabolic parameters were assessed. The ketonuria group had lower prevalence of obesity, central obesity, and metabolic syndrome than the non-ketonuria group. In addition, all metabolic parameters (including body weight, waist circumference, blood glucose, high-density lipoprotein, triglyceride, blood pressure, and insulin) were favorable in the ketonuria group than in the non-ketonuria group, even after adjustment for age, tobacco use, and alcohol consumption. The odds ratios of having obesity (odds ratio [OR]=1.427 in women, OR=1.582 in men, P<0.05), central obesity (OR=1.675 in women, OR=1.889 in men, P<0.05), and metabolic syndrome (OR=3.505 in women, OR=1.356 in men, P<0.05) were increased in the non-ketonuria group compared to the ketonuria group. The presence of ketonuria after at least an 8 hr fast may be indicative of metabolic superiority.
Blood Glucose/analysis
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Blood Pressure
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Body Weight
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Cross-Sectional Studies
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*Fasting
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Female
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Humans
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Insulin/blood
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Ketosis/*complications/diagnosis
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Lipoproteins, HDL/blood
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Male
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Metabolic Syndrome X/*complications/epidemiology
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Obesity/complications/epidemiology
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Odds Ratio
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Time Factors
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Triglycerides/blood
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Waist Circumference
3.Heart Rate Variability and Metabolic Syndrome in Hospitalized Patients with Schizophrenia.
Kyunghee LEE ; Jeongeon PARK ; Jeongim CHOI ; Chang Gi PARK
Journal of Korean Academy of Nursing 2011;41(6):788-794
PURPOSE: Reduced heart rate variability significantly increases cardiovascular mortality. Metabolic syndrome increases the cardiac autonomic dysfunction. Recently, increasing cardiovascular mortality has been reported in patients with schizophrenia. This study was done to compare heart rate variability between adults with and without schizophrenia and to compare the relationship of heart rate variability to metabolic syndrome in hospitalized patients with schizophrenia. METHODS: This was a descriptive and correlational study in which 719 adults without schizophrenia and 308 adults with schizophrenia took part between May and June 2008. We measured the following: five-minute heart rate variability; high-frequency, low-frequency, the ratio of low-frequency to high-frequency, and the Standard Deviation of all the normal RR intervals. Data was also collected on metabolic syndrome, abdominal obesity, triglycerides, HDL cholesterol, blood pressure and fasting glucose. RESULTS: The Standard Deviation of all the normal RR intervals values of heart rate variability indices were 1.53+/-0.18. The low-frequency and high-frequency values of heart rate variability indices were significantly higher in hospitalized patients with schizophrenia (3.89+/-1.36; 3.80+/-1.20) than those in the healthy participants (2.20+/-0.46; 2.10+/-0.46). There were no significant differences between the schizophrenic patients with and without metabolic syndrome. CONCLUSION: The results of this study indicate that schizophrenia patients have significantly lower cardiac autonomic control, but they have significantly higher low-frequency and high-frequency values than those of healthy adults. Use of antipsychotic drug may affect the autonomic nervous system in schizophrenic patients. Metabolic syndrome was not associated with cardiac autonomic control in schizophrenia patients.
Adult
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Autonomic Nervous System/physiopathology
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Blood Glucose/analysis
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Blood Pressure
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Cardiovascular Diseases/complications/diagnosis/mortality
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Cholesterol, HDL/blood
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Female
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*Heart Rate
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Hospitalization
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Humans
;
Male
;
Metabolic Syndrome X/*complications/*physiopathology
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Middle Aged
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Obesity/etiology
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Schizophrenia/*complications/mortality/*physiopathology
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Triglycerides/blood
4.Differences in Clinical Characteristics between Patients with Non-Erosive Reflux Disease and Erosive Esophagitis in Korea.
Na Rae HA ; Hang Lak LEE ; Oh Young LEE ; Byung Chul YOON ; Ho Soon CHOI ; Joon Soo HAHM ; You Hern AHN ; Dong Hee KOH
Journal of Korean Medical Science 2010;25(9):1318-1322
Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.
Adult
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Alcohol Drinking
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Body Mass Index
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Esophagitis, Peptic/complications/*diagnosis
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Female
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Gastroesophageal Reflux/complications/*diagnosis
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Gastroscopy
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Hernia, Hiatal/complications
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Humans
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Male
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Middle Aged
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Obesity/complications
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Republic of Korea
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Risk Factors
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Sex Factors
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Smoking/adverse effects
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Triglycerides/blood
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Waist-Hip Ratio
5.A Useful Predictor of Early Atherosclerosis in Obese Children: Serum High-sensitivity C-reactive Protein.
Eui Jung ROH ; Jae Woo LIM ; Kyoung Og KO ; Eun Jung CHEON
Journal of Korean Medical Science 2007;22(2):192-197
Childhood obesity seems to contribute to the development of vascular inflammation and the progression of arterial wall changes. High-sensitivity C-reactive protein (hs-CRP) has recently emerged as a useful biomarker for vascular inflammation associated with atherosclerosis. The objectives of this study were to evaluate the association of the serum hs-CRP level with ultrasonic findings of early atherosclerosis, carotid intima-media wall thickness (IMT) and brachial flow-mediated dilation (FMD), in obese children. Thirty eight obese children and 45 sex/age-matched healthy control children were recruited. Serum CRP levels were measured by the high-sensitive latex turbidimetric immunoassay, and we measured carotid IMT and brachial FMD using high-resolution B-mode ultrasonography. Obese children had significantly higher hs-CRP levels (1.40+/-0.74 mg/L vs. 0.55+/-0.49 mg/L, p<0.01), as well as increased IMT (0.52+/-0.09 mm vs. 0.41+/-0.07 mm, p<0.01) and impaired FMD (7.35+/-7.78% vs. 20.34+/-16.81%, p<0.01) compared to healthy controls. Serum hs-CRP correlated positively with IMT (r=0.413, p<0.05) and inversely with FMD (r=-0.350, p<0.05) in the obesity group. Measurement of the serum hs-CRP level is a simple, cheap, and highly reproducible assay and correlates with IMT and FMD in obese children. Thus, it would be a useful marker for evaluating and estimating the degree of atherosclerosis in children.
Sensitivity and Specificity
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Risk Factors
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Risk Assessment/*methods
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Reproducibility of Results
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Prognosis
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Obesity/*blood/*complications/diagnosis
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Male
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Humans
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Female
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C-Reactive Protein/*analysis
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Biological Markers/blood
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Atherosclerosis/*blood/complications/*diagnosis
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Adolescent
6.Nonalcoholic fatty liver disease as a risk factor of cardiovascular disease; Relation of non-alcoholic fatty liver disease to carotid atherosclerosis.
Su Yeon CHOI ; Donghee KIM ; Jin Hwa KANG ; Min Jung PARK ; Young Sun KIM ; Seon Hee LIM ; Chung Hyeon KIM ; Hyo Suk LEE
The Korean Journal of Hepatology 2008;14(1):77-88
BACKGROUND/AIMS: Non-alcoholic fatty liver disease (NAFLD) is closely associated with abdominal obesity, dyslipidemia, hypertension, and Type 2 diabetes, which are all features of the metabolic syndrome. The aim of the present study was to elucidate whether NAFLD is associated with carotid atherosclerosis. METHODS: The study population comprised 659 subjects without hepatitis B and C infections and who did not consume alcohol. Fatty infiltrations of liver were detected by abdominal ultrasonography, and intima-media thickness (IMT) and plaque prevalence were estimated by carotid ultrasonography. RESULTS: The mean values of systolic and diastolic pressures, body mass index (BMI), aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, uric acid, total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, fasting glucose, fasting insulin, homeostasis model of assessment (HOMA) index, hemoglobin A1c, and plasminogen activator inhibitor-1 differed significantly between patients with NAFLD (n=314) and normal controls (n=345). The carotid IMT was 0.817+/-0.212 (mean+/-SD) mm in patients with NAFLD and 0.757+/-0.198 mm in normal controls (p<0.001). The prevalence of carotid plaques was higher in patients with NAFLD (26.4%) than in normal controls (15.9%) (p<0.001). This association persisted significantly after adjusting for age, sex, BMI, HOMA index and individual factors of metabolic syndrome by multiple logistic regression analysis. CONCLUSIONS: Patients with NAFLD are at a high risk of carotid atherosclerosis regardless of metabolic syndrome and classical cardiovascular risk factors. Therefore, the detection of NAFLD should alert to the existence of an increased cardiovascular risk. Moreover, NAFLD might be an independent risk factor for cardiovascular disease.
Aged
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Body Mass Index
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Carotid Arteries/pathology/ultrasonography
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Carotid Artery Diseases/diagnosis/*etiology
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Cholesterol, HDL/blood
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Demography
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Diabetes Mellitus, Type 2/complications/diagnosis
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Diabetic Diet
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Fatty Liver/*complications/diagnosis/ultrasonography
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Female
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Humans
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Male
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Metabolic Syndrome X/complications/diagnosis
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Middle Aged
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Obesity/complications/diagnosis
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Regression Analysis
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Risk Factors
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Triglycerides/blood
7.Association among Histopathology, Clinical Manifestation, and Ultrasonographic Grades in Pediatric Non-alcoholic Fatty Liver Disease.
Sue Jung JEE ; Yong Joo KIM ; Soon Young SONG ; Seung Sam PAIK
The Korean Journal of Gastroenterology 2011;57(3):158-165
BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD), and its prevalence is increasing worldwide. Liver biopsy remains the best way to diagnose NASH and establish the presence of fibrosis, but has not been performed easily in children because of its invasiveness. We analyzed the ultrasonographic and histopathologic findings of pediatric NAFLD patients, and studied to find their association with clinical characteristics and laboratory findings. METHODS: The study involved 18 obese children ranging from 7 to 15 years of age, who were diagnosed with NASH by liver biopsy. We performed the abdomen ultrasonography before the liver biopsy. We reviewed their pathology slides and classified them by NASH CRN (Clinical Research Network) scoring system. We also reviewed the abdomen ultrasonographic findings of the patients and classified them into grade of 1, 2, and 3. We reviewed the medical records of the patients and investigated their clinical characteristics and laboratory findings. RESULTS: The ultrasonographic grades had significant association with NAFLD activity score, grade of steatosis amount, ballooning change, and portal inflammation. Serum triglyceride level was significantly higher in patients who showed high grade steatosis and high NAFLD activity score. CONCLUSIONS: This study showed that serum triglycerides and ultrasonographic findings are highly correlated with pathologic findings in children with NAFLD.
Adolescent
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Biopsy, Fine-Needle
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Child
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Disease Progression
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Fatty Liver/diagnosis/pathology/ultrasonography
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Female
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Humans
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Male
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Obesity/complications
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Retrospective Studies
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*Severity of Illness Index
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Triglycerides/blood
8.Relation between Obesity and Bone Mineral Density and Vertebral Fractures in Korean Postmenopausal Women.
Kyong Chol KIM ; Dong Hyuk SHIN ; Sei Young LEE ; Jee Aee IM ; Duk Chul LEE
Yonsei Medical Journal 2010;51(6):857-863
PURPOSE: The traditional belief that obesity is protective against osteoporosis has been questioned. Recent epidemiologic studies show that body fat itself may be a risk factor for osteoporosis and bone fractures. Accumulating evidence suggests that metabolic syndrome and the individual components of metabolic syndrome such as hypertension, increased triglycerides, and reduced high-density lipoprotein cholesterol are also risk factors for low bone mineral density. Using a cross sectional study design, we evaluated the associations between obesity or metabolic syndrome and bone mineral density (BMD) or vertebral fracture. MATERIALS AND METHODS: A total of 907 postmenopausal healthy female subjects, aged 60-79 years, were recruited from woman hospitals in Seoul, South Korea. BMD, vetebral fracture, bone markers, and body composition including body weight, body mass index (BMI), percentage body fat, and waist circumference were measured. RESULTS: After adjusting for age, smoking status, alcohol consumption, total calcium intake, and total energy intake, waist circumference was negatively related to BMD of all sites (lumbar BMD p = 0.037, all sites of femur BMD p < 0.001) whereas body weight was still positively related to BMD of all sites (p < 0.001). Percentage body fat and waist circumference were much higher in the fracture group than the non-fracture group (p = 0.0383, 0.082 respectively). Serum glucose levels were postively correlated to lumbar BMD (p = 0.016), femoral neck BMD (p = 0.0335), and femoral trochanter BMD (p = 0.0082). Serum high density lipoprotein cholesterol (HDLC) was positively related to femoral trochanter BMD (p = 0.0366) and was lower in the control group than the fracture group (p = 0.011). CONCLUSION: In contrast to the effect favorable body weight on bone mineral density, high percentage body fat and waist circumference are related to low BMD and a vertebral fracture. Some components of metabolic syndrome were related to BMD and a vertebral fracture.
Aged
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Blood Glucose/metabolism
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Body Composition
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Body Mass Index
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Body Weight
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*Bone Density
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Female
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Humans
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Middle Aged
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Obesity/*complications/diagnosis
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Overweight
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*Postmenopause
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Republic of Korea
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Risk Factors
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Spinal Fractures/*complications/diagnosis
9.Relationship between carotid atherosclerosis and nonalcoholic fatty liver disease.
Chinese Journal of Hepatology 2009;17(11):875-876
Aged
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Body Mass Index
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Carotid Arteries
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diagnostic imaging
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pathology
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Carotid Artery Diseases
;
diagnosis
;
epidemiology
;
etiology
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Cholesterol, HDL
;
blood
;
Fatty Liver
;
complications
;
diagnosis
;
epidemiology
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Female
;
Humans
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Insulin Resistance
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Intercellular Signaling Peptides and Proteins
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blood
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Male
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Metabolic Syndrome
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complications
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Middle Aged
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Obesity
;
complications
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Risk Factors
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Triglycerides
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blood
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Tunica Intima
;
diagnostic imaging
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pathology
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Ultrasonography
10.The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients.
Jung Ah LEE ; Sung SUNWOO ; Young Sik KIM ; Byung Yeon YU ; Hoon Ki PARK ; Tae Hee JEON ; Byung Wook YOO
Journal of Korean Medical Science 2016;31(2):240-246
Sleep has important effects on physical and mental health, and sleep disorders are associated with increased mortality and morbidity. This study was conducted to evaluate the relationship between sleep duration or sleep quality and the risk of type 2 diabetes. The FACTS (FAmily CohorT Study in primary care) was established to investigate the relations between familial environment and health which was conducted at 22 family medicine outpatient clinics in general hospitals. Total 563 patients without diabetes who received > or =1 year follow-up examination were included in the analysis. We used the Pittsburgh Sleep Quality Index to determine sleep quality, and a score of > or =5 was considered to define poor sleep quality. Patients taking oral hypoglycemic agents, having a fasting glucose level of >126 mg/dL, or diagnosed with diabetes by physicians were classified as having diabetes. The median follow-up period was 2.5 years. Poor sleep quality was associated with a higher risk of diabetes after adjusting for age, sex, body mass index, income, physical activity, and family history of diabetes (relative risk=2.64; 95% confidence interval, 1.03-6.78). As a risk factor for the development of diabetes, poor sleep quality may independently increase the incidence of diabetes.
Aged
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Blood Glucose/analysis
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Body Mass Index
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Cohort Studies
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Demography
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Diabetes Mellitus, Type 2/complications/*diagnosis/drug therapy
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Female
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Follow-Up Studies
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Humans
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Hypoglycemic Agents/therapeutic use
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Male
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Middle Aged
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Obesity/complications
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Primary Health Care
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Risk Factors
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*Sleep
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Surveys and Questionnaires