OBJECTIVES: This cross-sectional study was performed to examine if the serum gamma-glutamyltransferase (GGT) level that is within its normal range is associated with the risk of type 2 diabetes and if the association between the waist hip ratio (WHR) and type 2 diabetes is different depending on the serum GGT levels. METHODS: The study subjects were 23,436 persons aged 40 years or older and who participated in regular health check-ups at 11 hospitals (males: 5,821, females: 17,615). The gender-specific quintiles of the serum GGT and WHR were used to examine the associations with type 2 diabetes. RESULTS: The serum GGT levels within their normal range were positively associated with type 2 diabetes only in women. The adjusted odds ratios (ORs) were 1.0, 1.0, 1.4, 2.1, and 2.5 according to the quintiles of the serum GGT (p(trend)<0.01). The WHR was more strongly associated with the prevalence of diabetes among the women with a high-normal serum GGT level as compared with those with a low-normal serum GGT level (p for interaction=0.02). For example, the adjusted ORs for women with a low normal serum GGT level were 1.0, 1.2, 1.5, 2.2, and 2.4 according to the quintiles of the WHR, while those figures were 1.0, 2.4, 3.6, 5.0, and 8.3 among the women with a high normal serum GGT level. However, in men, the serum GGT was very weakly associated with type 2 diabetes and the association between the WHR and type 2 diabetes was not different depending on the serum GGT level. CONCLUSIONS: Serum GGT within its normal range was positively associated with type 2 diabetes, and central obesity was more strongly associated with the prevalence of type 2 diabetes when the serum GGT level was high-normal. However, these associations were observed only in women, which is different from the previous findings. The stronger relation between central obesity and type 2 diabetes among women with a high-normal serum GGT level can be useful for selecting a group that is at high risk for type 2 diabetes irregardless of whatever the underlying mechanism is.
Blood Glucose ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/blood/enzymology/*epidemiology ; Epidemiologic Studies ; Female ; Humans ; Male ; Middle Aged ; Obesity, Abdominal/*epidemiology ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; *Waist-Hip Ratio ; gamma-Glutamyltransferase/*blood

OBJECTIVES: This study was conducted to investigate the associations of non alcoholic fatty liver with metabolic syndrome and the serum carotenoids. METHODS: This study was conducted in a general hospital in South Korea from November, 2004 to August, 2005. The study subjects were 350 sampled persons who were aged from 40 years and older (males: 180, females: 170). They were grouped into the normal, mild and severe groups according to fat accumulation in their livers, as determined by ultrasonography. We analyzed the association between non alcoholic fatty liver and metabolic syndrome by multiple logistic regression analysis and we analyzed the association between non alcoholic fatty liver and the serum carotenoids by a general linear model(ANCOVA). RESULTS: After adjustment for the effect of potential covariates, the prevalence of metabolic syndrome was associated with fat accumulation in the liver (p trend <0.001). If the odds ratio of normal group is 1.00, then that of the mild group is 2.80 (95% C.I=1.17-6.71) and that of the severe group is 7.29 (95% C.I=2.76-19.30). The prevalence of metabolic alterations fitting the criteria of metabolic syndrome, according to the class of fat accumulation in the liver, was significantly increased, except for criteria of high blood pressure, a large waist circumference and low HDL (high density lipoprotein) cholesterol level (p trend <0.001). The level of serum beta-carotene was decreased according to the class of fat accumulation in the liver (p trend=0.036), but the levels of serum alpha-carotene, lycopene, bata-cryptoxanthin and lutein were not decreased. CONCLSIONS: This study shows that non alcoholic fatty liver was associated with metabolic syndrome and with the serum beta-carotene level.
Adult ; Carotenoids/*blood ; Fatty Liver/*complications ; Female ; Health Behavior ; Humans ; Male ; Metabolic Syndrome X/*complications ; Middle Aged ; Prevalence ; Regression Analysis

BACKGROUND: Recent studies have suggested that the outcomes of the patients with acute renal failure (ARF) may related to delivered dose of dialysis. In such context, a number of investigators have reported about delivered dose of dialysis and its contribution to outcomes of ARF, using Kt/V. The purpose of the study was to evaluate actual delivered dose of dialysis in intermittent hemodialysis (HD) in critically ill ARF patients, clinical factors contributing delivery of dialysis dose, and relationship of delivered dialysis dose and survival. METHODS: Delivered and prescribed dose of dialysis, presented as Kt/V, were measured in ARF patients intermittent HD in intensive care unit of Inha University Hospital from January 1999, until December 1999, using single pool urea kinetic model. RESULTS: All subjects received intermittent HD of 6.4+/-4.8 times with mean of 225.6+/-40.4 min per session. Overall survival was 55.5%. Prescribed Kt/V in all subjects was 1.24+/-0.39, but actual delivered Kt/ V was 1.08+/-0.17. A mean delivered/prescribed Kt/V ratio was 87.1+/-43%. Duration of HD session (R= -0.547, p=0.019), Cleveland Clinic Foundation Severity Score (R=-0.486, p=0.041), and frequency of hypotensive episodes (R=-0.419, p=0.043) were significantly correlated with delivered/prescribed Kt/V ratio. Delivered dose was under 1.2 in 66.7% of the subjects. Survival rate of these patients was 50.0%, which was lower as compared to 66.6% of the patients with delivered dose over 1.2. Patients with low delivered dose (Kt/V<1.2) showed significantly low prescribed dose and short HD time (p<0.05). Delivered Kt/V was correlated with BUN at initiation of dialysis, HD duration, and prescribed Kt/V (p<0.05). Non-survivors showed significantly low initial serum creatinine, low CCF severity score, high frequency of hypotensive episodes, and less use of heparin (p< 0.05). Prescribed Kt/V was not different between survivors and non-survivor (1.22+/-0.30 vs 1.31+/-0.45), but delivered Kt/V (1.17+/-0.17 vs. 1.04+/-0.17; p<0.05) and delivered/prscribed Kt/V (95.9+/-22.6% vs. 73.9+/-15.6%; p<0.05) were significantly higher in survivors than in non-survivors. CONCLUSION: In ARF patients, the delivery of dialysis was significantly lower than as was expected. Delivered/prescribed Kt/V was about 87% and more than half of the patients received intermittent HD of Kt/V less than 1.2. Better survival was associated with higher delivered dose of dialysis. We need further prospective studies about the causal relationship between delivered dose of dialysis and outcomes in ARF patients.
Acute Kidney Injury* ; Creatinine ; Critical Illness ; Dialysis* ; Heparin ; Humans ; Intensive Care Units ; Prospective Studies ; Renal Dialysis* ; Research Personnel ; Survival Rate ; Survivors ; Urea

Craniopharyngioma accounts for 3% to 5% of intracranial tumors and is the second most common neoplasm in the sellar region. Panhypopituitarism associated with craniopharyngioma has been reported in 7% of all patients with craniopharyngioma. Slipped capital femoral epiphysis is the condition in which the femoral head slips downward and backward on the femoral neck at the epiphyseal plate due to growth disturbance of capital physis, the actual cause of which is unknown. It is a disease of adolescence, during which many physiologic hormonal changes occur. The clinical association between slipped capital femoral epiphysis and endocrine disease is well known. There have been four cases of slipped capital femoral epiphysis associated with endocrine disorders in Korea. This is the first Korean case report of slipped capital femoral epiphysis combined with craniopharyngioma caused by hypopituitarism
Adolescent ; Craniopharyngioma* ; Endocrine System Diseases ; Epiphyses* ; Femur Neck ; Growth Plate ; Head ; Humans ; Hypopituitarism ; Korea ; Slipped Capital Femoral Epiphyses

Primary biliary cirrhosis (PBC)is a chronic inflammatory disease characterized by fibrous obliteration of intrahepatic bile ductules.Although the etiopathogenesis of PBC remains unclear,several studies suggest that a disordered immune response may be involved.This disease is commonly associated with various autoimmune diseases,such as Sjogren's syndrome,scleroderma, rheumatoid arthritis,Hashimoto's thyroiditis,polymyositis,and pernicious anemia.More than 80%of cases with PBC are accompanied by at least one autoimmune disorder,and 40%by two or more. Sjogren's syndrome,defined by dry eyes and xerostomia,may be found in 69 to 81%of PBC patients. However, concurrent coexistence of PBC and systemic lupus erythematosus (SLE)has been rarely described in the literature.We report a 46-year-old female with PBC and Sjogren's syndrome who also satisfied a classification criteria of SLE.
Bile ; Classification ; Female ; Humans ; Liver Cirrhosis, Biliary* ; Lupus Erythematosus, Systemic* ; Middle Aged ; Sjogren's Syndrome

PURPOSE: Diabetic children should be classified into type 1 or 2 for adequate diabetic control. However, there is a shortage of information of the appropriate criteria in Korea. This study is desinged to discover the clinical types and characteristics of diabetes mellitus(DM) in Korean children. METHODS: We studied the clinical characteristics and laboratory findings of 177 diabetic children. Classification was based on the serum C-peptide levels, presence of ketoacidosis, autoantibodies, and insulin dependence. RESULTS: Among 177 diabetic children, 147(83.1%) were classified as type 1 and 21(11.9%) as type 2, and 12(57.1%) children in type 2 were obese. All patients with age of onset before 9 were type 1. In cases of type 1, initial serum C-peptide levels were < 0.6(50%), 0.6-1.0(44%) and > 1.0ng/mL (6%). All patients with initial serum C-peptide level above 1.5ng/mL were type 2. Four patients initially diagnosed as type 2 DM changed to type 1 during follow-up, and 2 patients of type 1 DM changed to type 2. Only 55.4% of type 1 DM patients had insulin autoantibody, islet cell cytoplasmic antibody or anti-glutamic acid decarboxylase antibodies. CONCLUSION: Most diabetic children in Korea were classified as type 1. Our results suggest that insulin requiring lean patients with positive autoantibody should be classified as type 1 even if their serum C-peptide levels are within normal range, and the clinical types could be changed during follow-up in a small proportion of diabetic children.
Age of Onset ; Antibodies ; Autoantibodies ; C-Peptide ; Child* ; Classification ; Cytoplasm ; Diabetes Mellitus* ; Follow-Up Studies ; Humans ; Insulin ; Islets of Langerhans ; Ketosis ; Korea ; Reference Values

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.
Adolescent ; Blood Glucose ; Blood Pressure ; C-Peptide ; Child* ; Cholesterol ; Diabetes Mellitus ; Fasting ; Fatigue ; Female ; Glucose ; Glycosuria ; Humans ; Polydipsia ; Polyuria ; Referral and Consultation ; Risk Factors ; Seoul* ; Triglycerides ; Weight Loss

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.
Adolescent ; Blood Glucose ; Blood Pressure ; C-Peptide ; Child* ; Cholesterol ; Diabetes Mellitus ; Fasting ; Fatigue ; Female ; Glucose ; Glycosuria ; Humans ; Polydipsia ; Polyuria ; Referral and Consultation ; Risk Factors ; Seoul* ; Triglycerides ; Weight Loss

BACKGROUNDS: Malnutrition is common in patients with chronic renal failure(CRF) and various signs of malnutrition are strong predictors of increased morbidity and mortality. Monitoring of protein intake and nutritional status is therefore important in the clinical management of CRF patients. Few studies have demonstrated direct correlations among renal function, protein intake, and nutritional status in a prospective study although clinical experiences suggest such relationship. The aim of this study was to prospectively evaluate correlations between renal function, protein intake, and nutritional status during progressive renal failure. METHODS: A total of 431 studies on renal function, protein intake, and nutritional status was carried out in 282 patients with normal renal function and varying degrees of renal failure before beginning dialysis. Renal functional indices included weekly Kt/Vurea, total weekly creatinine clearance(Ccr, L/week/1.73m2), creatinine clearance(Ccr, mL/min/1.73m2), urea clearance(Curea, mL/min) and residual renal function(RRF, mL/min). Protein intake was assessed from the protein equivalent of total nitrogen appearance normalized by standard weight(nPNA, g/kg/day) by DOQI formula[nPNA(D)], Bergstr m formula 1[nPNA(B1)] and Bergstr m formula 2[nPNA(B2)]. Nutritional indices were fat free edema free body mass(FFEFBM, kg) by creatinine kinetics, %lean body mass(LBM, %) and serum albumin(g/dL). We evaluated correlations between renal function, protein intake and nutritional status by linear regression analysis. In a separate analysis, 237 studies from 94 patients with follow-up studies were analyzed for correlations among renal function, protein intake, and nutritional status. RESULTS: There was a highly significant correlation among weekly Kt/Vurea, weekly creatinine clearance, and residual renal function, among nPNA(D), nPNA (B1), nPNA(B2), and between FFEFBM and %LBM. Significant correlation was also observed between weekly Kt/Vurea and nPNA, between weekly Kt/ Vurea and FFEFBM, between weekly Kt/Vurea and %LBM, between nPNA and FFEFBM, and between nPNA and %LBM. The results were the same in patients with follow-up studies. CONCLUSION: These results clearly demonstrate that renal urea and creatinine clearance is closely correlated with protein intake and nutritional status in predialysis patients. With declining small solute clearances, protein intake decreased and nutritional status became worse. Starting dialysis before malnutrition becomes apparent may improve patient morbidity and mortality after dialysis.
Creatinine ; Dialysis ; Edema ; Follow-Up Studies ; Humans ; Kinetics ; Linear Models ; Malnutrition ; Mortality ; Nitrogen ; Nutrition Assessment ; Nutritional Status* ; Prospective Studies ; Renal Insufficiency* ; Urea

Insulin-dependent diabetes mellitus (IDDM) is an autoimmune disease occurring among genetically susceptible individuals. Although the HLA class II genes and immunological abnormalities are clearly associated with IDDM in all racial groups, there are considerable variations in associated genotypes and prevalence of autoantibodies. Especially, it seems that adult-onset IDDM is somewhat different from childhood-onset IDDM in clinical and immunogenetic aspect. In order to determine the characteristics of the immunogenetic patterns and to use these results as an early diagnostic tool and a guideline of the therapeutic plan in Korean adult- onset IDDM, we investigated the clinical and immunogenetic characteristics in adult-onset IDDM patients. METHODS: We investigated the clinical and biochemical characteristics, and measured anti-GAD antibody by immunoradiometric assay or immunoprecipitation after in vitro translation of human GAD cDNA and IA-2 antibody by immunoprecipitaion after in vitro translation of human IA-2cDNA. The distribution of HLA-DR serotypes by lymphocyte microcytotoxicity method, HLA-DQA1 genotypes by restriction fragment length polymorphism and HLA-DQB1 genotypes by dot-blotting analysis using sequence specific oligonucleotide probe were analysed in 233 IDDM patients and controls. RESULTS: 1) Adult-onset patients had more preserved beta cell functions and slowly evolving form of clinical pattern rather than childhood-onset cases. 2) Each prevalences of anti-GAD and IA-2 antibody were 64% and 14.4% in adult-onset patients. Among them, the group with DR9-DQ9 had higher prevalence of antiGAD antibody rather than DR4-DQ4 group. 3) There were increased frequencies of HLA-DR4 and -DR9 in adult-onset patients. Considering the frequency of HLA-DQA1 and -DQB1 and the distribution of DQ heterodimers, they had no significantly increased genotypes or haplotypes. But childhood-onset cases had high frequencies in HLA DR3, -DR4, -DR9 serotypes and DQA1*0301, DQA1*0501, DQB1*0201 genotypes. CONCLUSION: Korean adult-onset IDDM patients have relatively higher prevalence of anti-GAD antibody implicating autoimmune pathogenesis. HLA genetic markers in adult-onset IDDM were somewhat different from those in childhood-onset cases. This pathogenetic heterogenesity according to age of onset may be due to the influences of other genetic markers and environmental factors involved in the etiology of Korean IDDM.
Adult* ; Age of Onset ; Autoantibodies ; Autoimmune Diseases ; Diabetes Mellitus* ; Diabetes Mellitus, Type 1 ; DNA, Complementary ; Genes, MHC Class II ; Genetic Markers ; Genotype ; Haplotypes ; HLA-DR Antigens ; HLA-DR4 Antigen ; Humans ; Immunogenetics* ; Immunoprecipitation ; Immunoradiometric Assay ; Insulin* ; Korea* ; Lymphocytes ; Polymorphism, Restriction Fragment Length ; Prevalence