Hee Man Kim

The Effect of Menopause on the Metabolic Syndrome Among Korean Women The Korean National Health and Nutrition Examination Survey, 2001

OBJECTIVE—This study examined the effect of menopausal status on the risk of the metabolic syndrome in Korean women. RESEARCH DESIGN AND METHODS—Data were obtained from the Korean National Health and Nutrition Examination Survey of 2001. A total of 2,671 women who did not receive hormone replacement therapy (1,893 premenopausal women and 778 postmenopausal women) were included in the analysis. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III. RESULTS—Postmenopausal women had significantly higher mean waist circumference, systolic blood pressure, pulse pressure, total cholesterol, LDL cholesterol, and triglyceride levels than premenopausal women after adjusting for age (P = 0.018, P = 0.001, P < 0.0001, P < 0.0001, P < 0.0001, and P = 0.006, respectively). Among postmenopausal women, the age-adjusted odds ratio was 1.61 (95% CI 1.15–2.25) for abdominal obesity, 1.11 (0.76–1.61) for elevated blood pressure, 1.24 (0.90–1.72) for low HDL cholesterol, 1.28 (0.89–1.83) for high triglycerides, and 1.07 (0.69–1.65) for high fasting glucose compared with premenopausal women. The multivariate-adjusted odds ratio for the metabolic syndrome was 1.60 (95% CI 1.04–2.46) among postmenopausal women compared with premenopausal women. CONCLUSIONS—Postmenopausal status is associated with an increased risk of the metabolic syndrome independent of normal aging in Korean women.

Prevalence and Management of Diabetes in Korean Adults: Korea National Health and Nutrition Examination Surveys 1998–2005

OBJECTIVE This research investigated recent changes in the prevalence and management status of diabetes among Korean adults. RESEARCH DESIGN AND METHODS The Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide survey examining the general health and nutrition status of the Korean people, was conducted in 1998, 2001, and 2005. Using the first (1998; n = 5,645), second (2001; n = 4,154), and third (2005; n = 4,628) KNHANES datasets, in the present study, we estimated the prevalence of diabetes among Korean adults (aged ≥30 years), the proportions of known cases of diabetes, and the proportions of well-controlled cases of diabetes, as defined by either the American Diabetes Association (A1C <7%) or the International Diabetes Federation guidelines (A1C <6.5%). RESULTS In 2005, the prevalence of diabetes was estimated to be 9.1% (∼2.58 million people: 10.2% of men and 7.9% of women), including 6.2% with known diabetes and 2.9% with newly diagnosed diabetes. The prevalence of impaired fasting glucose was 17.4% (∼4.94 million people). The proportion of known cases of diabetes drastically increased from 23.2% in 1998 to 41.2% in 2001 and 68.0% in 2005 (P < 0.0001). Among known diabetic patients in 2005, 43.5 and 22.9% had A1C levels <7.0 and <6.5%, respectively. CONCLUSIONS The overall prevalence of diabetes in Korea has not changed significantly between 1998 and 2005. Physician diagnosis and treatment rates of diabetes have significantly improved during this period, but glycemic control was still poorer than that in other developed countries.

Active locomotion of a paddling-based capsule endoscope in an in vitro and in vivo experiment (with videos)

BACKGROUND Capsule endoscopy that could actively move and approach a specific site might be more valuable for the diagnosis or treatment of GI diseases. OBJECTIVE We tested the performance of active locomotion of a novel wired capsule endoscope with a paddling-based locomotion mechanism, using 3 models: a silicone tube, an extracted porcine colon, and a living pig. DESIGN In vitro, ex vivo, and in vivo experiments in a pig model. SETTING Study in an animal laboratory. INTERVENTIONS For the in vitro test, the locomotive capsule was controlled to actively move from one side of a silicone tube to the other by a controller-operated automatic traveling program. The velocity was calculated by following a video recording. We performed ex vivo tests by using an extracted porcine colon in the same manner we performed the in vitro test. In in vivo experiments, the capsule was inserted into the rectum of a living pig under anesthesia, and was controlled to move automatically forward. After 8 consecutive trials, the velocity was calculated. MAIN OUTCOME MEASUREMENTS Elapsed time, velocity, and mucosal damage. RESULTS The locomotive capsule showed stable and active movement inside the lumen both in vitro and ex vivo. The velocity was 60 cm/min in the silicone tube, and 36.8 and 37.5 cm/min in the extracted porcine colon. In the in vivo experiments, the capsule stably moved forward inside the colon of a living pig without any serious complications. The mean velocity was 17 cm/min over 40 cm length. We noted pinpoint erythematous mucosal injuries in the colon. LIMITATION Porcine model experiments, wired capsule endoscope. CONCLUSIONS The novel paddling-based locomotive capsule endoscope performed fast and stable movement in a living pig colon with consistent velocity. Further investigation is necessary for practical use in humans.

The association between sleep duration and general and abdominal obesity in Koreans: data from the Korean National Health and Nutrition Examination Survey, 2001 and 2005.

This study aimed to investigate the association between self‐reported sleep duration and general and abdominal obesity in Korean adults. A total of 8,717 adults aged 20–65 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 2001 and 2005 were included. General obesity was defined as BMI ≥25 kg/m2 and abdominal obesity as waist circumference ≥90 cm in men and ≥85 cm in women. To control for sociodemographic and lifestyle factors and comorbidities, multivariable logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of general and abdominal obesity across the following sleep duration categories: ≤5, 6, 7, 8, and ≥9 h/day. Mean sleep duration (±s.d.) was 6.9 ± 1.3 h. Those sleeping ≤5 h/day had the highest BMI and waist circumference compared with those sleeping 7, 8, or ≥9 h/day (P < 0.05 for all comparisons). After controlling for sociodemographic and lifestyle factors, the adjusted ORs (95% CIs) associated with sleeping ≤5 h/day (vs. 7 h/day) were 1.25 (1.06–1.48) for general obesity and 1.24 (1.03–1.48) for abdominal obesity. Further adjustment for hypertension and diabetes mellitus did not significantly affect the associations. These data suggest that short sleep duration is significantly associated with a modest increase in general and abdominal obesity in Korean adults.

A Simple Screening Score for Diabetes for the Korean Population Development, validation, and comparison with other scores

OBJECTIVE We developed and validated a self-assessment score for diabetes risk in Korean adults and compared it with other established screening models. RESEARCH DESIGN AND METHODS The Korea National Health and Nutrition Examination Survey (KNHANES) 2001 and 2005 data were used to develop a diabetes screening score. After excluding patients with known diabetes, 9,602 participants aged ≥20 years were selected. Undiagnosed diabetes was defined as a fasting plasma glucose ≥126 mg/dL and/or nonfasting plasma glucose ≥200 mg/dL. The SAS Survey Logistic Regression analysis was used to determine predictors of undiagnosed diabetes (n = 341). We validated our model and compared it with other existing methods using the KNHANES 2007–2008 data (n = 8,391). RESULTS Age, family history of diabetes, hypertension, waist circumference, smoking, and alcohol intake were independently associated with undiagnosed diabetes. We calculated a diabetes screening score (range 0–11), and a cut point of ≥5 defined 47% of adults as being at high risk for diabetes and yielded a sensitivity of 81%, specificity of 54%, positive predictive value of 6%, and positive likelihood ratio of 1.8 (area under the curve [AUC] = 0.73). Comparable results were obtained in validation datasets (sensitivity 80%, specificity 53%, and AUC = 0.73), showing better performance than other non-Asian models from the U.S. or European population. CONCLUSIONS This self-assessment score may be useful for identifying Korean adults at high risk for diabetes. Additional studies are needed to evaluate the utility and feasibility of this score in various settings.

Long‐term follow up of gallbladder polyps

Background and Aim:  The management of gallbladder polyps (GBP) is directly linked to the early diagnosis of gallbladder cancer (GBC). This study aimed to evaluate the malignant risk of GBP.

Bifidobacterium lactis inhibits NF-κB in intestinal epithelial cells and prevents acute colitis and colitis-associated colon cancer in mice

Background: The aim of this study was to investigate the antiinflammatory effects of Bifidobacterium lactis on intestinal epithelial cells (IECs) and on experimental acute murine colitis and its tumor prevention effects on colitis‐associated cancer (CAC) in mice. Methods: Human HT‐29 cells were stimulated with IL‐1&bgr;, lipopolysaccharides, or tumor necrosis factor‐&agr; with and without B. lactis, and the effects of B. lactis on nuclear factor kappa B (NF‐&kgr;B) signaling in IEC were examined. For in vivo study, dextran sulfate sodium (DSS)‐treated mice were fed with and without B. lactis. Finally, we induced colonic tumors in mice by azoxymethane (AOM) and DSS and evaluated the effects of B. lactis on tumor growth. Results: B. lactis significantly suppressed NF‐&kgr;B activation, including NF‐&kgr;B‐binding activity and NF‐&kgr;B‐dependent reporter gene expression in a dose‐dependent manner, and suppressed I&kgr;B‐&agr; degradation, which correlated with the downregulation of NF‐&kgr;B‐dependent gene products. Moreover, B. lactis suppressed the development of acute colitis in mice. Compared with the DSS group, the severity of DSS‐induced colitis as assessed by disease activity index, colon length, and histological score was reduced in the B. lactis‐treated group. In the CAC model, the mean number and size of tumors in the B. lactis‐treated group were significantly lower than those in the AOM group. Conclusions: Our data demonstrate that B. lactis inhibits NF‐&kgr;B and NF‐&kgr;B‐regulated genes in IEC and prevents acute colitis and CAC in mice. These results suggest that B. lactis could be a potential preventive agent for CAC as well as a therapeutic agent for inflammatory bowel disease. (Inflamm Bowel Dis 2010)

Negative capsule endoscopy without subsequent enteroscopy does not predict lower long-term rebleeding rates in patients with obscure GI bleeding

BACKGROUND Capsule endoscopy (CE) is now widely accepted as a first-line diagnostic modality for obscure GI bleeding (OGIB). However, the clinical implications of negative results of CE studies remain unclear. OBJECTIVE To investigate long-term (>1 year) outcomes for patients undergoing CE for OGIB and to identify risk factors associated with rebleeding. DESIGN AND SETTING Retrospective study in a tertiary care hospital. METHODS A total of 57 consecutive patients who had undergone CE for OGIB were enrolled and their pre- and post-CE clinical data were collected. Specific treatments were defined as treatments directly aimed at presumed bleeding causes including hemostasis and disease-specific medical therapy, whereas nonspecific treatments were defined as symptomatic treatments for anemia. RESULTS Of the 57 patients, the indication for CE was obscure-overt bleeding in 46 patients and obscure-occult bleeding in 11 patients. Among 51 patients for whom long-term data were available, significant (P2) lesions were found in 23 (45.1%) patients. The overall rebleeding rate was 35.3% during a median follow-up duration of 31.7 months (range 12.8-58.0 months). There was no statistically significant difference in the cumulative rebleeding rate between patients with positive and negative CE results (34.8% vs 35.7%, respectively; P = .989). However, specific treatments after CE (hazard ratio, 0.111; 95% CI, 0.013-0.980; P = .043) significantly decreased rebleeding. LIMITATIONS Small number of patients, retrospective study design. CONCLUSIONS The rebleeding rate for patients with OGIB and negative CE results was substantial, indicating that these patients should be closely observed. However, specific treatment after CE significantly reduced the incidence of recurrent bleeding.

A Pilot Study of Sequential Capsule Endoscopy Using MiroCam and PillCam SB Devices with Different Transmission Technologies.

BACKGROUND/AIMS Studies have investigated the use of different types of radiofrequency capsules for comparison or sequential capsule endoscopy, but none have compared the MiroCam device - which utilizes a novel data transmission technology - with other capsules. This study compared the feasibility of sequential capsule endoscopy using the MiroCam and PillCam SB devices, which employ different transmission technologies. METHODS Patients with diseases requiring capsule endoscopy were enrolled. After a 12-hour fast, one randomly selected capsule was swallowed. The second capsule was swallowed once fluoroscopy had indicated that the first capsule had migrated below the gastric outlet. RESULTS The total operating time in 24 patients was 702+/-60 min (mean+/-SD) for the MiroCam and 446+/-28 min for the PillCam SB (p<0.0001). The rate of a complete examination to the cecum was 83.3% for the MiroCam and 58.3% for the PillCam SB (p=0.031). Diagnostic yields for the MiroCam, PillCam SB, and sequential capsule endoscopy were 45.8%, 41.7%, and 50.0%, respectively. The agreement rate between the two capsules was 87.5%, with a kappa value of 0.74. Electrical interference in data transmission between the two capsules was not observed, but temporary visual interferences were observed in seven patients (29.2%). CONCLUSIONS Sequential capsule endoscopy with the MiroCam and PillCam SB produced slight but nonsignificant increases in the diagnostic yield, and the two capsules did not exhibit electrical interference. A larger trial is necessary for elucidating the usefulness of sequential capsule endoscopy.

Old age and male sex are associated with increased risk of asymptomatic erosive esophagitis: Analysis of data from local health examinations by the Korean National Health Insurance Corporation

Background and Aims:  Silent gastroesophageal reflux disease (GERD) is often detected during routine screening esophagogastroduodenoscopy (EGD). However, the risk factors and clinical implications of silent GERD remain unclear. In the present study, we investigated the risk factors for asymptomatic erosive esophagitis by analyzing the local area health examination data.