Hye-Ree Lee

Body composition and its association with cardiometabolic risk factors in the elderly: A focus on sarcopenic obesity

Important changes in body composition with aging are a progressive loss of muscle mass and increase of fat mass. Despite their enormous clinical importance, body composition changes such as sarcopenic obesity in the elderly are under-recognized. This study aimed to examine the relationship of body composition with a wide variety of cardiometabolic risk factors among 2943 subjects (1250 men and 1693 women) aged 60 years or older from Korean National Health Examination and Nutrition Survey (KNHANES). Sarcopenia was defined as an appendicular skeletal muscle mass (ASM) divided by weight (%) of < 1 SD below the sex-specific mean for young adults. Obesity was defined as a body mass index (BMI) ≥ 25 kg/m(2). Body composition was categorized into four non-overlapping groups: the sarcopenic obese, sarcopenic nonobese, nonsarcopenic obese, and nonsarcopenic nonobese groups. A wide variety of cardiometabolic risk factors, including blood pressure (BP), glucose tolerance indices, lipid profiles, inflammatory markers, and vitamin D level, were compared according to body composition group. The prevalence of sarcopenic obesity was 18.4% in men and 25.8% in women. In both sexes, the prevalence of vitamin D deficiency and metabolic syndrome was highly prevalent in the sarcopenic obese group. Serum insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride levels, and ferritin levels were the highest in the sarcopenic obese group in both men and women, whereas HDL-cholesterol and 25-hydroxyvitamin D (25(OH)D) levels were the lowest in the sarcopenic obese group. The sarcopenic obese group was more closely associated with insulin resistance, metabolic syndrome, and cardiovascular disease (CVD) risk factors than any other group in this elderly population.

Increased arterial stiffness in healthy subjects with high-normal glucose levels and in subjects with pre-diabetes

BackgroundIncreased fasting plasma glucose (FPG), which includes impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes, is a risk factor for arterial stiffness. While IFG is widely accepted as a cardiovascular risk factor, recent studies have argued that subjects with high-normal glucose level were characterized by a high incidence of cardiovascular disease. The purpose of this study is to investigate the relationship between FPG and arterial stiffness in non-diabetic healthy subjects.MethodsWe recruited 697 subjects who visited the health promotion center of a university hospital from May 2007 to August 2008. Age, sex, body mass index (BMI), resting heart rate, smoking habits, alcohol intake, exercise, blood pressure, medical history, FPG, lipid profile, high sensitivity C-reactive protein (hs-CRP), and Brachial-ankle pulse wave velocity (ba-PWV) were measured. We performed correlation and multiple linear regression analyses to divide the research subjects into quartiles: Q1(n = 172), 65 mg/dL ≤FPG < 84 mg/dL; Q2(n = 188), 84 mg/dL ≤FPG < 91 mg/dl; Q3(n = 199), 91 mg/dL ≤FPG < 100 mg/dL; Q4(n = 138), 100 mg/dL ≤FPG < 126 mg/dL.ResultsFPG has an independent, positive association with ba-PWV in non-diabetic subjects after correcting for confounding variables, including age, sex, BMI, blood pressure, resting heart rate, hs-CRP, lipid profile, and behavioral habits. The mean ba-PWV of the high-normal glucose group (Q3, 1384 cm/s) was higher than that of the low-normal glucose group (1303 ± 196 cm/s vs.1328 ± 167 cm/s, P < 0.05). The mean ba-PWV value in the IFG group (1469 ± 220 cm/s) was higher than that in the normoglycemic group (P < 0.05, respectively).ConclusionsAn increase in FPG, even within the normal range, was associated with aggravated arterial stiffness. Further research is needed to determine the glycemic target value for the prevention of arterial stiffness in clinical and public health settings.

Visceral Adiposity Is Associated with Serum Retinol Binding Protein‐4 Levels in Healthy Women

Objective: Retinol binding protein‐4 (RBP4) has been reported to impair insulin sensitivity throughout the body. We investigated the relationship between serum RBP4 levels and adiposity indices as well as metabolic risk variables.

High dose concentration administration of ascorbic acid inhibits tumor growth in BALB/C mice implanted with sarcoma 180 cancer cells via the restriction of angiogenesis.

To test the carcinostatic effects of ascorbic acid, we challenged the mice of seven experimental groups with 1.7 × 10-4 mol high dose concentration ascorbic acid after intraperitoneal administrating them with sarcoma S-180 cells. The survival rate was increased by 20% in the group that received high dose concentration ascorbic acid, compared to the control. The highest survival rate was observed in the group in which 1.7 × 10-4 mol ascorbic acid had been continuously injected before and after the induction of cancer cells, rather than just after the induction of cancer cells. The expression of three angiogenesis-related genes was inhibited by 0.3 times in bFGF, 7 times in VEGF and 4 times in MMP2 of the groups with higher survival rates. Biopsy Results, gene expression studies, and wound healing analysis in vivo and in vitro suggested that the carcinostatic effect induced by high dose concentration ascorbic acid occurred through inhibition of angiogenesis.

Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score

BACKGROUND Emerging evidence suggests that the neutrophil/lymphocyte ratio (NLR) may be a useful marker of cardiovascular disease and a more powerful predictor than any other leukocyte subtypes. We determined whether NLR is related to atherosclerosis measured by brachial-ankle pulse wave velocity (baPWV) and coronary calcium score (CCS). METHODS We examined the relationship of NLR with baPWV and CCS in 849 Korean adults in a health examination program. The odds ratios for a high baPWV or a high CCS were calculated using multivariate logistic regression analysis across NLR quartiles. A high baPWV was defined as >1500 cm/s (>75th percentile) and a high CCS was defined as over 100 (at least moderate atherosclerotic plaque burden). RESULTS The ORs (95% CIs) for a high baPWV by NLR quartiles were 1.00, 0.76 (0.41-1.39), 1.08 (0.61-1.90), and 2.12 (1.18-3.83) after adjusting for confounding variables. Similarly, positive associations between NLR and a high CCS were also observed after adjusting for the same co-variables. CONCLUSION A higher NLR was independently associated with arterial stiffness and CCS. Accordingly, a higher NLR may be a useful additional measure in assessing cardiovascular risks in clinical practice.

Association between serum uric acid and non-alcoholic fatty liver disease in Korean adults.

Abstract Background: Increased uric acid is associated with the metabolic syndrome, conditions linked to oxidative stress and insulin resistance. Non-alcoholic fatty liver disease (NAFLD) is now considered a hepatic manifestation of insulin resistance. However, little has been written regarding the association between uric acid and NAFLD. Methods: We examined the association between uric acid and the presence of NAFLD in 3768 Koreans (2133 men, 1635 women; aged 20–75 years) in a health examination program. Uric acid quartiles were categorized separately as follows: Q1: ≤291.5, Q2: 291.6–333.1, Q3: 333.2–380.7, and Q4: ≥380.8 μmol/L for men; Q1: ≤202.2, Q2: 202.3–232.0, Q3: 231.1–267.7, and Q4: ≥267.8 μmol/L for women. Hepatic steatosis was diagnosed based on abdominal ultrasonographic findings by hyperechogenicity of liver tissue, difference of echogenicity between the liver and diaphragm, and visibility of vascular structures. The odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were calculated across each quartile of serum uric acid. Results: The prevalence of NAFLD was 25.8% (32.2% in men and 17.4% in women). After adjustment for age, body mass index (BMI), smoking, regular exercise, blood pressure, fasting plasma glucose (FPG), triglycerides, and high-density lipoprotein (HDL) cholesterol, the ORs (95% CIs) for NAFLD according to each quartile of uric acid were 1.00, 1.55 (1.13–2.14), 1.77 (1.30–2.41), and 2.01 (1.45–2.78) for men and 1.00, 0.69 (0.40–1.20), 1.12 (0.67–1.88), and 1.94 (1.21–3.13) for women. Conclusions: Serum uric acid is independently associated with the presence of NAFLD, and uric acid may be a useful additional measure in assessing the risk of NAFLD in the clinical setting. Clin Chem Lab Med 2010;48:175–80.

Viscerally obese women with normal body weight have greater brachial‐ankle pulse wave velocity than nonviscerally obese women with excessive body weight

Objective  To confirm the association of visceral obesity and brachial‐ankle pulse wave velocity (baPWV) and to compare metabolic indices and baPWV between individuals who have normal body weight but are viscerally obese and individuals with excessive body weight who are not viscerally obese.

The Relationship Between Arterial Stiffness and Nonalcoholic Fatty Liver Disease

AimNonalcoholic fatty liver disease (NAFLD) is currently the most common form of chronic liver disease and some studies have documented its link with cardiovascular risk factors. This study aimed to investigate the association between arterial stiffness and NAFLD.MethodsAmong 1,442 health check-up subjects (955 men, 487 women), we examined the association between brachial-ankle pulse wave velocity (baPWV) as a measurement of arterial stiffness and the presence of NAFLD based on abdominal sonographic findings. Multivariate linear and logistic regression analyses were conducted to examine the independent association between baPWV and the presence of NAFLD in gender-specific manners.ResultsIn multivariate regression analysis, NAFLD was found to be independently associated with baPWV in both men and women. Moreover, in multivariate logistic regression analysis, a graded independent relation was found between higher levels of baPWV and the prevalence risk of NAFLD. Odds ratios (95% CI) for the highest vs. the lowest quartile of baPWV were 1.85 (range, 1.13–2.62) in men and 3.32 (1.45–7.62) in women after adjusting for age, smoking status, regular exercise, body mass index, blood pressure, fasting plasma glucose, triglyceride, HDL-cholesterol, hypertension and diabetes.ConclusionArterial stiffness was independently associated with the prevalence risk for NAFLD regardless of classical CVD risk factors.

Association between screen time and metabolic syndrome in children and adolescents in Korea: The 2005 Korean National Health and Nutrition Examination Survey

OBJECTIVE To examine the association between screen time and the metabolic syndrome (MetS) in a nationally representative sample of children and adolescents. METHODS A cross-sectional survey was conducted in 845 children and adolescents (10-18 years of age) from the 2005 Korean National Health and Nutrition Examination Surveys (KNHANES). Screen time was defined as TV time+computer time. The definition of MetS was based on the modified criteria used by the National Cholesterol Education Program-Adult Treatment Panel III, using age- and sex-specific values for some of the criteria. RESULTS In comparison with the children and adolescents in the ST-Q1 (<or=16h for a week), the odds ratio (95% confidence interval) for MetS of subjects in the ST-Q4 (>or=35h for a week) was 2.23 (95% CI, 1.02-4.86) after the adjustment for age, household income, and residence area. Moreover, screen time for a weekend day was also strongly associated with the prevalence of MetS, but not for a weekday. CONCLUSIONS Screen time was independently associated with an increased prevalence risk of MetS in children and adolescents in Korea. Public health intervention to reduce screen time particularly for a weekend may be needed to prevent pediatric MetS in Korea.

Association between resting heart rate and arterial stiffness in Korean adults

BACKGROUND Higher resting heart rate, a simple and useful indicator of autonomic balance and metabolic rate, has emerged as an independent predictor for atherosclerotic cardiovascular disease. AIM To determine the association between resting heart rate and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV). METHODS We examined the association between resting heart rate and baPWV in 641 Korean adults (366 men, 275 women) in a health examination program. A high baPWV was defined as greater than 1450 cm/s (>75th percentile). The odds ratios for high baPWVs were calculated using multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1<or=56, Q2=57-62, Q3=63-68, Q4>or=69 beats/min). RESULTS Age-adjusted baPWV mean values increased gradually with heart rate quartile (Q1=1281, Q2=1285, Q3=1354, Q4=1416 cm/s). The odds ratios (95% confidence intervals) for high baPWVs in each heart rate quartile were 1.00, 1.28 (0.57-2.86), 2.63 (1.20-5.79) and 3.66 (1.66-8.05), respectively, after adjusting for age, sex, smoking status, alcohol intake, exercise, body mass index, hypertension medication, diabetes medication, hyperlipidaemia medication, mean arterial blood pressure, fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, white blood cell count, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and uric acid. CONCLUSION These findings indicate that a higher resting heart rate is independently associated with arterial stiffness. Accordingly, early detection of increased resting heart rate is important for preservation of arterial function and assessment of cardiovascular risk.