Hyuktae Kwon

Association of nonalcoholic fatty liver disease with components of metabolic syndrome according to body mass index in Korean adults.

OBJECTIVES:Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease, and its prevalence is much higher in obese individuals. NAFLD is closely related to metabolic syndrome (MetS); however, most concepts about the relationship between NAFLD and MetS have emphasized obesity, although NAFLD is not a rare disease in the non-obese population. In the present study, we aim to determine the association between NAFLD and MetS and to compare this association between non-obese and obese individuals.METHODS:A total of 29,994 adults who underwent routine comprehensive health evaluations, including abdominal ultrasonography, were selected. We calculated the adjusted prevalence ratios (PRs) for components of MetS (high blood pressure (BP), impaired fasting glucose, low high-density lipoprotein cholesterol (HDL-C), and high triglycerides (TG)) according to NAFLD in non-obese and obese patients.RESULTS:NAFLD was found in 12.6% of non-obese subjects and 50.1% of obese subjects. NAFLD was associated with most components of MetS in both obese and non-obese subjects. However, non-obese NAFLD patients had significantly higher PRs for certain components of MetS than did obese patients, especially among women. Adjusted PRs (95% confidence interval) for components of MetS in non-obese women vs. obese women were as follows: (1) high BP: 1.41 (1.31–1.51) vs. 1.05 (0.89–1.22) (2) impaired fasting glucose: 2.04 (1.95–2.75) vs. 1.37 (1.21–1.53) (3) low HDL-C: 2.00 (1.92–2.08) vs. 1.40 (1.26–1.55), and (4) high TG: 3.36 (3.24–3.47) vs. 1.97 (1.76–2.17).CONCLUSIONS:NAFLD was associated with risk for components of MetS, and the association was stronger in non-obese than in obese individuals, especially in women. Therefore, NAFLD should be considered a meaningful predictor of metabolic diseases in the non-obese population.

A low level of serum total testosterone is independently associated with nonalcoholic fatty liver disease

BackgroundThe association between low serum testosterone levels, visceral adipose tissue (VAT), and metabolic syndrome is now well known. However, the relationship between hepatic steatosis and serum testosterone levels has not been extensively studied. Our aim was to investigate the association of serum total testosterone levels with nonalcoholic fatty liver disease (NAFLD), adjusting for the influence of VAT and insulin resistance.MethodsThis study is a retrospective observational cross-sectional one of healthy Korean men and was conducted at the Seoul National University Hospital Healthcare System Gangnam Center. We used data obtained from 495 men who were at least 20 years of age and who had undergone blood testing, abdominal computed tomography, and ultrasonography. Multiple logistic regression analysis was used to explore the association of serum total testosterone levels with NAFLD.ResultsMen in the low serum testosterone quintile were at a higher risk for NAFLD than men in the highest serum testosterone quintile. After adjusting for age, smoking, diabetes, exercise, BMI, triglycerides, and high-density-lipoprotein cholesterol, subjects with serum testosterone levels in the lowest quintile had an odds ratio (OR) (95% confidence interval (CI)) of 5.12 (2.43–10.77) for NAFLD (p value, 0.0004). The inverse association between serum testosterone and NAFLD was attenuated by further adjustment for variables including VAT; however, it remained statistically significant (OR (95% CI): 4.52 (2.09–9.80) in the lowest quintile; p value=0.004).ConclusionsA low serum total testosterone level was independently associated with NAFLD. This report is the first one suggesting the association remains unchanged even after controlling for VAT and insulin resistance.

Distribution of Abdominal Visceral and Subcutaneous Adipose Tissue and Metabolic Syndrome in a Korean Population

OBJECTIVE This study aimed to assess the correlation between abdominal subcutaneous adipose tissue (SAT) and metabolic syndrome (MetS) in Korean adults after adjusting for the effects of visceral adipose tissue (VAT). RESEARCH DESIGN AND METHODS The SAT/VAT ratio (SVR) was calculated using abdominal computed tomography in 2,655 subjects. We used regression analyses to assess whether the SVR predicted MetS. RESULTS For both sexes, the prevalence of elevated triglycerides, reduced HDL, and elevated fasting glucose significantly decreased with increasing quintiles of SVR (P for trend < 0.05). The prevalence and odds ratios of MetS significantly decreased as the SVR increased (men: odds ratio 0.5 [95% CI 0.3–0.7]; women: 0.2 [0.1–0.5] for comparisons of lowest vs. highest quintile; P for trend < 0.05). CONCLUSIONS After adjustment for VAT, abdominal SAT was inversely correlated with the occurrence of MetS.

Aspirin use and risk for lung cancer: a meta-analysis

BACKGROUND Aspirin has received increasing attention owing to its potential as a chemopreventive agent against lung cancer. Previous observational studies have reported inconsistent findings on this issue. We investigated the association between aspirin use and risk for lung cancer by conducting a meta-analysis. PATIENTS AND METHODS Relevant studies were identified by searching Medline, EMBASE, and Cochrane Library to December 2009. We also reviewed relevant bibliographies from the retrieved articles. Two authors independently extracted data and assessed study quality. Disagreements were resolved by consensus. RESULTS Fifteen studies (six case-control studies and nine prospective cohort studies) were included in the final meta-analysis. When all studies were pooled, the odds ratio (OR) of aspirin use for lung cancer risk was 0.86 [95% confidence interval (CI) 0.76-0.98]. In subgroup meta-analyses, there was no association between aspirin use and lung cancer risk among cohort studies (relative risk, 0.97; 95% CI 0.87-1.08), while there was a significant association among case-control studies (OR, 0.74; 95% CI 0.57-0.99). In a subgroup meta-analysis by quality of study methodology, a significant protective effect of aspirin use on lung cancer was observed only among eight low-quality studies (OR, 0.82; 95% CI 0.68-0.99), but not among seven high-quality studies (OR, 0.90; 95% CI 0.76-1.07). CONCLUSIONS Overall, the findings of this meta-analysis support that there was no association between aspirin use and lung cancer risk. Our findings should be confirmed in future prospective cohort studies or randomized, controlled trials.

Metabolic Syndrome and Accompanying Hyperinsulinemia have Favorable Effects on Lower Urinary Tract Symptoms in a Generally Healthy Screened Population

PURPOSE We assessed the association of metabolic syndrome, insulin resistance and lower urinary tract symptoms in a large, screened adult population. MATERIALS AND METHODS We analyzed 33,841 Korean men 30 years old or older who underwent routine health assessments from October 2003 to February 2010. Metabolic syndrome was defined according to the modified Adult Treatment Panel III guidelines. Lower urinary tract symptoms were assessed using the International Prostate Symptom Score. Blood samples were drawn in the morning after patients had fasted at least 12 hours. RESULTS Lower urinary tract symptoms had a marginally negative association with metabolic syndrome after adjusting for age (p = 0.045). This negative association became more significant as the number of metabolic syndrome components increased (p trend <0.01), especially voiding symptoms (p trend <0.01). Increasing the level of fasting insulin and the severity of insulin resistance were associated with a lower age adjusted OR for lower urinary tract symptoms (p <0.01 and 0.03, respectively). However, the diabetes group with high HbA1c (8.0% or greater) had a higher age adjusted OR for lower urinary tract symptoms, especially storage symptoms. The group with metabolic syndrome plus insulin resistance had lower total International Prostate Symptom Score, voiding symptoms, storage symptoms and quality of life scores than those without metabolic syndrome and/or insulin resistance (p <0.01, 0.01, 0.047 and 0.03, respectively). CONCLUSIONS Metabolic syndrome, insulin resistance and the accompanying hyperinsulinemia may have favorable effects on lower urinary tract symptoms in the early compensatory stage, especially voiding symptoms. However, advanced diabetes may have unfavorable effects on lower urinary tract symptoms, especially storage symptoms. Hyperinsulinemia in patients with metabolic syndrome or insulin resistance may be a key factor in this phenomenon.

Visceral obesity is associated with microalbuminuria in nondiabetic Asians

Microalbuminuria is an indicator of renal disease and is known to be related to obesity. The aim of this study is to investigate the association between the cross-sectional area of visceral adipose tissue (VAT) and the prevalence of microalbuminuria. We conducted a cross-sectional study of 1154 subjects who underwent routine checkups, including computed tomography (CT) scans of abdominal adipose tissue. We used the lowest tertile as a reference of abdominal fat. The highest tertile of VAT was related to the highest prevalence of microalbuminuria (odds ratio (OR): 1.96; 95% CI: 1.12–3.43). Subcutaneous adipose tissue (SAT) was not associated with microalbuminuria. In men, the highest tertile for VAT was associated with the highest prevalence of microalbuminuria (OR: 2.74; 95% CI: 1.44–5.22). In women, VAT or SAT was not associated with microalbuminuria. In nondiabetic subjects, the highest tertile for VAT was associated with the highest prevalence of microalbuminuria (OR: 2.23; 95% CI: 1.15–4.32). Among subjects without metabolic syndrome or with body mass index <25 kg m−2, the highest tertile for VAT was associated with microalbuminuria in age- and sex-adjusted model, respectively (OR: 1.62; 95% CI: 1.01–2.31; OR: 2.21; 95% CI: 1.05–4.65). The analysis of the association of VAT and insulin resistance (IR) indicated that a higher VAT was associated with a higher IR (highest tertile for VAT—OR: 2.91; 95% CI: 1.70–4.96). In conclusion, the highest VAT of the current study was significantly correlated with the highest prevalence of microalbuminuria, even in traditionally low-risk subjects without diabetes, and this association is potentially related with a higher IR.

Developing a biological age assessment equation using principal component analysis and clinical biomarkers of aging in Korean men

The purpose of the present study is to find clinically useful candidate biomarkers of aging, and using these to develop an equation measuring biological age (BA) in Korean men, then to validate the clinical usefulness of it. Among 4288 men who received medical health examinations, we selected 1588 men who met the normality criteria of each variable. We assumed that chronological ages (CA) of healthy persons represent the BA of them. Variables showing significant correlations with CA were selected. Redundant variables were excluded. We selected 11 variables: VO(2)max, percent body fat (%BF), waist circumference (WC), forced expiratory volume in 1 s (FEV1), systolic blood pressure (SBP), low density cholesterol (LDLCH), blood urea nitrogen (BUN), serum albumin (SA), erythrocyte sedimentation rate(ESR) hearing threshold (HT), and glycosylated hemoglobin (HBA1C). These 11 variables were then submitted into principal component analysis (PCA) and standardized BA scores were obtained. Using them and T-scale idea, the following equation to assess BA was developed: BA=-28.7+0.83(%BF)+0.48(WC)+0.13(SBP)-0.27(VO(2)max)+0.19(HT)-3.1(FEV1)+0.32(BUN)+0.06(LDLCH)-3.0(SA)+0.34(ESR)+4.6(HBA1C). We compared the BA of 3122 men by their fasting glucose and age level. The BA of the higher glucose level group was significantly higher than that of others at all CA levels. The selected 11 biomarkers encompassed known clinically important factors of adult diseases and functional disabilities. This BA assessment equation can be used in the general Korean male population and it proved to be clinically useful.

I148M variant in PNPLA3 reduces central adiposity and metabolic disease risks while increasing nonalcoholic fatty liver disease.

The I148M variant because of the substitution of C to G in PNPLA3 (rs738409) is associated with the increased risk of nonalcoholic fatty liver disease (NAFLD). In liver, I148M variant reduces hydrolytic function of PNPLA3, which results in hepatic steatosis; however, its association with the other clinical phenotype such as adiposity and metabolic diseases is not well established.

Comparative effectiveness of oral antidiabetic drugs in preventing cardiovascular mortality and morbidity: A network meta-analysis.

In the Guidance for Industry from the Food and Drug Administration in 2008, excess cardiovascular risk should be ruled out in trials of all new antidiabetic drugs; however, relatively few studies have focused on cardiovascular safety with antidiabetic drug use. We aimed to examine mortality and cardiovascular risk using a network meta-analysis. We searched the Medline, Embase, Cochrane, and ClinicalTrials.gov registry databases in March 2016 to identify randomized controlled trials reporting cardiovascular risk with the following oral antidiabetic drugs: metformin, sulfonylureas, thiazolidinedione (TZD), dipeptidyl peptidase-4 (DPP4) inhibitors, and sodium-glucose co-transporter-2 (SGLT2) inhibitors. We assessed the differences in the risks of all-cause mortality, cardiovascular-related mortality, acute coronary syndrome (ACS), and myocardial infarction (MI) among antidiabetic drugs with fixed effect models for direct pairwise comparisons and Bayesian network meta-analyses to integrate direct and indirect comparisons. Of the 101,183 patients in 73 randomized controlled trials, 3,434 (3.4%) died. The relative risks of all-cause mortality with SGLT2 inhibitor use were 0.68 (95% credible interval: 0.57–0.80), 0.74 (0.49–1.10), 0.63 (0.46–0.87), 0.71 (0.55–0.90), and 0.65 (0.54–0.78), compared with placebo, metformin, sulfonylurea, TZD, and DPP4 inhibitor, respectively. The relative risks of cardiovascular-related mortality with SGLT2 inhibitor use were 0.61 (0.50–0.76), 0.81(0.36–1.90), 0.52(0.31–0.88), 0.66(0.49–0.91), and 0.61(0.48–0.77), compared with placebo, metformin, sulfonylurea, TZD, and DPP4 inhibitor, respectively. The relative risks of ACS with SGLT2 inhibitor use was consistent with that of all-cause mortality. SGLT2 inhibitor use was associated with a lower risk of ACS than the other OADs and placebo. The relative risks of MI with SGLT2 inhibitor use were 0.77 (0.63–0.93) and 0.75 (0.60–0.94), compared with placebo and DPP4 inhibitor, respectively. The currently available data provide the evidence of cardiovascular benefit from use of SGLT2 inhibitors to patients with type 2 diabetes, although additional results from ongoing studies will be pivotal.

Alcohol consumption and its relation to visceral and subcutaneous adipose tissues in healthy male Koreans.

Aims: The purpose of the present study is to investigate the association of alcohol with visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) distribution and metabolic syndrome (MetS). Design: We conducted a cross-sectional study in 951 healthy male Korean participants who underwent health checkups. We measured the cross-sectional areas of VAT and SAT by computed tomography of the abdomen and performed a study of alcohol consumption based on questionnaire responses and a 24-hour dietary recall assessment. We analyzed the relationship of alcohol consumption with VAT, SAT, and MetS. Results: Alcohol consumption showed a negative association with SAT (β = -18.76, p = 0.047) but a positive association with VAT (β = 17.70, p = 0.037), independent of other factors. The adjusted odds ratios for MetS for those who consumed <7, 7 to <14, 14 to <28, and ≧28 standard drinks per week were 0.99 (0.59-1.68), 1.49 (0.84-2.63), 1.95 (1.10-3.45), and 1.99 (1.07-3.70), respectively (p for linear trend = 0.042). Conclusions: Alcohol consumption is associated with decreased SAT and increased VAT accumulation. Further, alcohol consumption of ≧14 standard drinks is associated with an increased risk of MetS. Light-to-moderate drinking, which has been regarded to lower the risk of cardiovascular diseases, did not show a protective effect on adipose tissue accumulation.