Jae Yong Shim

Trends in Prevalence of Overweight and Obesity in Korean Adults, 1998–2009: The Korean National Health and Nutrition Examination Survey

Background Although obesity is increasing worldwide and becoming a major public health problem, some countries report a trend toward stabilization. We investigated prevalence trends in overweight/obesity and obesity among Korean adults during a 12-year period. Methods This study was based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005), and IV (2007–2009). The χ2 and ANOVA tests were used to compare the prevalence and mean values for age and BMI, respectively. P-values for trends were determined by linear and logistic regression analyses, with KNHANES phase as the continuous variable. Results The prevalences of overweight/obesity in KNHANES I through IV were 50.8%, 57.4%, 62.5%, and 62.6%, respectively, among men (P for trend = 0.002, β = 0.021) and 47.3%, 51.9%, 50.0%, and 48.9% among women (P for trend = 0.017, β = −0.015). The respective prevalences of obesity were 26.0%, 32.4%, 35.1%, and 36.3% among men (P for trend = 0.006, β = 0.018) and 26.5%, 29.3%, 28.0%, and 27.6% among women (P for trend = 0.143, β = −0.008). During the same period, the respective prevalences of grade 2 obesity (BMI ≥30 kg/m2) were 1.7%, 2.8%, 3.6%, and 3.8% among men (P for trend = 0.075, β = 0.005) and 3.0%, 3.5%, 3.4%, and 4.0% among women (P for trend = 0.398, β = 0.003). Conclusions The prevalences of overweight/obesity and obesity showed an upward trend among men during the 12-year period, whereas the prevalence of overweight/obesity slightly decreased among women from 2001.

Effect of fruits and vegetables on metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials

Abstract Evidence regarding the effect of fruit and vegetable consumption on metabolic syndrome remains inconclusive. Using MEDLINE, EMBASE, and Cochrane, we searched for relevant studies published before 10 December 2013. Of the 383 articles identified, eight randomized controlled trials with 396 participants (205 in intervention groups and 191 in control groups) were included in the final analyses. Fruit and vegetable intake was associated with a reduction in diastolic blood pressure (standardized mean difference: −0.29; 95% confidence interval: −0.57 to −0.02; pu2009=u20090.04); however, such intake did not affect waist circumference, systolic blood pressure, fasting glucose, high-density lipoprotein cholesterol, and triglyceride levels in metabolic syndrome patients. In a subgroup analysis, there were no statistically significant differences found according to the intervention period and provision type. Our results suggest an inverse association between fruit and vegetable consumption and diastolic blood pressure in metabolic syndrome patients.

Low vitamin D levels increase anemia risk in Korean women

BACKGROUNDnWe assessed the impact of vitamin D on hemoglobin levels in Korean adults, considering gender and menopausal status.nnnMETHODSnWe analyzed 2528 men and 3258 women divided into quartiles of vitamin D from the Fifth Korean National Health and Nutrition Examination Survey 2010. Anemia was defined as a hemoglobin level of <13 g/dl in men and <12 g/dl in women.nnnRESULTSnPre- and post-menopausal women in the lowest 25-hydroxyvitamin D group were at an increased risk of anemia, after adjusting for confounding factors (OR (95% CI); Premenopausal: Q1 (≥18.45 ng/ml), 1; Q2 (14.69-18.44 ng/ml), 1.120 (0.745, 1.683); Q3 (11.93-14.68 ng/ml), 1.427 (0.963, 2.116); and Q4 (≤11.92 ng/ml), 1.821 (1.240, 2.673); P=0.009; and Post: Q1 (≥22.04 ng/ml), 1; Q2 (16.92-22.03 ng/ml), 1.106 (0.697, 1.756); Q3 (13.37-16.91 ng/ml), 1.167 (0.740, 1.839); and Q4 (≤13.36 ng/ml), 1.583 (1.026, 2.447); P=0.038). In addition, pre- and post-menopausal women in the lower 25-hydroxyvitamin D group were at a higher risk of iron deficient anemia and anemia of inflammation. However, post-menopausal women did not show a higher risk of anemia with CKD (P=0.470). Men with the lowest 25-hydroxyvitamin D levels did not show a higher risk of anemia (P=0.528).nnnCONCLUSIONSnVitamin D-deficient Korean women had a higher risk of anemia.

Relationship between employment status and obesity in a Korean elderly population, based on the 2007-2009 Korean National Health and Nutrition Examination Survey (KNHANES).

We investigated the relationship between employment status and obesity prevalence in an elderly Korean, using a nationally representative sample. This cross-sectional study included 2991 participants (1396 men and 1595 women) aged 60 years or older. Employment status was categorized into full-time employees, part-time employees, and an unemployed group, based on a self-reported questionnaire. According to Asia Pacific regional guidelines from the World Health Organization (WHO) and International Obesity Task Force (IOTF), obesity was defined as a body mass index (BMI)≥25kg/m(2). Mean BMI in women was highest in the unemployed group, whereas the mean BMI in men did not differ significantly between employment groups. The obesity prevalence in full-time employees, part-time employees, and the unemployed group were 25.1%, 25.5%, and 27.1% in men and 36.0%, 37.9%, and 40.4% in women, respectively. Compared to the full-time employees, the odds ratios (ORs) (95% confidence intervals) for obesity were 1.172 (0.765-1.795) and 1.164 (0.843-1.609) in the part-time employees, and 1.451 (1.054-1.999) and 1.399 (1.090-1.795) in the unemployed group, for men and women, respectively, after adjusting for age, lifestyle factors (physical activity, alcohol consumption, smoking status, daily calorie intake), socioeconomic factors (education level and household income), and inflammatory factor (white blood cell (WBC) counts). Unemployment appears to be significantly related to a higher prevalence risk of obesity in an elderly Korean population, regardless of age, lifestyle, socioeconomic factors, and inflammatory factor.

Significance of high-normal serum uric acid level as a risk factor for arterial stiffness in healthy Korean men

A high serum uric acid (SUA) level is a known risk factor for cardiovascular disease. However, little is known about the relationship between arterial stiffness and uric acid in healthy subjects with a normal SUA level. We assessed whether a high-normal uric acid level increased arterial stiffness by measuring brachial–ankle pulse wave velocity (ba-PWV) in healthy subjects. Among 779 subjects who visited the health promotion center, 393 men and 234 women with normal SUA levels (male: 3.5–8.0 mg/dl, female: 2.5–5.4 mg/dl) were divided into quartiles: in men, Q1 (n = 90, 3.5–4.3 mg/dl), Q2 (n = 94, 4.4–5.1 mg/dl), Q3 (n = 106, 5.2–5.9 mg/dl) and Q4 (n = 103, 6.0–8.0 mg/dl); in women, Q1 (n = 57, 2.5–3.6 mg/dl), Q2 (n = 49, 3.7–4.1 mg/dl), Q3 (n = 61, 4.2–4.6 mg/dl) and Q4 (n = 67, 4.7–5.4 mg/dl). The mean values of ba-PWV increased gradually by SUA quartile. The men’s SUA had an independent, positive association with ba-PWV after correcting for age, glucose, body mass index, blood pressure, resting heart rate, high-sensitivity C-reactive protein (hs-CRP), high-density lipoprotein (HDL)-cholesterol and triglyceride (R2 = 0.39, adjusted R2 = 0.37, p < 0.001). The odds ratios (95% CI) for high ba-PWVs (> 75th percentile, 1473 cm/s) in men were 1.89 (0.69–5.20, Q2), 2.36 (1.10–5.08, Q3), and 2.91 (1.39–6.11, Q4), after adjusting for confounding factors (p < 0.001). In women, SUA showed no independent association with ba-PWV (p = 0.186). After adjusting for confounding factors, the mean ba-PWV values of Q3 (1418 cm/s) and Q4 (1421 cm/s) in men were higher than those of Q1 (1355 cm/s) (p < 0.05). Above the SUA level of 5.2 mg/dl, arterial stiffness was increased in healthy Korean men.

Effects of Korean Red Ginseng on Cardiovascular Risks in Subjects with Metabolic Syndrome: a Double-blind Randomized Controlled Study.

Background This study investigated the effects of Korean red ginseng (KRG) supplementation on metabolic parameters, inflammatory markers, and arterial stiffness in subjects with metabolic syndrome. Methods We performed a randomized, double-blind, placebo-controlled, single-center study in 60 subjects who were not taking drugs that could affect metabolic and vascular functions. Subjects were randomized into either a KRG (4.5 g/d) group or a placebo group for a 12-week study. We collected anthropometric measurements, blood for laboratory testing, and brachial-ankle pulse wave velocity (baPWV) at the initial (week 0) and final (week 12) visits. Results A total of 48 subjects successfully completed the study protocol. Oral administration of KRG did not significantly affect blood pressure, oxidative or inflammatory markers, or baPWV. Conclusion We found no evidence that KRG had an effect on blood pressure, lipid profile, oxidized low density lipoprotein, fasting blood glucose, or arterial stiffness in subjects with metabolic syndrome. These findings warrant subsequent longer-term prospective clinical investigations with a larger population. Trial Registration ClinicalTrials.gov Identifier: NCT00976274

The association between coronary artery calcification and mean platelet volume in the general population.

Patients with coronary artery calcification have an increased risk of coronary vascular events and mortality. Coronary artery calcification can be quantified using the coronary calcium score (CCS) from multi-detected row computed tomography (MDCT), and the score is proportionally related to the severity of atherosclerotic disease. Mean platelet volume (MPV) is gaining interest as a new independent cardiovascular risk factor. Accordingly, the aim of our study was to evaluate the relationship between CCS and MPV in the general population. A total of 2116 individuals were enrolled from a health promotion center between July 2007 and June 2010. Among them, 259 subjects were included in the final analysis. MDCT was used to measure CCS and CCSu2009>u20091 was defined as the presence of coronary calcification. The MPV value was significantly higher in the coronary artery calcification group than in the control group. Multivariate analyses showed that MPV was positively associated with coronary calcification (OR, 1.61; 95% CI 1.02–2.55). In summary, there was a significant association between coronary artery calcification and MPV in the general population. Therefore, the detection of elevated MPV should alert clinicians to the coexistence of multiple underlying CVD risk factors warranting early evaluation and treatment.

Serum carcinoembryonic antigen level is associated with arterial stiffness in healthy Korean adult

BACKGROUNDnCarcinoembryonic antigen (CEA), a widely used tumor marker, has been reported to be related with atherosclerosis and cardiovascular disease. However, little is known about the relationship between arterial stiffness and CEA level. We assessed whether serum CEA level is related with arterial stiffness by measuring brachial-ankle pulse wave velocity (ba-PWV) in healthy subjects.nnnMETHODSnSerum CEA level, ba-PWV and conventional risk factors were measured in 2909 subjects (1767 men and 1142 women) who underwent routine health checkup. We performed correlation, multiple linear regression and multiple logistic regression analyses to divide into quartiles according to CEA level.nnnRESULTSnThe mean values of ba-PWV increased gradually by CEA quartile. After correcting for significantly correlated variables, the ba-PWV was independently associated with CEA (P<0.001). The odds ratios (95% CI) for high ba-PWV (>75th percentile; men: 1518 cm/s, women: 1487 cm/s) according to CEA quartile were 1.00 (Q1), 1.044 (0.659-1.652; Q2), 1.075 (0.688-1.681; Q3), and 1.595 (1.009-2.520; Q4) after adjusting for age, blood pressure, BMI, fasting glucose, heart rate, log hs-CRP, LDL-cholesterol, WBC count, alcohol intake, smoking and exercise in men (P<0.001). The odds ratios (95% CIs) in women were 1.00 (Q1), 1.719 (0.971-3.032; Q2), 1.793 (1.019-3.156; Q3), and 2.330 (1.312-4.139; Q4) (P<0.001) after adjusting for age, blood pressure, BMI, fasting glucose, heart rate, log hs-CRP, lipid profile, uric acid, WBC count, alcohol intake, smoking and exercise.nnnCONCLUSIONSnThe CEA level is associated with arterial stiffness which measured by ba-PWV in healthy Korean men and women.

Comparison of Lipid-Related Ratios for Prediction of Chronic Kidney Disease Stage 3 or More in Korean Adults

Dyslipidemia is implicated in increased cardiovascular risk associated with chronic kidney disease (CKD) and in the progression of renal damage. This study compared 4 different lipid-related ratios (total cholesterol [TC]/high-density lipoprotein cholesterol [HDL-C], triglyceride [TG]/HDL-C, calculated low-density lipoprotein cholesterol [c-LDL-C]/HDL-C, and non-HDL-C/HDL-C ratio) for prediction of CKD stage 3 or more to investigate the association between them. This cross-sectional study included 8,650 adults who participated in the 2007-2008 Korean National Health and Nutrition Examination Survey. The overall prevalence of CKD stage 3 or more was 6.4%. For TG/HDL-C, the prevalence with CKD stage 3 or more increased with increasing quartile group in both sexes (P value for trend = 0.046 in men, 0.002 in women) while other lipid-related ratios showed increasing prevalence only in women. In comparison with the lowest quartile of the lipid-related ratios, only the fourth quartile of TG/HDL-C was associated with the prevalence of CKD stage 3 or more in both sexes after adjustment for multiple covariates (odds ratio [OR] for TG/HDL-C-Q4, 1.82; 95% CI [confidence interval], 1.09-3.03 in men, OR 2.45; 95% CI, 1.52-3.95 in women). In conclusion, TG/HDL-C is the only lipid-related ratio that is independently associated with CKD stage 3 or more in both sexes of Koreans.

High-normal Glucose Levels in Non-diabetic and Pre-diabetic Men Are Associated with Decreased Testosterone Levels.

Background Testosterone levels are decreased in diabetic patients and recent studies have suggested that high-normal fasting glucose is a risk factor for cardiovascular disease. To further elucidate the relationship between plasma glucose and testosterone, we investigated the association between fasting plasma glucose (FPG) and endogenous sex hormones (serum total testosterone, sex hormone binding globulin, estradiol, and the ratio of testosterone to estradiol) in non-diabetic and pre-diabetic men. Methods This study included 388 men (age ≥ 40 years) who visited the health promotion center of a university hospital from May 2007 to August 2008. The subjects were divided into quartiles based on their FPG levels and correlation and multiple linear regression analyses were performed. Q1 (65 mg/dL ≤ FPG < 88 mg/dL), Q2 (88 mg/dL ≤ FPG < 94 mg/dL), Q3 (94 mg/dL ≤ FPG < 100 mg/dL) and Q4 (100 mg/dL ≤ FPG < 126 mg/dL). Results FPG was independently, inversely associated with total testosterone in the non-diabetic population after adjusting for age, body mass index, smoking, and alcohol consumption (β = -0.082, P < 0.01). Among the quartiles, subjects in the high-normal FPG groups (Q2, Q3, and Q4 with FPG ≥ 88 mg/dL) had significantly decreased testosterone levels when compared with subjects in the normal FPG group (Q1 with FPG < 88 mg/dL, P < 0.005). Sex hormone binding globulin, estradiol and the ratio of testosterone to estradiol were not correlated with FPG. Conclusion Our study indicates that high-normal fasting glucose levels are associated with decreased testosterone levels in non-diabetic and pre-diabetic men.