Kyoung Kon Kim

Effects on Weight Reduction and Safety of Short-Term Phentermine Administration in Korean Obese People

The phentermine, an appetite suppressant, has been widely applied in Korea since 2004. However, there have been relatively few reports about the efficacy and the safety of phentermine in Korea. The aim of this study is to verify the effect of phentermine on weight reduction and the safety in Korean patients. This randomized, double-blind, placebo-controlled study had been performed between February and July, 2005, in Seoul on 68 relatively healthy obese adults whose body mass index was 25 kg/m2 or greater. They received phentermine-HCl 37.5 mg or placebo once daily with behavioral therapy for obesity. The primary endpoints were the changes of body weight and waist circumference from the baseline in the intention-to-treat population. Mean decrease of both body weight and waist circumference in phentermine-treated subjects were significantly greater than that of placebo group (weight: -6.7 ± 2.5 kg, p < 0.001; waist circumference: -6.2 ± 3.5 cm, p < 0.001). Significant number of subjects in phentermine group accomplished weight reduction of 5% or greater from the baseline and 10% or more (p < 0.001). There were no significant differences in systolic and diastolic blood pressure between the groups (p = 0.122 for systolic BP; p = 0.219 for diastolic BP). Dry mouth and insomnia were the only statistically significant adverse events that occurred more frequently in phentermine group. Most side effects of phentermine were mild to moderate in intensity. Short-term phentermine administration induced significant weight reduction and reduction of waist circumference without clinically problematic adverse events on relatively healthy Korean obese people.

Relationships between serum osteocalcin, leptin and the effect of weight loss by pharmacological treatment in healthy, nonsmoking Korean obese adults.

BACKGROUND Recent studies have reported a relationship between osteocalcin (OC) levels and factors associated with energy metabolism and insulin resistance. As any detailed understanding of OC mechanisms still remains elusive, this study aimed at revealing a correlation between serum OC levels and obesity in healthy, nonsmoking, Korean obese adults who had undergone weight loss through pharmacological treatment. METHODS 119 healthy, nonsmoking, Korean obese adults were investigated at 3 months following weight loss through pharmacological treatment. Serum OC, leptin, HOMA score, ghrelin, visceral fat mass, total body fat, and BMI were measured. RESULTS Increase in serum OC was significantly associated with decreases in: BMI (and weight change %) (r=-0.209, p=0.023), visceral fat mass (r=-0.189, p=0.049), HOMA (r=-0.203 p=0.027), and leptin (r=-0.253 p=0.006), but not with changes in adiponectin (r=+0.029, p=NS), and Ghrelin (r=+0.019, p=NS). Decrease in leptin (β=-0.280, p=0.002) was significantly associated with an increase in serum OC, after pharmacological weight loss treatment was adjusted for age, sex, drug type, and BMI (or visceral fat mass). CONCLUSIONS Serum OC was significantly increased at 3 months after pharmacological weight loss. We further found that leptin levels were associated with changes in serum OC. These findings suggest a relationship between bone and adipose tissue.

Analysis of factors influencing general practitioners’ decision to refer obese patients in Australia: a qualitative study

BackgroundReferral for both lifestyle and surgical interventions are recommended as part of the clinical management of obesity in general practice. However, current practice falls short of this. This qualitative study aimed to describe the factors influencing general practitioners’ (GPs) referral intentions for their obese patients.MethodsSemi-structured qualitative interviews were conducted with 24 GPs from four geographically different areas in New South Wales, Australia about the management of their obese patients. A qualitative analysis was applied using inductive thematic analysis.ResultsThe predominant factors influencing GPs’ referral were their own attitudes and experience, and their patient’s motivation. Lifestyle intervention Referrals were usually initiated by GPs and influenced by their patients and the local health system. Referrals to conduct bariatric surgery were frequently initiated by the patient and influenced by GPs’ limited previous experience, patients’ expectations and ability to pay, as well as professional and legal issues. There was no strong link between referral and the remoteness of areas or the availability of surgical referral services.ConclusionThere were differences between GPs reported referral behaviour for lifestyle and surgical interventions. GPs’ attitudes to referral were often formed by their limited case experience rather than by a review of more systematic evidence, especially for surgical interventions. These patterns may be improved by educating and better communicating with GPs about the outcomes for their patients when they are referred.

Effects of CYP3A5, CYP2C19, and CYP2B6 on the clinical efficacy and adverse outcomes of sibutramine therapy: a crucial role for the CYP2B6*6 allele.

BACKGROUND Various cytochrome P450 isoforms modulate sibutramine activity and influence sibutramine plasma levels and pharmacokinetics. However, there are no available data to demonstrate the association of these polymorphisms with the clinical outcomes of sibutramine administration. METHODS This study was a sub-investigation of a 12-week, double-blind, placebo-controlled trial examining the additive effect of orlistat on sibutramine. The final analysis was restricted to 101 women who had fulfilled the protocol. We evaluated the effects of genetic polymorphisms of CYP3A5, CYP2C19 and CYP2B6 on the % weight loss and the occurrence of adverse events. RESULTS The change of pulse rate from baseline value was affected by both CYP2B6 and CYP3A5 genetic polymorphisms (P<.01 for CYP3A5 and P=.01 for CYP2B6). Both CYP2B6 and CYP3A5 showed gene-gene interactions (P<.01). After adjusting for significant variables in the backward stepwise regression model, the change of pulse rate and time-dependent weight reduction were significant only among the CYP2B6 genotypes (P=.027 and P<.01, respectively). CONCLUSION The CYP2B6*6 allele influences the extent of weight reduction and pulse rate changes in patients undergoing sibutramine treatment.

Genomic health status assessed by a cytokinesis-block micronucleus cytome assay in a healthy middle-aged Korean population

The aim of this study was to determine the typical incidence of micronuclei (MNi) in the peripheral blood lymphocytes of healthy middle-aged Koreans using the cytokinesis-block micronucleus cytome (CBMN-Cyt) assay. Non-smoking, low-risk alcohol-drinking healthy Korean men and women aged 30 to 59 years were recruited. Participants were divided into three groups according to age, i.e., 30 to 39, 40 to 49, and 50 to 59 years. Fifty participants were included in each age group, for a total of 300 participants. DNA damage was measured based on the number of binucleated (BN) cells with MNi, nucleoplasmic bridges (NPBs), and nuclear buds (NBUDs) using the CBMN-Cyt assay. The frequencies of BN cells with MNi in men were 14.0±4.9 (mean±SD) in 30-39year olds, 20.0±6.1 in 40-49year olds, and 21.7±7.6 in 50-59year olds. In women, they were 19.7±7.1 in 30-39year olds, 28.7±11.2 in 40-49year olds, and 31.9±12.9 in 50-59year olds. MNi and NPBs scores were higher in females than in males. The elder groups showed higher MNi frequencies for both genders, and the NPB frequency was higher in elder groups than younger groups, but only for males. Based on a regression analysis of the CBMN-Cyt parameters, MNi frequencies showed a positive relationship with age for both genders. BMI and blood vitamin B concentration were not significantly associated with CBMN-Cyt parameters, except vitamin B6 levels, which were positively associated with MNi scores in males. These results provide the standard frequencies of MNi, NPBs, and NBUDs in peripheral blood lymphocytes in middle-aged Korean individuals with healthy lifestyles. In this group, CBMN-Cyt assay parameters varied according to gender and age; however, BMI and micronutrient levels were not significantly associated with assay parameters.

Influence of eating behaviors on short-term weight loss by orlistat and anorectic agent.

Little data exists concerning whether eating behaviors determine the response to orlistat treatment, especially with added anorectic agents. This study was a sub-investigation of a 12-week randomized controlled trial for the additive effect of orlistat on sibutramine treatment. The analysis presented here was restricted to 98 women who had fulfilled the protocol. The Dutch eating behavior questionnaire and three-factor eating questionnaire were used to assess eating behaviors. Scores of emotional eating, external eating, disinhibition and hunger are significantly interrelated. Using multiple logistic analysis with adjustment for potential confounders, such as age, initial BMI and the other 2 eating behavior scores, traits of emotional eating (OR 0.30, 95% CI 0.13-0.74) and disinhibition (OR 0.61, 95% CI 0.40-0.82) have a significant influence on prediction for additional 5% weight loss in the treatment with orlistat and sibutramine. Subjects with less vulnerability to emotional cues had significantly more weight loss with orlistat treatment and anorectic agents.

Effect of Influenza Vaccination on Risk of Stroke: A Systematic Review and Meta-Analysis

Background: Despite the presence of a strong association between influenza infection and stroke, whether influenza vaccination reduces the risk of stroke is yet a matter of controversy. We conducted a meta-analysis to determine whether influenza vaccination protects against stroke. Methods: We searched PubMed, EMBASE, and the Cochrane Library from database inception date to November 18, 2016, without language restrictions, to identify studies investigating the effect of influenza vaccination on subsequent risk of stroke. We conducted a meta-analysis to quantify the risk of stroke in overall and subgroup analyses and calculated a pooled OR for developing stroke with a 95% CI. Publication bias was assessed by Beggs rank correlation test. Results: Eleven studies fulfilled our inclusion criteria. In a random-effects model, vaccinated individuals had a decreased risk of stroke compared with unvaccinated individuals (OR 0.82; 95% CI 0.75-0.91; p < 0.001). The relationship between influenza vaccination and stroke risk remained robust in subgroup analyses. The significant effect of influenza vaccination was associated with ascertainment of vaccination status and stage of prevention. Conclusion: Vaccination against influenza is associated with a lower risk of stroke. Well-designed prospective studies are needed to provide stronger evidence of the protective effect of influenza vaccination against stroke.

Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia

Background/Aims The use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications. Methods We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment. Results Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed. Conclusions Endoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.

Gaps in health-related quality of life among survivors of cancer and cardiovascular disease: the Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III).

Few studies performed so far have weighed the health-related quality of life (HRQoL) of cancer survivors against that of cardiovascular disease (CVD) survivors. This study was based on data obtained from the Third Korean National Health and Nutrition Examination Survey. Of adults with available EuroQoL (EQ) information, a total 23 370 individuals (658 CVD survivors, 389 cancer survivors, and 22 323 controls) remained in the final analysis. Cancer survivors have the lowest HRQoL scales among the 3 groups, independent of age. The HRQoL of young cancer survivors was as impaired as that of older cancer survivors, whereas the HRQoL of CVD survivors and controls decreased with increasing age. Cancer survivors also have more problems in all domains of EQ-5D, especially domains of pain/discomfort and anxiety/depression. The study suggests that cancer survivors should receive more intensive attention to develop means of identifying them and to improve their quality of life.

Association between blood lead levels and blood pressures in a non-smoking healthy Korean population.

Objective The Korea National Health and Nutrition Examination Survey (KNHANES) has been performed every 3 years in Korea to help prevent cardiovascular mortality in the general population. Previous studies showed an association between blood lead levels and cardiovascular mortality. In order to assess the relationship between blood lead concentration and blood pressure in the healthy general population, we investigated whether blood lead levels were related to blood pressure in a non-smoking healthy population without any known medical diseases in the 2013 KNHANES. Methods 896 (mean age 40.55±13.83 years; body mass index 23.06±3.33 kg/m2) subjects who had no known diseases were included among 8018 subjects. Exclusion criteria were: hypertension, diabetes, hyperlipidaemia, cerebrovascular events, renal insufficiency, liver cirrhosis, thyroid dysfunction, any cardiovascular or renal disease, and any malignancy. Blood pressures were measured three times by sphygmomanometers, 5 min apart. Blood pressures were then expressed as the average between the second and third values. Height, weight, waist circumferences and blood pressure, as well as total cholesterol, high density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), white blood cell count and blood lead levels were measured. In addition, dietary components were analysed by 24 hour recall. Results The association between log blood lead levels and systolic/diastolic pressure was stronger after it was controlled for age, sex, education, body mass index (BMI), waist circumference and fasting plasma glucose (FPG) (p=0.048, 0.002). Furthermore, the association between log blood lead levels and systolic pressure (p=0.048) and diastolic pressure (p=0.002) was more evident when controlled for age, sex, education, BMI, waist circumference, FPG, AST and ALT. Conclusions Blood lead levels are significant determinants of systolic and diastolic blood pressure in a healthy Korean population, irrespective of sociodemographic factors and metabolic derangements.