Kyu Rae Lee

2014 clinical practice guidelines for overweight and obesity in Korea.

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index ≥25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.

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.

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.

Waist circumference and risk of breast cancer in Korean women: A nationwide cohort study: WC and breast cancer risk

Although postmenopausal breast cancer (BC) risk has been linked to adiposity, associations between adiposity and premenopausal BC remain unclear. To address this question, we investigated the association of BC risk with measures of adiposity, including body mass index (BMI) and waist circumference (WC), in a large cohort of Asian women. We used a nationwide cohort of adult Korean women selected from the National Health Insurance Corporation database merged with national health examination data from 2009 to 2015. A total of 11,227,948 women were tracked to retrospectively identify incident cases of BC. Our analysis used Cox proportional hazards models to calculate hazard ratios and assess the association of BC risk with BMI and/or WC in both pre‐ and postmenopausal women. BMI and WC were robustly associated with increased risk for postmenopausal BC (ptrend<0.001 for both BMI and WC) but not with premenopausal BC. Association between WC and premenopausal BC was only statistically significant when considering BMI (ptrend=0.044). In contrast, postmenopausal BC was negatively associated with WC when considering BMI (ptrend=0.011). In premenopausal women, WC may predict increased BC risk when considering BMI. However, in postmenopausal women, WC is not superior to BMI as an indicator of BC risk.

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.

Does Weight Gain Associated with Thiazolidinedione Use Negatively Affect Cardiometabolic Health

Thiazolidinediones (TZDs) are oral anti-diabetic drugs that are peroxisome proliferator-activated receptor gamma (PPARγ) agonists and act as insulin sensitizers. The clinical efficacy and durability of the currently available TZDs in improving glycemic control are well established. However, TZDs cause weight gain, which has been thought to be a class effect of TZDs. TZD-associated weight gain may result mainly from increased fat mass and fluid retention and may be in part congruent to the mechanism of action of TZD. Increases in fat mass are almost exclusively limited to subcutaneous fat, while there are no effects or even decreases in visceral fat. Insulin resistance and cardiovascular risk associated with fat accumulation (obesity) depend on body fat distribution, with visceral fat associated with insulin resistance and a greater degree of risk than subcutaneous fat. Therefore, despite TZD-associated weight gain, TZDs are less likely to confer an increased risk of insulin resistance and cardiovascular complications. As patients with diabetes are younger and/or more obese in Korea, TZDs may be a cost-effective treatment option, offering a unique insulin-sensitizing action and good durability for the long-term management of type 2 diabetes.

Waist circumference and risk of 23 site-specific cancers: a population-based cohort study of Korean adults

BackgroundLarge waist circumference (WC) is a risk factor for several site-specific cancers, but a large-scale systematic investigation across all common cancers adjusted for potential confounders has not been conducted. This study aimed to evaluate the possible links between WC and common cancers.MethodsWe prospectively examined the association between WC and the risk of cancers in a 7-year cohort study of nearly 22.9 million Korean adults. Using the claims database merged with the national health check-up data, we fitted proportional hazard models to investigate associations between WC and 23 of the most common cancers, with adjustment for potential confounders, including body mass index (BMI). We also evaluated the modification of BMI on the relationships between WC and the incidence of cancer.ResultsA total of 769,871 cancer cases were identified. WC was positively associated with 18 of 23 cancers, and the effects varied substantially by site in each sex. The modification of BMI on the WC-cancer association also varied across the cancer site; in most cases it mitigated the association. For cancers of the oral cavity, larynx, oesophagus, lung, and premenopausal breast, the BMI adjustment reversed the association toward being positive (all Ptrend < 0.001).ConclusionsCentral obesity, independent of general obesity, was associated with the risk of several cancers. The heterogeneity in the mediating effects of BMI suggests that different mechanisms are associated with different cancer sites. Based upon these findings, active strategies to monitor and prevent central obesity should be implemented.