Yong Jae 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.

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.

Chronic liver inflammation: Clinical implications beyond alcoholic liver disease

Chronic alcohol exposure can lead to alcoholic liver disease, including hepatitis, cirrhosis and hepatocellular carcinoma, and chronic inflammation can simultaneously cause systemic medical illness. Recent evidence suggests that alcoholic liver disease is a predictor for liver-related diseases, cardiovascular disease, immunologic disease, and bone disease. Chronic inflammation in alcoholic liver disease is mediated by a direct inflammatory cascade from the alcohol detoxification process and an indirect inflammatory cascade in response to gut microflora-derived lipopolysaccharides (LPS). The pathophysiology of alcoholic liver disease and its related systemic illness is characterized by oxidative stress, activation of the immune cascade, and gut-liver interactions. Integrative therapeutic strategies for alcoholic liver disease include abstaining from alcohol consumption; general anti-inflammatories such as glucocorticoid, pentoxifylline, and tumour necrosis factor-α antagonist; antioxidants such as N- acetylcysteine; gut microflora and LPS modulators such as rifaximin and/or probiotics. This review focuses on the impact of chronic liver inflammation on systemic health problems and several potential therapeutic targets.

Trends in the prevalence of chronic kidney disease in Korean adults: the Korean National Health and Nutrition Examination Survey from 1998 to 2009

BACKGROUND Chronic kidney disease (CKD) is associated with a poor quality of life and cardiovascular events and is a great threat to public health. METHODS We investigated the trends of CKD prevalence over 12 years in Korean adults at least 20 years old using sampling weight methods based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005) and IV (2007-09). Of the 135 954 subjects participating in KNHANES I-IV, 33 276 (14 307 men, 18 969 women) were included in the present study. RESULTS The percentage of glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) in KNHANES I-IV was 1.0, 5.4, 3.1 and 2.6% in men and 3.4, 9.7, 10.2 and 4.6% in women, respectively. The percentage of proteinuria ≥ 1+ measured by a dipstick method across KNHANES phases gradually declined in men (3.1, 3.0, 2.8 and 2.2% in KNHANES I-IV, respectively), while those in women rebounded in KNHANES IV after reduction through KNHANES III (3.3, 2.3, 1.4 and 1.9%, respectively). The prevalence of CKD (GFR <60 mL/min/1.73 m(2) or proteinuria ≥ 1+) in KNHANES I-IV was 3.9, 7.9, 5.4 and 4.5% in men and 6.4, 11.3, 12.0 and 6.3% in women, respectively. After stratification by age (20-39 years, 40-59 years and ≥ 60 years), the prevalence trends were similar to those before the stratification by sexes. CONCLUSIONS The prevalence of CKD in Korean adults has decreased since 2001 in men and since 2005 in women.

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.

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 CCS > 1 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.

Elevated intraocular pressure is associated with metabolic syndrome in postmenopausal women: the Korean National Health and Nutrition Examination Survey.

ObjectiveThis study aimed to investigate the association between intraocular pressure and metabolic syndrome according to menopause status in nonglaucomatous Korean women. MethodsWe examined the relationship between intraocular pressure and metabolic syndrome in 4,524 nonglaucomatous Korean women (2,866 premenopausal women and 1,658 postmenopausal women) who participated in the 2008 Korean National Health and Nutrition Examination Survey. Multivariate linear regression analysis was used to assess the relationship between metabolic syndrome and intraocular pressure after adjusting for age, body mass index, smoking status, alcohol consumption, regular exercise, hypertension medication, and diabetes medication according to menopause status in women. ResultsThe prevalence of metabolic syndrome was 5.4% for premenopausal women and 28.0% for postmenopausal women. The mean intraocular pressure gradually increased in accordance with the increasing number of components for metabolic syndrome in postmenopausal women (P = 0.002), but not in premenopausal women (P = 0.387). In multivariate regression analysis, intraocular pressure was significantly associated with metabolic syndrome in postmenopausal women (P = 0.015) after adjusting for confounding variables, but not in premenopausal women (P = 0.940). ConclusionsIntraocular pressure was associated with metabolic syndrome in postmenopausal women, but not in premenopausal women. These findings suggest that intraocular pressure changes may be linked to metabolic syndrome in postmenopausal women.

Prevalence of metabolic syndrome in children and adolescents - the recent trends in South Korea.

Abstract Background: Although the metabolic syndrome (MetS) in childhood is increasing worldwide and becoming a significant public health problem, some countries report trends for stabilization. After 2005, the Health Plan 2010 of the Korean Ministry of Health and Welfare has carried out the standardization of school lunch provisions for all students and reinforced nutritional and physical education in schools. Thus, an investigation of changes in the prevalence of MetS in Korean children and adolescents is important and intriguing in the aspect of evaluating the national public health intervention. Methods: We investigated trends in the prevalence of MetS among a nationally representative sample of 5652 children and adolescents aged 10–18 years from the Korean National Health and Nutrition Examination Surveys (KNHANES) I (1998), II (2001), III (2005), and IV (2008). Results: Prevalence trends in MetS were 7.5%, 9.8%, 10.9%, and 6.7% in the KNHANES I through IV, respectively (p<0.001). Among the five components of MetS, the prevalence of low high-density lipoprotein (HDL) cholesterol increased most over the 1998–2005 period and decreased over the 2005–2008 period. Conclusion: The prevalence of MetS has decreased since 2005 mainly because of changes in the prevalence of low levels of HDL cholesterol.

Age-related change in serum concentrations of testosterone in middle-aged Korean men

The objective of this study was to determine whether testosterone and sex hormone binding globulin (SHBG) levels are different between healthy men and men with chronic illness, and to evaluate the age-related changes of testosterone and SHBG in healthy men in Korea. Enrolment took place between January 2000 and December 2001 at Pundang CHA General Hospital in Korea. All men who came for male climacteric and geriatric health screening examinations were eligible. Of the 762 men recruited, 136 men had at least one present or previous medical illness and 626 men were healthy. Higher serum concentrations of total testosterone (5.31 ± 1.88 ng/ml vs. 4.96 ± 1.43 ng/ml; p < 0.05), free androgen index (16.60 ± 7.36 vs. 14.57 ± 5.55; p < 0.01) and calculated bioavailable testosterone (8.88 ± 3.52 nmol/l vs. 7.91 ± 2.52 nmol/l; p < 0.01) were demonstrated in the healthy compared with the disease group. Total testosterone declined at a rate of 0.2% per year, SHBG increased by 1.74% per year, calculated bioavailable testosterone declined by 0.8% per year, and free androgen index declined by 1.15% per year in healthy subjects aged between 40 and 70. The above results seem to be consistent with previous Western studies, showing higher concentrations of testosterone in healthy men, that decline with increasing age.