Cut-Off Values of Visceral Fat Area and Waist-to-Height Ratio: Diagnostic Criteria for Obesity-Related Disorders in Korean Children and Adolescents

PURPOSE: The aim of this study was to study the appropriate cut-off value of visceral fat area (VFA) and waist-to-height ratio (WTHR) which increase the risk of obesity-related disorders and to validate the diagnostic criteria of abdominal obesity and metabolic syndrome in Korean children and adolescents. MATERIALS AND METHODS: A total 314 subjects (131 boys and 183 girls) were included in this study. The subjects were selected from Korean children and adolescents who visited three University hospitals in Seoul and Uijeongbu from January 1999 to December 2009. All patients underwent computed tomography to measure VFA. RESULTS: The cut-off value of VFA associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 68.57 cm2 (sensitivity 59.8%, specificity 76.6%, p=0.01) for age between 10 to 15 years, and 71.10 cm2 (sensitivity 72.3%, specificity 76.5%, p<0.001) for age between 16 to 18 years. By simple regression analysis, the WTHR corresponding to a VFA of 68.57 cm2 was 0.54 for boys and 0.61 for girls, and the WTHR corresponding to a VFA of 71.10 cm2 was 0.51 for boys and 0.56 for girls (p=0.004 for boys, p<0.001 for girls). CONCLUSION: Based on the results of this study, VFA which increases the risk of obesity-related disorders was 68.57 cm2 and the WTHR corresponding to this VFA was 0.54 for boys and 0.61 for girls age between 10-15 years, 71.70 cm2 and the WTHR 0.51 for boys and 0.56 for girls age between 16-18 years. For appropriate diagnostic criteria of abdominal obesity and obesity-related disorders in Korean children and adolescents, further studies are required.

Association of Endotoxins and Colon Polyp: A Case-Control Study

Endotoxins are known to be associated with the occurrence of various chronic diseases. This study was conducted to investigate the role of endotoxins in the pathogenesis of colon polyps through a case-control study. A total of 145 subjects (74 subjects in the polyp group and 71 subjects in the control group) had undergone a colonoscopy. Age, body mass index (BMI) and endotoxin levels were found to be significantly higher in the polyp group than in the control group. The endotoxin level was still significantly higher in the polyp group than in the control group, even after age and BMI had been adjusted (polyp group 0.108 +/- 0.007 EU/mL, control group 0.049 +/- 0.008 EU/mL, P < 0.001). In subgroup analysis, the endotoxin level significantly increased in accordance with the number of colon polyps (one-polyp group, 0.088 +/- 0.059 EU/mL; two-polyp group, 0.097 +/- 0.071 EU/mL; three-or-more-polyp group, 0.149 +/- 0.223 EU/mL). The endotoxin levels also significantly increased in groups with tubular adenoma with high-grade dysplasia (hyperplastic polyp group, 0.109 +/- 0.121 EU/mL; tubular adenoma with low grade dysplasia group, 0.103 +/- 0.059 EU/mL; tubular adenoma with high grade dysplasia group, 2.915 +/- 0.072 EU/mL). In conclusion, the serum level of endotoxins is quantitatively correlated with colon polyps.

Association of Visceral Fat and Risk Factors for Metabolic Syndrome in Children and Adolescents

PURPOSE: Visceral fat (VF) is closely associated with many metabolic risk factors and is also known to be a strong predictive factor for severe metabolic complications in adults. But there are only a few studies concerning the association of VF and risk factors for metabolic syndrome (MS) in children and adolescents. In our study, we emphasized the association of VF [measured by VF computed tomography (VFCT)] and risk factors for metabolic syndrome in children and adolescents. MATERIALS AND METHODS: The subjects were outpatients aged 6 to 18 years who underwent VFCT in the family medicine of The Catholic University of Korea from January 2005 to August 2009. There were 82 patients in total (42 children, 40 adolescents). Height, weight, blood pressure (BP), blood tests, body composition analysis and VF were measured. The three groups were also classified by metabolic score. RESULTS: In children, only high density lipoprotein cholesterol (HDL-C) showed a statistically significant difference, while in adolescents, triglyceride, HDL-C, BP, body mass index (BMI), waist circumference (WC) and VFA showed statistically significant differences. In terms of VFA, fasting glucose, BP, BMI, basal metabolic rate (BMR) and WC showed statistically significant differences. BMI showed a statistically significant difference in terms of BP, BMR, WC, VFA and HDL-C. CONCLUSION: There is a need to acknowledge the statistically significant associations of VF and risk factors for MS in children and adolescents. Screening tests for BP, cholesterol, fasting glucose and WC should be given in clinics for children and adolescents so that MS can be detected and its risk factors treated early.

Comparison of Prevalence of Visceral Obesity between Hemodialysis and Peritoneal Dialysis Patients / 대한신장학회지

PURPOSE: Visceral obesity is a more reliable indicator of cardiovascular risk factor than BMI. Our study was designed to compare the prevalence of visceral obesity in peritoneal dialysis (PD) patients to hemodialysis (HD) patients with abdominal fat CT in a single center. METHODS: In this cross sectional study, the result of abdominal fat CT of dialysis patients was investigated from January, 2007 to March, 2007 in Uijeongbu St. Mary s Hospital. To evaluate the risk factors related to visceral obesity, we analyzed patients medical records such as duration of dialysis, lipid profiles, anthropometric data and the presence of DM. RESULTS: We enrolled 65 HD patients and 67 PD patients. PD group had higher mean body weight, mean body mass index (BMI), and triglyceride level, compared to HD group. The PD group had higher visceral fat area, measured by abdominal fat CT than HD group. The prevalence of visceral obesity was higher in PD group than HD group. Visceral fat area showed positive co-relation with BMI in HD group, but did not in PD group. The age related prevalence of visceral obesity was significantly increased in the patients with older age group (>65). CONCLUSION: Our cross sectional study points to the fact that visceral obesity is more common in PD patients than HD patients. It is necessary to control weight and nutritional status, especially in PD patients for preventing metabolic complications.

Prediction of Poor Outcome in Coma Patients Resuscitated from Cardiac Arrest due to Submersion

PURPOSE: This study was conducted to predict poor outcomes in coma patients resuscitated from cardiac arrest due to submersion. METHODS: We retrospectively investigated 27 submersion victims who were comatose for more than 6 hours after cardiac arrest. Vegetative state and death (GOS 1-2) were classified as poor outcomes whereas all other outcomes (GOS 3-5) were classified as good outcomes. Demographic, clinical, laboratory, radiologic, eletrophysiologic, and treatment variables were evaluated for their usefulness in predicting outcome. RESULTS: Of the 27 patients, 9 (33%) presented with good outcomes. Among the many variables, a GCS score of 3-5 in the first 24 hours, absence of pupillary reactions in the first 24 hours or on day 3, motor response to pain flexion or less (M1 - 3) or no motor response to pain (M1) in the first 24 hours or on day 3, bilateral absence of N20 on SEP showed significant differences between the two outcome groups (p<0.05). Prognostic factors with 100% specificity for prediction of poor outcome included absence of pupillary reactions in the first 24 hours or on day 3, no motor response to pain (M1) on day 3, and bilateral absence of N20 on SEP. CONCLUSION: The factors including chest radiography, body temperature, and laboratory findings which were associated with submersion showed no significant differences between the good and the poor outcome groups. Absence of pupillary reactions in the first 24 hours or on day 3, no motor response to pain (M1) on day 3, and bilateral absence of N20 on SEP helped predict poor outcome in submersion patients resuscitated from cardiac arrest.

Cut-off Values of Visceral Fat Area and Waist Circumference: Diagnostic Criteria for Abdominal Obesity in a Korean Population

The aim of this study was to determine the appropriate cut-off values for visceral fat area and waist circumference (WC) associated with an increase in risk for obesity-related disorder, and to validate diagnostic criteria for abdominal obesity and the metabolic syndrome in a Korean adult population. We included 413 subjects (174 men and 239 women) for this study. Subjects were selected among Korean adults who visited the obesity clinic at St. Mary's Hospital and Kangnam St. Mary's Hospital from January 1999 to August 2005. All patients had computed tomography performed. The cut-off value, of visceral fat area associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 103.8 cm2 (sensitivity 74.5%, specificity 64.7%, p<0.001). The cut-off value for the WC was 89.8 cm in men (sensitivity 84.7%, specificity 91.7%, p<0.005) and 86.1 cm in women (sensitivity 83.9%, specificity 62.9%, p<0.001). Based on the results of this study, the visceral fat area associated with an increased risk of obesity-related disorder in Korea was 103.8 cm2 and the WC was 89.8 cm in men and 86.1 cm in women.

Cut-off Value of Visceral Fat Area at Risk of Obesity-related Disorders in Korean Adult Population

BACKGROUND: Recently, obesity has become an important health problem in Korea. In 2000, the WHO Western Pacific Region recommended an obesity diagnostic criteria for Asian population. But among Asians, each ethnic group had their own anthrometric characteristics and so it was difficult to apply the same criteria to different ethnic groups. Thus, the aim of this study was to study the appropriate cut-off value of visceral fat area (VFA) and waist circumference (WC) which increases the risk of obesity-related disorders and to validate the diagnostic criteria of abdominal obesity and metabolic syndrome in Korean adult population. METHODS: A total of 278 of subjects (101 men and 177 women) were included for this study. The subjects were selected among Korean adults who visited the Department of Family Medicine, St. Mary's Hospital from January 1999 to August 2005. Three obesity-related disorders were defined to hypertension, hyperglycemia, and dyslipidemia. RESULTS: The cut-off value of visceral fat area which increased the risk of obesity-related disorders by ROC curve was 114.3 cm2 (sensitivity 76.3%, specificity 65.9%, P<0.005), and the waist circumference corresponding to a VFA of 114.3 cm2 by simple regression analysis was 74.2 cm in men and 87.37 cm in women (P<0.05). CONCLUSION: Based on the results of this study, the visceral fat area which increased the risk of obesity-related disorders was 114.3 cm2 and the WC corresponding to this VFA was 74.2 cm in men and 87.37 cm in women. For appropriate diagnostic criteria of abdominal obesity and metabolic syndrome in Korean adult population, further studies are required.

The Association between Obesity Indices and Physical Fitness

BACGROUND: Physical fitness is defined as the ability to carry out work necessary for muscle exercise satisfactorily. Generally, obese person have been considered to have low physical performance. In addition, obesity has been known to be a risk factor of cardiovascular disease such as hyperlipidemia, hypertension, and coronary arterial disease. Based on previous epidemiologic studies, abdominal obesity, especially, visceral obesity, is thought to be more important risk factor for cardiovascular disease rather than obesity itself. Therefore, the interest on assessment of abdominal visceral fat has been increasing. The aim of this study was to see the difference in physical fitness and blood pressure according to obesity degree assessed by BMI, and compare the anthropometric obesity indices with abdominal visceral fat accumulation measured by abdominal CT (Computed Tomogram). METHODS: Four hundred thirty-two subjects, who participated in the exercise program for more than one month duration at the 'Clinic for Obesity' in St. Mary's Hospital from November 1998 to June 2000, were included in the analysis. They were categorized into 4 groups [severe obesity group (BMI 30), obesity group (25 BMI <30), overweight group (23 BMI<25), normal group (BMI<23)] according to their BMI. Blood pressure, anthropometric obesity indices and physical fitness (V02 max, back muscle strength, sit up, forward bending, vertical jump, side step, balance) were measured by one skillful exercise trainer. Among them, one hundred thirty-one subjects performed abdominal CT to assess visceral fatness. We compared anthropometric indices (waist to hip ratio, body mass index, abdominal circumference, skin foldness) with abdominal visceral fat accumulation measured by CT. RESULTS: Blood pressure, cardiovascular endurance, muscular endurance, muscle strength, speed and balance were significantly different among the four groups categorized by BMI in both sexes, but flexibility and agility were not significant. In women, the correlation coefficients between visceral fat area measured by abdominal CT and each of waist to hip ratio, BMI, abdominal circumference, and skin foldness adjusted for age were 0.487, 0.479, 0.464, 0.31, respectively (P<0.01). However in men, there were no significant correlations. CONCLUSION: Obesity tended to increase blood pressure, and reduce physical performance. Only in women, obesity related indices reflected the abdominal visceral fat accumulation.

Age Associated Changes in Body Mass Index and Body Fat Distribution

BACKGROUND: Body mass index is currently applied as the diagnostic standard of overweight and obesity, regardless of age. Percentage body fat ratio applies separate standards among different sex, but does not have separate standards for different age groups. Since body mass index and percentage body fat may differ according to age, we conducted this study to see if a separate standard for overweight and obesity is indeed necessary for different age groups. METHODS: We selected 2,190 subjects, who were the 10 percent picked randomly by computer, among 21,921 clients who had visited the St. Mary's Hospital's health promotion center in Seoul. Those diagnosed with diabetes, thyroid disease, renal failure, and tuberculosis were excluded, leaving 1,939 over the age of 20, as final subjects. Anthropometric measurements were done using electronic scales and height meters, while body composition was measured with a multi-frequency bioelectric impedance analysis (Inbody 3.0 Biospace, Seoul). The results of this study were shown in mean and standard deviation, and mean values according to ages were compared by Ancova test. RESULTS: In the case of adult men, percentage body fat increased with age. This was observed especially with subjects over 30 compared to subjects in their 20s, although not proven to be statistically significant. A decrease in fat free mass rather than increase in body fat mass was noted with aging. With adult women, percentage body fat increased markedly with subjects over 50, mainly due to increased body fat mass rather than decreased fat free mass. Subjects exceeding a body mass index of 25, which is the standard limit of body mass index for obesity, was 60th percentile for adult men, and 70~80th percentile for adult women. Percentage body fat in this case was 22.54% for men and 31.99~33.46% for women. CONCLUSION: Our study indicates that both men and women show changes in body mass index and fat free mass with aging. Hence, there are limitations to applying a universal standard for body mass index, regardless of age. We suggest that further studies on standards for adult obesity should be conducted based on specific Korean epidemiologic data.

Analysis of Cancer Screening Recommendations by Physicians for Various Types of Cancer / 예방의학회지

OBJECTIVES: The purpose of this study was to examine the present status of cancer screening recommendations(beginning age, interval, recommended screening methods, etc.) by physicians and analyze the association between physician's characteristics and the content of their recommendations. METHODS: Data were collected from March 1 to April 30 of 1997, and 373 physicians who were from different hospital settings all over Korea were interviewed by telephone about their screening recommendations for stomach, cervical and breast cancer for those who provided cancer screening services. RESULTS: For stomach cancer screening, respondents recommended that cancer screening begin at 40 years of age(57.8%), with a 1 year interval(77.2%), and by gastrofibroscopy (86.2%). For cervical cancer screening, respondents recommended that cancer screening begin at 25 years of age(42.0%), with a 1 year interval(67.8%), and by using a Pap smear(100.0%). For breast cancer screening, respondents recommended that cancer screening begin at 35 years of age(38.7%), with a 1 year interval(57.3%), and by mammography (97.3%). CONCLUSIONS: To establish appropriate cancer screening recommendations for Korea, it may be useful to consider the above results concerning medical care providers.

The psychological characteristics of functional dyspepsia patients by MMPI

BACKGROUND: The functional dyspepsia gives rise to such a symptom similar to peptic ulcer without showing a noticeable lesion(e.g, gastric or duodenal ulcer) by endoscopy or upper GI serises, and it has been known that this is about twice as many as the peptic ulcer. However, there is no exact theory about its pathophysiology and it is suggested that multiple factors including genetic, physiologic, psychologic, environmental factors are engaged. Especially, in respect to the occurrence of functional dyspepsia and psychological factors, there have been many clinical studies over the world. But, we still need more studies in this country, therefore, this study has been initiated to give help patients of functional dyspepsia, invest.igating their characteristic traits through MMPI. METHODS: From March to September in 1996, the patients who visited the family medicine out-patients department of St. Marys hospital of Catholic Medical College were sampled in this study. There were 46 patients having a similar symptoms to peptic ulcer without showing pathologic lesions by endoscopy. Through an interview and some basic tests, the 41 controls who had no dyspeptic symptoms and were not affected to a noticeable physical or physiological disorders were selected for the normal reference group. The standardized MMPI of our country was applied to the whole object groups to get a result. Then each average value of the measure(mean T-score) was calculated, and the differences of the average value were analyzed by the t-test and chi-square test. And the psychological pattern analysis was done. RESULTS: In demographic aspects, there were no significant differences between the two groups. The mean T score for each measure of the two groups falls within the normal ranges with their values being of between 30 to 70. And the average of L, F, and K measure, known as the validity measure, did not give a significant differences between the two groups. The measure of Hs, D, and Hy have appeared significantly high in the patients group(p<0.01) and the Pd measure, too(p<0.05). While Mf, Pa, and Ma measure have not shown a significant differences, Pt, Sc, and Si measure have very significant differences(p<0.01). CONCLUSIONS: In the patient group with the functional dyspepsia, the measures of Hs, D, and Hy where they indicate a neurotic pattern have shown a very significantly high point as well as those of Pd, Pt, Sc, and Si where they indicate a psychotic pattern. This reveals that in the group of the functional dyspepsia neurotic or psychotic trends to attribute. However, it is very hard to define the characteristics of a group with just one test, so further study with more variable test will be necessary.