Impaired fasting glucose levels in overweight or obese subjects for screening of type 2 diabetes in Korea

Background/Aims@#We examined the concordance rate among fasting plasma glucose (FPG), 2-hour post-challenge glucose (2hr PG), and hemoglobin A1c (HbA1c) in the diagnosis of diabetes in a population with a high-risk for type 2 diabetes mellitus (T2DM) in Korea. @*Methods@#Among the participants from the Korean Diabetes Prevention Study, individuals with FPG ≥ 100 mg/dL, body mass index (BMI) ≥ 23.0 kg/m2, and no previous history of T2DM were consecutively enrolled after a 75 g glucose tolerance test. We analyzed the differences in the clinical characteristics in subjects with stage 1 (FPG, 100 to 109 mg/dL) and stage 2 (FPG, 110 to 125 mg/dL) impaired fasting glucose (IFG). @*Results@#Of 1,637 participants, 27.2% had T2DM and 59.3% had IFG and/or impaired glucose tolerance (IGT). The mean age was 55.0 ± 8.1 years and the mean BMI was 26.3 ± 2.7 kg/m2. Based on FPG criteria, 515 (31.4%) and 352 (21.5%) subjects were classified as having stage 1 and stage 2 IFG, respectively. The 19.0% of stage 1 and 43.5% of stage 2 subjects showed 2hr PG levels in the diabetic range. Even for those in the normal FPG range, 63 (9.5%) participants showed a 2hr PG level of ≥ 200 mg/dL. Of 446 subjects with newly-diagnosed diabetes, 340 (76.2%) showed FPG levels < 126 mg/dL. @*Conclusions@#The oral glucose tolerance test should be actively considered for Korean adults who are overweight or obese with the IFG range (FPG, 100 to 125 mg/ dL) to allow for early detection of diabetes and prompt intervention.

Short-Term Effects of the Internet-Based Korea Diabetes Prevention Study: 6-Month Results of a Community-Based Randomized Controlled Trial

The aims of this study were to determine the short-term effectiveness of an internet-based lifestyle modification (LSM) program in preventing the onset of type 2 diabetes mellitus (T2DM) in prediabetes patients in community settings. A total of 415 subjects who were diagnosed with prediabetes were randomly assigned to the LSM and standard management (SM) groups. After the 6-month intervention, the LSM group had a statistically significant reduction in body weight, body mass index compared to the SM group participants. In the LSM group, blood glucose levels were significantly decreased after intervention and the clinical improvement effect was evident in the group that achieved the target weight loss of 5% or more of the initial weight for 6 months. Internet-based 6-month-intensive LSM programs conducted by public health center personnel are an effective way to provide lifestyle intervention programs and encourage maintenance of healthy behaviors in subjects with a high risk of T2DM in community settings.

Reliability and Validity of the Korean Version of the General-Food Craving Questionnaire-Trait for Children

OBJECTIVE: The General-Food Craving Questionnaire-Trait (G-FCQ-T) is a validated, assessment scale for food craving. The aim of this study was to measure its reliability and validity for Korean children. METHODS: A total of 172 children (94 boys and 78 girls) were selected to fill out a set of questionnaires, including the G-FCQ-T, the Children's version of the Dutch Eating Behavior Questionnaire (DEBQ-C), and the Three-Factor Eating Questionnaire (TFEQ) in the Korean language. RESULTS: The internal consistency (Cronbach's alpha=0.933) and test-retest reliability (r=0.653) were satisfactory. The G-FCQ-T showed a significantly positive correlation with the DEBQ-C (r=0.560) and the TFEQ (r=0.397). The optimum cutoff score of the G-FCQ-T set by Receiver Operating Characteristics analysis was 51, with sensitivity and specificity of 0.833 and 0.825, respectively, for children. CONCLUSION: The G-FCQ-T showed good reliability and validity for assessing food craving for children and could become a practial instrument in clinical and research settings.

Needs for Development of IT-based Nutritional Management Program for Women with Gestational Diabetes Mellitus / 대한지역사회영양학회지

OBJECTIVES: The aim of this study was to examine self-management status, nutritional knowledge, barrier factors in dietary management and needs of nutritional management program for women with Gestational Diabetes Mellitus (GDM). METHODS: A total of 100 women with GDM were recruited from secondary and tertiary hospitals in Seoul. The questionnaire composed of general characteristics, status of self-management, dietary habits, nutrition knowledge, barrier factors in dietary management, needs for nutrition information contents and nutritional management programs. Data were collected by a self-administered questionnaire. All data were statistically analyzed using student's t-test and chi-square test using SAS 9.3. RESULTS: About 35% of the subjects reported that they practiced medical nutrition and exercise therapy for GDM control. The main sources of nutrition information were ‘internet (50.0%)’ and ‘expert advice (45.0%)’. More than 70% of the subjects experienced nutrition education. The mean score of nutrition knowledge was 7.5 point out of 10, and only about half of the subjects were reported to be correctly aware of some questions such as ‘the cause of ketosis’, ‘the goal of nutrition management for GDM’, ‘the importance of sugar restriction on breakfast’. The major obstructive factors in dietary management were ‘eating more than planned when dining out’, ‘finding the appropriate menu when dining out’. The preferred nutrition information contents in developing management program were ‘nutritional information of food’, ‘recommended food by major nutrients’, ‘the relationship between blood glucose and food’, ‘tips on menu selection at eating out’. The subjects reported that they need management program such as ‘example of menu by calorie prescription’, ‘recommended weight gain guide’, ‘meal recording and dietary assessment’, ‘expert recommendation’, ‘sharing know-how’. CONCLUSIONS: Based on the results of this study, it is necessary to develop a program that provide personalized information by identifying the individual characteristics of the subjects and expert feedback function through various information and nutrition information contents that can be used in real life.

The Effect of Subjective Xerostomia and Salivary pH in Salivary Glands Stimulated by Laughter Therapy in Frail Elderly Women

PURPOSE: The purpose of this study was to identify the effect of subjective xerostomia and salivary pH in salivary glands stimulated by laughter therapy in frail elderly women. METHODS: The research used a one-group pretest-posttest design. Data were collected from July 2, 2015 to September 30, 2015. A sample of 41 frail female elderly patients was recruited at A Nursing Home in K City, Korea. We measured xerostomia and salivary pH using a questionnaire and BCP test paper (pH 5.6~7.2). Laughter therapy was given once a week for four weeks (3 items). Data were analyzed through descriptive statistics, independent t-test, ANOVA, paired t-test and Cronbach's using the SPSS 18.0 program. RESULTS: There were significant differences in salivary pH according to oral health (t=-2.06, p<.05). There were significant differences in xerostomia (t=4.41, p<.001) and salivary pH (t=-7.94, p<.001) after salivary glands stimulated by laughter therapy. CONCLUSION: Salivary glands stimulated by laughter therapy improved xerostomia and salivary pH of the frail elderly. Therefore, salivary glands stimulated by laughter therapy may be useful in promoting and maintaining oral health among the frail elderly in the rapidly increasing population of old people.

A Preliminary Study on the Standardization of Fundamental Nursing Practice Education / 기본간호학회지

PURPOSE: This study was undertaken to develop directions for research on nursing practice education and also for standardization of contents of Fundamental Nursing Practice (FNP) by identifying and analyzing the present content and inconsistency in FNP textbooks. METHOD: Eleven FNP textbooks published between 2007 and 2013 were selected and itemized nursing contents were compared and analyzed. Nursing professors and practicingnurses prioritized contents identified from an actual condition survey based on theoretical reason and clinical guides for each item. RESULTS: Inconsistencies were found for 34 domains with 219 sub items and of them, 21 domains and 84 items needed to be standardized. Number of items that showed consistency between professors and nurses (ICC > or = .800) was 29 (34.5%) and for complete consistency (ICC=1), 4 (4.8%). Number of items that showed inconsistency between the groups (ICC< .600) was 30 (35.7%) and very low consistency (ICC=0), 10 (11.9%). CONCLUSION: The results indicate a difference between understood validity of content by professors and by nurses and technical differences among FNP textbooks. Therefore confirmation of the items needing to be standardized and differences in understanding content by professors and by nurses shows a need for standardization of practice education between course and clinical practice. These results provide basic data for developing standardized form of FNP education.

Nurses' Management of Nursing Home Residents' Remaining Functional Ability: Concept Development / 기본간호학회지

PURPOSE: Nurses' management of Nursing Home residents' remaining functional ability is phenomena emphasizing as the main practice focus in long term care and has specific meanings within the context of quality of life for fragile and disabled elderly people in nursing homes. This study was conducted to clarify and to conceptualize the phenomena of nurses' management of nursing home residents' remaining functional ability. METHOD: The Hybrid Model of concept development was applied to develop a concept of nurses' management of residents' remaining functional ability. RESULTS: This concept of nurse' management emerged as a phenomenon having meanings in two different dimensions, deliberation and enactment for five types of residents: residents with declining function and dementia requiring nursing assistance, bed-ridden residents with moderate dementia, residents with advanced dementia and behavior problems, but good physical health, residents at the end of life stage, and bed-ridden residents with intact mental health. CONCLUSIONS: Results indicate that nurses' management of remaining functional ability of residents in nursing homes is a concept having types of needs that should be treated in specified ways. Interventions should have a positive impacts on practical applications in nursing homes and on enhancing residents' remaining function.

Ascorbic acid insufficiency induces the severe defect on bone formation via the down-regulation of osteocalcin production / 대한해부학회지

The L-gulono-gamma-lactone oxidase gene (Gulo) encodes an essential enzyme in the synthesis of ascorbic acid from glucose. On the basis of previous findings of bone abnormalities in Gulo-/- mice under conditions of ascorbic acid insufficiency, we investigated the effect of ascorbic acid insufficiency on factors related to bone metabolism in Gulo-/- mice. Four groups of mice were raised for 4 weeks under differing conditions of ascorbic acid insufficiency, namely, wild type; ascorbic acid-sufficient Gulo-/- mice, 3-week ascorbic acid-insufficient Gulo-/- mice, and 4-week ascorbic acid-insufficient Gulo-/- mice. Four weeks of ascorbic acid insufficiency resulted in significant weight loss in Gulo-/- mice. Interestingly, average plasma osteocalcin levels were significantly decreased in Gulo-/- mice after 3 weeks of ascorbic acid insufficiency. In addition, the tibia weight in ascorbic acid-sufficient Gulo-/- mice was significantly higher than that in the other three groups. Moreover, significant decreases in trabecular bone volume near to the growth plate, as well as in trabecular bone attachment to the growth plate, were evident in 3- or 4-week ascorbic acid-insufficient Gulo-/-. In summary, ascorbic acid insufficiency in Gulo-/- mice results in severe defects in normal bone formation, which are closely related to a decrease in plasma osteocalcin levels.

Vitamin C Is an Essential Factor on the Anti-viral Immune Responses through the Production of Interferon-alpha/beta at the Initial Stage of Influenza A Virus (H3N2) Infection

L-ascorbic acid (vitamin C) is one of the well-known anti-viral agents, especially to influenza virus. Since the in vivo anti-viral effect is still controversial, we investigated whether vitamin C could regulate influenza virus infection in vivo by using Gulo (-/-) mice, which cannot synthesize vitamin C like humans. First, we found that vitamin C-insufficient Gulo (-/-) mice expired within 1 week after intranasal inoculation of influenza virus (H3N2/Hongkong). Viral titers in the lung of vitamin C-insufficient Gulo (-/-) mice were definitely increased but production of anti-viral cytokine, interferon (IFN)-alpha/beta, was decreased. On the contrary, the infiltration of inflammatory cells into the lung and production of pro-inflammatory cytokines, tumor necrosis factor (TNF)-alpha and interleukin (IL)-alpha/beta, were increased in the lung. Taken together, vitamin C shows in vivo anti-viral immune responses at the early time of infection, especially against influenza virus, through increased production of IFN-alpha/beta.

Nutritional Intake of Pregnant Women with Gestational Diabetes or Type 2 Diabetes Mellitus

Adequate intake of nutrients by pregnant women diagnosed with gestational diabetes mellitus (GDM) or type 2 diabetes (T2DM) is very important for appropriate weight gain and maintenance of normoglycemia without ketonuria. The aim of this study was to investigate the nutritional intake of pregnant women with GDM or T2DM who had not been provided with nutritional education regarding blood glucose management. Between June 2008 and May 2010, 125 pregnant women who had been diagnosed with GDM or T2DM and had not received any nutrition education regarding glycemic control and proper diet during pregnancy were interviewed to collect data regarding background characteristics, health-related behaviors, and course of pregnancy and instructed to record their dietary intake using a 24-hour recall method for one day. Using the collected data, the index of nutritional quality, nutrient adequacy ratio, and mean adequacy ratio values of the subjects were calculated. Analysis of the values indicated that the majority of the subjects did not meet recommended intake levels for most micronutrients and consumed an undesirable ratio of macronutrients, specifically a higher percentage of total carbohydrates than the current recommendation level. The GDM and T2DM groups obtained 56.6% and 63.6%, respectively (p = 0.012), of their calories by carbohydrate intake, which exceeded the recommended levels (125.8% in GDM groups, 141.3% in T2DM groups).

Factors Associated with Insulin Resistance in a Middle-Aged Non-Obese Rural Population: The Chungju Metabolic Disease Cohort (CMC) Study / 한국역학회지

OBJECTIVES: We aimed to determine the characteristics affecting insulin resistance in non-obese middle-aged adults in a rural community. METHODS: A total of 1,270 non-diabetic adults aged between 40 and 64 years old with body mass index (BMI) less than 25 kg/m2 were analyzed. Subjects with insulin resistance were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population. RESULTS: A total of 217 subjects (20.6%) had insulin resistance. Prevalence of metabolic syndrome was significantly higher in insulin-resistant subjects in both men (29.3% vs. 10.3%) and women (34.1% vs. 15.6%). Among metabolic syndrome components, elevated waist circumference and elevated triglyceride were higher in insulin-resistant subjects in both genders. After being controlled for socioeconomic status and lifestyle related covariates, the association between insulin resistance and BMI was statistically significant in the category of 23.0-24.9 kg/m2 in men (adjusted OR, 4.63; 95% confidence interval [95% CI], 1.77-12.15) using the category of 18.5-20.9 kg/m2 as a reference. In addition, the association between insulin resistance and abdominal obesity was statistically significant only for men (adjusted OR, 2.57; 95% CI, 1.29-5.11). CONCLUSION: Insulin resistance appears to be highly associated with high BMI and abdominal obesity, even in non-obese, non-diabetic middle-aged men.

Optimal Waist Circumference Cutoff Value Reflecting Insulin Resistance as a Diagnostic Criterion of Metabolic Syndrome in a Nondiabetic Korean Population Aged 40 Years and Over: The Chungju Metabolic Disease Cohort (CMC) Study

PURPOSE: We aimed at determining the cutoff value of waist circumference with respect to its ability to reflect insulin resistance in a Korean population. MATERIALS AND METHODS: A total of 8,817 subjects aged 40 years and over were analyzed. Insulin resistant individuals were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population. Receiver operating characteristic (ROC) curve analysis and multiple logistic regression analysis were applied. RESULTS: The cutoff value of waist circumference reflecting insulin resistance from the ROC analysis was 84.4 cm for men and 80.6 cm for women. Sensitivity and specificity were 70.0% and 54.2% in men and 71.1% and 59.3% in women, respectively. After being controlled for other covariates, the odds ratio for the risk of insulin resistance using < 70 cm of waist circumference as a reference increased significantly in the category of 85.0-89.9 cm for men and 80.0-84.9 cm for women. In addition, statistically significant associations were consistently observed over the category of 85.0-89.9 cm for men and 80.0-84.9 cm for women. CONCLUSION: The optimal cutoff value for waist circumference reflecting insulin resistance is considered to be 85 cm for men and 80 cm for women, suggesting that the Asian criterion of abdominal obesity (90 cm for men and 80 cm for women) as a component of metabolic syndrome (MetS) might not be applicable for middle-aged to older men in Korea.

Frequency of Irritable Bowel Syndrome, Entrance Examination Stress, Mental Health, and Quality of Life among Adolescent Women / 기본간호학회지

PURPOSE: This study was done to examine the frequency of irritable bowel syndrome (IBS), entrance examination stress, mental health, and quality of life among adolescent women. Methods: A survey conducted to collect data from 925 adolescent women in Gyeonggi Province. The measurements included the Rome III criteria (to diagnose IBS), the entrance examination stress scale (to evaluate stress), symptom check list90R (SCL-90R to evaluate mental health), and World Health Organization Quality of Life Abbreviated Version (WHOQOL-BREF to evaluate quality of life). Frequency, chi square-tests, t-test, and analysis of variance (ANOVA) with the SPSS 16.0 program were used to analyze the data. RESULTS: The frequency of IBS in the women was 22.8%. One hundred thirty eight women (65.4%) had the mixed constipation and diarrhea subtype of IBS. Compared to the women without IBS, those with IBS reported significantly higher scores on entrance examination stress scale, SCL-90R, all subscales of SCL-90R, and lower scores on WOLQOL-BREF. CONCLUSION: Nursing interventions targeting adolescent women with IBS should be developed in order to alleviate the associated stress and mental health and to promote quality of life.

Best surrogate marker for insulin resistance in middle aged non-diabetic Korean: Chungju metabolic syndrome study / 대한내과학회지

BACKGROUND: To investigate the best surrogate marker for insulin resistance in the non-diabetic middle-aged population in Korea. METHODS: This study was performed from February to April 2003-2005 in adults over 40 years of age living in Chungju City, South Korea, selected by stratified random cluster sampling. We analyzed the data from a total 6,149 non-diabetic subjects that completed a survey consisting of anthropometric measurement and blood chemistry. We defined the highest quartile of the homeostasis model for insulin resistance (HOMA-IR) as the insulin resistant group in our study population. We also analyzed the correlation of various anthropometric (body mass index, waist circumference, waist to hip ratio, waist to height ratio) and biochemical parameters (total cholesterol to HDL cholesterol ratio, non-HDL cholesterol level, triglycerides to HDL cholesterol ratio and level of triglycerides) with insulin resistance using simple and multiple regression analysis for detecting the insulin resistance group. RESULTS: By simple regression analysis, among the anthropometric parameters including the body mass index, waist circumference, waist to hip ratio, waist to height ratio, and the biochemical parameters, including the total cholesterol to HDL cholesterol ratio, non-HDL cholesterol level, triglyceride to HDL cholesterol ratio and triglycerides level, the body mass index was the best surrogate marker for insulin resistance (95% CI 1.215-1.262). The cut-off value of the body mass index was 24.6 kg/m2 (male; 24.7, female; 24.6 kg/m2), with a sensitivity of 62.6% and specificity of 66.9%. Multiple logistic regression analysis for insulin resistance also gave the same results. Furthermore, the cut-off value of the body mass index for the metabolic syndrome as defined by NCEP-ATP III was also 24.1 kg/m2 (male; 24.0, female; 24.2 kg/m2). CONCLUSIONS: Our study results suggest that the body mass index was the best surrogate marker for insulin resistance of a non-diabetic population and its cut-off value was approximately 24 kg/m2.