Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Relationship between Plasma Lipids and Osteoporosis in Korean Postmenopausal Women

BACKGROUND: Recent studies have suggested associations between cardiovascular diseases (CVD) and osteoporosis and between serum lipids and osteoporosis. However, there are only a few studies about the relationship between bone mineral density (BMD) and serum lipids in Koreans. The aim of this study was to evaluate the correlation of serum lipid levels with osteoporosis in postmenopausal women in Korea. METHODS: This cross-sectional study consisted of 1,093 Korean postmenopausal women who visited a university hospital for medical checkup from March 2007 to March 2009. Anthropometric measurements and blood tests were done for body mass index (BMI), plasma lipids, and fasting glucose. BMD was measured using a dual energy X-ray absorptiometry. Blood pressure was taken. After the subjects were classified into three groups (osteoporosis, osteopenia, or normal) by lumbar or femur BMD, the correlation between serum lipids and BMD was analyzed. RESULTS: Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the osteoporosis group (52.74+/-13.94 mg/dL) than in the other two groups (osteopenia, 56.22+/-13.40 mg/dL; normal, 56.54+/-13.22 mg/dL; p=0.007) when participants were grouped by lumbar BMD. In addition, serum triglyceride in the osteoporosis group was higher than in the other two groups. The results were statistically significant after adjusting for confounding factors including age, BMI and blood pressure. However, there was no significant difference when grouped by femur BMD. CONCLUSION: With decreasing lumbar BMD, we saw lower HDL-C levels and higher triglyceride levels. Osteoporosis may play a role as a risk factor for CVD through its relationships with lumbar BMD and serum lipids.

The Effect of Gamma-Glutamyltransferase on Impaired Fasting Glucose or Type 2 Diabetes in Korean Men / 당뇨병

BACKGROUND: We sought to determine the association between serum gamma-glutamyltransferase (GGT) levels within the normal range and the risk for development of impaired fasting glucose (IFG) or type 2 diabetes. METHODS: This retrospective cohort study spanned four years (2002~2006) with 1,717 Korean men who underwent periodic health examinations at a university hospital in Incheon, Korea and were not diagnosed with IFG or type 2 diabetes. Fasting plasma glucose levels were measured at the annual health examination. IFG and diabetes were defined as a serum fasting glucose concentration of 100~125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between serum GGT levels and development of IFG or type 2 diabetes. RESULTS: There was a strong dose-response relationship between serum GGT levels and the incidence of IFG and diabetes. A total of 570 cases (33.2%) of incident IFG and 50 cases (2.9%) of diabetes were found. After controlling potential predictors, the relative risks for the incidence of IFG for GGT levels or = 51 were 1.00, 0.99, 1.17, 1.23 and 1.38 respectively (P for trend 0.015), and for the incidence of diabetes were 1.00, 1.44, 1.80, 2.55 and 2.58 respectively (P for trend 0.050). CONCLUSION: The risk for development of IFG and type 2 diabetes increased in a dose-dependent manner as serum GGT increased within its normal range in Korean men.

Effect of Barley on Variation of Blood Glucose and Lipid Metabolism / 가정의학회지

BACKGROUND: It is regarded that contemporary Korean diet, the combination of carbohydrates-based Korean traditional diet and the Western eating patterns, increases the vulnerability to chronic diseases such as coronary vascular disease, diabetes mellitus, and hypertension. Therefore, there is a rising interest in carbohydrate sources with low glycemic index; many researches have proven the medical benefits of low glycemic index diet. Barley has recently drawn attention and various benefits of barley, such as improvements of obesity and bowel function, have been suggested. It seems that the beta-glucan, a content of barley helps to lower blood sugar level. This study aimed to evaluate the advantages of barley consumption compared to wheat consumption in blood sugar and blood lipid profile levels. METHODS: Twenty-four healthy Korea University students were randomly assigned to two groups: 12 of barley bread consumption group (treatment group) and 12 of wheat bread consumption group (control group). Both groups took bread on an empty stomach and the changes of their blood sugar and lipid levels were measured, compared, and analyzed every hour for four hours. RESULTS: The blood sugar level one hour later in the barley bread consumption group was statistically low. In addition, the area under curve of the barley bread intake group was found to be statistically smaller. However, the blood lipid profiles between the two groups did not show meaningful difference. CONCLUSION: This study suggests that the consumption of food containing barley could bring various medical benefits to one's health by lowering blood sugar.

The Effect of Smoking Status upon Occurrence of Impaired Fasting Glucose or Type 2 Diabetes in Korean Men / 예방의학회지

OBJECTIVES: To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. METHODS: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. RESULTS: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the neversmokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). CONCLUSIONS: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.

Association of TV Viewing and Computer Using Habits with Obesity and Obesity Related Lifestyles

BACKGROUND: TV viewing and computer use are sedentary behaviors and recent surveys report that they are associated with obesity in children. Association of these activities with obesity or obesity related lifestyles was investigated in this study. METHODS: Using the database of questionnaires and physical check-ups among 4th to 6th grade elementary school students in Incheon, the association of television viewing and internet using time with obesity and obesity related factors (dietary habits, and physical activities) were investigated. A total of 2,750 students (1,100 normal weighted/1,650 overweight or obese) were included. RESULTS: In the multiple analyses of computer using time among the boys and girls in weekdays and weekends respectively, according to their obesity degree, except for overweight and obese boys in weekends (P<0.001), there were no significant differences examined. Multiple logistic regression revealed that children who watched TV more than 2 hours per day ate faster (OR 1.27), had breakfast more irregularly (OR 1.41) and ate vegetables more rarely (OR 1.53). The children who used computer more than 1 hour per day in weekdays were faster eaters (OR 1.38) and hardly ate fruits (OR 1.26) or vegetables (OR 1.60). In weekends, the children who spent time more than 90 minutes in the computer were faster to eat (OR 1.46), more snack eating (OR 1.22), less vegetable consuming (OR 1.59) and more obese (OR 1.46, 95%CI 1.24~1.73) compared to the others. CONCLUSION: TV viewing and computer use were associated with several obesity related lifestyles in children.