A Comparison of the Factor Analysis on Smoking Cessation Success between Inpatient Smoking Cessation Program and Residential Smoking Cessation Program

Background@#Since 2015, Smoking cessation program have been provided by the local smoking cessation support center in Korea. This program consisted of a 5-days of residential smoking cessation program and an inpatient program. This article is to assist smokers to quit smoking by analyzing and comparing the success factor in smoking cessation from the two different programs. @*Methods@#This study was conducted with a total of 996 participants from the residential smoking cessation program and the inpatient program, from January 2018 to December 2020 at the University Hospitals. Based on the registration card information, we did a retrospective research. Success defines that the smoking cessation continued after 6 months of program participation when it is confirmed by urine cotinine test or phone consultation. The outcome of this study was performed by cross-tabulation analysis and regression analysis. @*Results@#The findings show that the expected value of success in smoking cessation is higher as the subject is older in their age (P<0.05 in 60s or older), and more frequent consultations (P<0.01) in both programs. The nicotine dependency (P<0.01), social security system (P<0.01), and drinking experience (P=0.01) showed a meaningful correlation to success in smoking cessation in the residential program. @*Conclusions@#It is required to improve the smoking cessation program to active intervention with frequent consultations when providing these two programs.

A Comparison of the Factor Analysis on Smoking Cessation Success between Inpatient Smoking Cessation Program and Residential Smoking Cessation Program

Background@#Since 2015, Smoking cessation program have been provided by the local smoking cessation support center in Korea. This program consisted of a 5-days of residential smoking cessation program and an inpatient program. This article is to assist smokers to quit smoking by analyzing and comparing the success factor in smoking cessation from the two different programs. @*Methods@#This study was conducted with a total of 996 participants from the residential smoking cessation program and the inpatient program, from January 2018 to December 2020 at the University Hospitals. Based on the registration card information, we did a retrospective research. Success defines that the smoking cessation continued after 6 months of program participation when it is confirmed by urine cotinine test or phone consultation. The outcome of this study was performed by cross-tabulation analysis and regression analysis. @*Results@#The findings show that the expected value of success in smoking cessation is higher as the subject is older in their age (P<0.05 in 60s or older), and more frequent consultations (P<0.01) in both programs. The nicotine dependency (P<0.01), social security system (P<0.01), and drinking experience (P=0.01) showed a meaningful correlation to success in smoking cessation in the residential program. @*Conclusions@#It is required to improve the smoking cessation program to active intervention with frequent consultations when providing these two programs.

Changes in the accreditation standards of medical schools by the Korean Institute of Medical Education and Evaluation from 2000 to 2019 / 보건의료교육평가

This review presents information on changes in the accreditation standards of medical schools in Korea by the Korean Institute of Medical Education and Evaluation (KIMEE) from 2000 to 2019. Specifically, the following aspects are explained: the development process, setting principles and directions, evaluation items, characteristics of the standards, and validity testing over the course of 4 cycles. The first cycle of accreditation (2000–2005) focused on ensuring the minimum requirements for the educational environment. The evaluation criteria emphasized the core elements of medical education, including facilities and human resources. The second cycle of accreditation (2007–2010) emphasized universities’ commitment to social accountability and the pursuit of excellence in medical education. It raised the importance of qualitative standards for judging the content and quality of education. In the post-second accreditation cycle (2012–2018) which means third accreditation cycle, accreditation criteria were developed to standardize the educational environment and programs and to be used for curriculum development in order to continually improve the quality of basic medical education. Most recently, the ASK 2019 (Accreditation Standards of KIMEE 2019) accreditation cycle focused on qualitative evaluations in accordance with the World Federation of Medical Education’s accreditation criteria to reach the international level of basic medical education, which emphasizes the need for a student-centered curriculum, communication with society, and evaluation through a comprehensive basic medical education course. The KIMEE has developed a basic medical education evaluation and accreditation system in a step-by-step manner, as outlined above. Understanding previous processes will be helpful for the future development of accreditation criteria for medical schools in Korea.

Changes in Indicators after Assessment of Diabetes Mellitus Adequacy Evaluation: Korean Health Insurance Review and Assessment Service Data 2010-2015

Background@#The Korean Health Insurance Review and Assessment Service has conducted diabetes medical adequacy evaluation projects since 2010. This study aimed to evaluate the medical adequacy of type 2 diabetes mellitus patients after the assessment project and help establish the direction of future projects. @*Methods@#Using data from the Health Insurance Review & Assessment Service (2010-2015), chi-square tests and t-tests were used to analyze the enforcement rate according to a combination of items for appropriate management methods. Logistic regression and linearity test were performed to assess the relationships among the evaluation group, appropriate test items, and prescription rate. @*Results@#We found that 33.6-39.8% of patients did not undergo any diabetes-related tests. Only about 7% of hemoglobin A1c (HbA1c) tests were performed, and 36% of cases were tested simultaneously with serum lipid profile tests. As age increased, the number of days taken to prescribe diabetes medications also increased.The prescription rate of diabetes drugs for 292 days or more was 61% in patients who had not been tested for adequacy, and the average prescription rate increased as the number of tests increased. @*Conclusions@#In older adults with a high prevalence of diabetes, it is necessary to establish a test rate for proper management of diabetes, including HbA1c, and related test items to increase the average prescription rate.

Changes in Indicators after Assessment of Diabetes Mellitus Adequacy Evaluation: Korean Health Insurance Review and Assessment Service Data 2010-2015

Background@#The Korean Health Insurance Review and Assessment Service has conducted diabetes medical adequacy evaluation projects since 2010. This study aimed to evaluate the medical adequacy of type 2 diabetes mellitus patients after the assessment project and help establish the direction of future projects. @*Methods@#Using data from the Health Insurance Review & Assessment Service (2010-2015), chi-square tests and t-tests were used to analyze the enforcement rate according to a combination of items for appropriate management methods. Logistic regression and linearity test were performed to assess the relationships among the evaluation group, appropriate test items, and prescription rate. @*Results@#We found that 33.6-39.8% of patients did not undergo any diabetes-related tests. Only about 7% of hemoglobin A1c (HbA1c) tests were performed, and 36% of cases were tested simultaneously with serum lipid profile tests. As age increased, the number of days taken to prescribe diabetes medications also increased.The prescription rate of diabetes drugs for 292 days or more was 61% in patients who had not been tested for adequacy, and the average prescription rate increased as the number of tests increased. @*Conclusions@#In older adults with a high prevalence of diabetes, it is necessary to establish a test rate for proper management of diabetes, including HbA1c, and related test items to increase the average prescription rate.

The Status and Effects of Influenza and Pneumococcal Vaccination in Hospitalized Patients Population with Chronic Conditions

BACKGROUND: This study was aimed to analyze the status and effects of influenza vaccine (IV) and pneumococcal vaccine (PV) in hospitalized patients in a University Hospital with chronic conditions.METHODS: The study is based on the medical records of 3,279 inpatients in pulmonary center of Yeungnam University Medical Center (Korea) between October 2015 and September 2016. The subjects were divided into two groups by age (under 65 years old and over 65 years old), and the preventive effects of IV and PV were analyzed by comparing vaccination rate, hospitalized period, pneumonia attach rate, and mortality rate. Vaccination data were obtained from the Korea Centers for Disease Control and Prevention web system. The chi-squared test, linear regression analysis and logistic regression analysis were used to analyze factors associated with the types of vaccinations and underlying medial factors.RESULTS: In the group under 65 years old, those without any vaccination had higher mortality rate. In addition, patients with IV vaccination were more likely to have shorter hospitalized periods. On the contrary, a group of people without any vaccination, hospitalized period increased. However, in the group of over 65 years old with various underlying conditions, the mortality rate was higher when IV or both IV and PV were vaccinated.CONCLUSION: The preventive effects show the opposite results in two age groups. This study indicates that the vaccines are more effective in the group under 65 years old than the group over 65 years old with chronic conditions.

The Relationship between Serum C-Reactive Protein and the Coffee Consumption in the Korean Adult Men and Women

BACKGROUND: Coffee is a rich source of dietary antioxidants and is one of the most popular beverages worldwide. In recent times, substantial research has been published on its anti-oxidative and anti-inflammatory effect in addition to its effect as a stimulant. Chronic low-grade inflammation is known to affect the pathogenesis of diverse diseases such as cerebrovascular and cardiovascular disease, cancer, metabolic syndrome, type 2 diabetes mellitus, and obesity. Serum C-reactive protein (CRP) is a good marker of chronic inflammation in the body. Therefore, we examined the relationship between coffee consumption and serum CRP.METHODS: Participants were 759 men and 1,003 women, aged 20–64 years, who participated in the Korea National Health and Nutrition Examination Survey, 2015. We categorized coffee consumption as follows: less than one cup a day, two to four cups a day, and five or more cups a day. Additionally, we classified women into pre- and post-menopausal women. Multiple linear regression analyses were conducted to evaluate the relationship between coffee consumption and serum CRP.RESULTS: Coffee consumption showed no measurable relationship with serum CRP in men and in pre- and post-menopausal women. However, serum CRP increased progressively with increase in coffee consumption in men reported high-risk alcohol use (P=0.005).CONCLUSION: Except for high-risk male drinkers, there is no association between coffee consumption and serum CRP.

Associations between Sleep Duration and Smoked Cigarettes per Day, Heavy Smoking in Smokers

BACKGROUND@#This study was performed to evaluate the associations between sleep duration and smoked cigarettes per day, prevalence of heavy smoking.@*METHODS@#This study was based on the data of 9,893 subjects who are currently smoking, from the 4th to 6th Korea National Health and Nutrition Examination Survey. Based on appropriate sleep duration from National Sleep Foundation, study subjects were categorized into short, appropriate and over sleep group. Multiple regression analysis was performed to evaluate the association between sleep duration and smoked cigarettes per day, prevalence of heavy smoking. Age, gender, household income, education, marital status, occupation, alcohol use, body weight, hypertension, diabetes mellitus, depression, and level of stress were controlled.@*RESULTS@#Compared with appropriate sleep group, smoked cigarettes per day and prevalence of heavy smoking were higher in short sleep group, and lower in over sleep group.@*CONCLUSIONS@#There is association between sleep duration and smoked cigarettes per day, prevalence of heavy smoking.

Associations between Sleep Duration and Smoked Cigarettes per Day, Heavy Smoking in Smokers

BACKGROUND: This study was performed to evaluate the associations between sleep duration and smoked cigarettes per day, prevalence of heavy smoking. METHODS: This study was based on the data of 9,893 subjects who are currently smoking, from the 4th to 6th Korea National Health and Nutrition Examination Survey. Based on appropriate sleep duration from National Sleep Foundation, study subjects were categorized into short, appropriate and over sleep group. Multiple regression analysis was performed to evaluate the association between sleep duration and smoked cigarettes per day, prevalence of heavy smoking. Age, gender, household income, education, marital status, occupation, alcohol use, body weight, hypertension, diabetes mellitus, depression, and level of stress were controlled. RESULTS: Compared with appropriate sleep group, smoked cigarettes per day and prevalence of heavy smoking were higher in short sleep group, and lower in over sleep group. CONCLUSIONS: There is association between sleep duration and smoked cigarettes per day, prevalence of heavy smoking.

Association between Physical Activity and Hypertension in Chronic Obstructive Pulmonary Disease

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have increased likelihood of hypertension, which may lead to increased mortality rates. This study investigated the incidence of hypertension in patients with COPD according to the levels of their physical activities. METHODS: This study used data from the fifth Korean National Health and Nutrition Examination Survey, conducted from 2010 to 2012, including 1,243 people aged 40 years or older with COPD who were cross-classified according to their levels of physical activity. The relevance of morbidity associated with high blood pressure was also evaluated through cross and logistic regression analyses. RESULTS: Among patients with COPD who performed moderate-intensity physical activities, the group without hypertension had 4.3% higher compared to the group with hypertension (P=0.012). Adjusted analysis for patient age, sex, body mass index, smoking, drinking habit, income, diabetes mellitus, hyperlipidemia, and energy intake performed to determine the relationship between physical activity level and hypertension revealed that patients with moderate-intensity physical activity had 53.6% lower (95% confidence interval: 0.288-0.997) incidence of hypertension. CONCLUSIONS: The results of the current study suggest that patients with COPD who perform moderate-intensity physical activity have a lower incidence of hypertension.

The Association between Sleep Duration and Hypertension in Non-obese Premenopausal Women in Korea / 가정의학회지

BACKGROUND: Previous studies have revealed that sleep duration is linked to both obesity and hypertension. Here, we evaluated the association between sleep duration and hypertension in obese and non-obese premenopausal women using representative national survey data from the Korean population. METHODS: A total of 4,748 subjects over 20 years of age from the Korean National Health and Nutrition Examination Survey from 2010 to 2012 were included. To control for risk factors, multivariable logistic regression was used to calculate the adjusted odds ratios and 95% confidence intervals of hypertension across the following sleep duration categories: 8 h/d. RESULTS: Among the participants, 367 subjects (7.7%) had hypertension. Their mean sleep duration was 7 hours. In the non-obese subjects, after controlling for potential confounding variables, the odds ratio for hypertension was 1.86 fold greater in those with a sleep duration of <6 hours (odds ratio, 1.79; 95% confidence interval, 1.05 to 3.03) as compared to those who slept for 6.8 hours. However, there was no association between sleep duration and the risk of hypertension in obese subjects. Long sleep duration (over 8 h/d) was not associated with hypertension in either the non-obese or the obese subjects in this study. CONCLUSION: Short sleep duration (less than 6 h/d) may be a significant risk factor for hypertension in non-obese premenopausal women. However, there is no association between sleep duration and the risk of hypertension in obese women.

The Factor Associated with Suicide Risk of High School Students Using the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II

BACKGROUND: The rate of suicide of adolescents is recently significantly increasing in South Korea. Suicide is the first leading cause of death of adolescents aged 15 to 19 years in South Korea and the mortality rate due to suicide of adolescents is 8.9 per 100,000. The aims of this study is to investigate factors that affect suicidal ideation through inventory and scale. METHODS: A questionnaire was conducted to 820 high school students in a city, and 776 subjects who finished questionare were included in this study. Suicidal ideation, school bullying, excessive sexual thought and family conflict were checked by adolescent mental health and problem behavior screening questionnaire-II (AMPQ-II). Internet addiction degrees and depression was evaluated by internet addiction scale (IAS) and Beck's depression inventory (BDI), respectively. RESULTS: AMPQ-II, IAS, BDI, school bullying, suicidal ideation, and family conflict were closely related to each other. Binary logistic analysis showed that victims of school bullying (odds ratio [OR], 2.3; 95% confidence Interval [CI], 1.439-3.816), AMPQ-II high risk (OR 4.9; CI 2.546-9.433) and depression of all grade (OR 1.8 [mild], 2.2 [moderate], 6.4 [severe]) were related to suicidal ideation. CONCLUSIONS: Presence of school bullying, depression, and AMPQ-II high risk were closely related to suicidal ideation of high school students. Thus, AMPQ-II and BDI score can use as a screening tool for adolescent suicide ideation.

Association between Actual or Perceptional Weight Status and Mental Health Issues in Adolescents in Korea

BACKGROUND: Mental health issues in adolescents have recently emerged as a social concern. Previous studies reported that there was a relationship between body image perception and mental health. The purpose of this study was to determine the correlations between actual or perceptional weight status and mental health issues in adolescents in Korea. METHODS: Data was based on the 5th National Health and Nutrition Examination Survey Data (2010-2012). The subjects were 1989 adolescents aged 12 to 18 years. Depending on the actual or perceptional weight status, participants were divided into several groups. Mental health indicators included experiencing stress, depressed mood and suicidal ideation. RESULTS: The multiple logistic regression analysis was conducted controlling for age, abdominal obesity, smoking and alcohol use, potency of exercises, and household income. Although this study did not find a correlation between actual weight status and mental health variables, it did find that girls who perceived themselves as overweight were more likely to experience stress (odds ratio, 2.24; 95% CI, 1.41-3.56) and depressed mood (odds ratio, 1.91; 95% CI, 1.01-3.62). CONCLUSIONS: Adolescent females in Korea who perceived themselves as overweight experienced significantly more stress and depressed mood.

Association Between Percent Body Fat and Cardiovascular Risk Factors in Normal Weight Korean Adults

BACKGROUND: Obesity is associated with metabolic syndrome and cardiovascular risk factors. We examined metabolic syndrome and cardiovascular risk factors by percent body fat difference in adult with normal weight adults. METHODS: We analysed 353 subjects whose body mass index (BMI) were between 18.5 and 23 kg/m2. They were examined in a health promotion center of a general hospital from Jan. to Dec. 2009. Age, gender, height, weight, BMI, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C, lipid profiles, fat free mass, lean body mass, body fat mass, percent body fat (%BF) were checked. Subjects were divided into two groups according to their %BF by 25% in men, 30% in women and analysed about metabolic syndrome and cardiovascular risk factors. RESULTS: The average age was 47.30+/-10.83 years old, and BMI was 21.75+/-1.32 kg/m2, %BF was 22.92+/-5.53% in men, 26.67+/-6.32% in women. High %BF group showed increased BMI, WC, SBP, DBP, serum FBS, total cholesterol, triglyceride, low-density lipoprotein cholesterol and body fat mass decreased high-density lipoprotein cholesterol, fat free mass and lean body mass. High %BF group showed increased frequency of metabolic syndrome components, hypertension, and dyslipidemia. Diabetes was increased in high %BF group of women. The result of binary logistic regression analysis with age adjusted, metabolic syndrome, hypertension and hyperlipidemia was related with %BF in men, metabolic syndrome, diabetes, hypertension, hyperlipidemia was related with %BF in women. CONCLUSIONS: High %BF was associated with metabolic syndrome and cardiovascular risk factors like hypertension, dyslipidemia in both men and women with normal weight. But, high %BF was associated with diabetes in only women in this study.

Effect of Lactobacillus gasseri BNR17 on Overweight and Obese Adults: A Randomized, Double-Blind Clinical Trial / 가정의학회지

BACKGROUND: Lactobacillus gasseri BNR17 is a type of probiotic strain isolated from human breast milk. A study was reported regarding the fact that BNR17 was an inhibitor of obesity and diabetic activities in the human body through previous animal experiments. This study was furthered to investigate the effect of BNR17, a probiotic strain isolated from human breast milk, on obese and overweight adults. METHODS: Sixty-two obese volunteers aged 19 to 60 with body mass index > or = 23 kg/m2 and fasting blood sugar > or = 100 mg/dL participated in a placebo controlled, randomized, and double-blind trial. For 12 weeks, 57 participants were given either placebo or BNR17 and were tested by measuring body fat, body weight, various biochemical parameters, vital signs, and computed tomography at the start of the study and at weeks 4, 8, and 12. The subjects assumed usual daily activities without having to make behavioral or dietary modifications during the course of the study. RESULTS: At the 12th week, a slight reduction in body weight was noted in the BNR17 group, but there were no significant weight changes between groups. Decrease of waist and hip circumferences in the BNR17 group was more pronounced than those in the placebo group. The two groups had no special or severe adverse reactions. CONCLUSION: Despite there being no change in behavior or diet, administration of only the supplement of BNR17 reduced weight and waist and hip circumference. However, there were no significant differences between the two groups. These findings warrant a subsequent longer-term prospective clinical investigation with a large population.

Association Between Percent Body Fat and Cardiovascular Risk Factors in Normal Weight Korean Adults

BACKGROUND: Obesity is associated with metabolic syndrome and cardiovascular risk factors. We examined metabolic syndrome and cardiovascular risk factors by percent body fat difference in adult with normal weight adults. METHODS: We analysed 353 subjects whose body mass index (BMI) were between 18.5 and 23 kg/m2. They were examined in a health promotion center of a general hospital from Jan. to Dec. 2009. Age, gender, height, weight, BMI, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C, lipid profiles, fat free mass, lean body mass, body fat mass, percent body fat (%BF) were checked. Subjects were divided into two groups according to their %BF by 25% in men, 30% in women and analysed about metabolic syndrome and cardiovascular risk factors. RESULTS: The average age was 47.30+/-10.83 years old, and BMI was 21.75+/-1.32 kg/m2, %BF was 22.92+/-5.53% in men, 26.67+/-6.32% in women. High %BF group showed increased BMI, WC, SBP, DBP, serum FBS, total cholesterol, triglyceride, low-density lipoprotein cholesterol and body fat mass decreased high-density lipoprotein cholesterol, fat free mass and lean body mass. High %BF group showed increased frequency of metabolic syndrome components, hypertension, and dyslipidemia. Diabetes was increased in high %BF group of women. The result of binary logistic regression analysis with age adjusted, metabolic syndrome, hypertension and hyperlipidemia was related with %BF in men, metabolic syndrome, diabetes, hypertension, hyperlipidemia was related with %BF in women. CONCLUSIONS: High %BF was associated with metabolic syndrome and cardiovascular risk factors like hypertension, dyslipidemia in both men and women with normal weight. But, high %BF was associated with diabetes in only women in this study.

Association Between Percent Body Fat and Cardiovascular Risk Factors in Normal Weight Korean Adults

BACKGROUND: Obesity is associated with metabolic syndrome and cardiovascular risk factors. We examined metabolic syndrome and cardiovascular risk factors by percent body fat difference in adult with normal weight adults. METHODS: We analysed 353 subjects whose body mass index (BMI) were between 18.5 and 23 kg/m2. They were examined in a health promotion center of a general hospital from Jan. to Dec. 2009. Age, gender, height, weight, BMI, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C, lipid profiles, fat free mass, lean body mass, body fat mass, percent body fat (%BF) were checked. Subjects were divided into two groups according to their %BF by 25% in men, 30% in women and analysed about metabolic syndrome and cardiovascular risk factors. RESULTS: The average age was 47.30+/-10.83 years old, and BMI was 21.75+/-1.32 kg/m2, %BF was 22.92+/-5.53% in men, 26.67+/-6.32% in women. High %BF group showed increased BMI, WC, SBP, DBP, serum FBS, total cholesterol, triglyceride, low-density lipoprotein cholesterol and body fat mass decreased high-density lipoprotein cholesterol, fat free mass and lean body mass. High %BF group showed increased frequency of metabolic syndrome components, hypertension, and dyslipidemia. Diabetes was increased in high %BF group of women. The result of binary logistic regression analysis with age adjusted, metabolic syndrome, hypertension and hyperlipidemia was related with %BF in men, metabolic syndrome, diabetes, hypertension, hyperlipidemia was related with %BF in women. CONCLUSIONS: High %BF was associated with metabolic syndrome and cardiovascular risk factors like hypertension, dyslipidemia in both men and women with normal weight. But, high %BF was associated with diabetes in only women in this study.

Nonalcoholic Fatty Liver Disease as a Risk Factor for Cardiovascular Disease: Using the Estimation of Framingham Risk Score and Carotid Artherosclerosis

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is known to be associated with obesity, type 2 diabetes, and dyslipidemia and highly related to metabolic syndrome. The purpose of this study was to examine NAFLD as a risk factor for cardiovascular disease using the Framingham risk score and carotid intima media thickness. METHODS: We examined 189 Korean adults older than 20 years who participated in a health screening test and had both carotid and abdominal ultrasounds. Patients with viral hepatitis and history of cardiovascular disease and alcohol consumption (>20 g/day) were excluded. We compared clinical characteristics, the Framingham risk scores, and carotid intima media thickness according to the presence of nonalcoholic fatty liver disease. RESULTS: Framingham risk scores and the estimated 10-year risk for coronary heart disease were higher in subjects with NAFLD (11.5+/-4.7 vs 10.2+/-4.3 P=0.04, 8.7+/-7.3% vs 4.9+/-5.0% P<0.001). Carotid intima media thickness was higher in subjects with NAFLD (0.72+/-0.18 mm) compared to the controls (0.63+/-0.15 mm) (P<0.001). This result persisted significantly after adjusting for age, sex, and the 5 components of metabolic syndrome. Multiple logistic regression analysis showed that the presence of NAFLD (odds ratio [OR], 2.95; 95% confidence interval [CI], 1.495-5.812) and triglyceride level (OR, 2.06; 95% CI, 1.041-4.066) were independently related with carotid atherosclerosis. CONCLUSIONS: These results suggest that NAFLD is a risk factor for cardiovascular disease. Physicians should be mindful of this association when seeing patients with NAFLD.

Nonalcoholic Fatty Liver Disease as a Risk Factor for Cardiovascular Disease: Using the Estimation of Framingham Risk Score and Carotid Artherosclerosis

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is known to be associated with obesity, type 2 diabetes, and dyslipidemia and highly related to metabolic syndrome. The purpose of this study was to examine NAFLD as a risk factor for cardiovascular disease using the Framingham risk score and carotid intima media thickness. METHODS: We examined 189 Korean adults older than 20 years who participated in a health screening test and had both carotid and abdominal ultrasounds. Patients with viral hepatitis and history of cardiovascular disease and alcohol consumption (>20 g/day) were excluded. We compared clinical characteristics, the Framingham risk scores, and carotid intima media thickness according to the presence of nonalcoholic fatty liver disease. RESULTS: Framingham risk scores and the estimated 10-year risk for coronary heart disease were higher in subjects with NAFLD (11.5+/-4.7 vs 10.2+/-4.3 P=0.04, 8.7+/-7.3% vs 4.9+/-5.0% P<0.001). Carotid intima media thickness was higher in subjects with NAFLD (0.72+/-0.18 mm) compared to the controls (0.63+/-0.15 mm) (P<0.001). This result persisted significantly after adjusting for age, sex, and the 5 components of metabolic syndrome. Multiple logistic regression analysis showed that the presence of NAFLD (odds ratio [OR], 2.95; 95% confidence interval [CI], 1.495-5.812) and triglyceride level (OR, 2.06; 95% CI, 1.041-4.066) were independently related with carotid atherosclerosis. CONCLUSIONS: These results suggest that NAFLD is a risk factor for cardiovascular disease. Physicians should be mindful of this association when seeing patients with NAFLD.

Differential Effects of High-carbohydrate and High-fat Diet Composition on Muscle Insulin Resistance in Rats

This study was conducted to evaluate whether the composition of carbohydrate or fat diet affects insulin resistance by measuring the muscle glucose transport rate. Both high-sucrose and high-starch diet with or without high-fat decreased insulin-stimulated glucose transport, but there were no significant differences among groups. Calorie intake in both high-sucrose and high-starch diet groups was higher than in chow group. The high-fat high-sucrose diet induced decrease in insulin-stimulated glucose transport was partially improved by supplement with fish oil. Calorie intake in high-fat high-sucrose and fish oil supplemented groups was higher than in chow group. The decreased insulin-stimulated glucose transport was accompanied by the increase in visceral fat mass, plasma triglyceride and insulin levels. These changes were improved by the supplement with fish oil. These results demonstrate that the composition of fat in diet is clearly instrumental in the induction of muscle insulin resistance. However, in high carbohydrate diet, it is likely that the amount of calorie intake may be a more important factor in causing insulin resistance than the composition of carbohydrate. Thus, the compositions of carbohydrate and fat in diet differentially affect on muscle insulin resistance.