Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension

Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.

Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hypertension

The Joint Committee of the Korean Diabetes Association, the Korean Society for the Study of Obesity, and the Korean Society of Hypertension announced a consensus statement on carbohydrate-restricted diets and intermittent fasting, representing an emerging and popular dietary pattern. In this statement, we recommend moderately-low-carbohydrate or low-carbohydrate diets, not a very-low-carbohydrate diet, for patients with type 2 diabetes mellitus. These diets can be considered a dietary regimen to improve glycemic control and reduce body weight in adults with type 2 diabetes mellitus. This review provides the detailed results of a meta-analysis and systematic literature review on the potential harms and benefits of carbohydrate-restricted diets in patients with diabetes. We expect that this review will help experts and patients by fostering an in-depth understanding and appropriate application of carbohydrate-restricted diets in the comprehensive management of diabetes.

Association of Fasting Glucose Level with Neutrophil-Lymphocyte Ratio Compared to Leukocyte Count and Serum C-Reactive Protein / 가정의학회지

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is often used as an inflammatory marker in chronic diseases such as cancer or cardiovascular diseases. However, there are few studies about the association between the NLR and diabetes mellitus (DM) or impaired fasting glucose (IFG) patients in Korea. This study investigated the association between the fasting plasma glucose (FPG) level and NLR in Koreans. METHODS: This cross-sectional retrospective study included 3,219 healthy subjects who visited Konyang University Hospital in South Korea for regular health examinations. Participants with a history of insulin administration, anti-diabetic drugs, anti-inflammatory drugs, or underlying diseases related to inflammation were excluded. RESULTS: All statistical evaluation was performed by dividing participants into males and females. Based on FPG levels, the subjects were classified into three groups, with normal fasting glucose (n=1,969), IFG (n=1,138), and DM (n=122). The NLR had no significant mean differences among these groups for both sexes. Multiple linear regression analysis between FPG level and NLR showed an independent and significantly negative association (β±standard error, −0.67±0.24; P=0.006) in normal subjects after adjustment. Log(serum C-reactive protein [S-CRP]) showed an independently and significantly positive association with FPG in male IFG/DM patients. Total leukocyte (white blood cell [WBC]) showed an independently and significantly positive association with FPG in female IFG/DM patients. CONCLUSION: In normal subjects, NLR shows an independently and significantly negative association with FPG. In IFG/DM patients, NLR was not significantly related to FPG. WBC count in female patients and S-CRP level in male patients were significantly positively associated with FPG only in IFG/DM.

Reply on “Vitamin D and coronary atherosclerosis”

No abstract available.

Relationship between coronary atherosclerosis in coronary computed tomography angiography and serum vitamin D level

OBJECTIVES: Vitamin D deficiency has been shown to influence the development of some cardiovascular disease. In this study, the association between the existence of coronary artery plaque and vitamin D was examined among participants who were not previously diagnosed with coronary artery disease. METHODS: A total of 339 participants (246 men and 93 women) who visited a health examination center for check-up including blood test for serum vitamin D level and coronary computed tomography angiography (CCTA) were selected for this study. RESULTS: Among the total 339 participants, 106 displayed coronary artery plaques. The serum 25-hydroxy vitamin D (25(OH)D) level of the group with plaque was lower than that of the group without (17.7 ± 7.72 ng/mL vs. 19.6 ± 7.12 ng/mL, P = 0.0316). The group with plaque had higher incidence rates of diabetes mellitus, hypertension, and dyslipidemia than that without (P = 0.0078, P = 0.0065, and P = 0.0174, respectively). The former displayed higher serum glucose and glycated hemoglobin levels than the latter (P = 0.0055 and P = 0.0137, respectively). The group with plaque showed higher systolic and diastolic blood pressure than that without (P < 0.0001 and P = 0.0012, respectively). Stepwise multivariate logistic regression analysis revealed that 25(OH)D (coefficient, −0.06; odd ratio, 0.9433; 95% confidence interval, 0.8967–0.9924), age, and sex were independently related with presence of coronary artery plaque. CONCLUSIONS: Relatively low vitamin D level was observed among participants with plaque, which was determined through CCTA during a health examination. Plaque formation and serum 25(OH)D level showed inverse relationship.

Association of Serum Osteocalcin with Metabolic Syndrome in Korean Adult Women

BACKGROUND: Serum osteocalcin level has been widely used as a bone turnover marker in clinical setting. In this study, we analyzed the relationship between serum osteocalcin concentration and metabolic syndrome as a cardiovascular risk factor in adult women. METHODS: We retrospectively reviewed the medical records of 89 adult women (29 premenopausal, 60 postmenopausal) who voluntarily measured serum osteocalcin concentration and lumbar spine bone mineral density (BMD) for the purpose of screening. The definition of metabolic syndrome was used National Cholesterol Education Program's Adult Treatment Panel III criteria except waist circumference which was adopted the Korean standard. RESULTS: The serum osteocalcin concentration with metabolic syndrome was significantly lower than those without metabolic syndrome (15.4±8.0 ng/mL vs. 22.4±12.2 ng/mL; P=0.001). The osteocalcin level was significantly lower in the groups with more than 4 risk factors for metabolic syndrome (10.1±6.7 ng/mL) than the groups with more than 3 (18.0±7.6 ng/mL) or 2 (23.6±7.1 ng/mL) risk factors. As a result of logistic regression analysis using serum osteocalcin, age, menopausal status, lumbar spine BMD and body mass index as independent variables, the presence of metabolic syndrome was independently associated with the serum osteocalcin level (β=-0.151, P=0.018). CONCLUSIONS: The serum osteocalcin levels in adult women were significantly lower in the metabolic syndrome group, and also lower in the group with higher clustering of individual risk factors of metabolic syndrome.

Association of Serum Osteocalcin with Insulin Resistance and Coronary Atherosclerosis

BACKGROUND: To determine the associations between serum osteocalcin level and insulin resistance, coronary atherosclerosis by using dual-source coronary computed tomography angiography. METHODS: A total of 98 subjects (24 men and 74 women) were selected for this retrospective cross-sectional study who voluntarily visited a health examination center for routine health check-up including the blood test for serum osteocalcin level and coronary computed tomography angiography. Multiple regression analysis was used to determine which variables were independently related to osteocalcin levels and coronary atherosclerosis. RESULTS: Stepwise multiple regression analysis adjusted for age, sex, menopausal status, body mass index, serum alkaline phosphatase, serum calcium and phosphate showed that osteocalcin negatively correlated with serum glucose (β=-0.145, P=0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) index (β=-1.794, P=0.027) independently. The age, serum glucose, smoking status but not osteocalcin level were independent risk factors for coronary atherosclerosis by use of multiple logistic regression analysis after controlling for other variables. CONCLUSIONS: Serum osteocalcin level was inversely associated with fasting glucose level and insulin resistance measured by HOMA-IR, suggesting that osteocalcin is important for glucose metabolism. However, in this study, no significant difference was observed in the serum osteocalcin level according to the presence of coronary atherosclerotic plaques.

Immune Cells in the Female Reproductive Tract

The female reproductive tract has two main functions: protection against microbial challenge and maintenance of pregnancy to term. The upper reproductive tract comprises the fallopian tubes and the uterus, including the endocervix, and the lower tract consists of the ectocervix and the vagina. Immune cells residing in the reproductive tract play contradictory roles: they maintain immunity against vaginal pathogens in the lower tract and establish immune tolerance for sperm and an embryo/fetus in the upper tract. The immune system is significantly influenced by sex steroid hormones, although leukocytes in the reproductive tract lack receptors for estrogen and progesterone. The leukocytes in the reproductive tract are distributed in either an aggregated or a dispersed form in the epithelial layer, lamina propria, and stroma. Even though immune cells are differentially distributed in each organ of the reproductive tract, the predominant immune cells are T cells, macrophages/dendritic cells, natural killer (NK) cells, neutrophils, and mast cells. B cells are rare in the female reproductive tract. NK cells in the endometrium significantly expand in the late secretory phase and further increase their number during early pregnancy. It is evident that NK cells and regulatory T (Treg) cells are extremely important in decidual angiogenesis, trophoblast migration, and immune tolerance during pregnancy. Dysregulation of endometrial/decidual immune cells is strongly related to infertility, miscarriage, and other obstetric complications. Understanding the immune system of the female reproductive tract will significantly contribute to women's health and to success in pregnancy.

Associations between Metabolic Syndrome and Three-dimensional Breast Density Using Digital Mammography

BACKGROUND: Metabolic syndrome is associated with increased risk of breast cancer, but little is known about the association between metabolic syndrome and mammographic density as an independent predictor of breast cancer. In this study, we investigated the association between metabolic syndrome or its components and three-dimensional breast density using digital mammography. METHODS: We analyzed cross-sectional data of 166 women, aged 20 or over (61 premenopausal and 105 postmenopausal women) in a district hospital. Metabolic syndrome was defined according to the modified National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) guideline. We measured volume percentage of dense breast tissue using digital mammography. Stepwise multiple regression analysis was used to estimate the association between mammographic density and metabolic syndrome, as well as its components. RESULTS: The Mean mammographic density was lower in the group with metabolic syndrome compared with the group without it. After adjusting for age and menopausal status, multiple regression analysis showed waist circumference (beta=-3.112, S.E.=0.927, P=0.001) and low HDL-cholesterol (beta=-2.967, S.E.=1.109, P=0.008) were independent variables for the percentage of mammographic density, although metabolic syndrome itself was not. After additional adjustment for body mass index, only low HDL-cholesterol was associated with percentage of mammographic density (beta=-2.953, S.E.=0.882, P=0.001). CONCLUSIONS: In this study, only low HDL cholesterol was associated with three-dimensional mammographic density independently after adjusting for age, menopausal status and body mass index. These findings need to be confirmed in further larger prospective studies.

Comparison of Proportions of Lymphocyte Subsets According to Serum 25(OH) Vitamin D Levels in Postmenopausal Women / 대한골다공증학회지

BACKGROUNDS: Many reports have proposed a significant role for vitamin D in immune mediated disease. This study analyzed the lymphocyte subsets according to serum 25(OH) vitamin D levels in postmenopausal women to determine the potential effect of vitamin D on immune-mediated disease. METHODS: We enrolled 31 postmenopausal women who underwent health checkup in a university hospital. Peripheral blood samples were taken for the investigation of the levels of T, B, and natural killer (NK) cells and the, proportion of CD3+, CD4+ ,CD8+, Th1, Th2, Th17 and Treg subsets of T lymphocyte in the morning after overnight fast. We also measured serum 25(OH) Vitamin D and evaluated the relationship between vitamin D levels and lymphocyte subpopulations. RESULTS: The subjects were divided into three groups according to serum vitamin D levels. There was no significant correlation between the level of vitamin D and the percentages of three lymphocyte subtypes. The proportion of CD4+ T cell (P for trend 0.024) and the CD4+/CD8+ T cell ratio(P for trend 0.000) was declined across increasing tertiles of vitamin D levels. The proportion of CD8+T cell was increased with increasing of tertiles of vitamin D levels (P for trend 0.004). And the results showed that the CD4+/CD8+ T cell ratio differed significantly between the groups with lowest and the middle vitamin D levels and between the groups with lowest and the highest. CONCLUSIONS: Serum vitamin D levels in postmenopausal women are associated with changes in the peripheral T cell compartment. These results provide insight into the immunomodulatory properties of vitamin D andthe possible beneficial associations between vitamin Dand immune-mediated disease.

2014 Clinical Practice Guidelines for Overweight and Obesity in Korea

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index > or =25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.

The Author Response: Comparison of Visceral Fat and Liver Fat as Risk Factors of Metabolic Syndrome

No abstract available.

Association between Plasma Vitamin D Level and Brachial-ankle Pulse Wave Velocity / 대한골다공증학회지

OBJECTIVES: Low 25 (OH) vitamin D increases the risk of cardiovascular disease and mortality. Pulse wave velocity (PWV), which is related with arterial stiffness, can be used evaluate the severity of systemic atherosclerosis. Brachial-ankle PWV (baPWV) is affected by sex, age, systolic blood pressure, body mass index, and waist circumference. We evaluated determinants of PWV in Korean adults andits associationwith the plasma vitamin D level and arterial stiffness. MATERIALS AND METHODS: The study was conducted on 178 adults (>age of 20) who visited thehealth promotion center. We investigated medical history, medication, smoking and alcohol use by means of questionnaire. We measuredblood pressure, pulse rate, fasting glucose, fasting insulin, lipid profile, hs-CRP, plasma 25 (OH) vitamin D level, and baPWV. We then analyzed retrospectively the relationship between baPWV and various risk factors. RESULTS: The mean ages in 97 males and 81 females were 47.9+/-13 and 43.6+/-11.4 years, respectively. baPWV is correlated with age, BMI, waist, blood pressure, fasting glucose, HTN, DM, total cholesterol, triglyceride, hs-CRP, and 25 (OH) vitamin D. We found out that age (beta=7.49, P<0.001), BMI (beta=-10.05, P=0.023), SBP (beta=7.69, P<0.001), TG (beta=111.41, P=0.039), and fasting glucose (beta=1.447, P=0.561) were independent predictors of baPWVafter performing multiple linear regression analysis. CONCLUSIONS: baPWV was affected by age, SBP, BMI, TG, and fasting glucose. Deficiency of 25 (OH) vitamin Dwas not associated with baPWV after adjusting the risk factors of cardiovascular diseases in this study group.

Comparison of Visceral Fat and Liver Fat as Risk Factors of Metabolic Syndrome

The principal objective of this study was to determine whether visceral fat or liver fat is a more relevant risk factor for metabolic syndrome. A total of 98 subjects aged 18-65 yr, who visited a health promotion center in a university hospital, were enrolled in this study. Metabolic syndrome was diagnosed based on the modified National Cholesterol Education Program's Adult Treatment Panel III report (NCEP-ATPIII) criteria. We defined the visceral obesity as a visceral fat area of > or = 100 cm2 which was acquired by CT at the L4-5 level. To evaluate fatty liver, we applied a liver-to-spleen attenuation ratio < or = 1.1 as measured by CT at the T12 level. We employed binary logistic regression models that used the presence or absence of metabolic syndrome as a dependent variable and age, sex, and the presence or absence of visceral obesity and fatty liver as independent variables. Visceral obesity was not found to be an independent variable as a risk factor of metabolic syndrome (odds ratio 2.7; 95% confidence interval 0.55-13.30), but fatty liver was found to be significant in this model (odds ratio 71.3; 95% CI 13.04-389.53). Our study suggests that liver fat may be a more important risk factor than visceral fat in terms of its association with metabolic syndrome.

Effects of Nano-sized Calcium on Intestinal Absorption and Bone Turnover / 대한골다공증학회지

OBJECTIVES: We compared the effects of two different nano-sized calcium supplements (synthesized by wet-chemical method or the dry-grinding method of calcium carbonate) and one micro-sized calcium supplement (calcium carbonate) on intestinal absorption and bone turnover in 20 young women. MATERIALS & METHODS: This study was carried out with a three week cross-over design. The subjects ingested one of three different calcium supplements (1 dose of 500 mg Ca++) at 8 AM, which was repeated three times weekly. Serum and urine samples were collected before and after the calcium load using a time table (serum sampling 0, 2 hr, 4 hr, 8 hr after loading; urine sampling 0, 4 hr, 8 hr after loading). RESULTS: Serum ionized calcium and parathyroid hormone concentrations significantly changed in response to all calcium supplements loading, the difference among calcium supplements was not significant. However, the postload urinary excretion of calcium and the N-telopeptide/creatinine ratio were significantly different among three calcium supplement over time by repeated measured ANOVA. CONCLUSIONS: The results of this study suggest the effect of nano-sized calcium supplements synthesized by the wet-chemical method is superior to the other calcium supplements in intestinal calcium absorption and bone turn-over.

Cutoff of Percent Body Fat to Predict Obesity and Metabolic Risk in Children and Adolescents: 2007 Children and Adolescent Physical Growth Standard / 가정의학회지

BACKGROUND: Body mass index (BMI) for gender and age and percentage-weight-for-height (PWH) for gender and height have been frequently used to diagnose childhood obesity. However, few studies have examined the optimal cutoff of percent body fat (%BF) to predict metabolic abnormalities in obese children. METHODS: One thousand fifteen obese children aged 10 to 15 years were enrolled in this study. The %BF cutoff values were calculated by ROC analysis for metabolic abnormalities. We also calculated %BF cutoff values corresponding to a BMI of > 85th or 95th percentile for gender and age and a PWH of > 120% for gender and height based on the 2007 Korean children and adolescents growth standard chart. To define metabolic abnormalities in children, we used the criteria of metabolic syndrome recommended by International Diabetes Federation consensus for children and adolescents. RESULTS: The %BF cutoff corresponding to the group having more than one metabolic abnormality in this study population were 38.4% (sensitivity 40.1%, specificity 84.4%) in total, 38.4% (sensitivity 35.4%, specificity 84.8%) in boys and 39.5% (sensitivity 38.9%, specificity 90.9%) in girls. The %BF cutoff values corresponding to a BMI > or = 95 percentile were 38.1% (sensitivity 50.5%, specificity 72.7%), a BMI > or = 85 percentile were 34.5% (sensitivity 69.3%, specificity 74.2%), and a PWH > or = 120% were 36.4% (sensitivity 72.3%, specificity 64.4%) in total. CONCLUSION: The optimal cutoff value of percent body fat to predict metabolic abnormalities in obese children may be 38.4% (boys 38.4, girls 39.5%) and we suggest 34.5% as a cutoff value of %BF for screening childhood obesity.

Relationship of Serum Adiponectin and Resistin Levels with Breast Cancer Risk

Obesity is one of the well-known risk factors of breast cancer. We evaluated the relationship between serum adiponectin and resistin levels and breast cancer risk in 41 biopsy-proven breast cancer patients and 43 age- and body mass index-matched controls. The mean serum adiponectin level was lower in the breast cancer group than the control group (6.93+/-3.2 microgram/mL, vs. 7.60+/-3.5 microgram/mL), but this difference did not reach statistical significance (p=0.37). There was a statistically significant difference in serum resistin levels between the groups (breast cancer group 5.23+/-6.9 ng/mL vs. control 1.46+/-2.0 ng/mL; p<0.001). The risk of breast cancer was significantly increased in the highest tertile group for serum resistin level compared to the lowest tertile group (adjusted odds ratio 2.77 [95% CI 1.40-5.50]). The lymph node metastasis was significantly increased in the patients with less than the median adiponectin level (p=0.017). In the patients whose resistin level was higher than the median, the frequency of tumor with the highest histological grade was significantly increased (p=0.025). In conclusions, both the low serum adiponectin levels and high resistin levels are likely to be associated with increased breast cancer risk in Korean women.

Factors Affecting Disease Duration in Patients with Tsutsugamushi Disease

BACKGROUND: Tsutsugamushi disease, which is caused by Orientia tsutsugamushi, is an acute febrile illness transmitted by infected mites. Recently, the incidence rate has been increased especially in the Daejeon and Chungcheongnam-do. We analyzed the patients with tsutsugamushi disease, who lived in Daejeon and Chungcheongnam-do, to find out their clinical manifestations and factors affecting the disease duration. METHODS: A total of 102 patients who were diagnosed with tsutsugamushi disease at the department of family medicine in a university hospital from September 2005 to November 2005 were studied. We analyzed their clinical characteristics and investigated the clinical factors associated with disease duration in tsutsugamushi disease by multiple regression analysis. The term "disease duration" was defined as the interval from symptom onset to discharge. RESULTS: Among 102 patients, 33 were males and 69 were female, and the mean age was 57.4 years. The average interval from symptom onset to admission was 6.6 days. The average interval from symptom onset to discharge was 14.5 days. From multiple regression analysis, interval from symptom onset to admission (beta=0.470, P<0.001), serum albumin level (beta=-3.441, P= 0.019), and abnormal findings of chest X-ray (beta=2.925, P=0.021) were shown to independently contribute to disease duration (R(2)= 0.458). CONCLUSION: Disease duration is significantly correlated with clinical factors such as abnormal findings of the chest X-ray, lower serum albumin level, and longer interval from symptom onset to admission. These factors could be used as parameters of the severity of disease in patients with tsutsugamushi disease.

The Usefulness of InBody 720 and Anthropometric Measurement Compared with Dual- energy X-ray Absorptiometry as a Diagnostic Tool of Childhood Obesity

Background: Bioelectrical impedance analysis (BIA) is frequently used to diagnose obesity in clinical setting, but the usefulness of BIA in children is not become known accurately. We analyzed the usefulness of BIA and anthropometric measurement compared with Dual-energy X-ray absorptiometry (DXA) as a diagnostic tool of childhood obesity. Methods: 205 volunteer primary and middle school children were recruited. We measured weight and height, and analyzed the body composition by BIA and DXA. By paired t-test and Bland-Altman plots, mean difference and limit of agreement were calculated between DXA and BIA according to sex and age groups. Sensitivity and specificity were displayed with the gold standard of PBF above 35% by DXA. Results: There was significantly positive correlation between DXA and BIA in fat mass (FM) (r=0.982, P<0.001), fat free mass (FFM) (r=0.990, P<0.001), and percent body fat (PBF) (r=0.956, P<0.001). Mean difference between DXA and BIA in FM, FFM, and PBF were -0.4+/-1.4 kg (P<0.001), -0.6+/-1.3 kg (P<0.001), and 0.5+/-2.8% (P=0.016), respectively. Limit of agreement in FM, FFM, and PBF were -0.4+/-2.7 kg, -0.6+/-2.5 kg, and 0.5+/-5.5%, respectively. The most sensitive method of diagnosis of obesity was Korean BMI standards for 85 percentile (94.7%) and IOTF BMI 25 kg/m2 (94.7%). The sensitivity and specificity by BIA were 90.7% and 97.7%. Conclusions: BIA was not interchangeable with DXA. However because of higher diagnostic accuracy and correlation, it could be used to measure body composition as simple field method. We recommend Korean BMI standards for 85 percentile or IOTF BMI 25 kg/m2 as the screening test for diagnosis of Korean childhood obesity.

The Accuracy of the Assessment of Visceral Obesity by InBody 4.0 and Waist Circumference

BACKGROUND: InBody 4.0, a bioelectrical impedance analyser (BIA) has an automatic function of printing out the measurement data of visceral fat area. The purpose of this study was to assess the usefulness of the visceral obesity measured by the InBody 4.0 and the waist circumference METHODS: A total of 124 participants who visited an obesity clinic in a university hospital were measured their waist circumference, height, weight and the visceral fat area by the InBody 4.0 and CT scan. The mean difference and agreement between the two visceral fat areas by the two methods had been analyzed according to sex, age and BMI groups. The accuracy of the visceral obesity by the BIA and the waist circumference was respectively compared with the visceral obesity by the CT scan. RESULTS: There was no significant difference between visceral fat area measured by the CT and the BIA in women participants under 46 years of age and below BMI 30. When comparing visceral fat area obtained from the CT with those obtained from the BIA, the 95% confidence interval for the limit agreement was higher in male subjects than in females. The waist circumference was the more sensitive method to diagnose visceral obesity than the BIA (91.80% vs. 77.94%), but the BIA method showed a higher specificity than the waist circumference (76.79% vs 52.38%). CONCLUSION: Waist circumference turned out to be more useful than the BIA as a screening tool for visceral obesity. In the group of males, BMI of over 30, or the age over 46 years, it is recommended that the CT rather than the BIA for measurement of visceral fat area be utiliged.