Differences in patient-reported and clinical characteristics by age group in adults with type 2 diabetes.

BACKGROUND: The global burden of type 2 diabetes (T2D) is growing, and the age of onset is widening, resulting in increasing numbers of young adults and elderly patients with T2D. Age-specific diabetes care needs have yet to be fully explored. AIMS: This study examined (1) differences in patient-reported and clinical characteristics by age group and (2) the effect of age on two proxy measures assessing psychological health and self-care adherence after adjusting for potential mediators. METHODS: A cross-sectional, correlational design was used. Adults with type 2 diabetes (T2D) were recruited from a university hospital in Korea between 2019 and 2020. Participants were divided into four groups based on years of age (40s and younger group [n = 27]; 50s group [n = 47]; 60s group [n = 54]; and 70s and older group [n = 48]) to compare patient-reported and clinical characteristics. Chi-square tests, ANOVA, Kruskal-Wallis tests, and logistic regression analysis were performed to assess group differences and effect of age on psychological health and self-care adherence. RESULTS: Of 178 participants, two-thirds were men (n = 114; 64.41%). The mean ages in the 40s and younger, 50s, 60s, and 70s and older groups were 39.4, 54.7, 63.9, and 76.0 years, respectively. There were significant differences in patient-reported and clinical characteristics by age group. The youngest group reported the poorest psychological health and self-care behaviors. Although the oldest group showed the poorest physical functioning, this group also showed the highest self-care adherence and the best psychological health. Regarding clinical characteristics, traditional diabetes-related blood test results showed no significant group differences. LINKING EVIDENCE TO ACTION: Age-specific diabetes care needs were identified in adults with T2D. Interventions to improve psychological health and priming effects of behavioral adherence need to be developed. Furthermore, meticulous investigation to detect potential complications early is essential in adults with T2D.

Effects of Cardiorespiratory Fitness on Cardiovascular Disease Risk Factors and Telomere Length by Age and Obesity.

Background: This study investigates differences in telomere length according to obesity, cardiovascular disease (CVD) risk factors, and fitness level in South Korean males. Methods: The subjects of this study were males in their 10s to 50s (n=249). We measured obesity indices, CVD risk factors, leukocyte telomere length (LTL), and cardiorespiratory fitness (CRF). Correlation and regression analyses were performed to analyze the data. Results: Measurement of participants' obesity indices, CVD risk factors, and maximum oxygen intake and analyzing their correlations with LTL revealed that LTL and CRF decreased with age and the levels and numbers of obesity indices and CVD risk factors increased. The LTL showed differences according to whether subjects exhibited obesity or dyslipidemia and by CRF level. When all the variables that influence the LTL were adjusted, the LTL became shorter as the age and low-density lipoprotein cholesterol (LDL-C) level increased, and it became longer as the maximum rate of oxygen utilization (VO2max) increased. When the age and CVD risk factors that influence the LTL were adjusted according to obesity and CRF for the obese group, the LTL became shorter as the age and LDL-C level increased (P<0.01), and it became longer as VO2max increased (P<0.01). Conclusion: We found that obesity influenced the LTL by increasing the levels of CVD risk factors and decreasing CRF, whereas maintaining high CRF could alleviate the effects of obesity and CVD risk factors according to age while maintaining and influencing the elongation of LTL.

Comparisons of Psycho-Behavioral Factors, Body Composition, and Clinical Outcomes in Adults With Type 2 Diabetes by Perceived Hypoglycemia.

PURPOSE: The purpose of the study was to examine the associations between perceived hypoglycemia and psycho-behavioral and clinical factors in persons with type 2 diabetes (T2D). METHODS: Adults with T2D were recruited from outpatient clinics in a university hospital in Korea. Sociodemographics, psycho-behavioral and clinical factors, and body composition were assessed. The participants were divided into 2 groups reporting perceived hypoglycemia or not in the previous month based on an item of the Control Problem Scale. Group differences were compared at α = .05 using SPSS (version 26.0). RESULTS: Of 177 participants, approximately one-third (n = 67) perceived hypoglycemia. The hypoglycemia group reported poor health-related quality of life, frequent blood monitoring and foot care, and sleep difficulties. However, no differences between groups were identified for diet, exercise, or glycosylated hemoglobin. The hypoglycemia group had a lower body mass index and a trend toward a lower skeletal muscle mass and fat free mass. CONCLUSIONS: Perceived hypoglycemia was associated with psycho-behavioral factors and body composition. Importantly, some persons on oral antidiabetic medications that do not cause hypoglycemia still perceived hypoglycemia. Further investigation is warranted to examine the efficacy of strategies to minimize hypoglycemia and inappropriate fear of hypoglycemia. In addition, clinicians should be aware of the potential risk of hypoglycemia in persons with lower muscle mass.

Moderate-Intensity Exercise Preserves Bone Mineral Density and Improves Femoral Trabecular Bone Microarchitecture in Middle-Aged Mice.

BACKGROUND: Aging leads to significant bone loss and elevated osteoporosis risk. Exercise slows age-related bone loss; however, the effects of various moderate-intensity exercise training volumes on bone metabolism remain unclear. This study aimed to determine the degree to which different volumes of moderate-intensity aerobic exercise training influence bone mineral density (BMD), bone mineral content (BMC), femoral trabecular bone microarchitecture, and cortical bone in middle-aged mice. METHODS: Twenty middle-aged male C57BL/6 mice were randomly assigned 8 weeks of either (1) non-exercise (CON); (2) moderate-intensity with high-volume exercise (EX_MHV); or (3) moderate-intensity with low-volume exercise (EX_MLV) (N=6-7, respectively). Femoral BMD and BMC were evaluated using dual energy X-ray absorptiometry, and trabecular and cortical bone were measured using micro-computed tomography. RESULTS: Femoral BMD in EX_MHV but not EX_MLV was significantly higher (P<0.05) than in CON. The distal femoral fractional trabecular bone volume/tissue volume (BV/TV, %) was significantly higher (P<0.05) in both EX_MHV and EX_MLV than in CON mice. Increased BV/TV was induced by significantly increased trabecular thickness (mm) and tended to be higher (P<0.10) in BV (mm3) and lower in trabecular separation (mm) in EX_MHV and EX_MLV than in CON. The femoral mid-diaphysis cortical bone was stronger in EX_MLV than EX_MHV. CONCLUSIONS: Long-term moderate-intensity aerobic exercise with low to high volumes can be thought to have a positive effect on hindlimb BMD and attenuate age-associated trabecular bone loss in the femur. Moderate-intensity aerobic exercise may be an effective and applicable exercise regimen to prevent age-related loss of BMD and BV.

2020 Korean Society for the Study of Obesity Guidelines for the Management of Obesity in Korea.

Obesity is a prevalent and complex disease. The prevalence of obesity in Korea increased from 29.7% in 2010 to 35.7% in 2018, with the prevalence of abdominal obesity being 23.8% in 2018. Obesity contributes to medical costs and socioeconomic burden due to associated comorbidities. The treatment and management of obesity is changing based on new clinical evidence. The 2020 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea summarizes evidence-based recommendations and treatment guidelines.

Trabecular Bone Microarchitecture Improvement Is Associated With Skeletal Nerve Increase Following Aerobic Exercise Training in Middle-Aged Mice.

Advancing age is associated with bone loss and an increased risk of osteoporosis. Exercise training improves bone metabolism and peripheral nerve regeneration, and may play a critical role in osteogenesis and increase in skeletal nerve fiber density. In this study, the potential positive role of aerobic exercise training in bone metabolism and skeletal nerve regeneration was comprehensively evaluated in 14-month-old male C57BL/6 mice. The mice were divided into two groups: no exercise (non-exercise group) and 8-weeks of aerobic exercise training (exercise group), with six mice in each group. Dual-energy X-ray absorptiometry and micro-computed tomography showed that femoral and tibial bone parameters improved after aerobic exercise training. Greater skeletal nerve fiber density was also observed in the distal femoral and proximal tibial periostea, measured and analyzed by immunofluorescence staining and confocal microscopy. Pearson correlation analysis revealed a significant association between skeletal nerve densities and trabecular bone volume/total volume ratios (distal femur; R 2 = 0.82, p < 0.05, proximal tibia; R 2 = 0.59, p = 0.07) in the exercise group; while in the non-exercise group no significant correlation was found (distal femur; R 2 = 0.10, p = 0.54, proximal tibia; R 2 = 0.12, p = 0.51). Analysis of archival microarray database confirmed that aerobic exercise training changed the microRNA profiles in the mice femora. The differentially expressed microRNAs reinforce the role of aerobic exercise training in the osteogenic and neurogenic potential of femora and tibiae. In conclusion, 8-weeks of aerobic exercise training positively regulate bone metabolism, an effect that paralleled a significant increase in skeletal nerve fiber density. These findings suggest that aerobic exercise training may have dual utility, both as a direct stimulator of bone remodeling and a positive regulator of skeletal nerve regeneration.

The Anabolic Response to Dietary Protein Is Not Limited by the Maximal Stimulation of Protein Synthesis in Healthy Older Adults: A Randomized Crossover Trial.

We have recently demonstrated in young adults that an anabolic response with mixed meal protein intake above ~35 g/meal, previously recognized as an "optimal" protein dose, was further stimulated. However, it is unknown if this applies to older adults. We therefore examined anabolic response to a mixed meal containing either 35 g (MOD, moderate amount of protein) or 70 g (HIGH, high amount of protein) in a randomized cross-over metabolic study in older adults (n = 8). Primed continuous infusions of L-[2H5] phenylalanine and L-[2H2]tyrosine were performed to determine whole-body protein kinetics and muscle protein fractional synthesis rate (MPS) in basal fasted and fed states. Whole-body protein kinetics (NB, net protein balance; PS, protein synthesis; PB, protein breakdown) and MPS was expressed as changes from the baseline post-absorptive state. Consistent with our previous findings in young adults, both feedings resulted in a positive NB, with HIGH being more positive than MOD. Furthermore, NB (expressed as g protein∙240 min) increased linearly with an increasing amount of protein intake, expressed relative to lean body mass. The positive NB was achieved due mainly to the suppression of PB in both MOD and to a greater extent HIGH, while PS was only increased in HIGH. Consistent with the whole-body data, MPS was significantly higher in HIGH than MOD. Plasma concentrations of essential amino acids and insulin were greater in HIGH vs. MOD. We conclude that in the context of mixed meals, whole-body anabolic response linearly increases with increasing protein intake primarily through the suppression of PB, and MPS was further stimulated with protein intake above the previously considered "optimal" protein dose in older adults.

Males with Obesity and Overweight.

Global average data suggest that the prevalence of obese and overweight males is much higher than that of females in some regions. The gender gap in obese and overweight individuals has deepened in many countries, and the gap is more prominent in overweight than in obesity. In particular, the prevalence of male obesity has continuously increased in the Republic of Korea over the past two decades, whereas the increase in female obesity has slowed and may even have plateaued. The cutoff point for obesity in Korea is a body mass index of ≥25 kg/m2, which is equivalent to the international classification of being overweight. Researching obesity in males is not as prevalent as studying obesity in females. Previous studies have rarely considered obesity type (android vs. gynoid), hormones (testosterone, androgen, etc.), awareness of body shape, or special resources such as exercise interventions to improve male weight issues. Adaptations to exercise interventions show individual variability as well as differences between men and women. Therefore, integrated approaches to research should be adopted, including evaluation of socio-demographic and physiological characteristics, to ensure that such interventions are not simply a symptomatic treatment but are actually treating the root cause of the obesity.

Comparison of performance-related physical fitness and anaerobic power between Korean wheelchair badminton national and backup players.

The purpose of this study was to compare performance-related physical fitness factors and anaerobic power between national and backup players to enhance the performance of wheelchair badminton players and to discover and foster new athletes. This study included 12 wheel-chair badminton players divided into two groups: national players (n=7) and backup players (n=5). Collected data included cardiorespiratory endurance, muscle endurance, muscle strength, power, agility, and anaerobic power. Results indicated that the national players achieved a significantly higher level of muscle endurance, peak power, and mean power than the backup players. Although none of the parameters showed statistically significant differences, the performance levels of the national players were higher than those of the backup players. Because the physical fitness aspects of wheelchair players vary according to their ability and are essential factors, individualized training programs for enhancing performance and preventing injuries among wheelchair badminton players should be developed.

How Does Obesity and Physical Activity Affect Aging?: Focused on Telomere as a Biomarker of Aging.

Obesity is known to continuously increase systemic inflammation and oxidative stress, leading to shorter telomere length. However, research regarding the correlation between physical activity, exercise, obesity, and telomere length is not consistent. Therefore, this review aims to summarize the effects of obesity, physical activity, and exercise on telomere length. Our search for effects of obesity, physical activity, and exercise, on telomeres was conducted using three computerized databases: Medline, PubMed, and EBSCO. Keywords in the search were "physical activity, exercise and obesity," "physical activity, exercise and telomere," and "obesity and telomere." Improving chronic inflammation and oxidative stress levels can prevent telomere attrition due to obesity. In addition, differences in the anti-aging effects of physical activity and exercise are shown in the post-middle-age period, when telomere length changes, rather than in past exercise habits. Maintaining high cardiorespiratory fitness levels through regular exercise and physical activity in the post-middle-age period minimizes obesity-related diseases and helps maintain telomere length, which is an index of cell senescence.

Corrigendum: 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea.

[This corrects the article on p. 40 in vol. 28, PMID: 31089578.].

2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea.

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.

Erratum: Comparison of performance-related physical fitness and anaerobic power between Korean wheelchair badminton national and backup players.

[This corrects the article on p. 663 in vol. 15, PMID: 31723554.].

Effects of Exercise on the Body Composition and Lipid Profile of Individuals with Obesity: A Systematic Review and Meta-Analysis.

BACKGROUND: Numerous researchers have worked to develop treatments for obesity; however, the prevalence of obesity continues to increase in many countries. Moreover, the effects of physical activity and exercise on obesity remain unclear. Therefore, it is necessary to perform a systematic review and meta-analysis to assess the relationship between exercise and obesity using mediator variables such as the mode of exercise. METHODS: Our review focuses on research tracking the effects of exercise on obesity conducted from 2007 to 2016 and available in any of three databases: Embase, PubMed, and EBSCO Academic Search Premier. The keywords used in the search were "exercise and obesity" and "exercise and obese." RESULTS: The average size of the effects that exercise interventions have on body mass index (standardized mean difference [SMD], 0.533), waist circumference (SMD, 0.666), total cholesterol (SMD, 0.721), and triglyceride (TG; SMD, 0.603) were medium or larger. Exercise had greater effects on the outward appearance of obesity (body mass index, waist circumference) than on its practical factors (weight, % body fat). The effect of exercise on TG (SMD, 0.603) was larger than that on low-density lipoprotein (SMD, 0.406) and high-density lipoprotein (SMD, -0.222). Exercise duration (weeks of exercise) and intensity correlate better than exercise time (minutes per week) with a large and consistent improvement in adult obesity. CONCLUSION: We suggest that individuals with obesity should exercise consistently to achieve significant improvements in their health.

Effects of weighted baseball throwing during warm-up on ball velocity and upper extremity muscle activation in baseball pitchers.

The objective of this study was to investigate the changes in the muscle activation of high school and college baseball pitchers during throwing of the ball with maximum effort (TBME) using a regular baseball (RB) subsequent to using a light baseball (LB), RB, and overweight baseball (OB) during warm-up (WU) and the resulting changes in the pitch velocity. The study aimed to use the findings in providing basic data for a training program designed to increase the pitch velocity of baseball pitchers. The study population consisted of 12 high school and college baseball players. The study measured and analyzed the upper extremity muscle activation and ball velocity in the stride, arm cocking, and acceleration phases during TBME using an RB subsequent to using an LB, RB, and OB during WU. During WU, the ball velocity was higher when pitching with an LB than with an RB or OB and when pitching with an RB than with an OB. However, there were no significant differences in the ball velocity when pitching with an RB during TBME. In conclusion, WU using weighted baseballs resulted in varying muscle activations, and although the velocity decreased when pitching with an OB, no difference was found during TBME using an RB. Therefore, it is believed that using weighted baseballs during WU does not have an effect on the ball velocity during TBME; future studies are needed on the effects through long-term training.

Erratum: Effects of exercise training on stroke risk factors, homocysteine concentration, and cognitive function according the APOE genotype in stroke patients.

[This corrects the article on p. 267 in vol. 14, PMID: 29740562.].

Effects of exercise training on stroke risk factors, homocysteine concentration, and cognitive function according the APOE genotype in stroke patients.

The apolipoprotein E (APOE) gene has been suggested to be associated with stroke and dementia. However, the effects of exercise training on dementia according to the APOE genotype are not consistent to those reported by previous studies. Therefore, we examined the effects of exercise training on stroke risk factors including blood pressure, lipid profiles, homocysteine (Hcy) concentrations, and cognitive function according to the APOE genotype in stroke patients. We examined the stroke risk factors, Hcy, and cognitive function in 28 ischemic stroke patients before and after 6 months of exercise training. After exercise training, body weight, body mass index (BMI), and percent body fat decreased significantly in both APOE groups. According to the APOE genotype, the changes in BMI in the APOE ɛ4 group higher than those in APOE ɛ3 group significantly. Total cholesterol (TC), low-density lipoprotein (LDL)-C, triglyceride (TG), and Hcy decreased and high-density lipoprotein (HDL)-C increased significantly in the both groups. According to the APOE genotype, systolic blood pressure in the APOE ɛ4 group decreased, but in the APOE ɛ3 group increased after exercise training. TC, LDL-C, and TG in the APOE ɛ4 group decreased more extensively than those in the APOE ɛ3 group after exercise training. VO2max (maximal oxygen consumption) and cognition increased significantly in both groups. Folate acid intake also increased significantly in both groups. The APOE genotype affects variations in the risk factors of stroke after exercise training. However, the Hcy and cognitive function did not differ based on the APOE genotype.

Quality of meal protein determines anabolic response in older adults.

BACKGROUND & AIMS: It has been demonstrated that the relative content and profile of essential amino acids (EAA) play a determining role for stimulation of muscle protein synthesis (MPS) following intake of pure EAA or protein alone. METHODS: To test if this also holds in the context of mixed meals at both whole body and muscle levels, twelve older subjects (57-74 yrs) received primed continuous infusion of L-[ring-2H5]phenylalanine and L-[ring-2H2]tyrosine over a 9-h experimental period to determine whole body protein kinetics and MPS in the fasted state and following consumption of egg-based (EGG) or cereal-based (CEREAL) isocaloric and isonitrogenous breakfast. A standardized lunch, primarily consisting of beef protein was also consumed by each group. Whole body protein kinetics [protein synthesis (PS), breakdown (PB), and net balance (NB)] were expressed as changes from basal fasted period. RESULTS: We found that EGG breakfast resulted in a greater NB through a greater suppression of PB compared with the CEREAL breakfast. The greater NB during the post-breakfast period with the EGG was normalized following the standard lunch despite the sustained elevations in plasma EAA concentrations. However, the EGG breakfast stimulated both PS and PB compared with the CEREAL breakfast during the post-lunch period. MPS was not different between meals despite larges differences in the plasma EAA responses. CONCLUSIONS: We conclude that in the context of mixed meals, quality of protein affects NB through changes in protein breakdown and affects protein turnover following subsequent meal intake.

Conduction, Evaluation, and Future Considerations for an Obesity Educator Training Program in Korea.

To reduce the prevalence of obesity and provide information on evidence-based obesity treatments, the Education Committee of the Korean Society for the Study of Obesity (KSSO) has developed and launched the first Obesity Educator Training Program (OETP). After the course, we analyzed the results of a survey from 110 participants, comprising medical doctors (n=58), nutrition specialists (n=19), exercise specialists (n=14), and students (n=6). Approximately half of the participants were recruited through the Internet (48%), followed by academic leaflets, such as conference posters (21%); the reasons for participation were to learn about evidence-based treatments for obesity (47%), to receive up-to-date knowledge on obesity treatments (39%), to obtain basic information on obesity (10%), and others (4%). More than half of the participants found the date, lecture time, process, and theme of the OETP favorable. The participants indicated that there should be an in-depth course, sharing of the presented files with attendees, a longer lecture time, and a broader OETP that includes other specialties such as nursing. To improve the OETP, the educational committee of the KSSO must develop an in-depth OETP that will reflect these participant's feedback.