• Journal of the Korea Convergence Society
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• v.9 no.1
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• pp.233-240
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• 2018

The aim of this study was to investigate the cardiometabolic risk factors (CRF) of community dwelling women based on a combination of body mass index (BMI) and waist circumference (WC). This cross-sectional study was based on 1,447 subjects between 30 and 60 years of age. Subjects were categorized into 4 groups by BMI and WC [group 1, BMI<$25kg/m^2$ and WC<85 cm; group 2, BMI<$25kg/m^2$ and WC>85 cm; group 3, BMI>$25kg/m^2$ and WC<85 cm; and group 4 (BMI>$25kg/m^2$ and WC>85 cm. Logistic regression analyses showed that subjects in group 2 had 1.75 times increased risk of clustering of 2 or more CRFs compared with subjects in group 1 (p<0.001). In conclusion, early detection of people with normal weight but high waist circumference may prevent them from getting worse by implementation of lifestyle intervention, consisting of regular exercise and healthy eating. In addition, further studies on appropriate exercise contents for them should be examined.

• Annals of Pediatric Endocrinology and Metabolism
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• v.23 no.4
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• pp.196-203
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• 2018

Purpose: The hemoglobin glycation index (HGI) represents the degree of nonenzymatic glycation and has been positively associated with cardiometabolic risk factors (CMRFs) and cardiovascular disease in adults. This study aimed to investigate the association between HGI, components of metabolic syndrome (MS), and alanine aminotransferase (ALT) in a pediatric nondiabetic population. Methods: Data from 3,885 subjects aged 10-18 years from the Korea National Health and Nutrition Examination Survey (2011-2016) were included. HGI was defined as subtraction of predicted glycated hemoglobin ($HbA1_c$) from measured $HbA1_c$. Participants were divided into 3 groups according to HGI tertile. Components of MS (abdominal obesity, fasting glucose, triglycerides, high-density lipoprotein cholesterol, and blood pressure), and proportion of MS, CMRF clustering (${\geq}2$ of MS components), and elevated ALT were compared among the groups. Results: Body mass index (BMI) z-score, obesity, total cholesterol, ALT, abdominal obesity, elevated triglycerides, and CMRF clustering showed increasing HGI trends from lower-to-higher tertiles. Multiple logistic regression analysis showed the upper HGI tertile was associated with elevated triglycerides (odds ratio, 1.65; 95% confidence interval, 1.18-2.30). Multiple linear regression analysis showed HGI level was significantly associated with BMI z-score, $HbA1_c$, triglycerides, and ALT. When stratified by sex, age group, and BMI category, overweight/obese subjects showed linear HGI trends for presence of CMRF clustering and ALT elevation. Conclusion: HGI was associated with CMRFs in a Korean pediatric population. High HGI might be an independent risk factor for CMRF clustering and ALT elevation in overweight/obese youth. Further studies are required to establish the clinical relevance of HGI for cardiometabolic health in youth.

• Archives of Obesity and Metabolism
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• v.3 no.1
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• pp.14-26
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• 2024

Ultra-processed foods, falling under group 4 of the Nova classification system, are manufactured from processed food ingredients such as oils, fats, sugars, starch, and protein isolates, containing minimal to no whole food. They commonly incorporate flavorings, colorings, emulsifiers, and various cosmetic additives to enhance their palatability. Ultra-processed foods have become increasingly prevalent in contemporary society owing to their convenience, affordability, extended shelf life, and enhanced taste and aroma through additives. This surge in the consumption of ultra-processed foods has sparked discussions regarding its adverse health effects. Numerous studies have highlighted that an increased intake of ultra-processed foods elevates the risk of metabolic disorders, such as cardiovascular diseases, obesity, and diabetes, along with an increased risk of various cancers. Moreover, its association with an increased mortality risk underscores the importance of recognizing that opting for these foods based solely on taste and convenience is risky. Thus, by recognizing dietary habits as modifiable factors that can prevent health issues, maintaining a balanced diet with diverse nutrient intakes is crucial for overall health. Therefore, raising awareness and understanding of ultra-processed food consumption can significantly contribute to promoting healthy lifestyles.

• Journal of Korean Academy of Nursing
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• v.48 no.6
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• pp.692-707
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• 2018

Purpose: We aimed to examine the effects of an integrated physical activity (PA) program developed for physically inactive workers on the theoretical basis of the PRECEDE-PROCEED model. Methods: Participants were 268 workers in three departments of L manufacturing unit in South Korea. The three departments were randomly allocated into integration (n=86) (INT), education (n=94) (ED), and control (n=88) (CT) groups. The INT group received self-regulation, support, and policy-environmental strategies of a 12-week integrated PA program, the ED group received self-regulation strategies only, and the CT group did not receive any strategies. After 12 weeks, process evaluation was conducted by using the measures of self-regulation (autonomous vs. controlled regulation), autonomy support, and resource availability; impact evaluation by using PA measures of sitting time, PA expenditure, and compliance; and outcome evaluation by using the measures of cardiometabolic/musculoskeletal health and presenteeism. Results: Among process measures, autonomous regulation did not differ by group, but significantly decreased in the CT group (p=.006). Among impact measures, PA compliance significantly increased in the INT group compared to the CT group (p=.003). Among outcome measures, the changes in cardiometabolic/musculoskeletal health and presenteeism did not differ by group; however, systolic blood pressure (p=.012) and a presenteeism variable (p=.041) significantly decreased only in the INT group. Conclusion: The integrated PA program may have a significant effect on increases in PA compliance and significant tendencies toward improvements in a part of cardiometabolic health and presenteeism for physically inactive workers. Therefore, occupational health nurses may modify and use it as a workplace PA program.

• Journal of Nutrition and Health
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• v.52 no.6
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• pp.540-551
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• 2019

Purpose: Dietary fiber is a component of carbohydrate that is linked closely with the carbohydrate quality, but few studies have investigated the association of high fiber intake with the cardiometabolic risk factors in Koreans. This study examined the association of high fiber and high carbohydrate intake with the cardiometabolic risk factors among Korean adults. Methods: This study included 15,095 adults aged ≥20 years, who participated in the 2013 ~ 2017 KNHANES. The dietary intake was obtained using a 24-h dietary recall method. The associations of high fiber and high carbohydrate intake with metabolic syndrome and dyslipidemia were examined by sex using multiple logistic regression analysis. Results: The median of dietary fiber was 23.6 g/day in men and 20.0 g/day in women. Dietary fiber intake increased gradually as dietary carbohydrate groups increased except for ≥80% of energy from the carbohydrate group. Women in the highest quintile of fiber intake showed a 33% lower risk of metabolic syndrome compared with those in the third quintile. When stratified into low fiber (LF) and high fiber (HF) groups using Adequate Intake of fiber for Koreans, men in the third quartile of carbohydrate intake showed a 44% and 51% higher risk of metabolic syndrome and atherogenic dyslipidemia than in the first quartile, respectively, but only in the LF group. Women in the second quartile of carbohydrate intake showed an 83% higher risk of hypercholesterolemia than in the first quartile in the LF group. On the other hand, as no significant association was observed between the carbohydrate intake and metabolic diseases among the HF groups in both sexes. Conclusion: These findings suggest that a high fiber intake might be associated with a reduced risk of metabolic syndrome and high carbohydrate intake with a low dietary fiber intake might be associated with an increased risk of several metabolic abnormalities among Korean adults. Further prospective studies will be needed to confirm the effects of high fiber and high carbohydrate intake on the cardiometabolic risk factors among Koreans.

• Journal of Nutrition and Health
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• v.52 no.4
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• pp.354-368
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• 2019

Purpose: This study evaluated the glycemic response of diets using estimated glycemic load (eGL), which had been developed for mixed meals for Korean adults, and examined its associations with cardiometabolic risk factors among Korean adults. Methods: A total of 4,655 men and 6,760 women aged 19 years and above were included from the 2013 ~ 2016 Korea National Health and Nutrition Examination Survey. eGL was calculated by each meal (breakfast, lunch, dinner, and snack) and then summed to give daily total eGL. A multiple logistic regression analysis was used to examine the association. Results: Mean daily total eGL was 112.6 in men and 99.3 in women. Daily total eGL was positively associated with carbohydrate and fiber intakes, but negatively associated with protein and fat intakes in both men and women (p < 0.05 for all). Daily total eGL showed an inverse association with HDL-cholesterol level in both men and women (p = 0.0036 for men and p = 0.0008 for women). Men in the highest quintile of daily total eGL showed a 66% increased risk of hypercholesterolemia (OR, 1.66; 95% CI, 1.10 ~ 2.50; p for trend = 0.0447) compared with those in the lowest quintile. Conclusion: These findings suggest that eGL based on carbohydrate, protein, fat and fiber intakes can reflect glycemic response and therefore can be used as an index for dietary planning, nutrition education and in the food industry.

• Nutrition Research and Practice
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• v.12 no.2
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• pp.173-173
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• 2018

• Clinical and Experimental Pediatrics
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• v.62 no.7
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• pp.261-268
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• 2019

Purpose: This study aimed to evaluate the time trends of waist circumference (WC) and waist-height ratio (WHR), and to present WC and WHR distributions with optimal WHR cutoff for abdominal obesity in Korean children and adolescents. Methods: We performed a retrospective cross-sectional analysis of data from 13,257 children and adolescents (6,987 boys and 6,270 girls) aged 6-18 years who were included in the third to sixth Korea National Health and Nutrition Examination Survey (KNHANES, 2005-2015). Linear regression analyses were used to identify secular changes in WC and WHR by age, sex, and KNHANES waves. A receiver operating characteristic curve analysis was used to determine the optimal WHR cutoff values for abdominal obesity and cardiometabolic risk factors. Results: The mean WC and WHR distributions from 2005 to 2015 showed no significant secular changes between the KNHANES 4 waves (P for trend ${\geq}0.05$ in all ages and both sexes). The mean WCs in the present study were lower than those in the 2007 Korean National Growth Charts. The mean WHR at ages <13 years was statistically higher in the boys than in the girls, but did not significantly differ between the sexes among those aged 13 to 18 years. The optimal WHR cutoff for abdominal obesity was 0.48 (area under the curve, 0.985; 95% confidence interval, 0.985-0.985) in the 13- to 18-year-old adolescents. Conclusion: WC and WHR showed no secular changes over 10 years. The optimal WHR cutoff for abdominal obesity of 0.48 is useful for diagnosing and managing obesity and thus preventing obesity-related cardiometabolic complications in 13- to 18-year-old Korean adolescents.

• Archives of Obesity and Metabolism
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• v.3 no.1
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• pp.27-34
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• 2024

The prevalence of obesity in children and adolescents is increasing worldwide. Obesity in children and adolescents not only increases the risk of transitioning to obesity in adulthood but also increases the risk of cardiometabolic diseases such as high blood glucose, high blood pressure, dyslipidemia, fatty liver, and hyperinsulinemia during childhood. The goal of treating obesity in children and adolescents is not to focus on weight loss but to help children reach a healthy weight while maintaining normal growth appropriate for their age and sex. To achieve this goal, regular physical activity and exercise, dietary modification, improvement of obesity-prone environmental factors, and behavioral changes are required for a healthy lifestyle. If appropriate weight control is not achieved through lifestyle modifications, pharmacotherapy may be considered for adolescents with severe obesity aged 12 and above. Recent clinical trials have reported the efficacy and safety of pharmacotherapy in severely obese adolescents. Currently, two medications can be prescribed in Korea for patients with obesity aged 12 and above: Orlistat and Liraglutide. However, despite effective weight control through drug treatment, body weight may increase again after treatment discontinuation. Therefore, it is crucial to evaluate adherence to health behaviors during visits and continue to educate on lifestyle modifications, even during pharmacotherapy, to minimize weight regain.

• Journal of Preventive Medicine and Public Health
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• v.53 no.5
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• pp.342-352
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• 2020

Objectives: The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease. Methods: This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient's age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors. Results: Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant. Conclusions: NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.