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Lifestyle
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Ultra-Processed Food Consumption and Obesity in Korean Adults
Jee-Seon Shim, Kyoung Hwa Ha, Dae Jung Kim, Hyeon Chang Kim
Diabetes Metab J. 2023;47(4):547-558.   Published online April 26, 2023
DOI: https://doi.org/10.4093/dmj.2022.0026
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AbstractAbstract PDFPubReader   ePub   
Background
This study aimed to investigate the association between consumption of ultra-processed foods (UPF) and obesity in Korean adults.
Methods
We included the Cardiovascular and Metabolic Diseases Etiology Research Center cohort study baseline data of adults aged 30 to 64 years who completed a validated food frequency questionnaire. UPF was defined using the NOVA food classification. Multivariable linear and logistic regression analyses were performed to assess the association of dietary energy contribution of UPF with obesity indicators (body mass index [BMI], obesity, waist circumference [WC], and abdominal obesity).
Results
Consumption of UPF accounted for 17.9% of total energy intake and obesity and abdominal obesity prevalence was 35.4% and 30.2%, respectively. Compared with those in the lowest quartile of UPF consumption, adults in the highest quartile had greater BMI (β=0.36; 95% confidence interval [CI], 0.15 to 0.56), WC (β=1.03; 95% CI, 0.46 to 1.60), higher odds of having obesity (odds ratio [OR], 1.24; 95% CI, 1.07 to 1.45), and abdominal obesity (OR, 1.34; 95% CI, 1.14 to 1.57), after adjusting for sociodemographic characteristics, health-related behaviors, and family history of diseases. Dose-response associations between UPF consumption and obesity indicators were consistently found (all P trend <0.01). However, the strength of association was halved for all obesity indicators after further adjustments for total energy intake and overall diet quality score, and the trend toward association for obesity and WC disappeared.
Conclusion
Our finding supports the evidence that consumption of UPF is positively associated with obesity among Korean adults.

Citations

Citations to this article as recorded by  
  • Ultra-processed food consumption and increased risk of metabolic syndrome in Korean adults: A cross-sectional analysis of the KNHANES 2016–2020
    Hansol Park, Youngmi Lee, Jinah Hwang, Yujin Lee
    Nutrition.2024; 122: 112374.     CrossRef
  • Association of maternal ultra-processed food consumption during pregnancy with atopic dermatitis in infancy: Korean Mothers and Children’s Environmental Health (MOCEH) study
    Won Jang, Minji Kim, Eunhee Ha, Hyesook Kim
    Nutrition Journal.2024;[Epub]     CrossRef
  • Diet quality partially mediates the association between ultraprocessed food consumption and adiposity indicators
    Jee‐Seon Shim, Kyoung Hwa Ha, Dae Jung Kim, Hyeon Chang Kim
    Obesity.2023; 31(9): 2430.     CrossRef
  • Development of a Semi-Quantitative Food-Frequency Questionnaire for Korean Adults with Obesity
    Jina Chung, Seoeun Ahn, Hyojee Joung, Sangah Shin
    Nutrients.2023; 15(22): 4848.     CrossRef
Complications
Article image
Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study
Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon
Diabetes Metab J. 2023;47(2):242-254.   Published online January 19, 2023
DOI: https://doi.org/10.4093/dmj.2022.0001
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  • 5 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Body mass index (BMI) is a risk factor for the type 2 diabetes (T2DM), and T2DM accompanies various complications, such as fractures. We investigated the effects of BMI and T2DM on fracture risk and analyzed whether the association varied with fracture locations.
Methods
This study is a nationwide population-based cohort study that included all people with T2DM (n=2,746,078) who received the National Screening Program during 2009–2012. According to the anatomical location of the fracture, the incidence rate and hazard ratio (HR) were analyzed by dividing it into four categories: vertebra, hip, limbs, and total fracture.
Results
The total fracture had higher HR in the underweight group (HR, 1.268; 95% CI, 1.228 to 1.309) and lower HR in the obese group (HR, 0.891; 95% CI, 0.882 to 0.901) and the morbidly obese group (HR, 0.873; 95% CI, 0.857 to 0.89), compared to reference (normal BMI group). Similar trends were observed for HR of vertebra fracture. The risk of hip fracture was most prominent, the risk of hip fracture increased in the underweight group (HR, 1.896; 95% CI, 1.178 to 2.021) and decreased in the obesity (HR, 0.643; 95% CI, 0.624 to 0.663) and morbidly obesity group (HR, 0.627; 95% CI, 0.591 to 0.665). Lastly, fracture risk was least affected by BMI for limbs.
Conclusion
In T2DM patients, underweight tends to increase fracture risk, and overweight tends to lower fracture risk, but association between BMI and fracture risk varied depending on the affected bone lesions.

Citations

Citations to this article as recorded by  
  • Dysuricemia—A New Concept Encompassing Hyperuricemia and Hypouricemia
    Naoyuki Otani, Motoshi Ouchi, Einosuke Mizuta, Asuka Morita, Tomoe Fujita, Naohiko Anzai, Ichiro Hisatome
    Biomedicines.2023; 11(5): 1255.     CrossRef
  • Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54)
    Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon
    Diabetes & Metabolism Journal.2023; 47(3): 439.     CrossRef
  • Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54)
    So Young Park
    Diabetes & Metabolism Journal.2023; 47(3): 437.     CrossRef
  • Effect of SGLT2 inhibitors on fractures, BMD, and bone metabolism markers in patients with type 2 diabetes mellitus: a systematic review and meta-analysis
    Xin Wang, Fengyi Zhang, Yufeng Zhang, Jiayi Zhang, Yingli Sheng, Wenbo Wang, Yujie Li
    Osteoporosis International.2023; 34(12): 2013.     CrossRef
Complication
Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial
Daniel Nyarko Hukportie, Fu-Rong Li, Rui Zhou, Jia-Zhen Zheng, Xiao-Xiang Wu, Xian-Bo Wu
Diabetes Metab J. 2022;46(5):767-780.   Published online May 10, 2022
DOI: https://doi.org/10.4093/dmj.2021.0258
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Obesity is associated with adverse health events among diabetic patients, however, the relationship between obesity fluctuation and risk of microvascular complications among this specific population is unclear. We aimed to examine the effect of waist circumference (WC) and body mass index (BMI) variability on the risk of diabetic microvascular outcome
Methods
Annually recorded anthropometric data in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was used to examine the association of WC and BMI variability defined as variability independent of mean, with the risk of microvascular outcomes, including neuropathy, nephropathy, and retinopathy. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) (Trial registration: ClinicalTrials.gov., no. NCT00000620).
Results
There were 4,031, 5,369, and 2,601 cases of neuropathy, nephropathy, and retinopathy during a follow-up period of 22,524, 23,941, and 23,850 person-years, respectively. Higher levels of WC and BMI variability were associated with an increased risk of neuropathy. Compared with the lowest quartile, the fully-adjusted HR (95% CI) for the highest quartile of WC and BMI variability for neuropathy risk were 1.21 (1.05 to 1.40) and 1.16 (1.00 to 1.33), respectively. Also, higher quartiles of BMI variability but not WC variability were associated with increased risk of nephropathic events. The fully-adjusted HR (95% CI) for the highest quartile compared with the lowest quartile of BMI variability was 1.31 (1.18 to 1.46). However, the results for retinopathic events were all insignificant.
Conclusion
Among participants with type 2 diabetes mellitus, WC and BMI variability were associated with a higher risk of neuropathic events, whereas BMI variability was associated with an increased risk of nephropathic events.

Citations

Citations to this article as recorded by  
  • Association of body mass index and blood pressure variability with 10-year mortality and renal disease progression in type 2 diabetes
    Stephen Fava, Sascha Reiff
    Acta Diabetologica.2024; 61(6): 747.     CrossRef
  • Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community‐based prospective study
    Jiaheng Chen, Yu Ting Li, Zimin Niu, Zhanpeng He, Yao Jie Xie, Jose Hernandez, Wenyong Huang, Harry H X Wang
    Diabetes, Obesity and Metabolism.2024; 26(7): 2796.     CrossRef
  • Serum Spexin Level Is Negatively Associated With Peripheral Neuropathy and Sensory Pain in Type 2 Diabetes
    Ying Liu, Di Wu, Hangping Zheng, Yunzhi Ni, Lu Zhu, Yaojing Jiang, Jiarong Dai, Quanya Sun, Ying Zhao, Qi Zhang, Yehong Yang, Rui Liu
    Journal of Diabetes Research.2024; 2024: 1.     CrossRef
  • Cardiovascular health metrics and diabetic nephropathy: a nationally representative cross-sectional study
    Yanpei Mai, Si Yan, Liya Gong
    International Urology and Nephrology.2024;[Epub]     CrossRef
  • Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial (Diabetes Metab J 2022;46:767-80)
    Yun Kyung Cho
    Diabetes & Metabolism Journal.2023; 47(1): 147.     CrossRef
  • Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial (Diabetes Metab J 2022;46:767-80)
    Daniel Nyarko Hukportie, Fu-Rong Li, Rui Zhou, Jia-Zhen Zheng, Xiao-Xiang Wu, Xian-Bo Wu
    Diabetes & Metabolism Journal.2023; 47(1): 150.     CrossRef
  • Weight variability and diabetes complications
    Francesco Prattichizzo, Chiara Frigé, Rosalba La Grotta, Antonio Ceriello
    Diabetes Research and Clinical Practice.2023; 199: 110646.     CrossRef
  • Risk Factors for Diabetic Retinopathy in Latin America (Mexico) and the World: A Systematic Review and Meta-Analysis
    Oscar Vivanco-Rojas, Sonia López-Letayf, Valentina Londoño-Angarita, Fátima Sofía Magaña-Guerrero, Beatriz Buentello-Volante, Yonathan Garfias
    Journal of Clinical Medicine.2023; 12(20): 6583.     CrossRef
  • Effects of body weight variability on risks of macro- and microvascular outcomes in individuals with type 2 diabetes: The Rio de Janeiro type 2 diabetes cohort
    Claudia R.L. Cardoso, Nathalie C. Leite, Gil F. Salles
    Diabetes Research and Clinical Practice.2023; 205: 110992.     CrossRef
  • Correlation Between the Variability of Different Obesity Indices and Diabetic Kidney Disease: A Retrospective Cohort Study Based on Populations in Taiwan
    Zhenzhen Sun, Kun Wang, Chuan Yun, Fang Bai, Xiaodan Yuan, Yaujiunn Lee, Qingqing Lou
    Diabetes, Metabolic Syndrome and Obesity.2023; Volume 16: 2791.     CrossRef
  • Unraveling shared risk factors for diabetic foot ulcer: a comprehensive Mendelian randomization analysis
    Kangli Yin, Tianci Qiao, Yongkang Zhang, Jiarui Liu, Yuzhen Wang, Fei Qi, Junlin Deng, Cheng Zhao, Yongcheng Xu, Yemin Cao
    BMJ Open Diabetes Research & Care.2023; 11(6): e003523.     CrossRef
Metabolic Risk/Epidemiology
Impact of Older Age Adiposity on Incident Diabetes: A Community-Based Cohort Study in China
Anthony Chen, Weiju Zhou, Jian Hou, Alan Nevill, Yuanlin Ding, Yuhui Wan, Rebecca Jester, Xia Qin, Zhi Hu, Ruoling Chen
Diabetes Metab J. 2022;46(5):733-746.   Published online April 29, 2022
DOI: https://doi.org/10.4093/dmj.2021.0215
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Obesity classifications vary globally and the impact of older age adiposity on incident diabetes has not been well-studied.
Methods
We examined a random sample of 2,809 participants aged ≥60 years in China, who were free of diabetes at baseline and were followed up for up to 10 years to document diabetes (n=178). The incidence of diabetes was assessed in relation to different cut-off points of body mass index (BMI) and waist circumference (WC) in multiple adjusted Cox regression models.
Results
The diabetic risk in the cohort increased linearly with the continuous and quartile variables of BMI and WC. The BMI-World Health Organization (WHO) and BMI-China criteria analysis did not show such a linear relationship, however, the BMI-Asian/Hong Kong criteria did; adjusted hazards ratio (HR) was 0.42 (95% confidence interval [CI], 0.20 to 0.90) in BMI <20 kg/m2, 1.46 (95% CI, 0.99 to 2.14) in 23–≤26 kg/m2, and 1.63 (95% CI, 1.09 to 2.45) in ≥26 kg/m2. The WC-China criteria revealed a slightly better prediction of diabetes (adjusted HRs were 1.79 [95% CI, 1.21 to 2.66] and 1.87 [95% CI, 1.22 to 2.88] in central obese action levels 1 and 2) than the WC-WHO. The combination of the BMI-Asian/Hong Kong with WC-China demonstrated the strongest prediction. There were no gender differences in the impact of adiposity on diabetes.
Conclusion
In older Chinese, BMI-Asian/Hong Kong criteria is a better predictor of diabetes than other BMI criterion. Its combination with WC-China improved the prediction of adiposity to diabetes, which would help manage bodyweight in older age to reduce the risk of diabetes.

Citations

Citations to this article as recorded by  
  • Investigating Gender and Age Variability in Diabetes Prediction: A Multi-Model Ensemble Learning Approach
    Rishi Jain, Nitin Kumar Tripathi, Millie Pant, Chutiporn Anutariya, Chaklam Silpasuwanchai
    IEEE Access.2024; 12: 71535.     CrossRef
  • Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China
    Jie Tang, Anthony Chen, Fan He, Martin Shipley, Alan Nevill, Hugh Coe, Zhi Hu, Tao Zhang, Haidong Kan, Eric Brunner, Xuguang Tao, Ruoling Chen
    Environmental Research.2023; 223: 115048.     CrossRef
  • Impact of fish consumption on all-cause mortality in older people with and without dementia: a community-based cohort study
    Aishat T. Bakre, Anthony Chen, Xuguang Tao, Jian Hou, Yuyou Yao, Alain Nevill, James J. Tang, Sabine Rohrmann, Jindong Ni, Zhi Hu, John Copeland, Ruoling Chen
    European Journal of Nutrition.2022; 61(7): 3785.     CrossRef
Short Communication
Metabolic Risk/Epidemiology
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Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus
Minji Kim, Kyu-Yeon Hur, Suk-Joo Choi, Soo-Young Oh, Cheong-Rae Roh
Diabetes Metab J. 2022;46(3):499-505.   Published online January 24, 2022
DOI: https://doi.org/10.4093/dmj.2021.0059
  • 5,568 View
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  • 3 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

Citations

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  • Challenges in the management of gestational diabetes mellitus in anorexia nervosa
    Rija Siddiqui, Carrie J McAdams
    Psychiatry Research Case Reports.2024; 3(1): 100215.     CrossRef
  • Is gestational diabetes mellitus in lean women a distinct entity warranting a modified management approach?
    Pradnyashree Wadivkar, Meredith Hawkins
    Frontiers in Clinical Diabetes and Healthcare.2024;[Epub]     CrossRef
  • Obesity Is Associated With Higher Risk of Adverse Maternal and Neonatal Outcomes Than Supervised Gestational Diabetes
    Namju Seo, You Min Lee, Ye-jin Kim, Ji-hee Sung, Kyu-Yeon Hur, Suk-Joo Choi, Cheong-Rae Roh, Soo-young Oh
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • Maternal pre-pregnancy obesity modifies the association between first-trimester thyroid hormone sensitivity and gestational Diabetes Mellitus: a retrospective study from Northern China
    Honglin Sun, Yibo Zhou, Jia Liu, Ying Wang, Guang Wang
    Diabetology & Metabolic Syndrome.2023;[Epub]     CrossRef
Original Articles
Metabolic Risk/Epidemiology
Article image
Level of Organochlorine Pesticide in Prediabetic and Newly Diagnosed Diabetes Mellitus Patients with Varying Degree of Glucose Intolerance and Insulin Resistance among North Indian Population
Shipra Tyagi, Brijesh Kumar Mishra, Tusha Sharma, Neha Tawar, Abdul Jamil Urfi, Basu Dev Banerjee, Sri Venkata Madhu
Diabetes Metab J. 2021;45(4):558-568.   Published online January 15, 2021
DOI: https://doi.org/10.4093/dmj.2020.0093
  • 5,269 View
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Organochlorine pesticides (OCPs) exposure may induce an endocrine disruption which may lead to the risk of developing diabetes through alteration and disturbance of glucose metabolism, insulin resistance, and destruction of β-cells. The present study determines the recent trend of OCPs residue in blood samples and their association with the known risk factors responsible for developing the risk of diabetes among the North Indian population.
Methods
Blood sample of 300 patients (100 each of normal glucose tolerance [NGT], prediabetes and newly detected diabetes mellitus [DM]) between the age group of 30 to 70 years were collected. OCPs residue in whole blood samples was analyzed by using gas chromatography equipped with a 63Ni selective electron capture detector.
Results
Significantly higher levels of β-hexachlorocyclohexane (HCH), dieldrin, and p,p’-dichloro-diphenyl-dichloroethylene (DDE) were found in the prediabetes and newly detected DM groups as compared to NGT group. Insulin resistance showed to be significantly positive correlation with β-HCH and dieldrin. Also, fasting and postprandial glucose levels were significantly positively correlated with levels of β-HCH, dieldrin, and p,p’-DDE. Further, when OCPs level was adjusted for age and body mass index (BMI), it was found that β-HCH, dieldrin, and p,p’-DDE levels in blood increases the risk of diabetes by 2.70, 2.83, and 2.55 times respectively. Moreover, when we adjust OCPs level based on BMI categories (BMI <23, ≥23, and ≤25, and >25 kg/m2); β-HCH and p,p’-DDE showed a significant risk of developing newly detected DM with BMI >25 and ≥23 and ≤25 kg/m2.
Conclusion
The OCPs level present in the environment may be responsible for biological, metabolic, and endocrine disruptions within the human body which may increase the risk of developing newly detected DM. Hence, OCPs exposure can play a crucial role in the etiology of diabetes.

Citations

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  • Combined effects of organochlorine pesticides on type 2 diabetes mellitus: Insights from endocrine disrupting effects of hormones
    Jiayu Shi, Dandan Wei, Cuicui Ma, Jintian Geng, Mengzhen Zhao, Jian Hou, Wenqian Huo, Tao Jing, Chongjian Wang, Zhenxing Mao
    Environmental Pollution.2024; 341: 122867.     CrossRef
  • Associations of chronic exposure to a mixture of pesticides and type 2 diabetes mellitus in a Chinese elderly population
    Tian Chen, Xiaohua Liu, Jianghua Zhang, Lulu Wang, Jin Su, Tao Jing, Ping Xiao
    Chemosphere.2024; 351: 141194.     CrossRef
  • Deciphering the complex interplay of risk factors in type 2 diabetes mellitus: A comprehensive review
    Samradhi Singh, Mona Kriti, Anamika K.S., Devojit Kumar Sarma, Vinod Verma, Ravinder Nagpal, Dheeraj Mohania, Rajnarayan Tiwari, Manoj Kumar
    Metabolism Open.2024; 22: 100287.     CrossRef
  • Application of In Vitro Models for Studying the Mechanisms Underlying the Obesogenic Action of Endocrine-Disrupting Chemicals (EDCs) as Food Contaminants—A Review
    Monika Kowalczyk, Jakub P. Piwowarski, Artur Wardaszka, Paulina Średnicka, Michał Wójcicki, Edyta Juszczuk-Kubiak
    International Journal of Molecular Sciences.2023; 24(2): 1083.     CrossRef
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    Yile Wei, Linping Wang, Jing Liu
    Environmental Pollution.2023; 331: 121927.     CrossRef
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    Ali Arab, Sara Mostafalou
    Pesticide Biochemistry and Physiology.2023; 195: 105521.     CrossRef
  • Circulating organochlorine pesticide levels, genetic predisposition and the risk of incident type 2 diabetes
    Chengyong Jia, Shiyang Zhang, Xu Cheng, Peiwen Li, Jun An, Xin Zhang, Wending Li, Yali Xu, Handong Yang, Tao Jing, Huan Guo, Meian He
    Environmental Pollution.2023; 337: 122541.     CrossRef
  • Targets for pollutants in rat and human pancreatic beta-cells: The effect of prolonged exposure to sub-lethal concentrations of hexachlorocyclohexane isomers on the expression of function- and survival-related proteins
    Nela Pavlíková, Jan Šrámek, Martin Jaček, Jan Kovář, Vlasta Němcová
    Environmental Toxicology and Pharmacology.2023; 104: 104299.     CrossRef
  • Association of Organochlorine Pesticides With Genetic Markers of Endoplasmic Reticulum Stress in Type 2 Diabetes Mellitus: A Case–Control Study Among the North-Indian Population
    Neha Tawar, Basu Dev Banerjee, Sri Venkata Madhu, Vivek Agrawal, Sanjay Gupta
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Acaricidal and insecticidal efficacy of new esters derivatives of a natural coumarin osthole
    Xijie Shan, Min Lv, Jingru Wang, Yujia Qin, Hui Xu
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Cardiovascular Risk/Epidemiology
Article image
Associations among Obesity Degree, Glycemic Status, and Risk of Heart Failure in 9,720,220 Korean Adults
Eun-Jung Rhee, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Yong-Gyu Park, Yang-Hyun Kim, Won-Young Lee
Diabetes Metab J. 2020;44(4):592-601.   Published online April 20, 2020
DOI: https://doi.org/10.4093/dmj.2019.0104
Correction in: Diabetes Metab J 2020;44(5):783
  • 7,076 View
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  • 16 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Recent studies suggest an association between diabetes and increased risk of heart failure (HF). However, the associations among obesity status, glycemic status, and risk of HF are not known. In this study, we analyzed whether the risk of HF increases in participants according to baseline glycemic status and whether this increased risk is associated with obesity status.

Methods

We analyzed the risk of HF according to baseline glycemic status (normoglycemia, impaired fasting glucose [IFG], and diabetes) in 9,720,220 Koreans who underwent Korean National Health Screening in 2009 without HF at baseline with a median follow-up period of 6.3 years. The participants were divided into five and six groups according to baseline body mass index (BMI) and waist circumference, respectively.

Results

Participants with IFG and those with diabetes showed a 1.08- and 1.86-fold increased risk of HF, respectively, compared to normoglycemic participants. Compared to the normal weight group (BMI, 18.5 to 22.9 kg/m2), the underweight group (BMI <18.5 kg/m2) showed a 1.7-fold increased risk of HF, and those with BMI ≥30 kg/m2 showed a 1.1-fold increased risk of HF, suggesting a J-shaped association with BMI. When similar analyses were performed for different glycemic statuses, the J-shaped association between BMI and HF risk was consistently observed in both groups with and without diabetes.

Conclusion

Participants with IFG and diabetes showed a significantly increased HF risk compared to normoglycemic participants. This increased risk of HF was mostly prominent in underweight and class II obese participants than in participants with normal weight.

Citations

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  • Association between underweight and risk of heart failure in diabetes patients
    Tae Kyung Yoo, Kyung‐Do Han, Eun‐Jung Rhee, Won‐Young Lee
    Journal of Cachexia, Sarcopenia and Muscle.2024; 15(2): 671.     CrossRef
  • Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database
    Sun Wook Cho, Jung Hee Kim, Han Seok Choi, Hwa Young Ahn, Mee Kyoung Kim, Eun Jung Rhee
    Endocrinology and Metabolism.2023; 38(1): 10.     CrossRef
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    Eun-Jung Rhee
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    Tae Kyung Yoo, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee
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    Tae Kyung Yoo, Kyung-Do Han, Yang-Hyun Kim, Ga Eun Nam, Sang Hyun Park, Eun-Jung Rhee, Won-Young Lee
    Diabetes & Metabolism Journal.2023; 47(6): 846.     CrossRef
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    Hazhmat Ali
    Al-Kufa University Journal for Biology.2023; 15(3): 28.     CrossRef
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    Eun-Jung Rhee
    Endocrinology and Metabolism.2022; 37(1): 1.     CrossRef
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    Inha Jung, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee
    Diabetes & Metabolism Journal.2022; 46(2): 327.     CrossRef
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    Kyung-Soo Kim, Sangmo Hong, You-Cheol Hwang, Hong-Yup Ahn, Cheol-Young Park
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    Seon-Ah Cha, Jae-Seung Yun, Gee-Hee Kim, Yu-Bae Ahn
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    O. V. Tsygankova, N. E. Evdokimova, V. V. Veretyuk, L. D. Latyntseva, A. S. Ametov
    Diabetes mellitus.2022; 25(6): 535.     CrossRef
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    Tae-Eun Kim, Hyeongsu Kim, JiDong Sung, Duk-Kyung Kim, Myoung-Soon Lee, Seong Woo Han, Hyun-Joong Kim, Sung Hea Kim, Kyu-Hyung Ryu
    Epidemiology and Health.2022; 44: e2022078.     CrossRef
  • Diabetes and Heart Failure
    Eun-Jung Rhee
    The Journal of Korean Diabetes.2021; 22(1): 12.     CrossRef
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    Xiaoyan Cai, Xiong Liu, Lichang Sun, Yiting He, Sulin Zheng, Yang Zhang, Yuli Huang
    Diabetes, Obesity and Metabolism.2021; 23(8): 1746.     CrossRef
  • Diabetes and Heart Failure
    Eun-Jung Rhee
    Cardiovascular Prevention and Pharmacotherapy.2021; 3(2): 21.     CrossRef
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    An Yan, Guinan Xie, Xinya Ding, Yi Wang, Liping Guo
    Hormone and Metabolic Research.2021; 53(12): 771.     CrossRef
  • Obesity Degree and Glycemic Status: Factors That Should Be Considered in Heart Failure
    Hye Soon Kim
    Diabetes & Metabolism Journal.2020; 44(4): 529.     CrossRef
  • Letter: Associations among Obesity Degree, Glycemic Status, and Risk of Heart Failure in 9,720,220 Korean Adults (Diabetes Metab J 2020;44:592-601)
    Darae Kim
    Diabetes & Metabolism Journal.2020; 44(5): 777.     CrossRef
  • Response: Associations among Obesity Degree, Glycemic Status, and Risk of Heart Failure in 9,720,220 Korean Adults (Diabetes Metab J 2020;44:592-601)
    Eun-Jung Rhee, Won-Young Lee
    Diabetes & Metabolism Journal.2020; 44(5): 781.     CrossRef
Genetics
Severity of Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus: Relationship between Nongenetic Factors and PNPLA3/HSD17B13 Polymorphisms
Mattia Bellan, Cosimo Colletta, Matteo Nazzareno Barbaglia, Livia Salmi, Roberto Clerici, Venkata Ramana Mallela, Luigi Mario Castello, Giuseppe Saglietti, Gian Piero Carnevale Schianca, Rosalba Minisini, Mario Pirisi
Diabetes Metab J. 2019;43(5):700-710.   Published online July 29, 2019
DOI: https://doi.org/10.4093/dmj.2018.0201
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AbstractAbstract PDFPubReader   
Background

The prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM) is high, though its severity is often underestimated. Our aim is to provide an estimate of the prevalence of severe NAFLD in T2DM and identify its major predictors.

Methods

T2DM patients (n=328) not previously known to have NAFLD underwent clinical assessment, transient elastography with measure of liver stiffness (LS) and controlled attenuation parameter (CAP), and genotyping for patatin like phospholipase domain containing 3 (PNPLA3) and 17β-hydroxysteroid-dehydrogenase type 13 (HSD17B13).

Results

Median LS was 6.1 kPa (4.9 to 8.6). More than one-fourth patients had advanced liver disease, defined as LS ≥7.9 kPa (n=94/238, 29%), and had a higher body mass index (BMI) than those with a LS <7.9 kPa. Carriage of the G allele in the PNPLA3 gene was associated with higher LS, being 5.9 kPa (4.7 to 7.7) in C/C homozygotes, 6.1 kPa (5.2 to 8.7) in C/G heterozygotes, and 6.8 kPa (5.8 to 9.2) in G/G homozygotes (P=0.01). This trend was absent in patients with ≥1 mutated HSD17B13 allele. In a multiple linear regression model, BMI and PNPLA3 genotype predicted LS, while age, gender, disease duration, and glycosylated hemoglobin did not fit into the model. None of these variables was confirmed to be predictive among carriers of at least one HSD17B13 mutated allele. There was no association between CAP and polymorphisms of PNPLA3 or HSD17B13.

Conclusion

Advanced NAFLD is common among T2DM patients. LS is predicted by both BMI and PNPLA3 polymorphism, the effect of the latter being modulated by mutated HSD17B13.

Citations

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  • miRNA and lncRNA as potential tissue biomarkers in hepatocellular carcinoma
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  • Review article: the role of HSD17B13 on global epidemiology, natural history, pathogenesis and treatment of NAFLD
    Maral Amangurbanova, Daniel Q. Huang, Rohit Loomba
    Alimentary Pharmacology & Therapeutics.2023; 57(1): 37.     CrossRef
  • Identification of shared genetic architecture between non-alcoholic fatty liver disease and type 2 diabetes: A genome-wide analysis
    Yajing Tan, Qian He, Kei Hang Katie Chan
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Polymorphisms of HSD17B13, GCKR, HFE, and CP as factors of the development of non-alcoholic fatty liver disease and comorbid diseases
    O. V. Smirnova, D. V. Lagutinskaya
    Meditsinskiy sovet = Medical Council.2023; (8): 119.     CrossRef
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    Elina En Li Cho, Chong Zhe Ang, Jingxuan Quek, Clarissa Elysia Fu, Lincoln Kai En Lim, Zane En Qi Heng, Darren Jun Hao Tan, Wen Hui Lim, Jie Ning Yong, Rebecca Zeng, Douglas Chee, Benjamin Nah, Cosmas Rinaldi Adithya Lesmana, Aung Hlaing Bwa, Khin Maung W
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    Pablo Gabriel-Medina, Roser Ferrer-Costa, Francisco Rodriguez-Frias, Andreea Ciudin, Salvador Augustin, Jesus Rivera-Esteban, Juan M. Pericàs, David Martinez Selva
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    Kyung‐Soo Kim, Sangmo Hong, Hong‐Yup Ahn, Cheol‐Young Park
    Obesity.2022; 30(6): 1279.     CrossRef
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    Stefano Ciardullo, Gianluca Perseghin
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    Wen-Yue Liu, Mohammed Eslam, Kenneth I. Zheng, Hong-Lei Ma, Rafael S. Rios, Min-Zhi Lv, Gang Li, Liang-Jie Tang, Pei-Wu Zhu, Xiao-Dong Wang, Christopher D. Byrne, Giovanni Targher, Jacob George, Ming-Hua Zheng
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Obesity and Metabolic Syndrome
The Association between Z-Score of Log-Transformed A Body Shape Index and Cardiovascular Disease in Korea
Wankyo Chung, Jung Hwan Park, Hye Soo Chung, Jae Myung Yu, Shinje Moon, Dong Sun Kim
Diabetes Metab J. 2019;43(5):675-682.   Published online April 26, 2019
DOI: https://doi.org/10.4093/dmj.2018.0169
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

In order to overcome the limitations of body mass index (BMI) and waist circumference (WC), the z-score of the log-transformed A Body Shape Index (LBSIZ) has recently been introduced. In this study, we analyzed the relationship between the LBSIZ and cardiovascular disease (CVD) in a Korean representative sample.

Methods

Data were collected from the Korea National Health and Nutrition Examination VI to V. The association between CVD and obesity indices was analyzed using a receiver operating characteristic curve. The cut-off value for the LBSIZ was estimated using the Youden index, and the odds ratio (OR) for CVD was determined via multivariate logistic regression analysis. ORs according to the LBSIZ value were analyzed using restricted cubic spline regression plots.

Results

A total of 31,227 Korean healthy adults were analyzed. Area under the curve (AUC) of LBSIZ against CVD was 0.686 (95% confidence interval [CI], 0.671 to 0.702), which was significantly higher than the AUC of BMI (0.583; 95% CI, 0.567 to 0.599) or WC (0.646; 95% CI, 0.631 to 0.661) (P<0.001). Similar results were observed for stroke and coronary artery diseases. The cut-off value for the LBSIZ was 0.35 (sensitivity, 64.5%; specificity, 64%; OR, 1.29, 95% CI, 1.12 to 1.49). Under restricted cubic spline regression, LBSIZ demonstrated that OR started to increase past the median value.

Conclusion

The findings of this study suggest that the LBSIZ might be more strongly associated with CVD risks compared to BMI or WC. These outcomes would be helpful for CVD risk assessment in clinical settings, especially the cut-off value of the LBSIZ suggested in this study.

Citations

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  • Body Shape Index and Cardiovascular Risk in Individuals With Obesity
    Nazlı Hacıağaoğlu, Can Öner, Hüseyin Çetin, Engin Ersin Şimşek
    Cureus.2022;[Epub]     CrossRef
  • Association between body shape index and risk of mortality in the United States
    Heysoo Lee, Hye Soo Chung, Yoon Jung Kim, Min Kyu Choi, Yong Kyun Roh, Wankyo Chung, Jae Myung Yu, Chang-Myung Oh, Shinje Moon
    Scientific Reports.2022;[Epub]     CrossRef
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    Scientific Reports.2019;[Epub]     CrossRef
Obesity and Metabolic Syndrome
The Risk of Myocardial Infarction and Ischemic Stroke According to Waist Circumference in 21,749,261 Korean Adults: A Nationwide Population-Based Study
Jung-Hwan Cho, Eun-Jung Rhee, Se-Eun Park, Hyemi Kwon, Jin-Hyung Jung, Kyung-Do Han, Yong-Gyu Park, Hye Soon Park, Yang-Hyun Kim, Soon-Jib Yoo, Won-Young Lee
Diabetes Metab J. 2019;43(2):206-221.   Published online December 27, 2018
DOI: https://doi.org/10.4093/dmj.2018.0039
  • 6,141 View
  • 107 Download
  • 24 Web of Science
  • 24 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Waist circumference (WC) is a well-known obesity index that predicts cardiovascular disease (CVD). We studied the relationship between baseline WC and development of incident myocardial infarction (MI) and ischemic stroke (IS) using a nationwide population-based cohort, and evaluated if its predictability is better than body mass index (BMI).

Methods

Our study included 21,749,261 Koreans over 20 years of age who underwent the Korean National Health Screening between 2009 and 2012. The occurrence of MI or IS was investigated until the end of 2015 using National Health Insurance Service data.

Results

A total of 127,289 and 181,637 subjects were newly diagnosed with MI and IS. The incidence rate and hazard ratio of MI and IS increased linearly as the WC level increased, regardless of adjustment for BMI. When the analyses were performed according to 11 groups of WC, the lowest risk of MI was found in subjects with WC of 70 to 74.9 and 65 to 69.9 cm in male and female, and the lowest risk of IS in subjects with WC of 65 to 69.9 and 60 to 64.9 cm in male and female, respectively. WC showed a better ability to predict CVD than BMI with smaller Akaike information criterion. The optimal WC cutoffs were 84/78 cm for male/female for predicting MI, and 85/78 cm for male/female for predicting IS.

Conclusion

WC had a significant linear relationship with the risk of MI and IS and the risk began to increase from a WC that was lower than expected.

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  • Usefulness of New Criteria for Metabolic Syndrome Optimized for Prediction of Cardiovascular Diseases in Japanese
    Yurie Yamazaki, Kazuya Fujihara, Takaaki Sato, Mayuko Harada Yamada, Yuta Yaguchi, Yasuhiro Matsubayashi, Takaho Yamada, Satoru Kodama, Kiminori Kato, Hitoshi Shimano, Hirohito Sone
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    Ji Soo Kim, Jihun Song, Seulggie Choi, Sung Min Kim, Young Jun Park, Sun Jae Park, Yoosun Cho, Yun Hwan Oh, Seogsong Jeong, Kyae Hyung Kim, Sang Min Park
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    Dae Young Cheon, Kyung do Han, Yeon Jung Lee, Jeen Hwa Lee, Myung Soo Park, Do Young Kim, Jae Hyuk Choi, Sook Jin Lee, Kyung-Ho Yu, Seongwoo Han, Sunki Lee, Minwoo Lee
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    Jung Eun Yoo, Kyungdo Han, Jin‐Hyung Jung, Yang‐Im Hur, Yang Hyun Kim, Eun Sook Kim, Jang Won Son, Eun‐Jung Rhee, Won‐Young Lee, Ga Eun Nam
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    Hye Soon Kim
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    Ga Eun Nam, Yang-Hyun Kim, Kyungdo Han, Jin-Hyung Jung, Yong Gyu Park, Kwan-Woo Lee, Eun-Jung Rhee, Jang Won Son, Seong-Su Lee, Hyuk-Sang Kwon, Won-Young Lee, Soon Jib Yoo
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  • Letter: Association of Z-Score of the Log-Transformed A Body Shape Index with Cardiovascular Disease in People Who Are Obese but Metabolically Healthy: The Korea National Health and Nutrition Examination Survey 2007-2010 (J Obes Metab Syndr 2018;27:158-65
    Eun-Jung Rhee
    Journal of Obesity & Metabolic Syndrome.2019; 28(2): 139.     CrossRef
  • Response: The Differential Association between Muscle Strength and Diabetes Mellitus According to the Presence or Absence of Obesity (J Obes Metab Syndr 2019;28:46-52)
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Epidemiology
Association of Thigh Muscle Mass with Insulin Resistance and Incident Type 2 Diabetes Mellitus in Japanese Americans
Seung Jin Han, Edward J. Boyko, Soo-Kyung Kim, Wilfred Y. Fujimoto, Steven E. Kahn, Donna L. Leonetti
Diabetes Metab J. 2018;42(6):488-495.   Published online September 5, 2018
DOI: https://doi.org/10.4093/dmj.2018.0022
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AbstractAbstract PDFPubReader   
Background

Skeletal muscle plays a major role in glucose metabolism. We investigated the association between thigh muscle mass, insulin resistance, and incident type 2 diabetes mellitus (T2DM) risk. In addition, we examined the role of body mass index (BMI) as a potential effect modifier in this association.

Methods

This prospective study included 399 Japanese Americans without diabetes (mean age 51.6 years) who at baseline had an estimation of thigh muscle mass by computed tomography and at baseline and after 10 years of follow-up a 75-g oral glucose tolerance test and determination of homeostasis model assessment of insulin resistance (HOMA-IR). We fit regression models to examine the association between thigh muscle area and incidence of T2DM and change in HOMA-IR, both measured over 10 years.

Results

Thigh muscle area was inversely associated with future HOMA-IR after adjustment for age, sex, BMI, HOMA-IR, fasting plasma glucose, total abdominal fat area, and thigh subcutaneous fat area at baseline (P=0.033). The 10-year cumulative incidence of T2DM was 22.1%. A statistically significant interaction between thigh muscle area and BMI was observed, i.e., greater thigh muscle area was associated with lower risk of incident T2DM for subjects at lower levels of BMI, but this association diminished at higher BMI levels.

Conclusion

Thigh muscle mass area was inversely associated with future insulin resistance. Greater thigh muscle area predicts a lower risk of incident T2DM for leaner Japanese Americans.

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Obesity and Metabolic Syndrome
Associations between Body Mass Index and Chronic Kidney Disease in Type 2 Diabetes Mellitus Patients: Findings from the Northeast of Thailand
Sojib Bin Zaman, Naznin Hossain, Muntasirur Rahman
Diabetes Metab J. 2018;42(4):330-337.   Published online August 21, 2018
DOI: https://doi.org/10.4093/dmj.2017.0052
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AbstractAbstract PDFPubReader   
Background

Chronic kidney disease (CKD) has emerged as a public health burden globally. Obesity and long-term hyperglycaemia can initiate the renal vascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the association of body mass index (BMI) with the CKD in patients with T2DM.

Methods

This study has used retrospective medical records, biochemical reports, and anthropometric measurements of 3,580 T2DM patients which were collected between January to December 2015 from a district hospital in Thailand. CKD was defined according to the measurement of estimated glomerular filtration rate (<60 mL/min/1.73 m2). Multiple logistic regression analysis was used to explore the association between BMI and CKD in patients with T2DM.

Results

The mean age of the participants was 60.86±9.67 years, 53.68% had poor glycaemic control, and 45.21% were overweight. About one-in-four (23.26%) T2DM patients had CKD. The mean BMI of non-CKD group was slightly higher (25.30 kg/m2 vs. 24.30 kg/m2) when compared with CKD patients. Multivariable analysis showed that older age, female sex, hypertension, and microalbuminuria were associated with the presence of CKD. No association was observed between CKD and poorly controlled glycosylated hemoglobin or hypercholesterolemia. Adjusted analysis further showed overweight and obesity were negatively associated with CKD (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.58 to 0.93) and (AOR, 0.53; 95% CI, 0.35 to 0.81), respectively.

Conclusion

The negative association of BMI with CKD could reflect the reverse causality. Lower BMI might not lead a diabetic patient to develop CKD, but there are possibilities that CKD leads the patient to experience reduced BMI.

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Review
Epidemiology
The Evidence for an Obesity Paradox in Type 2 Diabetes Mellitus
Seung Jin Han, Edward J. Boyko
Diabetes Metab J. 2018;42(3):179-187.   Published online May 31, 2018
DOI: https://doi.org/10.4093/dmj.2018.0055
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AbstractAbstract PDFPubReader   

Although overweight/obesity is a major risk factor for the development of type 2 diabetes mellitus, there is increasing evidence that overweight or obese patients with type 2 diabetes mellitus experience lower mortality compared with patients of normal weight. This paradoxical finding, known as the “obesity paradox,” occurs in other chronic diseases, and in type 2 diabetes mellitus is particularly perplexing given that lifestyle intervention with one goal being weight reduction is an important feature of the management of this condition. We summarize in this review the findings from clinical and epidemiologic studies that have investigated the association between overweight and obesity (usually assessed using body mass index [BMI]) and mortality in type 2 diabetes mellitus and discuss potential causes of the obesity paradox. We conclude that most studies show evidence of an obesity paradox, but important conflicting findings still exist. We also evaluate if potential bias might explain the obesity paradox in diabetes, including, for example, the presence of confounding factors, measurement error due to use of BMI as an index of obesity, and reverse causation.

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Original Articles
Obesity and Metabolic Syndrome
Association between Blood Mercury Level and Visceral Adiposity in Adults
Jong Suk Park, Kyoung Hwa Ha, Ka He, Dae Jung Kim
Diabetes Metab J. 2017;41(2):113-120.   Published online December 21, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.2.113
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AbstractAbstract PDFPubReader   
Background

Few studies have examined the association between mercury exposure and obesity. The aim of this study is to investigate the association between blood mercury concentrations and indices of obesity in adults.

Methods

A total of 200 healthy subjects, aged 30 to 64 years, who had no history of cardiovascular or malignant disease, were examined. Anthropometric and various biochemical profiles were measured. Visceral adipose tissue (VAT) was measured using dual-energy X-ray absorptiometry (DXA).

Results

All subjects were divided into three groups according to blood mercury concentrations. Compared with the subjects in the lowest tertile of mercury, those in the highest tertile were more likely to be male; were current alcohol drinkers and smokers; had a higher body mass index (BMI), waist circumference (WC), and VAT; had higher levels of blood pressure, fasting glucose, and insulin resistance; and consumed more fish. The blood mercury concentration was significantly associated with anthropometric parameters, showing relationships with BMI, WC, and VAT. After adjusting for multiple risk factors, the odds ratios (ORs) for high mercury concentration was significantly higher in the highest VAT tertile than in the lowest VAT tertile (OR, 2.66; 95% confidence interval, 1.05 to 6.62; P<0.05).

Conclusion

The blood mercury concentration was significantly associated with VAT in healthy adults. Further studies are warranted to confirm our findings.

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The Relationship between the Level of Fatness and Fitness during Adolescence and the Risk Factors of Metabolic Disorders in Adulthood
Yoonsuk Jekal, Ji Eun Yun, Sang Wook Park, Sun Ha Jee, Justin Y Jeon
Korean Diabetes J. 2010;34(2):126-134.   Published online April 30, 2010
DOI: https://doi.org/10.4093/kdj.2010.34.2.126
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AbstractAbstract PDFPubReader   
Background

The purpose of the current study was to investigate the association between the level of obesity and physical fitness (PF) during adolescence and the risk factors of metabolic disorders during adulthood.

Methods

In the current analysis, 3,993 Korean adults (mean age, 38.70 ± 1.69 years) were recruited. The level of body index (BI) and PF were examined during adolescence through high school record, and their health examination data, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG), total cholesterol (TC), and current body mass index (BMI) were obtained from National Health Insurance Corporation Data. Gender-specific analyses were administered to compare health exam data across the level of BI, the level of PF, and a mixed level of BI and PF.

Results

Most obese males during high school had statistically higher SBP, DBP, FG, and BMI in adulthood, and most obese females had higher BMI, as compared to most lean males or females. Least fit males during high school had statistically higher BMI in adulthood, and least fit females had statistically higher SBP, DBP, FG, TC, and BMI, as compared to most fit males or females. There was a significant relationship between the mixed level of BI and PF and SBP, DBP, TC and current BMI in both genders.

Conclusion

Maintaining a healthy level of body weight and PF during adolescence is recommended to prevent the development of metabolic diseases in adulthood.

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