Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Differential Impact of Obesity on the Risk of Diabetes Development in Two Age Groups: Analysis from the National Health Screening Program: Tae Kyung Yoo, Kyung-Do Han, Yang-Hyun Kim, Ga Eun Nam, Sang Hyun Park, Eun-Jung Rhee, Won-Young Lee; Diabetes Metab J. 2023;47(6):846-858. Published online August 23, 2023; DOI: https://doi.org/10.4093/dmj.2022.0242

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Abstract PDF Supplementary Material PubReader ePub: Background
The effect of obesity on the development of type 2 diabetes mellitus (DM) in different age groups remains unclear. We assessed the impact of obesity on the development of DM for two age groups (40-year-old, middle age; 66-year-old, older adults) in the Korean population.
Methods
We analyzed Korean National Health Insurance Service data of 4,145,321 Korean adults with 40- and 66-year-old age without DM, between 2009 and 2014. Participants were followed up until 2017 or until the diagnosis of DM. We assessed the risk of DM based on the body mass index and waist circumference of the participants. Multiple confounding factors were adjusted.
Results
The median follow-up duration was 5.6 years. The association of general and abdominal obesity with the risk of DM development was stronger in the 40-year-old group (general obesity: hazard ratio [HR], 3.566, 95% confidence interval [CI], 3.512 to 3.622; abdominal obesity: HR, 3.231; 95% CI, 3.184 to 3.278) than in the 66-year-old group (general obesity: HR, 1.739; 95% CI, 1.719 to 1.759; abdominal obesity: HR, 1.799; 95% CI, 1.778 to 1.820). In the 66-year-old group, abdominal obesity had a stronger association with the development of DM as compared to general obesity. In the 40-year-old group, general obesity had a stronger association with the risk of DM development than abdominal obesity.
Conclusion
The influence of general and abdominal obesity on the development of DM differed according to age. In older adults, abdominal obesity had a stronger association with DM development than general obesity.

Lifestyle
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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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
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

Cardiovascular Risk/Epidemiology
Clinical Significance of Body Fat Distribution in Coronary Artery Calcification Progression in Korean Population: Heesun Lee, Hyo Eun Park, Ji Won Yoon, Su-Yeon Choi; Diabetes Metab J. 2021;45(2):219-230. Published online October 28, 2020; DOI: https://doi.org/10.4093/dmj.2019.0161; Correction in: Diabetes Metab J 2021;45(6):974

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Background
Although obesity differs according to ethnicity, it is globally established as a solid risk factor for cardiovascular disease. However, it is not fully understood how obesity parameters affect the progression of coronary artery calcification (CAC) in Korean population. We sought to evaluate the association of obesity-related parameters including visceral adipose tissue (VAT) measurement and CAC progression.
Methods
This retrospective observational cohort study investigated 1,015 asymptomatic Korean subjects who underwent serial CAC scoring by computed tomography (CT) with at least 1-year interval and adipose tissue measurement using non-contrast CT at baseline for a routine checkup between 2003 and 2015. CAC progression, the main outcome, was defined as a difference of ≥2.5 between the square roots of the baseline and follow-up CAC scores using Agatston units.
Results
During follow-up (median 39 months), 37.5% of subjects showed CAC progression of a total population (56.4 years, 80.6% male). Body mass index (BMI) ≥25 kg/m², increasing waist circumferences (WC), and higher VAT/subcutaneous adipose tissue (SAT) area ratio were independently associated with CAC progression. Particularly, predominance of VAT over SAT at ≥30% showed the strongest prediction for CAC progression (adjusted hazard ratio, 2.20; P<0.001) and remained of prognostic value regardless of BMI or WC status. Further, it provided improved risk stratification of CAC progression beyond known prognosticators.
Conclusion
Predominant VAT area on CT is the strongest predictor of CAC progression regardless of BMI or WC in apparently healthy Korean population. Assessment of body fat distribution may be helpful to identify subjects at higher risk.

Citations

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Gender-specific abdominal fat distribution and insulin resistance associated with organophosphate esters and phthalate metabolites exposure
Xiaoliu Shi, Wanyue Wang, Jiafan Feng, Xiaochun Ma, Mengting Xu, Cui Wang
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The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis
Amirhossein Tajani, Masoumeh Sadeghi, Navid Omidkhoda, Amir Hooshang Mohammadpour, Sara Samadi, Vahid Jomehzadeh
BMC Cardiovascular Disorders.2024;[Epub] CrossRef
Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study
Neftali Eduardo Antonio-Villa, Juan Gabriel Juárez-Rojas, Rosalinda Posadas-Sánchez, Juan Reyes-Barrera, Aida Medina-Urrutia
Cardiovascular Diabetology.2023;[Epub] CrossRef
Deep learning-based prediction for significant coronary artery stenosis on coronary computed tomography angiography in asymptomatic populations
Heesun Lee, Bong Gyun Kang, Jeonghee Jo, Hyo Eun Park, Sungroh Yoon, Su-Yeon Choi, Min Joo Kim
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Relationship between a novel non–insulin-based metabolic score for insulin resistance (METS‐IR) and coronary artery calcification
Zhenwei Wang, Xiaofang Hui, Xu Huang, Jingjie Li, Naifeng Liu
BMC Endocrine Disorders.2022;[Epub] CrossRef
Association Between Abdominal Adipose Tissue Distribution and Risk of Endometrial Cancer: A Case-Control Study
Yuan Cheng, Zhongyu Wang, Xiaoxuan Jia, Rong Zhou, Jianliu Wang
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Sex differences in cardiovascular risk may be related to sex differences in diet patterns: a narrative review
A. M. Tindall, V. A. Stallings
Annals of Human Biology.2021; 48(6): 517. CrossRef

Metabolic Risk/Epidemiology
Association of Soybean Food Intake and Cardiometabolic Syndrome in Korean Women: Korea National Health and Nutrition Examination Survey (2007 to 2011): Sook-Hyun Jun, Woo-Kyoung Shin, Yookyung Kim; Diabetes Metab J. 2020;44(1):143-157. Published online December 2, 2019; DOI: https://doi.org/10.4093/dmj.2019.0078

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Background

Soybean food consumption has been considered as a possible way to lower incidence of cardiometabolic syndrome (CMS) among Asians. However, results from studies investigating its efficacy on CMS in Asians have been inconsistent.

Methods

We analyzed the association between soybean intake frequency and prevalence of CMS based on data from the Korea National Health and Nutrition Examination Survey 2007 to 2011. Data of 9,287 women aged 20 to 64 years were analyzed. Food frequency questionnaire was used to assess soybean food consumption frequency. General linear model and multivariable logistic regression model were used to examine the association of soybean intake quintile with CMS and its risk factors. Least square means of metabolic factors mostly showed no significant relevance except liver indexes.

Results

Compared to participants in the 1st quintile (<2 times/week of soybean food), odds ratios (OR) for CMS and abdominal obesity (AO) in the 4th quintile (8.5 times/week<soybean food≤17 times/week) were 0.73 (95% confidence interval [CI], 0.57 to 0.95) and 0.72 (95% CI, 0.58 to 0.90), respectively. After excluding Tofu products, ORs of CMS, AO, high blood pressure, and hypertriglyceridemia were lower than those without excluding Tofu products. However, results still did not show significant inverse linear trend across frequency quintiles.

Conclusion

Our findings suggest that soybean intake of 8.5 to 17 times/week was inversely associated with CMS in Korean women. The relation between soybean intake >17 times/week and CMS varied depending on soybean food items.

Citations

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Anti-obesogenic effects of plant natural products: A focus on Korean traditional foods
Gitishree Das, Luis Alfonso Jiménez Ortega, Sandra Gonçalves, J. Basilio Heredia, Maria de Lourdes Gomes Pereira, Anabela Romano, Han-Seung Shin, Jayanta Kumar Patra
Trends in Food Science & Technology.2024; : 104470. CrossRef
Sex differences in waist circumference obesity and eating speed: a cross-sectional study of Japanese people with normal body mass index
Yuri Yaguchi, Tsuneo Konta, Nahomi Imaeda, Chiho Goto, Yoshiyuki Ueno, Takamasa Kayama
Frontiers in Nutrition.2024;[Epub] CrossRef
Association of Dietary Patterns with Metabolic Syndrome in Chinese Children and Adolescents Aged 7–17: The China National Nutrition and Health Surveillance of Children and Lactating Mothers in 2016–2017
Jia Shi, Hongyun Fang, Qiya Guo, Dongmei Yu, Lahong Ju, Xue Cheng, Wei Piao, Xiaoli Xu, Zizi Li, Di Mu, Liyun Zhao, Li He
Nutrients.2022; 14(17): 3524. CrossRef
What Is the Relationship between Antioxidant Efficacy, Functional Composition, and Genetic Characteristics in Comparing Soybean Resources by Year?
Han-Na Chu, Suji Lee, Xiaohan Wang, Chi-Do Wee, Hye-Myeong Yoon, Eun-Suk Jung, Mi-Kyung Seo, Yongseok Kwon, Kyeong-A Jang, Haeng-Ran Kim
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The Effects of Dietary Pattern on Metabolic Syndrome in Jiangsu Province of China: Based on a Nutrition and Diet Investigation Project in Jiangsu Province
Yuanyuan Wang, Yue Dai, Ting Tian, Jingxian Zhang, Wei Xie, Da Pan, Dengfeng Xu, Yifei Lu, Shaokang Wang, Hui Xia, Guiju Sun
Nutrients.2021; 13(12): 4451. CrossRef
Sex-Specific Energy Intakes and Physical Activity Levels According to the Presence of Metabolic Syndrome in Korean Elderly People: Korean National Health and Nutrition Examination Survey 2016–2018
Won-Sang Jung, Hun-Young Park, Sung-Woo Kim, Kiwon Lim
International Journal of Environmental Research and Public Health.2020; 17(15): 5416. CrossRef

Obesity and Metabolic Syndrome
Comparison of Competitive Models of Metabolic Syndrome Using Structural Equation Modeling: A Confirmatory Factor Analysis: Karimollah Hajian-Tilaki; Diabetes Metab J. 2018;42(5):433-441. Published online October 22, 2018; DOI: https://doi.org/10.4093/dmj.2018.0010

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Background

The purpose of this study was to apply the structural equation modeling (SEM) to compare the fitness of different competing models (one, two, and three factors) of the metabolic syndrome (MetS) in Iranian adult population.

Methods

Data are given on the cardiometabolic risk factors of 841 individuals with nondiabetic adults from a cross-sectional population-based study of glucose, lipids, and MetS in the north of Iran. The three conceptual hypothesized models (single factor, two correlated factors, and three correlated latent factors) were evaluated by using confirmatory factor analysis with the SEM approach. The summary statistics of correlation coefficients and the model summary fitting indexes were calculated.

Results

The findings show that a single-factor model and a two-correlated factor model had a poorer summary fitting index compared with a three-correlated factor model. All fitting criteria met the conceptual hypothesized three-correlated factor model for both sexes. However, the correlation structure between the three underlying constructs designating the MetS was higher in women than in men.

Conclusion

These results indicate the plausibility of the pathophysiology and etiology of MetS being multifactorial, rather than a single factor, in a nondiabetic Iranian adult population.

Citations

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Structural Equation Modelling for Predicting the Relative Contribution of Each Component in the Metabolic Syndrome Status Change
José E. Teixeira, José A. Bragada, João P. Bragada, Joana P. Coelho, Isabel G. Pinto, Luís P. Reis, Paula O. Fernandes, Jorge E. Morais, Pedro M. Magalhães
International Journal of Environmental Research and Public Health.2022; 19(6): 3384. CrossRef
New risk score model for identifying individuals at risk for diabetes in southwest China
Liying Li, Ziqiong Wang, Muxin Zhang, Haiyan Ruan, Linxia Zhou, Xin Wei, Ye Zhu, Jiafu Wei, Sen He
Preventive Medicine Reports.2021; 24: 101618. CrossRef
Definition and early diagnosis of metabolic syndrome in children
Gunter Matthias Christian Flemming, Sarah Bussler, Antje Körner, Wieland Kiess
Journal of Pediatric Endocrinology and Metabolism.2020; 33(7): 821. CrossRef
Calcium-Sensing Receptor in Adipose Tissue: Possible Association with Obesity-Related Elevated Autophagy
Pamela Mattar, Sofía Sanhueza, Gabriela Yuri, Lautaro Briones, Claudio Perez-Leighton, Assaf Rudich, Sergio Lavandero, Mariana Cifuentes
International Journal of Molecular Sciences.2020; 21(20): 7617. CrossRef

Obesity and Metabolic Syndrome
Proportion and Characteristics of the Subjects with Low Muscle Mass and Abdominal Obesity among the Newly Diagnosed and Drug-Naïve Type 2 Diabetes Mellitus Patients: Jung A Kim, Soon Young Hwang, Hye Soo Chung, Nam Hoon Kim, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Hye Jin Yoo; Diabetes Metab J. 2019;43(1):105-113. Published online September 28, 2018; DOI: https://doi.org/10.4093/dmj.2018.0036

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Background

Sarcopenic obesity (SO) is a serious public health concern, few studies have examined the clinical implications of SO in newly-diagnosed type 2 diabetes mellitus (T2DM) patients. We evaluated the prevalence of the newly diagnosed, drug-naïve T2DM patients with low muscle mass with abdominal obesity and its association with insulin resistance and other diabetic complications.

Methods

We classified 233 drug-naïve T2DM subjects into four groups according to abdominal obesity (waist circumference ≥90 cm in men and ≥85 cm in women) and low muscle mass status (appendicular skeletal muscle <7.0 kg/m² for men and <5.4 kg/m² for women).

Results

The proportion of the subjects with low muscle mass and abdominal obesity among the newly diagnosed, drug-naïve T2DM patients was 8.2%. Homeostasis model assessment of insulin resistance (HOMA-IR) increased linearly according to body composition group from normal to abdominal obesity to both low muscle mass and abdominal obesity. The multiple logistic regression analysis indicated that subjects with low muscle mass and abdominal obesity (odds ratio [OR], 9.39; 95% confidence interval [CI], 2.41 to 36.56) showed a higher risk for insulin resistance, defined as HOMA-IR ≥3, than those with abdominal obesity (OR, 5.36; 95% CI, 2.46 to 11.69), even after adjusting for other covariates. However, there were no differences in lipid profiles, microalbuminuria, or various surrogate markers for atherosclerosis among the four groups.

Conclusion

Subjects with both low muscle mass and abdominal obesity had a higher risk of insulin resistance than those with low muscle mass or abdominal obesity only.

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Waist circumference and end‐stage renal disease based on glycaemic status: National Health Insurance Service data 2009–2018
Yun Kyung Cho, Ji Hye Huh, Shinje Moon, Yoon Jung Kim, Yang‐Hyun Kim, Kyung‐do Han, Jun Goo Kang, Seong Jin Lee, Sung‐Hee Ihm
Journal of Cachexia, Sarcopenia and Muscle.2023; 14(1): 585. CrossRef
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Satoshi Ida, Ryutaro Kaneko, Kanako Imataka, Kaoru Okubo, Kentaro Azuma, Kazuya Murata
Endocrine Journal.2023; 70(6): 591. CrossRef
A Novel Anthropometric Parameter, Weight-Adjusted Waist Index Represents Sarcopenic Obesity in Newly Diagnosed Type 2 Diabetes Mellitus
Min Jeong Park, Soon Young Hwang, Nam Hoon Kim, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Hye Jin Yoo
Journal of Obesity & Metabolic Syndrome.2023; 32(2): 130. CrossRef
Prevalence of sarcopenic obesity in patients with diabetes and adverse outcomes: A systematic review and meta-analysis
Yuan-yuan Zhou, Jin-feng Wang, Qian Yao, Qiu-feng Jian, Zhi-peng Luo
Clinical Nutrition ESPEN.2023; 58: 128. CrossRef
The Correlation Between Leg Muscle Mass Index and Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus
Menggege Liu, Qing Zhang, Juan Liu, Huiling Bai, Ping Yang, Xinhua Ye, Xiaoqing Yuan
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Tingting Han, Ting Yuan, Xinyue Liang, Ningxin Chen, Jia Song, Xin Zhao, Yurong Weng, Yaomin Hu
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Body Composition and Diabetes
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Dima Khadra, Leila Itani, Hana Tannir, Dima Kreidieh, Dana El Masri, Marwan El Ghoch
World Journal of Diabetes.2019; 10(5): 311. CrossRef

Obesity and Metabolic Syndrome
Serum Calcium and the Risk of Incident Metabolic Syndrome: A 4.3-Year Retrospective Longitudinal Study: Jong Ha Baek, Sang-Man Jin, Ji Cheol Bae, Jae Hwan Jee, Tae Yang Yu, Soo Kyoung Kim, Kyu Yeon Hur, Moon-Kyu Lee, Jae Hyeon Kim; Diabetes Metab J. 2017;41(1):60-68. Published online December 26, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.60

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Background

An association between serum calcium level and risk of metabolic syndrome (MetS) has been suggested in cross-sectional studies. This study aimed to evaluate the association between baseline serum calcium level and risk of incident MetS in a longitudinal study.

Methods

We conducted a retrospective longitudinal study of 12,706 participants without MetS who participated in a health screening program, had normal range serum calcium level at baseline (mean age, 51 years), and were followed up for 4.3 years (18,925 person-years). The risk of developing MetS was analyzed according to the baseline serum calcium levels.

Results

A total of 3,448 incident cases (27.1%) of MetS developed during the follow-up period. The hazard ratio (HR) for incident MetS did not increase with increasing tertile of serum calcium level in an age- and sex-matched model (P for trend=0.915). The HRs (95% confidence interval [CI]) for incident MetS comparing the second and the third tertiles to the first tertile of baseline serum calcium level were 0.91 (95% CI, 0.84 to 0.99) and 0.85 (95% CI, 0.78 to 0.92) in a fully adjusted model, respectively (P for trend=0.001). A decreased risk of incident MetS in higher tertiles of serum calcium level was observed in subjects with central obesity and/or a metabolically unhealthy state at baseline.

Conclusion

There was no positive correlation between baseline serum calcium levels and incident risk of MetS in this longitudinal study. There was an association between higher serum calcium levels and decreased incident MetS in individuals with central obesity or two components of MetS at baseline.

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Independent associations of serum calcium with or without albumin adjustment and serum phosphorus with nonalcoholic fatty liver disease: results from NHANES 1999-2018
Haolong Qi, Bin Wang, Lei Zhu
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Jer-min Chen, Tai-yin Wu, Yi-fan Wu, Kuan-liang Kuo
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Optimal Waist Circumference Cutoff Value Based on Insulin Resistance and Visceral Obesity in Koreans with Type 2 Diabetes: Jung Soo Lim, Young Ju Choi, Soo-Kyung Kim, Byoung Wook Huh, Eun Jig Lee, Kap Bum Huh; Diabetes Metab J. 2015;39(3):253-263. Published online April 24, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.3.253

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Background

Visceral obesity is the most powerful contributor to the development of metabolic syndrome (MetS) and cardiovascular diseases. In light of visceral obesity, however, there is a paucity of data on the appropriate cutoff point of waist circumference (WC) in subjects with type 2 diabetes. The aim of this study was to investigate the optimal cutoff value for WC that signals insulin resistance (IR) and visceral obesity in Koreans with type 2 diabetes.

Methods

We evaluated 4,252 patients with type 2 diabetes (male 2,220, female 2,032, mean age 57.24 years) who visited our clinic between January 2003 and June 2009. WC was measured at the midpoint between the lower rib and the iliac crest, and insulin sensitivity was assessed by the rate constant of plasma glucose disappearance (Kitt %/min) using an insulin tolerance test. Visceral fat thickness was measured using ultrasonography. Statistical analysis was performed using receiver operating characteristic curve.

Results

The optimal cutoff points for WC for identifying the presence of IR and visceral obesity, as well as two or more metabolic components, were 87 cm for men and 81 cm for women. Moreover, these cutoff points had the highest predictive powers for the presence of visceral obesity. The MetS defined by new criteria correlated with the increased carotid intima-media thickness in female subjects.

Conclusion

Our results suggest that the optimal cutoff values for WC in Koreans with type 2 diabetes should be reestablished based on IR and visceral obesity.

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A Cross-Sectional Study of the Phenotypes of Obesity and Insulin Resistance in Adults with Down Syndrome: Diego Real de Asua, Pedro Parra, Ramón Costa, Fernando Moldenhauer, Carmen Suarez; Diabetes Metab J. 2014;38(6):464-471. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.464

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Background

Despite the confluence of multiple cardiovascular risk factors, subclinical atherosclerotic damage and cardiovascular events remain extremely rare in adults with Down syndrome (DS). We aim to determine the prevalence of obesity and metabolic disorders in an adult cohort with DS and to compare our findings with adults without DS.

Methods

Cross-sectional study of 51 consecutively selected adults with DS living in the community and 51 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Epidemiological data (age and gender), anthropometric data (body mass index and waist-to-height ratio), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, vitamins, and lipid profile) were measured and compared between the groups.

Results

Adults with DS were significantly younger and more often men with a higher prevalence of overweight and obesity than controls. Their waist-to-height ratio was higher, and they more frequently had abdominal obesity. The results of an analysis adjusted for age and gender revealed no differences in fasting insulin levels, homeostatic model assessment indexes, or lipid profile between adults with DS and controls.

Conclusion

Adults with DS presented a high prevalence of overweight and obesity. However, we found no differences in lipid profile, prevalence of insulin resistance, or metabolic syndrome between adults with DS and controls.

Citations

Citations to this article as recorded by

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