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The Association of Unintentional Changes in Weight, Body Composition, and Homeostasis Model Assessment Index with Glycemic Progression in Non-Diabetic Healthy Subjects
Eun-Jung Rhee, Ji-Hun Choi, Seung-Hyun Yoo, Ji-Cheol Bae, Won-Jun Kim, Eun-Suk Choi, Se Eun Park, Cheol-Young Park, Seok Won Park, Ki-Won Oh, Sung-Woo Park, Sun-Woo Kim, Won-Young Lee
Diabetes Metab J. 2011;35(2):138-148.   Published online April 30, 2011
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  • 39 Download
  • 14 Crossref
AbstractAbstract PDFPubReader   

We performed a retrospective longitudinal study on the effects of changes in weight, body composition, and homeostasis model assessment (HOMA) indices on glycemic progression in subjects without diabetes during a four-year follow-up period in a community cohort without intentional intervention.


From 28,440 non-diabetic subjects who participated in a medical check-up program in 2004, data on anthropometric and metabolic parameters were obtained after four years in 2008. Body composition analyses were performed with a bioelectrical impedance analyzer. Skeletal muscle index (SMI, %) was calculated with lean mass/weight×100. Subjects were divided into three groups according to weight change status in four years: weight loss (≤-5.0%), stable weight (-5.0 to 5.0%), weight gain (≥5.0%). Progressors were defined as the subjects who progressed to impaired fasting glucose or diabetes.


Progressors showed worse baseline metabolic profiles compared with non-progressors. In logistic regression analyses, the increase in changes of HOMA-insulin resistance (HOMA-IR) in four years presented higher odds ratios for glycemic progression compared with other changes during that period. Among the components of body composition, a change in waist-hip ratio was the strongest predictor, and SMI change in four years was a significant negative predictor for glycemic progression. Changes in HOMA β-cell function in four years was a negative predictor for glycemic progression.


Increased interval changes in HOMA-IR, weight gain and waist-hip ratio was associated with glycemic progression during a four-year period without intentional intervention in non-diabetic Korean subjects.


Citations to this article as recorded by  
  • Increased Risk of Nonalcoholic Fatty Liver Disease in Individuals with High Weight Variability
    Inha Jung, Dae-Jeong Koo, Mi Yeon Lee, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Eun-Jung Rhee, Won-Young Lee
    Endocrinology and Metabolism.2021; 36(4): 845.     CrossRef
  • Effects of nutritional supplementation on glucose metabolism and insulin function among people with HIV initiating ART
    Hiwot Amare, Mette F. Olsen, Henrik Friis, Pernille Kæstel, Åse B. Andersen, Alemseged Abdissa, Daniel Yilma, Tsinuel Girma, Daniel Faurholt-Jepsen
    BMC Nutrition.2021;[Epub]     CrossRef
  • The ratio of estimated average glucose to fasting plasma glucose level as an indicator of insulin resistance in young adult diabetes
    Jun Guo, Sisi Lei, Yu Zhou, Congqing Pan
    Medicine.2020; 99(40): e22337.     CrossRef
  • Reduced Skeletal Muscle Volume and Increased Skeletal Muscle Fat Deposition Characterize Diabetes in Individuals after Pancreatitis: A Magnetic Resonance Imaging Study
    Andre E. Modesto, Juyeon Ko, Charlotte E. Stuart, Sakina H. Bharmal, Jaelim Cho, Maxim S. Petrov
    Diseases.2020; 8(3): 25.     CrossRef
  • Insulin resistance increases the risk of incident type 2 diabetes mellitus in patients with non‐alcoholic fatty liver disease
    Yuya Seko, Yoshio Sumida, Saiyu Tanaka, Kojiroh Mori, Hiroyoshi Taketani, Hiroshi Ishiba, Tasuku Hara, Akira Okajima, Atsushi Umemura, Taichiro Nishikawa, Kanji Yamaguchi, Michihisa Moriguchi, Kazuyuki Kanemasa, Kohichiroh Yasui, Shunsuke Imai, Keiji Shim
    Hepatology Research.2018;[Epub]     CrossRef
  • Use of Novel High-Protein Functional Food Products as Part of a Calorie-Restricted Diet to Reduce Insulin Resistance and Increase Lean Body Mass in Adults: A Randomized Controlled Trial
    Carol Johnston, Barry Sears, Mary Perry, Jessica Knurick
    Nutrients.2017; 9(11): 1182.     CrossRef
  • Gender differences in the association between food insecurity and insulin resistance among U.S. adults: National Health and Nutrition Examination Survey, 2005–2010
    Junxiu Liu, Yong-Moon Mark Park, Seth A. Berkowitz, Qingwei Hu, Kyungdo Han, Andrew Ortaglia, Robert E. McKeown, Angela D. Liese
    Annals of Epidemiology.2015; 25(9): 643.     CrossRef
  • 1,5-Anhydroglucitol Is Associated with Early-Phase Insulin Secretion in Chinese Patients with Newly Diagnosed Type 2 Diabetes Mellitus
    Xiaojing Ma, Yaping Hao, Xiang Hu, Yuqi Luo, Zixuan Deng, Jian Zhou, Yuqian Bao, Weiping Jia
    Diabetes Technology & Therapeutics.2015; 17(5): 320.     CrossRef
  • Serum glycated albumin as a new glycemic marker in pediatric diabetes
    Ji Woo Lee, Hyung Jin Kim, Young Se Kwon, Yong Hoon Jun, Soon Ki Kim, Jong Weon Choi, Ji Eun Lee
    Annals of Pediatric Endocrinology & Metabolism.2013; 18(4): 208.     CrossRef
  • The Association of Maximum Body Weight on the Development of Type 2 Diabetes and Microvascular Complications: MAXWEL Study
    Soo Lim, Kyoung Min Kim, Min Joo Kim, Se Joon Woo, Sung Hee Choi, Kyong Soo Park, Hak Chul Jang, James B. Meigs, Deborah J. Wexler, Noel Christopher Barengo
    PLoS ONE.2013; 8(12): e80525.     CrossRef
  • Relative contributions of insulin resistance and β‐cell dysfunction to the development of Type 2 diabetes in Koreans
    C.‐H. Kim, H.‐K. Kim, E. H. Kim, S. J. Bae, J.‐Y. Park
    Diabetic Medicine.2013; 30(9): 1075.     CrossRef
  • Body Mass Index and Waist Circumference According to Glucose Tolerance Status in Korea: The 2005 Korean Health and Nutrition Examination Survey
    Hye Mi Kang, Dong-Jun Kim
    Journal of Korean Medical Science.2012; 27(5): 518.     CrossRef
  • The Relationship between β-cell Function and Nutrient Intakes in Korean Adult - Using 4thKorea National Health and Nutrition Examination Survey 2009 -
    You Mi Lee, Hye Kyung Chung, Heejin Kimm, Sun Ha Jee
    Korean Journal of Community Nutrition.2012; 17(2): 243.     CrossRef
  • The ratio of glycated albumin to glycated haemoglobin correlates with insulin secretory function
    Daham Kim, Kwang J. Kim, Ji H. Huh, Byung‐Wan Lee, Eun S. Kang, Bong S. Cha, Hyun C. Lee
    Clinical Endocrinology.2012; 77(5): 679.     CrossRef
The Correlation Between Visceral Fat Distance Measured by Ultrasonography and Visceral Fat Amount by Computed Tomography in Type 2 Diabetes.
Eui Dal Jung, Duck Soo Chung, Ji Yun Lee
Korean Diabetes J. 2008;32(5):418-427.   Published online October 1, 2008
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  • 25 Download
  • 4 Crossref
AbstractAbstract PDF
Visceral adipose tissue accumulation highly correlates with metabolic abnormalities and cardiovascular disease. Computed tomography (CT) is considered to be the standard method for visceral fat evaluation, but it is not used as a routine procedure. Ultrasonography (US) is a safe method, fairly inexpensive and widely available modality for measuring abdominal fat thickness. The aim of this study was to investigate the correlation between the intra-abdominal fat distance by US measurement and the visceral fat amount by CT and cardiovascular risk factors and to evaluate whether the intra-abdominal fat distance is better correlate with visceral fat amount by CT than other anthropometric parameters and to assess the cut-off value of intra-abdominal fat distance for visceral obesity in type 2 diabetic patients. METHODS: We obtained abdominal subcutaneous and intra-abdominal fat distance by using a high-resolution US (HDI 5000, ATL, Phillps, USA) at 1 cm above umbilical level in one hundred twenty-eight type 2 diabetic patients. CT scan (Light Speed plus, GE, USA) for the measurement of subcutaneous and intra-abdominal visceral fat area was also performed in the supine position at the L4-5 level. Lean body mass and % body fat were measured in a bioimpedance using DSM (Direct Segmental Measurement by 8-point electrode) method (InBody 3.0, Biospace, Seoul, Korea). We measured patient's height, weight, BMI (Body mass index), waist circumference, WHR(Waist-hip ratio) and blood pressure and also measured fasting blood glucose, HbA1c and lipid profiles. RESULTS: Abdominal subcutaneous and visceral fat distance measured by US is 2.05 +/- 0.52 cm, 4.43 +/- 1.54 cm, respectively. In pearson's correlations, visceral fat distance were correlated with BMI (r = 0.681, P < 0.001), waist circumference (r = 0.661, P < 0.001), WHR (r = 0.571, P < 0.001), triglyceride (r = 0.316, P < 0.001), HDL-cholesterol (r = -0.207, P < 0.004). US-determined visceral fat distance was also correlated with visceral fat amount by CT (r = 0.674, P < 0.001) and BMI (r = 0.610, P < 0.001), waist circumference (r = 0.626, P < 0.001), WHR (r = 0.557, P < 0.001). When we used waist circumference (men: 90 cm, women: 85 cm) as parameters for visceral obesity, the cutoff value of visceral fat distance, obtained by the receiver operating characteristic curve analysis, were 4.670 cm in men, 3.695 cm in women diabetic patients. CONCLUSION: Intra-abdominal fat distance measured by US reveals strongly correlated with visceral fat area, which is determined by CT and also well correlated with anthropometric parameters and lipid profiles. We suggest that US provided a better index compared to anthropometry for the prediction of visceral obesity and could be an alternative method for CT for visceral fat determination in diabetic patients.


Citations to this article as recorded by  
  • Aspects of transthoracic echocardiography protocol in obese patients
    O. N. Dzhioeva, O. A. Maksimova, E. A. Rogozhkina, O. M. Drapkina
    Russian Journal of Cardiology.2023; 27(12): 5243.     CrossRef
  • Ultrasound-assisted assessment of visceral and subcutaneous adipose tissue thickness. Methodological guidelines
    O. M. Drapkina, R. K. Angarsky, E. A. Rogozhkina, O. A. Maksimova, A. A. Ivanova, E. V. Zyatenkova, O. N. Dzhioeva
    Cardiovascular Therapy and Prevention.2023; 22(3): 3552.     CrossRef
  • The Correlations between Extremity Circumferences with Total and Regional Amounts of Skeletal Muscle and Muscle Strength in Obese Women with Type 2 Diabetes
    Hwi Ryun Kwon, Kyung Ah Han, Hee Jung Ahn, Jae Hyuk Lee, Gang Seo Park, Kyung Wan Min
    Diabetes & Metabolism Journal.2011; 35(4): 374.     CrossRef
  • Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients
    Hee-Jung Ahn, Kyung-Ah Han, Hwi-Ryun Kwon, Bo-Kyung Koo, Hyun-Jin Kim, Kang-Seo Park, Kyung-Wan Min
    Korean Diabetes Journal.2010; 34(2): 86.     CrossRef
Characteristics of the Newly Established Diabetic Model Mice, TallyHo.
Sang Dal Rhee, Won Hun Jeong, Yoon Young Sung, Hye Sung Lee, Kun Bock Lee, Hee Yeon Kim, Sung Don Yang
Korean Diabetes J. 2004;28(3):177-186.   Published online June 1, 2004
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AbstractAbstract PDF
TallyHo(TH) mice are a newly established model for non-insulin dependent diabetes mellitus(NIDDM), for polygenic causative genes that have not yet been identified. It has been reported that TH mice show mild obesity, hyperinsulinemia, hyperlipidemia and male-limited hyperglycemia. The characteristics of these mice were examined. METHODS: Diabetes related physiological data of TH mice, such as body weight, the plasma concentration of biochemical parameters(glucose, triglyceride and nonesterified free fatty acid) and changes in the pattern of the oral glucose tolerance test(OGTT), were obtained up to the age of 35 weeks. The insulin tolerance test(ITT) was performed at 7 weeks of age and the weights of the fat pad and liver were measured at 35 weeks of age. RESULTS: TH mice revealed hyperlipidemia, glucose intolerance and disturbed insulin tolerance, even when prediabetic at 7 weeks of age. Hyperglycemia and hyper- insuline-mia were observed as early as 10 weeks of age; however, individual variations in the blood glucose level were large at this age. Obesity in TH mice seems to be caused by the predominant deposition of visceral fat. CONCLUSION: These results suggest that TH mice are an appropriate rodent model for diabetes with visceral obesity and insulin resistance.
The Effect of Growth Hormone on Insulin Resistance and Atherosclerotic Risk Factors in Obese Patients with Uncontrolled Type 2 Diabetes Mellitus.
Jae Hyun Nam, Soo Jee Yoon, Dol Mi Kim, Chul Sik Kim, Joo Young Nam, Jong Suk Park, Jina Park, Chul Woo Ahn, Suk Won Park, Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh
Korean Diabetes J. 2003;27(2):141-152.   Published online April 1, 2003
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  • 18 Download
AbstractAbstract PDF
Insulin resistance in visceral obesity constitutes a risk factor for the development of atherosclerosis. The insulin resistance in obese type 2 diabetic patients can be improved by a decrease in the visceral fat and an increase in the skeletal muscle, which may influence the insulin sensitivity. Growth hormone (GH) accelerates lipolysis and promotes protein conservation. The effects of GH therapy, with diet restriction, on lipolysis and protein anabolism, were evaluated, which may change body composition, insulin resistance and atherosclerotic risk factors in obese type 2 diabetes mellitus. METHODS: Sixteen obese type 2 diabetic patients (31~56yrs), who had high glucose levels (glucose 12.8+/-1.7 mmol/L, HbA1c 10.2+/-2.1%), were treated with recombinant human GH (GH; 1 unit/d, 5 times/week), diet restriction (25 kcal/kg ideal body weight/day) and exercise (250 kcal/day) for 12 weeks. They underwent anthropometric measurement, bioelectrical impedance for total body fat and lean body mass, as well as computed tomography, for visceral and subcutaneous fat, at the umbilicus and muscle area at the mid-thigh levels. All subjects underwent the test for GH response to hypoglycemia. The insulin sensitivity index (ISI) was measured using insulin tolerance tests (ITT). RESULTS: 1. The visceral fat area (VFA)/thigh muscle area (TMA) ratio was more decreased in the GH-treated group than in the control group, but there was no change of body weight. 2. The ISI was significantly increased in only the GH-treated group, which was negatively correlated with the VFA/TMA ratio. The serum free fatty acid, fibrinogen and plasminogen activator inhibitor-1 were significantly decreased after the GH treatment. The serum glucose level and HbA1c remained unchanged during the GH therapy, but were significantly decreased after 3 months. 3. The total cholesterol and triglyceride levels were decreased in the GH treated group. 4. The insulin-like growth factor-I, fasting c-peptide and insulin level were all significantly increased after the GH treatment. CONCLUSION: This study suggested that in type 2 diabetic patients, with insulin resistance and uncontrolled blood sugar, GH treatment caused a decrease in the visceral fat and an increase in the muscle mass, which could result in the improvement of the ISI, atherosclerotic risk factors and dyslipidemia.
Atherosclerotic Severity and Risk Factors in Type 2 Diabetic Patients with Visceral (Metabolic) Obesity in Korea.
Jae Hyun Nam, Suk Won Park, Chul Woo Ahn, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh
Korean Diabetes J. 2001;25(1):20-34.   Published online February 1, 2001
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  • 17 Download
AbstractAbstract PDF
Type 2 diabetes with hypertension and dyslipidemia are frequently associated with metabolic obesity. It is proposed that such individuals might be characterized by increased insulin resistance and visceral fat, and that macrovascular complications might be more common in these individuals. Thereofer, the aim of this study was to investigate the atherosclerotic severity and risk factors in type 2 diabetic patients with metabolic obesity (MO) in Korea. METHODS: Coronary artery calcification (CAC) score, intima-media thickness (IMT) of common carotid artery, and ankle-brachial pressure index (ABPI) were measured. Insulin sensitivity index (ISI) was also measured by the plasma glucose disappearance rate (kitt: %/min). RESULTS: 1. Among 530 type 2 diabetes mellitus (DM) patients, the percent of under-weight (UW), normal-weight (NW), over-weight (OW) and obese (OB) (BMI< 20, 20-25, 25-29.9 and >30, respectively) were 8.9%, 62.1%, 25.1% and 3.9%, respectively. Waist-hip ratio and systolic blood pressure (sBP) were significantly different among the groups according to BMI. Serum triglyceride (TG), HDL-C, free fatty acid (fFA), fibrinogen and fasting c-peptide were significantly different among the groups. The percents of patients with insulin resistance in UW, NW, OW and OB groups were 28%, 60%, 68% and 75%, respectively. The visceral fat area/subcutaneous fat area ratio and visceral fat area/thigh muscle area ratio were significantly increased according to ISI. 2. The patients with MO have above the median values of WHR (0.95 in men and 0.91 in women). sBP, TG, HDL-C, fFA,fibrinogen and ISI were significantly different between the patients with MO and the patients without MO. 3. In OW group as well as NW group, carotid IMT, ABPI and CAC score were significantly different between the patients with MO and the patients without MO. However, these were not different between NW group and OW group. CONCLUSION: In conclusion, this study suggest that patients with MO have more advanced atherosclerosis and aggravated risk profiles for atherosclerosis than those without MO, regardless of BMI.

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