• Korean Journal of Community Nutrition
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• v.23 no.5
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• pp.431-443
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• 2018

Objectives: Normal weight obesity (NWO) is defined as excessive body fat in the context of a normal body mass index (BMI). This condition carries a greater risk of developing noncommunicable chronic disease and has been associated with early inflammation. This study was conducted to compare the anthropometric measurements, eating behaviors, and blood clinical indices among four groups: underweight, normal, normal weight obesity and obesity. Methods: The subjects included 215 female college students. A questionnaire was administered regarding general characteristics, dietary behaviors, food consumption frequency. Anthropometric measurements and blood clinical indices were also investigated. Results: The average BMI, body fat percentage, waist circumference, fat-free mass, and muscle mass were highest in the obesity group (p<0.05). Most subjects had tried to lose weight and perceived that their health was worse than before they became college students. The ratio of students in the NWO group who thought their health was very poor was significantly higher than in the other three groups (p<0.05). The obesity and NWO groups seemed to eat more and their eating speed was significantly faster than the other groups (p<0.001). The consumption frequency of caffeinated beverages was significantly higher in the NWO group than in the other three groups (p<0.01). WBC was significantly higher in the obesity group (p<0.05). Serum levels of TG and total cholesterol were also significantly higher in the obesity group (p<0.05). Serum GPT was significantly higher in the obesity group (p<0.05) while BUN level was highest in the NWO group (p<0.05). Conclusions: The obesity group showed the most health problems while the NWO group seemed relatively healthy. However, NWO can lead to problems such as metabolic syndrome and cardiovascular disease in later life if poor dietary habits are maintained. Therefore, education in appropriate eating habits is needed for these subjects.

• Healthcare Informatics Research
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• v.24 no.4
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• pp.346-358
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• 2018

Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years ($186{\pm}58$ months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ${\geq}5.0$. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ${\leq}55$ years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).

• Korea Journal of Hospital Management
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• v.27 no.1
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• pp.1-10
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• 2022

Background: This study aims to empirically compare and evaluate the current status of medical accessibility and health inequality between people with disabilities and without. We calculated the ACSC hospitalization rate, which is a medical accessibility index, for hypertension, a major risk factor for cardiovascular disease that accounts for more than 20% of deaths among people with disabilities using the 2016 National Health Insurance Big Data. Methods: The subjects of the study were a total of 601,520, including 64,018 people with disabilities and 537,501 people without. Logistic regression was performed to analyze the differences in hypertension hospitalization rates adjusted for demographic and sociological characteristics and disease characteristics using SAS 9.4 program. Results: Before adjusting for the characteristics, the hypertension hospitalization rate of people with disabilities was 1.55%, and the people without disabilities were 0.49%. After adjusting, it was found that people with disabilities were 2.11 times higher than people without disabilities, and it was statistically significant. Conclusion: The preventable hospitalization rate of people with disabilities is higher than that of people without, suggesting that the disabled have problems with access to medical care and health inequality. Therefore, the government's policy improvement is required to close the medical gap for the disabled.

• Journal of Yeungnam Medical Science
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• v.20 no.1
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• pp.62-70
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• 2003

Background: Most of all studies about the relation between the health risk and obesity are based on the European and American data. The purpose of this study is to examine the relation between adiposity and risk factors for cardiovacular disease (CVD) in normal weight individuals. Materials and Methods: Normal weight subjects with a body mass index (BMI) between 18.5 and $23kg/m^2$ (76 subjects) and overweight subjects with a BMI between 23 and $25kg/m^2$ (53 subjects) were retained for this study. Normal weight subjects were divided into three group of each adiposity variable, then three group and the overweight group were evaluated for the presence of CVD risk factors and analyze the correlation coefficients between adiposity variables and risk factors controlled for age in normal weight, overweight groups. Using logistic regression analysis, the odds ratio (OR) for the prevalence of risk factors for each group of adiposity variables and the overweight group was estimated relative to the first group in normal weight subjects. Results: Systolic BP, diastolic BP, LDL cholestrol, HDL cholesterol, triglycerides in normal weight subjects were significantly correlated with all adiposity variables (P<0.01). Third group (3.7 for %fat and 4.7 for fat mass)of adiposity variables in the normal weight group and the overweight group (6.6 for %fat and 11.5 for fat mass) tended to have higher ORs compared to first group for risk factor variables. Conclusion: Normal weight subjects with elevated adiposity had higher prevalence of risk factors than normal weights subjects with less adiposity. Measuring of adiposity added additional information of cardiovascular disease risk factors in normal weight subjects.

• Tuberculosis and Respiratory Diseases
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• v.56 no.4
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• pp.364-373
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• 2004

Background : Obstructive sleep apnea is a contributory factor of hypertension, arrhythmia, ischemic heart disease and other cardiovascular diseases. However, the pathophysiology underlying this relationship is unclear. Recent reports have shown that the soluble intercellular adhesion molecule-1(sICAM-1) and vascular endothelial growth factor(VEGF) are involved in the initiation and progression of atherosclerosis, and some reports state that increased levels of these cytokines are found in patients with obstructive sleep apnea. In this study, the levels of sICAM-1 and VEGF were measured in patients with obstructive sleep apnea in order to determine if obstructive sleep apnea is involved in the pathophysiology of cardiovascular diseases. Methods : Thirty-seven patients were chosen amongst a population who visited the Sleep Disorders Clinic of St. Paul's Hospital in Seoul, Korea for a diagnosis of obstructive sleep apnea and who had subsequently undergone an overnight polysomnography at the clinic. The sera from these patients were retrieved after an overnight polysomnography session and the samples were kept at $-70^{\circ}C$. The cytokine levels were determined with ELISA and the relationships between the serum levels of sICAM-1 and VEGF along with polysomnography parameters were analyzed. Results : No statistically significant correlation was observed between the sICAM-1 levels and the apnea-hypopnea index(r=0.27, P>0.05). Positive correlations were found between the apnea-hypopnea index and serum VEGF levels (r=0.50, P<0.01), the apnea index and the serum sICAM-1 levels (r=0.31, P<0.01), and the apnea index and the serum VEGF levels (r=0.45, P<0.01). Conclusions : Obstructive apnea or hypopnea leads to an increase in the sICAM-1 and VEGF levels. Such an increase in the cytokine levels most likely leads to the higher incidence of cardiovascular diseases observed in patients with obstructive sleep apnea.

• Journal of Nutrition and Health
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• v.51 no.5
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• pp.386-399
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• 2018

Purpose: This study examined whether the supply of healthy Korean diets for 12 weeks is effective in improving the risk factors related to serum GGT and cardiovascular diseases in patients with hypertension and diabetes. Methods: This study selected 41 patients, who were treated with hypertension and diabetes. The Korean diet was composed of cooked-rice, soup, kimchi, and various banchan with one serving called bapsang, which emphasize proportionally high consumption of vegetables and fermented foods, moderate to high consumption of legumes and fish, and low consumption of animal foods. The control group was instead instructed to "eat and exercise as usual" while following the Korean Diabetes Association's dietary guidelines with an intake that can assist in glycemic control, maintain adequate weight, and meet the nutritional requirements. The Korean diet group (21 patients) were served three healthy Korean meals a day for 12 weeks, and the control group (20 patients, who trained in the diet guideline of diabetes) maintained their usual diabetic diet. The serum GGT, blood pressure, heart rate, glycemic control data, cardiovascular risk indicators, and changes in diet measured at the four visits (week 0, 4, 8, and 12) during the course of 12 weeks were compared and evaluated. Results: The serum GGT (p < 0.001), HbA1c (p = 0.004), heart rate (p = 0.007), weight (p = 0.002), Body Mass Index (p = 0.002), body fat mass (p < 0.001), body fat (%) (p < 0.001), and free fatty acid (p = 0.007) in the Korean diet group decreased significantly after the dietary intervention compared to the control group. The amount of intake of rice, whole grains, green vegetables, Kimchi, and soybean fermented food were increased significantly compared to the control group (p < 0.001). The Korean diet group showed significant decreases (p < 0.001) in the intake of animal protein, lipid, and cholesterol derived from animal foods compared to the control group but significant increases (p < 0.001) in the intake of total calories, folic acid, dietary fiber, sodium, potassium, and vitamins A, E, and C. Conclusion: In patients with hypertension and diabetes, it was confirmed that regular eating of a healthy Korean diet helps improve the risk factors for GGT and cardiovascular diseases.

• Journal of agricultural medicine and community health
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• v.39 no.2
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• pp.104-115
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• 2014

Background: The glycemic index (GI) indicates the rise in blood glucose caused by carbohydrate-containing foods. In Korea, there have been few studies on the understanding adults have of GI. Thus, this study investigated differences GI knowledge among the korean adults. Methods: A questionnaire on the perspective of GI and experience in GI education, participational intent to learn, general knowledge level, and dietary practice was conducted among those living in agricultural areas. Respondents were visitors to the health promotion center of a university hospital. Results: When asked about the GI familiarity, the standard of education, the relationships between diseases and GI, the diabetes group was better able to answer correctly than the other groups. However, the diabetes group showed either no difference or less correct responses for general knowledge of GI. With respect to their usual consideration and low GI dietary practice, the diabetes group provided higher responses than the other groups. On the whole, the diabetes group was better than the other groups for GI relative factor but none of the groups showed high levels for perspective, education, dietary practice of GI. Conclusions: The groups other than the diabetes group had a low perspective of GI, a lack of correct knowledge of GI, and did not follow a proper diet without considering GI. Even in the diabetes group the perspective, knowledge, and proper dietary practices were not adequate. Accordingly, further education of GI is necessary for diabetic patients, patients with chronic diseases and also people without diseases.

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

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

• Korean Journal of Radiology
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• v.21 no.9
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• pp.1055-1064
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• 2020

Objective: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison to a clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemic stroke patients without chest pain. Materials and Methods: This retrospective study included 1418 patients with acute stroke who had no previous cardiac disease and underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) were assessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed: low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognostic value of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%, respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS, and stenosis degree were positively associated with MACE (all p < 0.05). Patients with high-risk plaque type showed the highest incidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p < 0.001). Among the prediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared to FRS or the FRS + CACS model (all p < 0.05). Furthermore, incorporating plaque type in the prediction model significantly improved reclassification (integrated discrimination improvement, 0.08; p = 0.023) and showed the highest discrimination index (C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p > 0.05). Conclusion: Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS and FRS to risk stratify stroke patients without prior history of CAD better.

• Journal of agricultural medicine and community health
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• v.36 no.2
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• pp.101-112
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• 2011

Objectives: The aim of this study is to determine arterial stiffness levels as measured by brachial-ankle pulse wave velocity (baPWV) and to identify the association between arterial stiffness and inflammatory markers, in healthy adults over 50 years old. Methods: The study population consisted of 4617 persons over the age of 50 years who participated in the baseline survey of the Dong-gu Study, which was conducted in 2007 and 2008. Arterial stiffness was measured using baPWV. A multiple regression analysis was performed to assess the relationship between conventional cardiovascular risk factors and inflammatory markers, including white blood cell (WBC) counts, high-sensitive C-reactive protein (hs-CRP), and gamma glutamyltransferase (GGT). Results: After adjustment for conventional cardiovascular risk factors including sex, age, smoking status, body mass index, systolic blood pressure, fasting glucose, hypertension or diabetic medication, total cholesterol, triglycerides, uric acid, and alanine aminotransferase, baPWV was significantly associated with WBC counts (${\beta}$=0.158, p<0.0001), hs-CRP (${\beta}$=0.244, p=0.026), and GGT (${\beta}$=0.003, p<0.0001). Conclusion: This study shows that arterial stiffness correlates with inflammatory markers. Arterial stiffness may be used as a composite risk factor to identify persons with higher risk for cardiovascular disease. Additionally, arterial stiffness may be a marker for future cardiovascular disease and a target for prevention.