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Background: Over the last decade, the male obesity rate in Korea has surged from 36.3% in 2012 to 46.3% in 2021. The proportion of overweight and obese students among elementary, middle, and high school students increased from 22.9% in 2016 to 30.8% in 2021.Current Concepts: Various methods, such as body mass index, waist circumference measurement, and impedance body fat analysis, are used to diagnose obesity. Obesity treatment is needed to establish an individualized treatment plan based on the cause of obesity, and behavioral changes should be induced through dietary therapy and exercise. Drug therapy should be considered in patients who could not lose weight despite non-pharmacological therapies for over 3 months and have one or more cardiovascular risk factors. Behavioral therapy is the core of obesity treatment because of its application as a programmed treatment for weight control and an approach to changing behaviors related to food intake and physical activity. If non-drug treatment does not lead to weight loss, drug therapy should be considered. Along with drug treatment, dietary therapy, exercise, and behavioral therapy are essential. In severely obese patients, surgical intervention can be considered for weight loss, the maintenance of reduced weight, and improvement of obesity-related comorbidities, including type 2 diabetes.Discussion and Conclusion: To successfully treat obesity, a combination of dietary plans, exercise programs, and drug therapy are required according to an accurate assessment of the cause and degree of obesity.

Introduction: The study sought to investigate the effect of weight change on hepatic steatosis (HS) incidence with or without liver fibrosis in metabolically healthy overweight or obese individuals. Methods: A cohort of 14,779 metabolically healthy men and women who were overweight or obese (body mass index ≥23 kg/m 2) and free from HS and an intermediate or high probability of fibrosis at baseline were followed for a median of 5.2 years. Metabolic health was defined as freedom from the components of metabolic syndrome and a homeostatic model assessment of insulin resistance 5.0%, relative to the no weight change group (–0.9% to 0.9%) were 0.52 (0.44–0.60), 0.83 (0.75–0.92), 1.21 (1.10–1.33), and 1.51 (1.36–1.69), respectively. Clinically relevant weight loss of >5% was also associated with a lowered risk of HS with intermediate or high probability of advanced fibrosis. In mediation analyses, associations remained significant, although adjustment for metabolic risk factors was attenuating. Discussion: Clinically relevant weight loss was associated with a reduced risk of developing nonalcoholic fatty liver disease with or without intermediate or high probability of advanced fibrosis in metabolically healthy overweight or obese individuals.

Purpose The aim of this study was to show that bariatric surgery (BS) is more effective than medical therapy (MT) in Asian obese patients. Methods In this prospective, multicenter, nonrandomized, controlled trial, obese patients with body mass index of ≥35 kg/m2 or 30.0–34.9 kg/m2 with obesity-related comorbidities were assigned to undergo BS, such as laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, or MT. Patients who underwent BS were evaluated 4, 12, 24, and 48 weeks after surgery, whereas patients who received MT were monitored at a hospital every 6 weeks for 1 year. At each visit, weight, waist and hip circumference, and blood pressure were measured, and patients underwent physical examination and laboratory testing. Health-related quality of life (HQOL) was investigated using Euro QOL-5 Dimension, Impact of Weight on Quality of Life questionnaire-Lite and Obesity-related Problems scale. Results The study included 264 patients from 13 institutions; of these, 64 underwent BS and 200 received MT. Of the patients who underwent BS, 6.3% experienced early complications. Relative weight changes from baseline to 48 weeks were significantly greater in the BS than in the MT group (26.9% vs. 2.1%, P < 0.001), as were the rates of remission of diabetes (47.8% vs. 16.7%, P = 0.014), hypertension (60.0% vs. 26.1%, P < 0.001), and dyslipidemia (63.2% vs. 22.0%, P < 0.001). HQOL was better in the BS than in the MT group at 48 weeks. Conclusion BS was safe and effective in Korean obese patients, with greater weight reduction, remission of comorbidities, and quality of life improvement than MT.

BACKGROUND Although individuals with hypertension (HT) or diabetes mellitus (DM) strive to change their lifestyle and take medications, target blood pressure and blood glucose levels may not be reached. Few studies have investigated the incidence and risk of cardiovascular disease or mortality in the uncontrolled HT or DM conditions. OBJECTIVE We aimed to examine the association of HT or DM with incident cardiovascular disease or death. METHODS The Korean National Health Insurance Service-Health Screening Cohort aged 40–79 years (n = 440,249) that participated in national screening during 2002–2003 was used and was followed up to 2015. According to the HT or DM control status, incidence rates and hazard ratio (HR) for major adverse cardiovascular events (MACE) and death were estimated. Extended Cox regression was employed using time-dependent variables such as blood pressure (BP), fasting blood glucose (FBG), medication prescription, and adherence. RESULTS More than 60% of patients with HT or DM taking medication did not achieve the target BP or FBG. The incidence of MACE was 10.8–15.5 and 9.6–13.3 per 1,000 person-years with increasing age in the uncontrolled DM and uncontrolled HT groups, respectively. In the uncontrolled HT & DM group, however, the incidence of MACE was high (15.2–17.5 per 1000 person-years) at a relatively early age and showed no age-related trend. The increased risk of MACE was 28% in the uncontrolled DM group (adjusted HR, 1.28; 95% confidence interval [CI], 1.23–1.32), 32% in the uncontrolled HT group (1.32; 1.29–1.35), and 54% in the uncontrolled HT & DM group (1.54; 1.47–1.60). CONCLUSIONS Uncontrolled HT and uncontrolled DM were independent risk factors of MACE and all-cause death. An efficient system to continuously monitor BP and blood glucose is needed, particularly at an early age and in the uncontrolled group for both BP and FBG.

Background and aims Increased levels of ketone bodies, an alternative fuel when glucose availability is low, may exert beneficial effects on cardiovascular disease (CVD) risk factors. Whether increased ketone bodies are associated with coronary artery calcium (CAC), a recognized and strong cardiovascular risk factor, remains unknown. We investigated the association of fasting ketonuria with CAC and its progression. Methods Cross-sectional and longitudinal studies were conducted in adults without diabetes or CVD. Subjects underwent routine health examinations including cardiac computed tomography estimations of CAC scores. Logistic regression models were performed to compute the odds ratios (ORs), 95% confidence intervals (CIs), for prevalent CAC scores >0 according to fasting ketonuria categories (0, 1, and ≥2). Linear mixed models with random intercepts and random slopes were used to estimate CAC progression. Results Of 144,346 subjects, 12.3% had CAC scores >0 at baseline. Overall, higher fasting ketonuria was associated with decreased prevalence of coronary calcification than no ketonuria. Multivariable-adjusted ORs (95% CIs) for prevalent CAC by comparing ketonuria categories 1 and ≥2 with no ketonuria, were 0.94 (0.84–1.06) and 0.82 (0.71–0.95), respectively. The associations did not differ according to clinically relevant subgroups. Ketonuria was associated with lower CAC progression over time; the multivariable adjusted ratio of progression rates comparing ketonuria ≥2 versus no ketonuria was 0.976 (0.965–0.995). Conclusions We found an inverse association between fasting ketonuria and subclinical coronary atherosclerosis, in both prevalence and progression. The potentially protective role of increased ketone body formation in CVD requires further investigation.

Background : The prevalence of obesity is increasing in South Korea. We aimed to identify the perceptions, attitudes, behaviors, and barriers to effective obesity care in South Korea. Methods : The Awareness, Care, and Treatment In Obesity maNagement–an International Observation (ACTION-IO) study was a cross-sectional survey conducted in 11 countries. Respondents were people with obesity (PwO; body mass index ≥25 kg/m² in South Korea from self-reported height/weight) and healthcare professionals (HCPs) primarily involved in direct care with PwO. Results : The survey was completed by 1,500 PwO and 200 HCPs in South Korea. PwO (78%) and HCPs (81%) agreed that obesity is a chronic disease, but more PwO (84%) believed that obesity has an extreme impact on their overall health compared with HCPs (65%). Most PwO felt completely responsible for their own weight loss (81%), and 78% reported at least one serious weight loss attempt in the past. In contrast, HCPs reported that, on average, only 35% of their patients with obesity had made a serious attempt at losing weight. Only 31% of PwO had discussed weight with their HCP in the past 5 years; of those, 78% appreciated that HCPs initiated these conversations. Short appointment times restricted weight loss discussions for 70% of HCPs, and 29% of HCPs expressed complete comfort with such conversations. Conclusion : South Korean PwO are motivated to lose weight and have expressed interest in HCPs being more active in their weight management. Further nationwide efforts may be required to lower the barriers to education about obesity and effective weight loss discussion and management.

Context The association of menstrual cycle length and irregularity with the risk of non-alcoholic fatty liver disease (NAFLD) is unknown. Objective We examined this association in large cross-sectional and cohort studies. Methods The cross-sectional study included 72 092 women younger than 40 years who underwent routine health examinations; the longitudinal analysis included the subset of 51 118 women without NAFLD at baseline. Long or irregular cycles were defined as menstrual cycles of 40 days or longer or too irregular to estimate. Abdominal ultrasonography was performed to identify NAFLD. Multivariable Cox proportional hazard regression analyses were performed to estimate hazard ratios (HRs) and 95% CIs for incident NAFLD according to menstrual cycle regularity and length, with 26- to 30-day cycles as the reference. Results At baseline, 27.7% had long or irregular menstrual cycles and 7.1% had prevalent NAFLD. Long or irregular menstrual cycles were positively associated with prevalent NAFLD. During a median follow-up of 4.4 years, incident NAFLD occurred in 8.9% of women. After adjustment for age, body mass index, insulin resistance, and other confounders, the multivariable-adjusted HR for NAFLD comparing long or irregular menstrual cycles to the reference group was 1.22 (95% CI, 1.14-1.31); this association strengthened in the time-dependent analysis with an HR of 1.49 (95% CI, 1.38-1.60). Conclusion Long or irregular menstrual cycles were associated with increased risk of both prevalent and incident NAFLD in young, premenopausal women. Women with long or irregular menstrual cycles may benefit from lifestyle modification advice to reduce the risk of NAFLD and associated cardiometabolic diseases.

Background The care of people with obesity is often suboptimal due to both physician and patient perceptions about obesity itself and clinical barriers. Using data from the ACTION-IO study, we aimed to identify factors that might improve the quality of obesity care through adoption of the 3D approach (Discussion, Diagnosis and Direction [follow-up]) by healthcare professionals (HCPs). Methods An online survey was completed by HCPs in 11 countries. Exploratory beta regression analyses identified independent variables associated with each component of the 3D approach. Results Data from 2,331 HCPs were included in the statistical models. HCPs were significantly more likely to initiate weight discussions and inform patients of obesity diagnoses, respectively, if (odds ratio [95% confidence interval]): they recorded an obesity diagnosis in their patient's medical notes (1.59, [1.43–1.76] and 2.16 [1.94–2.40], respectively); and they were comfortable discussing weight with their patients (1.53 [1.39–1.69] and 1.15 [1.04–1.27]). HCPs who reported feeling motivated to help their patients lose weight were also more likely to initiate discussions (1.36 [1.21–1.53]) and schedule follow-up appointments (1.21 [1.06–1.38]). By contrast, HCPs who lacked advanced formal training in obesity management were less likely to inform patients of obesity diagnoses (0.83 [0.74–0.92]) or schedule follow-up appointments (0.69 [0.62–0.78]). Conclusion Specific actions that could improve obesity care through the 3D approach include: encouraging HCPs to record an obesity diagnosis; providing tools to help HCPs feel more comfortable initiating weight discussions; and provision of training in obesity management. Clinical trial registration NCT03584191.

AIMS: Despite increased recognition as a chronic disease, obesity remains greatly underdiagnosed and undertreated. We aimed to identify international perceptions, attitudes, behaviours and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). METHODS: An online survey was conducted in 11 countries. Participants were adults with obesity and HCPs primarily in direct patient care. RESULTS: 14,502 PwO and 2,785 HCPs completed the survey. Most PwO (68%) and HCPs (88%) agreed that obesity is a disease. However, 81% of PwO assumed complete responsibility for their own weight loss and only 44% of HCPs agreed that genetics were a barrier. There was a median of 3 (mean 6) years between the time when PwO started struggling with excess weight or obesity and when they first discussed their weight with an HCP. Many PwO were concerned about the impact of excess weight on health (46%) and were motivated to lose weight (48%). Most PwO (68%) would like their HCP to initiate a conversation about weight and only 3% were offended by such a conversation. Among HCPs, belief that patients have little interest/motivation for weight management may constitute a barrier for weight management conversations. When discussed, HCPs typically recommended lifestyle changes; but more referrals and follow-up appointments are required. CONCLUSIONS: Our international dataset reveals a need to increase understanding of obesity and improve education on its physiological basis and clinical management. Realisation that PwO are motivated to lose weight offers an opportunity for HCPs to initiate earlier weight management conversations. SPONSOR: Novo Nordisk. This article is protected by copyright. All rights reserved.

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m². Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m² and for Korean patients with BMI ≥30 kg/m² who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.

Abstract Aims The longitudinal relationship between depression and the risk of non-alcoholic fatty liver disease is uncertain. We examined: (a) the association between depressive symptoms and incident hepatic steatosis (HS), both with and without liver fibrosis; and (b) the influence of obesity on this association. Methods A cohort of 142 005 Korean adults with neither HS nor excessive alcohol consumption at baseline were followed for up to 8.9 years. The validated Center for Epidemiologic Studies-Depression score (CES-D) was assessed at baseline, and subjects were categorised as non-depressed (a CES-D < 8, reference) or depression (CES-D ⩾ 16). HS was diagnosed by ultrasonography. Liver fibrosis was assessed by the fibrosis-4 index (FIB-4). Parametric proportional hazards models were used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results During a median follow-up of 4.0 years, 27 810 people with incident HS and 134 with incident HS plus high FIB-4 were identified. Compared with the non-depressed category, the aHR (95% CIs) for incident HS was 1.24 (1.15–1.34) for CES-D ⩾ 16 among obese individuals, and 1.00 (0.95–1.05) for CES-D ⩾ 16 among non-obese individuals (p for interaction with obesity p for interaction = 0.201). Conclusions Depression was associated with an increased risk of incident HS and HS plus high probability of advanced fibrosis, especially among obese individuals.

Background People with obesity (PwO) often struggle to achieve and maintain weight loss. This can perpetuate and/or be influenced by feelings of low motivation. This analysis from ACTION-IO data identified factors associated with PwO motivation to lose weight. Methods PwO completed an online survey in 11 countries. Exploratory multinomial logistic regression analyses identified independent variables associated with self-report of feeling motivated versus not motivated to lose weight. Results Data from 10,854 PwO were included (5,369 motivated; 3,312 neutral; 2,173 not motivated). Variables associated with feeling motivated versus not motivated included (odds ratio [95% confidence interval]): acknowledgement of healthcare professional (HCP) responsibility to contribute to weight loss (2.32 [1.86–2.88]), comfort in talking to their HCP about weight (1.46 [1.24–1.72), agreement that it is easy to lose weight (1.73 [1.30–2.31]), and a goal of reducing risks from excess weight (1.45 [1.22–1.73]). Conversely, if PwO considered obesity less important than other diseases they were less likely to report feeling motivated (0.49 [0.41–0.58]). PwO who reported being motivated to lose weight were more likely to exercise ≥5 times a week versus Conclusions Positive interactions with HCPs, self-efficacy, setting goals and knowledge of the importance of weight management, in addition to regular exercising, may increase PwO motivation for weight loss. Appropriate HCP support may help PwO who are ready to engage in weight management. Clinical trial registration : NCT03584191.

The impact of depression on the risk of liver-related mortality in individuals with hepatitis B virus (HBV) infection remains unclear. We examined the association between depression, HBV infection, and liver-related mortality. A total of 342,998 Korean adults who underwent health examinations were followed for up to 7.8 years. Depressive symptoms were defined as a Center for Epidemiologic Studies-Depression score ≥ 16. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). During 1,836,508 person-years of follow-up, 74 liver-related deaths and 54 liver cancer deaths were identified (liver-related mortality rate of 4.0 per 105 person-years and liver cancer mortality rate of 2.9 per 105 person-years). Subjects with depressive symptoms had an increased risk of liver-related mortality with a corresponding multivariable aHR of 2.00 (95% CI 1.10–3.63) compared to those without depressive symptoms. This association was more evident in HBsAg-positive participants with a corresponding multivariable aHR of 4.22 (95% CI 1.81–9.88) than HBsAg-negative participants (P for interaction by HBsAg positivity = 0.036). A similar pattern was observed in relation to liver cancer mortality. In this large cohort, depressive symptoms were associated with an increased risk of liver-related mortality, with a stronger association in HBsAg-positive individuals.

Obesity is a medical condition that presents excessive fat accumulation with high risk of serious chronic diseases. The aim of this clinical trial is to investigate the anti-obesity effects of Cornus officinalis (CO) and Ribes fasciculatum (RF) on body fat reduction in Korean overweight women. A total of 147 overweight female participants enrolled in double-blinded clinical trial for 12 weeks and 76 participants completed the clinical study. Participants were treated with four CO and RF mixture (COEC, 400 mg per tablet) or four placebo tablets once a day. Obesity associated parameters (body weight, body mass index (BMI), waist circumference, waist-to-hip ratio, body fat percentage and body fat mass) and safety assessment were analyzed. After 12 weeks of COEC treatment, primary outcomes such as body fat percentage (0.76% vs. 0.01%, p = 0.022) and mass (1.1 kg vs. 0.5 kg, p = 0.049) were significantly decreased. In addition, the results were statistically significant between the COEC and placebo groups, strongly indicated that COEC had anti-obesity effects on overweight women. Secondary outcomes&mdash, including body weight, waist and hip circumference, waist-to-hip ratio, body mass index and computed tomography measurement of visceral fat area, subcutaneous fat area, total abdominal fat area and visceral-to-subcutaneous fat ratio&mdash, were reduced in COEC-treated group, but no statistical differences were found between the COEC and placebo groups. The safety assessment did not differ between the two groups. These results suggest that treatment of COEC extract reduces body fat percentage and mass in Korean overweight women, indicating it as a protective functional agent for obesity.

Obesity is a medical condition that presents excessive fat accumulation with high risk of serious chronic diseases. The aim of this clinical trial is to investigate the anti-obesity effects of Cornus officinalis (CO) and Ribes fasciculatum (RF) on body fat reduction in Korean overweight women. A total of 147 overweight female participants enrolled in double-blinded clinical trial for 12 weeks and 76 participants completed the clinical study. Participants were treated with four CO and RF mixture (COEC; 400 mg per tablet) or four placebo tablets once a day. Obesity associated parameters (body weight, body mass index (BMI), waist circumference, waist-to-hip ratio, body fat percentage and body fat mass) and safety assessment were analyzed. After 12 weeks of COEC treatment, primary outcomes such as body fat percentage (0.76% vs. 0.01%; p = 0.022) and mass (1.1 kg vs. 0.5 kg; p = 0.049) were significantly decreased. In addition, the results were statistically significant between the COEC and placebo groups, strongly indicated that COEC had anti-obesity effects on overweight women. Secondary outcomes—including body weight, waist and hip circumference, waist-to-hip ratio, body mass index and computed tomography measurement of visceral fat area, subcutaneous fat area, total abdominal fat area and visceral-to-subcutaneous fat ratio—were reduced in COEC-treated group, but no statistical differences were found between the COEC and placebo groups. The safety assessment did not differ between the two groups. These results suggest that treatment of COEC extract reduces body fat percentage and mass in Korean overweight women, indicating it as a protective functional agent for obesity.

The effect of light-to-moderate alcohol consumption on cancer risk remains controversial. We examined the association between low-level alcohol consumption and cancer mortality. A cohort study included 331,984 Korean adults free of cancer at baseline who underwent a comprehensive health checkup examination. Participants were categorized into never drinkers, former drinkers, and current drinkers who were further divided into light, moderate, heavy, and very heavy drinkers. Vital status and cancer-related deaths were ascertained through links to national death records. During 1,633,906 person-years of follow-up (median 5.3 years interquartile range 3.8–6.2), 374 cancer-related deaths were identified (cancer-cause mortality rate of 23 per 105 person-years). When former and never drinkers were classified as non-drinkers, the light drinkers had a lowest risk of cancer mortality compared with non-drinkers and other current drinkers (J-shaped); however, with consideration of lifetime abstinence history, current drinking was positively associated with cancer mortality in a dose-dependent manner. When changes in alcohol drinking status and confounders during follow-up were updated as time-varying covariates and never drinkers were used as the reference, the multivariable-adjusted hazard ratios (HRs) (95% confidence intervals, CIs) for cancer mortality among current light, moderate, heavy, and very heavy drinkers were 1.58 (1.03–2.43), 2.28 (1.41–3.70), 2.34 (1.42–3.85), and 2.97 (1.80–4.90), respectively, and the highest risk of cancer mortality was observed in former drinkers, who had an HR (95% CI) of 3.86 (2.38–6.28). Alcohol consumption was significantly and positively associated with an increased risk of cancer mortality in a dose-dependent manner, beginning with light drinkers.

ObjectiveThe early identification of predictors related to cardiovascular disease risk factor clustering (CVD-RFC) can help prevent chronic disease. We aimed to identify the risk factors for CVD-RFC in adolescents.MethodsA prospective longitudinal cohort study design was used to obtain data included in these analyses from school-aged children who participated in the Korean Child-Adolescent Study 2008–2014. A total of 1309 children aged 6–15 years were enrolled. We compared the participants based on the presence or absence of CVD-RFC and examined the cumulative incidence of CVD-RFC.ResultsOf the total 1309 children, 410 (31.32%) had CVD-RFC in adolescence. A higher average household income ≥3 million Korean Republic won (KRW)/month (3–5 million KRW/month: HR 0.75 (95% CI 0.58 to 0.97); ≥5 million KRW/month: HR 0.58 (95% CI 0.44 to 0.77)) was associated with a lower CVD-RFC incidence, while the presence of parental CVD history (HR 1.28 (95% CI 1.04 to 1.57)), overweight or obesity (HR 3.83 (95% CI 3.05 to 4.80)) and shorter sleep duration of 8–9 hour/day (HR 1.80 (95% CI 1.05 to 3.07)) and ConclusionsObesity in childhood, short sleep duration and parental factors such as low socioeconomic status and parental history of CVD are significant risk factors for the development of CVD-RFC in adolescents. Efforts to create awareness regarding sufficient sleep duration in children via intervention programmes targeting cardiometabolic health in children and special attention to lifestyle modifications and socioeconomic components of the family should be considered.

Context Irisin, a novel exercise-induced myokine, has been suggested to regulate energy metabolism. Objective We studied the relationship between circulating irisin and metabolic and metabolite profiles of Korean adolescents, and investigated the effects of physical activity, obesity, and metabolic syndrome (MetS) on irisin levels. Materials and Methods Data were obtained from the Korean Children–Adolescents Study. Our cross-sectional study included 618 adolescents (370 normal-weight and 248 obese adolescents; 316 boys and 302 girls) aged 12–15 years. Body composition was determined using an impedance body composition analyzer and general participant characteristics and lifestyle information were obtained from questionnaires. Serum irisin levels were measured using a commercial kit. Results Mean body mass index (BMI) was 19.4 kg/m 2 in normal-weight adolescents and 31.4 kg/m 2 in obese adolescents. Circulating irisin was positively correlated with adiposity indices, including BMI z-score, waist circumference, percent body fat, fat mass, fat-free mass, fat mass to fat-free mass ratio, and lipid and glucose metabolism markers, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, glucose, insulin, and homeostasis model assessment-estimated insulin resistance (all p ≤ 0.006). Of these, increased body fat mass [standardized (Std) s, 0.23; p p = 0.0005) and fasting glucose (Std s, 0.08; p = 0.0383) were the main independent factors associated with higher irisin levels. Moreover, elevated serum irisin was associated with the risk of obesity [odds ratio (OR], 2.2; confidence interval (CI), 1.19–3.87] and MetS (OR, 2.0; CI, 1.15–3.47). Furthermore, irisin and branched-chain amino acids were positively associated ( p − 4 for Bonferroni correction). Additionally, in the normal-weight group, girls had higher irisin levels than boys ( p = 0.006) and adolescents who engaged in regular physical activity had higher levels of irisin than sedentary adolescents ( p = 0.0388). The relationship between physical activity and irisin levels was not observed in obese adolescents. Conclusions Elevated serum irisin was independently associated with the risk of obesity and positively correlated with unhealthy metabolic parameters and metabolites. Moreover, irisin levels were higher in active versus sedentary adolescents in the normal-weight group, but not in the obese group. Our findings suggest that irisin plays an important role in metabolic disorders and may be affected by physiopathological status.

The aim of the present study was to investigate the association between hypertension and carbonated sugar-sweetened beverages (SSB) intake according to gender and obesity.The study used data from 2007, 2008 and 2009 Korea National Health and Nutrition Examination Surveys. A total of 9869 subjects (men = 3845 and women = 6024) were included. SSB intakes were calculated from food frequency questionnaires. Odds ratios (ORs) and 95 % confidence interval (CI) for hypertension were assessed using survey logistic regression and multivariable adjusted models.A total of 14.5 % of individuals were classified as having hypertension. The likelihood of hypertension in the third, fourth and fifth quintiles for SSB intake increased to OR 1.00, 1.20 and 1.42 respectively, after adjusting for confounding factors. Compared to the participants in the lowest tertile for SSB intake, participants in the third tertile showed an increased likelihood of hypertension with ORs (CI) of 2.00 (1.21-3.31) and 1.75 (1.23-2.49) for obese women and non-obese men, respectively.The present study showed gender differences in the relationship between carbonated SSB intake and the hypertension according to obesity.

습관과 신체활동 습관은 성인기까지 지속되어 소아기의 건강 문제뿐 아니라 성인이 된 이후의 건강 문제에도 영향을 미치게 된다. 2012 년 학교건강검사 표본조사 결과에 의하면, 우리나라 초등학생은 10 명 중 약 3명만이 매일 채소를 섭취하는 반면, 절반 이상이 주 1회 이 상 패스트푸드를 섭취하였고, 3명 중 약 1명의 초등학생이 하루 2시간 이상 TV를 보고 있어 식습관과 신체활동 습관에 문제가 있었다. 이 는 소아 비만의 증가로 이어져 초등학생의 비만율은 2008년 11.0%에 서 2012년 14.2%로 꾸준히 증가하고 있다. 소아 비만의 예방 및 관리 를 위해서는 올바른 영양, 신체활동 및 생활습관에 대한 지속적인 교 육이 필요하다. 소아의 건강습관 개선과 비만 예방을 위한 학교, 가족, 지역사회 중 심의 많은 중재 프로그램들이 그동안 시도되었지만, 소아 비만 문제 를 해결하는 데에는 한계가 있어, 소아 비만 예방에 효과적인 또 다른 초등학교 4-6학년 학생의 비만 예방을 위한 스마트 폰 어플리케이션 개발

The prevalence of obesity is increasing in South Korea. We aimed to identify the perceptions, attitudes, behaviors, and barriers to effective obesity care in South Korea.The Awareness, Care, and Treatment In Obesity maNagement-an International Observation (ACTION-IO) study was a cross-sectional survey conducted in 11 countries. Respondents were people with obesity (PwO; body mass index ≥25 kg/mThe survey was completed by 1,500 PwO and 200 HCPs in South Korea. PwO (78%) and HCPs (81%) agreed that obesity is a chronic disease, but more PwO (84%) believed that obesity has an extreme impact on their overall health compared with HCPs (65%). Most PwO felt completely responsible for their own weight loss (81%), and 78% reported at least one serious weight loss attempt in the past. In contrast, HCPs reported that, on average, only 35% of their patients with obesity had made a serious attempt at losing weight. Only 31% of PwO had discussed weight with their HCP in the past 5 years; of those, 78% appreciated that HCPs initiated these conversations. Short appointment times restricted weight loss discussions for 70% of HCPs, and 29% of HCPs expressed complete comfort with such conversations.South Korean PwO are motivated to lose weight and have expressed interest in HCPs being more active in their weight management. Further nationwide efforts may be required to lower the barriers to education about obesity and effective weight loss discussion and management.

Background/objectives This study evaluated whether a mobile health (mHealth) application can instigate healthy behavioral changes and improvements in metabolic disorders in individuals with metabolic abnormalities. Subjects/methods Participants were divided into an mHealth intervention group (IG), which used a mobile app for 24 weeks, and a conventional IG. All mobile apps featured activity monitors, with blood pressure and glucose monitors, and body-composition measuring devices. The two groups were compared after 24 weeks in terms of health-behavior practice rate and changes in the proportion of people with health risks, and health behaviors performed by the IG that contributed to reductions in more than one health risk factor were analyzed using multiple logistic regression. Results Preference for low-sodium diet, reading nutritional facts, having breakfast, and performing moderate physical activity significantly increased in the mHealth IG. Furthermore, the mHealth IG showed a significant increase of eight items in the mini-dietary assessment; particularly, the items "I eat at least two types of vegetables of various colors at every meal" and "I consume dairies, such as milk, yogurt, and cheese, every day." The proportion of people with health risks, with the exception of fasting glucose, significantly decreased in the mHealth IG, while only the proportion of people with at-risk triglycerides and waist circumference of females significantly decreased in the control group. Finally, compared to those who did not show improvements of health risks, those who showed improvements of health risks in the mHealth IG had an odds ratio of 1.61 for moderate to vigorous physical activity, 1.65 for "I do not add more salt or soy sauce in my food," and 1.77 for "I remove fat in my meat before eating." Conclusions The findings suggest that the additional use of a community-based mHealth service through a mobile application is effective for improving health behaviors and lowering metabolic risks in Koreans.

Controversy exists on whether animal and plant proteins influence obesity differently. The purpose of this study was to evaluate the association between total, animal, and plant protein intake with the body mass index (BMI), waist circumference (WC), and renal function in the Korean elderly. Study participants included Korean adults aged 60 years or older from the Korean National Health and Nutrition Examination Survey in 2013–2014. Height, weight, and waist circumference were measured and the body mass index was calculated. One-day 24-hour recall data were used to estimate daily total, animal, and plant protein intake. Glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease (MDRD) equation. General linear modellings were used to assess the relationships between protein intake, BMI and WC. The mean age was 69.2 ± 0.2 years and 44.2% were male. The total daily protein intake was 1.1 ± 0.02 g/kg/day and 0.9 ± 0.02 g/kg/day for males and females, respectively. Only one third of protein intake was from animal sources. In males, BMI (regression coefficient (95% CI); −1.30 (−1.55, −1.06), p < 0.001; −0.29 (−0.52, −0.05), p = 0.016; −1.30 (−1.8, −1.02), p < 0.001, respectively) and WC (−3.87 (−4.58, −3.16), p < 0.001; −0.90 (−1.58, −0.22), p = 0.010; −3.88 (−4.68, −3.08), p < 0.001, respectively) decreased as daily intake of plant protein (g/kg/day), animal protein (g/kg/day) and total protein (g/kg/day) increased. Similar associations were shown in Korean females. GFR was not associated with protein intake regardless of protein source in both sexes. In Korean adults aged 60 years or older, the protein intake was associated with a favorable obesity index without decrease in renal function. The effect was similar in both males and females, with both animal and plant proteins.

Controversy exists on whether animal and plant proteins influence obesity differently. The purpose of this study was to evaluate the association between total, animal, and plant protein intake with the obesity index and renal function in Korean adults. Study participants included Korean adults aged 60 years or older from the Korean National Health and Nutrition Examination Survey in 2013-2014. Height, weight, and waist circumference (WC) were measured and the body mass index (BMI) was calculated. One-day 24-hour recall data were used to estimate the daily total, animal, and plant protein intake. Glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease (MDRD) equation. General linear modellings were used to assess the relationships between protein intake, BMI and WC. The mean age was 69.2 ± 0.2 years, 44.2% were male. The total daily protein intake was 1.1 ± 0.02 g/kg/d and 0.9 ± 0.02 g/kg/d for males and females, respectively. Only one third of protein intake was from animal sources. In males, BMI (p < 0.001, p = 0.016, p < 0.001 respectively) and WC (p < 0.001, p = 0.010, p < 0.001, respectively) decreased as daily intake of plant protein (g/kg/d), animal protein (g/kg/d) and total protein (g/kg/d) increased. Similar associations were shown in Korean female. GFR was not associated with protein intake regardless of protein source in both sexes. In Korean adults aged 60 years or older, the protein intake was associated with a favorable obesity index without decrease in renal function. The effect was similar in both male and females, with both animal and plant proteins.

We evaluated the effects of baseline body mass index (BMI) and its changes over 4 years on all-cause mortality in Korean population. We analyzed 351 735 participants whose BMI was measured in both 2002/2003 and 2006/2007. Mortality was assessed until 2013. Multivariate hazard ratios for all-cause mortality were estimated. Underweight and severe obesity with BMI >30 kg/m2 were significantly associated with higher mortality. Similarly, >5% decrease or >10% increase of BMI for 4 years was associated with the increased risk of death. Comparing the results between baseline BMI and BMI change, the BMI change showed more stable associations with mortality than the baseline BMI in subgroup analysis such as nonsmokers and healthy participants. This study suggests that BMI change could be a useful health indicator along with obesity level by BMI. In addition, maintaining a healthy weight is needed for longevity, but rapid weight change should be carefully monitored.

Childhood obesity is strongly related to future insulin resistance and metabolic syndrome. Thus, identifying early biomarkers of obesity-related diseases based on metabolic profiling is useful to control future metabolic disorders. We compared metabolic profiles between obese and normal-weight children and investigated specific biomarkers of future insulin resistance and metabolic syndrome.In all, 186 plasma metabolites were analysed at baseline and after 2 years in 109 Korean boys (age 10.5±0.4 years) from the Korean Child Obesity Cohort Study using the AbsoluteIDQ™ p180 Kit.We observed that levels of 41 metabolites at baseline and 40 metabolites at follow-up were significantly altered in obese children (p0.05). Obese children showed significantly higher levels of branched-chain amino acids (BCAAs) and several acylcarnitines and lower levels of acyl-alkyl phosphatidylcholines. Also, baseline BCAAs were significantly positively correlated with both homeostasis model assessment for insulin resistance (HOMA-IR) and continuous metabolic risk score at the 2-year follow-up. In logistic regression analyses with adjustments for degree of obesity at baseline, baseline BCAA concentration, greater than the median value, was identified as a predictor of future risk of insulin resistance and metabolic syndrome.High BCAA concentration could be "early" biomarkers for predicting future metabolic diseases.

Background YY-312 is a herbal extract powder from Imperata cylindrica Beauvois, Citrus unshiu Markovich, and Evodia officinalis Dode, which have health promoting effects, including body fat reduction. We aimed to evaluate the efficacy and safety of YY-312 for body fat reduction in overweight adults. Methods This was a 12-week, randomized, double-blind, placebo-controlled, parallel-group clinical trial performed in overweight Korean adults aged 19–60 years with a body mass index of 25.0–29.9 kg/m2. The daily dose of YY-312 was 2400 mg (containing 1800 mg of active herbal extract and 600 mg of cyclodextrin). Primary outcomes were reductions in body fat mass (BFM) and body fat percentage (BF%) after 12 weeks. Secondary outcomes included reductions in body weight and waist circumference (WC) after 12 weeks. Results After 12 weeks, BFM (1.6 kg vs. 0.1 kg; P = 0.023) and BF% (1.5% vs. -0.2%; P = 0.018) decreased significantly more in the YY-312 group than in the placebo group, as did body weight (2.7 kg vs. 1.0 kg; P = 0.014) and WC (2.2 cm vs. 0.8 cm; P = 0.049). All safety parameters were within normal limits; no serious adverse events occurred in either group. Conclusions In a 12-week clinical trial in overweight adults, YY-312 resulted in significantly greater reduction in body fat vs. placebo, while being safe and well tolerated. Trial registration cris.nih.go.kr: ( KCT0001225 ).

The aims of this study were to assess the diagnostic value of the weight-to-height ratio (WHtR) for the detection of obesity and metabolic syndrome (MS) in Korean children and adolescents, and to determine the advantages of WHtR as a population-based screening tool in comparison with other obesity indicators, such as body mass index (BMI) and waist circumference (WC). We performed a cross-sectional analysis of data from 3057 children and adolescents (1625 boys, 1332 girls) aged 10–19 years who were included in the fifth Korean National Health and Nutrition Examination Survey (KNHANES, 2010–2012) up to the second year of the sixth KNHANES (2013–2014). Receiver operation characteristic (ROC) curves were generated to determine the optimal cutoff value and accuracy of WHtR for predicting individual obesity indicators or more than two non-WC components of MS. The area under the ROC curve (AUC) is a measure of the diagnostic power of a test. A perfect test will have an AUC of 1.0, and an AUC equal to 0.5 means that the test performs no better than chance. The optimal WHtR cutoff for the evaluation of general obesity and central obesity was 0.50 in boys and 0.47–0.48 in girls, and the AUC was 0.9. Regarding the assessment of each MS risk factor, the optimal WHtR cutoff was 0.43–0.50 in boys and 0.43–0.49 in girls, and these cutoffs were statistically significant only for the detection of high triglyceride and low High-density lipoprotein (HDL) cholesterol levels. When a pairwise comparison of the AUCs was conducted between WHtR and BMI/WC percentiles to quantify the differences in power for MS screening, the WHtR AUC values (boys, 0.691; girls, 0.684) were higher than those of other indices; however, these differences were not statistically significant (boys, p = 0.467; girls, p = 0.51). The WHtR cutoff value was 0.44 (sensitivity, 67.7%; specificity, 64.6%) for boys and 0.43 (sensitivity, 66.4%; specificity, 66.9%) for girls. There was no significant difference between the diagnostic power of WHtR and that of BMI/WC when screening for MS. Although the use of WHtR was not superior, WHtR is still useful as a screening tool for metabolic problems related to obesity because of its convenience.

• A genome wide association study identifies a LEPR gene as a novel predisposing factor for childhood fasting plasma glucose

ObjectivesObesity in childhood increases the risk of obesity in adulthood, and is predictive of the development of metabolic disorders. The fatty acid compositions of various tissues, including blood, are associated with obesity and obesity-associated disorders. Thus, tracking plasma phospholipid (PL) features and metabolic parameters in young individuals may strengthen the utility of fatty acid composition as an early biomarker of future metabolic disorders.MethodsAnthropometric and blood biochemical data were obtained from 131 Korean males aged 10.5 ± 0.4 years, and followed up at 2 years. We analyzed the plasma PL fatty acids according to obesity. Obese children were defined as those with a body mass index (BMI) greater than the 85th percentile for age and gender, based on Korean child growth standards.ResultsActivities of lipid desaturases, stearyl-CoAD (SCD-16,16:1n-7/16:0), delta-6D (D6D, 20:3n-6/18:2n-6), and delta-5D (D5D, 20:4n-6/20:3n-6), were estimated. Obese individuals had significantly higher proportions of palmitoleic acid (16:1n-7) and dihomo-gamma linolenic acid (DGLA, 20:3n-6) at both baseline and follow-up than did lean individuals. The activities of SCD-16 and D6D were higher in obese than lean boys. The baseline SCD-16 activity level was positively associated with the baseline waist circumference (WC) and the metabolic risk score. The baseline D6D level was positively associated with WC and also with the homeostasis model of assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance (IR), and metabolic risk score at both baseline and follow-up.ConclusionIn young Korean males, higher D6D activity predicts the future development of IR and associated metabolic disorders including dyslipidemia.

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m

Background Underweight is associated with increased risk of mortality and morbidity. It is reported that the prevalence of underweight is increasing among Korean young women. However, there have been few studies on sociodemographic factors related to being underweight. This study was conducted to elucidate the sociodemographic characteristics of Korean underweight adults. Methods This study is a cross-sectional study of 7,776 adults aged 25 to 69 years using data from the Korea National Health and Nutrition Examination Survey, 2007-2010. Study subjects were composed of underweight and normal-weight adults excluding overweight adults. Body mass index was calculated from measured height and weight. Health behaviors such as smoking, drinking, and physical activity were surveyed through self-administered questionnaires, and socioeconomic status, marital status, and history of morbidity were surveyed through face-to-face interviews. Results Women had a higher frequency of underweight (10.4% vs. 7.0%, P < 0.001) than men. Among men, current smoking (odds ratio [OR], 1.62) and past history of cancer (OR, 2.55) were independently related to underweight. Among women, young age (OR, 2.06), former smoking (OR, 1.69), and being unmarried (OR, 1.56) were identified as independently related factors of underweight. In addition, among both men and women, alcohol drinking (men OR, 0.57; women OR, 0.77) and past history of chronic diseases (men OR, 0.55; women OR, 0.43) were independently related to a lower frequency of underweight. Conclusion We showed that various sociodemographic factors were associated with underweight. It was ascertained that there were differences in the sociodemographic factors related to underweight between Korean men and women.

The diagnostic criteria (KCDC Criteria) to define obesity and overweight of Korean children and adolescents were newly presented in the 2007 Korean National Growth Charts. The KCDC Criteria were criticized for several problems caused by upward shift of body mass index (BMI) percentile curves of the growth charts. This study was conducted to establish new diagnostic criteria (New Criteria) for obesity and overweight in Korean children and adolescents that would be less affected by a change of BMI distribution in the reference population of the Growth Charts. The BMI values for ages 2-18 years corresponding to Asia-Pacific adult BMI cutoffs of obesity (25.0 kg/m(2)) and overweight (23.0 kg/m(2)) were calculated with L, M and S values presented in the 2007 Korean National Growth Charts. Additionally, we examined the frequencies of obesity and overweight among children and adolescents who participated in the 2005 National Growth Survey based on both New Criteria and KCDC Criteria. The Z-scores corresponding to BMIs of 25 and 23 kg/m(2) at 18-years-of-age were 0.99 and 0.41 in boys, and 1.34 and 0.71 in girls, respectively. The BMI values corresponding to these Z-scores from age 2 to 18 years were determined as new BMI cutoffs for obesity and overweight. The frequencies of obesity and overweight estimated by New Criteria were greater by 2 times in boys and 1.5 times in girls than those by KCDC Criteria. We suggest that New Criteria could be a good alternative that can resolve problems caused by upward shift of BMI percentile curves of the 2007 Korean National Growth Charts.

Background The gut microbiota has emerged as an important environmental factor associated with obesity, type 2 diabetes, and cardiovascular disease, through its interactions with dietary factors. Therefore, we analyzed the composition of the fecal microbiota and levels of biochemical markers related to metabolic disease according to dietary pattern in Korean adolescents. Methods We collected fecal samples from 112 student subjects aged 13–16 years with sufficient information available regarding clinical biomarkers and diet, and performed 16S rRNA targeted gene sequencing. Results Regarding bacterial composition according to taxonomic rank, we found that traditional dietary patterns enriched in plant-based and fermented foods were associated with higher proportions of Bacteroides (Bacteroidaceae) and Bifidobacterium (Bifidobacteriaceae-Actinobacteria) and a lower proportion of Prevotella (Prevotellaceae) relative to modified Western dietary patterns (a greater proportion of animal-based foods). Specifically, the proportion of Bacteroides (Bacteroidaceae) was associated with intake of plant-based nutrients such as fiber; however, that of Prevotella (Prevotellaceae) was negatively associated with these factors. Additionally, we observed that the increase of prevotella (Prevotellaceae) and decrease of Bacteroides (Bacteroidaceae) and Ruminococcaceae had a higher risk of obesity. We also found that the traditional dietary pattern was negatively associated with general and central adiposity and levels of clinical biomarkers, including AST, ALT, total cholesterol, triglyceride, hs-CRP, insulin, and HOMA-IR, whereas the positive associations were found for a modified Western dietary pattern. Conclusions These findings suggest that the gut microbiota composition differs markedly according to dietary intake and suggest a role for diet in promoting a gut microbiome associated with the pathogenesis of metabolic disease. Electronic supplementary material The online version of this article (doi:10.1186/s40795-016-0125-z) contains supplementary material, which is available to authorized users.