Diabetes & Metabolism Journal

Original Article

Metabolic Risk/Epidemiology
Healthy Lifestyle and the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease: A Large Prospective Cohort Study: Qing Chang, Yixiao Zhang, Tingjing Zhang, Zuyun Liu, Limin Cao, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Yang Ding, Yuhong Zhao, Kaijun Niu, Yang Xia; Received April 27, 2023 Accepted November 30, 2023 Published online March 19, 2024; DOI: https://doi.org/10.4093/dmj.2023.0133 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
The incidence density of metabolic dysfunction-associated fatty liver disease (MAFLD) and the effect of a healthy lifestyle on the risk of MAFLD remain unknown. We evaluated the prevalence and incidence density of MAFLD and investigated the association between healthy lifestyle and the risk of MAFLD.
Methods
A cross-sectional analysis was conducted on 37,422 participants to explore the prevalence of MAFLD. A cohort analysis of 18,964 individuals was conducted to identify the incidence of MAFLD, as well as the association between healthy lifestyle and MAFLD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) with adjustments for confounding factors.
Results
The prevalence of MAFLD, non-alcoholic fatty liver disease, and their comorbidities were 30.38%, 28.09%, and 26.13%, respectively. After approximately 70 thousand person-years of follow-up, the incidence densities of the three conditions were 61.03, 55.49, and 51.64 per 1,000 person-years, respectively. Adherence to an overall healthy lifestyle was associated with a 19% decreased risk of MAFLD (HR, 0.81; 95% CI, 0.72 to 0.92), and the effects were modified by baseline age, sex, and body mass index (BMI). Subgroup analyses revealed that younger participants, men, and those with a lower BMI experienced more significant beneficial effects from healthy lifestyle.
Conclusion
Our results highlight the beneficial effect of adherence to a healthy lifestyle on the prevention of MAFLD. Health management for improving dietary intake, physical activity, and smoking and drinking habits are critical to improving MAFLD.

Review

Others
Mitochondrial Toxins and Healthy Lifestyle Meet at the Crossroad of Hormesis: Yu-Mi Lee, Duk-Hee Lee; Diabetes Metab J. 2019;43(5):568-577. Published online October 24, 2019; DOI: https://doi.org/10.4093/dmj.2019.0143

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Mitochondrial function is crucial for the maintenance of cellular homeostasis under physiological and stress conditions. Thus, chronic exposure to environmental chemicals that affect mitochondrial function can have harmful effects on humans. We argue that the concept of hormesis should be revisited to explain the non-linear responses to mitochondrial toxins at a low-dose range and develop practical methods to protect humans from the negative effects of mitochondrial toxins. Of the most concern to humans are lipophilic chemical mixtures and heavy metals, owing to their physical properties. Even though these chemicals tend to demonstrate no safe level in humans, a non-linear dose-response has been also observed. Stress response activation, i.e., hormesis, can explain this non-linearity. Recently, hormesis has reemerged as a unifying concept because diverse stressors can induce similar stress responses. Besides potentially harmful environmental chemicals, healthy lifestyle interventions such as exercise, calorie restriction (especially glucose), cognitive stimulation, and phytochemical intake also activate stress responses. This conceptual link can lead to the development of practical methods that counterbalance the harm of mitochondrial toxins. Unlike chemical hormesis with its safety issues, the activation of stress responses via lifestyle modification can be safely used to combat the negative effects of mitochondrial toxins.

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Original Article

Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program: Seung-Hyun Ko, Sin-Ae Park, Jae-Hyoung Cho, Sun-Hye Ko, Kyung-Mi Shin, Seung-Hwan Lee, Ki-Ho Song, Yong-Moon Park, Yu-Bae Ahn; Diabetes Metab J. 2012;36(3):222-229. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.222

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Abstract PDF PubReader

Background

Diabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes.

Methods

Two hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program (≤1 year [≤1Y] vs. ≥3 years [≥3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint.

Results

The mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the ≤1Y group. Self-care behaviors, measured by scores for dietary habits (P=0.004) and physical activity (P<0.001), were higher at the endpoint in the ≤1Y group than in the ≥3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol).

Conclusion

Diabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes.

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Reviews

Obesity and Metabolic Syndrome in Korea: Sang Woo Oh; Diabetes Metab J. 2011;35(6):561-566. Published online December 26, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.6.561

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Abstract PDF PubReader

In Korea, a person with a body mass index (BMI) ≥25 kg/m² is considered obese, and a person with a BMI ≥30 kg/m² is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.

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Educational Inequality in Obesity-Related Mortality in Korea
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Yu Mi Kang, Chang Hee Jung, Jung Eun Jang, Jenie Yoonoo Hwang, Eun Hee Kim, Joong‐Yeol Park, Hong‐Kyu Kim, Woo Je Lee
Clinical Endocrinology.2016; 85(2): 207. CrossRef
Prevalence of Atopic Dermatitis in Korean Children Based on Data From the 2008-2011 Korean National Health and Nutrition Examination Survey
Ji Hyun Lee, Kyung Do Han, Kyung min Kim, Yong Gyu Park, Jun Young Lee, Young Min Park
Allergy, Asthma & Immunology Research.2016; 8(1): 79. CrossRef
The correlation between pancreatic steatosis and metabolic syndrome in a Chinese population
Jie Zhou, Ming-Long Li, Dan-Dan Zhang, Hai-Yan Lin, Xiao-Hua Dai, Xiang-Lan Sun, Jian-Ting Li, Li-Yuan Song, Hui Peng, Meng-Meng Wen
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Ga Eun Nam, Seonjoo Kim, Ji-Sun Paik, Hyun-Seung Kim, Kyung-Sun Na
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Aster spathulifolius Maxim extract reduces body weight and fat mass in obese humans
In-Jin Cho, Se Young Choung, You-Cheol Hwang, Kyu Jeung Ahn, Ho Yeon Chung, In-Kyung Jeong
Nutrition Research.2016; 36(7): 671. CrossRef
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Eugene Han, Yong-ho Lee, Gyuri Kim, So Ra Kim, Byung-Wan Lee, Eun Seok Kang, Chul Woo Ahn, Bong-Soo Cha
Metabolism.2016; 65(10): 1531. CrossRef
Sarcopenia is associated with significant liver fibrosis independently of obesity and insulin resistance in nonalcoholic fatty liver disease: Nationwide surveys (KNHANES 2008‐2011)
Yong‐ho Lee, Seung Up Kim, Kijun Song, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Byung‐Wan Lee, Eun Seok Kang, Bong‐Soo Cha, Kwang‐Hyub Han
Hepatology.2016; 63(3): 776. CrossRef
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Kirang Kim, Sangmo Hong, Eun Young Kim, Bin He
PLOS ONE.2016; 11(4): e0153383. CrossRef
Association Between Obesity, Abdominal Obesity, and Adiposity and the Prevalence of Atopic Dermatitis in Young Korean Adults: the Korea National Health and Nutrition Examination Survey 2008-2010
Ji Hyun Lee, Kyung Do Han, Han mi Jung, Young Hoon Youn, Jun Young Lee, Yong Gyu Park, Seung-Hwan Lee, Young Min Park
Allergy, Asthma & Immunology Research.2016; 8(2): 107. CrossRef
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World Journal of Gastroenterology.2016; 22(8): 2592. CrossRef
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Hye Jin Yoo, Soon Young Hwang, Kyung Mook Choi, Sei Hyun Baik, Eun Mi Lee, Eung Joo Kim, Seung-Woon Rha, Chang Gyu Park, Dong Joo Oh, Hong Seog Seo
Metabolism.2016; 65(11): 1589. CrossRef
Associations of Obesity and Dyslipidemia with Intake of Sodium, Fat, and Sugar among Koreans: a Qualitative Systematic Review
Yoon Jung Kang, Hye Won Wang, Se Young Cheon, Hwa Jung Lee, Kyung Mi Hwang, Hae Seong Yoon
Clinical Nutrition Research.2016; 5(4): 290. CrossRef
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Hye-Sang Lee
Journal of the Korean Dietetic Association.2016; 22(2): 106. CrossRef
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Ji Young Kim, Choae Lee, Minsuk Oh, Jee-Aee Im, Ji-Won Lee, Sang Hui Chu, Hyangkyu Lee, Justin Y. Jeon
Clinica Chimica Acta.2016; 458: 12. CrossRef
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Youngran Yang, Jerald R. Herting, Jongsan Choi
Quality of Life Research.2016; 25(6): 1537. CrossRef
High Prevalence of Obesity, Hypertension, Hyperlipidemia, and Diabetes Mellitus in Japanese Outpatients with Schizophrenia: A Nationwide Survey
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Hye Jin Yoo, Kyung Mook Choi, Sei Hyun Baik, Jong Heon Park, Soon-Ae Shin, Soon-Cheol Hong, Min-Jeong Oh, Hai-Joong Kim, Geum Joon Cho
Metabolism.2016; 65(9): 1259. CrossRef
Influence of occupation on lumbar spine degeneration in men: the Korean National Health and Nutrition Examination Survey 2010–2013
Seoyon Yang, Won Kim, Kyoung Hyo Choi, You Gyung Yi
International Archives of Occupational and Environmental Health.2016; 89(8): 1321. CrossRef
Relationship Between Sarcopenia and Albuminuria
Tae Nyun Kim, Eun Ju Lee, Jae Won Hong, Jung Min Kim, Jong Chul Won, Mi Kyung Kim, Jung Hyun Noh, Kyung Soo Ko, Byoung Doo Rhee, Dong-Jun Kim
Medicine.2016; 95(3): e2500. CrossRef
Relationship between Weekly Physical Activity Frequency and Metabolic Syndrome
Jung Eun Oh
The Korean Journal of Obesity.2016; 25(2): 77. CrossRef
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Sue Kim, Yunhee Ko, Gihong Yi
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Routine Screening and Consultation Facilitate Improvement of Metabolic Syndrome
Nan-He Yoon, Seunghyun Yoo, Hyekyeong Kim, Yoonjung Han
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The risk of chronic kidney disease in a metabolically healthy obese population
Chang Hee Jung, Min Jung Lee, Yu Mi Kang, Jenie Y. Hwang, Eun Hee Kim, Joong-Yeol Park, Hong-Kyu Kim, Woo Je Lee
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Interleukin-6 is associated with obesity, central fat distribution, and disease severity in patients with acute pancreatitis
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Pancreatology.2015; 15(1): 59. CrossRef
The Economic Burden of Cancers Attributable to Metabolic Syndrome in Korea
Dongwoo Kim, Seok-Jun Yoon, Young-Hoon Gong, Young Ae Kim, Hye-Young Seo, Jihyun Yoon, A-Rim Kim
Journal of Preventive Medicine and Public Health.2015; 48(4): 180. CrossRef
Food Insecurity and Related Risk Factors in the Elderly: Korea National Health and Nutrition Examination Survey 2013 Data
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Journal of the Korean Dietetic Association.2015; 21(4): 308. CrossRef
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Endocrine Journal.2015; 62(7): 585. CrossRef
Can body mass index predict survival outcomes in patients treated with radical nephroureterectomy for upper-tract urothelial carcinoma?
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Association between Thyroid Hormone and Risk Factors of Metabolic Syndrome in Adult Men of Normal Thyroid Function
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Korean Journal of Clinical Laboratory Science.2015; 47(4): 324. CrossRef
Vasomotor symptoms and metabolic syndrome in Korean postmenopausal women
Ki-Jin Ryu, Hyun-Tae Park, Dae Hui Kwon, Kyung-Sook Yang, Yong Jin Kim, Kyong Wook Yi, Jung Ho Shin, Jun Young Hur, Tak Kim
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Hyekyeong Kim, Eunhee Nah
Korean Journal of Health Education and Promotion.2015; 32(4): 37. CrossRef
Association of metabolic syndrome with coronary artery calcification
Kyoung Hwa Ha, Dae Jung Kim
The Korean Journal of Internal Medicine.2015; 30(1): 29. CrossRef
Association between theCLOCKgene 3111 T > C polymorphism and an irregular menstrual cycle in Korean adolescents
Kye-Hyun Kim, Yunsin Kim, Juwon Ha, Dong-Won Shin, Young-Chul Shin, Kang-Seob Oh, Hee-Yeon Woo, Se-Won Lim
Journal of Psychosomatic Obstetrics & Gynecology.2015; 36(4): 148. CrossRef
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Annals of Human Biology.2015; 42(6): 528. CrossRef
The effects ofMomordica charantiaon obesity and lipid profiles of mice fed a high-fat diet
Jun Wang, Ho Kyung Ryu
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Undiagnosed diabetes is prevalent in younger adults and associated with a higher risk cardiometabolic profile compared to diagnosed diabetes
Yong-ho Lee, Ehrin J. Armstrong, Gyuri Kim, Jaewon Oh, Seok-Min Kang, Byung-Wan Lee, Chul Woo Ahn, Bong Soo Cha, Hyun Chul Lee, Christos S. Mantzoros, Eun Seok Kang
American Heart Journal.2015; 170(4): 760. CrossRef
Association of serum angiopoietin-like protein 2 with carotid intima-media thickness in subjects with type 2 diabetes
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Cardiovascular Diabetology.2015;[Epub] CrossRef
Association between body size phenotype and sleep duration: Korean National Health and Nutrition Examination Survey V (KNHANES V)
Ja Young Ryu, Ji Sung Lee, Ho Cheol Hong, Hae Yoon Choi, Hye Jin Yoo, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Dong Seop Choi, Kyung Mook Choi
Metabolism.2015; 64(3): 460. CrossRef
Sociodemographic Differences in the Association Between Obesity and Stress: A Propensity Score-Matched Analysis from the Korean National Health and Nutrition Examination Survey (KNHANES)
Kwok-Kei Mak, Dae-Hwan Kim, J. Paul Leigh
Nutrition and Cancer.2015; 67(5): 804. CrossRef
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Internal Medicine Journal.2015; 45(4): 428. CrossRef
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The Korean Journal of Obesity.2015; 24(3): 166. CrossRef
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Annals of Hematology.2015; 94(10): 1655. CrossRef
Epidemiologic Characteristics of Dyslipidemia in Korea
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Journal of Diabetes.2015; 7(6): 791. CrossRef
Vascular Inflammation in Metabolically Abnormal but Normal-Weight and Metabolically Healthy Obese Individuals Analyzed With 18F-Fluorodeoxyglucose Positron Emission Tomography
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The American Journal of Cardiology.2015; 115(4): 523. CrossRef
Sarcopaenia is associated with NAFLD independently of obesity and insulin resistance: Nationwide surveys (KNHANES 2008–2011)
Yong-ho Lee, Kyu Sik Jung, Seung Up Kim, Hye-jin Yoon, Yu Jung Yun, Byung-Wan Lee, Eun Seok Kang, Kwang-Hyub Han, Hyun Chul Lee, Bong-Soo Cha
Journal of Hepatology.2015; 63(2): 486. CrossRef
Use of a Diabetes Self-Assessment Score to Predict Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis
Gyuri Kim, Yong-ho Lee, Young Min Park, Jungghi Kim, Heesuk Kim, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Dae Jung Kim
Medicine.2015; 94(27): e1103. CrossRef
Body composition changes were related to nutrient intakes in elderly men but elderly women had a higher prevalence of sarcopenic obesity in a population of Korean adults
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PLOS ONE.2015; 10(7): e0131427. CrossRef
Central obesity is an independent risk factor for microalbuminuria in both the general Korean women and nondiabetic nonhypertensive subpopulation: Association of microalbuminuria and metabolic syndrome from the Korea National Health and Nutrition Examinat
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Clinica Chimica Acta.2015; 448: 74. CrossRef
Optimal Waist Circumference Cutoff Value Based on Insulin Resistance and Visceral Obesity in Koreans with Type 2 Diabetes
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Diabetes & Metabolism Journal.2015; 39(3): 253. CrossRef
Tolerability, effectiveness and predictive parameters for the therapeutic usefulness of exenatide in obese, Korean patients with type 2 diabetes
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Journal of Diabetes Investigation.2014; 5(5): 554. CrossRef
Sex Factors in the Metabolic Syndrome as a Predictor of Cardiovascular Disease
Sunghwan Suh, Jongha Baek, Ji Cheol Bae, Kyoung-Nyoun Kim, Mi Kyoung Park, Duk Kyu Kim, Nam H. Cho, Moon-Kyu Lee
Endocrinology and Metabolism.2014; 29(4): 522. CrossRef
Association Between Metabolic Syndrome and Incident Fractures in Korean Men: A 3-Year Follow-Up Observational Study Using National Health Insurance Claims Data
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The Journal of Clinical Endocrinology & Metabolism.2014; 99(5): 1615. CrossRef
Gender Differences and Socioeconomic Status in Relation to Overweight among Older Korean People
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Journal of the Korean Society of Food Science and Nutrition.2014; 43(5): 763. CrossRef
Association between Cigarette Smoking History and Mortality in 36,446 Health Examinees in Korea
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Asian Pacific Journal of Cancer Prevention.2014; 15(14): 5685. CrossRef
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Indian Journal of Surgery.2014; 76(3): 187. CrossRef
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Chorong Oh, Jae-Kyung No, Hak-Seon Kim
Nutrition Research and Practice.2014; 8(2): 192. CrossRef
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International Journal for Equity in Health.2014;[Epub] CrossRef
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Hye-Sang Lee
Korean Journal of Community Nutrition.2014; 19(5): 479. CrossRef
Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores
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Sae Young Jae, Kevin S. Heffernan, Do-Kyung Kim, Won Hah Park, Yoon-Ho Choi, Seol Hyang Kim
Annals of Human Biology.2014; 41(5): 477. CrossRef
Metabolic Syndrome and Cardiovascular Diseases in Korea
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Journal of Atherosclerosis and Thrombosis.2014; : S31. CrossRef
Subclinical vascular inflammation in subjects with normal weight obesity and its association with body Fat: an 18 F-FDG-PET/CT study
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Cardiovascular Diabetology.2014;[Epub] CrossRef
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The association between ectopic fat in the pancreas and subclinical atherosclerosis in type 2 diabetes
Mee Kyoung Kim, Hyun Ji Chun, Jin Hee Park, Dong Myung Yeo, Ki-Hyun Baek, Ki-Ho Song, Dong Jin Chung, Hyuk-Sang Kwon
Diabetes Research and Clinical Practice.2014; 106(3): 590. CrossRef
Histologically proven non‐alcoholic fatty liver disease and clinically related factors in recipients after liver transplantation
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Clinical Transplantation.2014; 28(5): 521. CrossRef
Short-term Effects of a Lifestyle Intervention Program on Eating Behaviors, Physical Activity and Cardiovascular Risks in Korean Adults
Jiyeon Park, Hyekyeong Kim
Korean Journal of Health Education and Promotion.2014; 31(4): 37. CrossRef
Serum Cholesterol Concentration and Prevalence, Awareness, Treatment, and Control of High Low‐Density Lipoprotein Cholesterol in the Korea National Health and Nutrition Examination Surveys 2008–2010: Beyond the Tip of the Iceberg
Yong‐ho Lee, Sang‐Guk Lee, Myung Ha Lee, Jeong‐Ho Kim, Byung‐Wan Lee, Eun Seok Kang, Hyun Chul Lee, Bong Soo Cha
Journal of the American Heart Association.2014;[Epub] CrossRef
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Hye Jin Yoo, Soon Young Hwang, Ho Cheol Hong, Hae Yoon Choi, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Dong Seop Choi, Sei Hyun Baik, Kyung Mook Choi
Atherosclerosis.2014; 234(1): 218. CrossRef
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Nutrition Research and Practice.2014; 8(2): 192. CrossRef
Weight Gain and its Correlates among Breast Cancer Survivors
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Asian Nursing Research.2013; 7(4): 161. CrossRef
Serum adipocyte fatty acid-binding protein levels are independently associated with sarcopenic obesity
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Diabetes Research and Clinical Practice.2013; 101(2): 210. CrossRef
Has the prevalence of cholesterol gallstones increased in Korea? A preliminary single‐center experience
Ju Wan Kim, Hyoung‐Chul Oh, Jae Hyuk Do, Yoo‐Shin Choi, Seung Eun Lee
Journal of Digestive Diseases.2013; 14(10): 559. CrossRef
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Clinical Endocrinology.2013; 79(3): 356. CrossRef
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Metabolism.2013; 62(9): 1305. CrossRef
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The Korean Journal of Obesity.2013; 22(4): 222. CrossRef
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Archives of Gerontology and Geriatrics.2013; 56(1): 270. CrossRef
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Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis
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World Journal of Gastroenterology.2013; 19(28): 4596. CrossRef
Gender and age differences in obesity among Korean adults
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Obesity: Introduction
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APOA5Polymorphism Is Associated with Metabolic Syndrome in Korean Postmenopausal Women
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Korean Journal of Urology.2012; 53(11): 761. CrossRef

The Causes and Consequences of Low Levels of High Density Lipoproteins in Patients with Diabetes: Philip J. Barter; Diabetes Metab J. 2011;35(2):101-106. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.101

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Type 2 diabetes is commonly accompanied by a low level of high density lipoprotein cholesterol (HDL-C) that contributes to the increased cardiovascular risk associated with this condition. Given that HDLs have the ability to improve increase the uptake of glucose by skeletal muscle and to stimulate the secretion of insulin from pancreatic beta cells the possibility arises that a low HDL concentration in type 2 diabetes may also contribute to a worsening of diabetic control. Thus, there is a double case for raising the level of HDL-C in patients with type 2 diabetes: to reduce cardiovascular risk and to improve glycemic control. Approaches to raising HDL-C include lifestyle factors such as weight reduction, increased physical activity and stopping smoking. Of currently available drugs, the most effective is niacin. Newer formulations of niacin are reasonably well tolerated and have the ability to increase HDL-C by up to 30%. The effect of niacin on cardiovascular events in type 2 diabetes is currently being tested in a large-scale clinical outcome trial.

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Original Article

Effects of Comprehensive Support on Glycemic Control Using Community Networks in Low- Income Elderly Patients with Diabetes.: Nam Hoon Kim, Yun Jeong Lee, Hye Ok Kim, Cho Rong Oh, Ju Ri Park, Soo Yoen Park, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim; Korean Diabetes J. 2008;32(5):453-461. Published online October 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.5.453

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BACKGROUND
Diabetes is common among elderly, and low-income is associated with poor adherence to treatment and increased mortality. We evaluated whether comprehensive support using community networks improves glycemic control among low-income elderly patients with diabetes. METHODS: A total of 49 low-income elderly patients with type 2 diabetes, mean age 73 years, were enrolled. For 1 year, study subjects underwent various lifestyle modification programs provided by community networks. The biochemical data including glycemic markers and anthropometric data were obtained at the baseline and at the end of the study. Also, the patients were asked to complete a questionnaire about their quality of life, self-confidence and self-care behavior. RESULTS: After lifestyle modification program, overall changes of fasting plasma glucose, HbA1c, blood pressure, body weight, and other biochemical markers were not significantly different. In a subgroup analysis of 21 patients with poorly controlled diabetes (fasting glucose > 140 mg/dL or HbA1c > 7.5%), fasting plasma glucose was significantly reduced (P = 0.030). Among patients with baseline HbA1c level > or = 8%, HbA1c levels after intervention decreased from 9.33 +/- 1.07% to 8.27 +/- 1.15% (P = 0.092). The results of the questionnaires revealed significant increases in the scores of quality of life, self-confidence and self-care behavior (P < 0.05). CONCLUSION: Among low-income, elderly patients with type 2 diabetes, lifestyle modification through community networks showed no significant changes in glycemic control markers. More intensive and precise interventions using community networks are needed for the glycemic control of low-income, elderly patients with type 2 diabetes.

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Review

Non-drug Intervention in Lipid Management: Dietary Portfolio.: In Ju Kim; Korean Diabetes J. 2007;31(5):377-382. Published online September 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.5.377

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Abstract PDF: Non-Pharmaceutical interventions are essential in lipid management. The NCEP recommends the following three tiered approach to lipid management: 1. Institution of therapeutic lifestyle changes (TLC); 2. Use of non-drug adjuncts, including viscous fibers and plant sterol/stanol products; and 3. Drug therapy when required to reach treatment goals. Even though non-drug approaches often receive minimal attention in clinical practice, the efficacy of non-drug therapies is not so small. Non-drug adjuncts are known to reduce LDL cholesterol as follows: 12.5% for 45 g of soy protein/d; 6% to 7% for 9 to 10 g of psyllium/d, with smaller reductions for other viscous fibers; 10% for 1 to 2 g of plant sterols/d and 1% for 10 g almonds/d. Recently, combining these foods in a single dietary portfolio decreased LDL cholesterol and CRP similarly to the extent which achieved by a usual dose of a statin. This dietary portfolio can be regarded as an effective non-drug approach to reduce the risk of cardiovascular disease.

Original Article

The Effects of Lifestyle Modification on the Metabolic Parameters of Type 2 Diabetes.: So Hun Kim, Eun Seok Kang, So Young Park, Suk Jeong Lee, Mi Jin Kim, Ji Soo Yoo, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Hyun Chul Lee; Korean Diabetes J. 2004;28(5):441-451. Published online October 1, 2004

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Abstract PDF: BACKGROUND
Lifestyle modification is known to have positive effects on glycemic control and improving the cardiovascular risk factors. Although lifestyle modification is considered to be important in treating diabetic patients, there are few studies concerning the direct effect of lifestyle modification on the patients with type 2 diabetes (T2DM). The aim of this study is to evaluate the effects of lifestyle modification on glycemic control, lipid profiles, body indices, serum adiponectin and the hsCRP levels for patients with T2DM in Korea. METHODS: Twenty two patients with T2DM who had no medication changes for the recent 3 months and who also had a HbA1c> or =7.0% were enrolled in a lifestyle modification program. These patients visited Severance Hospital Diabetes Center once every week for 12 weeks, and they were educated about exercise and diet control. Their metabolic and anthropometric parameters were compared with 22 control T2DM patients who were not in the program. RESULTS:Lifestyle modification group patients showed significant decrements in HbA1c (-0.62 +/- 1.29 vs. 0.14 +/- 0.91%, p=0.044), total cholesterol (-0.57 +/- 0.54 vs. -0.06 +/- 0.61 mmol/l, p=0.007), LDL cholesterol (-0.57 +/- 0.62 vs. 0.02 +/- 0.59 mmol/l, p=0.003), body weight (-1.5 +/- 19 vs. 0.2 +/- 1.5 kg, p=0.005) and BMI (-0.6 +/- 0.7 vs 0.0 +/- 0.6 kg/m2, p=0.003) compared with the control subjects. HOMAIR, serum triglyceride, adiponectin, and hsCRP levels showed no significant difference compared to the control subjects. CONCLUSION: Lifestyle modification in Korean T2DM patients had positive effects on weight loss, glycemic control, and lipid profiles. These changes imply that lifestyle modification will be helpful for managing DM and its complications.

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