Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Novel Asian-Specific Visceral Adiposity Indices Are Associated with Chronic Kidney Disease in Korean Adults: Jonghwa Jin, Hyein Woo, Youngeun Jang, Won-Ki Lee, Jung-Guk Kim, In-Kyu Lee, Keun-Gyu Park, Yeon-Kyung Choi; Diabetes Metab J. 2023;47(3):426-436. Published online March 6, 2023; DOI: https://doi.org/10.4093/dmj.2022.0099

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Background
The Chinese visceral adiposity index (CVAI) and new visceral adiposity index (NVAI) are novel indices of visceral adiposity used to predict metabolic and cardiovascular diseases in Asian populations. However, the relationships of CVAI and NVAI with chronic kidney disease (CKD) have not been investigated. We aimed to characterize the relationships of CVAI and NVAI with the prevalence of CKD in Korean adults.
Methods
A total of 14,068 participants in the 7th Korea National Health and Nutrition Examination Survey (6,182 men and 7,886 women) were included. Receiver operating characteristic (ROC) analyses were employed to compare the associations between indices of adiposity and CKD, and a logistic regression model was used to characterize the relationships of CVAI and NVAI with CKD prevalence.
Results
The areas under the ROC curves for CVAI and NVAI were significantly larger than for the other indices, including the visceral adiposity index and lipid accumulation product, in both men and women (all P<0.001). In addition, high CVAI or NVAI was significantly associated with a high CKD prevalence in both men (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31 to 3.48 in CVAI and OR, 6.47; 95% CI, 2.91 to 14.38 in NVAI, P<0.05) and women (OR, 4.87; 95% CI, 1.85 to 12.79 in CVAI and OR, 3.03; 95% CI, 1.35 to 6.82 in NVAI, P<0.05); this association remained significant after adjustment for multiple confounding factors in men and women.
Conclusion
CVAI and NVAI are positively associated with CKD prevalence in a Korean population. CVAI and NVAI may be useful for the identification of CKD in Asian populations, including in Korea.

Citations

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Association between Chinese visceral adiposity index and risk of stroke incidence in middle-aged and elderly Chinese population: evidence from a large national cohort study
Zenglei Zhang, Lin Zhao, Yiting Lu, Xu Meng, Xianliang Zhou
Journal of Translational Medicine.2023;[Epub] CrossRef

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

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

Citations

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Gender-specific abdominal fat distribution and insulin resistance associated with organophosphate esters and phthalate metabolites exposure
Xiaoliu Shi, Wanyue Wang, Jiafan Feng, Xiaochun Ma, Mengting Xu, Cui Wang
Environmental Pollution.2024; 349: 123959. CrossRef
The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis
Amirhossein Tajani, Masoumeh Sadeghi, Navid Omidkhoda, Amir Hooshang Mohammadpour, Sara Samadi, Vahid Jomehzadeh
BMC Cardiovascular Disorders.2024;[Epub] CrossRef
Visceral adipose tissue is an independent predictor and mediator of the progression of coronary calcification: a prospective sub-analysis of the GEA study
Neftali Eduardo Antonio-Villa, Juan Gabriel Juárez-Rojas, Rosalinda Posadas-Sánchez, Juan Reyes-Barrera, Aida Medina-Urrutia
Cardiovascular Diabetology.2023;[Epub] CrossRef
Deep learning-based prediction for significant coronary artery stenosis on coronary computed tomography angiography in asymptomatic populations
Heesun Lee, Bong Gyun Kang, Jeonghee Jo, Hyo Eun Park, Sungroh Yoon, Su-Yeon Choi, Min Joo Kim
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Relationship between a novel non–insulin-based metabolic score for insulin resistance (METS‐IR) and coronary artery calcification
Zhenwei Wang, Xiaofang Hui, Xu Huang, Jingjie Li, Naifeng Liu
BMC Endocrine Disorders.2022;[Epub] CrossRef
Association Between Abdominal Adipose Tissue Distribution and Risk of Endometrial Cancer: A Case-Control Study
Yuan Cheng, Zhongyu Wang, Xiaoxuan Jia, Rong Zhou, Jianliu Wang
Clinical Medicine Insights: Oncology.2022; 16: 117955492211407. CrossRef
Sex differences in cardiovascular risk may be related to sex differences in diet patterns: a narrative review
A. M. Tindall, V. A. Stallings
Annals of Human Biology.2021; 48(6): 517. CrossRef

Lifestyle
Body Fat Is Related to Sedentary Behavior and Light Physical Activity but Not to Moderate-Vigorous Physical Activity in Type 2 Diabetes Mellitus: Keun Hee An, Kyung Ah Han, Tae Seo Sohn, Ie Byung Park, Hae Jin Kim, Sung Dae Moon, Kyung Wan Min; Diabetes Metab J. 2020;44(2):316-325. Published online November 12, 2019; DOI: https://doi.org/10.4093/dmj.2019.0029

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Background

Sedentary behavior (SB) has emerged as a new risk factor for cardiovascular accidents. We investigated whether physical activity levels or SB were related to percent body fat (%BF) in type 2 diabetes mellitus (T2DM).

Methods

In this cross sectional study, we measured the duration of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), total energy expenditure, and step counts using a wireless activity tracker (Fitbit HR; FB) for 7 days in free-living conditions, along with %BF using a bio impedance analyzer (Inbody; Biospace) in 120 smartphone users with T2DM. Subjects were divided into exercise (Exe, n=68) and non-exercise (nonExe, n=52) groups based on self-reports of whether the recommended exercises (30 min/day, 3 days/week for 3 months) were performed. SBt, LPAt, MVPAt were transformed from SB, LPA, MVPA for normally distributed variables.

Results

Participants were: female, 59.2%; age, 59.3±8.4 years; body mass index, 25.5±3.4 kg/m²; glycosylated hemoglobin (HbA1c), 7.6%±1.2%; %BF, 30.4%±7.1%. They performed SB for 15.7±3.7 hr/day, LPA for 4.4±1.7 hr/day, and MVPA for 0.9±0.8 hr/day. The %BF was related to SBt and LPAt, but not to MVPA after adjustments for age, gender, and HbA1c. VPA was significantly higher in the Exe group than in the nonExe group, but SB, LPA, and moderate physical activity were not different. Predicted %BF was 89.494 to 0.105 (age), −13.047 (gender), −0.507 (HbA1c), −7.655 (LPAt) (F[4, 64]=62.929, P<0.001), with an R² of 0.785 in multiple linear regression analysis.

Conclusion

Reduced body fat in elderly diabetic patients might be associated with reduced inactivity and increased LPA.

Citations

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Explanatory variables of objectively measured 24-h movement behaviors in people with prediabetes and type 2 diabetes: A systematic review
Lotte Bogaert, Iris Willems, Patrick Calders, Eveline Dirinck, Manon Kinaupenne, Marga Decraene, Bruno Lapauw, Boyd Strumane, Margot Van Daele, Vera Verbestel, Marieke De Craemer
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2024; 18(4): 102995. CrossRef
Association between depression, anemia and physical activity using isotemporal substitution analysis
Hee-kyoung Nam, Jungmi Park, Sung-il Cho
BMC Public Health.2023;[Epub] CrossRef
The Impact of Wearable Technologies in Health Research: Scoping Review
Sophie Huhn, Miriam Axt, Hanns-Christian Gunga, Martina Anna Maggioni, Stephen Munga, David Obor, Ali Sié, Valentin Boudo, Aditi Bunker, Rainer Sauerborn, Till Bärnighausen, Sandra Barteit
JMIR mHealth and uHealth.2022; 10(1): e34384. CrossRef
The Correlation of Prediabetes and Type 2 Diabetes With Adiposity in Adults
Juan Sun, Zhen Liu, Zimu Zhang, Ziyang Zeng, Weiming Kang
Frontiers in Nutrition.2022;[Epub] CrossRef
The Physical Activity Assessment of Adults With Type 2 Diabetes Using Accelerometer-Based Cut Points: Scoping Review
Ioana A Moldovan, Alexa Bragg, Anna S Nidhiry, Barbara A De La Cruz, Suzanne E Mitchell
Interactive Journal of Medical Research.2022; 11(2): e34433. CrossRef
Effects of 4 Weeks of a Technique-Specific Protocol with High-Intensity Intervals on General and Specific Physical Fitness in Taekwondo Athletes: An Inter-Individual Analysis
Alex Ojeda-Aravena, Tomás Herrera-Valenzuela, Pablo Valdés-Badilla, Jorge Cancino-López, José Zapata-Bastias, José Manuel García-García
International Journal of Environmental Research and Public Health.2021; 18(7): 3643. CrossRef
Inter-Individual Variability of a High-Intensity Interval Training With Specific Techniques vs. Repeated Sprints Program in Sport-Related Fitness of Taekwondo Athletes
Alex Ojeda-Aravena, Tomás Herrera-Valenzuela, Pablo Valdés-Badilla, Jorge Cancino-López, José Zapata-Bastias, José Manuel García-García
Frontiers in Physiology.2021;[Epub] CrossRef
EFFECT OF SPORTS MEDICINE ON REDUCING BODY FAT PERCENTAGE AND LEAN BODY MASS
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Sung Woon Park, Gyuri Kim, You-Cheol Hwang, Woo Je Lee, Hyunjin Park, Jae Hyeon Kim
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Ergonomics.2020; 63(11): 1359. CrossRef

Epidemiology
Lower Leg Fat Depots Are Associated with Albuminuria Independently of Obesity, Insulin Resistance, and Metabolic Syndrome (Korea National Health and Nutrition Examination Surveys 2008 to 2011): Eugene Han, Nan Hee Cho, Mi Kyung Kim, Hye Soon Kim; Diabetes Metab J. 2019;43(4):461-473. Published online March 7, 2019; DOI: https://doi.org/10.4093/dmj.2018.0081

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Background

Although the involvement of obesity in metabolic disorders is well known, leg fat depot influences on albuminuria have not been determined.

Methods

This population-based, cross-sectional study used a nationally representative sample of 2,076 subjects aged ≥20 years from the Korea National Health and Nutrition Examination Surveys of 2008 to 2011. The ratio of leg fat to total fat (LF/TF ratio) was assessed by dual X-ray absorptiometry, and albuminuria was defined as more than one positive dipstick test or an albumin-to-creatinine ratio of ≥30 mg/g.

Results

Individuals whose LF/TF ratio was in the lowest tertile showed a higher proportion of albuminuria than those in the highest tertile (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.01 to 3.96; P<0.001). This association was observed in both sexes, all age groups, and all subgroups stratified by body mass index, waist circumference, homeostasis model assessments of insulin resistance, and the presence of metabolic syndrome (all, P<0.05). Multiple logistic regression analyses also demonstrated that the lowest LF/TF ratio was independently associated with albuminuria risk (OR, 1.55 to 2.16; all, P<0.05). In addition, the risk of albuminuria was higher in sarcopenic individuals with lower LF/TF ratios than in the highest LF/TF ratio subjects without sarcopenia (OR, 3.73; 95% CI, 2.26 to 6.13).

Conclusion

A lower LF/TF ratio was associated with an increased risk of albuminuria independent of obesity, insulin resistance, and metabolic syndrome, and when combined with sarcopenia, the albuminuria risk synergistically increased. Hence, our findings may have implications to improve risk stratification and recommendations on body fat distribution in the general population.

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Eugene Han, Mi Kyung Kim, Hye Won Lee, Seungwan Ryu, Hye Soon Kim, Byoung Kuk Jang, Youngsung Suh
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Eugene Han, Mi Kyung Kim, Byoung Kuk Jang, Hye Soon Kim
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Obesity and Metabolic Syndrome
Relationship between Regional Body Fat Distribution and Diabetes Mellitus: 2008 to 2010 Korean National Health and Nutrition Examination Surveys: Soo In Choi, Dawn Chung, Jung Soo Lim, Mi Young Lee, Jang Yel Shin, Choon Hee Chung, Ji Hye Huh; Diabetes Metab J. 2017;41(1):51-59. Published online December 21, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.51

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Background

The aim of this study was to investigate the association between regional body fat distribution, especially leg fat mass, and the prevalence of diabetes mellitus (DM) in adult populations.

Methods

A total of 3,181 men and 3,827 postmenopausal women aged 50 years or older were analyzed based on Korea National Health and Nutrition Examination Surveys (2008 to 2010). Body compositions including muscle mass and regional fat mass were measured using dual-energy X-ray absorptiometry.

Results

The odds ratios (ORs) for DM was higher with increasing truncal fat mass and arm fat mass, while it was lower with increasing leg fat mass. In a partial correlation analysis adjusted for age, leg fat mass was negatively associated with glycosylated hemoglobin in both sexes and fasting glucose in women. Leg fat mass was positively correlated with appendicular skeletal muscle mass and homeostasis model assessment of β cell. In addition, after adjusting for confounding factors, the OR for DM decreased gradually with increasing leg fat mass quartiles in both genders. When we subdivided the participants into four groups based on the median values of leg fat mass and leg muscle mass, higher leg fat mass significantly lowered the risk of DM even though they have smaller leg muscle mass in both genders (P<0.001).

Conclusion

The relationship between fat mass and the prevalence of DM is different according to regional body fat distribution. Higher leg fat mass was associated with a lower risk of DM in Korean populations. Maintaining leg fat mass may be important in preventing impaired glucose tolerance.

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Review

Clinical Relevance of Adipokines: Matthias Blüher; Diabetes Metab J. 2012;36(5):317-327. Published online October 18, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.5.317

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The incidence of obesity has increased dramatically during recent decades. Obesity increases the risk for metabolic and cardiovascular diseases and may therefore contribute to premature death. With increasing fat mass, secretion of adipose tissue derived bioactive molecules (adipokines) changes towards a pro-inflammatory, diabetogenic and atherogenic pattern. Adipokines are involved in the regulation of appetite and satiety, energy expenditure, activity, endothelial function, hemostasis, blood pressure, insulin sensitivity, energy metabolism in insulin sensitive tissues, adipogenesis, fat distribution and insulin secretion in pancreatic β-cells. Therefore, adipokines are clinically relevant as biomarkers for fat distribution, adipose tissue function, liver fat content, insulin sensitivity, chronic inflammation and have the potential for future pharmacological treatment strategies for obesity and its related diseases. This review focuses on the clinical relevance of selected adipokines as markers or predictors of obesity related diseases and as potential therapeutic tools or targets in metabolic and cardiovascular diseases.

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Original Articles

Effects of Rosiglitazone on Body Fat Mass and Distribution in Type 2 Diabetic Patients.: Hong Kyu Kim, Hyo Joong Yoon, Seung Min You, Ki Young Lee, Hye Young Park, Moon Ho Kang; Korean Diabetes J. 2003;27(3):272-279. Published online June 1, 2003

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Abstract PDF: BACKGROUND
Rosiglitazone, an insulin-sensitizing drug of the thiazolidinediones class, has a high affinity for the ligands of the peroxisome proliferator activated receptor-gamma(PPAR-gamma), is highly expressed in adipose tissue, and plays an important role in the differentiation of adipocyte. The influence of rosiglitazone was investigated on the total fat mass and regional adiposity in type 2 diabetic patients. METHODS: Rosiglitazone (4 mg/day) was administered for 6 months to type 2 diabetic patients (n=20) whose glycemic control was unacceptable with the use of other treatments. Measurements of the total, trunk and leg region body fats (by dual energy X-ray absorptiometry) and abdominal fat distributions (by computed tomography) were compared before and after treatment. RESULTS: Nine patients received rosiglitazone monotherapy and 11 a combined therapy of sulfonylurea and/or metformin. The HbA1C, serum insulin level and homeostasis model assessment insulin resistance index were decreased following the rosiglitazone therapy, but the body weight and BMI were increased. As for the body fat changes, the total (19,382+/-4,786 vs. 22,940+/- 7,300 g, p<0.01), trunk (11,399+/- 2,678 vs. 13,960+/-4,698 g, p<0.01) and leg (4,734+/-1,319 vs. 6,203+/-2,231g, p<0.05) region fat masses were significantly increased. The percentage increase in the total, trunk and leg region fat masses were 20+/-25, 25+/-35 and 58+/-130%, respectively. As for abdominal fat distribution after the treatment, the visceral fat area (225+/-84 vs. 187+/-87 cm2, p<0.05) was significantly decreased, while the subcutaneous fat area tended to increase (178+/-83 vs. 201+/-80 cm2, NS), although these were not statistically significant. The visceral/subcutaneous fat ratio (V/S ratio) was significantly decreased (1.45+/- 0.64 vs. 0.95+/-0.25, p<0.05). CONCLUSION: Although the total body fat mass was increased following the rosiglitazone therapy, a shift in the body fat distribution, from the visceral to the subcutaneous region, was observed, which may be associated with an improvement in insulin resistance. However, a long-term assessment of the consequences of an increasing total fat mass and change in the body fat distribution will be required.

Dehydroepiandrosterone-Sulfate, Sex Hormone Binding Globulin, Body Fat Distribution Pattern and Insulin Resistance in Women.: Young Sun Hong, Jee Young Oh, Yeon Ah Sung, Nan Ho Kyung, Yeon Jin Jang; Korean Diabetes J. 1998;22(3):328-337. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Sex hormone-binding globulin (SHBG) has been known to be associated with obesity, central fat accumulation and insulin resistance and thought to be a indirect marker for androgenicity in women. The relationships between circulating dehydroepiandrosterone(DHEA). dehydroepiandrosterone sulfate(DHEA-S) levels and body fat accumulation are still controversial. We conducted a cross-sectional study to eva]uate the relationships between serum levels of SHBG, DHEA-S, body fat distribution pattern and insulin sensitivity in women. METHODS: We tested 57 women(age 30~65yr; BMI 18.5~32.8kg/m, 45 premenopausal on the 5~10 day of the menstrual cycle, 12 postmenopausal who were not using hormone replacement therapy) with varying degree of glucose tolerance(32 normal glucose tolerance(NGT), 17 impaired glucose tolerance(IGT) and 8 newly diagnosed diabetes). lnsulin sensitivity was measured as minimal model derived sensitivity index(S) using insulin modified IV glucose tolerance test and fasting serum levels of SHBG and DHEA-S were measured by RIA. Body fat distribution pattern was assessed by waist to hip ratio(WHR),% body fat measured by bioelectrical impedance analyzer, subcutaneous fat area(SFA), visceral fat area(VFA) and VFA to SFA ratio(VSR) at the level of umbilicus using the computed tomography. RESULTS: 1) Measured SHBG and DHEA-S levels were not significantly different among subjects with NGT, IGT and diabetes. 2) SHBG was inversely associated with age, BMI, WHR, diastolic blood pressure, VFA, SFA, VSR,% body fat, fasting insulin and positively associated with S, whereas DHEA-S did not show any significant correlation with above variables except diastolic blood pressure. 3) SHBG level was significantly lower(p<0.05) and DHEA-S level was insignificantly lower (p=0.05) in postmenopausal women than in premenopausal women but the significance disappeared after adjustment for age, BMI, WHR and% body fat. 4) BMI was independently and negatively related to S, WHR and fasting insulin to SHBG by multiple regression analysis. CONCLUSION: We confirmed that SHBG was independently associated with central obesity and fasting hyperinsulinemia. However, S was independently associated with BMI only. It suggested that hyperinsulinemia in insulin resistance might cause the decreased level of SHBG even thaugh the directionality of the association was uncertain because of a cross-sectional nature of this study.

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