The effects of sarcopenia and obesity on femur neck bone mineral density in elderly Korean men and women.

OBJECTIVES: We aimed to clarify the relationship between fat, muscle, and bone in elderly men and women. METHODS: We analyzed 1373 men and 1803 women who were older than 65 years from the 2008-2010 Korea National Health and Nutritional Examination Surveys. Body composition and femur neck bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry. Sarcopenia was defined as an appendicular skeletal muscle index (SMI) below one standard deviation (SD). Obesity was classified by fat mass index (FMI). Osteoporosis was defined as a BMD of 2.5 SD below that of femur neck BMD. RESULTS: SMI and FMI were positively correlated with femur neck BMD. In multiple regression analysis, SMI (ß = 0.302 in men, ß = 0.154 in women; p < 0.001 each) and FMI (ß = 0.079 in men, ß = 0.179 in women; p = 0.003 and p < 0.001 respectively) had a positive relationship with femur neck BMD. Men with sarcopenia were 3.89 times more likely to develop osteoporosis. Women with sarcopenia were 1.87 times more likely to develop osteoporosis. Sarcopenia was more clinically significant in the development of osteoporosis in men with a fat deficit and women with excess fat. CONCLUSIONS: Muscle mass and fat mass were identified as determinants of femur neck BMD in men and women. Among them, muscle mass of men and fat mass of women are the most important determinants of femur neck osteoporosis.

Partial Androgen Insensitivity Syndrome Presenting with Gynecomastia.

Gynecomastia is a benign enlargement of the male breast caused by the proliferation of glandular breast tissue. Determining the various causes of gynecomastia such as physiological causes, drugs, systemic diseases, and endocrine disorders is important. Androgen insensitivity syndrome (AIS) is a rare endocrine disorder presenting with gynecomastia and is a disorder of male sexual differentiation caused by mutations within the androgen receptor gene. All individuals with AIS have the 46 XY karyotype, although AIS phenotypes can be classified as mild, partial or complete and can differ among both males and females including ambiguous genitalia or infertility in males. We experienced a case of partial AIS presenting with gynecomastia and identified the androgen receptor gene mutation.

The association between bone mineral density and metabolic syndrome: a Korean population-based study.

This study was conducted to investigate the association between the metabolic syndrome (MS), which includes a cluster of major risk factors for cardiovascular diseases, and bone mineral density (BMD) from a population-based study. This cross-sectional study was based on a nationwide representative survey data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2008. A total of 3,207 subjects were included from the KNHANES 2008 and composed of men (mean age 48.4 years), premenopausal women (mean age 36.5 years) and postmenopausal women (mean age 64.8 years). The MS was identified according to the new criteria from a joint scientific statement endorsed by major organizations including the National Heart, Lung, and Blood Institute. The mean age of study participants was significantly different according to MS status (58.2 years in the MS group vs. 45.7 years in the non-MS group, P < 0.001). The association between MS and BMD at the lumbar spine and proximal femur was analyzed with adjustment for potential confounders. Although the adjusted BMD at all skeletal sites was not significantly different between participants with and without MS, an increased number of MS components was associated with low adjusted femoral neck (FN) BMD only in men (P = 0.01). After adjusting confounding factors, the triglyceride component of MS was related to low FN BMD in men, but to high BMD at all of the skeletal sites measured in postmenopausal women. The glucose component of MS showed an association with high adjusted BMD at total hip in men. Men with MS had significantly higher odds for pooled osteopenia and osteoporosis (odds ratio: 1.49, 95 % confidence interval: 1.04-2.14). In conclusion, low BMD is associated with MS in Korean men, and the association between the MS component and the BMD is different according to gender.

A case of acute suppurative thyroiditis with thyrotoxicosis in an elderly patient.

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

Dissimilarity of femur aging in men and women from a Nationwide Survey in Korea (KNHANES IV).

In light of the differences in hip fracture rates between men and women of different ages, age-related changes in bone structure that lead to bone fragility might differ depending on both age and gender. To investigate age-related bone loss and geometric deterioration of the femur, hip scans of 1,504 men and 2,076 women aged 19-92 years acquired during the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) using dual-energy X-ray absorptiometry (DXA) were analyzed with a structural analysis program. Cross-sectional area and cortical thickness with bone mineral density in men started to decline from the third decade and continued to decline at a constant rate. However, in women, these parameters remained nearly constant until the fifth decade and then declined at a more rapid rate than that seen in men. Consequently, changes in the buckling ratio, earlier onset, and continuation of increase over the lifetime were observed in men. A relatively later onset with a greater acceleration with aging was observed in women. Taken together, there were obvious gender and age differences in structural trends with age. Bone aging, i.e., bone loss and geometric deterioration, actually begins at a young age, especially in men, and osteoporosis prevention strategies should target not only the elderly but also younger individuals.

Comparative study of robotic versus endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach.

BACKGROUND: Robotic thyroidectomy and conventional endoscopic thyroidectomy have not been thoroughly compared. In this study, we compared the potential advantages of robotic versus endoscopic thyroidectomy. METHODS: We analyzed 218 consecutive patients who underwent endoscopic (105 cases) or robotic (113 cases) thyroidectomy using a gasless unilateral axillo-breast or gasless unilateral axillary approach. RESULTS: Because of the dexterity of robotic instruments and the improved surgical view, it was subjectively easier and took less time to perform a complete total thyroidectomy and central compartment neck dissection in robotic thyroidectomy. In the case of unilateral lobectomy, endoscopic and robotic thyroidectomy had quite similar surgical outcomes. Cosmetic satisfaction was excellent in both groups. CONCLUSION: In this series by a single surgeon, robotic thyroidectomy was superior to endoscopic thyroidectomy for performing total thyroidectomy and bilateral central compartment neck dissection. However, in terms of cost-effectiveness, endoscopic thyroidectomy was comparable to robotic thyroidectomy in patients who undergo unilateral lobectomy.

Optimal surgical extent of lateral and central neck dissection for papillary thyroid carcinoma located in one lobe with clinical lateral lymph node metastasis.

BACKGROUND: The indications and extent of cervical lymph node dissection in papillary thyroid carcinoma (PTC) are still being debated. The aim of this study was to analyze the patterns of cervical lymph node metastasis in the lateral and central compartment and related factors and suggest the optimal extent of lateral and central neck dissection for PTC patients with clinical lateral lymph node metastasis. METHODS: We retrospectively analyzed 72 patients with unilateral PTC who underwent therapeutic lateral neck dissections with concomitant total thyroidectomy and central neck dissection between January 2001 and December 2009. RESULTS: The 72 patients underwent 79 sides of therapeutic lateral neck dissection. The most frequent metastatic level in the ipsilateral lateral compartment was level IV (75.0%), followed by level III (69.4%), level II (56.9%) and level V (20.8%). Multiple level metastases were common (77.8%) and were correlated with tumor size (≥ 10 mm). The central compartment lymph node metastasis rate was 87.5%, including 26.4% of contralateral central compartment metastases. CONCLUSION: In PTC patients with clinical lateral lymph node metastasis, the optimal extent of lateral and central neck dissection should include levels II, III, IV and V as well as the bilateral central compartment.

Characteristics of body fat, body fat percentage and other body composition for Koreans from KNHANES IV.

Accurate measurement of fat mass has become increasingly important with the increasing incidence of obesity. We assessed fat and muscle mass of Koreans with the Korea National Health and Nutrition Examination Survey IV (KNHANES IV). We studied 10,456 subjects (aged 20 to 85 yr; 4,476 men, 5,980 women). Fat and muscle mass were measured by dual-energy x-ray absorptiometry. Reference values of body compositions were obtained using the LMS method. The fat mass index (FMI, body fat mass/height(2); kg/m(2)) of Korean men did not correlate with age (P = 0.452), but those of Korean women (P < 0.001) did. The ratio of percentage of fat in the trunk and legs was positively related with age in both the genders. The appendicular lean mass/height(2) (kg/m(2)) of Korean men was negatively related to age (P < 0.001). In women, this ratio increased with age (P < 0.001). When we defined obesity according to the FMI classification, the rates of obesity were 6.1% (FMI > 9 kg/m(2)) in men and 2.7% (FMI > 13 kg/m(2)) in women. It is concluded that the muscle mass decreases and obesity increases with aging in Korean men, whereas both fat mass and obesity increase with aging in Korean women.

Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008.

CONTEXT: Vitamin D status in the Korean population has not been adequately determined. OBJECTIVE: To investigate the vitamin D status and the prevalence of vitamin D insufficiency in the Korean population, and also identify the predictors for vitamin D insufficiency in Korea. DESIGN AND SETTING: The Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) in the Korean population conducted in 2008. PARTICIPANTS: 3,047 males and 3,878 females aged 10 years and older selected in all the 16 administrative districts of South Korea. MAIN OUTCOME MEASURES: Serum 25-hydroxyvitamin D [25(OH)D] levels and the prevalence of vitamin D insufficiency defined as serum 25(OH)D level of less than 20 ng/ml. RESULTS: Vitamin D insufficiency was found in 47.3% of males and 64.5% of females, whereas only 13.2% of male and 6.7% of female population had a serum 25(OH)D level of greater than 30 ng/ml. Vitamin D insufficiency was most prevalent in the age of 20-29, with a rate of 65.0% in males and 79.9% in females, and least prevalent in the age of 60-69 in males and 50-59 in females. Those who work usually indoors were more predisposed to vitamin D insufficiency. In the adult population, predictors for vitamin D insufficiency included young age groups, spring and winter seasons, living in an urban area, and indoor occupations. CONCLUSIONS: Vitamin D insufficiency is very common, and it is now a greater threat to the younger generation in Korea. Current recommendations for vitamin D intakes for Koreans are inadequate, especially for the youth.

Comparison of monthly ibandronate versus weekly risedronate in preference, convenience, and bone turnover markers in Korean postmenopausal osteoporotic women.

Patient preferences, convenience, and bone turnover markers were evaluated for the monthly ibandronate over the weekly risedronate regimen in Korean postmenopausal osteoporotic women. This was a 6-month, prospective, randomized, open-label, multicenter study with a two-period and two-sequence crossover treatment design. After a 30-day screening period, eligible participants with postmenopausal osteoporosis were randomized to receive either monthly oral ibandronate 150 mg for 3 months followed by weekly oral risedronate 35 mg for 12 weeks (sequence A) or the same regimen in reverse order (sequence B). Patient preference and convenience were evaluated by questionnaire. The changes in serum C-telopeptide after 3 months of treatment were analyzed. A total of 365 patients were enrolled in this study (sequence A 182, sequence B 183). Of patients expressing a preference (83.4%), 74.8% preferred the monthly ibandronate regimen over the weekly regimen (25.2%). More women stated that the monthly ibandronate regimen was more convenient (84.2%) than the weekly regimen (15.8%). There was no significant difference in the change in bone turnover marker between the two treatments. The two regimens were similarly tolerable. There were fewer adverse events in the monthly ibandronate group compared to the weekly risedronate group in terms of gastrointestinal side effects (nausea and abdominal distension). This study revealed a strong preference and convenience for monthly ibandronate over weekly risedronate in Korean postmenopausal osteoporotic women. There was no significant difference in change of bone turnover marker and safety profile between the two regimens.

Effects of seaweed supplementation on blood glucose concentration, lipid profile, and antioxidant enzyme activities in patients with type 2 diabetes mellitus.

The present study was carried out to evaluate the physiological effects of seaweed supplementation on blood glucose levels, lipid profile, and antioxidant enzyme activities in subjects with type 2 diabetes mellitus. Subjects were randomized into either a control group or a seaweed supplementation group. Pills with equal parts of dry powdered sea tangle and sea mustard were provided to the seaweed supplementation group three times a day for 4 weeks. Total daily consumption of seaweed was 48 g. We found that total dietary fiber intake was 2.5 times higher in subjects receiving seaweed supplementation than in the control group. Accordingly, fasting blood glucose levels (p<0.01) and 2-hour postprandial blood glucose measurements (p<0.05) were decreased significantly in those ingesting seaweed. Furthermore, the serum concentrations of triglycerides were decreased and high-density lipoprotein cholesterol was increased significantly in seaweed supplement group (p<0.05). However, the concentrations of total cholesterol and low-density lipoprotein cholesterol were not affected by seaweed supplementation. The level of thiobarbituric acid reactive substances in erythrocytes was significantly lower with seaweed supplementation compared to controls (p<0.05). Catalase and glutathione peroxidase activities with seaweed supplementation were higher than the controls (p<0.05), but superoxide dismutase activity was not affected. We, therefore, conclude that ingestion of seaweed influences glycemic control, lowers blood lipids, and increases antioxidant enzyme activities.

Diabcare Asia 2001--Korea country report on outcome data and analysis.

BACKGROUND: The Diabcare-Asia study was designed for the purpose of describing diabetes control and management, and late complication status in the diabetic population. METHODS: From the 1st of July 2001 to the 1st of September 2001, data from 1170 diabetic patients were collected in 21 centers (one university hospital and 20 clinics located in Seoul and in Gyeonggi, Korea), and blood samples were collected for centralized HbAtc measurements. RESULTS: Only 16.8% of patients at the clinics reported self-monitoring their blood glucose. The mean HbA(1c) was 7.3 +/- 1.4% at the hospital and 7.5 +/- 1.5% at the clinics, and the mean fasting plasma glucose (FPG) levels were 7.0 +/- 3.3 mmol/L at the hospital and 7.9 +/- 2.5 mmol/L at the clinics. About 40% of patients had a HbA(1c) and FPG above the normal upper limits. Screening for microalbuminuria was rarely performed. The available data represents only about 0.9% of the patients at the hospital and 12.3% of the patients at the clinics. Nephropathy (serum creatinine >2 mg/dL) was found in 0.8% of the patients at the hospital and in 3.4% of the patients at the clinics. Retinopathy and neuropathy were commonly reported diabetic complications. The prevalence of other severe late complications was relatively low. CONCLUSION: The data revealed suboptimal glycemic control in about 40% of patients.

The metabolic syndrome and associated lifestyle factors among South Korean adults.

INTRODUCTION: The importance of managing the metabolic syndrome has been emphasized in the prevention of cardiovascular disease. Although South Koreans have a low prevalence of obesity, little information is available about the prevalence of the metabolic syndrome and its associated risk factors. METHODS: Data was obtained from individuals aged 20-79 years from the Korean National Health and Nutrition Examination Survey 1998, a cross-sectional health survey of a nationally representative sample of non-institutionalized civilian South Koreans. The prevalence of the metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III), was determined, and lifestyle factors associated with predisposition to the metabolic syndrome were analysed. RESULTS: Among South Korean adults, the age-adjusted prevalence of the metabolic syndrome was 14.2% for men and 17.7% for women, whereas the age-adjusted prevalence of obesity (body mass index (BMI) >or=30 kg/m(2)) was 1.7% and 3.0% for men and women, respectively. Age, unemployment, higher BMI, and current smoking were associated factors for the metabolic syndrome regardless of gender. Moderate exercise (2-3 sessions/week) in men and light alcohol drinking (<15 g/day) in women decreased the odds of the metabolic syndrome. CONCLUSIONS: Metabolic syndrome is present in more than 15% of South Koreans despite a low prevalence of obesity. Higher BMI and current smoking were identified as independent modifiable risk factors of the metabolic syndrome. Weight control and smoking cessation may therefore decrease the prevalence of the metabolic syndrome in South Korean adults.

Atrophy of brown adipocytes in the adult mouse causes transformation into white adipocyte-like cells.

Adipose tissue is an important endocrine regulator of glucose metabolism and energy homeostasis. Researches have focused on this tissue not only as a target for pharmacotherapy of obesity and insulin resistance but also as an endocrine tissue with leptin secretion and high insulin sensitivity. Brown adipose tissue (BAT) additionally plays a unique role in thermoregulation through the mitochondrial uncoupling protein 1 (UCP1), which uncouples oxidative phosphorylation. As a genetic tissue ablation model of BAT, we made transgenic mice expressing herpes simplex virus thymidine kinase (HSV-TK) driven by the brown adipocyte- specific UCP1 minimal regulatory element. The HSV-TK transgene was expressed specifically in BAT and more than 35% increase of apoptosis was induced by ganciclovir (GCV) treatment. Nevertheless, the expression level was not high enough to induce BAT ablation in GCV-treated adult mice. Importantly, however, we found that brown adipocytes in the periphery of interscapular BAT were transformed into white adipocyte-like unilocular cells. These cells express white adipocyte-specific leptin protein but are different in the ultrastructure of mitochondria from classical white adipocytes. Our data indicates that atrophy of BAT causes transformation into white adipocyte-like cells in the adult mouse and also suggests that further molecular understanding of adipocyte plasticity using our transgenic mouse model might be beneficial for the development of anti-obesity/anti-diabetic therapies.

Quantification of tumor suppressor mRNA expression by poly-competitive RT-PCR using a TS-IS that contained multiple internal competitors.

Despite the recent introduction of real-time PCR methods and cDNA microarrays, competitive PCR techniques continue to play an important role in nucleic acid quantification because of the significantly lower cost of equipment and consumables. In this study, we developed a construct, termed tumor suppressor-internal standard (TS-IS) that produced polycompetitive RNA templates as an internal standard to quantify cellular RNA concentration of tumor suppressor genes. This construct is composed of not only sets of primers for detecting the expression of several tumor suppressor genes (such as pRB, p16(INK4A) 15(INK4B), p14(ARF) p53, and p21(WAF1)), but also HPRT as an endogenous marker. Using an internal standard RNA that was synthesized from the TS-IS construct, we were able to establish optimized conditions for the quantification of tumor suppressor genes with minimal amounts (50 ng) of cellular RNA. In addition, the usefulness of this method was confirmed by analyzing the expression levels of tumor suppressor genes in fourteen hepatoma cell lines as a model. The TS-IS assay that we used was inexpensive and a widely applicable method that permitted the reliable and accurate quantification of tumor suppressor genes.