Background : We aimed to investigate the influence of metabolic dysfunction-associated steatotic liver disease (MASLD) and handgrip strength (HGS) on the risk of atherosclerotic cardiovascular disease (ASCVD) in the general population. Methods : We used data from 20,611 individuals from the 2014-2019 Korea National Health and Nutrition Examination Survey. MASLD was defined as a Framingham steatosis index of ≥23. Low HGS was defined as <28 kg in men and <18 kg in women. The 10-year ASCVD risk score was assessed, and high-probability ASCVD was defined as >10%. Results : Individuals with both MASLD and low HGS had a greater risk of high-probability ASCVD (odds ratio [OR], 6.88; 95% confidence interval [CI], 6.81 to 6.97; P<0.001) than those without MASLD and with intact HGS. The association between low HGS and high-probability ASCVD was stronger when MASLD was accompanied by advanced liver fibrosis (OR, 20.94; 95% CI, 20.04 to 21.88; P<0.001). In the population with MASLD, ASCVD risk was lower in individuals with low HGS who engaged in regular exercise than in those without low HGS who did not exercise regularly (P<0.001). Conclusion : Individuals with MASLD and low HGS had a significantly higher risk of ASCVD than those without MASLD. Concurrent advanced liver fibrosis was further associated with increased ASCVD risk among individuals with MASLD.
Background:Most bariatric surgery studies have been conducted at single centers, with limited research focusing on Asian populations. In Korea, bariatric surgery has been covered by the National Health Insurance System since 2019. Using this nationally representative data, we assessed the clinical outcomes of bariatric surgery in Korea. Methods:We included 856 individuals who underwent bariatric surgery between 2019 and 2020 with repeated health checkups before (2 years) and after (2±0.5 years) surgery. Anthropometric indicators and the prevalence of metabolic diseases were compared pre- and postoperatively. Logistic regression analysis was used to identify predictors of sufficient weight loss. Results:Two years post-surgery, significant reductions were observed in body weight (-22.1 kg), body mass index (BMI; -7.9 kg/m2), and waist circumference (-17.4 cm). The number of patients with study-defined diabetes and hypertension decreased by 71% (245/345) and 52% (267/513), respectively. Metabolic dysfunction-associated fatty liver disease improved in 70% of cases. Sufficient weight loss, defined as ≥20% total weight loss, was achieved by 56.3% of the study population, and 76.6% achieved ≥50% excess weight loss. Predictors of sufficient weight loss included younger age, female sex, higher baseline BMI, and higher systolic blood pressure (SBP), whereas the type of surgical procedure (Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion with duodenal switch) was not significantly associated with the outcome. Conclusion:Bariatric surgery in Korean patients led to substantial weight loss and metabolic improvement. Greater benefits were observed in younger, female patients with higher baseline BMI and SBP.
Background : Preoperative analysis of body composition is critical for anticipating metabolic changes and optimizing outcomes after bariatric surgery (BS). This study assessed agreement between dual-energy X-ray absorptiometry (DXA)-derived fat-free mass (FFM) and lean soft tissue (LST) and estimates from anthropometric equations in individuals with class-II obesity or greater. Methods : FFM and LST were measured by DXA in 123 participants with class-II obesity or greater before and approximately 1 month after BS. Six equations were used to estimate FFM and five to estimate LST. The estimates were calculated at both time points, and changes from pre- to post-BS were compared with the DXA-derived values. Paired t-tests were used to evaluate differences between the predicted and measured values. Results : At the group level, the Li et al. equation for higher body mass index (BMI) values demonstrated the highest agreement with DXA-FFM before surgery (mean-difference, 0.01 kg; 95% confidence interval [CI], -0.74 to 0.74), whereas the Li et al. equation for normal BMI values showed the greatest agreement at follow-up (mean-difference, 1.71 kg; 95% CI, 1.30 to 2.13). For LST estimation, the Salamat et al. equation provided the greatest accuracy before BS (mean-difference, 0.03 kg; 95% CI, -1.35 to 1.40), and the Kulkarni et al. equation achieved the best performance in capturing group-level changes during follow-up (mean-difference, 0.48 kg; 95% CI, 0.05 to 0.92). Conclusion : Although certain predictive equations yielded acceptable group-level agreement with DXA, their individual-level performance was inconsistent, limiting their clinical utility. Further research is warranted to develop predictive models with enhanced precision and reliability.
Background : Overweight and obesity are health challenges in children and adolescents and have increased in prevalence in years. This study evaluated the effects of home-based high-intensity interval training (HIIT), resistance training (RT), or combined HIIT+RT on anthropometric indices and health-related quality of life (HRQoL) in children and adolescents with overweight or obesity. Methods : A randomized, single-blinded clinical trial was conducted in Isfahan, Iran. A total of 120 patients (aged 10-18 years) with overweight or obesity participated. Eligible participants were recruited using a simple sampling method and randomly assigned to one of four groups: three intervention groups (HIIT, RT, and combined HIIT+RT) or one non-exercising control group with dietary advice. The intervention groups received 24 home-based training sessions over 2 months. Anthropometric indices and the KIDSCREEN-27 questionnaire were assessed both pre- and post-intervention. Results : After 2 months, body weight decreased significantly in the RT group compared with baseline measurements (P=0.010). Waist circumference (WC) also decreased significantly in the RT group (P=0.001), and hip circumference (HC) decreased significantly across the three intervention groups. Adjusted analyses revealed significant reductions in body weight (P=0.028), WC (P=0.024), and HC (P=0.006) across interventions. No significant changes were observed in waist-to-hip ratio or body mass index (BMI). In addition, an analysis of covariance showed no significant differences in the mean changes in HRQoL among the three intervention and control groups pre- and post-intervention. Conclusion : Home exercise was associated with improvements in anthropometric indices excluding BMI, whereas HRQoL remained unchanged in children and adolescents with overweight or obesity.
Background: The 2025 obesity fact sheet provides an updated overview of the prevalence of obesity and abdominal obesity, as well as the prevalence of major chronic diseases according to obesity status in Korea. Methods: This study analyzed data from 17,576,389 adults who underwent general health examinations provided by the National Health Insurance Service from 2014 to 2023 and 17,660 participants from the Korean National Health and Nutrition Examination Survey (2019-2021). Results: In 2023, the prevalence of obesity and abdominal obesity was 38.4% (male 49.8%, female 27.5%) and 24.3% (male 31.3%, female 17.7%), respectively. Class II obesity was most prevalent among individuals aged 35-39 years (9.4%), and class III obesity peaked among those aged 30-34 years (2.6%). The prevalence of chronic diseases-including hypertension, diabetes mellitus, hypercholesterolemia, metabolic syndrome, and hyperuricemia-was 1.5-to 3.6-fold higher in individuals with obesity than in those without obesity, with particularly large differences in young adults and female. The prevalence of obstructive sleep apnea was 4.5-fold higher in the obese group, whereas osteoporosis was less common in the obese group than the non-obese group. Conclusion: The 2025 obesity fact sheet provides updated national data on obesity, abdominal obesity, and obesity-related chronic diseases in Korea, highlighting the substantial and persistent burden associated with obesity. These findings emphasize the urgent need for timely and effective strategies for obesity prevention and management.
Background : Dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors are contemporary oral antidiabetic medications, each offering distinct advantages and challenges. Understanding their comparative effectiveness in real-world settings is crucial for optimizing treatment strategies. Methods : We retrospectively analyzed adults with type 2 diabetes mellitus who switched between DPP-4 inhibitors and SGLT2 inhibitors from December 1, 2014, to November 26, 2023, using a clinical data warehouse. All participants had baseline glycosylated hemoglobin (HbA1c) levels between 6.5% and 10.0% and were receiving metformin. To reduce baseline imbalance in HbA1c and fasting plasma glucose (FPG), we excluded patients with an estimated glomerular filtration rate <45 mL/min/1.73 m²; and performed 1:1 propensity-score matching on baseline levels of HbA1c and FPG. The matched cohort included 168 patients (84 per group). The primary outcome was the between-group difference in change in HbA1c over 3 months. Secondary outcomes were changes in FPG, body mass index (BMI), liver enzymes, and renal function. Results : Switching to DPP-4 inhibitors was associated with a greater reduction in HbA1c (β, -0.26; 95% confidence interval [CI], -0.51 to -0.01; P<0.001). In contrast, switching to SGLT2 inhibitors led to significant improvements in FPG (β, 10.50; 95% CI, 0.22 to 20.78; P<0.001) and liver enzyme levels. Older patients and those with a lower BMI, higher baseline HbA1c, or chronic kidney disease derived greater benefit from switching to DPP-4 inhibitors. Conclusion : Transitioning to DPP-4 inhibitors reduced HbA1c levels significantly, whereas switching to SGLT2 inhibitors improved FPG and liver-related metabolic parameters.
Background : Prader-Willi syndrome (PWS) is a rare genetic disorder associated with substantial comorbidity and early mortality. However, the epidemiologic burden on Asian populations, particularly in South Korea, remains poorly understood. This study evaluates the nationwide incidence, prevalence, mortality, comorbidities, and healthcare costs of PWS in South Korea. Methods : We conducted a retrospective, population-based cohort study using the Korean National Health Insurance Database from 2005 to 2021. Among 2,553 individuals with PWS-related diagnostic codes, 458 patients were included in the study based on predefined criteria incorporating growth hormone therapy (GHT) or methylation-specific polymerase chain reaction testing. Epidemiologic trends, comorbidities, intensive care unit (ICU) admissions, and healthcare expenditures were analyzed. Results : The overall birth incidence was 6.8 per 100,000 live births, with a significant increase evident after 2016. The median age at diagnosis was 1.0 years, and GHT was initiated at a median age of 2.0 years. The all-cause mortality rate was 3.5%, with pneumonia being the leading cause of death. ICU admission occurred in 25.5% of patients, often during infancy. Intellectual disability and/or developmental delay was present in 68.6% of patients, and type 2 diabetes mellitus in 15.1%. The mean cumulative healthcare cost per patient exceeded 86 million Korean won. Comorbidity prevalence and annual medical costs increased steadily over time. Conclusion : This is the first nationwide study to quantify the long-term epidemiological and economic burden of PWS in South Korea. Our findings underscore the need for early diagnosis, integrated care models, and policy support for this complex population.
Obesity is a global epidemic that has rapidly increased in prevalence in East Asian countries. Complications of obesity, such as metabolic dysfunction-associated steatohepatitis (MASH), have increased in parallel with the recent rise in obesity. Rapidly aging populations, increasingly Westernized lifestyles, and a likelihood of developing higher-risk fat types (e.g., visceral adipose tissue) all play a role in the rising influence of obesity and MASH in East Asian populations. Additionally, East Asian patients are at high risk for developing lean MASH at lower body mass indexes than are common in Western populations. Tools to specifically detect and diagnose MASH in East Asia are lacking. Non-invasive tests (NITs) used globally to detect MASH have inadequate evidence of efficacy in East Asian populations. Current treatment strategies are also inadequate, with East Asian patients largely underrepresented in obesity and MASH clinical trials. Given large, diverse healthcare systems and a lack of awareness and infrastructure to support prevention and long-term management, obesity and MASH are rapidly becoming serious public health concerns in these countries. Therefore, both patients and physicians need better awareness of obesity and MASH, improved access to NITs to diagnose MASH, and more effective treatment options than they currently have. Educational methods should be developed to improve awareness, and more clinical studies of NITs and treatments in East Asian populations are needed.
Background : Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and confer cardiovascular and renal benefits in individuals with type 2 diabetes mellitus (T2DM) partly by promoting urinary glucose excretion and modulating energy metabolism. However, the clinical relevance of ketogenesis induced by SGLT2 inhibitors remains unclear. Methods : This retrospective cohort study was conducted at the Seoul National University Bundang Hospital, South Korea. In total, 151 adults with T2DM who were newly treated with SGLT2 inhibitors (empagliflozin or dapagliflozin) between November 2021 and June 2024 were enrolled. Glycemic parameters (glycosylated hemoglobin [HbA1c], body mass index [BMI], and fasting plasma glucose [FPG]) as well as metabolic profiles (lipid profile, renal function, and hepatic function) were assessed at baseline and after 6 months of treatment. The participants were stratified into tertiles based on the relative increase in serum ketone levels. Results : SGLT2 inhibitor treatment significantly improved HbA1c, FPG, BMI, insulin sensitivity, and the lipid profile. Mean serum ketone levels increased from 92.7±69.4 to 173.5±172.6 μmol/L (P<0.001), although with substantial inter-individual variability. Although ketone elevation did not independently predict HbA1c reduction, participants with elevated ketone responses exhibited enhanced FPG reduction, higher urinary glucose excretion, and favorable triglyceride reduction, suggesting metabolic benefits. A moderate decline in kidney function was also observed in these participants. Conclusion : Ketogenesis did not independently predict HbA1c reduction; however, elevated ketone levels following SGLT2 inhibitor treatment were associated with favorable metabolic adaptations, suggesting potential extra-glycemic benefits.
Amylin is a pancreatic peptide hormone that regulates blood glucose levels and appetite. This review outlines the physiological role of amylin and highlights recent clinical studies exploring its therapeutic potential in diabetes and obesity. Amylin lowers postprandial glucose levels by delaying gastric emptying and suppressing glucagon secretion, while promoting satiety via central nervous system pathways. Preclinical research has driven the development of long-acting amylin analogs with enhanced pharmacokinetics and reduced aggregation, resulting in significant weight loss and metabolic benefits in animal models. Clinically, the synthetic analog pramlintide has been shown to modestly improve glycemic control and induce weight loss in patients with diabetes. More recently, cagrilintide, a long-acting analog, has produced substantial weight reduction in individuals with obesity. Combination therapy with glucagon like peptide-1 receptor agonists has achieved synergistic effects, with weight loss exceeding 15%, positioning amylin analogs as a promising approach for treatment of diabesity-the co-existence of diabetes and obesity. This review summarizes recent advancements and discusses their implications for future therapeutic applications in diabesity management.
Background:This study was conducted to examine the association of body mass index (BMI)-adjusted body cell mass (BCM; BCMbmi) and lean body mass (LBM; LBMbmi) with metabolic markers, metabolic syndrome (MetS), and insulin resistance (IR) in middle-aged and older Korean adults. Methods:This cross-sectional study included 9,522 adults (4,456 males and 5,066 females) without a history of myocardial infarction, stroke, or cancer from the Ansan-Ansung Study of the Korean Genome and Epidemiology Study. Multivariable linear regression was conducted to evaluate the association of BCMbmi and LBMbmi with metabolic markers. Logistic regression analyses were conducted to evaluate the association of BCMbmi and LBMbmi with metabolic abnormalities, including MetS and IR. MetS diagnosis followed National Cholesterol Education Program Adult Treatment Panel III criteria, and IR was assessed using the homeostatic model assessment index of insulin resistance (HOMA-IR). Results:BCMbmi and LBMbmi were negatively associated with fasting glucose, fasting insulin, HOMA-IR, triglycerides, alanine/aspartate aminotransferase, uric acid, and high-sensitivity C-reactive protein, while they were positively associated with high-density lipoprotein cholesterol. The magnitudes of regression coefficients were generally greater for BCMbmi than for LBMbmi. A total of 3,590 (37.7%) and 3,490 (36.7%) participants were categorized as having MetS and IR. Compared to the lowest tertile of BCMbmi, the highest tertiles were associated with lower odds ratio of MetS (males: 0.36 [95% confidence interval, CI, 0.30 to 0.42], females: 0.23 [95% CI, 0.20 to 0.27]) and IR (males: 0.34 [95% CI, 0.30 to 0.40], females: 0.33 [95% CI, 0.28 to 0.38]), all with significant trends (P for trend <0.001). Conclusion:The results suggest that BCMbmi is independently associated with metabolic markers and demonstrate comparable predictive power to LBMbmi for MetS and IR, particularly in males.
Obesity promotes carcinogenesis through interlocking metabolic, inflammatory, immune, and hormonal pathways. We narratively synthesize recent meta-analyses and selected cohort studies that examine adiposity-principally body mass index (BMI) and waist circumference-in relation to cancer incidence. Across the 13 cancers designated by the U.S. National Cancer Institute as obesity-associated, risk elevations are generally consistent, though magnitudes vary by histology (e.g., esophageal adenocarcinoma vs. squamous cell carcinoma), anatomic subsite (gastric cardia vs. non-cardia), sex or menopausal status, and adiposity metric, with central adiposity often revealing additional risk beyond BMI. Evidence is mixed for several sites (e.g., pancreas and thyroid), and emerging but less established signals are noted for oral cavity, melanoma, bladder, non-Hodgkin lymphoma, and leukemia. We also review prevention data: observational studies and select trials suggest that intentional weight loss-via lifestyle interventions, pharmacotherapy (including glucagon-like peptide-1 receptor agonists), or bariatric surgery-can reduce overall or site-specific cancer incidence, although estimates are heterogeneous and causal certainty is limited. Taken together, biologic plausibility and convergent epidemiology support obesity as a modifiable cancer risk factor. Future studies are warranted using standardized exposure definitions, consistent stratification, and rigorous control of confounding to improve comparability. Adequately powered, long-term randomized or quasi-experimental studies may further refine effect sizes and inform precision prevention for obesity-related cancers.
Background : Bariatric surgery (BS) is an effective intervention for morbid obesity; however, it is often accompanied by undesirable muscle mass loss, which can negatively affect metabolic function and physical performance. Probiotics and resistance training (RT) have been studied discretely to address this complication. The present randomized controlled trial investigated the independent and combined effects of fortified yogurt (FY) and RT on muscle preservation and related health outcomes in post-BS patients. Methods : In this parallel, randomized controlled trial, 52 participants who had recently undergone BS and met the eligibility criteria were randomly assigned to one of four groups: group A (FY+RT), group B (FY), group C (RT), and group D (control), with 13 participants in each group. Anthropometric indices, body composition, functional performance, inflammatory and oxidative stress markers, lipid profile, and liver enzymes were measured at baseline and after a 12-week intervention. Results : All participants completed the intervention. The FY+RT group showed the greatest preservation of muscle mass, with the smallest reductions in fat-free mass percentage (-2.32%, P=0.001) and skeletal muscle mass (-1.34 kg, P<0.001). This group also exhibited significant improvements in muscle strength, as measured by hand grip strength (P=0.038) and 30-second chair stand test repetitions (P<0.001). Conclusion : The combination of FY and RT was the most effective strategy for preserving muscle mass and improving strength following BS. Further research is warranted to elucidate the underlying mechanisms and validate these findings.
Background : Reduced handgrip strength (HGS) is associated with adverse cardiometabolic outcomes. This study aimed to determine reference values for HGS among Korean youth and young adults and to evaluate their relationships with metabolic syndrome (MS). Methods : We analyzed data from 9,024 individuals aged 10 to 29 years in the Korea National Health and Nutrition Examination Survey (2014-2019). The adjusted combined handgrip strength (aCHGS; the average of maximum values from both hands divided by body weight) was used as the primary outcome variable. Percentile curves for aCHGS were generated using the lambda-mu-sigma (LMS) method and locally estimated scatterplot smoothing regression analysis, excluding outliers. Associations between aCHGS z-scores and MS were assessed. Results : Percentile curves for aCHGS plateaued after 20 years of age in both sexes. At age 10, aCHGS was comparable between males and females. Males showed a marked rise in aCHGS after early adolescence, maintaining higher levels thereafter. The adjusted odds ratio for MS was 0.313 (95% confidence interval [CI], 0.276 to 0.354) using International Diabetes Federation (IDF) criteria and 0.348 (95% CI, 0.310 to 0.390) using modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. aCHGS z-scores demonstrated strong predictive power for MS (area under the curve, 0.802 for IDF and 0.776 for modified NCEP-ATP III criteria). The optimal aCHGS z-score cutoff values for predicting MS were -0.508 (IDF) and -0.519 (modified NCEP-ATP III). Conclusion : We established age- and sex-specific aCHGS reference values among Korean youth and young adults, demonstrating effectiveness in predicting MS risk. These standards may serve as a practical clinical tool to identify individuals at increased risk of MS early in development.
Background : Current evidence concerning a link between metabolic phenotypes and their dynamic changes over time and the risk of cancer is limited. The present study aimed to assess the association between different metabolic health statuses and the risk of cancer occurrence among adult individuals. Methods : This prospective cohort study enrolled 11,445 adults aged ≥18 years from the Tehran Lipid and Glucose Study and followed them for 18 years. We identified metabolic phenotypes based on the Joint Interim Statement. Accordingly, participants were divided into four groups: metabolically healthy normal weight/overweight (MHNW/OW), metabolically unhealthy normal weight/overweight (MUNW)/OW, metabolically healthy obesity (MHO), and metabolically unhealthy obesity (MUO). Cox proportional hazards modeling was performed to assess the association between metabolic phenotype and the risk of cancer occurrence. Results : The multivariable adjusted hazard ratio (HR) (95% confidence interval [CI]) for cancer risk in participants with the MUNW/OW phenotype was 1.37 (95% CI, 1.04 to 1.82) and that in those with the MUO phenotype was 1.84 (95% CI, 1.21 to 2.79) when compared to those with the MHNW/OW phenotype, respectively. More particularly, the risk of breast cancer was higher in women with the MHO phenotype (HR, 3.60; 95% CI, 1.34 to 9.60) as well as those with the MUO phenotype (HR, 4.69; 95% CI, 1.96 to 11.20) relative to those with the MHNW/OW phenotype. Ultimately, however, we found no relationship between phenotype transition and the risk of cancer occurrence. Conclusion : Based on our findings, metabolically unhealthy phenotypes may be associated with a higher overall incidence of cancer. In addition, obesity, independent of metabolic status, was linked to an increased risk of breast cancer incidence. No association between the transition from a metabolically healthy to unhealthy phenotype and cancer risk was established.
Background:This study prospectively assessed the combined versus individual effects of reducing energy intake (EI) and increasing physical activity (PA) on body weight and composition in older adults with overweight/obesity and metabolic syndrome. The interaction between both exposures was likewise assessed. Methods:A subsample of 1,110 participants (aged 55-75 years) from the Prevención con Dieta Mediterránea-Plus (PREDIMED-Plus) trial was followed for 1 year. The combined effects of 1-year changes in EI and PA on reduction of ≥5% in baseline body weight and total fat, and on ≥5% increments in lean mass were examined using dual-energy X-ray absorptiometry. Multivariate logistic regression models were used to assess the combined association. Multiplicative and additive interactions were tested. Results:Participants who had reduced EI and increased PA over 1 year were significantly more likely to exhibit ≥5% reduction in body weight (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.83 to 5.72) and fat mass (OR, 2.13; 95% CI, 1.23 to 3.69) and ≥5% increase in lean mass (OR, 2.46; 95% CI, 1.24 to 4.87) compared to those who had increased EI and reduced PA. A potential for biological, rather than statistical, interaction between PA and EI was found, with synergy index (>1): 1.08 (95% CI, 0.58 to 1.99) for beneficial changes in body weight, 1.88 (95% CI, 0.41 to 8.65) for fat mass, and 1.44 (95% CI, 0.43 to 4.88) for lean mass. Conclusion:Encouraging an increase in PA with complementary nutritional education to reduce dietary EI may be more effective in managing body composition in older adults with overweight/obesity and metabolic syndrome than focusing on lifestyle behaviors alone.
