Background
It is well known that the metabolic syndrome is associated with visceral adipose tissue (VAT), but several recent studies showed stronger association between the subcutaneous adipose tissue (SAT) and insulin resistance. The purpose of this study was to investigate the clinical significance of deep SAT as a cardiovascular and a metabolic risk factor. Methods: A cross-sectional survey was conducted among fifty-one subjects (21 men and 30 women) who visited an obesity clinic in Yeungnam University Hospital. We performed cross-sectional abdominal CT, and undertook the novel approach of partitioning SAT into the plane superficial to the fascia within SAT (Superficial SAT) and within subcutaneous adipose tissue (deep SAT), as well as the measurement of VAT. Percent body fat was measured by bioimpedance analysis (Inbody 2.0, Biospace). Fasting blood samples were analyzed for total cholesterol, HDL-cholesterol, TG, LDL-cholesterol, FFA, insulin, uric acid and glucose. Resting blood pressure was measured. Results: After adjustment for age, sex, smoking, alchol and exercise, deep SAT was proved to be significantly and positively correlated with fasting insulin, FFA, and uric acid (P＜0.05). VAT was significantly correlated with unfavorable levels of FFA, insulin, HDL-cholesterol, TG and diastolic blood pressure (P＜0.05). In stepwise multiple regression analysis, deep SAT was shown to be the most powerful of the adiposity measures for explaining the variance in fasting insulin and uric acid levels (r2=0.196 and 0.225, respectively; both P＜0.001; including superficial SAT, deep SAT, VAT). Conclusion: Our results suggest that the association exists between deep SAT and fasting insulin, a finding which provides further support to the observation that deep SAT may be involved in insulin sensitivity. (J Korean Acad Fam Med 2007;28:100-105)

Background
: In general, long-term weight loss maintenance is difficult. Thus we have attempted to examine the factors associated with weight loss maintenance after weight reduction to appropriate level in obese people.

Methods : The study subjects were 170 obese adults who visited the Yeung Nam University Medical Center Obesity Clinic from January 2002 to April 2004. Selected individuals for this study were those who have intentionally lost at least 5% of their body weight and have kept it off for at least 1 year and considered to be ; weight loss maintainers ; and the factors that are associated with weight loss maintenance were obsened and assessed by telephone survey.

Results : Among all study subjects, the successful weight loss maintainers were 61 (35.9%) subjects (males: 23, females: 38) and re-gainers were 109 (64.1%) subjects (males: 42, females: 67). The difference between maintainers and re-gainers according to sex, age and basal body weight was not statistically significant. The difference between maintainers and retainers were statistically significant in those with regular exercise more than 3 times per week (P=0.001), no alcohol intake (P= 0.001), physical activity more than moderate level (P＜0.001), TV viewing (internet using) times less than 2 hours (P＜0.001), dietary control (P＜0.001), and no overeating (P＜0.001). According to multiple regression analysis, obesity treatment medication use during the weight loss maintenance period had the greatest influence (R²=0.336, P=0.000), and the following were TV (internet) viewing time, smoking, exercise, and physical activity in order.

Conclusion : By using, medications, reducing TV viewing (internet using) times, smoking cessation, diet control exercise weight loss were maintained significantly.

Background
: In this study we estimated the prevalence of cardiovascular (CV) risk factors according to waist-to- height ratio (W/Ht ratio) in adult obese women to ensure the importance of abdominal obesity and determined the usefulness of W/Ht ratio as a index of abdominal obesity in adult obese women.

Methods : The study subjects were 190 adult obese women who visited an obesity clinic from August, 2001 to January, 2003. They were divided into 4 groups: Group 1; BMI＜30, W/Ht＜0.6, Group 2; BMI＜30, W/Ht≥0.6, Group 3; BMI≥30, W/Ht＜0.6, and Group 4; BMI≥30, W/Ht≥0.6. In each group, we compared the prevalence and odds ratio for CV risk factors.

Results : In obese group, the prevalence of high blood glucose (P＜0.01), hypertriglyceridemia (P＜0.01) were significantly higher in group 2 than group 1. In high obese group, the prevalence of systolic hypertension (P＜0.01), high blood glucose (P＜0.01), hypercholesterolemia (P＜0.01), hypertriglyceridemia (P＜0.05), and high LDL-cholesterol were significantly higher in group 4 than group 3. When odds ratio for each group with reference to group 1 were compared after adjusting for age, high blood glucose (4.48), and hypertriglyceridemia (6.10) in group 2, and systolic hypertension (2.69), high blood glucose (3.02), and hypertriglyceridemia (4.00) in group 4 were significantly higher.

Conclusion : The prevalence of CV risk factors were likely to be increased in higher W/Ht group independently to BMI. W/Ht ratio can be a simple, useful index for abdominal obesity and its related risk factors not only in adult males but also in adult obese women.

Background
: The effect of smoking on obesity and fat distribution is controversial. We evaluated the difference of fat distribution and obesity according to the amount of smoking, and the influence of leptin level between obesity and the amount of smoking.

Methods : Subjects were selected among patients who visited the Health Promotion Center of Yeungnam University Hospital for general health evaluation from May to August, 2001. They were aged from thirty to fifty and had no weight change during six months. We excluded the patients who had disease and medication history that can cause weight change. One hundred thirty-five men were included in this study. Smoking status, alcohol and exercise history were reviewed by interview method. Height, weight, waist and hip circumference, %body fat, blood pressure, and blood chemistry were measured. Leptin was measured by a commercial radioimmunoassay (Linco Research, Inc., St., Louis, MO). The differences of obesity parameters and leptin levels according to the amount of smoking were evaluated by analysis of covariance with multiple comparision. All statistical analyses were performed with SPSS 10.0

Results : Body mass index, %body fat, waist circumference and waist to height ratio (W/H ratio) were significantly increased according to the amount of smoking after adjustment for age, alcohol intake and exercise (P＜0.05). But, BMI, %BF, WC and W/H ratio in mild and mild-moderate smokers were lower than those of the non-or ex-smoker, paradoxically (P＜0.05). Also, serum leptin level was increased according to the increase of amount of smoking, but it had no statistical significance. Over one pack per day smokers had 3.5 times higher risk of hypertension than under one pack per day smokers.

Conclusion : In Korean middle-aged men, obesity index showed difference between the amount of smoking status. BMI, %BF, WC and W/H ratio were significantly higher in heavy smokers than mild and mild-moderate smokers. Though it was not statistically significant, leptin was higher in heavy smokers than in mild and mild- moderate smokers.

Background
: Abdominal obesity is a risk factor for morbidity and mortality associated with cardiovascular disease. It has been reported that metabolically obese is common even in normal weight individuals. In this study, we analysed characteristics of cardiovascular risk factors in normal and overweight men using waist-to-height ratio to find out whether it reflects such risks.

Methods : Study subjects were 516 men.(18.5≤BMI<30.0) According to BMI and waist-to-height ratio(W/Ht), they were divided into four group: Group 1; 18.5≤BMI<25.0, W/Ht<0.5, Group 2;18.5≤BMI<25.0, W/Ht≥0.5, Group 3; 25.0≤BMI<30.0, W/Ht<0.5, Group 4; 25.0≤30.0, W/Ht≥0.5. The prevalence, Odds ratio for cardiovascular risk factors were compared.

Results : In normal weight group, the prevalence of hypertension(P<0.01), high blood glucose(P<0.01), hypercholesterolemia(P<0.05), hypertriglyceridemia(P<0.01) was significantly higher in group 1 than gorup 2. In overweight group, the prevalence of hypercholesterolemia(P<0.01), low HDL(P<0.01) was significantly higher in group 4 than group 3. When compared Odds ratio for each groups with reference to group 1, adjusted for age, smoking status and regular exercise, high blood glucose(4.48), hypertriglyceridemia(5.91) in group 2, hypertension(3.54), hypertriglyceridemia(3.44) in group 3, hypertension(2.90), hypertriglyceridemia(3.81), low HDL(2.60) in group 4 were significantly higher.

Conclusion : Waist-to-height ratio may be a useful method for early detection of abdominal obesity and it's related risk factors in normal and overweight individuals.

Background
: As the mean life span is prolonged, the concern about health care in postmenopausal women is now promoted. Especially, osteoporosis is the serious health problem in postmenopausal women. Bone mineral density in postmenopause is controlled by that in premenopause. Therefore, we searched for the factors which contribute to bone mineral density in premenopause.

Methods : The study subjects who visited the Health Screening and Diagnosis Center in Yeungnam University Hospital from March 1998 to July 1999 was measured BMD at the lumbar spine using dual Energy X-ray Absorptiometry. Subjects were checked past medical history, life style (smoking, drinking, physical activity, exercise etc.), birth history, breast feeding, oral pill intake. The subjects who had disorders known to interfere with bone metabolism and premature menopausal and surgical menopausal women were excluded from the study. And we reviewed the results of the laboratory and radiologic findings which had done in Health Screening and Diagnosis Center.

Results : 352 women were included in this study. The number of normal BMD was 228 and the number of osteopenia was 124. Weight, height, BMI, exercise was significant positively correlated with bone mineral density(P<0.05). Previous operation history was significant negatively correlation with bone mineral density (P<0.05). Multiple logistic regression result showed that weight was the most significant factor affecting to BMD and the history of operation and exercise were significant factors affecting BMD(P<0.05).

Conclusion : In postmenopaual women, who has low weight, past operation history and lack of exercise, evaluation of BMD and education for prevention of osteoporosis are needed.

Background
: With increase in the prevalence of obesity in recent years, much interest has focused on obesity nowdays. Inerease in abdominal fatness and there is some possibility that smoking has effect on obesity. We evaluated the influence of smoking on abdominal fatness.

Methods : This study was carried out on 475 individuals who visited the Health Promotion Center in Youngnam University Hospital in May, 1999. The subjects were checked on age, sex, life style (smoking, drinking, physical activity, exercise, etc.), past medical history, blood pressure, height, weight, waist circumference, hip circumference, body fat percent and other obesity indexes.

Results : In men, waist circumference(P<0.01), body fat percent (P<0.05), waist hip ratio (P<0.01) were significantly increased according to the amount of smoking after adjustment for BMI, age, alcohol intake, exercise and physical activity. But, the waist circumference, waist to hip ratio and percent body fat of mild smoker were rather shorter than that of the non-smoker or on who abstained from smoking.

Conclusion : In men, it seems that obesity index of abdominal fatness may be significantly high in moderate to heavy smokers and low in mild smokers.

Background
: Osteoporosis is an important and common medical problem in postmenopausal women. Depression is another major public health concern. Due to the high prevalence of both depression and osteoporosis, even a weak association between them might result in a greater health problem. We have investigated whether depression is associated with bone mineral density (BMD) in peri- and postmenopausal women.

Methods : The study subjects who visited the office of family medicine department and the health screening and diagnosis center in one general hospital from January to May, 2000 were selected. BMD was measured at the lumbar spine using Dual Energy X-ray Absorptiometry. We evaluated the depression scale using the Beck Depression Inventory. The subjects who had disorders known to interfere with bone metabolism or those who had taken medication related to depression were excluded from the study.

Results : Significant positive correlation were noted between BMD and height and weight (P<0.05) but no correlation was found with depression in perimenopausal women. In postmenopausal women, significant negative correlation was noted between BMD and age, and postmenopausal duration and depression. Significant positive correlation was found between BMD and height and weight (P<0.05).

Conclusion : Our results showed that depression was associated with BMD in postmenopausal women which was independent of other factors strongly associated with osteoporosis.

Background
: Overweight and obesity are associated with increased mortality and morbidity. Obesity is influenced by multiple factors, both genetic and environmental factors. We investigated the relationship between socioeconomic, behavioral, dietary, reproductive factors and body mass index(BMI).

Methods : The subjects were 3000 adults who had visited the Health Screening and Diagnosis Center of Yeungnam University School of Medicine from February to June, 1997. We evaluated BMI and occupation, exercise, smoking, alcohol intake, total calorie intake, fat and carbohydrate intake in both gender and reproductive factors in women. Then, we analyzed the association between BMI and such variables as above.

Results : 1629 men and 1371 women were analyzed. The mean BMI was 23.4±2.8kg/M² in men, 22.9±3.1kg/M² in women. In both gender, 9.7% of our population had BMI over 27. Mean BMI increased with age. Those who were active and light smokers(≤20cigarette/day) had the lowest BMI in men. But no relationship was observed between BMI and exercise, smoking in women. Heavy alcohol drinkers(>1cup/day) had higher BMI than other group in both gender. We found significant correlation between BMI and total calorie intake, calorie intake to recommended calorie ratio in both gender. In women, the group whose number of parity was above 3 had significantly higher BMI than the other. And age at first birth was significantly correlated with BMI in a negative direction.

Conclusion : Our results showed that BMI was associated with age, smoking, alcohol, total calorie intake, calorie intake to recommended calorie ratio, parity, age at first birth. Socioeconomic class, exercise and diet composition appeared to have little influence.

Background
: In order to treat obese individuals, control of caloric intake after determination of patient's energy expenditure and recommendation of exercise program with possible use of specific medication is advised. There are many limitations in measuring all individual's energy expenditure by calorimetry, thus estimation is made using many variables such as weight, height, age, and gender. But, commonly used equations to predict resting energy expenditure(REE) are thought to result in overstimation of energy expenditure for use with obese individuals. This study investigated difference between measured and predicted resting energy expenditure in obese individuals..

Methods : Subjects were 133 adults who were admitted either to Internal Medicine Department and ENT Department of Yeung Nam University Hospital and their resting energy expenditure was measured indirest calorimetry between groups was compared. Predicted REE estimated by 6 equations to measured REE was compared in the two groups by body mass index 27 kg/m² under 65 years old individuals.

Results : There was no significant difference of measured REE between groups according to smoking habits(p>0.05). In the older group(≥65 years old), REE was lower compared to the younger groups(<65 years old)(p<0.05). In the obese group(body mass index>27kg/m²) measured REE was higher than the normal weight group(BMI<27kg/m²)(p<0.05). Among 108 indibiduals under 65 years old, other equation except for Fleish equation and Robertson and Ried equation were inaccurate when applied to the obese group.

Conclusion : These commonly used prediction equations tend to overestimate the REE in obese individuals, and the best estimates for the obese seem to be derived from the Fleish and Robertson and Reid equations.

Background
: The increase of smoking prevalence in adolescents is serious problem because of physical and psychological influences furthermore, fixation of smoking habit. This study is aimed at providing applicable basic information to setting up the education programs and strategies to prevent smoking among high school students by analysis smoking behavior an its related factors.

Methods : 835 students from one senior high school in Taegu completed a self administerd questionnaire during school hours in May, 1996. 813 questionnaires with adequate responses were analyzed using SPSS/PC program. All students were asked class years, school satisfaction, school performance score, number of their three best friends who smoke, smoking status of their fathers, religion, allowance, alcoholic drinks, addicting drug use, Zung's self-rating depression scale(SDS) and Zung's self-rating anxiety scale(SAS). Smokers were asked amount of smoking, motives for smoking, when they started smoking, Fagerstrom score.

Results : Of the 813 students in the sample 135(16.6%) were current smokers. About the amount of smoking, 59.3% smoked less than 5 cigarettes/day. About the motives of smoking, 34.8% started smoking through the solicitation by friends or for making friends. About when they started smoking, 52.6% started smoking before entrance into senior high school. The related factor with smoking included class years, school satisfaction, school performance score, number of three best friends who smoke, allowance, alcoholic drinking, addicting drug use, SDS. Predictors of smoking were number of three best friends who smoke, number of alcoholic drinking, and allowance. The related factors of nicotine dependency were amount of smoking, allowance, when they started smoking. Predictor of nicotine dependency were amount of smoking, number of three best friends who smoke.

Conclusion : The related factors with smoking included class years, school satisfaction, school performance score, number of three best friends who smoke, allowance, alcoholic drinking, addicting drug use, and SDS. Predictors of smoking were number of three best friends who smoke, number of alcoholic drinking, and allowance.

Background
: Urography(IVU) is considered the best first investigation in patient with suspected urinary calculi, but recently ultrasonography(USG), combined with a plain film of the abdomen, has been suggested as an alternative.

Methods : We undertaken study to see if this approach can be used in emergency patients and outpatients by radiologists with different amounts of ultrasound experience. Some 192 patients with suspected urinary colic presenting to Koo Hospital Emergency Department and Youngnam Universith Hospital outward Department(IM, URO, FM) over 12-month period were studied. They had a plain abdominal film(KUB) and USG examination of the kidney, ureter, bladder following hydration and subsequently underwent IVU. Of these, 22 patients passed a stone before their IVU. The data analysis was performed on the remaining 170 patients. Urography was used as the gold standard.

Results : Some 170 patients subsequently underwent IVU at a mean interval of 1.8 days after the ultrasound examination. In 91 of 170 patients the IVU was positive. In 97 of 170 patients the combination of JUB plus USG was 97%, specificity was 89%, positive predictive value was 91%, and negative predictive value was 96%.

Conclusion : Our findings in this study suggest that in the hydrated patient the combination of KUB plus US is a very sensitive and relative specific screening test. Because of the high negative predictive value of KUB plus US, urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessary.

Background
: Marked weight loss is generally viewed as a manifestation of serious disease.
Thus, patients who are experiencing involuntary weight loss(generally defined as more than 5% of usual body weight) can present a perplexing challenge. They may view such weight loss with alarm because of fears of occult malignancy. How does a primary care physician approach the evaluation of involuntary weight loss? An awareness of the most common cause of weight loss and the most efficient diagnostic strategy is essential.

Methods : The study populations were patients who visited the department of Family Practice of Yeungnam university hospital from February 1, 1994 to June 31, 1994. Cases were selected if there were a documented involuntary weight loss more than 5% of their baseline body weight during 6 month period of time, and routine initial laboratory tests were done. The remainder of the diagnostic evaluation was left to the patient's physician. Final diagnoses were made by their personal physicians.

Results : The proportion of involuntary weight loss of the outpatients was 2.38%(105) among 4,409 during the period. The causes were mental disorder, digestive system disorder, uncertain, endocrine system disorder, miscellaneous diseases, infectious diseases, neoplasm and genitourinary system diseases in order of frequency. The sex ratio was 1.26:1, male dominantly. Their chief complaints were epigastric pain, fatigue, weight loss, cough and headache in order of frequency.

Conclusion : Among the patients who visit the department of family practice in university hospital, the main cause of involuntary weight loss is depression. So family physicians should consider this point during patients evaluation.

Background
: Family function and types can influence on family members and may be related to marriage satisfaction degree of couples. The factors related to family function and types have been studied many times, but the study concernng the degree of marriage satisfaction's difference according to family function and types is rare. This study is attempted to see the difference of marriage satisfaction score in family groups according to Family APGAR Score and Family Adaptability Cohesion Evaluationg Scale.

Methods : 67 couples answered the questionaire among 200 couples who registered at Lifelong Health Care Program of Department of Family Medicine of Yeungnam University Medical Center from April 1 to May 31, 1992. The questionnaire is composed of Family APGAR Score, Family Adaptability Cohesion Evaluating Scale an Marriage Satisfaction Score.

Results : We compared into marriage satisfaction mean scores each group. Marriage satisfaction score is increased with high family APGAR score, balanced family type, appropriate adaptability and appropriate cohesion, It is statistically significant.

Conclusion : Families belong to high functional group and balanced type are showed high marriage satisfaction mean scores and marriage satisfaction score was a significant difference according to family function and types.

Background
: In Korea, prevalence rate of pulmonary tuberculosis has been decreasing, but pulmonary tuberculosis is still one of significant public health problem. This study was done for evaluate for therapeutic efficiency of 6-months short course chemotherapy in Family Practice.

Methods : We prescribed 2HERZ/4HER for 68 pulmonary tuberculosis patients from September 1, 1990 to August 31, 1992 at Department of Family Medicine, Yeungnam University Medical Center.
We studied the therapeutic efficiency of 6-months short course chemotherapy-negative conversion, adverse reaction, treatment failure, drop out cause and recurrence rate.

Results : Among 68 patients, bacteriologically positive rate was 14.7% and negative conversion rate was 100%. There was no cases of recurrence, treatment failure and treatment interruption due to drug adverse reaction.

Conclusion : This 6-months regimen (2HERZ/4HER) is effective and can be recommended as a promising regimen for the treatment of pulmonary tuberculosis in Family Practice.