Background
: Elevated plasma total homocysteine is a risk factor for cardiovascular diseases. The authors investigated the parameters such as habit, body index, cardiovascular risk factors, nutrition relative to the plasma homocysteine concentration.

Methods : The subjects were 6,223 adults (3,377 males, 2,846 females) who were over 18 years of age and visited a health promotion center of a university hospital from March 2002 to January 2003. We assessed the relationship between the homocysteine level and the following parameters: sex, age, weight, body mass index, waist circumference, smoking, alcohol, systolic and diastolic blood pressure (BP), triglyceride, total cholesterol, high density lipoprotein cholesterol, creatinine, albumin and hemoglobin.

Results : The homocysteine levels was 10.5±5.9μmol/L in males, 7.3±2.6μmol/L in female. Thus it was significantly higher in males (P＜0.001). After adjusting for variables that affect the homocysteine, the subjects over the age of 54 showed 10.7μmol/L (9.5, 12.0, 95% Confidence Interval), which was significantly (P=0.002) higher than the below the age of 38 groups 8.5μmol/L (7.8, 9.2, 95% CI). Non-smoking group showed 8.6μmol/L (8.4, 8.9, 95% CI), while over 28 pack-year group showed 9.6μmol/ L (9.2, 10.0, 95% CI), which was significantly (P＜0.001) higher than the non-smoking groups. For the group with systolic BP over 132mmHg, it was 9.3μmol/L (8.8, 9.5, 95% CI). This was significantly (P=0.004) higher than 8.7μmol/L (8.4, 9.0, 95% CI) in the group whose systolic BP was less than 108 mmHg. The homocysteine was 10.4μmol/L (10.1, 11.7, 95% CI) for the group with creatinine over 1.0 mg/dL, which was significantly (P＜0.001) higher than 7.9μmol/L (7.6, 8.2, 95% CI) in the group whose creatinine was less than 0.8 mg/dL.

Conclusion : After adjusting for variables that affect the homocysteine, significant difference in its values was found between males and females. The homocysteine was significantly increased in the group whose age, systolic BP, amount of smoking, and creatinine were higher.

Background
: The purpose of this study was to assess the lifestyle associated with weight gain and persistent overweight for 2 years.

Methods : The subjects were 580 workers (109 men, 471 women) at one university affiliated hospital. Their height and weight were measured twice in 2000 and 2002. A questionnaire, about lifestyle was filled out in 2000. The questionnaire included the average amount of alcohol intake and the number of days per week in which alcohol was consumed, smoking status, and the number of days per week in which exercise was done. Their weight change in 2 years was calculated and their weight status was classified into two groups: persistent normal weight (BMI＜23 kg/m²) and persistent overweight (BMI≥23 kg/m²).

Results : Among the total, 54.3% of men and 10.0% of women had persistent overweight over 2 years. Overall 93.4% of overweight men and 68.7% of overweight women remained overweight after 2 years. Compared with male non-smokers and male ex- smokers, current male smokers gained weight as much as 1.17 kg over 2 years after adjusting for age and initial BMI (P=0.033). Compared with females who exercised less than 3 per week, those who exercised 3 or more per week lost weight as much as 1.21 kg over 2 years after adjusting for age and initial BMI (P=0.005). Compared with males who consumed alcohol an average of ≤30 g per consumption, those who consumed an average of ＞30 g were 4.1 times (95% C.I. 1.04∼16.21) more likely to maintain persistent overweight over 2 years after adjustment for age and frequency of alcohol use. However no particular lifestyle was shown to predict the risk of persistent overweight for women.

Conclusion : Regular exercise of moderate intensity and modest alcohol consumption seemed to prevent weight gain and persistent overweight. Such lifestyle may be encouraged to maintain healthy weight.

Background
: Smoking greatly increases the risk of cancer, cardiovascular diseases and osteoporosis. Besides direct harm from smoking, some dietary pattern of smokers have been reported to increase such risk. This study aimed to analyze various nutrients by smoking status, and to find out whether smokers maintain harmful dietary patterns.

Methods : One thousand and six hundred fourteen men were selected who visited the health promotion center of an university hospital in Seoul. The inclusion criteria was the completion of dietary survey. Dietary analysis was done by calculation of amounts of each nutrients from 24-hour recall method. We compared total intake of each nutrients and total calories by smoking status with analysis of variance (ANOVA). Then we adjusted the results for exercise and education level by ANCOVA (analysis of covariance).

Results : The study subjects were 840 current smokers (52.0%), 479 ex-smokers (29.7%) and 295 non-smokers (18.3%). The consumption of total fat and cholesterol was significantly high in smokers than non-smokers (P=0.012, P=0.005). The alcohol intake was higher in smokers and ex-smokers than non-smokers (P＜0.001, P=0.007). The smokers and ex-smokers had less calcium than non-smokers (P=0.001, P=0.044). Furthermore, the smokers exercised less than ex-smokers and non-smokers (P＜0.001).

Conclusion : The smokers consumed more total fat and cholesterol which increases the risk of cardiovascular diseases. They also had less calcium and drank more alcohol. Comprehensive approach which includes intervention for dietary intakes in addition to smoking cessation is desirable to decrease health risk for smokers.

Background
: Obesity increases morbidities and mortalities due to cardiovascular diseases. In previous studies, decrease in heart rate variability was associated with cardiovascular death and reduced heart rate variability in the obese had been reported. The authors investigated immediate changes in the heart rate variability after weight reduction in obese individuals.

Methods : The subjects for this study were 39 Korean adults (35 female, 4 male), who visited obesity clinic in a university hospital from January 2002 to July 2003. At first visit, weight, height, body mass index (BMI) and waist circumference of the subjects were measured. We also measured parameters of heart rate variability: Mean Heart Rate (MHR), Standard Deviation of N-N interval (SDNN), The Square Root of the Mean Squared Difference of successive NN intervals (RMSSD), Total Power (TP), Low Frequency (LF), High Frequency (HF), and LF/HF ratio. Weight reduction protocol included nutritional counseling, exercise, behavioral modification and anti-obesity medications, if needed.

Results : At 12 weeks of intervention, weight, BMI, waist circumference, fat mass, and lean body mass significantly decreased (3.90±3.11 kg, -1.50±1.21 kg/m², -4.45±5.61 cm, -3.03±2.45 kg, -1.32±1.16 kg, P＜0.01, respectively). MHR (-6.17±9.65 bpm, P＜0.01) and LF/ HF (-0.61±1.56, P＜0.05) showed significant reduction. Changes of weight and LF were positively correlated (r=0.338, P＜0.01). Changes of waist circumference was correlated with changes of SDNN (r= 0.331, P＜0.05). Changes of BMI showed positive correlation with changes in TP (r=0.327, P＜0.05) and LF (r=0.345, P＜0.05).

Conclusion : Short term intervention for obese people decreased sympathetic nervous activity.

Background
: A considerable portion of patients in primary care are thought to have mental disorders in Korea. But they are not easily noticed and are thus underdiagnosed and approached improperly. This study was done to assess the prevalence of common mental disorders in a hospital-based family practice and to evaluate the utility of a diagnostic tool, the Patient Health Questionnaire (PHQ).

Methods : Ten or more patients each day were systematically selected in family practice clinics for two weeks in a university and a community hospital-based family practice clinics in Seoul, Korea. Routine care was delivered as a control during the first week and the PHQ was administered to patients during the second week and the physicians were allowed to review the PHQ just before making clinical decisions. Physicians were asked to answer whether they recognized patients' with mental disorders before reviewing the PHQ.

Results : The prevalence of mental disorders was higher in the test group than the control except for eating disorders and other anxiety disorders (P＜0.05)(test vs. control group): major depressive disorders 1.75% vs. 3.8%, other depressive disorders 6.8% vs. 11.4%, panic disorders 0.6% vs. 2.3, somatoform disorders 3% vs. 5%, alcohol abuse 2.2% vs. 8.7%, and any mental disorders 20.9% vs. 29.4%. In the test group, the percentage (95% confidence interval in parenthesis) of newly diagnosed mental disorders after physicians' review of the PHQ were 66% (49∼82) in major depressive disorders, 70% (50∼90) in panic disorders, 70% (56∼83) in somatoform disorders, 84% (75∼92) in alcohol abuse, and 68% (62∼74) in any mental disorders. Patients' response to the PHQ was overall very receptive.

Conclusion : One-week prevalence of common mental disorders in the hospital-based family practice was 29.4% and the PHQ tool was efficient to help the family physicians recognize hidden mental disorders.