Background
This study was designed to elucidate which factors affected left ventricular hypertrophy (LVH) on ECG in middle-aged normotensive healthy men. Methods: A total of 436 normotensive office workers who visited the health examination center of St. Mary's Hospital of Catholic University in Korea from August 1 to October 30, 2002, were divided into two groups; 138 with LVH on ECG were grouped as LVH and 298 who showed no LVH on ECG were grouped as non-LVH. Questionnaires on history of smoking, drinking and exercise were filled out, and body fat, body mass index, blood pressure and biochemical markers were measured. Related factors with LVH on ECG were statistically analyzed with Chi-square test, t-test and logistic regression. Results: The mean systolic and diastolic blood pressure and mean alcohol intake (g/day) were significantly elevated in the LVH group (P＜0.005). The non-LVH group had a tendency to show increased pulse rate (P=0.058), a higher percentage of people who did not exercise at all, and a lower percentage of people who exercised regularly (P=0.056). The smoking history, BMI and other biochemical markers showed no significant differences (P＞0.1). On logistic regression analysis, there was a significant increase in odds ratio for LVH with increase in diastolic blood pressure (adjusted OR 1.048, 95% CI 1.019∼1.077), with exercise more than 3 times a week (adjusted OR 2.317, 95% CI 1.258∼4.269) and with increased alcohol intake (adjusted OR 1.010, 95% CI 1.001∼1.019). In contrast, odds ratio for LVH decreased as the pulse rate per minute increased (adjusted OR 0.974, 95% CI 0.952∼0.997). In detailed analysis comparing those who exercised regularly more than 3 times a week with those who exercised less than 3 times a week, the increase in diastolic blood pressure was a significant factor which increased the odds ratio for LVH in both groups. A significant increase in the odds ratio by mean alcohol intake per day was shown only in a group who exercised less than 3 times a week. Conclusion: As a result of this study, in normotensive middle-aged men with LVH on ECG, patients should be monitored for regular exercise and increase in diastolic blood pressure should be regarded as a risk factor for LVH on ECG irrespective of exercise. In those who do not do exercise regularly, diastolic blood pressure as well as alcohol intake should be evaluated as risk factors for LVH. (J Korean Acad Fam Med 2007;28:92-99)

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
Diabetes mellitus is one of the most common chronic diseases which primary care family physician encounters. This study was performed to describe the medical care for patients with diabetes based on the Cheonan Practice-Based Research Network. Methods: From May 2005 to July 2005, 193 patients with diabetes were assessed among the patients visiting seven family medicine clinics in Cheonan. The data were collected through a questionnaire about patient's socioeconomic characteristics, the details of medical care including screening practices of diabetic complications, self-monitoring of blood glucose and exercise. Results: Among the patients with diabetes, 25.4% reported no exercise and another 29.6% reported regular exercise of more than 4 times a week. The less educated and the more elderly patients reported less exercise. Only 37.3% of patients monitored their blood glucose at home. The more educated, the more likely the patients monitored their blood glucose. Only 18.1% of patients reported having an annual 24-hour urine protein examination. The more educated and the more income they had, the more annual 24-hour urine protein examination was done. Only 32.6% of patients reported having an annual ophthalmologic examination, but there was no associated factors with having an annual ophthalmologic examination. Conclusion: These data indicate that the medical care for diabetic patients, including exercise, self-monitoring of blood glucose, screening of complications, may not be optimal for preventing diabetes complications, and was influenced by demographic characteristics such as age and education level. It is necessary for health care team to provide systematic education for diabetes and ongoing close monitoring of self care practices. (J Korean Acad Fam Med 2007;28:106-113)

Background
Depression is the most frequently encountered mental disorder in primary care. In it is necessary to order to, have a screening tool has high sensitivity and specificity and consumes less time. Therefore, the aim of this study was to assess the validity of the Korean version of Patient Health Questionnaire-9 (PHQ-9). Methods: A convenience sample of 160 ambulatory patients in a family practice clinic at Inha university hospital and the health care center at Bakae hospital received the Korean version of PHQ-9. Then the subjects were interviewed by a resident of family medicine according to DSM- IV criteria. The sensitivity, the specificity, the likelihood ratio, the ROC curve, the validity and the reliability of the Korean version of PHQ-9, and the consumptive time were examined. Results: There were 22 pationts in the depression group and 138 in the non-depression group. The Cronbach's α was 0.852. The sensitivity and the specificity were 81.8% and 89.9%, respectively, and the positive likelihood ratio was 8.10. The area under curve had an excellent value, 0.944 (P＜0.05). The consumptive time was 2.66⁑1.13 minutes. Conclusion: The Korean version of PHQ-9 hay a good reliability and validity, less consumptive time, and easy calculating score. Therefore, the Korean version of PHQ-9 seems to be a useful measure for detecting depression in primary care. (J Korean Acad Fam Med 2007;28:114-119)

Background
Moderate drinking has been known to be associated with a risk of reduced cardiovascular disease morbidity and mortality. The metabolic syndrome has been associated with a risk of increased cardiovascular diseases. Because drinking is considered as a risk factor of the metabolic syndrome, this study was performed to examine the association between alcohol drinking and the metabolic syndrome in Korean women. Methods: The subjects were 262 women who visited the health promotion center of Chungnam National University Hospital for general health check-up. The metabolic syndrome was diagnosed according to the definition by the National Cholesterol Education Program Adult Treatment Panel III. The abdominal obesity guidelines for waist circumference applied the WHO Asian Pacific Guideline. The subjects were classified into nondrinking, moderate drinking (≤1 drink), and heavy drinking (＞1 drink) according to their drinking amount per day. The relationship between the components of the metabolic syndrome and drinking state were investigated. The prevalence of the metabolic syndrome was compared according to the drinking state. Results: The women with moderate drinking showed significantly lower levels of triglyceride than nondrinkers (P＜0.05). The women with drinking showed significantly higher levels of HDL cholesterol than nondrinkers (moderate drinkers P＜0.05, heavy drinkers P＜0.05). Considering nondrinkers as standard, the risk of the metabolic syndrome was significantly low in women with moderate drinking (odds ratio=0.43, 95% confidence interval: 0.22∼0.84, P=0.013). Conclusion: The results of the present study suggest that moderate drinking is related to a lower rate of the metabolic syndrome in Korean women. (J Korean Acad Fam Med 2007;28:120-126)

Background
Insulin-like growth factor-1 (IGF-1) has been suggested to be involved in the pathogenesis of atherosclerosis. The biological activity of IGF-1 is influenced by IGF binding protein-3 (IGFBP-3). We hypothesized that IGF-1 and IGFBP-3 levels may be associated with the metabolic syndrome which is a cluster of cardiovascular risk factors. Methods: We assessed the circulating levels of IGF-1 and IGFBP-3 in 12,415 individuals (men 6,626, women 5,789), aged 18∼81 years, who visited a hospital for regular health examination. The metabolic syndrome was defined according to the definition of the National Cholesterol Education Program Adult Panel III (NCEP-ATP III). Results: The IGF-1 concentrations were positively correlated with the waist circumference and systolic blood pressure. The IGFBP-3 concentrations were positively correlated with the waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood sugar, and triglyceride, and negatively correlated with HDL cholesterol. The subjects in the lowest IGF-1 quartile had a significantly higher adjusted odds ratio (OR) of the metabolic syndrome compared with the highest IGF-1 quartile group (adjusted for age, smoking, alcohol intake, and physical activity). Conversely, the subjects in the highest IGFBP-3 quartile group had a significantly higher adjusted OR of the metabolic syndrome compared with the lowest IGFBP-3 quartile group. Conclusion: The subjects with low IGF-1 level or high IGFBP-3 level showed increased prevalence of the metabolic syndrome. The metabolic syndrome is recognized as a cluster of cardiovascular risk factors. Therefore, the results of this study suggest that low IGF-1 or high IGFBP-3 can be considered to increase the risk of cardiovascular diseases. (J Korean Acad Fam Med 2007;28:124-133)

Background
With increased prevalence of colorectal cancer, it is important to establish the risk factors of colorectal cancer. The prevalence of the metabolic syndrome (MS) is also increasing. Insulin resistance may play an important role in the pathogenesis of MS and colorectal polyps. The aim of this study was to assess the relationship between MS and colorectal polyps. Methods: A total 558 subjects underwent colonoscopic examination from April 2004 to July 2005 at the health promotion center of Bundang CHA Hospital. According to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III definition of MS, the waist circumference, blood pressure (BP), fasting blood glucose (FBG), triglyceride (TG) and HDL cholesterol were measured. Alcohol consumption, smoking and other confounding factors were assessed by a self-administered questionnaire. Results: The incidence of MS and colorectal polyps was 16.3% and 33.0%, respectively. In subjects with polyps, the number of men, smokers and drinkers were higher than in subjects without polyps. In subjects with polyps, BP, FBG and TG were also higher than in subjects without polyps. After adjustment for possible confounding factors, MS was associated with increased risk of colorectal polyps (odds ratio, 1.74; 95% confidence interval, 0.94∼3.22). MS strongly increased the risk of colorectal polyps in men (odds ratio 2.19; 95% confidence interval, 1.07∼4.45), but not in women. Conclusion: We concluded that MS is a risk factor for colorectal polyps in asymptomatic Korean adults and this suggests that insulin resistance may play an important role in the development of colorectal polyps. (J Korean Acad Fam Med 2007;28:134-140)