Background
Recently, the diagnosis of non-alcoholic fatty liver disease (NAFLD) has been made more frequently, as the use of ultrasonography on health screening has been on the rise. The aim of this study was to elucidate the relationship between NAFLD and the metabolic syndrome defined by NCEP-ATP III criteria. Methods: A total of 1,675 subjects, who attended for routine physical check‐ups, were screened. Among those, 401 subjects were selected after excluding the subjects with either significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, or overt thyroid disease. NAFLD was diagnosed if the subjects had a "bright liver" on ultrasonographic examination. The diagnosis of metabolic syndrome was made according to the criteria of NCEP-ATP III established in 2001. Results: The prevalence of NAFLD was 27.2%. Blood pressure, body weight, body mass index, waist circumference, and serum levels of total cholesterol, triglyceride, fasting glucose and liver enzymes were higher among the subjects with NAFLD than the control. The prevalence of obesity, IFG/DM, dyslipidemia and hypertension was higher in the NAFLD group. The prevalence of the metabolic syndrome was 19.2%, which was higher in the NAFLD group than the control group. The odds ratio of NAFLD for the metabolic syndrome was 6.458 (95% C.I. 3.178∼13.124). Conclusion: NAFLD was closely associated with the metabolic syndrome regardless of the presence of obesity. (J Korean Acad Fam Med 2007;28:667-674)

Background
The metabolic risks associated with obesity are closely correlated with a central rather than a peripheral fat pattern. These complications of obesity have been attributed to increase in visceral adipose tissue. The aim of this study was to investigate whether the dual- energy X-ray absorptiometry (DEXA) method offers a good alternative to computed tomography (CT) for the prediction of visceral fat in the obese women in correlation of metabolic complication markers. Methods: The design is a cross-sectional analysis. Total body fat and truncal fat amounts were measured by using DEXA, while total abdominal fat area was measured by CT, and divided into visceral abdominal fat area and subcutaneous fat area. Partial correlation after controlling for age and multiple regression analyses after adjusting for age and total percent body fat were performed to relate the metabolic variables to the CT and DEXA body composition variables. Results: For serum uric acid, total abdominal fat area by CT had the largest R² values (R²=0.259). For AST, ALT, total cholesterol and log triglyceride, visceral fat area had the largest R² values (R²= 0.360, 0.407, 0.147, and 0.339), respectively, and for log insulin, truncal fat by DEXA had the largest R² values (R²=0.275). Conclusion: Truncal fat amount measured by DEXA had a strong correlation with visceral fat area measured by CT. Truncal fat amount measured by DEXA and correlated significantly with visceral abdominal fat area measured by CT reflected most of the metabolic complication markers. (J Korean Acad Fam Med 2007; 28:675-681)

Background
Accurate prediction of survival in terminal cancer patients is important for planning effective palliative care. But, the prediction of survival most often relies on the physicians' prediction. Recently, simple prognostic scores such as Palliative Prognostic Index and Palliative Prognostic Score have been developed to estimate duration of survival. The aim of this study was to validate these prognostic scores and physicians' prediction for terminally ill cancer patients in Korea to determine its value in clinical practice. Methods: The subjects of this study were 40 terminal cancer inpatients of one hospital who died between March to May 2005. All patients' Palliative Prognostic Index, Palliative Prognostic Score, and physicians' prediction were recorded on admission by a physician. Results: When a Palliative Prognostic Index of more than 6 was adopted as a cut-off point 3 weeks' survival was predicted with a sensitivity of 90% and a specificity of 60%. When the three groups were grouped by Palliative Prognostic Scores (group A: ≤5.5, group B: 5.6∼11, group C: ＞11), the 30 day survival probability were 60% for group A, 16.7% for group B, and 4.3% for group C, respectively. Physicians' prediction showed moderate correlation (correlation coefficient=0.604) with actual survival and had a tendency to overestimate survival. Conclusion: Palliative Prognostic Index was proved to be a reliable survival prediction tool in Korea. Palliative Prognostic Score had a tendency to overestimate survival as compared with other studies. Physicians' prediction had a correlation with actual survival, and it was presumed to be more accurate when combined with other prognostic score. (J Korean Acad Fam Med 2007;28: 682-689)

Background
Left ventricular hypertrophy (LVH) is closely related with a high death rate, rhythmia, ischemic heart disease, stroke and sudden death. It is known that the prognosis becomes better as LVH regresses. Therefore, it is important to diagnose it correctly with ease in primary care. The authors evaluated the most standard cardio-thoracic ratio (CTR) with respect to LVH oriented towards elderly people whose body habitus changed over time as they had become older, and evaluated the factors which affect the rate of diagnosis including sensitivity and specificity. Methods: A total of 231 subjects over 60 years of age who visited a general hospital health promotion center from March 1997 to August 2003, underwent echocardiography and identified not to have heart disease were selected. LV (left vetricular) mass was measured through echocardiography. LV mass was divided by 2.7 times of height (m) by Deveruex's method, and 49.1 g/m^2.7 for men and 46.7 g/m^2.7 for women were set to be standards of LVH. CTR was obtained by dividing the maximum transverse diameter of the heart by maximum transverse diameter of thorax on chest PA. Results: CTR was observed on the basis of 0.45, 0.5, 0.55, and the agreement was highest of 0.5 for men and 0.45 for women. However, considering the sensitivity, the specificity, and the positive predictive value, it was thought to be most proper to be set at 0.5 was be standard for both men and women. When diagnosing LVH through chest PA, if 0.5 was set to be standard, false positive become high in women, false negative became high as height increased, and false negative became high as body mass index (BMI) increased. The smoking group showed higher false negative compared to the non- smoking group, and the false negative was higher as the level of hemoglobin increased. Conclusion: When diagnosing LVH through CTR in elderly people, it was appropriate to set 0.5 as a standard, but it is necessary to consider sex, body habitus, BMI, smoking and the level of hemoglobin. (J Korean Acad Fam Med 2007;28:690-697)

Background
Smoking is one of the known major risk factors of coronary artery disease and previous studies have shown that the risk of mortality declines after cessation of smoking. The goal of this study was to determine the influence of smoking on mortality after percutaneous coronary intervention, which has still not been established in Korea. Methods: Patients who had undergone successful percutaneous coronary intervention at Asan Medical Center between January 1996 and June 1997 were classified into nonsmokers (n=306), ex-smokers (n=178), and current smokers (n=360). According to subsequent smoking status, current smokers were divided into quitters (n=152), persistent smokers (n=173), and unknown status (n=35). The data of the death Roll was from the National Statistical Office. Results: The maximum follow-up was 119 months (mean±SD=100±26.5). The total smoking rate was 42.7%. The mortality rates of nonsmokers, ex-smokers and current smokers were 17.6%, 20.8%, and 17.2%, respectively. In analyses adjusted for base line characteristics, the relative risk of death among current smokers was 1.57 (95% confidence interval [CI], 0.98 to 2.53) and among ex-smokers was 1.37 (95% CI, 0.80 to 2.35) compared with nonsmokers. The persistent smokers had a greater relative risk of death from all causes (relative risk, 2.20 [95% CI, 1.08 to 4.48]) as compared with the quitters. Conclusion: The persistent smokers were at greater risk for death than the quitters. Therefore, patients undergoing percutaneous intervention should be encouraged to stop smoking. (J Korean Acad Fam Med 2007;28: 698-704)

Background
Recently, in our ageing society, the change in dietary pattern and increase in obesity have caused the metabolic syndrome to increase in Korea. Because of the association of the risk of cardiovascular diseases, the metabolic syndrome must be prevented and well managed. We examined the association between the metabolic syndrome and the serum testosterone and DHEA-S concentration. Methods: The subject of this study included 231 men aged more than 40 years old who visited the health promotion center of a university hospital from March 2004 to March 2006. We excluded the subjects who were currently on medications except for antihypertensive and hypoglycemic agents. We defined the metabolic syndrome according to the ATP III with Asia-Pacific waist circumference. To examine the association between the metabolic syndrome and the serum testosterone concentration, we used the method of multiple logistic regression analysis. Results: The prevalence of the metabolic syndrome in our subjects was 32.9%. Decreased serum testosterone concentration was significantly associated with large waist circumference and high fasting blood sugar. Men with testosterone values in the upper tertile had a significantly lower risk of metabolic syndrome (OR=0.34, P=0.018). Conclusion: After statistical adjustment for age, smoking, income, exercise, alcohol intake, and body mass index, the serum testosterone concentration was negatively associated with the metabolic syndrome. (J Korean Acad Fam Med 2007;28:705-711)