Korean Journal of Family Medicine

"Kayoung Lee"

Original Articles

Relationship between Decreased Estimated Glomerular Filtration Rate and Sarcopenic Obesity among Postmenopausal Women: Korea National Health and Nutrition Examination Survey (2008–2011): Changbin Hong, Jae Yong Baek, Ji Won Lee, Ji Hoon Lee, Kayoung Lee, Tae-jin Park, Jinseung Kim; Korean J Fam Med 2020;41(5):332-338. Published online May 21, 2020; DOI: https://doi.org/10.4082/kjfm.19.0032

Abstract
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Background
Previous studies have shown that body composition is associated with chronic kidney disease (CKD), and perimenopause is associated with increased fat mass and decreased lean body mass. Muscle wasting is common among patients with CKD. Sarcopenic obesity (SO) refers to excess adiposity with decreased muscle mass. However, little is known about the relationship between SO and renal function decline. Here, we identified the relationship between SO and decreased estimated glomerular filtration rate (eGFR) in postmenopausal women.
Methods
We conducted a cross-sectional study based on the data from the Korea National Health and Nutrition Examination Survey (2008–2011). We analyzed 4,560 postmenopausal women who underwent dual energy X-ray absorptiometry. Sarcopenia was defined based on weight-adjusted appendicular skeletal muscle mass. Obesity was defined based on body mass index. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Subjects were classified into four groups: normal, obese, sarcopenic, and sarcopenic obese. Logistic regression analysis was performed to examine the association between SO and decreased eGFR. The results were adjusted for variable confounders.
Results
In the unadjusted model, the odds ratio (OR) of decreased eGFR for SO was 1.67 (95% confidence interval [CI], 1.23–2.26). The obese and sarcopenic groups had ORs of 0.67 (95% CI, 0.44–1.03) and 0.70 (95% CI, 0.44–1.10), respectively. After controlling for confounding variables, there was also a significant association between SO and decreased eGFR (adjusted OR, 1.48; 95% Cl, 1.05–2.07).
Conclusion
SO was independently associated with decreased eGFR in postmenopausal Korean women.

Citations

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Sarcopenic obesity in predialysis chronic kidney disease: Muscle strength is a predictor of mortlity and disease progression in a six-year prospective cohort
Dílmerson Oliveira, Viviane Angelina de Souza, Guilherme Cardenaz Souza, Lucas Fernandes Suassuna, Marcus Gomes Bastos, Maycon Moura Reboredo, Natália Maria da Silva Fernandes, Jeremy P Loenneke,
PLOS ONE.2025; 20(3): e0318773. CrossRef
Obesity paradox in older sarcopenic adults ― a delay in aging: A systematic review and meta-analysis
Szimonetta Eitmann, Peter Matrai, Peter Hegyi, Marta Balasko, Balint Eross, Kira Dorogi, Erika Petervari
Ageing Research Reviews.2024; 93: 102164. CrossRef
Association of skeletal muscle index with postoperative acute kidney injury in living donor hepatectomy: A retrospective single‐centre cohort study
Ji‐Hoon Sim, Hye‐Mee Kwon, In‐Gu Jun, Sung‐Hoon Kim, Kyoung‐Sun Kim, Young‐Jin Moon, Jun‐Gol Song, Gyu‐Sam Hwang, YouSun Ko, Kyung‐Won Kim
Liver International.2022; 42(2): 425. CrossRef
Dynapenic-abdominal obesity as an independent risk factor for chronic kidney disease in postmenopausal women: a population-based cohort study
Youngju Choi, Jinkyung Cho, Jiyeon Kim, Jun Hyun Bae, Eun-Jeong Cho, Eunwook Chang, Kyung-Lim Joa, Junghoon Kim, Dong-Ho Park, Ju-Hee Kang, Hyo-Bum Kwak
Menopause.2022; 29(9): 1040. CrossRef
Current status of health promotion in Korea
Soo Young Kim
Journal of the Korean Medical Association.2022; 65(12): 776. CrossRef
Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis
Qianqian Gao, Fan Mei, Yi Shang, Kaiyan Hu, Fei Chen, Li Zhao, Bin Ma
Clinical Nutrition.2021; 40(7): 4633. CrossRef

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The Relationship between Body Fat Percent and Bone Mineral Density in Korean Adolescents: The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1), 2010: Hee-Cheol Jeon, Kayoung Lee, Jinseung Kim, Tae-Jin Park, Dae-Won Kang, Da-Jung Park; Korean J Fam Med 2014;35(6):303-308. Published online November 21, 2014; DOI: https://doi.org/10.4082/kjfm.2014.35.6.303

Abstract
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Background

The relationships of total and regional body fat percent with bone mineral density (BMD) in Korean adolescents were examined using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1), 2010.

Methods

Body fat percent at whole body (WBFP), trunk (TBFP), and extremities (both upper and lower extremities fat mass/body weight, EBFP), ratio of trunk fat mass to extremities fat mass (TEFR), and BMD at whole body, total femur, and lumbar spine were measured by dual energy X-ray absorptiometry in a population-based sample of 433 boys and 362 girls, aged 12 to 18 years. The analyses were conducted using linear regression analysis with complex sampling design.

Results

After adjusting for confounders such as age, height, weight, serum 25-(OH) vitamin D concentration, energy intake, calcium intake, physical activity, and menarche status for girls, WBFP, TBFP, and EBFP were inversely associated with whole and regional BMD in both sexes (P < 0.05). TEFR was positively associated with whole and regional BMD in boys after adjusting for confounders, while it was negatively associated in girls (P < 0.05). However, the associations were non-significant when bone mass-free lean mass was adjusted instead of bodyweight except for a positive association between TEFR and BMD in boys.

Conclusion

In Korean adolescents, total and regional body fat percent is not independently associated with BMD after adjusting for bone mass-free lean mass but higher fat in trunk as compared to extremities may be protective for BMD in boys.

Citations

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Association between segmental body composition and bone mineral density in US adults: results from the NHANES (2011–2018)
Yanze Lin, Xun Wang, Ruiji Wu, Jinlei Zhou, Fabo Feng
BMC Endocrine Disorders.2023;[Epub] CrossRef
Novel Insight into the Relationship Between Muscle-Fat and Bone in Type 2 Diabetes Ranging from Normal Weight to Obesity
Hui Wang, Huaiming Peng, Linlin Zhang, Wei Gao, Jingya Ye
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 1473. CrossRef
Effect of obesity status on adolescent bone mineral density and saturation effect: A cross-sectional study
Gao-Xiang Wang, Ze-Bin Fang, Hui-Lin Li, De-Liang Liu, Shu-Fang Chu, Heng-Xia Zhao
Frontiers in Endocrinology.2022;[Epub] CrossRef
Non-linear association of body composition and its components with bone density in Iranian children and adolescents
Marjan Jeddi, Arash Ardalan, Seyed Taghi Heydari, Mohammad Hossein Dabbaghmanesh
Archives of Osteoporosis.2021;[Epub] CrossRef
Relationship Between Bone Mineral Density and Body Composition According to Obesity Status in Children
Young-Gyun Seo, YoonMyung Kim, Hyunjung Lim, Min Jae Kang, Kyung Hee Park
Endocrine Practice.2021; 27(10): 983. CrossRef
Association between Body Composition and Bone Mineral Density in Children and Adolescents: A Systematic Review and Meta-Analysis
Kai-Li Deng, Wan-Yu Yang, Jin-Li Hou, Hui Li, Hao Feng, Su-Mei Xiao
International Journal of Environmental Research and Public Health.2021; 18(22): 12126. CrossRef
Body composition and bone mineral density in childhood
Lisa B. Rokoff, Sheryl L. Rifas-Shiman, Karen M. Switkowski, Jessica G. Young, Clifford J. Rosen, Emily Oken, Abby F. Fleisch
Bone.2019; 121: 9. CrossRef
Detrimental Effects of Higher Body Mass Index and Smoking Habits on Menstrual Cycles in Korean Women
An Na Jung, Ju Hwan Park, Jihyun Kim, Seok Hyun Kim, Byung Chul Jee, Byung Heun Cha, Jae Woong Sull, Jin Hyun Jun
Journal of Women's Health.2017; 26(1): 83. CrossRef
Association between serum ferritin and hemoglobin levels and bone health in Korean adolescents
Dong-Wook Jung, Joo-Hyun Park, Do-Hoon Kim, Moonyoung Choi, Shinhye Kim, Hyonchong Kim, Da-eun Seul, Soo Gyeong Park, Jin-Hyung Jung, Kyungdo Han, Young-Gyu Park
Medicine.2017; 96(51): e9403. CrossRef
Association between Anthropometric Indices, Body Composition and Bone Parameters in Thai Female Adolescents
Rapheeporn Khwanchuea, Chuchard Punsawad
The Indian Journal of Pediatrics.2017; 84(12): 908. CrossRef
Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors
Anna Lee, Se Hwi Kim, Chung Mo Nam, Young-Jin Kim, Soo-Ho Joo, Kyoung-Ryul Lee
Laboratory Medicine Online.2016; 6(2): 70. CrossRef

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Association of Heart Rate Variability with the Framingham Risk Score in Healthy Adults: Cheol Seung Yoo, Kayoung Lee, Sang Hoon Yi, Jun-Su Kim, Hee-Cheol Kim; Korean J Fam Med 2011;32(6):334-340. Published online September 28, 2011; DOI: https://doi.org/10.4082/kjfm.2011.32.6.334

Abstract
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Background

The aim of this study was to investigate the relationship between heart rate variability (HRV), the Framingham risk score (FRS), and the 10-year risk of coronary heart disease (CHD) development among Korean adults.

Methods

The subjects were 85 healthy Korean adults recruited from a health check-up center. The FRS and 10-year risk of CHD development were calculated.

Results

The FRS in men was inversely correlated with the standard deviation of all normal to normal RR-intervals (SDNN); the root mean square successive difference (RMSSD); the percentage of successive normal cardiac inter-beat intervals greater than 20 ms, 30 ms, and 50 ms (pNN20, pNN30, pNN50); the low frequency (LF); and the high frequency (HF) (P < 0.05). There was no significant relationship between the FRS and HRV in women. Overall, in the receiver operating characteristic (ROC) analysis, the RMSSD, HF, SDNN, LF, LF/HF ratio, and pNN30 predicted an increased 10-year CHD risk. After adjusting for sex and body mass index, those with greater than one standard deviation in the RMSSD, HF, and LF had a 52-59% reduction in their 10-year risk of CHD development ≥ 10%.

Conclusion

This study therefore indicates that the HRV indices, particularly SDNN, RMSSD, pNN30, LF, and HF may be useful parameters for the assessment of CHD risk. Most notably, the usefulness of these HRV measures as indicators for CHD risk evaluation may be greater among men than among women.

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The Effect of Yoga Nidra Intervention on Blood Pressure and Heart Rate Variability Among Hypertensive Adults: A Single-arm Intervention Trial
Navdeep Ahuja, Monika Pathania, Latika Mohan, Sunita Mittal, Praag Bhardwaj, Minakshi Dhar
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The value of circadian heart rate variability for the estimation of obstructive sleep apnea severity in adult males
Baokun Zhang, Mengke Zhao, Xiao Zhang, Xiaoyu Zhang, Xiaomin Liu, Weiwei Huang, Shanshan Lu, Juanjuan Xu, Ying Liu, Wei Xu, Xiuhua Li, Jiyou Tang
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Neurophysiologie Clinique.2024; 54(6): 103009. CrossRef
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Máire B. Ford
Frontiers in Psychology.2023;[Epub] CrossRef
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Moon-Soo Lee, Yae Eun Seo, Young Eun Mok, So Hee Lee
Applied Psychophysiology and Biofeedback.2021; 46(1): 11. CrossRef
Changes in heart rate variability in first-episode drug-naïve adolescents with major depressive disorder: A 12-week prospective study
Sang-won Park, Jong-ha Lee, Jihyun Kim, Sangil Suh, Moon-Soo Lee
Journal of Affective Disorders.2018; 238: 250. CrossRef
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Nikhil Singh, Kegan James Moneghetti, Jeffrey Wilcox Christle, David Hadley, Victor Froelicher, Daniel Plews
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Plastics and cardiovascular health: phthalates may disrupt heart rate variability and cardiovascular reactivity
Rafael Jaimes, Adam Swiercz, Meredith Sherman, Narine Muselimyan, Paul J. Marvar, Nikki Gillum Posnack
American Journal of Physiology-Heart and Circulatory Physiology.2017; 313(5): H1044. CrossRef
Psychological and autonomic effects of art making in college-aged students
David A. Sandmire, Nancy E. Rankin, Sarah R. Gorham, Daniel T. Eggleston, Cecelia A. French, Emily E. Lodge, Gavin C. Kuns, David R. Grimm
Anxiety, Stress, & Coping.2016; 29(5): 561. CrossRef
Sex differences in healthy human heart rate variability: A meta-analysis
Julian Koenig, Julian F. Thayer
Neuroscience & Biobehavioral Reviews.2016; 64: 288. CrossRef
A community study of the effect of polycyclic aromatic hydrocarbon metabolites on heart rate variability based on the Framingham risk score
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Occupational and Environmental Medicine.2014; 71(5): 338. CrossRef
The relationship between mental and physical health: Insights from the study of heart rate variability
Andrew H. Kemp, Daniel S. Quintana
International Journal of Psychophysiology.2013; 89(3): 288. CrossRef

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Reliability and Validity of Korean Version of Questionnaire for Weight Bias Measurement.: Eun Mi Kim, Kayoung Lee, Kyu Man Hwang, Jun Su Kim, Tae Jin Park; Korean J Fam Med 2010;31(6):461-471. Published online June 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.6.461

Abstract
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Background
Korean versions of Fat Phobia Scale (short form) (F-scale), Beliefs About Obese Persons Scale (BAOP), and Attitudes Toward Obese Persons Scale (ATOP) which are scales of rating weight bias were assessed to find out the reliability and validity.Methods: Korean versions of F-scale, BAOP, and ATOP were completed twice by 165 adults (85 males, 80 females; 73 hospital staffs, and 92 teachers). Validity was tested using Spearman correlation and factor analysis. Reliability was analyzed using test-retest analyses (Spearman Rho value).Results: Using factor analyses, F-scale comprised of three factors explaining 55.20% of the total variance, BAOP two factors explaining 53.3% of the total variance, and ATOP six factors explaining 61.61% of the total variance. Spearman correlation between F-scale and ATOP was -0.28 to -0.36 (P < 0.05), suggesting that people who worried about being obese tended to have negative attitudes against obesity. The correlation between F-scale and BAOP was -0.25 to -0.27 (P < 0.05), meaning that people who worried about being obese had a tendency to blame obesity on environmental factors. Cronbach's alpha coefficients were 0.79 to 0.90 for F-scale, 0.34 to 0.38 for BAOP and 0.82 to 0.87 for ATOP. Spearman Rho values were 0.47 for F-scale, 0.50 for BAOP, and 0.47 for ATOP (P < 0.05). The scores of each scale were not related to subjects' sex, BMI, body perception, and weight control efforts, while for ATOP scores older subjects were more likely to have a negative view for obesity (P < 0.05).Conclusion: The Korean version of F-scale, ATOP and BAOP could be considered as a tool to evaluate weight-bias however, further study is needed for appropriate application.

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From flab to fab: A cross-sectional study for cultural adaptation and validation of the Fat Phobia Scale-Short Form in India
Kumari Rina, Rosali Bhoi, Anubhav Vindal, Pawanindra Lal
Journal of Minimal Access Surgery.2025;[Epub] CrossRef
Validity and Reliability of the Korean Version of the Weight Self-Stigma Questionnaire (WSSQ-K)
Seyoen Park, Kawoun Seo
Nursing Reports.2023; 13(2): 835. CrossRef
The Effects of Obesity Stress, Weight Bias, and Heath Care on BMI in Soldiers of Non-combat Area
Kyeng Jin Kim, Yeon Kyung Na
Korean Journal of Occupational Health Nursing.2016; 25(3): 199. CrossRef
Teachers' Influence on Weight Perceptions in Preschool Children
Jin Suk Ra, Hyun Jung Yun, Yoon Hee Cho
Applied Nursing Research.2016; 31: 111. CrossRef

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Factors Related to Eating Behavior Assessed Using the Dutch Eating Behavior Questionnaire and Change of Eating Behavior after Receiving Weight Reduction Treatment.: Sukyeong Lee, Kayoung Lee, Sang Yeoup Lee, Tae Jin Park, Jun Su Kim; Korean J Fam Med 2010;31(5):361-368. Published online May 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.5.361

Abstract
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Background
This study aimed to examine the factors related to eating behavior subscales and change of eating behavior subscales among obese patients received weight reduction management. Methods: Eating behavior subscales (restrained eating, emotional eating, and external eating) were assessed using the Korean version of Dutch Eating Behavior Questionnaire in 76 obese female patients at obesity clinic and 83 female visitors at health promotion center. Fifty nine patients received weight reduction management and completed followup survey after 2-3 months. Demographics, physical activity, health behaviors, diet experience, BMI, and weight change were assessed. Results: The score of restrained eating was significantly higher in obese patients compared to controls, while scores of other subscales were not different between the two groups. Diet experience, score of emotional eating, and BMI explained 15% of variance of restrained eating score after adjustment for covariates. Likewise, increase of restrained and external eating scores and younger age explained 27% of variance of emotional eating score. External eating score was associated with increase in emotional eating score, higher education, regular exercise, and frequent overeating (R2 = 30%). Among obese patients, the follow-up score of restrained eating was significantly higher compared to that score at baseline, while the scores of emotional and external eating were not significantly changed. After adjustment for covariates, only irregular eating habit was associated with the change of restrained eating score. Conclusion: Restrained eating score was associated with BMI regardless of subjects group, while, among obese patients, the change of restrained eating score was associated with frequent irregular eating habit.

Citations

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Relationship between convergence awareness for healthy weight management and eating behavior, creativity and convergence competency of adolescents
Yunhwa Kim, Youngmi Lee, Yeon-Kyung Lee
Journal of Nutrition and Health.2022; 55(3): 376. CrossRef
Body Image Perception and Eating Behaviors among Male Middle and High School Students according to Weight Status in Seoul
Bo-Mi Kim, Kyung-Hee Kim
Journal of the East Asian Society of Dietary Life.2018; 28(2): 123. CrossRef
Short-term Effects of a Lifestyle Intervention Program on Eating Behaviors, Physical Activity and Cardiovascular Risks in Korean Adults
Jiyeon Park, Hyekyeong Kim
Korean Journal of Health Education and Promotion.2014; 31(4): 37. CrossRef

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The Relationship between Relative BMI Change and Height Growth among Overweight Children.: Young Woo Son, Kayoung Lee, Young Bae Jeon; Korean J Fam Med 2009;30(9):688-694. Published online September 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.9.688

Abstract
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Background
Many parents of overweight children have believed that their children's weight may be lost with the increase of their height. The purpose of this 2-year prospective study was to examine whether such belief is valid. Methods: A total of 190 children (113 boys and 77 girls) aged 6-11 years who were overweight (BMI > 85th percentile of age and gender-specifi c 1999 Korean children standard) from two elementary schools were the subjects. Their height and weight were measured again after 2 years. Children and their parents completed questionnaires on eating habits and physical activity, and their attitude on weight in the beginning of study. Children's weight status was evaluated using relative BMI. Results: Children's baseline relative BMI was 134.9 ± 13.8%. About 60% of the children reported weight loss attempt and 49% of their parents tried to persuade their child to lose weight. Children's BMI increased by 1.6 ± 2.1 kg/m2 and their relative BMI decreased by 1.2 ± 12.1% over 2 years. While children's eating habits and physical activity, and their attitude on the child's weight were not related to the 2-year relative BMI change, the child's age, gender, baseline relative BMI, and the 2-year height change were associated with the 2-year relative BMI change (R2 = 0.15, P < 0.001). The 2-year relative BMI increased with the 2-year height increase after controlling for the three predictors (B = 0.86, SE = 0.28, P = 0.002). Conclusion: We found the 2-year height change positively associated with the 2-year relative BMI change among schoolaged overweight children. Then, the belief that children's weight status may be improved with the increase of their height should be denied.

Citations

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Vitamin D deficiency and Metabolic Syndrome among Korean Adolescents: Based on Korea National Health and Nutrition Examination Survey V (KNHANES)
Ha Na Yoo, Hyeon Suk Kim
Journal of the Korean Society of School Health.2016; 29(1): 22. CrossRef

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The Relationship between Body Mass Index and Mammographic Density in Korean Women.: Jin Sik Jung, Jun Su Kim, Young Mi Park, Kayoung Lee, Tae Jin Park; J Korean Acad Fam Med 2008;29(11):831-837. Published online November 10, 2008

Abstract
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Background: There have been very few studies on the relationship between obesity and dense breast as risk factors of breast cancer in Korean women. Therefore, we evaluated the relationship between BMI and mammographic density in Korean women. Methods: We recruited 332 women without prior history of breast cancer, breast surgery, radiotherapy, hormone replacement therapy, and family history of breast cancer who underwent screening for mammography and completed a self-administered questionnaire in one general hospital. On the basis of ACR BI-RADS breast composition, four density patterns were classified repeatedly by a radiologist. Results: The mean age, Body Mass Index (BMI), the proportion of postmenopausal women of the study population were 50.4 years, 23.2 kg/m², and 29.8%, respectively. The proportion of extremely dense breast women was 100% in the underweight group, 77.3% in the normal weight group, 41.4% in class 1 obesity group, and 25% in class 2 obesity group, decreased with increasing BMI. The odds Ratio of BMI to extremely dense breast was 0.82 (95% CI: 0.72∼0.93, P value=0.002) after adjustment for age, menache, menopause, and BI-RADS assessment category in logistic regression. Conclusion: Our findings showed that the BMI was negatively correlated with mammographic density as well in Korea. Therefore, primary physicians should consider sensitive additional method for breast cancer screening especially in underweight and normal weight Korean women. (J Korean Acad Fam Med 2008;29:831-837)

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Effects of a School-based Obesity Prevention Program in Adolescents.: Sang Joon Yun, Kayoung Lee; J Korean Acad Fam Med 2008;29(8):585-594. Published online August 10, 2008

Abstract
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Background
We aimed to evaluate the effect of school- based obesity prevention and management program applied to adolescents in a middle school on body mass index (BMI), weight-related attitude, eating behavior and physical activity of adolescents. Methods: A total of 664 adolescents (14.7±0.9 years old) in a middle school located in Busan were study subjects. The obesity prevention and management program was conducted for 6 months, from March to September, 2005. Their weight and height were measured and their weight-related attitude, eating habit and physical activity were assessed using a questionnaire at baseline and after 6 months. Their weight status was classified into under-, normal-, and overweight according to their BMI at baseline. Results: The prevalence of underweight and overweight was 6.2% and 19.3%, respectively. Among the adolescents with overweight, the BMI significantly decreased after 6 months compared to the BMI at baseline (P＜0.05), while the BMI was not significantly changed over 6 months among the under- and normal weight groups. The adolescents were more likely to become highly concerned about obesity-related problems (P=0.002) and actively participating in obesity prevention program (P=0.007) after 6 months compared to those attitude at baseline. The BMI significantly decreased in the adolescents whose eating behavior or physical activity were improved compared to their counterparts (P＜0.05). Conclusion: The 6-months program for obesity prevention and management seemed to reduce BMI in overweight adolescents and raise concern about obesity related problems and promote participation in obesity prevention program in adolescents as a whole. Further long-term intervention studies need to be implemented. (J Korean Acad Fam Med 2008;29:585-594)

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Body Mass Index Change during and after the Childhood Obesity Prevention Program.: Wook Je Cho, Kayoung Lee, Tae Jin Park; J Korean Acad Fam Med 2008;29(8):572-578. Published online August 10, 2008

Abstract
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Background
This study was designed to find out the effect of school based obesity prevention intervention by considering the changes of BMI during both at the time of intervention and post-intervention. Methods: The research was conducted at an elementary school located in Busan metropolitan city, where we measured the height and weight of 260 students at baseline, 6 months after the initiation, and 6 months after the intervention. The students were classified into three weight groups of normal, overweight and obesity according to the age and sex-specific BMI. Results: The BMI decreased or maintained in 60% of the boys and 65% of the girls after the initial six months of the intervention, while after six months from the end of the intervention, BMI increased in 91% of the boys and 83% of the girls. The children's BMI significantly decreased during the intervention (P＜0.01), whereas it significantly increased post intervention (P＜0.05). In the logistic regression model including age, sex, initial BMI, and the follow-up status after the intervention, the increase of BMI by 1 unit was associated with 11% lower odds (95% CI 0.83∼0.98) for BMI decrease and maintenance. Likewise, the increase of age by 1 year was associated with 24% lower odds (95% CI 0.59∼0.98) for BMI decrease and maintenance. However, there was no significant predictors for BMI decrease and maintenance after the intervention. Conclusion: As the positive effect of this intervention for children is not consistent, the research should be more focused in finding out the effective method for prevention of obesity among elementary school children, as a better solution in the longrun. (J Korean Acad Fam Med 2008;29:572-578)

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Regional Fat Measured by DEXA and Metabolic Risk Factors among Women with Central Obesity.: Jin Seung Kim, Kayoung Lee, Jun Su Kim, Tae Jin Park, Sangyeoup Lee, Young Joo Kim, Yun Jin Kim; J Korean Acad Fam Med 2008;29(7):506-512. Published online July 10, 2008

Abstract
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Background: This study was carried out to determine the usefulness of regional body fat measured by dual energy X-ray absorptiometry (DEXA) by examining the relationship between regional body fat and metabolic risk factors. Methods: A total of 98 women aged 18∼65 years with central obesity (waist circumference ≥80 cm) took the evaluation for metabolic risk factors (blood pressure, fasting glucose, insulin, high sensitive c-reactive protein (hs-CRP), lipid profile, homeostasis model assessment of insulin resistance (HOMA-IR)) and the anthropometric measurement, and regional body fat measurement using DEXA. The relationship of regional body fat with the metabolic risk factors, the metabolic syndrome (MS) defined by the International Diabetes Federation and insulin resistance (IR, defined by HOMA-IR≥2.48) were assessed. The analyses were conducted using regression and logistic regression analyses. Results: After adjustment for age and total body fat (%), legs fat (%) was significantly and negatively associated with LDL-C, triglyceride, HOMA-IR, and hs-CRP, while positively with HDL-C. The 1% increase of legs fat was associated with the MS by odds ratio of 0.82 (95% C.I 0.71∼0.96) and with the IR by odds ratio of 0.80 (95% C.I. 0.67∼0.95). Trunk fat (%) was significantly and positively associated with LDL-C, triglycerides, and HOMA-IR. The 1% increase of trunk fat was associated with the MS by odds ratio of 1.32 (95% C.I. 1.03∼1.71) and with the IR by odds ratio of 1.33 (95% C.I. 1.01∼1.77). The ratio of android fat to gynoid fat was significantly and positively associated with LDL-C, triglycerides, glucose, and HOMA- IR, while negatively with HDL-C. The 0.1 increase of the ratio was associated with the MS by odds ratio of 1.66 (95% C.I. 1.07∼2.60). Conclusion: The trunk fat, and legs fat, the ratio of android fat to gynoid fat assessed by DEXA seemed to be useful indicators to predict the metabolic risk factors in women with central obesity. (J Korean Acad Fam Med 2008;29:506-512)

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The Relationship between Change of Parental Weight and Change of Child's Weight over 2 Years.: Tae Ho Hwang, Kayoung Lee; J Korean Acad Fam Med 2008;29(5):336-341. Published online May 10, 2008

Abstract
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Background
The purpose of this study was to examine the association between the change of parental weight status and the change of their child's weight status over 2 years. Methods: A total of 379 children ages 11-13 years were measured their height and weight in 2001 and 2003. Their parents completed a questionnaire including self-reported parental weight and height during the same period. Parental weight status was classified as overweight (BMI≥25 kg/m²) and non-overweight (BMI＜25 kg/m²). Children's weight status was classified as overweight and non-overweight using the age and gender-specific BMI established by the Korean Academy of Pediatrics. The weight status over 2 years was categorized as a group of persistent overweight, persistent non-overweight, shifting overweight to non-overweight, and shifting non-overweight to overweight. Results: After adjusting for the child's gender and the father's weight status, the odds ratio for being persistently overweight over 2 years in a child having a mother with persistent overweight was 2.8 (95% CI: 0.9-8.5) compared to a child having a mother with persistent non-overweight. Likewise, the odds ratio for being persistently overweight over 2 years in a child having a father with persistent overweight was 2.9 (95% CI: 1.4-6.1) compared to the child having a father with persistent non-overweight. Conclusion: Parental weight status over 2 years was associated with the 2-year weight status in children. The parents- and family-based intervention are needed to prevent and manage childhood obesity. (J Korean Acad Fam Med 2008;29:336-341)

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Is a Telephone Reminder Effective in Improving Retention Rate of Obese Patients?.: Sungja Ha, Kayoung Lee, Tae Jean Park, Youngbae Jeon, Changjae Lee; J Korean Acad Fam Med 2007;28(3):204-209. Published online March 10, 2007

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Background
The purpose of this study was to evaluate the effectiveness of telephone call reminder on retention rate in obese patients. Methods: A total of 118 patients (85 first-time visitors, 33 re-visitors), who visited an obesity management clinic from May 2003 to May 2004, were divided into the intervention group (n=64) and the comparison group (n=54). The intervention was a telephone call reminder before the appointment date. The retention rate up to 7th visit and body mass index were compared between the two groups. Results: The retention rate was 64.4% at 4th visit (after 66.5⁑29.2 days from the first visit) and 36.4% at 7th visit (after 142.1⁑57.8 days from the first visit). For the first- time visitors, the retention rate at 3rd visit was significantly higher (85.1%) in the intervention group than those in the comparison group (67.6%, P=0.049). Otherwise, there were no significant differences in retention rate and body mass index at each visit between the two groups regardless of the visiting status. However, the body mass index at 4th and 7th visit was significantly lower in the intervention group than in the comparison group among the first-time visitors who completely attended 7 times (P=0.031). Conclusion: We could not find the telephone call reminder to be an effective method to improve retention rate in obesity management clinic. Further intensive approach is needed to promote attendance. (J Korean Acad Fam Med 2007;28:204-209)

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Weight-related Factors Associated with Active Attitude Toward Weight Loss in Overweight Children and Parents.: Ji Sun Park, Soo Kyoung Lee, Jung Won Park, Tae Jin Park, Kayoung Lee; J Korean Acad Fam Med 2007;28(3):179-186. Published online March 10, 2007

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Background
The purpose of this study was to find the weight-related factors related to active attitude towards weight loss in children who are overweight or obese and their parents. Methods: A total of 252 elementary school children who were overweight or obese and their parents were surveyed on weight-related attitudes for one month in May 2003 in Kimhae. The definition of overweight and obesity was based on age and sex-specific Korean children's BMI references established in 1998. Results: Among the total, 64.5% of children and 76.4% of parents thought frequently about losing weight in children. Among the total, 52.8% of children and 47.6% of parents tried losing weight in children more than three times. In children, the factors related to frequent thoughts of losing weight were gender, body mass index (BMI), body dissatisfaction index, and the score of eating attitude (P＜0.05). Parents' thought about their children's losing weight and the efforts to persuade their children to lose weight were related to children's frequent thought about losing weight. The children's factors related to trying to lose weight by themselves were age, BMI, and the score of eating attitude. The parent's factors related to children trying to lose weight were body dissatisfaction index of their children by parents, parent's eating attitude score, parent's thought about children's losing weight and making efforts to persuade children to lose weight by parents. The children's eating attitude was related to frequent thoughts about losing weight (odds ratio 1.05, 95% CI 1.03∼1.07) and trying to lose weight more than 3 times (odds ratio 1.02, 95% CI 1.003∼1.04) after adjusting for other factors. Likewise, parents' effort to persuade their childrento lose weight was related to children's effort to lose weight (odds ratio 2.62, 95% CI 1.34∼5.1). Conclusion: Active attitude towards losing weight in overweight or obese children was related to parent's attitude to wards losing weight. (J Korean Acad Fam Med 2007;28:179-186)

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Managing Outpatients with Dyslipidemia in a University Hospital.: Ha Jung Choi, Kayoung Lee, Bit Na Kim, Tae Jin Park, Jeong Nyeo Lee; J Korean Acad Fam Med 2005;26(7):384-390. Published online July 10, 2005

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Background
: We evaluated physician's management of hypercholesterolemia on the basis of the third Adult Treatment Panel (ATP III) report of the National Cholesterol Education Program.

Methods : The subjects were 85 adult patients. The inclusion criteria were as follows: outpatients with an initial total cholesterol level of ≥200 mg/dL or HDL-cholesterol ＜40 mg/dL from October to November in 2002, and those visiting the clinic at least three times for the 12 weeks after the baseline test. We reviewed the patients' cardiovascular risk factors (age, low and high HDL, hypertension, history of coronary heart disease (CHD), and diabetes) and the use of LDL-lowering drugs using hospital records. Smoking status and family history of premature CHD were obtained from 19 patients out of 36 patients without CHD or diabetes by telephone. On the whole, cardiovascular risk in 68 patients was identified. Among the total, 52 patients responded to telephone interview concerning education of therapeutic lifestyle change (TLC) provided by a physician.

Results : Forty nine (72.1%) of 68 patients were diagnosed as CHD or diabetes. Fifty three (77.9%) showed undesirable LDL that was categorized by the number of cardiovascular risk factors (≥160 mg/dL for patients with risk factor＜2; ≥130 mg/dL for patients with risk factors ≥2; ≥100 mg/dL for patients with CHD or diabetes). In 59.5% of patients with undesirable LDL reported that they did not provide education about TLC and in 40.0% of patients with desirable LDL were provided prescription of LDL-lowering drugs from physicians. Physicians were more likely to prescribe if the patients had more risk factors (P=0.001) and educated patients when they prescribed them (P=0.049). However, physicians did not educate on TLC and did not recheck lipid profile prior to first prescription.

Conclusion : The physicians did not follow the ATP III guideline for management of hypercholesterolemia. Barriers to comply with these guidelines and ways to eliminate barriers should be found.

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The Factors Associated with Becoming Obese Children: in 6th Grade Children of Elementary Schools in Busan.: Kyoung Won Park, Kayoung Lee, Tae Jean Park, Eun Ryoung Kwon, Sung Ja Ha, Hye Jeong Moon, Jin Kyoung Kim; J Korean Acad Fam Med 2003;24(8):739-745. Published online August 10, 2003

Abstract
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Background
: The purpose of this study was to find the factors associated with becoming obese children during the past 2 years in 6th grade children of elementary school and then to evaluate the high risk groups for childhood obesity.

Methods : The 738 children from May to June, 2001 in 6th grade of 5 elementary schools in Busan were the subjects of this study. The children's height and weight in 4th grade and 6th grade were obtained from school health records. We calculated the body mass index in 4th and 6th grades and classified into 3 weight groups (normal, at risk for obesity, and obese) according to the age and sex-specific BMI established by the Korean Academy of Pediatrics. If children's weight group in 4th grade was changed to heavier weight group in 6th grade, we defined it as increased group. Otherwise, we defined it as non-increased group. The association between the increase in weight group and parental and children's characteristics were analyzed by χ²-test, χ²-test for the trend, t-test, ANOVA and multiple logistic regression.

Results : Among the total, 3.3% of children with normal weight and 16.9% of children at the risk for obesity in 4th grade were transformed to increased group in 6th grade, respectively (P＜0.001). Children who had excessive appetite (P＜0.001), watched TV greater than or equal to 2 hours per day (P=0.004) or had an obese father (P=0.044) were more likely to become increased group. After adjusting for father's obesity, appetite and TV watching time in children, the odds ratio of transforming to increased group after 2 years in children at risk for obesity or in obese child in 4th grade was 2.5 (95% CI: 1.09∼5.55) compared to children with normal weight. Children having excessive appetite were 3.2 times (95% CI: 1.42∼7.01) more likely to become the increased group after adjusting for father's obesity, TV watching time and weight in 4th grade. Children watching TV greater than or equal to 2 hours/day was 2.8 times (95% CI: 1.27∼6.18) more likely to become increased group after adjusting for father's obesity, appetite and weight in 4th grade.

Conclusion : The risk of becoming obese was higher in children at risk for obesity or obese children in those with excessive appetite or those who have watched TV ≥2 hours/day for the past two years. These findings suggest promotion of educational plan to prevent childhood obesity.