Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지

Abdominal Obesity in Relation to the Incidence of Type 2 Diabetes Mellitus and Impaired Fasting Glucose among some Korean Adults: A Retrospective Cohort Study

복부비만이 제2형 당뇨병 및 공복혈당장애 발생에 미치는 영향: 후향적 코호트 연구

  • Ryu, Seung-Ho (Department of Occupational Medicine, Health Screenig Center, Kangbuk Samsung Hospital & Sungkyunkwan University, School of Medicine) ;
  • Beck, Sung-Ho (Department of Family medicine and health promotion, Seoul Paik Hospital, Inje University) ;
  • Kim, Dong-Il (Department of Occupational Medicine, Kangbuk Samsung Hospital & Sungkyunkwan University, School of Medicine) ;
  • Suh, Byung-Seong (Department of Occupational Medicine, Kangbuk Samsung Hospital & Sungkyunkwan University, School of Medicine) ;
  • Kim, Woon-Sool (Department of Occupational Medicine, Health Screenig Center, Kangbuk Samsung Hospital & Sungkyunkwan University, School of Medicine) ;
  • Sung, Ki-Chul (Department of Internal Medicine, Kangbuk Samsung Hospital & Sungkyunkwan University, School of Medicine) ;
  • Chang, Yoo-Soo (Health Screenig Center, Kangbuk Samsung Hospital & Sungkyunkwan University, School of Medicine)
  • 류승호 (성균관의대 강북삼성병원 산업의학과, 종합건진센터) ;
  • 백승호 (인제의대 서울백병원 가정의학교실) ;
  • 김동일 (성균관의대 강북삼성병원 산업의학과) ;
  • 서병성 (성균관의대 강북삼성병원 산업의학과) ;
  • 김원술 (성균관의대 강북삼성병원 산업의학과, 종합건진센터) ;
  • 성기철 (성균관의대 강북삼성병원 순환기내과) ;
  • 장유수 (성균관의대 강북삼성병원 종합건진센터)
  • Published : 2004.12.01
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Abstract

Objectives : This study was performed to determine whether an increase in abdominal obesity is an independent risk factor for impaired fasting glucose and type 2 DM. Methods : Among 24,212 adults over 30 years who undertook comprehensive medical screening examinations from Jan to Dec 1999, in a university hospital in Seoul, a total of 11,183 subjects were selected who had no DM at baseline and who were followed up more than once by Dec 2002. The average follow up period was 2.4 (${\pm}0.5$) years. DM was defined as having a fasting glucose level $\geq$ 126mg/dl, and impaired fasting glucose as showing a fasting glucose level between 110 and 125 mg/dl. Body weight, height and waist circumference (WC) were simultaneously measured with blood sampling. The relative risks (RRs) for DM and impaired fasting glucose by WC were calculated using Cox proportional hazard model. Ageadjusted rates were estimated by direct standardization using a reference population of 2000 from 30 to 80 years. Results : The average age of the subjects was 41.7 (${\pm}7.0$) years; males 41.2 (${\pm}6.5$) and females 45.6 (${\pm}9.2$). RRs for type 2 DM by WC with the reference group of WC < 80cm were as follows: 2.66 (95%, CI $0.55{\sim}12.8$) for WC of $80{\sim}89cm$ in men, 5.92 (95%, CI $1.08{\sim}32.3$) for WC $\geq$ 90 cm in men, and 2.64 (95%, CI $0.23{\sim}29.8$) for WC of $80{\sim}89cm$ in females. RRs for impaired fasting glucose by WC were 3.03 (95%, CI $2.18{\sim}4.22$) for WC $80{\sim}89cm$ in men, 6.10 (95%, CI $4.25{\sim}8.75$) for WC $\geq$ 90cm in men, and 1.56 (95%, CI $0.43{\sim}5.67$) for WC $80{\sim}89cm$ in women, and 8.08 (95%, CI $2.22{\sim}29.4$) for WC $\geq$ 90cm in females. These results remained significant after adjustment for age, BMI and fasting glucose concentrations at baseline in both sexes. Annual increment of more than 1 cm in WC was associated with the development of DM and impaired fasting glucose independently of age, sex, BMI, or presence of abdominal obesity. Conclusion : In Korean adults, abdominal obesity increased the risk for the development of type 2 diabetes and impaired fasting glucose. This result supports many other prospective studies suggesting abdominal obesity as a risk factor for type 2 diabetes.

Keywords

References

  1. Popkin BM, Drewnoski A. Dietary fats and the nutrition: new trends in the glolbal diet. Nutr Rev 1997; 5: 31-43 https://doi.org/10.1111/j.1753-4887.1947.tb07524.x
  2. 대한 일차의료학회 비만연구회. 대한 일차의료의를 위한 비만학 이론과 실제. 한국 의학; 1996,(35~54쪽)
  3. Rissanen A, Heliovaara M, Knekt P, Reunanen A, Aromaa A, Maatela J. Risk of disability and mortality due to overweight in a Finnish population. BMJ 1990; 301(6756): 835-837 https://doi.org/10.1136/bmj.301.6756.835
  4. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias, Lancet 1990; 335(8692): 765-774
  5. 대한비만학회. 임상비만학. 고려의학. 1995,(254-258쪽)
  6. Wei M, Gaskill SP, Haffner SM, Stem MP. Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans--a 7-year prrupective study, Obes Res 1997; 5(1):16-23
  7. Dowse GK, Zimmet PZ, Gareeboo H, George K, Alberti MM, Tuomilehto J, Finch CF, Chitson P, Tulsidas H. Abdominal obesity and physical inactivity as risk factors for NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Diabetes Care 1991; 14(4): 271-282 https://doi.org/10.2337/diacare.14.4.271
  8. Cassano PA, Rosner B, Vokonas PS, Weiss ST. Obesity and body fat distribution in relation to the incidence of non-insulin-dependent diabetes mellitus. A prospective coholt study of men in the normative aging study. Am J Epidemiol 1992; 136(12): 1474-1486 https://doi.org/10.1093/oxfordjournals.aje.a116468
  9. Carey VJ, Walters EE, Colditz GA, Solomom CG, Willett WC, Rosner BA, Speizer FE, Manson JE. Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study. Am J EpidemioI 1997;145(7): 614-619 https://doi.org/10.1093/oxfordjournals.aje.a009158
  10. Warram JH, Martin BC, Krolwski AS, Soeldner JS, Kahn CR, Warram JH, Martin BC，Krolewski AS, Soeldner JS, Kahn CR. Ann Intern Med 1990; 113(12): 909-915
  11. Saad MF, Knowler WC, Petti DJ, Nelson RG, Charles MA, Bennett PH. A two-step model for development of non-insulin-dependent diabetes, Am J Med 1991; 90(2): 229-235 https://doi.org/10.1016/0002-9343(91)80165-I
  12. Martin BC, Warram JH, Krolewski AS, Bergrrnn RN, Soeldner JS, Kahn CR, Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study. Lancet 1992; 340 (8825): 925-929 https://doi.org/10.1016/0140-6736(92)92814-V
  13. Song TH, Choi BR, Tak SM, Kang JW, Kim CE，Moon HC, Woo JT, Kim EJ. Retrospective study of body weight in Korean diabetic patients. J Korean Diabetes Assoc 1990; 14: 229-233(Korean)
  14. Cho JK, Kim HM, Lim SK, Hong Y, Lee HC, Huh KB, A study of body weight change in non-insulin dependent diabetic patients. J Korean Dabetes Assoc 1986; 10: 89-93(Korean)
  15. Lee KW, Son HY, Kang SK, Bang BK, Park DH, Min BS, Epidemiological study of diseases related to diabetes in18201 Koreans. J Korean Diabetes Assoc 1984; 8:5-14(Korean)
  16. Huh KB, Kim HM, Lim SK, Lee EJ, Kim DY, Kim KR, Lee HC, Kim DH.. A typical diabetes in Koreans. Kor J Int Med 1987; 33(6): 762-770 (Korean)
  17. Park SW, Yun YS, Song YD, Lee HC, Huh KB. Pathogenetic heterogeneity of type 2 diabetes mellitus inKorea. J Korean Diabetes Assoc. 1999; 23(1):62-69(Korean)
  18. Kim HK, Park KS, Shin CS, Kim SY, Cho BY, Lee HK, Koh CS, Oh TG. Measurement of insulin sensitivity in patients with non-insulin-depeentdent diabetes mellitus. J Korean Diabetes Assoc 1995(19): 374-383 J Korean Diabetes Assoc 1998; 22: 192-198 (Korean)
  19. Kim YI, Choi CS, Kim SW, Kim HK, Kim CH, Park JY, Hong SK, Lee KU. Changes in serum true insulin and C-peptide levels during oral glucose tolerance test in Koreans with glucose intolerance, J Korean Diabetes Assoc 1998; 22: 192-198 (Korean)
  20. Shin CS, Lee HK, Koh CS, Kim YI, Shin YS, Yoo KY, Paik HY, Park YS, Yang BG, Risk factors for the development of NIDDM in Yonchon County, Korea. Diabetes Care 1997 Dec;20(12): 1842-1846
  21. Ramachandran A, Snehalatha C, Viswanathan V, Viswanathan M, Haffner SM. Risk of noninsulin dependent diabetes mellitus conferred by obesity and central adiposity in different ethnic groups: a comparative analysis between Asian Indians, Mexican Americans and Whites. Diabetes Res Clin Pract 1997; 36(2): 121-125 https://doi.org/10.1016/S0168-8227(97)00040-5
  22. World Health Organization. Measuring obesity classification and description of anihrometric data Copenhagen: WHO, 1989
  23. Expert committee on the diagnosis and classification of diabetes mellitus: Report of the expert committee on the diagnosis and classification of diabetes mellitus, Diabetes Care 1997; 20: 1183-1197
  24. World Health Organization: Definition, diagnosis and classification of diabetes mellitus and its complications; report of a WHO consultation, Part 1: diagnosis and classification of diabetes mellitus, Geneva: WHO, 1999
  25. Expert committee on the diagnosis and classification of diabetes mellitus: Follow-up report on the diagnosis of diabetes mellitus, Diabetes Care 2003; 26(11): 3160-3167
  26. Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary-heart-disease risk and impaired glucose tolerance. The Whitehall study, lancet 1980; 1(8183): 1373-1376
  27. Charles MA, Balkau B, Vauzelle-Kervroedan F, Thibult N, Eschwege E, Revision of diagnostic criteria for diabetes, Lancet 1996; 348(9042): 1657-1658
  28. Klein R, Comor EB, Bloont BA Wingard DL. Visual impairment and retinopathy in people with normal glucose tolerance, impaired glucose tolerance and newly diagnosed NIDDM. Diabetes Care 1991; 14: 914-918 https://doi.org/10.2337/diacare.14.10.914
  29. Chen KT, Chen CJ, Gregg EW, Imperatore G, Narayan KM. Inpaired fasting glucose and risk of diabetes in Taiwan: follow-up over 3 years, Diabetes Res Clin Pract 2003; 60(3): 177-182 https://doi.org/10.1016/S0168-8227(03)00037-8
  30. McFarlane SI, Banerji M, Sowers JR, Insulin resistance and cardiovascular disease, J Clin Endocrinol Metab 2001; 86(2): 713-718
  31. Tchernof A, Lamarche B, Pmd' Homme D, Nadeau A, Moorjani S, Labrie F, Lupien PJ, Despres JP The dense LDL phenotype, Association with plasma lipoprotein levels, visceral obesity, and hyperinsulinemia in men, Diabetes Care 1996; 19(6): 629-637
  32. Zierath JR, Livingston JN, Thorne A, Bolinder J, Reynisdottir S, Lonnqvist F, Arner P. Regional difference in insulin in hibition of non-esterified fatty acid release from human adipocytes: relation to insulin receptor phosphorylation and intracellular signalling through the insulin receptor substrate-l pathway. Diabetologia 1998; 41(11): 1343-1354 https://doi.org/10.1007/s001250051075
  33. Seidell JC, Oosterlee A, Deurenberg P, Hautvast JG, Ruijs JH, Abdominal fat depots measured with computed tonmography: effects of degree of obesity, sex, and age, Fur J Clin Nutr 1988; 42(9): 805-815
  34. Han TS, McNeill G, Seidell JC, Lean ME. Predicting intra-abdominal fatness from anthropometric measures: the influence of stature, Int J Obes Relat Metab Disord 1997; 21(7): 587-593 https://doi.org/10.1038/sj.ijo.0800446
  35. Expert panel on detection, evaluation and treatment of high blood cholesterol in adulst. Executive sumrrary of the third report of the national cholesterol education program(NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(adult treatment panel III). JAMA 2001; 285(19): 2486-2497 https://doi.org/10.1001/jama.285.19.2486
  36. World Health Organization Western Pacific Region, international association for the study of obesity, and international obesity taskforce. The asian-pacific perspective: redefining obesity and its treatment. Geneva: WHO Western Pacific Region; 2000
  37. World Health Organization, Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894:i-xii, 1-253
  38. Kim SM, Kim SS, Yoon SJ, Shim KW, Choi HJ, Kim KM, Lee DJ. What is the best simple anthropometric kidexes of abdominal visceral fat in obesepatients? J Korean Soc Study Obes 1998; 7(2): 157-168 (Korean)
  39. Lee KM, Waist circumference as a screening tool for cardiovascular risk factors in Korea: evaluation of receiver operating characteristics(ROC), J Korean Acad Fam Med 2000; 21(3): 395-405 (Korean)
  40. Ohlson LO, Larsson B, Svardsudd K, Welin L, Eriksson H, Wilhelmsen L, Bjorntorp P, Tibblin G, The influence of body fat distribution on the incidence of diabetes mellitus, 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes 1985 Oct;34(10): 1055-1058. https://doi.org/10.2337/diabetes.34.10.1055
  41. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men, Diabetes Care 1994; 17(9): 961-969 https://doi.org/10.2337/diacare.17.9.961
  42. Kim DH, Ahn YO, Park SW, Choi MG, Kim DS, Lee MS, Shin MH, Bae JM, Incidence and risk factors for diabetes mellitus in Korean middle-aged men: Seoul cohort DM follow-up study. Korean J Prev Med 1999; 32(4): 526-537(Korean)