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Obesity and Metabolism
2014 Clinical Practice Guidelines for Overweight and Obesity in Korea
Mee Kyoung Kim, Won-Young Lee, Jae-Heon Kang, Jee-Hyun Kang, Bom Taeck Kim, Seon Mee Kim, Eun Mi Kim, Sang-Hoon Suh, Hye Jung Shin, Kyu Rae Lee, Ki Young Lee, Sang Yeoup Lee, Seon Yeong Lee, Seong-Kyu Lee, Chang Beom Lee, Sochung Chung, In Kyung Jeong, Kyung Yul Hur, Sung Soo Kim, Jeong-taek Woo
Endocrinol Metab. 2014;29(4):405-409.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.405
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  • 227 Web of Science
  • 246 Crossref
AbstractAbstract PDFPubReader   

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index ≥25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.

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Close layer
Bone Metabolism
NF-κB-Mediated Regulation of Osteoclastogenesis
Brendan F. Boyce, Yan Xiu, Jinbo Li, Lianping Xing, Zhenqiang Yao
Endocrinol Metab. 2015;30(1):35-44.   Published online March 27, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.1.35
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AbstractAbstract PDFPubReader   

Osteoclasts are multinucleated cells formed mainly on bone surfaces in response to cytokines by fusion of bone marrow-derived myeloid lineage precursors that circulate in the blood. Major advances in understanding of the molecular mechanisms regulating osteoclast formation and functions have been made in the past 20 years since the discovery that their formation requires nuclear factor-kappa B (NF-κB) signaling and that this is activated in response to the essential osteoclastogenic cytokine, receptor activator of NF-κB ligand (RANKL), which also controls osteoclast activation to resorb (degrade) bone. These studies have revealed that RANKL and some pro-inflammatory cytokines, including tumor necrosis factor, activate NF-κB and downstream signaling, including c-Fos and nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1), and inhibition of repressors of NFATc1 signaling, to positively regulate osteoclast formation and functions. However, these cytokines also activate NF-κB signaling that can limit osteoclast formation through the NF-κB signaling proteins, TRAF3 and p100, and the suppressors of c-Fos/NFATc1 signaling, IRF8, and RBP-J. This paper reviews current understanding of how NF-κB signaling is involved in the positive and negative regulation of cytokine-mediated osteoclast formation and activation.

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Close layer
Original Article
Adrenal gland
Effects of Chronic Restraint Stress on Body Weight, Food Intake, and Hypothalamic Gene Expressions in Mice
Joo Yeon Jeong, Dong Hoon Lee, Sang Soo Kang
Endocrinol Metab. 2013;28(4):288-296.   Published online December 12, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.4.288
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AbstractAbstract PDFPubReader   
Background

Stress affects body weight and food intake, but the underlying mechanisms are not well understood.

Methods

We evaluated the changes in body weight and food intake of ICR male mice subjected to daily 2 hours restraint stress for 15 days. Hypothalamic gene expression profiling was analyzed by cDNA microarray.

Results

Daily body weight and food intake measurements revealed that both parameters decreased rapidly after initiating daily restraint stress. Body weights of stressed mice then remained significantly lower than the control body weights, even though food intake slowly recovered to 90% of the control intake at the end of the experiment. cDNA microarray analysis revealed that chronic restraint stress affects the expression of hypothalamic genes possibly related to body weight control. Since decreases of daily food intake and body weight were remarkable in days 1 to 4 of restraint, we examined the expression of food intake-related genes in the hypothalamus. During these periods, the expressions of ghrelin and pro-opiomelanocortin mRNA were significantly changed in mice undergoing restraint stress. Moreover, daily serum corticosterone levels gradually increased, while leptin levels significantly decreased.

Conclusion

The present study demonstrates that restraint stress affects body weight and food intake by initially modifying canonical food intake-related genes and then later modifying other genes involved in energy metabolism. These genetic changes appear to be mediated, at least in part, by corticosterone.

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Close layer
Review Articles
Obesity and Metabolism
Diabetes in Asians
Eun-Jung Rhee
Endocrinol Metab. 2015;30(3):263-269.   Published online September 22, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.3.263
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AbstractAbstract PDFPubReader   

The prevalence of diabetes is increasing globally, particularly in Asia. According to the 2013 Diabetes Atlas, an estimated 366 million people are affected by diabetes worldwide; 36% of those affected live in the Western Pacific region, with a significant proportion in East Asia. The reasons for this marked increase in the prevalence of diabetes can be extrapolated from several distinct features of the Asian region. First, the two most populated countries, China and India, are located in Asia. Second, Asians have experienced extremely rapid economic growth, including rapid changes in dietary patterns, during the past decades. As a result, Asians tend to have more visceral fat within the same body mass index range compared with Westerners. In addition, increased insulin resistance relative to reduced insulin secretory function is another important feature of Asian individuals with diabetes. Young age of disease onset is also a distinctive characteristic of these patients. Moreover, changing dietary patterns, such as increased consumption of white rice and processed red meat, contributes to the deteriorated lifestyle of this region. Recent studies suggest a distinctive responsiveness to novel anti-diabetic agents in Asia; however, further research and efforts to reverse the increasing prevalence of diabetes are needed worldwide.

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Obesity and Metabolism
Association of Adipokines with Development and Progression of Nonalcoholic Fatty Liver Disease
Chrysoula Boutari, Nikolaos Perakakis, Christos Socrates Mantzoros
Endocrinol Metab. 2018;33(1):33-43.   Published online March 21, 2018
DOI: https://doi.org/10.3803/EnM.2018.33.1.33
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AbstractAbstract PDFPubReader   ePub   

Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease affecting 30% of the general population and 40% to 70% of obese individuals. Adipose tissue plays a crucial role in its pathogenesis, as it produces and secretes pro- and anti-inflammatory cytokines called adipokines. Adiponectin and leptin have well-determined actions in terms of NAFLD pathophysiology. Adiponectin deficiency is associated with a pro-inflammatory condition, as it is observed in obesity and other metabolic disorders. On the other hand, increased leptin levels, above the normal levels, act as a pro-inflammatory stimulus. Regarding other adipokines (resistin, visfatin, chemerin, retinol-binding protein 4, irisin), data about their contribution to NAFLD pathogenesis and progression are inconclusive. In addition, pharmacological agents like thiazolidinediones (pioglitazone and rosiglitazone), that are used in the management of NAFLD exert favourable effects on adipokine levels, which in turn may contribute to the improvement of liver function. This review summarizes the current knowledge and developments in the association between adipokines and NAFLD and discusses possible therapeutic implications targeting the modulation of adipokine levels as a potential tool for the treatment of NAFLD.

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Adrenal gland
How to Establish Clinical Prediction Models
Yong-ho Lee, Heejung Bang, Dae Jung Kim
Endocrinol Metab. 2016;31(1):38-44.   Published online March 16, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.1.38
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AbstractAbstract PDFPubReader   

A clinical prediction model can be applied to several challenging clinical scenarios: screening high-risk individuals for asymptomatic disease, predicting future events such as disease or death, and assisting medical decision-making and health education. Despite the impact of clinical prediction models on practice, prediction modeling is a complex process requiring careful statistical analyses and sound clinical judgement. Although there is no definite consensus on the best methodology for model development and validation, a few recommendations and checklists have been proposed. In this review, we summarize five steps for developing and validating a clinical prediction model: preparation for establishing clinical prediction models; dataset selection; handling variables; model generation; and model evaluation and validation. We also review several studies that detail methods for developing clinical prediction models with comparable examples from real practice. After model development and vigorous validation in relevant settings, possibly with evaluation of utility/usability and fine-tuning, good models can be ready for the use in practice. We anticipate that this framework will revitalize the use of predictive or prognostic research in endocrinology, leading to active applications in real clinical practice.

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Close layer
Bone Metabolism
Effects of Resistance Exercise on Bone Health
A Ram Hong, Sang Wan Kim
Endocrinol Metab. 2018;33(4):435-444.   Published online November 30, 2018
DOI: https://doi.org/10.3803/EnM.2018.33.4.435
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AbstractAbstract PDFPubReader   ePub   

The prevalence of chronic diseases including osteoporosis and sarcopenia increases as the population ages. Osteoporosis and sarcopenia are commonly associated with genetics, mechanical factors, and hormonal factors and primarily associated with aging. Many older populations, particularly those with frailty, are likely to have concurrent osteoporosis and sarcopenia, further increasing their risk of disease-related complications. Because bones and muscles are closely interconnected by anatomy, metabolic profile, and chemical components, a diagnosis should be considered for both sarcopenia and osteoporosis, which may be treated with optimal therapeutic interventions eliciting pleiotropic effects on both bones and muscles. Exercise training has been recommended as a promising therapeutic strategy to encounter the loss of bone and muscle mass due to osteosarcopenia. To stimulate the osteogenic effects for bone mass accretion, bone tissues must be exposed to mechanical load exceeding those experienced during daily living activities. Of the several exercise training programs, resistance exercise (RE) is known to be highly beneficial for the preservation of bone and muscle mass. This review summarizes the mechanisms of RE for the preservation of bone and muscle mass and supports the clinical evidences for the use of RE as a therapeutic option in osteosarcopenia.

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Close layer
Thyroid
Clinical Relevance of Environmental Factors in the Pathogenesis of Autoimmune Thyroid Disease
Wilmar M. Wiersinga
Endocrinol Metab. 2016;31(2):213-222.   Published online May 13, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.2.213
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AbstractAbstract PDFPubReader   

Genetic factors contribute for about 70% to 80% and environmental factors for about 20% to 30% to the pathogenesis of autoimmune thyroid disease (AITD). Relatives of AITD patients carry a risk to contract AITD themselves. The 5-year risk can be quantified by the so-called Thyroid Events Amsterdam-score, based on serum thyroid-stimulating hormone, thyroid peroxidase (TPO)-antibodies and family history. Subjects at risk may ask what they can do to prevent development of AITD. This review summarizes what is known about modulation of exposure to environmental factors in terms of AITD prevention. To stop smoking decreases the risk on Graves disease but increases the risk on Hashimoto disease. Moderate alcohol intake provides some protection against both Graves and Hashimoto disease. Low selenium intake is associated with a higher prevalence of thyroid autoimmunity, but evidence that selenium supplementation may lower TPO antibodies and prevent subclinical hypothyroidism remains inconclusive. Low serum vitamin D levels are associated with a higher prevalence of TPO antibodies, but intervention studies with extra vitamin D have not been done yet. Stress may provoke Graves hyperthyroidism but not Hashimoto thyroiditis. Estrogen use have been linked to a lower prevalence of Graves disease. The postpartum period is associated with an increased risk of AITD. Taking together, preventive interventions to diminish the risk of AITD are few, not always feasible, and probably of limited efficacy.

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Thyroid
The Revised 2016 Korean Thyroid Association Guidelines for Thyroid Nodules and Cancers: Differences from the 2015 American Thyroid Association Guidelines
Ka Hee Yi
Endocrinol Metab. 2016;31(3):373-378.   Published online September 26, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.3.373
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AbstractAbstract PDFPubReader   

Increased detection of thyroid nodules using high-resolution ultrasonography has resulted in a world-wide increase in the incidence of differentiated thyroid cancer (DTC). Despite the steep increase in its incidence, the age-standardized mortality rate of thyroid cancer has remained stable, which leads toward a trend of more conservative treatment. The latest American Thyroid Association (ATA) guidelines for thyroid nodules and thyroid cancer revised in 2015 suggested that fine needle aspiration biopsy should be performed for thyroid nodules larger than 1 cm and lobectomy might be sufficient for 1 to 4 cm intrathyroidal DTC. In addition, active surveillance instead of immediate surgical treatment was also recommended as a treatment option for papillary thyroid microcarcinoma based on the results of a few observational studies from Japan. The Korean Thyroid Association (KTA) has organized a task force team to develop revised guidelines for thyroid nodules and DTC after an extensive review of articles and intense discussion on whether we should accept the changes in the 2015 ATA guidelines. This paper introduces and discusses the updated major issues and differences in the ATA and the KTA guidelines.

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Close layer
Obesity and Metabolism
Trends in the Diabetes Epidemic in Korea
Kyoung Hwa Ha, Dae Jung Kim
Endocrinol Metab. 2015;30(2):142-146.   Published online June 30, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.2.142
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AbstractAbstract PDFPubReader   

Diabetes mellitus is a leading cause of mortality and increased disability-adjusted life years worldwide. In Korea, the prevalence of diabetes increased from 8.6% to 11.0% in 2001 to 2013 and the prevalence of adult obesity, which is the most important risk factor of diabetes, increased from 29.2% to 31.8% during the same period. There has been a dramatic increase in the number of obese Koreans with diabetes in recent decades and the prevalence of diabetes in people aged 40 years and older also increased in 2001 to 2013. Nevertheless, the mean age at the first diagnosis of diabetes was very similar for men in 2005 and 2013, while the mean age for women decreased slightly. There is an inverse linear relationship between body mass index and age at the diagnosis of diabetes among those who are newly diagnosed. Accordingly, the prevalence of diabetes is increasingly shifting to younger individuals and those who are obese. Therefore, public efforts should focus on healthy lifestyle changes, primary prevention measures, screening for the early detection of diabetes, and long-term management.

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Miscellaneous
Sarcopenia and Muscle Aging: A Brief Overview
Tam Dao, Alexander E. Green, Yun A Kim, Sung-Jin Bae, Ki-Tae Ha, Karim Gariani, Mi-ra Lee, Keir J. Menzies, Dongryeol Ryu
Endocrinol Metab. 2020;35(4):716-732.   Published online December 23, 2020
DOI: https://doi.org/10.3803/EnM.2020.405
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AbstractAbstract PDFPubReader   ePub   
The world is facing the new challenges of an aging population, and understanding the process of aging has therefore become one of the most important global concerns. Sarcopenia is a condition which is defined by the gradual loss of skeletal muscle mass and function with age. In research and clinical practice, sarcopenia is recognized as a component of geriatric disease and is a current target for drug development. In this review we define this condition and provide an overview of current therapeutic approaches. We further highlight recent findings that describe key pathophysiological phenotypes of this condition, including alterations in muscle fiber types, mitochondrial function, nicotinamide adenine dinucleotide (NAD+) metabolism, myokines, and gut microbiota, in aged muscle compared to young muscle or healthy aged muscle. The last part of this review examines new therapeutic avenues for promising treatment targets. There is still no accepted therapy for sarcopenia in humans. Here we provide a brief review of the current state of research derived from various mouse models or human samples that provide novel routes for the development of effective therapeutics to maintain muscle health during aging.

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Close layer
Original Article
Clinical Study
Triglyceride Glucose Index Is Superior to the Homeostasis Model Assessment of Insulin Resistance for Predicting Nonalcoholic Fatty Liver Disease in Korean Adults
Sang Bae Lee, Min Kyung Kim, Shinae Kang, Kahui Park, Jung Hye Kim, Su Jung Baik, Ji Sun Nam, Chul Woo Ahn, Jong Suk Park
Endocrinol Metab. 2019;34(2):179-186.   Published online May 20, 2019
DOI: https://doi.org/10.3803/EnM.2019.34.2.179
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AbstractAbstract PDFPubReader   ePub   
Background

Recently, the triglyceride glucose (TyG) index has been considered a surrogate marker of insulin resistance which is a well-known pathogenic factor in nonalcoholic fatty liver disease (NAFLD). However, few studies have investigated the relationship between the TyG index and NAFLD. Thus, we investigated the relationship between the TyG index and NAFLD and the effectiveness of the TyG index compared with the homeostasis model assessment of insulin resistance (HOMA-IR) in identifying NAFLD in Korean adults.

Methods

Participants of 4,986 who underwent ultrasonography in a health promotion center were enrolled. The TyG index was calculated as ln [fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2], and HOMA-IR was estimated. NAFLD was diagnosed by ultrasonography.

Results

Significant differences were observed in metabolic parameters among the quartiles of the TyG index. The prevalence of NAFLD significantly increased with increment in the TyG index. After adjusting for multiple risk factors, a logistic regression analysis was performed. When the highest and lowest quartiles of the TyG index and HOMA-IR were compared, the odds ratios for the prevalence of NAFLD were 2.94 and 1.93 (95% confidence interval, 2.32 to 3.72 and 1.43 to 2.61; both P for trend <0.01), respectively. According to the receiver operating characteristic analysis, the TyG index was superior to HOMA-IR in predicting NAFLD.

Conclusion

The TyG index and prevalence of NAFLD were significantly related and the TyG index was superior to HOMA-IR in predicting NAFLD in Korean adults.

Citations

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Close layer
Review Articles
Obesity and Metabolism
Recent Progress on Branched-Chain Amino Acids in Obesity, Diabetes, and Beyond
Md Abu Bakkar Siddik, Andrew C. Shin
Endocrinol Metab. 2019;34(3):234-246.   Published online September 26, 2019
DOI: https://doi.org/10.3803/EnM.2019.34.3.234
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AbstractAbstract PDFPubReader   ePub   

Branched-chain amino acids (BCAAs) are essential amino acids that are not synthesized in our body; thus, they need to be obtained from food. They have shown to provide many physiological and metabolic benefits such as stimulation of pancreatic insulin secretion, milk production, adipogenesis, and enhanced immune function, among others, mainly mediated by mammalian target of rapamycin (mTOR) signaling pathway. After identified as a reliable marker of obesity and type 2 diabetes in recent years, an increasing number of studies have surfaced implicating BCAAs in the pathophysiology of other diseases such as cancers, cardiovascular diseases, and even neurodegenerative disorders like Alzheimer's disease. Here we discuss the most recent progress and review studies highlighting both correlational and potentially causative role of BCAAs in the development of these disorders. Although we are just beginning to understand the intricate relationships between BCAAs and some of the most prevalent chronic diseases, current findings raise a possibility that they are linked by a similar putative mechanism.

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Close layer
Thyroid
Effects of Increased Iodine Intake on Thyroid Disorders
Xin Sun, Zhongyan Shan, Weiping Teng
Endocrinol Metab. 2014;29(3):240-247.   Published online September 25, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.3.240
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AbstractAbstract PDFPubReader   

Iodine is a micronutrient essential for the production of thyroid hormones. Iodine deficiency is the most common cause of preventable mental impairment worldwide. Universal salt iodization (USI) has been introduced in many countries as a cost-effective and sustainable way to eliminate iodine deficiency disorders for more than 25 years. Currently, the relationship between USI and iodine excess has attracted more attention. Iodine excess can lead to hypothyroidism and autoimmune thyroiditis, especially for susceptible populations with recurring thyroid disease, the elderly, fetuses, and neonates. Nationwide USI was introduced in China in 1996. This review focused on the effects of iodine excess worldwide and particularly in China.

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Obesity and Metabolism
Regulation of Adipocyte Differentiation via MicroRNAs
You Hwa Son, Sojeong Ka, A Young Kim, Jae Bum Kim
Endocrinol Metab. 2014;29(2):122-135.   Published online June 26, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.2.122
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AbstractAbstract PDFPubReader   

Adipocyte differentiation, termed adipogenesis, is a complicated process in which pluripotent mesenchymal stem cells differentiate into mature adipocytes. The process of adipocyte differentiation is tightly regulated by a number of transcription factors, hormones and signaling pathway molecules. Recent studies have demonstrated that microRNAs, which belong to small noncoding RNA species, are also involved in adipocyte differentiation. In vivo and in vitro studies have revealed that various microRNAs affect adipogenesis by targeting several adipogenic transcription factors and key signaling molecules. In this review, we will summarize the roles of microRNAs in adipogenesis and their target genes associated with each stage of adipocyte differentiation.

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