Korean Journal of Family Medicine

"Body Fat"

Original Articles

Association between percent body fat and low high-density lipoproteinemia in middle-aged men in Korea: Chang-Hyun Lee, Seon-Hye Won, Hee-Yeon Kim, Sung-Eun Choi, Sang-Yeon Suh; Korean J Fam Med 2025;46(4):247-252. Published online June 7, 2024; DOI: https://doi.org/10.4082/kjfm.23.0246

Abstract
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Background
Obesity is a significant health risk factor for cardiovascular diseases. Dyslipidemia, defined as a low high-density lipoprotein cholesterol (HDL-C) level, is associated with these risks. Recent bioelectrical impedance analysis (BIA) devices offer precise measurements of the percent body fat (PBF). We aimed to determine the association between PBF and HDL-C levels in middle-aged men in Korea.
Methods
We conducted a cross-sectional sstudy of men aged 40-65 years who visited a health examination center. Body composition was analyzed using BIA. Health habits were assessed using a self-administered questionnaire. The participants were divided into four groups based on their PBF: group 1 (<21%), group 2 (21%–23.99%), group 3 (24%–28.99%), and group 4 (≥29%). Logistic regression was used to obtain the odds ratio (OR) between the PBF group and the low HDL-C level and adjusted for other variables.
Results
In this study, 2,685 men were analyzed. The number of individuals diagnosed with low HDL-C levels increased significantly as the group-specific PBF increased. Group 4 showed a 5.5-fold greater association with low HDL-C compared to group 1 (P<0.01), whereas group 3 and group 2 showed an OR of 4.38 and 2.95 (P<0.01 and P<0.01), respectively.
Conclusion
These results suggest that if middle-aged men are able to decrease their body fat by <5%, their HDL-C levels will increase. We suggest that 3%–5% PBF is a useful guideline for general body fat reduction in Korean middle- aged men in primary care.

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Bioelectrical Impedance Analysis as a Helpful Tool in Pediatric Obesity Monitoring: A Case Report
Agata Przytula, Joanna Popiolek-Kalisz
Reports.2025; 8(1): 15. CrossRef
Health behaviors, lifestyle factors, and healthcare challenges in family medicine: a comprehensive review of recent evidence from Asian populations
Joung Sik Son
Korean Journal of Family Medicine.2025; 46(4): 215. CrossRef

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Short-term Changes in Thyroid-Stimulating Hormone Level after Body Fat Reduction via Partial Meal Replacement: Nam-Kyu Kim, Min-Ah Jung, Seok-Hoon Lee, Nam-Seok Joo; Korean J Fam Med 2023;44(1):58-63. Published online January 19, 2023; DOI: https://doi.org/10.4082/kjfm.22.0131

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Background
Serum thyroid-stimulating hormone (TSH) levels change during body weight reduction. However, the changes that occur during short-term body weight control interventions remain controversial. Thus, this study aimed to evaluate the changes in TSH levels according to body fat reduction.
Methods
We performed a 3-month intervention study involving partial meal replacement. Forty-nine participants completed the study. Correlations between changes in TSH levels and other body composition parameters were determined. The subjects were divided into two groups according to their body fat reduction (>1 kg, n=20; <1 kg, n=29). The changes in metabolic parameters, including TSH levels, were compared. For significant values, a multivariate analysis was performed after adjustment to evaluate the relationship between TSH changes and body fat reduction.
Results
The 3-month intervention caused favorable changes in body proportions and metabolic parameters. TSH levels changed significantly only after changes in total body fat, showing a partial correlation. Changes in TSH levels were significantly different between groups (P=0.014). Moreover, the change in TSH levels was significantly different after adjustment (P=0.012).
Conclusion
A body fat reduction, especially >1 kg, can reduce serum TSH concentrations in subjects with metabolic syndrome after short-term body weight intervention.

Citations

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The impact of weight loss interventions on thyroid function: a systematic review and meta-analysis
Sandeep Samethadka Nayak, Seyyed Mohammad Hashemi, Masum Patel, Nimra Shafi, Pubali Biswas, Sepide Javankiani, Padmavathi Jaladi, Sanjana B. Patil, Rahiq Rashid, Ehsan Amini-Salehi, Daniyal Ameen, Khushbu Viresh Janani, Anil Kumar Jonnalagadda, Kwame Boat
Annals of Medicine & Surgery.2025; 87(7): 4484. CrossRef

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Association between Appendicular Fat Mass and Metabolic Risk Factors: Si Young Park, Kil Young Kwon, Jung Hwan Kim, Hyung Hwa Choi, Kun Hee Han, Jee Hye Han; Korean J Fam Med 2014;35(4):182-189. Published online July 25, 2014; DOI: https://doi.org/10.4082/kjfm.2014.35.4.182

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Background

Different regional fat depots have different effects on lipid and glucose metabolism. The purpose of this study is to examine the relationship between body fat distribution as measured by dual-energy X-ray absorptiometry (DEXA) and metabolic risk factors and to disclose whether there is any difference between groups with and without metabolic syndrome (MS).

Methods

A total of 292 participants (98 men, 194 women) over 19 years old underwent whole-body DEXA to evaluate body composition with respect to the whole body, leg, arm, and android regions. Anthropometry and blood tests for metabolic risks were measured.

Results

One hundred and seven participants were diagnosed with MS. The MS group had significantly higher android fat (%) and had lower leg fat (%), arm fat (%), and appendicular (arms + legs) fat (%) than the non-MS group. Android fat (%) had a positive correlation with waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, log insulin, hemoglobin A1c (HbA1c), triglyceride (TG), and low density lipoprotein cholesterol, and had a negative correlation with high density lipoprotein (HDL) cholesterol. Appendicular fat (%) had a negative correlation with WC, SBP, DBP, glucose, log insulin, HbA1c, and TG, and had a positive correlation with HDL cholesterol. The association of appendicular fat with metabolic risk was consistently observed in non-MS, but the association was not observed except for SBP, glucose and log insulin in MS.

Conclusion

In contrast with the adverse effects of android fat, appendicular fat distribution was associated with decreased risks of MS. The protective effect of appendicular fat against metabolic risk factors in non-MS was less characteristic in MS.

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Regional fat distribution and hepatic fibrosis and steatosis severity in patients with nonalcoholic fatty liver disease and type 2 diabetes
Asieh Mansour, Saeed Pourhassan, Hadis Gerami, Mohammad Reza Mohajeri‐Tehrani, Marziye Salahshour, Ali Abbasi, Elham Madreseh, Sayed Mahmoud Sajjadi‐Jazi
Obesity Science & Practice.2024;[Epub] CrossRef
Sex-Related Disparities in Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Type 2 Diabetes and Heart Failure
Andreas Hammer, Felix Hofer, Niema Kazem, Lorenz Koller, Eva Steinacher, Ulrike Baumer, Felix Wollmann, Alexandra Kautzky-Willer, Klara Beitl, Franziska Remer, Christian Hengstenberg, Alexander Niessner, Patrick Sulzgruber
Journal of Women's Health.2023; 32(11): 1219. CrossRef
Leg and arm adiposity is inversely associated with diastolic hypertension in young and middle-aged United States adults
Aayush Visaria, David Lo, Pranay Maniar, Bhoomi Dave, Parag Joshi
Clinical Hypertension.2022;[Epub] CrossRef
The Relationship between Fat Mass Percentage and Glucose Metabolism in Children and Adolescents: A Systematic Review and Meta-Analysis
Fangfang Chen, Junting Liu, Dongqing Hou, Tao Li, Yiren Chen, Zijun Liao, Lijun Wu
Nutrients.2022; 14(11): 2272. CrossRef
Young, healthy males and females present cardiometabolic protection against the detrimental effects of a 7-day high-fat high-calorie diet
Katie L. Whytock, Sam O. Shepherd, Matt Cocks, Anton J. M. Wagenmakers, Juliette A. Strauss
European Journal of Nutrition.2021; 60(3): 1605. CrossRef
Body composition reference ranges in community‐dwelling adults using dual‐energy X‐ray absorptiometry: the Australian Body Composition (ABC) Study
Ben Kirk, Ebrahim Bani Hassan, Sharon Brennan‐Olsen, Sara Vogrin, Stefanie Bird, Jesse Zanker, Steven Phu, Jarrod D. Meerkin, Steven B. Heymsfield, Gustavo Duque
Journal of Cachexia, Sarcopenia and Muscle.2021; 12(4): 880. CrossRef
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Inmaculada Gómez-Carrascosa, María L. Sánchez-Ferrer, Ernesto de la Cruz-Sánchez, Julián J. Arense-Gonzalo, María T. Prieto-Sánchez, Emilia Alfosea-Marhuenda, Miguel A. Iniesta, Jaime Mendiola, Alberto M. Torres-Cantero
Journal of Clinical Medicine.2021; 10(17): 3933. CrossRef
Relationship between fat distribution and cardiometabolic risk in Hispanic girls
Megan Hetherington‐Rauth, Jennifer W. Bea, Vinson R. Lee, Robert M. Blew, Janet L. Funk, Timothy G. Lohman, Scott B. Going
American Journal of Human Biology.2018;[Epub] CrossRef
Specific characterization of regional storage fat in upper and lower limbs of young healthy adults
Junichiro Yamauchi, Toshiyuki Kurihara, Maki Yoshikawa, Sadayoshi Taguchi, Takeshi Hashimoto
SpringerPlus.2015;[Epub] CrossRef
Comments on Statistical Issues in September 2014
Yong Gyu Park
Korean Journal of Family Medicine.2014; 35(5): 257. CrossRef

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Changes in Blood Pressure, Blood Glucose, and Lipid Profile Caused by Changes of Weight, Percent Body Fat, and Waist Circumference in Adult Men with Normal Weight and Waist Circumference.: Ho Chun Choi, Hyun Jin Kim, Seong Jun Min, Kiheon Lee, Kyung Woo Kim, Seung Min Oh, Tae Woo Yoo; Korean J Fam Med 2010;31(6):430-436. Published online June 20, 2010; DOI: https://doi.org/10.4082/kjfm.2010.31.6.430

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Background
Metabolic indexes (blood pressure, blood glucose, and lipid) differ depending on lower or upper normal value of obesity indexes (weight, percent-body-fat, and waist circumference) despite normal value. Therefore, we examined metabolic indexes changes across obesity indexes changes. Methods: We analyzed 344 adult men who received routine-checkups with normal weight and waist circumference before and after follow-up. We used multiple-linear-regression to examine associations between changes of obesity indexes and metabolic indexes before and after follow-up. We examined differences of metabolic indexes by t-test and odds ratios of normal or abnormal metabolic indexes by multiple-logistic-regression in groups where obesity indexes were increased and decreased.Results: The mean follow-up was 1.38 ± 0.32 years and there were associations between weight change rate and changes in systolic-blood-pressure (SBP), diastolic-blood-pressure (DBP), triglyceride (TG), and high–density-lipoprotein (HDL) (P = 0.001, 0.03, 0.001, 0.01), associations between percent-body-fat change and changes in SBP, DBP, fasting-blood-glucose (FBG) and TG (P = 0.02, 0.002, < 0.001, 0.03), and associations between waist circumference change rate and changes in FBG, TG, HDL (P = 0.01, 0.01, 0.02). There were significant SBP and HDL differences in weight decrease and increase groups (P = 0.04, < 0.001), FBG difference in percent-body-fat decrease and increase groups (P = 0.01), and FBG and TG differences in waist circumference decrease/increase groups (P = 0.03, 0.03). As compared with percent-body-fat decrease group, percent-body-fat increase group had odds ratio of FBG ≥ 100 of 2.98 (95% confidential interval [CI], 1.18 to 7.51) with a significance on only FBG of initially normal metabolic components and conversely percent-body-fat decrease group had odds ratio of FBG < 100 of 3.22 (95% CI, 1.21 to 8.60) with a significance on only FBG of initially abnormal metabolic components. Conclusion: Increased obesity indexes even within normal range, could change metabolic indexes.

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Correlation between Endoscopic Severity of Gastroesophageal Reflux Disease (GERD) and Indexes of Obesity.: Ki Byung Lee, Keunmi Lee, Seung Pil Jung; Korean J Fam Med 2009;30(12):962-971. Published online December 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.12.962

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Background
There are many reports that obesity could be associated with gastoesophageal refl ux disease (GERD) but the outcomes are controversial and the studies on correlation between endoscopic severity of GERD and obesity are rare. Therefore, we investigated the association between endoscopic severity of GERD and indexes of obesity. Methods: Among the subjects who visited a health promotion center of a general hospital from January 2007 to March 2008, a total of 527 subjects with typical symptoms of GERD who underwent esophagogastroduodenoscopy and analysis of body composition were enrolled. The endoscopic severity of GERD was classifi ed depending on LA grading classifi cation system. Results: Among 527 subjects, 125 subjects were classifi ed with Non-erosive refl ux disease (NERD) while 254, 105, and 43 subjects were classifi ed as LA grade A, B, and C group, respectively. Men and frequent alcohol drinkers (≥ 5 times/week) were likely to be in higher endoscopic severity group (OR, 2.065 and 2.394, respectively; P < 0.05). If the subject was obese by BMI and waist circumference, it showed a higher possibility of belonging to the higher endoscopic severity group (OR, 2.319 and 2.596, respectively; P < 0.001). In the case of %body fat, the obesity group was more likely to be in the higher endoscopic severity group only in men (OR, 1.906; P < 0.001). Conclusion: Indexes of obesity such as BMI, %body fat (only in men), and waist circumference were related with endoscopic severity of GERD and this relationship is more apparent in men and alcohol drinkers (≥ 5 times/week).

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Cutoff of Percent Body Fat to Predict Obesity and Metabolic Risk in Children and Adolescents: 2007 Children and Adolescent Physical Growth Standard.: Young Sok Kang, Jee Hyun Kang, Moon Chul Kim, Byung Yeon Yu, Eun Ju Sung, Seon Yeong Lee, Yeon Jung Lee; Korean J Fam Med 2009;30(11):887-894. Published online November 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.11.887

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Backgroud: Body mass index (BMI) for gender and age and percentage-weight-for-height (PWH) for gender and height have been frequently used to diagnose childhood obesity. However, few studies have examined the optimal cutoff of percent body fat (%BF) to predict metabolic abnormalities in obese children. Methods: One thousand fi fteen obese children aged 10 to 15 years were enrolled in this study. The %BF cutoff values were calculated by ROC analysis for metabolic abnormalities. We also calculated %BF cutoff values corresponding to a BMI of > 85th or 95th percentile for gender and age and a PWH of > 120% for gender and height based on the 2007 Korean children and adolescents growth standard chart. To defi ne metabolic abnormalities in children, we used the criteria of metabolic syndrome recommended by International Diabetes Federation consensus for children and adolescents. Results: The %BF cutoff corresponding to the group having more than one metabolic abnormality in this study population were 38.4% (sensitivity 40.1%, specifi city 84.4%) in total, 38.4% (sensitivity 35.4%, specifi city 84.8%) in boys and 39.5% (sensitivity 38.9%, specifi city 90.9%) in girls. The %BF cutoff values corresponding to a BMI ≥ 95 percentile were 38.1% (sensitivity 50.5%, specifi city 72.7%), a BMI ≥ 85 percentile were 34.5% (sensitivity 69.3%, specifi city 74.2%), and a PWH ≥ 120% were 36.4% (sensitivity 72.3%, specifi city 64.4%) in total. Conclusion: The optimal cutoff value of percent body fat to predict metabolic abnormalities in obese children may be 38.4% (boys 38.4, girls 39.5%) and we suggest 34.5% as a cutoff value of %BF for screening childhood obesity.

Citations

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Characterization of focal hypermetabolic thyroid incidentaloma: An analysis with F-18 fluorodeoxyglucose positron emission tomography/computed tomography parameters
Haejun Lee, Yoo Seung Chung, Joon-Hyop Lee, Ki-Young Lee, Kyung-Hoon Hwang
World Journal of Clinical Cases.2022; 10(1): 155. CrossRef
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Chun-Kun Park, Hong-Jae Lee, Kyeong-Sik Ryu
Journal of Korean Neurosurgical Society.2017; 60(5): 540. CrossRef

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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

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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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Percent Body Fat and Abdominal Circumference Cutoff Points Accounted for 85th and 95th Percentile of Body Mass Index in One City of Gyeonggi Province.: Chan Won Kim, Kyung Hee Park, Young Su Ju, Hong Ji Song, Yu Jin Paek, Jong Won Choi, He Mi Chang, Jung Jin Cho; J Korean Acad Fam Med 2008;29(7):492-498. Published online July 10, 2008

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Background: Childhood obesity is becoming more prevalent, associated with a variety of adverse consequences which leads to adulthood obesity. Although diagnosis is usually made by body mass index, there is neither a cutoff point for the percentage body fat nor abdominal circumference. The aim of this study was to identify each cutoff point for both measures. Methods: The measurement of height, weight, abdominal circumference and percentage body fat was performed through manual assessment and bioelectrical impedance analysis for 4,242 subjects aged 11 in Gunpo City, South Korea. The cutoff point for body fat percentage and abdominal circumference is set to maximize the sum of sensitivity and specificity for detecting obesity and overweight using the Receiver Operating Characteristics (ROC) curve. Results: The mean percentage body fat was 13.6±6.9% for boys and 19.4±5.3% for girls. The mean abdominal circumference of boys was 68.0±9.1 cm, and that of girls was 64.3±7.7 cm. The cutoff point of percentage body fat for obesity was 21.8% in boys and 24.5% in girls. The prevalence of obesity was 15.2%, 16.7% for males and females, respectively. The abdominal circumference cutoff for obesity was 76.9 cm in boys and 70.7cm in girls. Based on that, the prevalence of obesity was 19.7% for boys and 20.0% for girls, which was higher than what was identified by body mass index, as in the case of body fat percentage. Conclusion: The cutoffs of body fat percentage and abdominal circumference in one city of Gyeonggi Province were lower than those suggested in the previous studies. (J Korean Acad Fam Med 2008;29:492-498)

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Factors Related to Increase of Blood Pressure in Obese Children and Adolescents.: Sang Hyun Lee, Eunju Sung, Ho Cheol Shin, Yong Woo Park, Cheol Hwan Kim, Kyung Seop Soh; J Korean Acad Fam Med 2007;28(7):515-522. Published online July 10, 2007

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Background
As obese population is increasing nowadays, research on blood pressure of obese children is being performed more frequently. However, there are only few research related to factors about blood pressure among obese children in Korea. The purpose of this study was to analyze the factors affecting blood pressure of obese children and adolescents. Methods: The subjects were elementary and middle school students diagnosed with obesity (n=1716). Height, weight, waist circumstance, body fat percent, blood pressure were measured. Family history and sexual maturity were investigated through the questionnaire. The relationship between the factors and the increase of blood pressure was analyzed. Results: Body weight was the most powerful factor among to factors related to increase of blood pressure (male r=0.45, P＜0.05, female r=0.37, P＜0.05). Also, height, percentage weight for height (PWH), body mass index (BMI) and waist circumference was correlated with the blood pressure. In multiple regression analysis, family history of hypertension and the sexual maturity were significant determinants of blood pressure in males after adjusting for weight. However, body fat percent was a significant determinant in females. Conclusion: Body weight was the most important factor which increased the blood pressure in obese children and adolescents in both sexes. But males and females had different factors related to the increase of blood pressure with the exception of body weight. (J Korean Acad Fam Med 2007;28:515-522)

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Correlations of C-reactive Protein Levels with Obesity Index and Metabolic Risk Factors in Healthy Adults.: Euijoo Jung, Myungsuk Kim, Eunyoung Jung, Jonguk Kim, Keunmi Lee, Seungpil Jung; J Korean Acad Fam Med 2006;27(8):620-628. Published online August 10, 2006

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Background
: C-reactive protein (CRP) is one of the increasing plasma proteins in inflammatory diseases and tissue necrosis and recent evidence show that increased elevated levels of CRP are associated with an increased risk of coronary heart disease (CHD) and obesity. To investigate the relationship of obesity and CRP, we evaluated the correlation of CRP with obesity index in healthy adults.

Methods : The subjects included 1,926 healthy adults (1,168 men and 758 women) who visited the Health Promotion Center of a general hospital from May to December 2004. We excluded subjects who had inflammatory diseases, and investigated based on age, physical examination, blood pressure, fasting plasma glucose, serum lipid profile, percentage of body fat, and body mass index (BMI). CRP was analyzed by method of Turbid Immuno Assay (TIA) which has high sensitivity-CRP. We evaluated serum level of CRP in relation to %body fat, BMI, and clustering of metabolic risk factors.

Results : Comparing the median CRP with the percentage of body fat, BMI, clustering of metabolic risk factors the value of CRP significantly increased according to increase in %body fat BMI and metabolic risk factor (P＜0.001). The proportion of elevated CRP levels (≥0.22 mg/dL) was increased as %body fat, BMI, and clustering of metabolic risk factor increased. The Odds Ratios for elevated levels of CRP were 1.5 (95% CI 1.0∼2.1) in men and 2.9 (95% CI 1.7∼4.8) in women for subjects with obesity (BMI≥25 kg/m²), 2.0 (95% CI 1.3∼2.9) in men with more than 25% %body fat, and 2.5 (95% CI 1.4∼4.1) in women with more than 30% %body fat.

Conclusion : As %body fat increased, the proportion of elevated CRP (≥0.22 mg/dL) level increased in men and women. We conclude that obesity is related with CRP.

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Relationship between Percent Body Fat and Cardiovascular Risk Factors for Normal Weight Adults.: Jee Hye Han, Seon Mee Kim; J Korean Acad Fam Med 2006;27(5):352-357. Published online May 10, 2006

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Background
: To investigate the relationship between adiposity and risk factors for cardiovascular disease (CVD) in normal weight individuals.

Methods : The study subjects were those over 19 years old, less than 23 kg/m² of body mass index (BMI). They were examined in a health promotion center of a general hospital from June to November, 2001 (309 men and 369 women). Height, weight, BMI, blood pressure (BP), serum lipids and fasting blood glucose (FBS) were checked. Percent body percent (%BF) was obtained by bioelectrical method. Normal weight subjects were divided into two groups according to their %BF; then, the groups were evaluated for the presence of CVD risk factors.

Results : The average age of the study subjects was 43.66±11.26 years old in men and 41.11±10.90 years old in women. The average BMI was 21.15±1.47 kg/m² in men and 20.68±1.53 kg/m² in women. High %BF group showed significantly increased frequency of higher BP, FBS, total cholesterol (TC), triglyceride (TG) and LDL- cholesterol (LDL-C) compared with low %BF group in both sexes. In men, odds ratios (ORs) of the high %BF group with respect to the low %BF group were significantly high for BP and TG elevation. ORs of the high %BF group were significantly high for FBS, TC, LDL-C and TG elevation in women. ORs for more than one CVD risk factor was 2.46 (1.38∼4.38) in men and 1.50 (0.95∼2.36) in women.

Conclusion : Increased %BF was related to cardiovascular risk factors in normal weight subjects. The result was more significant for normal weight men than normal weight women.

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Age Associated Changes in Body Mass Index and Body Fat Distribution.: Jung Ho Lee, Chan Hee Song, Keun Sang Yum, Kyung Soo Kim, Soon Woo Nam, Jun Yeol Han, Gyu Won Jeong, Hei Sik Sun; J Korean Acad Fam Med 2003;24(11):1010-1016. Published online November 10, 2003

Abstract
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Background
: Body mass index is currently applied as the diagnostic standard of overweight and obesity, regardless of age. Percentage body fat ratio applies separate standards among different sex, but does not have separate standards for different age groups. Since body mass index and percentage body fat may differ according to age, we conducted this study to see if a separate standard for overweight and obesity is indeed necessary for different age groups.

Methods : We selected 2,190 subjects, who were the 10 percent picked randomly by computer, among 21,921 clients who had visited the St. Mary's Hospital's health promotion center in Seoul. Those diagnosed with diabetes, thyroid disease, renal failure, and tuberculosis were excluded, leaving 1,939 over the age of 20, as final subjects. Anthropometric measurements were done using electronic scales and height meters, while body composition was measured with a multi-frequency bioelectric impedance analysis (Inbody 3.0 Biospace, Seoul). The results of this study were shown in mean and standard deviation, and mean values according to ages were compared by Ancova test.

Results : In the case of adult men, percentage body fat increased with age. This was observed especially with subjects over 30 compared to subjects in their 20s, although not proven to be statistically significant. A decrease in fat free mass rather than increase in body fat mass was noted with aging. With adult women, percentage body fat increased markedly with subjects over 50, mainly due to increased body fat mass rather than decreased fat free mass. Subjects exceeding a body mass index of 25, which is the standard limit of body mass index for obesity, was 60th percentile for adult men, and 70∼80th percentile for adult women. Percentage body fat in this case was 22.54% for men and 31.99∼33.46% for women.

Conclusion : Our study indicates that both men and women show changes in body mass index and fat free mass with aging. Hence, there are limitations to applying a universal standard for body mass Index, regardless of age. We suggest that further studies on standards for adult obesity should be conducted based on specific Korean epidemiologic data.

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Association of Body Fat and Body Mass Index with Pulmonary Function in Women in Their Forties.: Sung Ryul Kim, Un Suk Choi, Ji Ho Choi, Hee Jeong Koh; J Korean Acad Fam Med 2003;24(9):827-832. Published online September 10, 2003

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Background
: Obesity and decreased pulmonary function increase mortality and morbidity of diseases. Obesity is a major factor of decreased pulmonary function. There are variable results of how much body mass index (BMI) and body fat percent influence pulmonary function. There arefew data between obesity and pulmonary function in Korea. This study observed the association of BMI, body fat percent and pulmonary function, and quantified the impact of obesity to pulmonary function.

Methods : 603, non-smoking women in their forbles visited the Health Promotion Center of Inha University Hospital from January 3, 2000 to December 31 2000. Questions concerning smoking, exercise, and past medical history were made. Body fat percent and pulmonary function were measured. Correlation, simple linear regression and multiple linear regression between obesity indices and pulmonary function were used executed.

Results : BMI has no correlation with FVC, FEV1 and FEV1/FVC ratio. Body fat percent was negatively correlated with FVC and FEV1 (r=-0.162; P＜0.01, r= -0.195; P＜0.01), and was not correlated with FEV1/FVC ratio. In a multiple linar regression, body fat percent was inversely related to FVC and FEV1 (β=-10.380; P＜0.01, β=-11.379; P＜0.01).

Conclusion : Increased body fat percent has association with decreased pulmonary function and has more impact on FEV1 than FVC. FVC was decreased by 10.380 mL and FEV1 was decreased by 11.379 mL when body fat percent increased by 1%.

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The Comparison of Body Fat Rate and Body Mass Index through the Relationship with Cardiovascular Risk Factors.: Be Long Cho, Han Jin Lee, Sang Woo Ou, Jong Seung Kim; J Korean Acad Fam Med 2003;24(8):731-738. Published online August 10, 2003

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Background
: Obesity has been generally diagnosed by 'Body Mass Index (BMI)' in primary care. Recently the use of Bioelectrical Impedance Analyzer' has become popular in Korea to evaluate body fat rate (BFR), as cost is inexpensive and the method to use is simple. As a result, the opposed finding of normal BMI and elevated BFR vice versa in same individuals are being encountered frequently. We designed this study to find out the characteristics and cardiovascular risk of people in these groups.

Methods : The medical records of health promotion center were obtained and 22,704 applicants visitor who undeerwent health risk questionnaire, screening tests and physical examination for cardiovascular disease were reviewed.

Results : After adjusting for age, sex, exercise and education level, cardiovascular risk such as hypertension, DM, and hypercholesterolemia, LDL tended to increase linearly and HDL tended to decrease linearly with increase of BFR or BMI. In comparison with normal BMI and BFR group, the odds ratios of normal BMI and elevated BFR group or vice versa were increased.

Conclusion : If either one of BMI or BFR of a person was elevated, even though the other was within normal range, the cardiovascular risk of that person was shown to be high.

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Body Fat Distribution and Serum Leptin Levels according to Amount of Cigarette Smoking in Korean Middle-aged Men.: Keun Mi Lee; J Korean Acad Fam Med 2003;24(6):524-531. Published online June 10, 2003

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Background
: The effect of smoking on obesity and fat distribution is controversial. We evaluated the difference of fat distribution and obesity according to the amount of smoking, and the influence of leptin level between obesity and the amount of smoking.

Methods : Subjects were selected among patients who visited the Health Promotion Center of Yeungnam University Hospital for general health evaluation from May to August, 2001. They were aged from thirty to fifty and had no weight change during six months. We excluded the patients who had disease and medication history that can cause weight change. One hundred thirty-five men were included in this study. Smoking status, alcohol and exercise history were reviewed by interview method. Height, weight, waist and hip circumference, %body fat, blood pressure, and blood chemistry were measured. Leptin was measured by a commercial radioimmunoassay (Linco Research, Inc., St., Louis, MO). The differences of obesity parameters and leptin levels according to the amount of smoking were evaluated by analysis of covariance with multiple comparision. All statistical analyses were performed with SPSS 10.0

Results : Body mass index, %body fat, waist circumference and waist to height ratio (W/H ratio) were significantly increased according to the amount of smoking after adjustment for age, alcohol intake and exercise (P＜0.05). But, BMI, %BF, WC and W/H ratio in mild and mild-moderate smokers were lower than those of the non-or ex-smoker, paradoxically (P＜0.05). Also, serum leptin level was increased according to the increase of amount of smoking, but it had no statistical significance. Over one pack per day smokers had 3.5 times higher risk of hypertension than under one pack per day smokers.

Conclusion : In Korean middle-aged men, obesity index showed difference between the amount of smoking status. BMI, %BF, WC and W/H ratio were significantly higher in heavy smokers than mild and mild-moderate smokers. Though it was not statistically significant, leptin was higher in heavy smokers than in mild and mild- moderate smokers.

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Comparison of Body Components and Mineral Mass between Women with Osteoporosis and Non-osteoporosis Postmenopausal Women.: Geun Ou Shin, Kyung Won Park, Dong Whan Lee, Tae Jin Park, Kayoung Lee; J Korean Acad Fam Med 2002;23(7):934-941. Published online July 10, 2002

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The association between dietary fat and body fat in obese adults.: Ka Young Lee, Ki Jung Kim; J Korean Acad Fam Med 2001;22(1):87-95. Published online January 1, 2001

Abstract
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Background
: There are different opinions on whether the percentage of dietary fat is associated with the development of obesity and on it's treatment. In this country, dietary fat intake has been smaller compared to the Western countries. The purpose of this study was to find whether intake of dietary fat is related to percentage body fat in obese adults cross-sectionally.

Methods : Nutrient intake form 24-hour dietary recall and percent body fat from bioelectrical impedance method were measured in 51 obese adults. Total energy intake was associated with intake of dietary fat and body size. Thus, the association of intake of dietary fat and three types of fat with percentage body fat were examined after adjustment for total energy intake by using 4 statistical models (standard multivariate model, and nutrient residual model, energy-partition model, and multivariate nutrient density model).

Results : In all of these models, the results for types of fat and total fat showed similar results. Higher intake of total fat, saturated and polyunsaturated fat was associated with increased percentage body fat, while higher intake of monounsaturated fat was associated with decreased percentage body fat.

Conclusion : We found positive association between dietary intake of fat and percentage body fat in obese adults. Our results suggest that reducing fat intake would be a helpful way to prevent and treat obesity in adults.

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The effects of cigarette smoking on abdominal fatness.: Jong Ho Kim, Hee Young Kim, Chun Hwa Song, Keun Mi Lee, Seung Pil Jeung; J Korean Acad Fam Med 2000;21(9):1172-1179. Published online September 1, 2000

Abstract
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Background
: With increase in the prevalence of obesity in recent years, much interest has focused on obesity nowdays. Inerease in abdominal fatness and there is some possibility that smoking has effect on obesity. We evaluated the influence of smoking on abdominal fatness.

Methods : This study was carried out on 475 individuals who visited the Health Promotion Center in Youngnam University Hospital in May, 1999. The subjects were checked on age, sex, life style (smoking, drinking, physical activity, exercise, etc.), past medical history, blood pressure, height, weight, waist circumference, hip circumference, body fat percent and other obesity indexes.

Results : In men, waist circumference(P<0.01), body fat percent (P<0.05), waist hip ratio (P<0.01) were significantly increased according to the amount of smoking after adjustment for BMI, age, alcohol intake, exercise and physical activity. But, the waist circumference, waist to hip ratio and percent body fat of mild smoker were rather shorter than that of the non-smoker or on who abstained from smoking.

Conclusion : In men, it seems that obesity index of abdominal fatness may be significantly high in moderate to heavy smokers and low in mild smokers.

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Comparison of clinical usefulness of low-calorie-diet combined with exercise and low-calorie-diet alone.: Jae Heon Kang, Sung Won Kim, Hye Soon Park, Hyun Soo Kim; J Korean Acad Fam Med 1998;19(2):167-176. Published online February 1, 1998

Abstract
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Background
: To assess the efficacy and safety of low-calorie-diet(LCD) using formular diet and to compare clinical usefulness of LCD combined with exercise with LCD alone, sixty obese females were prescribed LCD with exercise or LCD alone, randomly.

Methods : Thirty obese females were treated with LCD of 1,000 kcal/d for 8 weeks(group A). Another thirty obese females were treated with LCD of 1,000 kcal/d combined with supervised aerobic exercise for 8 weeks(group B).

Results : 22 out of 30 obese females in group A[37.3±5.0yr ; body fat 40.3±3.9%] and 26 out of 30 obese female in group B[37.9±7.6yr ; body fat 41.5±3.7%] completed the study. At the eighth week, mean weight loss was 5.8±2.1kg(8.1%) for group A, and 6.8±1.6kg(9.7%) for group B. Differences in weight loss between two groups were statistically significant(p<0.05). In group A, blood pressure, serum glucose, uric acid, total cholesterol, HDL-cholesterol, sodium, chloride, body fat were significantly reduced, and serum zinc, calcium, phosphorus were significantly increased(p<0.05). In group B, blood pressure, serum glucose, uric acid, total cholesterol, HDL-cholesterol, triglyceride, insulin, iron, sodium, body fat were significantly reduced, and serum zinc, calcium, phosphorus, magnesium were significantly increased(p<0.05). However, the differences of the changes in the above laboratory data between two groups were not statistically significant. Side effects were few and occurred mainly during the frist week of the trial.

Conclusion : Low calorie diet for 8 weeks decreased body fat, BP, glucose, uric acid, total cholesterol, HDL-cholesterol levels significantly, and when combined with exercise weight loss was much more than LCD only.