Energy Balance Equation
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5 Energy Balance Equation Intake Expenditure Hunger Satiety Nutrient Absorption Metabolic Rate Thermogenesis Activity
6 Eat to Live! Live to Eat!
7 EAT TO LIVE Intake = Expenditure Weight Stable LIVE TO EAT Intake > Expenditure Obese
8 Body Energy Stores of a Lean 70-kg Man Liver triglyceride = 450 kcal Muscle triglyceride = 3000 kcal Liver glycogen = 400 kcal Muscle glycogen = 2500 kcal Adipose tissue triglyceride 120,000 kcal
9 Initial Body Fat Mass (kg) Effect of Fat Mass on Survival During Starvation Lean men (66 kg) Obese man (207 kg) kg 102 kg Body Fat 60 d 382 d Survival Duration of Fast (d) Stewart and Fleming. Postgrad Med J 1973;49:203. Leiter and Marliss. JAMA 1982;248:2306.
10 High-Tech increases Body Weight Cellular phones and remote controls deprive us from walking! 20 times daily x 20 m = 400 m Walking distance lost/year 400x365 = 146,000 m 146 km = 25 h of walking 1 h of walking = kcal Energy saved = kcal kg adipose tissue
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12 Odds Ratio Obesity increases Risk for Diabetes Most (BMI >35 vs <22 kg/m 2 ) Males BMI <22.0 Females 77,690 females and 46,060 males adjusted for age, smoking, race, 10-year risk Gallstones 4.2 BP Coronary Disease Diabetes Field AE, Arch Intern Med 2001;161:1581-6
13 Obesity related conditions Diabetes Mellitus Nurse s Health Study Obesity Diabetes BMI kg/m 2 BMI > 35 kg/m 2 Risk of T2 DM Compare with BMI < 22 kg/m 2 28-fold increase 93-fold increase Colditz G et al. Am J Epidemiol 1990;132:
14 Relative Risk Relationship Between Weight Gain in Adulthood and Risk of Type 2 Diabetes Mellitus 6 5 Men Women Weight Change (kg) Willett et al. N Engl J Med 1999;341:427.
15 Obesity as a predictor of deterioration in all components of the Metabolic Syndrome HDL Cholesterol p<0.05 p<0.01 p<0.001 Insulin Sensitivity Fasting Plasma Glucose Obesity Systolic Blood Pressure 2-h Post Load Plasma Glucose Triglycerides From AusDiab study
16 Do components of the Metabolic Syndrome predict an increase in obesity? HDL Cholesterol p<0.05 p<0.01 p<0.001 Insulin Sensitivity Fasting Plasma Glucose Obesity Systolic Blood Pressure 2-h Post Load Plasma Glucose Triglycerides From AusDiab study
17 LeRoith, Diabetes Mellitus, A Fundamental and Clinical Text Reduction in Incidence of DM compared to Control Diet Exercise Da Quing Diet & Exercise Life Style Arcabose FDPS STOP NIDDM Life Style DPP Metformin
18 XENDOS (XENical in the Prevention of Diabetes in Obese Subjects) L. Sjöström, J.S. Torgerson, J. Hauptman, M. Boldrin
19 Diabetes Prevention Program Cumulative incidence of diabetes (%) Placebo Metformin Lifestyle Year Lifestyle + Xenical? DPP. N Engl J Med 2002; 346:
20 XENDOS study design Xenical 120 mg t.i.d + lifestyle Screening Baseline examinations Placebo t.i.d + lifestyle Double-blind treatment Day -21 Day -14 Day 1 Week 208
21 XENDOS results ; Effect of Xenical on body weight Change in weight (kg) 0 Placebo + lifestyle Xenical + lifestyle kg -6.9 kg p<0.001 vs placebo Week
22 Diabetes Prevention Program Cumulative incidence of diabetes (%) 40 XENDOS - IGT at baseline patients a Placebo + lifestyle Xenical + lifestyle Placebo Metformin DPP lifestyle RR 52% Year a. Confirmed diagnosis - FBG test ( 6.1 mmol/l), 2h OGTT ( 10 mmol/l) or 2 consecutive FBG tests ( 6.1 mmol/l). DPP. N Engl J Med 2002; 346:
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24 Yoon KH et al. Lancet 2006; 368:
25 DIABETES FACT SHEET IN KOREA 2012
26 DIABETES FACT SHEET IN KOREA 2012
27 DIABETES FACT SHEET IN KOREA 2013
28 The Body shape of Type 2 Diabetes in Korea is changing rapidly!! Yonchon study, 1997 Mokdong study, 1997 Chongup study, 2000 Ansan study ; mean BMI : 23.8 ± 3.2 kg/m Kim DJ et al ; mean BMI : 24.7 ± 3.2 kg/m ~ 2008 PEAM study ; 25.64±3.21 kg/m 2
29 InSUlin Resistance as Primary pathogenesis in newly diagnosed, drug naïve type 2 diabetes patients in Korea SURPRISE study JW Son, CY Park, SR Kim, In Press
30 SURPRISE study Aim : To investigate whether insulin resistance is the primary pathogenesis in newly diagnosed, drug naïve type 2 diabetes mellitus in Korea 1,314 patients SURPRISE study was a nationwide, cross-sectional primary care unit-based study JW Son, CY Park, SR Kim, In Press
31 Primary endpoint The prevalence of insulin resistance - insulin resistance was defined as HOMA-IR>2.5 Secondary endpoint The prevalence of insulin deficiency - insulin deficiency was defined as C-peptide < 1.1ng/ml The prevalence of metabolic syndrome - modified ATPIII Correlation : Insulin resistance - metabolic syndrome - obesity JW Son, CY Park, SR Kim, In Press
32 Summary of HOMA-IR>2.5, C-peptide<1.1, metabolic syndrome and obesity Variables N n(%) 95% CI HOMA-IR (59.5) (56.9, 62.2) C-peptide 1.1ng/ml (3.3) (2.3, 4.2) Metabolic syndrome (70.6) (68.2, 73.1) Obeisty (BMI 25kg/m 2 ) Central obesity (WC; M 90cm, F 85cm) (49.8) (47.1, 52.6) (49.8) (47.1, 52.6) JW Son, CY Park, SR Kim, In Press
33 C-peptide & BMI Variables N=1314, n(%) Severe (<1.1 ng/ml) 43 (3.3) C-peptide Moderate ( ng/ml) 233 (17.7) Mild to non-secretory defect ( 1.7 ng/ml) 1038 (79.0) Lower body weight (<18.5 kg/m 2 ) 13 (1.0) Normal weight ( kg/m 2 ) 285 (21.7) BMI Overweight ( kg/m 2 ) 361 (27.5) Stage I obesity ( kg/m 2 ) 569 (43.3) Stage II obesity ( 30.0 kg/m 2 ) 86 (6.5) JW Son, CY Park, SR Kim, In Press
34 Demographic and clinical characteristics Variables HOMA 2.5 HOMA>2.5 Total p-value* Sex Age Bwt ( kg) BMI(kg/m 2 ) M F N n(%) n(%) (50.9) 261(49.1) (54.0) 360(46.0) (52.7) 621(47.3) N Mean[SD] [11.5] [11.7] [11.6] 65 n(%) 404(75.9) 601(77.0) 1005(76.5) 65 n(%) 128(24.1) 180(23.0) 308(23.5) N Mean[SD] 64.5[9.6] 69.0[11.6] 67.2[11.1] N Mean[SD] 24.3[2.8] 25.9[3.3] 25.2[3.2] BMI ~22.9 n(%) 169(31.8) 129(16.5) 298(22.7) BMI 23.0 ~ 24.9 n(%) 161(30.3) 200(25.6) 361(27.5) < < < WC (cm) Metabolic Syndrome BMI 25~ n(%) 202(38.0) 453(57.9) 655(49.8) N Mean[SD] 85.6[10.1] 88.7[9.2] 87.5[9.7] 1~ N n(%) n(%) n(%) n(%) (36.5) 185(34.8) 112(21.1) 41(7.7) (24.4) 245(31.3) 229(29.3) 117(15.0) (29.3) 430(32.7) 341(26.0) 158(12.0) < < MetS n(%) 222(41.7) 395(50.5) 617(47.0) JW Son, CY Park, SR Kim, In Press
35 The relationship of HOMA-IR with C- peptide, metabolic syndrome and obesity Variables HOMA-IR 2.5 N=532, n(%) HOMA-IR>2.5 N=782, n(%) P C-peptide < 1.1ng/ml 38(7.1) 5(0.6) 1.1ng/ml 494(92.9) 777(99.4) < Metabolic syndrome Yes 337(63.3) 591(75.6) No 195(36.7) 191(24.4) < Obesity Yes 202(38.0) 453(57.9) No 330(62.0) 329(42.1) < JW Son, CY Park, SR Kim, In Press
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43 G. A. Nichols Diabetes, Obesity and Metabolism, 9, 2007,
44 Despoina Vasilakou,Ann Intern Med. 2013;159:
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46 Michael A.Curr Atheroscler Rep (2013) 15:366
47 Harold E. Lebovitz OBES SURG (2013) 23:
48 Harold E. Lebovitz OBES SURG (2013) 23:
49 Harold E. Lebovitz OBES SURG (2013) 23:
50 Harold E. Lebovitz OBES SURG (2013) 23:
51 Harold E. Lebovitz OBES SURG (2013) 23:
52 Harold E. Lebovitz OBES SURG (2013) 23:
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