Energy Balance Equation Intake Expenditure Hunger Satiety Nutrient Absorption Metabolic Rate Thermogenesis Activity
Eat to Live! Live to Eat!
EAT TO LIVE Intake = Expenditure Weight Stable LIVE TO EAT Intake > Expenditure Obese
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
Initial Body Fat Mass (kg) Effect of Fat Mass on Survival During Starvation Lean men (66 kg) Obese man (207 kg) 120 100 80 60 40 20 0 12 kg 102 kg Body Fat 60 d 382 d Survival 400 300 200 100 0 Duration of Fast (d) Stewart and Fleming. Postgrad Med J 1973;49:203. Leiter and Marliss. JAMA 1982;248:2306.
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 = 113-226 kcal Energy saved =2800-6000 kcal 0.4-0.8 kg adipose tissue
Odds Ratio Obesity increases Risk for Diabetes Most (BMI >35 vs <22 kg/m 2 ) 50 30 5 4 3 2 1 0 Males BMI <22.0 Females 77,690 females and 46,060 males adjusted for age, smoking, race, 10-year risk 3.3 3.7 Gallstones 4.2 BP 2.9 2.4 1.7 Coronary Disease 41.2 30.1 Diabetes Field AE, Arch Intern Med 2001;161:1581-6
Obesity related conditions Diabetes Mellitus Nurse s Health Study Obesity Diabetes BMI 29-31 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;132:501-13.
Relative Risk Relationship Between Weight Gain in Adulthood and Risk of Type 2 Diabetes Mellitus 6 5 Men Women 4 3 2 1 0-10 -5 0 5 10 15 20 Weight Change (kg) Willett et al. N Engl J Med 1999;341:427.
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
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
LeRoith, Diabetes Mellitus, A Fundamental and Clinical Text Reduction in Incidence of DM compared to Control -20-40 -60 Diet Exercise Da Quing Diet & Exercise Life Style Arcabose FDPS STOP NIDDM Life Style DPP Metformin
XENDOS (XENical in the Prevention of Diabetes in Obese Subjects) L. Sjöström, J.S. Torgerson, J. Hauptman, M. Boldrin
Diabetes Prevention Program Cumulative incidence of diabetes (%) 40 30 20 Placebo Metformin Lifestyle 10 0 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Year Lifestyle + Xenical? DPP. N Engl J Med 2002; 346: 393-403
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
XENDOS results ; Effect of Xenical on body weight Change in weight (kg) 0 Placebo + lifestyle Xenical + lifestyle -3-6 -9-12 -4.1 kg -6.9 kg p<0.001 vs placebo 0 52 104 156 208 Week
Diabetes Prevention Program Cumulative incidence of diabetes (%) 40 XENDOS - IGT at baseline patients a 30 20 10 Placebo + lifestyle Xenical + lifestyle Placebo Metformin DPP lifestyle RR 52% 0 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 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: 393-403
Yoon KH et al. Lancet 2006; 368: 1681 88
DIABETES FACT SHEET IN KOREA 2012
DIABETES FACT SHEET IN KOREA 2012
DIABETES FACT SHEET IN KOREA 2013
The Body shape of Type 2 Diabetes in Korea is changing rapidly!! - 1993 Yonchon study, 1997 Mokdong study, 1997 Chongup study, 2000 Ansan study ; mean BMI : 23.8 ± 3.2 kg/m 2-2005 Kim DJ et al ; mean BMI : 24.7 ± 3.2 kg/m 2-2007~ 2008 PEAM study ; 25.64±3.21 kg/m 2
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
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
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
Summary of HOMA-IR>2.5, C-peptide<1.1, metabolic syndrome and obesity Variables N n(%) 95% CI HOMA-IR 2.5 1314 782(59.5) (56.9, 62.2) C-peptide 1.1ng/ml 1314 43(3.3) (2.3, 4.2) Metabolic syndrome 1314 928(70.6) (68.2, 73.1) Obeisty (BMI 25kg/m 2 ) Central obesity (WC; M 90cm, F 85cm) 1314 655(49.8) (47.1, 52.6) 1314 655(49.8) (47.1, 52.6) JW Son, CY Park, SR Kim, In Press
C-peptide & BMI Variables N=1314, n(%) Severe (<1.1 ng/ml) 43 (3.3) C-peptide Moderate (1.10-1.69 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 (18.5-22.9 kg/m 2 ) 285 (21.7) BMI Overweight (23.0-24.9 kg/m 2 ) 361 (27.5) Stage I obesity (25.0-29.9 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
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(%) 532 271(50.9) 261(49.1) 782 422(54.0) 360(46.0) 1314 693(52.7) 621(47.3) N Mean[SD] 532 55.8[11.5] 781 55.3[11.7] 1313 55.5[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 532 782 1314 Mean[SD] 64.5[9.6] 69.0[11.6] 67.2[11.1] N 532 782 1314 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) 0.2811 0.4399 0.6707 <0.0001 <0.0001 <0.0001 WC (cm) Metabolic Syndrome BMI 25~ n(%) 202(38.0) 453(57.9) 655(49.8) N 530 781 1311 Mean[SD] 85.6[10.1] 88.7[9.2] 87.5[9.7] 1~2 + 3 + 4 + 5 + N n(%) n(%) n(%) n(%) 532 194(36.5) 185(34.8) 112(21.1) 41(7.7) 782 191(24.4) 245(31.3) 229(29.3) 117(15.0) 1314 385(29.3) 430(32.7) 341(26.0) 158(12.0) <0.0001 <0.0001 MetS n(%) 222(41.7) 395(50.5) 617(47.0) 0.0017 JW Son, CY Park, SR Kim, In Press
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) <0.0001 Metabolic syndrome Yes 337(63.3) 591(75.6) No 195(36.7) 191(24.4) <0.0001 Obesity Yes 202(38.0) 453(57.9) No 330(62.0) 329(42.1) <0.0001 JW Son, CY Park, SR Kim, In Press
+ 3.3 + 1.8-2.4 + 5.0 G. A. Nichols Diabetes, Obesity and Metabolism, 9, 2007, 96 102
Despoina Vasilakou,Ann Intern Med. 2013;159:262-274.
Michael A.Curr Atheroscler Rep (2013) 15:366
Harold E. Lebovitz OBES SURG (2013) 23:800 808
Harold E. Lebovitz OBES SURG (2013) 23:800 808
Harold E. Lebovitz OBES SURG (2013) 23:800 808
Harold E. Lebovitz OBES SURG (2013) 23:800 808
Harold E. Lebovitz OBES SURG (2013) 23:800 808
Harold E. Lebovitz OBES SURG (2013) 23:800 808
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