The evaluation of obesity related quality of life

오은정 건국대학교 대학원 2018 국내석사

비만인구가 증가하면서, 비만관련 질환과 의료비용이 증가하고 있다. 비만은 적극적인 치료와 관리가 필요하며, 비만관련 삶의 질은 중요한 건강문제이다. 일차 진료를 위해 일개 대학병원 가정의학과에 내원한 환자들을 대상으로 키, 체중을 측정하였고, 인구사회학적 특성 및 비만관련 삶의 질에 관한 자가기록 설문지를 수집하였다. 96명의 환자들(19세이상 75세 이하)이 참여하였고, 그 중 53명은 남성이었다. 비만 군에서 현재 흡연자의 비율이 높았다. 비만이 아닌 환자 군에서, 자아 신체상이 비만한 경우, 신체건강 항목의 비만관련 삶의 질이 낮았다. 연령, 성별, 현재 흡연, 위험 음주, 신체 활동부족, 월 수입, 고혈압, 고지혈증, 당뇨병, 자아신체상을 보정 한 후, 다 변량 선형 회귀 분석 결과, 비만은 신체 건강 항목의 비만 관련 삶의 질에 영향을 주는 것으로 나타났다(p = 0.003, R2 = 0.128). 신체 건강 항목 외의 비만 관련 삶의 질은 인구사회학적인 특성 또는 생활습관 요인에 의해 영향을 받는 것으로 나타났다. 보다 다양한 인구집단을 대상으로 한 연구가 필요할 것으로 사료된다. The increased prevalence of obesity has led to increases in associated medical costs and the incidence of related diseases. Obesity management and the related quality of life are key concerns. Patients who visited a family medicine clinic at a university hospital for primary care underwent height and weight measurements. A self-reporting questionnaire that included questions from the Korean version of the Obesity-related Quality of Life (KOQOL) measure, along with items about health habits and socioeconomic factors, was administered. The KOQOL comprised 15 items regarding mental health (4 items), physical health (3 items), work and family affairs (3 items), daily life (2 items), sexual relationships (2 items), and the relationship with food (1 item). Ninety-six patients aged 19–75 years were analyzed. Fifty-three patients were male. The percentage of current smokers was higher in the obese group than in the non-obese group. The obese group had worse scores on KOQOL items related to physical health. Non-obese patients who considered themselves to be overweight also had worse KOQOL scores related to physical health. Obesity was a significant determinant of the physical health-related KOQOL score (p = 0.003, R2 = 0.128) in a multivariate linear regression model adjusted for age, sex, current smoking, risky alcohol consumption, physical inactivity, monthly income, hypertension, hyperlipidemia, diabetes, and self-body image. In summary, the physical health-related quality of life was found to be affected by obesity in a primary care setting. Other aspects in obesity-related quality of life were affected not by obesity but by socioeconomic or life style factors. Additional studies of diverse populations are needed.

Ergonomics Studies on Foot Reach Tasks for Obese Individuals

백승원 서울대학교 대학원 2022 국내박사

세계보건기구(World Health Organization)에 따르면, 비만이란 과도하게 신체에 지방이 축적된 물리적 상태로 정의된다. 비만을 정의하는 변수 중 널리 쓰이는 것으로 BMI(Body mass index)가 있으며, 체중을 키의 제곱으로 나눈 값으로 계산된다. BMI가 30 이상인 경우 비만으로 분류되고, 35 이상인 경우 고도비만으로 분류된다. 비만 인구는 매년 증가하는 추세로, WHO에 따르면 2016년 성인 중 19억명이 과체중(BMI 25 이상 30 이하)에 해당한다. 이 중 6억 5천만명이 비만으로 분류되어, 전체 성인 중 13%에 달한다. 2020년 기준 5세 이하의 아동 3900만명이 과체중이거나 비만인 것으로 추정되며, 3억 4천만명의 청소년 인구도 과체중이거나 비만으로 집계되고 있어 앞으로도 계속 비만인구는 증가할 것으로 예측되었다. 비만인구가 증가함에 따라 비만인 작업자의 비율도 꾸준히 증가하고 있으며, 결국 비만으로 발생하는 작업자의 능률 및 지각불편도에 대한 연구가 점점 더 필요한 실정이다. 많은 일상 생활과 작업활동에서 인간은 계속해서 육체적 과업 또는 자세를 유지하는 과업을 수행하고 있다. 따라서, 비만인들이 이런 육체적 과업을 수행할 때, 어떠한 양상을 보이는지에 대해 연구하는 것은 매우 중요하다고 할 수 있다. 기존 인간공학 연구에서 비만 관련 연구는 주로 자세 유지나 걷기 등과 같은 기초적인 것에 국한되어 있었다. 위에서 언급한 중요성에도 불구하고, 아직까지 일반적인 과업을 수행할 때, 비만이 신체적 능력 및 불편도에 어떠한 영향을 미치는지에 대한 연구는 미흡한 실정이다. 특히, 발 도달 작업 같은 기본적인 동작 같은 경우에도 비만의 영향을 알아본 연구는 전무하다. 따라서, 본 연구의 목적은 발 도달 작업에서 비만이 미치는 영향에 관해 파악하는 것이다. 이러한 연구 목적의 달성을 위해 크게 3가지 주요 연구가 수행되었다. 연구 1에서는 앉은 자세에서 발 도달 작업을 수행할 때 비만이 미치는 영향에 대해서 파악하였다. 비만인 그룹과 일반인 그룹을 모집하여 다양한 타겟의 위치 배치에 따른 발 도달 능력을 알아보았다. 실험 결과, 비만인 그룹과 일반인 그룹간 반응 시간, 이동 시간, 과업 수행 시간에 통계적으로 유의한 차이가 나타남을 확인할 수 있었다. 지각불편도는 비만인 그룹과 일반인 그룹간 유의한 차이가 나타나지 않았다. 연구 2에서는 연구 1의 확장으로 자세 요인을 추가적으로 넣어 실험을 수행하였다. 기존 연구 1의 데이터를 활용하여, 추가적인 비만인 모집을 수행한 후 데이터 수집을 진행하였다. 실험 분석 결과, 서 있는 자세에서도 앉은 자세와 마찬가지로 비만의 영향이 나타남을 확인할 수 있었다. 앉은 자세에서 먼 거리를 이동하는 발 도달 과업의 경우, 더 많은 이동 시간이 발생함을 알 수 있었다. 앉아 있는 자세에서 발 도달 과업을 수행할 때 지각불편도가 더 큰 값을 보임을 관측하였다. 연구 3에서는 연구1, 2의 결과 데이터를 통해 예측 발 도달 과업 범위를 제안하는 연구를 수행하였다. 기존 도달 범위 모델의 경우 대부분 손을 활용한 도달 범위를 제안하는 경우가 많았다. 일부 모델 생성 연구에서 최적 발 도달 범위를 제안하는 연구가 있었지만, 비만과 같은 인적 변수를 고려하지 않고 신체치수 등과 같은 변수만을 활용하였다. 본 연구의 데이터를 활용하여, 인적 요인에 따른 최적 발 도달 범위값을 제안하였다. 회귀분석을 통해 수행시간과 불편도에 대한 높은정확도의 예측추정식을 제안하였다. 앉은 자세일 때 수용될 수 있는 최대기준값이 더 작게 나타나는 것으로 보이며, 이를 고려한 발 도달 작업 가이드라인을 제시하였다. 본 연구의 결과를 통해 비만이 발 도달 과업에서 미치는 영향에 대한 이해를 향상시켰으며, 비만인 작업자들을 위해 최적의 발 도달 작업을 할 수 있는 작업장 설계에 도움이 되는 방법론을 제시하였다. 또한, 본 연구를 통해 기존 발 도달 작업 관련 인간공학 분야에 도움이 되는 지식을 제공할 수 있을 것으로 기대하고 있다. 비만이 발 도달 작업에 미치는 영향을 알 수 있게 되며, 발 도달 작업에서 발생하는 주관적 불편도에 대한 예측 모델을 생성할 때 비만요인과 작업자세를 적용할 수 있을 것으로 기대하고 있다. 또한 본 연구를 통해 실제 산업현장에서 비만인을 위한 작업 설계를 도와줄 수 있을 것이다. 추후 여성 작업자들의 발도달 작업 데이터를 수집하여 모든 작업자들에 대한 디지털 휴먼 모델링을 생성하는 것을 기대하고 있다. 비만인들의 부상 및 근골격계 질환 위험을 예방하여 경제적 이득을 가져올 수 있으며, 실제 비만인 작업자의 능률을 향상시켜 작업자의 사용자경험(UX) 개선에 도움이 될 것으로 기대하고 있다. Obesity is prevalent worldwide and the obese population continues to increase. Therefore, research is needed to find out the impacts of obesity in basic tasks, and, it could help with ergonomic design in the workplace. Existing ergonomic studies have examined the basic physical abilities of obese people, such as walking and balancing. Through an understanding of the physical capabilities of obese individuals, it is possible to design a workplace that is suitable for obese individuals. Foot reach work is a basic movement that occurs frequently in the workplace. In light of the results of ergonomic research related to obesity, it is possible that the foot reach task will exhibit a different result. Despite the importance mentioned above, understanding how obesity impacts physical performance and discomfort rating is still insufficient. Particularly, no studies have been found that have examined the effects of obesity on foot reach. Therefore, this study aims to investigate the impact of obesity on foot reach and develop a method to improve the performance of obese groups. To accomplish the objectives, three major studies were conducted. In the study 1, the impact of obesity was investigated in the foot target reach in a seated position. Task performance and discomfort rating data were analyzed. The differences between the participant groups (non-obese, obese) were compared statistically. It was found that the obese group had a statistical difference from the non-obese group in reaction time, movement time, and task completion time. In terms of discomfort rating, there was no significant difference between the obese and the non-obese group. In the study 2, the impact of obesity in standing posture was investigated as an expanding study of study 1. In the standing position, the movement time decreased, but the reaction time increased. There was no significant interaction effect between participant group and posture factors. Foot reach in a seated position was more uncomfortable. As a result of task performance time analysis, a significant interaction effect between posture and target distance was observed. In the study 3, a study was conducted to propose the prediction model. It describes the possible range of foot reach for workers using the existing prediction model. Task performance time data is used to present an area that optimizes the foot reach task of obese/non-obese workers. It was found that obese people have a smaller foot reach area. The above-mentioned findings investigate the impact of obesity on foot reach task and provide an understanding that helps design workplaces for obese people. Based on the findings from study 1, it was possible to understand how obesity affects foot reach in a seated position. The findings provided in the study 2 would be helpful to provide an understanding of the possible changes in performance in standing posture. The results of study 3 provide inspiration for workplace improvements for obese workers. For obese workers, it is possible to propose increasing the size of the target where the reduced foot reach performance is evident.

골관절염 노인에서 근감소성 비만과 슬관절전치환술 후 하지기능과의 관계

문수희 제주대학교 대학원 2021 국내석사

This retrospective study aimed to investigate the prevalence of obesity,sarcopenia, and sarcopenic obesity in elderly patients with osteoarthritis, todetermine the relationship between obesity, sarcopenia, sarcopenic obesity, andlower limb function in these patients after total knee arthroplasty, and toprovide basic data for the development of nursing intervention for therehabilitation of lower limb function in the elderly who had undergone totalknee arthroplasty.This study analyzed the data obtained from the medical records of 986patients who underwent total knee arthroplasty and rehabilitation treatmentfor knee osteoarthritis in a university hospital with >600 beds between June2014 and December 2019. We excluded 329 patients who underwent total kneearthroplasty on both knees at the same time and 397 patients who were notevaluated before or after surgery. Altogether, the medical records of 260patients were reviewed for data analysisThe collected data were analyzed using the SPSS 23.0 program. Weperformed χ2-test and covariance analysis (ANCOVA) to examine thedifferences in obesity, sarcopenia, sarcopenic obesity, and lower limb functionafter total knee arthroplasty. Analysis of covariance (ANCOVA) was used toexamine the relationship between obesity, sarcopenia, sarcopenic obesity, andlower limb function after total knee arthroplasty. Post-test was used formultiple comparisons using the Bonferroni correction.The results of this study are as follows1) The patients’ average age was 72.7(±4.59) years, and most of the patientswere female(n=225, 86.5%). The average Number of diagnosed diseases was4.18(±1.76), and the number of drugs during hospitalization was 8.00(±2.98),with 87.3% of the patients taking ≥5 drugs per day.2) The prevalence of obesity was 51.2%, with 23.1% of the patients beingoverweight and 11.2% having extremity obesity. The prevalence of sarcopeniaand sarcopenic obesity was 15.4% and 6.2%.3) When comparing the prevalence of obesity, sarcopenia, and sarcopenicobesity characteristics of the participants and disease-related characteristics,type of insurance(χ2=8.39, p=.020) and education(χ2=17.57, p=.007) werestatistically significantly different among patients classified according to thedegree of obesity. age(χ2=9.97, p=.002), gender(χ2=4.88, p=.027), Cohabitant(χ2=7.57, p=.006), type of insurance(χ2=6.68, p=.023), and education(χ2=17.46,p<.001) were significantly different between patients with and withoutsarcopenia. Age(χ2=5.87, p=.015) and education(χ2=15.31, p<.001) weresignificantly different between patients with and without sarcopenic obesity.4) When comparing the lower limb function after total knee arthroplastyaccording to characteristics of the participants among their disease-relatedcharacteristics, the flexion angle was statistically significantly different amongpatients classified according to the number of drugs(F=4.47, p=.004) duringhospitalization. isometric knee flexor and extensor strength was significantlydifferent among patients stratified by gender(F=11.05, p=.001; F=10.54, p=.001)and job(F=9.56, p=.002; F=11.65, p=.001). TUG was statistically significantlydifferent among patients stratified by age(F=4.66, p=.032), education(F=7.15,p=.001), Kellgren Lawrence grade(F=7.19, p=.008), and Number of paindrugs(F=4.51, p=.035) during hospitalization. The time to stairs ascending aftertotal knee arthroplasty was statistically significantly different amongcharacteristics of the participants, job(F=8.55, p=.004), type of insurance(F=4.92,p=.027) and education(F=5.14, p=.007). as well as according to theirdisease-related characteristics, Kellgren Lawrence grade(F=5.22, p=.023) andNumber of diagnosed diseases(F=2.80, p=.041). The time to stairs descendingafter total knee arthroplasty was significantly different among characteristicsof the participants age(F=4.65, p=.032), job(F=8.75, p=.003), education(F=5.47,p=.005), Kellgren Lawrence grade(F=6.95, p=.009), Number of diagnoseddiseases(F=3.75, p=.012), and number of drugs(F=3.15, p=.026) duringhospitalization.There was a statistically significant difference 6MWT before total kneearthroplasty among characteristics of the participants gender(F=10.14, p=.002),job(F=4.89, p=.028), education(F=7.32, p=.001), and among disease-relatedcharacteristics number of diagnosed diseases(F=4.44, p=.005). The gait speed wasstatistically significantly different among characteristics of the participantsaccording to gender(F=4.46, p=.036), job(F=7.78, p=.006), and education(F=5.40,p=.005). There was no statistically significant difference in the K-WOMACamong characteristics of the participants and disease-related characteristics.There was a significant difference in the pain score among of the participantsdisease-related characteristics according to the number of drugs(F=3.44,p=.017) during hospitalization.5) Among the lower limb functions after total knee arthroplasty Knee JointRange of Motion extension angle(F=4.50, p=.004), stairs ascending(F=2.73,p=.045) and stairs descending(F=2.74, p=.044), 6MWT(F=5.02, p=.002) werestatistically significantly different according to the degree of obesity.6) Among the lower limb functions after total knee arthroplasty Knee JointRange of Motion flexion angle(F=5.143, p=.024), isometric knee extensorstrength(F=4.522, p=.034), and stairs descending(F=6.089, p=.014) werestatistically significantly different between patients with and withoutsarcopenia.7) Among the lower limb functions after total knee arthroplasty, isometricknee flexor strength(F=3.97, p=.047), TUG(F=5.83, p=.016), stairsascending(F=6.98, p=.009) and stairs descending(F=8.96, p=.003) werestatistically significantly different between patients with and withoutsarcopenic obesityIn summary, the prevalence of obesity, sarcopenia, and sarcopenic obesitywas high in women and elderly patients. obesity, sarcopenia, and sarcopeniawere all identified as variables that negatively affect the lower limb functionof elderly patients with osteoarthritis who had undergone total kneearthroplasty. For the elderly with obesity, sarcopenia, or sarcopenic obesity,the risk of complications after total knee arthroplasty is high, and there maybe a high risk of physical function limitations and falling, along with delayedrecovery of lower limb function. Thus, comprehensive assessment andmanagement, including evaluation of risk factors for obesity, sarcopenia, andsarcopenic obesity, should be considered in elderly patients with osteoarthritiswho are scheduled to undergo total knee arthroplasty. In addition, to reducethe risk of complications after total knee arthroplasty and to promote therecovery of lower limb function in elderly patients with obesity, sarcopenia,and sarcopenic obesity, it is necessary to provide long-term comprehensiveexercise interventions pre operatively until 1 year postoperatively.

Effect of Lactobacillus plantarum LRCC5282 on modulation of the gut microbiota and alleviates obesity

윤석민 중앙대학교 대학원 2022 국내박사

본 연구에서는 Lactobacillus plantarum LRCC5282의 비만 조절과 관련하여 in vitro와 in vivo 수준에서 그 효능을 조사하였다. In vitro에서는 3T3-L1 cell을 이용하여 lipid accumulation rates와 triglyceride를 측정한 결과, LRCC5282를 투여한 실험군에서는 대조군 대비하여 각각 41.2%, 73.4%로 감소하였다. 또한 지방세포로의 분화와 관련된 mRNA발현량을 측정하였으며, LRCC5282 투여 시 adiponectin, PPAR/γ, CEBP/α, FAS expressions이 각각 0.33%, 15.34%, 2.07%, 7.27%로 감소하였다. 고지방식이로 비만을 유도한 동물을 이용하여 LRCC5282의 비만 예방 효능을 평가하였다. 10주간의 동물실험 결과, PBS만을 투여한 대조군에서는 초기 대비하여 체중은 24.49g, BMI는 약 90.5% 증가하였다. 반면 LRCC5282 투여 시엔 초기 대비하여 체중은 15.79g, BMI는 약 51.0% 증가하여 뚜렷한 체중 저감 효과를 보였다. 또한 실험종료 후의 지방조직을 적출하여 white 및 brown 지방무게를 측정하였으며, neck, subcutaneous, epididymal 지방조직은 대조군 대비하여 각각 약 68.7%, 74.6%, 62.9%로 감소하였으나 brown 지방은 약 64.4% 증가하였다. 혈청 내 ALT와 AST를 비롯하여 cholesterol(total, LDL)과 triglyceride 분석 결과 역시 대조군 대비하여 뚜렷한 감소를 나타내었다. 또한 leptin을 비롯하여 adiponectin, PPAR/γ 등 지방세포 분화 관련 지표들도 대조군 대비하여 뚜렷하게 감소한 것으로 나타나, 3T3-L1 cell을 이용한 in vitro 결과와 일치함을 보였다. 동물 실험군별로 분변 마이크로바이옴을 비교한 결과, 대조군을 제외한 모든 그룹에서 alpha diversity가 증가하였으며, LRCC5282를 투여한 그룹에서 observed OTUs 및 Chao1에서 유의적인 차이를 보였다. 또한 Weighted UniFrac기반 군집 간 차이(Beta diversity)의 경우에는 그룹 간 유의한 차이를 나타내었다. Taxonomy의 phylum수준을 비교하였을 때 LRCC5282를 투여한 그룹에서 Firmicutes, Proteobacteria, Bacteroidetes가 증가한 것으로 나타났다. Genus 수준에서는 LRCC5282 투여 시 Alistipes와 Lactococcus, Lactiplantibacillus가 증가하였으며, Acetatifactor 및 Lachnoclostridium는 대조군 대비 낮은 것으로 나타났다. 따라서 LRCC5282가 in vitro는 물론 in vivo 비만 유도 동물에서도 우수한 비만 개선 효과를 보유하고 있음을 입증하였고, 이후의 연구를 통하여 potential therapeutic agent, pharma-biotics로도 제공이 가능할 것으로 제안한다. In this study, in vitro and in vivo assays were performed to examine the effects of Lactobacillus plantarum LRCC5282 administration on obesity. The lipid accumulation rate and triglyceride levels in the LRCC5282-treated 3T3-L1 cells decreased by 41.2% and 73.4%, respectively, compared with those in the control 3T3-L1 cells. In addition, LRCC5282 decreased the mRNA expression levels of adipogenesis-related genes including FAS, PPAR/γ, CEBP/α in the 3T3-L1 cells. In vivo study for evaluation of LRCC5282 administration on obesity was performed using obesity induced mouse model by high-fat-diet. As a result of the animal experiment for 10 weeks, the body weight and BMI increased by 24,49 g, 90.5% compared to the initial, respectively. In contrast, in the animal group administered with LRCC5282, body weight and BMI was increased by 15.97g, 51.0% compared to initial, respectively. In addition, the adipose tissue was extracted from sacrificed animals and weight of tissue were measured. Compared to the control group, the white tissue in neck, subcutaneous, and epididymal in LRCC5282 group was decreased by 68.7%, 74.6%, and 62.9%, respectively, whereas brown tissue was increased by 64.4% The effect of LRCC5282 on liver toxicity and hyperlipidemia was also determined. The levels of alanine aminotransferase, aspartate aminotransferase, total cholesterol, low-density lipoprotein-cholesterol, and triglyceride in serum was decreased in the LRCC5282 group, compared to those in the control group. Additionally, the mRNA levels of leptin, adiponectin, and PPAR/γ, which were related to adipogenesis, were decreased in the LRCC5282 group also, which was consistent with the results of in vitro assays performed using 3T3-L1 cells. The gut microbiota was analyzed to find out the correlation between changes in microbiota composition and obesity symptoms in vivo. The group administered with LRCC5282 showed a significantly different pattern from the control group in the microbiome diversity including α- and β-. In addition, the relative abundances of microbiota were analyzed at the phylum and genus levels. At the phylum level, The Firmicutes/Bacteroidetes ratio decreased to 3.0% in the LRCC5282 group, compared to the control group, which was 3.9%. Moreover, the relative abundances of Erysipelatoclostridium, Oscilibacter, and Acetatifactor, which are associated with obesity, were decreased in LRCC5282 group, whereas those of Lactobacillus and Lactiplantibacillus, which are involved in immune-modulatory, were increased. Therefore, it has been demonstrated that LRCC5282 has an excellent anti-obesity effect in in vitro as well as in vivo obesity-inducing animals, and suggests that it can be provided as a potential therapeutic agent, pharma-biotics in further studies.

비만기준에 따른 의료비 지출 크기 비교 연구 : 경기·인천지역 비만사업 성인 중심으로

고민경 연세대학교 보건대학원 2005 국내석사

산업화에 따른 급속한 경제발전으로 생활양식이 편리해지고 식생활이 서구화 됨에 따라 비만은 중요한 건강상의 문제로 대두되고 있다. 비만은 전세계적으로 큰 유행이 되었고, 지금까지 많은 연구는 비만환자가 전세계적으로 급격히 늘고 있음을 보여주고 있으며, 이러한 상황이 보다 악화될 것을 시사하고 있다. 국내에서도 지난 십여년간 비만환자 수가 빠른 속도로 증가하여 국민 건강관리체계에 큰 부담으로 작용하고 있다.비만은 또한, 만성퇴행성질환인 고혈압, 만성심질환, 뇌경색, 당뇨병, 이상지혈증, 통풍, 골관절염, 요통, 담낭질환, 대장암, 유방암 등의 발생과 밀접한 관련이 있어서 보건학적 측면에서 그 중요성이 매우 크다고 할 수 있다.본 연구에서는 비만에 영향을 줄 수 있는 요인을 살펴보고, 비만기준에 따른 의료비 지출의 크기 비교로 비만과 의료비의 상호관련성을 파악하고자 한다. 이를 통해 국민건강보험공단의 비만사업과 재정안정 및 정책결정에 있어 기초 자료로 제공하고자 한다.본 연구는 비만기준에 따른 과거 의료이용의 크기를 비교하기 위해 비만기준에 따른 비만관련질병 의료비와 총 의료비의 크기를 분석하였다. 2004년 4월 1일부터 2005년 4월 15일까지 국민건강보험공단 경인지역본부 비만사업에 참가한 6,898명을 대상으로 하였으며, 2001년부터 2004년 4년동안 국민건강보험공단의 건강검진 문진표와 3개 질병군 진료내역과 총 진료내역을 연계하여 의료비 지출의 크기를 비교한 연구로서 주요 결과는 다음과 같다.체질량지수 분포는 남자는 비만1단계가 많았고, 여자는 정상이 많았으며, 연령은 40세 미만에서는 정상이 많았고, 40세 이상에서는 비만1단계가 많았다.비만기준인 체질량지수, 허리엉덩이둘레비, 허리둘레에서 정상인 경우 보다 비만인 경우가 비만관련질병 의료비와 총 의료비 지출이 높았다. 체질량지수 비만2단계는 정상인 경우보다 현저하게 의료비 지출이 높았다.체질량지수에 따른 총 의료비는 정상 4,356천원, 비만1단계 5,173천원, 비만2단계 6,115천원으로 정상인 경우보다 비만1단계와 비만2단계가 평균지출이 높았고, 비만관련질병 평균 의료비는 과체중 1,388천원, 비만1단계 1,488천원, 비만2단계 2,849천원으로 과체중과 비만1단계보다 비만2단계가 평균지출이 높았다.허리엉덩이둘레비에 따른 총 의료비는 정상 3,790천원, 비만 5,930천원으로 정상인 경우보다 비만인 경우가 평균지출이 높았고, 비만관련질병 평균 의료비는 정상 1,490천원, 비만 1,820천원으로 정상인 경우보다 비만인 경우가 평균지출이 높았다.허리둘레에 따른 총 의료비는 정상 3,870천원, 비만 5,930천원으로 정상인 경우보다 비만인 경우가 평균지출이 높았고, 비만관련질병 평균 의료비는 정상 1,480천원, 비만 1,860천원으로 정상인 경우보다 비만인 경우가 평균지출이 높았다.이상의 결과를 종합해 볼 때, 비만기준에 따른 의료비 지출에 차이가 있었으며, 비만기준과 의료비의 상호관련성을 확인 할 수 있었다. 비만의 예방과 의료비 관리를 위해 비만의 위험에 대한 교육이 지속적으로 이루어져야 하겠다. Obesity is becoming an epidemic due to westernization of diet, improved lifestyle, and economic development. Obesity has become a global trend and to date, many studies reveal rapid increase in the number of people suffering from obesity, and an even greater number is expected. In the past decade, obesity in Korea has also rapidly increased and has become a national health issue.Obesity is closely related to the cause of serious diseases such as hypertension, chronic heart disease, diabetes mellitus, hyperlipidemia, cardiovascular disease, osteoarthritis, gallgladder, colon cancer, and breast cancer ; therefore, its significance is getting bigger on the pointof health sciences.This study will evaluate the causes of obesity, and will provide correlations between medical expenses based on obesity criteria. Also this study will provide basic information of financial requirements and obesity treatment policies of National Health Insurance Corporation.In order to compare the amount of medical expenses for obesity in the past, the obesity related diseases medical expenses and total medical expenses were analyzed. And 6,898 people had been participated in the research through the obesity clinics of Gyeongin Regional Headquarters of National Health Insurance Corporation from April 1, 2004 to April 15, 2005. Also medical check-up records, medical expenses for specified 3 disease group, and all the diagnosis records from National Health Insurance Corporation dating from 2001 to 2004 were examined, and the results of the study are as follows.In BMI(Body Mass Index) distribution, significant numbers of male patients were in obese class group I, while the majority of women were in normal group of BMI distributions. Based on age bracket, the majority of patients under the age of 40 were in normal group BMI distribution, and the majority of patients older than 40 years of age were in obese class group I.Patients with higher BMI(Body Mass Index), waist circumference and WHR(Waist-Hip Ratio) than the normal group spent higher medical expenses for treating obesity related diseases and also for the total medical expenses. Medical expenses for the patients in obese class group Ⅱ were much greater than normal group.Total medical expenses based on BMI were found to be 4,356,000KRW for normal group, 5,173,000KRW for obese class group Ⅰ, and 6,115,000KRW at obese class group Ⅱ, which shows medical expense increase with increased level of obesity. Medical expenses for treatment of obesity related diseases were 1,388,000KRW for the overweight, 1,488,000KRW for obese class group Ⅰ and 2,849,000KRW for obese class group Ⅱ. Average medical expenses for patients at obese class group Ⅱ were higher than for the patients in overweight group and obese class group Ⅰ.Total medical expenses based on WHR measure were 3,790,000KRW for normal group and 5,930,000KRW for the obesity group, showing higher average medical expenses for the obesity group than normal group. Average medical expenses for obesity related diseases were 1,490,000KRW for the normal group and 1,820,000KRW for the obesity group, higher than that of patients with normal group measurements.Total medical expenses based on waist circumference measure were 3,870,000KRW for normal group and 5,930,000KRW for the obesity group, which shows higher average medical expenses were spent for the obesity group than for the normal group. Average medical expenses for obesity related diseases were 1,480,000KRW for the normal group and 1,860,000KRW for the obesity group, which also proved higher average medical expenses were spent for the obesity group than normal group.In examining the results above, there are significant differences in medical expenses based on criteria of obesity. And the medical expenses and obesity criteria are mutually related. Hence the prevention of obesity and management of medical expenses and education of the dangers of obesity must be continued.

육군 간부의 건강행위, 직무스트레스와 비만과의 관계

김수연 연세대학교 대학원 2016 국내석사

본 연구는 육군 간부의 건강행위, 직무스트레스와 비만과의 관계를 파악하기 위한 서술적 상관관계 연구이다. 본 연구의 도구로 성인의 건강행위 측정도구(김애경, 1998), 한국인 직무스트레스 측정도구 단축형(장세진 등, 2005), 일반적 특성을 포함한 구조화된 설문지와 생리적 측정을 포함하였다. 자료수집은 2015년 10월 13일부터 11월 9일까지 전·후방 4개 부대에서 근무하는 140명의 육군 간부를 대상으로 하였으나 남성 육군 간부 114명의 자료가 분석에 이용되었다. SPSS 21.0 program을 이용하여 기술통계, χ2 test, Fisher’s exact test, t-test, ANOVA로 분석한 후 Scheffe test로 사후검증을 실시하였다. 연구결과는 다음과 같다. 1. 체질량지수 25kg/m2이상의 비만자는 42.1%인데, 체질량지수 30kg/m2이상의 고도비만자는 7.0%였고, 허리둘레 90cm이상의 복부비만자는 28.1%였다. 2. 체질량지수에 따른 비만군에서 자신의 체형을 비만하다고 인식한 대상자(χ2=79.923, p<.000), 몸무게가 늘었다고 인식한 대상자(χ2=22.817, p<.000), 폭음 빈도가 일주일에 1번 이상인 대상자(χ2=13.500, p<.01)와 유연성 운동을 전혀 하지 않는 대상자(χ2=10.306, p<.05)의 비율이 높았다. 허리둘레에 따른 복부비만군에서 최종 학력이 고졸인 대상자(χ2=4.698, p<.05), 자신의 체형을 비만하다고 인식한 대상자(χ2=39.344, p<.000), 몸무게가 늘었다고 인식한 대상자(χ2=10.759, p<.01)와 폭음 빈도가 한 달에 1번 정도인 대상자(χ2=7.396, p<.05)의 비율이 높았다. 3. 건강행위 점수는 120점 만점 중 평균 81.11±12.34점(평균평점 4점 만점 중 2.70±0.41점)으로 건강행위 수행정도가 높았다. 건강행위 영역 중 스트레스 관리 영역이 24점 만점 중 평균 19.15±2.71점(평균평점 4점 만점 중 3.19±0.45점)으로 수행정도가 가장 높았고 그 다음으로 기호품 제한 영역이 8점 만점 중 6.12±1.54점(평균평점 4점 만점 중 3.06±0.77점)이었으며 자연식 영역이 8점 만점 중 4.34±1.50점(평균평점 4점 만점 중 2.17±0.75점)으로 가장 수행정도가 낮았다. 4. 폭음빈도에 따라 건강행위 수행정도에 차이가 있었으나(F=3.350, p<.05) 사후 검정 결과 집단 간 차이는 없었고 수면 시간이 6시간 이상인 대상자가 6시간 미만인 대상자보다(F=6.198, p<.01), 근력 운동을 하는 대상자가 전혀 하지 않는 대상자보다(F=7.755, p<.01), 유연성 운동을 하는 대상자가 전혀 하지 않는 대상자보다(F=9.321, p<.000), 아침 식사 횟수가 주 5회 이상인 대상자가 거의 안하는 대상자보다(F=3.898, p<.05), 점심 식사 횟수가 주 5회 이상인 대상자가 주 5회 미만인 대상자보다(t=3.175, p<.01), 저녁 식사 횟수가 주 5회 이상인 대상자가 주 5회 미만인 대상자보다(t=2.034, p<.05), 외식 횟수가 월 1-8회인 대상자와 거의 안하는 대상자가 주 3-6회인 대상자보다(F=4.303, p<.01) 건강행위 수행정도가 높았다. 5. 직무스트레스는 100점 만점으로 환산한 결과 평균 34.40±11.09점으로 직무스트레스가 낮았다. 직무스트레스 영역 중 직무요구 영역이 평균 45.76±18.23점으로 가장 높았고 그 다음으로 직무자율성 결여 영역이 평균 43.49±13.88점이었으며 관계갈등 영역은 평균 25.34±16.43점으로 가장 낮았다. 직무스트레스 4분위 수에 따른 대상자 분포에서 본 연구대상자의 78.9%가 하위 24.99%에 해당되어 스트레스 관리가 필요한 대상자는 많지 않았으나 스트레스 관리가 요구되는 상위 25%에 속하는 대상자는 1.8%이었다. 6. 수면시간이 6시간 미만인 대상자가 6시간이상-8시간미만인 대상자보다(F=4.024, p<.05), 점심식사 횟수가 주 5회 미만인 대상자가 주 5회 이상인 대상자보다(t=-2.405, p<.05) 직무스트레스 점수가 높았다. 7. 체질량지수에 따른 과체중군은 정상군보다 운동 영역(F=3.620, p<.05)과 이완 영역(F=3.473, p<.05)의 건강행위 수행정도가 높았다. 허리둘레에 따른 복부비만군이 정상군보다 자연식 영역의 건강행위 수행정도가 낮았다(t=2.397, p<.05). 결론적으로 육군 간부의 비만 유병률은 42.1%이었고 건강행위는 점수는 높았으며 직무스트레스 점수는 낮았다. 육군 간부의 체질량지수에 따른 과체중군은 정상군보다 건강행위의 운동 영역, 이완 영역의 점수가 높았고, 허리둘레에 따른 복부비만군은 정상군보다 건강행위의 자연식 영역 점수가 낮았다. 따라서 육군 간부들의 비만 유병률을 낮추기 위한 지속적인 관리 프로그램의 개발이 필요하며 건강증진사업과 연계한 효율적인 비만 관리 전략 수립이 필요하다. This cross-sectional study was done to identify the relationship between health behaviors, occupational stress and obesity among Korean army officers and non-commissioned officers. A structured questionnaire was used to assess general characteristics, health behaviors, occupational stress and physiological measurement was conducted to survey the participants’ body mass index and waist circumference. Data were collected from October 13 to November 9, 2015. Participants were 140 Korean army officers and non-commissioned officers recruited from 4 army units. Data from 114 participants were used for statistical analysis. The collected data were analyzed using descriptive statistics, χ2 test, Fisher’s exact test, t-test, and ANOVA with SPSS/WIN Statistics 21.0. The major results are as follows: 1. The percentage of obese participants (over 25kg/m2 BMI) was 42.1% and extremely obese participants (over 30kg/m2 BMI), 7.0%. The percentage of abdominal obese participants (WC over 90cm) was 28.1%. 2. The association of participants’ characteristics to obesity was significantly different according to perception of body type (χ2=79.923, p<.000), weight change (χ2=22.817, p<.000), frequency of heavy drinking (χ2=13.500, p<.01) and number of days doing flexibility exercises (χ2=10.306, p<.05). The association of participants’ characteristics to abdominal obesity was significantly different according to education (χ2=4.698, p<.05), perception of body type (χ2=39.344, p<.000), weight change (χ2=10.759, p<.01) and frequency of heavy drinking (χ2=7.396, p<.05). 3. The mean score for health behavior was 81.11±12.34 of 120 points (average mean score was 2.70±0.41 of 4 points). The mean scores for the health behaviors, stress management, limiting smoking and drinking, and ingestion of natural food were 19.15±2.71 of 24 points (average mean scores were 3.19±0.45 of 4 points), 6.12±1.54 of 8 points (average mean scores were 3.06±0.77 of 4 points), 4.34±1.50 of 8 points (average mean scores were 2.17±0.75 of 4 points) respectively. 4. The association of participants’ characteristics to health behavior was significantly different according to frequency of heavy drinking (F=3.350, p<.05), hours of sleep (F=6.198, p<.01), number of days doing strength exercises (F=7.755, p<.01), number of days doing flexibility exercises (F=9.321, p<.000), number of times that meals were eaten: breakfast (F=3.898, p<.05), lunch (t=3.175, p<.01), dinner (t=2.034, p<.05) and number of times eating out (F=4.303, p<.01). 5. The mean calculated score for occupational stress was 34.40±11.09 of 100 points. The mean scores for the occupational stress of high job demand, insufficient job control, and interpersonal conflict were 45.76±18.23 of 100 points, 43.49±13.88 of 100 points, 25.34±16.43 of 100 points respectively. According to quartile, 78.9% of participants were in Q~.24 and 1.8% of participants were in Q.75~. 6. The association of participant’s characteristics to occupational stress was significantly different according to hours of sleep (F=4.024, p<.05) and number of times that lunch was eaten (t=-2.405, p<.05). 7. The association of health behavior to obesity was significantly different according to exercise (F=3.620, p<.05) and relaxation (F=3.473, p<.05). The association of health behavior to abdominal obesity was significantly different according to ingestion of natural food (t=2.397, p<.05). In conclusion, the prevalence ratio of obesity was 42.1%. Also, health behavior was high and occupational stress was low. Exercise and relaxation were the health behaviors associated with obesity and ingestion of natural food was the health behavior associated with abdominal obesity. The results of this study suggest that developing of a continuous obesity management program for army officers and non-commissioned officers is needed to decrease the prevalence ratio of obesity. Also, an effective obesity management strategy as part of the army health promotion policy is needed.

(A) dual role of sulfuretin in adipocyte, osteoclast, and osteoblast differentiation

Kim, Suji Sungkyunkwan university 2020 국내박사

Obesity is increasing in worldwide and it has various complications such as type 2 diabetes, cardiovascular disease, fatty liver and osteoporosis. Obesity lowers the quality of life and causes discomfort in social activities. Of note, increased obesity threatens public health and causes national financial losses. In order to treat such obesity and obesity-related metabolic diseases, a lot of researcher is trying to find out how to conquer obesity in various fields. Obesity is caused by energy imbalances from excessive energy accumulation (in the form of triglycerides) in whole body. The differentiation of adipocytes is largely regulated by a gene called Pparγ, a member of the nuclear hormone receptor group. Pparγ plays an important role in the regulation of transcription factors related to adipocyte differentiation with the highest expression in adipose tissue. Therefore, in this study, I tried to find a single compound that reduces the expression of Pparγ mRNA in adipocytes after separating a single compound from Rhus verniciflua extract. Screening for finding an anti-obesity compound revealed that, among eight single substances, sulfuretin reduced the mRNA expression of Pparγ and its target genes. Part 2 shows that sulfuretin decreased triglyceride accumulation in adipocytes, and reduced body weight and improved insulin sensitivity in mice. Sulfuretin induced anti-obesity effects was evaluated in cell and animal models, but underlying mechanisms were not clarified. Therefore, I listed up the genes which were upregulated in sulfuretin-treated adipocytes by using microarray assay. Among upregulated genes, Atf3 specifically reduced fat accumulation in adipocytes. Part 3 shows that Atf3 played a significant role in the inhibition of obesity in cell and animal model. When fed a high-fat diet, increased weight gain and impaired glucose metabolism were observed in Atf3 knockout mice compared to wild-type. The origin of adipocytes is mesenchymal stem cells, which also differentiate into osteoblasts and chondrocytes. In Part 4, sulfuretin inhibited the differentiation of mesenchymal stem cells to adipocytes, and it was confirmed that sulfuretin affected the differentiation of osteoblasts and chondrocytes. Even though recent studies have suggested that sulfuretin increases osteoblast differentiation, its mechanisms have not been studied. Therefore, in this study, I tried to identify the genes that changed the most significantly through RNA sequencing after sulfuretin treatment in osteoblasts. Experiments confirmed that all the features of the genes increased by sulfuretin are related to Nrf2. This means that sulfuretin has a function related to bone formation through Nrf2. As a result, this study was found that sulfuretin has an anti-obesity effect and bone formation through Atf3-Nrf2 axis. Although the movement to treat obesity and metabolic syndrome through natural products is active, it should be applied to humans to cure diseases without side effects.

과체중 및 비만 성인에서 한의 비만 변증에 따른 식생활 및 건강행태 비교 연구 : 선행 연구

김수연 경희대학교 대학원 2023 국내석사

Obesity is increasing worldwide, and the prevalence of obesity in Korea has reached 40 %. Among the various methods to treat obesity, oriental medical obesity treatment is receiving a lot of attention from young women. The oriental medicine diagnostic method uses Korean medicine patterns to classify the patient's physical and mental symptoms and present the treatment direction. These Korean medicine patterns are also applied to obesity. The causes of obesity are caused by long-term unhealthy lifestyles and eating habits, and these habits have been studied as factors that cause excessive nutrient accumulation of obesity However, there have been no studies that analyzed the characteristics of lifestyle and dietary factors that cause obesity by Obesity Syndrome Differentiation patterns yet. Therefore, we aimed to compare and correlate the differences between lifestyle and dietary factors by Obesity Syndrome Differentiation of Korean adults overweight and obesity. Eating habitual and health behaviors characteristics by type among Korean obese adults. The study was conducted among overweight and obesity adults at a random sample with an online survey. In this cross-sectional study, the participants body composition, dietary habits, eating behaviors, health behaviors, food intake frequency were comparing each Obesity Syndrome Differentiation type. Through Spearman correlation analysis, the linear correlation between the scores and factors of the Obesity Syndrome Differentiation type was analyzed. Based on this, as a result of examining the characteristics of each Obesity Syndrome Differentiation type, there was a difference in weight status, overeating, and sedentary activity in Excess Syndrome and Deficiency Syndrome. As a result of analyzing the correlation between scores by obesity syndrome differentiation type and health behavior, there was a negative correlation between moderate and vigorous activity and excess syndrome, and there was a strong negative correlation with sleep time in the blood stasis type. In deficiency syndrome, only yang deficiency type showed a positive correlation with alcohol intake. Obesity Syndrome Differentiation type and eating habits showed correlation only in Excess Syndrome. Food Retention type had a positive correlation between overeating and night eating, and Liver qi stagnation type and blood stasis type correlated negative with regularity meals. In DEBQ, food retention type showed a correlation in all three items, and only positive correlation was found in Liver qi stagnation type emotional eating. In the Yang deficiency type, there was a positive correlation between emotional eating and external eating. As a result of correlating the frequency of food intake with Obesity Syndrome Differentiation type score through FFQ, Food Retention type and Liver qi stagnation type showed a positive correlation with the frequency of snack intake, and only blood stasis type among Excess Syndrome type showed an inverse correlation with vegetables. Spleen deficiency type and Yang deficiency type showed an inverse correlation with vegetable foods, and Yang deficiency type showed a positive correlation with snacks. Overall, there was a difference in health behavior and eating habits by Observation Syndrome differentiation type, and it was confirmed that the factors correlated according to the score were different. Therefore, it was confirmed that obesity treatment and customized counseling for symptom improvement were needed for each Obesity Syndrome Differentiation type. Through the results of the study, it is possible to predict the diet and lifestyle of each Obesity Syndrome Differentiation type, and it is hoped that it will be used as an oriental medical personalized obesity treatment by applying nutrition education and lifestyle intervention suitable for the Obesity Syndrome Differentiation type in the future.

Interaction analyses of obesity traits using Korean cohorts and UK Biobank data

이원준 경희대학교 대학원 2020 국내석사

Obesity results from alteration of balance between calorie intake and expenditure and leads to lifestyle-related diseases. Although genome-wide association studies (GWASs) have revealed many obesity-related genetic factors, their interactions with calorie intake and smoking status remain unknown. This study is divided into two parts. In first part, we aimed to investigate interactions between calorie intake and the polygenic risk score (PRS) of obesity. Three Korean cohorts, Korea Association REsource (KARE; N=8,736), CArdioVAscular disease association Study (CAVAS; N=9,334), and Health EXAminee (HEXA; N=28,445) were recruited for this study. Obesity-related genetic loci were selected from previous GWASs, and two polygenic risk scores, PRS and association PRS (aPRS), were used; the former was determined from 201 SNPs from 5 GWAS data, and the latter was determined from 78 SNPs potentially associated in three Korean cohorts (meta-analysis P < 0.01). PRS and aPRS were significantly associated with BMI in all three cohorts, but PRS and aPRS did not show significant interactions with total calorie intake on BMI. Similar results were obtained for obesity. PRS and aPRS were significantly associated with obesity, but PRS and aPRS did not have significant interaction with calorie intake on obesity. We further analyzed the interaction with protein, fat, and carbohydrate intake. The results were similar to total calorie intake, and PRS and aPRS were not associated with the interaction of any of the three nutrition components. The second part, we aimed to discover novel SNPs associated with obesity traits through interaction with smoking status. UK Biobank data (N=334,808) was recruited for this study. We discovered 2 novel SNPs associated with four obesity traits (BMI, severe obesity, waist circumferences, WHR) through interaction with smoking status. We also conducted stratified analysis, we found that the effect of SNPs on obesity trats are different in smoker group and nonsmoker group. 비만은 칼로리 섭취와 소비 사이의 균형에 변화로부터 유래되며 생활과 직결된 질병으로 이어진다. GWAS는 많은 비만 관련 유전적 요인을 밝혀냈지만, 칼로리 섭취와 흡연 상태와의 상호작용은 여전히 알려지지 않고 있다. 이 연구는 두 부분으로 나뉘며 1부에서는 영양소 섭취와 비만의 polygenic risk score(PRS) 사이의 상호작용을 조사하는 것을 목표로 하였다. 이 연구에는 Korea Association REsource (KARE; N=8,736), CArdioVAscular disease association Study (CAVAS; N=9,334)와 Health EXAminee (HEXA; N=28,445) 등 3명의 한국 코호트가 사용됐다. 이전 GWAS에서 비만 관련 유전자좌가 선택되었고, PRS와 association PRS(aPRS)라는 PRS 지표가 2개가 사용되었으며, 전자는 5개의 GWAS 데이터로부터 얻은 201개의 SNP로 결정되었으며, 후자는 3개의 한국 코호트에서 연관 가능성이 있는 78개의 SNP로 결정되었다 (Meta-analysis P-value < 0.01). PRS와 aPRS는 세 가지 코호트에서 모두 BMI와 유의하게 연관되었지만 PRS와 aPRS는 BMI의 총 칼로리 섭취와 유의한 상호작용을 보이지 않았다. 또한 비만에 대해서도 유사한 결과를 얻었다. PRS와 aPRS는 비만과 상당히 관련이 있었지만, PRS와 aPRS는 비만에 대한 칼로리 섭취와 큰 상호작용을 하지 않았다. 이후 단백질, 지방, 탄수화물 섭취와의 상호작용을 추가로 분석했으며 결과는 총 칼로리 섭취와 비슷했다. PRS와 aPRS는 세 가지 영양 성분 중 어느 것 하나와의 상호작용과는 관련이 없었다. 두 번째 연구에서는 흡연 여부와의 상호작용을 통해 비만 형질과 관련된 새로운 SNP를 발견하는 것을 목표로 했다. UK Biobank data (N=334,808)가 이 연구를 위해 모집되었다. 흡연 여부와의 상호작용을 통해 4가지 비만 특성 (BMI, 중증 비만, 허리둘레, WHR)과 관련된 2개의 새로운 SNP를 발견했다. 또한 stratified analysis을 실시하여 각 SNP들이 비만 형질에 미치는 영향이 흡연자 그룹과 비흡연자 그룹에서 다르다는 것을 발견했다.

Study on the role of 4-1BB/4-1BBL interaction in obesity-induce adipose inflammation and metabolic dysfunctions

투 티 히엔 울산대학교 2015 국내박사

Obesity-induced inflammation plays a crucial role in the development of metabolic diseases such as insulin resistance and type 2 diabetes, cardiovascular diseases, and certain types of cancers. Adipose macrophages accumulation/activation and increased levels of inflammatory cytokines are a hallmark of obesity-induced inflammatory phenotype, and they play a pivotal role in the development of metabolic derangement in obesity. In obese adipose tissue, the interaction of cell with cell (adipose cell-macrophage) is likely crucial for the adipose inflammation and the development of metabolic diseases. However, molecules that mediate the cell-cell crosstalk remain unclear. 4-1BB (tumor necrosis factor receptor superfamily 9, TNFRSF9), a costimulatory receptor, modulates inflammatory processes through interaction with its ligand 4-1BBL on immune cell and/or non-immune cell surfaces. Our previous study using 4-1BB knockout obese mice has strongly suggested a critical role of 4-1BB and 4-1BBL interaction in the development of adipose tissue inflammation and metabolic disorders, but the underlying molecular mechanisms are unknown. This study aims to clarify the potential role of 4-1BB/4-1BBL interaction and the mechanisms involved in promoting obesity-induced adipose inflammation and metabolic derangements. The findings are as follows. First, the involvement of interaction between 4-1BB/4-1BBL in obesity-induced adipose inflammation was investigated. 4-1BB was expressed on adipocytes and was upregulated by obesity-related factors, which also enhanced 4-1BBL expression in macrophages. 4-1BB and/or 4-1BBL agonists, respectively, activated inflammatory signaling molecules (MAPK/IκBα and MAPK/Akt) in adipocytes and macrophages, and enhanced the release of inflammatory cytokines (MCP-1, TNF-α, IL-6). Disruption of the 4-1BB/4-1BBL interaction decreased the release of inflammatory cytokines from contact co-cultured adipocytes/macrophages. Moreover, 4-1BB/4-1BBL-mediated bidirectional signaling in adipocytes/macrophages promoted adipose inflammation. Second, the role of 4-1BB/4-1BBL interaction in obesity-induced macrophage proliferation and metabolism was examined. 4-1BBL stimulation on monocytes/macrophages enhanced reprogramming of glucose and lipid metabolism in the cells, and this was accompanied by cell proliferation. 4-1BBL stimulation on macrophages increased glucose uptake, transcript/protein levels of glucose transporter 1 and glycolytic enzymes, and lactate production. It also enhanced transcript levels of genes involved in the pentose phosphate pathway and lipogenesis. The 4-1BBL-induced metabolic reprogramming was mediated by Akt/mTOR signaling. Furthermore, the 4-1BB/4-1BBL interaction enhanced lipolysis in adipocytes followed by reduction of lipid droplets. Similar patterns of lipid alterations were observed by stimulating adipocytes/macrophages with 4-1BB/4-1BBL agonists, respectively. Thus, 4-1BB/4-1BBL-mediated bidirectional signaling in adipocytes/macrophages promotes adipose metabolic dysfunction. Thirdly, 4-1BB expression was examined in obese human patients. Levels of 4-1BB transcripts and soluble 4-1BB (s4-1BB) were correlated with BMI and expression of inflammatory markers, as well as with serum metabolic parameters. Moreover, s4-1BB was released from human adipocytes, and elicited chemotactic responses from human monocytes/T cells as well as enhancing their inflammatory activity, indicating that it may promote human adipose inflammation in obese conditions. Overall, these findings suggest that 4-1BB and 4-1BBL play crucial roles in obesity-induced adipose inflammation, and these molecules could serve as therapeutic targets and/or novel biomarkers for obesity-induced inflammation and metabolic complications. Phytochemicals/ food components targeting control of 4-1BB and/or 4-1BBL expression and their signaling pathways may be beneficial in protecting against obesity-induced inflammation and metabolic complications.