비만 환자의 조혈모세포이식 후 체중 적용 기준에 따른 Cyclosporine 초기 농도 비교

권지은,박애령,김순주,나현오 한국병원약사회 2014 病院藥師會誌 Vol.31 No.6

Cyclosporine is the most common immunosuppressant agent against graft-versus-hostdisease (GVHD) in patients with hematopoietic stem cell transplantation (HSCT). The therapeuticrange of cyclosporine is narrow, and there is significant inter-individual and intra-individual variabilityin the pharmacokinetics of the drug. Therefore, therapeutic drug monitoring of cyclosporine isessential to optimize immunosuppressant therapy. In Seoul St. Mary’s hospital, the dose ofcyclosporine is based on the actual body weight. Cyclosporine 5 mg/kg/day is given the day beforeHSCT by 24hrs intravenous infusion. The dose is then changed to 3 mg/kg/day after HSCT. We conductedtherapeutic drug monitoring for the optimal therapeutic range of cyclosporine. The concentrationof cyclosporine is often higher for obese patients than the initial therapeutic range of200~300 ng/ml. As a result, obese patients have a greater risk of cyclosporine side effects than nonobese patients. We evaluated the effects of cyclosporine at an initial dose based on ideal body weightin obese patients. We retrospectively collected the data from obese patients (actual body weight > 120% ideal bodyweight) who received cyclosporine therapy after HSCT, at the Catholic BMT (blood and marrowtransplantation) center from April 2009 to September 2011. Pharmacokinetic parameters were calculatedfrom data collected from monitored patient profiles and actual blood concentration ofcyclosporine. We subsequently calculated the concentration of cyclosporine, according to the dosebased on ideal body weight. Out of 32 patients who received cyclosporine therapy after HSCT, 1 patient who receivedcyclosporine based on actual body weight reached the therapeutic range (3.1%). However, 7 patientswho received cyclosporine based on ideal body weight reached the therapeutic range (21.9%). Theresults showed a significant difference (p=0.014). The median gap between the actual blood concentrationand the upper limit of therapeutic range was 164.1 (-25.3~440.0) ng/ml in patients whoreceived cyclosporine based on actual body weight. The median gap between the calculated bloodconcentration and the upper limit of therapeutic range was 67.7 (-74.0~239.0) ng/ml in patients whoreceived cyclosporine based on ideal body weight. The blood concentration of cyclosporine based onideal body weight was indicative of a more efficient approach to a therapeutic range of cyclosporine. In conclusion, this study suggested that the administration of cyclosporine based on ideal bodyweight might lead to optimal blood concentration and a reduction in cyclosporine side effects. Thecurrent observation needs to be confirmed by prospective investigation in order to determine appropriatecyclosporine therapy in obese patients.

이상적 체형과 체중 감량 선호에 관한 국제비교연구

임인숙(In Sook Lim),백수경(Soo Gyoung Paek) 한국사회학회 2016 韓國社會學 Vol.50 No.4

이 연구는 한국 여성들이 다른 나라의 여성들보다 과도하게 마른 몸을 이상적 체형으로 설정하고 있는지, 결과적으로 이 체형 이상(理想)이 체중 감량 선호를 자극하고 있는지 검증하는 데 목적을 둔다. ‘2007년 ISSP 데이터’를 분석한 결과, 17개 조사 대상국들 중 한국 여성들은 가장 마른 편이지만 살빼기를 원하는 강도나 날씬한 몸을 이상적인 체형으로 삼는 수위가 가장 높게 나타난다. 날씬함은 글로벌한 몸매 이상이지만 그 미적 기준은 한국 여성들에게 더욱 높게 설정되어 있고 실질적인 육체 변형을 요구할 수 있는 외모규범으로 강력하게 작용하고 있다. 체질량지수 등의 변수를 통제한 로짓분석에서 이상적 체형의 영향력은 특히 한국 여성들에게 더욱 크게 나타난다. 더욱 마른 몸을 이상화하는 단계로 나아갈수록 감량 욕구는 약 73%씩 증가한다(외국 여성들은 약 20%). 반면, 한국 남성들의 살빼기 선호에는 실제 자신의 몸 상태, 즉 객관적 비만 여부만 영향을 미친다. 여성권한척도(GEM) 범주별로도 이상적 체형의 영향은 다르게 나타난다. 마른 몸매 이상이 감량 욕구를 자극할 승산은 한국이 속한 하위 범주국에서 가장 높은 반면, 상위 범주국에선 그 영향력 자체가 사라진다. 이처럼 이상적 체형이 육체 변형을 실제로 추동할 수 있는 여지는 성별과 국가별 성 평등 정도에 따라 차이를 보이고 있다. This study aims to verify whether Korean women regard slender body as ideal more excessively than women in other countries do; and to see as a result, if the ideal body image stimulates higher preference for weight loss. Analysis of ‘2007 ISSP data’ shows that among 17 countries Korean women are the most skinny, but their standard of slim body and desire for losing weight are the highest. Although slenderness is a global ideal, its more highly set aesthetic standard in Korea acts as an appearance norm, which may require substantial body transformation. In a regression analysis controlling BMI, the body ideal variable maintains significant impact on the preference for weight loss. In particular, the influence is stronger on Korean Women. The more they idealize the skinnier body, their preference for weight loss increase by about 73%, while it does by about 20% among foreign women in the survey. As for Korean men, their actual physical condition, namely object obesity level only exerts their preference for weight loss. Also the influence of body ideal varies by the 3 categories of Gender Empowerment Measure. The odds ratio which the ideal body-shape stimulates preference for weight loss is the highest among low level category, while the ideal body-shape variable loses statistical significance among top level. In sum, the driving power of body ideal over preference for weight loss differently exerts by gender and its equality of country.

여대생의 신체이미지와 신체만족도 연구

이현미(Lee Hyun-Mi),김용주(Kim Yong-Ju) 한국인체미용예술학회 2003 한국인체미용예술학회지 Vol.4 No.2

  This study purposes to reserch body image and body satisfaction of college women. <BR>  The subjects of this study are 430 students of attending universities in Seoul, who are selected on the basis of the number of female students at four colleges, two universities and two woman"s universities.<BR>  Modified survey based on references and former studies in used, and using SAS packages, methods such as frequency, percentage, arithmetic mean, Pearson"s correlation analysis, regression analysis are applied. The results of analysis are as follows:<BR>  1. Female students wish to have a taller, thinner, and full-bosomed figure than they actual are.<BR>  2. As a result of dividing into R?hrer Index and perception on weight consciousness, 65.4% of the female students consider themselves as more overweight than they actual are.<BR>  3. Most female students come up to 76.9% idealized a thinner figure than their subjective body image.<BR>  4. Female students dissatisfied with the lower part of their body and a figure mainly. On the other hand, most female students strongly believe that their figure and facial features are the most important part of their body.<BR>  5. It was found that body satisfaction was affected by R?hrer Index, perception on weight consciousness and ideal body image. Also the lower R?hrer Index is, the more they are conscious of themselves as thin, and the more the subjective body image is thinner than the ideal body image, the higher body satisfaction becomes. By looking at the results perception on weight consciousness most affected body satisfaction.

실제 체중과 이상적 체중에 근거한 Remifentanil 투여 용량이 기관 내 삽관 상태와 혈역학적 부작용에 미치는 영향

김신성 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.1

Background: Remifentanil presents good intubation conditions and blunting adverse hemodynamic responses following intubation. So, we evaluated to determine optimal dosage of remifentanil for intubation which consider ideal body weight. Methods: 160 ASA class 1-2 patients were selected and divided 4 groups, which were composed of 40 patients. Group 1 and 2 were administrated dosage calculated by TBW (total body weight). Each group was administrated intravenous continuous infusion dose of 1.0 ug/kg/min of remifentanil during 2 minutes followed by intravenous bolus dose of 2 mg/kg of propofol (Group 1) and 2.0 ug/kg/min of remifentanil followed by same dose of propofol (Group 2). Group 3 and 4 were administerated same dosage of Group 1 and 2 but administrated dosage calculated by IBW (ideal body weight). We didn’t use any muscle relaxant. Intubation conditions and postintubation hemodynamic responses were assessed by 5 items based on GCRP (good clinical research practice), MAP (mean arterial pressure) and HR (heart rate). Results: We have done intubation safely 60, 75, 55 and 98% of Group 1, 2, 3 and 4 respectively. Group 1, 3 have ‘technically unacceptable’ cases, but group 2, 4 have ‘clinically unacceptable’ cases. Hemodynamic responses of Group 4 were more stable than Group 2, especially obese patients. Obese patients present a problem for the appropriate dosing of remifentanil and profound hypotension and/or bradycardia developed more frequently when administerated agent calculated by total body weight. Conclusions: The optimal dosage which produce best intubation conditions and least side effects has to be determined according to IBW.

Gender Differences in the Effects of Weight, Weight Perception, and Weight Satisfaction on Depression in Adolescents

라진숙,류정림,김혜선 한국지역사회간호학회 2017 지역사회간호학회지 Vol.28 No.4

Purpose: This study aims to investigate gender differences in the association between depressive symptoms and weight, weight perception, and body satisfaction among Korean adolescents. Methods: A secondary data analysis was performed on data from 33,374 adolescents who participated in the 2015 Adolescent Health Behavior Online Survey. They were classified as underweight, normal weight, or overweight/obese; weight perception was classified into perception of being underweight, normal weight, or overweight/obese; and weight satisfaction into desire to gain weight, satisfied, and desire to lose weight. Results: Among boys, perception of being underweight (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.07~1.35) and desire to gain weight (AOR: 1.45, 95% CI: 1.30~1.62) were associated with depression. Among girls, perception of being overweight or obese (AOR: 1.18, 95% CI: 1.07~ 1.29) and a desire to lose weight (AOR: 1.30, 95% CI: 1.18~1.42) were associated with depression. Conclusion: Gender differences were observed in the association between weight perception and depression in adolescents. The perception of being underweight among boys and the perception of being overweight/overweight among girls were associated with depression. Thus, gender-specific intervention programs to correct weight perception and weight satisfaction are needed in order to relieve depressive symptoms in adolescents.

비만환자의 조혈모세포이식 후 체중 적용 기준에 따른 Tacrolimus 초기 농도 비교

이수진,배진아,권지은,이연지,윤정이,강진숙 한국병원약사회 2021 병원약사회지 Vol.38 No.2

Background : Tacrolimus is an immunosuppressive agent and is largely used to prevent graft-versus-host disease in hematopoietic stem cell transplantation patients. Tacrolimus requires therapeutic drug monitoring because of its narrow therapeutic range. The number of cases where the dose of tacrolimus was reduced in obese patients because the blood concentration was higher than the initial effective therapeutic range (10–15 ng/mL)is increasing. Therefore, this study attempted to assess the adequacy of early tacrolimus dosages and establish more suitable weight-based dosing strategies for obese patients. Methods : This was a retrospective study, conducted on patients 20 years of age or older who received tacrolimus from the day before transplantation from January 2019 to June 2020 in Seoul St. Mary’s Hospital. The blood concentration of tacrolimus in the actual body weight (ABW) group was obtained from the actual blood collection, from which patient-specific pharmacokinetic parameters were obtained. The expected blood concentration of tacrolimus in the ideal body weight (IBW) group was then calculated. To evaluate the adequacy of the tacrolimus dosage, the average blood concentration and the number of patients within the effective therapeutic range were investigated. To evaluate the risk of developing side effects and the reduction in therapeutic effects, the number of patients above and below the effective therapeutic range and their average tacrolimus level were compared based on ABW and IBW, respectively. Results : The average blood concentration of 74 patients was 18±5.7 ng/mL in the ABW group and 14±4.5 ng/mL in the IBW group (p<0.001). The number of patients within the effective therapeutic range was 22 (29.7%) in the ABW group and 35 (47.3%) in the IBW group (p=0.043). The number and average tacrolimus level of the patients above the effective therapeutic range were 50 (67.6%) and 20.6±5.1 ng/mL, respectively, in the ABW group and 25 (33.8%) and 19.1±3.5 ng/mL, respectively, in the IBW group. The number and the average tacrolimus level of patients below the effective therapeutic range were 2 (2.7%) and 8.8±0.7 ng/mL, respectively, in the ABW group and 14 (18.9%) and 8.7±1.0 ng/mL, respectively, in the IBW group. There was no statistical difference in the average tacrolimus levels of the patients above and below the effective therapeutic range (p=0.190 and p=0.908, respectively). Conclusion : In obese patients, the administration of tacrolimus based on IBW is more preferred than ABW-based administration. However, additional pharmacokinetic model studies are needed.

대한지역사회영양학회지 게재 논문에서의 한국인 비만 판정에 관한 연구

김영남(Young Nam Kim) 대한지역사회영양학회 2013 대한지역사회영양학회지 Vol.18 No.5

The purpose of this study was to provide information on obesity assessment for Koreans. Among total of 1012 research papers enlisted in the Korean J Community Nutrition form 1996 to 2011, 248 articles were examined in which subjects were divided into more than 2 groups by obesity rate. About the method of anthropometric data collection, more than half of the research papers examined 52.5% and 28.7% of studies utilized the directly measured data and self-described data, respectively. About the utilization of obesity assessment methods, indirect methods of weight-height index (BMI, BMI percentile, and Rohrer index) and PIBW (WLR, Broca index, and KDA) were 62.4% and 23.2%, respectably, and the direct method of percent body fat assessment was only 9.3%. The most frequently utilized methods were WLR in under primary and primary school children, and BMI in the middle and high school students and in adults. For primary school students, WLR was the most frequently utilized method up to 2007, but it changed to BMI percentile afterward. Broca Index was no longer utilized since 2008. There were no articles utilizing BMI percentile and Rohrer index for obesity assessment in adults. Criteria for obesity assessment were not consistent among research papers: for example, % body fat, 19~40%; BMI, 20~30; BMI percentile, 85th or 95th. In the case of PIBW, 120% of ideal weight was the most frequently utilized criterion for obesity. Based on these findings, we suggest that proper methods and criteria of obesity assessment for each age group should be determined and proclaimed. (Korean J Community Nutr 18(5) : 525~538, 2013)

A loading dose of 1 μg/kg and maintenance dose of 0.5 μg/kg/h of dexmedetomidine for sedation under spinal anesthesia may induce excessive sedation and airway obstruction

염종훈,오미경,안대웅,박수인 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3

Background: For many drugs, dosing scalars such as ideal body weight (IBW) and lean body mass are recommended over the use of total body weight (TBW) during weight-based dose calculations. Doses based on TBW are frequently used, and this may cause under- or over-dosing. Because dexmedetomidine (DEX) overdosing could increase the incidence of side effects, and spinal anesthesia may increase sensitivity to a sedative agent, determining an appropriate dose is critical. Methods: Eighty patients were randomly divided into 2 groups, the IBW and TBW groups. Patients received a loading dose of DEX 1 μg/kg IBW or TBW for 10 min, followed by a continuous infusion at 0.5 μg/kg/h IBW or TBW after the induction of spinal anesthesia. The patients’ vital signs, bispectral index (BIS), peripheral capillary oxygen saturation, time to reach a BIS of 80, airway obstruction score, and coughing were monitored and recorded at 0, 10, 30, and 50 min after the start of the loading dose injection. Results: The changes in BIS, airway obstruction score, the incidence of side effects, and time to reach a BIS of 80 did not show statistically significant differences between the two groups. However, airway obstruction and/or coughing occurred in both groups, and the average BIS in both groups was lower than the target BIS of 60?80 at 30 and 50 min. Conclusions: A loading dose of DEX 1 μg/kg for 10 min, and a maintenance dose of DEX 0.5 μg/kg/h of either IBW or TBW, may induce excessive sedation, airway obstruction, and/or coughing under spinal anesthesia.

The Impact of Weight Changes on Nonalcoholic Fatty Liver Disease in Adult Men with Normal Weight

Ji-Young Cho,Tae-Heum Chung,Kyoung-Mo Lim,Hee-Jin Park,Jung-Mi Jang 대한가정의학회 2014 Korean Journal of Family Medicine Vol.35 No.5

Background: Although it is known that losing weight has an effect on the treatment of non-alcoholic fatty liver disease, the studies that show how losing weight affects the non-alcoholic fatty liver disease for the normal weight male adults are limited so far. In this study, we set body mass index as criteria and investigated how the weight changes for 4 years makes an impact on the risk of non-alcoholic fatty liver disease for the male adults who have the normal body mass index.Methods: From January to December of 2004, among the normal weight male adults who had general check-up at the Health Promotion Center of Ulsan University Hospital, 180 people (average age, 47.4 ± 4.61 years) who were diagnosed with fatty liver through abdominal ultrasonography were included in this study and were observed according to the variety of data and ultrasonography after 4 years (2008). People who had a history of drinking more than 140 g of alcohol per week or who had a past medical history were excluded from the analysis. The weight change of subjects was calculated using the formula ‘weight change = weight of 2008 (kg) - weight of 2004 (kg)’ and classified into three groups, loss group (≤-3.0 kg), stable group (-2.9 to 2.9 kg), and gain group (≥3.0 kg). The odds for disappearance of non-alcoholic fatty liver disease in those three different groups were compared.Results: Among 180 subjects, compared with stable group (67.2%, 121 subjects), loss group (11.7%, 21 subjects) showed 18.37-fold increase in the odds of disappearance of non-alcoholic fatty liver disease (95% confidence interval [CI], 4.34 to 77.80) and gain group (21.1%, 38 subjects) showed 0.28-fold decrease in the odds of disappearance of non-alcoholic fatty liver disease (95% CI, 0.10 to 0.83).Conclusion: Even for the normal weight people, losing weight has an effect on the improvement of non-alcoholic fatty liver disease.

A Study of the Anthropometric Indices and Eating Habits of Female College Students

Chung, Hae-Young,Song, Mi-Kyune,Park, Mi-Hyun The Korean Society of Community Nutrition 2003 Journal of community nutrition Vol.5 No.1

A study was conducted to investigate the anthropometric indices, fat distribution, eating habits and levels of daily physical activity based on the body mass index (BMI ; kg/㎡) of 180 female college students. This stady was based on survey 2001 using a questionnaire. The results are as follow ; The mean age, height, weight and BMI were 20.41 ${\pm}$ 1.82 years, 161.86 ${\pm}$ 4.51cm, 53.49 ${\pm}$ 7.02kg, and 20.43 ${\pm}$ 2.65kg/㎡, respectively. The group with BMI of under 20 (the lean group) comprised 48.9% : the group with BMI of 20 to 25 (the normal group) comprised 44.4% and the group with BMI of over 25 (the obese group) comprised 6.7% of the subjects. Even though the lean and the normal groups were determined according to BMI. 12.5% of the lean group and 31.3% of the normal group had more than 25% body fat. Of the students, 11.5% of the lean group, 25.0% of the normal group and 58.3% of the obese group had of more than 0.8 waist/Hip Ratio (WHR). The medical problems suffered by the subjects were constipation (24.4%), gastroenteritis (20.6%), anemia(15.0%) and edema(13.3%), which was a result of their eating habits. Out of all the subjects, 27.2% ingested their meals irregularly, 74.4% skipped breakfast, and 92.4% of the lean group, 89.2% of the normal group and 81.8% of the obese group ingested snacks on a daily basis. Their favorite types of snacks were cookies breads and cakes (33.7%), spicy sliced rice cakes pork sausage and boiled fish cakes (18.5%), fruits (15.2%), juices and sodas (13.5%) and hamburgers and pizzas (3.9%). Their consumption of high calorie and processed foods was high, Of the subjects, 38.9% ate out daily. 45.1% had tried weight loss. Those with large upper bodies comprised 11.5%, large intermediate bodies 18.5% and large lower bodies 69.0%. Most of the students were dissatisfied with their body snaps. Of the subjects, 95.1% exercised irregularly. Daily physical activity tended to increase significantly with an increase in BMI : the lean group's average energy consumption was 1509.40㎉ the normal group's was 1792.21㎉ and the obese group's was 2334.63㎉, which were below the recommended value. This study suggests that the maintenance of an ideal weight, the improvement of eating habits and adequate exercise are needed for female college students to improve their health and nutritional status. (J Community Nutrition 5(1) 21∼28, 2003)