Si-Hoon Park and Kyung Won Shim waveform in response to inhalation of β2 -ago- nists. Changes can be measured by tonometry and quantified according to the augmentation index (AIx).5,6 The present study utilized the advanta- ges of pulse wave analysis, i.e., its simplicity, re- peatability, operator-independency and non-inva- siveness. We evaluated the impact of substantial weight reduction on VED in premenopausal obese women without complications or any other car- diac risk factors to determine whether weight re- duction alone was associated with improved VED. MATERIALS AND METHODS Subjects The same healthy, premenopausal obese women included in a previous study8 were enrolled in the present study. These subjects were visiting a university hospital obesity clinic and were 20 to 45 years-old (mean age: 33.81 ± 7.13) with a body mass index (BMI) 25 kg/m2. Obesity was de- fined according to the guidelines established by the 'Redefining Obesity and its Treatment'- a Joint Enterprise by the Regional Office for the Western Pacific of the World Health Organization and the International Association for the Study of Obesity and International Obesity Task Force. Subjects with any of the following co-morbidities were ex- cluded: hypertension (systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mm Hg), dyslipidemia {LDL (low density lipoprotein) cholesterol 160 mg/dL, HDL (high-density lipo- protein) cholesterol < 40 mg/dL, or triglyceride 200 mg/dL}, type 2 diabetes, coronary heart dis- ease, stroke, thyroid disease, and depression. In- formation was obtained by administering a self- report questionnaire to patients and by clinical examination and blood tests. Current smokers and those who had undergone a commercial diet pro- gram or received anti-obesity medication during the previous three months were also excluded. As in our previous study, obese subjects were matched with healthy, premenopausal non-obese women for clinical, metabolic, and lipid charac- teristics. Initially, 42 obese patients were enrolled, but six dropped out over the 12-week study period, leaving a total of 36 subjects. All subjects Yonsei Med J Vol. 46, No. 4, 2005 were given informed consent, and the study pro- tocol was approved by the Institutional Review Board of Ewha Womans University, Mokdong Hospital. Data collection All examinations were performed during the follicular phase of the menstrual cycle, within 10 days of the onset of menstruation. Subjects re- ceived dietary and exercise consultations every two weeks for three months, during which BP, height, weight, and waist and hip circumferences were measured. Anthropometric measurements Body weights were measured to an accuracy of 0.1 kg, with subjects wearing light clothing. Height was measured to an accuracy of 0.1 cm. The waist circumference was measured at the mid-point between the upper iliac and lower costal level at the end of normal expiration, to an accuracy of 0.1 cm, and the hip circumference was defined as the largest measurement around the hip area. Body mass index (BMI) was calculated as the weight in kilograms divided by the square 2 of the height in meters (kg/m ). Body fat measurements Percent body fat (%) was measured using bio- electrical impedance analysis while subjects were in a fasting state (Inbody 2.0, Biospace Co., Seoul, Korea), and body fat distribution was determined by computed tomography (GE High Speed Ad- vantage CT scanner, GE Co., Waukesha, USA). Single slices of abdominal subcutaneous adipose tissue and visceral adipose tissue (measured in cm2) were taken at the 4-5 level of the lumbar spine, as described elsewhere.9 The attenuation interval was -40 to -140 Hounsfield units. Blood tests Plasma glucose, total cholesterol, HDL choles- terol, LDL cholesterol, triglyceride, and non- esterified fatty acid (NEFA) concentrations were measured after overnight fasting for at least 12 hours. Plasma insulin was measured by radioim- munoassay. Estradiol levels were measured by microparticle enzyme immunoassay (Axsym,