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Abstract: Aims: To investigate the prevalence of undiagnosed diabetes mellitus (DM) and cardiovascular risk factors among professional drivers in Hong Kong. Methods: Chinese professional drivers with no history of DM were invited to complete a questionnaire on their health status, followed by taking their body measurements, fasting blood glucose (FG) and lipids. 75g OGTT were performed when FG≥5.6 to <7.0mmol/L. Results: Of these 3376 drivers (male 92.6%, mean age 50.9±7.6 years), the prevalence of undiagnosed DM, prediabetes, and metabolic syndrome was 8.1% (272/3376, 95% CI 7.1–9.0%), 10.0% (337/3376, 95% CI 9.0–11.0%) and 26.8% (904/3376, 95% CI 25.3–28.3%) respectively, while the corresponding WHO Standard Population age-standardized prevalence was 7.8%, 9.0% and 24.7% respectively. Many of them were obese (51.2%), had hypertension (57.0%) and high cholesterol (58.7%), and a third had hypertriglyceridaemia (34.9%) and low HDL-cholesterol (29.3%). Their median working hours were 60.0 (IQR 14)h. Majority had exercise <1h/week (56.0%) and ate out ≥6times/week (54.9%). Conclusions: Hong Kong professional drivers have higher prevalence of undiagnosed DM, cardiovascular risk factors and metabolic syndrome than the general population. Therefore, health care measures targeting against them should be taken to prevent and detect DM and cardiovascular diseases. [Copyright &y& Elsevier]

Abstract: To explore the utility of the HbA1c criterion in the definition of metabolic syndrome (MS) in Koreans, we cross-sectionally analyzed clinical and laboratory data on 11,293 non-diabetic Korean adults (aged 20–89years, 34% women) collected during regular health checkups. Dysglycemia was defined as either fasting plasma glucose (FPG) ≥5.6mmol/l or HbA1c ≥5.7%. The prevalence of MS as judged by the HbA1c criterion alone (17.8%) was significantly less than that determined by FPG level alone (24.5%). Use of a combination of both criteria slightly increased the prevalence of MS (26.0%). Among the 2953 subjects categorized as having MS using the combined criteria, 929 (31%) were diagnosed by the FPG criterion alone, 177 (6%) by the HbA1c criterion alone, and 1847 (63%) using both criteria. The group diagnosed using FPG values alone had significantly higher BMI, waist circumference, blood pressure, fasting plasma insulin levels, and insulin resistance index compared with those in the group diagnosed using HbA1c levels alone. In men, the brachial-ankle pulse wave velocity was significantly higher and the HDL-cholesterol level was lower in the HbA1c-alone group. Therefore, employment of the HbA1c criterion may be useful to define MS in subjects at increased risk for atherosclerosis. [Copyright &y& Elsevier]

Abstract: Background: Cross-sectional studies have reported inconsistent findings on whether the risk of metabolic syndrome is high among cancer survivors. We conducted a meta-analysis of cross-sectional studies. Methods: We searched MEDLINE (PubMed) and EMBASE in April 2010. Two evaluators independently reviewed and selected articles, based on pre-determined selection criteria. Results: Out of 257 articles meeting our initial criteria, 9 cross-sectional studies, which involved 6763 participants (1762 cases and 5001 controls) were included in the final analysis. Compared with the healthy control groups, the cancer survivors were at an increased risk of metabolic syndrome, in the random-effects meta-analysis of all 9 cross-sectional studies (OR=1.84; 95% CI=1.14–2.97; I 2 =80.5). In the subgroup meta-analysis by cancer type, a significant positive association was observed for hematologic malignancies, including ALL (acute lymphoblastic leukemia), AML (acute myelogenous leukemia), NHL (non-Hodgkin''s lymphoma), and CML (chronic myelogenous leukemia) (OR=1.94; 95% CI=1.06–3.55; I 2 =68.1%), whereas no significant association was found for non-hematologic malignancies, including testicular tumor, prostate cancer, sarcoma, and epithelial ovarian cancer. Conclusions: Our meta-analyses of cross-sectional studies found that adult cancer survivors with hematologic malignancies were at an increased risk of metabolic syndrome. [Copyright &y& Elsevier]

Abstract: Aims: Pyruvate dehydrogenase kinase 4 (PDK4) plays a crucial role in glucose utilization and lipid metabolism by regulating the pyruvate dehydrogenase complex (PDC) and is an emerging therapeutic target for type 2 diabetes. To date, no study has specifically examined the relationship between PDK4 gene polymorphisms and type 2 diabetes or metabolic syndrome. Methods: The association of common single nucleotide polymorphisms (SNPs) was examined in PDK4 [−208A/G (rs10085637), IVS3+192C/T (rs3779478), IVS6+31A/G (rs2301630), IVS7+514A/G (rs12668651), IVS10+75C/T (rs10247649)] with type 2 diabetes and metabolic syndrome in 651 Korean subjects with type 2 diabetes and 350 nondiabetic Korean subjects. The association of these SNPs with clinical parameters related to metabolic syndromes including obesity, hyperglycemia, hypertension, and dyslipidemia was also examined. Results: No significant association was found between the studied SNPs and type 2 diabetes, metabolic syndrome, or clinical parameters. The PDK4 gene haplotype ACAGC showed a modest association with type 2 diabetes. However, the significance of this association was lost after considering for multiple comparisons. Conclusions: PDK4 polymorphisms may not be associated with type 2 diabetes or metabolic syndrome. Further studies utilizing a larger study population are required to confirm these results. [Copyright &y& Elsevier]

Abstract: Background: The aim of this study is to compare the effect of physical exercise program on the endothelial function of patients with metabolic syndrome and type 2 diabetes mellitus. Methods: Patients were randomized for high intensity aerobic training (HI: 80% maximum heart rate, n =10), low intensity aerobic training (LI: 55% of maximum heart rate, n =10) and control (n =11). Before and after 6 weeks of training, subjects performed the maximal exercise test and a study of the endothelial function, through a high resolution ultrasound of the brachial artery, which was assessed after reactive hyperemia (endothelium dependent vasodilation) and nitrate administration (endothelium independent vasodilation). Results: A total of 31 patients with metabolic syndrome and type 2 diabetes mellitus were studied, with mean age of 58±6 years, The percentage diameter difference of the vessel after hyperemia was significantly higher for the high intensity group (HI before 2.52±2.85% and after 31.81±12.21%; LI before 3.23±3.52% and after 20.61±7.76%; controls before 3.56±2.33% and after 2.43±2.14%; p <0.05). Conclusions: High intensity aerobic training improved the functional capability and endothelium dependent vasodilator response, but it does not improve the endothelium independent vasodilation in patients with metabolic syndrome and type 2 diabetes mellitus. [Copyright &y& Elsevier]

Abstract: Aims: To know which MS criteria best predict the presence of NAFLD and the prevalences of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) diagnosed ultrasonographically among pre-diabetic and diabetic subjects based on three different MS criteria (IDF, ATP III, WHO). Methods: Subjects were screened and those with a fasting serum glucose level ≥100mg/dL were further tested with a 75g oral glucose tolerance test. And those who were newly diagnosed as having pre-diabetes or diabetes were evaluated for MS and NAFLD. We compared the risk ratios of NAFLD among three MS criteria using multivariate and multiple logistic regression analyses. Results: A total of 1365 subjects (977 males, mean age 48.4±9.5 years) were analyzed. The WHO criteria produced the highest prevalence of MS in both the pre-diabetic (49.8%) and diabetic (58.9%) groups. The IDF criteria produced the highest odds ratio for NAFLD in both pre-diabetic (3.89 [95% CI 2.75–5.51]) and diabetic (5.53 [95% CI 3.21–9.52]) groups. Conclusions: The prevalence of MS depends on the set of diagnostic criteria used. IDF criteria best predicts the presence of NAFLD. The presence of NAFLD should be considered as a component of the diagnostic criteria for MS. [Copyright &y& Elsevier]

Abstract: Aims: The magnitude of the association between metabolic syndrome (MetS) and incident diabetes is still not widely evaluated in China. This study explored the association of MetS and its components with the development of diabetes among professionals living in Beijing. Methods: Population-based 6-year prospective study. The cohort consisted of 7922 eligible persons aged ≥20. Either fasting glucose (FPG) level ≥7.0mmol/l at the follow-up survey or diagnoses of diabetes during the 6-year period were considered incident diabetes cases. MetS was identified by both the definitions proposed by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF). Results: The accumulated incidence of diabetes was 3.6% for men and 2.5% for women. MetS associated a 4.7- and 5.7-fold increase of the diabetic risk in men and women, respectively. Hyperglycemia exhibited the highest association with diabetes. FPG of 5.6–5.79mmol/l already presented a risk of diabetes. However, without hyperglycemia in the clustering of any 1, 2, 3 to 4 metabolic components, the tendency of increased diabetic risk was still observed. Conclusions: MetS has a strong association with incident diabetes. Of the individual components, hyperglycemia is the strongest predictor of diabetes. Additional numbers of metabolic components increase the risk of developing diabetes. [Copyright &y& Elsevier]

Abstract: Aims: To evaluate the association between total dietary fiber and its types and sources with the risk of MetS. Methods: This population-based cross-sectional study was conducted on a representative sample of 2457 adults (1327 male and 1130 female), aged 19–84 years. Dietary intake was assessed using a validated semiquantitative food-frequency questionnaire. Anthropometrics, blood pressure, and fasting blood glucose and lipids were measured according to standard protocols. The MetS was defined according to definition by Adult Treatment Panel III. Results: Multivariate-adjusted odds ratio of MetS between highest and lowest quartiles was 0.53 (95% CI: 0.39–0.74; P for trend <0.05) for total dietary fiber, 0.60 (0.43–0.84; P for trend <0.05) for soluble fiber, and 0.51 (0.35–0.72; P for trend <0.05) for insoluble fiber. Among sources of dietary fiber, fruit fiber (OR: 0.51; 95% CI: 0.37–0.72), cereal fiber (0.74; 0.57–0.97), and legume fiber (0.73; 0.53–0.99) were inversely associated with the risk of MetS, after adjustment for confounding factors. Intake of vegetable fiber and nut fiber were unrelated to the risk of MetS. Conclusions: Total dietary fiber, soluble- and insoluble fiber, fruit fiber, cereal fiber and legume fiber were associated with a protective effect for the presence of MetS among this Tehranian population. [Copyright &y& Elsevier]

Abstract: Background: Abnormally elevated alanine aminotransferase (ALT) of nonspecific causes is a common outpatient problem. Without considering ethnicity, several studies had suggested that it was associated with insulin resistance (IR). Objective: To investigate whether nonspecific elevated ALT in Taiwanese population could reflect a likely underlying IR and was associated with impaired fasting glucose or type 2 diabetes mellitus (IFG/T2DM). Methods: The health examination profiles of 1313 Taiwanese were investigated cross-sectionally. The prevalence and odds ratios (ORs) for IFG/T2DM and metabolic abnormalities in relation to elevated ALT were analyzed. Results: Subjects with metabolic syndrome (MS) all had IFG/T2DM. The elevated ALT significantly correlated with MS and IFG/T2DM (i.e., 19.9–29.2% vs. 7.8% for MS, and 27.0–31.5% vs. 16.1% for IFG/T2DM). However, after excluding MS and adjustment for age and sex, the elevated ALT alone was not consistently associated with IFG/T2DM (36120 had IFG). Conclusions: In a cross-sectional analysis of Taiwanese industrial employees, elevated ALT associated with MS, but in subjects who did not meet MS criteria, elevated ALT by itself did not associate with IFG/T2DM. [Copyright &y& Elsevier]

Abstract: Aims: To investigate the familial concordance of metabolic syndrome and its components in a nationally representative survey in Korean. Methods: We used data from the Korean National Health and Nutrition Examination Survey (KNHANES), a nationwide survey examining the general health and nutritional status of the Korean people. We enrolled 1641 married couples and 1527 parents–1342 offspring. Results: Prevalence of the metabolic syndrome was 17.1% for husbands, 11.7% for wives, 14.3% for parents, and 7.2% for offspring. After adjustment for age, there were strong positive correlations between family members for the metabolic variables. Compared with husbands whose wives did not have metabolic syndrome, adjusted odds ratio in husbands whose wives had metabolic syndrome was 1.43 (95% CI: 1.10–1.87) for the risk of having metabolic syndrome. Similarly, wives whose husbands had metabolic syndrome had 1.41 (95% CI: 1.08–1.84) times higher risk of having metabolic syndrome. Compared with children whose parents did not have metabolic syndrome, adjusted odds ratio in children with at least one parent with the metabolic syndrome was 2.56 (95% CI: 1.09–5.98) for the metabolic syndrome. Conclusions: Our study revealed that there is significant familial concordance for metabolic syndrome and its components in Korean families. [Copyright &y& Elsevier]

Aims: The recent definitions of the metabolic syndrome (MS) recognize the need for ethnic and region-specific waist circumference (WC) cut-offs that identify people with abdominal obesity. We tested WC as a diagnostic tool to identify people with visceral adiposity in Hispanics from the Latin America region.Methods: We used the area of visceral adipose tissue (VAT) ≥ 100 cm² at the level between the 4th and 5th lumbar vertebrae in abdominal CT scans as a marker of visceral adiposity and established the optimal WC threshold for men and women by means of receiver operating characteristic (ROC) curves.Results: 179 men and 278 women from Mexico, El Salvador, Venezuela, Colombia and Paraguay were included. The ROC curves were highly discriminative of excess VAT for men and women (area under the curve 0.9 and 0.8 respectively) and the WC threshold was identified at 94 cm for men and between 90 and 92 cm for women.Conclusion: In men the WC cutoff was equal to that proposed for europids and suggested for US adults who may have strong genetic contribution to insulin resistance such as Hispanics. In women the threshold was significantly higher than previously proposed for South and Central Americans. [ABSTRACT FROM AUTHOR]

Aims: Sarcopenia measured as appendicular skeletal muscle mass (ASM), and central obesity measured as visceral fat area (VFA) may act synergistically to influence metabolic syndrome and atherosclerosis. However, several previous studies reported that metabolic risk is higher in non-sarcopenic obesity groups than in sarcopenic obesity groups because of the close relationship between muscle mass and body fat. We investigated the association of the ASM to VFA ratio, which we have termed the muscle-to-fat ratio (MFR), with metabolic syndrome and arterial stiffness.Methods: This study was performed in 526 apparently healthy adults enrolled in the Korean Sarcopenic Obesity Study, an ongoing prospective observational cohort study. ASM was evaluated with dual energy X-ray absorptiometry and VFA with computed tomography. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV).Results: MFR was significantly associated with waist circumference, blood pressure, lipid profiles, glucose and baPWV. By multiple logistic regression analysis, the odds ratio for metabolic syndrome was 5.43 (lowest versus highest tertile of MFR, 95% confidence interval, 2.56-13.34). Multiple stepwise regression analysis showed that MFR was an independent determinant of baPWV (R²=0.57).Conclusions: MFR, a new index of sarcopenic obesity, showed an independent negative association with metabolic syndrome and arterial stiffness. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The goal of this study was to investigate the association between omentin-1 and carotid atherosclerosis in patients with metabolic syndrome (MetS). Method: We enrolled randomly 60 MetS patients, evaluated their carotid atherosclerosis employing ultrasonography and then divided them into two subgroups, MetS with atherosclerosis (MetS+AS) and MetS without atherosclerosis (MetS−AS) according to the level of carotid intima-media thickness (CIMT) and presence of plaque. Stiffness, strain and distensibility were calculated. Waist circumference and blood pressure (BP) were measured. Fasting blood sample was collected to determine biochemical indicators and insulin resistance index (HOMA-IR). Omentin-1 plasma level was assessed by ELISA. Association of omentin-1 with CIMT and metabolic markers were studied. Results: Levels of omentin-1 were lower in MetS than in controls and reduced further in MetS+AS compared with MetS−AS. In correlation analysis, omentin-1 was negative associated with CIMT, stiffness, waist circumference, body mass index (BMI), systolic blood pressure (SBP), fast blood glucose (FBG), and HOMA-IR. Conclusions: Omentin-1 is closely related to MetS and might play an important role in atherosclerosis in MetS patients. [Copyright &y& Elsevier]

Abstract: Aims: To assess the association of alcohol consumption with metabolic syndrome (Mets) in a Chinese population. Methods: A community-based cross-sectional study was performed in 19,215 participants aged 40 years or over in Shanghai of China during June 2008–April 2009. Information about the alcohol consumption including quantity and type of alcoholic beverage was obtained using a standard questionnaire. Physical examination was performed and fasting blood samples were obtained for the measurements of biochemical indicators. Results: In male wine-only consumers, after adjusted for age, sex, BMI, education levels, exercise and smoking habit, severe alcohol consumption (≥50.0g/d), compared with non-alcohol consumption, conferred 53% increased risk of having MetS. In women, alcohol consumption did not have relation to the prevalence of Mets. In the beer-only, liquor-only and mixed type consumers, no significant associations between MetS or its components and the quantity of alcohol consumption were detected. Conclusions: Our findings suggest that excessive wine consumption (alcohol ≥50.0g/d) is associated with higher prevalence of MetS in Chinese men. [Copyright &y& Elsevier]

Abstract: Antioxidants probably play an important role in the etiology of type 2 diabetes (DM2). This study evaluated the effects of supplementation with lipoic acid (LA) and α-tocopherol on the lipid profile and insulin sensitivity of DM2 patients. A randomized, double-blind, placebo-controlled trial involving 102 DM2 patients divided into four groups to receive daily supplementation for 4 months with: 600mg LA (n =26); 800mg α-tocopherol (n =25); 800mg α-tocopherol+600mg LA (n =25); placebo (n =26). Plasma α-tocopherol, lipid profile, glucose, insulin, and the HOMA index were determined before and after supplementation. Differences within and between groups were compared by ANOVA using Bonferroni correction. Student''s t-test was used to compare means of two independent variables. The vitamin E/total cholesterol ratio improved significantly in patients supplemented with vitamin E+LA and vitamin E alone (p ≤0.001). There were improvements of the lipid fractions in the groups receiving LA and vitamin E alone or in combination, and on the HOMA index in the LA group, but not significant. The results suggest that LA and vitamin E supplementation alone or in combination did not affect the lipid profile or insulin sensitivity of DM2 patients. [Copyright &y& Elsevier]

Abstract: Aims: Detection of risk of type 2 diabetes mellitus (T2DM) among adults with dysglycemia. Methods: We used a nested case-cohort prospective design to estimate risk of new diabetes (diabetes treatment or FPG ≥7.0mmol/L) among 1004 Framingham Heart Study Offspring with baseline dysglycemia [fasting plasma glucose (FPG) 5.4–6.9mmol/L and/or 2-h post glucose load level 7.8–11.0mmol/L]. Using clinical characteristics previously shown to predict incident T2DM, we used logistic regression to estimate odds ratios (OR), p-values for predictors, and assessment of model discrimination. Results: At the end of 7 years follow-up there were 118 incident T2DM cases. In a model that included age, sex, elevated blood pressure or blood pressure treatment, lipid-lowering treatment and elevated triglycerides, we found the following additional characteristics to be independently associated with new T2DM: parental history of diabetes (OR 2.28, p =0.004); excess adiposity (BMI≥30kg/m2 or waist circumference ≥101.6cm) (OR 2.04, p =0.0005), and low HDL-C [<1.0 (men) or <1.3mmol/L (women)] (OR 2.77, p <0.0001). The multivariable C-statistic for this model was 0.701, and with glycemic category information included, c =0.751. Conclusions: The key non-glycemic traits that predicted later T2DM in adults with dysglycemia were parental history of diabetes, excess adiposity and low HDL-C. [Copyright &y& Elsevier]

Abstract: Aim: This study sought to assess the association between metabolic syndrome (MS) and health-related quality of life (HRQOL) in the general population. Methods: We analyzed data for 4463 adults, aged 30 years or older, from the Korea National Health and Nutrition Examination Survey 2005. “EuroQol 5D”, which measures two dimensions, the EuroQol 5D index score (EQ-5D) and the EuroQol visual analogue scale (EQ-VAS), was used to evaluate HRQOL. Results: Mean scores for the EQ-5D in both sexes and EQ-VAS in women decreased with increasing number of MS components, and women''s means for both scores were significantly lower than men''s. In individual domains of HRQOL, men with more MS components tended to have higher odds ratios for decreased self-care, and women had decreased mobility, according to the EQ-5D. In men, high blood pressure led to decreased EQ-5D, and in women, abdominal obesity and high blood pressure did so. Additionally, we found that taking medication had an impact on decreased HRQOL, especially in subjects with impaired fasting glucose. Conclusions: HRQOL was negatively associated with the number of MS components and it was decreased by taking hypoglycemic medications. This association differed by gender. [Copyright &y& Elsevier]

Abstract: Aims: The CIDEA gene is involved in energy metabolism and a non-synonymous single nucleotide polymorphism (SNP), V115F (G/T), is a risk factor for obesity in Swedish subjects and metabolic syndrome (MetS) in Japanese subjects. However, the risk allele was a G in Swedish subjects and a T in Japanese subjects. The present study investigated the association between this SNP and MetS in a Chinese population. Methods: Three hundred and fifty-one subjects evaluated at the Cardiac Clinic in Xuanwu Hospital for MetS risks were recruited. Anthropometric measurements, blood pressure, fasting blood glucose, and blood lipid levels were determined in addition to the polymorphism. Results: The proportion of subjects with MetS was significantly higher based on genotype, in the order: GG

Abstract: Aim: To report the national prevalence of metabolic syndrome (MetS) and its risk factors among adult Malaysians (>18 years old) based on World Health Organization (WHO), the National Cholesterol Education Program Expert Panel III (ATP III), International Diabetes Federation (IDF) and the ‘Harmonized’ criteria. Methods: A multi-stage stratified sampling method was used to select 4341 subjects from Peninsular and East Malaysia. Subjects underwent physical and clinical examinations. Results: Based on the WHO, ATP III, IDF and Harmonized definitions, the overall crude prevalences of MetS were 32.1, 34.3, 37.1 and 42.5%, respectively. Regardless of the criteria used, MetS was higher in urban areas, in females, in the Indian population and increased significantly with age. Risk factors also increased with age; abdominal obesity was most prevalent (57.4%), was higher in females (64.2%) and was highest in Indians (68.8%). Hypertension was higher in males (56.5%) and highest among Malaysians (52.2%). In contrast, the Chinese had the highest prevalence of hypertriglyceridaemia (47.4%). Conclusions: Malaysia has a much higher prevalence of MetS compared with other Asian countries and, unless there is immediate intervention to reduce risk factors, this may pose serious implications on the country''s healthcare costs and services. [Copyright &y& Elsevier]

Abstract: Aims: The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD). Methods: Forty-five type 1 diabetic women were evaluated (age 36±9 years; body mass index 24.6±4.4kg/m2). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively. Results: Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9±2.0% vs. 33.7±1.8%, p =0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15±0.34mm vs. 4.96±0.25mm; p =0.006) and EAT was positively correlated with android (central) fat distribution (r =0.44; p =0.002), however no correlation was found with gynoid (peripheric) fat distribution. Conclusions: There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk. [ABSTRACT FROM AUTHOR]

Abstract: Osteoprotegerin (OPG), a novel soluble member of tumour necrosis factor receptor superfamily, has been shown to link cardiovascular disorders. The aim of this study is to investigate the potential relationship between serum OPG levels, cardiovascular risk factors and metabolic syndrome in a relatively large group of women with previous GDM. In this cross-sectional case–control study, 128 women with previous GDM and 67 age-matched controls were enrolled. Subjects were evaluated for the diagnosis of metabolic syndrome according to the criteria of the American Heart Association (AHA). Fasting glucose, insulin, serum lipids, CRP and OPG were assayed. HOMA score was calculated. Carotid intima media thickness (IMT) was measured. There was no significant increase in OPG levels in women with previous GDM when compared to controls. On the other hand, women with previous GDM developing metabolic syndrome had higher OPG levels than those without metabolic syndrome and healthy controls. Serum OPG levels were associated with obesity, insulin resistance, serum CRP and carotid IMT. Serum OPG is related to cardiovascular risk factors and metabolic syndrome, and might be involved in the development of cardiovascular disorders in women with previous GDM. [ABSTRACT FROM AUTHOR]

Abstract: Aims: We tested the hypothesis that high cardiorespiratory fitness (fitness) is associated with lower levels of arterial stiffness in 1035 (age 52±6 years) men with and without the metabolic syndrome. Methods: Arterial stiffness was derived from brachial–ankle pulse wave velocity (baPWV). Fitness was directly measured by peak oxygen uptake during a standard treadmill test. Results: Men with the metabolic syndrome (n =168) had significantly higher baPWV than men without the metabolic syndrome (1424±175cm/s vs. 1333±150cm/s, p <0.05). When separated according to quartiles of fitness, men with and without the metabolic syndrome in the highest quartile of fitness had significantly lower baPWV compared to men in the lowest quartile of fitness (p <0.05). Fitness was inversely correlated with baPWV in men with (p =−0.29, p <0.05) and without the metabolic syndrome (p =−0.22, p <0.05). There was no differences in baPWV levels between fit men with the metabolic syndrome and unfit men without the metabolic syndrome (fit/MetS; 1366±140 vs. unfit/no MetS; 1401±194cm/s, p =0.81). Conclusions: These results demonstrate that high fitness is inversely associated with arterial stiffness in men with and without the metabolic syndrome. Increased arterial stiffness in the metabolic syndrome is attenuated by high fitness. [ABSTRACT FROM AUTHOR]

Abstract: Aims: This study evaluates the effectiveness of three metabolic syndrome (MS) criteria in identifying cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) in the Chinese population. Methods: 3598 subjects were recruited from a cohort study on Prevention of Multiple Metabolic disorders and MS in Jiangsu of China (PMMJS), followed at 6.3 years. MS was diagnosed using criteria of the National Cholesterol Education Program''s Adult Treatment Panel III (ATPIII), the International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS). Cox regression model was used to analysis the association between MS and onset of CVD and T2DM. Receiver operating characteristic (ROC) curve, sensitivity and specificity were also used to test the ability of three MS criteria to identify CVD or T2DM. Results: Among three criteria, CDS has the highest specificity but lowest sensitivity. Using the CDS criterion, over 50 percent of patients would be misdiagnosed. ATPIII criterion has the shortest distance in ROC curve, lowest false positive rate and false negative rate for identifying CVD and T2DM. ATPIII+/IDF+ has lower ability to predict CVD than ATPIII+/IDF−. ATPIII+/IDF+ and ATPIII+/IDF− has similar ability to predict T2DM. Conclusions: The ATPIII-MS criterion has the highest ability to predict CVD and T2DM. ATPIII is the best MS criterion for the Chinese population. [Copyright &y& Elsevier]

Abstract: This study aimed at identifying predictors of success (retention after one year of intervention with ≥5% weight loss) in subjects at high risk for type 2 diabetes enrolled in a lifestyle modification program. Fifty-one individuals with BMI ≥27kg/m2 and pre-diabetes or metabolic syndrome were enrolled in an individualized multidisciplinary lifestyle intervention to induce weight loss. Subjects were assessed initially with a 16-item weight-loss readiness tool (WLRT) based on stages of change model; a 6-min walk test; and anthropometric measures. The most significant independent factor associated with no success was a lower result to the question “I am capable of doing more physical activity” (P =0.001). The second significant independent predictor was ≤0.5% weight loss 6 weeks after initiating intervention (P =0.01). Excluding subjects with both criteria would have reduced by 52% the number of subjects eligible for the program, decreased the dropout rate from 30% to 17%, and increased the proportion of subjects with ≥5% weight loss at one year from 51% to 80%. Importantly, only 4% of subjects would have been falsely identified as non-responders. These results indicate that a practical WLRT, in combination with early weight-loss response, is helpful to identify subjects with greater chances of success to lifestyle intervention. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Because metabolic syndrome (MetS) is defined as any three of five criteria, not all persons with MetS have the same risk factors. Whether the combinations of criteria confer equal diabetes risk is unknown. Methods: We identified 58,056 non-diabetic adults age >=30 with all MetS components measured in 2003–2004. We estimated age- and sex-adjusted diabetes incidence over 5 years for all possible combinations of MetS components. Results: The overall incidence rate of diabetes was 12.5/1000 person-years (95% CI 12.1–12.9). Although incidence increased with the MetS factor count, incidence varied by >9-fold in patients with 3 risk factors, >5-fold in patients with 4 factors, and >54-fold in patients with <3 factors. All two-factor combinations that included hyperglycemia had higher incidence rates than three- or four-factor combinations that did not. For example, incidence in patients with only hyperglycemia and obesity was 21.7/1000 person-years (95% CI 17.4–27.1), compared to 11.4 (9.8–13.4) among those with four components without hyperglycemia. Conclusions: Diabetes risk increases exponentially with MetS factor count, but varies substantially depending upon which factors are present. Hyperglycemia, regardless of the presence of MetS, is a much stronger predictor of incident diabetes than MetS without hyperglycemia. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To assess the utility of different definitions of the metabolic syndrome (MetS) in predicting adulthood MetS among Tehranian adolescents in a 6-year follow-up. Methods: A random sample of 2645 adolescents was selected from the Tehran Lipid and Glucose Study (TLGS) in 1999–2001; MetS was assessed based on five definitions for adolescents. In 2005–2007, 572 age 18 years and over were assessed for MetS by NCEP ATP III adults’ criteria. Sensitivity, specificity, and area under receiver operating curve for attaining adulthood MetS, obesity and overweight were calculated for each MetS definitions. Results: The prevalence of adolescence MetS varied from 0.7±0.2 to 15.1±0.8% by different definitions in adolescents and 4.0±0.9% among adults. The highest area under curve for prediction of adulthood MetS pertained to the de Ferranti''s definition (0.723), and for prediction of adulthood obesity and overweight were 0.723 and 0.606, respectively, for this definition. Kappa for agreement between these definitions was fair (0.195). Conclusions: Definition of MetS for adolescents showed a fair agreement with adult definition. Yet, a diagnosis of MetS in adolescents seems to be a good predictor of developing adulthood MetS within a short time. [Copyright &y& Elsevier]

Abstract: Aim: To determine the prevalence of and risk factors for metabolic syndrome (MS) among urban Asian Indian adults. Methods: 2225 subjects aged ≥20 years were studied in a population based cross-sectional survey in Chandigarh, a city in north India. Anthropometric measurements, estimation of capillary plasma glucose, HDL cholesterol and triglycerides were done. Metabolic syndrome prevalence was estimated using National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III), modified NCEP ATP III and International Diabetes Federation (IDF) criteria. Multiple logistic regression analysis was done to find out risk factors for metabolic syndrome. Results: The prevalence rates of metabolic syndrome were 35.8% (NCEP ATP III), 45.3% (modified NCEP ATP III) and 39.5% (IDF criteria). As per modified NCEP ATP III criteria, central obesity was the commonest abnormality among females and elevated blood pressure among males. Risk factors for MS were increasing age, female gender, sedentary lifestyle and diabetes in parents. Conclusions: Our study showed a high prevalence of metabolic syndrome and its individual components. Independent risk factors for metabolic syndrome included increasing age, female gender, sedentary lifestyle and diabetes mellitus in parents. [Copyright &y& Elsevier]

Abstract: Attempts to explain the associations among metabolic syndrome (MetS) features using factor analysis to identify unobserved potential causes have resulted in inconsistent findings. We examined whether an unobserved categorical factor explains the associations among MetS features using latent class analysis. A cross-sectional analysis of 499 non-diabetic Japanese-Americans who underwent measurements of fasting blood, waist circumference (WC) and CT-measured intra-abdominal fat (IAF) area was conducted. MetS components were defined by IDF criteria. IAF and fasting serum insulin (FI) were dichotomized at the 75th percentile. Latent two- and three-class models were fit that included hypertension, dyslipidemia, hyperglycemia, and either WC, IAF, or FI for a total of six models. A three-class latent model fit the data well, while a two-class model did not. In the three-class model, one latent class was strongly associated with all MetS components, while another was associated with hyperglycemia and hypertension only. IAF was associated with only one latent class. Latent class analysis supports the presence of an unobserved factor linked to the co-occurrence of MetS features. One class of this factor was associated with hypertension and hyperglycemia but not central adiposity or FI, suggesting another pathway for observed MetS features. [Copyright &y& Elsevier]

Abstract: Objective: To examine the association between screen time and the metabolic syndrome (MetS) in a nationally representative sample of children and adolescents. Methods: A cross-sectional survey was conducted in 845 children and adolescents (10–18 years of age) from the 2005 Korean National Health and Nutrition Examination Surveys (KNHANES). Screen time was defined as TV time+computer time. The definition of MetS was based on the modified criteria used by the National Cholesterol Education Program-Adult Treatment Panel III, using age- and sex-specific values for some of the criteria. Results: In comparison with the children and adolescents in the ST-Q1 (≤16h for a week), the odds ratio (95% confidence interval) for MetS of subjects in the ST-Q4 (≥35h for a week) was 2.23 (95% CI, 1.02–4.86) after the adjustment for age, household income, and residence area. Moreover, screen time for a weekend day was also strongly associated with the prevalence of MetS, but not for a weekday. Conclusions: Screen time was independently associated with an increased prevalence risk of MetS in children and adolescents in Korea. Public health intervention to reduce screen time particularly for a weekend may be needed to prevent pediatric MetS in Korea. [Copyright &y& Elsevier]

Abstract: Aims: Animal studies indicate a role for 11β-hydroxysteroid dehydrogenase type 1 (HSD11B1) in the development of obesity. The association to glucose homeostasis is less clear. We investigated the relationship between HSD11B1 mRNA levels in adipose tissue and in skeletal muscle and anthropometric and metabolic measurements in humans with and without impaired glucose homeostasis. Methods: Twelve obese subjects with impaired glucose homeostasis (MetS+) and 12 obese controls (MetS−) received a Very Low Calorie Diet for 16 weeks and adipose tissue biopsies, blood samples and measurements were obtained. In a second cohort, skeletal muscle biopsies, blood samples and measurements were obtained from 18 subjects with type 2 diabetes (T2DM) and 17 subjects with normal glucose tolerance (NGT). Gene expression was measured by DNA microarray in both studies. Results: HSD11B1 mRNA levels were reduced during diet, and anthropometric measurements and metabolic parameters were associated with HSD11B1 mRNA levels in the MetS− group. However, in the MetS+ group these associations were lost or in opposite direction. This difference was also observed in skeletal muscle between T2DM and NGT. Conclusions: HSD11B1 mRNA levels are associated with metabolic parameters and anthropometric measurements in subjects with normal glucose homeostasis but not in subjects with impaired glucose homeostasis. [Copyright &y& Elsevier]

Abstract: Background: In the modified ATP III definition for metabolic syndrome (MS), the cut-off values for central obesity were set to ≥90cm for male and ≥80cm for women. Recently, a new Chinese definition for central obesity was set to ≥90cm for male and ≥85cm for women according to the corresponding BMI value of 25kg/m2. Objective: The purpose of this study was to explore the optimal WC cut-off points to reflect the cluster of multiple risk factors for adults in Beijing. Method: The data collected during the surveillance of risk factors for non-communicable diseases in Beijing 2005 were used, with a total of 16,711 adults studied. Subjects with two or more components from the modified ATP III definition other than central obesity were considered to have multiple risk factors. Results: The optimal WC cut-off points were 87cm in men and 80cm for women. When applied the WC advised definition for MS, the age-standardized prevalence was 38.0% for male and 32.3% for women, which is significantly higher than using the original one for men (34.7% vs 32.3%, P <0.001). Conclusion: The present study indicated that optimal waist circumference cut-off points were lower than that proposed in the modified ATP III definition, especially for men. [Copyright &y& Elsevier]

Abstract: Aim: To determine mutable risk factors for asymptomatic diastolic dysfunction in ethnic minority patients newly diagnosed with type 2 diabetes. Methods: We recruited consecutive adults with newly diagnosed diabetes who had no signs or symptoms or history of heart disease. All patients received standardized evaluation including interview, physical examination, laboratory tests and echocardiogram with tissue Doppler studies. We used logistic regression models to identify mutable risk factors for diastolic dysfunction. Results: Among 126 study subjects (52% women, age 45±10 years, BMI 33±7, 42% with hypertension, 100% ejection fraction ≥50%), evidence of diastolic dysfunction was present in 64 (51%). After controlling for age, heart rate and blood pressure, independent predictors of diastolic dysfunction included physical inactivity (OR: 2.3; 95% CI: 0.9–6.1; P =0.08) and glucose (OR: 4.9; 95% CI: 1.4–17.8; P =0.02). Physical inactivity was associated with early diastolic dysfunction (impaired relaxation), whereas epicardial fat thickness and glucose levels were associated with late diastolic dysfunction (impaired compliance). The hs-CRP and BNP levels were not associated with diastolic dysfunction. Conclusions: Asymptomatic diastolic dysfunction was prevalent among urban minority patients newly diagnosed with diabetes. Important differences exist among factors that affect early and late diastolic function that may have prognostic and therapeutic implications. [Copyright &y& Elsevier]

Abstract: Moderate alcohol consumption is known to be associated with a reduced risk of cardiovascular disease and mortality. However, few studies reported that long-term alcohol drinking may increase the prevalence of central obesity, and cardiovascular disease. We examined the association between metabolic syndrome, nutritional factors and alcohol intake amount in Korean male rural population. We performed a cross-sectional analysis on data from Korean Rural Genomic Cohort (KRGC) study. We used multiple logistic regression analysis to estimate the adjusted odds ratio of metabolic syndrome according to alcohol intake amount categories (never, 0–16g/day, 16–40g/day, and >40g/day). The age adjusted odds ratio for the prevalence of metabolic syndrome was significantly increased in the quartile with the highest alcohol consumption compared to the non-alcohol drinking group (1.33; C.I., 1.11–1.59). These results were similar in the high energy intake group, but not in the low energy intake group. Waist circumference, blood pressure, and serum triglyceride levels were significantly higher in the quartile with the highest alcohol consumption compared to the non-alcohol drinking group. These results suggest that large alcohol consumption is associated with metabolic syndrome and may be a modifiable risk factor of metabolic syndrome especially in subjects with high calorie intake. [Copyright &y& Elsevier]

Abstract: Background: To investigate the effects of Glimepiride on blood glucose in patients with newly diagnosed type 2 diabetes mellitus (T2DM) in connection with plasma lipoproteins and plasminogen activity. Methods: A total of 565 T2DM patients were received Glimepiride (n =333) or Glibenclamide (n =232) for 12 weeks. We observed the level of blood glucose (BG), glycated hemoglobin (HbA1C), the insulin resistance (IR) state, plasma lipoproteins, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor type I (PAI-1) before and after a 12 weeks of treatment. Results: After 12 weeks with Glimepiride treatment, significant reductions were observed in fasting blood glucose (FBG) and 2-h postprandial BG(PBG), HbA1C (from 8.60±3.10 to 7.10±1.60%) and HOMA-IR (from 4.11±0.85 to 2.42±0.91%). The level of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were significantly decreased, whereas that of high-density lipoprotein (HDL) was increased markedly with statistical significance. In addition, there was an obvious improvement in t-PA activity (from 0.225±0.11 to 0.457±0.177IU/ml); whereas the PAI-1 activity was decreased significantly (from 0.898±0.168 to 0.533±0.215AU/ml). No significant changes were observed in plasma lipoprotein profiles and plasminogen activity in Glibenclamide receiving group. Conclusions: Glimepiride can rapidly and stably improve glycemic control and lipoprotein metabolism, significantly alleviate insulin resistance and enhance fibrinolytic activity. [Copyright &y& Elsevier]

Abstract: Aims: Comparing waist circumference (WC) role in diabetes risk prediction and diagnosis of metabolic syndrome (MS) in different populations. Methods: Population-based samples from Australia (n =9026) and Iran (n =8259) were studied in 2000 and followed for ∼4 years. Follow-up attendance was ∼58% and mean age was 51 vs. 47. Pearson correlations calculated between WC and other MS components. ROC for the role of WC in the prediction of incident diabetes was used. Results: Prevalences of MS (48% vs. 28%), an increased WC (58.5% vs. 54.5%), low HDL-C (35% vs. 11.2%), high triglyceride (52.2% vs. 29.6%) were significantly higher in Iran. Fasting glucose ≥5.6mmol/L was higher in Australia (26% vs. 23%). Hypertension was no different (∼38%). Pearson correlations between WC and other MS components were stronger in Australians: FPG (0.32 vs. 0.2), HDL (0.47 vs. 0.16), TG (0.38 vs. 0.30) and SBP (0.38 vs. 0.36). Among women, area under ROC curve for WC as a predictor for diabetes was significantly higher for Australians (0.76 vs. 0.68, p <0.001) with no difference among men (0.69 vs. 0.71, p =0.4). Conclusion: WC was more strongly related to other components of MS in Australia. Association between WC and MS or incident diabetes varies between ethnicities. [Copyright &y& Elsevier]

Abstract: Objective: To investigate whether alanine aminotransferase (ALT), even within the reference range, is associated with atherosclerotic burden in apparently healthy adults. Methods: This was an observational study performed on 830 healthy individuals with normal ALT concentration (≤40U/L). Atherosclerotic burden was assessed by carotid arterial intima-media thickness (IMT). All subjects were divided according to the quartile based on their ALT concentrations. Results: Despite all subjects having a normal ALT concentration, ultrasonographic liver steatosis was observed in 48.4% and 36.7% of men and women, respectively. In both genders, subjects in the highest quartile of ALT concentration had a significantly higher waist circumference, triglyceride concentration, HOMA-IR, a higher prevalence of metabolic syndrome, and a greater severity of ultrasonographic liver steatosis than did those in the lower quartiles. In women, the carotid IMT increased significantly with increasing quartiles of ALT concentration (0.62±0.14mm, 0.66±0.15mm, 0.69±0.15mm, vs. 0.72±0.24mm; P for trend<0.001). Based on multivariate regression analysis, the serum ALT, even within the normal range, was associated with the carotid IMT in both men and women, and independently of traditional cardiovascular risk factors. Conclusions: ALT concentrations, albeit within the reference range, were associated with atherosclerotic burden in healthy adults. [Copyright &y& Elsevier]

Abstract: Juvenile metabolic syndrome (MetS) is a growing major medical problem in industrialised countries. We estimated its prevalence among two similar clinic-based sequentially recruited cohorts of extremely obese adolescents (age: 12–18 years) from Italy (N =665, males=271, females=394) and Germany (N =661, males=261, females=400) using the recent IDF paediatric criteria. The prevalence of the MetS was 23.3% among the Italians and 40.4% among the Germans. A multivariate logistic regression revealed an increased risk related to age (adjusted odd ratio (AOR): 2.24; 95% confidence interval (CI): 1.59–3.16; p <0.001), BMI SDS (AOR: 3.61; 95% CI: 2.33–5.60; p <0.001), male gender (AOR: 2.36; 95% CI: 1.80–3.10; p <0.001), and in German adolescents (AOR: 2.56; 95% CI: 1.98–3.31; p <0.001). Among Italian adolescents having the MetS, 83% had 3 abnormalities, 16% had 4 abnormalities while less than 1% had all the 5 abnormalities. In the German cohort, 67%, 28% and 5% of affected individuals had 3, 4 and 5 abnormalities, respectively. These results indicate that MetS is highly prevalent among extremely obese adolescents, and suggest that (besides age, obesity and gender) national sociocultural factors, as alimentary trends, could be important. Further tools should be developed to understand international epidemiological differences concerning obesity and its comorbidities in relation to lifestyles in the countries of European Union. [Copyright &y& Elsevier]

Abstract: Aims: To compare the cardiovascular disease (CVD) risk associated with the metabolic syndrome (MetS) and dysglycemia, independent of each other during a median follow-up of 6.7 years. Methods: Study population included 4018 Iranian subjects≥40 years, free of CVD or coronary heart disease (CHD) at baseline. Incidence rates and hazard ratio (HR) were estimated by the presence or absence of MetS and dysglycemia. Considering the glycemic status, the ability of MetS in prediction of CVD after adjustment for age, sex and CVD risk factors was assessed. Results: The prevalence of MetS, impaired fasting glucose or impaired glucose tolerance (IFG/IGT) and diabetes were 51.4%, 27.3%, and 18.7%, respectively. The addition of MetS to diabetes did not change the CVD risk compared to diabetic subjects without MetS (reference group) after adjustment for age and sex [HR: 1.62 (95% CI 0.93–2.81)] and CVD risk factors [HR: 1.49 (95% CI 0.86–2.60)]. However, addition of MetS to IFG/IGT increased the risk of CVD by 2.5 times compared to those with IFG/IGT without MetS (the risk factor adjusted HR: 2.45 (95% CI 1.32–4.55)). Conclusions: In Iranian population, MetS did not add to diabetes to predict incident CVD however, IFG/IGT was a significant predictor only in the presence of MetS. [Copyright &y& Elsevier]

Abstract: Aims: The mechanism for the association between diabetes and hypomagnesaemia remains uncertain. This study aimed to test whether hypomagnesaemia is present in pre-diabetes, obesity and the metabolic syndrome. Methods: 1453 adults from randomly selected households from rural Victoria, Australia, attended for biomedical assessment. Serum magnesium concentrations, hypomagnesaemia defined using local laboratory criteria (<0.70mmol/l), and defined by the bottom quintile of serum magnesium concentrations, were compared in different diabetes pre-cursor states including metabolic syndrome using ATP III criteria. Results: The mean serum magnesium was 0.84±0.06mmol/l and 25 (1.7%) had a low magnesium. Mean magnesium was lower among those with known diabetes than those with new diabetes, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) and normal subjects (0.79 (0.78–0.81) vs 0.83 (0.81–0.86); 0.84 (0.82–0.85); 0.84 (0.82–0.86); 0.85 (0.84–0.85)mmol/l). After adjusting for confounders, and compared with those without diabetes, hypomagnesaemia was 10.51 (1.37–80.60)-fold more common with new diabetes, 8.63 (2.20–33.90)-fold more common with known diabetes, 6.77 (1.75–26.17)-fold more common among those taking anti-hypertensive medication but with no difference to those with IGT/IFG (0.90 (0.10–8.10)). Conclusion: Diabetes is associated with hypomagnesaemia, but not its pre-cursor states. [Copyright &y& Elsevier]

Abstract: The activities of the enzymes to eliminate reactive oxygen species prevent the progression of atherosclerosis. We conducted a cross-sectional study among 3234 people that underwent total health check-up service, and studied the relationship between the serum superoxide dismutase (SOD) activity and risk factors of atherosclerosis or carotid artery intima-media thickness (IMT). Serum SOD activity negatively correlated with body mass index (BMI), systolic and diastolic blood pressure, serum triglyceride (TG) concentration and serum glucose concentration. Low serum SOD activity positively correlated with the carotid IMT thickening. But on the other hand, existence of carotid artery plaque positively correlated with serum SOD activity especially among men. Serum SOD activity negatively correlated with the components of metabolic syndrome and low serum SOD activity seems to be an independent risk of the thickening of carotid IMT. On the other hand, serum SOD activity level seems to elevate limitedly but reactively to the status of increased oxidative stress, such as carotid plaque formation. [Copyright &y& Elsevier]

Abstract: Aims: Metabolic syndrome (MetS) is associated with increased cardiovascular risk. We hypothesize that early vascular changes are already present at the time of diagnosis of MetS. The relationship of different measures of early vascular impairment with body fat distribution and the natural progression of MetS was examined in newly diagnosed subjects non-pharmacologically treated. Methods: 246 consecutively enrolled subjects were categorized according to the presence of MetS and type 2 diabetes (T2D). Intra-renal Doppler flow was used to ascertain resistive (RI) and pulsatility (PI) indices as markers of vascular resistance. Carotid intima-media thickness (IMT), cutis-rectis (CR) and rectis-aorta (RA) thicknesses were measured by ultrasonography; RA/CR ratio was used as measure of body fat distribution. Pro-inflammatory cytokines, C-reactive protein, oxidative markers insulin and adiponectin blood concentrations were also measured. Results: Baseline characteristics demonstrated increasing trends in biochemical, inflammatory, and oxidative parameters from MetS−, MetS+, to MetS+/T2D (p <0.001). After adjusting for age, the same increasing trends across the groups were observed in both sexes in IMT (p <0.001), RI (p <0.001) and PI (p <0.001). IMT correlated with RI (r =0.25; p <0.001), PI (r =0.26; p <0.001), and RA/CR ratio (r =0.43; p <0.001). Conclusions: Carotid IMT and intra-renal resistances are elevated at an early stage in MetS and are associated with a dysregulated production of fat-derived hormones and cytokines. [Copyright &y& Elsevier]

Abstract: Aims: We conducted this study to compare the relationships between subclinical atherosclerosis and metabolic syndrome (MS) defined by four definitions in Chinese subjects. Methods: In 2006–2007, we enrolled 140 Chinese subjects without reported diabetes in this study. Anthropometric, biochemical profile, and carotid intima-media thickness (IMT) were measured. MS was defined by International Diabetes Federation (IDF), American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI), National Cholesterol Education Program Adult Treatment Panal III (NCEP-ATP III), and World Health Organization (WHO) criteria. Results: Subjects with MS defined by IDF and AHA/NHLBI criteria had significantly higher carotid IMT, controlling for age, gender, smoking, and serum LDL-C (MS by IDF, partial r =0.225, p =0.008; AHA/NHLBI, partial r =0.176, p =0.04). The association between carotid IMT and MS defined by NCEP-ATP III or WHO criteria was not significant. Subjects with more components of MS defined by IDF, AHA/NHLBI, or NCEP-ATP III criteria correlated to higher carotid IMT in adjusted models (p-values for trend, MS by IDF, 0.011; AHA/NHLBI, 0.011; NCEP-ATPIII, 0.01; WHO, 0.113). Conclusion: MS definitions by IDF and AHA/NHLBI criteria are the best among four definitions in detecting subclinical atherosclerosis in non-diabetic Chinese subjects; whereas MS defined by WHO criteria is the worst. [Copyright &y& Elsevier]

Abstract: Aims: We investigated the associations between indices of cholesterol metabolism and features of the metabolic syndrome (MS) in the presence and absence of type-2 diabetes (T2DM). Methods: Men with the MS (N =140) and 10 age- and sex-matched controls were recruited. Plasma lathosterol and campesterol were measured by gas chromatography–mass spectrometry, and their ratios to total cholesterol were used to estimate cholesterol metabolism. Results: Compared with healthy controls, MS subjects had significantly higher lathosterol:cholesterol and lower campesterol:cholesterol ratios (p <0.05). In the MS subjects without T2DM (N =82), campesterol:cholesterol ratio was positively associated with age and negatively associated with plasma triglyceride and insulin concentrations, while in MS subjects with T2DM (N =58), the ratio was positively associated with age and adiponectin concentration, and negatively associated with BMI and insulin. Age and fasting insulin were independent predictors of campesterol:cholesterol ratio in MS subjects with T2DM. There was a significant negative association between plasma lathosterol:cholesterol with campesterol:cholesterol ratio (r =−0.436, p =0.014) in MS subjects without T2DM but not in MS subjects with T2DM. Conclusions: Cholesterol absorption efficiency was lower and cholesterol synthesis higher in MS subjects with or without T2DM compared with healthy individuals. Moreover, the reciprocal relationship between cholesterol synthesis and cholesterol absorption is lost in the presence of diabetes. [Copyright &y& Elsevier]

Abstract: Aims: The aim of the present study was to determine the prevalence of abnormal glucose tolerance and the metabolic syndrome in a cohort of previously gestational diabetic (GDM) women 4 years after delivery. Methods: Sixty-eight prior GDM and a control group of 39 women with normal glucose tolerance during pregnancy were invited to participate in a follow-up study. Results: The prevalence of diabetes, impaired glucose tolerance and impaired fasting glucose (IFG) was 21%, 16%, and 6% among prior GDM women and 0%, 15%, and 0% among controls respectively (P =0.0039). Independently of the metabolic syndrome criteria used this status was found more frequently among women with prior GDM (all P <0.05). The prevalence of the metabolic syndrome showed a dose–response relationship with the level of weight categories (P <0.005) as well as with the level of glucose intolerance (P =0.024). Conclusion: According to our results a disturbed carbohydrate metabolism and a clustering of cardiovascular risk factors might be observed in previous GDM women 4 years after delivery. [Copyright &y& Elsevier]

Abstract: We describe changes in markers and prevalence of glucose metabolism disorders following a 2-year community-wide intervention aimed at reducing insulin resistance (IR) prevalence in a high risk community. Surveys were undertaken before and 2 years after implementation of a community developed and led diabetes prevention program. Proportions and means were calculated and compared by sex and age groups: 25–49 years and 50+ years. A process evaluation contributed to interpretation of results. Response rates were around 50% and demographic characteristics similar in both surveys. Overall, IR prevalence decreased markedly from 35.5% to 25.4% (p =0.003). Most changes were observed amongst 25–49 years old women for whom there was a significant change in prevalences of IR and glucose metabolism disorders (p =0.015), largely due to reduced IR prevalence (38.2–25.6%). In 2006, 60.3% achieved minimum recommended exercise levels and 65.4% ate wholegrain bread compared with 45.1% (p =0.002) and 42.2% (p =0.044), respectively, in 2003. Participation in a community diabetes prevention intervention appeared to reduce IR prevalence after 2 years in those with the highest level of participation and most marked lifestyle changes. [Copyright &y& Elsevier]

Abstract: 11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1), one of the isoforms of the 11β-hydroxysteroid dehydrogenase enzymes, acts as an oxo-reductase to reactivate cortisone to cortisol, plays a critical role in tissue-specific corticosteroid reactions, and is therefore a key molecule associated with the development of metabolic syndrome. We investigated whether variations in the 11β-HSD1 gene correlated with metabolic syndrome. We performed case–control study using a population-based urban Japanese cohort. Among 3005 urban residents, we examined 431 subjects diagnosed with metabolic syndrome according to the Japanese definition and 777 subjects with none of metabolic syndrome criteria as control. We genotyped three single nucleotide polymorphisms (SNPs) (+9410T>A, +17925C>T, +27447G>C) across the 11β-HSD1 gene in them and analyzed the associations of SNPs and haplotypes with metabolic syndrome. The +9410A allele showed a tendency to metabolic syndrome (OR=1.5, 95%C.I., 1.0–2.2; P =0.041 and Bonferroni corrected P =0.123) without statistical significance. However, we could not find any significant association between metabolic syndrome and SNPs in the 11β-HSD1 gene. Our findings indicate that polymorphisms and haplotypes in the 11β-HSD1 gene are not significantly associated with metabolic syndrome in the Japanese population. [Copyright &y& Elsevier]

Abstract: Aims: The aim of the present study was to examine the cross-sectional relationship between vital capacity and diabetes, metabolic syndrome (MS), and high-sensitivity C-reactive protein (hs-CRP) among Japanese men. Methods: Medical check-up data of 1353 men were examined. Spearman''s correlation coefficients between respiratory function and MS-related risk factors were calculated excluding subjects with hypoglycemic medication. The prevalence of diabetes and MS were compared between subjects with the lowest and the highest quartiles of % vital capacity (%VC). Area under receiver operating characteristic curve (AUC) were calculated for risk factors excluding fasting glucose. Logistic regression using diabetes as a dependent variable and %VC and MS-related risk factors excluding fasting glucose as independent variables was performed. Results: %VC was significantly correlated with some components of MS and hs-CRP. The prevalence of diabetes, MS, and MS components other than blood pressure were significantly lower in the highest quartile than in the lowest quartile of %VC. AUC of -%VC was highest among MS-related risk factors excluding fasting glucose though statistically not significant. %VC was an independent marker of diabetes in the multivariable logistic regression analysis. Conclusions: Vital capacity was an independent marker of diabetes and associated with MS and hs-CRP in Japanese men. [Copyright &y& Elsevier]

Abstract: Aims: To determine the appropriate cutoff value of waist circumference associated with cardiometabolic risk factors in Koreans. Methods: Clinical and laboratory data on 31,076 Korean adults (age 20–89 years, 40% women) were recorded at regular health check-ups. Receiver operating characteristic curves were used to determine the cutoff values of waist circumference with respect to myocardial ischemia, hypertension, diabetes, and multiple risk factors for metabolic syndrome. Results: Age-adjusted odds ratios for myocardial ischemia, diabetes, hypertension, and multiple components of metabolic syndrome for one standard-deviation increase in waist circumference were 1.45, 1.37, 1.55, and 1.89 for men, and 1.28, 2.03, 1.64, and 2.08 for women, respectively. The cutoff value showing the maximum sensitivity plus specificity for detecting myocardial ischemia was 87cm for men and 74cm for women. The cutoff values for discrimination of hypertension, diabetes, and multiple risk factors for metabolic syndrome, were 84, 85, and 83cm, respectively, for men, and 77, 77, and 76cm, respectively, for women. Conclusions: The waist-circumference cutoff values for cardiometabolic disease and its risk factors are lower than those recommended for Asians by the WHO. Waist-circumference cutoff for defining metabolic syndrome should be lowered in the Korean population. [Copyright &y& Elsevier]

Abstract: Background: This study investigates the relationship between serum concentration of RBP4 and visfatin and the metabolic syndrome. Methods: Patients with metabolic syndrome were studied between October, 2004 and September, 2005. All study subjects were aged 40 and over and lived in Taichung city, Taiwan. The Third Report of the National Cholesterol Education Program''s Adult Treatment Panel (ATP III, 2001) was used to define the metabolic syndrome. Serum RBP4 and visfatin levels were measured by enzyme-linked immunosorbent assay. Results: Serum mean RBP4 levels in subjects who had all five abnormal components of metabolic syndrome (mean±SD=40.8±18.6) and those who had all components except hyperglycemia (43.5±23.5) were significantly higher than those in healthy controls (30.3±14.0μg/ml) (p <0.05). Similar results were not found in serum visfatin levels. Using log-transformed serum RBP4 or visfatin levels as a dependent variable, we found that subjects with all five and four abnormal components of metabolic syndrome had significantly higher mean serum RBP4 levels (p =0.043 and 0.034, respectively), compared to healthy controls, after adjusting for other covariates. In contrast, similar results were not found in serum visfatin levels. Conclusion: Metabolic syndrome is significantly associated with serum RBP4, but not serum visfatin. [Copyright &y& Elsevier]

Abstract: Aim: To investigate the influences of bacterial or viral pathogen burden in the relationship of high sensitivity C-reactive protein (hs-CRP) and the metabolic syndrome in a population-based study. Methods: Data from 1754 men and women aged ≥25 years, from the Persian Gulf Healthy Heart Study were analyzed. The definition of the metabolic syndrome according to the Adult Treatment Panel III was used. Sera were analyzed for IgG antibodies to Chlamydia pneumoniae, Herpes simplex virus type 1, Helicobacter pylori and cytomegalovirus using ELISA. Measurement of CRP by a high-sensitivity CRP assay was done. Results: The subjects with the metabolic syndrome had a higher geometric mean of CRP levels than the normal persons (p <0.0001). A linear relationship between an increase in the number of metabolic syndrome components and CRP concentrations was observed (p for trend<0.0001). In multiple logistic regression models, hs-CRP showed significant associations with the metabolic syndrome after controlling for cardiovascular risk factors and infectious burden divided into 2, 3 and 4 pathogens [OR=2.06, CI (1.32–3.21), p =0.001; OR=1.75, CI (1.26–2.42), p =0. 001; OR=2.12, CI (1.46–3.08), p <0.0001; respectively]. Conclusion: There was a strong association between inflammation and the metabolic syndrome independent to viral and bacterial infectious burden. [Copyright &y& Elsevier]