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1、Frequency of Metabolic Syndrome and its Absorption Abnormality by Plant Sterols in General Population, Japan Toshio Shimada, Yo Murakami, Nobuyuki Oyake, Hiroyuki Yoshitomi, Nobuhiro Kodani, Akira Matsumori* Division of Cardiovascular Medicine, Department of Internal Medicine, Shimane University Fac
2、ulty of Medicine, Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine*,Background Health problems on aged people have been growing bigger in Japan because with advancing age, a variety of diseases especially on vascular diseases, such as cardio- and cerebro-vascular
3、diseases have been increasing. And therefore, early detection of vascular diseases is a very important issue for vascular prevention and reduction of mortality.,Obesity,Insulin Resistance,DM,Dyslipidemia,Hypertension,Atherosclerosis Arteriosclerosis,Pathophysiology of Metabolic Syndrme,Over-eating,P
4、oor Exercise,Inheritance,LDL I,Synthesis of Cholesterol in the Liver and Absorption of Cholesterol in the Intestine - Two Important Supply Sources of Cholesterol in Vivo-,Bile,Food,Liver,Vessels,Cholesterol,Small Intestine,Biliary 8002000mg/day Dietary 400500mg/day,Aim Our purpose is to investigate
5、the frequency of metabolic syndrome (MS) and life style related diseases and also to examine whether any difference in absorption of cholesterol from the digestive system is present in participants between with metabolic syndrome (MS) and non-MS randomly selected, using plant sterols in general popu
6、lation.,Subjects and method In 2007, 1980 participants for annual health check-up were subjected for this cohort study. Average age is 6610.8 years, and female is 1260(64%)；male is 720(36%). All subjects underwent routine blood examinations, insulin, remnant like particle cholesterol (RemLC), hs-CRP
7、, cystatin C, plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) measurements. Blood pressure, abdominal circumference, and electrocardiography were measured at the same time. Abdominal circumference was measured at the navel level in the supine position like CT for visceral fa
8、t. Evaluation of cholesterol absorption was done by plant sterols in each 30 participants chosen randomly from the participants. BNP and NT-proBNP were measured for heart failure screening by immunoluminesence method. Plant sterols were measured by gas chromatography.,In 1964 participants, 218 parti
9、cipants(11%) were diagnosed as MS, using 80cm waist circumference in female and 85cm in male as major criterion. From each group, 30 participants were randomly chosen to check plant sterol levels for the evaluation of absorption of cholesterol and lathosterol for the evaluation of cholesterol synthe
10、sis. Each sterol level was measured by gas chromatography.,The Measurement of Serum Plant Sterols to Evaluate Cholesterol Absorption in Okuizumo Cohort, 2007,Abnormal and Normal Proportion of Clinical Paramerers in General Population, Japan Okuizumo Cohort 2007,0%,10%,20%,30%,40%,50%,60%,70%,80%,90%
11、,100%,Syst BP(130mmHg),Diast BP(85mmHg),Gender(F/M),Waist Circum90-85,Waist Circum80-85,Metabo90-85,Metabo80-85,CKD,normal,abnormal,N=1972,N=1972,N=1972,N=1972,N=1972,N=1972,N=1972,N=1980,N=1964,N=1964,N=1964,N=1964,N=1980,DM (HbA1c 5.8% ）,（220mg/dL）,TG (150mg/dL）,LowHDL (40mg/dL）,Obesity (BMI 25）,M
12、etabolic Syndrome and its Influential Factors Analyzed by Multivariate Logistic Regression Female Waist Circumference 90cm,Influential Parameters BMI Hb Cystatin C Insulin Rem LC Tcho,Metabolic Syndrome and its Influential Factors Analyzed by Multivariate Logistic Regression Female Waist Circumferen
13、ce 80cm,Influential Parameters BMI Hb Cystatin C Rem LC Tcho,Sensitivity 0.81 Specificity 0.65 Odds Ratio 5278 AUC 0.77 p = 0.0000,Cut-Off Value,7.34mg/dL,Cut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome (Abdominal Circumference of Women 90 cm and that of Men 85 cm),Cut-Of
14、f Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome (Abdominal Circumference of Women 80 cm and that of Men 85 cm),7.26mg/dL,Cut-Off Value,Sensitivity 0.82 Specificity 0.67 Odds Ratio 429156 AUC 0.79 p = 0.0000,Cut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Synd
15、rome (Abdominal Circumference of Women 90 cm),Sensitivity 0.89 Specificity 0.70 Odds Ratio 300 AUC 0.83 p = 0.0000,6.19mg/dL,Cut-Off Value,Sensitivity 0.80 Specificity 0.72 Odds Ratio 429156 AUC 0.82 p = 0.0000,6.88mg/dL,Cut-Off Value,Cut-Off Value of Rem LC Based on ROC Curve for Screening Metaboli
16、c Syndrome (Abdominal Circumference of Women 80cm),Sensitivity 0.81 Specificity 0.63 Odds Ratio 1647 AUC 0.75 p = 0.0000,7.27mg/dL,Cut-Off Value,Cut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome (Abdominal Circumference of Men 85cm),Abnormal and Normal Proportion of Plasma
17、BNP Levels With Advancing Age in General Population, Japan Okuizumo Cohort 2007 Cut-Off Value 20pg/mL,N=145,N=322,N=721,N=341,N=269,N=132,N=48,Years,Abnormal and Normal Proportion of NT-proBNP Levels With Advancing Age in General Population, Japan Okuizumo Cohort 2007 Cut-Off Value 55pg/mL,N=145,N=3
18、22,N=721,N=341,N=269,N=132,N=48,Years,Comparison of Campesterol Between Metabo(0) and Non-Metabo(1) in General Population, Japan Okuizumo Cohort 2007 Campesterol(Absorption Marker of Cholesterol),Metabo,Non-Metabo,NS,Comparison of Sitosterol Between Metabo(0) and Non-Metabo(1) in General Population,
19、 Japan Okuizumo Cohort 2007 Sitosterol(Absorption Marker of Cholesterol),Metabo,Non-Metabo,p0.05,Comparison of Lathosterol Between Metabo(0) and Non-Metabo(1) in General Population, Japan Okuizumo Cohort 2007 Lathosterol(Synthesis Marker of Cholesterol),Metabo,Non-Metabo,NS,Summary Results High bloo
20、d pressure was 52%, high cholesterol 25%, low HDL-cholesterol 5%, high triglyceridemia 18%, high blood sugar 17% and in women, abdominal circumference 90cm 10% and 80cm 44%, respectively. According to Japanese abdominal circumference criteria for MS in women, only 3% of women were diagnosed as MS. U
21、sing 80cm as criteria for abdominal circumference, 10% were diagnosed as MS. In men (85cm), 13% were MS. Participants with possible cardiac dysfunction were 46% in BNP and 52% in NT-proBNP, respectively. RemLC was very closely related to MS. Receiver operating characteristic (ROC) curve analysis for
22、 diagnosing MS demonstrated that cut-off value of LemLC was 7.26mg/dl using female waist circumference 80cm and male waist circumference 85cm , 7.28mg/dl only using male waist circumference 85cm and 6.88mg/dl only using female waist circumference 80cm.,Summary Results（Continued) Absorption of choles
23、terol marker levels were paradoxically lower in MS than in non MS. Lathosterol, a marker of cholesterol synthesis was 2.4g/mL in MS and 2.8 g/mL in non MS (p=0.1133), sitosterol, a marker of cholesterol absorption 1.5 g/mL in MS and 1.8 g/mL in non MS (p=0.0107), campesterol, a marker of cholesterol
24、 absorption, 2.4 g/mL in MS and 2.8 g/mL in non MS (p=0.1551). CKD was found in 9.5% of the participants using MDRD.,Conclusion MS was found in about 10% in general population of Japan. Absorption cholesterol marker, plant sterols were paradoxically lower in MS than in non MS and then abnormal absor
25、ption was strongly suspected in MS. In other words, low plant sterol levels may implicate increased cholesterol absorption in the small intestine. RemLC may be a useful single marker for screening of MS. Present Japanese criteria for MS should be modified correctly as early as possible. We need more detail investigation for more clarification on MS.,Thank you very much for your attention (Beijing Olympic Year),The Lake Shinji, Shimane,