日本普通人群中代谢综合征及植物甾酮的吸收异常发生率实用教案

《日本普通人群中代谢综合征及植物甾酮的吸收异常发生率实用教案》由会员分享，可在线阅读，更多相关《日本普通人群中代谢综合征及植物甾酮的吸收异常发生率实用教案（25页珍藏版）》请在装配图网上搜索。

1、BackgroundHealth 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 diseases have been increasing. And therefore, early detection of vascular diseases is a very important is

2、sue for vascular prevention and reduction of mortality.第1页/共25页第一页，共25页。Diagnostic Criteria for Metabolic Syndrome (8 Japanese Medical Associations Joint-Committee) Fat accumulation in the intra-abdominal cavityAbdominal Circumference at the WaistMale85cm, Female90cm( 80cm recommended by me)（Viscera

3、l fat areaMale and Female 100 cm2)Hypertriglyceridemia 150 mg/dLLow HDL-cho 40 mg/dLSystolic Blood Pressure 130 mmHgDiastolic Blood Pressure 85 mmHgFasting Blood Sugar 110 mg/dL Lipoprotein abnormality High Blood Pressure High Blood Sugar At least, more than following 2 itemsand / orand / ormodified

4、 and translated into English by Toshio ShimadaMajor CriteriaMinor Criteria第2页/共25页第二页，共25页。ObesityInsulin ResistanceDMDyslipidemiaHypertensionAtherosclerosisArteriosclerosisPathophysiology of Metabolic SyndrmeOver-eatingPoor ExerciseInheritance第3页/共25页第三页，共25页。LDLISynthesis of Cholesterol in the Liv

5、er and Absorption of Cholesterol in the Intestine- Two Important Supply Sources of Cholesterol in Vivo-BileFoodLiverVesselsCholesterolSmall IntestineBiliary8002000mg/dayDietary400500mg/day第4页/共25页第四页，共25页。AimOur purpose is to investigate the frequency of metabolic syndrome (MS) and life style relate

6、d diseases and also to examinewhether 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 population.第5页/共25页第五页，共25页。Subjects and method In 2007, 1980 parti

7、cipants 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, cystatin C, plasma brain natriuretic peptide

8、(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 fat. Evaluation of cholesterol absorption was don

9、e 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.第6页/共25页第六页，共25页。In 1964 participants, 218 participants(11%) were diagnosed as

10、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 synthesis.Each sterol level was measur

11、ed by gas chromatography.The Measurement of Serum Plant Sterols to Evaluate Cholesterol Absorptionin Okuizumo Cohort, 2007第7页/共25页第七页，共25页。Abnormal and Normal Proportion of Clinical Paramerers in General Population, JapanOkuizumo Cohort 20070%10%20%30%40%50%60%70%80%90%100%Syst BP(130mmHg)Diast BP(8

12、5mmHg)Gender(F/M)Waist Circum90-85Waist Circum80-85Metabo90-85Metabo80-85CKDnormalabnormalN=1972N=1972N=1972N=1972N=1972N=1972N=1972N=1980N=1964N=1964N=1964N=1964N=1980DM (HbA1c 5.8% ）（220mg/dL）TG (150mg/dL）LowHDL (40mg/dL）Obesity (BMI 25）第8页/共25页第八页，共25页。True PositiveSensitivity0.000.100.200.300.40

13、0.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .80 .901-SpecificityFalse PositiveUsing MSF90M85-Dx=0 to be the positive levelArea Under Curve = 0.93304Receiver Operating CharacteristicReceiver Operating CharacteristicMetabolic Syndrome and its Influential Factors Analyzedby Multivariate Log

14、istic RegressionFemale Waist Circumference 90cm90cmInfluential ParametersBMIHbCystatin CInsulinRem LC Tcho第9页/共25页第九页，共25页。True PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .80 .901-SpecificityFalse PositiveUsing Abd-CF80M85=0 to be the positive leve

15、lArea Under Curve = 0.89483Receiver Operating CharacteristicReceiver Operating CharacteristicMetabolic Syndrome and its Influential Factors Analyzed by Multivariate Logistic Regression Female Waist Circumference 80cm80cmInfluential ParametersBMIHbCystatin CRem LC Tcho第10页/共25页第十页，共25页。True PositiveS

16、ensitivity0.000.100.200.300.400.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .80 .901-SpecificityFalse PositiveSensitivity 0.81Specificity 0.65Odds Ratio 5278AUC 0.77p = 0.0000 Cut-Off Value7.34mg/dLCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circum

17、ference of Women 90 cmand that of Men 85 cm)第11页/共25页第十一页，共25页。Cut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 80 cmand that of Men 85 cm)True PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .

18、80 .901-SpecificityFalse Positive7.26mg/dLCut-Off ValueSensitivity 0.82Specificity 0.67Odds Ratio 429156AUC 0.79p = 0.0000 第12页/共25页第十二页，共25页。Cut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 90 cm)Sensitivity 0.89Specificity 0.70Odds Ratio

19、300AUC 0.83p = 0.0000 True PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .80 .901-SpecificityFalse Positive6.19mg/dLCut-Off Value第13页/共25页第十三页，共25页。Sensitivity 0.80Specificity 0.72Odds Ratio 429156AUC 0.82p = 0.0000 True PositiveSensitivity0.000.100.2

20、00.300.400.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .80 .901-SpecificityFalse Positive6.88mg/dLCut-Off ValueCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 80cm)第14页/共25页第十四页，共25页。Sensitivity 0.81Specificity 0.63Odds Ratio 164

21、7AUC 0.75p = 0.0000 True PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00 .10 .20 .30 .40 .50 .60 .70 .80 .901-SpecificityFalse Positive7.27mg/dLCut-Off ValueCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Men 85cm)第15页/共25页第十五

22、页，共25页。Abnormal and Normal Proportion of Plasma BNP Levels With Advancing Age in General Population, JapanOkuizumo Cohort 2007Cut-Off Value 20pg/mLN=145N=322N=721N=341N=269N=132N=48Years 第16页/共25页第十六页，共25页。Abnormal and Normal Proportion of NT-proBNP Levels With Advancing Age in General Population, J

23、apanOkuizumo Cohort 2007Cut-Off Value 55pg/mLN=145N=322N=721N=341N=269N=132N=48Years 第17页/共25页第十七页，共25页。Comparison of Campesterol Between Metabo(0) and Non-Metabo(1) in General Population, JapanOkuizumo Cohort 2007Campesterol(Absorption Marker of Cholesterol)MetaboNon-MetaboNS第18页/共25页第十八页，共25页。Comp

24、arison of Sitosterol Between Metabo(0) and Non-Metabo(1) in General Population, JapanOkuizumo Cohort 2007Sitosterol(Absorption Marker of Cholesterol)MetaboNon-Metabop0.05第19页/共25页第十九页，共25页。Comparison of Lathosterol Between Metabo(0) and Non-Metabo(1) in General Population, JapanOkuizumo Cohort 2007L

25、athosterol(Synthesis Marker of Cholesterol)MetaboNon-MetaboNS第20页/共25页第二十页，共25页。Summary Results High blood 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. Accordi

26、ng to Japanese abdominal circumference criteria for MS in women, only 3% of women were diagnosed as MS. Using 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, respe

27、ctively. RemLC was very closely related to MS. Receiver operating characteristic (ROC) curve analysis for 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

28、and 6.88mg/dl only using female waist circumference 80cm. 第21页/共25页第二十一页，共25页。Summary Results（Continued)Absorption of cholesterol 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), sitostero

29、l, 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 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.第22页/共25页第二十二页，共25页。ConclusionMS was found in about 10% in g

30、eneral population of Japan. Absorption cholesterol marker, plant sterols were paradoxically lower in MS than in non MS and then abnormal absorption was strongly suspected in MS. In other words, low plant sterol levels may implicate increased cholesterol absorption in the small intestine. RemLC may b

31、e 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.第23页/共25页第二十三页，共25页。Thank you very much for your attention(Beijing Olympic Year)The Lake Shinji, Shimane第24页/共25页第二十四页，共25页。感谢您的观看(gunkn)！第25页/共25页第二十五页，共25页。