Fasting plasma glucose and clustering of cardiometabolic risk factors in normoglycemic outpatient children and adolescents

OBJECTIVE

To evaluate whether fasting plasma glucose (FPG) within a normoglycemic range is associated with cardiometabolic risk factors (CMRF) among children and adolescents in an outpatient setting.

RESEARCH DESIGN AND METHODS

Subjects (780; age 6–16 years) with FPG <100 mg/dL were divided into tertiles of FPG.

RESULTS

BMI, waist circumference, homeostasis model assessment-insulin resistance, systolic blood pressure, and white blood cell (WBC) count (P < 0.0001) increased across tertiles of FPG. Subjects with high-normal FPG (89–99 mg/dL) showed a higher risk of insulin resistance, hypertension, and high WBC count compared with subjects with low-normal FPG, independent of BMI z score.

CONCLUSIONS

In outpatient children and adolescents, higher FPG within the normal range is associated with several CMRF, independent of obesity. Thus the simple measurement of FPG may help identify subjects who warrant some monitoring in relation to cardiovascular risk.The prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT), is increasing in the pediatric population (1). Similar to adults, prediabetes in children is associated with both an elevated risk of developing type 2 diabetes and a worsened cardiovascular risk profile compared with normoglycemic subjects (2,3). Recent studies have shown that in obese children some impairment of glucose homeostasis might already be present at fasting glucose concentrations below the threshold for IFG (4–6). However, the question whether fasting plasma glucose (FPG) in the normal range is associated with some cardiometabolic risk factors (CMRF) is little explored. Therefore, we assessed whether FPG clustered with CMRF in an outpatient setting of normoglycemic Caucasian children and adolescents. In addition we evaluated whether subjects with high-normal FPG showed a worse cardiometabolic risk profile.     

Association of BMI and fasting insulin with cardiovascular disease risk factors in seven-year-old Icelandic children

Objective

To look at overweight and common cardiovascular disease (CVD) risk factors, and associations with body mass index (BMI) and fasting insulin in seven-year-old schoolchildren in Reykjavik, Iceland.

Study design

Cross-sectional study of seven-year-old schoolchildren.

Setting

Six elementary schools in Reykjavik.

Subjects

All children attending second grade in these six schools were invited to participate.

Main outcome measures

Overweight, fasting serum insulin, CVD risk factors.

Results

Some 14% of the participating children were classified as overweight. Overweight children had higher fasting insulin, higher fasting glucose, and higher systolic and diastolic blood pressure. Furthermore, they had significantly lower total cholesterol (TC), lower high-density lipoprotein (HDL), and lower low-density lipoprotein (LDL) but a similar TC/LDL ratio to normal-weight children. The factors that were strongly associated with BMI were serum fasting insulin, systolic blood pressure (SBP), HDL and fasting glucose, while the sum of four skinfolds, triglycerides, glucose, and LDL were highly associated with fasting insulin.

Conclusion

Overweight children are likelier to have unfavourable levels of common CVD risk factors included in metabolic syndrome, but surprisingly had lower LDL and TC. Skinfold thickness, higher triglyceride and glucose levels, and being female were associated with increased serum insulin.     

Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men.

OBJECTIVE: Because of the available conflicting epidemiological data, we investigated the possible impact of fasting blood glucose as a risk factor for cardiovascular death in nondiabetic men. This study reports the results from a 22-year prospective study on fasting blood glucose as a predictor of cardiovascular death. RESEARCH DESIGN AND METHODS: Of the 1,998 apparently healthy nondiabetic men (aged 40-59 years), a total of 1,973 with fasting blood glucose < 110 mg/dl were included in the study in which also a number of conventional risk factors were measured at baseline. RESULTS: After 22 years of follow-up, 483 men had died, 53% from cardiovascular diseases. After dividing men into quartiles of fasting blood glucose level, it was found that men in the highest glucose quartile (fasting blood glucose > 85 mg/dl) had a significantly higher mortality rate from cardiovascular diseases compared with those in the three lowest quartiles. Even after adjusting for age, smoking habits, serum lipids, blood pressure, forced expiratory volume in 1 s, and physical fitness (Cox model), the relative risk of cardiovascular death for men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.04-1.8). Noncardiovascular deaths were unrelated to fasting blood glucose level. CONCLUSIONS: Fasting blood glucose values in the upper normal range appears to be an important independent predictor of cardiovascular death in nondiabetic apparently healthy middle-aged men.     

体脂分布类型和胰岛素抵抗对心血管病危险因素聚集性的影响

目的探讨体脂分布类型和胰岛素抵抗对心血管病危险因素聚集性的影响。方法在2 668名自然人群中调查体质量指数、腰围/臀围比值、血压、血胆固醇、三酰甘油、高密度脂蛋白-胆固醇、低密度脂蛋白-胆固醇、血糖、胰岛素及胰岛素敏感性指数。结果外周型超重组血压、三酰甘油、胰岛素高于非超重组,高密度脂蛋白-胆固醇、胰岛素敏感性指数低于非超重组;而中心型超重组血压、胰岛素及危险因素聚集程度高于外周型超重组,胰岛素敏感性指数低于外周型超重组;分析显示胰岛素敏感性指数与血脂、血糖及危险因素聚集程度密切相关。结论体脂分布类型是影响心血管危险因素聚集的重要因素。     

Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study

This report examines prospectively, in the Framingham cohort, the relation of diabetes and impaired glucose tolerance to each of the cardiovascular sequelae, taking into account age, sex, and associated cardiovascular risk factors. The incidence of cardiovascular disease, as well as the levels of cardiovascular risk factors, were found to be higher in diabetic than in nondiabetic men and women. The relative impact of diabetes on coronary heart disease, peripheral vascular disease, or stroke incidence was the same in men and women, but for cardiovascular mortality and cardiac failure the impact is greater for women. Present evidence suggests that alleviation of associated cardiovascular risk factors is the most promising course in reducing cardiovascular sequelae in diabetic patients.     

Insulin resistance and cardiovascular disease risk factors in children of parents with the insulin resistance (metabolic) syndrome

OBJECTIVE: To evaluate whether children of parents with the insulin resistance syndrome (IRS) themselves have greater insulin resistance and unfavorable patterns of cardiovascular disease (CVD) risk factors. RESEARCH DESIGN AND METHODS: This cross-sectional study included 220 white and 36 black children aged 11-15 years identified through a school-based blood pressure screening program, along with 378 of their parents. Measures of insulin resistance (glucose disposal per minute per kilogram of lean body mass in a euglycemic-hyperinsulinemic clamp [Mlbm] and fasting insulin), adiposity, and other CVD risk factors were compared in children with and without a parental history of IRS, defined according to the National Cholesterol Education Program Adult Treatment Panel III consensus definition. RESULTS: Compared with children in whom neither parent had IRS, children who had at least one parent with the syndrome had statistically significantly lower mean Mlbm (12.1 vs. 13.6 mg.kg(-1).min(-1); P=0.04) and higher fasting insulin (geometric means 99 vs. 76 pmol/l; P=0.01) after adjustment for sex, race, age, and Tanner stage. Mean BMI, waist circumference, waist-to-hip ratio, triceps and subscapular skinfolds, and percentage of body fat were also significantly higher in children of an affected parent, but there were no significant differences in lipid or blood pressure levels between the two groups. CONCLUSIONS: Insulin resistance and obesity may be the earliest manifestations of IRS in children with a parental history of the syndrome.     

Differences in cardiovascular risk factors, insulin resistance, and insulin secretion in individuals with normal glucose tolerance and in subjects with impaired glucose regulation: the Telde Study

OBJECTIVE: To assess the cardiovascular risk profile, the degree of insulin resistance, and beta-cell secretion in a cohort of subjects with different categories of impaired glucose regulation (IGR): impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT. RESEARCH DESIGN AND METHODS: We studied 902 nondiabetic subjects between 30 and 80 years of age, recruited from a cross-sectional population-based study in Telde, Gran Canaria Island, Spain. Categories of glucose tolerance were defined according to 2003 modified American Diabetes Association criteria. Risk factors for cardiovascular disease, the presence of the metabolic syndrome, and indirect measures of both insulin resistance and beta-cell function were analyzed. RESULTS: A total of 132 (14.6%) participants had isolated IFG, 59 (6.5%) isolated IGT, and 48 (5.3%) combined IFG/IGT. Groups with normal glucose tolerance (NGT) and combined IFG/IGT had, respectively, the most favorable and unfavorable levels of cardiovascular risk factors, metabolic syndrome rates, and measures of insulin resistance. Subjects with IFG and IGT showed an intermediate profile between NGT and IFG/IGT categories. We found no significant differences between IFG and IGT in cardiovascular risk factors, metabolic syndrome prevalence, or insulin resistance. The IFG group exhibited a more impaired insulin secretion than those with IGT or IFG/IGT. CONCLUSIONS: Individuals with IGR, especially those with IFG/IGT, have increased values of cardiovascular risk factors and higher indexes of insulin resistance. Groups with isolated IFG and isolated IGT present similar cardiovascular risk profiles. Subjects with IFG are characterized by more defective beta-cell function than other forms of IGR.     

老年人超重或肥胖对心血管疾病危险因素的影响

目的探讨老年人超重或肥胖对心血管疾病危险因素的影响。方法选择来我院疗养和体检的60岁以上老年人643例作为研究对象,按体重指数(BMI)分组后,设置正常体重组327例,超重或肥胖组316例,分别观察两组老年人的血压(SBP/DBP)、空腹血糖(FPG)、血甘油三酯(TG)、血总胆固醇(TC)、高密度脂蛋白(HDL)低密度脂蛋白(LDL)、血尿酸(UA);统计两组老年人高血压病、2型糖尿病、高血脂、高尿酸血症、脂肪肝和冠心病的患病率,分析超重或肥胖与心血管疾病危险因素的相关性。结果超重或肥胖组老年人的SBP/DBP、FPG、TG、TC、LDL、UA均值均高于正常体重组,HDL低于正常体重组,差异有统计学意义(P0.01);超重或肥胖组老年人的高血压病、2型糖尿病、高血脂、高尿酸血症、脂肪肝和冠心病的患病率均高于正常体重组(P0.01);相关分析显示,老年人超重或肥胖与心血管疾病危险因素呈明显正相关。结论老年人超重或肥胖与心血管疾病密切相关,是心血管疾病的重要危险因素之一。     

Abnormal glucose tolerance and increased risk for cardiovascular disease in Japanese-Americans with normal fasting glucose

OBJECTIVE: To compare the American Diabetes Association (ADA) fasting glucose and the World Health Organization (WHO) oral glucose tolerance test (OGTT) criteria for diagnosing diabetes and detecting people at increased risk for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: Study subjects were 596 Japanese-Americans. Fasting insulin, lipids, and C-peptide levels; systolic and diastolic blood pressures (BPs); BMI (kg/m2); and total and intra-abdominal body fat distribution by computed tomography (CT) were measured. Study subjects were categorized by ADA criteria as having normal fasting glucose (NFG), impaired fasting glucose (IFG), and diabetic fasting glucose and by WHO criteria for a 75-g OGTT as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetic glucose tolerance (DGT). RESULTS: Of 503 patients with NFG, 176 had IGT and 20 had DGT These patients had worse CVD risk factors than those with NGT . The mean values for NGT, IGT, and DGT, respectively, and analysis of covariance P values, adjusted for age and sex, are as follows; intra-abdominal fat area by CT 69.7, 95.0, and 101.1 cm2 (P < 0.0001); total CT fat area 437.7, 523.3, and 489.8 cm2 (P < 0.0001); fasting triglycerides 1.40, 1.77, and 1.74 mmol/l (P = 0.002); fasting HDL cholesterol 1.56, 1.50, and 1.49 mmol/l (P = 0.02); C-peptide 0.80, 0.90, 0.95 nmol/l (P = 0.002); systolic BP 124.9, 132.4, and 136.9 mmHg (P = 0.0035); diastolic BP 74.8, 77.7, and 78.2 mmHg (P = 0.01). CONCLUSIONS: NFG patients who had IGT or DGT had more intra-abdominal fat and total adiposity; higher insulin, C-peptide, and triglyceride levels; lower HDL cholesterol levels; and higher BPs than those with NGT. Classification by fasting glucose misses many Japanese-Americans with abnormal glucose tolerance and less favorable cardiovascular risk profiles.     

Fasting and postchallenge glycemia and cardiovascular disease risk: the Framingham Offspring Study

OBJECTIVE: To test the hypothesis that fasting hyperglycemia (FHG) and 2-h postchallenge glycemia (2hPG) independently increase the risk for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: During 1991-1995, we examined 3,370 subjects from the Framingham Offspring Study who were free from clinical CVD (coronary heart disease, stroke, or intermittent claudication) or medication-treated diabetes, and we followed them for 4 years for incident CVD events. We used proportional-hazards regression to assess the risk associated with FHG (fasting plasma glucose > or =7.0 mmol/l) and 2hPG, independent of the risk predicted by standard CVD risk factors. RESULTS: Mean subject age was 54 years, 54% were women, and previously undiagnosed diabetes was present in 3.2% by FHG and 4.9% (164) by FHG or a 2hPG > or =11.1 mmol/l. Of these 164 subjects, 55 (33.5%) had 2hPG > or =11.1 without FHG, but these 55 subjects represented only 1.7% of the 3,261 subjects without FHG. During 12,242 person-years of follow-up, there were 118 CVD events. In separate sex- and CVD risk-adjusted models, relative risk (RR) for CVD with fasting plasma glucose > or =7.0 mmol/l was 2.8 (95% CI 1.6-5.0); RR for CVD per 2.1 mmol/l increase in 2hPG was 1.2 (1.1-1.3). When modeled together, the RR for FHG decreased to 1.5 (0.7-3.6), whereas the RR for 2hPG remained significant (1.1, 1.02-1.3). The c-statistic for a model including CVD risk factors alone was 0.744; with addition of FHG, it was 0.746, and with FHG and 2hPG, it was 0.752. CONCLUSIONS: Postchallenge hyperglycemia is an independent risk factor for CVD, but the marginal predictive value of 2hPG beyond knowledge of standard CVD risk factors is small.     

The relationship between homeostasis model assessment and cardiovascular risk factors in Iranian subjects with normal fasting glucose and normal glucose tolerance

BACKGROUND: Insulin resistance is a complex problem which may not always correlate with all its cardiovascular risk factors in various populations. We investigated the relationship between homeostasis model assessment of insulin resistance (HOMA-IR) with cardiovascular risk factors in Iranian subjects with normal fasting glucose (NFG) and normal glucose tolerance (NGT). METHODS: Of the 605 subjects aged 25-79 y enrolled in this study, after the oral glucose tolerance test, 366 subjects aged 25-50 y and 135 aged >50 y were classified as NFG and NGT. Insulin resistance was estimated by the HOMA-IR. RESULTS: Women had higher values of body mass index (BMI), insulin and HOMA-IR than men in both age groups. The prevalence of insulin resistance, general and abdominal obesity, low HDL-C and physical inactivity was higher in women than men in the 2 age groups. Men had a higher prevalence of hypertension and hypertriglyceridemia in the group with age 25-50 y. The Pearson correlation controlled for age, BMI, waist circumference and physical activity showed that HOMA-IR had significant correlation with triglyceride and inversely associated with HDL-C in both sexes. In addition, the results of HOMA-IR quartiles demonstrated that the prevalence of hypertension, obesity, and low HDL-C was particular high in women with HOMA-IR >2.39. Multiple regression indicated that log HOMA-IR was independently predicted by BMI, triglyceride and HDL-C in men and BMI, HDL-C and waist-to-hip (WHR) ratio in women. CONCLUSIONS: HOMA-IR is associated with the features of metabolic syndrome with a sex difference in the degree and predictors of HOMA-IR and the frequency of cardiovascular risk factors.     

Traditional and emerging risk factors for cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in the United States and most western societies, further, approximately 50% of CVD is related to coronary heart disease (CHD). Most CVD results from an athero-thrombotic pathologic process in the body's arterial beds, and is largely preventable through risk factor reduction. Risk factors are diseases, physiologic states, biologic markers, or other identifiable factors associated with increased incidence of CVD. This article breaks down traditional, emerging,and possible risk factors for discussion.     

Relation between acanthosis nigricans and insulin sensitivity in overweight Hispanic children at risk for type 2 diabetes

OBJECTIVE: To investigate in a population of Hispanic children if 1) the presence of acanthosis nigricans (AN) is related to insulin sensitivity (S(i)) independent of adiposity and 2) scale scoring AN severity adds to the clinical estimation of insulin sensitivity, above and beyond the presence or absence AN alone. RESEARCH DESIGN AND METHODS: The study population, 131 Hispanic overweight children (mean BMI percentile 97.0 +/- 3.1, 72 boys, 59 girls, ages 8-13 years, mean Tanner stage 2.4 +/- 1.5) with a family history of type 2 diabetes, underwent a physical examination of the neck to determine AN absence or presence (0-1), AN extent score (0-4 scale), AN texture score (0-3 scale), and an AN combined score (extent + texture; 0-7 scale). S(i) was measured by the frequently sampled intravenous glucose tolerance test and minimal modeling. Multivariate linear regression analysis was used to determine the role of BMI and AN in predicting S(i). RESULTS: BMI was the main predictor of S(i), explaining approximately 41% of the variance. The presence of AN explained an additional 4% of the variability in S(i); scale scoring of AN extent or texture did not significantly improve the prediction. CONCLUSIONS: Although AN is an independent risk factor for insulin resistance in overweight Hispanic children at risk for type 2 diabetes, body adiposity is the primary determinant of insulin sensitivity. In addition, scale scoring AN seems of minimal usefulness in clinically estimating the severity of insulin resistance over and above assessing the presence or absence of AN and calculating BMI.     

糖耐量受损:心血管疾病的重要危险因子

学术背景:糖耐量受损阶段的异常血糖水平已导致机体组织器官损害,尤其是心血管病变.此阶段心血管疾病的患病率和死亡率均显著高于正常糖代谢人群,其心血管病变的危险性已接近糖尿病.目的:探讨糖耐量受损发生心血管疾病的危险性及其伴随的相关危险因素.检索策略:由该论文的研究人员应用计算机检索Pubmed、Blackwell Synergy数据库1997-01/2007-06的相关文献,检索词“impaired glucose tolerance,diabetes mellitus,cardiovascular disease“,并限定文章语言种类为English.同时计算机检索中国期刊全文数据库1998-01/2007-06的相关文献,检索词为“糖耐量受损,糖尿病,心血管疾病,血糖漂移“,并限定语种为中文.共检索到109篇文献,对资料进行初审,纳入标准:评估糖代谢状况的检测方法,糖耐量受损与2型糖尿病,糖耐量受损与心血管疾病.排除标准:重复性研究.文献评价:文献的来源主要是通过对糖耐量受损的定义、流行病学特点、评估方式及其危害性进行汇总分析.所选用的36篇文献中,6篇为综述,其余为临床或基础实验研究.资料综合:糖耐量受损与正常血糖者相比,已呈现明显的糖代谢紊乱.糖耐量受损进展为糖尿病的风险增大,且常合并一系列的心血管危险因子,致发生心血管疾病的危险性亦显著增加,糖耐量受损阶段心血管疾病的危险性已接近糖尿病.结论:糖耐量受损是心血管疾病的重要危险因子.有必要进一步研究及评估糖耐量受损阶段高血糖对机体的损害,早期采取干预措施,能降低及延缓心血管疾病的发生、进展.     

Relationships between insulin secretion, insulin action, and fasting plasma glucose concentration in nondiabetic and noninsulin-dependent diabetic subjects

The relationships between insulin secretion, insulin action, and fasting plasma glucose concentration (FPG) were examined in 34 southwest American Indians (19 nondiabetics, 15 noninsulin-dependent diabetics) who had a broad range of FPG (88-310 mg/100 ml). Fasting, glucose-stimulated, and meal-stimulated plasma insulin concentrations were negatively correlated with FPG in diabetics but not in nondiabetics. In contrast, fasting and glucose-stimulated plasma C-peptide concentrations did not decrease with increasing FPG in either group and 24-h urinary C-peptide excretion during a diet of mixed composition was positively correlated with FPG for all subjects (r = 0.36, P less than 0.05). Fasting free fatty acid (FFA) was correlated with FPG in nondiabetics (r = 0.49, P less than 0.05) and diabetics (r = 0.77, P less than 0.001). Fasting FFA was also correlated with the isotopically determined endogenous glucose production rate in the diabetics (r = 0.54, P less than 0.05). Endogenous glucose production was strongly correlated with FPG in the diabetics (r = 0.90, P less than 0.0001), but not in the nondiabetics. Indirect calorimetry showed that FPG was also negatively correlated with basal glucose oxidation rates (r = -0.61, P less than 0.001), but positively with lipid oxidation (r = 0.74, P less than 0.001) in the diabetics. Insulin action was measured as total insulin-mediated glucose disposal, glucose oxidation, and storage rates, using the euglycemic clamp with simultaneous indirect calorimetry at plasma insulin concentrations of 135 +/- 5 and 1738 +/- 59 microU/ml. These parameters of insulin action were significantly, negatively correlated with FPG in the nondiabetics at both insulin concentrations, but not in the diabetics although all the diabetics had markedly decreased insulin action. We conclude that decreased insulin action is present in the noninsulin-dependent diabetics in this population and marked hyperglycemia occurs with the addition of decreased peripheral insulin availability. Decreased peripheral insulin availability leads to increased FFA concentrations and lipid oxidation rates (and probably also increased concentrations of gluconeogenic precursors) that together stimulate gluconeogenesis, hepatic glucose production, and progressive hyperglycemia.     

Risk factors for cardiovascular disease in children with Type I diabetes

BACKGROUND: The major cause of morbidity and mortality in individuals with Type I insulin-dependent diabetes mellitus (IDDM) is premature and extensive atherosclerotic cardiovascular disease (CVD). OBJECTIVES: To determine the prevalence and predictors of hypercholesterolemia and to examine the distribution and interrelationship of risk factors for CVD. METHODS: This observational (mixed-longitudinal) study, guided by an epidemiologic framework, assessed a sample of 140 children with IDDM. Total cholesterol (TC) and diabetes control were measured in the total sample. Standard CVD risk factors were measured in a subsample of 67 children. RESULTS: Observed frequency of TC greater than the 75th percentile and greater than the 95th percentile was significantly more than expected (p < 0.01 and p < 0.0001, respectively). In the total sample, TC-CVD risk factor associations were not observed. However, diabetes control and physical activity were correlated with TC in the risk sample of children at highest risk, as demonstrated by hypercholesterolemia. CONCLUSIONS: Results demonstrate the importance of assessing the lipid profile in children with IDDM and monitoring CVD risk factors in hyperlipidemic children with IDDM. Future research should focus on prospective longitudinal studies in population-based multiethnic samples of children with IDDM.     

Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes

OBJECTIVE

Overweight and obese individuals are encouraged to lose 5–10% of their body weight to improve cardiovascular disease (CVD) risk, but data supporting this recommendation are limited, particularly for individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

We conducted an observational analysis of participants in the Look AHEAD (Action For Health in Diabetes) study (n = 5,145, 40.5% male, 37% from ethnic/racial minorities) and examined the association between the magnitude of weight loss and changes in CVD risk factors at 1 year and the odds of meeting predefined criteria for clinically significant improvements in risk factors in individuals with type 2 diabetes.

RESULTS

The magnitude of weight loss at 1 year was strongly (P < 0.0001) associated with improvements in glycemia, blood pressure, tryiglycerides, and HDL cholesterol but not with LDL cholesterol (P = 0.79). Compared with weight-stable participants, those who lost 5 to <10% ([means ± SD] 7.25 ± 2.1 kg) of their body weight had increased odds of achieving a 0.5% point reduction in HbA_1c (odds ratio 3.52 [95% CI 2.81–4.40]), a 5-mmHg decrease in diastolic blood pressure (1.48 [1.20–1.82]), a 5-mmHg decrease in systolic blood pressure (1.56 [1.27–1.91]), a 5 mg/dL increase in HDL cholesterol (1.69 [1.37–2.07]), and a 40 mg/dL decrease in triglycerides (2.20 [1.71–2.83]). The odds of clinically significant improvements in most risk factors were even greater in those who lost 10–15% of their body weight.

CONCLUSIONS

Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.Overweight and obese individuals are frequently encouraged to lose 5–10% of their weight and are told that weight losses of that magnitude will help improve their cardiovascular disease (CVD) risk factors. For example, the Centers for Disease Control and Prevention website (www.cdc.gov/healthyweight/losing_weight/index.html) states, “The good news is that no matter what your weight loss goal is, even a modest weight loss, such as 5 to 10% of your total body weight, is likely to produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.” The benefits of modest weight loss also are noted by the Surgeon General (www.surgeongeneral.gov/), the Institutes of Medicine (1), and the National Institutes of Health (e.g., www.nhlbi.nih.gov/ and www2.niddk.nih.gov/), with citations to a variety of reviews of the literature (2–4) and meta-analyses (5). For example, the statement from the Centers for Disease Control and Prevention website cites a review by Blackburn (6) for the benefits of 5% weight loss and the National Heart, Lung, and Blood Institute Clinical Guidelines (7) as the reference for the benefit of a 10% weight loss. However, the studies included in these reviews often had limited sample sizes, focused on nondiabetic individuals, and typically presented only average weight loss and the average reduction in risk factors, which did not allow a careful analysis of the association between specific magnitudes of weight loss and consequent improvements in CVD risk factors.Look AHEAD (Action for Health in Diabetes) provides a unique opportunity to carefully assess the effects of modest weight loss on CVD risk factors in individuals with type 2 diabetes, a population at high risk for CVD. Look AHEAD is a multicenter, randomized clinical trial examining the long-term effects of lifestyle interventions on cardiovascular morbidity and mortality in 5,145 overweight or obese participants with type 2 diabetes who were randomly assigned to intensive lifestyle intervention (ILI) or to usual care, referred to as diabetes support and education (DSE) (8,9). Differences between ILI and DSE at 1 year have been reported previously (9). In this article, we examine the associations between the magnitude of weight loss and the degree of improvement in glycemic control, blood pressure, and lipid levels at 1 year in the full cohort. We also determine the average risk factor change and the odds of meeting predefined criteria for clinically significant improvement in risk factors that are associated with specific categories of weight change. These analyses provide important data to address the recommendations regarding modest weight loss.     

心血管危险因素在老年糖耐量低减病人中的聚集及护理干预

[目的]通过对老年糖耐量低减病人的调查，为心血管危险因素在老年糖耐量低减病人中聚集提供依据，同时探索有效的护理干预措施。[方法]根据葡萄糖耐量试验结果，将131例老年病人分为糖耐量正常（NGT）组，糖耐量低减（IGT）组，比较两组病人的心血管疾病危险因素的聚集性及冠心病、脑卒中的患病率．[结果]IGT组与NGT组相比，三酰甘油明显升高，高密度脂蛋白胆固醇明显降低．（P〈0，05）。IGT组的收缩压、舒张压、体重指数均值亦较NGT组明显增高，（P〈0．01）；纤维蛋白原比较（P〉0．05）。IGT组合并高血压、肥胖、血脂异常等各项心血管疾病危险因素的比例及≥两个危险因素（2RFs）的比例均明显高于NGT组（P〈0．01）。≥2RFs的IGT病人其冠心痛、脑卒中的患病率明显高于NGT组（P〈0.05）。[结论]IGT病人已存在明显的心血管疾病风险．该阶段已有心血管疾病危险因素聚集的现象，冠心病、脑卒中的患病率明显增加，应通过有效的护理措施对IGT病人给予积极干预。