Life style and cardiovascular risk factors in the Japanese population--from an epidemiological survey on serum lipid levels in Japan 1990 part 2: association of lipid parameters with hypertension

The importance of metabolic syndrome as a risk factor of coronary artery disease (CAD) has recently become more and more recognized. In view of such a background, changes in cholesterol and other lipid parameters in the Japanese population associated with excess body weight and hypertension were analyzed in this study based on data obtained in an epidemiological survey carried out in 1990. Hypertension was closely associated with a higher body mass index (BMI). Among the lipid parameters, triglyceride (TG) and non-HDL-C (total cholesterol minus HDL-cholesterol) levels showed remarkable differences between hypertensive and normotensive subjects, with a greater statistical significance than LDL-cholesterol (LDL-C) levels. Changes in lipid parameters in the presence of hypertension were mostly associated with an increase in BMI in younger men aged 20-39, while increases in TG levels took place independently of excess body weight in middle-aged (40-59-year old) men. Considering that hypertension is a common and the greatest risk factor in the Japanese population, TG and non-HDL-C appear to be more important than LDL-C as major lipid parameters related to atherogenesis.     

Adiponectin levels and cardiovascular risk factors in Japanese men with type 2 diabetes

Several cardiovascular risk factors correlate with adiponectin levels. It is not known whether total homocysteine, folate and gamma-glutamyl transferase levels correlate with adiponectin. We cross-sectionally analyzed the association between adiponectin and these cardiovascular risk factors in diabetic patients. One hundred and two male inpatients with type 2 diabetes without overt nephropathy or insulin use were studied. In a regression analysis of the quartiles of adiponectin, plasma levels of adiponectin were associated positively with HDL-cholesterol and age, and inversely with body mass index and HbA1c, but not with total homocysteine, folate or gamma-glutamyl transferase. Non-traditional cardiovascular risk factors such as homocysteine and folate levels were not associated with adiponectin levels in male type 2 diabetic patients who are not subject to insulin therapy.     

Birth weight and cardiovascular risk factors in an epidemiological study

Summary Low birth weight has been proposed as a risk factor for development of non-insulin-dependent diabetes mellitus, hypertension, and cardiovascular disease in the adult. To ascertain the extent to which birth weight was associated with cardiovascular risk factors, we examined 620 subjects (median age 48 years) in a cross-sectional study. Of these 317 were offspring of diabetic patients and 303 were offspring of non-diabetic control subjects. Known risk factors for development of cardiovascular disease were correlated to birth weight and examined as dependent variables by multiple linear regression. Age, body mass index (BMI), subjects gender along with parental gender, diabetes status of the parents, and birth weight were independent variables. The variance of the risk factors as dependent variables explained by age, gender, and BMI as independent variables was examined and birth weight was added as an independent variable. We found birth weight was inconsistently correlated to the different risk factors in the different groups of subjects. When adjusted for age, BMI, subject's gender, parental gender, and the diabetes status of the parents, birth weight was negatively correlated to fasting blood glucose. In offspring of diabetic patients the explained variance of risk factors did not change as we added birth weight to the model. In offspring of non-diabetic subjects we found that the explained variance of diastolic blood pressure, fasting blood glucose, HbA_IC, and cholesterol increased 1–3 % as birth weight was added to the model. We conclude that birth weight may not be a major risk factor for development of hypertension and cardiovascular disease in our population. [Diabetologia (1996) 39: 1598–1602]     

Analysis of serum lipid levels in Japanese men and women according to body mass index. Increase in risk of atherosclerosis in postmenopausal women. Research Group on Serum Lipid Survey 1990 in Japan

Relatively low serum lipid levels are thought to be an important factor contributing to the low incidence of ischemic heart diseases (IHD) in Japanese. It has been proven that obesity or overweight constitutes a basal condition for several risk factors in atherosclerosis. The purpose of this study is to obtain data on serum lipids and lipoprotein profiles in relation to body mass index (BMI), which will enable us to compare the nature and weight of metabolic risk factors in atherosclerosis between Japanese and people in Western countries. Data of total serum cholesterol, triglyceride, and HDL-cholesterol levels of Japanese men and women obtained from a large-scale survey in 1990 were analysed according to BMI for different age groups. Apolipoprotein A-I and B and Lp(a) were also measured in randomly selected samples and their contribution as a risk factor was estimated especially in postmenopausal women. The subjects in two age groups of men (20-39 and 40 59 years) and women (20 39 and 50-69 years) were graded into quintiles according to the BMI. The middle grades of BMI were 21.9-23.3 and 22.4-23.6 for younger and older men, and 20.0-21.1 and 22.2-23.6 for younger and older women, respectively. These values are much lower than those in Western populations, the border between the IVth and the top quintile almost corresponding to the average for Americans. Total cholesterol showed a tendency to shift into higher ranges in all age groups in both men and women as BMI increased, with the highest distribution remaining in the range of 160-199 mg/dl (4.2-5.2 mmol/l). The average cholesterol levels for the top quintile of BMI were still lower than most of the average values in Western populations. The distribution of cholesterol in higher ranges was much greater and the difference according to BMI was smaller in older women than in men. In both men and women, whether younger or older, about 90% of the subjects in the lower quintiles of BMI had triglyceride levels lower than 150 mg/dl. The distribution in the higher range of triglyceride was small in women, not only at younger ages but also in postmenopausal women at the top quintile of BMI. About 85% of the younger women with a middle grade of BMI had an HDL-cholesterol level higher than 50 mg/dl. The values in postmenopausal women were still higher than in men aged 40-59 years. Shift of the distribution curves of HDL-cholesterol according to BMI was similar in all groups and more remarkable than the change in triglyceride. The average HDL-cholesterol levels at the top quintile were almost comparable to the average values in Western countries; the difference in HDL-cholesterol levels between the two populations can mostly be explained by the difference in BMI. Smokers showed a slightly lower total cholesterol and significantly (3-4 mg/dl) lower HDL-cholesterol levels, although there was no difference in distribution of BMI between smokers and non-smokers. Relatively low total cholesterol levels even in smokers has probably contributed to the low incidence of IHD in spite of the high frequency of smoking in Japanese population. Mean Lp(a) levels showed a tendency to increase after age 40 in women. BMI itself did not have a correlation with serum Lp(a) levels. The distribution curve of Lp(a) shifted to higher levels as total cholesterol increased and the tendency was most remarkable in women around or after the menopause. It was remarkable in older women that as the total cholesterol or apo B level increased there was also an increased prevalence of abnormal ECG with a pattern of myocardial ischemia. Postmenopausal women seem to have a great risk of atherosclerosis regarding the lipid and lipoprotein profile even in the Japanese population.     

Effects of ten year body weight variability on cardiovascular risk factors in Japanese middle-aged men and women.

OBJECTIVE: The purpose of the present study was to determine the effects of weight variability on cardiovascular risk factors (CRF) based on a large sample of community-resident Japanese males and females. METHOD: A total of 3564 men and 1955 women, all Japanese, aged 30-69 y in the baseline year (1987), were followed-up for up to 10 y (end-point in 1996). Height, body weight, systolic and diastolic blood pressure, fasting serum total cholesterol, triglyceride and fasting plasma glucose were measured as an annual health check-up. At least six times in 10 y, body mass index (BMI) mean was calculated as an index of the BMI level of each subject (BMI mean). Direction and magnitude of the change in a subject's BMI was determined by a regression slope of BMI values over time (BMI slope). BMI fluctuation was defined as the root mean square error (BMI RMSE) of a regression line. The slopes of the five CRF were calculated using each regression equation over time. RESULTS: The BMI slope strongly correlated to each CRF slope independent of baseline age, baseline CRF value, smoking habit, BMI mean and BMI RMSE. BMI RMSE did not correlate to any CRF slopes. CONCLUSION: This study indicates that weight gain and weight loss have a much greater effect on CRF change than does weight fluctuation in Japanese middle-aged men and women.     

Relationship between birth weight and cardiovascular risk factors in Japanese young adults

A number of studies have recently shown a significant inverse relationship between birth weight and incidences of chronic and metabolic disorders such as hypertension and type 2 diabetes, though the findings are not consistent. So far, few investigations have been performed to determine whether this relationship exists in Japanese young adults. We investigated the influence of birth weight on cardiovascular risk factors such as blood pressure and several metabolic variables in Japanese young adults. The data of 299 medical students of Dokkyo University School of Medicine (207 men, 92 women; mean age +/- SD: 23 +/- 2 years) who underwent a medical check-up in 1998 were analyzed. Information on pregnancies and measurements at birth were obtained from The Maternal and Child Health Handbook, which is provided to every pregnant woman by the Ministry of Health and Welfare of Japan. Blood pressure was measured twice in the sitting position using an automated device based on the cuff-oscillometric method. The systolic and diastolic blood pressure in young adulthood was positively correlated with current body weight and body mass index (BMI) in both genders. Although birth weight was not significantly correlated with blood pressure in the young adults examined in the present study, male birth weight was inversely correlated with serum total cholesterol and triglyceride concentrations in young adulthood, independently of current BMI. These results partly support the hypothesis for the first time that low birth weight may be one of the risk factors for subsequent cardiovascular disease in Japanese men.     

Relation of serum total cholesterol and other factors to risk of cerebral infarction in Japanese men with hypercholesterolemia.

BACKGROUND: Risk factors for cerebral infarction have not been well clarified, except for hypertension (HT), and few studies have examined the risk factors in the elderly. METHODS AND RESULTS: Clinical and behavioral risk factors for cerebral infarction were examined in 4,349 Japanese men aged 45-74 years with a serum total cholesterol (TC) concentration of 220 mg/dl or greater who participated in the Kyushu Lipid Intervention Study. A total of 81 men developed definite cerebral infarction in a 5-year follow-up period. The Cox proportional hazards model was used with serum TC at baseline and during the follow-up, serum high-density lipoprotein-cholesterol (HDL-C), HT, diabetes mellitus (DM), and other factors as covariates. Serum TC during the follow-up, not at baseline, was positively associated with cerebral infarction, showing a stronger association in the elderly (>or=65 years old) than in the middle-aged (<65 years old). Statin use was related to a moderate decrease in the risk of cerebral infarction when follow-up TC was not considered, but the decrease was almost nullified after adjustment for follow-up TC. A low concentration of serum HDL-C, diabetes mellitus, hypertension, and angina pectoris were each related to an increased risk. No clear association was observed for body mass index, smoking or alcohol use. CONCLUSIONS: Lowering cholesterol is important in the prevention of cerebral infarction in men with moderate hypercholesterolemia. A low concentration of HDL-C, DM, and HT are independent predictors of cerebral infarction.     

Primary cardiovascular events and serum lipid levels in elderly Japanese with hypercholesterolemia undergoing 6-year simvastatin treatment: a subanalysis of the Japan lipid intervention trial

OBJECTIVES: To determine the relationship between serum lipid levels and the incidence of coronary events in older Japanese hypercholesterolemic patients without prior coronary heart disease (CHD). DESIGN: Post hoc subanalysis of the results in the Japan Lipid Intervention Trial. SETTING: A large-scale cohort observational study conducted throughout Japan. PARTICIPANTS: Men aged 35 to 70 and postmenopausal women younger than 70 with serum total cholesterol (TC) level of 220 mg/dL or greater treated for 6 years with low-dose simvastatin (52,421 total patients). After exclusion of 5,127 patients because of prior CHD and 4,934 patients because of incomplete data, 42,360 patients were divided into an older (9,860 patients, aged 65-70, mean age 67.1) and younger (32,500 patients, younger than 65, mean age 54.9) group and analyzed. MEASUREMENTS: Fasting serum lipid levels were measured every 6 months. Major coronary events, including fatal or nonfatal myocardial infarction, and sudden cardiac death as the primary endpoint and other cardiovascular diseases, including onset of angina pectoris, cerebrovascular events, and any causes of death, as the secondary endpoints were monitored. RESULTS: Simvastatin treatment in older patients was as safe and effective as in younger patients. Incident rates of major coronary events were 1.30 per 1,000 patient-years in the older group and 0.80 per 1,000 patient-years in the younger group. The incidence of a major coronary event was correlated to serum TC and low-density lipoprotein cholesterol (LDL-C) levels in both groups. The absolute risk of major coronary events in the older group was higher than in the younger group at any level of LDL-C, whereas the relative risk increased by 1.7% with an elevation of each 1 mg/dL LDL-C level in both groups. In the older group, the risk of major coronary events also increased as triglyceride level increased, whereas the risk decreased as high-density lipoprotein cholesterol level increased above 60 md/dL. CONCLUSION: The LDL-C level-dependent increase of relative risk of CHD was similar in elderly and younger patients, whereas the absolute risk at any LDL-C level in elderly patients was higher than in younger patients.     

Effect of walking with a pedometer on serum lipid and adiponectin levels in Japanese middle-aged men

OBJECTIVE: To clarify the effects of walking with a pedometer on metabolic parameters, including adiponectin (APN). METHODS: We recruited 44 male Japanese volunteers (age, 37 +/- 9 yrs; body mass index (BMI), 24.2 +/- 2.9 kg/m2; fasting plasma glucose (FPG), 96 +/- 11 mg/dL; total cholesterol (TC) 190 +/- 26 mg/dL; triglycerides (TG) 119 +/- 80 mg/dL; HDL-C56 +/- 14 mg/dL). Subjects were instructed to walk with a pedometer and record the number of steps they walked every day for 50 days. Serum adiponectin (APN) levels were measured by enzyme immunoassay. Treatment effects were examined by Wilcoxon's rank test. RESULTS: The average number of steps was 8211 +/- 2084 per day. There were significant reductions in BMI, sBP, TG and TNF-alpha levels after 50 days, but no changes in adiponectin levels. We then divided the subjects into 2 groups according to the steps walked per day, namely, more than 8000 steps (MT group, n = 22) and less than 8000 steps (LT group, n = 22) and found that the reduction in TG and BP was observed only in the MT group. CONCLUSIONS: Walking with a pedometer is effective for improving metabolic parameters, such as TG and blood pressure, but is not sufficient to increase adiponectin levels in Japanese men.     

Association between serum uric acid levels and cardiovascular risk factors among adults in India

Background and aimThe objective of this study was to explore the association between serum uric acid (SUA) levels and cardiovascular risk factors in the Indian population.Methods and resultsThis was a cross-sectional, population-based study. The study enrolled adults aged 20 years and above residing in rural, sub-urban, and urban. All participants completed a detailed questionnaire, underwent anthropometric measurements, and had blood samples collected. Participants were divided into three tertiles based on their SUA concentrations. A total of 2976 participants were included in this study, with 865 from rural, 1030 from sub-urban, and 1081 from urban populations. The mean values of cardiovascular risk factors were significantly higher in tertile 3 (p < 0.001) as compared to the other tertiles. However, we observed a negative trend between the increase of SUA and SUA/Scr ratio and HbA1c levels (Pearson correlation r = −0.068; p < 0.001 and r = −0.140; p < 0.001, respectively). The healthy and prediabetic groups did not show any significant change in HbA1c with increasing SUA levels, while an inverse trend was observed in diabetics. In the diabetic population, both men and women showed an inverse trend between increasing SUA levels and HbA1c in both known and newly diagnosed diabetes (p < 0.001).ConclusionsThe study found a positive association between SUA levels and cardiovascular risk factors. However, HbA1c was inversely correlated with increasing SUA tertiles in both known and newly diagnosed diabetes, as compared to the general population. Additionally, both men and women with diabetes consistently showed an inverse relationship between increasing SUA/SCr ratio and HbA1c levels.     

Correlation between change in body weight rather than current body weight and change in serum adiponectin levels in a Japanese population -- the Funagata study

Serum adiponectin levels are decreased in obese subjects. We examined the association of current body weight (BW) and its change with a change in serum adiponectin levels. Serum adiponectin levels at the baseline (from 1995 to 1997) and the 5-year follow-up (from 2000 to 2002) examinations were evaluated in 1003 (M/F, 425/578; age at the baseline examinations, 58.3 +/- 11.7/57.5 +/- 11.0 years) Japanese subjects from a cohort population (N = 2013) of the Funagata study. Correlations and associations of BW at the baseline examinations and changes in BW between the baseline and the follow-up examinations (deltaBW) with changes in the serum adiponectin levels in the study period (deltaAdiponectin) were examined. Stepwise regression analyses revealed a significant correlation of the deltaBW (r = -0.233 and -0.204 for men and women, respectively; r = -0.324 for the upper tertile group divided based on their body mass index in women) with the deltaAdiponectin. However, the BW at the baseline examinations was not significantly correlated in both sexes. Multiple logistic regression analyses revealed that subjects who reduced their BW by 2 kg or more were 2.56 (95% confidence interval, 1.21-5.42; P = .014) and 8.24 times (95% confidence interval, 3.59-18.9; P < .001) more likely to be in the upper tertile of the deltaAdiponectin than those who increased their BW by 2 kg or more in men and women, respectively, independent of their BW at the baseline examinations. In conclusion, we showed here that the deltaBW was strongly associated with the deltaAdiponectin in both sexes, whereas the BW at the baseline examinations was not associated with the deltaAdiponectin, at least in women.     

Age-related changes in plasma androgen levels and their association with cardiovascular risk factors in male Japanese office workers

Aim:   To assess the age-related change in plasma androgen levels in healthy middle-aged men and whether any clinical parameters are associated with the hormonal change.
Methods:   The study was comprised of male Japanese office-workers aged 40–64 years, who had undergone an annual health check-up in 2002 and 2007 (96 and 76 men, respectively). Body mass index and blood pressure were measured, and serum concentration of lipids, glucose and uric acid in addition to plasma total testosterone, free testosterone and dehydroepiandrosterone sulfate (DHEA-S) levels were determined in the morning after an overnight fast. The 5-year hormonal changes and their associations with clinical parameters were analyzed in 33 men who repeated the examination at both check-ups. The cross-sectional associations of hormonal levels with clinical parameters were also investigated.
Results:   Age was negatively associated with free testosterone ( r  = −0.399, P  < 0.001 in 2002; r  = −0.458, P  < 0.001 in 2007) and DHEA-S ( r  = −0.233, P  = 0.02 in 2002; r  = −0.336, P  < 0.01 in 2007) but not with total testosterone, while the 5-year changes of free testosterone and DHEA-S levels were not significant and showed no associations with major cardiovascular risk factors. Cross-sectionally, after adjustment for age, linear regression analysis showed a positive association between free testosterone and blood hemoglobin and a negative association between total testosterone and serum uric acid.
Conclusion:   In Japanese middle-aged men, 5-year androgen decline is too subtle to detect, and endogenous androgen levels seem to have relatively weak association with cardiovascular risk profiles.     

Leptin receptor polymorphism is associated with serum lipid levels and impairment of cholesterol lowering effect by simvastatin in Japanese men

OBJECTIVE: To investigate whether leptin receptor (Ob-R) Arg223Gln polymorphism influences serum lipid levels and whether this polymorphism affects the efficiency of the cholesterol lowering HMG-CoA reductase inhibitor, simvastatin [Clin. Cardiol. 16 (1993) 317]. DESIGN: Case-control association study. SUBJECTS: We studied 201 Japanese men without medical care, and 78 Japanese who took simvastatin. METHODS: Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serum lipid and leptin levels were determined. RESULTS: Subjects with the Arg/Arg homozygotes had significantly higher serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels than those with the Arg/Gln heterozygotes and Gln/Gln homozygotes (TC: Arg/Arg: 213+/-3, Arg/Gln: 196+/-6, Gln/Gln: 184+/-5, P=0.004 for comparison among three genotypes, P=0.008 for difference between Arg/Arg and Arg/Gln, and P=0.025 for difference between Arg/Arg and Gln/Gln, LDL-C: Arg/Arg: 127+/-3, Arg/Gln: 112+/-6, Gln/Gln: 114+/-8, P=0.027) for comparison among three genotypes and P=0.011 for difference between Arg/Arg and Arg/Gln. Subjects with the Arg/Arg homozygotes had significantly lower serum high density lipoprotein cholesterol (HDL-C) levels than those with the Arg/Gln heterozygotes and Gln/Gln homozygotes (Arg/Arg: 55+/-1, Arg/Gln: 62+/-3, Gln/Gln: 57+/-7, P=0.046) for comparison among three genotypes and P=0.013 for difference between Arg/Arg and Arg/Gln. In addition, in 78 patients with hypercholesterolemia who took 5 mg simvastatin, the TC lowering effect by simvastatin in subjects with the Arg/Arg homozygotes was significantly lower than in those with the Arg/Gln heterozygotes and Gln/Gln homozygotes (the reduction in serum TC levels; 62+/-4 vs. 79+/-6, P=0.044). CONCLUSIONS: We demonstrate that Ob-R Arg223Gln polymorphism in Japanese men is associated with significant elevation of serum TC and LDL-C levels. Our data also show that the Arg/Arg homozygotes tend to show lowered level of serum HDL-C. Furthermore, this polymorphism tends to show an attenuated response to an HMG-CoA reductase inhibitor in terms of the cholesterol lowering effect. These results suggest that the Ob-R gene may serve as a novel modifier gene for hypercholesterolemia in Japanese men.     

Relationship between total and regional bone mineral density and menopausal state, body composition and life style factors in overweight Japanese women.

OBJECTIVE: To investigate whether menopausal state, body composition and lifestyle factors influence total and regional bone mineral density in overweight Japanese women. DESIGN: Cross-sectional study of women who were recruited to the weight reduction program held at community-based health promotion center in Tokyo area. SUBJECTS: A total of 178 women with a mean age of 48 y old (20-69 y) with a clear menstrual history and BMI over 24. MEASUREMENTS: Total, regional and lumbar spine bone mineral density (BMD) and body composition were measured using DXA (Lunar). Menstrual history was taken by a questionnaire and walking steps per day and energy intake were measured. Physical fitness was assessed by cardio-respiratory fitness and leg extension power. Subjects were divided into pre-menopausal and post-menopausal groups. RESULTS: Pre-menopausal group had significantly higher total body BMD as well as regional BMD than post-menopausal group. However, no differences in BMI, percentage fat and fat mass (FM) were seen between the two groups. The multiple regression analysis stepwise method revealed that total and regional BMD correlated with menopausal state and total FM independently. Total and regional BMD did not correlate with total non-fat soft tissue mass (NFSM), energy intake, walking steps or physical fitness levels. Trunk and lower extremities BMD correlated with corresponding regional FM and NFSM, and upper extremities BMD correlated with only corresponding body part NFSM after adjusting menopausal state. CONCLUSION: Total and regional BMD had strong negative correlation with menopausal state rather than total FM in overweight Japanese women. Weight-bearing site BMD correlated with corresponding body part FM and NFSM and non-weight bearing site BMD only correlated with corresponding body part NFSM after adjusting for menopausal state.     

Common carotid intima-media thickness and von Willebrand factor serum levels in rheumatoid arthritis female patients without cardiovascular risk factors

High atherosclerosis prevalence was found in rheumatoid arthritis (RA), and the von Willebrand factor (vWF) was shown to be a marker for endothelial damage. The aim of this study was to evaluate the association of intima-media thickness of the left common carotid artery with vWF serum levels in rheumatoid arthritis patients without cardiovascular risk factors. We included 55 RA female patients, each with at least 5 years of duration of the disease, and 20 healthy female subjects as members of the control group. The vWF, cholesterol, triglycerides, and the immune variables—rheumatoid factor and reactive C protein—were evaluated. The media thickness and intima-media thickness (IMT) in patients and in the control subjects were assessed by Doppler ultrasound of the left common carotid artery. Although the ages for RA patients and healthy female controls were not different, the IMT of the left common carotid artery (IMT CCA) in rheumatoid arthritis patients was increased in comparison with healthy control measurements, the mean being 0.67 mm (SD 0.18) vs 0.58 mm (SD 0.10) with a p value 0.01. The vWF serum levels showed differences in RA patients from those in control patients, 145.6 (SD 30.08) vs 121.8 (SD 37.17), respectively, with p=0.007. A correlation was also found between vWF with IMT CCA in the RA patients: r=0.390 and p<0.05. We concluded that the measurements of the left common carotid artery intima-media thickness together with the von Willebrand factor serum levels could give valuable information about the artery status and the atherosclerosis process in early stages in patients with rheumatoid arthritis without cardiovascular risk factors.     

Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women

Overweight and obese men and women (24-61 yr of age) were recruited into a randomized trial to compare the effects of a low-fat (LF) vs. a low-carbohydrate (LC) diet on weight loss. Thirty-one subjects completed all 10 wk of the diet intervention (retention, 78%). Subjects on the LF diet consumed an average of 17.8% of energy from fat, compared with their habitual intake of 36.4%, and had a resulting energy restriction of 2540 kJ/d. Subjects on the LC diet consumed an average of 15.4% carbohydrate, compared with habitual intakes of about 50% carbohydrate, and had a resulting energy restriction of 3195 kJ/d. Both groups of subjects had significant weight loss over the 10 wk of diet intervention and nearly identical improvements in body weight and fat mass. LF subjects lost an average of 6.8 kg and had a decrease in body mass index of 2.2 kg/m2, compared with a loss of 7.0 kg and decrease in body mass index of 2.1 kg/m2 in the LC subjects. The LF group better preserved lean body mass when compared with the LC group; however, only the LC group had a significant decrease in circulating insulin concentrations. Group results indicated that the diets were equally effective in reducing systolic blood pressure by about 10 mm Hg and diastolic pressure by 5 mm Hg and decreasing plasminogen activator inhibitor-1 bioactivity. Blood beta-hydroxybutyrate concentrations were increased in the LC only, at the 2- and 4-wk time points. These data suggest that energy restriction achieved by a very LC diet is equally effective as a LF diet strategy for weight loss and decreasing body fat in overweight and obese adults.     

Total homocysteine levels relation with chronic complications of diabetes, body composition, and other cardiovascular risk factors in a population of patients with diabetes mellitus type 2

OBJECTIVE: The significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function and vitamin status. The aim of our study was to analyze the relationship between total homocysteine (tHcy) in a population of type 2 diabetic patients and chronic complications. We also analyzed the relationship between tHcy and the body composition of these patients and other cardiovascular risk factors. DESIGN: In a cross-sectional study, a total of 155 patients with diabetes mellitus attending in our diabetes service (90 females/65 males) were enrolled in a consecutive way. MATERIAL AND METHODS: All enrolled patients underwent the following examinations: (i) biochemical cardiovascular risk factors including total cholesterol, triglyceride, lipoprotein (a), low-density lipoprotein (LDL-cholesterol), high-density lipoprotein (HDL-cholesterol), glucose, HbA(1c), fibrinogen, homocysteine, vitamin B12, folate, and microalbuminuria; and (ii) fat mass assessed by body mass index, weight, percentage of fat mass, and tricipital skinfold. RESULTS: Patients were divided in two groups (Group I: tHcy> or =15 micromol/l; Group II: tHcy<15 micromol/l). Smoking habit was similar in both groups. A prevalence of cerebrovascular accident was present in 3.3% in the total group. This prevalence was not different in both groups (7.4% vs. 2.3%; ns) (OR 3.3; 95% CI 0.49-19.68). The prevalence of coronary heart disease in the total group was 5.8% without statistical differences between groups (3.5% vs. 6.3%; ns) (OR 0.57; 95% CI 0.065-4.53). Concerning macrovascular complications, only peripheral vascular disease prevalence was higher in Group I (16% vs. 3.1%; P<0.05; OR 5.33; 95% CI 1.18-21.5). A prevalence of nephropathy was higher in Group I (93.3% vs. 12.8%; P<0.05; OR 7.15; 95% CI 2.9-17.9). No statistical differences were detected in prevalence of retinopathy (global group 41.9%) (42.5% vs. 40.9%; ns) (OR 1.75; 95% CI 0.78-3.9). Also, peripheral neuropathy was similar in both groups (7.1% vs. 6.5%; ns) (OR 1.1; 95% CI 0.15-8.2). No correlation was detected among homocysteine and anthropometric parameters (body mass index, weight, percentage of fat mass, fat mass, and tricipital skinfold). Elevated levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure were detected in Group I. CONCLUSION: The present study shows that elevation of plasma tHcy levels in type 2 diabetic patients is associated with a higher prevalence of peripheral arteriopathy and nephropathy. Our data suggest that hyperhomocysteinemia is not associated with fat mass but it is associated with high levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure levels.     

Effect of growth hormone therapy on serum adiponectin and resistin levels in short, small-for-gestational-age children and associations with cardiovascular risk parameters

BACKGROUND: Adiponectin and resistin are fat cell-derived hormones, which are thought to be respectively protective and disadvantageous with regard to the development of cardiovascular disease and diabetes mellitus type 2. Low birth weight has been associated with increased risks for the development of these diseases. In short, small-for-gestational-age (SGA) children, GH therapy has several positive effects regarding cardiovascular risk factors. On the other hand, concern has been expressed about the effects of GH therapy on insulin sensitivity. METHODS: We measured adiponectin and resistin levels in 136 short prepubertal children born SGA and their association with cardiovascular risk parameters and growth factors. Also, we compared the levels with normal-statured controls. The effect of GH treatment was evaluated in 50 short SGA children vs. baseline and vs. an untreated sex- and age-matched SGA control group. RESULTS: Short SGA children had similar adiponectin and lower resistin levels, compared with normal-statured controls. In GH-treated SGA children, neither adiponectin nor resistin levels changed significantly during 2 yr of GH treatment. Compared with untreated sex- and age-matched SGA controls, GH-treated SGA children had similar adiponectin and lower resistin levels. Adiponectin correlated inversely with age but not any cardiovascular risk parameter or growth factor. Higher IGF-I levels in GH-treated children were associated with lower resistin levels. CONCLUSIONS: Compared with normal-statured controls, short prepubertal SGA children had similar adiponectin and lower resistin levels. Two years of GH treatment had no effect on their adiponectin and resistin levels.     

Trends in the incidence of coronary heart disease and stroke and the prevalence of cardiovascular risk factors among Japanese men from 1963 to 1994

PURPOSE: To determine trends in the incidence of cardiovascular disease in Japan, we examined observational data on coronary heart disease, stroke, and cardiovascular risk factors among urban Japanese working men. SUBJECTS AND METHODS: The surveyed population included all male employees aged 40 to 59 years who worked for eight industrial companies in Osaka, the second largest metropolitan city in Japan. Surveillance for cardiovascular disease and risk factors was conducted from 1963 to 1994. RESULTS: The age-adjusted incidence of coronary heart disease increased from 0.4 per 1000 person-years during 1963 to 1970, to 1.5 per 1000 person-years during 1979 to 1986, and then plateaued until 1987 to 1994 (P for trend = 0.002), whereas the incidence of stroke declined from 1.2 per 1,000 person-years during 1971 to 1978, to 0.6 per 1,000 person-years in 1987 to 1994 (P for trend = 0.02). The age-adjusted mean (+/- SD) total cholesterol level, which was 4.87 +/- 2.88 mmol/L during 1963 to 1966, increased to 5.11 +/- 0.62 mmol/L during 1982 to 1983 (P <0.001), and 5.09 +/- 0.75 mmol/L during 1990 to 1991. Both mean systolic and diastolic blood pressures increased by 1 mm Hg between the periods of 1966 to 1967 and 1982 to 1983, and declined below the 1966 to 1967 levels during 1990 to 1991. The prevalence of smoking declined from 72% during 1975 to 1976, to 58% during 1990 to 1991 (P for trend <0.001). CONCLUSION: Although these findings were limited to urban middle-aged men, the increase in serum cholesterol is likely to attenuate the reduction in future rates of coronary heart disease in Japan that would have been expected to result from the declining prevalence of smoking.