腰围／身高比值与代谢综合征关系的7年随访研究

目的探讨和评价腰围／身高比值（WHtR）作为腹型肥胖指标预测代谢综合征发病危险的可行性和价值。方法以2000年参加石家庄市社区健康检查的35～55岁城市居民中筛选出无高血压、血脂异常、糖尿病或糖耐量异常及其他疾病的单纯肥胖者558例作为研究对象。2007年对上述人群进行随访（n=511）,分析评价WHtR与代谢综合征发病风险的关系,应用logistic回归方程分析wHtR、腰围（WC）、体质量指数（BMI）、腰臀比（WHR）对代谢综合征的预测作用。结果两组基线资料比较,WHtR≥0．5组WC、WHR、血压（BP）、总胆固醇（TC）、甘油三酯（TG）、胰岛素抵抗指数（HOMA—IR）明显高于WHtR〈0．5组（P〈0．01或〈0．05）,两组BMI、低密度脂蛋白胆固醇（LDLC）、高密度脂蛋白胆固醇（HDL-C）之间差异无统计学意义。2007年进行随访,WHtR≥0．5组代谢综合征的发病率明显高于WHtR〈0．5组（42．7％vs14．4％,P〈0．01）;WHtR≥0．5组的BP、TC、TG、LDL—C、HOMA-IR明显高于WHtR〈0．5组（P〈0．01或〈0．05）,HDL-C明显低于WHtR〈0．5组（P〈0．01）。相关分析显示,WHtR与WC相关性好（r男=0．951,r女=0．962）,优于BMI、WHR与WC的相关（r男=0．768、0．823,r女=0．707、0．752）。logistic回归分析显示,以是否患有代谢综合征为因变量,以BMI、WC、WHR、WHtR、为自变量,WHtR、WC、BMI、WHR均进入回归方程,优势比（OR）值分别为3．686、3．533、1．751、1．956。结论WHtR与WC高度相关,可成为腹型肥胖的有效参考指标,同时WHtR可作为预测单纯肥胖人群发生代谢综合征发病危险的指标。     

5274份健康风险评估结果分析及腰围过大在健康风险增高中的意义

目的从总体上把握北京市公职人员7种健康危险因素目前的患病率,探讨腰围指标在健康风险增高中的意义。方法参评人员统一填写《健康风险评估问卷》,并接受健康体检,统计各危险因素的患病率及个人患糖尿病、冠心病、脑卒中的危险性。结果男性和女性在体质量超标、腰围过大、血压超标、总胆固醇(TC)超标、低密度脂蛋白胆固醇(LDL-C)超标、运动不充分方面的患病率分别为:81.58%、49.28%,81.85%、41.94%,61.59%、36.91%,43.65%、44.60%,43.38%、37.34%,53.21%、54.75%。男女在TC超标与运动不充分两项患病率上的差异无统计学意义(P>0.05),其余危险因素患病率的差异具有极显著性(P<0.005)。腰围过大组在糖尿病、冠心病、脑卒中3种疾病患病风险大于平均水平的比率分别为95.09%、29.32%、67.74%。与腰围正常组(对照组)相比,具有极显著性差异(P<0.005)。结论北京市公职人员存在较多的健康风险,尤其是男性;腰围过大在糖尿病、冠心病、脑卒中的患病风险增高方面意义重大,应重视对腰围过大群体的健康监测与早期干预。     

The prevalence of metabolic syndrome and determination of the optimal waist circumference cutoff points in a rural South african community

OBJECTIVE

To determine the prevalence of metabolic syndrome and to define optimal ethnic-specific waist-circumference cutoff points in a rural South African black community.

RESEARCH DESIGN AND METHODS

This was a cross-sectional survey conducted by random-cluster sampling of adults aged >15 years. Participants had demographic, anthropometric, and biochemical measurements taken, including a 75-g oral glucose tolerance test. Metabolic syndrome was defined using the 2009 Joint Interim Statement (JIS) definition.

RESULTS

Of 947 subjects (758 women) studied, the age-adjusted prevalence of metabolic syndrome was 22.1%, with a higher prevalence in women (25.0%) than in men (10.5%). Peak prevalence was in the oldest age-group (≥65 years) in women (44.2%) and in the 45- to 54-year age-group in men (25.0%). The optimal waist circumference cutoff point to predict the presence of at least two other components of the metabolic syndrome was 86 cm for men and 92 cm for women. The crude prevalence of metabolic syndrome was higher with the JIS definition (26.5%) than with the International Diabetes Federation (IDF) (23.3%) or the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII) (18.5%) criteria; there was very good agreement with the IDF definition (κ = 0.90 [95% CI 0.87–0.94]) and good concordance with ATPIII criteria (0.77 [0.72–0.82]).

CONCLUSIONS

There is a high prevalence of metabolic syndrome, especially in women, suggesting that this community, unlike other rural communities in Africa, already has entered the epidemic of metabolic syndrome. Waist circumference cutoff points differ from those currently recommended for Africans.Metabolic syndrome is a cluster of risk factors for type 2 diabetes and cardiovascular disease (CVD), with insulin resistance proposed as a linking factor (1–8). Metabolic syndrome is common and is increasing in prevalence worldwide, largely attributed to increasing obesity and sedentary lifestyles, and now is both a public health and clinical problem (5).Since the first formalized definition (6) of metabolic syndrome, there have been several definitions using different criteria (1–4,7,8), leading to widely differing prevalence estimates (5). The two major sets of criteria that have been used are those of the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) (2–4) and International Diabetes Federation (IDF) (1). The main difference between the two systems is that central obesity, as measured by waist circumference, is a prerequisite in the IDF definition, with cut points of waist circumference being ethnic specific and lower than in the ATPIII definition.In 2009, an additional definition of metabolic syndrome was proposed as a joint interim statement (JIS) by several organizations in an attempt to harmonize the definition of metabolic syndrome (5). The available information based on ATPIII and IDF criteria suggests that metabolic syndrome is pandemic but that prevalence varies widely depending on the ethnic groups studied and criteria applied (9).Sub-Saharan Africa currently is experiencing one of the most rapid demographic and epidemiological transitions with one of the fastest rates of urbanization, which is thought to be mainly responsible for the rising burden of diabetes and other noncommunicable diseases (10–13).The available information on the prevalence of metabolic syndrome in epidemiology studies in sub-Saharan Africa is limited to reports on West Africans in Cameroon (14), Benin (15), and Nigeria (16) and based on ATPIII (2–4) or IDF definitions (1). The crude prevalence in these studies ranged from an absence or low prevalence (0–4.1%) in rural communities in all three countries as well as in an urban community in Cameroon. In Benin, prevalence was higher in semiurban (6.4%) and urban samples (11.0%). To date, there are no reports on the prevalence of metabolic syndrome from epidemiology studies in South Africa and none (urban or rural) using the JIS definition.A cross-sectional diabetes epidemiology study in rural South Africans of Zulu descent allowed for the determination of the prevalence of metabolic syndrome using the JIS definition and the optimal waist circumference cutoff points to predict the presence of metabolic syndrome in this population.     

非中心性肥胖患者代谢综合征危险因素与体质量及腰围的关系

背景：2005年国际糖尿病联盟修改代谢综合征诊断标准时，把腰围作为诊断代谢综合征的必备条件，这一改变对中国代谢综合征的诊断是否有影响还需进一步调查分析。 目的：分析非中心性肥胖患者体质量和腰围与代谢综合征危险因素的关系。 设计、时间及地点：横断面调查及描述性研究，于2002—04／2005—09在乌鲁木齐及哈什地区完成调查。 对象：共计5340人，其中维吾尔族2623人，汉族2716人。①整群抽样调查乌鲁木齐市新市区农机厂工人及社区汉族居民共3000人，其中资料完整的2716人，男1664人，女1052人，年龄26～86岁。②多级整群抽样调查喀什市及周边县与乡的维吾尔族居民2876人，其中资料完整者共计2623人，男990人，女1633人，年龄25-90岁，包括政府机构工作人员、公安干警、教师、农民、自由职业者及从事家务劳动者。 方法：问卷调查包括年龄、性别、族别、婚姻、职业、劳动性质、劳动强度、人均收入、文化水平、饮酒史、吸烟史、糖尿病史及家族史、高血压史及家族史等。同时进行2型糖尿病相关因素危险因素的问卷调查。 主要观察指标：受试者测定血压、体质量指数、臀围，取血化验血糖、三酰甘油、高密度脂蛋白胆固醇水平。 结果：①维吾尔族男性除舒张期血压和高密度脂蛋白胆固醇外，其他所有指标都随着腰围的增加与加重；除空腹血糖≥7．0mmol／L的切点外，体质量指数与其他所有变量的切点间不相关。②维吾尔族女性除三酰甘油与体质量指数的切点相关外，其他所有指标的切点无论与体质量指数还是腰围之间均没有关系。③汉族男性无论什么指标切点都与腰围有明显的关系；除空腹血糖≥6．1mmol／L的切点及高密度脂蛋白胆固醇的切点与体质量指数间没有关系外，其他指标的切点也都与体质量指数有显著的关系。④汉族女性除空腹血糖≥6．1mmol／L的切点及高密度脂蛋白胆固醇切点与腰围没有关系外，其他所有指标的切点均与腰围有非常显著的关系；汉族女性的血压指标及三酰甘油指标还与体质量指数相关。⑤维吾尔族男性和女性的舒张期血压及高密度脂蛋白胆固醇与腰围和体质量指数都没有关系；而汉族男性和女性的舒张期血压与体质量指数和腰围都有关。 结论：腰围对维吾尔族男性、汉族男性及汉族女性的代谢综合征危险因素都有重要的影响，但对维吾尔族女性没有显著影响。体质量指数与维吾尔族的代谢综合征危险因素无关。但汉族的大多数代谢综合征危险因素受体质量指数的影响。     

中国维吾尔族、汉族、哈萨克族成人不同腰围切点代谢综合征患病率的研究

目的 调查分析我国维吾尔族、汉族及哈萨克族成人不同腰围切点下的代谢综合征(MS)患病率,初步探讨不同民族采用适合本民族特点的腰围切点诊断MS的可行性.方法 采用分层整群随机抽样方法,对新疆乌鲁木齐市、和田地区及阿勒泰地区维吾尔族、汉族、哈萨克族20～74岁人群进行MS横断面调查.MS诊断以国际糖尿病联盟(IDF)定义为基础,腰围切点根据不同民族区分.结果 当腰围切点均为男≥90 cm,女≥80cm时,维吾尔族、汉族、哈萨克族MS粗患病率分别为42.1%、16.7%和9.5%;年龄标化患病率分别为28.3%,10.5%和5.9%.调整腰围切点为维吾尔族男≥93cm,女≥89 cm;汉族男≥85 cm,女≥80 cm;哈萨克族男≥99 cm,女≥88cm,维吾尔族、汉族、哈萨克族MS粗患病率分别为25.6%、20.3%和6.9%;标化患病率分别为17.6%,13.4%和4.5%.结论 根据各民族自身特点调整腰围切点可减少维吾尔族和哈萨克族MS的误诊率,减少汉族MS的漏诊率,维吾尔族与汉族和哈萨克族之间的MS患病率差距缩小.应该根据民族异质性确定适合不同民族的MS腰围切点.对各民族MS进行客观、公正地评估,有针对性地开展健康教育活动及疾病预防控制会起到一定的指导作用.     

重视代谢综合征的防治

本刊代谢综合征专题报道征文在3个月内共收到论文40余篇,从论文的内容可见:护理人员对代谢综合征已有一定认识,并进行了临床观察与健康教育尝试,但对代谢综合征的系统的临床观察,大规模的干预性研究还欠缺。代谢综合征是一多因素、多疾病聚集成的高危险性症候群,其发生率正在逐年增加,因此观察总结各种疾病患者伴代谢综合征的特点,提高相关患者及社会人群对代谢综合征的认识,改变其不良的生活方式是护理人员的一项重要专业工作,它也涉及与其他多个领域的合作。本次报道除从征稿中筛选的近10篇论文外,我们还特别邀请首都医科大学附属安贞医院心内科副教授陈韵岱博士为本专题撰文,在此深表感谢!本期刊登5篇论文,另5篇论文将在11期刊出,敬请关注。     

The metabolic syndrome increases cardiovascular mortality in Taiwanese elderly

Background   The prevalence of the metabolic syndrome (MetS) is high among the elderly. However, evidence that mortality increases with MetS is rare. In this study, we investigated the relationship between MetS, cardiovascular disease (CVD) and all cause mortality in the elderly.
Materials and methods   A total 10 547 participants, aged 65 years and older, of baseline cohort were recruited from four nationwide Health Screening Centres in Taiwan from 1998 to 1999. The metabolic syndrome was defined according to the America Heart Association/National Heart Lung Blood Institute definition. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all cause mortality for those with MetS for up to 8 years of follow-up.
Results   The baseline prevalence of MetS was 50·1% (45·6% in men and 54·4% in women, respectively). A total of 1312 participants died; of these, 300 participants died from CVD. Adjusted for age, gender, smoking, total cholesterol and estimated glomerular filtration rate, the RRs for CVD and all cause mortality among participants with MetS were 1·48 (95% confidence interval = 1·16–1·90) and 1·16 (1.03–1.30), respectively, for participants compared to those without MetS. The mean RRs for CVD, however, ranged from 1·21 to 5·31 among different combinations of MetS components.
Conclusion   The elderly with MetS, compared to those without MetS, had a higher CVD and all cause mortality in Taiwan. Furthermore, different combinations of MetS components posed different risks to the mortality, which deserves further research in the future.     

The correlation between waist circumference and ESC cardiovascular risk score: data from the German metabolic and cardiovascular risk project (GEMCAS)

Background  Identification of patients with high cardiovascular risk, an immanent task of primary care physicians, is laborious, cost intensive and thus difficult to perform. Waist circumference (WC), given its association with multiple risk factors, is an easy to use tool for initial assessment of cardiovascular risk, but its predictive validity in primary care has not been assessed. Patients and methods  In 2005 a nationwide sample of 35,869 unselected patients visiting a primary care physician was screened. The global cardiovascular risk using the SCORE Score of the European Society of Cardiology was assessed in 10,323 men (aged 35–65) and 18,852 women (45–65). Logistic regressions and Spearman correlations were used to evaluate the interdependence of WC and cardiovascular risk factors as well as the estimated cardiovascular risk. Results  Of these unselected patients 21.9% had an increased WC (women >80–88, men >94–102 cm) and further 36.5% had a high WC (women >88, men >102 cm). The proportion of patients with a low HDL-cholesterol was higher in high WC compared to normal WC (prevalence rate ratio (PRR) 1.88 [95%CI 1.74–2.02] in men and 2.97 [2.75–3.21] in women). The same applied to elevated triglycerides (PRR 1.72 [1.62–1.84] and 2.57 [2.36–2.80], respectively), impaired fasting glucose (PRR 2.30 [2.13–2.49] and 3.66 [3.29–4.06]), and elevated blood pressure (PRR 1.27 [1.23–1.30] and 1.57 [1.52–1.62]), respectively. The estimated risk to die from cardiovascular events within 10 years based on the SCORE scoring scheme increased with increasing WC (age adjusted ρ 0.18 in women and 0.19 in men). A SCORE score of more than 5% was observed in 24.12% of men (age adjusted PRR 1.27, 95%CI 1.12; 1.44) and 3.19% of women (age adjusted PRR 1.77, 95%CI 1.26;2.49) with a high WC as compared to 10.88% of men and 0.95% of women with a normal WC. Particularly, in the age groups 50–59 years (men, 11.1%) and 60–65 years (women, 10.2%) a high WC identified more frequently patients with a SCORE result necessitating action (>5% risk) than in lean men (3.52%, P < 0.0001) and women (4.32%, P < 0.0001). Conclusions  Routine measurement of waist circumference in primary care attendees is a suitable screening tool to identify patients with high cardiovascular risk in which a further diagnostic workup is necessary. Current cut-off values reflect a higher risk threshold in men than in women. Future research should identify new thresholds based on cardiovascular risk burden.     

Porphyrin metabolism in men with metabolic syndrome

Forty-three patients with metabolic syndrome (MS) were examined. The urinary (uroporphyrin--UP and coproporphyrin--CP) and fecal (CP and protoporphyrin) fractions of porphyrin, as well as the urinary excretion of porphyrin precursors (S-aminolevulinic acid and porphobilinogen) were measured. Porphyrin metabolic disturbances were registered in 33 (76.7%) patients. Nine of these patients displayed such qualitative changes as fraction mismatch (CP/UP < 1; the normal value is 2.1 +/- 0.4), and an increase in the level of porphyrin precursors, while their total urinary porphyrin level was normal. In 24 patients pathological changes in porphyrin exchange were characterized by such quantitative changes as a many-fold increase in urinary and/or fecal porphyrin fraction as well as the development of secondary biochemical coproporphyrinuria syndromes, symptomatic elevation of fecal porphyrin level, and latent late cutaneous porphyria. Changes in porphyrin exchange in patients with metabolic syndrome broaden the scope of disturbances occurring in this syndrome, and allow considering these changes as additional criteria.     

Cardiovascular morbidity and mortality of the metabolic syndrome

Cardiovascular disease remains the single leading cause of morbidity and mortality in the United States. The metabolic syndrome has received increased attention in recent years, partly because of the growing prevalence of obesity and its association with cardiovascular disease. This article reviews current evidence from longitudinal observational studies that evaluated the impact of metabolic syndrome on cardiovascular morbidity and mortality in various population subsets. The approach to cardiovascular risk assessment in individuals who have multiple risk factors and the clinical implications of diagnosing the metabolic syndrome are also discussed.     

Design and validation of a population-based definition of the metabolic syndrome

OBJECTIVE: The National Cholesterol Education Program (NCEP) definition of the metabolic syndrome was modified to be described as a continuous variable and adapted to the characteristics of a Hispanic population. RESEARCH DESIGN AND METHODS: Age/sex population percentiles for every component of the NCEP criteria were included in this approach using population-based data from a Mexican nationwide survey (2,158 subjects). One point was given per decile for every component. The total number of points accumulated was used to classify subjects. The predictive power for incident diabetes was evaluated using the 7-year follow-up results of the Mexico City Diabetes Study. RESULTS: Our population-based method had a significantly better prognostic power compared with the original and the updated NCEP definitions (area under the receiver operating characteristic curve 0.746 vs. 0.697 and 0.723, respectively, P < 0.05). Using individuals with /=39 points) (12.71 [95% CI 5.67-28.49]) compared with that calculated for the original (9.52 [4.69-19.31]) and the updated (11.14 [5.33-23.30]) NCEP criteria. The major advantage of our approach is the detection of subjects at the extremes of the range of diabetes risk and the ability to estimate this risk as a continuum. CONCLUSIONS: Our method adapts the NCEP criteria to the characteristics of a Hispanic population. It improves the predictive power of the NCEP criteria for future diabetes.     

腰围预测非酒精性脂肪性肝病的切点研究

目的:研究腰围与非酒精性脂肪性肝病(NAFLD)的关系,寻找腰围预测NAFLD的最佳切点.方法:采用分层随机抽样法,对研究对象进行体格检查、空腹血糖、血脂、腹部超声检查,通过受试者工作特性(ROC)曲线分析得到腰围预测NAFLD的最佳切点.结果:1 535例研究对象中共检出375例NAFLD,总患病率为24.4％,其中男性患病率为41.2％,女性为10.2％.腰围是NAFLD的危险因素.在ROC曲线分析中,男性腰围预测NAFLD的曲线下面积(AUC)为0.905,女性为0.949.男性及女性腰围预测NAFLD的最佳切点值分别为88.3 cm(敏感度:86.4％,特异度:85.9％)和82.4 cm(敏感度:93.2％,特异度:89.9％).结论:腰围对NAFLD有良好的诊断效能.佛山地区人群腰围预测NAFLD的最佳切点值男性为88.3 cm,女性为82.4 cm.