Low serum high density lipoprotein is associated with the greatest risk of metabolic syndrome among U.S. adults

Aims

Better understanding risk factors for metabolic syndrome (MetS) will allow early targeted intervention to mitigate long term risk. We aim to determine the disparate impact of each individual MetS component on overall risk of developing MetS, stratified by sex, race/ethnicity, and age.

对代谢综合征的探索和研究在继续

代谢综合征具体组分的确立、组分指标的异常阈值、其运用侧重于科研还是临床等观点,于不同的学术组织、不同国家和地区都有各自的侧重.再加之代谢综合征的发病机制并不清楚,尚缺少一致认同的诊断定义等因素,这使得其在公共卫生预防及临床诊断方面都导致了一些理念上的混淆和实践中的不便.近年来对代谢综合征既有共识又不乏争议,百家争鸣此起彼伏,为此如何理解及明辨,我们不仅需要引经据典更要善于捕捉新的证据.本文主要阐述了代谢综合征理念的新争议和亚洲人腹型肥胖诊断标准趋向统一的新证据.     

Prevalence of the metabolic syndrome in individuals with hyperuricemia

Purpose

The link between hyperuricemia and insulin resistance has been noted, but the prevalence of the metabolic syndrome by recent definitions among individuals with hyperuricemia remains unclear. Our objective was to determine the prevalence of the metabolic syndrome according to serum uric acid levels in a nationally representative sample of US adults.

Methods

By using data from 8669 participants aged 20 years and more in The Third National Health and Nutrition Examination Survey (1988-1994), we determined the prevalence of the metabolic syndrome at different serum uric acid levels. We used both the revised and original National Cholesterol Education Program Adult Treatment Panel (NCEP/ATP) III criteria to define the metabolic syndrome.

Results

The prevalences of the metabolic syndrome according to the revised NCEP/ATP III criteria were 18.9% (95% confidence interval [CI], 16.8-21.0) for uric acid levels less than 6 mg/dL, 36.0% (95% CI, 32.5-39.6) for uric acid levels from 6 to 6.9 mg/dL, 40.8% (95% CI, 35.3-46.4) for uric acid levels from 7 to 7.9 mg/dL, 59.7% (95% CI, 53.0-66.4) for uric acid levels from 8 to 8.9 mg/dL, 62.0% (95% CI, 53.0-66.4) for uric acid levels from 9 to 9.9 mg/dL, and 70.7% for uric acid levels of 10 mg/dL or greater. The increasing trends persisted in subgroups stratified by sex, age group, alcohol intake, body mass index, hypertension, and diabetes. For example, among individuals with normal body mass index (<25 kg/m²), the prevalence increased from 5.9% (95% CI, 4.8-7.0), for a uric acid level of less than 6 mg/dL, to 59.0%, (95% CI, 20.1-97.9) for a uric acid level of 10 mg/dL or greater. With the original NCEP/ATP criteria, the corresponding prevalences were slightly lower.

Conclusions

These findings from a nationally representative sample of US adults indicate that the prevalence of the metabolic syndrome increases substantially with increasing levels of serum uric acid. Physicians should recognize the metabolic syndrome as a frequent comorbidity of hyperuricemia and treat it to prevent serious complications.     

中老年男性肥胖者阻塞性睡眠呼吸暂停低通气综合征与代谢综合征相关性研究

目的 探讨中老年男性肥胖者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)与代谢综合征(metabolic syndrome,MS)及其组分之间的关系.方法 选择中老年男性肥胖患者154例,根据多导睡眠呼吸监测仪监测结果诊断OSAHS及病情严重程度,测定MS相关指标,应用统计学方法对OSAHS各组相关指标及OSAHS与MS之间的关系进行比较分析.结果 与对照组比较,重度OSAHS组高密度脂蛋白胆固醇明显降低[(1.03±0.29)mmol/L对(1.31±0.38)mmol/L,P＜0.05],血糖[(6.61±1.76)mmol/L对(5.47±0.64)mmol/L]、收缩压[(133±13)mm Hg对(125±12)mm Hg]及舒张压[(99±10)mm Hg对(80±5)mm Hg]明显升高(均P＜0.05);MS患病率轻度OSAHS组25.7%,中度OSAHS组46.5%,重度OSAHS组84.4%,均明显高于对照组16.1%(均P＜0.01);在OSAHS患者中,MS患病率是对照组的6.16倍.结论 中老年男性肥胖患者OSAHS是MS发病的独立危险因素.

Abstract：

Objective To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and metabolic syndrome (MS) in obese middle-aged and older men. Methods We selectively recruited 154 obese middle-aged and older men matched for body mass index (BMI) and age. The polysomnography was performed for diagnosing OSAHS and for discriminating disease severity. The BMI, waist circumference, blood pressure, plasma glucose and lipid profiles were measured and analyzed in all subjects. Appropriate statistical methods were used to compare the components of MS in each group. Logistic regression was taken to elucidate the relationship between OSAHS and MS. Results Compared to control group, severe OSAHS group had significantly lower high density lipoprotein cholesterol level [( 1.03 ± 0.29 ) mmol/L vs. ( 1.31 ± 0. 38) mmol/L,P＜0. 05] and higher fasting glucose [(6.61±1.76) mmol/L vs. (5.47±0.64) mmol/L, P＜0. 05]as well as higher systolic blood pressure [( 133 ± 13) mm Hg vs. ( 125 ± 12) mm Hg, P＜0. 05] and diastolic blood pressure [(99±10) mm Hg vs. (80±5) mm Hg, P＜0. 05]. The prevalence of MS was significantly higher in OSAHS group than in control group (mild OSAHS group: 25.7%,moderate OSAHS group: 46. 5%, severe OSAHS group: 84.4%, control group: 16. 1 %, all P＜0. 01). OSAHS was independently associated with an increased prevalence of MS Odds ratio, 6.16).Conclusions OSAHS is independently associated with MS in obese middle-aged and older men.     

代谢正常肥胖个体的临床特点及其发生代谢异常性疾病的风险

目的了解代谢正常肥胖（MHO）个体的临床特点并探讨其发生代谢异常性疾病的风险。方法回顾性分析湖南省人民医院体检中心2006年4月至2010年1月体检人群的临床资料,排除资料不全者,共有2830名人员纳入研究。其中1367名于1—3年后再次来院体检。记录受检者临床及生化指标。多组间比较进行方差分析,率的比较用χ2 检验。结果肥胖者占39．58％（1120／2830）,MHO占肥胖者的23．30％（261／1120）。女性MHO的百分比明显高于男性（31．22％比21．64％,χ2=8．126,P〈0．05）。与肥胖伴代谢综合征组比较,MHO组收缩压、舒张压、空腹血糖、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、谷丙转氨酶、尿酸、外周血白细胞计数较低,高密度脂蛋白胆固醇（HDL-C）较高,差异有统计学意义（t值为2．036～20．985,均P〈0．05）;与正常对照组比较,MHO组体质指数、血压、空腹血糖、甘油三酯、LDL—C、谷丙转氨酶、尿酸、外周血白细胞计数较高,HDL．c较低,差异有统计学意义（t值为3．458～10．978,均P〈0．05）。随访1—3年后,正常对照组中有17．6％（44／250）的个体出现代谢异常,而MHO组中46．8％（51／109）出现代谢异常,MHO代谢异常发生风险明显高于正常对照组（OR=4．117,95％CI：2．503—6．770,P〈0．05）。结论MHO个体临床表型介于正常对照与肥胖伴代谢综合征者之间,其发生代谢异常性疾病的风险随时间延长而增加。     

功能性食品与代谢综合征

由于代谢综合征在世界范围内日益增多,饮食干预越发受到人们重视.近年来研究发现一些食物或成分(即功能性食品或成分)有希望改善代谢综合征,尤其是肥胖、糖尿病、血脂异常.此文主要从这三方面举例并评估了一些潜在功能性食品或成分.     

Prevalence of metabolic syndrome,obesity and diabetes type 2 in cryptogenic cirrhosis

AIM: To evaluate the prevalence of metabolic syndrome (MS),obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (CC) and to compare this group with patients with cirrhosis secondary to other causes (disease controls).METHODS: Patients with CC,diagnosed between January,1990 and April,2005,were included in a retrospective study.Patients with cirrhosis caused by chronic hepatitis C,alcohol abuse or autoimmune hepatitis (AIH) served as disease controls.RESULTS: A total of 134 patients with CC were analyzed.Disease controls consisted of 81 patients with chronic hepatitis C,33 with alcohol abuse and 20 with AJH.The median age of patients with CC was 57 years (range,16-87); 83 (61.9%) patients were female; 53 (39.6%) were Child A,65 (48.5%) Child B,and 16 (11.9%) were Child C cirrhosis.The prevalence of MS (29.1% vs 6%; P ＜ 0.001),obesity (16.4% vs 8.2%; P = 0.04) and T2DM (40% vs 22.4%; P = 0.013)was higher in CC patients than in disease controls.There were no differences in sex,age or liver function tests between the two groups.CONCLUSION: The prevalence of MS，obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes.Our findings support the hypothesis that non-alcoholic steatohepatitis (NASH) plays an under-recognized role in CC.     

Prevalence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis

AIM： To evaluate the prevalence of metabolic syndrome （MS）, obesity and type 2 diabetes mellitus （T2DM） in a group of Mexican Mestizo patients with cryptogenic cirrhosis （CC） and to compare this group with patients with cirrhosis secondary to other causes （disease controls）. METHODS： Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis （AIH） served as disease controls. RESULTS： A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years （range, 16-87）; 83 （61.9%） patients were female; 53 （39.6%） were Child A, 65 （48.5%） Child B, and 16 （11.9%） were Child C cirrhosis. The prevalence of MS （29.1% vs 6%; P 〈 0.001）, obesity （16.4% vs 8.2%; P = 0.04） and T2DM （40% vs 22.4%; P = 0.013） was higher in CC patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. CONCLUSION： The prevalence of MS, obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis （NASH） plays an under-recognized role in CC.     

多囊卵巢综合征患者代谢综合征患病风险研究

目的 研究多囊卵巢综合征(PCOS)患者代谢综合征(MS)患病率,并探讨MS发生的危险因素.方法 比较348例年轻的PCOS患者及113名非PCOS正常女性的MS及其组分的患病率.结果 PCOS组MS的患病率为27.0%,明显高于正常对照组的10.6%(P<0.01),除甘油三酯外,其他MS组分在PCOS组均高于正常对照组(P<0.05或P<0.01),但校正年龄和体重指数(BMI)后,差异就不存在统计学意义(P=0.737).分层分析也显示PCOS非肥胖组和肥胖组的MS患病率与相应的正常对照组均无明显差异(均P>0.05).多元逐步回归分析显示稳态模型评估的胰岛素抵抗指数(HOMA-IR)和BMI是MS的独立预测因素(均P<0.01).结论 肥胖和胰岛素抵抗是MS的独立危险因素,PCOS单独并不增加MS的发生风险.     

代谢综合征认识和防治的新进展 --评《国际糖尿病联盟关于代谢综合征定义的全球共识》

近年来代谢综合征(MS)引起了越来越多的关注。国际糖尿病联盟(IDF)在今年4月份的一次国际专家研讨会上提出了一个全球统一的新定义,强调以中心性肥胖为核心组分。新定义反映了对MS基础和流行病学研究的新进展,虽有需要完善之处,但仍将有利于在全球范围防治MS及相关疾病,是值得推广的一个MS新定义。     

广东佛山地区代谢综合征患病率现况调查

2003年广东省佛山地区2512名职员按中华糖尿病学会建议诊断的代谢综合征及其各组分的标化患病率计为：代谢综合征11．46％，糖尿病5．17％，高血压16．35％，TG升高25．59％，HDL-C降低4．72％，超重及肥胖18．84％。代谢综合征患病率随年龄增大而升高。     

Body fat,metabolic syndrome and hyperglycemia in South Asians

The prevalence of overweight and obesity is escalating in South Asian countries. South Asians display higher total and abdominal obesity at a lower BMI when compared to Whites. Consequently, metabolic dysfunction leading to metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) will account for a majority of the health burden of these countries. In this review, we discuss those factors that contribute to MetS and T2DM in South Asians when compared to whites, focusing on adiposity. Abdominal obesity is the single-most important risk factor for MetS and its predisposition to T2DM. Excessive ectopic fat deposition in the liver (non-alcoholic fatty liver disease) has been linked to insulin resistance in Asian Indians, while the effects of ectopic fat accumulation in pancreas and skeletal muscle need more investigation. South Asians also have lower skeletal muscle mass than Whites, and this may contribute to their higher risk T2DM. Lifestyle factors contributing to MetS and T2DM in South Asians include inadequate physical activity and high intakes of refined carbohydrates and saturated fats. These are reflective of the recent but rapid economic transition and urbanization of the South Asian region. There is need to further the research into genetic determinants of dysmetabolism as well as gene x environment interactions. Collectively, MetS and T2DM have multi-factorial antecedents in South Asians and efforts to combat it through low-cost and socio-culturally appropriate lifestyle interventions need to be supported.     

酒精性肝病与代谢综合征

长期持续大量饮酒不仅直接导致终末期肝硬化或肝癌的发生,还可以影响肝脏的代谢而出现代谢综合征(MS)。众多研究表明,酗酒可增加MS的危险性,后者可发展为肝性糖尿病、高血压和冠心病,并增加这些疾病的死亡率。研究表明,相对于没有或者偶尔饮酒,适度饮酒的人群高血压和2型糖尿病的患病率较低。事实并非如此,饮酒与MS各组分之间存在着保护、有害或J型的复杂机制。因此,本文回顾了饮酒与MS组分的关系,并讨论了酒精合理的潜在的生物学机制,以期引起临床和研究的注意。     

Cardiovascular risk and adrenergic overdrive in the metabolic syndrome

AimsThis paper will review the role of the sympathetic nervous system in the pathogenesis of the metabolic syndrome as well as its importance as target of non-pharmacologic and pharmacologic treatment.Data synthesisSeveral indices of adrenergic drive, such as plasma norepinephrine, norepinephrine spillover from adrenergic nerve terminals and efferent postganglionic muscle sympathetic nerve traffic, have all shown an increase in the different conditions clustering in metabolic syndrome, such as obesity, hypertension and insulin resistance state. This increase: 1) appears to be potentiated in the metabolic syndrome; and 2) contributes to a large extent at the cardiovascular structural and functional alterations typical of the disease. Based on this evidence, non-pharmacologic life-style interventions as well as drug treatment procedures used in the therapeutic approach to the metabolic syndrome should be aimed at exerting not only favourable haemodynamic and metabolic effects but also pronounced sympathoinhibition.ConclusionThe data reviewed in this paper strongly support the relevance of the sympathetic nervous system in the pathogenesis of the metabolic syndrome and the importance of the sympathomodulation as a specific aim of therapeutic intervention.     

老年代谢综合征患病情况及特点

目的　 调查老年干部代谢综合征的患病情况及特点。　 方法　通过体检的方法 ,测定血糖、血脂、血压、心电图、身高、体重、腰围、臀围、眼底等 ,并详细对受检人员询问病史。　 结果 　 1615名老年干部中发现代谢综合征 198例 ,发生率为 12 2 6% ;10 0 4名中年干部中发现 65例 ,发生率仅为 6 47% (P <0 0 1)。老年干部糖尿病、高血压的发生率分别为 2 1 67%、5 7 71% ,较中年干部的发生率 13 5 5 %、2 9 5 8%有明显增高 (P <0 0 1)。老年代谢综合征者冠心病、腹型肥胖、眼底动脉硬化的发生率分别为 5 4 0 4%、63 64%和 40 91% ;而非老年代谢综合征者为 2 6 15 %、44 61%和 2 9 2 3% ,明显低于老年代谢综合征者 (P <0 0 1)。　 结论　老年代谢综合征发病率较高 ,其主要原因是糖尿病和高血压的高发病率。老年代谢综合征伴有高冠心病、动脉硬化发病率 ,是威胁老年人身体健康的主要疾病     

Practical aspects of the control of cardiovascular risk in type 2 diabetes mellitus and the metabolic syndrome

Cardiovascular disease is unanimously recognized as the major burden in type 2 diabetes, in terms of both mortality and morbidity. There is an extensive evidence coming from epidemiological studies that supports this statement. The presence of the metabolic syndrome confers a higher risk of long-term death, and dysglycemia appears to be responsible for the most of the excess risk. The metabolic syndrome also has an essential role in the modern concept of cardiovascular prevention.     

首钢糖代谢异常高危人群代谢综合征的调查分析--探讨适合中国人群的代谢综合征诊断标准

目的 在糖代谢异常高危人群中，评价WHO的代谢综合征(MS)诊断标准和中国的MS建议定义诊断MS的一致性，探讨适合于中国人群的MS诊断标准。方法 对首都钢铁公司2882例30岁以上、无糖尿病史、经口服葡萄糖耐量试验(OGTT)初筛后2h血糖≥6．67mmol／L者重复进行OGTT后的资料进行分析，计算标准化患病率，同时试对MS诊断标准进行调整。结果 在该人群中：(1)糖代谢异常、超重、高血压、高甘油三酯(TG)血症、胰岛素抵抗(IR)等MS单组分的患病率均超过30％；(2)以中国建议的定义诊断MS的患病率(28．4％)高于wH0的MS诊断标准(20．2％)；(3)WHO的MS诊断标准体质指数(BMI)界点过高；(4)微量白蛋白尿(MAU)阳性者的MS各组分发生率以及MS的患病率均较高。结论 糖代谢异常高危人群中根据中国建议定义MS的患病率较高；中国MS诊断标准中加入MAU组分，对MS的患病率影响不大。     

北京自然人群代谢综合征发病率及影响因素的研究

目的:探讨北京自然人群代谢综合征(metabolic syndrome,MetS)的发病规律及影响因素。方法:1999年在北京城乡自然人群中采用分层随机抽样方法建立了25~64岁男女两性共1304人的心血管病研究队列。2004年对该人群进行了随访和第2次危险因素调查。2次调查资料完整者893人。本研究对基线时未患MetS的617人5年后MetS的发病情况进行了分析。结果:1.本队列人群1999-2004年5年间MetS的累积年龄标化发病率为12.7%。2.采用多因素Logistic模型调整了年龄、性别等因素的影响后,基线有冠心病家族史、缺乏体育锻炼、胰岛素抵抗和具有MetS的任一组分均可增加MetS的发病危险,其中腹型肥胖对MetS的预测作用最强(OR=5.34,P<0.001)。3.调整其他因素的影响后,基线具有1个和2个MetS组分者5年后发生MetS的危险分别为没有任何组分者的4.39倍和12.48倍。结论:早期预防,特别是肥胖的预防,在MetS及相关的心血管病和糖尿病防治中起着至关重要的作用。     

南宁市部分群体代谢综合征IDF-2005年定义的危险因素分析

依据IDF2005年定义的南宁市事业单位群体代谢综合征（MS）的患病率为16．32％，MS防治工作重点为高血糖、高TG、肥胖或腹型肥胖和高血压，特别是40～70岁的群体。     

黄嘌呤氧化还原酶与代谢综合征

黄嘌呤氧化还原酶(XOR)通过将嘌呤分解为尿酸,控制着人体内嘌呤代谢的限速步骤.近年来研究表明XOR活性的异常不仅可导致高尿酸血症和痛风,还积极地参与了代谢综合征的发生、发展.XOR如何影响肥胖、高血压、动脉粥样硬化、糖尿病等代谢综合征相关疾病尚不明确,其可能机制包括调节脂质代谢转录调控因子,影响尿酸、一氧化氮及活性氧簇的生成等.XOR抑制剂如别嘌呤醇和非布索坦对上述疾病有一定的保护效果,这为代谢综合征的防治提供了新思路.