日本普通人群中代謝綜合征及植物甾酮的吸收異常發(fā)生率課件

1、Frequency of Metabolic Syndrome and its Absorption Abnormality by Plant Sterols in General Population, JapanToshio Shimada, Yo Murakami, Nobuyuki Oyake, Hiroyuki Yoshitomi, Nobuhiro Kodani, Akira Matsumori*Division of Cardiovascular Medicine, Department of Internal Medicine, Shimane University Facul

2、ty of Medicine, Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine*BackgroundHealth problems on aged people have been growing bigger in Japan because with advancing age, a variety of diseases especially on vascular diseases, such as cardio- and cerebro-vascular dise

3、ases have been increasing. And therefore, early detection of vascular diseases is a very important issue for vascular prevention and reduction of mortality.Diagnostic Criteria for Metabolic Syndrome (8 Japanese Medical Associations Joint-Committee) Fat accumulation in the intra-abdominal cavityAbdom

4、inal Circumference at the WaistMale85cm, Female90cm( 80cm recommended by me)（Visceral fat areaMale and Female 100 cm2)Hypertriglyceridemia 150 mg/dLLow HDL-cho 40 mg/dLSystolic Blood Pressure 130 mmHgDiastolic Blood Pressure 85 mmHgFasting Blood Sugar 110 mg/dL Lipoprotein abnormality High Blood Pre

5、ssure High Blood Sugar At least, more than following 2 itemsand / orand / ormodified and translated into English by Toshio ShimadaMajor CriteriaMinor CriteriaObesityInsulin ResistanceDMDyslipidemiaHypertensionAtherosclerosisArteriosclerosisPathophysiology of Metabolic SyndrmeOver-eatingPoor Exercise

6、InheritanceLDLISynthesis of Cholesterol in the Liver and Absorption of Cholesterol in the Intestine- Two Important Supply Sources of Cholesterol in Vivo-BileFoodLiverVesselsCholesterolSmall IntestineBiliary8002000mg/dayDietary400500mg/dayAimOur purpose is to investigate the frequency of metabolic sy

7、ndrome (MS) and life style related diseases and also to examinewhether any difference in absorption of cholesterol from the digestive system is present in participants between with metabolic syndrome (MS) and non-MS randomly selected, using plant sterols in general population.Subjects and method In

8、2007, 1980 participants for annual health check-up were subjected for this cohort study. Average age is 6610.8 years, and female is 1260(64%)；male is 720(36%). All subjects underwent routine blood examinations, insulin, remnant like particle cholesterol (RemLC), hs-CRP, cystatin C, plasma brain natr

9、iuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) measurements. Blood pressure, abdominal circumference, and electrocardiography were measured at the same time. Abdominal circumference was measured at the navel level in the supine position like CT for visceral fat. Evaluation of cholesterol ab

10、sorption was done by plant sterols in each 30 participants chosen randomly from the participants. BNP and NT-proBNP were measured for heart failure screening by immunoluminesence method. Plant sterols were measured by gas chromatography.True PositiveSensitivity0.000.100.200.300.400.500.600.700.800.9

11、01.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse PositiveUsing MSF90M85-Dx=0 to be the positive levelArea Under Curve = 0.93304Receiver Operating CharacteristicMetabolic Syndrome and its Influential Factors Analyzedby Multivariate Logistic RegressionFemale Waist Circumference 90cmInfluential Pa

12、rametersBMIHbCystatin CInsulinRem LC TchoTrue PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse PositiveUsing Abd-CF80M85=0 to be the positive levelArea Under Curve = 0.89483Receiver Operating CharacteristicMetabolic Syndrome and its Infl

13、uential Factors Analyzed by Multivariate Logistic Regression Female Waist Circumference 80cmInfluential ParametersBMIHbCystatin CRem LC TchoTrue PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse PositiveSensitivity 0.81Specificity 0.65Odd

14、s Ratio 5278AUC 0.77p = 0.0000 Cut-Off Value7.34mg/dLCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 90 cmand that of Men 85 cm)Sensitivity 0.81Specificity 0.63Odds Ratio 1647AUC 0.75p = 0.0000 True PositiveSensitivity0.000.100.200.300.400

15、.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse Positive7.27mg/dLCut-Off ValueCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Men 85cm)Abnormal and Normal Proportion of Plasma BNP Levels With Advancing Age in General Popu

16、lation, JapanOkuizumo Cohort 2007Cut-Off Value 20pg/mLN=145N=322N=721N=341N=269N=132N=48Years Abnormal and Normal Proportion of NT-proBNP Levels With Advancing Age in General Population, JapanOkuizumo Cohort 2007Cut-Off Value 55pg/mLN=145N=322N=721N=341N=269N=132N=48Years Comparison of Campesterol B

17、etween Metabo(0) and Non-Metabo(1) in General Population, JapanOkuizumo Cohort 2007Campesterol(Absorption Marker of Cholesterol)MetaboNon-MetaboNSComparison of Lathosterol Between Metabo(0) and Non-Metabo(1) in General Population, JapanOkuizumo Cohort 2007Lathosterol(Synthesis Marker of Cholesterol)

18、MetaboNon-MetaboNSSummary Results High blood pressure was 52%, high cholesterol 25%, low HDL-cholesterol 5%, high triglyceridemia 18%, high blood sugar 17% and in women, abdominal circumference 90cm 10% and 80cm 44%, respectively. According to Japanese abdominal circumference criteria for MS in wome

19、n, only 3% of women were diagnosed as MS. Using 80cm as criteria for abdominal circumference, 10% were diagnosed as MS. In men (85cm), 13% were MS. Participants with possible cardiac dysfunction were 46% in BNP and 52% in NT-proBNP, respectively. RemLC was very closely related to MS. Receiver operat

20、ing characteristic (ROC) curve analysis for diagnosing MS demonstrated that cut-off value of LemLC was 7.26mg/dl using female waist circumference 80cm and male waist circumference 85cm , 7.28mg/dl only using male waist circumference 85cm and 6.88mg/dl only using female waist circumference 80cm. Summ

21、ary Results（Continued)Absorption of cholesterol marker levels were paradoxically lower in MS than in non MS. Lathosterol, a marker of cholesterol synthesis was 2.4g/mL in MS and 2.8 g/mL in non MS (p=0.1133), sitosterol, a marker of cholesterol absorption 1.5 g/mL in MS and 1.8 g/mL in non MS (p=0.0107), campesterol, a marker of cholesterol absorption, 2.4 g/mL in M