PURPOSE To identify the predictors of death from other causes in patients with localized renal cell carcinoma (RCC). MATERIALS AND METHODS We identified 1,101 patients with pathologically confirmed T1 or T2 RCC with a follow-up duration of over 6 months. Survival according to the cause of death was evaluated by using the Kaplan-Meier analysis with log-rank test. Prognostic factors for death from other causes were assessed by multivariate analysis using the Cox proportional hazard regression model. Once the prognostic factors were identified, a risk-group variable was created by counting the number of unfavorable features present for each patient. RESULTS The median follow-up was 62 months, and RCC-related death occurred in 50 patients (4.5%), whereas death from other causes occurred in 47 (4.3%). Patients who died from other causes had a higher American Society of Anesthesiologist (ASA) score (26.1% vs. 10.2%; p=0.044), older age (63.4 years vs. 55.0 years; p<0.001), smaller mass size (5.1 cm vs. 7.9 cm; p<0.001), and lower nuclear grade (p=0.003). In the multivariate Cox regression analysis, older age, higher ASA score, and lower body mass index were independent factors predicting death from other causes in patients with localized RCC. On the basis of the number of risk factors for death from other causes, the 5-year other-cause-specific survival was 98.3%(0 risk factors), 84.7%(1 risk factor), and 67.6%(2 or 3 risk factors), respectively (p<0.001). CONCLUSIONS Older age, higher ASA score, and lower body mass index were independent predictors of death from other causes in patients with localized RCC.

BACKGROUND Metabolic syndrome (MS) is thought to be a risk marker for cardiovascular diseases in the general population and in patients with chronic kidney disease. This study investigated whether the presence of MS also modifies cardiovascular (CV) outcomes among non-diabetic patients undergoing long-term peritoneal dialysis (PD). METHODS We enrolled 280 patients from a medical centre in North Taiwan who began PD between January 1999 and December 2005 and followed them until December 2009. MS was defined by the modified National Cholesterol Educational Programme (Adult Treatment Panel III) criteria. All parameters and biochemical data were collected by chart review. Patient outcomes (overall and CV death, fatal or non-fatal CV events) were recorded during the follow-up period. Survival was analysed by the Kaplan-Meier method, and the influence of MS and its components on outcomes were analysed by Cox regression models. RESULTS The average follow-up period was 49.2 months. Non-diabetic patients with MS had worse outcomes than those without MS or at risk for MS, but better than their diabetic counterparts. By multivariate analysis, MS was independently associated with increased risk for CV death (hazard ratio, HR = 13.27) and fatal or non-fatal CV events (HR = 10.50). Among five MS components, hypertriglyceridaemia, low high-density lipoprotein levels and hyperglycaemia were significant risk factors for adverse CV outcomes. CONCLUSIONS MS is a potent risk marker for adverse CV outcomes in non-diabetic patients on PD. Timely interventions targeting specific component of this syndrome may be required in this subset of patients.

BACKGROUND The purpose of this study was to document the prevalence of shoulder osteoarthritis (OA) in the elderly population in South Korea, to determine the risk factors for shoulder OA, and to evaluate the relationship with function. MATERIALS AND METHODS This project was part of a population-based prospective cohort study of health, aging, and common geriatric diseases in the elderly population of the authors' area of Seongnam. A total of 1118 residents were randomly invited, and 679 participated. The mean age of respondents was 71.8 ± 5.7 years (range, 65-97 years), and 396 (58.3%) were women. Bilateral shoulder radiographs were taken, and the grade of OA was evaluated using the Samilson-Prieto method. Functional status was evaluated using the Disabilities of Arm, Shoulder and Hand (DASH) instrument. RESULTS Radiographic primary shoulder OA was detected in 109 people (16.1%), and secondary OA in 9 (1.3%). There were 77 shoulders of grade 1 (11.3%), 23 of grade 2 (3.4%), and 9 of grade 3 (1.3%). The risk of shoulder OA increased according to age, with odds ratio (OR) of 2.20 in patients aged 70 to 74 years (P =.004) and 3.42 in patients aged 75 years and older (P <.001). Knee OA was also a significant risk factor for shoulder OA (OR, 1.96; P =.002). The DASH score was significantly higher in the OA group and increased according to the grade of shoulder OA (P <.001). CONCLUSION Primary shoulder OA is not as rare as previously reported. Our data also demonstrated that older age and knee OA were determining risk factors for shoulder OA, and shoulder OA was related to poor function.

BACKGROUND AND AIM Cytokines activation is a common feature in chronic hepatitis C (CHC) infection. Visfatin, as a recently-recognized adipocytokine, may correlate with metabolic abnormalities. We aimed to elucidate the characteristics of visfatin in CHC patients. METHODS This retrospective study included 102 treatment-naïve CHC patients and 97 sex-/age-matched healthy adults. Serum visfatin levels were examined by an enzyme linked immunosorbent assay test. The correlation between visfatin and hepatitis C virus (HCV) infection in terms of virological, metabolic, and histopathological profiles was analyzed. The impact of visfatin on the treatment response to pegylated interferon plus ribavirin (PEGIFN/RBV) therapy was also assessed. RESULTS The visfatin level was correlated significantly with fibrosis scores (r = 0.23, P = 0.02) in CHC patients. A significant higher visfatin level was observed in CHC patients with histological activity index scores of mild and more (P = 0.01) and advanced fibrosis (P = 0.04). The mean visfatin level (0.81 ± 0.28 log ng/mL) of 26 CHC patients with metabolic syndrome was significantly lower than their counterparts (0.95 ± 0.30 log ng/mL)(P = 0.03). There was no significant correlation between visfatin and HCV genotypes, viral load, and treatment response to PEGIFN/RBV therapy. Multiple logistic regression analyses demonstrated that metabolic syndrome was the leading negative variable (odds ratio = 0.09, 95% confidence interval = 0.02-0.46, P = 0.004) associated with high visfatin level, followed by advanced fibrosis (odds ratio = 2.88, 95% confidence interval = 1.06-6.78, P = 0.03). CONCLUSIONS Serum visfatin was correlated with disease severity and metabolic syndrome in CHC patients.

With regard to metabolic syndrome-related risks (MS risks), obese workers have been the focus of attention, and less attention has been paid to non-obese subjects as if they were free from the risks. The present analysis was initiated to know if no-obesity means no-MS risks. Participants of the study were 804 male workers, who showed no pathological findings in 12 MS-related and other health parameters in 2003, and had complete sets of data in 2008. They were classified by BMI in 2003 into lean (< 18.5), normal (> or = 18.5 to < 25) and obese groups (> or =25). Proportion of MS in 2008 was examined by use of the second phase of MS criteria. Proportions for the lean, normal and obese subjects who met MS criteria in 2008 were 3.2, 4.8 and 5.3%, respectively, with no significant difference in proportions among them. In the non-obese (i.e., lean+normal) group, age was not significantly influential to increase BMI. Thus, the MS risk exists even in non-obese young workers. Anti-MS effort should be directed not only to obese but to non-obese workers, and care should be extended irrespective of ages.

A total of 959 Taiwanese patients undergoing maintenance hemodialysis-102 underweight (BMI < 18.5 kg/m(2)), 492 normal weight (BMI 18.5-22.9 kg/m(2)), 187 overweight (BMI 23.0-24.9 kg/m(2)), and 178 obese (BMI >or= 25 kg/m(2)) were recruited into this three-year, multicenter longitudinal study. It was found initially that the underweight group had more females, longer hemodialysis durations, less use of a biocompatible membrane (BCM) dialyzer, higher erythropoietin doses and Kt/V(urea), and lower white blood cell counts, hemoglobin, serum creatinine and phosphate, and high sensitivity C-reactive protein (hsCRP) than other groups (P < 0.001). Furthermore, a chi(2)-test demonstrated that underweight patients had poorer nutrition (P = 0.023), but less systemic inflammation (P < 0.001) than other groups. A stepwise multiple linear regression analysis established that age, sex, diabetes mellitus, hemodialysis duration, use of BCM dialyzer, Kt/V(urea), creatinine, high-density lipoprotein cholesterol, and hsCRP were significant risk factors associated with BMI (P < 0.001-0.002). After three years, 149 (15.5%) patients had died, including 22 of 102 (21.6%) underweight patients, 64 of 492 (13.0%) normal weight patients, 38 of 187 (20.3%) overweight patients, and 25 of 178 (15.5%) obese patients. The primary causes of mortality were cardiovascular (52.3%) and infection (39.6%). A multivariate Cox regression analysis revealed that age, diabetes mellitus, BMI, albumin, hsCRP, and cardiothoracic ratio were significant risk factors associated with all-cause mortality over three years (P < 0.001-0.022). Finally, Kaplan-Meier analysis confirmed that underweight patients suffer higher mortality than other groups (Log rank, P = 0.0392); therefore, the data have demonstrated a survival disadvantage of low BMI in Taiwanese patients undergoing maintenance hemodialysis.

BACKGROUND AND AIM The aim of this study was to investigate the influence of polygenetic polymorphisms, which play a role in the pathogenesis of metabolic syndrome, on the susceptibility to non-alcoholic fatty liver disease (NAFLD) of Chinese people. METHODS The subjects were selected from an epidemiological survey in the Guangdong province of southern China. In each polymorphism study, 50-117 subjects who met the diagnostic criteria of NAFLD and had typical clinical and ultrasonographic findings were placed into the case group. Using a nested case-control design, the same numbers of matched people without NAFLD were included as controls. Single nucleotide polymorphisms (SNP) at nine positions in seven candidate genes were tested. These SNP were found to be associated with the pathogenesis of metabolic syndrome. Genetic analyses were performed using genomic DNA extracted from peripheral blood leukocytes. Polymerase chain reaction-restriction fragment length polymorphism was applied to detect SNP. RESULTS Most candidate genes' SNP were associated with susceptibility to NAFLD. Some showed positive relationships (increased risk): tumor necrosis factor-alpha-238, adiponectin-45, leptin-2548, peroxisome proliferator-activated receptors-161 and phosphatidyletha-nolamine N-methyltransferase-175. Other SNP demonstrated a negative association (decreased risk): adiponectin-276 and hepatic lipase-514. Only two were not associated: tumor necrosis factor-alpha-380 and peroxisome proliferator-activated receptors-gamma co-activator-1alpha-482. CONCLUSION Most candidate genes' SNP examined in metabolic syndrome patients were associated with susceptibility to NAFLD.

We investigated the impact of metabolic syndrome (MS) on the occurrence of in-stent restenosis (ISR) and long-term major adverse cardiac events (MACEs), including cardiovascular death, myocardial infarction, and target vessel revascularization (TVR) during a follow-up period of 36 months after percutaneous coronary intervention (PCI) with stent implantation in patients with significant preexisting coronary artery disease. MS was not an independent predictor of increased ISR and MACE after PCI.

BACKGROUND Laparoscopic colon resection for left-sided colon cancer is being performed with increasing frequency worldwide. The purpose of this study is to evaluate the influence of patient- and procedure-related factors on difficulty of laparoscopic surgery for left-sided colon cancer. METHODS Two hundred sixty consecutive patients underwent laparoscopic surgery for left-sided colon cancer from July 2005 to December 2008. Gender, body mass index (BMI), tumor location, tumor size, previous abdominal surgery, tumor depth, tumor stage, splenic flexure mobilization, type of anastomosis, and site of arterial division were analyzed as potential variables that affect difficulty of laparoscopic surgery. Dependent variables were operative time, intraoperative blood loss, intra- and postoperative complications, and proximal and distal tumor margin. Univariate and multivariate analyses were performed to determine predictive significance of variables. RESULTS Multivariate analysis showed that male gender (P = 0.0183) and splenic flexure mobilization (P < 0.0001) were independently predictive of longer operative time. Splenic flexure mobilization was related to greater intraoperative blood loss (P = 0.0006), intraoperative complications (P = 0.0111, odds ratio: 7.22), and wider distal tumor margin (P = 0.0048). CONCLUSIONS Male gender and splenic flexure mobilization were independent predictors of difficulty of laparoscopic surgery for left-sided colon cancer. In contrast, our findings also showed that BMI, tumor location, previous abdominal surgery, tumor stage, type of anastomosis, and site of arterial division did not have an adverse impact on difficulty of laparoscopic surgery for left-sided colon cancer in our clinical setting. Our data support the safety of performing laparoscopic surgery for left-sided colon cancer in well-selected patients by well-experienced surgical teams.

OBJECTIVE Previous studies have shown that coffee consumption is inversely related to serum levels of liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), but few have addressed the relation in women and effect modifications of alcohol use and obesity. We examined the association of coffee and green tea consumption with serum activities of liver enzymes in free-living Japanese men and women, focusing on sex difference and effect modifications of alcohol and obesity. MATERIAL AND METHODS The data were derived from the baseline survey of the Kyushu University Fukuoka Cohort Study, and included 12,020 Japanese men and women aged 49-76 years who were free of chronic liver diseases. RESULTS There was an inverse association between coffee consumption and elevated ALT in men, and the association between the two was weaker in women. In the analyses stratified by aminotransferases category, inverse associations of coffee consumption with serum activities of liver enzymes were observed in both men and women within the whole range and among those with aminotransferases within the reference range (ALT/AST <or=40 IU/L for men and ALT/AST <or=30 IU/L for women). Inverse associations of coffee with liver enzymes were more evident in those with high alcohol consumption and in those with low body mass index. CONCLUSIONS Coffee drinking probably confers protection against alcohol-related increase in liver enzymes.

OBJECTIVE Asians have a unique feature characterized by a low frequency of obesity, but a high frequency of diabetes and metabolic syndrome. It is important to develop simple and reliable anthropometric measurement tools for multiple metabolic disorders, but the cut-off values of anthropometric measurements for Asians have been less clear than those for Caucasians. RESEARCH DESIGN Data from 361 Japanese and 252 Mongolians aged 30-60 years were investigated for the relationship between multiple metabolic disorders parameters and anthropometric measurements. Pearson's correlation coefficients and receiver operating characteristic (ROC) analysis were done. RESULTS Mongolians of both genders had significantly higher values for all anthropometric measurements than did the Japanese. The Japanese anthropometric measurements showed the highest correlation coefficient of the area under the curve (AUC) from an ROC analysis for HDL-C and triglyceride, while the Mongolians showed the highest values for HOMA-IR. BMI and waist circumference (WC) for both ethnic groups showed relatively higher AUCs for the multiple metabolic disorders parameters. Optimal cut-off values predicting multiple metabolic disorders in the Japanese were estimated at 24 BMI and 82 cm WC (men) and 23 BMI and 73 cm WC (women); for the Mongolian, 27 BMI and 92 cm WC (men) and 27 BMI and 84 cm WC (women). CONCLUSIONS There were great differences in diagnostic accuracy for the anthropometric measurements by ethnicity, and a relatively lower magnitude of differences by kind of anthropometric measurement. The present study suggests that BMI and WC were useful for predicting multiple metabolic disorders in non-diabetic Mongolians and Japanese, while the use of plasma triglyceride and HDL-cholesterol levels in combination with BMI and WC may enhance the ability of predicting metabolic parameters in the Japanese.

A clustering of insulin resistance, hypertension and dyslipidemia has been labeled as the metabolic syndrome. Asians have a lower frequency of obesity than do Caucasians, but have an increasing tendency toward metabolic syndrome. Most data on metabolic syndrome are based on studies from Western countries with only limited information derived from Asian populations. We conducted a cross-sectional study of individuals aged 30-60 yr in workplace settings. We examined and analyzed the health data of 1,384 Japanese, Koreans and Mongolians for metabolic syndrome based on the modified definitions of the working definition proposed by the Third Report of the National Cholesterol Educational Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III definition). The prevalence of metabolic syndrome using the ATP III-BMI30 and ATP III-BMI25 definitions was 7% and 12% for Japanese, 7% and 13% for Koreans, and 12% and 16% for Mongolians, respectively. With the exception of obesity, the prevalences of individual metabolic abnormalities within each of the three Asian groups were similar to each other and to reported rates of prevalence in the U.S.A. Nevertheless, the values of sensitivity and specificity by the metabolic syndrome definitions are remarkably different relative to ethnicity. A universal metabolic syndrome definition is inappropriate for comparisons of metabolic syndrome among Asian ethnic groups. We believe that the ATP III-BMI25 definition is suitable for the determination of metabolic syndrome among Japanese and Koreans, and that the ATP III-BMI30 is more appropriate for Mongolians.

BACKGROUND A clustering of insulin resistance, hypertension, and dyslipidemia has been labeled as metabolic syndrome. Asians have a lower frequency of obesity than do Caucasians but have an increasing tendency toward metabolic syndrome. METHODS We conducted a cross-sectional study of individuals aged 30-60 years. We analyzed the health data of 596 Japanese and Mongolians for metabolic syndrome based on the Third Report of the National Cholesterol Educational Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) definition and the three modified ATP III definitions. RESULTS The prevalence of metabolic syndrome using ATP III criteria was 6% for the Japanese and 12% for the Mongolians, a remarkable lower prevalence relative to the reported prevalence in the United States. With the exception of visceral obesity, the prevalences of individual metabolic abnormalities within each of the two Asian groups were similar to each other and to reported rates of prevalence in the United States. CONCLUSIONS A universal metabolic syndrome definition is inappropriate for comparisons of metabolic syndrome among Asian ethnic groups. We believe that the ATP III index for visceral obesity should be adjusted for Asian populations.

Accumulated evidence suggests that hypertriglyceridemia (HTG) is independently associated with an increased incidence of cardiovascular disease. The hypotriglyceridemic effects of n-3 PUFAs have been confirmed in Caucasians, but the effect in Asians is less clear. Recent evidence indicates that stearoyl-CoA desaturase (SCD) activity induced with high-carbohydrate diets increases plasma triglyceride levels. We investigated the relationship between triglyceride levels and the ratio of plasma oleic acid to stearic acid (the 18:1/18:0 ratio), a plasma marker of SCD activity, and n-3 PUFAs in 411 Japanese, 418 Korean, and 251 Mongolian adults. The Japanese and Koreans had higher values for triglyceride than their Mongolian counterparts, despite lower body mass index values for the Japanese and Koreans. The Japanese and Koreans ate fish more frequently and had remarkably higher values for n-3 PUFAs than did the Mongolians. Multiple regression analysis showed that triglyceride levels had a great magnitude of correlation with the increases in 18:1/18:0 ratio for the Japanese and Mongolians, and n-3 PUFAs remained significant for the Mongolians. HTG is ethnicity-specifically associated with an increase in the 18:1/18:0 ratio and a decrease in n-3 PUFA in plasma for Japanese, Koreans, and Mongolians.

The effects of dietary consumption of mulberry (Morus alba L.) leaves and their major flavonol glycoside, quercetin 3-(6-malonylglucoside)(Q3MG), on the development of atherosclerotic lesions, in relation to the susceptibility of plasma LDL to oxidative modification, was studied in LDL receptor-deficient (LDLR-/-) mice. Male mice aged 8 wk were randomly assigned to 4 groups (control, quercetin, Q3MG, and mulberry). The control group was fed an atherogenic-diet containing 3 g cholesterol and 15 g cocoa butter/100 g. The other experimental groups were fed the same atherogenic diet supplemented with 0.05 g quercetin/100 g for the quercetin group, 0.05 g Q3MG/100 g for the Q3MG group, and 3 g dried mulberry-leaf powder/100 g for the mulberry group. The mice were fed their respective diets for 8 wk. The susceptibility of LDL to oxidative modification was significantly decreased in the Q3MG- and mulberry-treated mice, as evidenced by the 44.3 and 42.2% prolongation of the lag phase for conjugated diene formation compared with that of the control mice. The atherosclerotic lesion area in both the Q3MG- and mulberry-treated mice was significantly reduced by 52% compared with that of the controls. However, in the quercetin group, no protective effects were observed against LDL oxidation or atherosclerotic lesion formation. In conclusion, mulberry leaves attenuated the atherosclerotic lesion development in LDLR-/- mice through enhancement of LDL resistance to oxidative modification, and these antioxidative and antiatherogenic protective effects were attributed mainly to Q3MG, the quantitatively major flavonol glycoside in mulberry leaves.

Oxidation of low-density lipoprotein (LDL) has been implicated in atherogenesis. Antioxidants that prevent LDL from oxidizing may reduce atherosclerosis. This study investigated LDL antioxidant activity in edible plant products for development of dietary supplementation to prevent atherosclerosis. Fifty-two kinds of edible plants were extracted using 70% aqueous ethanol solution, and the antioxidant activity of the extracts, which inhibit human LDL oxidation induced by copper ion, was determined on the basis of the oxidation lag time and represented as epigallocatechin 3-gallate equivalent. 1,1-Diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity and total phenolic content were also measured for comparisons with antioxidant activity in LDL. Plant products showing the greatest activity in LDL oxidation assay were akamegashiwa (Mallotus japonicus) leaf, Japanese privet (Ligustrum japonicum) leaf, green tea [Camellia sinensis (L.) O. Kuntze], and astringent persimmon (Diospyros kaki). The present study revealed high levels of LDL antioxidant activity in plant products for which such activity levels are underestimated in the DPPH radical scavenging assay and Folin-Ciocalteu assay.

OBJECTIVE: Mechanisms underlying the cardiovascular risk of lipoprotein(a) are poorly understood. We investigated the relationship of apolipoprotein(a)(apo(a)) size, lipoprotein(a), and allele-specific apo(a) levels with HIV disease activity parameters in a biethnic population. METHODS AND RESULTS: Lipoprotein(a) and allele-specific apo(a) levels were determined in 139 white and 168 black HIV-positive patients. Plasma HIV RNA viral load and CD4+ T-cell count were used as surrogates for disease activity. Lipoprotein(a) and allele-specific apo(a) levels were higher in blacks than whites (for both P<0.001). Apo(a) allele size distribution was similar between the 2 ethnic groups, with a median apo(a) size of 28 kringle 4 repeats. Allele-specific apo(a) levels were positively associated with CD4+ T-cell count (P=0.027) and negatively with plasma HIV RNA viral load (P<0.001). Further, allele-specific apo(a) levels associated with smaller (<28 kringle 4) atherogenic apo(a) sizes were higher in subjects with CD4+ T-cell counts of ≥350 (P=0.002). CONCLUSIONS: Allele-specific apo(a) levels were higher in subjects with high CD4+ T-cell count or low plasma HIV RNA viral load. The findings suggest that HIV disease activity reduced allele-specific apo(a) levels. Higher allele-specific apo(a) levels associated with atherogenic small apo(a) sizes might contribute to increased cardiovascular risk in HIV-positive subjects with improved disease status.

OBJECTIVE Apolipoprotein E (apoE) has been implicated as conveying increased risk for coronary artery disease (CAD). Previous studies suggest a role of apoE as a modulator of immune response and inflammatory properties. We hypothesized that the presence of apo E4 is associated with an increased inflammatory burden in subjects with CAD as compared to subjects without CAD. METHODS ApoE genotypes, systemic (C-reactive protein [CRP], fibrinogen, serum amyloid-A [SAA]) and vascular inflammatory markers (Lipoprotein-associated phospholipase A(2)[Lp-PLA(2)] and pentraxin-3 [PTX-3]) were assessed in 324 Caucasians and 208 African Americans, undergoing coronary angiography. RESULTS For both ethnic groups, Lp-PLA(2) index, an integrated measure of Lp-PLA(2) mass and activity, increased significantly and stepwise across apoE isoforms (P = 0.009 and P = 0.026 for African Americans and Caucasians respectively). No differences were found for other inflammatory markers tested (CRP, fibrinogen, SAA and PTX-3). For the top cardiovascular score tertile, apo E4 carriers had a significantly higher level of Lp-PLA(2) index in both ethnic groups (P = 0.027 and P = 0.010, respectively). CONCLUSION The presence of the apo E4 isoform was associated with a higher level of Lp-PLA(2) index, a marker of vascular inflammation. Our results suggest that genetic variation at the apoE locus may impact cardiovascular disease risk through enhanced vascular inflammation.

INTRODUCTION Obesity is a worldwide public health issue. Since the epidemiological behaviour of this disease is not well established in our country, the purpose of this study was to determinate its prevalence in the Maracaibo City, Zulia State- Venezuela. MATERIALS AND METHODS A cross-sectional study was undertaken using the data set from the Maracaibo City Metabolic Syndrome Prevalence Study. The sample consists of 2108 individuals from both genders and randomly selected: 1119 (53.09%) women and 989 (46.91%) men. The participants were interrogated for a complete clinical history and anthropometric measurements. To classify obesity, the WHO criteria for Body Mass Index (BMI), and Waist Circumference (WC) from the IDF/NHLBI/AHA/WHF/IAS/IASO-2009 (IDF-2009) and ATPIII statements were applied. RESULTS For BMI, obesity had an overall prevalence of 33.3%(n = 701), and according to gender women had 32.4%(n = 363) and men had 34.2%(n = 338). Overweight had a prevalence of 34.8%(n = 733), Normal weight had 29.8%(n = 629), and Underweight had 2.1%(n = 45). Adding Obesity and Overweight results, the prevalence of elevated BMI (>25 Kg/m(2)) was 68.1%. Using the IDF-2009 WC's cut-off, Obesity had 74.2% prevalence, compared to 51.7% using the ATPIII parameters. CONCLUSIONS These results show a high prevalence of abdominal obesity in our locality defined by the WHO, IDF-2009 and ATPIII criteria, which were not designed for Latin-American populations. We suggest further investigation to estimate the proper values according to ethnicity, genetic background and sociocultural aspects.

We describe the lipoprotein and apolipoprotein profiles and their relationship to cardiovascular risk factors in Australian Aboriginal children. This cross-sectional study within a longitudinal birth cohort study involved Australian Aboriginal children born between 1987 and 1990 and re-examined between 1998 and 2001. Height, weight, blood pressure, waist circumference, body fat percentage, cholesterol, triglycerides, HDL-c, LDL-c, apolipoprotein B and A1 were measured. Mean age was 11.4 years (52% male). Mean cholesterol, triglyceride, HDL-c and LDL-c did not differ from reference data. Measures of obesity, blood pressure and prevalence of the metabolic syndrome did not differ in those children with lipoproteins in the upper quartile of the cohort (lower quartile for HDL-c). Boys with an Apo-B/A1 ratio in the upper quartile of the cohort had higher BMI z-score, waist z-score,% body fat, diastolic blood pressure and frequency of the metabolic syndrome (p<0.05). In girls, waist circumference,% body fat and the prevalence of the metabolic syndrome was higher in those with an Apo-B/A1 ratio in the upper quartile (p<0.05).The Apo-B/A1 ratio may be useful to identify cardiovascular risk in Australian Aboriginal children and is suited to clinical practice as the assays are standardised, accurate, automated and a fasting sample is not required.

As part of the Isfahan Healthy Heart Program, we evaluated the prevalence of cardiovascular disease risk factors in Iranians with generalized and abdominal obesity. We carried out a cross-sectional study on 3694 > or = 19 years. Overall, 36.6% of men and 35.9% of women were overweight; 11.2% of men and 28.l% of women were obese. Mean body mass index (BMI), waist circumference (WC) and waist/hip ratio (WHR) increased with age up to 65 years. Total serum cholesterol, triglycerides and 2-hour post-load plasma glucose increased with BMI, WC and WHR in both sexes. Prevalence of metabolic syndrome was 19.8% in females with normal BMI, 48.1% in overweight females and 63.2% in obese females. In males, corresponding values were 3.7%, 18.0% and 40.1%.

The clustering of central obesity, dyslipidemia, hypertension, and hyperglycemia known as metabolic syndrome has been associated with a two- to three-fold increase in type 2 diabetes (T2DM) and cardiovascular disease (CVD). It is recognized that the features of the metabolic syndrome can be present 10 years preceding T2DM and CVD. The objective of our study was to determine the prevalence of metabolic syndrome in adults aged 25 years and older from an urban population of Karachi, Pakistan, according to the International Diabetes Federation (IDF) definition and modified Adult Treatment Panel III (ATP III) criteria. This study involved a survey conducted from July, 2004, to December, 2004, by generating a computerized random sample of households in Lyari Town using a geographical imaging system (GIS). Out of the 85,520 households, 532 households were randomly selected and 867 adults > or =25 years old consented to take part in the survey; 363 of these subjects gave blood samples. The prevalence of diabetes was 9.4%, whereas 5.6% had impaired fasting glucose (abnormal glucose tolerance 15%). The prevalence of metabolic syndrome according to the IDF definition and modified ATP III criteria was 34.8% and 49%, respectively. Inclusion of modified waist circumference and specific body mass index (BMI) cut offs for Asians may help predict metabolic syndrome at an early stage. High prevalence of metabolic syndrome was identified irrespective of the definition applied in this population. This may call for immediate action to halt the accelerating risk of diabetes and CVD that would lead to a possible unparalleled rise in the cost of health care and human suffering.

We measured the prevalence and have evaluated the sensitivity, specificity, positive and negative predictive value of different predictors according to different standard criteria for metabolic syndrome in non-obese newly detected type 2 diabetes. Two hundred and fifteen patients of BMI <25 kg/m2 were studied. Metabolic syndrome prevalence was high in non-obese newly detected type 2 diabetes mellitus individuals. Greater prevalence of metabolic syndrome was observed in modified WHO (50.23%) and lesser in IDF (30.69%) classification. Non-obese metabolic syndrome individuals display significantly higher BMI, per cent body fat, waist circumference, hip circumference, waist hip ratio, blood pressure, triglyceride and a lower high density lipopratein than non-obese individuals without metabolic syndrome. The cut-off point for waist circumference in men was 86 cm and 79.7 cm for women (modified ATP III). Elevated serum triglyceride for men and low serum high density lipoprotein in women were the strongest predictors that effectively indicated the presence of metabolic syndrome in non-obese individuals.

CONTEXT Adults with polycystic ovary syndrome (PCOS) may be at increased risk for metabolic syndrome (MBS) and related cardiovascular disease. It is not clear whether PCOS diagnosed in adolescence increases the risk of MBS in this age group. OBJECTIVE The aim was to compare the prevalence and related characteristics of MBS in obese adolescents with and without PCOS. DESIGN We conducted a cross-sectional study of overweight and obese PCOS adolescents and BMI matched controls. PATIENTS AND PARTICIPANTS A total of 74 subjects, 43 with PCOS and 31 controls, participated in the study. Interventions: Each subject underwent a physical examination and laboratory evaluation for a diagnosis of MBS. Regional fat distribution was determined by computerized tomography scan in the PCOS adolescents. MAIN OUTCOME MEASURES We measured the prevalence of MBS and its components in adolescent subjects and controls. RESULTS The PCOS group had larger ovarian volume and higher measures of total testosterone and free androgen index than controls, but there were no differences in waist circumference, fasting glucose, blood pressure, or lipids. PCOS adolescents demonstrated more glucose abnormalities and higher plasminogen activator inhibitor-1. By pediatric criteria, 53% of the PCOS and 55% of the control adolescents had MBS. By adult criteria, 26% of PCOS and 29% of controls met diagnostic criteria for MBS. CONCLUSIONS Obese adolescent women have a high prevalence of MBS, and PCOS does not add additional risk for MBS. There appears to be an association between MBS and visceral adiposity. PCOS is associated with increased incidence of glucose intolerance and increased plasminogen activator inhibitor-1. Our results reinforce the importance of obesity counseling in adolescents to recognize the possible risk of future cardiovascular disease in these young women.

OBJECTIVE To describe the prevalence and clinical characteristics of the metabolic syndrome (MetS) in a cohort of Australian Aboriginal children. STUDY DESIGN Body mass index (BMI), waist circumference, skin fold thickness, body fat percentage, insulin resistance, and the prevalence of MetS were evaluated in 486 children age 9 to 14 years from the Darwin Health Region, Northern Territory, Australia. RESULTS Using an age- and sex- specific definition, 14% of the children in the cohort had MetS, 6.4% were overweight, 4.9% were obese, and 26.2% had an elevated waist circumference. The mean percentage of body fat was 30.2%. The children with MetS had higher BMI and waist z-scores, percent body fat, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score, and skin fold thickness compared with those without MetS (P <.001); however,>50% of those with MetS were neither overweight nor obese. Waist circumference was significantly associated with insulin resistance as measured by the HOMA-IR (P <.001). CONCLUSIONS MetS is common in our cohort despite low rates of overweight and obesity. A tendency for central adiposity is already evident in these young children. Measurement of waist circumference may help identify Aboriginal children at high risk for MetS.

This study aimed to examine the relationship between metabolic syndrome (MS) and different types of obesity in urban Moroccan women. On 213 women aged 25-55 years, Triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-c), lower-density lipoprotein cholesterol (LDL-c), and fasting blood glucose levels were assessed. Body mass index (BMI), waist to hip ratio (WHR), Waist circumference (WC), and blood pressure (BP) were also measured. Globally 36.6% of women were overweight (25 < or = BMI < 30 m2), 23.9% obese (BMI > 30 m2), 19.7% had WHR > 0.85 and 28.8% had WC > or = 88 cm. Indicators of obesity increased with age and the prevalence of co-morbid factors increased with obesity. The women with android obesity (WHR > 0.85) and central obesity (WC > or = 88 cm) had greater risk compared to those with overweight and general obesity. The prevalence of MS was 17.8% and increased (31.49%) with high BMI and high WHR (50%). MS and its co-morbidity factors are prevalent among Moroccan women aged 35 years and over. The exaggerated influence of obesity in this prevalence suggests that the prevention of obesity could prevent MS and its complications.

OBJECTIVE We investigated the link between a reduction in waist circumference and metabolic syndrome. METHODS 105 obese Japanese men were enrolled in this study with a 1-year follow-up. Anthropometric and body composition parameters, i.e. height, body weight, body fat percentage, waist circumference and hip circumference, blood pressure, triglyceride, HDL cholesterol and blood sugar, were evaluated. Metabolic syndrome was diagnosed using criteria developed in Japan. RESULTS After a 1-year follow-up, the parameters of metabolic syndrome were significantly improved. The prevalence of metabolic syndrome was significantly reduced in subjects with at least 3 cm of waist circumference reduction (Group R). However, in subjects without such reduction (Group C), the prevalence of metabolic syndrome was similar to baseline levels. The prevalence of abdominal obesity, hypertension and dyslipidemia was also significantly reduced in Group R. In addition, there were remarkable differences of delta triglyceride (delta represents positive changes in parameters) and delta HDL cholesterol between Group R and Group C. CONCLUSION At least 3 cm of waist circumference reduction may be beneficial for improving metabolic syndrome in obese Japanese men.

BACKGROUND In populations predisposed to cardiovascular disease, type 2 diabetes and visceral obesity, use of additional measurements of waist girth and waist/hip ratio (WHR) can help define risk levels associated with body mass index (BMI) for screening and clinical purposes. PURPOSE To investigate measures of obesity associated with presence of metabolic syndrome and its risk factors in asymptomatic American adults of Asian Indian origin between 29 and 59 years of age. METHODS Fifty-six apparently healthy men (43.7 years +/- 7.1, BMI 21-34 kg/m2) and women (43.1 years +/- 6.9, BMI 21-36 kg/m2) were recruited for participation in this cross-sectional study. Height, weight, hip girth, waist girth, and blood pressure were recorded by using standard procedures. Blood samples were taken after an overnight fast and analyzed for measures defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for the metabolic syndrome. RESULTS Prevalence of the metabolic syndrome was 33.9%(29-59 years, average BMI 26.1 +/- 3.7 kg/m2). Risk factors most prevalent were low high-density lipoprotein cholesterol (HDL-C)(55%), hypertriglyceridemia (61%), and high blood pressure (50%) in men and low HDL-C (56%), high waist circumference (44%), and high blood pressure (32%) in women. Waist girth of 90.8 +/- 6.8 cm (men) and 75 +/- 3 cm (women), waist/hip ratios (WHRs) of .89 +/-.06 (men) and .76 +/-.03 (women), and BMI values of 24.8 +/- 2.5 kg/m2 (men) and 23.7 +/- 1 kg/m2 (women) were associated with absence of all risk factors associated with metabolic syndrome. Average waist girth (men: 99.6 +/- 8.1 cm, P <.05; women: 95.5 +/- 5.2 cm, P <.001) of those positive was significantly higher than those negative for the metabolic syndrome. Waist girth in women was significantly associated with fasting glucose (r =.40, P <.05), two-hour glucose (r =.57, P <.05), triglyceride (r =.42, P < 05), and HDL-C (r =-.47, P <.05). Waist/ hip ratio (WHR) for women with the metabolic syndrome was significantly higher (.87 +/-.07, P <.05) compared to those without (.79 +/-.05) and most significantly correlated with two-hour glucose (r =.51, P <.05). Body mass index (BMI) in the overweight range for men (28.3 +/- 3 kg/m2, P <.05) and women (30.0 +/- 3.5 kg/m2, P <.05) was associated with metabolic syndrome and significantly correlated with low HDL-C levels in men (r =-.49, CONCLUSION Prevalence of the metabolic syndrome in Indian Americans aged 29- 59 years using the NCEP ATP III criteria was similar to rates reported in urban populations in India. Low HDL-C, hypertriglyceridemia, high waist circumference, and high blood pressure were most prevalent risk factors in this study. Among obesity measures, waist girth was significantly associated with most risk factors for the syndrome; WHR was most significant for two-hour glucose in women, whereas BMI mostly correlated with HDL-C for men. While BMI < or = 24.9 was associated with absence of all risk factors, BMI in overweight range was associated with presence of metabolic syndrome. These results point to clinical significance of using additional measures of obesity in addition to BMI to determine health risk in this population, particularly in premenopausal Asian Indian women.