日本普通人群中代谢综合征及植物甾酮的吸收异常发生率课件

FrequencyofMetabolicSyndromeanditsAbsorptionAbnormalitybyPlantSterolsinGeneralPopulation,JapanToshioShimada,YoMurakami,NobuyukiOyake,HiroyukiYoshitomi,NobuhiroKodani,AkiraMatsumori*DivisionofCardiovascularMedicine,DepartmentofInternalMedicine,ShimaneUniversityFacultyofMedicine,DepartmentofCardiovascularMedicine,KyotoUniversity,GraduateSchoolofMedicine*编辑课件FrequencyofMetabolicSyndrom1BackgroundHealthproblemsonagedpeoplehavebeengrowingbiggerinJapanbecausewithadvancingage,avarietyofdiseasesespeciallyonvasculardiseases,suchascardio-andcerebro-vasculardiseaseshavebeenincreasing.Andtherefore,earlydetectionofvasculardiseasesisaveryimportantissueforvascularpreventionandreductionofmortality.编辑课件Background编辑课件2DiagnosticCriteriaforMetabolicSyndrome

(8JapaneseMedicalAssociationsJoint-Committee)Fataccumulationintheintra-abdominalcavityAbdominalCircumferenceattheWaistMale≧85cm,Female≧90cm(≧80cmrecommendedbyme)（VisceralfatareaMaleandFemale≧100cm2)Hypertriglyceridemia≧150mg/dLLowHDL-cho＜40mg/dLSystolicBloodPressure≧130mmHgDiastolicBloodPressure≧85mmHgFastingBloodSugar≧110mg/dL•Lipoproteinabnormality•HighBloodPressure•HighBloodSugar＋Atleast,morethanfollowing2itemsand/orand/ormodifiedandtranslatedintoEnglishbyToshioShimada•MajorCriteria•MinorCriteria编辑课件DiagnosticCriteriaforMetabo3ObesityInsulinResistanceDMDyslipidemiaHypertensionAtherosclerosisArteriosclerosisPathophysiologyofMetabolicSyndrmeOver-eatingPoorExerciseInheritance编辑课件ObesityInsulinResistanceDMDys4LDLレセプタISynthesisofCholesterolintheLiverandAbsorptionofCholesterolintheIntestine

-TwoImportantSupplySourcesofCholesterolinVivo-BileFoodLiverVesselsCholesterolSmallIntestineBiliary800~2000mg/dayDietary400~500mg/day编辑课件LDLSynthesisofCholesterolin5AimOurpurposeistoinvestigatethefrequencyofmetabolicsyndrome(MS)andlifestylerelateddiseasesandalsotoexaminewhetheranydifferenceinabsorptionofcholesterolfromthedigestivesystemispresentinparticipantsbetweenwithmetabolicsyndrome(MS)andnon-MSrandomlyselected,usingplantsterolsingeneralpopulation.编辑课件Aim编辑课件6SubjectsandmethodIn2007,1980participantsforannualhealthcheck-upweresubjectedforthiscohortstudy.Averageageis66±10.8years,andfemaleis1260(64%)；maleis720(36%).Allsubjectsunderwentroutinebloodexaminations,insulin,remnantlikeparticlecholesterol(RemLC),hs-CRP,cystatinC,plasmabrainnatriureticpeptide(BNP)andN-terminalproBNP(NT-proBNP)measurements.Bloodpressure,abdominalcircumference,andelectrocardiographyweremeasuredatthesametime.AbdominalcircumferencewasmeasuredatthenavellevelinthesupinepositionlikeCTforvisceralfat.Evaluationofcholesterolabsorptionwasdonebyplantsterolsineach30participantschosenrandomlyfromtheparticipants.BNPandNT-proBNPweremeasuredforheartfailurescreeningbyimmunoluminesencemethod.Plantsterolsweremeasuredbygaschromatography.编辑课件Subjectsandmethod编辑课件7In1964participants,218participants(11%)werediagnosedasMS,using≥80cmwaistcircumferenceinfemaleand≥85cminmaleasmajorcriterion.Fromeachgroup,30participantswererandomlychosentocheckplantsterollevelsfortheevaluationofabsorptionofcholesterolandlathosterolfortheevaluationofcholesterolsynthesis.Eachsterollevelwasmeasuredbygaschromatography.TheMeasurementofSerumPlantSterolstoEvaluateCholesterolAbsorptioninOkuizumoCohort,2007编辑课件In1964participants,218part8AbnormalandNormalProportionofClinicalParamerersinGeneralPopulation,Japan[OkuizumoCohort2007]0%10%20%30%40%50%60%70%80%90%100%SystBP(130mmHg)DiastBP(85mmHg)Gender(F/M)WaistCircum90-85WaistCircum80-85Metabo90-85Metabo80-85CKDnormalabnormalN=1972N=1972N=1972N=1972N=1972N=1972N=1972N=1980N=1964N=1964N=1964N=1964N=1980DM(HbA1c5.8%≤）Ｈｙｐｅｒｃｈｏｌ（220mg/dL≤）ＨｙｐｅｒTG(150mg/dL≤）LowHDL(40mg/dL>）Obesity(BMI25≤）编辑课件AbnormalandNormalProportion9TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositiveUsingMSF90M85-Dx='0'tobethepositivelevelAreaUnderCurve=0.93304ReceiverOperatingCharacteristicMetabolicSyndromeandits

InfluentialFactorsAnalyzedbyMultivariateLogisticRegressionFemaleWaistCircumference≥90cmInfluentialParametersBMIHbCystatinCInsulinRemLCTcho编辑课件TruePositiveSensitivity0.000.10TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositiveUsingAbd-CF80M85='0'tobethepositivelevelAreaUnderCurve=0.89483ReceiverOperatingCharacteristicMetabolicSyndrome

anditsInfluentialFactorsAnalyzedbyMultivariateLogisticRegressionFemaleWaistCircumference≥80cmInfluentialParametersBMIHbCystatinCRemLCTcho编辑课件TruePositiveSensitivity0.000.11TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositiveSensitivity0.81Specificity0.65OddsRatio5278AUC0.77p=0.0000Cut-OffValue7.34mg/dLCut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥90cmandthatofMen≥85cm)编辑课件TruePositiveSensitivity0.000.12Cut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥80cmandthatofMen≥85cm)TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive7.26mg/dLCut-OffValueSensitivity0.82Specificity0.67OddsRatio429156AUC0.79p=0.0000编辑课件Cut-OffValueofRemLCBased13Cut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥90cm)Sensitivity0.89Specificity0.70OddsRatio300AUC0.83p=0.0000TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive6.19mg/dLCut-OffValue编辑课件Cut-OffValueofRemLCBased14Sensitivity0.80Specificity0.72OddsRatio429156AUC0.82p=0.0000TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive6.88mg/dLCut-OffValueCut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥80cm)编辑课件Sensitivity0.80TruePositiveS15Sensitivity0.81Specificity0.63OddsRatio1647AUC0.75p=0.0000TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive7.27mg/dLCut-OffValueCut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofMen≥85cm)编辑课件Sensitivity0.81TruePositiveS16AbnormalandNormalProportionofPlasmaBNPLevelsWithAdvancingAgeinGeneralPopulation,Japan[OkuizumoCohort2007]Cut-OffValue20pg/mLN=145N=322N=721N=341N=269N=132N=48Years编辑课件AbnormalandNormalProportion17AbnormalandNormalProportionofNT-proBNPLevelsWithAdvancingAgeinGeneralPopulation,Japan[OkuizumoCohort2007]Cut-OffValue55pg/mLN=145N=322N=721N=341N=269N=132N=48Years编辑课件AbnormalandNormalProportion18ComparisonofCampesterolBetweenMetabo(0)andNon-Metabo(1)inGeneralPopulation,Japan[OkuizumoCohort2007]Campesterol(AbsorptionMarkerofCholesterol)MetaboNon-MetaboNS编辑课件ComparisonofCampesterolBetw19ComparisonofSitosterolBetweenMetabo(0)andNon-Metabo(1)inGeneralPopulation,Japan[OkuizumoCohort2007]Sitosterol(AbsorptionMarkerofCholesterol)MetaboNon-Metabop<0.05编辑课件ComparisonofSitosterolBetwe20ComparisonofLathosterolBetweenMetabo(0)andNon-Metabo(1)inGeneralPopulation,Japan[OkuizumoCohort2007]Lathosterol(SynthesisMarkerofCholesterol)MetaboNon-MetaboNS编辑课件ComparisonofLathosterolBetw21SummaryResults

Highbloodpressurewas52%,highcholesterol25%,lowHDL-cholesterol5%,hightriglyceridemia18%,highbloodsugar17%andinwomen,abdominalcircumference≥90cm10%and≥80cm44%,respectively.AccordingtoJapaneseabdominalcircumferencecriteriaforMSinwomen,only3%ofwomenwerediagnosedasMS.Using≥80cmascriteriaforabdominalcircumference,10%werediagnosedasMS.Inmen(≥85cm),13%wereMS.Participantswithpossiblecardiacdysfunctionwere46%inBNPand52%inNT-proBNP,respectively.RemLCwasverycloselyrelatedtoMS.Receiveroperatingcharacteristic(ROC)curveanalysisfordiagnosingMSdemonstratedthatcut-offvalueofLemLCwas7.26mg/dlusingfemalewaistcircumference≥80cmandmalewaistcircumference≥85cm,7.28mg/dlonlyusingmalewaistcircumference≥85cmand6.88mg/dlonlyusingfemalewaistcircumference≥80cm.编辑课件SummaryResults编辑课件22SummaryResults（Continued)AbsorptionofcholesterolmarkerlevelswereparadoxicallylowerinMSthaninnonMS.Lathosterol,amarkerofcholesterolsynthesiswas2.4μg/mLinMSand2.8μg/mLinnonMS(p=0.1133),sitosterol,amarkerofcholesterolabsorption1.5μg/mLinMSand1.8μg/mLinnonMS(p=0.0107),campesterol,amarkerofcholesterolabsorption,2.4μg/mLinMSand2.8μg/mLinnonMS(p=0.1551).CKDwasfoundin9.5%oftheparticipantsusingMDRD.编辑课件SummaryResults（Continued)编辑课件23ConclusionMSwasfoundinabout10%ingeneralpopulationofJapan.Absorptioncholesterolmarker,plantsterolswereparadoxicallylowerinMSthaninnonMSandthenabnormalabsorptionwasstronglysuspectedinMS.Inotherwords,lowplantsterollevelsmayimplicateincreasedcholesterolabsorptioninthesmallintestine.RemLCmaybeausefulsinglemarkerforscreeningofMS.PresentJapanesecriteriaforMSshouldbemodifiedcorrectlyasearlyaspossible.WeneedmoredetailinvestigationformoreclarificationonMS.编辑课件Conclusion编辑课件24Thankyouverymuchforyourattention(BeijingOlympicYear)TheLakeShinji,Shimane编辑课件Thankyouverymuchforyoura25FrequencyofMetabolicSyndromeanditsAbsorptionAbnormalitybyPlantSterolsinGeneralPopulation,JapanToshioShimada,YoMurakami,NobuyukiOyake,HiroyukiYoshitomi,NobuhiroKodani,AkiraMatsumori*DivisionofCardiovascularMedicine,DepartmentofInternalMedicine,ShimaneUniversityFacultyofMedicine,DepartmentofCardiovascularMedicine,KyotoUniversity,GraduateSchoolofMedicine*编辑课件FrequencyofMetabolicSyndrom26BackgroundHealthproblemsonagedpeoplehavebeengrowingbiggerinJapanbecausewithadvancingage,avarietyofdiseasesespeciallyonvasculardiseases,suchascardio-andcerebro-vasculardiseaseshavebeenincreasing.Andtherefore,earlydetectionofvasculardiseasesisaveryimportantissueforvascularpreventionandreductionofmortality.编辑课件Background编辑课件27DiagnosticCriteriaforMetabolicSyndrome

(8JapaneseMedicalAssociationsJoint-Committee)Fataccumulationintheintra-abdominalcavityAbdominalCircumferenceattheWaistMale≧85cm,Female≧90cm(≧80cmrecommendedbyme)（VisceralfatareaMaleandFemale≧100cm2)Hypertriglyceridemia≧150mg/dLLowHDL-cho＜40mg/dLSystolicBloodPressure≧130mmHgDiastolicBloodPressure≧85mmHgFastingBloodSugar≧110mg/dL•Lipoproteinabnormality•HighBloodPressure•HighBloodSugar＋Atleast,morethanfollowing2itemsand/orand/ormodifiedandtranslatedintoEnglishbyToshioShimada•MajorCriteria•MinorCriteria编辑课件DiagnosticCriteriaforMetabo28ObesityInsulinResistanceDMDyslipidemiaHypertensionAtherosclerosisArteriosclerosisPathophysiologyofMetabolicSyndrmeOver-eatingPoorExerciseInheritance编辑课件ObesityInsulinResistanceDMDys29LDLレセプタISynthesisofCholesterolintheLiverandAbsorptionofCholesterolintheIntestine

-TwoImportantSupplySourcesofCholesterolinVivo-BileFoodLiverVesselsCholesterolSmallIntestineBiliary800~2000mg/dayDietary400~500mg/day编辑课件LDLSynthesisofCholesterolin30AimOurpurposeistoinvestigatethefrequencyofmetabolicsyndrome(MS)andlifestylerelateddiseasesandalsotoexaminewhetheranydifferenceinabsorptionofcholesterolfromthedigestivesystemispresentinparticipantsbetweenwithmetabolicsyndrome(MS)andnon-MSrandomlyselected,usingplantsterolsingeneralpopulation.编辑课件Aim编辑课件31SubjectsandmethodIn2007,1980participantsforannualhealthcheck-upweresubjectedforthiscohortstudy.Averageageis66±10.8years,andfemaleis1260(64%)；maleis720(36%).Allsubjectsunderwentroutinebloodexaminations,insulin,remnantlikeparticlecholesterol(RemLC),hs-CRP,cystatinC,plasmabrainnatriureticpeptide(BNP)andN-terminalproBNP(NT-proBNP)measurements.Bloodpressure,abdominalcircumference,andelectrocardiographyweremeasuredatthesametime.AbdominalcircumferencewasmeasuredatthenavellevelinthesupinepositionlikeCTforvisceralfat.Evaluationofcholesterolabsorptionwasdonebyplantsterolsineach30participantschosenrandomlyfromtheparticipants.BNPandNT-proBNPweremeasuredforheartfailurescreeningbyimmunoluminesencemethod.Plantsterolsweremeasuredbygaschromatography.编辑课件Subjectsandmethod编辑课件32In1964participants,218participants(11%)werediagnosedasMS,using≥80cmwaistcircumferenceinfemaleand≥85cminmaleasmajorcriterion.Fromeachgroup,30participantswererandomlychosentocheckplantsterollevelsfortheevaluationofabsorptionofcholesterolandlathosterolfortheevaluationofcholesterolsynthesis.Eachsterollevelwasmeasuredbygaschromatography.TheMeasurementofSerumPlantSterolstoEvaluateCholesterolAbsorptioninOkuizumoCohort,2007编辑课件In1964participants,218part33AbnormalandNormalProportionofClinicalParamerersinGeneralPopulation,Japan[OkuizumoCohort2007]0%10%20%30%40%50%60%70%80%90%100%SystBP(130mmHg)DiastBP(85mmHg)Gender(F/M)WaistCircum90-85WaistCircum80-85Metabo90-85Metabo80-85CKDnormalabnormalN=1972N=1972N=1972N=1972N=1972N=1972N=1972N=1980N=1964N=1964N=1964N=1964N=1980DM(HbA1c5.8%≤）Ｈｙｐｅｒｃｈｏｌ（220mg/dL≤）ＨｙｐｅｒTG(150mg/dL≤）LowHDL(40mg/dL>）Obesity(BMI25≤）编辑课件AbnormalandNormalProportion34TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositiveUsingMSF90M85-Dx='0'tobethepositivelevelAreaUnderCurve=0.93304ReceiverOperatingCharacteristicMetabolicSyndromeandits

InfluentialFactorsAnalyzedbyMultivariateLogisticRegressionFemaleWaistCircumference≥90cmInfluentialParametersBMIHbCystatinCInsulinRemLCTcho编辑课件TruePositiveSensitivity0.000.35TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositiveUsingAbd-CF80M85='0'tobethepositivelevelAreaUnderCurve=0.89483ReceiverOperatingCharacteristicMetabolicSyndrome

anditsInfluentialFactorsAnalyzedbyMultivariateLogisticRegressionFemaleWaistCircumference≥80cmInfluentialParametersBMIHbCystatinCRemLCTcho编辑课件TruePositiveSensitivity0.000.36TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositiveSensitivity0.81Specificity0.65OddsRatio5278AUC0.77p=0.0000Cut-OffValue7.34mg/dLCut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥90cmandthatofMen≥85cm)编辑课件TruePositiveSensitivity0.000.37Cut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥80cmandthatofMen≥85cm)TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive7.26mg/dLCut-OffValueSensitivity0.82Specificity0.67OddsRatio429156AUC0.79p=0.0000编辑课件Cut-OffValueofRemLCBased38Cut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥90cm)Sensitivity0.89Specificity0.70OddsRatio300AUC0.83p=0.0000TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive6.19mg/dLCut-OffValue编辑课件Cut-OffValueofRemLCBased39Sensitivity0.80Specificity0.72OddsRatio429156AUC0.82p=0.0000TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive6.88mg/dLCut-OffValueCut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofWomen≥80cm)编辑课件Sensitivity0.80TruePositiveS40Sensitivity0.81Specificity0.63OddsRatio1647AUC0.75p=0.0000TruePositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalsePositive7.27mg/dLCut-OffValueCut-OffValueofRemLCBasedonROCCurveforScreeningMetabolicSyndrome(AbdominalCircumferenceofMen≥85cm)编辑课件Sensitivity0.81TruePositiveS41AbnormalandNormalProportionofPlasmaBNPLevelsWithAdvancingAgeinGeneralPopulation,Japan[OkuizumoCohort2007]Cut-OffValue20pg/mLN=145N=322N=721N=341N=269N=132N=48Years编辑课件AbnormalandNormalProportion42AbnormalandNormalProportionofNT-proBNPLevelsWithAdvancingAgeinGeneralPopulation,Japan[OkuizumoCohort2007]Cut-OffValue55pg/mLN=145N=322N=721N=341N=269N=132N=48Years编辑课件AbnormalandNormalProportion43ComparisonofCampesterolBetweenMetabo(0)andNon-Metabo(1)inGeneralPopulation,Japan[OkuizumoCohort2007]Campesterol(AbsorptionMarkerofCholesterol)MetaboNon-MetaboNS编辑课件ComparisonofCampesterolBetw44ComparisonofSitosterolBetweenMetabo(0)andNon-Metabo(1)inGeneralPopulation,Japan[OkuizumoCohort2007]Sitosterol(AbsorptionMarkerofCholesterol)MetaboNon-Metabop<0.05编辑课件ComparisonofSitosterolBetwe45ComparisonofLathosterolBetweenMetabo(0)andNon-Metabo(1)inGeneralPopulation,Japan[OkuizumoCohort2007]Lathosterol(SynthesisMarkerofCholesterol)MetaboNon-MetaboNS编辑课件ComparisonofLathosterolBetw46SummaryResu