Frequency of Metabolic Syndrome and its Absorption Abnormality by Plant Sterols in General Populatio

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Frequency of Metabolic Syndrome and its
Absorption Abnormality by Plant Sterols in
General Population, Japan Toshio Shimada, Yo
Murakami, Nobuyuki Oyake, Hiroyuki Yoshitomi,
Nobuhiro Kodani, Akira Matsumori Division of
Cardiovascular Medicine, Department of Internal
Medicine, Shimane University Faculty of Medicine,
Department of Cardiovascular Medicine, Kyoto
University, Graduate School of Medicine
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Background Health 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 diseases have been increasing.
And therefore, early detection of vascular
diseases is a very important issue for vascular
prevention and reduction of mortality.
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(No Transcript)
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Pathophysiology of Metabolic Syndrme
Inheritance
Over-eating
Poor Exercise
Obesity
Insulin Resistance
Dyslipidemia
Hypertension
DM
Atherosclerosis Arteriosclerosis
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Synthesis of Cholesterol in the Liver and
Absorption of Cholesterol in the Intestine- Two
Important Supply Sources of Cholesterol in Vivo-
Food
Liver
Bile
Cholesterol
Small Intestine
LDL ? ? ? ? I
Biliary 8002000mg/day Dietary 400500mg/day
Vessels
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Aim Our purpose is to investigate the frequency
of metabolic syndrome (MS) and life style related
diseases and also to examine whether 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.
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Subjects and method In 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
natriuretic 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 absorption 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.
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The Measurement of Serum Plant Sterols to
Evaluate Cholesterol Absorption in Okuizumo
Cohort, 2007

• In 1964 participants, 218 participants(11) were
  diagnosed as MS, using 80cm waist circumference
  in female and 85cm in male as major criterion.
• From each group, 30 participants were randomly
  chosen to check plant sterol levels for the
  evaluation of absorption of cholesterol and
  lathosterol for the evaluation of cholesterol
  synthesis.
• Each sterol level was measured by gas
  chromatography.

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Abnormal and Normal Proportion of Clinical
Paramerers in General Population,
Japan Okuizumo Cohort 2007
N1972
N1972
N1972
N1972
N1972
N1980
N1964
N1964
N1964
N1964
N1980
N1972
N1972
100
90
80
70
60
normal
50
abnormal
40
30
20
10
0
CKD
Gender(F/M)
Metabo90-85
Metabo80-85
Obesity (BMI 25)
DM (HbA1c 5.8 )
Diast BP(85mmHg)
LowHDL (40mg/dLgt)
Syst BP(130mmHg)
Waist Circum90-85
Waist Circum80-85
HyperTG (150mg/dL)
Hyperchol(220mg/dL)
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Metabolic Syndrome and its Influential Factors
Analyzed by Multivariate Logistic
Regression Female Waist Circumference 90cm

• Influential Parameters
• BMI
• Hb
• Cystatin C
• Insulin
• Rem LC
• Tcho

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Metabolic Syndrome and its Influential Factors
Analyzed by Multivariate Logistic Regression
Female Waist Circumference 80cm

• Influential Parameters
• BMI
• Hb
• Cystatin C
• Rem LC
• Tcho

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Cut-Off Value of Rem LC Based on ROC Curve for
Screening Metabolic Syndrome (Abdominal
Circumference of Women 90 cm and that of Men
85 cm)
Cut-Off Value
7.34mg/dL
Sensitivity 0.81 Specificity 0.65 Odds Ratio
5278 AUC 0.77 p 0.0000
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Cut-Off Value of Rem LC Based on ROC Curve for
Screening Metabolic Syndrome (Abdominal
Circumference of Women 80 cm and that of Men
85 cm)
Cut-Off Value
7.26mg/dL
Sensitivity 0.82 Specificity 0.67 Odds Ratio
429156 AUC 0.79 p 0.0000
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Cut-Off Value of Rem LC Based on ROC Curve for
Screening Metabolic Syndrome (Abdominal
Circumference of Women 90 cm)
Cut-Off Value
6.19mg/dL
Sensitivity 0.89 Specificity 0.70 Odds Ratio
300 AUC 0.83 p 0.0000
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Cut-Off Value of Rem LC Based on ROC Curve for
Screening Metabolic Syndrome (Abdominal
Circumference of Women 80cm)
Cut-Off Value
6.88mg/dL
Sensitivity 0.80 Specificity 0.72 Odds Ratio
429156 AUC 0.82 p 0.0000
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Cut-Off Value of Rem LC Based on ROC Curve for
Screening Metabolic Syndrome (Abdominal
Circumference of Men 85cm)
Cut-Off Value
7.27mg/dL
Sensitivity 0.81 Specificity 0.63 Odds Ratio
1647 AUC 0.75 p 0.0000
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Abnormal and Normal Proportion of Plasma BNP
Levels With Advancing Age in General Population,
Japan Okuizumo Cohort 2007 Cut-Off Value 20pg/mL
N145
N322
N721
N341
N269
N132
N48
Years
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Abnormal and Normal Proportion of NT-proBNP
Levels With Advancing Age in General Population,
Japan Okuizumo Cohort 2007 Cut-Off Value 55pg/mL
N145
N721
N341
N269
N132
N48
N322
Years
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Comparison of Campesterol Between Metabo(0) and
Non-Metabo(1) in General Population,
Japan Okuizumo Cohort 2007 Campesterol(Absorptio
n Marker of Cholesterol)
NS
Non-Metabo
Metabo
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Comparison of Sitosterol Between Metabo(0) and
Non-Metabo(1) in General Population,
Japan Okuizumo Cohort 2007 Sitosterol(Absorption
Marker of Cholesterol)
plt0.05
Metabo
Non-Metabo
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Comparison of Lathosterol Between Metabo(0) and
Non-Metabo(1) in General Population,
Japan Okuizumo Cohort 2007 Lathosterol(Synthesis
Marker of Cholesterol)
NS
Non-Metabo
Metabo
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Summary 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 women, 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 operating 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.
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Summary Results(Continued) Absorption of
cholesterol marker levels were paradoxically
lower in MS than in non MS. Lathosterol, a marker
of cholesterol synthesis was 2.4µg/mL in MS and
2.8 µg/mL in non MS (p0.1133), sitosterol, a
marker of cholesterol absorption 1.5 µg/mL in MS
and 1.8 µg/mL in non MS (p0.0107), campesterol,
a marker of cholesterol absorption, 2.4 µg/mL in
MS and 2.8 µg/mL in non MS (p0.1551). CKD was
found in 9.5 of the participants using MDRD.
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Conclusion MS was found in about 10 in general
population of Japan. Absorption cholesterol
marker, plant sterols were paradoxically lower in
MS than in non MS and then abnormal absorption
was strongly suspected in MS. In other words, low
plant sterol levels may implicate increased
cholesterol absorption in the small intestine.
RemLC may be a useful single marker for screening
of MS. Present Japanese criteria for MS should be
modified correctly as early as possible. We need
more detail investigation for more clarification
on MS.
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Thank you very much for your attention (Beijing
Olympic Year)
The Lake Shinji, Shimane