Effect of body mass index and waist circumference on prostate specific antigen and prostate volume in a generally healthy Korean population

PURPOSE

We examined the influences of age, body mass index and waist circumference on prostate specific antigen before and after adjusting for prostate volume. We also examined associations among age, body mass index, waist circumference and prostate volume.

MATERIALS AND METHODS

We analyzed 38,380 Korean men 30 to 79 years old who received regular checkups at our health examination center. We had prostate volume data for 3,593 of them. We divided the subjects into 5 groups by age, 4 groups by body mass index and waist circumference (using Asia-Pacific obesity reference values), and quartiles for prostate volume. We compared prostate specific antigen and prostate volume by multivariate regression analysis across body mass index and waist circumference after adjusting for age and/or prostate volume.

RESULTS

Increasing body mass index or waist circumference was associated with decreasing prostate specific antigen (with or without prostate volume adjustment) and increasing prostate volume (p for trend <0.01). When we stratified prostate volume by quartile, age was not associated with prostate specific antigen except in quartile 4 (p for trend by quartile 0.402, 0.639, 0.056 and <0.01). Mean prostate specific antigen of the group with a body mass index less than 23 in prostate volume quartile 4 was approximately 3 times that of the group with a body mass index greater than 30 in prostate volume quartile 1 (1.42 vs 0.55).

CONCLUSIONS

Obesity had a negative association with prostate specific antigen regardless of prostate volume, and a positive association with prostate volume. Age was not associated with prostate specific antigen after prostate volume adjustment. Obese men, especially those with a small prostate volume, may have lower baseline prostate specific antigen and, thus, be at higher risk for having prostate cancer undetected in a prostate specific antigen screening test.

Metabolic syndrome and quality of life (QOL) using generalised and obesity-specific QOL scales

OBJECTIVES

We investigated the association between metabolic syndrome (MS) and health-related quality of life (HRQOL) assessed using generalised and obesity-specific QOL instruments.

METHODS

We recruited 456 outpatients [age: 19-81 years, body mass index (BMI): 16.3-36.7 kg/m2] in the primary care division from 12 general hospitals in Korea. HRQOL was measured using EuroQol comprising the health states descriptive system (EQ-5D) and visual analogue scale (EQ-VAS) as a general instrument. The Korean Obesity-related QOL scale (KOQOL) composed of six domains was used as a disease-specific QOL instrument. MS was defined on the basis of International Diabetes Federation (IDF) criteria with Korean-specific waist circumference cutoffs (men: 90 cm, women: 85 cm).

RESULTS

Subjects with MS displayed significantly higher impairment of EQ-5D and KOQOL. Binary logistic regression analysis of MS patients with controls for age, gender, smoking, alcohol, exercise, education, income, marital status and medication history disclosed odds ratio (OR) values of 2.13 (1.33-3.41) for impaired total KOQOL, 2.07 (1.31-3.27) for impaired physical health, 1.63 (1.03-2.60) for impaired work-related health, 2.42 (1.45-4.04) for impaired routine life, 2.08 (1.27-3.40) for impaired sexual life and 2.56 (1.59-4.11) for diet distress. Among the EQ-5D dimensions, only pain/discomfort displayed a significantly increased OR of 1.60 (1.01-2.56) in MS group.

CONCLUSIONS

Subjects with MS displayed a significantly impaired HRQOL compared with those without MS. MS and HRQOL were more strongly associated in obesity-specific QOL than in generalised QOL.

Acylated ghrelin concentrations are markedly decreased during pregnancy in mothers with and without gestational diabetes: relationship with cholinesterase

Acylated (octanoylated) ghrelin stimulates food intake and growth hormone secretion and is deacylated into desacyl ghrelin by butyrylcholinesterase. Acylated and desacyl ghrelin both promote adipogenesis. Ghrelin concentrations decrease with hyperglycemia and hyperinsulinism. We hypothesized that 1) acylated ghrelin increases during pregnancy, contributing positively to energy balance, but is lower in women with gestational diabetes and 2) butyrylcholinesterase activity is inversely correlated with acylated ghrelin concentrations. In a first group of subjects, using two-site sandwich ghrelin assays that specifically detect full-length forms, we investigated women with and without gestational diabetes (n = 14/group) during pregnancy and after delivery. We examined whether changes in ghrelin during a test meal were correlated with changes in pituitary growth hormone [assessed through calculation of the area under the curve (AUC) during the test meal]. In postpartum subjects, the percent of total ghrelin that is acylated was four to five times higher than previously observed using single antibody assays. During pregnancy, acylated ghrelin concentrations (mean +/- SE) were lower compared with the postpartum period throughout the meal (AUC 1.2 +/- 0.2 vs. 10.2 +/- 1.9 ng.ml(-1).90 min(-1), P < 0.001). In the postpartum, acylated ghrelin and growth hormone were positively correlated (r = 0.50, P = 0.007). Desacyl (but not acylated) ghrelin was increased in subjects with gestational diabetes during and after pregnancy (AUC 15.4 +/- 1.9 vs. 8.6 +/- 1.2 ng.ml(-1).90 min(-1), P = 0.005). In a second group of subjects (n = 13), acylated ghrelin was similarly suppressed during pregnancy. Circulating octanoate concentrations (3.1 +/- 0.5 vs. 4.5 +/- 0.6 microg/ml, P = 0.029) and cholinesterase activity (705 +/- 33 vs. 1,013 +/- 56 U/ml, P < 0.001) were lower during pregnancy compared with the postpartum period. In conclusion, acylated ghrelin markedly decreases during pregnancy, likely because of a decrease in the acylation process. Desacyl ghrelin increases in gestational diabetes, possibly reflecting resistance to the inhibitory effect of insulin on ghrelin secretion.

Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study

BACKGROUND/AIM

Serum uric acid level has been suggested to be associated with factors that contribute to the metabolic syndrome. The aim of this study was to investigate the association of serum uric acid level with non-alcoholic fatty liver disease (NAFLD).

METHODS

A cross-sectional study was performed among the employees of Zhenhai Refining & Chemical Company Ltd., Ningbo, China.

RESULTS

The study included 8925 subjects (6008 men) with a mean age of 43 years. The prevalence rates of NAFLD and hyperuricemia were 11.78% and 14.71%, respectively. NAFLD patients had significantly higher serum uric acid levels than controls (370.3+/-86.6 vs. 321.1+/-82.6 micromol/L; P<0.001). The prevalence rate of NAFLD was significantly higher in subjects with hyperuricemia than in those without hyperuricemia (24.75% vs. 9.54%; P<0.001), and the prevalence rate increased with progressively higher serum uric acid levels (P value for trend <0.001). Multiple regression analysis showed that hyperuricemia was associated with an increased risk of NAFLD (odds ratio [OR]: 1.291, 95% confidence interval [CI]: 1.067-1.564; P<0.001).

CONCLUSION

Serum uric acid level is significantly associated with NAFLD, and elevated serum uric acid level is an independent risk factor for NAFLD.

Depressive symptoms and increased visceral fat in middle-aged women

OBJECTIVE

To examine whether depressive symptoms are differentially associated with visceral adipose tissue (VAT), which is more metabolically active and confers greater cardiovascular risk than subcutaneous fat (SAT). Prior research has shown an association between depression and central adiposity. Mechanisms underlying the association between depression and increased cardiovascular risk remain poorly understood. Central adiposity is one potential pathway.

METHODS

We investigated the cross-sectional association between depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D), and VAT and SAT, assessed by computed tomography, in a sample of 409 middle-aged women (44.7% African-Americans, 55.3% Whites; mean age = 50.4 years) participating in the Chicago site of the Study of Women's Health Across the Nation (SWAN).

RESULTS

With adjustments for age, race, total percent fat, and sex hormone binding globulin (SHBG), each 1-point higher score on the CES-D was associated with 1.03-cm(2) greater VAT (p < .001). Women with a CES-D score of >or=16, indicative of clinically relevant depressive symptomatology, had 24.5% more VAT than women with lower CES-D scores (p < .001). Further adjustment for Framingham Risk Score and physical activity did not alter the findings, and associations did not vary by race. Associations were strongest in obese and overweight women. Depressive symptoms were unrelated to SAT.

CONCLUSIONS

Increased visceral fat may be one pathway by which depression contributes to excess risk for cardiovascular disease and diabetes. Further research is needed to examine whether depressive symptoms influence accumulation of VAT over time.

Association between inappropriateness of left ventricular mass and left ventricular diastolic dysfunction: a study using the tissue Doppler parameter, e/e'

BACKGROUND AND OBJECTIVES

The structural significance of the inappropriateness of left ventricular mass (iLVM) is known to be an important prognostic factor for cardiovascular events; however, the functional changes associated with iLVM have not been established. This study was performed to determine if diastolic dysfunction is associated with iLVM using a tissue Doppler technique.

SUBJECTS AND METHODS

Three hundred sixty consecutive subjects, including 221 hypertension patients from the echocardiography database, were analyzed. Regarding the appropriateness of left ventricular (LV) mass, an observed/predicted ratio of LV mass (OPR) >130% was defined as inappropriate. Echocardiographic parameters, including early diastolic peak velocity (E)/late diastolic peak velocity (A), deceleration time (DT), isovolumetric relaxation time (IVRT), and E/early mitral annulus velocity (E'), were compared between the appropriate LV mass (aLVM) group and the iLVM group.

RESULTS

Among transmitral flow parameters, only the E velocity was negatively correlated with the OPR when adjusted for age (adjusted r=-0.107, p=0.04). Based on multiple regression analysis, the OPR (beta=0.163, p=0.003), as well as age (beta=0.286, p=0.0001), systolic blood pressure (beta=0.120, p=0.019), fasting blood glucose (beta=0.098, p=0.042), and male gender (beta=0.157, p=0.002) were independent factors determining E/E'. The cholesterol level was not an independent factor (beta=-0.059, p=0.355). In the iLVM group (n=105), the adjusted E/E' was higher than in the aLVM group (n=255; 11.7+/-3.4 vs. 10.8+/-3.1, p=0.02), while the peak E flow velocity was significantly lower than in the aLVM group (70.9+/-15.1 vs. 75.5+/-17.6, p=0.03).

CONCLUSION

Inappropriateness of LV mass is independently associated with increased E/E'. Thus, E/E' may be a useful parameter for the evaluation of diastolic dysfunction.

Effects of obesity and weight loss in patients with nononcological urological disease

PURPOSE

We reviewed the effects of obesity and long-term weight loss on nononcological urological disease, particularly urinary stone formation, erectile dysfunction, female sexual dysfunction, voiding dysfunction and urinary incontinence.

MATERIALS AND METHODS

A literature search was conducted using Ovid's MEDLINE, accessed through Emory University's Health Sciences Library web site. The subject headings obesity, weight loss surgery, urolithiasis, sexual dysfunction, erectile dysfunction, benign prostatic hyperplasia and urinary incontinence were used as indices for the search. Articles published earlier than 10 years before the literature review (performed in summer of 2007) were not used.

RESULTS

There is ample evidence to support an increased risk of urolithiasis in obese patients. However, the effects of long-term weight loss on urinary stone formation have not been studied as extensively in the literature. It is unclear whether the decreased food intake after surgical weight loss procedures may negate the associated risk of malabsorption and decrease the risk of urolithiasis in the long term. The incidence and severity of erectile dysfunction in men increase with obesity. Female sexual dysfunction also appears to be positively correlated with obesity, although the literature is less clear as to the extent to which this is true. Despite a scarcity of relevant data, preliminary evidence indicates that weight loss improves sexual function in men and women. Obesity is associated with an increased incidence of benign prostatic hyperplasia and subsequent lower urinary tract symptoms in men, as well as an increased incidence of stress urinary incontinence in women. Despite a lack of relevant data, there is preliminary evidence that stress urinary incontinence and benign prostatic hyperplasia may be reversible after weight loss.

CONCLUSIONS

Despite the abundant evidence that indicates a correlation between obesity and several urological diseases, there is a paucity of data regarding the effects of long-term weight loss on these conditions. However, the preliminary data indicate that the detrimental effects of obesity are reversible, and that long-term weight loss may decrease the incidence and severity of urological disease. Therefore, further research is needed to elucidate the impact of long-term surgical and medical weight loss on urolithiasis, lower urinary tract symptoms and incontinence, and sexual dysfunction.

Weight perception and dieting behavior among Korean adolescents

This study examines relationships among weight status, weight perceptions, and dieting behaviors in South Korean adolescents. As perceptions of an ideal body for teens in Korea have changed over time, it is important for school nurses to understand these relationships to help students achieve health. A cross-sectional survey of 3,191 8th and 2,252 11th-grade students from 21 middle and high schools across Korea completed a self-administered questionnaire. The prevalence of overweight among adolescents was 17.5% in males and 6.0% in females. Overall, 65.9% of students perceived their weight status accurately. Females overestimated their weight status 2.3 times more often than males. Male students underestimated their weight status 2.7 times more frequently than females. Approximately one third of participants misperceived their weight status, with variations existing between males and females. Study results suggest the need to develop male- and female-specific interventions to promote healthy body images and body weight.

The association between sleep duration and general and abdominal obesity in Koreans: data from the Korean National Health and Nutrition Examination Survey, 2001 and 2005

This study aimed to investigate the association between self-reported sleep duration and general and abdominal obesity in Korean adults. A total of 8,717 adults aged 20-65 years from the Korean National Health and Nutrition Examination Survey (KNHANES) 2001 and 2005 were included. General obesity was defined as BMI >or=25 kg/m(2) and abdominal obesity as waist circumference >or=90 cm in men and >or=85 cm in women. To control for sociodemographic and lifestyle factors and comorbidities, multivariable logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of general and abdominal obesity across the following sleep duration categories: <or=5, 6, 7, 8, and >or=9 h/day. Mean sleep duration (+/-s.d.) was 6.9 +/- 1.3 h. Those sleeping <or=5 h/day had the highest BMI and waist circumference compared with those sleeping 7, 8, or >or=9 h/day (P < 0.05 for all comparisons). After controlling for sociodemographic and lifestyle factors, the adjusted ORs (95% CIs) associated with sleeping <or=5 h/day (vs. 7 h/day) were 1.25 (1.06-1.48) for general obesity and 1.24 (1.03-1.48) for abdominal obesity. Further adjustment for hypertension and diabetes mellitus did not significantly affect the associations. These data suggest that short sleep duration is significantly associated with a modest increase in general and abdominal obesity in Korean adults.

The prevalence and clinical characteristics of reflux esophagitis in koreans and its possible relation to metabolic syndrome

The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44+/-10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m(2) (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol >/=160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride >/=150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose >/=110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusion, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.

Central corneal thickness and its associations with ocular and systemic factors: the Singapore Malay Eye Study

PURPOSE

To examine the association between central corneal thickness (CCT) and potential systemic and ocular factors affecting CCT in an Asian population.

DESIGN

Population-based cross-sectional study.

METHODS

A total of 3,280 (78.7% response) adults aged 40 to 80 years of Malay ethnicity living in Singapore underwent a standardized interview and ocular and systemic examination at a centralized study clinic. CCT was measured with an ultrasound pachymeter. Blood samples were obtained to determine serum glucose, cholesterol, and triglyceride levels, and urine samples to determine glomerular filtration rate. The presence of diabetes, hypertension, chronic kidney disease (CKD), and metabolic syndrome were defined based on a combination of investigation results and participant's history.

RESULTS

CCT was obtained from 3,239 individuals. CCT was normally distributed with a mean of 541.2 microm in the right eye. While controlling for age and gender, CCT was greater in individuals with higher body mass index (BMI) (P = .038), greater intraocular pressure (IOP) (P < .001), greater axial length (P = .005), and greater radius of corneal curvature (P < .001). Individuals with CKD (P = 0.012) and metabolic syndrome (P < .001) also had greater CCT.

CONCLUSION

CCT is associated with higher IOP, longer axial length, and greater radius of corneal curvature, as well as higher BMI, metabolic syndrome, and CKD.

Ghrelin restores 'lean-type' hunger and energy expenditure profiles in morbidly obese subjects but has no effect on postgastrectomy subjects

OBJECTIVE

To examine the effects of ghrelin on appetite and energy expenditure in lean, obese and postgastrectomy subjects.

DESIGN

A randomized, double-blind, placebo-controlled study.

PATIENTS

Nine lean subjects (mean body mass index (BMI) 23.5+/-3 kg/m(2)) and nine morbidly obese subjects (mean BMI 51.4+/-10 kg/m(2)) and eight postgastrectomy subjects (mean BMI 22.4+/-1.0 kg/m(2)).

INTERVENTIONS

Subjects were infused with either intravenous ghrelin (5 pmol kg(-1) min(-1)) or saline over 270 min. They were given a fixed energy breakfast followed by a free buffet lunch towards the end of the infusion.

MAIN OUTCOME MEASURES

Visual analogue scales were used to record hunger and energy expenditure was measured by indirect calorimetry.

RESULTS

Ghrelin increased energy intake at the buffet lunch in lean subjects (a 41% increase, P<0.01) and obese subjects (35% increase, P=0.04) but not in postgastrectomy subjects. Lean subjects showed a characteristic preprandial rise and postprandial fall in hunger scores, which was exaggerated by ghrelin infusion. Obese subjects showed little variation in hunger scores, but a 'lean-type' pattern was restored when given exogenous ghrelin. Ghrelin had no effect on resting metabolic rate but did increase respiratory quotient (RQ) in obese subjects. Ghrelin also increased RQ variability over time in all three groups (ANOVA, P<0.001).

CONCLUSIONS

Hunger scores are abnormal in the obese, perhaps because of impaired ghrelin secretion. The effect of ghrelin in restoring normal hunger profiles in the obese suggests causality, confirming an important role in eating behaviour. Ghrelin also increases RQ in obese humans and increased RQ variability in all groups. This suggests that ghrelin regulates substrate utilization and may promote metabolic flexibility.

Adipogenic risk factor differences between Korean and white adults--potential role of plasma free fatty acid and adiponectin

Asian adults are at greater risk for metabolic abnormalities (insulin resistance, dyslipidemia) at the same body mass index (BMI) than are whites. Elevated free fatty acids (FFA) and decreased adiponectin are linked with these same metabolic abnormalities. We tested the hypothesis that fasting plasma FFA are greater and adiponectin concentrations are lower in Korean than white adults matched for age, sex, and BMI. Plasma FFA and adiponectin concentrations were analyzed using a microfluorometric assay and radioimmunoassay, respectively. Fasting plasma FFA concentrations were not different (P = .51) between Korean and white subjects (208 [183-232] vs 215 [168-262] mumol/L, median and 95% confidence interval). Despite similar body composition in the 2 groups, the plasma adiponectin concentrations in Koreans were significantly lower than those in whites in men, women, and total subgroups (adjusted mean +/- SEM: 4.9 +/- 0.8 vs 9.1 +/- 0.8 microg/mL, P = .004; 8.9 +/- 1.0 vs 13.2 +/- 1.0 microg/mL, P = .006; and 6.5 +/- 0.6 vs 11.1 +/- 0.6 microg/mL, P Collapse

Key Words

• ethnicity
• body composition
• lipolysis

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MESH Headings

• Adipogenesis/physiology
• Adiponectin/blood
• Adult
• Asian People/statistics & numerical data
• Body Mass Index
• Dyslipidemias/ethnology
• Dyslipidemias/metabolism
• Fatty Acids, Nonesterified/blood
• Female
• Humans
• Insulin Resistance
• Male
• Middle Aged
• Risk Factors
• White People/statistics & numerical data

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Grants

• R01 DK045343 NIDDK NIH HHS
• UL1 RR024150 NCRR NIH HHS
• DK45343 NIDDK NIH HHS

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Affiliation(s)

Sangyeoup Lee Center for Obesity, Nutrition and Metabolism and Department of Family Medicine, Pusan National University Hospital and Medical Education Unit, Pusan National University School of Medicine, and Medical Research Institute, Pusan National University, Busan, South Korea Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota, U.S.A
Michael D. Jensen Endocrine Research Unit, Mayo Clinic, Rochester, Minnesota, U.S.A

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Collaborators Collapse

Lung function in Korean adolescent girls: in association with obesity and the menstrual cycle

Gender differences in asthma have been observed with a preponderance of boys affected before puberty and girls during and after puberty. The known influences of the menstrual cycle on asthma support a role for female sex hormones on the changing expression of asthma during adolescence. The purpose of this study was to investigate obesity, the menstrual cycle and lung function in adolescent girls. One hundred and three female high school girls (mean age: 15.9+/-0.8 yr) were enrolled. The investigation was performed using a questionnaire that included history of asthma, the menstrual cycle, other combined allergic disease and obesity. The skin prick and pulmonary function test during menstruation period and non-menstruation period. Analyses of these factors were compared. The forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) was significantly lower in the obese group compared to the non-obese group (99.8+/-13.8 vs. 107.1+/-10.2, p=0.03). The FEV(1) was significantly lower in the girls during menstruation period than in the girls who were not on menstruation (77.5+/-10.2 vs. 80.4+/-8.6, p=0.03). Our results showed that changes of pulmonary function were related to menstrual cycle and obesity in Korean adolescent girls.

Can tactile plantar stimulation improve postural control of persons with superficial plantar sensory deficit?

BACKGROUND AND AIMS

Complex interactions between visual, vestibular and somatosensory information and the cerebellar system are involved in the maintenance of upright posture. Previous studies have shown that normal aging and pathologies may lead to deterioration of the control of upright standing posture.

METHODS

In order to investigate postural control during quiet standing in the elderly, the center of pressure (CoP) was analysed on two force platforms in three different groups. The first group was composed of 13 healthy older adults (O), the second consisted of 9 older adults with plantar sole deficit (OD), and the third (control) group was composed of 8 young healthy subjects (Y). All subjects were tested with eyes closed, before and after tactile plantar stimulation lasting ten minutes. Center of pressure displacements were analyzed in terms of sway area, mean velocity, and mean root mean square (RMS) along both mediolateral and antero-posterior axes.

RESULTS

Results showed that, before tactile plantar stimulation, the sway area and mean RMS were greater in O and OD subjects compared with Y ones. After tactile plantar stimulation, a decrease in the mean RMS was observed in OD subjects, this effect being significant only for the medio-lateral axis.

CONCLUSIONS

These results suggest that application of tactile plantar stimulation may compensate a loss of superficial plantar sensitivity.

Metabolic syndrome and major depressive disorder: co-occurrence and pathophysiologic overlap

The metabolic syndrome and its components are associated with depressive symptomatology. This article discusses the rate of co-occurrence and the points of pathophysiologic commonality between the metabolic syndrome and major depressive disorder.

An association between colonic adenoma and abdominal obesity: a cross-sectional study

BACKGROUND

Colorectal adenoma is a precursor lesion of colorectal cancer and thus, it is an important target for preventing colorectal cancer. Only a few studies suggest an association between colorectal adenoma and obesity, but results show considerable heterogeneity. In this study, we investigated the association between colorectal adenoma and waist circumference.

METHODS

165 adenoma cases and 365 polyp-free controls with a normal colon were compared in this cross-sectional study. Subjects underwent screening colonoscopy by experienced endoscopists. Demographic data, including smoking habit, were obtained by interview and waist circumference and anthropometric measurements were examined. Dietary intakes were evaluated using a food frequency questionnaire, and abdominal obesity was evaluated by measuring waist circumference. Statistical analysis was performed using SPSS for 13.0.

RESULTS

Age, waist circumference, and BMI were significantly higher in cases than controls. And smokers and men were more prevalent among cases than controls.Among the abdominal obese subjects, 45.6% had 1 or more adenoma, and 9.0% of these had advanced adenoma, whereas among subjects with a normal waist circumference, only 25.7% had 1 or more adenomas. The prevalence of adenoma was higher among abdominal obese group (P < 0.05). Logistic regression analysis showed that abdominal obesity was associated with an increased risk of colorectal adenoma (OR, 2.74; 95% CI, 1.66~4.51 in men, OR, 2.58; 95% CI, 1.08~6.12 in women). These associations persisted even after adjusting for BMI. While BMI was found to be weekly associated with the risk of adenoma among men at the highest BMI levels. However, BMI was not associated with the risk for adenoma after adjusting for waist circumference.

CONCLUSION

Our data suggest that abdominal obesity is associated with an increased risk of colorectal adenoma.

Metabolic Syndrome and the Risk of Ischemic Heart Disease and Stroke among Middle-Aged Japanese

Limited information is available regarding risk of cardiovascular disease and trends for the metabolic syndrome in Asia. We examined the impact of the metabolic syndrome and its components on risk of cardiovascular disease among middle-aged Japanese according to four criteria. We followed 2,613 subjects from a rural Japanese community who participated in cardiovascular health examinations between 1990 and 1993. After 27,477 person-years of follow-up through 2003, there were 42 incidents of ischemic heart disease, 73 total strokes (54 ischemic and 18 hemorrhagic), and 115 total cases of cardiovascular disease. The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), International Diabetes Federation (IDF), and Japanese criteria. The multivariable hazard ratios (95%CI) associated with the metabolic syndrome based on NCEP-ATPIII criteria were 2.1 (1.1-4.0) for ischemic heart disease, 1.7 (1.0-2.7) for total stroke, 2.0 (1.2-3.5) for ischemic stroke, 1.1 (0.4-2.8) for hemorrhagic stroke, 2.0 (1.3-3.1) for ischemic cardiovascular disease, and 1.7 (1.2-2.5) for total cardiovascular disease. The population-attributable fractions of the metabolic syndrome based on NCEP-ATPIII criteria were 26-27% for ischemic heart disease and ischemic stroke and 20% for total cardiovascular disease. The metabolic syndrome based on AHA/NHLBI, IDF and Japanese criteria had weaker associations with risk of cardiovascular disease, and the association with risk of ischemic heart disease was not statistically significant. The metabolic syndrome based on NCEP-ATP III criteria predicted risks of ischemic heart disease, ischemic stroke and total cardiovascular disease, whereas that based on three other criteria predicted them less effectively.

Depressive symptoms and change in abdominal obesity in older persons

CONTEXT

Depression has been hypothesized to result in abdominal obesity through the accumulation of visceral fat. No large study has tested this hypothesis longitudinally.

OBJECTIVE

To examine whether depressive symptoms predict an increase in abdominal obesity in a large population-based sample of well-functioning older persons.

DESIGN

The Health, Aging, and Body Composition Study, an ongoing prospective cohort study with 5 years of follow-up.

SETTING

Community-dwelling older persons residing in the areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee.

PARTICIPANTS

A total of 2088 well-functioning white and black persons aged 70 to 79 years.

MAIN OUTCOME MEASURES

Baseline depression was defined as a Center for Epidemiological Studies Depression score of 16 or higher. At baseline and after 5 years, overall obesity measures included body mass index (calculated as weight in kilograms divided by height in meters squared) and percentage of body fat (measured by dual-energy x-ray absorptiometry). Abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computed tomography).

RESULTS

After adjustment for sociodemographics, lifestyle, diseases, and overall obesity, baseline depression was associated with a 5-year increase in sagittal diameter (beta = .054; P = .01) and visceral fat (beta = .080; P = .001).

CONCLUSIONS

This study shows that depressive symptoms result in an increase in abdominal obesity independent of overall obesity, suggesting that there may be specific pathophysiological mechanisms that link depression with visceral fat accumulation. These results might also help explain why depression increases the risk of diabetes and cardiovascular disease.

Fasting-induced suppression of LH secretion does not require activation of ATP-sensitive potassium channels

Reproductive hormone secretions are inhibited by fasting and restored by feeding. Metabolic signals mediating these effects include fluctuations in serum glucose, insulin, and leptin. Because ATP-sensitive potassium (K(ATP)) channels mediate glucose sensing and many actions of insulin and leptin in neurons, we assessed their role in suppressing LH secretion during food restriction. Vehicle or a K(ATP) channel blocker, tolbutamide, was infused into the lateral cerebroventricle in ovariectomized mice that were either fed or fasted for 48 h. Tolbutamide infusion resulted in a twofold increase in LH concentrations in both fed and fasted mice compared with both fed and fasted vehicle-treated mice. However, tolbutamide did not reverse the suppression of LH in the majority of fasted animals. In sulfonylurea (SUR)1-null mutant (SUR1(-/-)) mice, which are deficient in K(ATP) channels, and their wild-type (WT) littermates, a 48-h fast was found to reduce serum LH concentrations in both WT and SUR(-/-) mice. The present study demonstrates that 1) blockade of K(ATP) channels elevates LH secretion regardless of energy balance and 2) acute fasting suppresses LH secretion in both SUR1(-/-) and WT mice. These findings support the hypothesis that K(ATP) channels are linked to the regulation of gonadotropin-releasing hormone (GnRH) release but are not obligatory for mediating the effects of fasting on GnRH/LH secretion. Thus it is unlikely that the modulation of K(ATP) channels either as part of the classical glucose-sensing mechanism or as a component of insulin or leptin signaling plays a major role in the suppression of GnRH and LH secretion during food restriction.

The metabolic syndrome as a concept of adipose tissue disease

The metabolic syndrome is a constellation of interrelated metabolic risk factors that appear to directly promote the development of diabetes and cardiovascular disease. However, in 2005, the American Diabetes Association and the European Association for the Study of Diabetes jointly stated that no existing definition of the metabolic syndrome meets the criteria of a syndrome, and there have been endless debates on the pros and cons of using the concept of this syndrome. The controversy may stem from confusion between the syndrome and obesity. Obesity is an epidemic, essentially contagious disease caused by an environment of excess nutritional energy and reinforced by deeply rooted social norms. The epidemic of obesity should be prevented or controlled by social and political means, similar to the approaches now being taken to combat global warming. The diagnosis of metabolic syndrome is useless for this public purpose. The purpose of establishing criteria for diagnosing metabolic syndrome is to find individuals who are at increased risk of diabetes and cardiovascular disease and who require specific therapy including diet and exercise. The syndrome may be an adipose tissue disease different from obesity; in that case, it would be characterized by inflammation clinically detected through systemic inflammatory markers such as high-sensitivity C-reactive protein and insulin resistance reflecting histological changes in adipose tissue. However, many problems in defining the optimal diagnostic criteria remain unresolved.

Evaluation of metabolic syndrome risk in Korean premenopausal women: not waist circumference but visceral fat

BACKGROUND

In clinical practice, using the patient's waist circumference (WC) to evaluate visceral obesity may underestimate disorders with a metabolic origin. This study examined whether or not the WC derived from the cut-off point of the visceral fat area (VFA) can reflect the features of metabolic syndrome (MetS) in premenopausal women.

METHODS AND RESULTS

Computed tomography-scanned VFA, MetS components and the concentrations of high-sensitivity C-reactive protein (CRP) and adiponectin were measured in a total of 349 premenopausal women. The VFA at the L1 and the L4 sites was a significant index (p<0.001) of incremental MetS risk. Receiver-operating characteristic curve analysis showed that 75 cm2 of VFA at L4 and 87.5 cm2 at L1 were the optimal thresholds for discrimination of MetS risk. Significant differences in all MetS components, as well as CRP (p<0.05) and adiponectin levels (p<0.005), were observed when subjects were subdivided by the L4 VFA cut-off point (<75/>or=75 cm2), whereas there was a significant difference only in the triglycerides level in the groups divided by WC (WC<88/>or=88 cm). Moreover, subjects with a lower WC-higher VFA showed a similar pattern in MetS components and lower adiponectin than those with a higher WC-higher VFA.

CONCLUSIONS

This study clarified that VFA rather than WC is a major determinant of MetS risk in premenopausal women.

Waist circumference cut-off points for the diagnosis of metabolic syndrome in Iranian adults

AIMS

Central obesity, a prominent feature of metabolic syndrome (MetS), is commonly assessed by gender- and ethnicity-specific waist circumference (WC) cut-off values. Since 2006, the recommended WC cut-offs by the International Diabetes Federation (IDF) for Europeans are used in Iran because of limited data availability. The purpose of this study was to determine optimal cut-off points for the diagnosis of MetS in Iran.

METHODS

A total of 2752 adults (1046 men) were studied. Subjects with two or more of the following risk factors from the IDF criteria were considered to have multiple risk factors: hyperglycemia (FBG>/=100mg/dL or diagnosed diabetes), high blood pressure (SBP>/=130mmHg, DBP>/=85mmHg, or using antihypertensive drugs), low HDL (<50mg/dL for females and <40mg/dL for males), and high TG (>150mg/dL).

RESULTS

The WC cut-off yielding maximum sensitivity plus specificity for predicting the presence of multiple risk factors was 91.5cm in men and 85.5cm in women. Sensitivity and specificity were 77% (86%) and 58% (50%) in men (women), respectively. MetS prevalence was estimated to be approximately 27% in Tehran.

CONCLUSIONS

WC cut-offs recommended by the IDF are not appropriate for use in Iran.

The effects of pre-disease risk factors within metabolic syndrome on all-cause and cardiovascular disease mortality

The metabolic syndrome has been criticized for being "polluted with the inclusion of frank "diseases" with "pre-diseases". We assessed the effect of a single and a combination of "pre-disease" risk factors of metabolic syndrome on the overall and cardiovascular disease (CVD) mortality. These pre-disease risk factors included pre-diabetes, pre-hypertension, overweight and borderline hypertriglycerdemia and were defined as: fasting glucose at 110-125 mg/dL, systolic blood pressure at 120-139 mmHg, body mass index at 25-29.9 kg/m(2) and serum triglyceride at 150-199 mg/dL, respectively. The metabolic syndrome in this paper was based on the version defined by the ATP III. The cohort consisted of 35,259 adults (>==40 years) with a medium follow-up of 15 years. Relative risks (RRs) for all-causes, CVD and "CVD plus diabetes" mortality were calculated with the Cox proportional hazards model. Prevalence of the pre-disease risk factors (40.2%) was nearly four times larger than the metabolic syndrome (10.6%). Individual pre-disease risk factor was associated with significant increases of 13% and 67% (pre-diabetes), 22% and 62% (pre-hypertension), 23% and 32% (overweight) and 17% and 46% (borderline hypertriglyceridemia) on all-cause and "CVD plus diabetes" mortality, respectively. Smoking had comparable risks as "pre-diseases", and, as such, should also be considered as the fifth "pre-disease". Like metabolic syndrome, each "Pre-disease" is a major and significant risk factor for all cause and cardiovascular mortality, but unlike metabolic syndrome, the definition or clinical follow up of "Pre-disease" is simple and straightforward. Recognizing each of the four "pre-disease" as a clinical entity, a hitherto sub-clinical status but involving significantly increased mortality, can alert and justify early intervention through changing lifestyle and modifying biologic risk factors.

Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia

The aetiology of benign prostatic hyperplasia (BPH) remains unclear. The objective of the present study was to test the insulin, oestradiol and metabolic syndrome hypotheses as promoters of BPH. The design was a risk factor analysis of BPH in which the total prostate gland volume was related to endocrine and anthropometric factors. The participants studied were 184 representative men, aged 72-76 years, residing in Göteborg, Sweden. Using a multivariate analysis, BPH as measured by the total prostate gland volume correlated statistically significantly with fasting serum insulin (beta=0.200, P=0.028), free oestradiol (beta=0.233, P=0.008) and lean body mass (beta=0.257, P=0.034). Insulin and free oestradiol appear to be independent risk factors for BPH, confirming both the insulin and the oestradiol hypotheses. Our findings also seem to confirm the metabolic syndrome hypothesis. The metabolic syndrome and its major endocrine aberration, hyperinsulinaemia, are possible primary events in BPH.

Metabolic syndrome is associated with erosive esophagitis

AIM

To clarify whether insulin resistance and metabolic syndrome are risk factors for erosive esophagitis.

METHODS

A case-control study was performed using the database of the Kangbuk Samsung Hospital Medical Screening Center.

RESULTS

A total of 1679 cases of erosive esophagitis and 3358 randomly selected controls were included. Metabolic syndrome was diagnosed in 21% of the cases and 12% of the controls (P < 0.001). Multiple logistic regressions confirmed the association between erosive esophagitis and metabolic syndrome (Odds ratio, 1.25; 95% CI, 1.04-1.49). Among the components of metabolic syndrome, increased waist circumference, elevated serum triglyceride levels and hypertension were significant risk factors for erosive esophagitis (all P < 0.01). Furthermore, increased insulin resistance (Odds ratio, 0.91; 95% CI, 0.85-0.98) and fatty liver, as diagnosed by ultrasonography (Odds ratio, 1.39; 95% CI, 1.20-1.60), were also related to erosive esophagitis even after adjustment for a series of confounding factors.

CONCLUSION

Metabolic syndrome and increased insulin resistance are associated with an increased risk of developing erosive esophagitis.

Metabolic syndrome according to different definitions in a rapidly developing country of the African region

AIMS

We examined, in a country of the African region, i) the prevalence of the metabolic syndrome (MetS) according to three definitions (ATP, WHO and IDF); ii) the distribution of the MetS criteria; iii) the level of agreement between these three definitions and iv) we also examined these issues upon exclusion of people with diabetes.

METHODS

We conducted an examination survey on a sample representative of the general population aged 25-64 years in the Seychelles (Indian Ocean, African region), attended by 1255 participants (participation rate of 80.3%).

RESULTS

The prevalence of MetS increased markedly with age. According to the ATP, WHO and IDF definitions, the prevalence of MetS was, respectively, 24.0%, 25.0%, 25.1% in men and 32.2%, 24.6%, 35.4% in women. Approximately 80% of participants with diabetes also had MetS and the prevalence of MetS was approximately 7% lower upon exclusion of diabetic individuals. High blood pressure and adiposity were the criteria found most frequently among MetS holders irrespective of the MetS definitions. Among people with MetS based on any of the three definitions, 78% met both ATP and IDF criteria, 67% both WHO and IDF criteria, 54% both WHO and ATP criteria and only 37% met all three definitions.

CONCLUSION

We identified a high prevalence of MetS in this population in epidemiological transition. The prevalence of MetS decreased by approximately 32% upon exclusion of persons with diabetes. Because of limited agreement between the MetS definitions, the fairly similar proportions of MetS based on any of the three MetS definitions classified, to a substantial extent, different subjects as having MetS.

The metabolic syndrome--from insulin resistance to obesity and diabetes

In today's society with the escalating levels of obesity, diabetes, and cardiovascular disease, the metabolic syndrome is receiving considerable attention and is the subject of much controversy. Greater insight into the mechanism(s) behind the syndrome may improve our understanding of how to prevent and best manage this complex condition.

Cooperative exonization of MaLR and AluJo elements contributed an alternative promoter and novel splice variants of RNF19

The RNF19 protein, which contains RING-finger and IBR motifs, acts as an E3 ubiquitin ligase localized to Lewy bodies. RNF19 is located on human chromosome 8q22.2, has a 4.4-kb transcript, and is ubiquitously expressed in various tissues. Here, we identified an alternative RNF19 promoter region and alternative RNF19 transcripts derived from MaLR (mammalian apparent LTR-retrotransposon) and AluJo elements. Comparative analyses indicated human-specific expression of the MaLR- and AluJo-related transcripts. From the expression analysis of 72 tissue samples including human normal, tumor, and primate tissues, three different isoforms (V1, V2, and V3) of MaLR-derived transcripts were identified. Quantitative RT-PCR analysis showed a dominant expression pattern of the V2 MaLR-derived transcript. A reporter gene assay for MaLR element promoter activity indicated that pGL2-RNF19/MaLR in the forward orientation is capable of driving luciferase gene expression in Cos7 and HCT116 cells. These findings suggest that RNF19 has acquired a new promoter and alternative exons via continuous retrotransposition events of MaLR and AluJo elements during mammalian and primate evolution, respectively.

Educating patients about lifestyle modifications for prostate health

Benign prostatic hyperplasia (BPH) and other prostatic diseases share many observational and mechanistic features with cardiovascular disease. Both BPH and cardiovascular disease increase significantly with age and affect a disproportionate number of men from racial/ethnic minority populations. Pharmacotherapy and surgical options are the treatments most often discussed in the medical literature for the 2 conditions, and these treatments have demonstrated remarkable effectiveness, regardless of the severity of the condition. Obesity, lack of physical activity, dyslipidemia, diabetes mellitus, higher blood pressure, a heart-unhealthy diet, and other factors that increase the risk for cardiovascular disease also appear to be associated with increased risk for BPH. However, the potential for lifestyle changes to prevent or reduce the severity of BPH, especially as an adjunct to conventional treatments, has not received significant attention, even in recent specialty treatment guidelines. Because lifestyle changes may affect the risk for developing BPH or its progression, clinicians are in need of guidelines they can use to educate patients about the potential links between increased risk of cardiovascular disease and increased risk or greater severity of BPH. Patients need to know that a heart-healthy lifestyle is also a prostate-healthy lifestyle. This article provides educational and lifestyle recommendations that may favorably affect BPH and improve overall health in men.

A double-blind, placebo-controlled, randomized clinical study of the effects of vardenafil on human nasal patency

BACKGROUND

Vardenafil, a selective phosphodiesterase 5 (PDE5) inhibitor, may affect nasal patency because of its adverse-effect profile. This double-blind, placebo-controlled, randomized clinical study sought to assess the effect of vardenafil on nasal patency in patients at a university hospital.

METHODS

Nasal patency was assessed using a visual analog score and by measuring the minimum cross-sectional areas (MCAs) and nasal cavity volumes with acoustic rhinometry in 14 subjects before and after administration of vardenafil. Measurements were repeated after administration of a local decongestant spray.

RESULTS

There was no statistically significant difference between the nasal cavity volumes, MCA, and visual analog scale (VAS) scores before and after the administration of placebo. However, there was a significant increase in the nasal cavity volumes, MCAs, and VAS scores after application of the local decongestant. A significant correlation was found between MCAs and VAS scores (r = 0.96; p < 0.001). After administration of vardenafil, there was a significant increase in the degree of subjective sense of nasal obstruction as measured by VAS scores. Total nasal volumes showed a significant decrease (p < 0.05). The congestion effect induced by the vardenafil was reversed after application of the local decongestant spray, and a significant increase in cross-sectional areas was noted. In the vardenafil group, a significant increase in MCA, total volume, and VAS scores was observed after application of the local decongestant (p < 0.05).

CONCLUSION

Objective and subjective nasal obstruction after administration of vardenafil was significantly higher in this study than in previously reported studies. The effect of congestion can be reversed by local decongestants. The role of PDE5 inhibitors in nasal physiology merits additional investigation.

Prevalence of type 2 diabetes among women with a previous history of gestational diabetes mellitus

We compared the prevalence of diabetes in women who experienced gestational diabetes mellitus (GDM) with that in the general population and identified risk factors for the development of diabetes. The analysis included 868 subjects (620 GDM and 248 single positive (SP) for one of the diagnostic criteria). The post-partum examinations included 2 h 75 g oral glucose tolerance tests, lipid profiles, anthropometric measurements, and documentation of medical history, diet, and lifestyle. All participants were followed up at 6 weeks after parturition and subsequent follow-ups were conducted annually. General population subjects were identified from the 2001 Korean National Health and Nutrition Survey and age-matched for case-control analysis. Eleven (4.4%) and 71 (11.5%) subjects in the SP and GDM groups, respectively, developed diabetes, while 22 (2.5%) subjects in the general population group presented with diabetes. The risk of developing diabetes was 3.5 times greater for GDM subjects than for general population subjects, after adjusting for confounding factors. A multiple logistic regression model revealed that GDM, a family history of diabetes, and waist circumference were independently associated with the development of diabetes. We concluded that GDM women in Korea are at high risk of diabetes irrespective of the absence of putative risk factors.

Lower touch sensibility in the extremities of healthy Indians: further deterioration with age

Touch sensibility testing is a cost-effective, psychophysical measure of peripheral nerve function and impairment. However, there is limited information regarding the natural variability in touch sensibility across different populations and different age groups. We studied 568 healthy Indian volunteers without any clinical evidence of peripheral nerve disease. Touch sensibility was evaluated bilaterally in palms, feet, and heels, using Semmes-Weinstein monofilaments, with target forces ranging from 0.008 to 300 g. No differences were observed between the right and the left limbs. The lowest target force detected ranged from 0.4 to 2 g in the palms and 1.4 to 15 g in the feet. These values showed further increase with age. Women compared with men had higher sensibility in the palms in most age groups. Touch sensibility thresholds recorded in a large group of Indians were higher than that reported in other populations. These findings have clinical implications for the diagnosis of early nerve impairment in the elderly and in disease states drawing attention to geographic variations in touch sensation.

Optimizing management of metabolic syndrome to reduce risk: focus on life-style

The prevalence of metabolic syndrome (MS) is increasing all over the world and its incidence is expected to rise in the next years. Although genetic predisposition appears to play an important role in the regulation of metabolic parameters and in particular of body weight, the rapid increase in the prevalence of obesity and MS suggests that ecological factors (social, economic, cultural and physical environment) are promoting those conditions in susceptible individuals. People with MS are at increased risk of type 2 diabetes and cardiovascular disease and therefore they represent a priority target for preventive strategies. Life-style modifications based on healthy diet and increased physical activity are an effective preventing and therapeutic approach. Unfortunately, implementation of life-style modification and maintenance of effects is a difficult task both at personal and social level, thus drug therapy can be taken into account.

Association between BMI and metabolic syndrome and adenomatous colonic polyps in Korean men

Obesity and insulin resistance are associated with the risk of colon cancer. Adenomatous colonic polyps are precancerous lesions of colon cancer. We investigated whether BMI and the metabolic syndrome are associated with the presence of adenomatous colonic polyps in Korean men. Anthropometric measurements, metabolic risk factors, and colonoscopic pathologic findings were assessed in 1,898 men who underwent routine colonoscopy at the Health Promotion Center of Asan Medical Center in 2005. The modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria were used for the definition of the metabolic syndrome. Multiple logistic regression analysis was used to evaluate the association between BMI and the metabolic syndrome and adenomatous polyps. Compared with men in the 1st quintile of the BMI, the adjusted odds ratio (OR) and 95% confidence interval (CI) for adenomatous polyps in men in the 2nd, 3rd, 4th, and 5th quintiles of the BMI were 1.55 (1.10-2.19), 1.57 (1.10-2.24), 1.94 (1.34-2.81), and 1.99 (1.31-3.01), respectively (P for trend <0.0001). Men with triglycerides (TGs) > or = 150 mg/dl were significantly more likely to have adenomatous polyps than were men with TG <150 mg/dl (OR 1.29; 95% CI 1.03-1.62). As a function of the number of metabolic risk factors, the ORs for adenomatous polyps were 1.41 (1.03-1.93), 1.52 (1.08-2.12), 1.46 (1.01-2.12), and 1.77 (1.08-2.90) for 1, 2, 3, and > or = 4 risk factors, respectively (P for trend <0.05). Adenomatous colonic polyps were significantly associated with increased BMI levels. Subjects with even one component of the metabolic syndrome had a significantly higher risk for developing adenomatous polyps compared to those subjects without any component in Korean men.

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

Acute liver failure (ALF)-related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both grey and white matter brain tissue. Quantitative multivoxel MRS was used here to compare grey and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters. Five pediatric patients with ALF-related encephalopathy and five controls, examined after successful liver transplantation, were examined by brain MRI/MRS. ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx + 125%: P < 0.01; lactate + 33%, P < 0.05) and higher Glx in grey matter (Glx + 125%: P < 0.01). Within the group of ALF patients positive correlations were found between grey or white matter lactate concentration and serum ammonia (P < 0.05), and negative correlations between grey or white matter Glx and venous pH (P < 0.001). This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF-related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, gamma-glutamyl transpeptidase, alkaline phosphatase).

Evaluation of metabolic syndrome in adults of Talca city, Chile

OBJECTIVE

Insulin resistance (IR) is an important risk factor for type 2 Diabetes Mellitus (DM2) and cardiovascular disease (CVD). Metabolic Syndrome (MS) is a clustering of metabolic alterations associated to IR; however, there is no international consensus for defining its diagnosis. Our objective was to evaluate the prevalence and characteristics of MS identified by the ATP III and IDF criteria in adults from Talca city.

RESEARCH AND METHODS

We studied 1007 individuals, aged 18-74, and residents from Talca. MS subjects were defined according to ATP III (three altered factors) and IDF criteria (patients with waist circumference >80/90 cm (W/M) and two others altered factors).

RESULTS

The prevalence of metabolic syndrome according to the IDF and ATP III criteria was 36.4% and 29.5%, respectively after adjustment for age and sex. The agreement for both criteria was 89%. The prevalence in men was higher than in women for both MS definitions, although not significant. MS probability increased with age, and the highest risk was in the 57-68 age group (ATP-MS) and 53-72 age group (IDF-MS). Hypertension, high triglycerides and abdominal obesity are the most frequent alterations in MS.

CONCLUSION

MS prevalence in adults was higher when diagnosed with IDF than with ATP criterion; in both, age is directly related with the MS presence. The MS subjects showed higher levels of blood pressure, waist circumference and plasma triglycerides. Considering our results, it is worrisome that one third of our population has a high risk of developing DM2 and CVD in the future.

Placenta-restricted expression of LTR-derived NOS3

Domestication events of long terminal repeat (LTR) sequences of the human endogenous retrovirus (HERV) family have been considered to be a new mechanism for the generation of alternative splicing in the human genome. We investigated an LTR10A belonging to the HERV-I family at the human endothelial nitric oxide synthase (NOS3) gene locus. The LTR10A element was located upstream of the original promoter sequences of NOS3. Expression analysis using RT-PCR and reporter gene assays in HCT116 and COS7 cells indicated placenta-specific expression of NOS3 driven by the LTR10A-derived promoter. The placenta-restricted expression was also determined to be associated with hypomethylation of the LTR10A element by methylation analysis using sodium bisulfite DNA sequencing. Furthermore, treatment of brain-derived cell lines with demethylation reagents did not restore expression of the LTR-derived NOS3 gene transcript. Taken together, the integration event of an LTR10A element in the upstream region of NOS3 led to the generation of a placenta-specific alternative transcript governed by cooperative mechanisms of epigenetic control (DNA methylation) and transcriptional regulation (interaction between cis- and trans-acting elements).