Relationship between gamma-glutamyltransferase and metabolic syndrome in a Korean population

AIMS

To investigate associations between gamma-glutamyltransferase (GGT) and components of metabolic syndrome (MS), insulin resistance and inflammatory markers in the Korean population.

METHODS

The 3508 subjects enrolled in this survey participated in the Korean Rural Genomic Cohort (KRGC) study. Written consent was obtained from the local ethical committee. Of these participants, 1437 were men (mean age 56.9 +/- 7.9 years) and 2071 were women (mean age 55.8 +/- 8.1 years). We measured GGT levels and various biochemical markers. To examine insulin resistance status, we used the homeostasis assessment method for insulin resistance (HOMA-IR). For inflammatory marker, we used C-reactive protein (CRP) levels.

RESULTS

Serum GGT levels were significantly higher in the MS group compared to the healthy patient group [23 (5-1403) vs. 19 (5-1920) IU/l; P = 0.01]. The prevalence of MS and adjusted relative risk were both significantly increased from the lowest to highest GGT quartiles; these results persisted after adjustments for multiple confounders. Positive correlations were established between GGT and HOMA-IR or CRP.

CONCLUSION

These results suggest that GGT levels may be a surrogate marker of insulin resistance, inflammation and MS.

Association among cigarette smoking, metabolic syndrome, and its individual components: the metabolic syndrome study in Taiwan

Insulin resistance is a common feature of metabolic syndrome. Smokers are at great risk of developing insulin resistance. Theoretically, smoking status should be associated with metabolic syndrome. This study aimed to explore the association among cigarette smoking, metabolic syndrome, and its individual components. Information of participants regarding previous and current diseases, family history of disease, smoking habits, alcohol consumption, betel nut chewing, and physical activity status were gathered from self-reported nutrition and lifestyle questionnaires. The fasting plasma glucose, triglyceride level, high-density lipoprotein cholesterol (HDL-C) level, blood pressure, and anthropometric indices in each patient were measured. Data of 1146 male subjects were analyzed. Individuals who currently smoked had a higher prevalence of metabolic syndrome than those who had never smoked and those who had quit smoking. The adjusted odds ratios of current smoking amount showed a statistically significant dose-dependent association with metabolic syndrome, high triglyceride level, and low HDL-C level. Current smokers who smoke > or =20 pack-years have a significantly increased risk of developing metabolic syndrome, high triglyceride level, and low HDL-C level. The higher risk of development of metabolic syndrome, high triglyceride level, and low HDL-C level was insignificant in former smokers. In conclusion, this community-based study supports the view that smoking is associated with metabolic syndrome and its individual components. Smoking cessation is beneficial to metabolic syndrome and its individual components.

Correlations of dietary patterns with prostate health

Both genetic and environmental influences may be involved in etiology of prostate health and prostate cancer. These include ethnic origin, family history, smoking, and diet. Adiposity and excess energy intake are potentially distinct risk factors and positive associations with prostate cancer risk for both were observed among case-control and cohort studies. Some epidemiological studies support an association between dietary fat, particularly saturated or animal fats, and prostate cancer risk. Of these, several suggest reduced risk with low-fat diets high in n-3 fatty acids and increased risk with high-fat diets rich in n-6 fatty acids. Others suggested association with higher meat intake, possibly due to heterocyclic amines and polycyclic aromatic hydrocarbons, produced during grilling or frying. Positive association of prostate cancer risk with dairy intake could involve alpha-methylacyl-CoA racemase activity (required for beta-oxidation of phytanic acid present in dairy products and red meat) or the suppression of vitamin D activity by calcium. Inverse associations were observed with dietary intake of plant foods. These include cereals, soy products, and fruit and vegetable sources of carotenoids. Numerous plant constituents may act synergistically in the prevention and inhibition of prostate disorders. These diet-risk associations may lead to future individualized diet recommendations based upon genetic polymorphisms.

Prevalence of metabolic syndrome compared between native Japanese and Japanese-Americans

Metabolic syndrome is a condition characterized by the accumulation of multiple risk factors for atherosclerosis. Japanese-Americans in the U.S. have a more rapid and intense progression of atherosclerosis than native Japanese in Japan due to a westernization of their lifestyle. We investigated the prevalence of metabolic syndrome between 416 native Japanese (194 men and 222 women) in Hiroshima and 574 Japanese-Americans (217 men and 357 women) in Los Angeles, aged 30-89 years. According to the criteria proposed by the Japanese Society of Internal Medicine, the prevalence was 13.9 and 2.7% for native Japanese men and women, and 32.7 and 3.4% for Japanese-American men and women, respectively. According to the IDF or AHA/NHLBI criteria, the prevalence was 20.1 and 6.3%, and 38.7 and 4.5%, or 13.4 and 14.4%, and 30.9 and 27.7%, respectively. Thus, the prevalence of metabolic syndrome in men was significantly higher in Japanese-American than in native Japanese by all the three criteria. However, the prevalence in women was similar between native Japanese and Japanese-American by the Japanese and IDF criteria, whereas it was significantly higher in Japanese-American than in native Japanese by the AHA/NHLBI criteria. This report demonstrates that a westernization of lifestyle can increase the prevalence of metabolic syndrome among Japanese-Americans as compared to native Japanese.

Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome

In the new world-wide criteria for metabolic syndrome (MetS) by the International Diabetes Federation (IDF) in 2006, the Japanese is the only ethnicity in which the recommended waist circumference (WC) cutoff value is higher in women (>or=90cm) than in men (>or=85cm), and its validity appears to be controversial. We investigated the optimal cutoff points for the diagnosis of central obesity in Japanese men and women, using the receiver operating characteristic (ROC) curve analysis for both of WC and visceral fat area (VFA) in 1870 middle-aged Japanese. VFA was superior to WC and Body mass index (BMI) for discriminating the subjects with two or more nonadipose components of MetS. The optimal cutoff points of VFA and WC were 132.6cm(2) and 89.8cm for men and 91.5cm(2) and 82.3cm for women. The stratifications of MetS components more than 1.0 in average occurred more steeply by the accumulation of VFA in women than in men. In conclusion, setting the cutoff points of WC and VFA lower values in women than in men for the definition of central obesity is needed to identify the subjects with MetS in Japanese, as in other Asian populations.

Apolipoprotein B is a better marker than non-HDL-cholesterol for the metabolic syndrome in Koreans

Apolipoprotein B (apoB) concentration reflects the number of atherogenic particles and is closely associated with atherosclerosis. Non-HDL-cholesterol (non-HDL-C) has been considered a therapeutic target for patients with hypertriglyceridemia. We compared the predictive values of apoB and non-HDL-C for the metabolic syndrome (MetS) in 3335 Korean adults (mean age, 45.2 years) who participated consecutively in a health examination in a university hospital. Anthropometry, blood pressure, fasting glucose, lipid profiles and apoB were measured. MetS, as defined by a modification of the NCEP-ATP III criteria, was present in 22.1% of men and 16.1% of women. Among the components of the MetS, triglycerides showed the strongest correlation with apoB (r=0.393, P<0.001 in men, and r=0.326, P<0.001 in women) and non-HDL-C (r=0.376, P<0.001 in men, and r=0.349, P<0.001 in women). When apoB and non-HDL-C were mutually adjusted, the ORs for the MetS of non-HDL-C were not significant. As a function of the quartile of apoB levels, the ORs for the MetS were 2.04 (1.26-3.30), 3.54 (2.11-5.93), and 5.38 (3.16-9.17) in men (P for trend <0.001) and 3.75 (1.42-9.87), 5.55 (2.09-14.69), and 13.41 (5.02-35.79) in women (P for trend <0.001), respectively. These findings indicate that apoB is a better marker than non-HDL-C for identifying the MetS among Koreans.

Prevalence of obesity and metabolic syndrome in Korean adults

We studied the prevalence and trend of obesity and metabolic syndrome in Korean adults aged at least 20 years using Korean National Health Examination and Nutrition Survey data from 1998 and 2001. The prevalence of body mass index (BMI) > or = 25 kg m(-2) among Korean adults in 2001 was 32.9% in men and 27.4% in women, and the number of Korean men with BMI > or = 25 kg m(-2) has increased markedly since 1998. A significant positive association between obesity and socioeconomic status was found in Korean men, whereas a significant negative association was identified in Korean women. The prevalence rates of waist circumference (WC) > or = 90 cm in men and WC > or = 85 cm in women were 23.4% and 23.1% in 2001 respectively. The prevalence of metabolic syndrome among Korean adults was 15-30% according to various criteria of metabolic syndrome. Future studies are needed to determine the changes in prevalence of obesity and contributing factors for obesity in Koreans.

Effects of exercise-induced weight loss on acylated and unacylated ghrelin in overweight children

OBJECTIVE

Controversial data on ghrelin concentration during exercise in human subjects have been published. We tested the hypothesis that exercise could affect acylated ghrelin (AG) and unacylated ghrelin (UAG), which could partly explain the previously reported inconsistent findings on the association of exercise with changes in ghrelin.

DESIGN

A prospective randomized study.

PATIENTS AND MEASUREMENTS

We randomized 17 overweight volunteers (11-year-old boys) to a 12-week combined exercise group (EG, n = 8) or control group (CG, n = 9). At baseline, 1, 4 and 12 weeks, we measured body weight and composition, insulin, leptin, total ghrelin and acylated ghrelin.

RESULTS

Compared with the CG, body weight, percentage body fat and homeostatic model assessment (HOMA) indices were significantly lower throughout the 12 weeks in the EG. Total ghrelin and UAG levels gradually increased to 131.9 +/- 5.2% and 130.4 +/- 5.2% of baseline, respectively, at week 12 in the EG, whereas AG concentration remained unchanged throughout the 12 weeks both within each group and between the groups. At week 12, there were differences in the total ghrelin level and UAG level between the groups.

CONCLUSIONS

This study shows an increase in unacylated acylated ghrelin and unchanged acylated ghrelin after a 12-week combined exercise programme in overweight children. These findings provide evidence of favourable effects of exercise on improving energy metabolism.

Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans

OBJECTIVES

We examined whether racial discrimination is associated with increased body mass index (BMI) and obesity among Asian Americans. Further, we explored whether this association strengthens with increasing time in the United States.

METHODS

We analyzed data from the 2002 to 2003 National Latino and Asian American Study (n=1956). Regression models tested whether reports of racial discrimination were associated with BMI and obesity, after accounting for weight discrimination, age, gender, marital status, ethnicity, generation, employment, health status, and social desirability bias (the tendency to seek approval by providing the most socially desirable response to a question).

RESULTS

We found that (1) racial discrimination was associated with increased BMI and obesity after we controlled for weight discrimination, social desirability bias, and other factors and (2) the association between racial discrimination and BMI strengthened with increasing time in the United States.

CONCLUSIONS

Racial discrimination may be an important factor related to weight gain among ethnic minorities.

Are non-prescription medications needed for weight control?

At any one time large numbers of people are attempting to control their weight. Women are the principal consumers of weight-control programs. Their options, outside the prescription drug market and surgical treatment, include diets and diet books, exercise alone or with supervision in exercise facilities, dietary supplements, group programs, doctors, dietitians, psychologists, and other health-care professionals. Non-prescription products available to help people control their weight cover a wide range, including herbal dietary supplements, diet drinks and portion-controlled foods, meal replacements, and low-carbohydrate diets and foods. The introduction of orlistat as an over-the-counter (OTC) product will provide the only Food and Drug Administration (FDA)-approved product for weight loss currently in that category since phenylpropanolamine (PPA) was withdrawn by the FDA. The FDA approval process is considerably more expensive than allowing untested herbal supplements to be marketed without testing, but the added safety evaluation by the FDA will reduce the risk of disastrous outcomes that have plagued many approaches to weight control. Support for a place for orlistat as an OTC product includes the inadequacy of current programs, empowerment of the public, lower cost, and bringing pharmacists into weight-control programs. The downside includes improper use of OTC orlistat that may not result in achieving individual expectations.

Effects of sibutramine and orlistat on mood in obese and overweight subjects: a randomised study

BACKGROUND AND AIM

Intentional weight loss results in improvement in mood. Very few data exist regarding the effects of sibutramine on the mood of obese and overweight patients in general clinical samples. Moreover, no study has evaluated the effects of orlistat treatment on mood. The purpose of our study was to assess the effects of sibutramine and orlistat on mood in obese and overweight subjects.

METHODS AND RESULTS

Sixty obese and overweight women were divided into three groups. The first group (n=20) received a low-calorie diet and sibutramine 10mg; the second group (n=20) received a low-calorie diet and orlistat 120 mg three times a day, and the third group received only the low-calorie diet.

CONCLUSION

A psychiatric assessment was performed with the Hamilton Depression Rating Scale (HAMD) before and after 3 months of treatment. In all the groups a statistically significant decrease in HAMD scores was observed. However, the decrease in the sibutramine group was greater compared to that observed in the two other groups (P<0.01). These results suggest that sibutramine treatment may improve mood more than diet alone or orlistat therapy in a general clinical sample of obese patients.

The TANTALUS system for obesity: effect on gastric emptying of solids and ghrelin plasma levels

BACKGROUND

Gastric electrical stimulation (GES), using the implantable TANTALUS System, is being explored as a treatment for obesity. The system delivers nonstimulatory electrical signals synchronized with gastric slow waves, resulting in stronger contractions. We hypothesized that this GES may enhance gastric emptying and as a result affect plasma ghrelin and insulin homeostasis. The aim was to test the effect of GES on gastric emptying of solids and on ghrelin and insulin blood levels in obese subjects.

METHODS

The system consists of 3 pairs of gastric electrodes connected to an implantable pulse generator. Gastric emptying test (GE) of solids was performed twice, on separate days, a few weeks after implantation, before and after initiation of stimulation. Blood samples for ghrelin and insulin were taken at baseline and at 15, 30, 60 and 120 min after the test meal.

RESULTS

There were 11 females, 1 male, mean age 39.1 +/- 8.9 years, mean BMI 41.6 +/- 3.4. Data is available from 11 subjects; GE was normal in 9 subjects and accelerated in 2 subjects. GES significantly accelerated GE compared to control: percent retention at 2 hours 18.7 +/- 12.2 vs 31.9 +/- 16.4, respectively (P < 0.01). Overall, there was no significant change in ghrelin or insulin profile after food intake. Ghrelin levels fell significantly at 60 min compared to baseline during stimulation (P = 0.014) and control (P = 0.046).

CONCLUSION

GES results in a significant acceleration of gastric emptying of solids in obese subjects. GES did not have a significant effect on postprandial ghrelin levels when compared to control.

A new 'crowded uterine horn' mouse model for examining the relationship between foetal growth and adult obesity

Obesity is an increasing health problem, not only in developed countries but also all over the world. In addition to the focus on food intake and energy expenditure, current studies suggest two other important influences on adult body weight: birth weight and postnatal rate of growth. A common procedure in laboratory animal studies to examine the relationship of low birth weight and adult obesity is maternal nutrient restriction, but maternal undernutrition is not the basis for the majority of obese individuals in developed countries. We have thus developed a new mouse model for human obesity referred to as 'the crowded uterine horn model'. By removing one ovary from a female CD-1 mouse, the female produces a litter of about 13 pups in one uterine horn, resulting in crowding and a 4-fold difference in placental blood flow among foetuses in a litter. Restricted placental blood flow results in intrauterine growth restriction (IUGR); these animals show a 2-fold increase in body weight during the week after weaning, while macrosomial foetuses that go through a very small amount of growth during the same postnatal period. Male mice categorized as IUGR or macrosomic at birth both are obese in adulthood. This pattern of changes in body weight throughout life in male mice mirrors findings from epidemiological studies of human foetuses with IUGR and macrosomia who become obese, and thus may provide a new model that reflects the condition of people in developed countries who become obese.

Metabolic syndrome in sub-Saharan Africa: "smaller twin" of a region's prostatic diseases?

Prostate cancer (PC) and benign prostate hyperplasia (BPH) constitute many of the health concerns of males around the world. Prostate cancer is the major cause of death after lung cancer in men. Benign prostate hyperplasia affects most males above 40 years of age. A variety of factors, chiefly age, genetics and lifestyle, have been linked to the development of PC and BPH. The metabolic syndrome describes a chain of chronic disorders that are inter-related in aetiology, and result from unhealthy lifestyles, often due to an affluent economy. The eating of processed foods and a sedentary lifestyle apparently are status symbols among the middle and upper classes in sub-Saharan Africa. These have resulted in a surge in the disease burden of sub-Saharan Africa. This paper looks at the aetiology and prevalence of the metabolic syndrome and prostatic diseases, especially in sub-Saharan Africa. Evidence from the available literature shows that prostate disorders may be related to the metabolic syndrome. There is a likelihood that if sub-Saharan Africans keep copying the lifestyles of the developed world, especially in the direction of the nature of food items consumed, then the rising prevalence of diseases of the metabolic syndrome and the attendant prostate disorders may become very formidable healthcare "twin" problems for the region.

Prevalence of metabolic syndrome and associated risk factors among Turkish adults: Trabzon MetS study

OBJECTIVE

In order to estimate the prevalence of metabolic syndrome (MetS) as defined by NCEP Adult Treatment Panel III (ATP III) criteria in the Trabzon Region and its associations with demographic factors (age, sex, marital status, reproductive history in women, and level of education), socioeconomic factors (household income and occupation), family history of selected medical conditions (diabetes, hypertension, and obesity), lifestyle factors (smoking habits, physical activity, and alcohol consumption) in the adult population.

RESEARCH METHODS AND PROCEDURES

In this cross-sectional survey, a sample of households was systematically selected from the central province of Trabzon and its nine towns. A total of 4,809 adult subjects > or = 20 years (2,601 women and 2,208 men) were included in the study. Blood pressure levels were measured for all subjects. The persons included in the questionnaire were invited to the local medical centers for blood examination between 08:00 and 10:00 following 12 h of fasting. Fasting serum glucose (FBG) levels and lipid profile were measured with autoanalyzer. MetS was defined according to guidelines from the NCEP ATP III diagnostic criteria.

RESULTS

The prevalence of MetS was 26.9%: 31.3 in women and 21.7% in men. The prevalence increased with age, being highest in the 60-69-year-old age group (53.4%) but lower again in the > or = 70 age group. MetS was associated positively with marital status, parity, cessation of cigarette smoking, and negatively with the level of education, alcohol consumption, current cigarette use, household income, and physical activity. Hypertension was found as the most common MetS component in our study (57.4%). Others in decreasing order were abdominal obesity (40.9%), low high-density lipoprotein-C (HDL-C) (31.8%), hypertriglyceridemia (30.7%), and high FBG levels (9.2%). Similarly, in the subjects diagnosed with MetS, HT had the highest prevalence (91.9%). This was followed by abdominal obesity (82.3%), hypertriglyceridemia (74%), low HDL-C (68.6%), and high fasting blood glucose levels (28.6%).

DISCUSSION

MetS is moderately common and an important health problem in the adult population of Trabzon. In order to control MetS and its components, effective public health education and taking urgent steps are needed. These steps include serious education, providing a well-balanced diet and increasing physical activity.

Relationship between nonalcoholic fatty liver disease prevalence and visceral fat in obese adolescents

BACKGROUND

Visceral adiposity is the major risk factor for paediatric nonalcoholic fatty liver disease.

AIMS

Determine the prevalence of nonalcoholic fatty liver disease according to the visceral fat quartile.

SUBJECTS

181 obese adolescents including 113 girls (16.58+/-1.56 years) and 68 boys (16.87+/-1.62 years) were evaluated.

METHODS

The inclusion criteria were obesity and post-pubertal stage of Tanner. Visceral fat of obese adolescents was distributed in quartiles after ultrasound nonalcoholic fatty liver disease diagnosis.

RESULTS

Nonalcoholic fatty liver disease prevalence was 45.30%. It was observed that 62.07% and 76.47% of girls and boys with nonalcoholic fatty liver disease were found in the 4th quartile. In a multivariate logistic analysis it was observed that only visceral fat remained statistically significant, every 1cm increase in visceral fat was associated with a 1.97 fold (95% CI 1.06-3.66) in boys and 2.08 fold (95% CI 1.38-3.13) in girls increased risk to develop nonalcoholic fatty liver disease. Indeed it was verified a positive correlation between visceral fat, body mass index, insulin levels, homeostasis model assessment insulin resistance index and steatosis degree.

CONCLUSIONS

Our findings suggested that the expansion of visceral fat was a determinant factor to increase nonalcoholic fatty liver disease prevalence and the visceral fat measured by ultrasound might be a good predictor to identify risk for nonalcoholic fatty liver disease in obese adolescents. It was confirmed by a stronger correlation between visceral fat and body mass index.

What is the present pathogenetic concept of glaucomatous optic neuropathy?

Glaucomatous optic neuropathy implies loss of neural tissue, activation of glial cells, tissue remodeling, and change of blood flow. The blood flow reduction is not only secondary but has a primary component. Activation of astrocytes leads to an altered microenvironment. An unstable ocular perfusion, either due to IOP fluctuation or a disturbed autoregulation (due to primary vascular dysregulation syndrome) leads to a mild reperfusion injury. The superoxide (O(2)(-)) anion produced in the mitochondria of the axons, fuses with the nitric oxide (NO) diffusing from the astrocytes, leading to the damaging peroxynitrite (ONOO(-)). It is possible that the diffusion of endothelin and metalloproteinases to the surrounding of the optic nerve head leads to a local vasoconstriction and thereby increases the risk for venous occlusion and weakens the blood-brain barrier, which in extreme situations results in splinter hemorrhages. Activated retinal astrocytes can be visualized clinically. The involvement of primary vascular dysregulation in the pathogenesis of glaucomatous optic neuropathy may explain why women, as well as Japanese, suffer more often from normal-tension glaucoma.

[Pathophysiology and therapy of benign prostatic hyperplasia]

Benign prostatic hyperplasia (BPH) and benign prostatic enlargement (BPE) are among the most frequent medical disorders of elderly men and cause a number of annoying symptoms of the lower urinary tract (LUTS), leading to reduced quality of life and severe complications, including acute urinary retention. Nodular overgrowth of the epithelium and in particular the fibromuscular tissue is observed in the transition zone and periurethral areas. In particular, functional and phenotypic transdifferentiation of fibroblasts into myofibroblasts is a hallmark of the tissue remodeling in the benign hyperplastic prostate. BPH/BPE have a complex pathophysiology with a multitude of endocrine and local factors involved. Two risk factors, namely aging and circulating androgens, contribute significantly to risk of BPH/BPE. One of the primary initiating mechanisms appears to be a consequence of age-related changes in systemic sex steroid hormone levels accompanied by alterations in local androgen metabolism. This results in the disruption of the delicate balance of interacting growth factor signaling pathways and stromal/epithelial interactions generating a growth promoting and tissue remodeling microenvironment that leads to an increase in prostate volume. Secondarily, altered cytokine and chemoattractant production by the remodeled stroma promotes local inflammation that may further contribute to disease progression via lymphocyte-derived inflammatory cytokines and reactive oxygen/nitrogen species. Local hypoxia as a result of increased oxygen demands of proliferating cells may induce low levels of reactive oxygen species promoting neovascularization and fibroblast-to-myofibroblast transdifferentiation. Medical therapies for LUTS due to BPH/BPE have changed little over the past 15 years with mainstay treatments being alpha-adrenoreceptor blockade and 5alpha-reductase inhibitors. We provide an in depth view of the mechanisms underlying BPH/BPE and relate new research findings to the clinical picture with the prospect of novel therapeutic targets, including selective hormone antagonists/agonists, anti-stromal therapy, vitamin-D analogues and approaches to redress the redox imbalance.

Visceral adipose tissue as a predictor for metabolic risk factors in the Korean population

AIMS

Visceral adipose tissue (VAT) accumulation is closely associated with an increased risk of cardiovascular disease. We have investigated the appropriate VAT cut-off values for predicting metabolic risk factors in the Korean population.

METHODS

We assessed 276 men and 540 women aged 17-69 years who were undergoing regular health examinations. Anthropometry, metabolic risk factors and VAT area determined by computed tomography were measured. Receiver-operating characteristic (ROC) analysis was used to define VAT cut-off points for metabolic risk factors.

RESULTS

Based on the first quintile of VAT, the odds ratios for having metabolic risk factors increased significantly with each VAT quintile in both men and women. Using ROC analysis, the appropriate VAT cut-offs for metabolic risk factors were 100 cm(2) in men and 70 cm(2) in women. Regression lines indicated that, in men, a VAT of 100 cm(2) corresponded to a waist circumference of 88.1 cm and a body mass index (BMI) of 24.9 kg/m(2); in women, a VAT of 70 cm(2) corresponded to a waist circumference of 84.0 cm and a BMI of 25.1 kg/m(2).

CONCLUSION

VAT cut-offs of 100 cm(2) in men and 70 cm(2) in women are useful for defining visceral obesity in Korean subjects. These VAT cut-offs were validated by the ethnic-specific cut-offs for waist circumference and BMI for Korean individuals.

Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea

STUDY OBJECTIVES

Nonalcoholic fatty liver disease (NAFLD) is a disorder that often presents with elevated serum aminotransferase levels. Although it has classically been linked with the metabolic syndrome, recent studies suggest NAFLD may also be associated with obstructive sleep apnea (OSA). This study evaluates the association between serum aminotransferase levels and factors connected with: either the metabolic syndrome (elevated body mass index [BMI], lipid profile, blood pressure, fasting glucose), or with OSA severity (apnea hypopnea index, lowest oxygen saturation level, oxygen desaturation index, percent of time below 90% saturation [%T<90]).

DESIGN

Retrospective case series.

PATIENTS AND SETTING

109 adult patients with OSA at a university hospital general clinical research center.

MEASUREMENTS AND RESULTS

Markers of hypoxia (lowest oxygen saturation level and %T<90), correlated significantly with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels (Pearson's r = -0.31 to -0.38, P <0.003), while apnea hypopnea index, body mass index, blood pressure, fasting glucose, triglyceride, and cholesterol levels did not. Hierarchical linear regression was then done to determine the best predictors of aminotransferase levels. Markers of metabolic syndrome were entered as one block and markers of sleep apnea as another. Regression analyses explained 16.3% of the variance in AST and 18.9% of the variance in ALT, with %T<90 playing the largest role.

CONCLUSIONS

In patients with obstructive sleep apnea, serum aminotransferase levels are better predicted by markers of oxygen desaturation than by factors traditionally associated with the metabolic syndrome.

Relation of serum total antioxidant status with metabolic risk factors in Korean adults

The purpose of the present study was to examine the relation of total antioxidant status (TAS) to metabolic risk factors in Korean adults. Anthropometric measures, blood pressure, serum lipids and fasting glucose were determined in 406 men and women. TAS was measured by using commercially available Randox kit. Serum TAS was significantly positively correlated with body weight (p=0.004), body mass index (BMI) (p=0.033), waist circumference (p=0.017), total cholesterol (p=0.038) and triglyceride (TG) (p<0.001). The mean TAS of hypertriglyceridemic subjects (TG ≥150 mg/dl) was significantly higher than that of subjects whose TG was lower than 150 mg/dl (p=0.001). When central obesity, TG, high density lipoprotein cholesterol, fasting glucose and blood pressure were considered as metabolic risk factors, TAS was shown to be elevated with increased number of metabolic risk factors (p=0.004). The positive association between TAS and a number of metabolic risk factors suggests that increased TAS may not always indicate one's healthier condition. In order to help understand TAS as a marker of total antioxidant capacity in humans with various metabolic conditions, it is needed to clarify the factors affecting TAS in relation to changes in metabolic risk factors.

Review article: The gastrointestinal tract: neuroendocrine regulation of satiety and food intake

BACKGROUND

The gastrointestinal tract elicits numerous signals regulating food intake and satiety, and recently many studies have been performed to elucidate the mechanisms regulating these signals.

AIM

To describe the effects of the gastrointestinal tract on satiety, satiation and food intake.

METHODS

A PubMed search was performed to identify and select the relevant literature using search terms including 'gastric satiety, intestine + satiety, satiation, cholecystokinin, ghrelin, peptide YY, glucagon-like peptide-1 and ileal brake'.

RESULTS

Satiation, satiety and food intake result, among other factors, from signals originating in the stomach caused by distension and signals from the small intestine. These intestinal signals result from nutrient sensing in the gut and activate neural and humoral pathways. Activation of the distal part of the gut, the so called ileal brake, leads to reduction in hunger and food intake, and models of chronic ileal brake activation lead to massive weight loss.

CONCLUSION

Gastrointestinal signals are crucial for the regulation of food intake, satiety and satiation. The ileal brake deserves special attention, as both ileal intubation studies and surgical studies demonstrate that activation of the ileal brake reduces food intake. In the surgical models, weight loss occurs without adaptation to the anorectic effects of ileal brake activation.

Impact of metabolic syndrome definitions on prevalence estimates: a study in a Portuguese community

This study compared the prevalence of metabolic syndrome (MS) according to World Health Organization (WHO), National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III), International Diabetes Federation (IDF) and American Heart Association/ National Heart, Lung and Blood Institute (AHA/NHLBI) definitions, to evaluate how well the different classifications agreed. The study also compared their 10-year predicted risk of coronary heart disease (CHD) with the Framingham risk score (FRS). Some 886 women and 547 men aged 18-92 years were included in the study. Demographic and personal medical history data were obtained at interview. Four operational definitions of MS were used (those of the WHO, NCEP-ATP III, AHA/NHLBI and IDF). The prevalence of metabolic syndrome was found to be 26.4% (WHO criteria), 24.0% (NCEP-ATP III criteria), 41.9% (IDF criteria) and 37.2% (AHA/NHLBI criteria). According to the definition used, central obesity ranged from 41.9% to 75.1% and high blood pressure from 52.9% to 65.8%. Agreement between classifications ranged from 75.2% (kappa=0.47) to 90.4% (kappa=0.80) and was lower in males. The 10-year predicted risk of CHD by FRS was similar between the different definitions. IDF and AHA/NHLBI definitions resulted in a higher prevalence of MS than the NCEP-ATP III or WHO definition. Overall, however, good agreement was found between definitions, and the predicted 10-year of CHD risk was similar.

Sedentary behaviour, physical activity and a continuous metabolic syndrome risk score in adults

OBJECTIVE

The association of sedentary behaviour and leisure time physical activity with a validated continuous metabolic syndrome risk score was investigated in adults.

SUBJECTS/METHODS

A number of 992 adults (559 men) without cardiovascular disease or diabetes. Subjects reported time spent in leisure time physical activity and television watching/computer activities. A validated metabolic syndrome risk score, based on waist circumference, triglycerides, blood pressure, fasting plasma glucose and high-density lipoprotein cholesterol, was used. The metabolic syndrome risk score and time spent in sedentary behaviour and physical activity were analysed as continuous variables using multiple linear regression.

RESULTS

Metabolic syndrome risk was positively associated with time spent watching television/computer activities, irrespective of physical activity level, and after adjustment for age, education level, smoking status and dietary intake in women aged > or =45 years (beta=0.184, P<0.05). Independent of the time being sedentary, moderate to vigorous leisure time physical activity was inversely associated with metabolic syndrome risk in men (<45 years: beta=-0.183, P<0.01; > or =45 years: beta=-0.192, P<0.01) and women aged > or =45 years (beta=-0.203, P<0.01).

CONCLUSIONS

Although cross-sectional, the present results support inclusion of efforts to decrease sedentary behaviour in metabolic syndrome prevention strategies for women aged > or =45 years, besides promotion of moderate to vigorous physical activity, since both behavioural changes might show additional effects.

Metabolic syndrome: treatment of hypertensive patients

Metabolic syndrome (MetSyndr), a constellation of abnormalities [obesity, glucose intolerance, insulin resistance (IR), dyslipidemia (low HDL-cholesterol, high LDL-cholesterol and triglycerides (TG)], and elevated blood pressure (BP)], increases the risk of cardiovascular (CV) disease and premature death. From 10% to 30% of the adult population in industrialized countries has MetSyndr, which effectively predicts the development of type 2 diabetes mellitus (T2D) and CV disease. Because of the complex etiology of MetSyndr, a multi-targeted, integrated therapeutic approach is required to simultaneously treat high BP, obesity, lipid disorders and T2D (if present), to fully protect CV, cerebrovascular and renal systems. If lifestyle modification (weight control, diet, exercise, smoking cessation, moderation of alcohol intake) is ineffective, pharmaco-theraphy should be added to treat simultaneously the lipid- and non-lipid CV risk factors. Patients with HTN and MetSyndr should be started on angiotensin-converting enzyme (ACE) inhibitors, unless contraindicated. The ACE inhibitors and angiotensin receptor blockers (ARBs) reduce the odds of developing new onset T2D and also decrease albuminuria. The ACE inhibitors provide cardioprotective and renoprotective benefits beyond their effect on BP; they also improve IR. The ARBs are renoprotective in addition to being cardioprotective. Long-acting calcium channel blockers are also recommended in hypertensive patients with MetSyndr; these drugs also improve IR. Thiazides (at low doses) and selected ss-blockers can be given to patients with HTN and MetSyndr. Celiprolol in combination with diuretics has a favorable effect on glucose tolerance and IR in patients with HTN and MetSyndr, and spironolactone added to ACE inhibitor or ARB therapy provides additional reno- and CV protective benefits in patients with diabetic nephropathy. Carvedilol, a ss-blocker with vasodilating properties, added to ACE inhibitor or ARB therapy, is effective in preventing worsening of microalbuminuria in patients with HTN and MetSyndr; it also improves IR and glycemic control. Most patients eventually require two or more antihypertensive drugs to reach BP goal. It is recommended that therapy in patients whose BP is more than 20/10 mm Hg above target at diagnosis be initiated with a combination of antihypertensive drugs, administered either as individual drugs or as fixed-dose formulations. Treatment with fixed-dose combinations, such as irbesartan + hydrochlorothiazide provides good BP control in more than two-thirds of hypertensive patients with MetSyndr. Lipid and BP targets are reached in a high percent of patients with HTN and CV disease treated with a combination of amlodipine + atorvastatin. In conclusion, hypertensive patients with the MetSyndr be treated aggressively for each component of the syndrome to provide CV, cerebrovascular and renal protection.

Prevalence and correlates of erectile dysfunction (ED) and treatment seeking for ED in Asian Men: the Asian Men's Attitudes to Life Events and Sexuality (MALES) study

INTRODUCTION

There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED).

AIMS

The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan).

MAIN OUTCOME MEASURE

Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia.

METHODS

Phase I of the study involved 10,934 adult men, aged 20-75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N = 1,209).

RESULTS

The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P < 0.01). Men with ED reported significantly greater rates of comorbid illness (P < 0.0001) and a reduced quality of life (P = 0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P = 0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia.

CONCLUSION

The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights a substantial need for the evaluation and treatment of ED in Asian men.

Considerable disagreement among definitions of metabolic syndrome for Japanese

BACKGROUND

The purpose of the present study is to examine the agreement of various existing definitions of metabolic syndrome for Japanese.

METHODS AND RESULTS

One hundred thirty-two apparently healthy men and 147 apparently healthy women underwent testing and diagnosis for metabolic syndrome using 5 different definitions of metabolic syndrome for Japanese, including a newly proposed definition: a modified National Cholesterol Education Program definition replacing abdominal obesity with C-reactive protein. The agreement of these various definitions of metabolic syndrome was studied using an agreement index defined as the number of subjects who met both definitions divided by the number of subjects who met either of the 2 definitions. Agreement indices among these various definitions of metabolic syndrome for Japanese were between 0.19 and 0.6 in men and between 0.31 and 0.89 in women. The average agreement index was 0.41 in men and 0.51 in women, and the overall agreement index was 0.15 in men and 0.21 in women.

CONCLUSIONS

There was considerable disagreement among various definitions of metabolic syndrome for Japanese. Therefore, diagnosis with this syndrome should not be made until a truly consensual definition of metabolic syndrome can be established.

Food reinforcement and eating: a multilevel analysis

Eating represents a choice among many alternative behaviors. The purpose of this review is to provide an overview of how food reinforcement and behavioral choice theory are related to eating and to show how this theoretical approach may help organize research on eating from molecular genetics through treatment and prevention of obesity. Special emphasis is placed on how food reinforcement and behavioral choice theory are relevant to understanding excess energy intake and obesity and how they provide a framework for examining factors that may influence eating and are outside of those that may regulate energy homeostasis. Methods to measure food reinforcement are reviewed, along with factors that influence the reinforcing value of eating. Contributions of neuroscience and genetics to the study of food reinforcement are illustrated by using the example of dopamine. Implications of food reinforcement for obesity and positive energy balance are explored, with suggestions for novel approaches to obesity treatment based on the synthesis of behavioral and pharmacological approaches to food reinforcement.

Lack of an acute effect of ghrelin on markers of bone turnover in healthy controls and post-gastrectomy subjects

BACKGROUND

Ghrelin is a gut-brain peptide that powerfully stimulates appetite and growth hormone secretion and is also known to directly regulate osteoblast cell function in vitro and in animal models. Little is known about the effects of ghrelin on bone turnover in humans. As the stomach is the main site of ghrelin synthesis, gastrectomy patients are deficient in ghrelin; they are also prone to osteopenia and osteomalacia.

HYPOTHESIS

Ghrelin may play a role in bone regulation in humans; ghrelin deficiency following gastrectomy is associated with the disrupted regulation of bone turnover seen in these subjects.

SUBJECTS AND METHODS

In a randomised, double-blind, placebo-controlled study 8 healthy controls and 8 post-gastrectomy subjects were infused with intravenous ghrelin (5 pmol/kg/min) or saline over 240 min on different days. Subjects were given a fixed energy meal during the infusion. Ghrelin, GH, type-1 collagen beta C-telopeptide (betaCTX), a marker of bone resorption, and procollagen type-1 amino-terminal propeptide (P1NP), a marker of bone formation, were measured.

RESULTS

Fasting ghrelin was significantly lower in the gastrectomy group during the saline infusion (226.1+/-62.0 vs. 762+/-71.1 ng/l p<0.001). Growth hormone was significantly higher at 90 min after the ghrelin infusion, compared to saline in both healthy controls (61.1+/-8.8 vs. 1.4+/-0.6 mIU/l p<0.001) and gastrectomy subjects (61.1+/-11.8 vs. 0.9+/-0.2 mIU/l p<0.001) confirming the ghrelin was bioactive. Gastrectomy subjects were significantly older and had significantly higher plasma betaCTX than healthy controls at all time points (ANOVA p=0.009). After adjustment for age and BMI ghrelin was found to be a significant predictor of baseline plasma betaCTX and was inversely correlated with baseline plasma betaCTX (beta=-0.54 p=0.03 R2=26%). However, there was no significant effect of the ghrelin infusion on plasma betaCTX or P1NP in either subject group.

CONCLUSIONS

Ghrelin infusion has no acute effect on markers of bone turnover in healthy controls and post-gastrectomy subjects, but is inversely correlated with bone resorption.

Prevalence and biopsychosocial correlates of erectile dysfunction in Hong Kong: a population-based study

OBJECTIVES

To describe the prevalence of erectile dysfunction (ED) in Hong Kong and identify the biopsychosocial correlates of ED.

METHODS

This was a descriptive and analytic population-representative cross-sectional study of ED in Hong Kong. The study subjects were 1506 men aged 26 to 70 years, recruited by two-stage stratified random sampling, and interviewed face-to-face by trained interviewers with structured questionnaires.

RESULTS

The overall prevalence of ED was 36.7% (95% confidence interval [CI] 33.7 to 39.7). The age-specific prevalence rate was 18.3% (95% CI 11.1% to 25.4%), 28.6% (95% CI 23.5% to 33.6%), 37.9% (95% CI 32.3% to 43.5%), 47.3% (95% CI 40.1% to 54.5%), and 61.1% (95% CI 51.1% to 71.0%) for the age groups 26 to 30, 31 to 40, 41 to 50, 51 to 60, and 61 to 70 years, respectively. The severity of ED increased with age (P <0.01), and sexual satisfaction decreased with age (P = 0.01). Age (odds ratio [OR] 1.26, P <0.01), living on Hong Kong Island (OR 0.71, P = 0.04), General Health Questionnaire score (OR 1.03, P <0.01), current smokers of 30 or more cigarettes per day (OR 2.11, P = 0.05), and hours spent on work, housework, and self-study (OR 0.945, P = 0.03) were independently associated with ED.

CONCLUSIONS

To our knowledge, this is the first population-representative study of ED in Hong Kong. The prevalence and severity of ED increased with age, and we found biological (age), psychological (General Health Questionnaire), and social (smoking, Hong Kong district, "hours spent on work") factors to have independent influences on ED. The negative association between "hours spent on work" and ED is a novel finding. The results of this study have shown that Hong Kong has a high prevalence of ED compared with Western populations.

Clinical significance of ghrelin concentration of plasma and tumor tissue in patients with gastric cancer

BACKGROUND

The nutritional status of gastric cancer patients is an important factor determining the outcome after a gastrectomy. Ghrelin is produced primarily in the gastrointestinal tract including the stomach, and has been reported to reflect the nutritional status and control homeostasis by influencing the level of food intake and adiposity. This study examined the difference in the plasma and tissue ghrelin levels according to the clinicopathological features and the extent of a gastric resection in gastric cancer patients who underwent a gastrectomy.

PATIENTS AND METHODS

Eighty patients over a 3 mo-period were divided into two groups according to the degree of preoperative weight loss (weight loss > or = 5% or < 5%) and the extent of the gastrectomy (subtotal or total gastrectomy). Blood samples were collected from all patients preoperatively and on postoperative day 7. The gastric tissues samples, including the tumor and normal tissues, were obtained from the resected stomach. The ghrelin levels in the plasma and tissue were measured using a commercial enzyme-linked immunosorbent assay kit.

RESULTS

There were no significant differences in the clinical characteristics and ghrelin levels in the plasma, gastric tumor tissue, and normal tissue according to the degree of weight loss. There was no correlation between the ghrelin levels in the plasma and tumor tissue. However, the ghrelin level in the tumor tissue was significantly lower than that in the normal tissue. There was an association between the degree of cellular differentiation and ghrelin production. A gastrectomy decreased the plasma ghrelin levels and nutritional index such as the body mass index, triceps skin fold, mid-arm muscle circumference, and biochemical markers regardless of the extent of the gastric resection.

CONCLUSIONS

Gastric cancer affects the production of ghrelin in the gastric mucosa. Moreover, ghrelin is produced mainly in the stomach even though it might be partially covered by the endogenous ghrelin produced by other organs after gastrectomy. However, more study will be needed to determine if there are other factors that have an impact on energy consumption, ghrelin secretion, and the changes in the ghrelin level after a gastrectomy.

Prevalence of metabolic syndrome in Iranian adult population, concordance between the IDF with the ATPIII and the WHO definitions

BACKGROUND

Different criteria have been proposed by the WHO, the ATPIII and the International Diabetes Federation (IDF) for the diagnosis of the metabolic syndrome (MES). The objective of this study was to estimate the prevalence of this syndrome using the IDF definition among Iranian adults and to compare it with the prevalence estimated using the two other definitions.

MATERIALS AND METHODS

The prevalence of the MES was determined according to the three different proposals in 10,368 men and women aged >/=20 years participated in the cross-sectional phase of the Tehran Lipid and Glucose Study. To assess the degree of agreement between different MES definitions, the k test was used.

RESULTS

The prevalence of MES (95% confidence interval) was 32.1% (31.2-33.0) by the IDF definition, 33.2% (32.3-34.1) by the ATPIII and 18.4% (17.6-19.2) according to the WHO definition. The sensitivity, specificity of the IDF definition for detecting MES were 91%, 89% for the ATPIII and 73%, 77% for the WHO definition, respectively. The k statistics for the agreement of the IDF definition was 66.3+/-0.01 with the ATPIII and 39.5+/-0.01 with the WHO definition.

CONCLUSION

In the Iranian population, the IDF definition for MES has a good concordance with the ATP III definition and a low concordance with the WHO definition.

Plasma obestatin levels are lower in obese and post-gastrectomy subjects, but do not change in response to a meal

OBJECTIVE

To investigate a potential role for obestatin in humans by examining response to a fixed energy meal.

CONTEXT

A new anorectic peptide hormone, obestatin has recently been isolated from rat stomach. The significance of this peptide in humans is unknown.

STUDY DESIGN

Case-control study.

SETTING

Hospital-based study.

PATIENTS

Nine healthy controls, nine morbidly obese subjects and eight post-gastrectomy subjects.

INTERVENTION

Subjects attended after an overnight fast and were given a fixed energy meal (1550 kJ).

MAIN OUTCOME MEASURE

The response of obestatin to a meal in the different groups.

RESULTS

Fasting obestatin was significantly lower in obese subjects as compared to lean subjects (27.8+/-4 vs 17.2+/-2 pg/ml, P=0.03). Obestatin was also decreased in gastrectomy subjects but this did not reach statistical significance (27.8+/-4 vs 21.9+/-3 pg/ml, P=0.3). Obestatin did not change significantly from baseline in response to the meal. Lean and obese subjects had a similar obestatin/ghrelin ratio (0.04+/-0.003 vs 0.05+/-0.009, P=0.32), but this was higher in the gastrectomy group (0.04+/-0.003 vs 0.1+/-0.01, P<0.001).

CONCLUSIONS

Obestatin does not vary significantly with a fixed energy meal, but is significantly lower in morbidly obese subjects as compared to lean subjects supporting a possible role for obestatin in long-term body weight regulation. Obestatin tended to be lower in gastrectomy subjects and their obestatin/ghrelin ratio differed from healthy controls. Hence, the expression of obestatin is altered following gastrectomy, suggesting other sites outside the stomach may also secrete obestatin.

Prevalence of the metabolic syndrome among Korean adults using the new International Diabetes Federation definition and the new abdominal obesity criteria for the Korean people

This study was performed to compare the prevalence of the metabolic syndrome according to the International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) definitions, and abdominal obesity criteria of WHO and the Korean Society for the Study of Obesity (KSSO) in Korean adults. A total of 4452 adults aged > or =20 years from the Korean National Health and Nutrition Examination Survey 2001 were analyzed. The prevalence of the metabolic syndrome estimated by NCEP definition with WHO criteria, NCEP with KSSO, IDF with WHO, and IDF with KSSO were 26.7%, 23.7%, 23.8% and 17.5%, respectively. The agreement percent among the four definitions ranged from 88.7% to 100% in men, and from 85.6% to 94.9% in women. The NCEP-defined metabolic syndrome was more strongly associated with hypertension and diabetes than the IDF-defined metabolic syndrome (age-adjusted odds ratio: 5.1 versus 3.6 for hypertension and 6.4 versus 3.2 for diabetes in men, respectively; 5.4 versus 3.4-4.3 for hypertension and 11.1 versus 3.8-4.2 for diabetes in women, respectively). Both definitions of the metabolic syndrome were associated with coronary heart disease or stroke only in women. Prospective studies are warranted to evaluate the predictive ability of the new definition of the metabolic syndrome and the new criteria of abdominal obesity for cardiovascular morbidity and mortality in Korean adults.

Sexual satisfaction among patients after coronary bypass surgery or percutaneous transluminal angioplasty: Eight-year follow-up

BACKGROUND

Cardiovascular diseases are currently the leading cause of death worldwide. In addition to risk factor prevention, the treatment interventions of coronary artery disease (CAD) include medication, percutaneous transluminal coronary angioplasty (PTCA) with stenting, and coronary artery bypass grafting (CABG). Patients with CAD have a more than twofold risk of sexual dysfunctions compared with age-matched healthy persons. The physiologic changes in sexual satisfaction, such as erectile dysfunctions in men and impaired sexual arousal in women, correlate with the severity of CAD.

OBJECTIVES

The purpose of this study was to describe the long-term effects of treatment interventions on the sexual satisfaction of patients with CAD.

METHODS

The original study series consisted of 280 patients with CAD who were followed up for 8 years. There were 189 men and 91 women. At the baseline of the study, 100 patients underwent CABG, 100 patients underwent PTCA, and 80 patients were prescribed medication. Eight years later, we were able to reach 63 patients who underwent CABG, 50 patients who underwent PTCA, and 34 patients who were prescribed medication. Descriptive statistics, the chi-square test for testing group differences, and McNemar's test for dependent sample were used to analyze the data.

RESULTS

Sixty percent of the patients were satisfied with their sexual functions before the treatment interventions, and 63% were satisfied 8 years after the interventions; 52% of men and 77% of women were sexually satisfied before the interventions. Eight years later, 59% of men and 70% of women were satisfied with their sex life. In the CABG group, 57% of the patients were satisfied with their sexual functions preoperatively, whereas 62% were satisfied 8 years later. The corresponding results were 56% and 64% in the PTCA group and 73% and 62% in the medication group, respectively. Women were more satisfied with their sex life than men (P = .002) before the interventions. However, the satisfaction of women declined during the 8-year follow-up period, whereas that of men increased, but the change was not statistically significant.

CONCLUSION

The findings provide new knowledge about the long-term impacts of treatment interventions on the sexual satisfaction of patients with CAD.

Post-marketing surveillance study of the efficacy and safety of vardenafil among patients with erectile dysfunction in primary care

To evaluate the safety and efficacy of vardenafil in primary care, we undertook a post-marketing surveillance study in 384 men with erectile dysfunction (ED), enrolled by 22 family physicians in Korea, from July 2004 to August 2005. Of the 384 patients enrolled, 343 (89.3%) returned for efficacy assessment and safety evaluation. Among the latter, 279 patients (81.3%) reported that their erectile function improved, 292 (92.1%) showed enhanced IIEF (International Index of Erectile Function)-5 scores and 265 (77.9%) responded that they were 'very satisfied' or 'satisfied' with vardenafil treatment. The most frequent reason for patient satisfaction with vardenafil was erectile potency (62.4%), followed by safety (42.4%), rapid onset (35.3%), adequate duration of efficacy (28.5%) and easy administration (25.9%). A total of 23 adverse events were observed in 18 patients, with the most frequent being hot flushes (3.2%), followed by headache (1.2%), nasal congestion (0.6%), color vision disturbance (0.3%), dizziness (0.3%), dry mouth (0.3%), dyspepsia (0.3%), nausea (0.3%) and diarrhea (0.3%). Only one patient discontinued vardenafil as a direct result of an adverse event. These results suggest that vardenafil prescribed by primary care physicians improved erectile function and was well tolerated by patients with ED.

Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems

PURPOSE

Benign prostatic hyperplasia is generally not regarded as a preventable disease. However, accumulating evidence suggests that modifiable factors may influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms.

MATERIALS AND METHODS

A structured, comprehensive literature review was done to identify modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms among observational studies of older men.

RESULTS

Outcome measures used to define benign prostatic hyperplasia in clinical studies include histological analysis of prostate tissue, radiographically determined prostate enlargement, acute urinary retention, decreased urinary flow rate, pressure flow studies consistent with bladder outlet obstruction, history of benign prostatic hyperplasia surgery, physician diagnosed benign prostatic hyperplasia and American Urological Association symptom score or International Prostate Symptom Score. Factors that potentially increase the risk of benign prostatic hyperplasia and lower urinary tract symptoms include obesity and diabetes. Factors that potentially decrease the risk include increased physical activity and moderate alcohol consumption. Other candidate factors for which clear risk patterns have not yet emerged are dyslipidemia, hypertension, smoking, diet and environment.

CONCLUSIONS

Obesity, diabetes, physical activity and alcohol intake may substantially influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms in older men. Further analyses of these and other potential modifiable risk factors may identify novel interventions for the prevention, diagnosis and treatment of these highly prevalent conditions.

How should we manage patients with non-alcoholic fatty liver disease in 2007?

Evidence-based management guidelines for non-alcoholic fatty liver disease (NAFLD) are lacking in the Asia-Pacific region or elsewhere. This review reports the results of a systematic literature search and expert opinions. The Asia-Pacific Working Party on NAFLD (APWP-NAFLD) has generated practical recommendations on management of NAFLD in this region. NAFLD should be suspected when there are metabolic risk factors and/or characteristic changes on hepatic ultrasonography. Diagnosis by ultrasonography, assessment of liver function and complications, exclusion of other liver diseases and screening for metabolic syndrome comprise initial assessment. Liver biopsy should be considered when there is diagnostic uncertainty, for patients at risk of advanced fibrosis, for those enrolled in clinical trials and at laparoscopy for another purpose. Lifestyle measures such as dietary restrictions and increased physical activity (aerobic exercise) should be encouraged, although the best management strategy to achieve this has yet to be defined. Complications of metabolic syndrome should be screened for regularly. Use of statins to treat hypercholesterolemia is safe and recommended; frequent alanine aminotransferase (ALT) monitoring is not required. Obese patients who do not respond to lifestyle measures should be referred to centers specializing in obesity management; consideration should be given to bariatric surgery or gastric ballooning. The role of pharmacotherapy remains investigational and is not recommended for routine clinical practice. Non-alcoholic fatty liver disease should be recognized as part of the metabolic syndrome and managed in a multidisciplinary approach that addresses liver disease in the context of risk factors for diabetes and premature cardiovascular disease. Lifestyle changes are the first line and mainstay of management.