Microalbuminuria and the metabolic syndrome and its components in the Chinese population

Alcohol consumption and microvascular dysfunction: a J-shaped association: The Maastricht Study

BACKGROUND

Microvascular dysfunction (MVD) is an important contributor to major clinical disease such as stroke, dementia, depression, retinopathy, and chronic kidney disease. Alcohol consumption may be a determinant of MVD.

OBJECTIVE

Main objectives were (1) to study whether alcohol consumption was associated with MVD as assessed in the brain, retina, skin, kidney and in the blood; and (2) to investigate whether associations differed by history of cardiovascular disease or sex.

DESIGN

We used cross-sectional data from The Maastricht Study (N = 3,120 participants, 50.9% men, mean age 60 years, and 27.5% with type 2 diabetes [the latter oversampled by design]). We used regression analyses to study the association between total alcohol (per unit and in the categories, i.e. none, light, moderate, high) and MVD, where all measures of MVD were combined into a total MVD composite score (expressed in SD). We adjusted all associations for potential confounders; and tested for interaction by sex, and history of cardiovascular disease. Additionally we tested for interaction with glucose metabolism status.

RESULTS

The association between total alcohol consumption and MVD was non-linear, i.e. J-shaped. Moderate versus light total alcohol consumption was significantly associated with less MVD, after full adjustment (beta [95% confidence interval], -0.10 [-0.19; -0.01]). The shape of the curve differed with sex (P_interaction = 0.03), history of cardiovascular disease (P_interaction < 0.001), and glucose metabolism status (P_interaction = 0.02).

CONCLUSIONS

The present cross-sectional, population-based study found evidence that alcohol consumption may have an effect on MVD. Hence, although increasing alcohol consumption cannot be recommended as a policy, this study suggests that prevention of MVD may be possible through dietary interventions.

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

A rapid decline in renal function can cause many complications, and therefore it is important to detect associated risk factors. Few studies have evaluated the associations among obesity-related indices and metabolic syndrome (MetS) with renal function decline. This longitudinal study aimed to explore these relationships in a large cohort of Taiwanese participants. The studied obesity-related indices were waist-to-height ratio (WHtR), A body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), body roundness index (BRI), conicity index (CI), body mass index (BMI), body adiposity index (BAI) and abdominal volume index (AVI). We included 122,068 participants in the baseline study, of whom 27,033 were followed for a median of four years. The baseline prevalence of MetS was 17.7%. Multivariable analysis showed that the participants with MetS and high VAI, WHtR, WHR, LAP, CI, BRI, BMI, BAI, AVI, and ABSI values were significantly associated with a high baseline estimated glomerular filtration rate (eGFR) (all p < 0.001). In addition, the participants with MetS (p < 0.001), high WHtR (p = 0.007), low LAP (p < 0.001), high BRI (p = 0.002), high CI (p = 0.002), high AVI (p = 0.001), high VAI (p = 0.017), and high ABSI (p = 0.013) were significantly associated with a low △eGFR, indicating a rapid decline in renal function. These results showed associations between MetS and high values of obesity-related indices except LAP with high baseline eGFR and rapid decline in kidney function. These findings suggest that screening for MetS and obesity may help to slow the decline in renal function in high-risk populations.

Spot urinary microalbumin concentration, metabolic syndrome and type 2 diabetes: Tehran lipid and glucose study

AIM

This study aimed to determine the association of urinary microalbumin concentrations with type 2 diabetes mellitus (T2DM), metabolic syndrome (MetS), and its phenotypes. The optimum cut-off values of urinary microalbumin and microalbumin-to-creatinine ratio (MCR) for predicting the chance of having T2DM and MetS were also defined.

METHODS

Adult men and women (n = 1192) participated in the sixth phase (2014-2017) of the Tehran Lipid and Glucose Study (TLGS), with completed data, were included in the analyses. Odds ratios (ORs) (and 95% confidence intervals (CIs)) of T2DM, MetS, and its components across tertile categories of urinary microalbumin concentrations were estimated using multivariable logistic regressions. The optimal cut-off points of urinary microalbumin and MCR were determined using the receiver operator characteristic (ROC) curve analysis.

RESULTS

Participants' mean (±SD) age was 44.9 (±14.0) years, and 44.6% of the participants were men. The prevalence of microalbuminuria was 14.4%. Chance of having T2DM was significantly higher in the highest tertile of urinary microalbumin concentration (OR = 2.29, 95% CI = 1.43-3.67) and MCR (OR = 1.82, 95% CI = 1.15-2.89). Subjects with the highest urinary microalbumin concentration were more likely to have MetS (OR = 1.66, 95% CI = 1.17-2.35), hypertension (OR = 1.63, 95% CI = 1.16-2.30) and hyperglycemia (OR = 1.78, 95% CI = 1.24-2.56). No significant association was observed between urinary microalbumin concentrations and other components of MetS. The optimal cut-off points of urinary microalbumin for predicting the chance of having T2DM and MetS were 14.0 and 13.6 mg/L, respectively.

CONCLUSIONS

Elevated spot urinary microalbumin, below the values defined as microalbuminuria, was associated with the chance of having T2DM and MetS.

Association of microalbuminuria with metabolic syndrome: a cross-sectional study in Bangladesh

BACKGROUND AND AIMS

The objectives of this study were to estimate the prevalence of microalbuminuria and examine the association of microalbuminuria with metabolic syndrome (MetS) and its component in a Bangladeshi adult cohort.

METHODS

This cross-sectional study included 175 subjects (84 males and 91 females; aged 19-59 years), recruited from the outdoor Department of Medicine and Endocrinology of a medical college hospital in Dhaka, Bangladesh. Lipid profile and fasting blood glucose (FBG) were measured in serum and albumin and creatinine were determined in urine samples. Microalbuminuria was defined as the urinary albumin-to-creatinine ratio (ACR) of 30 to 300 mg/g. The MetS was defined according to the criteria of the National Cholesterol Education Program (NECP). The association of microalbuminuria with MetS and its components was evaluated by multivariate logistic regression analysis.

RESULTS

Among the study subjects, 66.3% were hypertensive and 70.3% were diabetic individuals. Overall, the prevalence of microalbuminuria was 29.7% with 31% in males and 28.6% in females. Microalbuminuria was 2.6 fold higher in hypertensive and diabetic adults than in the non-hypertensive or non-diabetic adults. The prevalence of microalbuminuria was much more frequent in persons with the MetS (36.0%) than the persons without the MetS (5.4%). The levels of FBG, systolic blood pressure (SBP), diastolic blood pressure (DBP) and triglycerides were significantly higher (p < 0.01 for all cases) in subjects with microalbuminuria. In regression analysis, after adjusting for sex, age, and body mass index, microalbuminuria was strongly correlated with MetS followed by elevated BP and FBG (p < 0.01 for all cases).

CONCLUSIONS

Microalbuminuria was strongly associated with MetS in Bangladeshi adults. Elevated BP and FBG were the most predominant components of MetS among the study subjects. Comprehensive management of MetS at its early stage can be effective to prevent and reduce the progression of kidney injury and cardiovascular complications.

How Clinically Relevant Is C-Reactive Protein for Blacks with Metabolic Syndrome to Predict Microalbuminuria?

Background: The metabolic syndrome (MetS) is associated with elevated urinary albumin (UA) excretion and C-reactive protein (CRP). However, potential differences in CRP levels on the association between individual components of the MetS and microalbuminuria (MA; 30-300 μg/mL) and/or UA (0-300 μg/mL) by race/ethnicity is unknown. Methods: We analyzed National Health and Nutrition Examination Surveys (NHANES) data, (1999-2010) for adults (≥20 years of age) with the MetS (N = 5700). The Sobel-Goodman mediation test examined the influence of CRP on the association between individual MetS components and both MA and UA by race/ethnicity. We applied machine learning models to predict UA. Results: CRP mediated the association between waist circumference (WC) and MA in Whites and Hispanics but not in Blacks. However, in general, the proportion of the total effect of MetS components on UA, mediated by CRP, was: 11% for high-density lipoprotein cholesterol (HDL-C) and 40% for WC (P < 0.001). In contrast to MA, the mediation effect of CRP for WC and UA was highest for Blacks (94%) compared with Whites (55%) or Hispanics (18%), P < 0.05. The prediction of an elevated UA concentration was increased in Blacks (∼51%) with the MetS when CRP was added to the random forest model. Conclusions: CRP mediates the association between UA and both HDL-C and WC in Whites and Blacks and between UA and WC in Hispanics. Moreover, the machine learning approach suggests that the incorporation of CRP may improve model prediction of UA in Blacks. These findings may favor screening for CRP in persons with the MetS, particularly in Blacks.

The Risk of Microalbuminuria by Obesity Phenotypes according to Metabolic Health and Obesity: The Korean National Health and Nutrition Examination Survey 2011-2014

BACKGROUND

The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity.

METHODS

This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m². Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level <40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO).

RESULTS

A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03-1.96), 2.02 fold (95% CI, 1.61-2.53), and 3.40 fold (95% CI, 2.70-4.26), respectively, after adjusting confounding factors.

CONCLUSION

The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes.

Association between metabolic syndrome and chronic kidney disease in a Chinese urban population

BACKGROUND

Few studies have examined the relationships between the prevalence of chronic kidney disease (CKD) and the metabolic risk factors in a developing country such as China, where genetic and environmental backgrounds differ from those in Western countries.

METHODS

The subjects of this cross-sectional study were the individuals from 18 to 92y. The metabolic syndrome (MetS) was defined based on the criteria of Adult Treatment Panel Third Report (ATP III), but using body mass index (BMI) instead of waist circumference. CKD was defined as decreased estimated glomerular filtration rate (eGFR<60mL/min/1.73m²) or presence of proteinuria (urine protein≥1+) assessed using dipstick method.

RESULTS

A total of 26,601 subjects (average age of 48.7y) were analyzed. Among them, the prevalence of the MetS and CKD was 36.4% and 3.0%, respectively. After adjustment for age, gender, cigarette smoking and alcohol drinking, the prevalence of CKD was significantly greater in subjects with than without MetS (OR 1.99, 95% CI 1.57-2.53, p<0.001). Multivariate-adjusted odd ratios for CKD in subjects with 3, 4 or 5 MetS components were 1.82 (95% CI 1.31-2.52, p<0.001), 2.92 (95% CI 2.09-4.09, p<0.001), and 3.07 (95% CI 1.67-5.67, p<0.001), respectively. After further adjustments were made for the other components of MetS, only high fasting glucose (OR 1.52, 95% CI 1.12-2.05) were significant risk factors for reduced renal function(eGFR<60mL/min/1.73m²). High blood pressure (OR 1.81, 95% CI 1,42-2.29), high triglycerides (OR 1.34, 95% CI 1.11-1.67) and high fasting glucose (OR 2.07, 95% CI 1.62-2.66) were significant risk factors for proteinuria.

CONCLUSIONS

MetS was highly prevalent in the middle-aged and elderly Chinese population in the city of Jinan. There was a graded relationship between the number of MetS components and risk of CKD. High fasting blood glucose levels were the main risk factor of reduced renal function. High blood pressure, high fasting blood glucose levels and high triglycerides were main risk factors for proteinuria.

Insulin-like growth factor-1 deficiency and metabolic syndrome

Consistent evidence associates IGF-1 deficiency and metabolic syndrome. In this review, we will focus on the metabolic effects of IGF-1, the concept of metabolic syndrome and its clinical manifestations (impaired lipid profile, insulin resistance, increased glucose levels, obesity, and cardiovascular disease), discussing whether IGF-1 replacement therapy could be a beneficial strategy for these patients. The search plan was made in Medline for Pubmed with the following mesh terms: IGF-1 and "metabolism, carbohydrate, lipids, proteins, amino acids, metabolic syndrome, cardiovascular disease, diabetes" between the years 1963-2015. The search includes animal and human protocols. In this review we discuss the relevant actions of IGF-1 on metabolism and the implication of IGF-1 deficiency in the establishment of metabolic syndrome. Multiple studies (in vitro and in vivo) demonstrate the association between IGF-1 deficit and deregulated lipid metabolism, cardiovascular disease, diabetes, and an altered metabolic profile of diabetic patients. Based on the available data we propose IGF-1 as a key hormone in the pathophysiology of metabolic syndrome; due to its implications in the metabolism of carbohydrates and lipids. Previous data demonstrates how IGF-1 can be an effective option in the treatment of this worldwide increasing condition. It has to distinguished that the replacement therapy should be only undertaken to restore the physiological levels, never to exceed physiological ranges.

Central obesity is an independent risk factor for microalbuminuria in both the general Korean women and nondiabetic nonhypertensive subpopulation: Association of microalbuminuria and metabolic syndrome from the Korea National Health and Nutrition Examination Survey 2011-2012

BACKGROUND

We investigated the major contributing component of metabolic syndrome (MetS) that results in microalbuminuria (MAU) in the general population as well as in nondiabetic nonhypertensive subjects.

METHODS

The study population consisted of a total of 9961 subjects (4429 men and 5532 women) who participated in the Korea National Health and Nutrition Examination Surveys conducted in 2011 and 2012. MAU was defined as a urine albumin-to-creatinine ratio of >3.39mg/mmol. After analyzing the contribution of each five MetS components for the presence of MAU with adjustment for other risk factors in the total population, we further examined the contribution of these components to MAU in the nondiabetic nonhypertensive subpopulation.

RESULTS

The most significantly associated factors for MAU in both genders were high blood pressure, followed by impaired fasting glucose, and high triglycerides. In addition, central obesity contributed significantly to MAU only in women. For the nondiabetic nonhypertensive subpopulation, high blood pressure in both genders and central obesity in women were important risk factors for MAU. We suggest two possible hypotheses for the gender different phenomenon.

CONCLUSIONS

Central obesity was an independent risk factor for MAU in the general Korean women as well as in the nondiabetic nonhypertensive women.

Comorbidities and Metabolic Derangement of NAFLD

Nonalcoholic fatty liver disease (NAFLD) is an increasingly common cause of chronic liver disease worldwide and is becoming a major public health problem. NAFLD has been recognized as a hepatic manifestation of metabolic syndrome linked with insulin resistance. Growing evidence supports that NAFLD is associated with systemic diseases such as cardiovascular disease (CVD), chronic kidney disease (CKD), type 2 diabetes, obesity, and metabolic syndrome. The majority of deaths in patients with NAFLD come from cardiovascular disease. These findings are strongly attributed to nonalcoholic steatohepatitis (NASH) rather than simple steatosis. NAFLD should be considered not only a liver specific disease but also an early mediator of systemic disease. The underlying mechanisms and pathogenesis of NAFLD with regard to other medical disorders are not yet fully understood. Further investigation is needed for future therapeutic strategies for NAFLD. This review focuses on the relationship between NAFLD and various comorbid diseases and metabolic derangement.

Clinical associations between metabolic syndrome and the development of microalbuminuria in Korean men

AIMS

There have been several studies on the association between metabolic syndrome (MetS) and microalbuminuria. However, none has examined whether MetS is associated with the prospective development of microalbuminuria. Accordingly, we performed a prospective study to evaluate the longitudinal effects of baseline number of MetS traits on the development of microalbuminuria in Korean men.

METHODS

1649 Korean men without microalbuminuria in 2005 were included and followed prospectively until 2010 with the endpoint being the development of microalbuminuria. MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Microalbuminuria was evaluated by urine albumin creatinine ratio (UACR). Risk estimations for development of microalbuminuria were analyzed according to the number of MetS traits using multivariate adjusted Cox proportional hazards model.

RESULTS

During 5611.8 person-years of follow-up (median 3.40±1.46 years), microalbuminuria developed in 91 (5.5%) participants between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence interval) for development of microalbuminuria comparing 1, 2 and 3-5 MetS traits vs 0 were 2.57 (0.97-6.82), 2.94 (1.09-7.98) and 3.85 (1.37-10.86), respectively.

CONCLUSIONS

The number of MetS traits independently associated with the future development of microalbuminuria during the 5-year follow-up period, and MetS per se was an independent risk factor for microalbuminuria.

Risk of chronic kidney disease in non-obese individuals with clustering of metabolic factors: a longitudinal study

OBJECTIVE

The impact of the clustering of metabolic factors on chronic kidney disease (CKD) in non-obese individuals remains unclear.

METHODS

We conducted a follow-up study of 23,894 Japanese adults (age, 18-69 years) who continuously received annual health examinations between 2000 and 2011. Obesity, high blood pressure, high triglycerides, low high-density lipoprotein (HDL) cholesterol and high fasting blood sugar were defined as metabolic factors, and CKD was defined as renal dysfunction (estimated glomerular filtration rate: <60 mL/min/1.73 m(2)) or proteinuria (dipstick test: ≥1+). The association between the clustering of metabolic factors and CKD was assessed based on the presence or absence of obesity using a Cox proportional hazard model.

RESULTS

Of 2,867 subjects with ≥3 metabolic factors, 650 (22.7%) were non-obese. These individuals were older and had higher metabolic risks than their obese counterparts at baseline. Among the entire cohort of 23,894 subjects, 1,764 developed renal dysfunction and 904 developed proteinuria during an average follow-up period of 7.8 years. The cumulative incidence of renal dysfunction was higher (22.1% vs. 16.1%), whereas that of proteinuria was lower (10.5% vs. 14.4%), among the non-obese subjects with ≥3 metabolic factors than the obese subjects with ≥3 metabolic factors after 11 years. The adjusted relative risk (RR) (95% confidence interval) of renal dysfunction was 1.54 (1.34-1.77) and 1.67 (1.35-2.07) for the obese and non-obese subjects with ≥3 metabolic factors, respectively.

CONCLUSION

Non-obese subjects with ≥3 metabolic factors, who are missed based on the essential criterion of obesity for metabolic syndrome, may have an equal or slightly higher risk of renal dysfunction than obese subjects with ≥3 metabolic factors.

Three-year incidence of elevated albuminuria and associated factors in a population-based cohort: The Taichung Community Health Study

BACKGROUND

early-stage elevated albuminuria can be effectively detected by a spot urine albumin-to-creatinine ratio (UACR). Elevated albuminuria is a key predictor of diabetic nephropathy, progression to chronic kidney disease (CKD) or end-stage renal disease (ESRD), plus risk of cardiovascular disease (CVD) and mortality. Understanding these detectors may prevent future renal and cardiovascular disease. This study estimates three-year incidence in a representative sample of Taiwanese metropolitan adults to explore predictors.

METHODS

the Taichung Community Health Study (TCHS) is a representative sample of 2359 Chinese adults aged 40 years and over living in a metropolitan city during 2004-2005. In 2007-2009, a total of 1648 (71.3%) individuals participated in follow-up. This study includes only individuals with normal albumin excretion at baseline examination. Three-year incidence and baseline factors linked with elevated albuminuria were evaluated.

RESULTS

about 87.0% (n = 1434) of subjects exhibited normal albumin excretion at baseline. Three-year age- and gender-weighted incidence was 4.5% (95% CI: 3.4-5.6%). Multivariate logistic regression showed subjects with elevated waist-to-hip ratio (WHR) (OR: 2.2, 95% CI: 1.2-3.9), abnormal creatinine (OR: 3.7, 95% CI: 1.1-12.6), hyperuricaemia (OR: 1.8, 95% CI: 1.0-3.3) and elevated baseline UACR (OR: 4.0, 95% CI: 1.1-14.3 for UACR of 3.20-6.39 mg/g; OR: 16.7, 95% CI: 5.0-55.5 for UACR of 6.40-29.99 mg/g) were more likely to have elevated albuminuria.

CONCLUSIONS

this is the first population-based longitudinal study to rate incidence of elevated albuminuria and identify associated factors in a random sample of a Chinese population. Central obesity, renal function, hyperuricaemia and baseline UACR are independent risk factors.

Risks of decreased renal function and increased albuminuria for glycemic status and metabolic syndrome components: Taichung Community Health study

BACKGROUND

The objective of this study was to assess the association of glycemic status and decreased renal function as determined by estimated glomerular filtration rate (eGFR) and albuminuria in an adult Taiwanese metropolitan population.

METHODS

We did a cross-sectional survey in a representative sample of 2,350 Taiwanese adults aged 40 years and over living in a metropolitan city in Taiwan from 2004 to 2005. Glycemic status was classified as normal glycemia, hyperglycemia, and type 2 diabetes (T2D). Renal function was assessed with eGFR using modified Modification of Diet in Renal Disease Study equation for Chinese. Albuminuria was determined by the urinary albumin-creatinine ratio. Decreased renal function was defined as eGFR <60 mL/min/1.73 m(2) and albuminuria as the albumin-creatinine ratio >30 mg g(-1) creatinine.

RESULTS

593 (25.23%) had hyperglycemia and 287 (12.21%) had T2D. As glycemia level increased, the prevalence of albuminuria and decreased eGFR increased. After adjustment, T2D was associated with an OR of 2.93 (95% CI: 2.11-4.07) for albuminuria, and an OR of 2.05 (95% CI: 1.18-3.58) for decreased eGFR.

CONCLUSIONS

In a representative sample from a metropolitan city in Taiwan, T2D was associated with albuminuria and decreased eGFR.

Cystatin C, CRP, log TG/HDLc and metabolic syndrome are associated with microalbuminuria in hypertension

BACKGROUND

In patients with systemic hypertension, microalbuminuria is a marker of endothelial damage and is associated with an increased risk for cardiovascular disease.

OBJECTIVE

To determine the factors that may lead to the occurrence of microalbuminuria in hypertensive patients with serum creatinine lower than 1.5 mg/dL.

METHODS

This cross-sectional study included 133 Brazilians with essential hypertension followed up at a hypertension outpatient clinic. Those with serum creatinine higher than 1.5 mg/dL, as well as those with diabetes mellitus, were excluded. Systolic and diastolic blood pressures were measured, and body mass index (BMI) and GFR estimated by using the CKD-EPI formula were calculated. The serum levels of the following were assessed: CysC, creatinine, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C-reactive protein (CRP) and fasting glucose. Microalbuminuria was determined in 24-hour urine. Hypertensive patients were classified according to the presence of one or more criteria for metabolic syndrome.

RESULTS

In a multiple regression analysis, the serum levels of CysC and CRP, the atherogenic index log TG/HDLc and the presence of three or more criteria for metabolic syndrome were positively correlated with microalbuminuria (r2: 0.277, p < 0.05).

CONCLUSION

CysC, CRP, log TG/HDLc, and the presence of three or more criteria for metabolic syndrome, regardless of serum creatinine, were associated with microalbuminuria, an early marker of kidney damage and cardiovascular risk in patients with essential hypertension.

Prevalence of microalbuminuria among middle-aged population of China: a multiple center cardiovascular epidemiological study

We assessed the prevalence of microalbuminuria (MAU) and the relationships with other cardiovascular (CV) risk factors among a middle-aged Chinese population. Data from 10 313 participants were included in our cross-sectional survey. Microalbuminuria was defined as the urine albumin to creatinine ratio of 30:300 mg/g from a single-spot morning urine sample. Microalbuminuria was found to be common in males and females (15.04% vs 10.09%) aged 35 to 64 years in this Chinese general population, especially in those with obesity, hypertension, and diabetes. Multivariate analysis found that body mass index, triglyceride, high-sensitivity C-reactive protein, alcohol consumption, hypertension, and diabetes were independently associated with MAU. Microalbuminuria may be a useful indicator for risk of CV disease in general populations.

Metabolic syndrome, C-reactive protein and microalbuminuria in a rural Chinese population: a cross-sectional study

Background

Microalbuminuria is an early marker of chronic kidney disease (CKD). Previous studies have shown that either metabolic syndrome (MetS) or chronic inflammation is related to renal impairment. The aim of this study was to investigate the association between MetS, C-reactive protein (CRP) and microalbuminuria in a rural Chinese population.

Methods

This was a cross-sectional study using data from the Handan Eye Study. MetS was defined according to the Chinese Diabetes Society (CDS) criteria. CRP levels ≥ 3 mg/L were classified as high CRP. Microalbuminuria was defined as a urinary albumin/creatinine ratio (ACR) of 30–300 mg/g.

Results

We included 4191 subjects aged ≥ 30 years in this analysis. The prevalence of MetS and microalbuminuria in the group was 25.7% and 15.6%, respectively. The odds ratio (OR) of microalbuminuria in subjects with MetS was 1.25 (95% confidence interval (CI): 1.03 − 1.51) compared with those without microalbuminuria. In multivariate logistic regression analysis, high blood pressure (OR 1.36, 95% CI: 1.10 − 1.67) and high fasting blood glucose (OR 1.44, 95% CI: 1.17 − 1.76) were independently associated with microalbuminuria. Subjects with high CRP and MetS had a 1.46-fold greater risk of having microalbuminuria compared with those with low CRP without MetS (95% CI: 1.06 − 2.01).

Conclusions

In this rural Chinese population aged ≥30 years, MetS and microalbuminuria were independently related and the combination of high CRP and MetS was associated with an increased risk of microalbuminuria.

High triglyceride-to-HDL cholesterol ratio associated with albuminuria in type 2 diabetic subjects

OBJECTIVE

Emerging evidence indicates that metabolic syndrome (MetS) predisposes diabetic subjects to nephropathy. Aside from hypertension and hyperglycemia, it is unclear which component of MetS also contributes to increased urinary albumin excretion (UAE). We compared the MetS profiles of subjects divided into two groups based on their UAE.

METHODS

The Asia Pacific Real-Life Effectiveness and Care Patterns of Diabetes Management (AP RECAP-DM) study is a cross-sectional survey in which type 2 diabetic subjects using oral anti-hyperglycemic drugs were enrolled. We analyzed the data of 162 type 2 diabetic subjects with normotension or taking antihypertensive medications.

RESULTS

There were 123 subjects with normal UAE (<30 mg/g) and 39 with abnormal UAE (≥30 mg/g). MetS was more prevalent in the abnormal UAE group (79.5%) than in the normal UAE group (58.5%) (P=0.018). Hypertriglyceridemia (odds ratio=8.65, P<0.001) and reduced high-density lipoprotein (HDL) cholesterol (odds ratio=3.27, P=0.022) were both independently associated with abnormal UAE. Using 3.4 as a cut-off value, a high triglyceride-to-HDL cholesterol ratio was a useful marker (odds ratio=15.05, P<0.001) for abnormal UAE.

CONCLUSIONS

A high triglyceride-to-HDL cholesterol ratio was found to be an important risk factor for nephropathy in type 2 diabetic subjects.

U-shaped association between central body fat and the urinary albumin-to-creatinine ratio and microalbuminuria

BACKGROUND

The prevalence of obese and overweight patients has increased dramatically worldwide. Both are common risk factors for chronic kidney disease (CKD) as indicated by a diminished estimated glomerular filtration rate (eGFR) or microalbuminuria. This study aimed to investigate whether anthropometric parameters [waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI)] are associated with renal function in a population-based study of Caucasian subjects.

METHODS

Data from 3749 subjects (1825 women) aged 20 to 81 years from the Study of Health in Pomerania (SHIP) were analysed. Renal indices, including the urinary albumin-to-creatinine ratio (uACR), microalbuminuria, eGFR and CKD, were studied. Parameters of anthropometry (WC, WHtR and BMI) were categorised into sex-specific quintiles.

RESULTS

Analysis of variance (ANOVA) models, adjusting for age, sex, type 2 diabetes mellitus and hypertension, revealed that a high and low WC or WHtR and low BMI were independently related to a higher uACR. Logistic regression models confirmed these results with respect to uACR and showed that subjects with a high or low WC or a high WHtR had increased odds of microalbuminuria. The ANOVA models revealed no relations of the investigated anthropometric parameters with eGFR. However, subjects with high values for these parameters had increased odds of CKD.

CONCLUSIONS

Our results demonstrate U-shaped associations between markers of central fat distribution and uACR or microalbuminuria in the general population, suggesting that both obese and very thin subjects have a higher risk of renal impairment.

Factors affecting levels of urinary albumin excretion in the general population of Spain: the Di@bet.es study

The present study was undertaken to examine the prevalence of urinary ACR (albumin/creatinine ratio) >30 mg/g and the associated clinical and environmental factors in a representative sample of the population of Spain. Di@bet.es study is a national, cross-sectional population-based survey conducted in 2009-2010. Clinical, metabolic, socio-demographic, anthropometric data and information about lifestyle habit were collected. Those subjects without KDM (known diabetes mellitus) were given an OGTT (oral glucose tolerance test). Albumin and creatinine were measured in a urinary sample and ACR was calculated. The population prevalence of ACR >30 mg/g was 7.65% (adjusted for sex and age). The prevalence of ACR >30 mg/g increased with age (P<0.001). Subjects with carbohydrate metabolism disorders had a greater prevalence of ACR >30 mg/g but after being adjusted for age, sex and hypertension, was significant only in those subjects with UKDM (unknown diabetes mellitus) {OR (odd ratio), 2.07 [95% CI (confidence interval), 1.38-3.09]; P<0.001] and KDM [OR, 3.55 (95% CI, 2.63-4.80); P<0.001]. Prevalence of ACR >30 mg/g was associated with hypertension [OR, 1.48 (95% CI, 1.12-1.95); P=0.001], HOMA-IR (homoeostasis model assessment of insulin resistance) [OR, 1.47 (95% CI, 1.13-1.92); P≤0.01], metabolic syndrome [OR, 2.17 (95% CI, 1.72-2.72); P<0.001], smoking [OR, 1.40 (95% CI, 1.06-1.83); P≤0.05], physical activity [OR, 0.68 (95% CI, 0.54-0.88); P≤0.01] and consumption of fish [OR, 0.38 (95% CI, 0.18-0.78); P≤0.01]. This is the first study that reports the prevalence of ACR >30 mg/g in the Spanish population. The association between clinical variables and other potentially modifiable environmental variables contribute jointly, and sometimes interactively, to the explanation of prevalence of ACR >30 mg/g. Many of these risk factors are susceptible to intervention.

Central obesity and albuminuria: both cross-sectional and longitudinal studies in Chinese

Background

Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increases the risk of cardiovascular disease. Little is known about the association between albuminuria and central obesity in Chinese. We aimed to assess the association between central obesity and prevalence and incidence of albuminuria in a middle-aged population-based cohort study.

Methods

This is a cross-sectional and longitudinal cohort study. A total of 2350 subjects aged ≥40 years were recruited in 2004 in Taiwan for cross-sectional analysis. Longitudinal analysis included 1432 baseline normoalbuminuria subjects with a mean 2.8 years follow-up, 67 of whom exhibited incident albuminuria. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥30 mg/g creatinine. Multiple logistic regression analyses were used to evaluate the relationship between central obesity and prevalence and incidence of albuminuria after adjustment for age, gender, body mass index, blood pressure, renal function, glucose, high sensitivity c-reactive protein, smoking, betel nut chewing, alcohol drinking, and physical activity.

Results

At baseline, albuminuria is significantly associated with central obesity. The adjusted odds ratio of having albuminuria among subjects with central obesity was 1.73(95% confidence interval (CI): 1.04–2.85), compared to the subjects without central obesity. In multivariable models, participants with central obesity at baseline had a 112% increase in risk of incident albuminuria (adjusted incidence rate ratio (95% CI): 2.12(1.01–4.44)) compared with participants with non-central obesity.

Conclusions

Abdominal adiposity was independently associated with increased prevalence and incidence of albuminuria in Chinese. The mechanisms linking adiposity and albuminuria need to be addressed.

Association of subcutaneous and visceral adiposity with albuminuria: the Framingham Heart Study

Microalbuminuria is a common condition associated with increased incidence of cardiovascular events and mortality. Abdominal obesity is associated with microalbuminuria, but studies linking visceral adipose tissue (VAT) and microalbuminuria are limited. Our objective was to determine the associations of albuminuria with VAT and subcutaneous adipose tissue (SAT). We performed a cross-sectional study in the Framingham Multi-Detector Computed Tomography (MDCT) cohort (n = 3099, 48.2% women, mean age 53 years). VAT and SAT volumes were measured using computed tomography. Urinary albumin-to-creatinine ratio (UACR) was calculated from spot urine samples. Microalbuminuria was defined as a UACR >25 mg/g in women or >17 mg/g in men. Overall, 7.9% (n = 244) of the sample had microalbuminuria. Among men, VAT (odds ratio (OR) 1.48 per s.d., P < 0.0001) and SAT (OR 1.37 per s.d., P = 0.0002) were associated with microalbuminuria in minimally adjusted models, which remained significant after multivariable adjustment (VAT OR 1.34 per s.d., P = 0.001; SAT OR 1.28 per s.d., P = 0.005). Additionally, when considered jointly, VAT (P = 0.002) but not SAT (P = 0.2) was associated with microalbuminuria. In women, VAT was associated with microalbuminuria after minimal adjustment (OR 1.28, P = 0.01), but not after multivariable adjustment (OR 1.03, P = 0.8). In multivariable models in women, SAT was associated with a decreased odds of having microalbuminuria (OR 0.75 per s.d., P = 0.03). In conclusion, VAT is associated with microalbuminuria in men but not women. Albuminuria may be a manifestation of visceral adiposity.

Coffee consumption is inversely associated with type 2 diabetes in Chinese

BACKGROUND

Coffee consumption has been shown to be inversely associated to type 2 diabetes mellitus (T2DM), but evidence in Chinese populations is limited. We investigated the relationship between coffee consumption and T2DM in a population-based cohort of middle-aged Chinese.

MATERIALS AND METHODS

We studied 2332 subjects who participated in the Taichung Community Health Study in Taiwan in 2004. The relationships between coffee consumption, T2DM and fasting glucose were assessed.

RESULTS

The prevalence of T2DM was 14·0% and 10·4% in men and women. After adjustment for age, body mass index, blood pressure, smoking, alcohol drinking, betel nut chewing, physical activity, income, education level, fat%, protein%, carbohydrate% and magnesium, coffee intake was inversely associated with T2DM. Habitual coffee drinkers had 38-46% lower risk of T2DM than nondrinkers. Compared to nondrinkers, the adjusted odds ratios (ORs) for T2DM according to subjects with habitual coffee consumption (<1, 1-6, ≥7 times per week) were 0·77 (0·52-1·13), 0·46 (0·28-0·76) and 0·37 (0·16-0·83), respectively. The decreasing ORs indicate a dose-response effect of coffee consumption on the likelihood of having T2DM (P<0·001). A similar relationship was also evident in newly diagnosed T2DM (P<0·05). The adjusted mean fasting glucose levels gradually decreased as the frequency of coffee consumption increased (P<0·05).

CONCLUSIONS

Coffee intake is inversely associated with T2DM in Chinese. Coffee may be a protective agent for T2DM in Chinese.

Microalbuminuria in relation to the metabolic syndrome and its components in a Chinese population

BACKGROUND

We investigated the prevalence of microalbuminuria and its association with the metabolic syndrome and its components in a Chinese population.

METHODS

The study subjects were recruited from a newly established residential area in the suburb of Shanghai. We measured anthropometry, blood pressure (BP), fasting plasma glucose, and serum lipids, and collected spot urine samples for the determination of albumin-creatinine ratio. We defined microalbuminuria as a urinary albumin-to-creatinine ratio of 30 to 299 mg/g. The metabolic syndrome was defined according to the International Diabetes Federation criteria.

RESULTS

The 1079 participants included 410 (38.0%) hypertensive patients, and 66 (6.1%) diabetic patients. The prevalence of microalbuminuria (4.3%) was 3.2 times higher in 167 patients with the metabolic syndrome than 912 subjects without the metabolic syndrome (12.0% vs. 2.9%, P < 0.0001). In multiple regression adjusted for sex, age, body mass index, current smoking, alcohol intake and the use of antihypertensive drugs, and mutually adjusted for the components, microalbuminuria was significantly associated with diastolic BP (odds ratio 1.74 for +10 mmHg; 95% confidence interval [CI] 1.10-2.76; P = 0.02) and fasting plasma glucose (1.18; 95% CI 1.01-1.41; P = 0.04), but not with waist circumference, systolic BP, or serum HDL cholesterol and triglycerides (P > 0.10).

CONCLUSIONS

Microalbuminuria is common in the Chinese population, and much more prevalent in the presence of the metabolic syndrome, mainly attributable to elevated diastolic BP and plasma glucose.

The associations of different measurements of obesity with cardiovascular risk factors in Chinese

BACKGROUND

Obesity increases the risks of cardiovascular diseases (CVD). This study examined the optimal cut-off values for overweight and obesity for CVD risks using different anthropometric indices in middle-aged Taiwanese.

MATERIALS AND METHODS

A total of 2359 subjects aged 40 and over were recruited in 2004 in Taiwan. Body mass index (BMI) was divided into four groups using three different definitions. Waist circumference (WC), waist-to-hip ratio (WC/HC) and waist-to-height ratio (WC/H) were divided into quartiles. The receiver operating characteristic analysis was used to compare their predictive validity and to find out their optimal cut-off values.

RESULTS

Men were older and had greater height, weight, BMI, WC, WC/HC, WC/H, blood pressure (BP), fasting glucose, uric acid and triglycerides than women. In all BMI definitions, subjects in higher BMI groups had higher BP, fasting glucose, triglycerides, uric acid and WC than subjects in lower BMI groups. Compared to quartile I of WC, WC/HC and WC/H, the odds ratios of having CVD risk factors increased in higher quartiles of WC, WC/HC and WC/H. The optimal cut-off values for overweight/obesity in middle-aged Taiwanese in men and women were as follows: BMI of 23·7 and 22·4 kg m(-2), WC of 82·5 and 72·5 cm, WC/HC of 0·87 and 0·79 and WC/H of 0·50 and 0·46. WC/H is the best indicator for predicting CVD risks.

CONCLUSIONS

Obesity, presenting with higher BMI, WC, WC/HC and WC/H, is closely related to CVD risk factors. WC/H is the best predictor of CVD risk factors in middle-aged Taiwanese.

Association between insulin resistance and development of microalbuminuria in type 2 diabetes: a prospective cohort study

OBJECTIVE

An association between insulin resistance and microalbuminuria in type 2 diabetes has often been found in cross-sectional studies. We aimed to reassess this relationship in a prospective Taiwanese cohort of type 2 diabetic subjects.

RESEARCH DESIGN AND METHODS

We enrolled 738 normoalbuminuric type 2 diabetic subjects, aged 56.6 ± 9.0 years, between 2003 and 2005 and followed them through the end of 2009. Average follow-up time was 5.2 ± 0.8 years. We used urine albumin-to-creatinine ratio to define microalbuminuria and the homeostasis model assessment of insulin resistance (HOMA-IR) to assess insulin resistance. The incidence rate ratio and Cox proportional hazards model were used to evaluate the association between HOMA-IR and development of microalbuminuria.

RESULTS

We found incidences of microalbuminuria of 64.8, 83.5, 93.3, and 99.0 per 1,000 person-years for the lowest to highest quartiles of HOMA-IR. Compared with those in the lowest quartile of HOMA-IR, the incidence rate ratios for those in the 2nd, 3rd, and highest quartiles were 1.28 (95% CI 0.88-1.87), 1.44 (0.99-2.08), and 1.52 (1.06-2.20), respectively (trend test: P < 0.001). By comparison with those in the lowest quartile, the adjusted hazard ratios were 1.37 (0.93-2.02), 1.66 (1.12-2.47), and 1.76 (1.20-2.59) for those in the 2nd, 3rd, and highest HOMA-IR quartiles, respectively.

CONCLUSIONS

According to the dose-response effects of HOMA-IR shown in this prospective study, we conclude that insulin resistance could significantly predict development of microalbuminuria in type 2 diabetic patients.

Impact of non-alcoholic fatty liver disease on microalbuminuria in patients with prediabetes and diabetes

BACKGROUND

It is unknown whether microalbuminuria is associated with non-alcoholic fatty liver disease (NAFLD) among patients with prediabetes and type 2 diabetes mellitus (DM). This study investigated the association of NAFLD with microalbuminuria among patients with prediabetes and diabetes.

METHODS

We evaluated 1361 subjects who had an abnormal oral glucose tolerance test (OGTT) on routine screening. All participants were divided into two groups, prediabetes and newly diagnosed type 2 DM, and the association of NAFLD with metabolic parameters on microalbuminuria was analysed.

RESULTS

The patients with NAFLD had higher prevalence rates of microalbuminuria (6.3% vs 19%; P = 0.001 in prediabetes, 4.5% vs 32.6%; P < 0.001 in diabetes) and also had a greater albumin-to-creatinine ratio (14.6 +/- 52.0 microg/mg Cr vs 27.7 +/- 63.9 microg/mg Cr; P = 0.051 in prediabetes, 11.4 +/- 21.4 microg/mg Cr vs 44.7 +/- 76.4 microg/mg Cr; P < 0.001 in diabetes) than those without NAFLD. The logistic regression analysis showed that NAFLD was associated with increased rates of microalbuminuria (odds ratio 3.66; 95%confidence interval (CI) 1.31-10.20, P = 0.013 in prediabetes, odds ratio 5.47;95% CI 1.01-29.61, P = 0.048 in diabetes), independently of age, sex, body mass index, waist circumference, liver enzymes, lipid profiles, HbA1c, insulin resistance as estimated by homeostasis model assessment, hypertension,smoking status and the metabolic syndrome.

CONCLUSIONS

The results of our study revealed a strong relationship between microalbuminuria and NAFLD in the patients with prediabetes and newly diagnosed diabetes. Further studies are required to confirm whether NAFLD is a predictor of the development of microalbuminuria in patients with prediabetes and diabetes.

Arterial stiffness is strongly associated with insulin resistance in Chinese--a population-based study (Taichung Community Health Study, TCHS)

AIM

Few studies have investigated the association between insulin resistance and arterial stiffness in Chinese. We aimed to investigate this relationship in a population-based study of middle-aged Chinese.

METHODS

A total of 2,188 subjects aged 40 years and older were recruited in 2004 in Taiwan. The association between arterial stiffness (measured by brachial-ankle pulse wave velocity (baPWV)) and insulin resistance (represented by homeostasis model assessment (HOMA-IR) and fasting glucose levels) was studied by multiple logistic and linear regression analyses.

RESULTS

The respective prevalence of diabetes and impaired fasting glucose (IFG) was 13.9% and 30.6% in males and 10.4% and 20.8% in females. Using multiple linear regression analyses, we found baPWV to be strongly associated with age, gender, body mass index (BMI), waist circumference (WC), systolic blood pressure (BP), diastolic BP, fasting glucose, and triglycerides. Compared to the lowest HOMA-IR tertile I and adjusting for age, BMI, WC, gender, triglycerides, systolic BP, diastolic BP, smoking, alcohol drinking, betel nut chewing, and physical activity, the odds ratios (95% confidence interval) of arterial stiffness for the higher HOMA-IR tertiles II and III were 1.15 (0.77-1.71) and 1.60 (1.05-2.46), respectively. Using a general linear model with adjustment for age, systolic BP, diastolic BP, BMI, WC, and triglycerides, baPWV was significantly lower in the diabetic group by 90.3 cm/sec in males and 100.5 cm/sec in females compared to the IFG group. When comparing the IFG group to the normal glucose group, baPWV was 28.5 cm/sec lower in males and 14.4 cm/sec lower in females.

CONCLUSIONS

Arterial stiffness is independently associated with insulin resistance in Chinese middle-aged adults. Subjects with diabetes or IFG have higher baPWV than normoglycemic subjects.

The relationship of high sensitivity C-reactive protein to percent body fat mass, body mass index, waist-to-hip ratio, and waist circumference in a Taiwanese population

BACKGROUND

High-sensitivity C-reactive protein (hs-CRP) is an easily measured inflammatory biomarker. This study compared the association of percent body fat mass (%FM), body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with hs-CRP in a Taiwanese population.

METHODS

A total of 1669 subjects aged 40-88 years were recruited in 2004 in a metropolitan city in Taiwan. The relationships between obesity indicators and a high level of hs-CRP were examined using multivariate logistic regression analysis. The upper quartile of the hs-CRP distributions was defined as the high category group. The areas under the curve (AUCs) of the receiver operating characteristic curves were calculated for all obesity indicators to compare their relative ability to correctly classify subjects with a high level of hs-CRP.

RESULTS

After multivariate adjustment, the odds ratio for %FM was the only significant indicator that was associated with a high level of hs-CRP in men (1.55, 95% CI: 1.07-2.25). All indicators were associated with a high level of hs-CRP in women. In men, the AUCs for %FM were significantly higher than those for BMI, WHR, and WC, when demographic and lifestyle behaviors were considered (p < 0.001 for all comparisons), but they were not significantly different in females.

CONCLUSIONS

Our study demonstrates that %FM is the only obesity indicator that is strongly associated with a high level of hs-CRP after adjusting for sociodemographic factors, lifestyle behaviors and components of metabolic syndrome in both genders in a Taiwanese population aged forty years and over. In men, %FM had the greatest ability to classify subjects with a high level of hs-CRP when only demographic and lifestyle behaviors were considered. Our study finding has important implications for the screening of obesity in community settings.

Sex difference in the association of metabolic syndrome with high sensitivity C-reactive protein in a Taiwanese population

BACKGROUND

Although sex differences have been reported for associations between components of metabolic syndrome and inflammation, the question of whether there is an effect modification by sex in the association between inflammation and metabolic syndrome has not been investigated in detail. Therefore, the aim of this study was to compare associations of high sensitivity C-creative protein (hs-CRP) with metabolic syndrome and its components between men and women.

METHODS

A total of 1,305 subjects aged 40 years and over were recruited in 2004 in a metropolitan city in Taiwan. The biochemical indices, such as hs-CRP, fasting glucose levels, lipid profiles, urinary albumin, urinary creatinine and anthropometric indices, were measured. Metabolic syndrome was defined using the American Heart Association and the National Heart, lung and Blood Institute (AHA/NHLBI) definition. The relationship between metabolic syndrome and hs-CRP was examined using multivariate logistic regression analysis.

RESULTS

After adjustment for age and lifestyle factors including smoking, and alcohol intake, elevated concentrations of hs-CRP showed a stronger association with metabolic syndrome in women (odds ratio comparing tertile extremes 4.80 [95% CI: 3.31-6.97]) than in men (2.30 [1.65-3.21]). The p value for the sex interaction was 0.002. All components were more strongly associated with metabolic syndrome in women than in men, and all sex interactions were significant except for hypertension.

CONCLUSIONS

Our data suggest that inflammatory processes may be of particular importance in the pathogenesis of metabolic syndrome in women.

Metabolic syndrome is independently associated with microalbuminuria in type 2 diabetes

We opted in this study to evaluate the association between metabolic syndrome (MetS) and microalbuminuria in type 2 diabetes. A total of 800 adults (344 males; age 54.8 +/- 9.6 years) with type 2 diabetes were studied. MetS was defined by the International Diabetes Federation criteria and microalbuminuria by urinary albumin excretion between 30 and 299 mg/day on at least two of three occasions. Patients with macroalbuminuria and those with poor renal function were not included. Microalbuminuria was present in 237 (29.6%) patients with MetS and increased in prevalence with increasing numbers of metabolic abnormalities (P < 0.001). The normo- and micro-albuminuric groups were not significantly different in age, sex, and renal function. However, MetS was significantly more common among patients with (90.3%) than those without (76.6%) microalbuminuria (P < 0.01). In multivariate regression, MetS was the strongest correlate of microalbuminuria (OR = 3.31, 95% CI = 1.91-5.75; P < 0.01). In conclusion, MetS is independently associated with microalbuminuria in type 2 diabetes.

Albuminuria is strongly associated with arterial stiffness, especially in diabetic or hypertensive subjects--a population-based study (Taichung Community Health Study, TCHS)

OBJECTIVE

Albuminuria is recognized as a marker of vascular dysfunction. Brachial-ankle pulse wave velocity (baPWV) reflects the stiffness of central and peripheral muscular arteries. Limited information is available for the association between albuminuria and arterial stiffness in Chinese. We aimed to assess the association between albuminuria and arterial stiffness in a middle-aged population-based study.

METHODS

A total of 2180 subjects aged 40 years and over were recruited in 2004 in Taiwan. Albuminuria was defined as urinary albumin-to-creatinine ratio (ACR)>or=30 mg/g creatinine. BaPWV was divided by quartile. Multiple logistic and linear regression analyses were used to evaluate the relationship between baPWV and albuminuria.

RESULTS

After adjusting for age, body mass index, mean arterial pressure, fasting glucose, triglycerides, total cholesterol, chronic kidney disease, smoking, alcohol drinking, and physical activity status, multiple logistic regression analyses revealed baPWV groups were significantly associated with albuminuria. Compared to the lowest baPWV quartile, the adjusted odds ratio of having albuminuria for baPWV quartile II, III, and IV were 1.12(0.63-2.02), 2.04(1.15-3.60), and 2.45(1.29-4.65). The significant increase in odds ratios for albuminuria in progressive baPWV quartiles reveals a dose-response effect (p<0.001). Among diabetic, hypertensive, and macroalbuminuria subjects, these relationships were stronger than in subjects without diabetes, hypertension, and microalbuminuria. Moreover, multiple linear regression analyses showed that baPWV was significantly associated with urinary ACR after adjusting for potential confounders.

CONCLUSION

Albuminuria was strongly related to arterial stiffness among Chinese middle-aged adults. These relationships were enhanced in subjects with hypertension, diabetes, or macroalbuminuria.

The relation of metabolic syndrome according to five definitions to cardiovascular risk factors--a population-based study

BACKGROUND

Although National Cholesterol Education Program (NCEP), International Diabetes Federation (IDF), American Heart Association and National Heart, Lung and Blood Institute (AHA/NHLBI), World Health Organization (WHO), and the European Group for the Study of Insulin Resistance (EGIR) definitions of metabolic syndrome (MetS) have been commonly used by studies, little is known about agreement among these five definitions. We examined the agreement among these five definitions and explored their relationship with risk factors of cardiovascular disease in a Taiwan population.

METHODS

A total of 1305 subjects aged 40 years and over in Taiwan were analyzed. Biomedical markers and anthropometric indices were measured. Agreement among definitions was determined by the kappa statistic. Logistic regression models were fit to estimate the odds of a high cardiovascular risk group for five definitions of MetS.

RESULTS

The agreement among the NCEP, IDF, and AHA/NHLBI definitions was from substantial to very good, and agreement between the WHO and EGIR definitions was also substantial. All MetS definitions were significantly associated prevalence of microalbuminuria, elevated highly sensitive CRP (hs-CRP), and arterial stiffness only in women. In men, MetS by NCEP and AHA/NHLBI was associated with elevated level of hs-CRP and arterial stiffness. MetS by WHO and EGIR were significantly associated with microalbuminuria. And MetS by WHO was the only MetS definition that significantly associated with prevalence of arterial stiffness (OR: 2.75, 95% CI: 1.22-6.19).

CONCLUSIONS

The associations of these five definitions with cardiovascular risk factors were similar in women, and it was evident that the five definitions performed better in women than in men, with higher ORs observed in relation to arterial stiffness, elevated hs-CRP, and higher Framingham risk scores.

Betel nut chewing is strongly associated with general and central obesity in Chinese male middle-aged adults

Betel nut chewing has been reported to increase the risk of cardiovascular disease and all-cause mortality. The reason is unclear. In this study, we investigated the association between betel nut chewing and general obesity (BMI>or=25 kg/m2) and central obesity (waist circumference (WC)>or=90 cm). A total of 1,049 male subjects, aged>or=40 years, were recruited from Taichung city in Taiwan in 2004. The relationships between betel nut chewing and general and central obesity were studied by multiple linear and logistic regression analyses. The prevalence of current and former betel nut chewing was 7.0 and 10.5% in our male Taiwanese cohort. Current/former betel nut chewers had a higher prevalence of general and central obesity when compared with individuals who had never chewed betel nut. Adjusted for age, diabetes, hypertension, lipids, smoking, alcohol drinking, physical activity, income, and education level, the odds ratios (ORs; 95% confidence intervals) of general and central obesity among the lower consumption of betel nut chewers were 1.78 (1.07, 2.96) and 1.19 (0.70, 2.02), respectively, compared to 2.01 (1.18, 3.41) and 1.89 (1.10, 3.23), respectively, among higher consumption chewers compared to individuals who had never chewed betel nut. The increasing ORs of general and central obesity with higher betel nut consumption revealed dose-response effects. Using multiple linear regression analyses, after adjusting for potential confounders, betel nut consumption was statistically significantly associated with BMI and WC. In conclusion, betel nut chewing was independently associated with general and central obesity in Taiwanese men. Dose-response effects of the association between betel nut consumption and general obesity as well as central obesity were found.

In addition to insulin resistance and obesity, brachial-ankle pulse wave velocity is strongly associated with metabolic syndrome in Chinese--a population-based study (Taichung Community Health Study, TCHS)

AIM

To investigate the association between arterial stiffness (present with brachial-ankle pulse wave velocity (baPWV)) and metabolic syndrome (MetS) in a population-based study of middle-aged Chinese.

METHODS

MetS was defined using the AHA/NHLBI criteria. A total of 1,018 subjects aged 40 years and over were recruited in 2004. Homeostasis model assessment was applied to estimate the degree of insulin resistance (HOMA-IR). The baPWV was divided into four groups by quartiles.

RESULTS

The prevalence of MetS and its individual components increased by the increase in baPWV quartiles. After adjusting for age, BMI, HOMA-IR, smoking, alcohol drinking, betel nut chewing, and physical activity status, multiple logistic regression revealed that baPWV groups were significantly associated with MetS. Compared with the lowest baPWV quartile, the adjusted odds ratio of having MetS in baPWV quartile II, III, IV was 2.10 (1.034.28), 4.48 (2.169.26), 10.4 (4.5324.0) in men, and 4.20 (1.4712.0), 14.6 (5.2240.6), 16.3 (5.4848.2) in women, respectively. The prevalence of MetS increased with the increase of age, HOMA-IR, and BMI groups. The optimal cut-off values of baPWV for MetS were 1,539 cm/sec in men and 1,482 cm/sec in women, respectively.

CONCLUSIONS

In addition to insulin resistance and obesity, baPWV was strongly related to MetS in middle-aged Taiwan Chinese. The cut-off value of baPWV for cardiovascular disease differed between genders.

The metabolic syndrome

The "metabolic syndrome" (MetS) is a clustering of components that reflect overnutrition, sedentary lifestyles, and resultant excess adiposity. The MetS includes the clustering of abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure and is associated with other comorbidities including the prothrombotic state, proinflammatory state, nonalcoholic fatty liver disease, and reproductive disorders. Because the MetS is a cluster of different conditions, and not a single disease, the development of multiple concurrent definitions has resulted. The prevalence of the MetS is increasing to epidemic proportions not only in the United States and the remainder of the urbanized world but also in developing nations. Most studies show that the MetS is associated with an approximate doubling of cardiovascular disease risk and a 5-fold increased risk for incident type 2 diabetes mellitus. Although it is unclear whether there is a unifying pathophysiological mechanism resulting in the MetS, abdominal adiposity and insulin resistance appear to be central to the MetS and its individual components. Lifestyle modification and weight loss should, therefore, be at the core of treating or preventing the MetS and its components. In addition, there is a general consensus that other cardiac risk factors should be aggressively managed in individuals with the MetS. Finally, in 2008 the MetS is an evolving concept that continues to be data driven and evidence based with revisions forthcoming.

Association between television viewing and the risk of metabolic syndrome in a community-based population

BACKGROUND

As a result of metabolic syndrome becoming an important issue during recent decades, many studies have explored the risk factors contributing to its development. However, less attention has been paid to the risk associated with sedentary behavior, especially television viewing. This study examined the association between television viewing time and the risk of having metabolic syndrome in a population of Taiwanese subjects.

METHODS

This community-based cross-sectional study included 2,353 subjects (1,144 men and 1,209 women) aged 40 and over from October, 2004 to September, 2005. Information about the time spent watching TV was obtained using a self-administered questionnaire. The definition of metabolic syndrome was according to the Third Report of the National Cholesterol Education Program's Adult Treatment Panel modified for Asians.

RESULTS

Compared to subjects who viewed TV < 14 hr/week, those who viewed TV > 20 hr/week had a 1.50-fold (95% confidence intervals (CI): 1.10, 2.03) risk for men and a 1.93-fold (95% CI: 1.37, 2.71) risk for women of having metabolic syndrome, after adjusting for physical activity and other covariates. Stratifying by the three categories of total activity levels, TV viewing time > 20 hr/week was found to still hold a significant risk for having metabolic syndrome in the lowest of the three categories of total activity level for men and in all three categories of total activity level for women.

CONCLUSION

The findings suggest that TV viewing is an independent risk factor associated with metabolic syndrome in Taiwanese people.