Clustering Of Multiple Risk Factors Research Articles

Predictors of Secondhand Smoke Exposure During Pregnancy in Costa Rica, the Dominican Republic, and Honduras.

Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras. Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings. Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes. SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations. The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations.

The burden of stroke and modifiable risk factors in Ethiopia: A systemic review and meta-analysis.

The burden and contribution of modifiable risk factors of stroke in Ethiopia are unclear. Knowledge about this burden and modifying risk factors is pivotal for establishing stroke prevention strategies. In recent decades, the issue of lifestyle and behavioral modification is a key to improve the quality of life. The modifiable risk factors are an importance as intervention strategies aimed at reducing these factors can subsequently reduce the risk of stroke. So far, many primary studies were conducted to estimate the burden of stroke and modifiable risk factors in Ethiopia. However, the lack of a nationwide study that determines the overall pooled estimation of burden and modifiable risk factors of stroke is a research gap. To conduct this systemic review and meta-analysis, we are following the PRISMA checklist. Three authors searched and extracted the data from the CINAHL (EBSCO), MEDLINE (via Ovid), PubMed, EMcare, African Journals Online (AJOL), and Google scholar. The quality of the primary study was assessed using the Newcastle-Ottawa Scale (NOS) by two independent reviewers. The primary studies with low and moderate risk of bias were included in the final analysis. The authors presented the pooled estimated burden of stroke and its modifiable risk factors. The registered protocol number in PROSPERO was CRD42020221906. In this study, the pooled burden of hemorrhagic and ischemic stroke were 46.42% (95%CI: 41.82-51.53; I2 = 91.6%) and 51.40% (95%CI: 46.97-55.82; I2 = 85.5%) respectively. The overall magnitude of modifiable risk factor of hypertension, alcohol consumption and dyslipidemia among stroke patients were 49% (95%CI: 43.59, 54.41), 24.96% (95CI%:15.01, 34.90), and 20.99% (95%CI: 11.10, 30.88), respectively. The least proportion of stroke recovery was in the Oromia region (67.38 (95%CI: 41.60-93.17; I2 = 98.1%). Farther more, the proportion of stroke recovery was decreased after 2017 (70.50 (56.80-84.20). In our study, more than 90% of stroke patients had one or more modifiable risk factors. All identified modifiable stroke risk factors are major public health issues in Ethiopia. Therefore, strategy is designed for stroke prevention to decrease stroke burden through targeted modification of a single risk factor, or a cluster of multiple risk factors, used on a population, community, or individual level.

Clustering of lifestyle risk factors among adult population in India: A cross-sectional analysis from 2005 to 2016.

IntroductionIndividual’s early life style and health behaviors are directly linked to chronic non-communicable diseases. Considering the increased burden of NCDs during the last two decades, the aim of this study is to assess co-occurrence/clustering of lifestyle risk factors and its association with different socio-demographic and economic characteristics among adult men and women in India from 2005–2016.MethodsThis study utilized the data from the National Family Health Survey 2005–06 and 2015–16 survey rounds. Multinomial logistic regression is employed to evaluate co-occurrence of multiple risk factors among adult men and women of different socio-economic and demographic characteristics to identify the subgroups with elevated risk of clustering of multiple unhealthy lifestyle risk factors.ResultsMore adult men in India tend to exhibit clustering of multiple non-communicable disease risk factors than females. Individuals between 30–49 years of age, residing in urban areas, the population with no education, separated couples and those from poor economic strata are the specific population subgroups show higher prevalence of co-occurrence of multiple risk factors. The regional pattern of clustering of risk factors shows that the prevalence of co-occurrence of multiple risk factors is higher among men and women from the North-Eastern part of India compared to the other regions of the country.ConclusionThe prevalence of clustering of multiple risk factors associated with chronic NCDs is substantially high and has increased between 2005–06 to 2015–16. India may therefore experience a significant increase in the burden of chronic non-communicable diseases in the coming years. We therefore conclude that appropriate strategies should be implemented by policy makers and the government to reduce the overall health burden of NCDs due to lifestyle habits.

Clustering of risk factors and the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline.

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) lowered the diagnostic criteria for hypertension. We aimed to explore whether clustering of multiple risk factors are associated with the risk of new-onset hypertension defined by the 2017 ACC/AHA Hypertension Guideline. Subjects who attended ≥2 annual health examinations without baseline hypertension and cardiovascular disease were included. Hypertension was defined according to the 2017 ACC/AHA Hypertension Guideline. Seven predefined risk factors, including age, resting heart rate, overweight or obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and a poor estimated glomerular filtration rate, were analyzed. A composite, individual-level, cumulative score incorporating these seven risk factors (no = 0 point; yes = 1 point; total range of 0-7 points) was calculated. The association between the cumulative score and the risk of hypertension was analyzed using a Cox regression model. A total of 4424 (21.6%) of 20,190 subjects included had new-onset hypertension during a follow-up duration of 3.6 years. Compared with subjects with 0 points, the adjusted hazard ratios (95% confidence intervals) for the development of hypertension for those with 1, 2, 3, and ≥4 points were 1.21 (1.07-1.38), 1.34 (1.19-1.52), 1.44 (1.26-1.63), and 1.64 (1.44-1.87), respectively (P < 0.001), after adjustment for sex and baseline blood pressure. Age, resting heart rate, overweight/obesity, dyslipidemia, hyperuricemia, impaired glucose regulation, and a poor estimated glomerular filtration rate are associated with an increased risk of future hypertension. When these factors are combined, there is an accumulated increase in risk.

Cardiometabolic Proteins Associated with Metabolic Syndrome

Background: Although metabolic syndrome (MetS) was described in the late 80s, the molecular mechanisms underlying clustering of risk factors in certain individuals are not fully understood. The present study used targeted proteomics to establish cardiometabolic proteins related to all MetS components, thereby providing new hypotheses regarding pathways involved in the pathogenesis of MetS. Methods: In the EpiHealth study, 249 cardiometabolic proteins were measured by proximity extension assay (PEA) and related to the five MetS components [consensus-modified National Cholesterol Education Program (NCEP) criteria] in 2,444 participants aged 45-75 years (50% women). Results: Thirty-one proteins were associated with systolic blood pressure following adjustment for age and sex (P < 0.000040, taking multiple testing into account). The corresponding number of proteins significantly associated with fasting glucose, waist circumference, high-density lipoprotein cholesterol, and serum triglycerides were 58, 132, 127, and 148. Twenty-two proteins were significantly related to all 5 MetS components, and of those, 20 were with MetS as a binary outcome (n = 600, 24% of the sample) following adjustment for age, sex, fat mass, and lifestyle factors (alcohol intake, smoking, education, and exercise habits). Conclusion: Using targeted proteomics, we identified 20 proteins reflecting a range of pathways, such as immunomodulation at different levels; regulation of adipocyte differentiation; lipid, carbohydrate, and amino acid metabolism; or insulin-like growth factor signaling, to be strongly associated with MetS independently of fat mass and lifestyle factors. Whether some of these proteins are causally involved in the pathogenesis of clustering of multiple risk factors in the same individual remains to be investigated.

Visceral obesity, but not central obesity, is associated with cardiac remodeling in subjects with suspected metabolic syndrome

Background and aimsMetabolic syndrome (MetS) is a cluster of multiple risk factors including central obesity that may lead to cardiac damage and cardiovascular events. We investigated whether visceral obesity induces cardiac structural and functional remodeling independently from central obesity and other risk factors in subjects with suspected MetS. Methods and resultsWe studied 229 participants with suspected MetS. Visceral fat area (VFA) was measured by bioelectrical impedance analysis. Left ventricular (LV) mass index, early diastolic velocity of mitral annulus (e′), and LV global longitudinal strain (GLS) were measured by echocardiography. Subjects were categorized into high and low VFA group (VFAh and VFAl). MetS was more prevalent in the VFAh than in the VFAl (p = 0.004). The VFAh had a higher waist circumference (WC) than the VFAl (p < 0.001). LV mass index was higher, but e' and GLS were lower in the VFAh than in VFAl (all p < 0.05). VFA was well correlated with blood pressure, fasting blood glucose, triglyceride, high-sensitivity C-reactive protein and adiponectin (all p < 0.05). VFA was correlated to LV mass index, e’, and GLS (all p < 0.05) and was independently associated with GLS after adjustment for other risk factors, including WC (p = 0.005). ConclusionsVisceral obesity assessed by VFA was well correlated with parameters of MetS. Visceral obesity, but not central obesity measured by WC, was independently associated with structural and functional cardiac remodeling in subjects with suspected MetS. It suggests that visceral obesity should be considered as an important risk factor for cardiac damage in dysmetabolic subjects. Trial registrationNCT02077530 (date of registration: November 1, 2013).

Lifestyle Intervention Program for Amelioration of Dysmetabolism in Overweight Women.

Overweight and obesity, a cluster of multiple risk factors for atherosclerosis such as elevated blood pressure, elevated glucose level, and dyslipidemia, increase the risk of all-cause mortality and cardiovascular morbidity and mortality. Physical activity and a proper diet are essential preventive measures. The aim of the study was to evaluate the effects of a two-month intervention program consisting of a low-caloric diet (1,500kcal) and increased physical activity on the anthropometric parameters, body composition, resting metabolic rate, and maximum oxygen uptake. The study was conducted in 22 women aged 20-38 with diagnosed overweight or obesity. We found that after completing the eight-week-long intervention program, there were significant changes in body composition, consisting of a smaller proportion of body fat and increased lean body mass. Further, we observed a decrease in body weight by 4.3±2.5kg (p<0.01), a reduction in waist and hip circumference of 2.6±4.5cm (p<0.01) and 4.4±2.9cm (p<0.01), respectively, and an increase in maximum oxygen uptake by about 5.2±8.4ml/kg/min (p<0.01). We conclude that the intervention program consisting of counseling on diet and physical activity may be highly motivational for patients with excess body weight and care givers should give it a try before commencing more aggressive psychopharmacological therapies.

Evaluation of Proinflammatory Cytokines in Obese vs Non-obese Patients with Metabolic Syndrome.

Background:Obesity is one of the most common yet neglected public health problems in both the developed and developing countries. Metabolic syndrome (MS) is a multiplex of risk factor for the development of type 2 diabetes (T2D) and cardiovascular disease (CVD) and it reflects the clustering of multiple risk factors resulting from obesity and insulin resistance. Despite its predominance in obese individuals, MS does occur in non-obese individuals. Many individuals characterised as normal weight as per their body mass index (BMI), have increased visceral adiposity thereby leading to an unfavourable inflammatory cytokine profile. There are limited studies from India with respect to inflammatory cytokines in obesity and MS in general and non-obese patients with MS in particular.Materials and Methods:An observational cross-sectional study was carried out in patients with MS with or without obesity. Anthropometric parameters such as height, weight and waist girth were measured and BMI was calculated. Serum levels of TNF-α, IL-6 and adiponectin were measured by using the enzyme-linked immunosorbent assay.Results:A significant proportion of individuals categorised as normal weight had an increased waist circumference which correlated with BMI, acanthosis nigricans (AN) and fatty liver. There was no statistically significant difference in the cytokine levels in obese and non-obese patients with MS; similarly among non-obese patients with MS, cytokine levels were comparable in patients with or without abdominal obesity. However, triglycerides inversely correlated with adiponectin levels and there was no significant correlation between the cytokines and other parameters of MS.Conclusion:There was no significant difference in various metabolic and inflammatory parameters between obese and non-obese patients with MS. Even in non-obese group, there were no differences in metabolic and inflammatory markers between individuals with or without abdominal obesity. This finding indicates that apart from adipose tissue, other factors are also responsible for the development of MS and its associated proinflammatory profile. There could be a significant contribution of genetic and epigenetic factors which needs to be further explored.

Absence of association between −286C&gt;A&gt;T polymorphism in the CRP gene and metabolic syndrome in Iranian pediatric

Background:As a common pathophysiological condition worldwide, metabolic syndrome (MetS) is a clustering of multiple risk factors implicating in the development of many chronic disorders. Of note, obesity-induced chronic, low-grade inflammation is a major cause of insulin resistance and MetS. In the present study, we evaluated the association of rs3091244 variant of the C-reactive protein (CRP) gene, a well-recognized systemic inflammatory marker, with MetS in Iranian children and adolescents.Materials and Methods:Genotyping was performed by mismatched polymerase chain reaction-restriction fragment length polymorphism in 100 MetS and 100 normal individuals aged 9–19 years recruited in the central part of Iran in 2011. A t-test or one-way ANOVA with post-hoc multiple comparisons were used to analyze the differences between groups. Statistical significance was defined as P ≤ 0.05. Logistic regression used to evaluate the association between alleles of the CRP rs3091244 and increased MetS risk.Results:There were no differences in the genotype frequencies or allele distribution for −286C>A>T CRP polymorphism between MetS and control groups. Logistic regression showed that only the T allele of the CRP rs3091244 and not any of the genotypes confers a borderline significant (P = 0.059) increased MetS risk compared to A allele with the odds ratio of 1.70 (0.98–2.96).Conclusions:This study suggests that in Iranian children and adolescents, −286C>A>T CRP polymorphism is not associated with the increased risk for MetS.

Fat Accumulation and Obesity-related Cardiovascular Risk Factors in Middle-aged Japanese Men and Women

A cluster of multiple risk factors has been noted to constitute the background of cardiovascular disease. The purpose of this study was to evaluate the relationship between the visceral fat area (VFA) or subcutaneous fat area (SFA) and a cluster of obesity-related cardiovascular risk factors, including hyperglycemia, dyslipidemia and elevated blood pressure, in middle-aged Japanese men and women. A total of 571 subjects (m=434; f=137; age: 53 ± 9 years) who underwent health examinations with evaluations of body fat distribution using computed tomography scans and assessments of 75-g oral glucose tolerance tests were enrolled in this study. The VFA and SFA were linearly correlated with the number of risk factors in both men and women. The area under the receiver-operating characteristic curve of VFA (m=0.741, f=0.763) was significantly higher than that of SFA (m=0.636, f=0.689) with respect to the clustering of risk factors (one or more). The men exhibited larger VFA values and smaller SFA values than the women in similar body mass index (BMI) categories. Men with a VFA of ≥100 cm(2) irrespective of BMI and women with a VFA of ≥100 cm(2) and a BMI of ≥25 kg/m(2) demonstrated a high prevalence of diabetes mellitus and impaired glucose tolerance. Men and women with a VFA of ≥100 cm(2) irrespective of BMI demonstrated a high prevalence of type IIb dyslipidemia. These results suggest that the absolute value of VFA rather than SFA is more closely associated with a cluster of risk factors irrespective of sex and is a good marker for selecting subjects to whom weight reduction should be recommended in order to prevent cardiovascular disease in the general population.

Coexistence of Visceral Fat and Multiple Risk Factor Accumulations is Strongly Associated with Coronary Artery Disease in Japanese (The VACATION-J Study)

Multiple risk factor syndrome is a target for the prevention of coronary artery disease (CAD). A cluster of multiple risk factors, such as hypertension, glucose intolerance, and/or dyslipidemia, is encountered in Japanese without and with excess visceral fat. The present study investigated the relationship between multiple risk factor accumulation and CAD in Japanese without and with visceral fat accumulation. The study subjects comprised 257 Japanese with suspected CAD (males/females= 153/ 104), who underwent 64-row multislice computed tomography (CT) coronary angiography and visceral fat area (VFA) measurement by CT. Based on the Japanese criteria for visceral fat accumulation, they were divided into those with VFA <100 and ≥10 cm(2). In subjects with VFA <100 cm(2), the age- and sex-adjusted odds ratios (ORs) for 2 and 3 risk factors were 5.33 (95% confidence intervals; 1.04-27.38, p=0.0449) and 4.07 (0.72-23.15, p=0.1138), respectively, compared with VFA <100 cm(2) and 0 risk factor set at 1.0 (p=0.0569 for trend). In contrast, the respective ORs for subjects with VFA ≥100 cm(2) were much higher [6.46 (1.25-33.44, p=0.0261) and 20.42 (3.60-115.73, p=0.0007)] (p<0.0001 for trend). The multivariate adjusted model demonstrated a significant relative excess CAD risk of 1.08 (p=0.0484) and 5.01 (p<0.0001) for the interactions of 2 risk factors and VFA ≥100 cm(2), and 3 risk factors and VFA ≥100 cm(2), whereas multiple risk factor accumulation was not related with the increase of CAD risk in subjects with VFA <100 cm(2). Coexistence of visceral fat and risk factor accumulations is strongly associated with CAD in Japanese.

Comparison Study of Metabolic Syndrome's Differences and Diagnostic Criteria's Applicability among Xingjiang Uighur, Kazak and Han Population

Our paper is a study about metabolism syndrome (MS) incidence situations of different nationalities, including Uighur, Kazak and Han nationality in Xinjiang by means of a cross-sectional survey and compare differences and adaptabilities of applications of the diagnostic criteria for MS recommended by Adult Treatment Protocol III of National Cholesterol Education Program of America (ATP III), International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) in three groups of populations. Conclusion tell us, for Uighur population and Kazak population, IDF criterion and ATPIII criterion had a better consistence, and CDS criterion was worst. For Han population, CDS criterion and IDF criterion had a better consistence, and ATPIII criterion was worst. For the screening of MS incidence rate of Uighur and Kazak adult populations in Xinjiang region, ATPIII criterion was optimal, while CDS criterion was optimal for Han population. However, as for screening of clustering of multiple risk factors of MS, IDF criterion was better than other criteria for the three nationalities.

Association of variations in the FTO, SCG3 and MTMR9 genes with metabolic syndrome in a Japanese population

Metabolic syndrome is defined as a cluster of multiple risk factors, including central obesity, dyslipidemia, hypertension and impaired glucose tolerance, that increase cardiovascular disease morbidity and mortality. Genetic factors are important in the development of metabolic syndrome, as are environmental factors. However, the genetic background of metabolic syndrome is not yet fully clarified. There is evidence that obesity and obesity-related phenotypes are associated with variations in several genes, including NEGR1, SEC16B, TMEM18, ETV5, GNPDA2, BDNF, MTCH2, SH2B1, FTO, MAF, MC4R, KCTD15, SCG3, MTMR9, TFAP2B, MSRA, LYPLAL1, GCKR and FADS1. To investigate the relationship between metabolic syndrome and variations in these genes in the Japanese population, we genotyped 33 single-nucleotide polymorphisms (SNPs) in 19 genes from 1096 patients with metabolic syndrome and 581 control individuals who had no risk factors for metabolic syndrome. Four SNPs in the FTO gene were significantly related to metabolic syndrome: rs9939609 (P=0.00013), rs8050136 (P=0.00011), rs1558902 (P=6.6 × 10(-5)) and rs1421085 (P=7.4 × 10(-5)). rs3764220 in the SCG3 gene (P=0.0010) and rs2293855 in the MTMR9 gene (P=0.0015) were also significantly associated with metabolic syndrome. SNPs in the FTO, SCG3 and MTMR9 genes had no SNP × SNP epistatic effects on metabolic syndrome. Our data suggest that genetic variations in the FTO, SCG3 and MTMR9 genes independently influence the risk of metabolic syndrome.

Relations Between Waist Circumference at Four Sites and Metabolic Risk Factors

The location of waist circumference (WC) measurement differs among diagnostic guidelines for the metabolic syndrome. The present study examined which of four WC measurements was associated most strongly with the clustering of metabolic risk factors in cross-sectional study. The subjects comprised 1,140 Japanese employees, aged 20-70 years, who underwent health examinations in 2007 and 2008. WC was measured at (i) the narrowest part of the waist, (ii) midway between the lowest rib and the iliac crest, (iii) the umbilical level, and (iv) immediately above the iliac crest. A receiver operator characteristic (ROC) curve was used to assess the ability of each WC measurement to predict the presence of two or more other components of the metabolic syndrome, as defined by the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) in 2005. Multiple risk factors were seen in 43.0% of the men and 12.9% of the women. The minimum and maximum WC measurements differed by 3.9 cm among the men and 12.6 cm among the women. The areas under the curve examining the ability of the four WC measurements to predict the clustering of multiple risk factors were similar. If the same WC cutoff value was applied, the prevalence of the metabolic syndrome changed considerably according to the site of WC measurement. The four WC measurements had similar screening abilities. Given the differences in the WC values according to the site of measurement, WC must be measured at the site specified by each diagnostic guideline.

Prevalence of metabolic syndrome and optimal waist circumference cut-off points for adults in Beijing

Background In the modified ATP III definition for metabolic syndrome (MS), the cut-off values for central obesity were set to ≥90 cm for male and ≥80 cm for women. Recently, a new Chinese definition for central obesity was set to ≥90 cm for male and ≥85 cm for women according to the corresponding BMI value of 25 kg/m 2. Objective The purpose of this study was to explore the optimal WC cut-off points to reflect the cluster of multiple risk factors for adults in Beijing. Method The data collected during the surveillance of risk factors for non-communicable diseases in Beijing 2005 were used, with a total of 16,711 adults studied. Subjects with two or more components from the modified ATP III definition other than central obesity were considered to have multiple risk factors. Results The optimal WC cut-off points were 87 cm in men and 80 cm for women. When applied the WC advised definition for MS, the age-standardized prevalence was 38.0% for male and 32.3% for women, which is significantly higher than using the original one for men (34.7% vs 32.3%, P < 0.001). Conclusion The present study indicated that optimal waist circumference cut-off points were lower than that proposed in the modified ATP III definition, especially for men.

The Frequency and Determinants of Metabolic Syndrome in Patients with Operable Stage I-III Breast Cancer.

Abstract Background: Metabolic syndrome is a cluster of multiple risk factors including obesity, insulin resistance, hypertriglyceridemia, low HDL (high density lipoprotein), and hypertension. Metabolic syndrome is associated with an increased risk of breast cancer. We evaluated the frequency and determinants of metabolic syndrome in patients with operable stage I-III breast cancer.Methods: In this cross-sectional study we analyzed the frequency and determinants of metabolic syndrome in patients with stage I-III breast cancer. Metabolic syndrome was defined according to NCEP (National Cholesterol Education Program) definitions. Data on metabolic syndrome criteria were collected along with demographic data, tumor size, grade, lymph node, estrogen, progesterone, HER2 status, grade and history of chemotherapy/endocrine therapy.Results: A total of 331 patients were analyzed. Median age was 50.0 years (range 20-84 years). Eighty-five patients were using tamoxifen, 98 patients were using aromatase inhibitors and the remaining 148 patients were not receiving hormonal therapy (newly diagnosed and/or triple-negative patients). According to the NCEP criteria 48.0% of the patients had metabolic syndrome. More patients receiving aromatase inhibitors had metabolic syndrome than those receiving tamoxifen (60.2% vs. 37.6%, p = 0.008). The frequency of MS among those not taking any hormonal therapy was 45.9%. Additionally, post-menopausal patients had higher rate of MS compared to pre-menopausal ones (53.4% vs. 25.0% p=&amp;lt;0.001). Patients with HER2 positive tumors and patients who had a history of oral contraceptive use had lower rates of metabolic syndrome than those with HER2 negative tumors and no oral contraceptive use, respectively (40,0% vs. 53,7% for HER2, p=0.028 and 32,6% vs. 50,3% for oral contraceptive use, p=0.034).There was no significant correlation between the presence of metabolic syndrome and estrogen/progesterone receptor status, tumor size, nodal status, stage, grade, adjuvant chemotherapy, hormone replacement therapy, smoking history.Conclusions: Nearly half of the patients with stage I-III breast cancer had metabolic syndrome. Adjuvant aromatase inhibitor therapy was found to be associated with higher rate of metabolic syndrome whereas history of oral contraceptive use and HER2 positivity were associated with lower rate. Whether the aromatase inhibitors contribute the development of metabolic syndrome or not needs to be elucidated by future prospective studies. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5121.

Abstract: P1374 THE EFFECT OF LPL PVU II POLYMORPHISM ON THE PREVALENCE OF KOREA METABOLIC SYNDROME

In the modified ATP III definition for metabolic syndrome (MS), the cut-off values for central obesity were set to ≥90 cm for male and ≥80 cm for women. Recently, a new Chinese definition for central obesity was set to ≥90 cm for male and ≥85 cm for women according to the corresponding BMI value of 25 kg/m2.The purpose of this study was to explore the optimal WC cut-off points to reflect the cluster of multiple risk factors for adults in Beijing.The data collected during the surveillance of risk factors for non-communicable diseases in Beijing 2005 were used, with a total of 16,711 adults studied. Subjects with two or more components from the modified ATP III definition other than central obesity were considered to have multiple risk factors.The optimal WC cut-off points were 87 cm in men and 80 cm for women. When applied the WC advised definition for MS, the age-standardized prevalence was 38.0% for male and 32.3% for women, which is significantly higher than using the original one for men (34.7% vs 32.3%, P < 0.001).The present study indicated that optimal waist circumference cut-off points were lower than that proposed in the modified ATP III definition, especially for men.

The role of fat topology in the risk of disease

Clustering of multiple risk factors such as impaired glucose metabolism, lipid disorders and hypertension has been shown to be the major background of atherosclerotic diseases, and disease entities such as the metabolic syndrome represent a highly atherogenic state. Although these common risks may generally co-exist by accident in one individual, clustering of multiple risk factors in the metabolic syndrome does not occur by accident, and there should be a key player for the syndrome. In 1983, we reported the method for fat analysis using computed tomography scan, which enables us to analyze intra-abdominal visceral adiposity as well as subcutaneous fat. Visceral fat accumulation has been shown to cause impaired glucose metabolism, lipid disorders, and hypertension, and therefore it is considered to be a key player in the metabolic syndrome. To clarify the mechanism by which visceral fat accumulation causes a variety of metabolic and vascular diseases, we studied the molecular characteristics of adipose tissue and adipocytes by investigating expressed genes in visceral and subcutaneous adipocytes and revealed that adipocytes, especially visceral adipocytes, secrete a variety of bioactive substances, the so-called adipocytokines. We showed that visceral fat accumulation causes abnormalities in adipocytokine secretion, such as hypersecretion of plasminogen activator inhibitor 1, which is related to thrombogenic vascular diseases. More importantly, we discovered an important benign adipocytokine named adiponectin, which protects against the development of diabetes mellitus, hypertension, inflammation, and atherosclerotic vascular diseases. Plasma levels of adiponectin decreased in individuals with visceral fat accumulation, and hypoadiponectinemia caused by visceral fat accumulation might be one of the major causes of metabolic syndrome.

Are Patients Who Have Metabolic Syndrome without Diabetes at Risk for Developing Chronic Kidney Disease? Evidence Based on Data from a Large Cohort Screening Population

Recently, metabolic syndrome (MS) was suggested to be an independent risk factor for chronic kidney disease (CKD). This study explored the relationship between MS and risk for development of CKD that is independent of diabetes. The study population consisted of 4607 adult (age >18 yr) individuals who did not have diabetes or CKD at baseline and were successfully followed for 3 yr in the Tehran Lipid and Glucose Study, a prospective, population-based study of risk factors for atherosclerosis and diabetes. Individuals with and without MS at baseline were compared regarding development of new CKD. A total of 1010 (21.9%) individuals met criteria for MS at baseline. During the follow-up, 38 (3.4%) individuals in MS group and 73 individuals (2.0%) of 3590 people in non-MS group developed CKD (OR = 1.88, 95% CI; 1.26-2.8). After exclusion of individuals with hypertension at baseline (n = 798), 406 people (10.7%) were defined as having MS. After follow-up, 62 (1.82%) people in the MS group and eight (1.98%) people in non-MS group developed CKD (OR = 0.925, 95% CI; 0.446-1.917; P = 0.844). The results of this study suggest that MS is a cluster of multiple risk factors, and, as a cluster, it is a significant risk for CKD. The risk of MS for developing CKD is highly affected by the presence of diabetes and hypertension, and it seems that clustering of individual risk factors is more plausibly associated with risk for developing CKD than a unique biologic phenomenon.

The prevalence and clustering of four major lifestyle risk factors in an English adult population

Background The aim of this study was to examine the clustering of four major lifestyle risk factors (smoking, heavy drinking, lack of fruit and vegetables consumption, and lack of physical activity), and to examine the variation across different socio-demographic groups in the English adult population. Methods The study population was derived from the 2003 Health Survey for England ( n = 11,492). Clustering was examined by comparing the observed and expected prevalence of the different possible combinations. A multinomial multilevel regression model was conducted to examine the socio-demographic variation in the clustering of the four risk factors. Results The study found that, when using British health recommendations, a majority of the English population have multiple lifestyle risk factors at the same time. Clustering was found at both ends of the lifestyle spectrum and was more pronounced for women than for men. Overall, multiple risk factors were more prevalent among men, lower social class households, singles, and people who are economically inactive, but less prevalent among homeowners and older age groups. Conclusions The clustering of multiple risk factors provides support for multiple-behavior interventions as opposed to single-behavior interventions.