Children sometimes develop metabolicsyndrome, and it is strongly associated with the same syndrome in adulthood.
Recently, there is evidence that obesity and metabolicsyndrome originate from fetal life. Possible explanations of fetal and developmental origin of metabolicsyndrome are the thrifty genotype and thrifty phenotype hypothesis, which together confer insulin resistance on developing fetus. Poor nutrition in utero as well as extrauterine growth restriction of preterm infants are important triggers of this hypothesis. Like metabolicsyndrome in adulthood, the high levels of inflammatory cytokines and adipokines are certainly characteristic in pediatric patients. Increased fat mass was also observed in these patients, although their birth weight was lower than average. The mitochondrial genome is responsible forthe inheritance of obesity from the maternal line. This can be a key as to why the phenotypes of obesity and metabolicsyndrome start in fetal life with an association with poor maternal nutrition. In such circumstances, catch- up growth with an over-nutrition strategy can aggravate those features, suggesting that rapid catch-up growth in early infancy should not be encouraged.
주제어 : 영양소 섭취, 대사증후군, 폐경여성, 미량영양소, 전향적 연구
Abstract The purpose of this study was to investigate the comparison between metabolicsyndromeindicators and nutrient intakes in Korean menopausal women from the Korean National Health and Nutrition Examinations Survey data (2010∼2012). Menopausal Status were classified into premature menopause(n=214) and natural menopause(n=2,546). Among the nutrient groups, retinol intake was a significant factor in natural menopausal women according to BMI levels and riboflavin intake was another significant factor in premature menopausal women according to fasting glucose levels. The results suggested that micronutrient including retinol, riboflavin, fiber and calcium were significantly associated with metabolicsyndrome risk in Korean postmenopausal women. Further research is required for elucidating the association between nutrient intakes and incidence of metabolicsyndrome in postmenopausal women within a large population in prospective studies.
SUBJECTS AND METHODS
This study was conducted with patients who visited a health-care center in Seoul and had abdominal ultrasonography between 2 March 2013 and 28 February, 2014. All participants signed a written informed consent form approved by the Institutional Review Board of the Hallym University of Graduate Studies. The eligible patients were divided into four groups and then underwent randomization: patients with a gallstone and metabolicsyndrome, patients with a gallstone but without metabolicsyndrome, patients who had metabolicsyndrome without a gallstone, and patients who did not have either meta- bolic syndrome or a gallstone. We included both genders but required the patient’s age to be over 20. However, we excluded patients who lacked medical records or had undergone hepatobiliary surgery. The total study population comprised 256 males and 172 females. Heights (m) and weights (kg) were measured by automatic devices and used in body mass index calculations (kg/m 2 ). Obesity was calculated as (current weight / standard weight) and expressed as a percentage. Waist circumference was measured by using a measuring tape in centimeter units. When the patient stands in an upright position, the narrowest point between the lower rib and upper edge of the iliac crest was measured circumferentially. Systolic and diastolic blood pressure were measured at the upper right arm using an automatic manometer. If the systolic blood pressure was more than 140 mmHg or the diastolic blood pressure was higher than 90 mmHg, the patients were required to rest for around 1 hour, and the blood pressure was checked again. Three radiologists examined the patients using abdominal ultrasonography and diagnosed the presence of a gallstone if they could find any acoustic shadow behind the gallbladder or movement of a hyperechoic lesion by changing the patients’ position. Patients were excluded if there was any other disease in the gallbladder other than of gallstones. Total number of gallstones was recorded based on radiographic imaging or its report.
central obesity as well as MS [22, 23]. Another interesting point was that liver functions, ALT and AST, were the key variables to classify the two groups.
13 rules except rule 2 in Table 3 included ALT and/or AST. It means that ALT and AST played a critical role in classifying the two groups together with other variables. This is consistent with the previous finding that ALT or AST were significantly correlated to fasting blood glucose as well as BMI and blood pressure levels . It is also noteworthy that although the values of ALT and AST do not exceed the normal range, they still played a critical role in classifying the two groups. Overall, the results of our experiment are more specific and thus more useful than those of the above researches.
Our study has several strengths. First, to our knowledge, we showed the significant association between MS and asthma in the elderly patients forthe first time. Second, this study is based on data from a nation-wide sur- vey that is representative of a large population. Third, mediation analyses provided a possible explanation of the link between MS and asthma, which supports the hypothesis that MS could be related to asthma through IR and systemic inflammation. We also admit limitations. Most of all, asthma was defined only based on self-reported wheezy episodes in our study. Although a questionnaire allowing the self-reporting wheezy episodes has been generally used in other studies for diagnosing asthma 6,29 , other various conditions can be related with wheezing sound. Of these, cases who could have chronic obstructive pulmonary disease were excluded based on spirome- try results in our study, but we admit that our definition based on a self-report questionnaire could overlap with exercise-induced bronchoconstriction related to conditions other than chronic asthma such as obesity, lack of fit- ness or vocal cord dysfunction 30,31 . Second, the KNHANES survey did not measure airway inflammation or other systemic inflammatory biomarkers such as C-reactive protein. Oxidative stress was not measured. Third, our study is cross-sectional, and we could not verify the cause-effect relationship. There is a possibility that asthma increased the risk of MS in elderly patients. In fact, the mediation analysis showed a statistical significance in the analysis of the direction from asthma to MS (data not shown). Fourth, there are also many elderly asthmatics without MS, although we focused on the link between MS and elderly asthma. Interestingly, their onset ages were slightly different from those with MS. However, we could not clarify the characteristics and mechanisms of asthma in elderly without MS. Fifth, because characteristics of participants included in this study were signifi- cantly different from those excluded, our findings should be interpreted with caution.
44 (2) Muscular endurance test
Muscle endurance was measured by sit-up (SU). The subject was laid down in a comfortable position on their back, and the subject’s knees were bent and such that the heel and the hip were at an angle of ninety degrees. The soles of the feet were kept flat so that they were spaced apart by a gap of one foot size. With the arms extended straight and the hands along the thighs, the upper body was then lifted up and forward so that the palm of the hand could slide up the thigh and wrap around the knee in response to a beeping sound once every three seconds. Then, when the measurer checked the time, the subject immediately went back to the ready position and repeatedly performed the upper SU. If the SU was not maintained for at least one second of the three-second interval, the SU was not counted, and if two in a row were not counted, then the count was terminated. A signal rhythm file for SU with a 'start' signal was played and the performance times were recorded.
나타냈으며 , 혼자 식사하는 빈도에 따른 평균값의 증가 · 감소 경향의 유의성을 p-for-trend로 나타내었다. 1,000 kcal 당 영양소 섭취량의 보정변수로는 나이, 소득수준, 교육수 준, 경제활동, 거주 지역, 흡연, 음주, 신체 활동을 이용하 였다. BMI와 대사증후군 구성지표들의 평균을 비교할 때, 이상지질혈증 약물 , 혈압조절제, 인슐린, 경구혈당강하제 를 복용하는 경우 평균값에 영향을 줄 수 있으므로 해당 약물을 복용한 사람을 제외하고 분석을 진행하였다 . 혼자 식사하는 빈도에 따른 대사증후군 구성지표에 대한 기준치 초과와 대사증후군 질병을 가질 오즈비를 알아보기 위해 단변량과 다변량 로지스틱 회귀분석 (proc surveylogistic) 을 실시하여, 분석결과는 오즈비 (odds ratio)와 95% 신뢰 구간 (confidence interval, CI)으로 나타내었으며, 혼자 식 사하는 빈도에 따른 비만 및 대사증후군 위험도의 증가 · 감소 경향에 대한 유의성을 p-for-trend로 나타내었다.
syndrome will be looked into in this study. Also, the pur- pose of this study lies in revealing the risk ratio of meta- bolic syndrome based on the level of hs-CRP risk groups and relevant risk factors including drinking and smoking among general traits. The diagnosis criteria of AHA/NHLBI was applied forthe diagnosis criteria of metabolic syn- drome except abdominal obesity (Grundy et al , 2005). In case of abdominal obesity, WHR was measured and men over 0.90 and women over 0.85 were classified as abdomi- nal obesity since the criteria for abdominal obesity is dif- ferent according to countries and regions. Then, the group with 3 or more metabolicsyndrome risk factors out of 5 was determined to have metabolicsyndrome.
Background: Metabolic syndrome is a serious modern health problem which contributes to various diseases such as diabetes, hypertension, chronic renal failure, and cerebral vascular disease. Risk factors formetabolicsyndrome include abdominal obesity, insulin resistance, excessive caloric intake, and lack of physical activity. These lifestyle factors are significantly associated with metabolicsyndrome(MS).The aim of this study was to evaluate the impact of lifestyle factors on the prevalence of MS.
Methods: This study used data from the National health screening program (NHSP) cohort database ofcollected from 2002 through 2003 and from 2009 through 2010. We sampled 313,748 adults from the cohort database of 2009-2010. The participants were evaluated on medical history, blood pressure, smoking, alcohol consumption, physical activity, and abdominal obesity. Participants were then grouped according to a modified ATP III criteria and matched to the cohort database of 2002-2003, respectively. This study analyzed whether a lifestyle change in each group during the follow-up period could influence development of MS.
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obesity . 2) However , since subgroups of obesity were found 3) , evaluating obesity by other various modalities has been suggested . One study , for example , focused on the prevalence of metabolicsyndrome in individuals with normal BMI and slightly elevated BMI . They suggested screening body fat distribution in individuals with normal or slightly elevated BMI would be an important contribution to prevent diabetes and cardiovascular diseases . For screening body fat distribution , bioimpedance is a widely - used technique due to its safety , accuracy , reliability , and low cost as compare to other body composition methods . 4)
대사증후군의 위험을 예방할 수 있는 식습관 개선과 관련된 연구 는 예전부터 활발히 진행되어 왔고, 21, 22) 미국의 경우 식사 지침인 Dietary Guidelines for Americans 2010 을 통해 알코올 섭취를 제 한하고 나트륨이나 포화지방의 함량이 낮은 식품 및 과일, 채소, 단 백질 식품의 섭취를 늘릴 것을 권고하고 있다. 23) 실제로 이 같은 지 침에 따랐을 때 대사증후군의 이환률 및 위험도가 감소되었다는 보 고도 있다. 24) 국내 연구에서도 아침 식사를 거르지 않고, 싱겁게 먹 으며, 외식과 알코올 섭취량을 줄이고, 과식을 피하는 식습관 등이 대사증후군을 예방할 수 있다고 밝히고 있다. 14) 이러한 식습관의 변 화는 개인에게만 맡겨서는 그 한계가 있기 때문에 올바른 식습관을 위한 체계적인 교육과 홍보가 필요하겠다. 또한 국민 건강 증진을 위한 식습관 중재 프로그램은 대사증후군 이환률을 낮추는데 많은 도움이 될 것으로 생각된다.
There are some limitations in this study. First, although ran- domly selected, participation in this study was on a voluntary basis. Study participants might have been more health conscious and willing to modify their health behaviors than non-partici- pants. Significant reduction of MetS prevalence observed in the BI group implies that relatively moderate efforts for promoting MetS management can give more motivation for a lifestyle change of the participants than expected. It is required to take more caution to develop universally effective strategies for a lifestyle modification intervention. Second, during the 1-yr follow-up period, 45.7% of participants dropped out of the study, and more than 20% of which occurred at T6. In previous intervention stud- ies in Korea and Japan, about 80% of participants refused or gave up their participation during the follow-up period (20, 31). Par- ticipants in this study had some difficulties with frequent visits to interventions which required fasting. Approximately 60% of the participants were employed, and half a day off from the work was needed for each visit to the intervention program. Remind- er calls and personalized text messages were attempted in this study to keep the participants in the program. There were no significantly different characteristics between retained partici- pants and dropouts in this study. Still, more effective strategies to lowering the dropout rates are needed in the future research.
Yong-Ook Kim, et al. Relationship between metabolicsyndrome and kidney stone in Korean
Korean Journal of Family Practice
목을 만족할 경우에 신장결석 발생의 비교위험도가 5 . 44 으로 가장 높게 나타났다. ( P < 0 . 001 ) 남녀를 구분하여 시행한 결과는, 남자에 서는 전체 표본수를 대상으로 시행한 결과와 비슷한 통계적 유의성 을 보였으나 여자에서는표본수가 남자에 비해 적고, 대사증후군과 신장결석의 유병률 역시 남자에 비해 낮아 유의성 있는 결과를 도출 하지 못하였다. 특히, 본 연구에서는 대사증후군의 5 가지 항목을 모 두 만족하는 여자는 없었다.
남녀 사이의 특성을 비교하는 데에는 student’s t-test를 사 용하였다. 비만도에 따른 남녀 차이, 같은 성별에서 2001년과 2005년 유병률을 비교하고, 대사증후군과 대사증후군의 각 항목을 남녀별로, 2001년과 2005년 자료에서 유병률을 비교 하고, 비만군에서 대사증후군의 유병률을 2001년과 2005년 자료와 비교하는데 카이제곱 검증을 사용하였다. 비만도별 대사증후군의 유병률은 경향성 카이제곱 검정(chi-square test for trend)을 사용하여 경향성을 검증하였으며, 다중 로지스틱 회귀분석을 이용하여 대사증후군에 미치는 변수들을 검증하 였다. 통계분석에는 제시된 가중치를 적용하여 STATA 10.0 SE를 사용하였다.
IV. Statistical Analysis
Prior to performing statistical analysis, the levels of triglycerides, fasting glucose, and C-reactive protein were log-transformed because of the skewed distribution. The differences between the investigated variables’ means according to sex-specific serum uric acid quartiles were tested using the chi-squared test and analysis of variance. The relationships between serum uric acid levels and other variables were assessed using the Pearson’s correlation coefficients. The trend test was performed to determine the trends with the number of metabolic abnormalities and prevalence of metabolicsyndrome according to the serum uric acid quartile. The association between the sex-specific serum uric acid quartile and metabolicsyndrome were tested using multivariate logistic regression analysis. We calculated the unadjusted and adjusted odds ratios (ORs) using the lowest quartile as the reference. In the adjusted model, we controlled age, smoking status (current smoker vs.