日本普通人群中代谢综合征及植物甾酮的吸收异常发生率课件.ppt

1、The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Frequency of Metabolic Syndrome and its Absorption Abnormality by Plant Sterols in General Population,JapanToshio Shimada,Yo Murakami,Nobuyuki Oyake,Hiroyuki Yoshitomi,Nobuhiro Kodani,Akira Matsumori*Division of Cardiovasc

2、ular Medicine,Department of Internal Medicine,Shimane University Faculty of Medicine,Department of Cardiovascular Medicine,Kyoto University,Graduate School of Medicine*The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件BackgroundHealth problems on aged people have been gro

3、wing bigger in Japan because with advancing age,a variety of diseases especially on vascular diseases,such as cardio-and cerebro-vascular diseases have been increasing.And therefore,early detection of vascular diseases is a very important issue for vascular prevention and reduction of mortality.The

4、4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Diagnostic Criteria for Metabolic Syndrome(8 Japanese Medical Associations Joint-Committee)Fat accumulation in the intra-abdominal cavityAbdominal Circumference at the WaistMale85cm,Female90cm(80cm recommended by me)（Visceral

5、fat areaMale and Female 100 cm2)Hypertriglyceridemia 150 mg/dLLow HDL-cho 40 mg/dLSystolic Blood Pressure 130 mmHgDiastolic Blood Pressure 85 mmHgFasting Blood Sugar 110 mg/dL Lipoprotein abnormality High Blood Pressure High Blood Sugar At least,more than following 2 itemsand/orand/ormodified and tr

6、anslated into English by Toshio ShimadaMajor CriteriaMinor CriteriaThe 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件ObesityInsulin ResistanceDMDyslipidemiaHypertensionAtherosclerosisArteriosclerosisPathophysiology of Metabolic SyndrmeOver-eatingPoor ExerciseInheritanceTh

7、e 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件LDLISynthesis of Cholesterol in the Liver and Absorption of Cholesterol in the Intestine-Two Important Supply Sources of Cholesterol in Vivo-BileFoodLiverVesselsCholesterolSmall IntestineBiliary8002000mg/dayDietary400500mg/d

8、ayThe 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件AimOur purpose is to investigate the frequency of metabolic syndrome(MS)and life style related diseases and also to examinewhether any difference in absorption of cholesterol from the digestive system is present in parti

9、cipants between with metabolic syndrome(MS)and non-MS randomly selected,using plant sterols in general population.The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Subjects and method In 2007,1980 participants for annual health check-up were subjected for this cohort stud

10、y.Average age is 6610.8 years,and female is 1260(64%)；male is 720(36%).All subjects underwent routine blood examinations,insulin,remnant like particle cholesterol(RemLC),hs-CRP,cystatin C,plasma brain natriuretic peptide(BNP)and N-terminal proBNP(NT-proBNP)measurements.Blood pressure,abdominal circu

11、mference,and electrocardiography were measured at the same time.Abdominal circumference was measured at the navel level in the supine position like CT for visceral fat.Evaluation of cholesterol absorption was done by plant sterols in each 30 participants chosen randomly from the participants.BNP and

12、 NT-proBNP were measured for heart failure screening by immunoluminesence method.Plant sterols were measured by gas chromatography.The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件In 1964 participants,218 participants(11%)were diagnosed as MS,using 80cm waist circumferen

13、ce in female and 85cm in male as major criterion.From each group,30 participants were randomly chosen to check plant sterol levels for the evaluation of absorption of cholesterol and lathosterol for the evaluation of cholesterol synthesis.Each sterol level was measured by gas chromatography.The Meas

14、urement of Serum Plant Sterols to Evaluate Cholesterol Absorptionin Okuizumo Cohort,2007The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Abnormal and Normal Proportion of Clinical Paramerers in General Population,JapanOkuizumo Cohort 20070%10%20%30%40%50%60%70%80%90%100%

15、Syst BP(130mmHg)Diast BP(85mmHg)Gender(F/M)Waist Circum90-85Waist Circum80-85Metabo90-85Metabo80-85CKDnormalabnormalN=1972N=1972N=1972N=1972N=1972N=1972N=1972N=1980N=1964N=1964N=1964N=1964N=1980DM(HbA1c 5.8%）（220mg/dL）TG(150mg/dL）LowHDL(40mg/dL）Obesity(BMI 25）The 4th Shino-Japan Cardiovascular Forum

16、 on October 23-24,2008 in Beijing 编辑课件DifferenceFullReducedModel 190.26599 288.24139 478.50738-LogLikelihood 10DF 380.532ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.3976 1963Converged by GradientWhole Model TestWhole Model TestInterceptageBMIHbCystatinCBNPpg/mlInsulinhsCRPRemLCGGTTchoTerm-22

17、.8051470.021023040.482891490.424063531.29025592-0.00157170.02058377-0.05252970.120160870.00117904-0.0074947Estimate2.29055890.01305390.04313070.08849030.55992250.0031283 0.0067180.06711130.01972250.00167760.0038915Std Error 99.12 2.59125.35 22.97 5.31 0.25 9.39 0.61 37.12 0.49 3.71ChiSquare.00010.10

18、73.0001.00010.02120.61540.00220.4338ChiSq-27.458855-0.00405540.401298640.251751980.20551102-0.00875360.00772354-0.21378630.08321302-0.0027261-0.0152304Lower 95%-18.4677920.047165930.570650550.599081832.40457893 0.0032556 0.03406730.033278730.160522370.004029270.00004675Upper 95%.4.83909518795859.059

19、378.75497325.49652980.2377459360.10967020.00195908 2584.58234.304435430.19083836Odds Ratio .0.73774446 80128.69133.93774411.675032670.000335214.650543229.5313e-12230.7418110.034219130.03453053Odds Lower .34.37896659402299.584390.26855418.004882 19.601818879.53493551.944975836190.7207146.6777721.0103

20、8549Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesageBMIHbCystatinCBNPpg/mlInsulinhsCRPRemLCGGTTchoSource 1 1 1 1 1 1 1 1 1 1Nparm 1 1 1 1 1 1 1 1 1 1DF2.68235372178.17741223.54888125.45324054 0.2853525 10.0994580.83403457 41.867040.441615913.79336512L-R ChiSquare 0.1015 0.0000

21、0.0000 0.0195 0.5932 0.0015 0.3611 0.0000 0.5063 0.0515ProbChiSqEffect Likelihood Ratio TestsEffect Likelihood Ratio TestsNominal Logistic Fit for MSF90M85-DxNominal Logistic Fit for MSF90M85-DxTrue PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-Specif

22、icityFalse PositiveUsing MSF90M85-Dx=0 to be the positive levelArea Under Curve=0.93304Receiver Operating CharacteristicReceiver Operating CharacteristicMetabolic Syndrome and its Influential Factors Analyzedby Multivariate Logistic RegressionFemale Waist Circumference 90cm90cmInfluential Parameters

23、BMIHbCystatin CInsulinRem LC TchoThe 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件DifferenceFullReducedModel 550.5289 761.5187 1312.0476-LogLikelihood 10DF1101.058ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.4196 1963Converged by GradientWhole Model TestWhole Mode

24、l TestInterceptageBMIHbCystatinCBNPpg/mlInsulinhsCRPRemLCGGTTchoTerm-18.6015930.009407250.83709624-0.1869676-0.958875-0.00192810.00615102-0.0044340.036492640.000503370.00580768Estimate1.26844290.00730960.03993060.05363570.41153680.00171970.00584050.01256940.01481360.00145630.0022599Std Error215.06 1

25、.66439.48 12.15 5.43 1.26 1.11 0.12 6.07 0.12 6.60ChiSquare.00010.1981ChiSq-21.142974-0.0048660.76108626-0.2926968-1.7654754-0.0055659-0.0050259-0.03257220.00721438-0.0024910.00139564Lower 95%-16.1676860.023805080.91770739-0.0823535-0.1522810.001173960.017786840.017756420.065700640.003069310.0102607

26、7Upper 95%.2.024947251.69491e10 0.0729817 0.09010530.171655033.400942920.5907795810.87268681.864833873.60924199Odds Ratio .0.6942320719967329170.01660992 0.01189850.006174970.367824390.020935151.60279342 0.04578181.36129396Odds Lower .5.961850841.63756e110.315704220.68234132 2.924127634.45250458.229

27、1869173.417666944.69229859.65649116Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesageBMIHbCystatinCBNPpg/mlInsulinhsCRPRemLCGGTTchoSource 1 1 1 1 1 1 1 1 1 1Nparm 1 1 1 1 1 1 1 1 1 1DF1.66491762952.81688212.35061455.39280408 1.40145031.135766870.130256865.934509040.116323366.6682

28、4093L-R ChiSquare 0.1969 0.0000 0.0004 0.0202 0.2365 0.2865 0.7182 0.0148 0.7331 0.0098ProbChiSqEffect Likelihood Ratio TestsEffect Likelihood Ratio TestsNominal Logistic Fit for Abd-CF80M85Nominal Logistic Fit for Abd-CF80M85True PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10

29、.20.30.40.50.60.70.80.901-SpecificityFalse PositiveUsing Abd-CF80M85=0 to be the positive levelArea Under Curve=0.89483Receiver Operating CharacteristicReceiver Operating CharacteristicMetabolic Syndrome and its Influential Factors Analyzed by Multivariate Logistic Regression Female Waist Circumfere

30、nce 80cm80cmInfluential ParametersBMIHbCystatin CRem LC TchoThe 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件DifferenceFullReducedModel 36.14842 442.42746 478.57588-LogLikelihood 1DF72.29684ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.0755 1964Converged by Gradien

31、tWhole Model TestWhole Model TestLack Of FitSaturatedFittedSource 864 865 1DF 307.65972 134.76773 442.42746-LogLikelihood615.3194ChiSquare1.0000ProbChiSqLack Of FitLack Of FitInterceptRemLCTerm-3.56518450.13107891Estimate0.1593054 0.016439Std Error500.84 63.58ChiSquare.0001ChiSq-3.88732440.09953428L

32、ower 95%-3.26243630.16394934Upper 95%.5277.7231Odds Ratio .670.850599Odds Lower .45281.1913Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesRemLCSource 1Nparm 1DF63.5795227Wald ChiSquare 0.0000ProbChiSqEffect Wald TestsEffect Wald TestsRemLCSource 1Nparm 1DF72.2968416L-R ChiSquare

33、0.0000ProbChiSqEffect Likelihood Ratio TestsEffect Likelihood Ratio TestsNominal Logistic Fit for MSF90M85-DxNominal Logistic Fit for MSF90M85-DxTrue PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse PositiveSensitivity 0.81Specificity 0.

34、65Odds Ratio 5278AUC 0.77p=0.0000 Cut-Off Value7.34mg/dLCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 90 cmand that of Men 85 cm)The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Cut-Off Value of Rem LC Based

35、on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 80 cmand that of Men 85 cm)DifferenceFullReducedModel 86.39771 598.24630 684.64401-LogLikelihood 1DF172.7954ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.1262 1964Converged by GradientWhole Model TestWhole Model Tes

36、tLack Of FitSaturatedFittedSource 864 865 1DF 392.34823 205.89806 598.24630-LogLikelihood784.6965ChiSquare0.9746ProbChiSqLack Of FitLack Of FitInterceptRemLCTerm-3.45451880.19834187Estimate0.14984460.0170002Std Error531.49136.12ChiSquare.0001ChiSq-3.75578580.16563887Lower 95%-3.16806380.23230396Uppe

37、r 95%.429155.572Odds Ratio .50570.6136Odds Lower .3954464.4Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesRemLCSource 1Nparm 1DF136.120162Wald ChiSquare 0.0000ProbChiSqEffect Wald TestsEffect Wald TestsRemLCSource 1Nparm 1DF172.795429L-R ChiSquare 0.0000ProbChiSqEffect Likelihood

38、 Ratio TestsEffect Likelihood Ratio TestsNominal Logistic Fit for MSF80M85-DxNominal Logistic Fit for MSF80M85-DxTrue PositiveSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse Positive7.26mg/dLCut-Off ValueSensitivity 0.82Specificity 0.67Odds Rat

39、io 429156AUC 0.79p=0.0000 The 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Cut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 90 cm)DifferenceFullReducedModel 16.90222 149.87402 166.77624-LogLikelihood 1DF33.80444

40、ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.1013 1253Converged by GradientWhole Model TestWhole Model TestLack Of FitSaturatedFittedSource 674 675 1DF 124.82440 25.04962 149.87402-LogLikelihood249.6488ChiSquare1.0000ProbChiSqLack Of FitLack Of FitInterceptRemLCTerm-4.73714260.16928943Estimat

41、e0.30152180.0270757Std Error246.83 39.09ChiSquare.0001ChiSq-5.36145690.11619794Lower 95%-4.17452420.22315915Upper 95%.300.381681Odds Ratio .50.1927448Odds Lower .1845.42194Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesRemLCSource 1Nparm 1DF 39.093168Wald ChiSquare 0.0000ProbChiS

42、qEffect Wald TestsEffect Wald TestsRemLCSource 1Nparm 1DF33.8044417L-R ChiSquare 0.0000ProbChiSqEffect Likelihood Ratio TestsEffect Likelihood Ratio TestsNominal Logistic Fit for MSF90M85-DxNominal Logistic Fit for MSF90M85-DxSensitivity 0.89Specificity 0.70Odds Ratio 300AUC 0.83p=0.0000 True Positi

43、veSensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse Positive6.19mg/dLCut-Off ValueThe 4th Shino-Japan Cardiovascular Forum on October 23-24,2008 in Beijing 编辑课件Sensitivity 0.80Specificity 0.72Odds Ratio 429156AUC 0.82p=0.0000 DifferenceFullReduce

44、dModel 78.47062 328.19877 406.66940-LogLikelihood 1DF156.9412ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.1930 1253Converged by GradientWhole Model TestWhole Model TestLack Of FitSaturatedFittedSource 674 675 1DF 244.75924 83.43953 328.19877-LogLikelihood489.5185ChiSquare1.0000ProbChiSqLack O

45、f FitLack Of FitInterceptRemLCTerm-4.1308570.27163009Estimate0.22042030.0243002Std Error351.22124.95ChiSquare.0001ChiSq-4.57858840.22521655Lower 95%-3.71348570.32058974Upper 95%.9451.54891Odds Ratio .1977.91364Odds Lower .49211.0934Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesR

46、emLCSource 1Nparm 1DF124.950051Wald ChiSquare 0.0000ProbChiSqEffect Wald TestsEffect Wald TestsRemLCSource 1Nparm 1DF156.941249L-R ChiSquare 0.0000ProbChiSqEffect Likelihood Ratio TestsEffect Likelihood Ratio TestsNominal Logistic Fit for MSF80M85-DxNominal Logistic Fit for MSF80M85-DxTrue PositiveS

47、ensitivity0.000.100.200.300.400.500.600.700.800.901.00.00.10.20.30.40.50.60.70.80.901-SpecificityFalse Positive6.88mg/dLCut-Off ValueCut-Off Value of Rem LC Based on ROC Curve for Screening Metabolic Syndrome(Abdominal Circumference of Women 80cm)The 4th Shino-Japan Cardiovascular Forum on October 2

48、3-24,2008 in Beijing 编辑课件Sensitivity 0.81Specificity 0.63Odds Ratio 1647AUC 0.75p=0.0000 DifferenceFullReducedModel 18.51012 257.29236 275.80248-LogLikelihood 1DF37.02024ChiSquare ChiSqRSquare(U)Observations(or Sum Wgts)0.0671 711Converged by GradientWhole Model TestWhole Model TestLack Of FitSatura

49、tedFittedSource 500 501 1DF 207.96904 49.32332 257.29236-LogLikelihood415.9381ChiSquare0.9975ProbChiSqLack Of FitLack Of FitInterceptRemLCTerm-2.67010310.11326969Estimate0.19397980.0218623Std Error189.47 26.84ChiSquare.0001ChiSq-3.0675730.07291559Lower 95%-2.30654810.15834166Upper 95%.1646.9906Odds

50、Ratio .117.677833Odds Lower .31381.1116Odds UpperFor log odds of 0/1Parameter EstimatesParameter EstimatesRemLCSource 1Nparm 1DF26.8433082Wald ChiSquare 0.0000ProbChiSqEffect Wald TestsEffect Wald TestsRemLCSource 1Nparm 1DF37.0202361L-R ChiSquare 0.0000ProbChiSqEffect Likelihood Ratio TestsEffect L