title: Differences in the pathology of the metabolic syndrome with or without visceral fat accumulation: a study in pre-diabetic Japanese middle-aged men.
abstract: To elucidate the role of visceral fat accumulation in the metabolic syndrome, differences in the pathology of the metabolic syndrome with or without visceral fat accumulation were investigated. A total of 472 prediabetic Japanese men (mean age, 47.5 +/- 7.2 yr) with impaired fasting glycemia (IFG) levels of 110-125 mg/dL were eligible for participation in the study. The study subjects were divided into the following four groups, and intergroup comparisons were made: group I without visceral fat area [VFA] > or = 100 cm2 but presenting with fewer than two other risk factors (i.e., TG > or =150 mg/dL, HDL-C < 40 mg/dL, BP > or = 130/ > or = 85 mmHg, or FPG > or = 110 mg/dL) (n = 231); group II without VFA of > or = 100 cm2 but presenting with three or more other risk factors (n = 57); group III with VFA of > or = 100 cm2 accompanied by FPG 110 mg/dL alone (n = 27); and group IV with VFA > or =100 cm2 and two or more other risk factors (n = 157). The prevalence of patients who had three or more risk factors with or without VFA > or = 100 cm2 was 45.3% (214 out of 472 patients), while that of those with VFA > or = 100 cm2 who had two or more other risk factors was 33% (157 out of 472 patients). Group II had significantly higher VFA values than group I (p < 0.05), and group IV had significantly higher VFA values than group II (p < 0.001). While no significant differences in HOMA-R values were seen between groups I and II, these values were significantly higher in group IV compared to groups I and II (p < 0.001 and p < 0.05, respectively). Furthermore, group IV showed significantly higher 2-h insulin levels after glucose loading compared to group I (p < 0.001). While no significant differences were seen between groups II and IV, insulin levels tended to be higher in group IV. Adiponectin levels showed an incremental fall in VFA from group I through groups II and III to group IV. Groups III and IV showed significantly lower adiponectin levels compared to group I (p < 0.05, p < 0.001, respectively); and group IV showed significantly lower adiponectin levels than group II (p < 0.05). A logistic regression analysis using VFA, TG and HDL-C, and BP as explanatory variables showed that the relative risk for high HOMAR values were 2.65 (p < 0.001) for patients with VFA > or =100 cm2; 1.64 (p < 0.05) for those with TG > or = 150 mg/dL and HDL < 40 mg/dL; and 1.79 (p < 0.01) for those with BP > or = 130/ > or = 85 mmHg. These findings demonstrate that the degree of insulin resistance and the risk of arteriosclerosis vary depending on whether or not the metabolic syndrome accompanied by a clustering of risk factors has visceral fat accumulation as an underlying pathology, strongly suggesting a crucial role for visceral fat accumulation in the metabolic syndrome.
authors.affiliation: Department of Internal Medicine, National Hospital Organization, Utsunomiya National Hospital, Kawachi, Tochigi, Japan. moriyutakajp@yahoo.co.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Mori
authors.forename: Kyouko
authors.initials: K
authors.lastname: Hoshino
authors.forename: Kuninobu
authors.initials: K
authors.lastname: Yokota
authors.forename: Yohta
authors.initials: Y
authors.lastname: Itoh
authors.forename: Naoko
authors.initials: N
authors.lastname: Tajima
mesh_terms: D052242:Adiponectin / Q000097:blood; D000328:Adult; D001161:Arteriosclerosis / Q000209:etiology / Q000503:physiopathology; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure / Q000502:physiology; D008076:Cholesterol, HDL / Q000097:blood; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D050152:Intra-Abdominal Fat / Q000473:pathology*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000473:pathology* / Q000503:physiopathology*; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D052242:Adiponectin; D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides