BackgroundThe aim of the present study was to examine how liver markers are associated with insulin resistance in Japanese community-dwelling adults.MethodsThis cross-sectional study included 587 men aged 58 ± 14 (mean ± standard deviation; range, 20–89) years and 755 women aged 60 ± 12 (range, 21–88) years. The study sample consisted of 998 (74.4%) non-obese [body mass index (BMI) <25.0 kg/m2] and 344 (25.6%) overweight (BMI ≥25 kg/m2) subjects. Insulin resistance was defined by homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5, and HOMA-IR and potential confounders were compared between the groups. Areas under the curve (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum markers.ResultsIn non-obese subjects, the best marker of insulin resistance was alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio of 0.70 (95% confidence interval (CI), 0.63-0.77). In overweight subjects, AUC values for the ALT/AST ratio and ALT were 0.66 (0.59-0.72) and 0.66 (0.59-0.72), respectively. Multiple linear regression analyses for HOMA-IR showed that ALT/AST ratios were independently and significantly associated with HOMA-IR as well as other confounding factors in both non-obese and overweight subjects. The optimal cut-off point to identifying insulin resistance for these markers yielded the following values: ALT/AST ratio of ≥0.82 in non-obese subjects and ≥1.02 in overweight subjects. In non-obese subjects, the positive likelihood ratio was greatest for ALT/AST ratio.ConclusionsIn non-obese Japanese adults, ALT/AST ratio may be the best reliable marker of insulin resistance.

The association of low muscle strength with cardio-metabolic risks remains controversial. The present study included 742 men aged 70 ± 9 years and 937 women aged 70 ± 8 years from a rural village. We examined the cross-sectional relationship between relative muscle strength defined by handgrip strength (HGS)/body weight (BW) ratio, and metabolic syndrome (MetS) based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report and its components. Of these, 203 men (27.4%) and 448 women (47.8%) had MetS. In men, increasing quartile of HGS/BW ratio was significantly and independently associated with high waist circumference {odds ratio, 0.31; 95% confidence interval (CI), 0.24-0.41} and elevated triglyceridemia (0.71, 0.59-0.86). In women, it was also significantly and independently associated with high waist circumference (0.41; 0.36-0.48), high blood pressure (0.78; 0.66-0.92), Low HDL-cholesterolemia (0.84; 0.73-0.98) and elevated triglyceridemia (0.65; 0.53-0.79). In both genders, the prevalence of MetS significantly decreased in relation to increasing HGS/BW ratio. After adjustment for age, smoking status, drinking status, LDL-C, estimated glomerular filtration ratio (eGFR), and medication, the respective odds ratio (95% CI) for the quartile of HGS/BW ratio for MetS was 1.00, 0.54 (0.34-0.85), 0.32 (0.19-0.53), and 0.16 (0.09-0.29) in men, and 1.00, 0.76 (0.50-1.16), 0.33 (0.22-0.51), and 0.16 (0.10-0.25) in women. These results suggest that HGS/BW ratio was significantly and negatively associated with an increased risk of cardio-metabolic disorders in Japanese-community dwelling persons.

BackgroundThere are few studies to demonstrate the associations between newly addressed lipid profiles and metabolic syndrome (MetS)-associated variables.MethodsStudy participants without medications for hypertension, diabetes, or dyslipidemia {614 men aged 58 ± 14 (mean ± standard deviation; range, 20-89) years and 779 women aged 60 ± 12 (range, 21-88) years} were randomly recruited from a single community at the time of their annual health examination. The association between lipid profiles (total cholesterol (T-C), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, T-C/HDL-C, TG/HDL-C, LDL-C/HDL-C ratio and MetS, Insulin resistance by homeostasis model assessment of insulin resistance (HOMA-IR), and serum HMW adiponectin were analyzed.ResultsIn multiple linear regression analysis, TG/HDL-C and T-C/HDL-C ratios as well as TG showed significantly strong associations with all three MetS-associated variables in both men and women. In men, the ROC curve analyses showed that the best marker for these variables was TG/HDL-C ratio, with the AUC for presence of MetS (AUC, 0.82; 95% CI, 0.77-0.87), HOMA-IR (AUC, 0.75; 95% CI, 0.70-0.80), and serum HMW adiponectin (AUC, 0.67; 95% CI, 0.63-0.71), respectively. The T-C/HDL-C ratio, TG, HDL-C, LDL-C/HDL-C ratio, and non-HDL-C also discriminated these markers; however all their AUC estimates were lower than TG/HDL-C ratio. These results were similar in women.ConclusionIn Japanese community-dwelling adults, lipid ratios of TG/HDL-C, T-C/HDL-C, LDL-C/HDL-C as well as TG and HDL-C were consistently associated with MetS, insulin resistance and serum HMW adiponectin. Lipid ratios may be used as reliable markers.

IntroductionThe increasing prevalence of chronic kidney disease (CKD), with its associated high annual rates of mortality and cardiovascular complications ( 1 -3 ), is a major public health problem. In Japan, clinical practice guidelines established by the Japanese Society of Nephrology estimate that 18.7% of adults have CKD, which is defined as kidney damage or glomerular filtration rate (GFR) < 60 mL/min/1.73 m 2 for 3 months or more regardless of cause ( 4 ), and 4.1% have moderate or severe CKD ( 5 ). Identifying risk factors for CKD is critical in order to devise effective, population-based preventive strategies. Obesity is also a major worldwide public health problem. Obesity increases the risk of cardiovascular disease, diabetes, hypertension, and dyslipidemia (6, 7). However, few studies have examined the relationship between excess weight and CKD risk. Obese patients are at a higher risk for focal segmental glomerulosclerosis and glomerulomegaly (8) Vol. 31, No. 8 (2008) (9). In Western countries, many patients have an estimated GFR (eGFR) of less than 60 mL/min/1.73 m 2 or a body mass index (BMI) of 30 kg/m 2 or more. However, the risk of slightly elevated weight (BMI, 22.0 to 24.9 kg/m 2 ) in a Japanese population for mildly reduced renal function (eGFR, 60 to 90 mL/min/1.73 m 2 ) is not clear. We evaluated the relationship of BMI to potential risk factors such as hypertension, hyperglycemia, and lipids, as well as to renal function, using cross-sectional data from community-dwelling participants. Methods SubjectsParticipants were recruited at the time of their annual health examination in a rural town that has a total population of 11,136 (as of April 2002) and located in Ehime Prefecture, Japan, in 2002. Among the 9,133 adults aged 19 to 90 years in this population, 3,164 (34.6%) subjects met the eligibility requirements to participate in the study. Information on medical history, present conditions, and drugs was obtained by interview. Subjects with a clinical history of stroke, transient ischemic attack, myocardial infarction, or angina were excluded. Subjects taking medications for hypertension, diabetes, or dyslipidemia were also excluded from the study. However, participants that met the eligibility requirements with BMI> 30 kg/m 2 were included (37 subjects). The final study sample included 1,716 eligible persons. All procedures were approved by the Ethics Committee of Ehime University School of Medicine. Evaluation of Risk FactorsWe measured blood pressure in the right upper arm of participants in a seated position using an automatic oscillometric blood pressure recorder. Cigarette smoking was quantified based on daily consumption and on duration of smoking. Fasting total cholesterol (T-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), creatinine (enzymatic method), and uric acid were measured during fasting. Low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald formula (10). Participants with TG levels ≥ 4...