bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Metabolic Syndrome and 11-Year Risk of Incident Cardiovascular Disease in the Atherosclerosis Risk in Communities Study
Authors: McNeill Ann Marie , Rosamond Wayne D. , Girman Cynthia J. , Golden Sherita Hill , Schmidt Maria I. , East Honey E. , Ballantyne Christie M. , Heiss Gerardo 
Published: March 2007

OBJECTIVE— To assess the magnitude of the association between the National Cholesterol Education Program’s Third Adult Treatment Panel Report (ATP III) definition of the metabolic syndrome and cardiovascular disease (CVD).
RESEARCH DESIGN AND METHODS— Cox regression was used to estimate the relative risk of incident coronary heart disease (CHD) and stroke among 12,089 black and white middle-aged individuals in the Atherosclerosis Risk in Communities (ARIC) study.
RESULTS— The metabolic syndrome was present in ∼23% of individuals without diabetes or prevalent CVD at baseline. Over an average of 11 years of follow-up, 879 incident CHD and 216 ischemic stroke events occurred. Among the components of the metabolic syndrome, elevated blood pressure and low levels of HDL cholesterol exhibited the strongest associations with CHD. Men and women with the metabolic syndrome were ∼1.5 and 2 times more likely to develop CHD than control subjects after adjustment for age, smoking, LDL cholesterol, and race/ARIC center (sex interaction P &lt; 0.03). Similar associations were found between the metabolic syndrome and incident ischemic stroke. Comparison of receiver operating characteristic curves indicated that the metabolic syndrome did not materially improve CHD risk prediction beyond the level achieved by the Framingham Risk Score (FRS).
CONCLUSIONS— Individuals without diabetes or CVD, but with the metabolic syndrome, were at increased risk for long-term cardiovascular outcomes, although statistical models suggested that most of that risk was accounted for by the FRS. Nevertheless, identification of individuals with the metabolic syndrome may provide opportunities to intervene earlier in the development of shared disease pathways that predispose individuals to both CVD and diabetes.
An Evaluation of Candidate Definitions of the Metabolic Syndrome in Adult Asian Indians
Authors: Misra Anoop , Wasir Jasjeet Singh , Pandey Ravinder Mohan 
Published: March 2007

OBJECTIVES—We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians.
RESEARCH DESIGN AND METHODS—We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as &gt;90 cm in men and &gt;80 cm in women, BMI cutoff as &gt;23 kg/m2, and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] &gt;18 mm).
RESULTS—The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure.
CONCLUSIONS—The criteria for defining MS in adult Asian Indians need revision. Inclusion of modified cutoffs of waist circumference and BMI and measures of truncal subcutaneous fat in the NCEP ATPIII definition requires further validation.
Caffeine Ingestion Is Associated With Reductions in Glucose Uptake Independent of Obesity and Type 2 Diabetes Before and After Exercise Training
Authors: Lee SoJung , Hudson Robert , Kilpatrick Katherine , Graham Terry E. , Ross Robert 
Published: March 2007

OBJECTIVE—We investigated the effect of caffeine ingestion on insulin sensitivity in sedentary lean men (n = 8) and obese men with (n = 7) and without (n = 8) type 2 diabetes. We also examined whether chronic exercise influences the relationship between caffeine and insulin sensitivity in these individuals.
RESEARCH DESIGN AND METHODS—Subjects underwent two hyperinsulinemic-euglycemic clamp procedures, caffeine (5 mg/kg body wt) and placebo, in a double-blind, randomized manner before and after a 3-month aerobic exercise program. Body composition was measured by magnetic resonance imaging.
RESULTS—At baseline, caffeine ingestion was associated with a significant reduction (P &lt; 0.05) in insulin sensitivity by a similar magnitude in the lean (33%), obese (33%), and type 2 diabetic (37%) groups in comparison with placebo. After exercise training, caffeine ingestion was still associated with a reduction (P &lt; 0.05) in insulin sensitivity by a similar magnitude in the lean (23%), obese (26%), and type 2 diabetic (36%) groups in comparison with placebo. Exercise was not associated with a significant increase in insulin sensitivity in either the caffeine or placebo trials, independent of group (P &gt; 0.10).
CONCLUSIONS—Caffeine consumption is associated with a substantial reduction in insulin-mediated glucose uptake independent of obesity, type 2 diabetes, and chronic exercise.
Incremental Predictive Value of Carotid Ultrasonography in the Assessment of Coronary Risk in a Cohort of Asymptomatic Type 2 Diabetic Subjects
Authors: Bernard Sophie , Sérusclat André , Targe François , Charrière Sybil , Roth Olivier , Beaune Jacques , Berthezène François , Moulin Philippe 
Published: March 2007

OBJECTIVE —Consensus guidelines recommend cardiovascular risk assessment as the initial step of primary prevention. The aim of this study was to evaluate the incremental predictive value for coronary events conferred by carotid ultrasonography in addition to risk assessment by Framingham score and screening for silent myocardial ischemia in a cohort of type 2 diabetic patients.
RESEARCH DESIGN AND METHODS —We prospectively studied 229 patients free of any cardiovascular complication with at least one additional cardiovascular risk factor. At baseline, all patients had an exercise treadmill test, carotid intima-media thickness (IMT) measurement, and coronary risk assessment by Framingham score. Cardiovascular events were registered during a 5-year follow-up period.
RESULTS —Age, carotid IMT, carotid plaques, number of risk factors, Framingham score, and suboptimal exercise electrocardiogram were associated with incident cardiovascular events (P &lt; 0.05). Carotid IMT was an independent predictor of cardiovascular events (P = 0.045). The predictive value for coronary events was similar for carotid IMT and Framingham score as assessed by area under the receiver operating characteristic curves. An improvement in risk prediction was conferred by addition of carotid IMT in a Cox model (global χ2 increased from 14.1 to 18.1, P = 0.035).
CONCLUSIONS —This prospective study confirms that carotid IMT is a marker of cardiovascular risk in this type 2 diabetic cohort, establishes that carotid IMT provides a similar predictive value for coronary events than Framingham score, and suggests that the combination of these two indexes significantly improves risk prediction for these patients.
Glucose Intolerance Is Common in Japanese Patients With Acute Coronary Syndrome Who Were Not Previously Diagnosed With Diabetes
Authors: Hashimoto Koichi , Ikewaki Katsunori , Yagi Hidenori , Nagasawa Hidetaka , Imamoto Satoshi , Shibata Takahiro , Mochizuki Seibu 
Published: March 2007

OBJECTIVE—Postprandial hyperglycemia has emerged as a new glycometabolic condition associated with an excessive risk for coronary artery disease. We therefore attempted to evaluate the frequency of postchallenge hyperglycemia in patients with acute coronary syndrome (ACS) who were not previously diagnosed to have diabetes and did not have a fasting glucose concentration of ≥7 mmol/l or an HbA1c level &gt;6.0%. We further correlated the presence of postchallenge hyperglycemia with the extent of coronary atherosclerosis.
RESEARCH DESIGN AND METHODS—In all, 134 consecutive ACS patients who met the above inclusion criteria were studied. An oral glucose tolerance test was performed before discharge.
RESULTS—The mean age, fasting glucose, and HbA1c were 60 years, 5.15 mmol/l, and 5.4%, respectively. Among ACS patients, impaired glucose tolerance (IGT) and diabetes were found in 50 (37%) and 13 patients (10%), respectively. The homeostasis model assessment for insulin resistance did not differ substantially among the normal glucose tolerance (NGT), IGT, and diabetic groups. Insulinogenic index, however, was lower and the number of stenosed vessels higher in diabetic patients compared with NGT patients.
CONCLUSIONS—Postchallenge hyperglycemia, caused primarily by impaired initial insulin secretion, is commonly found in Japanese ACS patients who have not been previously diagnosed with diabetes, and this phenomenon is considered to be associated with advanced coronary atherosclerosis. Therefore, the present study strongly supports the notion that oral glucose tolerance test assessment of postchallenge hyperglycemia is essential to identify any previously undiagnosed diabetes cases among Japanese ACS patients.
Efficient Cutoff Points for Three Screening Tests for Detecting Undiagnosed Diabetes and Pre-Diabetes
Authors: Zhang Ping , Engelgau Michael M. , Valdez Rodolfo , Cadwell Betsy , Benjamin Stephanie M. , Narayan K.M. Venkat 
Published: March 2007

OBJECTIVE—Opportunistic screening for undiagnosed type 2 diabetes and pre-diabetes (either impaired glucose tolerance or impaired fasting glucose) is recommended by the American Diabetes Association. The aim of this study was to determine efficient cutoff points for three screening tests for detecting undiagnosed diabetes alone or both undiagnosed diabetes and pre-diabetes.
RESEARCH DESIGN AND METHODS— We estimated the number of individuals with undiagnosed diabetes alone or with both undiagnosed diabetes and pre-diabetes that could be detected by using different cutoff points for each screening test as the product of the prevalence of each condition, the sensitivity of the tests at each cutoff point for identifying each condition, and the number of individuals who would be eligible for screening in the U.S. We estimated the total cost of opportunistic screening by multiplying the cost for screening one person by the number of individuals screened.
RESULTS—The most efficient cutoff points for both detecting pre-diabetes and undiagnosed diabetes (100 mg/dl for the fasting plasma glucose test, 5.0% for the HbA1c test, and 100 mg/dl for the random capillary blood glucose test) were less than those for detecting undiagnosed diabetes alone (110 mg/dl for the fasting plasma glucose test, 5.7% for the HbA1c test, and 120 mg/dl for the random capillary blood glucose test).
CONCLUSIONS—A lower cutoff value should be used when screening for pre-diabetes and undiagnosed diabetes together than when screening for undiagnosed diabetes alone.
Depression and All-Cause and Coronary Heart Disease Mortality Among Adults With and Without Diabetes
Authors: Egede Leonard E. , Nietert Paul J. , Zheng Deyi 
Published: March 2007

OBJECTIVE—The aim of this study was to evaluate the effect of depression on all-cause and coronary heart disease (CHD) mortality among adults with and without diabetes.
RESEARCH DESIGN AND METHODS—We studied 10,025 participants in the population-based National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale. Four groups were created based on diabetes and depression status in 1982: 1) no diabetes, no depression (reference group); 2) no diabetes, depression present; 3) diabetes present, no depression; and i4) diabetes present, depression present. Cox proportional hazards regression models were used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group compared with the reference group.
RESULTS—Over 8 years (83,624 person-years of follow-up), 1,925 deaths were documented, including 522 deaths from CHD. Mortality rate per 1,000 person-years of follow-up was highest in the group with both diabetes and depression. Compared with the reference group, HRs for all-cause mortality were no diabetes, depression present, 1.20 (95% CI 1.03–1.40); diabetes present, no depression 1.88 (1.55–2.27); and diabetes present, depression present, 2.50 (2.04–3.08). HRs for CHD mortality were no diabetes, depression present, 1.29 (0.96–1.74); diabetes present, no depression 2.26 (1.60–3.21); and diabetes present, depression present, 2.43 (1.66–3.56).
CONCLUSIONS—The coexistence of diabetes and depression is associated with a significantly increased risk of death from all causes, beyond that due to having either diabetes or depression alone.
A Prospective Study of Soluble Tumor Necrosis Factor-α Receptor II (sTNF-RII) and Risk of Coronary Heart Disease Among Women With Type 2 Diabetes
Authors: Shai Iris , Schulze Matthias B. , Manson JoAnn E. , Rexrode Kathryn M. , Stampfer Meir J. , Mantzoros Christos , Hu Frank B. 
Published: March 2007

OBJECTIVE—Tumor necrosis factor-α (TNF-α), a cytokine secreted by adipose tissue and other cells, might play a role in insulin resistance.RESEARCH DESIGN AND METHODS—Of 32,826 women from the Nurses’ Health Study who provided blood at baseline, we followed 929 women with type 2 diabetes. During 10 years of follow-up, we documented 124 incident cases of coronary heart disease (CHD).RESULTS—After adjustment for age, smoking, BMI, and other cardiovascular risk factors, the relative risks (RRs) comparing extreme quartiles of soluble TNF-α receptor II (sTNF-RII) were 2.48 (95% CI 1.08–5.69; P = 0.034) for myocardial infarction (MI) and 2.02 (1.17–3.48; P = 0.003) for total CHD. The probability of developing CHD over 10 years was higher among diabetic subjects with substantially higher levels of both sTNF-RII (&gt;75th percentile) and HbA1c (&gt;7%), compared with diabetic subjects with lower levels (25% vs. 7%, P &lt; 0.0001). Diabetic subjects with only higher sTNF-RII or HbA1c had similar (16–17%) risk. In a multivariate model, diabetic subjects with higher levels of both sTNF-RII and HbA1c had an RR of 3.66 (1.85–7.22) for MI and 3.03 (1.82–5.05) for total CHD, compared with those with lower levels of both biomarkers.CONCLUSIONS—Increased levels of sTNF-RII were strongly associated with risk of CHD among diabetic women, independent of hyperglycemia.
Bimodality of 2-h Plasma Glucose Distributions in Whites
Authors: Fan Juanjuan , May Susanne J. , Zhou Yue , Barrett-Connor Elizabeth 
Published: March 2007

OBJECTIVE—Several studies have shown a bimodal curve in the distribution of glucose in populations with a high prevalence of type 2 diabetes, but bimodality has not been reported among whites of Northern European ancestry. It is not clear whether this difference reflects the lower prevalence of diabetes, obscuring a second mode, or implies a more fundamental difference between whites and nonwhites. We investigate this issue by studying glucose distributions in older white patients.
RESEARCH DESIGN AND METHODS—A study of diabetes was conducted among older community-dwelling white residents of a suburban Southern California community between 1984 and 1987. Two-hour plasma glucose data were collected from 2,326 older white men and women aged 23–92. To investigate bimodality of glucose distributions, we fit unimodal and bimodal normal models to 2-h plasma glucose concentrations transformed by the Box-Cox family of transformations.
RESULTS—We found that the bimodal normal mixture model fit the data significantly better than the unimodal skewed distribution model for both sexes and all age-groups except those ≥80 years. The cut points separating the two modes were generally within the 11.1- to 13.6-mmol/l range.
CONCLUSIONS—The bimodality of glucose distributions among whites, combined with previous findings, indicates that this phenomenon may be universal. A smaller second mode in our study compared with other studies suggests that whites have diabetes susceptibility but may require more obesity to demonstrate it. With increasing obesity in the U.S., the predicted epidemic of diabetes may affect all ethnic groups including whites.
Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents With Type 1 Diabetes in Chronic Poor Metabolic Control
Authors: Ellis Deborah A. , Frey Maureen A. , Naar-King Sylvie , Templin Thomas , Cunningham Phillippe , Cakan Nedim 
Published: March 2007

OBJECTIVE—The aim of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could improve adherence and metabolic control and decrease rates of hospital utilization among adolescents with chronically poorly controlled type 1 diabetes.
RESEARCH DESIGN AND METHODS—A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and chronically poor metabolic control (HbA1c [A1C] ≥8% for the past year) who received their diabetes care in a children’s hospital located in a major Midwestern city. Participants randomly assigned to MST received treatment for ∼6 months. Data were collected at baseline and at 7 months posttest (i.e., treatment termination). Changes in A1C adherence, as measured by semistructured interviews and blood glucose meters and hospital admissions and emergency department visits, were assessed.
RESULTS—In intent-to-treat analyses, participation in MST was associated with significant improvements in the frequency of blood glucose testing as assessed by blood glucose meter readings (F[1,125] = 16.75, P = 0.001) and 24-h recall interviews (F[1,125] = 6.70, P = 0.011). Participants in MST also had a decreasing number of inpatient admissions, whereas the number of inpatient admissions increased for control subjects (F[1,125] = 6.25, P = 0.014). Per protocol analyses replicated intent-to-treat analyses but also showed a significant improvement in metabolic control for adolescents receiving MST compared with control subjects (F[1,114] = 4.03, P = 0.047).
CONCLUSIONS—Intensive, home-based psychotherapy improves the frequency of blood glucose testing and metabolic control and decreases inpatient admissions among adolescents with chronically poorly controlled type 1 diabetes.
Relation of C-Reactive Protein to Insulin Resistance and Cardiovascular Risk Factors in Youth
Authors: Moran Antoinette , Steffen Lyn M. , Jacobs David R. , Steinberger Julia , Pankow James S. , Hong Ching-Ping , Tracy Russell P. , Sinaiko Alan R. 
Published: March 2007

OBJECTIVE—Insulin resistance and C-reactive protein (CRP) levels are strongly correlated in adults. This study explored the relationship in youth.RESEARCH DESIGN AND METHODS—Associations between CRP levels, cardiovascular risk, and insulin resistance measured by the euglycemic clamp were investigated in 342 healthy Minneapolis youth.RESULTS—There was no difference in mean CRP levels among boys (n = 189, CRP 1.10 ± 0.46 mg/l) and girls (n = 153, CRP 1.16 ± 0.63 mg/l; P = 0.32). There was also no difference between CRP and Tanner stage. CRP, adjusted for BMI, was significantly greater in black subjects compared with white subjects (P = 0.03). CRP was strongly related to adiposity in both girls and boys. CRP levels were related to fasting insulin levels (r = 0.16, P = 0.003) but this association was not significant after adjustment for BMI (r = 0.07, P = 0.21). Similarly, M, the euglycemic clamp measurement of insulin sensitivity, was significantly related to CRP levels (r = −0.13, P = 0.02) but not when M was normalized to lean body mass (Mlbm) (r = −0.10, P = 0.09). There was a significant inverse correlation between Mlbm and CRP quartiles, which disappeared after adjustment for BMI. There was no significant association between CRP levels and lipids, blood pressure, physical activity, or left ventricular mass.CONCLUSIONS—In contrast to adult subjects, after adjustment for adiposity, CRP levels in children age 10–16 years were not significantly associated with insulin resistance or with other factors comprising the metabolic syndrome. This is consistent with the concept that insulin resistance may precede the development of CRP elevation in the evolution of the metabolic syndrome.
Dietary Fat Is Associated With Metabolic Syndrome in Japanese Brazilians
Authors: Freire Renata D. , Cardoso Marly A. , Gimeno Suely G.A. , Ferreira Sandra R.G. ,   for the Japanese-Brazilian Diabetes Study Group
Published: March 2007

OBJECTIVE—The aim of this study was to examine the association of nutrient intakes with metabolic syndrome in a Japanese descendant population at high risk for metabolic abnormalities.
RESEARCH DESIGN AND METHODS—In a population-based study of Japanese Brazilians aged ≥30 years, 412 men and 465 women were studied. The diagnosis of metabolic syndrome was based on the National Cholesterol Education Program criteria modified for Asians. Food intake was assessed by a validated food frequency questionnaire.
RESULTS—Men and women showed similar mean ages (55.7 ± 12.7 and 54.4 ± 11.9 years) and 49% (95% CI 44.8–54.6) and 43% (38.4–47.6) had metabolic syndrome, respectively. As expected, clinical parameters were less favorable in the subset of subjects with metabolic syndrome. Men with metabolic syndrome showed higher cholesterol (233.2 ± 116.3 vs. 211.7 ± 5.8 g/day, P &lt; 0.05) and lower carbohydrate (288.5 ± 45.8 vs. 300.1 ± 39.8 g/day, P &lt; 0.001) intakes than those without metabolic syndrome, but no difference was observed among the women. After adjusting for sex, age, smoking, education level, generation, physical activity, total energy, and dietary fiber intake, a positive association between metabolic syndrome and total fat intake was detected. Comparing people in the highest quintile of total fat consumption with those in the lowest quintile, odds ratio (OR) of metabolic syndrome was 5.0 ([95% CI 1.58–16.00]; P &lt; 0.005). In contrast, linoleic acid intake was inversely associated with metabolic syndrome (OR 0.50 [95% CI 0.26–0.98]; P &lt; 0.05). Considering food groups, after adjustments only fried food intake was shown to be associated with increased risk of metabolic syndrome.
CONCLUSIONS—Despite the limitation of such a study design in investigating cause-effect relationships, our findings favor the hypothesis that dietary total fat may increase whereas linoleic acid intake may reduce the risk of metabolic syndrome in Japanese descendants living in Brazil.