Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, and is commonly associated with obesity. The spectrum of NAFLD ranges from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Fructose ingestion, visceral obesity, and metabolic syndrome are risk factors for liver fibrosis. NAFLD is characterized by two steps of liver injury: intrahepatic lipid accumulation in the setting of insulin resistance, and inflammatory progression to NASH by oxidative stress and inflammatory mediators. Noninvasive methods (e.g., abdominal ultrasonography) are safe ways to support a diagnosis of hepatic steatosis, but liver biopsy remains the gold standard for accurate diagnosis and staging of NASH. Pediatric NASH often displays a histologic pattern distinct from that found in adults. Lifestyle modification through diet and exercise should be attempted in patients diagnosed with NAFLD.
Diet ; Fatty Liver/*diagnosis/therapy/ultrasonography ; Humans ; Inflammation Mediators/metabolism ; Insulin Resistance ; Lipase/genetics ; Membrane Proteins/genetics ; Metabolic Syndrome X/complications ; Reactive Oxygen Species/metabolism ; Risk Factors

OBJECTIVES: This study was performed to assess the association between physical activity and the clustering of metabolic abnormalities among Korean children. The effect of substituting moderate to vigorous physical activity for the time spent in inactivity was examined as well. METHODS: The study subjects were comprised of 692 (354 boys, 338 girls) 4th grade elementary school students. We used a modified form of the physical activity questionnaire that was developed in the Five-City Project. The subjects with clustering of metabolic abnormalities were defined as having two or more of the following five characteristics: waist circumference > or =90 %, systolic or diastolic blood pressure > or =90 %, fasting glucose > or =110 mg/dl, triglycerides > or =110 mg/dl and HDL cholesterol < or =40 mg/dl. We calculated the odds ratios to assess the effect of substituting moderate to vigorous physical activity for time spent in inactivity. RESULTS: The risk of clustered metabolic abnormalities was inversely correlated with the increased time spent on moderate to vigorous physical activity, but the correlation was not significant. The odds ratio for clustering of metabolic abnormalities that represented the effect of substituting moderate to vigorous physical activity for 30minutes of sedentary activity was 0.87 (95% CI=0.76-1.01). CONCLUSIONS: These findings suggest that substituting moderate to vigorous physical activity for sedentary activity could decrease the risk of clustered metabolic abnormalities.
Blood Glucose/metabolism ; Blood Pressure ; Child ; Cholesterol, HDL ; *Exercise ; Female ; Humans ; Male ; Metabolic Syndrome X/diagnosis/*epidemiology ; Questionnaires ; Risk Factors ; Triglycerides/blood ; Urban Population ; Waist Circumference

PURPOSE: Recent studies have revealed close relationships between hepatic injury, metabolic pathways, and gut microbiota. The microorganisms in the intestine also cause irritable bowel syndrome (IBS). The aim of this study was to examine whether IBS was associated with elevated hepatic enzyme [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)], gamma-glutamyl transferase (gamma-GT) levels, and metabolic syndrome (MS). MATERIALS AND METHODS: This was a retrospective, cross-sectional, case-control study. The case and control groups comprised subjects who visited our health promotion center for general check-ups from June 2010 to December 2010. Of the 1127 initially screened subjects, 83 had IBS according to the Rome III criteria. The control group consisted of 260 age- and sex-matched subjects without IBS who visited our health promotion center during the same period. RESULTS: Compared to control subjects, patients with IBS showed significantly higher values of anthropometric parameters (body mass index, waist circumference), liver enzymes, gamma-GT, and lipid levels. The prevalences of elevated ALT (16.9% vs. 7.7%; p=0.015) and gamma-GT (24.1% vs. 11.5%; p=0.037) levels were significantly higher in patients with IBS than in control subjects. A statistically significant difference was observed in the prevalence of MS between controls and IBS patients (12.7% vs. 32.5%; p<0.001). The relationships between elevated ALT levels, MS, and IBS remained statistically significant after controlling for potential confounding factors. CONCLUSION: On the basis of our study results, IBS may be an important condition in certain patients with elevated ALT levels and MS.
Adult ; Alanine Transaminase/analysis/*metabolism ; Aspartate Aminotransferases/analysis/*metabolism ; Body Mass Index ; Case-Control Studies ; Cross-Sectional Studies ; Female ; Humans ; Irritable Bowel Syndrome/diagnosis/*enzymology/epidemiology ; Liver/metabolism ; Male ; Metabolic Syndrome X/complications/diagnosis/*enzymology/epidemiology ; Middle Aged ; Obesity/epidemiology ; Prevalence ; Retrospective Studies ; Waist Circumference ; gamma-Glutamyltransferase/analysis/*metabolism

The aim of the present study was to investigate the relationship of plasma resistin levels with determinants of the metabolic syndrome (MetS) and anthropometric parameters in healthy Korean subjects. Plasma resistin levels were determined in 276 subjects. In subjects with MetS, the plasma resistin levels were not significantly increased compared to those without MetS (8.3+/-4.3 ng/mL vs. 8.5+/-3.6 ng/mL, respectively, P=0.84). In addition, the plasma resistin levels were not correlated with the body mass index, the waist circumference, homeostasis model assessment-insulin resistance (HOMA-IR), fasting plasma glucose or insulin levels. However, the plasma resistin levels were positively correlated with the abdominal subcutaneous fat (r=0.18, P<0.01) in all subjects and correlated with TNF alpha(r=-0.16, P<0.05) and hsCRP (r=0.15, P<0.05) in subjects without MetS but not with MetS. With multiple linear regression analysis, these linear associations remained to be significant. The results of this study show that plasma resistin levels in humans were not associated with markers of insulin resistance, obesity or other determinants of the MetS.
Adult ; Aged ; Anthropometry ; Biological Markers/blood ; Blood Glucose/analysis ; Body Mass Index ; C-Reactive Protein/metabolism ; Female ; Humans ; Insulin/blood ; *Insulin Resistance ; Male ; Metabolic Syndrome X/diagnosis/*metabolism ; Middle Aged ; Obesity/diagnosis/metabolism ; Resistin/*blood ; Subcutaneous Fat/*chemistry ; Tumor Necrosis Factor-alpha/metabolism

The objectives of this cohort analysis were to explore the relationship between insulin resistance (IR) and the criteria for metabolic syndrome (MetS) and to evaluate the ability to detect IR in subjects fulfilling those criteria. We enrolled 511 healthy subjects (218 men and 283 women) and measured their blood pressure (BP), body mass index, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and fasting plasma glucose levels. Insulin suppression testing was done to measure insulin sensitivity as the steady-state plasma glucose (SSPG) value. Subjects with an SSPG value within the top 25% were considered to have IR. The commonest abnormality was a low HDL-C level, followed by high BP. The sensitivity to detect IR in subjects with MetS was about 47%, with a positive predictive value of about 64.8%, which has higher in men than in women. In general, the addition of components to the criteria for MetS increased the predictive value for IR. The most common combination of components in subjects with MetS and IR were obesity, high BP, and low HDL-C levels. All of the components were positive except for HDL-C, which was negatively correlated with SSPG. The correlation was strongest for obesity, followed by high TG values. In subjects with MetS, sensitivity for IR was low. However, body mass index and TG values were associated with IR and may be important markers for IR in subjects with MetS.
Adult ; Aged ; *Biological Markers ; Blood Glucose/metabolism ; Blood Pressure ; Body Mass Index ; Cholesterol, HDL/blood ; Female ; Humans ; *Insulin Resistance ; Male ; Metabolic Syndrome X/*diagnosis/*epidemiology ; Middle Aged ; Obesity, Morbid/diagnosis/epidemiology ; Predictive Value of Tests ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Triglycerides/blood

BACKGROUND/AIMS: The aim was to determine which of three sets of metabolic syndrome (MetS) criteria (International Diabetes Federation [IDF], National Cholesterol Education Program Adult Treatment Panel III [ATP III], and European Group for the Study of Insulin Resistance [EGIR]) best predicts the coronary artery calcification (CAC) score in a cross-sectional study. This has not been evaluated in previous studies. METHODS: A total of 24,060 subjects were screened for CAC by multi-detector computed tomography. The presence of CAC was defined as a CAC score > 0. The odds ratio for the presence of CAC was analyzed for three different sets of MetS criteria and according to number of MetS components. RESULTS: CAC was observed in 12.6% (3,037) of the subjects. Patients with MetS, as defined by the IDF, ATP III, and EGIR criteria, had a CAC rate of 23.0%, 25.1%, and 29.5%, respectively (p < 0.001). Comparisons of C statistics for multivariate regression models revealed no significant difference among the three sets of criteria. After adjustment for risk factors, the ATP III criteria produced a slightly higher odds ratio for CAC compared with the other criteria, but this difference was not significant. The risk factor-adjusted odds ratio for the presence of CAC increased from 1 to 1.679 as the number of MetS components defined by ATP III increased from 0 to > or = 3 (p for trend < 0.001). CONCLUSIONS: The presence of MetS was associated with the presence of CAC. There was no significant difference among the three sets of MetS criteria in terms of the ability to predict CAC. An increase in the number of MetS components was associated with an increased odds of CAC.
Adult ; Asymptomatic Diseases ; Biological Markers/blood ; Calcium/*analysis ; Coronary Angiography/methods ; Coronary Artery Disease/blood/*epidemiology/radiography ; Coronary Vessels/*chemistry/radiography ; Cross-Sectional Studies ; Female ; Humans ; Male ; Metabolic Syndrome X/blood/diagnosis/*epidemiology ; Middle Aged ; Multidetector Computed Tomography ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Vascular Calcification/blood/*epidemiology/metabolism/radiography