Insulin Resistance and Cardiovascular Disease INSULIN RESISTANCE Type

胰島素阻抗性與許多慢性疾病的致病機轉有關 Insulin Resistance and Cardiovascular Disease INSULIN RESISTANCE Type 2 diabetes Hypertension Vascular Abnormalities, Inflammation Dyslipidemia Cardiovascular disease

Metabolic Syndrome Causes ► Acquired causes – Overweight and obesity – Physical inactivity – High carbohydrate diets (>60% of energy intake) in some persons ► Genetic causes NCEP ATP III JAMA 285: 2486, 2001.

Definition of Metabolic Syndrome ► WHO (1999) ► EGIR (1999) ► ATP III of NCEP (2001) ► AACE (2003)

1999年WHO代謝性症候群的定義 Insulin resistance (必要條件 type 2 diabetes, IFG>110, IGT* ) Plus any 2 of the following Elevated BP BP >140/90 or drug Rx Plasma TG TG > 150 mg/dl HDL-C HDL <35 mg/dl (men); <39 mg/dl (women) Obesity BMI >30 and/or W/H >0. 9 (men), >0. 85 (women) Microproteinuira Urinary albumin >20 mg/min; Alb/Cr >30 mg/g (*Note that 1999 WHO uses hyperinsulinemic euglycemic clamp whereas 1998 WHO and EGIR use HOMA-IR. )

EGIR 胰島素阻抗症候群診斷準則 ► European Group for the study of Insulin Resistance (EGIR) ► 胰島素阻抗：空腹血糖 2次>=110 mg/dl或是 fasting hyperinsulinaemia (the highest 25%)。 ► 脂質異常：TG>180 mg/dl ，HDL-C<40 mg/dl 其中一項即可。 ► 高血壓：BP ≧ 140/90 mm. Hg。 ► 中心性肥胖：腰圍，男≧ 94 cm，女≧ 80 cm 。

ATP III: The Metabolic Syndrome Diagnosis is established when 3 of these risk factors are present Risk Factor Abdominal obesity (Waist circumference) Men Women TG HDL-C Men Women Blood pressure Fasting glucose Defining Level >102 cm (>40 in) >88 cm (>35 in) ≧ 150 mg/dl <40 mg/dl <50 mg/dl ≧ 130/ ≧ 85 mm Hg ≧ 110 mg/dl Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001; 285: 2486 -2497.

Consequences of metabolic syndrome Non-diabetic subjects Diabetic patients 4 -fold increased risk for type 2 diabetes -30% increased risk for CVD 40 -70% increased risk for CVD Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001; 285: 2486 -2497.

ATP III definition Prevalence of the metabolic syndrome Nation Prevalence France (general population): 9 % Finland (Eastern)(men 51. 5 yrs)*: 8. 8 % China (35 -64 yrs): 13. 3 % Porto (random sample of adult): 23. 9% Italy (Bruneck Study) (40 -79 years): 17. 8 % USA Framingham offspring cohort: 21. 4 % Arab Americans (20 -75 years): 23 % Filipino adults* (>20 years): 28 % American Indians**: 35 % * Men with diabetes and CVD excluded ** Non-diabetics

National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children JAMA. 2003; 290: 1345 -1350 ► Results – 6 -18 (Y/O)： 9. 0 -15. 3 /106 (boy： 9. 0 ，girl： 15. 3) – 253 Patients： type 1 DM 24 (9. 5%) type 2 DM 137 (54. 2%) secondary diabetes 22 (8. 7%) ► Conclusions – Type 2 DM is the leading cause of childhood DM in Taiwan. – Obesity is a major risk factor for the development of type 2 DM in children.

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