Elevated C-reactive Protein Levels Independently Predict the Development of Prediabetes Markers in Subjects with Normal Glucose Regulation.

AIMS: Prediabetes is a precursor of diabetes and increases the risk of cardiovascular disease. Individuals with prediabetes reportedly have higher C-reactive protein levels, which is a risk factor for diabetes, relative to individuals with normal glucose regulation. Inflammation may play a role in the very early-phase deterioration of glucose metabolism, although there is insufficient knowledge regarding this relationship. Thus, we examined the association between serum C-reactive protein level and the development of three prediabetes markers. METHODS: This study included 743 subjects with normal glucose regulation at baseline who completed oral glucose tolerance tests at baseline and after approximately 5 years. Subjects with a history of cardiovascular disease were excluded. RESULTS: During the 5-year follow-up, 55 subjects developed isolated impaired glucose tolerance (IGT; 2h-plasma glucose levels of 7.8-11.0 mmol/L), 24 subjects developed isolated impaired fasting glucose (IFG; fasting plasma glucose levels of 6.1-7.0 mmol/L), 3 subjects developed IFG plus IGT, and 53 subjects developed isolated elevated glycated hemoglobin levels (HbA1c; level of 41-47 mmol/mol). The multivariate analysis revealed that, relative to the lowest quartile, the highest serum C-reactive protein quartile was independently associated with an increased risk of developing isolated elevated HbA1c levels (odds ratio: 2.95, 95% confidence interval: 1.16-7.51, P=0.024) and marginally associated with an increased risk of developing impaired glucose tolerance plus diabetes. However, C-reactive protein levels were not associated with an increased risk of developing IFG. CONCLUSIONS: Elevated serum C-reactive protein levels independently predicted elevated HbA1c levels, but not IFG.

Association Between Elevated C-Reactive Protein Levels and Prediabetes in Adults, Particularly Impaired Glucose Tolerance.

OBJECTIVES: Prediabetes is a precursor of diabetes and increases the risk for cardiovascular disease. A high C-reactive protein (CRP) level is a risk factor for diabetes, and individuals with prediabetes have higher CRP levels than those with normal glucose tolerance. In addition, systemic inflammation may play a role in the early-phase deterioration of glucose metabolism. We examined the association between serum CRP levels and prediabetes. METHODS: Overall, 4,101 subjects without diabetes underwent oral glucose tolerance tests. Levels of serum CRP were divided into quartiles; the lowest quartile was used as the reference when calculating odds ratios (ORs) and confidence intervals. Isolated fasting glucose, isolated glucose tolerance and elevated glycated hemoglobin levels (i.e. between 42 and 47 mmol/mol [6.0% to 6.4%]) were indicative of prediabetes. RESULTS: In the multiple logistic regression analysis, the ORs (95% confidence intervals) for impaired glucose tolerance, impaired fasting glucose and elevated glycated hemoglobin levels corresponding to the highest quartile of CRP levels were 1.67 (1.31 to 2.14); 1.62 (1.15 to 2.28); and 1.47 (1.14 to 1.90), respectively. In the stratified analysis, the ORs for impaired glucose tolerance were consistently higher in the uppermost quartile than in the reference quartile in both the presence and absence of hypertension or dyslipidemia. In contrast, the ORs for impaired fasting glucose in the uppermost quartile were higher only in the presence of hypertension and dyslipidemia, and the OR for elevated glycated hemoglobin levels in the uppermost quartile was higher only in the presence of hypertension. CONCLUSIONS: Elevated serum CRP levels are associated with prediabetes, particularly impaired glucose tolerance.

Sleep-disordered breathing and disorders of glucose metabolism.

AIMS: The authors identified the risk of disorders of glucose metabolism (DGM) for sleep-disordered breathing (SDB). METHODS: We conducted a cross-sectional study in 536 men aged 33-84 years. Patients with diabetes medication were excluded for the analysis and DGM were diagnosed by fasting plasma glucose≥100mg/dl and/or 2h plasma glucose ≥140mg/dl. RESULTS: The prevalence of DGM in subjects with and without severe SDB, which was judged by an apnea-hypopnea index (AHI) of 30, were 64.9% and 53.3%, which showed no significant difference. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of the logarithmic-transformed AHI and that of C-reactive protein for DGM were 1.3 (0.87-2.0) and 2.3 (1.5-3.6), respectively. When the subjects were categorized by the severity of SDB, the ORs (95% CIs) of subjects with mild, moderate and severe SDB against subjects without SDB were 2.9 (1.8-4.6), 1.2 (0.72-2.1) and 1.5 (0.8-3.0), respectively. CONCLUSION: A significant association was observed between mild SDB and the presence of DGM in male subjects of this study.

Relationship between sleep-disordered breathing and metabolic syndrome after adjustment with cardiovascular risk factors.

AIMS: It is important to identify the risk factors for metabolic syndrome (MetS) in order to prevent the development of cardio-/cerebrovascular diseases. The authors estimated the risk factors for the development of MetS with special emphasis on the severity of sleep-disordered breathing (SDB). METHODS: We conducted as a cross-sectional study in subjects undergoing intensive health examination (581 men aged 33-84 years). Diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Expert Panel. RESULTS: The prevalence of MetS in subjects with severe SDB, which was defined as an apnea-hypopnea index (AHI) of 30 or higher, was 40.7%, which was significantly higher than that in the subjects without severe SDB (29.3%). The odds ratio (OR) (95% confidence interval [CI]) of the logarithmic-transformed AHI for MetS was 1.6 (1.1-2.4) after adjustments for age, serum uric acid, logarithmic-transformed serum C-reactive protein, smoking history, exercise history and alcohol history. When the subjects were categorized by the severity of SDB, the OR (95% CI) of severe SDB, which was the only category that showed significant association, was 2.2 (1.2-4.0). CONCLUSION: A significant association was observed between severe SDB and the presence of MetS in the subjects (all male) of this study.

Number of components of the metabolic syndrome; smoking and inflammatory markers.

BACKGROUND: The association between inflammatory markers and the combination of the smoking status plus a number of components of the metabolic syndrome was not fully evaluated in male Japanese subjects. OBJECTIVES: To demonstrate the association between inflammatory markers and the number of components of the metabolic syndrome by considering smoking status. PATIENTS AND METHODS: A total of 3,017 male subjects (1,047 current smokers, 1,970 non-smokers) were included. Metabolic syndrome (MetS) was defined by the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The smoking status was categorized in a binary manner into current smokers or non-smokers. RESULTS: The geometric mean value of the serum CRP increased linearly as the number of components of MetS increased (P < 0.05). In contrast, the mean values of the total WBC, neutrophil, lymphocyte and monocyte counts showed peak values when the number of MetS components was 3 or 4. The log-transformed serum CRP levels and the WBC counts were significantly correlated with one another (P < 0.001), but Pearson's correlation coefficient was under 0.3 for current smokers. CONCLUSIONS: Among several inflammatory markers, the serum CRP predominantly changed linearly as the number of MetS increased regardless of smoking status.

Aging, components of metabolic syndrome and serum C-reactive protein showed significant relationship with carotid atherosclerosis.

OBJECTIVE: metabolic syndrome (MetS) is known to be associated with an increased risk for cerebro- as well as cardio-vascular disease. Prediction of carotid atherosclerosis by components of MetS, serum C-reactive protein, aging and related factors was conducted for Japanese inhabitants. METHODS: A total of 887 subjects (761 males, 126 females) were included in the present study. Early atherosclerosis was assessed by measurement of the intima-media thickness of the common carotid arteries. RESULTS: The carotid arterial intima-media thickness on both the right and left sides significantly increased as the number of components of MetS increased. The maximum intima-media thickness values in the right (left) carotid arteries in the male and female subjects who fulfilled the criteria for MetS were 0.65 ± 0.18 (0.66 ± 0.17) mm and 0.58 ± 0.12 (0.59 ± 0.11) mm, respectively. After adjustment for several factors, the intima-media thickness related significantly with aging, some components of MetS and serum C-reactive protein by multiple regression analysis. ß-coefficient of age was largest, presenting 0.457 in right side and 0.479 in left side. CONCLUSIONS: Aging, metabolic components and serum C-reactive protein are independent predictors of intima-media thickness in subjects.

Prevalence of the metabolic syndrome and its relationship with diabetes mellitus by aging.

INTRODUCTION: It is important to make a prompt diagnosis of metabolic syndrome (MetS) in order to prevent the development of cardio-/cerebro- vascular diseases and diabetes mellitus (DM). The authors estimated the risk of development of DM by the presence/absence of MetS and age groups. METHODS: A cross-sectional study of subjects undergoing intensive health examination was conducted (3149 men aged 30-69 years). Diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Expert Panel (NCEP). RESULTS: The prevalence of DM occurring in association with MetS increased with age; it was 11.9% in subjects with MetS in their 30s, it was 19.8% in subjects with MetS in their 60s. The prevalence of DM among subjects who had one or two components of MetS also increased with age. There was a significant progressive increase of the odds ratio in subjects in their 30s, 40s, 50s and 60s who were judged as having MetS; significant increase of the odds ratio was seen in subjects in their 60s, even in those who were not judged as having MetS. CONCLUSIONS: Subjects with MetS show a high prevalence of DM, and the prevalence increased with age in the subjects.

[A case report of complete response by S-1/docetaxel combination chemotherapy for advanced gastric cancer].

A 52-year-old male patient with advanced gastric cancer and multiple lymph node metastasis was treated by S-1/docetaxel combination chemotherapy from April, 2004. As of January 2005, after the tenth course, a scarred tumor was observed with an endoscope, and negative neoplastic cells were found on endoscopic biopsy. After the sixteenth course in July, 2005, CT scan showed that the lymph node metastasis had disappeared. The primary and metastatic lesions were regarded to have responded completely. A total of 26 courses of chemotherapies were undergone until March, 2006. We are taking a wait and see approach at this writing without treatment since then. The patient has had a recurrence-free survival for about five years since the onset. The results suggested that the S-1/docetaxel chemotherapy for metastatic gastric cancer had confirmed feasibility and sufficient efficacy while maintaining the patient's quality of life.