Proposal for an Empirical Japanese Diet Score and the Japanese Diet Pyramid.

A traditional Japanese diet (JD) has been widely regarded as healthy, contributing to longevity. The modern Japanese lifestyle has become markedly westernized, and it is speculated that the number of people who eat JD is decreasing. A simple evaluation of people with low adherence to JD will help improve dietary life. We developed a simple assessment tool that can capture JD, and examined factors associated with low adherence to JD. A total of 1458 subjects aged 18 to 84 years completed a brief self-administered diet history questionnaire. We constructed an empirical Japanese diet score (eJDS) consisting of 12 items from the common characteristics of a JD. In our participants, 47.7% of subjects reported low adherence to JD and only 11.1% demonstrated high adherence. In multivariate logistic regression analysis, younger age persons, physically inactive persons, and heavy drinkers were associated with low adherence to JD. Based on the cutoff values of eJDS, we proposed to create a Japanese diet pyramid that is easy to use visually. In conclusion, the eJDS and the Japanese diet pyramid will be useful tools for nutrition education and dietary guidance.

A novel dietary inflammatory index reflecting for inflammatory ageing: Technical note.

OBJECTIVE: Chronic inflammation plays an important role in the development of several chronic diseases. Existing dietary inflammatory indexes require complicated calculations, which are difficult to use in clinical practice. We developed a new and simple index, based solely on the frequency of consumption of only 16 foods, to capture the inflammatory potential of diet. METHODS: The new index, an empirical dietary inflammatory index (eDII), is based on 8 pro-inflammatory and 8 anti-inflammatory components. First, in a validation study, 168 community-dwelling persons were invited to participate and an inflammatory aging disease (IAD) score of each participant was calculated by total number of IADs. Second, in the nutritional epidemiologic study, we calculated the eDII for 1464 participants and compared the eDII with healthy diet quality scores. RESULTS: In a validation study, when subjects were classified by eDII tertile, a higher eDII was significantly associated with a higher IAD score. In the nutritional epidemiologic study, a higher eDII was inversely associated with the Mediterranean diet score, the World Health Organization's healthy diet indicator, and the American Heart Association's recommended healthy diet score. CONCLUSIONS: The eDII is an easy and valid instrument to assess the inflammatory potential of dietary factors. This index is easy to use and does not require detailed estimations of nutrient intake.

The World Health Organization's Healthy Diet Indicator and its associated factors: A cross-sectional study in central Kinki, Japan.

The Healthy Diet Indicator (HDI), which is based on adherence to World Health Organization's (WHO) nutrition guidelines, is used worldwide. In 2015, the WHO updated the Fact Sheet for their recommended healthy diet. We investigated diet quality assessed by the updated HDI (HDI-2015) and factors related to adherence to this diet in a Japanese population. We conducted a cross-sectional study of 1370 participants from 8 workplaces, 1 college, and 2 communities. All participants completed a brief-type self-administered diet history questionnaire. The HDI-2015 assesses 7 components: fruits and vegetables, total fat, saturated fatty acid, polyunsaturated fatty acid, free sugar, dietary fiber, and potassium. Only 6.6% of subjects demonstrated high adherence to HDI-2015 (met ≥6 components), whereas 52.0% demonstrated moderate adherence (4-5 components), and 41.4% demonstrated low adherence (0-3 components). Male sex, older age, and regular physical activity were associated with higher adherence. The contemporary Japanese population has an overall low diet quality as evaluated by the updated HDI score. Improving adherence to healthier dietary patterns may promote better health in Japan.

A cross-sectional study of the association between dynapenia and higher-level functional capacity in daily living in community-dwelling older adults in Japan.

BACKGROUND: There are many reports that dynapenia, sarcopenia and frailty each have associations with bodily function or with Instrumental Activities of Daily Living (IADL). However, studies that compare all three conditions and their effects on IADL are lacking. The purpose of this study is to examine associations of sarcopenia, frailty, and dynapenia with IADL. METHODS: Participants included 123 community-dwelling older adults (31 men, 92 women,) aged 65 years or older (75.0 ± 5.3 years) who were independent in IADL. In terms of physical function, measurements were performed for muscle mass, grip strength, walking speed, isometric knee extension strength, and unipedal standing. A questionnaire survey was carried out, the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was administered, and participants were asked about sense of fatigue and amount of activity. RESULTS: Dynapenia was associated with classifications of both frailty and sarcopenia. In addition, sarcopenia had a sensitivity and specificity for dynapenia of 33 and 89%, respectively. Frailty had a sensitivity and specificity for dynapenia of 17 and 98%, respectively. Dynapenia was a significant independent related factor for the TMIG-IC (ß = -0.21, P < 0.05). CONCLUSIONS: Dynapenia, more than sarcopenia or frailty, was related to difficulties with IADL; therefore, assessment of dynapenia should be given greater emphasis in evaluating the physical functioning of older adults.

Development of a Mediterranean diet score adapted to Japan and its relation to obesity risk.

BACKGROUND: The Mediterranean diet (MD) is well known as a healthy diet that protects against several chronic diseases. However, there is no appropriate and easy index to assess adherence to the MD pattern in Japan. OBJECTIVE: The aim of this study was to develop a novel instrument to measure MD adherence adapted to a Japanese diet and to examine its association with overweight/obesity risk. METHODS: A cross-sectional nutritional survey provided the data for construction of a novel MD score. In total, 1,048 subjects who were employees and university students, aged 18-68 years (645 men and 403 women), completed a 58-item brief-type self-administered dietary history questionnaire. We constructed a Japanese-adapted MD score (jMD score) focusing on 13 components. Adherence to the jMD was categorized as low (score 0-4), moderate (5-7), or high (8-13). RESULTS: Men had higher jMD scores than women, and adherence to the jMD score increased with age. Only 11.6% of subjects showed high adherence to the jMD, whereas 29.6% showed low adherence. A higher jMD adherence was associated with a higher intake of favorable nutrients with the exception of salt. The jMD adherence was significantly associated with a reduced likelihood of having overweight/obesity for the highest category compared with lowest category (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.30-0.85, p-trend=0.017) after adjusting for age, sex, smoking, physical activity, alcohol intake, and hypertension. A two-point increment in jMD score was related to a reduced likelihood of having overweight/obesity with an odds ratio of 0.76 (95% CI 0.65-0.90, p=0.002). CONCLUSIONS: Our novel jMD score confirmed reasonable associations with nutrient intakes, and higher MD adherence was associated with a lower prevalence of overweight/obesity.

Diet quality and adherence to a healthy diet in Japanese male workers with untreated hypertension.

OBJECTIVES: As Japanese societies rapidly undergo westernisation, the prevalence of hypertension is increasing. We investigated the association between dietary quality and the prevalence of untreated hypertension in Japanese male workers. DESIGN AND METHODS: We conducted a cross-sectional study of 433 male workers who completed a brief food frequency questionnaire. Adherence to the WHO-based Healthy Diet Indicator (HDI), the American Heart Association 2006 Diet and Lifestyle Recommendations, the Dietary Approaches to Stop Hypertension (DASH) diet, and Mediterranean-style diet was assessed using four adherence indexes (HDI score, AI-84 score, DASH score and MED score). Hypertension classes were classified into three categories: non-hypertension, untreated hypertension and treated hypertension (ie, taking antihypertensive medication). RESULTS: The prevalence of untreated hypertension and treated hypertension was 22.4% and 8.5%, respectively. Patients with untreated hypertension had significantly lower HDI and AI-84 scores compared with non-hypertension. DASH and MED scores across the three hypertension classes were comparable. After adjusting for age, energy intake, smoking habit, alcohol drinking, physical activity and salt intake, a low adherence to HDI and a lowest quartile of AI-84 score were associated with a significantly higher prevalence of untreated hypertension, with an OR of 3.33 (95% CI 1.39 to 7.94, p=0.007) and 2.23 (1.09 to 4.53, p=0.027), respectively. CONCLUSIONS: A lower dietary quality was associated with increased prevalence of untreated hypertension in Japanese male workers. Our findings support a potential beneficial impact of nutritional assessment using diet qualities.

Renal histological heterogeneity and functional progress in normoalbuminuric and microalbuminuric Japanese patients with type 2 diabetes.

BACKGROUND AND OBJECTIVES: Renal histological injury patterns in type 2 diabetes are heterogeneous. We compared renal histological injury patterns using renal biopsy findings with renal function and followed up renal functional changes in normoalbuminuric and microalbuminuric patients with type 2 diabetes to determine whether renal function progresses according to injury patterns. DESIGN SETTING PARTICIPANTS AND MEASUREMENTS: We examined 111 patients with type 2 diabetes with percutaneous renal biopsy (78 men, 52±11 years old, 59 normoalbuminuria, 52 microalbuminuria) and followed up 37 cases for 11 years. Light microscopy of tissues revealed renal injury patterns as: category I (CI), normal or near-normal structure; category II (CII), typical diabetic glomerulopathy; category III (CIII), atypical (disproportionately severe tubulointerstitial/vascular damage with no/mild glomerulopathy). RESULTS: There were 29 CI, 62 CII, and 20 CIII patients. CII patients had a higher frequency of chronic kidney disease (CKD) G3-4, while the injury pattern distribution was not different among the albuminuria stages. The mean glomerular volume and volume fraction of cortical interstitium were larger than those of controls. The arteriolar hyalinosis index was larger in CII and CIII, while the percent global glomerular sclerosis was larger in CKD G3-4 compared with CKD G1-2. Renal function at follow-up was decreased in CII and CIII compared with the baseline estimated glomerular filtration rate (eGFR), while the GFR decline rate was faster in CII. CONCLUSIONS: In normoalbuminuric and microalbuminuric patients with type 2 diabetes, loss of GFR could indicate typical diabetic glomerulosclerosis and a high frequency of global glomerular sclerosis. Urinary biomarkers identifying histological patterns of renal injury are necessary because GFR decline rates differed according to histological injury patterns.

Aspirin possibly reduces cerebrovascular events in type 2 diabetic patients with higher C-reactive protein level: subanalysis from the JPAD trial.

BACKGROUND AND PURPOSE: There are few data that demonstrate a significant effect of aspirin therapy for diabetic patients as primary prevention for cardiovascular events. A guideline recommends the use of aspirin as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk including those who have additional risk factors. To clarify the effect of primary prevention with aspirin therapy on diabetic patients, the relationship between C-reactive protein (CRP) and the incidence of atherosclerotic events was investigated in participants in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial. METHODS AND SUBJECTS: We divided the JPAD participants according to the CRP level at enrollment; CRP ≥0.1mg/dl: high CRP group, CRP <0.1mg/dl: low CRP group. The high CRP group consisted of 1131 patients and the low CRP group consisted of 398 patients. ESSENTIAL RESULTS: There was no significant difference in the incidence of primary atherosclerotic events between the high CRP group and the low CRP group. Of the atherosclerotic events, the incidence of cerebrovascular events, however, was significantly higher in the high CRP group than in the low CRP group. The incidence of cerebrovascular events was higher in the high CRP group than in the low CRP group in patients without aspirin therapy, although there was no significant difference in the incidence of the cerebrovascular events between the high CRP group and the low CRP group in patients undergoing aspirin therapy. PRINCIPAL CONCLUSIONS: Aspirin therapy may reduce cerebrovascular events in diabetic patients with higher CRP. Aspirin therapy could be an additional strategy as primary prevention for diabetic patients with higher CRP.

Adherence index to the American Heart Association Diet and Lifestyle Recommendation is associated with the metabolic syndrome in Japanese male workers.

BACKGROUND: As Japanese societies rapidly undergo Westernization, the prevalence of metabolic syndrome is increasing. We investigated the association between dietary habits and the prevalence of metabolic syndrome using a new adherence index to optimal dietary habits based on the American Heart Association Diet and Lifestyle Recommendation (AHA-DLR). METHODS: We conducted a cross-sectional study of 503 male workers who completed a brief food frequency questionnaire. Adherence to the AHA-DLR was assessed using a 10-component adherence index (AI-84; a total possible score of 84 points). Metabolic syndrome was defined according to the most recently published harmonized criteria by the International Diabetes Federation in conjunction with the National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. RESULTS: The prevalence of metabolic syndrome was 26.6% and the AI-84 score ranged from 5 to 56 points. Subjects with metabolic syndrome had a significantly lower AI-84 score compared with those without (27.1 ± 9.1 vs. 28.9 ± 9.2, p=0.042). After adjusting for age, energy intake, smoking habit and physical activity, a higher AI-84 score was associated with a significantly lower prevalence of metabolic syndrome, with an odds ratio of 0.778 (95% CI 0.614-0.986, p=0.038) for each 10-point score increment. CONCLUSIONS: A lower AI-84 score was associated with increased prevalence of metabolic syndrome. Our findings support a potential beneficial impact of nutritional assessment using adherence to the AHA-DLR for prevention of metabolic syndrome.

Aspirin reduces cerebrovascular events in type 2 diabetic patients with poorly controlled blood pressure. Subanalysis from the JPAD trial.

BACKGROUND: There are few data that demonstrate a significant effect of aspirin therapy for diabetic patients. To clarify the effect of the primary prevention of aspirin therapy in diabetic patients, the relationship between blood pressure (BP) and the incidence of atherosclerotic events was investigated in participants in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial. METHODS AND RESULTS: We divided the JPAD participants according to their systolic (SBP) and diastolic (DBP) BPs at enrollment (SBP ≥140 mmHg and/or DBP ≥90 mmHg: unattained group, SBP <140 mmHg and DBP <90 mmHg: attained group). The incidence of the primary atherosclerotic events, especially cerebrovascular events, was higher in the unattained group than in the attained group. The incidence of cerebrovascular events was higher in the unattained group than in the attained group in patients without aspirin therapy; however, the incidence of cerebrovascular events in the unattained group was as low as the incidence in the attained group in patients undergoing aspirin therapy. Cox proportional hazards analysis revealed that BP level was an independent predictor for cerebrovascular events in diabetic patients. CONCLUSIONS: Aspirin therapy may reduce cerebrovascular events in diabetic patients with higher BP. Aspirin therapy could be an additional strategy as primary prevention for diabetic patients with higher BP.

Differential effect of low-dose aspirin for primary prevention of atherosclerotic events in diabetes management: a subanalysis of the JPAD trial.

OBJECTIVE: Recent reports showed that low-dose aspirin was ineffective in the primary prevention of cardiovascular events in diabetic patients overall. We hypothesized that low-dose aspirin would be beneficial in patients receiving insulin therapy, as a high-risk group. RESEARCH DESIGN AND METHODS: This study is a subanalysis of the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial-a randomized, controlled, open-label trial. We randomly assigned 2,539 patients with type 2 diabetes and no previous cardiovascular disease to the low-dose aspirin group (81 or 100 mg daily) or to the no-aspirin group. The median follow-up period was 4.4 years. We investigated the effect of low-dose aspirin on preventing atherosclerotic events in groups receiving different diabetes management. RESULTS: At baseline, 326 patients were treated with insulin, 1,750 with oral hypoglycemic agents (OHAs), and 463 with diet alone. The insulin group had the longest history of diabetes, the worst glycemic control, and the highest prevalence of diabetic microangiopathies. The diet-alone group had the opposite characteristics. The incidence of atherosclerotic events was 26.6, 14.6, and 10.4 cases per 1,000 person-years in the insulin, OHA, and diet-alone groups, respectively. In the insulin and OHA groups, low-dose aspirin did not affect atherosclerotic events (insulin: hazard ratio [HR] 1.19 [95% CI 0.60-2.40]; OHA: HR 0.84 [0.57-1.24]). In the diet-alone group, low-dose aspirin significantly reduced atherosclerotic events, despite the lowest event rates (HR 0.21 [0.05-0.64]). CONCLUSIONS: Low-dose aspirin reduced atherosclerotic events predominantly in the diet-alone group and not in the insulin or OHA groups.

Epithelial-mesenchymal transition as a potential explanation for podocyte depletion in diabetic nephropathy.

BACKGROUND: Depletion of glomerular podocytes is an important feature of progressive diabetic nephropathy. Although the most plausible explanation for this podocyte depletion is detachment from the glomerular basement membrane after cellular apoptosis, the mechanism is unclear. Fibroblast-specific protein 1 (FSP1; encoded by the S100A4 gene) is a member of the S100 family of calcium-binding proteins and is constitutively expressed in the cytoplasm of tissue fibroblasts or epithelial cells converted into fibroblasts by means of epithelial-mesenchymal transition. STUDY DESIGN: Retrospective cross-sectional analysis. SETTINGS & PARTICIPANTS: 109 patients with type 2 diabetes mellitus, of whom 43 (39%) underwent kidney biopsy. PREDICTOR: Clinical stage (4 categories) and histological grade (5 categories) of diabetic nephropathy. OUTCOME: FSP1 expression in podocytes in urine and glomeruli in kidney biopsy specimens. MEASUREMENTS: Immunohistochemistry, real-time polymerase chain reaction, and in situ hybridization. RESULTS: 38 of 109 patients (35%) were normoalbuminuric, 16 (15%) had microalbuminuria, 8 (7%) had macroalbuminuria, and 47 (43%) had decreased kidney function. Approximately 95% of podocytes in urine sediment were not apoptotic, and 86% expressed FSP1. The number of FSP1-positive podocytes in urine sediment was significantly larger in patients with macroalbuminuria than in those with normoalbuminuria (P = 0.03). Intraglomerular expression of FSP1 occurred almost exclusively in podocytes from patients with diabetes, and the number of FSP1-positive podocytes was larger in glomeruli showing diffuse mesangiopathy than in those showing focal mesangiopathy (P = 0.01). The number also was larger in glomeruli with nodular lesions than in those without nodular lesions (P < 0.001). FSP1-positive podocytes selectively expressed Snail1 and integrin-linked kinase, a known trigger for epithelial-mesenchymal transition. LIMITATIONS: Nonrepresentative study population. CONCLUSIONS: These results suggest that the appearance of FSP1 in podocytes of patients with diabetes is associated with more severe clinical and pathological findings of diabetic nephropathy, perhaps because of induction of podocyte detachment through epithelial-mesenchymal transition-like phenomena.

Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial.

CONTEXT: Previous trials have investigated the effects of low-dose aspirin on primary prevention of cardiovascular events, but not in patients with type 2 diabetes. OBJECTIVE: To examine the efficacy of low-dose aspirin for the primary prevention of atherosclerotic events in patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, prospective, randomized, open-label, blinded, end-point trial conducted from December 2002 through April 2008 at 163 institutions throughout Japan, which enrolled 2539 patients with type 2 diabetes without a history of atherosclerotic disease and had a median follow-up of 4.37 years. INTERVENTIONS: Patients were assigned to the low-dose aspirin group (81 or 100 mg per day) or the nonaspirin group. MAIN OUTCOME MEASURES: Primary end points were atherosclerotic events, including fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke, and peripheral arterial disease. Secondary end points included each primary end point and combinations of primary end points as well as death from any cause. RESULTS: A total of 154 atherosclerotic events occurred: 68 in the aspirin group (13.6 per 1000 person-years) and 86 in the nonaspirin group (17.0 per 1000 person-years) (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.58-1.10; log-rank test, P = .16). The combined end point of fatal coronary events and fatal cerebrovascular events occurred in 1 patient (stroke) in the aspirin group and 10 patients (5 fatal myocardial infarctions and 5 fatal strokes) in the nonaspirin group (HR, 0.10; 95% CI, 0.01-0.79; P = .0037). A total of 34 patients in the aspirin group and 38 patients in the nonaspirin group died from any cause (HR, 0.90; 95% CI, 0.57-1.14; log-rank test, P = .67). The composite of hemorrhagic stroke and significant gastrointestinal bleeding was not significantly different between the aspirin and nonaspirin groups. CONCLUSION: In this study of patients with type 2 diabetes, low-dose aspirin as primary prevention did not reduce the risk of cardiovascular events. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00110448.

Contrast-enhanced ultrasonography with Sonazoid for evaluation of renal microcirculation.

PURPOSE: The renal medullary microcirculation plays an important role in regulating sodium and water excretion, and its impairment is closely associated with various renal diseases. Contrast-enhanced ultrasonography (CEUS) using Sonazoid has not yet been reported as a method for evaluating the renal microcirculation; consequently, this study was carried out to reveal the characteristics of renal microcirculation using CEUS with Sonazoid. METHODS: CEUS was performed on three healthy volunteers after they had fasted for at least 6 h. A GE LOGIQ7 ultrasound unit was used with a 2.0- to 5.5-MHz convex probe. Within approximately 1 min of intravenous injection of 0.0050 ml/kg Sonazoid, contrast images of the right kidney were acquired using a coded phase-inversion mode. Time-intensity curves were calculated for the cortex and medulla. RESULTS: Peak contrast intensity was significantly higher in the cortex (-56.4 ± 1.9 dB) than in the medulla (-66.7 ± 1.7 dB; P < 0.005). Peak times were significantly earlier in the cortex (17.4 ± 3.7 ms) than in the medulla (28.8 ± 6.3 ms; P < 0.05). CONCLUSION: CEUS using Sonazoid enables differentiation between the cortical and medullary microcirculation and is useful in clarifying renal pathophysiology and pharmacology.

Surrogate markers of insulin resistance in assessing individuals with new categories "prehypertension" and "prediabetes".

BACKGROUND: There are few data on the impact of insulin resistance on the recently defined categories of prehypertension (PHT) and prediabetes (PDM). The aim of this study was to examine associations of surrogate markers of insulin resistance with PHT/PDM. METHODS: Subjects included 554 individuals who underwent a 75-g oral glucose tolerance test (OGTT). They were classified into four groups using a severity score for high blood pressure and glucose tolerance. Insulin resistance was measured using the homeostasis model assessment of insulin resistance (HOMA-R) and three surrogate markers obtained from 75-g OGTT values (ISI-composite, Stumvoll index, and OGIS index). RESULTS: HOMA-R increased significantly, but the other three surrogate indices decreased with increasing severity score. Of these markers, the OGIS index was mostly associated with prevalent PHT/PDM and the odds ratio for insulin resistance was 3.61 (95% CI 1.68-7.76, p=0.001) for subjects with either PHT or PDM and 29.98 (12.81-70.18, p<0.001) for subjects with both PHT and PDM. CONCLUSIONS: PHT and PDM frequently coexist in relatively lean Japanese subjects. Decreased insulin sensitivity may contribute to the underlying status of PHT/PDM. Among the surrogate markers of insulin resistance, the OGIS index is the most sensitive for assessment of PHT/PDM status.

Utility of elevated 2-hour postload plasma glucose as an alternative to elevated fasting glucose as a criterion for the metabolic syndrome.

We hypothesize that many persons with postchallenge hyperglycemia (PCH) but who do not meet the National Cholesterol Education Program (NCEP) criteria characterize a phenotype that is similar to the metabolic syndrome (MS) traits. Subjects included 725 Japanese who underwent a 75-g oral glucose tolerance test. If 2-hour plasma glucose of 7.8 mmol/L or higher was present, subjects with fasting glucose of less than 6.1 mmol/L could have one component of the MS (PCH-MS). Data obtained by the 75-g oral glucose tolerance test were used to calculate 3 insulin sensitivity indexes according to formulas proposed by Matsuda and DeFronzo (insulin sensitivity index composite), Stumvoll et al (Srumvoll index), and Mari et al (oral glucose insulin sensitivity index). Based on the PCH-MS and NCEP-MS criteria, 395 had neither PCH-MS nor NCEP-MS, 85 had PCH-MS, and 245 had NCEP-MS. Subjects with PCH-MS exhibited higher systolic blood pressure and triglyceride levels, lower high-density lipoprotein cholesterol levels, and lower insulin sensitivity than those who had neither PCH-MS nor NCEP-MS. A similar profile was observed when subjects with NCEP-MS were compared with those who had neither PCH-MS nor NCEP-MS. All 3 indexes of insulin sensitivity were significantly lower in subjects with PCH-MS than in those who had neither PCH-MS nor NCEP-MS, and approximately 66% of PCH-MS was in an insulin-resistant state. On the other hand, there was no statistical difference in the values between PCH-MS and NCEP-MS. Our data support the addition of abnormal 2-hour plasma glucose as a criterion for the MS, when fasting glucose is normal.