on December 13, 2004
Published online before print December 13, 2004, doi: 10.1161/01.CIR.0000150391.38660.9B
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Submitted on June 24, 2004
From the Departments of Medicine (U.S., E.R., J.P., I.V., M.L.), Radiology (S.K.), Clinical Chemistry (K.P.), and Clinical Physiology and Nuclear Medicine (E.V.), University of Kuopio, Kuopio, Finland. * To whom correspondence should be addressed. E-mail: markku.laakso{at}kuh.fi.
Background--Detailed metabolic defects in glucose and energy metabolism and abnormalities in a variety of cardiovascular risk factors are largely unknown in subjects with the metabolic syndrome. Methods and Results--We characterized the metabolic syndrome in 119 nondiabetic offspring of diabetic probands. Cardiovascular risk factors, including cytokines and adhesion molecules, were measured. Insulin sensitivity was assessed by the euglycemic hyperinsulinemic clamp and indirect calorimetry; intra-abdominal fat and subcutaneous fat were assessed by CT; and maximal oxygen consumption was measured with a bicycle ergometer test. By applying factor analysis, we identified a single factor, the metabolic syndrome factor, from the following variables: 2-hour glucose, fasting insulin, body mass index, waist, HDL cholesterol, triglycerides, and mean blood pressure. Subjects with the highest factor score were defined as having the metabolic syndrome. During hyperinsulinemia, the highest factor score was associated with decreased rates of glucose oxidation and nonoxidative glucose disposal, high rates of lipid oxidation, low energy expenditure, and impaired suppression of free fatty acids during hyperinsulinemia. Furthermore, the metabolic syndrome was associated with a high amount of visceral fat, hypoadiponectinemia, a low maximum oxygen uptake, and high levels of C-reactive protein, proinflammatory cytokines, and adhesion molecules. Conclusions--The metabolic syndrome is characterized by an excess of intra-abdominal fat, hypoadiponectinemia, insulin resistance in skeletal muscle and adipose tissue, multiple defects in glucose and energy metabolism, and elevated levels of cytokines and adhesion molecules.
Revised on August 3, 2004
Accepted on August 4, 2004
Multiple Abnormalities in Glucose and Energy Metabolism and Coordinated Changes in Levels of Adiponectin, Cytokines, and Adhesion Molecules in Subjects With Metabolic Syndrome
Urpu Salmenniemi MD,
Key words: adiponectin • cell adhesion molecules • cytokines • insulin resistance • metabolic syndrome X
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