The Optimal Cut-off Point of C-Reactive Protein as an Optional Component of Metabolic Syndrome in Japan

Abstract

ardiovascular risk factors have a tendency to cluster together in the same person in both males and females. 1,2 Reaven described that insulin resistance and hyperinsulinemia, clustering with hypertriglyceridemia and hypo-high-density lipoprotein (HDL)-cholesterolemia, might cause non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease (CHD). 3 Kaplan described that upper-body obesity induced by caloric excess in the presence of androgens, mediates these problems by way of hyperinsulinemia. 4 Since then, insulin resistance, leptin resistance, low-grade systemic inflammatory state, oxidant stress, and endothelial dysfunction have been thought to link these risk factors as the underlying common mechanisms. [5][6][7][8][9] The pro-inflammatory state of obesity as a result of over-nutrition induces insulin resistance and leptin resistance, and the insulin and leptin resistance promotes inflammation further through interference with the antiinflammatory effect of insulin 5 and the anti-obesity effect of leptin, leading to the metabolic syndrome (MS). However, the term 'metabolic syndrome' can be premature and the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) jointly stated that clinicians should avoid labeling patients with the term 'metabolic syndrome'. 10 Meanwhile, high-sensitivity C-reactive protein (CRP) has emerged as the most promising inflammatory marker which independently predicts cardiovascular risk, [11][12][13][14][15][16][17][18][19] and is considered to be an optional component of MS. [20][21][22] The CRP concentrations are proposed to be <1.0 mg/L as low risk, 1.0 to 3.0 mg/L as intermediate risk, and >3.0 mg/L as high risk for CHD in Western society. 11 However, CRP values are substantially lower in Japan than in Western countries. 15,[23][24][25][26] Therefore, we tried to find the optimal cut-off points of CRP as an optional component of MS by sex. To the best of our knowledge, the current study is the first trial to find the optimal cut-off points of CRP as an optional component of MS in Japan. MethodsApparently healthy 278 men and 258 women visited our hospital for a routine medical check-up between September 2002 and March 2005. These men and women were the sample population of the present study. The data collected included body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum levels of total cholesterol (Tchol), triglyceride (TG), HDL cholesterol (HDLc), fasting blood sugar (FBS), CRP, and uric acid (UA). CRP levels were measured with CRP-Latex (II) (Denka Seiken, Tokyo, Japan), and the values lower than the measurement limit (0.1 mg/L) were considered to be 0.05 mg/L.A total of 57 men and 61 women were excluded from the study because their CRP or other data including the information about drug administration were absent. Forty-one men and 31 women were excluded from the study because

Ironmaking Technology for the Last 100 Years: Deployment to Advanced Technologies from Introduction of Technological Know-how, and Evolution to Next-generation Process

“…Development of a number of recycling technologies went forward, including processing of waste plastics in blast furnaces 44) and coke ovens, 45) dezincification of dust with high Zn contents using rotary hearth furnaces (RHF) 46) and use of the generated reduced iron in the blast furnace, and dust and scrap processing. 50,51) From 2000 onward, the trend in blast furnace improvements was toward expansion of furnace capacity, and by 2013, 13 of the 27 blast furnaces in Japan had been converted to 5 000 m 3 class large blast furnaces.…”

“…Use of these pellets is contributing to reduction of RAR at the blast furnace. 46,215) Slag-free nugget/pebble production processes have been developed as new advances in RHF technology. These include Kobe Steel's ITmk3 (Ironmaking Technology mark three) 48) and JFE Steel's Hi-QIP (High Quality Iron Pebble).…”

“…In response to subsequent economic and environmental trends, the steel industry has taken on the role of a world leader 4) in driving technological development in various fields of the steel production process, from environment-friendly technologies such as technologies for using low-cost raw materials and reducing agents [5][6][7][8][9][10][11][12][13][14][15] (including low Si operation technology [16][17][18][19][20][21][22][23][24][25][26][27] and high rate pulverized coal injection [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] ), recycling of waste plastics, 44,45) and processing of ironmaking dust [46][47][48][49][50][51] ...…”

Comparison between High-Sensitivity C-Reactive Protein (hs-CRP) and White Blood Cell Count (WBC) as an Inflammatory Component of Metabolic Syndrome in Japanese

“…Hs-CRP is an independent risk factor of diabetes (15) and cardiovascular disease (16) and it is proposed as a component of MetS (16). Previously, we studied the cutoff point of hs-CRP as a component of MetS with a small-sized data (179 men and 166 women) and with a relatively rough hs-CRP measurement method (the measurement limit was 0.1 mg/L) and reported 0.65 mg/L as an optimal cutoff point of hs-CRP in Japanese for both men and women (37). Later, we restudied with data from 1,062 men and 647 women and with a more sensitive hs-CRP measurement method (the measurement limit was 0.02 mg/L) and reported 0.…”

No existing definition of metabolic syndrome meets criteria as a syndrome

“…Anthropometric markers of obesity such as body mass index (BMI), WC, waist-to-hip ratio, and waist-to-height ratio are not direct causes for the clustering of the cardiovascular risk factors but remote upstream factors indirectly leading to the clustering through metabolic susceptibility as illustrated by Grundy 6 and should be used as simple tools for the screening of more proximal risk factors for cardiovascular disease. C-reactive protein 7 may be superior to anthropometric parameters as an obesityrelated risk factor.…”