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Öğe Clustering of risk factors for abdominal obesity in Turkish adults and its demographic distribution(Turkish Soc Cardiology, 2005) Onat, Allan; Uyarel, Huseyin; Karabulut, Ahmet; Albayrak, Sinan; Dogan, Yuksel; Can, Gunay; Hergenc, GunayObjectives: We investigated the distribution of abdominal obesity among Turkish adults, according to age groups and geographic regions, and the prevalence and type of its clustering with traditional risk factors including high total and low HDL cholesterol levels, smoking, hypertension, and diabetes. Study design: The study included a cohort of 3267 individuals (1607 men, 1660 women; mean age 52 +/- 12 years) whose waist circumferences were measured at least one time in the past three surveys of the Turkish Adult Risk Factor Study from 2000 to 2004. Cardiovascular disease was diagnosed on the basis of the presence of angina history, the Minnesota coding of resting electrocardiograms, and a history of stroke. Criteria of the NCEP ATP III guidelines proposed for metabolic syndrome were adopted for defining abdominal obesity and hypertension. Results: Out of every four adults aged 50 years or above, one man and three women had abdominal obesity. The prevalence of abdominal obesity did not exhibit marked changes among geographic regions. Coexistence of 3-5 risk factors in subjects with abdominal obesity showed a significantly higher proportion than other clusters of risk factors (p<0.001). All of the six risk factors studied exhibited significant and independent associations with abdominal obesity in women, whereas in men, only smoking, low HDL-C levels, and hypertension were independent factors. In contradistinction to men, there was an over three-fold adjusted likelihood of diabetes to accompany abdominal obesity in women, with hypercholesterolemia significantly clustering with both. While abdominal obesity conferred an increased likelihood of coronary heart disease through mediation of five risk factors in women, it was found as a residual independent component in men. Conclusion: According to the NCEP ATP III criteria, abdominal obesity is three times more prevalent among Turkish women than in men. The female-specific combination of abdominal obesity, diabetes, and hypercholesterolemia may partly contribute to the comparatively high risk for cardiovascular disease in Turkish women. This study needs a re-evaluation of the role of abdominal obesity in Turkish men with a threshold of >= 96 cm, which was previously proposed by the authors.Öğe Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men(Elsevier Ireland Ltd, 2007) Onat, Altan; Uyarel, Huseyin; Hergenc, Gulay; Karabulut, Ahmet; Albayrak, Sinan; Can, GunayWe aimed to investigate determinants of abdominal obesity and its clinical impact on metabolic syndrome (MS), diabetes (DM) and coronary heart disease (CHD) in men. Methods: Prospective evaluation of 1638 male participants (aged 48.5 +/- 12.3), representative of Turkey's men who have a high prevalence of MS. For components of MS, criteria of NCEP guidelines were adopted, modified for abdominal obesity. Follow-up constituted 9650 person-years. Results: Insulin level (relative risk [RR] 1.40 for doubling), C-reactive protein (CRP) and heavy smoking (protective) were independent predictors of newly developing abdominal obesity. High triglyceride and low HDL-cholesterol were significantly associated already with waist girth quartile II, apolipoprotein B with quartile III. Waist girth significantly predicted future MS from quartile II on, independent of insulin resistance (IR) by homeostatic model assessment, whereby its hazard ratio (HR, 2.6) exceeded double that of HOMA. CRP independently predicted MS. Age-adjusted HR of waist girth (1.59) was significant in predicting DM. Age- and smoking-adjusted top waist quartile conferred significant risk for incident CHD (RR 1.71) but not for overall mortality. As judged by sensitivity and specificity rates for future CHD, DM and MS, abdominal obesity was most appropriately defined with a waist girth of >= 95 cm, and an action level 1 of >= 87 cm was proposed for MS in this population. Conclusions: Serum insulin, CRP levels and (inversely) heavy smoking are predictors for abdominal obesity in Turkish men. Atherogenic dyslipidemia and elevated blood pressure are associated significantly already with modest rises in waist girth adjusted for age and smoking. Abdominal obesity shows substantial independence of IR in the development of MS. Increasing waist girth was predictive of MS, more strongly than of DM. Risk for CHD imparted by abdominal obesity is essentially mediated by risk factors it induces. (c) 2006 Elsevier Ireland Ltd. All rights reserved.Öğe Mild Renal Dysfunction Among Turkish Adults: Prevalence and Its Association With Insulin Resistance(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2006) Onat, Altan; Yazici, Mehmet; Hergenc, Gulay; Uyarel, Huseyin; Esen, A. Metin; Karabulut, Ahmet; Can, GunayObjectives: To investigate the prevalence of mild renal dysfunction and its association with insulin resistance (IR), metabolic syndrome (MS) or its components among Turkish adults. Methods: Serum creatinine concentrations were measured in 1048 male and female subjects. After excluding cases with diabetes mellitus, 933 participants of a representative cohort were studied cross-sectionally. Glomerular filtration rate (GFR) was estimated based on serum creatinine concentrations using the Modification of Diet in Renal Disease formula. GFR was divided into 3 categories constituting chronic kidney disease stages 2 and 3 3. MS was identified by modified criteria of the Adult Treatment Panel-III. Results: MS existed in 38.7% of the cohort. Mild renal dysfunction (estimated GFR 60 to 89.9 mL/min/1.73 m(2)) existed in 50% of the study sample in both genders. Compared to the group with normal GFR, in category II, age-adjusted estimates of body mass index, homeostatic model assessment (HOMA) index, blood pressures, total, HDL-, LDL-cholesterol and serum proteins were all significantly elevated in both genders, as were apo B and log TSH in women alone. Stated variables were also significantly and inversely correlated with GFR. Whereas MS was not significantly associated with GFR categories, nor with reduced GFR when controlled for HOMA, HOMA D adjusted for MS as well as for sex, age and systolic BP-was significantly associated with likelihood for reduced GFR. Conclusions: Mild impairment of kidney function is very common in nondiabetic middle-aged and elderly adults, is associated mainly with IR and related cardiovascular risk factors, in the absence of MS-related atherogenic dyslipidemia. IR is important even in mild reduction in GFR, an action independent of central obesity-related components of MS.Öğe Serum total and high-density lipoprotein phospholipid levels in a population-based study and relationship to risk of metabolic syndrome and coronary disease(Sage Publications Inc, 2008) Hergenc, Gulay; Onat, Altan; Sari, Ibrahim; Yazici, Mehmet; Eryonucu, Beyhan; Can, GunayThe aim of study was to investigate the role of serum total (TPL) and high-density lipoprotein phospholipids (HDL-pl) as a risk factor in coronary heart disease (CHD) and metabolic syndrome (MS). In a random sample, total and HDL-pI were measured in 1088 and 642 adults from Turkey, respectively, who have a high prevalence of MS; this was done with an enzymatic method that measures total phosphatidylcholine, sphingomyelin, and lysophosphatidylcholine. Serum TPL and HDL-pl levels were significantly higher in women (TPL, 2.8 mmol/L; HDL-pl, 1.21 mmol/L) than in men. Strong correlations existed between serum TPL levels and non-HDL cholesterol (HDL-C), triglycerides, apolipoprotein (apo) B, complement C3, and gamma-glutamyltransferase. Non-HDL-C, HDL triglyceride, and apo A-I were strongly correlated with HDL-pl. Linear regression analyses revealed HDL-C, apo B, triglycerides, diabetes, and female gender as independent significant determinants of TPL levels in adults. HDL-C and impaired glucose regulation were sole significant variables, together contributing one-quarter of serum HDL-pl. Individuals with MS or diabetes had significantly higher TPL concentrations. The gender- and age-adjusted odds ratio (OR) of TPL for MS was 1.73 (95% confidence interval, 1.35-2.21), whereas the multiadjusted OR of HDL-pl per 1 SD increment corresponded to a significantly reduced independent MS likelihood by 26% in women (and 18% in the entire group). The multiadjusted OR of HDL-pl for CHD in men and women combined was 0.32 (P =.057) corresponding to a reduced CHD likelihood by 32% per I SD increment of HDL-pl. Plasma TPL levels point to an adverse relationship to MS, whereas their role in CHD risk needs further investigation. HDL-pls, in contrast, mark substantial protection from MS as well as from CHD.
