本研究結果顯示低濃度脂締素會增加罹患代謝症候群的危險 性，若具有越多代謝症候群指標異常者，其脂締素濃度會隨之下降。
脂締素基因 SNP276 及 SNP-11377 的基因多型性與罹患代謝症候群並 無顯著之相關性，且發現脂締素基因亦無交互作用關係。
脂締素基因變異性與第二型糖尿病及(或)胰島素阻抗之相性，
在五個不同族群已被證實，包括日本人，德國人，法國人，美國人，
及瑞典人，但是第二型糖尿病及(或)胰島素阻抗性與脂締素基因單一 核甘酸多型性之敏感度，在這五個族群卻有不同的結果，這似乎意味 著脂締素單一核甘酸之基因缺失，在不同的族群可能與基因背景及環 境因素有相關聯。
未來更多脂締素基因多型性與罹患代謝症候群間的關係，及環境危 險因子與脂締素基因的基因多型性之交互作用，宜再進一步探討。
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Table 5-1. Distribution of metabolic syndrome associated with selected demographic characteristics
Factor/category Cases N(%) N=137
Controls N(%)
N=110
P-value
Age(years)# 56.6±10.2 55.2±10.7 0.3 Age group
40-49 49(35.8) 44(40.0) 0.9 50-59 47(34.3) 35(31.8)
60-69 22(16.1) 17(15.5)
>70 19(13.9) 14(12.7) Gender
Female 75(54.7) 58(52.7) 0.7 Male 62(45.3) 52(47.3)
Years of education
<6 42(30.7) 21(19.1) 0.4 7-9 19(13.9) 16(14.6)
9-12 38(27.7) 38(34.6)
>12 38(27.7) 35(31.8)
# Mean±Standard deviation
Table 5-2 Odds ratios of metabolic syndrome associated with potential risk factors Cases(%)
N=137
Controls(%) N=110
Crude OR (95% CI) Adjusted OR(95%
CI) Susatance use
Cigarette smoking
Never-smoker 90(65.7) 83(75.5) 1 1
Former-smoker 28(20.4) 21(19.1) 2.85(1.09-7.49)* 1.72(0.47-6.38)a Current-smoker 19(13.9) 6(5.4) 1.11(0.58-2.13) 1.25(0.52-3.03)a Alcohol
drinking
Never-drinker 88(64.2) 73(66.4) 1 1
Former-drinker 36(26.3) 33(30.0) 2.46(0.76-7.94) 1.80(0.38-8.46)b Current-drinker 13(9.5) 4(3.6) 0.90(0.51-1.59) 1.02(0.47-2.20)b Areca chewing
Never-chewer 119(86.9) 99(90.0) 1 1
Former-chewer 8(5.9) 7(6.4) 2.05(0.63-6.75) 0.80(0.18-3.58)c Current-chewer 10(7.3) 4(3.6) 0.82(0.28-2.42) 0.42(0.11-1.67)c Exercise
No 52(38.0) 38(34.5) 1 1
Yes 85(62.0) 72(65.5) 0.92(0.55-1.56) 1.01(0.54-1.92)d
* P<0.05
a Odds ratios were adjusted for age, gender, education, alcohol drinking areca chewing and exercise
b.Odds ratios were adjusted for age, gender, education, cigarette smoking, areca chewing and exercise
c.Odds ratios were adjusted for age, gender, education, cigarette smoking, alcohol drinking, and exercise
d.Odds ratios were adjusted for age, gender, education, cigarette smoking, alcohol drinking, and areca chewing
Table 5-3 Relationships between serum adiponectin levels and metabolic parameters in metabolic syndrome Multiple regression
Simple
regression Adjusted for
BMI Adjusted for age,
Gender(male/female) -1.139 0.15 -1.103 0.15 -1.121 0.15
WHR -16.48 <0.01 -14.29 0.02 -14.472 0.02 -14.211 0.06 HDL cholesterol(mg/dl) 0.192 <0.001 0.176 <0.001 0.177 0.18 0.170 0.001 Fasting blood Abbreviation WHR: Waist-hip radio ,BMI: Body mass index, CRP: C reactive protein
Table 5-4 Relationships between serum adiponectin levels and metabolic parameters in non-metabolic syndrome
Multiple regression Simple
regression Adjusted for BMI Adjusted for
age, BMI Adjusted for age, HDL cholesterol(mg/dl) 0.168 <0.001 0.166 <0.001 0.161 <0.001 0.124 0.01 Fasting blood Abbreviation WHR: Waist-hip radio, BMI: Body mass index, CRP: C reactive protein
Table 5-5 Distribution of component factors of metabolic syndrome Cases
N=137
Controls N=110
P-value
Body mass index(kg/m2) 27.3±3.3 22.1±2.1 <0.001
Waist(cm) 90.8±8.7 74.6±6.8 <0.001
Cholesterol(mg/dl) 206.4±36.1 207.3±35.9 0.848 Triglycerides(mg/dl) 194.8±97.4 68.8±26.4 <0.001 HDL cholesterol(mg/dl) 37.2±7.8 56.9±3.3 <0.001 Systolic blood pressure(mmHg) 148.5±19.9 116.9±7.5 <0.001 Diastolic blood pressure(mmHg) 87.4±11.5 69.8±7.0 <0.001 Fasting blood glucose(mg/dl) 125.0±44.7 91.8±7.1 <0.001 Abbreviation HDL: High density lipoprotein
Table5-6 Distribution of related risk factors of metabolic syndrome Cases
N=137
Controls N=110
P-value
Adiponectin(ug/ml) 6.8±4.6 11.8±6.0 <0.001
Uric acid(mg/dl) 6.3±1.6 5.3±1.4 <0.001
CRP(mg/dl) 0.31±0.30 0.17±0.16 0.006
Insulin(uU/ml) 13.5±9.1 6.1±3.9 <0.001
HOMA 4.3±3.7 1.4±0.9 <0.001
Abbreviation CRP:C reactive protein, HOMA: Homeostasis Model Assessment
Table5-7 Odds ratios of metabolic syndrome associated with related risk factors Cases
N=137
Controls N=110
Crude OR(95 CI %) Adjusted OR(95 CI %)
Adiponectin(ug/ml) 6.8±4.6 11.8±6.0 0.83(0.78-0.88) 0.86(0.79-0.94) Uric acid(mg/dl) 6.3±1.6 5.3±1.4 1.61(1.32-1.95) 1.63(1.18-2.27) CRP(mg/dl) 0.31±0.30 0.17±0.16 9.63(1.14-81.30) 1.62(0.30-8.68) Insulin(uU/ml) 13.5±9.1 6.1±3.9 1.23(1.14-1.34) 1.21(1.11-1.33) HOMA 4.3±3.7 1.4±0.9 2.48(1.75-3.42) 2.32(1.48-3.31) Abbreviation CRP:C reactive protein, HOMA: Homeostasis Model Assessment
Odds ratios were adjusted for age, gender, education, smoking, alcohol drinking ,areca chewing and exercise
Table5-8 Distribution of component factors of metabolic syndrome by numbers of metabolic syndrome 0 component
N=110
3 components N=42
4 components N=58
5 components N=37
P-values Body mass index(kg/m2) 22.1±2.1 26.4±4.1# 27.6±2.7# 28.0±3.0# <0.001 Waist(cm) 74.6±6.8 87.6±10.1#＊ 91.1±7.9#＊ 93.9±7.0# <0.001 Cholesterol(mg/dL) 207.3±35.9 203.0±35.2 207.0±35.8 209.5±38.3 0.873 Triglycerides(mg/dL) 68.8±26.4 151.0±80.8#＊￥ 202.0±72.5# 233.3±27.6# <0.001 HDL cholesterol(mg/dL) 56.9±3.3 40.5±7.4# 35.9±8.4# 35.6±6.1# <0.001 Systolic blood
pressure(mmHg)
116.9±7.5 140.7±15.8#＊ 147.5±18.3#＊ 158.3±2.3# <0.001 Diastolic blood
pressure(mmHg)
69.8±7.0 83.2±9.2#＊ 88.6±11.1# 90.4±13.1# <0.001 Fasting blood
glucose(mg/dL)
91.8±7.1 114.8±33.6#＊ 108.8±27.0#＊ 161.9±56.1# <0.001
#: compaired with o component by Scheffe＇s test, P<0.05
*: compaired with 5 component by Scheffe＇s test, P<0.05
￥: compaired with 4 component by Scheffe＇s test, P<0.05
Table5-9 Distribution of metabolic syndrome associated with related risk factors of metabolic syndrome by numbers of metabolic syndrome
0 component N=110
3compornents N=42
4 components N=58
5 components N=37
P-values
Adiponectin (ug/ml)
11.8±5.95 9.72±3.33＊￥ 6.05±4.57# 4.72±4.01# <0.001
Uric acid (mg/dl)
5.31±1.37 6.02±1.35 6.42±1.47# 6.35±2.03# <0.001
CRP(mg/dl) 0.17±0.16 0.25±0.41 0.30±.54# 0.43±0.58# 0.024 Insulin(uU/ml) 6.13±3.87 12.03±7.66# 13.6±10.54# 15.54±9.05# <0.001 HOMA 1.41±0.92 3.52±2.54#＊ 3.84±3.5#＊ 6.34±4.75# <0.001
#: compaired with o component by Scheffe＇s test, P<0.05
*: compaired with 5 component by Scheffe＇s test, P<0.05
￥: compaired with 4 component by Scheffe＇s test, P<0.05
Abbreviation CRP:C reactive protein, HOMA: Homeostasis Model Assessment
Table5-10 Odds ratios of metabolic syndrome associated with adiponectin genetic polymorphism Genotype Cases(%)
N=137
Controls(%) N=110
Crude OR (95% C.I.) Adjusted OR (95% C.I.) SNP-11377
C/C 77(56.2) 64(58.2) 1 1
C/G 50(36.5) 40(36.4) 1.25(0.82-1.89) 0.94(0.50-1.78) G/G 10(7.3) 6(5.4) 1.67(0.60-4.59) 1.96(0.55-7.00) G carriers 60(43.8) 46(41.8) 1.30(0.89-1.92) 1.05(0.58-1.93) SNP276
G/G 60(43.8) 44(40.0) 1 1
G/T 49(35.8) 47(42.7) 1.04(0.70-1.56) 0.89(0.46-1.70) T/T 28(20.4) 19(17.3) 1.47(0.82-2.63) 0.92(0.40-2.12) T carriers 77(56.2) 66(60.0) 1.17(0.84-1.62) 1.13(0.62-2.06)
Odds ratios were adjusted for age, gender, education, smoking,alcohol drinking areca chewing and exercise
Table 5-11 Distribution of anthropometric and biochemical variables in metabolic syndrome by ACDC11377 genotype
Abbreviation :HDL: High density lipoprotein , CRP:C reactive protein
146.7±21.2 150.5±18.9 149.9±14.1 0.5528 Diastolic blood
pressure(mmHg)
87.0±10.9 87.8±12.7 88.5±10.4 0.8930 Waist(cm) 90.9±8.3 91.1±8.7 88.6±11.7 0.7088 Triglycerides(mg/dl) 199.4±99.1 186.9±100.0 199.1±74.2 0.7717 HDL
cholesterol(mg/dl)
37.0±7.4 37.3±8.9 38.1±4.2 0.9156 Cholesterol(mg/dl) 203.8±39.9 211.2±31.3 203.0±27.8 0.5077 Fasting blood
glucose(mg/dl)
122.6±43.3 129.3±50.0 121.8±24.1 0.6995 Uric acid(mg/dl) 6.5±1.5 6.2±1.8 5.5±1.3 0.1597 Insulin(uU/ml) 12.3±9.3 15.6±8.8 12.3±8.9 0.2417 CRP(mg/dl) 0.28±0.43 0.32±0.54 0.62±1.0 0.3541 Adiponectin(ug/ml) 7.3±4.6 6.2±4.6 6.4±3.6 0.4360
Table 5-12 Distribution of anthropometric and biochemical variables in non-metabolic syndrome by ACDC11377 genotype
ACDC_11377 Genotypes
117.0±7.1 116.7±8.4 116.5±6.1 0.9710 Diastolic blood
pressure(mmHg)
69.7±6.9 70.1±7.2 68.8±6.0 0.9012 Waist(cm) 74.7±6.7 74.7±7.4 73.5±5.8 0.9184 Triglycerides(mg/dl) 66.9±27.5 69.8±23.3 82.8±34.2 0.3585 HDL cholesterol
(mg/dl)
56.5±13.1 56.2±11.8 65.5±22.9 0.2639 Cholesterol(mg/dl) 204.2±33.6 209.8±41.0 224.3±17.1 0.3675 Fasting blood
glucose(mg/dl)
91.1±7.4 92.1±6.1 97.3±7.0 0.1119 Uric acid(mg/dl) 5.3±1.4 5.3±1.4 5.1±1.1 0.9037 Insulin(uU/ml) 5.8±4.0 6.3±3.4 9.8±5.9 0.2291 CRP(mg/dl) 0.16±0.16 0.18±0.18 0.15±0.06 0.9119 Adiponectin(ug/ml) 12.0±6.0 11.1±5.3 14.0±9.6 0.5057 Abbreviation HDL: High density lipoprotein , CRP:C reactive protein
Table 5-13 Distribution of anthropometric and biochemical variables in metabolic syndrome by ACDC11377 genotype
Abbreviation HDL: High density lipoprotein , CRP:C reactive protein
146.7±21.2 150.4±18.1 0.2770 Diastolic blood
pressure(mmHg)
87.0±10.9 87.9±12.2 0.6607 Waist(cm) 90.9±8.3 90.7±9.2 0.8825 Triglycerides(mg/dl) 199.4±99.1 188.9±95.7 0.5324 HDL cholesterol
(mg/dl)
37.0±7.4 37.4±8.2 0.7596 Cholesterol(mg/dl) 203.8±39.9 209.8±30.7 0.3182 Fasting blood
glucose(mg/dl)
122.6±43.3 128.0±46.6 0.4854 Uric acid(mg/dl) 6.5±1.5 6.1±1.7 0.1570 Insulin(uU/ml) 12.3±9.3 15.2±8.8 0.1317 CRP(mg/dl) 0.28±0.43 0.36±0.61 0.4915 Adiponectin(ug/ml) 7.3±4.6 6.2±4.4 0.1978
Table 5-14 Distribution of anthropometric and biochemical variables in non-metabolic syndrome by ACDC11377 genotype
Abbreviation HDL: High density lipoprotein , CRP:C reactive protein Triglycerides(mg/dl) 66.9±27.5 71.5±24.9 0.3748 HDL cholesterol(mg/dl) 56.5±13.1 57.4±13.7 0.7216 Cholesterol(mg/dl) 204.2±33.6 211.7±38.9 0.2825 Fasting blood
glucose(mg/dl)
91.1±7.4 92.8±6.4 0.2271 Uric acid(mg/dl) 5.3±1.4 5.3±1.4 0.7303 Insulin(uU/ml) 5.8±4.0 6.6±3.7 0.3781 CRP(mg/dl) 0.16±0.16 0.17±0.17 0.7159 Adiponectin(ug/ml) 12.0±6.0 11.5±6.0 0.6504
Table 5-15 Distribution of anthropometric and biochemical variables in metabolic syndrome by ACDC276 genotype
Abbreviation HDL: High density lipoprotein, CRP: C reactive protein
148.3±18.3 144.8±21.4 154.5±19.8 0.1213 Diastolic blood
pressure(mmHg)
86.5±9.9 86.2±11.0 91.5±14.4 0.1070 Waist(cm) 91.1±8.6 90.0±9.5 91.4±7.6 0.7385 Triglycerides(mg/dl) 185.2±66.8 191.5±90.7 221.3±150.1 0.2609 HDL cholesterol
(mg/dl)
36.5±6.6 38.1±6.2 37.3±11.8 0.5744 Cholesterol(mg/dl) 206.8±38.5 208.0±36.4 203.0±30.9 0.8409 Fasting blood
glucose(mg/dl)
131.8±45.4 116.6±33.8 125.2±57.3 0.2103 Uric acid(mg/dl) 6.3±1.6 6.2±1.6 6.3±1.8 0.9274 Insulin(uU/ml) 13.0±8.9 15.2±9.5 10.8±8.5 0.2355 CRP(mg/dl) 0.23±0.18 0.41±0.71 0.33±0.56 0.2556 Adiponectin(ug/ml) 6.5±4.6 7.4±3.7 6.4±5.8 0.5810
Table 5-16 Distribution of anthropometric and biochemical variables in non-metabolic syndrome by ACDC276 genotype
ACDC_276 Genotypes Triglycerides(mg/dl) 65.4±20.0 70.9±32.2 71.8±23.7 0.5325 HDL cholesterol
(mg/dl)
57.0±12.4 58.4±15.0 53.0±10.4 0.3378 Cholesterol(mg/dl) 208.2±29.1 208.9±40.8 201.3±38.8 0.7278 Fasting blood
glucose(mg/dl)
93.3±6.6 91.5±6.8 89.0±8.1a 0.0735
Uric acid(mg/dl) 5.5±1.5 5.2±1.3 5.1±1.2 0.4737 Insulin(uU/ml) 7.2±4.0 5.3±3.8 5.1±2.8 0.0703 CRP(mg/dl) 0.15±0.09 0.19±0.23 0.14±0.08 0.4378 Adiponectin(ug/ml) 11.6±4.9 12.6±7.0 10.5±5.3 0.4296 Abbreviation HDL: High density lipoprotein , CRP:C reactive protein
a compaired with GG genotype by Scheffe＇s test ,p<0.05
b compaired with GT genotype by Scheffe＇s test ,p<0.05
Table 5-17 Distribution of anthropometric and biochemical variables in metabolic syndrome by ACDC276 genotype
Abbreviation HDL: High density lipoprotein , CRP:C reactive protein
148.3±18.3 148.3±21.2 0.9920 Diastolic blood
pressure(mmHg)
86.5±9.9 88.1±12.5 0.4133 Waist(cm) 91.1±8.6 90.5±8.8 0.6800 Triglycerides(mg/dl) 185.2±66.8 202.3±115.8 0.2805 HDL
cholesterol(mg/dl)
36.5±6.6 37.8±8.6 0.3168 Cholesterol(mg/dl) 206.8±38.5 206.1±34.4 0.9184 Fasting blood
glucose(mg/dl)
131.8±45.4 119.7±43.7 0.1173 Uric acid(mg/dl) 6.3±1.6 6.2±1.7 0.7194 Insulin(uU/ml) 13.0±8.9 13.9±9.4 0.6351 CRP(mg/dl) 0.23±0.18 0.39±0.66 0.1186 Adiponectin(ug/ml) 6.5±4.6 7.0±4.6 0.5389
Table 5-18 Distribution of anthropometric and biochemical variables in non-metabolic syndrome by ACDC276 genotype
Abbreviation HDL: High density lipoprotein , CRP:C reactive protein Triglycerides(mg/dl) 65.4±20.0 71.1±29.9 0.2277 HDL
cholesterol(mg/dl)
57.0±12.4 56.8±14.0 0.9329 Cholesterol(mg/dl) 208.2±29.1 206.7±40.1 0.8172 Fasting blood
glucose(mg/dl)
93.3±6.6 90.8±7.2 0.0609 Uric acid(mg/dl) 5.5±1.5 5.2±1.3 0.2644 Insulin(uU/ml) 7.2±4.0 5.2±3.6 0.0210 CRP(mg/dl) 0.15±0.09 0.18±0.21 0.4043 Adiponectin(ug/ml) 11.6±4.9 12.0±6.6 0.7179
Table 5-19 The joint effect of ACDC-11377 and ACDC276 genotype on metabolic syndrome
Genotype Cases(%)
N=137
Controls(%) N=110
Crude OR (95%CI) Adjusted OR (95%CI)
ACDC-11377 ACDC276
C/C G/G 29(21.2) 26(36.6) 1 1
C/C T/G or T/T 48(35.1) 38(34.5) 1.26(0.83-1.93) 1.15(0.57-2.33) C/G or G/G T/G or T/T 29(21.1) 28(25.5) 1.72(0.96-3.08) 1.73(0.76-3.93) C/G or G/G G/G 31(22.6) 18(16.4) 1.03(0.62-1.74) 1.08(0.50-2.32) Odds ratios were adjusted for age, gender, education, smoking,alcohol drinking, areca chewing and exercise
Table 5-20 Adiponectin level between life-style factors
Substance use Classifications Cases N=137 Controls N=110 Cigarette smoking
Never-smoker 7.1±4.8 12.3±5.9 Current-smoker 6.0±4.3 10.7±6.5 Former-smoker 6.5±3.8 8.1±3.4 Alcohol drinking
Never-drinker 6.8±4.5 11.9±5.7 Current-drinker 6.6±4.9 11.8±6.8 Former-drinker 7.4±4.1 8.9±2.4 Areca chewing
Never-chewer 7.2±4.7 12.2±6.0 Current-chewer 4.4±3.0* 8.0±5.2 Former-chewer 4.5±3.1* 8.9±2.5 Exercise
No 6.9±4.0 9.9±4.9
Yes 6.8±5.0 12.8±6.2
* compared with never-chewer use multiple comparison and adjusted for metabolic syndrome, p<0.05
Table 6-1 Allele frequencies of ACDC-11377 genotypes among different racial groups.
Populations No. C/C(%) C/G(%) G/G(%) C alleles(%) Reference Germany 550 increased risk
of T2DM
562. 36.7 7.1 74.5 Schwarz et al 2006
106 T2DM 56.3 33.0 10.7 74.5
Sweden
497 nonT2DM 50.8 38.2 11.0 69.9
Gu et al 2004
1373 T2DM 48.4 44.2 7.4 70.5
France
743 non T2DM 55.3 38.2 6.5 74.4
Vasseur et al 2002
384 T2DM 60.7 33.1 6.2 77.3
Japan
480 non T2DM 55.2 37.1 7.7 73.8
Hava et al 2002
France 5200 general populations
55.2 37.4 7.4 73.9 Fumeron et al 2004
Abbreviation; T2DM type 2 diabetes mellitus
Table 6-2 Allele frequencies of ACDC276 genotypes among different racial groups. American 879T2DM 239CVD
640 nonCVD 46.0 48.7 5.3 70.4 Qi et al 2005 Multiple 1429 high risk of IGT(STOP
NIDDM) 49.2 41.8 9.0 70.1 Zacharova et al 2005
310 T2DM 51.0 40.0 9.0 71.0
America
304 non T2DM 52.6 38.5 8.9 71.9 Menzaghi et al 2002 Abbreviation T2DM:type 2 diabetes mellitus CAD: coronary artery disease IGT: impairment glucose tolerance CVD: cerebral vascular disease
Figure 4-1 Study design
4280 名民眾參加本研究之社區篩檢，後 來共計有 2359 位參與本研究
二階段隨機取樣
二階段隨機取樣