Beruflich Dokumente
Kultur Dokumente
O R I G I N A L
A R T I C L E
, MD, PHD1
DONNA KRITZ-SILVERSTEIN, PHD1
From the 1Department of Family and Preventive Medicine, University of California, San Diego, La Jolla,
California; and the 2Graduate School of Public Health, San Diego State University, San Diego, California.
Address correspondence and reprint requests to Elizabeth Barrett-Connor, MD, Department of Family
and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr., 0607, La Jolla, CA 920930607. E-mail: ebarrettconnor@ucsd.edu.
Received for publication 29 November 2006 and accepted in revised form 19 February 2007.
Published ahead of print at http://care.diabetesjournals.org on 10 March 2007. DOI: 10.2337/dc06-2438.
Abbreviations: 25(OH)D, 25-hydroxyvitamin-D; CBP, competitive binding protein; HOMA-IR, homeostasis model assessment of insulin resistance; PTH, parathyroid hormone.
A table elsewhere in this issue shows conventional and Syste`me International (SI) units and conversion
factors for many substances.
2007 by the American Diabetes Association.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby
marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Men
Women
n
Clinical
Age (years)*
BMI (kg/m2)
Waist (cm)
SBP (mmHg)
DBP (mmHg)
Diabetes (%)
Biochemical measures
Triglycerides (mmol/l)
Glucose (mmol/l)
HDL (mmol/l)
ATP IIIdefined MetSyn (%)
MetSyn criteria (%)
Abdominal obesity
High blood pressure
High triglycerides
Hyperglycemia
Low HDL
Number of MetSyn criteria (%)
0
1
2
3
4
5
Serum 25(OH)D (nmol/l)
PTH (ng/l)
410
660
74.5 9.5
26.5 0.2
95.0 0.5
135.4 1.0
75.2 0.5
13.2
1.4 0.04
5.9 0.02
1.3 0.05
23.5
20.3
72.5
23.2
30.8
20.9
13.5
40.0
22.9
14.3
7.0
2.2
108.9 0.3
51.3 1.2
74.6 10.7
24.9 0.2
79.9 0.4
136.7 0.8
72.9 0.4
7.1
0.1
0.0001
0.0001
0.3
0.0001
0.001
1.4 0.03
5.4 0.02
1.7 0.04
18.0
0.7
0.0001
0.0001
0.03
22.0
68.2
26.9
12.0
17.2
19.3
41.3
21.3
11.2
5.3
1.5
101.6 0.2
50.1 1.0
0.5
0.1
0.2
0.0001
0.1
0.004
0.002
0.3
Data are means SE or percentages unless otherwise indicated. *Unadjusted means SD. To convert to
conventional units (mg/dl), multiply triglycerides by 89, glucose by 39, and HDL by 18. Criteria as defined
by the NCEP/ATP III (41). Untransformed means SE; P based on log-transformed data. DBP, diastolic
blood pressure; MetSyn, metabolic syndrome; SBP, systolic blood pressure.
cantly higher among men with the metabolic syndrome compared with men
without the metabolic syndrome (P
0.004) but were similar by metabolic syndrome status in women (P 0.9). Neither
diastolic blood pressure nor mean
25(OH)D concentrations varied by presence of metabolic syndrome in either sex.
The sex-specific associations of
25(OH)D and PTH with the metabolic
syndrome and its components are displayed in Table 3. In men, a significant
positive trend (P 0.03) in the adjusted
odds of metabolic syndrome across increasing quintiles of PTH was found; this
association was largely explained by odds
ratio (OR) 2.02 (95% CI 0.96 4.24)
among men in the top quintile of PTH
(63 ng/l). A modest J- or U-shaped association was found (P value for quadratic
PTH 0.08). Results were not materially
changed after including 25(OH)D levels
as a covariate in the multivariate model
(OR 1.90 [95% CI 0.90 4.02], comparing the highest PTH quintile with the low-
n
Age (years)
MetSyn components
Waist circumference (cm)
SBP (mmHg)
DBP (mmHg)
Triglycerides (mmol/l)
Fasting glucose (mmol/l)
HDL (mmol/l)
Health-related behaviors (%)
Vitamin D supplement use
Calcium supplement use
Thyroid hormone use
Current hormone therapy
Current smoker
Alcohol use (3 times per week)
Exercise (3 times per week)
Serum 25(OH)D (nmol/l)
PTH (ng/l)
MetSyn
present
MetSyn
absent
97
72.9 8.9
Women
P
MetSyn
present
MetSyn
absent
313
75.0 9.7
0.07
120
75.8 9.7
540
74.3 11.0
103.6 0.9
140.5 2.0
75.0 0.9
2.3 0.1
6.9 0.1
1.1 0.03
92.2 0.5
133.7 1.1
75.2 0.5
1.1 0.1
5.6 0.05
1.4 0.02
0.0001
0.003
0.8
0.0001
0.0001
0.0001
92.0 0.9
141.4 1.8
73.5 0.9
2.1 0.1
6.4 0.1
1.3 0.04
77.2 0.4
135.7 0.9
72.7 0.4
1.3 0.03
5.3 0.04
1.8 0.02
0.0001
0.005
0.5
0.0001
0.0001
0.0001
10.2
14.9
6.7
2.5
57.8
68.6
104.0 3.4
57.3 2.7
9.3
23.8
8.9
4.8
57.7
80.4
110.4 1.9
49.4 1.5
0.7
0.08
0.4
0.4
0.9
0.01
0.1
0.004
26.8
55.6
22.8
36.9
3.4
28.4
51.7
97.9 3.2
51.2 2.2
28.9
58.3
20.7
50.6
5.0
45.0
73.1
102.5 1.5
49.8 1.1
0.7
0.6
0.8
0.005
0.5
0.001
0.0001
0.2
0.9
P
0.2
Data are means SE or percentages unless otherwise indicated. *Criteria as defined by the NCEP/ATP III (41), see text for full description. Unadjusted means
SD. To convert to conventional units (mg/dl), multiply triglycerides by 89, fasting glucose by 39, and HDL by 18. Untransformed means SE; P based on
log-transformed data. DBP, diastolic blood pressure; MetSyn, metabolic syndrome; SBP, systolic blood pressure.
OR
(95% CI)
29.8
17.3
22.3
18.0
17.9
0.04
Prevalence
1.0 (ref.)
0.84 (0.441.61)
0.82 (0.451.50)
0.82 (0.431.56)
0.51 (0.261.02)
0.09
1.0 (ref.)
0.51 (0.221.20)
0.82 (0.381.79)
0.61 (0.281.32)
0.47 (0.201.13)
0.2
OR
(95% CI)
63.8
73.6
70.2
75.9
80.1
0.4
74.7
65.2
66.3
66.5
71.5
0.8
75.8
72.4
73.1
69.7
72.2
0.6
Prevalence
1.0 (ref.)
1.25 (0.702.22)
1.51 (0.842.72)
1.50 (0.812.78)
1.27 (0.702.31)
0.3
1.0 (ref.)
2.15 (1.034.47)
1.43 (0.702.92)
1.80 (0.873.74)
2.41 (1.105.26)
0.08
1.0 (ref.)
0.77 (0.401.46)
0.80 (0.441.47)
0.81 (0.431.53)
1.01 (0.531.93)
0.8
1.0 (ref.)
0.92 (0.412.07)
0.90 (0.411.96)
0.88 (0.421.84)
1.28 (0.582.81)
0.6
OR
(95% CI)
32.4
24.1
26.0
26.8
28.4
0.9
26.6
16.9
22.6
20.8
30.9
0.2
27.1
21.1
22.5
33.5
29.6
0.2
32.0
19.3
23.4
23.2
21.9
0.1
Prevalence
1.0 (ref.)
0.62 (0.341.11)
0.79 (0.441.41)
0.70 (0.381.27)
0.86 (0.481.54)
0.8
1.0 (ref.)
0.53 (0.231.23)
0.89 (0.401.97)
0.73 (0.331.63)
0.96 (0.442.12)
0.8
1.0 (ref.)
0.85 (0.441.62)
0.93 (0.511.69)
1.68 (0.923.08)
1.68 (0.913.10)
0.01
1.0 (ref.)
0.52 (0.221.19)
0.69 (0.321.50)
0.78 (0.371.63)
0.62 (0.281.41)
0.5
OR
(95% CI)
10.3
13.2
7.9
11.9
17.6
0.3
22.3
23.5
24.9
33.4
46.4
0.001
18.8
9.1
12.1
13.2
8.2
0.1
42.9
37.5
25.7
28.1
24.7
0.004
Prevalence
1.0 (ref.)
1.12 (0.502.51)
0.60 (0.241.50)
0.77 (0.331.81)
1.31 (0.592.92)
0.7
1.0 (ref.)
0.94 (0.422.10)
0.76 (0.341.70)
1.41 (0.663.03)
2.16 (1.014.59)
0.02
1.0 (ref.)
0.60 (0.261.39)
0.84 (0.401.76)
0.94 (0.442.04)
0.62 (0.261.46)
0.6
1.0 (ref.)
0.93 (0.451.93)
0.46 (0.220.96)
0.53 (0.261.08)
0.43 (0.200.95)
0.001
OR
(95% CI)
16.0
21.0
14.5
18.6
16.4
0.9
17.0
19.1
17.0
18.7
33.6
0.02
24.0
18.5
17.8
14.1
11.0
0.02
23.2
21.7
21.7
19.5
23.0
0.6
Prevalence
1.0 (ref.)
1.52 (0.743.14)
0.84 (0.391.84)
0.82 (0.381.75)
0.69 (0.311.50)
0.1
1.0 (ref.)
1.37 (0.563.35)
1.03 (0.422.56)
1.23 (0.512.98)
2.33 (1.025.35)
0.07
1.0 (ref.)
1.30 (0.642.65)
1.15 (0.582.26)
0.78 (0.371.63)
0.77 (0.351.69)
0.3
1.0 (ref.)
1.03 (0.442.42)
1.39 (0.613.18)
1.11 (0.492.52)
1.51 (0.633.62)
0.4
OR
(95% CI)
Low HDL
Prevalence
1.0 (ref.)
0.83 (0.391.73)
0.68 (0.321.43)
0.65 (0.321.34)
0.57 (0.261.25)
0.1
32.9
22.2
21.7
22.5
15.0
0.01
1.0 (ref.)
0.74 (0.311.78)
1.17 (0.512.70)
0.76 (0.331.78)
0.65 (0.281.53)
0.4
61.4
67.7
70.0
72.0
68.1
0.3
Hyperglycemia
29.6
26.7
22.7
21.4
21.8
0.08
1.0 (ref.)
0.96 (0.481.90)
0.96 (0.511.79)
1.33 (0.692.57)
0.88 (0.431.80)
0.9
19.5
17.3
22.6
18.7
21.8
0.6
1.0 (ref.)
1.31 (0.652.63)
1.22 (0.602.51)
2.53 (1.285.00)
1.70 (0.853.40)
0.03
High triglycerides
24.4
15.5
17.2
20.9
12.6
0.1
1.0 (ref.)
0.62 (0.271.44)
0.93 (0.422.05)
0.88 (0.401.94)
2.02 (0.964.24)
0.03
16.0
20.7
18.7
30.6
26.0
0.02
19.7
16.6
23.0
21.9
36.0
0.009
1.0 (ref.)
1.38 (0.702.71)
0.85 (0.411.75)
1.02 (0.512.06)
1.13 (0.572.26)
0.9
Abdominal obesity
16.6
19.9
15.7
18.5
21.2
0.6
Metabolic syndrome*
Table 3Age-adjusted prevalence, adjusted ORs, and 95% CIs of metabolic syndrome and its components by quintiles of 25(OH)D and PTH among men and women: Rancho Bernardo, CA,
19971999
Quintiles
25 (OH)D (nmol/l)
Men
I (087.5)
II (8.7597.4)
III (97.5110.0)
IV (110.1126.2)
V (126.3)
Ptrend
Women
I (77.5)
II (77.592.4)
III (92.5103.7)
IV (103.8119.9)
V (120.0)
Ptrend
PTH (ng/l)
Men
I (35.0)
II (35.042.9)
III (43.049.9)
IV (50.062.9)
V (63.0)
Ptrend
Women
I (33.0)
II (33.040.9)
III (41.048.9)
IV (49.963.9)
V (64.0)
Ptrend
*Criteria as defined by the NCEP/ATP III (41). Adjusted for age (years). Adjusted for age (years), current smoking, alcohol use (3 times per week), exercise (3 times per week), season of study participation,
and, in women, hormone therapy. Adjusted for variables listed above in addition to other components of metabolic syndrome.
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