Severity of ultrasonographic liver steatosis and metabolic syndrome in Korean men and women

AIM: To evaluate the association between the severity of liver steatosis and metabolic syndrome in apparently healthy Korean adults. METHODS: We examined 1 022 men and women, aged 30-79 years, who participated in a health screening test. A standard interview, anthropometrics, biochemical studies, and abdominal ultrasonography were conducted for each participant. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III, with a modification for the waist circumference cut-off level. The severity of liver steatosis was evaluated using liver ultrasonography, and serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (gamma-GT) levels were determined. RESULTS: Ultrasonographic liver steatosis was strongly associated with metabolic syndrome and common metabolic abnormalities. Compared with people without steatosis, people with mild, moderate, and severe steatosis had adjusted odds ratios for metabolic syndrome of 1.72 (95%CI, 1.01-2.94), 2.89 (1.75-4.76) and 3.53 (1.25-9.98) in men, and 2.86 (1.64-5.01), 3.19 (1.80-5.65) and 3.70 (0.82-16.73) in women, respectively. The serum AST level was not associated with metabolic syndrome. The serum ALT and gamma-GT levels were significantly associated with metabolic syndrome in men but not in women. CONCLUSION: The occurrence of metabolic syndrome shows a stronger association with the severity of ultrasonographic steatosis than with the serum liver enzyme levels. The degree of fatty infiltration detected on ultrasonography can be used as an indicator of liver dysfunction attributable to metabolic abnormalities.ope

Visceral fat thickness measured by ultrasonography can estimate not only visceral obesity but also risks of cardiovascular and metabolic diseases

BACKGROUND: Visceral obesity is closely associated with cardiovascular disease and the metabolic syndrome. Estimating the amount of visceral fat is important and requires a straightforward, reliable, and practical method. OBJECTIVE: We investigated whether visceral fat thickness (VFT) measured by ultrasonography can adequately assess visceral fat accumulation and predict cardiovascular or metabolic diseases. DESIGN: Diabetic patients (240 men and 106 women) underwent ultrasonography to estimate visceral fat accumulation. RESULTS: The visceral adipose tissue area had the best correlation with VFT (r = 0.799, P < 0.001). VFT correlated with HDL-cholesterol, triacylglycerol, and high-sensitivity C-reactive protein concentrations, the homeostasis model assessment for insulin resistance, and the intima-media thickness at the common carotid artery (r = -0.30, 0.39, 0.34, 0.31, and 0.33, respectively; P < 0.05) in men and with triacylglycerol and high-sensitivity C-reactive protein concentrations and the homeostasis model assessment for insulin resistance (r = 0.33, 0.44, and 0.30, respectively; P < 0.05) in women. Men in the middle and high VFT tertiles had a higher odds ratio (OR) of coronary artery disease [ORs: 4.48 (95% CI: 1.29, 5.51) and 2.04 (1.06, 3.94), respectively; P = 0.016], hypertriacylglycerolemia [ORs: 2.87 (1.41, 5.86) and 1.91 (1.24, 2.95), respectively; P = 0.003], and the metabolic syndrome [ORs: 3.38 (1.61, 7.10) and 1.95 (1.16, 3.27), respectively; P = 0.003] than did those in the low tertile, after adjustment for age, waist circumference, and body mass index. CONCLUSION: VFT might be a reliable index for assessing the amount of visceral fat and for identifying diabetic patients, particularly men, who are at high risk of cardiovascular disease.ope

The Degree of Atherosclerosis and the Metabolic Characteristics according to the Abdominal Obesity in Type 2 Diabetic Patients

Background: Many of the maturity-onset type 2 diabetic patients with hypertension and dyslipidemia in Korea are not associated with obesity. However, these patients are at risk for developing macrovascular complications such as atherosclerosis due to hyperinsulinemia, insulin resistance and abdominal obesity. The aims of this study were to compare the clinical and biochemical differences between the type 2 diabetic patients that are with and without abdominal obesity, and we also wished to investigate the degree of insulin resistance and atherosclerosis in these patients. Methods: Among 530 type 2 diabetes mellitus (DM) patients, the percentages of under-weight (UW), normal-weight (NW), over-weight (OW) and obese (OB) (BMI or =30, respectively) subjects were 8.9%, 62.1%, 25.1% and 3.9%, respectively. To evaluate the severity of their atherosclerosis, the coronary artery calcification (CAC) score was measured by electron beam computed tomography, and the intima-media thickness (IMT) of the common carotid artery and the ankle-brachial pressure index (ABPI) were also measured. The Insulin sensitivity index (ISI) was measured by the plasma glucose disappearance rate (kitt: %/min). Results: 1. There were no differences in age, duration of DM and the HbA1c levels according to BMI for both the men and women, but the waist-hip ratio (WHR) and systolic blood pressure (SBP) were significantly different among each group. Serum triglyceride (TG), HDL-cholesterol (HDL-C), free fatty acid (FFA), fibrinogen, and fasting c-peptide levels, {excluding total cholesterol (TC)}, were also significantly different. The ISI, which is a marker for insulin resistance, as well correlated with the patients’ BMI. Subjects having an with ISI above 2.5%/min were considered as having insulin resistance, and 28%, 60%, 68% and 75% of patients in the UW, NW, OW and OB groups, respectively, demonstrated insulin resistance. The visceral fat area/subcutaneous fat area ratio and visceral fat area/thigh muscle area ratio also increased with BMI. 2. The median values of the WHR were 0.95 for the men and 0.91 for the women. There were no significant differences for age, BMI, duration of DM and HbA1c between patients with and without abdominal obesity, but the SBP, TG, HDL-C, FFA, fibrinogen and ISI were significantly different between those two groups. 3. For the OW group as well as the NW group, the carotid IMT, ABPI and CAC scores were significantly different between the patients with and without abdominal obesity. However, there were no differences between the NW group and the OW group. Conclusion: In conclusion, those patients with abdominal obesity, regardless of their BMIs, have a higher prevalence for atherosclerosis, dyslipidemia, and hypertension, compared to those patients without abdominal obesity. Therefore, it is important to screen for atherosclerosis and to manage it accordingly, for the patients with insulin resistance or abdominal obesity in order to decrease their risk of developing atherosclerotic events.ope

(The) dynamic aspect of sodium metabolism in both healthy koreans and patients with essential hypertension

의학과/박사[한글] The Dynamic Aspect of Sodium Metabolism in Both Healthy Koreans and Patients with Essential Hypertension Kap Bum Huh, M.D. Department of Medical Science The Graduate School, Yonsei University (Directed by Prof. Eung Suk Chai) Systemic studies on the sodium metabolism and various renal functions of healthy Koreans were conducted by Hong et al. (1967), Lee et al. (1952) and Kim et al. (1965) One of the outstanding characteristics is that they live on a low protein and high salt diet. Although contributing factors to hypertension have not been clearly elucidated, dietary salt intake has been considered one of the most possible factors (Ambard and Beaujard, 1904; Dahl and Love, 1957). In addition. an alteration in water and salt metabolism in essential hypertension is generally well known (Baldwin et al., 1559; Cottier et al., 1958; Green et 3l., 1954). Since Goldblatt et al. (1934) observed an important role of the ischemic kidney in renal hypertension, extensive efforts have been focused in isolating the pressor substance and now it is well known as angiotensin(Page and Helmer, 1939; Skeggs et al., 1956). Currently, the retrain-angiotensin system has been the subject of a study for its physiological role in renal functions and sodium metabolism because it can cause a change in the renal hemodynamics as a result of constricting vascular smooth muscle (Gross and Bock. 1962; Helmer, 1964) and effects the sodium transport in the renal tubule directly (Laragh et al., 1953) and indirectly through a regulatory mechanism of aldosterone secretion (Davis et al., 1961; Genest, 1961). In view of sodium regulatory factors in man mentioned above and high sodium intake in the Koreans, it is worthwhile to study the dynamic aspect of sodium metabolism by measuring the turnover rate and the amount of exchangeable sodium along with the secretory activity of hormones such as aldosterone and lenin-angiotensin. Furthermore it is expected to get some insight into the pathogenesis of essential hypertension by comparing the results obtained from patients with essential hypertension to those of healthy Koreans. Materials and methods Normal volunteers (medical students) and patients with uncomplicated essential hypertension, 10 subjects from each group, were selected for this studs. An ordinary Korean diet (high salt diet) was supplied and medications, if any, were discontinued at least one week prior to this study. Salt intake was then reduced to less than 5 gm. per day for a period of 5 days. Plasma lenin activity (PRA) and the amount of urinary aldosterone excreted in 24 hours were measured on the 3rd day of high sodium intake and on the 5th day of the low sodium regimen. By repeating all of the above schedules, the total exchangeable body sodium store and it's turnover rate were determined in the corresponding periods of plasma lenin activity and urinary aldosterene measurements. PRA was measured by radioimmunoassay method of Haber et .al. (1969), and urinary aldosterone excretion was determined by double isotope derivative assay method of Kliman and Peterson(1960). Total exchangeable body sodium store and the turnover rate were measured with (22)**Na by the method of Adesman et al. (1960). Results and conclusions 1) The mean blood pressures of both control and hypertensive groups were significantly decreased after 5 days of low salt diet compared to those checked haying a normal diet. 2) PRA for the control group was significantly elevated after sodium restriction compared to that found having a high salt diet. On the contrary, PRA for the hypertensive patients was not significantly increased with sodium restriction. Regardless of high or low sodium intake, PRA measured in the control group was significantly higher than that found in the hypertensive group. 3) OR the high salt diet, Urinary aldosterone excreted in 24 hours was not Significantly different between the healthy and the hypertensive groups. However, the amount of daisy urinary aldosterone excretion in both groups was significantly increased after the administration of a low salt diet. This increase of urinary aldosterone excretion was particularly remarkable in the hypertensive group. 4) Plasma sodium concentrations measured in both groups were not significantly changed regardless of high or low sodium intake. 5) The amount of daily urinary sodium excretion in the hypertensive patients was significantly higher than that measured in the control group on a liberal Korean diet. On the other hand, there was no significant difference in the daily urinary sodium excretion between the two groups on sodium restriction. 6) PRA measured in the control group was inversely correlated with the daily urinary sodium excretion, but the patient group showed persistently low PRA regardless of high or low urinary sodium excretion. On the other hand, daily urinary aldosterone excretions in both control and patient groups were inversely correlated with urinary sodium excreted in 24 hours. 7) The total exchangeable body sodium stoles were net significantly different between the control and the hypertensive patient groups regardless of high or low sodium intake. On the contrary, the disappearance rate of plasma (22)**Na in hypertensive patients during low sodium diet revealed somewhat an accelerated tendency in comparison with that found in normal subjects. In view of the above experimental findings, the regulatory mechanism of aldosterone secretion in the patients with essential hypertension may be different from that of the control group. That is, the retrain-angiotensin system in the hypertensive patients may play a minor role in the regulation of aldosterone secretion compared to normal subjects. Furthermore it is speculated that the sensitivity of renal tubules to aldosterone in patients with essential hypertension is reduced compared to that of normal Korean healthy subjects. [영문] Systemic studies on the sodium metabolism and various renal functions of healthy Koreans were conducted by Hong et al. (1967), Lee et al. (1952) and Kim et al. (1965) One of the outstanding characteristics is that they live on a low protein and high salt diet. Although contributing factors to hypertension have not been clearly elucidated, dietary salt intake has been considered one of the most possible factors (Ambard and Beaujard, 1904; Dahl and Love, 1957). In addition. an alteration in water and salt metabolism in essential hypertension is generally well known (Baldwin et al., 1559; Cottier et al., 1958; Green et 3l., 1954). Since Goldblatt et al. (1934) observed an important role of the ischemic kidney in renal hypertension, extensive efforts have been focused in isolating the pressor substance and now it is well known as angiotensin(Page and Helmer, 1939; Skeggs et al., 1956). Currently, the retrain-angiotensin system has been the subject of a study for its physiological role in renal functions and sodium metabolism because it can cause a change in the renal hemodynamics as a result of constricting vascular smooth muscle (Gross and Bock. 1962; Helmer, 1964) and effects the sodium transport in the renal tubule directly (Laragh et al., 1953) and indirectly through a regulatory mechanism of aldosterone secretion (Davis et al., 1961; Genest, 1961). In view of sodium regulatory factors in man mentioned above and high sodium intake in the Koreans, it is worthwhile to study the dynamic aspect of sodium metabolism by measuring the turnover rate and the amount of exchangeable sodium along with the secretory activity of hormones such as aldosterone and lenin-angiotensin. Furthermore it is expected to get some insight into the pathogenesis of essential hypertension by comparing the results obtained from patients with essential hypertension to those of healthy Koreans. Materials and methods Normal volunteers (medical students) and patients with uncomplicated essential hypertension, 10 subjects from each group, were selected for this studs. An ordinary Korean diet (high salt diet) was supplied and medications, if any, were discontinued at least one week prior to this study. Salt intake was then reduced to less than 5 gm. per day for a period of 5 days. Plasma lenin activity (PRA) and the amount of urinary aldosterone excreted in 24 hours were measured on the 3rd day of high sodium intake and on the 5th day of the low sodium regimen. By repeating all of the above schedules, the total exchangeable body sodium store and it's turnover rate were determined in the corresponding periods of plasma lenin activity and urinary aldosterene measurements. PRA was measured by radioimmunoassay method of Haber et .al. (1969), and urinary aldosterone excretion was determined by double isotope derivative assay method of Kliman and Peterson(1960). Total exchangeable body sodium store and the turnover rate were measured with (22)**Na by the method of Adesman et al. (1960). Results and conclusions 1) The mean blood pressures of both control and hypertensive groups were significantly decreased after 5 days of low salt diet compared to those checked haying a normal diet. 2) PRA for the control group was significantly elevated after sodium restriction compared to that found having a high salt diet. On the contrary, PRA for the hypertensive patients was not significantly increased with sodium restriction. Regardless of high or low sodium intake, PRA measured in the control group was significantly higher than that found in the hypertensive group. 3) OR the high salt diet, Urinary aldosterone excreted in 24 hours was not Significantly different between the healthy and the hypertensive groups. However, the amount of daisy urinary aldosterone excretion in both groups was significantly increased after the administration of a low salt diet. This increase of urinary aldosterone excretion was particularly remarkable in the hypertensive group. 4) Plasma sodium concentrations measured in both groups were not significantly changed regardless of high or low sodium intake. 5) The amount of daily urinary sodium excretion in the hypertensive patients was significantly higher than that measured in the control group on a liberal Korean diet. On the other hand, there was no significant difference in the daily urinary sodium excretion between the two groups on sodium restriction. 6) PRA measured in the control group was inversely correlated with the daily urinary sodium excretion, but the patient group showed persistently low PRA regardless of high or low urinary sodium excretion. On the other hand, daily urinary aldosterone excretions in both control and patient groups were inversely correlated with urinary sodium excreted in 24 hours. 7) The total exchangeable body sodium stoles were net significantly different between the control and the hypertensive patient groups regardless of high or low sodium intake. On the contrary, the disappearance rate of plasma (22)**Na in hypertensive patients during low sodium diet revealed somewhat an accelerated tendency in comparison with that found in normal subjects. In view of the above experimental findings, the regulatory mechanism of aldosterone secretion in the patients with essential hypertension may be different from that of the control group. That is, the retrain-angiotensin system in the hypertensive patients may play a minor role in the regulation of aldosterone secretion compared to normal subjects. Furthermore it is speculated that the sensitivity of renal tubules to aldosterone in patients with essential hypertension is reduced compared to that of normal Korean healthy subjects.restrictio

Effect of gastric freezing on liver function.

의학과/석사[한글] [영문] Since Wangensteen et al.(1958) introduced gastric hypothermia for the control of massive upper gastrointestinal hemorrhage, ample evidence has accumulted that gastric hypothermia markedly alters gastric function. Recent findings indicate that the physiologic changes induced by this form of cooling are not limited to the stomach. Data from many centers have shown that gastric cooling affects hepatic blood flow, circulatory blood volume, pancreatic and renal functions. In contrast to studies of the heart and brain, tests of hepatic function during hypothermia have been few. In this situation it would certainly seem proper that the effects of gastric freezing itself upon the normal liver be first evaluated. The purpose of this study was to ascertain the effects of gastric freezing on liver function in the normal anesthetized dogs. Fifteen mongrel dogs of both sees, weighting form 12 to 22 kg., were starved for 12 hours before gastric freezing, and they were then subjected to gastric freezing under general anesthesia with pentothal sodium(20mg./kg.). Gastric freezing was maintained for 50 minutes, and serial blood samples for liver function test were taken before the freezing, and 12 hors, 24 hours, 48 hours, 72 hours and 96 hours after the freezing, respectively. The results are as follows: 1. SGOT activity in ten dogs was 37±10.0 units before gastric freezing. After the freezing it showed rapid rise with a peak of 128±62.9 units at 12 hours, and gradually returned to normal in 72 hours. 2. SGPT activity in thirteen dogs was 35±5.7 units before the freezing. After the freezing it showed rapid rise with a peak of 79±30.3 units at 12 hours and slowly returned to normal in 72 hors. 3. Serum total protein level in fifteen dogs was 6.6±0.51gm.% before the freezing. After the freezing it showed progressively decreasing values, and lowest levels of 5.2±0.99 and 5.2±0.65 gm.% at 48 and 72 hours respectively, and thereafter it showed a tendency toward gradual increase. 4. A/G ratio showed no significant change before and after gastric freezing. 5. Serum alkaline phosphatase activity showed no significant change before and after gastric freezing.restrictio

Is high-sensitivity C-reactive protein associated with carotid atherosclerosis in healthy Koreans?

BACKGROUND: There is a positive association between chronic inflammation and the risk of cardiovascular disease, but whether there is an association between C-reactive protein (CRP) and carotid atherosclerosis is controversial. We investigated the relationship between high-sensitivity CRP (hsCRP) levels and carotid intima-media thickness (IMT) in healthy Koreans. DESIGN: We measured hsCRP levels, the carotid IMT, and conventional cardiovascular risk factors including obesity parameters, blood pressure, lipid profiles, insulin resistance, and smoking habits in 820 volunteers (35-79 years old) in a cross-sectional study. RESULTS: Higher hsCRP quartile groups had higher mean IMTs, as compared with the lowest quartile (P or = 1.0 mm) was also positively related to hsCRP quartile, but this relationship was not significant after adjustment for age and other cardiovascular risk factors. CONCLUSIONS: Both hsCRP levels and the carotid IMT were strongly correlated with conventional cardiovascular risk factors, but there was no independent association between hsCRP levels and carotid IMT in healthy Korean adults.restrictio

Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults

BACKGROUND: Obesity and type 2 diabetes are well-known risk factors for the development of nonalcoholic fatty liver disease (NAFLD). However, NAFLD is not rare in nonobese, nondiabetic adults. The aim of this study was to evaluate the metabolic significance of NAFLD in nonobese, nondiabetic adults. METHODS: This study examined 768 nonobese (body mass index [BMI] [calculated as weight in kilograms divided by the square of height in meters], > or =18.5 and <30) (460 normal-weight and 308 overweight subjects), nondiabetic individuals older than 30 years who participated in a medical checkup. All the subjects had negative serologic findings for hepatitis B and C viruses and had an alcohol intake less than 140 g/wk. A standard interview, anthropometrics, a biochemical study, and abdominal ultrasonography were conducted. RESULTS: The prevalence of NAFLD in the enrolled subjects was 23.4%. In the normal-weight (BMI, > or =18.5 and or =25 and <30) groups, NAFLD was a significant predictor of insulin resistance and other metabolic disorders, including hypertriglyceridemia and hyperuricemia. The odds ratio of the metabolic disorders in subjects with NAFLD compared with those without NAFLD in the normal-weight group was higher than that in the overweight group. Multiple logistic regression analysis showed that sex, waist circumference, triglyceride level, and insulin resistance were independently associated with NAFLD in the normal-weight group. CONCLUSIONS: Nonalcoholic fatty liver disease is closely associated with metabolic disorders, even in nonobese, nondiabetic subjects. Nonalcoholic fatty liver disease can be considered an early predictor of metabolic disorders, particularly in the normal-weight population.ope

Predictive clinical parameters for therapeutic efficacy of rosiglitazone in Korean type 2 diabetes mellitus

This study evaluated the efficacy of rosiglitazone in non-obese and obese Korean type 2 diabetic patients of long duration. A total of 125 patients (M:F = 44:81, mean age: 58.4 ± 9.1 years, BMI: 24.2 ± 2.7 kg/m2, duration of diabetes: 11.0 ± 6.4 years) were randomly allocated to 12 weeks of rosiglitazone treatment (4 mg per day) or a control group. Responders were defined as patients who experienced fasting plasma glucose (FPG) reduction of >20% or HbA1c reduction of >1 (%). Rosiglitazone significantly improved glycemic control by reducing FPG and HbA1c (−3.4 mmol/l and −1.1%, P < 0.001, respectively). It also significantly increased HOMAβ-cell function (+9.7, P < 0.01) and QUICKI (+0.029, P < 0.001), and decreased HOMAIR (−1.73, P < 0.001). Females and those with higher waist–hip ratio made up a greater portion of rosiglitazone-responders. Responders (45 patients, 75%) also showed significantly higher FPG, HbA1c, systolic blood pressures, fasting insulin levels and HOMAIR, and lower QUICKI than nonresponders. Among these parameters of responders, waist–hip ratio of non-obese subgroup, initial glycemic control of obese subgroup, and systolic blood pressure of both subgroups lost their significance after subdivision analysis. However, the baseline HOMAIR and QUICKI were significantly correlated with the response rate to rosiglitazone. Moreover, in multiple logistic regression analysis, HOMAIR and QUICKI retained their significance as the independent predictors. Even in Korean type 2 diabetic patients of long duration but with relatively preserved β-cell function, rosiglitazone improved glycemic control, insulin sensitivity, and β-cell function. In this ethnic group, female gender, central obesity, and especially severe insulin resistance were identified as predictive clinical parameters of rosiglitazone-responders.restrictio

The level of 2-h post-challenge glucose is an independent risk factor of carotid intima-media thickness progression in Korean type 2 diabetic patients

OBJECTIVE: To evaluate the relationship between the metabolic abnormalities commonly associated with diabetes and the changes in carotid intima-media thickness (IMT) in Korean type 2 diabetic patients who do not have clinically manifest cardiovascular disease (CVD). DESIGN: In a prospective study, a total of 152 type 2 diabetic patients were recruited from a group of outpatients at the Yonsei University Hospital. MATERIALS AND METHODS: The carotid IMTs of 152 subjects with type 2 diabetes (mean age 63.5+/-7.0 years) were determined at baseline and after a mean follow-up time of 23.7+/-3.7 months. Fasting plasma glucose, serum total cholesterol (TC), serum triglyceride, high-density lipoprotein cholesterol (HDL-C), HbA1c, oral glucose tolerance test (OGTT) results for 2-h post-challenge glucose (2hPG), and blood pressure measurements were collected every 3 months and averaged. RESULTS: The highest quartiles of baseline C-peptide and homeostatic model assessment (HOMA) index showed more IMT progression than the lowest quartiles. The change in the mean IMT correlated with average values of HbA1c (r=.219, P=.007), the 2-h post-challenge glucose (r=.239, P=.003), HDL-C (r=-.228, P=.005), LDL-C (r=.175, P=.033), and non-HDL-C (r=.194, P=.016). Multiple regression analysis demonstrated that the independent risk factor for the mean IMT change in diabetic patients was the average 2hPG level (P=.004). The change in the mean IMT of those in the lowest quartile of average 2hPG (15.3 mmol/l), however, the mean IMT increased from 794+/-127 to 882+/-153 microm (P<.001). CONCLUSION: The 2hPG parameter among the various metabolic parameters exerts the greatest influence upon the prevention of carotid IMT progression in type 2 diabetic subjects. The level of 2hPG is an independent risk factor for the progression of carotid IMT in Korean type 2 diabetic patients.ope

The correlation between insulin resistance and the visceral fat to skeletal muscle ratio in middle-aged women

Central obesity with visceral fat accumulation and the amount of skeletal muscle mass may influence insulin sensitivity via its capacity for glucose load uptake. We investigated the relationships among the following metabolic variables: ratio of fat area to skeletal muscle area (VMR), percent ideal body weight, body mass index, waist-to-hip circumference (WHR) and visceral fat to subcutaneous fat ratio (VSR) in 114 nondiabetic middle-aged women. Anthropometric parameters, lipid profiles and sex hormone-binding globulin were measured. Visceral and subcutaneous fat areas at the umbilical level and the skeletal muscle area at the mid-thigh level were measured and computed. 75-gram OGTT tests were performed, along with measuring plasma glucose, insulin and free fatty acid levels, according to which area under the curve of glucose (Glu-AUC), insulin (Ins-AUC), free fatty acid (FFA-AUC) and glucose/insulin ratio (GIR=Glu- AUC/Ins-AUC), were calculated. 1) Triglyceride was more correlated with VSR than VMR. 2) The independent anthropometric parameters for each metabolic variable were In conclusion, VMR for Ins-AUC, WHR for Glu-AUC and total cholesterol, and VSR for triglyceride. 3) For subjects with higher VMR, age, Ins-AUC and triglyceride were significantly higher. 4) Subjects with higher VMR were older and showed higher Ins-AUC and lower GIR than the subjects with lower VMR. In conclusion, VMR is an anthropometric parameter that reflects insulin resistance concerning glucose metabolism, and VSR is thought to be a good parameter that that reflects the serum lipid levels. Further prospective studies are necessary to reevaluate the visceral fat vs. skeletal muscle relationship.ope