2．生活自立からみた生活習慣病の基準値 （4）メタボリックシンドローム
メタボリックシンドローム（MetS）は，内臓肥満を基盤として，耐糖能障害，高血圧，脂質異常，肥満などの複合合併した病態である．加齢とともに腹囲や内臓脂肪は増加し，筋肉量は低下するため，高齢者ではMetSの頻度が増加する．わが国の70歳以上高齢者では，MetSとその予備群の総和は，男性で2人に1人，女性の3人に1人にみられる．MetSの臨床的意義は，心血管疾患や糖尿病のリスクであることであり，高齢者も例外ではない．高齢者では，さらにADL低下や認知症などの生活機能障害と関連することが重要である．本稿では，寝たきりの主要な原因である，脳卒中，認知症，虚弱，転倒と，肥満・MetSとの関係をまとめた．...
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| Published in | 日本老年医学会雑誌 Vol. 50; no. 2; pp. 182 - 186 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本老年医学会
2013
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0300-9173 |
| DOI | 10.3143/geriatrics.50.182 |
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| Abstract | メタボリックシンドローム（MetS）は，内臓肥満を基盤として，耐糖能障害，高血圧，脂質異常，肥満などの複合合併した病態である．加齢とともに腹囲や内臓脂肪は増加し，筋肉量は低下するため，高齢者ではMetSの頻度が増加する．わが国の70歳以上高齢者では，MetSとその予備群の総和は，男性で2人に1人，女性の3人に1人にみられる．MetSの臨床的意義は，心血管疾患や糖尿病のリスクであることであり，高齢者も例外ではない．高齢者では，さらにADL低下や認知症などの生活機能障害と関連することが重要である．本稿では，寝たきりの主要な原因である，脳卒中，認知症，虚弱，転倒と，肥満・MetSとの関係をまとめた． MetSは認知症（血管性認知症，アルツハイマー病（AD））の危険因子である．AD病理でも老人斑は，空腹時インスリン値，HOMA-IRと関連する．肥満とMetSは，ともに移動能力低下の独立した危険因子である．虚弱との関連では，CRP高値，HOMA-IRとの関連が示されたが，MetSとは関連なかった．MetSの背景にあるインスリン抵抗性，炎症が虚弱に関連すると考えられた．また肥満は高齢者の転倒に関する危険因子である．特に高度の肥満ほど転倒のリスクは高い．高齢者の腹部肥満・MetSと脳卒中との関連では，肥満を伴うMetSより，肥満以外の他の動脈硬化の危険因子が集積したMetSが，脳卒中のリスクとして重要であった． 上記のように，高齢者の肥満・MetSは，様々な生活機能障害と関連する．高齢者でも過度の肥満は避けるべきであろう．またMetSの背景にあるインスリン抵抗性や炎症が，認知症や虚弱との関連で指摘されている．一方，MetSが個々の危険因子の総和を超えるリスクであるというエビデンスはみられない．生活機能障害を予防するための，MetSの管理目標値についての知見もいまだ乏しい． |
|---|---|
| AbstractList | メタボリックシンドローム（MetS）は，内臓肥満を基盤として，耐糖能障害，高血圧，脂質異常，肥満などの複合合併した病態である．加齢とともに腹囲や内臓脂肪は増加し，筋肉量は低下するため，高齢者ではMetSの頻度が増加する．わが国の70歳以上高齢者では，MetSとその予備群の総和は，男性で2人に1人，女性の3人に1人にみられる．MetSの臨床的意義は，心血管疾患や糖尿病のリスクであることであり，高齢者も例外ではない．高齢者では，さらにADL低下や認知症などの生活機能障害と関連することが重要である．本稿では，寝たきりの主要な原因である，脳卒中，認知症，虚弱，転倒と，肥満・MetSとの関係をまとめた． MetSは認知症（血管性認知症，アルツハイマー病（AD））の危険因子である．AD病理でも老人斑は，空腹時インスリン値，HOMA-IRと関連する．肥満とMetSは，ともに移動能力低下の独立した危険因子である．虚弱との関連では，CRP高値，HOMA-IRとの関連が示されたが，MetSとは関連なかった．MetSの背景にあるインスリン抵抗性，炎症が虚弱に関連すると考えられた．また肥満は高齢者の転倒に関する危険因子である．特に高度の肥満ほど転倒のリスクは高い．高齢者の腹部肥満・MetSと脳卒中との関連では，肥満を伴うMetSより，肥満以外の他の動脈硬化の危険因子が集積したMetSが，脳卒中のリスクとして重要であった． 上記のように，高齢者の肥満・MetSは，様々な生活機能障害と関連する．高齢者でも過度の肥満は避けるべきであろう．またMetSの背景にあるインスリン抵抗性や炎症が，認知症や虚弱との関連で指摘されている．一方，MetSが個々の危険因子の総和を超えるリスクであるというエビデンスはみられない．生活機能障害を予防するための，MetSの管理目標値についての知見もいまだ乏しい． |
| Author | 櫻井, 孝 |
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| Copyright | 2013 一般社団法人 日本老年医学会 |
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| References | 23) Himes CL, Reynolds SL: Effect of obesity on falls, injury, and disability. J Am Geriatr Soc 2012; 60: 124-129. 7) Simons LA, Simons J, Friedlander Y, McCallum J: Does a diagnosis of the metabolic syndrome provide additional prediction of cardiovascular disease and total mortality in the elderly? The Dubbo Study. Med J Aust 2007; 186: 400-403. 16) Matsuzaki T, Sasaki K, Tanizaki Y, Hata J, Fujimi K, Matsui Y, et al.: Insulin resistance is associated with the pathology of Alzheimer disease: the Hisayama study. Neurology 2010; 75: 764-770. 8) Ravaglia G, Forti P, Maioli F, Bastagli L, Chiappelli M, Montesi F, et al.: Metabolic Syndrome: prevalence and prediction of mortality in elderly individuals. Diabetes Care 2006; 29: 2471-2476. 25) Corbeil P, Simoneau M, Rancourt D, Tremblay A, Teasdale N: Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural Syst Rehabil Eng 2001; 9: 126-136. 4) Scuteri A, Najjar SS, Morrell CH, Lakatta EG; Cardiovascular Health Study: The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the Cardiovascular Health Study. Diabetes Care 2005; 28: 882-887. 9) Sattar N, McConnachie A, Shaper AG, Blauw GJ, Buckley BM, de Craen AJ, et al.: Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 2008; 371: 1927-1935. 6) Otiniano ME, Du XL, Maldonado MR, Ray L, Markides K: Effect of metabolic syndrome on heart attack and mortality in Mexican-American elderly persons: findings of 7-year follow-up from the Hispanic established population for the epidemiological study of the elderly. J Gerontol A Biol Sci Med Sci 2005; 60: 466-470. 10) 厚生労働省健康局総務課生活習慣病対策室（平成14年糖尿病実態調査） http://www.mhlw.go.jp/shingi/2004/03/s0318-15.html 15) Razay G, Vreugdenhil A, Wilcock G: The metabolic syndrome and Alzheimer disease. Arch Neurol 2007; 64 (1): 93-96. 1) 厚生労働省健康局総務課生活習慣病対策室（平成16年国民健康・栄養調査） http://www.mhlw.go.jp/houdou/2006/05/h0508-1.html 22) Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al.: Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med 2007; 167: 635-641. 14) Vanhanen M, Koivisto K, Moilanen L, Helkala EL, Hänninen T, Soininen H, et al.: Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology 2006; 67 (5): 843-847. 2) McNeill AM, Katz R, Girman CJ, Rosamond WD, Wagenknecht LE, Barzilay JI, et al.: Metabolic syndrome and cardiovascular disease in older people: The cardiovascular health study. J Am Geriatr Soc 2006; 54: 1317-1324. 13) Yaffe K, Kanaya A, Lindquist K, Simonsick EM, Harris T, Shorr RI, et al.: The metabolic syndrome, inflammation, and risk of cognitive decline. AMA 2004; 292: 2237-2242. 19) Blaum CS, West NA, Haan MN: Is the metabolic syndrome, with or without diabetes, associated with progressive disability in older Mexican Americans? J Gerontol A Biol Sci Med Sci 2007; 62: 766-773. 28) Kadota A, Hozawa A, Okamura T, Kadowak T, Nakmaura K, Murakami Y, et al.; NIPPON DATA Research Group: Relationship between metabolic risk factor clustering and cardiovascular mortality stratified by high blood glucose and obesity: NIPPON DATA90, 1990-2000. Diabetes Care 2007; 30: 1533-1538. 20) Blazer DG, Hybels CF, Fillenbaum GG: Metabolic syndrome predicts mobility decline in a community-based sample of older adults. J Am Geriatr Soc 2006; 54: 502-506. 24) 荒木 厚: 肥満（メタボリック症候群）高齢者の転倒予防ガイドライン（鳥羽研二監修）, MEDICAL VIEW社, 2012, p76-80. 21) Stenholm S, Koster A, Alley DE, Houston DK, Kanaya A, Lee JS, et al.; Health, Aging, and Body Composition Study: Joint association of obesity and metabolic syndrome with incident mobility limitation in older men and women--results from the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2010; 65: 84-92. 18) Craft S: Insulin resistance syndrome and Alzheimer's disease: age- and obesity-related effects on memory, amyloid, and inflammation. Neurobiol Aging 2005; 26 Suppl 1: 65-69. 3) He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, et al.: Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population. J Am Coll Cardiol 2006; 47: 1588-1594. 26) Katzmarzyk PT, Janssen I, Ross R, Church TS, Blair SN: The importance of waist circumference in the definition of metabolic syndrome: prospective analyses of mortality in men. Diabetes Care 2006; 29: 404-409. 12) Kalmijn S, Foley D, White L, Burchfiel CM, Curb JD, Petrovitch H, et al.: Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. The Honolulu-Asia aging study. Arterioscler Thromb Vasc Biol 2000; 20 (10): 2255-2260. 27) Yoon YS, Lee ES, Park C, Lee S, Oh SW: The new definition of metabolic syndrome by the international diabetes federation is less likely to identify metabolically abnormal but non-obese individuals than the definition by the revised national cholesterol education program: the Korea NHANES study. Int J Obes (Lond) 2007; 31: 528-534. 17) Kaiyala KJ, Prigeon RL, Kahn SE, Woods SC, Schwartz MW: Obesity induced by a high-fat diet is associated with reduced brain insulin transport in dogs. Diabetes 2000; 49: 1525-1533. 11) Sakurai T, Iimuro S, Araki A, Umegaki H, Ohashi Y, Yokono K, et al.: Age-associated increase in abdominal obesity and insulin resistance, and usefulness of AHA/NHLBI definition of metabolic syndrome for predicting cardiovascular disease in Japanese elderly with type 2 diabetes mellitus. Gerontology 2010; 56: 141-149. 5) Butler J, Rodondi N, Zhu Y, Figaro K, Fazio S, Vaughan DE, et al.; Health ABC Study: Metabolic syndrome and the risk of cardiovascular disease in older adults. J Am Coll Cardiol 2006; 47: 1595-1602. |
| References_xml | – reference: 18) Craft S: Insulin resistance syndrome and Alzheimer's disease: age- and obesity-related effects on memory, amyloid, and inflammation. Neurobiol Aging 2005; 26 Suppl 1: 65-69. – reference: 11) Sakurai T, Iimuro S, Araki A, Umegaki H, Ohashi Y, Yokono K, et al.: Age-associated increase in abdominal obesity and insulin resistance, and usefulness of AHA/NHLBI definition of metabolic syndrome for predicting cardiovascular disease in Japanese elderly with type 2 diabetes mellitus. Gerontology 2010; 56: 141-149. – reference: 3) He Y, Jiang B, Wang J, Feng K, Chang Q, Fan L, et al.: Prevalence of the metabolic syndrome and its relation to cardiovascular disease in an elderly Chinese population. J Am Coll Cardiol 2006; 47: 1588-1594. – reference: 26) Katzmarzyk PT, Janssen I, Ross R, Church TS, Blair SN: The importance of waist circumference in the definition of metabolic syndrome: prospective analyses of mortality in men. Diabetes Care 2006; 29: 404-409. – reference: 1) 厚生労働省健康局総務課生活習慣病対策室（平成16年国民健康・栄養調査） http://www.mhlw.go.jp/houdou/2006/05/h0508-1.html – reference: 24) 荒木 厚: 肥満（メタボリック症候群）高齢者の転倒予防ガイドライン（鳥羽研二監修）, MEDICAL VIEW社, 2012, p76-80. – reference: 4) Scuteri A, Najjar SS, Morrell CH, Lakatta EG; Cardiovascular Health Study: The metabolic syndrome in older individuals: prevalence and prediction of cardiovascular events: the Cardiovascular Health Study. Diabetes Care 2005; 28: 882-887. – reference: 25) Corbeil P, Simoneau M, Rancourt D, Tremblay A, Teasdale N: Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural Syst Rehabil Eng 2001; 9: 126-136. – reference: 10) 厚生労働省健康局総務課生活習慣病対策室（平成14年糖尿病実態調査） http://www.mhlw.go.jp/shingi/2004/03/s0318-15.html – reference: 12) Kalmijn S, Foley D, White L, Burchfiel CM, Curb JD, Petrovitch H, et al.: Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. The Honolulu-Asia aging study. Arterioscler Thromb Vasc Biol 2000; 20 (10): 2255-2260. – reference: 19) Blaum CS, West NA, Haan MN: Is the metabolic syndrome, with or without diabetes, associated with progressive disability in older Mexican Americans? J Gerontol A Biol Sci Med Sci 2007; 62: 766-773. – reference: 23) Himes CL, Reynolds SL: Effect of obesity on falls, injury, and disability. J Am Geriatr Soc 2012; 60: 124-129. – reference: 5) Butler J, Rodondi N, Zhu Y, Figaro K, Fazio S, Vaughan DE, et al.; Health ABC Study: Metabolic syndrome and the risk of cardiovascular disease in older adults. J Am Coll Cardiol 2006; 47: 1595-1602. – reference: 22) Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al.: Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med 2007; 167: 635-641. – reference: 2) McNeill AM, Katz R, Girman CJ, Rosamond WD, Wagenknecht LE, Barzilay JI, et al.: Metabolic syndrome and cardiovascular disease in older people: The cardiovascular health study. J Am Geriatr Soc 2006; 54: 1317-1324. – reference: 8) Ravaglia G, Forti P, Maioli F, Bastagli L, Chiappelli M, Montesi F, et al.: Metabolic Syndrome: prevalence and prediction of mortality in elderly individuals. Diabetes Care 2006; 29: 2471-2476. – reference: 13) Yaffe K, Kanaya A, Lindquist K, Simonsick EM, Harris T, Shorr RI, et al.: The metabolic syndrome, inflammation, and risk of cognitive decline. AMA 2004; 292: 2237-2242. – reference: 6) Otiniano ME, Du XL, Maldonado MR, Ray L, Markides K: Effect of metabolic syndrome on heart attack and mortality in Mexican-American elderly persons: findings of 7-year follow-up from the Hispanic established population for the epidemiological study of the elderly. J Gerontol A Biol Sci Med Sci 2005; 60: 466-470. – reference: 15) Razay G, Vreugdenhil A, Wilcock G: The metabolic syndrome and Alzheimer disease. Arch Neurol 2007; 64 (1): 93-96. – reference: 7) Simons LA, Simons J, Friedlander Y, McCallum J: Does a diagnosis of the metabolic syndrome provide additional prediction of cardiovascular disease and total mortality in the elderly? The Dubbo Study. Med J Aust 2007; 186: 400-403. – reference: 27) Yoon YS, Lee ES, Park C, Lee S, Oh SW: The new definition of metabolic syndrome by the international diabetes federation is less likely to identify metabolically abnormal but non-obese individuals than the definition by the revised national cholesterol education program: the Korea NHANES study. Int J Obes (Lond) 2007; 31: 528-534. – reference: 21) Stenholm S, Koster A, Alley DE, Houston DK, Kanaya A, Lee JS, et al.; Health, Aging, and Body Composition Study: Joint association of obesity and metabolic syndrome with incident mobility limitation in older men and women--results from the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2010; 65: 84-92. – reference: 14) Vanhanen M, Koivisto K, Moilanen L, Helkala EL, Hänninen T, Soininen H, et al.: Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology 2006; 67 (5): 843-847. – reference: 9) Sattar N, McConnachie A, Shaper AG, Blauw GJ, Buckley BM, de Craen AJ, et al.: Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 2008; 371: 1927-1935. – reference: 28) Kadota A, Hozawa A, Okamura T, Kadowak T, Nakmaura K, Murakami Y, et al.; NIPPON DATA Research Group: Relationship between metabolic risk factor clustering and cardiovascular mortality stratified by high blood glucose and obesity: NIPPON DATA90, 1990-2000. Diabetes Care 2007; 30: 1533-1538. – reference: 17) Kaiyala KJ, Prigeon RL, Kahn SE, Woods SC, Schwartz MW: Obesity induced by a high-fat diet is associated with reduced brain insulin transport in dogs. Diabetes 2000; 49: 1525-1533. – reference: 20) Blazer DG, Hybels CF, Fillenbaum GG: Metabolic syndrome predicts mobility decline in a community-based sample of older adults. J Am Geriatr Soc 2006; 54: 502-506. – reference: 16) Matsuzaki T, Sasaki K, Tanizaki Y, Hata J, Fujimi K, Matsui Y, et al.: Insulin resistance is associated with the pathology of Alzheimer disease: the Hisayama study. Neurology 2010; 75: 764-770. |
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| Snippet | メタボリックシンドローム（MetS）は，内臓肥満を基盤として，耐糖能障害，高血圧，脂質異常，肥満などの複合合併した病態である．加齢とともに腹囲や内臓脂肪は増加し，... |
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| SubjectTerms | メタボリックシンドローム 生活機能 脳卒中 認知症 転倒 |
| Title | 2．生活自立からみた生活習慣病の基準値 （4）メタボリックシンドローム |
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| ispartofPNX | 日本老年医学会雑誌, 2013, Vol.50(2), pp.182-186 |
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