Metabolic syndrome (MS) is a rising disease entity characterized by a clustering of metabolic conditions. Although prevalence of obesity as defined by the World Health Organization (WHO) is relatively low in Asia compared to western countries, metabolic syndrome is growing into a significant public health problem. Comparative studies indicate that metabolic responses to obesity may be greater in South and East Asians than their western counterparts at given Body Mass Indexes (BMIs). Higher percentage body fat in Asians at given BMIs and over-responsiveness to obesity may in part explain the phenomenon for which the underlying causes are not clear. Furthermore, aborigines may be at an even greater MS risk. The metabolic syndrome definition itself as well as whether it should be defined are controversial. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) gives equal weight to each component disorder, while the International Diabetes Federation (IDF) takes central obesity as a pre-requisite. Both criteria adopt ethnic-specific cut-off points for waist circumference. Asian data favour the new NCEP-ATP III definition, as individuals that were selected through the NCEP criteria but disregarded by the IDF criteria had similar Framingham cardiovascular disease risk scores to those picked by both definitions. Prospective data show that the metabolic syndrome not only increases the risk of coronary artery disease but also cerebrovascular disease in Asians. Macronutrient composition and the quality of the diet are associated with the risk of metabolic syndrome. More research is needed to relate diet and metabolic syndrome in Asians.

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Epidemiology of metabolic syndrome in Asia.

Background
Risk prediction models estimate the risk of developing future outcomes for individuals based on one or more underlying characteristics (predictors). We review how researchers develop and validate risk prediction models within an individual participant data (IPD) meta-analysis, in order to assess the feasibility and conduct of the approach.

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Developing and validating risk prediction models in an individual participant data meta-analysis

Background: The risk association between low-density lipoprotein (LDL) cholesterol and cancer remains controversial and largely unexplored for people not receiving statin therapy. Methods: We examined the risk association between LDL cholesterol and cancer among patients with type 2 diabetes mellitus who were free of cancer at enrolment and whose statin use was known. We considered a variety of nonlinear relationships in our analysis. Results: During a median follow-up period of 4.90 years, cancer developed in 270 (4.4%) of 6107 patients. Among the 3800 patients who did not receive statin therapy, the risk association between LDL cholesterol and cancer was represented by a V-shaped curve. Compared with patients whose LDL cholesterol was at least 2.80 mmol/L but less than 3.80 mmol/L, the risk of cancer, death from any cause or the composite outcome of cancer or death was greater among those with an LDL cholesterol level of less than 2.80 mmol/L (hazard ratio for cancer 1.74, 95% confidence interval [CI] 1.20–2.52) and those with an LDL cholesterol level of 3.80 mmol/L or greater (hazard ratio for cancer 1.87, 95% CI 1.29–2.71). Using 3.8 mmol/L as a reference point, we found that the hazard ratio for cancer for every millimole per litre absolute change in LDL cholesterol was 1.54 (95% CI 1.19–1.99) among patients not using statins; the hazard ratio was reduced to 1.24 (1.01–1.53) for the entire sample (statin users and those not using statins). These associations persisted after adjustment for covariates and exclusion of patients with less than 2.5 years of follow-up. Interpretation: Among patients with type 2 diabetes, the association between LDL cholesterol and cancer was V-shaped, whereby both low and high levels of LDL cholesterol were associated with elevated risk of cancer.

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Independent associations between low-density lipoprotein cholesterol and cancer among patients with type 2 diabetes mellitus

Metabolic syndrome and incidence of liver and breast cancers in Japan

Within the last four decades Asia has witnessed major transformation in its population demographics, which gave rise to changes in food availability, food habits and lifestyle. A significant consequence of these changes has been the continuing rise in overweight and obesity across Asia. In parallel, there has been a significant rise in Asians in the incidence of the major chronic diseases, particularly in cardiometabolic disorders such as metabolic syndrome, type 2 diabetes, hypertension, and other cardiovascular diseases. Given that the majority of the evidence, to date, investigating the associations between adiposity and cardiometabolic disorder risk have been obtained from studies undertaken either in European or in North American Caucasians, in this chapter, we have reviewed differences in body fat content and distribution between East Asians, South Asians, and Caucasians. The evidence is consistent that the content and distribution of body fat are markedly different between the various ethnic groups. We found that Asians have a greater predisposition towards adiposity at higher BMI than in Caucasians. Moreover, at any given level of adiposity, Asians have a much greater predisposition to risk of cardiometabolic disorders than Caucasians. We therefore strongly endorse the need for different adiposity cutoffs in Asians as compared to the Caucasians. We have also reviewed the predictive abilities of the various body composition/adiposity measures in determining risk of cardiometabolic disorders in Asians.

T. Okhubo

Papers

An evaluation of metabolic risks for coronary death in the Asia Pacific region.