What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome

Sports Medicine

Volumn 34, Issue 6, 2004, Pages 371-418

  Carroll, Sean ^a   Dudfield, Mike ^b  

^a LEEDS METROPOLITAN UNIVERSITY   (United Kingdom)

^b Leeds Leisure Services   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

BLOOD PRESSURE; CARDIOVASCULAR RISK; CHOLESTEROL BLOOD LEVEL; CLUSTER ANALYSIS; CORRELATION ANALYSIS; DISEASE ASSOCIATION; EXERCISE; HEALTH PROGRAM; HUMAN; HYPERGLYCEMIA; HYPERTENSION; HYPERURICEMIA; INSULIN RESISTANCE; METABOLIC DISORDER; PATHOPHYSIOLOGY; PHYSICAL ACTIVITY; POPULATION RESEARCH; REVIEW; RISK FACTOR; TRAINING; WORLD HEALTH ORGANIZATION;

CROSS-SECTIONAL STUDIES; EXERCISE; GREAT BRITAIN; HUMANS; METABOLIC SYNDROME X; PRACTICE GUIDELINES; RANDOMIZED CONTROLLED TRIALS; RISK FACTORS; SPORTS MEDICINE;

EID: 3042620042     PISSN: 01121642     EISSN: None     Source Type: Journal    
DOI: 10.2165/00007256-200434060-00004     Document Type: Review

References (317)

1. Grundy SM, Bazzarre T, Cleeman J, et al. Prevention Conference V: beyond secondary prevention. Identifying the high-risk patient for primary prevention: medical office assessment: Writing Group 1. American Heart Association Medical/ Scientific Statement. Circulation 2000; 101: 111-6
2. Grundy SM, Brewer Jr HB, Cleeman JI, et al. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation 2004; 109: 433-8
3. Einhorn D, Reaven GM, Cobin RH, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract 2003; 9: 237-52
4. Wilson PWF, Kannel WB, Silbershatz H, et al. Clustering of metabolic factors and coronary heart disease. Arch Intern Med 1999; 159: 1104-9
5. Garvey WT, Hermayer KL. Clinical implications of the insulin resistance syndrome. Clin Cornerstone 1998; 1: 13-8
6. Lamarche B, Lewis GF. Atherosclerosis prevention for the next decade: risk assessment beyond low density lipoprotein cholesterol. Can J Cardiol 1998; 14: 841-51
7. Yki-Jarvinen H. Pathogenesis of non-insulin dependent diabetes mellitus. Lancet 1994; 343: 91-5
8. De Fronzo RA. The triumvirate: β-cell, muscle and liver: a collusion responsible for NIDDM. Diabetes 1988; 37: 667-87
9. Smiley T, Oh P, Shane LG. The relationship of insulin resistance measured with reliable indexes to coronary artery disease risk factors and outcomes: a systematic review. Can J Cardiol 2001; 17: 797-805
10. Ruige JB, Assenfelt WJJ, Dekker JM, et al. Insulin and risk of cardiovascular disease: a meta-analysis. Circulation 1998; 97: 996-1001
11. Ferrannini E, Haffner SM, Mitchell BD, et al. Hyperinsulinemia: the key feature of a cardiovascular and metabolic syndrome. Diabetologia 1991; 34: 416-22
12. Stern MP. Diabetes and cardiovascular disease: the common soil hypothesis. Diabetes 1995; 44: 369-74
13. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37: 1595-607
14. De Fronzo RA. Insulin resistance, hyperinsulinemia, and coronary artery disease: a complex metabolic web. J Cardiovasc Pharm 1992; 20 Suppl. 11: 51-16
15. Meigs JB. Epidemiology of the metabolic syndrome. Am J Manag Care 2002; 8 Suppl. 11: S283-92
16. Reaven G. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation 2002; 106: 286-8
17. Hansen BC. The metabolic syndrome X. Ann N Y Acad Sci 1999; 18: 1-24
18. World Health Organisation Consultation. Definition, diagnosis and classification of diabetes mellitus and its complications: report of the World Health Organisation Consultation. Geneva: World Health Organisation, 1999
19. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary on the third report on the The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97
20. The European Group for the Study of Insulin Resistance (EGIR). Frequency of the WHO metabolic syndrome in European cohorts, and an alternative definition of an insulin resistance syndrome. Diabetes Metab 2002; 28: 364-76
21. Westheim A, Os I. Physical activity and the metabolic cardiovascular syndrome. J Cardiovasc Pharmacol 1992; 20 Suppl. 8: S49-53
22. Buemann B, Tremblay A. Effects of exercise training on abdominal obesity and related metabolic complications. Sports Med 1996; 21: 191-212
23. Shahid SK, Schneider SH. Effects of exercise on insulin resistance syndrome. Coron Artery Dis 2000; 11: 103-9
24. Eriksson J, Taimela S, Koivisto VA. Exercise and the metabolic syndrome. Diabetologia 1997; 40: 125-35
25. Dela F. Physical training in the treatment of metabolic syndrome. Ugeskr Laeger 2002; 164: 2147-52
26. Stefanick ML. Physical activity for preventing and treating obesity-related dyslipoproteinemias. Med Sci Sports Exerc 1999; 31: S609-18
27. Ivy JL. Role of exercise training in the prevention and treatment of insulin resistance and non-insulin dependent diabetes mellitus. Sports Med 1997; 24: 321-36
28. Kelley DE, Goodpaster BH. Effects of physical activity on insulin action and glucose tolerance in obesity. Med Sci Sports Exerc 1999; 31: S619-23
29. National Heart, Lung and Blood Institute. Obesity Education Initiative Expert Panel: clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: the evidence report. Bethesda (MD): National Institutes of Health, 1998 Sep. NIH publication no.98-4083: 1-228
30. Grundy SM, Blackburn G, Higgins M, et al. Consensus statement physical activity in the prevention and treatment of obesity and its comorbidities. Med Sci Sports Exerc 1999; 31: S502-8
31. Bouchard C. Physical activity and health: introduction to the dose-response symposium. Med Sci Sports Exerc 2001; 33: S347-50
32. Groop L. Genetics of the metabolic syndrome. Br J Nutr 2000; 83 Suppl. 1: S39-48
33. Ginsberg HN. Insulin resistance and cardiovascular disease. J Clin Invest 2000; 106: 453-8
34. Timar O, Sestier F, Levy E. Metabolic syndrome X: a review. Can J Cardiol 2000; 16: 779-89
35. Hayden MR, Tyagi SC. Intimal redox stress: accelerated atherosclerosis in metabolic syndrome and type 2 diabetes. Atheroscleropathy. Cardiovascular Diabetology 2002 [online]. Available from URL: http: //www.Cardiab.com/content/ 1/1/3 [Accessed 2003 Jan]
36. Reaven GM. Syndrome X: past, present, and future. In: Draznin B, Rizza R, editors. Clinical research in diabetes and obesity. Vol 2. Totowa (NJ): Humana Press Inc., 1997: 357-82
37. Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med 1993; 44: 121-31
38. De Fronzo RA, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for non-insulin dependent diabetes, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173-94
39. Ferrannini E. The insulin resistance syndrome. Curr Opin Nephrol Hypertens 1992; 1: 291-8
40. Kissebah AH, Vydelingum N, Murray R, et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 1982; 54: 254-60
41. Krotkiewski M, Bjorntorp P, Sjostrom L, et al. Impact of obesity on metabolism in men and women: importance of regional adipose tissue distribution. J Clin Invest 1983; 72: 1150-62
42. Vague J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout and uric calculous disease. Am J Clin Nutr 1956; 4: 20-34
43. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989; 149: 1514-20
44. Liese AD, Mayer-Davis EJ, Haffner SM. Development of the multiple metabolic syndrome: an epidemiological perspective. Epidemiol Rev 1998; 20: 157-72
45. Fagan TC, Deedwania PC. The cardiovascular dysmetabolic syndrome. Am J Med 1998; 105: 77S-82S
46. Sowers JR. Update on the cardiometabolic syndrome. Clin Cornerstone 2002; 4: 17-22
47. Groop L, Orho-Melander M. The dysmetabolic syndrome. J Intern Med 2001; 250: 105-20
48. Haffner SM, Ferrannini E, Hazuda HP, et al. Clustering of cardiovascular risk factors in confirmed prehypertensive individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? Hypertension 1992; 20: 38-45
49. Haffner SM, Valdez RA, Hazuda HP, et al. Prospective analysis of the insulin resistance syndrome (syndrome X). Diabetes 1992; 41: 715-22
50. Everson SA, Goldberg DE, Helmrich SP, et al. Weight gain and the risk of developing insulin resistance syndrome. Diabetes Care 1998; 21: 1637-43
51. Mykkanen L, Kuusisto J, Haffner SM, et al. Hyperinsulinemia predicts multiple atherogenic changes in lipoproteins in elderly subjects. Arterioscler Thromb 1994; 14: 518-26
52. Liese AD, Mayer-Davis EJ, Tyroler HA, et al. Development of the multiple metabolic syndrome in the ARIC cohort: joint contribution of insulin, BMI, and WHR. Ann Epidemiol 1997; 7: 407-16
53. Salonen JT, Lakka TM, Lakka HM, et al. Hyperinsulinemia is associated with the incidence of hypertension and dyslipidemia in middle-aged men. Diabetes 1998; 47: 270-5
54. Meigs JB, D'Agostino RB, Wilson PWF, et al. Risk variable clustering in the insulin-resistance syndrome. The Framingham Offspring Study. Diabetes 1997; 46: 1594-600
55. Hanson RL, Imperatore G, Bennett PH, et al. Components of the 'metabolic syndrome' and incidence of type 2 diabetes. Diabetes 2002; 51: 3120-7
56. Arya R, Blangero J, Williams K, et al. Factors of insulin resistance syndrome-related phenotypes are linked to genetic locations on chromosomes 6 and 7 in nondiabetic Mexican-Americans. Diabetes 2002; 51: 841-7
57. Gray RS, Fabsitz RR, Cowan LD, et al. Risk factor clustering in the insulin resistance syndrome: the Strong Heart Study. Am J Epidemiol 1998; 148: 869-78
58. Donahue RP, Bean JA, Donahue RD, et al. Does insulin resistance unite the separate components of the insulin resistance syndrome?: evidence from the Miami Community Health Study. Arterioscler Thromb Vasc Biol 1997; 17: 2413-7
59. Anderson PJ, Critchley JAJH, Chan JCN, et al. Factor analysis of the metabolic syndrome: obesity vs insulin resistance as the central abnormality. Int J Obes Relat Metab Disord 2001; 25: 1782-8
60. Hanley AJG, Karter AJ, Festa A, et al. Factor analysis of the metabolic syndrome using directly measured insulin sensitivity: the Insulin Resistance Atherosclerosis Study. Diabetes 2002; 51: 2642-7
61. Meigs JB. Invited commentary: insulin resistance syndrome?. Syndrome X? Multiple metabolic syndrome? A syndrome at all?: factor analysis reveals patterns in the fabric of correlated metabolic risk factors. Am J Epidemiol 2000; 152: 908-11
62. Zimmet P, Boyko EJ, Collier GR, et al. Etiology of the metabolic syndrome: potential role of insulin resistance, leptin resistance, and other players. Ann N Y Acad Sci 1999; 13: 25-44
63. Liese AD, Mayer-Davis EJ, Tyroler HA, et al. Familial components of the multiple metabolic syndrome: the ARIC study. Diabetologia 1997; 40: 963-70
64. Hong Y, Rice T, Gagnon J, et al. Familial clustering of insulin and abdominal visceral fat: the Heritage Family Study. J Clin Endocrinol Metab 1998; 83: 4239-45
65. Samaras K, Nguyen TV, Jenkins AB, et al. Clustering of insulin resistance, total and central fat: same genes or same environment. Twin Res 1999; 2: 218-25
66. Mitchell BD, Kammerer CM, Mahaney MC, et al. Genetic analysis of the IRS: pleiotropic effects of genes influencing insulin levels on lipoprotein and obesity measures. Arterioscler Thromb Vasc Biol 1996; 16: 281-8
67. Nelson TL, Vogler GP, Pedersen NL, et al. Genetic and environmental influences on body fat distribution, fasting insulin levels and CVD: are the influences shared. Twin Res 2000; 3: 43-50
68. Hong Y, Pedersen NL, Brismar K, et al. Genetic and environmental architecture of the features of the insulin-resistance syndrome. Am J Hum Genet 1997; 60: 143-52
69. Brunner EJ, Marmot MG, Nanchahal K, et al. Social inequality in coronary disease risk: central obesity and the metabolic syndrome: evidence from the Whitehall II Study. Diabetologia 1997; 40: 1341-9
70. Imperatore G, Riccardi G, Iovine C, et al. Plasma fibrinogen: a new factor of the metabolic syndrome: a population-based study. Diabetes Care 1998; 21: 649-54
71. Trevisan M, Liu J, Bahsas FB, et al. Syndrome X and mortality: a population-based study: For the Risk Factor and Life Expectancy Research Group. Am J Epidemiol 1998; 148: 958-66
72. Valdez R. Epidemiology. Nutr Rev 2000; 58 (3 Pt 2): S4-6
73. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683-9
74. Hulthe J, Bokemark L, Wikstrand J, et al. The metabolic syndrome, LDL particle size, and atherosclerosis. Arterioscler Thromb Vasc Biol 2000; 20: 2140-7
75. Okosun IE, Liao Y, Rotimi CN, et al. Abdominal adiposity and clustering of multiple metabolic syndrome components in White, Black and Hispanic Americans. Ann Epidemiol 2000; 10: 263-70
76. Rantala AO, Kauma H, Lilja M, et al. Prevalence of the metabolic syndrome in drug treated hypertensive patients and control subjects. J Intern Med 1999; 245: 163-74
77. Whaley MH, Kampert JB, Kohl HW, et al. Physical fitness and clustering of risk factors associated with the metabolic syndrome. Med Sci Sports Exerc 1999; 31: 287-93
78. Wannamethee SG, Shaper AG, Durrington PN, et al. Hypertension, serum insulin, obesity, and the metabolic syndrome. J Hum Hypertens 1998; 12: 735-41
79. Yarnell JWG, Patterson CC, Bainton D, et al. Is metabolic syndrome a discrete entity in the general population?: evidence from the Caerphilly and Speedwell population studies. Heart 1998; 79: 248-52
80. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. JAMA 2002; 287: 356-9
81. Lakka H-M, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288: 2709-16
82. Ford ES, Giles WH. A comparison of the prevalence of the metabolic syndrome using two proposed definitions. Diabetes Care 2003; 26: 575-81
83. Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-Reactive Protein as a predictor of coronary heart disease and diabetes in the West of Scotland Prevention Study. Circulation 2003; 108: 414-9
84. Meigs JB, Wilson PWF, Nathan DM, et al. Prevalence and characteristics of the metabolic syndrome in the San Antonio Heart and Framingham Offspring Studies. Diabetes 2003; 52: 2160-7
85. Bonora E, Kiechl S, Willeit J, et al. Metabolic syndrome: epidemiology and more extensive phenotypic description: cross-sectional data from the Bruneck Study. Int J Obes 2003; 27: 1283-9
86. Yarborough DE, Barrett-Connor E, Kritz-Silverstein D, et al. Birth weight, adult weight and girth as predictors of the metabolic syndrome in postmenopausal women. Diabetes Care 1998; 21: 1652-8
87. Ridker PM, Buring JE, Cook NR, et al. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 2003; 107: 391-7
88. Reilly MP, Rader DJ. The metabolic syndrome: more than the sum of its parts? Circulation 2003; 108: 1546-51
89. Hanley AJ, Wagenknecht LE, D'Agostino Jr RB, et al. Identification of subjects with insulin resistance and beta-cell dysfunction using alternative definitions of the metabolic syndrome. Diabetes 2003; 52: 2740-7
90. World Health Organisation (1998) Obesity. Preventing and managing the global epidemic. Report of the WHO consultation on obesity [WHO/NUT/NCD/981]. Geneva: WHO, 1997 Jun 3-5
91. Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002; 156: 1070-7
92. Kekalainen P, Sarlund H, Pyorala K, et al. Hyperinsulinemia cluster predicts development of type 2 diabetes independently of family history of diabetes. Diabetes Care 1999; 22: 86-92
93. Pyorala M, Miettinen H, Halonen P, et al. Insulin resistance syndrome predicts the risk of coronary heart disease and stroke in healthy middle-aged men: the 22 year follow-up results of the Helsinki Policemen Study. Arterioscler Thromb Vasc Biol 2000; 20: 538-44
94. Howard BV, Criqui MH, Curb JD, et al. Risk factor clustering in the insulin resistance syndrome and its relationship to cardiovascular disease in postmenopausal White, Black, Hispanic, and Asian/Pacific Islander women. Metabolism 2003; 52: 362-71
95. Lempiainen P, Mykkanen L, Pyorala K, et al. Insulin resistance syndrome predicts coronary heart disease events in elderly nondiabetic men. Circulation 1999; 100: 123-8
96. Lehto S, Ronnemaa T, Pyorala K, et al. Cardiovascular risk factor clustering with endogenous hyperinsulinemia predict death from coronary heart disease in patients with type II diabetes. Diabetologia 2000; 43: 148-55
97. Kuusisto J, Lempiainen P, Mykkanen L, et al. Insulin resistance syndrome predicts coronary heart disease events in elderly type 2 diabetic men. Diabetes Care 2001; 24: 1629-33
98. Girman CJ, Rhodes T, Mercuri M, et al. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/Tex-CAPS). Am J Cardiol 2004 93(2): 136-41
99. Bjorntorp P, Rosmond R. The metabolic syndrome: a neuroendocrine disorder? Br J Nutr 2000; 83 Suppl. 1: S49-57
100. Hedman A, Byberg L, Reneland R, et al. Muscle morphology, self-reported physical activity and insulin resistance syndrome. Acta Physiol Scand 2002; 175: 325-32
101. Goodpaster BH, Kelley DE. Role of muscle in triglyceride metabolism. Curr Opin Lipidol 1998; 9: 231-6
102. Simoneau J-A, Veerkamp JH, Turcotte LP, et al. Markers of capacity to utilise fatty acids in human skeletal muscle: relation to insulin resistance and obesity and effects of weight loss. FASEB J 1999; 13: 2051-60
103. Radzuik J, Pye S. The role of the liver in insulin action and resistance. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999: 197-231
104. Ansell BJ. The metabolic syndrome: an interplay of multiple subtle cardiovascular risk factors: case study and commentary. JCOM 2002 [online]. Available from URL: http://www.turner-white.com [Accessed 2003 Oct 1]
105. Despres J-P. Abdominal obesity as important component of insulin resistance syndrome. Nutrition 1993; 9: 452-9
106. Juhan-Vague I, Alessi MC, Vague P. Increased plasminogen activator inhibitor 1 levels: a possible link between insulin resistance and atherothrombosis. Diabetologia 1991; 34: 457-62
107. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001; 86: 713-8
108. Corry DB, Tuck ML. Selective aspects of the insulin resistance syndrome. Curr Opin Nephrol Hypertens 2001; 10: 507-14
109. Bjorntorp P. Visceral obesity: a 'civilisation syndrome'. Obes Res 1993; 1: 216-22
110. Bonara E, Kiechl S, Willeit J, et al. Prevalence of insulin resistance in metabolic disorders. Diabetes 1998; 47: 1643-9
111. Despres J-P, Lemieux I, Prud'homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 2001; 322: 716-20
112. Abate N. Obesity and cardiovascular disease: pathogenetic role of the metabolic syndrome and therapeutic implications. J Diabet Complications 2000; 14: 154-74
113. Verdecchia P, Reboldi G, Schillaci G, et al. Circulating insulin and insulin growth factor-1 are independent determinants of left ventricular mass and geometry in essential hypertension. Circulation 1999; 100: 1802-7
114. Ferrannini E. Insulin resistance and blood pressure. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999
115. Landsberg L. Insulin-mediated sympathetic stimulation: role in the pathogenesis of obesity-related hypertension (or how insulin affects blood pressure, and why). ) J Hypertens 2001; 19: 523-8
116. Sundstrom J, Lind L, Nystrom N, et al. Left ventricular concentric remodelling rather than left ventricular hypertrophy is related to the insulin resistance syndrome in elderly men. Circulation 2000; 101: 2595-600
117. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities-the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334: 374-81
118. Juhan-Vague I, Alessi MC. PAI-1, obesity, insulin resistance and risk of cardiovascular events. Thromb Haemost 1997; 78: 656-60
119. Kohler HP, Grant PJ. Plasminogen-activator inhibitor type 1 and coronary artery disease. N Engl J Med 2000; 342: 1792-801
120. Meigs JB, Mittleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglycaemia, and impaired hemostasis. JAMA 2000; 283: 221-8
121. Miller GJ. Hyperlipidemia and hypercoagulability. Prog Lipid Res 1993; 32: 61-9
122. Chrousos GP. The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuroendocrine and target tissue related causes. Int J Obes Relat Metab Disord 1999; 24 Suppl. 2: S50-5
123. Das UN. Is metabolic syndrome x an inflammatory condition. Exp Biol Med (Maywood) 2002: 227: 989-7
124. Festa A, D'Agostino R, Howard G, et al. Inflammation and microalbuminuria in nondiabetic subjects: the Insulin Resistance Atherosclerosis Study. Kidney Int 2000; 58: 1703-10
125. Frolich M, Imhof A, Berg G, et al. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000; 23: 1835-9
126. Hak AE, Stehouwer CD, Bots ML, et al. Associations of C-reactive protein with measures of obesity, insulin resistance and atherosclerosis in healthy middle-aged women. Arterioscler Thromb Vasc Biol 2000; 19: 1986-91
127. Hotamisligil GS, Spiegelman BM. Tumor necrosis factor alpha: a key component of the obesity-diabetes link. Diabetes 1994; 43: 1271-8
128. McLaughlin T, Abbasi F, Lamendola C, et al. Differentiation between obesity and insulin resistance in the association with C-reactive protein. Circulation 2002; 106: 2908-12
129. Pinkney JH, Stehouwer CDA, Coppack SW, et al. Endothelial dysfunction: cause of the insulin resistance syndrome. Diabetes 1997; 46 Suppl. 2: S9-S13
130. Tooke JE, Hanneman MM. Adverse endothelial function in the insulin resistance syndrome. J Intern Med 2000; 247: 425-31
131. Baron AD, Quon MJ. Insulin action and endothelial function. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999: 247-63
132. Bjorntorp P. Androgens, the metabolic syndrome and non-insulin dependent diabetes. Ann N Y Acad Sci 1993; 676: 242-52
133. Rantala AO, Kauma H, Lilja M, et al. Gamma-glutamyl transpeptidase and the metabolic syndrome. J Intern Med 2000; 248: 230-8
134. Reaven GM. The kidney: an unwilling accomplice in syndrome X. Am J Kidney Dis 1997; 30: 928-31
135. Simoneau J-A, Colberg SR, Thaete FL, et al. Skeletal muscle glycolytic and oxidative enzyme capacities and determinants of insulin sensitivity and muscle composition in obese women. FASEB J 1995; 9: 273-8
136. Kelley DE, Mandriano LJ. Fuel selection in human skeletal muscle in insulin resistance. Diabetes 2000; 49: 677-83
137. Pan DA, Lillioja S, Kritetos AD, et al. Skeletal muscle triglyceride levels are inversely related to insulin action in man. Diabetes 1997; 46: 983-8
138. Lillioja S, Young AA, Cutler CL, et al. Skeletal muscle capillary density and fibre type are possible determinants of in vivo insulin resistance in man. J Clin Invest 1987; 80: 415-24
139. Vessby B, Tengblad S, Lithell H. The insulin sensitivity is related to the fatty acid composition of the serum lipids and skeletal muscle phospholipids in 70 year old men. Diabetologia 1994; 37: 1044-50
140. Frayn KN. Insulin resistance, impaired postprandial lipid metabolism and abdominal obesity: a deadly triad. Med Princ Pract 2002; 11 Suppl. 2: 31-40
141. Bonora E. Relationship between regional fat distribution and insulin resistance. Int J Obes Relat Metab Disord 2000; 24 Suppl. 2: S32-5
142. Lewis GF, Carpentier A, Khosrow A, et al. Disordered fat storage and mobilisation in the pathogenesis of insulin resistance and type 2 diabetes. Endocrine Rev 2002; 23: 201-29
143. de Courten M, Zimmet P, Hodge A, et al. Hyperleptinaemia: the missing link in the metabolic syndrome? Diabetes Med 1997; 14: 200-8
144. Poppitt SD, Keogh GF, Prentice AM, et al. Long-term effects of ad libitum low fat, high carbohydrate diets on body weight and serum lipids in overweight subjects with metabolic syndrome. Am J Clin Nutr 2002; 75: 11-20
145. Lehtovirta M, Kaprio J, Forsblom C, et al. Insulin secretion and insulin sensitivity in monozygotic and dizygotic twins. Diabetologia 2000; 43: 285-93
146. McKeigue PM. Fetal effects on insulin resistance and glucose tolerance. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999
147. Ruderman N, Chisholm D, Pi-Sunyer X, et al. The metabolically obese, normal weight individual revisited. Diabetes 1998; 47: 699-713
148. Laaksonen DE, Lakka HM, Lynch J, et al. Cardiorespiratory fitness and vigorous leisure-time physical activity modify the association of small size at birth with the metabolic syndrome. Diabetes Care 2003; 26: 2156-64
149. Martyn CN, Hales CN, Barker DJ, et al. Fetal growth and hyperinsulinemia in adult life. Diabet Med 1998; 15: 688-94
150. Phillips DI, Barker DJ, Hales CN, et al. Thinness at birth and insulin resistance in adult life. Diabetologia 1994; 37: 150-4
151. Phipps K, Barker DJ, Hales CN, et al. Fetal growth and impaired glucose tolerance in men and women. Diabetologia 1993; 36: 225-8
152. Davey Smith G, Hart C. Insulin resistance syndrome and childhood social conditions. Lancet 1997; 349: 284-5
153. Vanhala MJ, Vanhala PT, Keinanen-Kiukaanniemi SM, et al. Relative weight gain and obesity as a child predict metabolic syndrome as an adult. Int J Obes Relat Metab Disord 1999; 23: 656-9
154. Chen W, Bao W, Begum S, et al. Age-related patterns of the clustering of cardiovascular risk variables of syndrome X from childhood to young adulthood in a population made up of Black and White subjects: the Bolalusa Heart Study. Diabetes 2000; 49: 1042-8
155. Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994; 17: 961-7
156. Colditz GA, Willett WC, Rotnitzky A, et al. Weight gain as a risk factor for clinical diabetes in women. Ann Intern Med 1995; 122: 481-6
157. Mayer-Davis J, Monaco JH, Hoen HM, et al. Dietary fat and insulin sensitivity in a triethnic population: the role of obesitas. The Insulin Resistance Atherosclerosis Study (IRAS). Am J Clin Nutr 1997; 65: 79-87
158. Tremblay A. Nutritional determinants of the insulin resistance syndrome. Int J Obes Relat Metab Disord 1995; 19 Suppl. 1: S60-8
159. Wirfalt E, Hedblad B, Gullberg B, et al. Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer Cohort. Am J Epidemiol 2001; 154: 1150-9
160. Vessby B. Dietary fat and insulin action in humans. Br J Nutr 2000; 83 Suppl. 1: S91-6
161. Wolever TMS. Dietary carbohydrates and insulin action in humans. Br J Nutr 2000; 83 Suppl. 1: S97-102
162. Zavaroni I, Bonini L, Gasparini P, et al. Cigarette smokers are relatively glucose intolerant, hyperinsulinemic and dyslipidemic. Am J Cardiol 1994; 73: 904-5
163. Facchini F, Hollenbeck CB, Jeppesen J, et al. Insulin resistance and cigarette smoking. Lancet 1992; 339: 1128-30
164. Eliasson B, Attvall S, Taskinen MR, et al. The insulin resistance syndrome in smokers is related to smoking habits. Arterioscler Thromb 1994; 14: 1946-50
165. Rosmond R, Bjorntorp P. Occupational status, cortisol secretory pattern, and visceral obesity in middle-aged men. Obes Res 2000; 8: 445-50
166. Horsten M, Mittleman MA, Wamala SP, et al. Social relations and the metabolic syndrome in middle-aged Swedish women. J Cardiovasc Risk 1999; 6: 391-7
167. Raikkonen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence? Metabolism 2002; 51: 1573-7
168. Raikkonen K, Matthews KA, Kuller LH, et al. Anger, hostility, and visceral adipose tissue in healthy postmenopausal women. Metabolism 1999; 48: 1146-51
169. Keltikangas-Jarvinen L, Raikkonen K, Hautanen A, et al. Vital exhaustion, anger expression, and pituitary and adrenocortical hormones: implications for the insulin resistance syndrome. Arteriocler Thromb Vasc Biol 1996; 16: 275-80
170. Keltikangas-Jarvinen L, Ravaja N, Viikari J. Identifying Cloninger's temperament profiles as related to the early development of the metabolic cardiovascular syndrome in young men. Arterioscler Thromb Vasc Biol 1996; 19: 1998-2006
171. Lakka TA, Venalainen JM, Rauramaa R, et al. Relation of leisure time physical activity and cardiorespiratory fitness to risk of acute myocardial infarction. N Engl J Med 1994; 330: 1549-54
172. Folsom AR, Arnett DK, Hutchinson RG, et al. Physical activity and incidence of coronary heart disease in middle-aged women and men. Med Sci Sports Exerc 1997; 29: 901-9
173. James SA, Jamjoum L, Raghunathan TE, et al. Physical activity and NIDDM in African-Americans: the Pitt County Study. Diabetes Care 1998; 21: 555-62
174. Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous activity and risk of type 2 diabetes in women: a prospective study. JAMA 1999; 282: 1433-49
175. Lynch J, Helmrich SP, Lakka TA, et al. Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. Arch Intern Med 1996; 156: 1307-14
176. Wei M, Gibbons LW, Mitchell TL, et al. The association between cardiorespiratory fitness and impaired fasting glucose and type 2 diabetes mellitus in men. Ann Intern Med 1998; 130: 89-96
177. Wannamethee SG, Shaper AG, Walker M, et al. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in British middle-aged men. Arch Intern Med 1998; 158: 2433-40
178. Kohl HW. Physical activity and cardiovascular disease: evidence for a dose response. Med Sci Sports Exerc 2001; 33: S472-83
179. Kelley DE, Goodpaster BH. The effects of exercise on glucose homeostasis in type 2 diabetes mellitus. Med Sci Sports Exerc 2001; 33: S495-501
180. Laaksonen DE, Lakka H-M, Salonen JT, et al. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care 2002; 25: 1612-8
181. Zimmet PZ, Collins VR, Dowse GK, et al. The relation of physical activity to cardiovascular disease risk factors in Mauritians. Am J Epidemiol 1991; 134: 862-75
182. Byberg L, Zethelius B, McKeigue PM, et al. Changes in physical activity are associated with changes in metabolic cardiovascular risk factors. Diabetologia 2001; 44: 2134-9
183. Wannamethee SG, Shaper AG, Alberti KGMM. Physical activity, metabolic factors, and the incidence of coronary heart disease and type 2 diabetes. Arch Intern Med 2000; 160: 2108-16
184. Clausen JO, Borch-Johnsen K, Ibsen H, et al. Insulin sensitivity index, acute insulin response, and glucose effectiveness in a population-based sample of 380 young healthy Caucasians: analysis of the impact of gender, body fat, physical fitness, and lifestyle factors. J Clin Invest 1996; 98: 1195-209
185. Mayer-Davis EJ, D'Agostino Jr R, Karter AJ, et al. For the IRAS Investigators. Intensity and amount of physical activity in relation to insulin sensitivity: the Insulin Resistance Atherosclerosis Study. JAMA 1998; 279: 669-74
186. Siscovick DS, Fried L, Mittlemark M, et al. Exercise intensity and subclinical cardiovascular disease in the elderly: the Cardiovascular Health Study. Am J Epidemiol 1997; 145: 977-86
187. Mensink GBM, Heerstrass DW, Neppelenbroek SE, et al. Intensity, duration and frequency of physical activity and coronary risk factors. Med Sci Sports Exerc 1997; 29: 1192-8
188. Thune I, Njolstad I, Lochen M-L, et al. Physical activity improves the
189. Wareham NJ, Hennings SJ, Byrne CD, et al. A quantitative analysis of the relationship between habitual energy expenditure, fitness and the metabolic cardiovascular syndrome. Br J Nutr 1998; 80: 235-41
190. Carroll S, Cooke CB, Butterly RJ. Metabolic risk factor clustering, associations of both physical activity and cardiorespiratory fitness in middle-aged men. Med Sci Sports Exerc 2000; 32: 2079-86
191. Irwin ML, Ainsworth BE, Mayer-Davis EJ, et al. Physical activity and the multiple metabolic syndrome in a tri-ethnic sample of women. Obes Res 2002; 10: 1030-7
192. Kullo IJ, Hensrud DD, Allison TG. Relation of low cardiorespiratory fitness to the metabolic syndrome in middle-aged men. Am J Cardiol 2002; 90: 795-7
193. Lakka TA, Laaksonen DE, Lakka H-M, et al. Sedentary lifestyle, poor cardiorespiratory fitness and the metabolic syndrome. Med Sci Sports Exerc 2003; 35: 1279-86
194. Bevis LC, Blackburn G. The obesity epidemic: prevention and treatment of the metabolic syndrome. Medscape 2002 [online]. Available from URL: http://www.medscape.com [Accessed 2003 Oct 1]
195. Despres J-P. Visceral obesity, insulin resistance, and dyslipidemia: contribution of endurance exercise training to the treatment of the plurimetabolic syndrome. Exerc Sport Sci Rev 1997; 25: 271-300
196. Giles T. Reducing the risk of cardiovascular events through weight loss. Medscape 2002 [online]. Available from URL: http://www.medscape.com [Accessed 2003 Jan]
197. Denke MA, Pasternack RC. Defining and treating the metabolic syndrome: a primer from the Adult Treatment Panel III. Curr Treat Options Cardiovasc Med 2001; 3: 251-3
198. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Relat Metab Disord 1997; 21: 941-7
199. Reaven G. Syndrome X. Curr Treat Options Cardiovasc Med 2001; 3: 323-32
200. Pescatello LS, Van Heest JL. Physical activity mediates a healthier body weight in the presence of obesity. Br J Sports Med 2000; 34: 86-93
201. Smutock MA, Reece PF, Kokkinos PF, et al. Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease. Metabolism 1993; 42: 177-84
202. Katzel LI, Bleecker ER, Rogus EM, et al. Sequential effects of aerobic exercise training and weight loss on risk factors for coronary disease in healthy, obese middle-aged and older men. Metabolism 1997; 46: 1441-7
203. Torjesen PA, Birkeland KI, Anderssen SA, et al. Lifestyle changes may reverse development of the insulin resistance syndrome. The Oslo Diet and Exercise Study: a randomized trial. Diabetes Care 1997; 20: 26-31
204. Anderssen SA, Holme I, Urdal P, et al. Associations between central obesity and indexes of hemostatic, carbohydrate and lipid metabolism: results of a 1-year intervention from the Oslo Diet and Exercise Study. Scand J Med Sci Sports 1998; 8: 109-15
205. Dengel DR, Hagberg JM, Pratley RE, et al. Improvements in blood pressure, glucose metabolism, and lipoprotein lipids after aerobic exercise plus weight loss in obese, hypertensive middle-aged men. Metabolism 1998: 47: 1075-82
206. Watkins LL, Sherwood A, Feinglos M, et al. Effects of exercise and weight loss on cardiac risk factors associated with syndrome X. Arch Intern Med 2003; 163: 1889-95
207. Katzmarzyk PT, Leon AS, Wilmore JH, et al. Targeting the metabolic syndrome with Exercise: evidence from the HERITAGE Family Study. Med Sci Sports Exerc 2003; 35 (10): 1703-9
208. Diabetes Prevention Program Research Group. The effect of intensive lifestyle Intervention (ILS) and metformin (MET) on the incidence of metabolic syndrome among the participants in the Diabetes Prevention Program. American Diabetes Association 63rd Scientific Session. Epidemiology: Predictors of Diabetes; 2003 Jun 16; New Orleans, abstract no. 250-OR
209. Minehira K, Tappy L. Dietary and lifestyle interventions in the management of the metabolic syndrome: present status and future perspective. Eur J Clin Nutr 2002; 56: 1262-9
210. Ryan DH, Diabetes Prevention Program Research Group. Diet and exercise in the prevention of diabetes. Int J Clin Pract Suppl 2003; 134: 28-35
211. Goodpaster BH, Kelley DE, Wing RR, et al. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 1999; 48: 839-47
212. Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med 1999; 20: 1-12
213. Henriksen EJ. Exercise effects of muscle insulin signalling and action. Invited review: effects of acute exercise and exercise training on insulin resistance. J Appl Physiol 2002; 93: 788-96
214. Katzel LI, Bleeker ER, Colman EG, et al. Effects of weight loss vs aerobic exercise training on risk factors for coronary artery disease in healthy, obese, middle-aged and older men. JAMA 1995; 274: 1915-21
215. Ross R, Dagone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after diet-induced weight-loss or exercise induced weight loss. Ann Intern Med 2000; 133: 92-103
216. Dengel DR, Pratley RE, Hagberg JM, et al. Distinct effects of aerobic exercise training and weightless on glucose homeostasis in obese sedentary men. J Appl Physiol 1996; 8: 318-25
217. Davey GJG, Roberts JD, Patel S, et al. Effects of exercise on insulin resistance in South Asians and Europeans. J Exerc Physiol [online] 2000; 3 (2). Available from URL: http:// www.asep.org/JEPDavey.html [Accessed 2004 Mar 23]
218. McAuley KA, Williams SM, Mann JI, et al. Intensive lifestyle changes are necessary to improve insulin sensitivity: a randomised controlled trial. Diabetes Care 2002; 25: 445-52
219. Houmard JA, Tanner CJ, Slentz CA, et al. The effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol 2004; 96 (1): 101-6
220. Short KR, Vittone JL, Bigelow ML, et al. Impact of aerobic exercise training on age-related changes in insulin sensitivity and muscle oxidative capacity. Diabetes 2003; 52: 1888-96
221. Despres J-P, Marette A. Obesity and insulin resistance: epidemiological, metabolic and molecular aspects. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999
222. Smith SR, Zachwieja JJ. Visceral adipose tissue: a critical review of intervention strategies. Int J Obes Relat Metab Disord 1999; 23: 329-35
223. Ross R, Freeman JA, Janssen I. Exercise alone is an effective strategy for reducing obesity and related comorbidities. Exerc Sport Sci Rev 2000; 28: 165-70
224. Di Pietro L, Seeman TE, Stachenfield NS, et al. Moderate-intensity aerobic exercise training improves glucose tolerance in aging independent of abdominal adiposity. J Am Geriatr Soc 1998; 46: 875-9
225. Torjesen PA, Birkeland KI, Anderssen SA, et al. The Oslo Diet and Exercise Study: a randomised trial: lifestyle changes may reverse development of the insulin resistance syndrome. Diabetes Care 1997; 20: 26-31
226. Irwin ML, Yasui Y, Ulrich CM, et al. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: a randomised controlled trial. JAMA 2003; 289: 323-30
227. Liao D, Asberry PJ, Shofer JB, et al. Improvement of BMI, body composition, and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance. Diabetes Care 2002; 25: 1504-10
228. Borch-Johnsen K. The new classification of diabetes mellitus and IGT: a critical approach. Exp Clin Endocrinol Diabetes 2001; 109 Suppl. 2: S86-93
229. Unwin N, Shaw J, Zimmet P, et al. International Diabetes Federation IGT/IFG Consensus Statement. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 2002; 19: 708-23
230. Davies MJ, Raymond NT, Day JL, et al. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics. Diabet Med 2000; 17: 433-40
231. Larsson H, Berglund G, Lindgarde F, et al. Comparison of WHO and ADA criteria for diagnosis of diabetes and glucose intolerance. Diabetologia 1998; 41: 1124-5
232. Rathman W, Giani G, Mielck A. Cardiovascular risk factors in newly diagnosed abnormal glucose tolerance: comparison of 1997 ADA and 1985 WHO criteria. Diabetologia 1999; 42: 1268-9
233. Hanefeld M, Temelkova-Kurktschiev T, Schaper F, et al. Impaired fasting glucose is not a risk factor for atherosclerosis. Diabet Med 1999; 16: 212-8
234. DECODE Study Group. Glucose tolerance and mortality: comparison of the WHO and ADA diagnostic criteria. Lancet 1999; 354: 617-21
235. Potteiger JA, Jacobsen DJ, Donnelly JE. A comparison of methods for analysing glucose and insulin areas under the curve following nine months of exercise in overweight adults. Int J Obes Relat Metab Disord 2002; 26: 87-9
236. Dengel DR, Galecki AT, Hagberg JM, et al. The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men. Am J Hypertens 1998; 11: 1405-12
237. Stefanick ML, Mackey S, Sheehan M, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med 1998; 339: 12-20
238. Blumenthal JA, Sherwood A, Gullette ECD, et al. Exercise and weight loss reduce blood pressure in men and women with mild hypertension. Arch Intern Med 2000; 160: 1947-58
239. Hellenius ML, Brismar KE, Berglund BH, et al. Effects on glucose tolerance, insulin secretion, insulin-like growth factor 1 and its binding protein, IGFBP-1, in a randomised controlled diet and exercise study in healthy middle-aged men. J Intern Med 1995; 238: 121-30
240. Pan X, Li G, Hu Y-H, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT Diabetes Study. Diabetes Care 1997; 20: 537-44
241. Li G, Hu Y, Yang W, et al. Effects of insulin resistance and insulin secretion on the efficacy of interventions to retard development of type 2 diabetes mellitus: the Da Qing IGT and Diabetes Study. Diabetes Res Clin Pract 2002; 58: 193-200
242. Toumilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-50
243. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403
244. Grundy SM. Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome. Am J Cardiol 1998; 81: 18B-25B
245. Howard BV, Mayer-Davis EJ, Goff D, et al. Relationships between insulin resistance and lipoproteins in nondiabetic African Americans, Hispanics, and non-Hispanic Whites: the Insulin Resistance Atherosclerosis Study. Metabolism 1998; 47: 1174-9
246. Reaven GM, Chen Y-DI, Jeppesen J, et al. Insulin resistance and hyperinsulinemia in individuals with small, dense, low density lipoprotein particles. J Clin Invest 1993; 92: 141-6
247. Sattar N, Tan CE, Han TS, et al. Associations of indicies of adiposity with atherogenic lipoprotein subfractions. Int J Obes Relat Metab Disord 1998; 22: 432-9
248. Abbassi F, McLaughlin T, Lamendola C, et al. Insulin regulation of plasma free fatty acid concentrations is abnormal in healthy subjects with muscle insulin resistance. Metabolism 2000; 49: 151-4
249. Bjorntorp P. 'Portal' adipose tissue as a generator of risk factors for cardiovascular disease and diabetes. Arterioscler Thromb 1990; 10: 493-6
250. Laws A. Insulin resistance and dyslipidemia: implications for coronary heart disease risk. In: Reaven G, Laws A, editors. Contemporary endocrinology. Insulin resistance: the metabolic syndrome X. Totowa (NJ): Humana Press Inc., 1999
251. Taskinen MR. Insulin resistance and lipoprotein metabolism. Curr Opin Lipidol 1995; 6: 153-601
252. Durstine JL, Grandjean PW, Davis PG, et al. Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis. Sports Med 2001; 31: 1033-62
253. Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc 2001: 33: S502-15
254. Halbert JA, Silagy CA, Finucane P, et al. Exercise training and blood lipids in hyperlipidemia and normolipidemic adults: a meta-analysis of randomised, controlled trials. Euro J Clin Nutr 1999; 53: 514-22
255. Gallagher D, Heymsfield SB, Heo M, et al. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr 2000 Sep; 72 (3): 694-701
256. Zhu S, Wang Z, Shen WS, et al. Percentage body fat ranges associated with metabolic syndrome risk: results based on the third National Health and Nutrition Examination Survey (1988-1994). Am J Clin Nutr 2003; 78: 228-35
257. Kiens B, Jorgensen I, Lewis S, et al. Increased plasma HDL-cholesterol and aop A-1 in sedentary middle-aged men after physical conditioning. Euro J Clin Invest 1980; 10: 203-9
258. Juneau M, Rogers F, De Santos V, et al. Effectiveness of self-monitored, home-based, moderate-intensity exercise training in middle-aged men and women. Am J Cardiol 1987; 60: 66-70
259. Wood PD, Stefanick ML, Dreon DM, et al. Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med 1988; 319: 1173-9
260. King AC, Haskell WL, Taylor B, et al. Group- vs home-based exercise training in healthy older men and women: a community-based clinical trial. JAMA 1991; 266: 1535-42
261. Nieman DC, Warren BJ, O'Donnell KA, et al. Physical activity and serum lipids in elderly women. J Am Geriatr Soc 1993; 41: 1339-44
262. Anderssen SA, Haaland A, Hjermann I, et al. Oslo Diet and Exercise Study: a one-year randomised intervention trial: effect on hemostatic and other coronary risk factors. Nutr Metab Cardiovasc Dis 1995; 5: 189-200
263. Ready EA, Drinkwater D, Ducas J, et al. Walking program reduces elevated cholesterol in women postmenopause. Can J Cardiol 1995; 11: 905-12
264. Eriksson J, Tuominen J, Valle T, et al. Aerobic endurance exercise or circuit-type resistance training for individuals with impaired glucose tolerance. Horm Metab Res 1998; 30: 37-41
265. Wing RR, Venditti EV, Jakicic JM, et al. Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care 1998; 21: 350-9
266. Kokkinos PF, Narayan P, Colleran J, et al. Effects of moderate intensity exercise on serum lipids in African-American men with severe systemic hypertension. Am J Cardiol 1998; 81: 732-5
267. Lavrencic A, Salobir BG, Keber I. Physical training improves flow-mediated dilation in patients with the polymetabolic syndrome. Arterioscler Thromb Vasc Biol 2000; 20: 551-60
268. Nieman DC, Brock DW, Butterworth D, et al. Reducing diet and/or exercise training decreases the lipid and lipoprotein risk factors of moderately obese women. J Am Coll Nutr 2002; 21: 344-50
269. Kraus WE, Houmard JA, Duscha BD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med 2002; 347: 1483-92
270. Schuit AJ, Schouten EG, Miles TP, et al. The effect of six months training on weight, body fatness and serum lipids in apparently healthy elderly Dutch men and women. Int J Obes Relat Metab Disord 1998; 22: 847-53
271. Clarke M, Oxman AD, editors. Cochrane Reviewers' Handbook 4.2.0 [updated 2003 Mar]. Available from URL: http:// www.cochrane.dk/cochrane/handbook/ handbook.htm. [Accessed 2003 Oct 10]
272. Sutton AJ, Abrams KR, Jones DR, et al. Methods for meta-analysis in medical research. Chichester: John Wiley & Sons, 2001
273. Follmann D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 1992; 45: 769-73
274. Egger M, Davey Smith G. Meta-analysis: potentials and promise. BMJ 1997; 315: 1371-4
275. Jüni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Books, 2001
276. Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando (FL): Academic Press, 1985
277. Decks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG, editors. Systematic reviews in healthcare: meta-analysis in context. 2nd ed. London: BMJ Books, 2001: 285-312
278. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-60
279. Sterne JAC, Egger M, Davey Smith G. Meta-analysis: investigating and dealing with publication and other bias. In: Egger M, Davey Smith G, Altman DG, editors: Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Books, 2001: 189-210
280. Sterne JAC, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001; 54: 1046-55
281. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-34
282. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-99
283. Oja P. Dose response between total volume of physical activity and health and fitness. Med Sci Sports Exerc 2001; 33: S428-34
284. Wing RR. Physical activity in the treatment of adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc 1999; 31 (11 Suppl.): S547-52
285. Couillard C, Despres J-P, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health Risk Factors Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol 2001; 21: 1226-32
286. Williams PT, Krauss RM, Vranizan KM, et al. Changes in lipoprotein subfractions during diet-induced and exercise-induced weight loss in moderately overweight men. Circulation 1990; 81: 1293-304
287. Williams PT, Krauss KM, Vranizan KM, et al. Effects of exercise-induced weight loss on LDL subfractions in healthy men. Arteriosclerosis 1989; 9: 623-32
288. Doria A, Fioretto P, Avogaro A, et al. Insulin resistance is associated with high sodium-lithium countertransport activity in essential hypertension. Am J Physiol 1991; 261: E691-4
289. Sowers JR, Epstein M, Frolich ED. Diabetes, hypertension and cardiovascular disease: an update. Hypertension 2001; 37: 1053-9
290. The sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413-46
291. World Health Organisation. International Society of Hypertension Guidelines for the Management of Hypertension: Guidelines Subcommittee. J Hypertens 1999; 17: 151-83
292. Staessen J, Fagard R, Amery A. The relationship between body weight and blood pressure. J Hypertens 1988; 2: 207-17
293. Brand MB, Mulrow CD, Chiquette E, et al. Dieting to reduce body weight for controlling hypertension in adults. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 1. Oxford: Update Software, 2000
294. Hermansen K. Diet, blood pressure and hypertension. Br J Nutr 2000; 83 Suppl. 1: S113-9
295. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med 2000; 30: 193-206
296. Fagard RH. Exercise characteristics and blood pressure response to dynamic physical training. Med Sci Sports Exerc 2001; 33: S484-92
297. Fagard RH. Physical activity in the prevention and treatment of hypertension in the obese. Med Sci Sports Exerc 1999; 31(11 Suppl.): S624-30
298. Niedfeldt MW. Managing hypertension in athletes and physically active patients. Am Fam Physician 2002; 66: 445-52
299. Gordon N. Hypertension. In: Durstine JL, Moore GE, editors. ACSM's exercise management for persons with chronic diseases and disabilities. 2nd ed. American College of Sports Medicine. Champaign (IL): Human Kinetics, 2003: 76-80
300. Miller ED, Erlinger TP, Young DR, et al. Results of the diet, exercise, and weight loss intervention trial. Hypertension 2002; 40: 612-8
301. Devereux RB, Roman MJ. Hypertensive cardiac hypertrophy: pathophysiologic and clinical characteristics. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis and management. 2nd ed. New York (NY): Reaven Press Ltd, 1995: 409-24
302. Rutter MK, Parise H, Benjamin EJ, et al. Impact of glucose intolerance and insulin resistance on cardiac structure and function: sex-related differences in the Framingham Heart Study. Circulation 2003; 107: 448-54
303. Lind L, Anderssen PE, Andren B, et al. Left ventricular hypertrophy in hypertension is associated with the insulin resistance syndrome. J Hypertens 1995; 13: 433-8
304. Morricone L, Malavazos AE, Coman C, et al. Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat. Obes Res 2002, 98
305. Kannel WB. Risk stratification in hypertension: new insights from the Framingham study. Am J Hypertens 2000; 13: 3S-10S
306. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J 2001; 141: 334-41
307. Weber MA, Smith DH, Neutel JM, et al. The therapeutic implications of left ventricular hypertrophy in the hypertensive patient. Am J Ther 1995; 2: 972-7
308. MacMahon SW, Wilcken DEL, Macdonald GJ. The effect of weight reduction on left ventricular mass: a randomised controlled trial in young overweight hypertensive patients. N Engl J Med 1986; 314: 334-9
309. Farerberg B, Berglund A, Anderssen OK, et al. Cardiovascular effects of weight reduction versus antihypertensive drug treatment: a comparative, randomised, 1-year study of obese men with mild hypertension. J Hypertens 1991; 9: 431-9
310. Hiemeno E, Nishino K, Okazaki T, et al. A weight reduction and weight maintenance program with long-lasting improvement in ventricular mass and blood pressure. Am J Hypertens 1999; 12: 682-90
311. Hinderlitter A, Sherwood A, Gullette ECD, et al. Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension. Arch Intern Med 2002; 162: 1333-9
312. Lalonde L, Gray-Donald K, Lowensteyn I, et al. Comparing the benefits of diet and exercise in the treatment of dyslipidemia. Prev Med 2002; 35: 16-24
313. Andersen RE, Wadden TA, Bartlett SJ, et al. Effects of lifestyle activity vs structured aerobic exercise in obese women: a randomised trial. JAMA 1999; 281: 335-40
314. Snyder KA, Donnelly JE, Jabobsen DJ, et al. The effects of long-term, moderate intensity, intermittent exercise on aerobic capacity, body composition, blood lipids, insulin and glucose in overweight females. Int J Obes Relat Metab Disord 1997; 21: 1180-9
315. Purnell JQ, Brunzell JD. The central role of dietary fat, not carbohydrate, in the insulin resistance syndrome. Curr Opin Lipidol 1997; 8: 17-22
316. Wolever TM, Mehling C. High carbohydrate-low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance. Br J Nutr 2002; 87: 477-87
317. Dumesnil JG, Turgeon J, Tremblay A, et al. Effect of a low-glycaemic index-low-fat-high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr 2001; 86: 557-68