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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">BR</journal-id>
<journal-title-group>
<journal-title>Biomedical Reports</journal-title>
</journal-title-group>
<issn pub-type="ppub">2049-9434</issn>
<issn pub-type="epub">2049-9442</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/br.2019.1242</article-id>
<article-id pub-id-type="publisher-id">BR-0-0-1242</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Articles</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Comparison of the effect of light alcohol consumption on Japanese men with and without fatty liver</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Hara</surname><given-names>Tasuku</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
<xref rid="af2-br-0-0-1242" ref-type="aff">2</xref>
<xref rid="c1-br-0-0-1242" ref-type="corresp"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Seko</surname><given-names>Yuya</given-names></name>
<xref rid="af2-br-0-0-1242" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Iwai</surname><given-names>Naoto</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Inada</surname><given-names>Yutaka</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tsuji</surname><given-names>Toshifumi</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Okuda</surname><given-names>Takashi</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Komaki</surname><given-names>Toshiyuki</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Itoh</surname><given-names>Yoshito</given-names></name>
<xref rid="af2-br-0-0-1242" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Kagawa</surname><given-names>Keizo</given-names></name>
<xref rid="af1-br-0-0-1242" ref-type="aff">1</xref>
</contrib>
</contrib-group>
<aff id="af1-br-0-0-1242"><label>1</label>Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama City, Kyoto 620-8505, Japan</aff>
<aff id="af2-br-0-0-1242"><label>2</label>Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kamigyou-ku, Kyoto 602-8566, Japan</aff>
<author-notes>
<corresp id="c1-br-0-0-1242"><italic>Correspondence to:</italic> Dr Tasuku Hara, Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, 231 Atsunaka-chou, Fukuchiyama City, Kyoto 620-8505, Japan <email>t-hara@koto.kpu-m.ac.jp</email></corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>11</month>
<year>2019</year></pub-date>
<pub-date pub-type="epub">
<day>20</day>
<month>09</month>
<year>2019</year></pub-date>
<volume>11</volume>
<issue>5</issue>
<fpage>191</fpage>
<lpage>198</lpage>
<history>
<date date-type="received">
<day>29</day>
<month>07</month>
<year>2019</year>
</date>
<date date-type="accepted">
<day>23</day>
<month>08</month>
<year>2019</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright: &#x00A9; Hara et al.</copyright-statement>
<copyright-year>2019</copyright-year>
<license license-type="open-access">
<license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivs License</ext-link>, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.</license-p></license>
</permissions>
<abstract>
<p>Light and moderate drinking is associated with lower risk of metabolic syndrome (Mets)-related diseases in the general population. Non-alcoholic fatty liver disease (NAFLD) is considered to be a phenotype of Mets in the liver. Although there have been some reports of the association between NAFLD and light alcohol consumption (LAC), the association between Mets-related diseases and LAC in the subjects with and without fatty liver is unclear. Therefore, this study aimed to determine the influence of LAC on Mets-related diseases in individuals with and those without fatty liver. This study included 1,190 men who underwent regular health check-ups and consumed &#x003C;20 g/day of alcohol. The subjects were divided into two groups, the non-fatty liver group and fatty liver group, and investigated the association between Mets-related diseases and LAC. Fatty liver was diagnosed by abdominal ultrasound. The effect of LAC was different between the non-fatty liver and fatty liver groups. In the non-fatty liver group, the odds ratio (OR) for hypertension was 1.73 (1.04-2.88;2 P=0.035). In the fatty liver group, the OR for each Mets-related diseases were as follows: Dyslipidemia, 0.64 (0.44-0.95, P=0.028); impaired glucose tolerance 0.57 (0.37-0.88; P=0.012); chronic kidney disease, 0.58 (0.36-0.94; P=0.029); and Mets by Japanese criteria, 0.63 (0.44-0.92; P=0.016). The influence of LAC on Mets-related diseases differs based on the presence of fatty liver. In individuals without fatty liver, light drinking is an independent risk factor for hypertension.</p>
</abstract>
<kwd-group>
<kwd>light alcohol consumption</kwd>
<kwd>fatty liver</kwd>
<kwd>metabolic syndrome</kwd>
<kwd>hypertension</kwd>
<kwd>regular health check-up</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>The prevalence of metabolic syndrome (Mets), which is defined as obesity with hypertension or glucose intolerance, has been increasing worldwide and varies from 12-41&#x0025; (<xref rid="b1-br-0-0-1242" ref-type="bibr">1</xref>). Several studies demonstrated that moderate alcohol consumption reduces the risk of Mets-related diseases and mortality (<xref rid="b2-br-0-0-1242 b3-br-0-0-1242 b4-br-0-0-1242 b5-br-0-0-1242 b6-br-0-0-1242 b7-br-0-0-1242 b8-br-0-0-1242" ref-type="bibr">2-8</xref>). Light or moderate alcohol consumption is reported to enhance insulin sensitivity, increase high-density lipoprotein cholesterol (HDL-C) and reduce the risk of type 2 diabetes mellitus (<xref rid="b9-br-0-0-1242" ref-type="bibr">9</xref>). Moreover, non-alcoholic fatty liver disease (NAFLD) is considered a phenotype of Mets in the liver (<xref rid="b10-br-0-0-1242 b11-br-0-0-1242 b12-br-0-0-1242" ref-type="bibr">10-12</xref>). According to previous studies in Japan, the prevalence of NAFLD in the general population ranges from 24.6-29.7&#x0025; (<xref rid="b13-br-0-0-1242" ref-type="bibr">13</xref>,<xref rid="b14-br-0-0-1242" ref-type="bibr">14</xref>) and light or moderate alcohol consumption is negatively associated with fatty liver (<xref rid="b15-br-0-0-1242 b16-br-0-0-1242 b17-br-0-0-1242 b18-br-0-0-1242 b19-br-0-0-1242" ref-type="bibr">15-19</xref>). Previously, chronic kidney disease (CKD) has been considered a renal phenotype of Mets (<xref rid="b20-br-0-0-1242" ref-type="bibr">20</xref>). Previous studies reported that light or moderate alcohol consumption reduced the risk of CKD (<xref rid="b21-br-0-0-1242" ref-type="bibr">21</xref>,<xref rid="b22-br-0-0-1242" ref-type="bibr">22</xref>). Elevated serum uric acid has been proposed as a risk factor for not only CKD (<xref rid="b23-br-0-0-1242" ref-type="bibr">23</xref>) but also diabetes (<xref rid="b24-br-0-0-1242" ref-type="bibr">24</xref>) and hypertension (<xref rid="b25-br-0-0-1242" ref-type="bibr">25</xref>). While alcohol consumption has been recognized as an important risk factor for gout and hyperuricemia, moderate alcohol consumption does not increase the risk of hyperuricemia (<xref rid="b26-br-0-0-1242" ref-type="bibr">26</xref>,<xref rid="b27-br-0-0-1242" ref-type="bibr">27</xref>). However, certain studies reported that even light alcohol consumption (LAC) could increase blood pressure in Japanese men (<xref rid="b28-br-0-0-1242 b29-br-0-0-1242 b30-br-0-0-1242" ref-type="bibr">28-30</xref>).</p>
<p>Recently, liver dysfunction and hypercholesterolemia have been reported as the most common abnormal findings associated with Mets among individuals who underwent a regular health check-up in Japan. The main reason for the increase in liver dysfunction is associated with the increasing incidence of NAFLD (<xref rid="b31-br-0-0-1242" ref-type="bibr">31</xref>). Although there have been some reports on the effect of LAC on Mets-related diseases in individuals with NAFLD, the association between LAC and each Mets-related disease among those with or without fatty liver is unclear. Therefore, this study investigated the effect of LAC on Mets-related diseases, such as obesity, dyslipidemia, impaired glucose tolerance (IGT), hyperuricemia and CKD, in individuals with and without fatty liver.</p>
</sec>
<sec sec-type="Patients|methods">
<title>Patients and methods</title>
<sec>
<title/>
<sec>
<title>Subjects</title>
<p>In this cross-sectional study, 2,096 men who underwent regular health check-up, including physical and physiological examinations, abdominal ultrasound, and blood screening examination, between January 2017 and December 2017 at Fukuchiyama City Hospital (Fukuchiyama City, Japan) were enrolled. Subjects were included if they fulfilled the following criteria: Absence of markers of hepatitis B surface antigen and hepatitis C antibody, alcohol consumption &#x2265;20 g/day, and chronic liver diseases, including autoimmune hepatitis, primary biliary cholangitis, and drug-induced liver disease. Patients judged to be inappropriate for this study were excluded (n=906). A total of 1,190 eligible subjects were analyzed. Patient characteristics are shown in <xref rid="tI-br-0-0-1242" ref-type="table">Table I</xref>. All patients provided written informed consent prior to participation and the study was conducted in accordance with the Declaration of Helsinki and was approved by the institutional review board of Fukuchiyama City Hospital.</p>
</sec>
<sec>
<title>Physical examination and serum biochemistry</title>
<p>The subjects were divided into two groups: Fatty liver group and non-fatty liver group. Body weight and height were obtained for both groups, and body mass index (BMI) was calculated. Waist circumference (WC) was measured at the level of the umbilicus according to the definition in the Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome (<xref rid="b32-br-0-0-1242" ref-type="bibr">32</xref>). Venous blood samples (10 ml) were obtained from all subjects following a 12-h overnight fast. Aspartate aminotransferase, alanine aminotransferase, &#x03B3;-glutamyl transpeptidase (GGT), total cholesterol, HDL-C, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c; National Glycohemoglobin Standardization Program) and estimated glomerular filtration rate (eGFR) were measured using standard clinical chemistry laboratory techniques.</p>
</sec>
<sec>
<title>Assessment of fatty liver</title>
<p>All the subjects received an abdominal ultrasound to assess fatty liver. Experienced technicians performed real-time ultrasonography to detect vascular blurring, deep attenuation and increased liver echotexture in comparison to the kidneys (liver-kidney contrast) to assess fatty infiltration (<xref rid="b33-br-0-0-1242" ref-type="bibr">33</xref>). Each certificated gastroenterologist independently reviewed the images and judged that the presence of one or more findings was indicative of a fatty liver.</p>
</sec>
<sec>
<title>Evaluation of alcohol consumption</title>
<p>Lifestyle-related information, such as medical history, smoking status and alcohol consumption, was obtained using a common standardized self-response questionnaire. The amount of alcohol consumption per day was calculated in grams using the representative percentage of alcohol by volume of each type of alcohol beverage. Subjects were classified into two groups according to drinking information: Non-drinkers and light drinkers; the latter is defined as those who consumed &#x003E;0 to &#x003C;20 g of alcohol per day.</p>
</sec>
<sec>
<title>Variables</title>
<p>Obesity was defined as BMI &#x2265;25 kg/m<sup>2</sup>, which is the commonly used definition of obesity in the Japanese population (<xref rid="b34-br-0-0-1242" ref-type="bibr">34</xref>). Hypertension was defined as systolic blood pressure (SBP) &#x2265;140 mmHg, diastolic blood pressure (DBP) &#x2265;90 mmHg, or the use of medications for hypertension. Dyslipidemia was defined as TG &#x2265;150 mg/dl, HDL-C &#x003C;40 mg/dl and LDL-C &#x2265;140 mg/dl or the use of medications for dyslipidemia. IGT was defined as FPG &#x2265;110 mg/dl or the use of medications for diabetes mellitus. Hyperuricemia was defined as UA &#x003E;7.0 mg/dl or the use of medications for hyperuricemia. CKD was defined as eGFR &#x003C;60 ml/min/1.73 m<sup>2</sup> and/or overt proteinuria (<xref rid="b35-br-0-0-1242" ref-type="bibr">35</xref>). According to the Japanese criteria, Mets is defined as WC &#x2265;85 cm and the presence of two or more of the following risk factors: SBP &#x2265;130 mmHg or DBP &#x2265;85 mmHg; reduced HDL-C (HDL-C &#x003C;40 mg/dl) and/or increased TG (TG &#x2265;150 mg/dl); and FPG &#x2265;110 mg/dl.</p>
</sec>
<sec>
<title>Statistical analysis</title>
<p>Baseline data were expressed as median with interquartile range and subject number (&#x0025;) for categorical variables. P-values were calculated using a Mann-Whitney U test for continuous variables and Fisher&#x0027;s exact probability test or the Chi square test for categorical variables. Factors with a significant influence on the prevalence of hypertension in the non-fatty liver group were determined by univariate analysis. Age, obesity, dyslipidemia, IGT, hyperuricemia, CKD, smoking and LAC were subsequently subjected to multivariable logistic regression analyses. P&#x003C;0.05 was considered to indicate a statistically significant difference. IBM SPSS version 16.0 for Windows (SPSS, Inc.) was used in the statistical analyses.</p>
</sec>
</sec>
</sec>
<sec sec-type="Results">
<title>Results</title>
<sec>
<title/>
<sec>
<title>Clinical characteristics of non-drinkers and light drinkers</title>
<p>The protocol followed for participant selection and enrollment is shown in <xref rid="f1-br-0-0-1242" ref-type="fig">Fig. 1</xref>. Of the 2,096 participants, 906 were excluded. Of the 1,190 participants included in the analysis, 505 (42.4&#x0025;) were non-drinkers and 685 (57.6&#x0025;) were light drinkers. <xref rid="tI-br-0-0-1242" ref-type="table">Table I</xref> shows the comparison of the clinical characteristics between non-drinkers and light drinkers. No significant difference was noted between non-drinkers and light drinkers in terms of age and BMI. TG, LDL, HbA1c and the prevalence of proteinuria were significantly decreased in light drinkers compared with in non-drinkers (P&#x003C;0.01). DBP, HDL, GGT, and Fib-4 index were significantly increased in light drinkers compared with in non-drinkers (P&#x003C;0.05). No significant difference was observed between non-drinkers and light drinkers in the prevalence of hypertension and hyperuricemia. The prevalence of obesity, dyslipidemia, IGT, fatty liver, CKD and Mets, according to the Japanese criteria, was significantly decreased in light drinkers compared with in non-drinkers (P&#x003C;0.05); in fact, this prevalence was lowest in light drinkers among the 4 groups of participants (non-drinkers; light drinkers, alcohol use/day &#x003C;20 g; moderate drinkers, alcohol use/day 20-59 g; heavy drinkers, alcohol use/day &#x2265;60 g; <xref rid="SD1-br-0-0-1242" ref-type="supplementary-material">Table SI</xref>). Among the lifestyle parameters, regular exercise habit was significantly more prevalent in light drinkers than in non-drinkers (P&#x003C;0.05), but no significant difference was noted between non-drinkers and light drinkers in terms of current smoking.</p>
</sec>
<sec>
<title>Treatment for each Mets-related diseases in non-drinkers and light drinkers</title>
<p>A comparison of the treatment for each Mets-related disease between non-drinkers and light drinkers is shown in <xref rid="tII-br-0-0-1242" ref-type="table">Table II</xref>. No significant difference in the treatment for hypertension was observed between non-drinkers and light drinkers. DBP in those without treatment for hypertension was significantly increased in light drinkers compared with in non-drinkers (P&#x003C;0.01). No significant difference in the treatment for dyslipidemia was noted between non-drinkers and light drinkers. Regardless of treatment for dyslipidemia, HDL was significantly increased in light drinkers compared with in non-drinkers (P&#x003C;0.001). TG and HDL levels in those without treatment for dyslipidemia were significantly decreased in light drinkers compared with those in non-drinkers. The number of subjects receiving treatment for IGT was significantly decreased among light drinkers compared with among non-drinkers (P&#x003C;0.05). No significant difference was found in the treatment for hyperuricemia between non-drinkers and light drinkers.</p>
</sec>
<sec>
<title>Prevalence of Mets-related diseases and risk factors between non-drinkers and light drinkers</title>
<p>A comparison of the prevalence of each risk factor for Mets-related diseases between non-drinkers and light drinkers in the non-fatty liver and fatty liver groups are shown in <xref rid="tIII-br-0-0-1242" ref-type="table">Table III</xref>. In the non-fatty liver group, no significant difference was found in age and BMI between non-drinkers and light drinkers. The prevalence of hypertension was significantly increased in light drinkers compared with in non-drinkers (P&#x003C;0.05; <xref rid="tIII-br-0-0-1242" ref-type="table">Table III</xref>). In the fatty liver group, no significant difference was observed in age and BMI between non-drinkers and light drinkers. The prevalence of dyslipidemia, IGT and Mets by the Japanese criteria was significantly decreased in light drinkers than in non-drinkers (P&#x003C;0.05; <xref rid="tIII-br-0-0-1242" ref-type="table">Table III</xref>).</p>
</sec>
<sec>
<title>Odds ratio for each Mets-related diseases comparing light drinkers to non-drinkers</title>
<p>The odds ratio &#x005B;OR; 95&#x0025; confidence interval (CI), P-value&#x005D; for each Mets-related disease in light drinkers and non-drinkers is shown in <xref rid="f2-br-0-0-1242" ref-type="fig">Fig. 2</xref>. In the non-fatty liver group, the OR for hypertension among light drinkers was 1.73 (1.04-2.88, P=0.035). In the fatty liver group, the OR for each Mets-related disease among light drinkers were as follows: Dyslipidemia, 0.64 (0.44-0.95, P=0.028); IGT, 0.57 (0.37-0.88, P=0.012); CKD, 0.58 (0.36-0.94, P=0.029) and Mets by the Japanese criteria, 0.63 (0.44-0.92, P=0.016).</p>
</sec>
</sec>
</sec>
<sec sec-type="Discussion">
<title>Discussion</title>
<p>In this cross-sectional study, the results indicated that the effect of LAC was different between individuals with and those without fatty liver. In the non-fatty liver group, the prevalence of hypertension in light drinkers was 35.3&#x0025;, which was increased compared with in non-drinkers (26.6&#x0025;). In the fatty liver group, the prevalence of dyslipidemia, IGT, CKD and Mets by the Japanese criteria was lower in light drinkers than that in non-drinkers.</p>
<p>Fatty liver among non-drinkers and light drinkers was diagnosed as NAFLD, which is considered a phenotype of Mets in the liver (<xref rid="b10-br-0-0-1242 b11-br-0-0-1242 b12-br-0-0-1242" ref-type="bibr">10-12</xref>). Previous studies reported that light or moderate alcohol consumption is negatively associated with fatty liver (<xref rid="b15-br-0-0-1242 b16-br-0-0-1242 b17-br-0-0-1242 b18-br-0-0-1242 b19-br-0-0-1242" ref-type="bibr">15-19</xref>). The mechanism of inverse association of alcohol consumption with fatty liver has been previously elucidated. Moderate alcohol consumption has been shown to reduce fasting serum insulin and TG levels and is associated with a lower incidence of diabetes, all of which are important risk factors for the development of NAFLD (<xref rid="b2-br-0-0-1242" ref-type="bibr">2</xref>,<xref rid="b36-br-0-0-1242" ref-type="bibr">36</xref>). In addition, certain studies revealed that the level of adiponectin, which is a hormone involved in lipid and glucose homeostasis and is reduced in patients with NAFLD, is upregulated in people who consume alcohol (<xref rid="b37-br-0-0-1242 b38-br-0-0-1242 b39-br-0-0-1242" ref-type="bibr">37-39</xref>). Antioxidant agents in alcoholic beverages, mostly in wine (<xref rid="b15-br-0-0-1242" ref-type="bibr">15</xref>), may also exert a protective effect in NAFLD. In this study, the serum levels of TG, LDL and HbA1c were lower, and the prevalence of IGT and fatty liver was decreased in light drinkers compared with in non-drinkers.</p>
<p>The relationship between alcohol consumption and all-cause mortality has been reported to have J- or U-shaped curve (<xref rid="b8-br-0-0-1242" ref-type="bibr">8</xref>). This effect is thought to be mainly because of reduction in cardiovascular disease (<xref rid="b40-br-0-0-1242" ref-type="bibr">40</xref>,<xref rid="b41-br-0-0-1242" ref-type="bibr">41</xref>), which can be attributed to the beneficial effect of alcohol on plasma lipids levels, hemostatic factors (<xref rid="b2-br-0-0-1242" ref-type="bibr">2</xref>,<xref rid="b41-br-0-0-1242" ref-type="bibr">41</xref>) and insulin sensitivity (<xref rid="b36-br-0-0-1242" ref-type="bibr">36</xref>). Several studies have shown the influence of lifestyle factors on better mortality in moderate drinkers. Moderate alcohol users tend to have higher socioeconomic status, high level of education, increased physical activity and less obesity (<xref rid="b42-br-0-0-1242" ref-type="bibr">42</xref>,<xref rid="b43-br-0-0-1242" ref-type="bibr">43</xref>). The prevalence of subjects with regular exercise habit was greater in light drinkers in the present study.</p>
<p>Moreover, the present study indicated that in all subjects, the prevalence of obesity, dyslipidemia, IGT, fatty liver, CKD and Mets by the Japanese criteria was decreased among light drinkers compared with among non-drinkers. These results agreed with those of previous reports (<xref rid="b2-br-0-0-1242 b3-br-0-0-1242 b4-br-0-0-1242 b5-br-0-0-1242 b6-br-0-0-1242 b7-br-0-0-1242 b8-br-0-0-1242 b9-br-0-0-1242" ref-type="bibr">2-9</xref>,<xref rid="b15-br-0-0-1242 b16-br-0-0-1242 b17-br-0-0-1242 b18-br-0-0-1242 b19-br-0-0-1242 b20-br-0-0-1242 b21-br-0-0-1242 b22-br-0-0-1242" ref-type="bibr">15-22</xref>,<xref rid="b36-br-0-0-1242" ref-type="bibr">36</xref>,<xref rid="b37-br-0-0-1242" ref-type="bibr">37</xref>,<xref rid="b40-br-0-0-1242 b41-br-0-0-1242 b42-br-0-0-1242 b43-br-0-0-1242 b44-br-0-0-1242 b45-br-0-0-1242" ref-type="bibr">40-45</xref>). In the non-fatty liver group, because the prevalence of Mets-related diseases was low, no significant relationship between LAC and the prevalence of Mets-related diseases without hypertension was observed. In the fatty liver group, a relationship between LAC and lower prevalence of dyslipidemia, IGT, CKD and Mets by the Japanese criteria was observed. The inverse association between LAC and the prevalence of dyslipidemia, IGT, CKD, and Mets by the Japanese criteria may be explained by an improvement in insulin sensitivity and other metabolic parameters, including improved cytokine profiles and decreased oxidative stress, as has been described in the general population (<xref rid="b8-br-0-0-1242" ref-type="bibr">8</xref>,<xref rid="b12-br-0-0-1242" ref-type="bibr">12</xref>,<xref rid="b30-br-0-0-1242" ref-type="bibr">30</xref>,<xref rid="b44-br-0-0-1242" ref-type="bibr">44</xref>,<xref rid="b45-br-0-0-1242" ref-type="bibr">45</xref>). NAFLD is considered a phenotype of Mets in the liver (<xref rid="b10-br-0-0-1242 b11-br-0-0-1242 b12-br-0-0-1242" ref-type="bibr">10-12</xref>) and in the fatty liver group, the prevalence of each Mets-related disease was actually increased compared with in the non-fatty liver group in this study. Thus, the effect of LAC to suppress Mets-related diseases has been shown more clearly in the fatty liver group.</p>
<p>Nonetheless, numerous studies have shown that alcohol consumption is associated with increased blood pressure. Furthermore, increased alcohol consumption affects endothelial function (<xref rid="b40-br-0-0-1242" ref-type="bibr">40</xref>,<xref rid="b46-br-0-0-1242" ref-type="bibr">46</xref>). Oda <italic>et al</italic> (<xref rid="b30-br-0-0-1242" ref-type="bibr">30</xref>) reported that light to moderate alcohol consumption impairs endothelial function. Endothelial dysfunction is the initial stage in the pathogenesis of atherosclerosis and plays an important role in the development of atherosclerosis and hypertension. The present study indicated that the prevalence of hypertension is increased in light drinkers compared with in non-drinkers, especially in the non-fatty liver group. While it may suppress fatty liver, LAC may promote hypertension. Increased caloric intake through consuming alcoholic beverages and elevated salt intake associated with drinking may also be involved in alcohol-related hypertension (<xref rid="b47-br-0-0-1242" ref-type="bibr">47</xref>). Taking into consideration that liver dysfunction is the most common abnormal finding associated with Mets in a regular health check-up (<xref rid="b31-br-0-0-1242" ref-type="bibr">31</xref>), hypertension could occur in Mets-related diseases first. Moreover, in the fatty liver group, no significant relationship between LAC and hypertension was found. VanWagner <italic>et al</italic> (<xref rid="b48-br-0-0-1242" ref-type="bibr">48</xref>) reported that alcohol use may not reduce the risk of cardiovascular disease in patients with NAFLD. A previous study also demonstrated that alcohol use is not associated with a significant difference in markers of subclinical atherosclerosis, such as coronary artery calcium, which is a well-established risk marker for future cardiovascular events (<xref rid="b49-br-0-0-1242" ref-type="bibr">49</xref>).</p>
<p>This study has some limitations. Eating habits, which may have an influence on Mets-related diseases and the types of beverages consumed were not evaluated. Selection bias was also possible. Most of the participants were healthy and willing to undergo medical check-up. Further studies are needed to address these limitations.</p>
<p>In conclusion, the present study found that the effect of LAC was different between individuals with and those without fatty liver. In the non-fatty liver group, LAC may increase the risk of hypertension, whereas in the fatty liver group, LAC may decrease the prevalence of dyslipidemia, IGT, CKD and Mets by the Japanese criteria. The effect of LAC to suppress Mets-related diseases has been shown more clearly in the fatty liver group, because of the higher prevalence of each Mets-related disease. On the other hand, it may suppress fatty liver and LAC may promote hypertension.</p>
</sec>
<sec sec-type="supplementary-material">
<title>Supplementary Material</title>
<supplementary-material id="SD1-br-0-0-1242" content-type="local-data">
<caption>
<title>Comparison of prevalence of Mets-associated diseases among participants.</title>
</caption>
<media mimetype="application" mime-subtype="pdf" xlink:href="Supplementary_Data.pdf"/>
</supplementary-material>
</sec>
</body>
<back>
<ack>
<title>Acknowledgements</title>
<p>The authors thank all the members of the Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital. The authors would also like to thank Noriko for assistance with data collection.</p>
</ack>
<sec>
<title>Funding</title>
<p>No funding was received.</p>
</sec>
<sec>
<title>Availability of data and materials</title>
<p>The datasets of the present study are available from the corresponding author on reasonable request.</p>
</sec>
<sec>
<title>Authors&#x0027; contributions</title>
<p>The study was conducted and designed by TH. TH, NI, YIn, TT, TO, TK and KK collected and interpreted clinical data. The results were analyzed and interpreted by TH, YS and YIt. TH wrote the first draft of the manuscript and YS and YIt contributed to the writing of the manuscript. All authors have read and approved the final version of the manuscript.</p>
</sec>
<sec>
<title>Ethics approval and consent to participate</title>
<p>This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board of Fukuchiyama City Hospital (Fukuchiyama City, Japan). All patients provided written informed consent prior to participation.</p>
</sec>
<sec>
<title>Patient consent for publication</title>
<p>Not applicable.</p>
</sec>
<sec>
<title>Competing interests</title>
<p>All authors declare that they have no competing interests.</p>
</sec>
<ref-list>
<title>References</title>
<ref id="b1-br-0-0-1242"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Deepa</surname><given-names>M</given-names></name><name><surname>Farooq</surname><given-names>S</given-names></name><name><surname>Datta</surname><given-names>M</given-names></name><name><surname>Deepa</surname><given-names>R</given-names></name><name><surname>Mohan</surname><given-names>V</given-names></name></person-group><article-title>Prevalence of metabolic syndrome using WHO, ATPIII and IDF definitions in Asian Indians: The chennai urban rural epidemiology study (CURES-34)</article-title><source>Diabetes Metab Res Rev</source><volume>23</volume><fpage>127</fpage><lpage>134</lpage><year>2007</year><pub-id pub-id-type="pmid">16752431</pub-id><pub-id pub-id-type="doi">10.1002/dmrr.658</pub-id></element-citation></ref>
<ref id="b2-br-0-0-1242"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gaziano</surname><given-names>JM</given-names></name><name><surname>Buring</surname><given-names>JE</given-names></name><name><surname>Breslow</surname><given-names>JL</given-names></name><name><surname>Goldhaber</surname><given-names>SZ</given-names></name><name><surname>Rosner</surname><given-names>B</given-names></name><name><surname>VanDenburgh</surname><given-names>M</given-names></name><name><surname>Willett</surname><given-names>W</given-names></name><name><surname>Hennekens</surname><given-names>CH</given-names></name></person-group><article-title>Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction</article-title><source>N Engl J Med</source><volume>329</volume><fpage>1829</fpage><lpage>1834</lpage><year>1993</year><pub-id pub-id-type="pmid">8247033</pub-id><pub-id pub-id-type="doi">10.1056/NEJM199312163292501</pub-id></element-citation></ref>
<ref id="b3-br-0-0-1242"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Conigrave</surname><given-names>KM</given-names></name><name><surname>Hu</surname><given-names>BF</given-names></name><name><surname>Camargo</surname><given-names>CA Jr</given-names></name><name><surname>Stampfer</surname><given-names>MJ</given-names></name><name><surname>Willett</surname><given-names>WC</given-names></name><name><surname>Rimm</surname><given-names>EB</given-names></name></person-group><article-title>A prospective study of drinking patterns in relation to risk of type 2 diabetes among men</article-title><source>Diabetes</source><volume>50</volume><fpage>2390</fpage><lpage>2395</lpage><year>2001</year><pub-id pub-id-type="pmid">11574424</pub-id><pub-id pub-id-type="doi">10.2337/diabetes.50.10.2390</pub-id></element-citation></ref>
<ref id="b4-br-0-0-1242"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mukamal</surname><given-names>KJ</given-names></name><name><surname>Conigrave</surname><given-names>KM</given-names></name><name><surname>Mittleman</surname><given-names>MA</given-names></name><name><surname>Camargo</surname><given-names>CA Jr</given-names></name><name><surname>Stampfer</surname><given-names>MJ</given-names></name><name><surname>Willett</surname><given-names>WC</given-names></name><name><surname>Rimm</surname><given-names>EB</given-names></name></person-group><article-title>Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men</article-title><source>N Engl J Med</source><volume>348</volume><fpage>109</fpage><lpage>118</lpage><year>2003</year><pub-id pub-id-type="pmid">12519921</pub-id><pub-id pub-id-type="doi">10.1056/NEJMoa022095</pub-id></element-citation></ref>
<ref id="b5-br-0-0-1242"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tolstrup</surname><given-names>J</given-names></name><name><surname>Jensen</surname><given-names>MK</given-names></name><name><surname>Tjonnald</surname><given-names>A</given-names></name><name><surname>Overvad</surname><given-names>K</given-names></name><name><surname>Mukamal</surname><given-names>KJ</given-names></name><name><surname>Gr&#x00F8;nbaek</surname><given-names>M</given-names></name></person-group><article-title>Prospective study of alcohol drinking patterns and coronary heart diseases in women and men</article-title><source>BMJ</source><volume>332</volume><fpage>1244</fpage><lpage>1248</lpage><year>2006</year><pub-id pub-id-type="doi">10.1136/bmj.38831.503113.7C</pub-id></element-citation></ref>
<ref id="b6-br-0-0-1242"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gaziano</surname><given-names>JM</given-names></name><name><surname>Gaziano</surname><given-names>TA</given-names></name><name><surname>Glynn</surname><given-names>RJ</given-names></name><name><surname>Sesso</surname><given-names>HD</given-names></name><name><surname>Ajani</surname><given-names>UA</given-names></name><name><surname>Stampfer</surname><given-names>MJ</given-names></name><name><surname>Manson</surname><given-names>JE</given-names></name><name><surname>Hennekens</surname><given-names>CH</given-names></name><name><surname>Buring</surname><given-names>JE</given-names></name></person-group><article-title>Light-to-moderate alcohol consumption and mortality in the Physicians&#x0027; Health Study enrollment cohort</article-title><source>J Am Coll Cardiol</source><volume>35</volume><fpage>96</fpage><lpage>105</lpage><year>2000</year><pub-id pub-id-type="pmid">10636266</pub-id><pub-id pub-id-type="doi">10.1016/s0735-1097(99)00531-8</pub-id></element-citation></ref>
<ref id="b7-br-0-0-1242"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Freiberg</surname><given-names>MS</given-names></name><name><surname>Cabral</surname><given-names>HJ</given-names></name><name><surname>Heeren</surname><given-names>TC</given-names></name><name><surname>Vasan</surname><given-names>RS</given-names></name><name><surname>Curtis Ellison</surname><given-names>R</given-names></name></person-group><article-title>Third National Health and Nutrition Examination Survey: Alcohol consumption and the prevalence of the metabolic syndrome in the US: A cross-sectional analysis of data from the Third National Health And Nutrition Examination Survey</article-title><source>Diabetes Care</source><volume>27</volume><fpage>2954</fpage><lpage>2959</lpage><year>2004</year><pub-id pub-id-type="pmid">15562213</pub-id><pub-id pub-id-type="doi">10.2337/diacare.27.12.2954</pub-id></element-citation></ref>
<ref id="b8-br-0-0-1242"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thun</surname><given-names>MJ</given-names></name><name><surname>Peto</surname><given-names>R</given-names></name><name><surname>Lopez</surname><given-names>AD</given-names></name><name><surname>Monaco</surname><given-names>JH</given-names></name><name><surname>Henley</surname><given-names>SJ</given-names></name><name><surname>Heath</surname><given-names>CW Jr</given-names></name><name><surname>Doll</surname><given-names>R</given-names></name></person-group><article-title>Alcohol consumption and mortality among middle-aged and elderly U.S. adults</article-title><source>N Engl J Med</source><volume>337</volume><fpage>1705</fpage><lpage>1714</lpage><year>1997</year><pub-id pub-id-type="pmid">9392695</pub-id><pub-id pub-id-type="doi">10.1056/NEJM199712113372401</pub-id></element-citation></ref>
<ref id="b9-br-0-0-1242"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wannamethee</surname><given-names>SG</given-names></name><name><surname>Camargo</surname><given-names>CA Jr</given-names></name><name><surname>Manson</surname><given-names>JE</given-names></name><name><surname>Willett</surname><given-names>WC</given-names></name><name><surname>Rimm</surname><given-names>EB</given-names></name></person-group><article-title>Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger women</article-title><source>Arch Intern Med</source><volume>163</volume><fpage>1329</fpage><lpage>1336</lpage><year>2003</year><pub-id pub-id-type="pmid">12796069</pub-id><pub-id pub-id-type="doi">10.1001/archinte.163.11.1329</pub-id></element-citation></ref>
<ref id="b10-br-0-0-1242"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Neuschwander-Tetri</surname><given-names>BA</given-names></name></person-group><article-title>Nonalcoholic steatohepatitis and the metabolic syndrome</article-title><source>Am J Med Sci</source><volume>330</volume><fpage>326</fpage><lpage>335</lpage><year>2005</year><pub-id pub-id-type="pmid">16355018</pub-id><pub-id pub-id-type="doi">10.1097/00000441-200512000-00011</pub-id></element-citation></ref>
<ref id="b11-br-0-0-1242"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marchesini</surname><given-names>G</given-names></name><name><surname>Brizi</surname><given-names>M</given-names></name><name><surname>Bianchi</surname><given-names>G</given-names></name><name><surname>Tomassetti</surname><given-names>S</given-names></name><name><surname>Bugianesi</surname><given-names>E</given-names></name><name><surname>Lenzi</surname><given-names>M</given-names></name><name><surname>McCullough</surname><given-names>AJ</given-names></name><name><surname>Natale</surname><given-names>S</given-names></name><name><surname>Forlani</surname><given-names>G</given-names></name><name><surname>Melchionda</surname><given-names>N</given-names></name></person-group><article-title>Nonalcoholic fatty liver disease: A feature of the metabolic syndrome</article-title><source>Diabetes</source><volume>50</volume><fpage>1844</fpage><lpage>1850</lpage><year>2001</year><pub-id pub-id-type="pmid">11473047</pub-id><pub-id pub-id-type="doi">10.2337/diabetes.50.8.1844</pub-id></element-citation></ref>
<ref id="b12-br-0-0-1242"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Eckel</surname><given-names>RH</given-names></name><name><surname>Grundy</surname><given-names>SM</given-names></name><name><surname>Zimmet</surname><given-names>PZ</given-names></name></person-group><article-title>The metabolic syndrome</article-title><source>Lancet</source><volume>365</volume><fpage>1415</fpage><lpage>1428</lpage><year>2005</year><pub-id pub-id-type="pmid">15836891</pub-id><pub-id pub-id-type="doi">10.1016/S0140-6736(05)66378-7</pub-id></element-citation></ref>
<ref id="b13-br-0-0-1242"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Eguchi</surname><given-names>Y</given-names></name><name><surname>Hyogo</surname><given-names>H</given-names></name><name><surname>Ono</surname><given-names>M</given-names></name><name><surname>Mizuta</surname><given-names>T</given-names></name><name><surname>Ono</surname><given-names>N</given-names></name><name><surname>Fujimoto</surname><given-names>K</given-names></name><name><surname>Chayama</surname><given-names>K</given-names></name><name><surname>Saibara</surname><given-names>T</given-names></name></person-group><article-title>JSG-NAFLD: Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: A multicenter large retrospective study</article-title><source>J Gastroenterol</source><volume>47</volume><fpage>586</fpage><lpage>595</lpage><year>2012</year><pub-id pub-id-type="pmid">22328022</pub-id><pub-id pub-id-type="doi">10.1007/s00535-012-0533-z</pub-id></element-citation></ref>
<ref id="b14-br-0-0-1242"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nishioji</surname><given-names>K</given-names></name><name><surname>Sumida</surname><given-names>Y</given-names></name><name><surname>Kamaguchi</surname><given-names>M</given-names></name><name><surname>Mochizuki</surname><given-names>N</given-names></name><name><surname>Kobayashi</surname><given-names>M</given-names></name><name><surname>Nishimura</surname><given-names>T</given-names></name><name><surname>Yamaguchi</surname><given-names>K</given-names></name><name><surname>Itoh</surname><given-names>Y</given-names></name></person-group><article-title>Prevalence of and risk factors for non-alcoholic fatty liver diseases in a non-obese Japanese population, 2011-2012</article-title><source>J Gastroenterol</source><volume>50</volume><fpage>95</fpage><lpage>108</lpage><year>2015</year><pub-id pub-id-type="pmid">24619537</pub-id><pub-id pub-id-type="doi">10.1007/s00535-014-0948-9</pub-id></element-citation></ref>
<ref id="b15-br-0-0-1242"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dunn</surname><given-names>W</given-names></name><name><surname>Xu</surname><given-names>R</given-names></name><name><surname>Schwimmer</surname><given-names>JB</given-names></name></person-group><article-title>Modest wine drinking and decreased prevalence of suspected nonalcoholic fatty liver disease</article-title><source>Hepatology</source><volume>47</volume><fpage>1947</fpage><lpage>1954</lpage><year>2008</year><pub-id pub-id-type="pmid">18454505</pub-id><pub-id pub-id-type="doi">10.1002/hep.22292</pub-id></element-citation></ref>
<ref id="b16-br-0-0-1242"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gunji</surname><given-names>T</given-names></name><name><surname>Matsuhashi</surname><given-names>N</given-names></name><name><surname>Sato</surname><given-names>H</given-names></name><name><surname>Fujibayashi</surname><given-names>K</given-names></name><name><surname>Okumura</surname><given-names>M</given-names></name><name><surname>Sasabe</surname><given-names>N</given-names></name><name><surname>Urabe</surname><given-names>A</given-names></name></person-group><article-title>Light and moderate alcohol consumption significantly reduces the prevalence of fatty liver in the Japanese male population</article-title><source>Am J Gastroenterol</source><volume>104</volume><fpage>2189</fpage><lpage>2195</lpage><year>2009</year><pub-id pub-id-type="pmid">19550408</pub-id><pub-id pub-id-type="doi">10.1038/ajg.2009.361</pub-id></element-citation></ref>
<ref id="b17-br-0-0-1242"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moriya</surname><given-names>A</given-names></name><name><surname>Iwasaki</surname><given-names>Y</given-names></name><name><surname>Ohguchi</surname><given-names>S</given-names></name><name><surname>Kayashima</surname><given-names>E</given-names></name><name><surname>Mitsumune</surname><given-names>T</given-names></name><name><surname>Taniguchi</surname><given-names>H</given-names></name><name><surname>Ikeda</surname><given-names>F</given-names></name><name><surname>Shiratori</surname><given-names>Y</given-names></name><name><surname>Yamamoto</surname><given-names>K</given-names></name></person-group><article-title>Alcohol consumption appears to protect against non-alcoholic fatty liver disease</article-title><source>Aliment Pharmacol Ther</source><volume>33</volume><fpage>378</fpage><lpage>388</lpage><year>2011</year><pub-id pub-id-type="pmid">21118396</pub-id><pub-id pub-id-type="doi">10.1111/j.1365-2036.2010.04520.x</pub-id></element-citation></ref>
<ref id="b18-br-0-0-1242"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hamaguchi</surname><given-names>M</given-names></name><name><surname>Kojima</surname><given-names>T</given-names></name><name><surname>Ohbora</surname><given-names>A</given-names></name><name><surname>Takeda</surname><given-names>N</given-names></name><name><surname>Fukui</surname><given-names>M</given-names></name><name><surname>Kato</surname><given-names>T</given-names></name></person-group><article-title>Protective effect of alcohol consumption for fatty liver but not metabolic syndrome</article-title><source>World J Gastroenterol</source><volume>18</volume><fpage>156</fpage><lpage>167</lpage><year>2012</year><pub-id pub-id-type="pmid">22253522</pub-id><pub-id pub-id-type="doi">10.3748/wjg.v18.i2.156</pub-id></element-citation></ref>
<ref id="b19-br-0-0-1242"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sogabe</surname><given-names>M</given-names></name><name><surname>Okahisa</surname><given-names>T</given-names></name><name><surname>Taniguchi</surname><given-names>T</given-names></name><name><surname>Tomonari</surname><given-names>T</given-names></name><name><surname>Tanaka</surname><given-names>T</given-names></name><name><surname>Tanaka</surname><given-names>H</given-names></name><name><surname>Nakasono</surname><given-names>M</given-names></name><name><surname>Takayama</surname><given-names>T</given-names></name></person-group><article-title>Light alcohol consumption plays a protective role against non-alcoholic fatty liver disease in Japanese men with metabolic syndrome</article-title><source>Liver Int</source><volume>35</volume><fpage>1707</fpage><lpage>1714</lpage><year>2015</year><pub-id pub-id-type="pmid">25438866</pub-id><pub-id pub-id-type="doi">10.1111/liv.12754</pub-id></element-citation></ref>
<ref id="b20-br-0-0-1242"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kang</surname><given-names>HT</given-names></name><name><surname>Kim</surname><given-names>JK</given-names></name><name><surname>Shim</surname><given-names>JY</given-names></name><name><surname>Lee</surname><given-names>HR</given-names></name><name><surname>Linton</surname><given-names>JA</given-names></name><name><surname>Lee</surname><given-names>YJ</given-names></name></person-group><article-title>Low grade inflammation, metabolic syndrome and the risk of chronic kidney disease: The 2005 Korean national health and nutrition examination survey</article-title><source>J Korean Med Sci</source><volume>27</volume><fpage>630</fpage><lpage>635</lpage><year>2012</year><pub-id pub-id-type="pmid">22690094</pub-id><pub-id pub-id-type="doi">10.3346/jkms.2012.27.6.630</pub-id></element-citation></ref>
<ref id="b21-br-0-0-1242"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yamagata</surname><given-names>K</given-names></name><name><surname>Ishida</surname><given-names>K</given-names></name><name><surname>Sairenchi</surname><given-names>T</given-names></name><name><surname>Takahashi</surname><given-names>H</given-names></name><name><surname>Ohba</surname><given-names>S</given-names></name><name><surname>Shiigai</surname><given-names>T</given-names></name><name><surname>Narita</surname><given-names>M</given-names></name><name><surname>Koyama</surname><given-names>A</given-names></name></person-group><article-title>Risk factors for chronic kidney disease in a community-based population: A 10-year follow-up study</article-title><source>Kidney Int</source><volume>71</volume><fpage>159</fpage><lpage>166</lpage><year>2007</year><pub-id pub-id-type="pmid">17136030</pub-id><pub-id pub-id-type="doi">10.1038/sj.ki.5002017</pub-id></element-citation></ref>
<ref id="b22-br-0-0-1242"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shankar</surname><given-names>A</given-names></name><name><surname>Klein</surname><given-names>R</given-names></name><name><surname>Klein</surname><given-names>BE</given-names></name></person-group><article-title>The association among smoking, heavy drinking, and chronic kidney disease</article-title><source>Am J Epidemiol</source><volume>164</volume><fpage>263</fpage><lpage>271</lpage><year>2006</year><pub-id pub-id-type="pmid">16775042</pub-id><pub-id pub-id-type="doi">10.1093/aje/kwj173</pub-id></element-citation></ref>
<ref id="b23-br-0-0-1242"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jalal</surname><given-names>DI</given-names></name><name><surname>Chonchol</surname><given-names>M</given-names></name><name><surname>Chen</surname><given-names>W</given-names></name><name><surname>Targher</surname><given-names>G</given-names></name></person-group><article-title>Uric acid as a target of therapy in CKD</article-title><source>Am J Kidney Dis</source><volume>61</volume><fpage>134</fpage><lpage>146</lpage><year>2013</year><pub-id pub-id-type="pmid">23058478</pub-id><pub-id pub-id-type="doi">10.1053/j.ajkd.2012.07.021</pub-id></element-citation></ref>
<ref id="b24-br-0-0-1242"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kodama</surname><given-names>S</given-names></name><name><surname>Saito</surname><given-names>K</given-names></name><name><surname>Yachi</surname><given-names>Y</given-names></name><name><surname>Asumi</surname><given-names>M</given-names></name><name><surname>Sugawara</surname><given-names>A</given-names></name><name><surname>Totsuka</surname><given-names>K</given-names></name><name><surname>Saito</surname><given-names>A</given-names></name><name><surname>Sone</surname><given-names>H</given-names></name></person-group><article-title>Association between serum uric acid and development of type 2 diabetes</article-title><source>Diabetes Care</source><volume>32</volume><fpage>1737</fpage><lpage>1742</lpage><year>2009</year><pub-id pub-id-type="pmid">19549729</pub-id><pub-id pub-id-type="doi">10.2337/dc09-0288</pub-id></element-citation></ref>
<ref id="b25-br-0-0-1242"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Feig</surname><given-names>DI</given-names></name><name><surname>Kang</surname><given-names>DH</given-names></name><name><surname>Johnson</surname><given-names>RJ</given-names></name></person-group><article-title>Uric acid and cardiovascular risk</article-title><source>N Engl J Med</source><volume>359</volume><fpage>1811</fpage><lpage>1821</lpage><year>2008</year><pub-id pub-id-type="pmid">18946066</pub-id><pub-id pub-id-type="doi">10.1056/NEJMra0800885</pub-id></element-citation></ref>
<ref id="b26-br-0-0-1242"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nakamura</surname><given-names>K</given-names></name><name><surname>Sakurai</surname><given-names>M</given-names></name><name><surname>Miura</surname><given-names>K</given-names></name><name><surname>Morikawa</surname><given-names>Y</given-names></name><name><surname>Yoshita</surname><given-names>K</given-names></name><name><surname>Ishizaki</surname><given-names>M</given-names></name><name><surname>Kido</surname><given-names>T</given-names></name><name><surname>Naruse</surname><given-names>Y</given-names></name><name><surname>Suwazono</surname><given-names>Y</given-names></name><name><surname>Nakagawa</surname><given-names>H</given-names></name></person-group><article-title>Alcohol intake and the risk of hyperuricemia: A 6-year prospective study in Japanese men</article-title><source>Nutr Metab Cardiovasc Dis</source><volume>22</volume><fpage>989</fpage><lpage>996</lpage><year>2012</year><pub-id pub-id-type="pmid">21421297</pub-id><pub-id pub-id-type="doi">10.1016/j.numecd.2011.01.003</pub-id></element-citation></ref>
<ref id="b27-br-0-0-1242"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>Z</given-names></name><name><surname>Guo</surname><given-names>X</given-names></name><name><surname>Liu</surname><given-names>Y</given-names></name><name><surname>Chang</surname><given-names>Y</given-names></name><name><surname>Sun</surname><given-names>Y</given-names></name><name><surname>Zhu</surname><given-names>G</given-names></name><name><surname>Abraham</surname><given-names>MR</given-names></name></person-group><article-title>The relation of moderate alcohol consumption to hyperuricemia in a rural general population</article-title><source>Int J Environ Res Public Health</source><volume>13</volume><issue>E732</issue><year>2016</year><pub-id pub-id-type="pmid">27447659</pub-id><pub-id pub-id-type="doi">10.3390/ijerph13070732</pub-id></element-citation></ref>
<ref id="b28-br-0-0-1242"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nakamura</surname><given-names>K</given-names></name><name><surname>Okamura</surname><given-names>T</given-names></name><name><surname>Hayakawa</surname><given-names>T</given-names></name><name><surname>Hozawa</surname><given-names>A</given-names></name><name><surname>Kadowaki</surname><given-names>T</given-names></name><name><surname>Murakami</surname><given-names>Y</given-names></name><name><surname>Kita</surname><given-names>Y</given-names></name><name><surname>Okayama</surname><given-names>A</given-names></name><name><surname>Ueshima</surname><given-names>H</given-names></name></person-group><article-title>NIPPON DATA90 Research Group: The proportion of individuals with alcohol-induced hypertension among total hypertensives in a general Japanese population: NIPPON DATA90</article-title><source>Hypertens Res</source><volume>30</volume><fpage>663</fpage><lpage>668</lpage><year>2007</year><pub-id pub-id-type="pmid">17917312</pub-id><pub-id pub-id-type="doi">10.1291/hypres.30.663</pub-id></element-citation></ref>
<ref id="b29-br-0-0-1242"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Okubo</surname><given-names>Y</given-names></name><name><surname>Sairenchi</surname><given-names>T</given-names></name><name><surname>Irie</surname><given-names>F</given-names></name><name><surname>Yamagishi</surname><given-names>K</given-names></name><name><surname>Iso</surname><given-names>H</given-names></name><name><surname>Watanabe</surname><given-names>H</given-names></name><name><surname>Muto</surname><given-names>T</given-names></name><name><surname>Tanaka</surname><given-names>K</given-names></name><name><surname>Ota</surname><given-names>H</given-names></name></person-group><article-title>Association of alcohol consumption with incident hypertension among middle-aged and older Japanese population: The Ibaraki Prefectural Hearth Study (IPHS)</article-title><source>Hypertension</source><volume>63</volume><fpage>41</fpage><lpage>47</lpage><year>2014</year><pub-id pub-id-type="pmid">24126168</pub-id><pub-id pub-id-type="doi">10.1161/HYPERTENSIONAHA.113.01585</pub-id></element-citation></ref>
<ref id="b30-br-0-0-1242"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Oda</surname><given-names>N</given-names></name><name><surname>Kajikawa</surname><given-names>M</given-names></name><name><surname>Maruhashi</surname><given-names>T</given-names></name><name><surname>Iwamoto</surname><given-names>Y</given-names></name><name><surname>Kishimoto</surname><given-names>S</given-names></name><name><surname>Matsui</surname><given-names>S</given-names></name><name><surname>Hidaka</surname><given-names>T</given-names></name><name><surname>Kihara</surname><given-names>Y</given-names></name><name><surname>Chayama</surname><given-names>K</given-names></name><name><surname>Goto</surname><given-names>C</given-names></name><etal/></person-group><article-title>Endothelial function is impaired in relation to alcohol intake even in the case of light alcohol consumption in Asian men: Flow-mediated Dilation Japan (FMD-J) Study</article-title><source>Int J Cardiol</source><volume>230</volume><fpage>523</fpage><lpage>528</lpage><year>2017</year><pub-id pub-id-type="pmid">28057366</pub-id><pub-id pub-id-type="doi">10.1016/j.ijcard.2016.12.065</pub-id></element-citation></ref>
<ref id="b31-br-0-0-1242"><label>31</label><element-citation publication-type="journal"><comment>Research Committee for the Mega Database of Japan Society of Ningen Dock, May 2019 : Nationwide data analysis of the Ningen Dock in 2016 (Part 1) (In Japanese). <ext-link ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="https://www.ningen-dock.jp/wp/wp-content/uploads/2013/09/2016dockdata-No1.pdf">https://www.ningen-dock.jp/wp/wp-content/uploads/2013/09/2016dockdata-No1.pdf</ext-link>. Accessed May 31, 2019</comment></element-citation></ref>
<ref id="b32-br-0-0-1242"><label>32</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Matsuzawa</surname><given-names>Y</given-names></name></person-group><article-title>Metabolic syndrome-definition and diagnostic criteria in Japan</article-title><source>J Atheroscler Thromb</source><volume>12</volume><issue>301</issue><year>2005</year><pub-id pub-id-type="pmid">16394611</pub-id><pub-id pub-id-type="doi">10.5551/jat.12.301</pub-id></element-citation></ref>
<ref id="b33-br-0-0-1242"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hamaguchi</surname><given-names>M</given-names></name><name><surname>Kojima</surname><given-names>T</given-names></name><name><surname>Itoh</surname><given-names>Y</given-names></name><name><surname>Harano</surname><given-names>Y</given-names></name><name><surname>Fujii</surname><given-names>K</given-names></name><name><surname>Nakajima</surname><given-names>T</given-names></name><name><surname>Kato</surname><given-names>T</given-names></name><name><surname>Takeda</surname><given-names>N</given-names></name><name><surname>Okuda</surname><given-names>J</given-names></name><name><surname>Ida</surname><given-names>K</given-names></name><etal/></person-group><article-title>The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation</article-title><source>Am J Gastroenterol</source><volume>102</volume><fpage>2708</fpage><lpage>2715</lpage><year>2007</year><pub-id pub-id-type="pmid">17894848</pub-id><pub-id pub-id-type="doi">10.1111/j.1572-0241.2007.01526.x</pub-id></element-citation></ref>
<ref id="b34-br-0-0-1242"><label>34</label><element-citation publication-type="journal"><comment>Examination Committee of Criteria for &#x2018;Obesity Disease&#x2019; in Japan; Japan Society for the Study of Obesity: New criteria for &#x2018;obesity disease&#x2019; in Japan. Circ J 66: 987-992, 2002</comment></element-citation></ref>
<ref id="b35-br-0-0-1242"><label>35</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Levey</surname><given-names>AS</given-names></name><name><surname>Coresh</surname><given-names>J</given-names></name><name><surname>Balk</surname><given-names>E</given-names></name><name><surname>Kausz</surname><given-names>AT</given-names></name><name><surname>Levin</surname><given-names>A</given-names></name><name><surname>Steffes</surname><given-names>MW</given-names></name><name><surname>Hogg</surname><given-names>RJ</given-names></name><name><surname>Perrone</surname><given-names>RD</given-names></name><name><surname>Lau</surname><given-names>J</given-names></name><name><surname>Eknoyan</surname><given-names>G</given-names></name></person-group><article-title>National Kidney Foundation: National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification</article-title><source>Ann Intern Med</source><volume>139</volume><fpage>137</fpage><lpage>147</lpage><year>2003</year><pub-id pub-id-type="pmid">12859163</pub-id><pub-id pub-id-type="doi">10.7326/0003-4819-139-2-200307150-00013</pub-id></element-citation></ref>
<ref id="b36-br-0-0-1242"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kiechl</surname><given-names>S</given-names></name><name><surname>Willeit</surname><given-names>J</given-names></name><name><surname>Poewe</surname><given-names>W</given-names></name><name><surname>Egger</surname><given-names>G</given-names></name><name><surname>Oberhollenzer</surname><given-names>F</given-names></name><name><surname>Muggeo</surname><given-names>M</given-names></name><name><surname>Bonora</surname><given-names>E</given-names></name></person-group><article-title>Insulin sensitivity and regular alcohol consumption: Large, prospective, cross sectional population study (Bruneck study)</article-title><source>BMJ</source><volume>313</volume><fpage>1040</fpage><lpage>1044</lpage><year>1996</year><pub-id pub-id-type="pmid">8898593</pub-id><pub-id pub-id-type="doi">10.1136/bmj.313.7064.1040</pub-id></element-citation></ref>
<ref id="b37-br-0-0-1242"><label>37</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sierksma</surname><given-names>A</given-names></name><name><surname>Patel</surname><given-names>H</given-names></name><name><surname>Ouchi</surname><given-names>N</given-names></name><name><surname>Kihara</surname><given-names>S</given-names></name><name><surname>Funahashi</surname><given-names>T</given-names></name><name><surname>Heine</surname><given-names>RJ</given-names></name><name><surname>Grobbee</surname><given-names>DE</given-names></name><name><surname>Kluft</surname><given-names>C</given-names></name><name><surname>Hendriks</surname><given-names>HF</given-names></name></person-group><article-title>Effect of moderate alcohol consumption on adiponectin, tumor necrosis factor-alpha, and insulin sensitivity</article-title><source>Diabetes Care</source><volume>27</volume><fpage>184</fpage><lpage>189</lpage><year>2004</year><pub-id pub-id-type="pmid">14693987</pub-id><pub-id pub-id-type="doi">10.2337/diacare.27.1.184</pub-id></element-citation></ref>
<ref id="b38-br-0-0-1242"><label>38</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pischon</surname><given-names>T</given-names></name><name><surname>Girman</surname><given-names>CJ</given-names></name><name><surname>Rifai</surname><given-names>N</given-names></name><name><surname>Hotamisligil</surname><given-names>GS</given-names></name><name><surname>Rimm</surname><given-names>EB</given-names></name></person-group><article-title>Association between dietary factors and plasma adiponectin concentration in men</article-title><source>Am J Clin Nutr</source><volume>81</volume><fpage>780</fpage><lpage>786</lpage><year>2005</year><pub-id pub-id-type="pmid">15817852</pub-id><pub-id pub-id-type="doi">10.1093/ajcn/81.4.780</pub-id></element-citation></ref>
<ref id="b39-br-0-0-1242"><label>39</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>You</surname><given-names>M</given-names></name><name><surname>Considine</surname><given-names>RV</given-names></name><name><surname>Leone</surname><given-names>TC</given-names></name><name><surname>Kelly</surname><given-names>DP</given-names></name><name><surname>Crabb</surname><given-names>DW</given-names></name></person-group><article-title>Role of adiponectin in the protective action of dietary saturated fat against alcoholic fatty liver in mice</article-title><source>Hepatology</source><volume>42</volume><fpage>568</fpage><lpage>577</lpage><year>2005</year><pub-id pub-id-type="pmid">16108051</pub-id><pub-id pub-id-type="doi">10.1002/hep.20821</pub-id></element-citation></ref>
<ref id="b40-br-0-0-1242"><label>40</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rimm</surname><given-names>EB</given-names></name><name><surname>Giovannucci</surname><given-names>EL</given-names></name><name><surname>Willett</surname><given-names>WC</given-names></name><name><surname>Colditz</surname><given-names>GA</given-names></name><name><surname>Ascherio</surname><given-names>A</given-names></name><name><surname>Rosner</surname><given-names>B</given-names></name><name><surname>Stampfer</surname><given-names>MJ</given-names></name></person-group><article-title>Prospective study of alcohol consumption and risk of coronary disease in men</article-title><source>Lancet</source><volume>338</volume><fpage>464</fpage><lpage>468</lpage><year>1991</year><pub-id pub-id-type="pmid">1678444</pub-id><pub-id pub-id-type="doi">10.1016/0140-6736(91)90542-w</pub-id></element-citation></ref>
<ref id="b41-br-0-0-1242"><label>41</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rimm</surname><given-names>EB</given-names></name><name><surname>Williams</surname><given-names>P</given-names></name><name><surname>Fosher</surname><given-names>K</given-names></name><name><surname>Criqui</surname><given-names>M</given-names></name><name><surname>Stampfer</surname><given-names>MJ</given-names></name></person-group><article-title>Moderate alcohol intake and lower risk of coronary heart disease: Meta-analysis of effects on lipids and haemostatic factors</article-title><source>BMJ</source><volume>319</volume><fpage>1523</fpage><lpage>1528</lpage><year>1999</year><pub-id pub-id-type="pmid">10591709</pub-id><pub-id pub-id-type="doi">10.1136/bmj.319.7224.1523</pub-id></element-citation></ref>
<ref id="b42-br-0-0-1242"><label>42</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mukamal</surname><given-names>KJ</given-names></name><name><surname>Ding</surname><given-names>EL</given-names></name><name><surname>Djouss&#x00E9;</surname><given-names>L</given-names></name></person-group><article-title>Alcohol consumption, physical activity, and chronic disease risk factors: A population-based cross-sectional survey</article-title><source>BMC Public Health</source><volume>6</volume><issue>118</issue><year>2006</year><pub-id pub-id-type="pmid">16670030</pub-id><pub-id pub-id-type="doi">10.1186/1471-2458-6-118</pub-id></element-citation></ref>
<ref id="b43-br-0-0-1242"><label>43</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fillmore</surname><given-names>KM</given-names></name><name><surname>Golding</surname><given-names>JM</given-names></name><name><surname>Graves</surname><given-names>KL</given-names></name><name><surname>Kniep</surname><given-names>S</given-names></name><name><surname>Leino</surname><given-names>EV</given-names></name><name><surname>Romelsj&#x00F6;</surname><given-names>A</given-names></name><name><surname>Shoemaker</surname><given-names>C</given-names></name><name><surname>Ager</surname><given-names>CR</given-names></name><name><surname>Allebeck</surname><given-names>P</given-names></name><name><surname>Ferrer</surname><given-names>HP</given-names></name></person-group><article-title>Alcohol consumption and mortality. I. Characteristics of drinking groups</article-title><source>Addiction</source><volume>93</volume><fpage>183</fpage><lpage>203</lpage><year>1998</year><pub-id pub-id-type="pmid">9624721</pub-id><pub-id pub-id-type="doi">10.1046/j.1360-0443.1998.9321834.x</pub-id></element-citation></ref>
<ref id="b44-br-0-0-1242"><label>44</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Goude</surname><given-names>D</given-names></name><name><surname>Fagerberg</surname><given-names>B</given-names></name><name><surname>Hulthe</surname><given-names>J</given-names></name></person-group><article-title>AIR Study Group: Alcohol consumption, the metabolic syndrome and insulin resistance in 58-year-old clinically healthy men (AIR study)</article-title><source>Clin Sci (Lond)</source><volume>102</volume><fpage>345</fpage><lpage>352</lpage><year>2002</year><pub-id pub-id-type="pmid">11869176</pub-id><pub-id pub-id-type="doi">10.1042/cs1020345</pub-id></element-citation></ref>
<ref id="b45-br-0-0-1242"><label>45</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yoon</surname><given-names>YS</given-names></name><name><surname>Oh</surname><given-names>SW</given-names></name><name><surname>Baik</surname><given-names>HW</given-names></name><name><surname>Park</surname><given-names>HS</given-names></name><name><surname>Kim</surname><given-names>WY</given-names></name></person-group><article-title>Alcohol consumption and the metabolic syndrome in Korean adults: The 1998 Korean National Health and Nutrition Examination Survey</article-title><source>Am J Clin Nutr</source><volume>80</volume><fpage>217</fpage><lpage>224</lpage><year>2004</year><pub-id pub-id-type="pmid">15213051</pub-id><pub-id pub-id-type="doi">10.1093/ajcn/80.1.217</pub-id></element-citation></ref>
<ref id="b46-br-0-0-1242"><label>46</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rehm</surname><given-names>J</given-names></name><name><surname>Mathers</surname><given-names>C</given-names></name><name><surname>Popova</surname><given-names>S</given-names></name><name><surname>Thavorncharoensap</surname><given-names>M</given-names></name><name><surname>Teerawattananon</surname><given-names>Y</given-names></name><name><surname>Patra</surname><given-names>J</given-names></name></person-group><article-title>Global burden of disease and injury and economic cost attribute to alcohol use and alcohol-use disorders</article-title><source>Lancet</source><volume>373</volume><fpage>2223</fpage><lpage>2233</lpage><year>2009</year><pub-id pub-id-type="pmid">19560604</pub-id><pub-id pub-id-type="doi">10.1016/S0140-6736(09)60746-7</pub-id></element-citation></ref>
<ref id="b47-br-0-0-1242"><label>47</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kawano</surname><given-names>Y</given-names></name></person-group><article-title>Physio-pathological effects of alcohol on the cardiovascular system: Its role in hypertension and cardiovascular disease</article-title><source>Hypertens Res</source><volume>33</volume><fpage>181</fpage><lpage>191</lpage><year>2010</year><pub-id pub-id-type="pmid">20075936</pub-id><pub-id pub-id-type="doi">10.1038/hr.2009.226</pub-id></element-citation></ref>
<ref id="b48-br-0-0-1242"><label>48</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>VanWagner</surname><given-names>LB</given-names></name><name><surname>Ning</surname><given-names>H</given-names></name><name><surname>Allen</surname><given-names>NB</given-names></name><name><surname>Ajmera</surname><given-names>V</given-names></name><name><surname>Lewis</surname><given-names>CE</given-names></name><name><surname>Carr</surname><given-names>JJ</given-names></name><name><surname>Lloyd-Jones</surname><given-names>DM</given-names></name><name><surname>Terrault</surname><given-names>NA</given-names></name><name><surname>Siddique</surname><given-names>J</given-names></name></person-group><article-title>Alcohol use and cardiovascular disease risk in patients with nonalcoholic fatty liver disease</article-title><source>Gastroenterology</source><volume>153</volume><fpage>1260</fpage><lpage>1272</lpage><year>2017</year><pub-id pub-id-type="pmid">28802566</pub-id><pub-id pub-id-type="doi">10.1053/j.gastro.2017.08.012</pub-id></element-citation></ref>
<ref id="b49-br-0-0-1242"><label>49</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yeboah</surname><given-names>J</given-names></name><name><surname>McClelland</surname><given-names>RL</given-names></name><name><surname>Polonsky</surname><given-names>TS</given-names></name><name><surname>Burke</surname><given-names>GL</given-names></name><name><surname>Sibley</surname><given-names>CT</given-names></name><name><surname>O&#x0027;Leary</surname><given-names>D</given-names></name><name><surname>Carr</surname><given-names>JJ</given-names></name><name><surname>Goff</surname><given-names>DC</given-names></name><name><surname>Greenland</surname><given-names>P</given-names></name><name><surname>Herrington</surname><given-names>DM</given-names></name></person-group><article-title>Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals</article-title><source>JAMA</source><volume>308</volume><fpage>788</fpage><lpage>795</lpage><year>2012</year><pub-id pub-id-type="pmid">22910756</pub-id><pub-id pub-id-type="doi">10.1001/jama.2012.9624</pub-id></element-citation></ref>
</ref-list>
</back>
<floats-group>
<fig id="f1-br-0-0-1242" position="float">
<label>Figure 1.</label>
<caption><p>Flow diagram of selection of subjects for this study. HBV, hepatitis B virus; HCV, hepatitis C virus.</p></caption>
<graphic xlink:href="br-11-05-0191-g00.tif"/>
</fig>
<fig id="f2-br-0-0-1242" position="float">
<label>Figure 2.</label>
<caption><p>Odds ratio for each Mets-related disease in light drinkers and non-drinkers (adjusted for age, regular exercise, smoking, and usage of drugs that potentially affect Mets-related diseases). (A) Non-fatty liver group. (B) Fatty liver group. CKD, chronic kidney disease; IGT, impaired glucose tolerance; Mets, metabolic syndrome; CI confidence interval.</p></caption>
<graphic xlink:href="br-11-05-0191-g01.tif"/>
</fig>
<table-wrap id="tI-br-0-0-1242" position="float">
<label>Table I</label>
<caption><p>Comparison of clinical characteristics between non-drinkers and light drinkers.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="middle">Characteristics</th>
<th align="center" valign="middle">Non-drinker (n=505)</th>
<th align="center" valign="middle">Light drinker (n=685)</th>
<th align="center" valign="middle">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="middle">Age (years)</td>
<td align="center" valign="middle">56 (28-83)</td>
<td align="center" valign="middle">56 (24-78)</td>
<td align="center" valign="middle">0.920</td>
</tr>
<tr>
<td align="left" valign="middle">BMI (kg/m<sup>2</sup>)</td>
<td align="center" valign="middle">23.6 (15.2-52.9)</td>
<td align="center" valign="middle">23.3 (16.0-41.4)</td>
<td align="center" valign="middle">0.150</td>
</tr>
<tr>
<td align="left" valign="middle">WC (cm)</td>
<td align="center" valign="middle">85.5 (61.0-143.0)</td>
<td align="center" valign="middle">85.0 (63.0-127.0)</td>
<td align="center" valign="middle">0.080</td>
</tr>
<tr>
<td align="left" valign="middle">Obesity</td>
<td align="center" valign="middle">174 (34.4)</td>
<td align="center" valign="middle">195 (28.3)</td>
<td align="center" valign="middle">0.020</td>
</tr>
<tr>
<td align="left" valign="middle">SBP (mmHg)</td>
<td align="center" valign="middle">126 (93-196)</td>
<td align="center" valign="middle">128 (94-190)</td>
<td align="center" valign="middle">0.212</td>
</tr>
<tr>
<td align="left" valign="middle">DBP (mmHg)</td>
<td align="center" valign="middle">79 (48-122)</td>
<td align="center" valign="middle">81 (54-112)</td>
<td align="center" valign="middle">0.028</td>
</tr>
<tr>
<td align="left" valign="middle">Hypertension</td>
<td align="center" valign="middle">200 (39.6)</td>
<td align="center" valign="middle">298 (43.3)</td>
<td align="center" valign="middle">0.194</td>
</tr>
<tr>
<td align="left" valign="middle">T-CHO (mg/dl)</td>
<td align="center" valign="middle">197 (86-330)</td>
<td align="center" valign="middle">195 (106-312)</td>
<td align="center" valign="middle">0.769</td>
</tr>
<tr>
<td align="left" valign="middle">TG (mg/dl)</td>
<td align="center" valign="middle">104 (18-772)</td>
<td align="center" valign="middle">93 (28-648)</td>
<td align="center" valign="middle">0.009</td>
</tr>
<tr>
<td align="left" valign="middle">HDL (mg/dl)</td>
<td align="center" valign="middle">50 (26-93)</td>
<td align="center" valign="middle">54 (27-100)</td>
<td align="center" valign="middle">&#x003C;0.001</td>
</tr>
<tr>
<td align="left" valign="middle">LDL (mg/dl)</td>
<td align="center" valign="middle">123 (33-228)</td>
<td align="center" valign="middle">119 (47-229)</td>
<td align="center" valign="middle">0.007</td>
</tr>
<tr>
<td align="left" valign="middle">Dyslipidemia</td>
<td align="center" valign="middle">296 (58.6)</td>
<td align="center" valign="middle">329 (47.8)</td>
<td align="center" valign="middle">&#x003C;0.001</td>
</tr>
<tr>
<td align="left" valign="middle">FPG (mg/dl)</td>
<td align="center" valign="middle">98 (74-284)</td>
<td align="center" valign="middle">98 (76-291)</td>
<td align="center" valign="middle">0.149</td>
</tr>
<tr>
<td align="left" valign="middle">HbA1c (NGSP) (&#x0025;)</td>
<td align="center" valign="middle">5.9 (4.6-12.0)</td>
<td align="center" valign="middle">5.8 (4.9-11.1)</td>
<td align="center" valign="middle">0.016</td>
</tr>
<tr>
<td align="left" valign="middle">IGT</td>
<td align="center" valign="middle">119 (23.5)</td>
<td align="center" valign="middle">117 (17.0)</td>
<td align="center" valign="middle">0.006</td>
</tr>
<tr>
<td align="left" valign="middle">UA (mg/dl)</td>
<td align="center" valign="middle">5.8 (0.9-11.1)</td>
<td align="center" valign="middle">6.0 (0.9-9.6)</td>
<td align="center" valign="middle">0.076</td>
</tr>
<tr>
<td align="left" valign="middle">Hyperuricemia</td>
<td align="center" valign="middle">106 (20.9)</td>
<td align="center" valign="middle">148 (21.6)</td>
<td align="center" valign="middle">0.798</td>
</tr>
<tr>
<td align="left" valign="middle">AST (IU/l)</td>
<td align="center" valign="middle">21 (12-64)</td>
<td align="center" valign="middle">22 (12-124)</td>
<td align="center" valign="middle">0.094</td>
</tr>
<tr>
<td align="left" valign="middle">ALT (IU/l)</td>
<td align="center" valign="middle">22 (6-108)</td>
<td align="center" valign="middle">21 (9-148)</td>
<td align="center" valign="middle">0.314</td>
</tr>
<tr>
<td align="left" valign="middle">GGT (IU/l)</td>
<td align="center" valign="middle">26 (9-202)</td>
<td align="center" valign="middle">30 (9-737)</td>
<td align="center" valign="middle">0.001</td>
</tr>
<tr>
<td align="left" valign="middle">Fib-4 index</td>
<td align="center" valign="middle">1.07 (0.29-3.96)</td>
<td align="center" valign="middle">1.16 (0.35-3.86)</td>
<td align="center" valign="middle">0.027</td>
</tr>
<tr>
<td align="left" valign="middle">Fatty liver</td>
<td align="center" valign="middle">269 (53.7)</td>
<td align="center" valign="middle">292 (42.8)</td>
<td align="center" valign="middle">&#x003C;0.001</td>
</tr>
<tr>
<td align="left" valign="middle">eGFR (ml/min/1.73 m<sup>2</sup>)</td>
<td align="center" valign="middle">75.7 (12.2-151.5)</td>
<td align="center" valign="middle">75.8 (40.9-136.1)</td>
<td align="center" valign="middle">0.644</td>
</tr>
<tr>
<td align="left" valign="middle">Proteinuria</td>
<td align="center" valign="middle">41 (8.1)</td>
<td align="center" valign="middle">32 (4.6)</td>
<td align="center" valign="middle">0.014</td>
</tr>
<tr>
<td align="left" valign="middle">CKD</td>
<td align="center" valign="middle">91 (18.0)</td>
<td align="center" valign="middle">89 (12.9)</td>
<td align="center" valign="middle">0.017</td>
</tr>
<tr>
<td align="left" valign="middle">Mets by Japanese criteria</td>
<td align="center" valign="middle">145 (28.7)</td>
<td align="center" valign="middle">144 (20.9)</td>
<td align="center" valign="middle">0.002</td>
</tr>
<tr>
<td align="left" valign="middle">Regular exercises</td>
<td align="center" valign="middle">109 (21.5)</td>
<td align="center" valign="middle">192 (28.0)</td>
<td align="center" valign="middle">0.011</td>
</tr>
<tr>
<td align="left" valign="middle">Current smoking</td>
<td align="center" valign="middle">99 (19.6)</td>
<td align="center" valign="middle">124 (18.1)</td>
<td align="center" valign="middle">0.512</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Results are presented as n (&#x0025;) for qualitative data or as median (range) for quantitative data. Light drinker, 0-19 g alcohol/day. AST, aspartate aminotransferase; ALT, alanine aminotransferase; BMI, body mass index; CKD, chronic kidney disease; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; GGT, &#x03B3;-glutamyl transpeptidase; HbA1c, hemoglobin A1c; HDL, high-density lipoprotein; IGT, impaired glucose tolerance; LDL, low-density lipoprotein; Mets, metabolic syndrome; NGSP, National Glycohemoglobin Standardization Program; SBP, systolic blood pressure; T-CHO, total cholesterol; TG, triglycerides; UA, uric acid; WC, waist circumference.</p></fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tII-br-0-0-1242" position="float">
<label>Table II</label>
<caption><p>Comparison between non- and light drinkers receiving treatment for Mets-associated diseases.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="middle" colspan="4">A, Hypertension</th>
</tr>
<tr>
<th align="left" valign="middle">Characteristics</th>
<th align="center" valign="middle">Non-drinker (n=505)</th>
<th align="center" valign="middle">Light drinker (n=685)</th>
<th align="center" valign="middle">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="middle">Treatment</td>
<td align="center" valign="middle">119 (23.6)</td>
<td align="center" valign="middle">159 (23.2)</td>
<td align="center" valign="middle">0.887</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;SBP (mmHg)</td>
<td align="center" valign="middle">132 (101-179)</td>
<td align="center" valign="middle">132 (94-170)</td>
<td align="center" valign="middle">0.383</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;DBP (mmHg)</td>
<td align="center" valign="middle">83 (54-111)</td>
<td align="center" valign="middle">83 (54-109)</td>
<td align="center" valign="middle">0.404</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (-)</td>
<td align="center" valign="middle">386 (76.4)</td>
<td align="center" valign="middle">526 (76.8)</td>
<td align="center" valign="middle">&#x00A0;</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;SBP (mmHg)</td>
<td align="center" valign="middle">123 (96-196)</td>
<td align="center" valign="middle">126 (94-190)</td>
<td align="center" valign="middle">0.068</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;DBP (mmHg)</td>
<td align="center" valign="middle">78 (48-122)</td>
<td align="center" valign="middle">81 (56-112)</td>
<td align="center" valign="middle">0.003</td>
</tr>
<tr>
<td align="left" valign="middle" colspan="4">B, Dyslipidemia</td>
</tr>
<tr>
<td align="left" valign="middle">Characteristics</td>
<td align="center" valign="middle">Non-drinker (n=505)</td>
<td align="center" valign="middle">Light drinker (n=685)</td>
<td align="center" valign="middle">P-value</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (+)</td>
<td align="center" valign="middle">101 (20.0)</td>
<td align="center" valign="middle">108 (15.7)</td>
<td align="center" valign="middle">0.058</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;T-CHO (mg/dl)</td>
<td align="center" valign="middle">185 (114-330)</td>
<td align="center" valign="middle">181 (128-293)</td>
<td align="center" valign="middle">0.894</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;TG (mg/dl)</td>
<td align="center" valign="middle">113 (42-772)</td>
<td align="center" valign="middle">100 (42-304)</td>
<td align="center" valign="middle">0.310</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;HDL (mg/dl)</td>
<td align="center" valign="middle">49 (26-77)</td>
<td align="center" valign="middle">54 (31-93)</td>
<td align="center" valign="middle">0.004</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;LDL (mg/dl)</td>
<td align="center" valign="middle">110 (46-228)</td>
<td align="center" valign="middle">105 (61-203)</td>
<td align="center" valign="middle">0.105</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (-)</td>
<td align="center" valign="middle">404 (80.0)</td>
<td align="center" valign="middle">577 (74.3)</td>
<td align="center" valign="middle">&#x00A0;</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;T-CHO (mg/dl)</td>
<td align="center" valign="middle">202 (86-300)</td>
<td align="center" valign="middle">198 (106-312)</td>
<td align="center" valign="middle">0.484</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;TG (mg/dl)</td>
<td align="center" valign="middle">101 (18-687)</td>
<td align="center" valign="middle">91 (28-648)</td>
<td align="center" valign="middle">0.028</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;HDL (mg/dl)</td>
<td align="center" valign="middle">51 (27-93)</td>
<td align="center" valign="middle">54 (27-100)</td>
<td align="center" valign="middle">&#x003C;0.001</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;LDL (mg/dl)</td>
<td align="center" valign="middle">126 (33-202)</td>
<td align="center" valign="middle">121 (47-229)</td>
<td align="center" valign="middle">0.006</td>
</tr>
<tr>
<td align="left" valign="middle" colspan="4">C, IGT</td>
</tr>
<tr>
<td align="left" valign="middle">Characteristics</td>
<td align="center" valign="middle">Non-drinker (n=505)</td>
<td align="center" valign="middle">Light drinker (n=685)</td>
<td align="center" valign="middle">P-value</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (+)</td>
<td align="center" valign="middle">44 (8.7)</td>
<td align="center" valign="middle">38 (5.5)</td>
<td align="center" valign="middle">0.033</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;FPG (mg/dl)</td>
<td align="center" valign="middle">130 (83-84)</td>
<td align="center" valign="middle">134 (87-220)</td>
<td align="center" valign="middle">0.649</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;HbA1c (NGSP) (&#x0025;)</td>
<td align="center" valign="middle">7.0 (5.0-12.0)</td>
<td align="center" valign="middle">6.8 (6.1-10.8)</td>
<td align="center" valign="middle">0.666</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (-), n (&#x0025;)</td>
<td align="center" valign="middle">461 (91.3)</td>
<td align="center" valign="middle">647 (94.5)</td>
<td align="center" valign="middle">&#x00A0;</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;FPG (mg/dl)</td>
<td align="center" valign="middle">98 (74-156)</td>
<td align="center" valign="middle">97 (76-291)</td>
<td align="center" valign="middle">0.360</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;HbA1c (NGSP) (&#x0025;)</td>
<td align="center" valign="middle">5.8 (4.6-8.4)</td>
<td align="center" valign="middle">5.7 (4.9-11.1)</td>
<td align="center" valign="middle">0.051</td>
</tr>
<tr>
<td align="left" valign="middle" colspan="4">D, Hyperuricemia</td>
</tr>
<tr>
<td align="left" valign="middle">Characteristics</td>
<td align="center" valign="middle">Non-drinker (n=505)</td>
<td align="center" valign="middle">Light drinker (n=685)</td>
<td align="center" valign="middle">P-value</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (+)</td>
<td align="center" valign="middle">30 (5.9)</td>
<td align="center" valign="middle">52 (7.6)</td>
<td align="center" valign="middle">0.229</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;UA (mg/dl)</td>
<td align="center" valign="middle">6.2 (4.3-7.9)</td>
<td align="center" valign="middle">6.5 (3.6-8.7)</td>
<td align="center" valign="middle">0.296</td>
</tr>
<tr>
<td align="left" valign="middle">Treatment (-), n (&#x0025;)</td>
<td align="center" valign="middle">475 (94.1)</td>
<td align="center" valign="middle">632 (92.4)</td>
<td align="center" valign="middle">&#x00A0;</td>
</tr>
<tr>
<td align="left" valign="middle">&#x00A0;&#x00A0;&#x00A0;&#x00A0;&#x00A0;UA (mg/dl)</td>
<td align="center" valign="middle">5.8 (0.9-11.1)</td>
<td align="center" valign="middle">6.0 (0.6-9.6)</td>
<td align="center" valign="middle">0.148</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Results are presented as n (&#x0025;) for qualitative data or as median (range) for quantitative data. Light drinker, 0-19 g alcohol/day. DBP, diastolic blood pressure; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c; HDL, high-density lipoprotein; IGT, impaired glucose tolerance; LDL, low-density lipoprotein; Mets, metabolic syndrome; NGSP, National Glycohemoglobin Standardization Program; SBP, systolic blood pressure; T-CHO, total cholesterol; TG, triglycerides; UA, uric acid.</p></fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tIII-br-0-0-1242" position="float">
<label>Table III</label>
<caption><p>Comparison of the prevalence of Mets-associated diseases and risk factors between non-drinkers and light drinkers.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="middle" colspan="4">A, Prevalence of Mets-associated diseases and risk factors in the non-fatty liver group</th>
</tr>
<tr>
<th align="left" valign="middle">Characteristic</th>
<th align="center" valign="middle">Non-drinker (n=236)</th>
<th align="center" valign="middle">Light drinker (n=393)</th>
<th align="center" valign="middle">P-value</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="middle">Age (years)</td>
<td align="center" valign="middle">56 (28-83)</td>
<td align="center" valign="middle">56 (24-78)</td>
<td align="center" valign="middle">0.610</td>
</tr>
<tr>
<td align="left" valign="middle">BMI (kg/m<sup>2</sup>)</td>
<td align="center" valign="middle">21.8 (15.2-31.4)</td>
<td align="center" valign="middle">22.1 (16.1-33.1)</td>
<td align="center" valign="middle">0.060</td>
</tr>
<tr>
<td align="left" valign="middle">Obesity</td>
<td align="center" valign="middle">28 (11.8)</td>
<td align="center" valign="middle">53 (13.4)</td>
<td align="center" valign="middle">0.557</td>
</tr>
<tr>
<td align="left" valign="middle">Hypertension</td>
<td align="center" valign="middle">63 (26.6)</td>
<td align="center" valign="middle">139 (35.3)</td>
<td align="center" valign="middle">0.024</td>
</tr>
<tr>
<td align="left" valign="middle">Dyslipidemia</td>
<td align="center" valign="middle">106 (44.9)</td>
<td align="center" valign="middle">148 (37.6)</td>
<td align="center" valign="middle">0.073</td>
</tr>
<tr>
<td align="left" valign="middle">IGT</td>
<td align="center" valign="middle">27 (11.4)</td>
<td align="center" valign="middle">53 (13.4)</td>
<td align="center" valign="middle">0.456</td>
</tr>
<tr>
<td align="left" valign="middle">Hyperuricemia</td>
<td align="center" valign="middle">31 (13.1)</td>
<td align="center" valign="middle">61 (15.5)</td>
<td align="center" valign="middle">0.413</td>
</tr>
<tr>
<td align="left" valign="middle">CKD</td>
<td align="center" valign="middle">38 (16.1)</td>
<td align="center" valign="middle">49 (12.4)</td>
<td align="center" valign="middle">0.202</td>
</tr>
<tr>
<td align="left" valign="middle">Mets by Japanese criteria</td>
<td align="center" valign="middle">25 (20.5)</td>
<td align="center" valign="middle">45 (11.4)</td>
<td align="center" valign="middle">0.741</td>
</tr>
<tr>
<td align="left" valign="middle">Regular exercises</td>
<td align="center" valign="middle">66 (27.9)</td>
<td align="center" valign="middle">128 (32.5)</td>
<td align="center" valign="middle">0.336</td>
</tr>
<tr>
<td align="left" valign="middle">Current smoking</td>
<td align="center" valign="middle">58 (24.5)</td>
<td align="center" valign="middle">71 (18.0)</td>
<td align="center" valign="middle">0.050</td>
</tr>
<tr>
<td align="left" valign="middle" colspan="4">B, Prevalence of Mets-associated diseases and risk factors in the fatty liver group</td>
</tr>
<tr>
<td align="left" valign="middle">Characteristic</td>
<td align="center" valign="middle">Non-drinker (n=269)</td>
<td align="center" valign="middle">Light drinker (n=292)</td>
<td align="center" valign="middle">P-value</td>
</tr>
<tr>
<td align="left" valign="middle">Age (years)</td>
<td align="center" valign="middle">56 (30-75)</td>
<td align="center" valign="middle">56 (31-76)</td>
<td align="center" valign="middle">0.479</td>
</tr>
<tr>
<td align="left" valign="middle">BMI (kg/m<sup>2</sup>)</td>
<td align="center" valign="middle">25.2 (19.3-52.9)</td>
<td align="center" valign="middle">24.8 (18.6-41.4)</td>
<td align="center" valign="middle">0.133</td>
</tr>
<tr>
<td align="left" valign="middle">Obesity</td>
<td align="center" valign="middle">146 (54.2)</td>
<td align="center" valign="middle">140 (47.9)</td>
<td align="center" valign="middle">0.134</td>
</tr>
<tr>
<td align="left" valign="middle">Hypertension</td>
<td align="center" valign="middle">137 (50.9)</td>
<td align="center" valign="middle">158 (54.1)</td>
<td align="center" valign="middle">0.451</td>
</tr>
<tr>
<td align="left" valign="middle">Dyslipidemia</td>
<td align="center" valign="middle">189 (70.2)</td>
<td align="center" valign="middle">179 (61.3)</td>
<td align="center" valign="middle">0.026</td>
</tr>
<tr>
<td align="left" valign="middle">IGT</td>
<td align="center" valign="middle">92 (34.2)</td>
<td align="center" valign="middle">64 (21.9)</td>
<td align="center" valign="middle">0.001</td>
</tr>
<tr>
<td align="left" valign="middle">Hyperuricemia</td>
<td align="center" valign="middle">75 (27.8)</td>
<td align="center" valign="middle">87 (29.2)</td>
<td align="center" valign="middle">0.617</td>
</tr>
<tr>
<td align="left" valign="middle">CKD</td>
<td align="center" valign="middle">53 (19.7)</td>
<td align="center" valign="middle">40 (13.6)</td>
<td align="center" valign="middle">0.057</td>
</tr>
<tr>
<td align="left" valign="middle">Mets by Japanese criteria</td>
<td align="center" valign="middle">120 (44.6)</td>
<td align="center" valign="middle">98 (33.5)</td>
<td align="center" valign="middle">0.007</td>
</tr>
<tr>
<td align="left" valign="middle">Regular exercises</td>
<td align="center" valign="middle">43 (15.9)</td>
<td align="center" valign="middle">64 (21.9)</td>
<td align="center" valign="middle">0.074</td>
</tr>
<tr>
<td align="left" valign="middle">Current smoking</td>
<td align="center" valign="middle">41 (15.2)</td>
<td align="center" valign="middle">53 (18.1)</td>
<td align="center" valign="middle">0.357</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn><p>Results are presented as n (&#x0025;) for qualitative data or as median (range) for quantitative data. Light drinker, 0-19 g alcohol/day. BMI, body mass index; CKD, chronic kidney disease; IGT, impaired glucose tolerance; Mets, metabolic syndrome.</p></fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</article>
