The association between adiposity and atypical energy-related symptoms of depression: A role for metabolic dysregulations

BACKGROUND

Adiposity has been shown to be linked with atypical energy-related symptoms (AES) of depression. We used genomics to separate the effect of adiposity from that of metabolic dysregulations to examine whether the link between obesity and AES is dependent on the presence of metabolic dysregulations.

METHOD

Data were from NEO (n = 5734 individuals) and NESDA (n = 2238 individuals) cohorts, in which the Inventory of Depressive Symptomatology (IDS-SR30) was assessed. AES profile was based on four symptoms: increased appetite, increased weight, low energy level, and leaden paralysis. We estimated associations between AES and two genetic risk scores (GRS) indexing increasing total body fat with (metabolically unhealthy adiposity, GRS-MUA) and without (metabolically healthy adiposity, GRS-MHA) metabolic dysregulations.

RESULTS

We validated that both GRS-MUA and GRS-MHA were associated with higher total body fat in NEO study, but divergently associated with biomarkers of metabolic health (e.g., fasting glucose and HDL-cholesterol) in both cohorts. In the pooled results, per standard deviation, GRS-MUA was specifically associated with a higher AES score (β = 0.03, 95%CI: 0.01; 0.05), while there was no association between GRS-MHA and AES (β = -0.01, 95%CI: -0.03; 0.01).

CONCLUSION

These results suggest that the established link between adiposity and AES profile emerges in the presence of metabolic dysregulations, which may represent the connecting substrate between the two conditions.

Association between integrase strand transfer inhibitor use with insulin resistance and incident diabetes mellitus in persons living with HIV: a systematic review and meta-analysis

Whether integrase strand transfer inhibitors (INSTIs) are associated with a higher risk of incident type 2 diabetes mellitus (DM) than other antiretroviral therapies (ART) needs to be established.MEDLINE, Embase, Web of Science, and ClinicalTrials.gov registries were searched for studies published between 1 January 2000 and 15 June 2022. Eligible studies reported incident DM or mean changes in insulin resistance measured by Homeostatic Model for Insulin Resistance (HOMA-IR) in patients on INSTIs compared with other ARTs. We performed random-effects meta-analyses to obtain pooled relative risks (RRs) with 95% CIs.A total of 16 studies were pooled: 13 studies meta-analyzed for incident diabetes with a patient population of 72 404 and 3 for changes in HOMA-IR. INSTI therapy was associated with a lower risk of incident diabetes in 13 studies (RR 0.80, 95% CI 0.67 to 0.96, I²=29%), of which 8 randomized controlled trials demonstrated a 22% reduced risk (RR 0.88, 95% CI 0.81 to 0.96, I²=0%). INSTIs had a lower risk compared with non-nucleoside reverse transcriptase inhibitors (RR 0.75, 95% CI 0.63 to 0.89, I²=0%) but similar to protease inhibitor-based therapy (RR 0.78, 95% CI 0.61 to 1.01, I²=27%). The risk was lower in studies with longer follow-up (RR 0.70, 95% CI 0.53 to 0.94, I²=24%) and among ART-naïve patients (RR 0.78, 95% CI 0.65 to 0.94, I²=3%) but increased in African populations (RR 2.99, 95% CI 2.53 to 3.54, I²=0%).In conclusion, exposure to INSTIs was not associated with increased risk of DM, except in the African population. Stratified analyses suggested reduced risk among ART-naïve patients and studies with longer follow-up.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021273040.

CRP/HDL-C and Monocyte/HDL-C ratios as Predictors of Metabolic Syndrome in Patients With Type 2 Diabetes Mellitus

Background

Metabolic syndrome (MetS) denotes a cluster of co-occurring medical conditions associated with regulating hyperglycemia and acute cardiovascular events and complications. The escalating frequency of MetS among individuals afflicted with type 2 diabetes mellitus (T2DM) underscores its burgeoning significance as a critical public health concern and a complex clinical conundrum. Timely identification is imperative to avert the expedited progression of diabetic complications.

Objective

To investigate the role of CRP/HDL-C and Monocyte/HDL ratios in predicting MetS in T2DM individuals.

Methods

The study was designed as a two-year prospective study and included 80 T2DM patients divided into MetS and non-MetS groups based on MetS development over two years. The patients' serums were analyzed for complete blood count parameters, lipid profile, and C-reactive protein (CRP). Based on the laboratory test results, Monocyte/HDL-C and CRP/HDL-C ratios were calculated and analyzed. The receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine prognostic accuracy.

Results

Monocyte/HDL-C ratio and CRP/HDL-C ratio were significantly higher in MetS-T2DM2 than in nonMetS-T2DM (p=0.003 and p=0.029, respectively). The results of ROC curve analysis have shown that the CRP/HDL-C ratio (AUC of 0.695) and Monocytes/HDL-C ratio (AUC of 0.645) can serve as good predictors of MetS in T2DM patients.

Conclusion

This study confirms the reliability of the Monocytes/HDL-C and CRP/HDL-C ratios as novel, simple, low-cost, and valuable predictors of MetS development in T2DM.

Socioeconomic status and metabolic syndrome in Southwest Iran: results from Hoveyzeh Cohort Study (HCS)

BACKGROUND

Socioeconomic status (SES) strongly predicts morbidity and premature mortality, especially for non-communicable diseases (NCDs). However, the effect of these factors on Metabolic Syndrome (MetS) is not clear yet. This study was conducted to assess the relationship between socioeconomic indicators and MetS.

METHODS

In this prospective cohort study, 10,009 people aged 35-70 enrolled from May 2016 to August 2018. The MetS was defined according to The Standard National Cholesterol Education Program (NCEP)-adult treatment panel III (ATP III) or NCEP-ATP III criteria. Demographics and socioeconomic data were gathered face-to-face through trained interviews. Also, lab, anthropometrics, and blood pressure measurements were assayed for participants. Logistic regression was used to estimate the association between SES and MetS, adjusted for the potential confounding factors.

RESULTS

The overall prevalence of MetS in the participants was 39.1%. The crude odds ratios were statistically significant for all the assessed variables (p < 0.05). After adjustment for age, sex, physical activity, smoking, and alcohol use as potential confounders, the results indicated significant direct independent associations between skill level (p = 0.006) and Townsend index (p = 0.002) with MetS. In contrast, no significant associations between educational level and wealth status with MetS.

CONCLUSION

The results of our study showed that SES is related to MetS. Among the four assessed SES indicators, skilled levels and Townsend score are strongly associated with MetS. We recommend considering people's SES when interventional programs are planned and conducted on MetS in similar communities.

Impact of high prebiotic and probiotic dietary education in the SARS-CoV-2 era: improved cardio-metabolic profile in schizophrenia spectrum disorders

BACKGROUND

The development of new aetiological premises, such as the microbiota-gut-brain axis theory, evidences the influence of dietary and nutritional patterns on mental health, affecting the patient's quality of life in terms of physical and cardiovascular health. The aim was to determine the impact of a nutritional programme focused on increasing the intake of prebiotic and probiotic food on cardio-metabolic status in individuals with schizophrenia spectrum disorders in the contextual setting of the SARS-CoV-2 era.

METHODS

A randomised clinical trial (two-arm, double-blind, balanced-block, six-month intervention) was conducted in a group of 50 individuals diagnosed with schizophrenia spectrum disorder during the SARS-CoV-2 confinement period. The control group received conventional dietary counselling on an individual basis. In the intervention group, an individual nutritional education programme with a high content of prebiotics and probiotics (dairy and fermented foods, green leafy vegetables, high-fibre fruit, whole grains, etc.) was established. Data on cardiovascular status were collected at baseline, three and six months. In addition, anthropometric parameters were analysed monthly.

RESULTS

Forty-four subjects completed follow-up and were analysed. Statistical differences (p < 0.05) were found in all anthropometric variables at baseline and six months of intervention. A 27.4% reduction in the prevalence of metabolic syndrome risk factors in all its components was evidenced, leading to a clinically significant improvement (decrease in cardiovascular risk) in the intervention group at six months.

CONCLUSIONS

The development of a nutritional programme focused on increasing the dietary content of prebiotics and probiotics effectively improves the cardio-metabolic profile in schizophrenia spectrum disorders. Therefore, nursing assumes an essential role in the effectiveness of dietary interventions through nutritional education and the promotion of healthy lifestyles. Likewise, nursing acquires a relevant role in interdisciplinary coordination in confinement contexts.

TRIAL REGISTRATION

The study protocol complied with the Declaration of Helsinki for medical studies; the study received ethical approval from referral Research Ethics Committee in November 2019 (reg. no. 468) and retrospectively registered in clinicaltrials.gov (NCT04366401. First Submitted: 28th April 2020; First Registration: 25th June 2020).

Adipokines as targets in musculoskeletal immune and inflammatory diseases

Adipokines are the principal mediators in adipose signaling. Nevertheless, besides their role in energy storage, these molecules can be produced by other cells, such as immune cells or chondrocytes. Given their pleiotropic effects, research over the past few years has also focused on musculoskeletal diseases, showing that these adipokines might have relevant roles in worsening the disease or improving the treatment response. In this review, we summarize recent advances in our understanding of adipokines and their role in the most prevalent musculoskeletal immune and inflammatory disorders.

The psychosis metabolic risk calculator (PsyMetRiC) for young people with psychosis: International external validation and site-specific recalibration in two independent European samples

Background

Cardiometabolic dysfunction is common in young people with psychosis. Recently, the Psychosis Metabolic Risk Calculator (PsyMetRiC) was developed and externally validated in the UK, predicting up-to six-year risk of metabolic syndrome (MetS) from routinely collected data. The full-model includes age, sex, ethnicity, body-mass index, smoking status, prescription of metabolically-active antipsychotic medication, high-density lipoprotein, and triglyceride concentrations; the partial-model excludes biochemical predictors.

Methods

To move toward a future internationally-useful tool, we externally validated PsyMetRiC in two independent European samples. We used data from the PsyMetab (Lausanne, Switzerland) and PAFIP (Cantabria, Spain) cohorts, including participants aged 16-35y without MetS at baseline who had 1-6y follow-up. Predictive performance was assessed primarily via discrimination (C-statistic), calibration (calibration plots), and decision curve analysis. Site-specific recalibration was considered.

Findings

We included 1024 participants (PsyMetab n=558, male=62%, outcome prevalence=19%, mean follow-up=2.48y; PAFIP n=466, male=65%, outcome prevalence=14%, mean follow-up=2.59y). Discrimination was better in the full- compared with partial-model (PsyMetab=full-model C=0.73, 95% C.I., 0.68-0.79, partial-model C=0.68, 95% C.I., 0.62-0.74; PAFIP=full-model C=0.72, 95% C.I., 0.66-0.78; partial-model C=0.66, 95% C.I., 0.60-0.71). As expected, calibration plots revealed varying degrees of miscalibration, which recovered following site-specific recalibration. PsyMetRiC showed net benefit in both new cohorts, more so after recalibration.

Interpretation

The study provides evidence of PsyMetRiC's generalizability in Western Europe, although further local and international validation studies are required. In future, PsyMetRiC could help clinicians internationally to identify young people with psychosis who are at higher cardiometabolic risk, so interventions can be directed effectively to reduce long-term morbidity and mortality.

Funding

NIHR Cambridge Biomedical Research Centre (BRC-1215-20014); The Wellcome Trust (201486/Z/16/Z); Swiss National Research Foundation (320030-120686, 324730- 144064, and 320030-173211); The Carlos III Health Institute (CM20/00015, FIS00/3095, PI020499, PI050427, and PI060507); IDIVAL (INT/A21/10 and INT/A20/04); The Andalusian Regional Government (A1-0055-2020 and A1-0005-2021); SENY Fundacion Research (2005-0308007); Fundacion Marques de Valdecilla (A/02/07, API07/011); Ministry of Economy and Competitiveness and the European Fund for Regional Development (SAF2016-76046-R and SAF2013-46292-R).For the Spanish and French translation of the abstract see Supplementary Materials section.

Clinical and Patient-Reported Outcomes From Patients With Nonalcoholic Fatty Liver Disease Across the World: Data From the Global Non-Alcoholic Steatohepatitis (NASH)/ Non-Alcoholic Fatty Liver Disease (NAFLD) Registry

BACKGROUND & AIMS

Globally, nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease. We assessed the clinical presentation and patient-reported outcomes (PROs) among NAFLD patients from different countries.

METHODS

Clinical, laboratory, and PRO data (Chronic Liver Disease Questionnaire-nonalcoholic steatohepatitis [NASH], Functional Assessment of Chronic Illness Therapy-Fatigue, and the Work Productivity and Activity Index) were collected from NAFLD patients seen in real-world practices and enrolled in the Global NAFLD/NASH Registry encompassing 18 countries in 6 global burden of disease super-regions.

RESULTS

Across the global burden of disease super-regions, NAFLD patients (n = 5691) were oldest in Latin America and Eastern Europe and youngest in South Asia. Most men were enrolled at the Southeast and South Asia sites. Latin America and South Asia had the highest employment rates (>60%). Rates of cirrhosis varied (12%-21%), and were highest in North Africa/Middle East and Eastern Europe. Rates of metabolic syndrome components varied: 20% to 25% in South Asia and 60% to 80% in Eastern Europe. Chronic Liver Disease Questionnaire-NASH and Functional Assessment of Chronic Illness Therapy-Fatigue PRO scores were lower in NAFLD patients than general population norms (all P < .001). Across the super-regions, the lowest PRO scores were seen in Eastern Europe and North Africa/Middle East. In multivariate analysis adjusted for enrollment region, independent predictors of lower PRO scores included younger age, women, and nonhepatic comorbidities including fatigue (P < .01). Patients whose fatigue scores improved over time experienced a substantial PRO improvement. Nearly 8% of Global NAFLD/NASH Registry patients had a lean body mass index, with fewer metabolic syndrome components, fewer comorbidities, less cirrhosis, and significantly better PRO scores (P < .01).

CONCLUSIONS

NAFLD patients seen in real-world practices in different countries experience a high comorbidity burden and impaired quality of life. Future research using global data will enable more precise management and treatment strategies for these patients.

Inflammatory Markers and Atherogenic Coefficient: Early Markers of Metabolic Syndrome

BACKGROUND

Considering the close link between metabolic syndrome (MetSyn) and cardiovascular diseases, considerable attention has been devoted to the identification of their shared underlying pathological mechanisms in recent decades.

OBJECTIVES

This study aimed to investigate the association between pro-inflammatory factors and newly-diagnosed MetSyn.

METHODS

This case-control study recruited obese and nonobese individuals who were newly diagnosed with MetSyn (cases, n = 84) and healthy individuals (controls, n = 83). The medical and sociodemographic data of the participants were collected on enrollment. Serum analysis was performed to ascertain the concentrations of tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), fasting blood sugar (FBS), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and atherogenic coefficient (AC). Multiple regression analysis was carried out to explore the relationship between inflammatory markers and AC with MetSyn odds. The Pearson correlation test was also performed to investigate the correlations between metabolic and inflammatory parameters.

RESULTS

Positive relationships were observed between the serum levels of TNF-α and CRP with the odds of MetSyn following controlling for confounders (adjusted odds ratio [AOR] = 1.32; 95% confidence interval [CI]: 1.01 - 1.72; AOR = 1.29; 95% CI: 1.18 - 1.41; respectively, P ≤ 0.03). Additionally, higher AC was accompanied by increased odds of MetSyn (AOR = 1.98; 95% CI: 1.31 - 2.98; P = 0.001). The Pearson correlation analysis also showed positive correlations between TNF-α levels and serum metabolic abnormalities, including elevated LDL-C, FBS, and AC and lowered HDL-C levels (P ≤ 0.02).

CONCLUSIONS

The present results revealed that higher serum concentrations of pro-inflammatory and atherogenic indices, including CRP, TNF-α, and AC, might be associated with elevated odds of newly diagnosed MetSyn regardless of potential confounders, particularly body mass index. The obtained findings might be moderated by the positive correlations observed between serum TNF-α, as the chronic inflammatory state indicator, and impaired lipid and glycemic markers.

Nonalcoholic Fatty Liver Disease Without Metabolic-associated Fatty Liver Disease and the Risk of Metabolic Syndrome

BACKGROUND & AIMS

Metabolic (dysfunction)-associated fatty liver disease (MAFLD) was proposed to replace nonalcoholic fatty liver disease (NAFLD). Some people fulfill diagnostic criteria of NAFLD but not MAFLD (NAFLD without MAFLD), but the clinical implications of NAFLD in these subjects is unknown.

METHODS

We followed cohort of 12,197 men and women 20 years of age or older without metabolic dysfunction (defined by MAFLD criteria), heavy alcohol use, chronic viral hepatitis, liver cirrhosis, or malignancy for their risk of incident metabolic syndrome defined by Adult Treatment Panel III criteria.

RESULTS

By design, none of the study participants had MAFLD at baseline. The prevalence of NAFLD among participants without metabolic dysfunction meeting MAFLD criteria and without significant alcohol intake was 7.6%. During 74,508 person-years of follow-up, 2179 participants developed metabolic syndrome. The fully adjusted hazard ratio for metabolic syndrome comparing participants with NAFLD to those without it was 1.61 (95% confidence interval, 1.42-1.83). The increased risk of incident metabolic syndrome associated with NAFLD persisted for all studied subgroups, and the association was stronger for those with increased waist circumference (P for interaction = .029) and those without elevated triglycerides levels (P for interaction = .047).

CONCLUSION

In this large cohort, participants with NAFLD without MAFLD were at higher risk of developing metabolic syndrome compared to participants with no NAFLD and no MAFLD. Using MAFLD criteria may miss opportunities for early intervention in these subjects.

Time to transition from a negative nomenclature describing what NAFLD is not, to a novel, pathophysiology-based, umbrella classification of fatty liver disease (FLD)

Non-alcoholic fatty liver disease (NAFLD) is a definition of a prevalent condition that has been given a name describing what the disease is not, mainly due to gaps in the physiopathological understanding of NAFLD when the name was given to it. NAFLD still remains an unmet clinical need to a large extent due to the heterogenicity of the disease and the lack of a more accurate physiology-based classification. In essence, fatty liver disease (FLD) has a multifactorial etiology, including metabolic abnormalities, environmental influences, genetic disorders, and/or their overlap which makes it difficult to diagnose, design appropriate trials for it and treat this disease. Therefore, we propose herein that as our knowledge about this disease continues to grow exponentially, it is time to consider ending this unspecific, negative and broad classification of NAFLD, and turn it into a positive and targeted one describing what the disease is and not what it is not. Thus, we propose the novel FLD "Mantzoros classification". This innovative classification proposes to classify the heterogeneous causes of FLD under one umbrella and eventually lead to a better nomenclature and classification system reflecting pathophysiology. This in turn could lead to both better clinical trials and more personalized care. An additional aim is to generate a dialogue among the experts in this field to eventually reach the right nomenclature for an appropriate disease classification that would facilitate our understanding, approach, diagnosis, and management of this epidemic of FLD. Overall, a novel classification, based on phenotypic manifestations, leading risk factors and probable causes of FLD, could help our understanding and clinically would be accurately defining and differentiating the disease, leading to a more accurate design and execution of clinical trials. This would in turn lead to tangible benefits for all patients suffering from FLD through targeted and more effective personalized treatments.

Fatty Pancreas Is Independently Associated With Subsequent Diabetes Mellitus Development: A 10-Year Prospective Cohort Study

BACKGROUND & AIMS

Although the association between fatty pancreas and metabolic syndrome has been suggested in retrospective studies, long-term prospective data on the effect of fatty pancreas on various metabolic outcomes are lacking. We aimed to prospectively investigate the association between fatty pancreas and the development of major metabolic outcomes.

METHODS

A total of 631 subjects from a population study using fat-water magnetic resonance imaging to quantify pancreatic and liver fat content during 2008 to 2010 were followed up prospectively until December 2020 (mean follow-up time, 11.1 ± 1.1 y). Subjects with significant alcohol intake and diabetes mellitus (DM) at baseline were excluded. Incidence of newly diagnosed DM, hypertension, dyslipidemia, ischemic heart disease, cardiovascular accidents, pancreatic cancer, and mortality were evaluated.

RESULTS

Among the 631 subjects (mean age, 48 ± 11 y), 93 (14.7%) had fatty pancreas. The fatty pancreas group had a higher incidence of DM (33.3% vs 10.4%; P < .001), hypertension (37.7% vs 22.7%; P = .003), and dyslipidemia (37.7% vs 14.6%; P < .001) during long-term follow-up evaluation. Individuals with both fatty liver and pancreas had the highest DM incidence, followed by fatty liver only and fatty pancreas only groups (P < .001). Fatty pancreas was associated independently with DM (adjusted hazard ratio, 1.81; 95% CI, 1.10-3.00; P = .020), but not hypertension or dyslipidemia on multivariate analysis. Each percentage increase of pancreatic fat increased the risk of incident DM by 7% (adjusted hazard ratio, 1.07; 95% CI, 1.01-1.13; P = .016). No participants developed pancreatic cancer during the follow-up period.

CONCLUSIONS

Fatty pancreas is associated independently with subsequent DM development, but not hypertension or dyslipidemia.

Association Between Metabolic Syndrome and the Risk of Colorectal Cancer Diagnosed Before Age 50 Years According to Tumor Location

BACKGROUND & AIMS

The increasing prevalence of obesity at younger ages is concurrent with an increased earlier-onset colorectal cancer (CRC) (before age 50 years) incidence, particularly left-sided colon cancer. We investigated whether obesity and metabolic syndrome (MetS) are associated with increased earlier-onset CRC risk according to tumor location.

METHODS

Our nationwide population-based cohort study enrolled 9,774,081 individuals who underwent health checkups under the Korean National Health Insurance Service from 2009 to 2010, with follow-up until 2019. We collected data on age, sex, lifestyle factors, body mass index (BMI), waist circumference (WC), blood pressure, and laboratory findings. A multivariate Cox proportional hazards regression analysis was performed.

RESULTS

A total of 8320 earlier-onset and 57,257 later-onset CRC cases developed during follow-up. MetS was associated with increased earlier-onset CRC (adjusted hazard ratio, 1.20; 95% CI, 1.14-1.27), similar to later-onset CRC (adjusted hazard ratio, 1.19; 95% CI, 1.17-1.21). The adjusted hazard ratios for earlier-onset CRC with 1, 2, 3, 4, and 5 MetS components were 1.07 (95% CI, 1.01-1.13), 1.13 (95% CI, 1.06-1.21), 1.25 (95% CI, 1.16-1.35), 1.27 (95% CI, 1.15-1.41), and 1.50 (95% CI, 1.26-1.79), respectively (P for trend < .0001). We found that higher body mass index and larger waist circumference were significantly associated with increased earlier-onset CRC (P for trend < .0001). These dose-response associations were significant in distal colon and rectal cancers, although not in proximal colon cancers.

CONCLUSIONS

MetS and obesity are positively associated with CRC before age 50 years with a similar magnitude of association as people diagnosed after age 50 years. Thus, people younger than 50 years with MetS require effective preventive interventions to help reduce CRC risk.

The Association between Abdominal Obesity, Metabolic Syndrome and Survival Outcomes in Patients with Breast Cancer

BACKGROUND

Obesity and metabolic syndrome (MetS) have been linked to the risk of developing certain cancers. This study aimed to analyze the association between obesity markers, MetS and survival outcomes of patients with breast cancer.

METHODS

This study retrospectively investigated patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-), nonmetastatic breast cancer diagnosed between January 2010 and December 2019. Data on clinical conditions, body mass index (BMI), waist-to-hip ratio (WHR), MetS, time of metastasis and death were collected.

RESULTS

A total of 223 breast cancer patient records were eligible for analysis. Obesity (BMI ≥ 25) was found in 38.1% of cases. Abdominal obesity measured as WHR ≥ 0.85 was found in 48.9%. Metabolic syndrome was detected in 56.1% of patients and was associated with older age (OR = 2.196, p = 0.005), postmenopausal status (OR = 2.585, p = 0.001), obesity (OR = 5.684, p = 0.001) and abdominal obesity (OR = 2.612, p = 0.001). Obesity was not associated with poor disease-free survival (DFS) or overall survival (OS), while abdominal obesity was modestly associated with poor DFS (HR = 1.539, p = 0.083) and OS (HR = 3.117; p = 0.019). Multivariate analysis revealed that WHR ≥ 0.85 was independently associated with unfavorable DFS (HR = 1.907, p = 0.027). Patients with MetS had a similar survival rate to those with normal metabolism.

CONCLUSION

In Indonesian women with HR+/HER2- breast cancers, obesity and MetS were not associated with poor survival outcomes. The abdominal obesity marker (WHR) was more accurate in predicting unfavorable DFS.

Effects of alpha lipoic acid supplementation on serum lipid profile in patients with metabolic syndrome: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Alpha lipoic acid (ALA) is considered a strong antioxidant with anti-inflammatory properties. Moreover, a number of previous studies have shown its lipid-lowering properties. Therefore, we designed this study to investigate the effects of ALA on lipid profile in patients with metabolic syndrome (MetS), which can lead to an increased risk of cardiovascular disease (CVD) and premature mortality.

METHODS

A total 46 patients with MetS were randomly divided into two groups. They received either 600 mg ALA (n = 23) or 600 mg placebo (n = 23) for 12 weeks. The body weight, height, body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and blood pressure (BP) were assessed at baseline of the study. Physical activity level and dietary intake were assessed at baseline and end of the study. Serum lipid profile including triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were measured before and after 12 weeks of intervention.

RESULTS

Baseline characteristics were similar in the ALA and placebo groups (P > 0.05). However, there were statistically significant differences in plasma levels of TG (-36.82 ± 42.48 versus 6.15 ± 25.04 mg/dl, P = 0.001) and TC (-8.91 ± 20.65 versus 10.84 ± 22.97 mg/dl, P = 0.01) after 12 weeks between the ALA group and the placebo group. Yet, there were no statistically significant differences in plasma levels of HDL-C and LDL-C after 12 weeks between the ALA group and the placebo group.

CONCLUSION

The results suggest that daily supplementation of 600 mg ALA for 12 weeks may improve the lipid profile in patients with MetS.

Precision medicine and metabolic syndrome

Metabolic syndrome (MetS) is one of the most important health issues around the world and a major risk factor for both type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The etiology of MetS is determined by the interaction between genetic and environmental factors. Effective prevention and treatment of MetS notably decreases the risk of its complications such as diabetes, obesity, hypertension, and dyslipidemia. According to recent genome-wide association studies, multiple genes are involved in the incidence and development of MetS. The presence of particular genes which are responsible for obesity and lipid metabolism, affecting insulin sensitivity and blood pressure, as well as genes associated with inflammation, can increase the risk of MetS. These molecular markers, together with clinical data and findings from proteomic, metabolomic, pharmacokinetic, and other methods, would clarify the etiology and pathophysiology of MetS and facilitate the development of personalized approaches to the management of MetS. The application of personalized medicinebased on susceptibility identified genomes would help physicians recommend healthier lifestyles and prescribe medications to improve various aspects of health in patients with MetS. In recent years, personalized medicine by genetic testing has helped physicians determine genetic predisposition to MetS, prevent the disease by behavioral, lifestyle-related, or therapeutic interventions, and detect, diagnose, treat, and manage the disease. Clinically, personalized medicine is providing effective strategies for the prevention and treatment of MetS by reducing the time, cost, and failure rate of pharmaceutical clinical trials. It is also eliminating trial-and-error inefficiencies that inflate health care costs and undermine patient care.

IL-18 Serum Levels in Patients with Obesity, Prediabetes and Newly Diagnosed Type 2 Diabetes

BACKGROUND

Obesity and diabetes are related to chronic low-grade inflammation. As a pro-inflammatory cytokine, IL-18 stimulates various cell types and has pleiotropic functions.

OBJECTIVE

To assess the levels of IL-18 in subjects from the entire spectrum of glycemic disorders.

METHODS

This study included 387 Caucasians divided into four groups: healthy controls, obese subjects without carbohydrate issues, prediabetic patients, and recently discovered type 2 diabetics.

RESULTS

Subject with body mass index ≥30kg/m2 and glycemic disorders showed significantly high levels of IL-18 (249.77 ± 89.96 pg/ml; 259.01 ± 95.70 pg/ml; and 340.98 ± 127.65 pg/ml) compared with that of the control group (219.47 ± 110.53 pg/ml, p < 0.05). IL-18 also had significant positive associations with some anthropometric parameters, liver enzymes, fasting, post-load glucose, insulin, uric acid, and triglycerides while negative with HDL. The circulating IL-18 levels for differentiating subjects with carbohydrate disturbances and those with metabolic syndrome were determined by ROC analysis. The AUC for the disturbances of the carbohydrate metabolism was 0.597 (p = 0.001; 95% CI = 0.539 - 0.654) and for MS AUC was 0.581 (p = 0.021; 95 % CI = 0.516 - 0.647).

CONCLUSION

Our data indicate that as the levels of IL-18 are increased the carbohydrate tolerance is deteriorated. However, the significance of IL-18 in the progression of diabetes mellitus and subsequent consequences requires further exploration.

Metabolic syndrome; Definition, Pathogenesis, Elements, and the Effects of medicinal plants on it's elements

Introduction

Metabolic syndrome (MetS) is a cluster of metabolic risk factors that include central obesity, hypertension, insulin resistance, and atherogenic dyslipidemia and is strongly associated with a greater risk for developing cardiovascular disease and type 2 diabetes mellitus.

Methods

A literature search was conducted using the words metabolic syndrome, definition and pathogenesis in Scopus, and PubMed. The search also extended to cover medicinal plants and their role as a potential treatment of the metabolic syndrome. The search based on studies published in the English language from 1st of January 2000 to 30th of May 2021. The abstracts and the articles were then screened. Articles were scanned and read; further relevant references in the reference lists are also included.

Results

Both lifestyle factors and genetic factors are involved in the pathogenesis of the metabolic syndrome. Recently, MetS have gained significant attention due to the high prevalence of obesity worldwide. Diagnosis of patients with MetS is important to improve the outcomes of the disease by employing lifestyle and risk factors modifications. Currently, there is a rising interest in medicinal plants and their extracts because the medicinal plants have minimal side effects. Here we review the history, definitions, pathogenesis, management of metabolic syndrome and summarize the beneficial effects of some medicinal plants and their extracts on MetS.

Conclusion

Further research and clinical studies are needed to establish whether medicinal plants can be safely given as potential therapy for metabolic syndrome and whether this can be beneficial in low resources setting countries.

A Systematic Review and Meta-analysis of Dietary Interventions Modulating Gut Microbiota and Cardiometabolic Diseases-Striving for New Standards in Microbiome Studies

BACKGROUND & AIMS

Cardiometabolic diseases (CMDs) have shared properties and causes. Insulin resistance is a risk factor and characteristic of CMDs and has been suggested to be modulated by plasma metabolites derived from gut microbiota (GM). Because diet is among the most important modulators of GM, we performed a systematic review of the literature to assess whether CMDs can be modulated via dietary interventions targeting the GM.

METHODS

A systematic review of the literature for clinical studies was performed on Ovid MEDLINE and Ovid Embase. Studies were assessed for risk of bias and patterns of intervention effects. A meta-analysis with random effects models was used to evaluate the effect of dietary interventions on clinical outcomes.

RESULTS

Our search yielded 4444 unique articles, from which 15 randomized controlled trials and 6 nonrandomized clinical trials were included. The overall risk of bias was high in all studies. In general, most dietary interventions changed the GM composition, but no consistent effect could be found. Results of the meta-analyses showed that only diastolic blood pressure is decreased across interventions compared with controls (mean difference: -3.63 mm Hg; 95% confidence interval, -7.09 to -0.17; I² = 0%, P = .04) and that a high-fiber diet was associated with reduced triglyceride levels (mean difference: -0.69 mmol/L; 95% confidence interval, -1.36 to -0.02; I² = 59%, P = .04). Other CMD parameters were not affected.

CONCLUSIONS

Dietary interventions modulate GM composition, blood pressure, and circulating triglycerides. However, current studies have a high methodological heterogeneity and risk of bias. Well-designed and controlled studies are thus necessary to better understand the complex interaction between diet, microbiome, and CMDs.

PROSPERO

CRD42020188405.

[Development and Evaluation of an Integrated Health Management Program for Psychiatric Patients with Metabolic Syndrome]

PURPOSE

This study developed an integrated health management program for metabolic syndrome in psychiatric patients and examined its effects on self-efficacy, healthy lifestyle, physiological indicators, knowledge of metabolic syndrome, attitudes toward healthy behavior, and social support.

METHODS

A non-equivalent control group pretest posttest design was used. The participants were 65 psychiatric patients with metabolic syndrome in psychiatric rehabilitation centers, with 33 in the experimental group and 32 in the control group. The experimental group participants engaged in daily mobile application and walking exercises three times a week for more than 40 minutes over 8 weeks, while those in the control group were provided education booklets. The outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. Intervention effects were analyzed using the independent t-test, Mann-Whitney U test, ANCOVA, and Ranked ANCOVA.

RESULTS

The experimental group showed a significant increase in self-efficacy (F = 8.85, p = .004, η_p² = .13) and knowledge of metabolic syndrome (t = 2.60, p = .012, d = 0.60) compared to the control group. Additionally, the experimental group demonstrated a significant decrease in waist circumference (Z = -2.34, p = .009, d = 0.58) and body mass index (Z = -1.91, p = .028, d = 0.47) compared to the control group.

CONCLUSION

The integrated health management program for psychiatric patients with metabolic syndrome is effective in improving self-efficacy and knowledge of metabolic syndrome and decreasing physiological indicators such as waist circumference and body mass index.

Serum Biomarkers are Associated With Atherosclerotic Cardiovascular Disease Among Patients With Nonalcoholic Fatty Liver Disease Undergoing Elective Angiography

BACKGROUND & AIMS

Cardiovascular disease is the most common cause of death among patients with nonalcoholic fatty liver disease (NAFLD). We assessed select cardiac biomarker associations for existing or future coronary artery disease (CAD) risk in patients with NAFLD.

METHODS

Patients with/without NAFLD undergoing elective cardiac angiography were prospectively enrolled. Severe CAD was defined as presence of at least 1 proximal artery >70% stenosis; risk of severe CAD as either existing severe CAD or atherosclerotic cardiovascular disease score ≥20; NAFLD was defined as hepatic fat in the absence of other liver diseases. Cardiac biomarkers (high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and high-sensitivity cardiac troponin I [hs-cTnI]) were measured using Atellica Solution assays (Siemens Healthineers).

RESULTS

A total of 619 patients were enrolled (mean age, 63 ± 10 years; 80% male; 31% type 2 diabetes; 65% NAFLD); 42% had severe CAD, and 57% had risk of severe CAD. NAFLD prevalence was similar between patients with and without severe CAD (68% vs 62%; P > .05). Patients with NAFLD with severe CAD (44%) or with risk of severe CAD (58%) had higher levels of hs-cTnI than NAFLD controls (both P < .001). Presence of severe CAD or risk of severe CAD in all patients was associated with older age, male, aspects of metabolic syndrome, and elevated hs-cTnI: odds ratio 2.0 (95% confidence interval [CI],1.4-2.9) and 1.8 (95% CI, 1.1-3.0), respectively; 2.3 (95% CI, 1.4-3.8) and 2.2 (95% CI, 1.2-4.2), respectively, in patients with NAFLD (all P < .02).

CONCLUSION

CAD is common in patients with NAFLD. High hs-cTnI was associated with an increased risk of CAD. Pending validation, hs-cTnI may be a useful marker for CAD risk prediction in patients with NAFLD.

DPPFit: Developing and Testing a Technology-Based Adaptation of the Diabetes Prevention Program (DPP) to Address Prediabetes in a Primary Care Setting

OBJECTIVE

The objective of this study was to adapt the National Diabetes Prevention Program (N-DPP) into a pragmatic tool for primary care settings by using daily text messaging to deliver all N-DPP content, supplemented by Fitbit technology to provide behavioral strategies typically delivered by personnel in traditional programs. Test the mobile health (mHealth), technology-based N-DPP adaptation (DPPFit) in primary care patients with prediabetes using a remote intervention based on the traditional 16 core sessions of the DPP.

METHODS

A pilot study with pre/post survey analysis of aggregate data were used to determine changes in weight, physical activity, sedentary behavior, and associated diabetes risk outcomes among study participants (n = 33). In this study, participants were issued Fitbit devices and provided the remote intervention over 16 weeks via automated text messaging technology, which followed the content of the DPP core education sessions.

RESULTS

Data analysis from baseline to 6-month follow-up demonstrate mean weight loss of 3.3 kg (95% CI: -6.2 to -0.5; P = .026), reduction in body mass index by 1.25 points (95% CI: -2.1 to -0.4; P = .005), a significant average increase of 2 days in self-reported physical activity per week (95% CI: 0.4 to 3.6; P = .015) and an average 10% decrease in sedentary time (P = .007).

CONCLUSIONS

The remote DPPFit intervention demonstrates a promising and practical approach to the management of prediabetes in a primary care setting. The results support the use of the DPPFit program and application to achieve meaningful outcomes in a population with prediabetes. A randomized controlled trial with a larger sample is warranted.

Clinical Correlates of Non-alcoholic Steatohepatitis in Nigerian Patients with Metabolic Syndrome

BACKGROUND

Non-alcoholic steatohepatitis (NASH) is a progressive form of non-alcoholic fatty liver disease (NAFLD). NASH is frequently associated with metabolic syndrome (MetS) and its prevalence is increasing due to rising global epidemics of MetS. This study aimed at determining the prevalence, risk factors and correlates of NASH in patients with MetS in a tertiary hospital in Nigeria.

METHODS

We caried out a hospital based cross-sectional study of 81 subjects with MetS. The diagnosis of NASH was made by ultrasound evidence of hepatic steatosis, and exclusion of significant consumption of alcohol as well as histologic evidence of NASH on liver biopsy. Subjects gave informed consent and ethical approval was obtained from the ethics committee of the hospital. Data obtained were entered into SPSS version 20 and analyzed using simple and inferential statistics. A p-value of < 0.05 was considered statistically significant.

RESULTS

Total of 81 subjects with MetS were studied, males 36(44.4%), females 45(55.6%), mean age(SD) of 49.77 (12.08) years. Ten (12.3%) subjects were diagnosed with NASH. Subjects with NASH had significant association with obesity, dyslipidaemia, and poor glycemic control. Regression analysis showed that morbid obesity, low HDL and presence of type 2 diabetes mellitus were independent risk factors for the development of NASH.

CONCLUSION

NASH is common in Nigerian patients with MetS and its presence is significantly associated with obesity, dyslipidemia, and type 2 diabetes mellitus.

The effect of Glucagon-like peptide-1 receptor agonists on serum uric acid concentration: A systematic review and meta-analysis

AIMS

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of medications mainly used for the treatment of type 2 diabetes. They improve glucose tolerance, increase insulin secretion, and induce weight loss. There is controversy about the effect of GLP-1RAs on serum uric acid (SUA) concentration. Our systematic review aims to objectively answer whether GLP-1RAs affect SUA levels.

METHODS

We performed a systematic search on PubMed, Web of Science, Embase, Scopus, and Google Scholar datasets up to 27August,2021 with a language restriction of English only. Randomized controlled trials, observational studies, uncontrolled trials, and conference abstracts were included. Studies with insufficient data, irrelevant types of study, and follow-up duration of less than a month were excluded from the review. After critical appraisal by the Joanna Briggs Institute checklists, articles underwent data extraction using a pre-specified Microsoft Excel sheet.

RESULTS

Of 1004 identified studies, 17 were eligible for inclusion in this systematic review. Pre- to post-administration analysis of GLP-1RA effects on SUA demonstrated that GLP-1RAs could significantly reduce SUA concentration (difference in means=-0.341;SE=0.063;P-value<0.001). However, when compared to placebo, GLP-1 RAs did not perform any better in lowering SUA concentration (difference in means=-0.455;SE=0.259;P-value=0.079). Surprisingly, the active controls, that included insulin, metformin, sodium-glucose co-transporter 2 (SGLT-2) inhibitors, and dipeptidyl-peptidase 4 (DPP-4) inhibitors, did outperform GLP-1RAs in reducing SUA concentration (difference in means=0.250;SE=0.038;P-value<0.001).

CONCLUSIONS

Administration of GLP-1RAs can result in a significant reduction in SUA concentration. However, this reduction is less than that seen with the use of insulin, metformin, and SGLT-2 inhibitors.

Association of Lipid Accumulation Product and Triglyceride-Glucose Index with Metabolic Syndrome in Young Adults: A Cross-sectional Study

BACKGROUND

Metabolic syndrome is a cluster of elements linked with type 2 diabetes mellitus and cardiovascular disease (CVD). The early detection of individuals at the risk of developing metabolic syndrome can prevent the development of type 2 diabetes mellitus and CVD.

OBJECTIVES

This study aimed to evaluate the association of the lipid accumulation product (LAP) and triglyceride-glucose (TyG) index with metabolic syndrome among young adults.

METHODS

This cross-sectional study included 300 young adults within the age range of 20 - 40 years. Metabolic syndrome was defined according to modified National Cholesterol Education Program Adult Treatment Panel III guidelines. The LAP and TyG index were calculated. Multivariate logistic regression and receiver operating characteristic curve analyses were performed to assess the association of the LAP and TyG index with metabolic syndrome.

RESULTS

The LAP and TyG index were significantly associated with metabolic syndrome (P < 0.05). The LAP showed the highest area under the curve (0.882 and 0.905 in male and female subjects, respectively), followed by the TyG index (0.875 and 0.886 in male and female subjects, respectively, at P < 0.0001. The cut-off values for the LAP were 45.65 in males with a sensitivity and specificity of 80% and 46.91 in females with a sensitivity and specificity of 88%. The cut-off points for the TyG index were 8.63 in males with 80% sensitivity and 78.9% specificity and 8.54 in females with 83.3% sensitivity and 79.6% specificity.

CONCLUSIONS

The LAP and TyG index are significantly associated with metabolic syndrome in young adults. As simple and inexpensive markers, they can be used to identify individuals with metabolic syndrome with high sensitivity and specificity.

Relationship between immunometabolic status and cognitive performance among major depression disorder patients

BACKGROUND

Alterations in cognitive performance have been described in patients with major depressive disorder (MDD). However, the specific risk factors of these changes are not yet known. This study aimed to explore whether inmunometabolic parameters are related to cognitive performance in MDD in comparison to healthy controls (HC) METHODS: Sample consisted of 84 MDD patients and 78 HC. Both groups were compared on the results of cognitive performance measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB), the presence of metabolic syndrome (MetS) and an inflammatory/oxidative index calculated by a principal component analysis of peripheral biomarkers (tumor necrosis factor, C-reactive protein and 4-hydroxynonenal). A multiple linear regression was carried out, to study the relationship between inmunometabolic variables and the global cognitive performance, being the latter the dependent variable.

RESULTS

Significant differences were obtained in the inflammatory/oxidative index between both groups (F₍₁₁₅₇₎= 12.93; p < .001), also in cognitive performance (F₍₁₁₅₇₎= 56.75; p < .001). The inmunometabolic covariate regression model (i.e., condition (HC/MDD), sex, age and medication loading, MetS, inflammatory/oxidative index and the interaction between MetS and inflammatory/oxidative index) was statistically significant (F₍₇₁₅₇₎= 11.24; p < .01) and explained 31% of variance. The condition, being either MDD or HD, (B=-0.97; p < .001), age (B=-0.28; p < .001) and the interaction between inflammatory/oxidative index and MetS (B=-0.38; p = .02) were factors associated to cognitive performance.

LIMITATIONS

Sample size was relatively small. The cross-sectional design of the study limits the possibilities of analysis.

CONCLUSIONS

Our results provide evidence on the conjoint influence of metabolic and inflammatory dysregulation on cognitive dysfunction in MDD patients. In this way, our study opens a line of research in immunometabolic agents to deal with cognitive decline associated with MDD.

Assessment of Metabolic Risk Factors and Heart-Healthy Lifestyle in Atherosclerotic Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention after a 6-Month Follow-Up

BACKGROUND

Mortality due to acute coronary syndrome (ACS) has dramatically diminished because of performing life-saving interventions. This study aims to assess the metabolic risk factors and heart healthy lifestyle following the first episode of ACS under percutaneous coronary intervention (PCI) treatment after the 6-month follow-up.

MATERIALS AND METHODS

This is a longitudinal study conducted on 40 patients who underwent PCI because of the first episode of ACS. The patients' information including age, weight, abdominal circumference, smoking, functional capacity, patients' metabolic equivalent of task (METS), and laboratory tests including triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine, fasting blood sugar (FBS), and hemoglobin A1C were recorded before discharge and reassessed after 6-month follow-up.

RESULTS

The patients were dominantly male (92.5%) with an average age of 56.8 ± 7.11 years. Physical activity and functional capacity (METS) significantly improved within 6 months (P = 0.019). BMI significantly improved; however, although the abdominal circumference decreased, it was not significant (P = 0.28). The number of smokers (P = 0.12) and the daily number of smoked cigarettes (P = 0.37) nonsignificantly decreased within 6 months. However, HDL-C (P = 0.013) and LDL-C (P = 0.027) changes were not desirable. TG, FBS, and blood pressure did not statistically significant change (P > 0.05).

CONCLUSION

Although BMI, physical activity, and METS remarkably improved, waist circumference decreased nonsignificantly and lipid profile got worse paradoxically. Although this population is limited for generalization, this study shows that we require further schedules to improve ACS secondary prevention practice in our community.

Gender differences in the relationships between housework and metabolic markers: a longitudinal cohort study in China

Background

Metabolic syndrome has become a major health threat throughout the world, but there are few studies that focus on the effects of housework on human metabolism. This study explores the association between housework and metabolic markers and examines whether there are gender differences in the relationship of housework intensity on these markers.

Methods

We obtained data for 2,624 participants from the China Health and Nutrition Survey and used binary logistic regression to analyze the association between housework and metabolic markers (triglycerides, high- and low-density lipoprotein cholesterol, hemoglobin, blood glucose, cholesterol, and blood pressure).

Results

We observed no association between housework and metabolic markers for men. However, we find that women who engaged in housework had a higher risk of triglycerides than those who did not (OR=1.16, 95% CI: 1.16, 4.25). Compared with low-intensity, we also find that women who performed moderate- and high-housework intensity had a higher risk of triglycerides (moderate-intensity: OR=1.78, 95% CI: 1.14, 2.78; high-intensity: OR=1.91, 95% CI: 1.22, 2.98), MetS (OR=1.54, 95% CI: 0.98, 2.43; OR=1.68, 95% CI: 1.07, 2.66), pre-hypertension (OR=1.68, 95% CI: 1.08, 2.62; OR=1.63, 95% CI: 1.04, 2.55), and obesity (OR=1.65, 95% CI: 1.01, 2.70; OR=1.66, 95% CI: 1.01, 2.72).

Conclusion

In women, we find that housework is positively associated with the metabolic markers, triglycerides, MetS, and pre-hypertension. However, we did not find evidence that this relationship exists in men, f or any biomarkers we considered. One possible explanation is that people who engage in high-intensity housework are more stressed and sleep less, which could be a mechanism by which housework becomes associated with metabolic disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12566-6.

Branched Chain Amino Acids are associated with Metabolic Complications in Liver Transplant Recipients

BACKGROUND

Obesity, dyslipidemia and type 2 diabetes (T2D) contribute substantially to increased cardiovascular morbidity and mortality in patients after orthotopic liver transplantation (OLTx). Elevated plasma branched chain amino acids (BCAA) are linked to metabolic disturbances and cardiovascular disease (CVD) risk profiles in several non-OLTx populations.

METHODS

Cross-sectional analysis of liver transplant recipients from TransplantLines, a single-center biobank and cohort study. BCAA plasma levels were measured by means of nuclear-magnetic resonance spectroscopy. CVD and cardiometabolic factors were collected by using data from electronic patient records. Associations were determined between BCAA plasma levels and T2D, Metabolic Syndrome (MetS), CVD as well as mTOR inhibition in liver transplant recipients.

RESULTS

336 Patients were divided into sex-stratified tertiles of total BCAA. MetS (P<0.001) and T2D (P=0.002) were significantly more frequent in subjects in the highest BCAA tertile. In logistic regression analyses, the multivariable adjusted odds ratio (OR) per 1 standard deviation increase in BCAA was 1.68 (95%CI: 1.18-2.20, P=0.003) for MetS and 1.60 (95%CI: 1.14-2.23, P=0.006) for T2D. Use of Sirolimus (mTOR inhibitor) was significantly associated with higher BCAA plasma levels, independent of age, sex, time after OLTx, MetS and other immunosuppressive medication (adjusted P=0.002).

CONCLUSION

Elevated BCAA plasma levels are associated with T2D, MetS and use of Sirolimus in liver transplant recipients. BCAA plasma levels may represent a valuable biomarker for cardiometabolic complications after OLTx.

FACI Is a Novel CREB-H-Induced Protein That Inhibits Intestinal Lipid Absorption and Reverses Diet-Induced Obesity

BACKGROUND & AIMS

CREB-H is a key liver-enriched transcription factor governing lipid metabolism. Additional targets of CREB-H remain to be identified and characterized. Here, we identified a novel fasting- and CREB-H-induced (FACI) protein that inhibits intestinal lipid absorption and alleviates diet-induced obesity in mice.

METHODS

FACI was identified by reanalysis of existing transcriptomic data. Faci^-/- mice were generated by clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9)-mediated genome engineering. RNA sequencing was performed to identify differentially expressed genes in Faci^-/- mice. Lipid accumulation in the villi was assessed by triglyceride measurement and Oil red O staining. In vitro fatty acid uptake assay was performed to verify in vivo findings.

RESULTS

FACI expression was enriched in liver and intestine. FACI is a phospholipid-binding protein that localizes to plasma membrane and recycling endosomes. Hepatic transcription of Faci was regulated by not only CREB-H, but also nutrient-responsive transcription factors sterol regulatory element-binding protein 1 (SREBP1), hepatocyte nuclear factor 4α (HNF4α), peroxisome proliferator-activated receptor γ coactivator-1α (PGC1α), and CREB, as well as fasting-related cyclic adenosine monophosphate (cAMP) signaling. Genetic knockout of Faci in mice showed an increase in intestinal fat absorption. In accordance with this, Faci deficiency aggravated high-fat diet-induced obesity, hyperlipidemia, steatosis, and other obesity-related metabolic dysfunction in mice.

CONCLUSIONS

FACI is a novel CREB-H-induced protein. Genetic disruption of Faci in mice showed its inhibitory effect on fat absorption and obesity. Our findings shed light on a new target of CREB-H implicated in lipid homeostasis.

Latent Autoimmune Diabetes in Adults and Metabolic Syndrome-A Mini Review

Latent autoimmune diabetes in adults (LADA) is a heterogeneous subtype of diabetes characterized by islet cell destruction mediated by islet autoimmunity and insulin resistance. Metabolic syndrome (MetS) is a state in which many risk factors for metabolic and cardiovascular diseases accumulate in an individual. Based on clinical data, this review covers the prevalence of MetS in LADA, focusing on the risk associated with and the role of insulin resistance in the development of LADA from the perspective of inflammatory factors, environmental factors, and the gut microbiota, aiming to improve our understanding of this condition.

Association of hyperglycaemia and periodontitis: an updated systematic review and meta-analysis

Purpose

The aim of this updated systematic review and meta-analysis was the association between hyperglycemia and periodontitis.

Methods

We searched PubMed/MEDLINE, Web of Science, and Scopus until March 2021. The key search words were based on "periodontitis" and "hyperglycemia." We included cohort, case-control, and cross-sectional studies, restricted to publications in English. The quality assessment of included studies and data extraction were done by two independent reviewers. Meta-analysis was performed for cross-sectional studies using the random-effects model.

Results

The literature search yielded 340 studies, and finally, 19 and 11 studies were included in systematic review and meta-analysis, respectively. The total sample size of the eligible studies in the meta-analysis was 38,896 participants, of whom 33% were male with a mean age of 51.20 ± 14.0 years. According to a random-effect meta-analysis in cross-sectional studies, the pooled odds ratio (OR) for the association between hyperglycemia and periodontal indices was statistically significant (OR: 1.50, 95%CI: 1.11, 1.90). There was evidence of publication bias (coefficient: - 3.53, p-value = 0.014) which, after imputing missing studies, the pooled OR of the association between hyperglycemia and periodontitis change to 1.55 (95%CI: 1.20, 1.90).

Conclusion

Results of the present study show that hyperglycemia was positively associated with periodontitis. However, more cohort and prospective longitudinal studies should be conducted to find the exact association. Overall, it seems the management of hyperglycemia could be considered as a preventive strategy for periodontitis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-021-00861-9.

Indazole Derivatives Effective against Gastrointestinal Diseases

BACKGROUND

In this fast-growing lifestyle, humans are in the race against time to cope up with busy schedule. Less exercise, consumption of high calorie-low fiber food and stress take us one step closer towards digestive dysfunction. Dysfunctional digestive system causes various gastrointestinal disorders like constipation, IBS, UC, diarrhea, gastrointestinal tract immobility, hyperglycemia, hemorrhoids, fistula, anal fissures, stomach cancer, hepatocellular carcinoma, pancreatic cancer, colon cancer and metabolic syndrome. Amongst various natural and synthetic indazole derivatives nigellicine, nigellamine, nigellidine, zanubrutinib and SCH772984 showed prominent results to cure various gastrointestinal disorders.

OBJECTIVE

In this manuscript, we focus on the importance of indazole derivatives in the treatment of various gastrointestinal diseases.

RESULTS AND CONCLUSION

In the treatment of IBS, four positions (R1, R2, R3 and R4) of indazole were mainly substituted with aromatic aldehyde/substituted methyl, aromatic acid/formamide, benzamide/sulfonamide and methyl groups, respectively. In case of diarrhea and metabolic syndrome treatment, substitutions with benzyl/isopropyl/acetaldehyde (R1 position) and carboxamide/formamide (R2 position) of indazole play a critical role. Also, in the treatment of diabetes melitus, all six positions of indazole derivative were substituted with substituted aryl/alkyl/aromatic acid, substituted formamide, substituted acetamide/hydrazide group, halo aryl, substituted aryl/aromatic acid and a long chain of alkyl-aryl alcohol groups, respectively. In the treatment of gastrointestinal cancers, all six positions of indazole derivative were substituted with benzylamide (R1), octanediamide/benzamide/formamide (R2), carbaldehyde (R4) and substituted phenyl (R5 and R6) groups, respectively. Six receptors (6NP0, 2YME, 4EFU, 4WZ8, 5U4W and 7KKP) associated with GI disorders (co-crystallized with indazole derivative) were identified. Analysis of the receptors showed that co-crystalized ligand molecules were well-interacted with receptors via pie-pie interaction, co-ordinate and sigma bonding within 4 Å distance. As per Ramachandran plot analysis, more than 90% of the amino acid residues were present in the most favored region. So, if sufficient focuses are imposed on the development of newer indazole derivatives to treat gastrointestinal diseases, it will work as a boon to society.

The interrelationship and accumulation of cardiometabolic risk factors amongst young adults in the United Arab Emirates: The UAE Healthy Future Study

INTRODUCTION

Similar to other non-communicable diseases (NCDs), people who develop cardiovascular disease (CVD) typically have more than one risk factor. The clustering of cardiovascular risk factors begins in youth, early adulthood, and middle age. The presence of multiple risk factors simultaneously has been shown to increase the risk for atherosclerosis development in young and middle-aged adults and risk of CVD in middle age.

OBJECTIVE

This study aimed to address the interrelationship of CVD risk factors and their accumulation in a large sample of young adults in the United Arab Emirates (UAE).

METHODS

Baseline data was drawn from the UAE Healthy Future Study (UAEHFS), a volunteer-based multicenter study that recruits Emirati nationals. Data of participants aged 18 to 40 years was used for cross-sectional analysis. Demographic and health information was collected through self-reported questionnaires. Anthropometric data and blood pressure were measured, and blood samples were collected.

RESULTS

A total of 5126 participants were included in the analysis. Comorbidity analyses showed that dyslipidemia and obesity co-existed with other cardiometabolic risk factors (CRFs) more than 70% and 50% of the time, respectively. Multivariate logistic regression analysis of the risk factors with age and gender showed that all risk factors were highly associated with each other. The strongest relationship was found with obesity; it was associated with four-fold increase in the odds of having central obesity [adjusted OR 4.70 (95% CI (4.04-5.46)], and almost three-fold increase odds of having abnormal glycemic status [AOR 2.98 (95% (CI 2.49-3.55))], hypertension (AOR 3.03 (95% CI (2.61-3.52))] and dyslipidemia [AOR 2.71 (95% CI (2.32-3.15)]. Forty percent of the population accumulated more than 2 risk factors, and the burden increased with age.

CONCLUSION

In this young population, cardiometabolic risk factors are highly prevalent and are associated with each other, therefore creating a heavy burden of risk factors. This forecasts an increase in the burden of CVD in the UAE. The robust longitudinal design of the UAEHFS will enable researchers to understand how risk factors cluster before disease develops. This knowledge will offer a novel approach to design group-specific preventive measures for CVD development.

Systematic Review and Meta-analysis: The Role of Diet in the Development of Nonalcoholic Fatty Liver Disease

BACKGROUND & AIMS

The association of nonalcoholic fatty liver disease (NAFLD) with dietary factors is well established but not thoroughly investigated. This systematic review and meta-analysis synthesizes available evidence regarding the effect of nutrition on the presence and severity of NAFLD.

METHODS

A literature search was conducted identifying studies published between January 1985 and May 2021. We included studies with a dietary assessment and anthropometry based on validated tools, performed by a qualified dietitian or a trained health professional. We examined differences between patients with NAFLD and healthy controls as well as patients with NAFLD and nonalcoholic steatohepatitis (NASH). Risk of bias was assessed with the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool.

RESULTS

There were 60 eligible studies with 100,621 patients. The risk of bias was moderate for the majority of studies (41/60; 68%). According to meta-analyses, total caloric intake was higher in patients with NAFLD compared with controls (mean difference, 78.08; 95% confidence interval, 41.03-115.13). Macronutrient (protein, fat, and carbohydrate) consumption as proportion of total caloric intake and daily intake of fiber, caffeine and vitamins E, A, and C did not significantly differ between patients with NAFLD and controls. Soft drink consumption had a trend towards association with the presence of NAFLD. However, the odds ratio was 4.4 and the confidence intervals very wide. Finally, there was no significant difference in any comparison between patients with NAFLD and NASH, although the number of patients was relatively small. All meta-analyses had significant heterogeneity.

CONCLUSIONS

Overall, despite high heterogeneity among studies, this meta-analysis demonstrated that higher caloric intake is positively associated with NAFLD, whereas diet composition in macronutrients was not associated with the presence or severity of the disease.

Is the Neutrophil-to-lymphocyte ratio an exceptional indicator for metabolic syndrome disease and outcomes?

Metabolic syndrome is a syndrome compromised of elevated fasting blood glucose, increased blood pressure, central obesity, decreased high density lipoprotein, and increased triglyceride levels. Because of its growing incidence and prevalence, and the effect that it has on developing other non-communicable disease, the importance gets even more value. Prediction and control of this disease in early stages and in the cheapest way, is a crucial need these days. Due to role of chronic low-grade inflammation in metabolic syndrome, cytokines and inflammatory factors like interleukin-6 and Tumor necrosis factor-a have a critical effect on this phenomenon. Neutrophil to lymphocyte (NLR) ratio is an inflammatory marker that has an unchallenging availability, and has a reasonable price. NLR has a relation with obesity, type 2 diabetes, hypertension (HTN), blood cholesterol levels. This states that there should be a relation between NLR and metabolic syndrome. NLR as a low-grade inflammation marker indicates a positive relationship with central obesity. Also, studies indicate that diabetes' incidence, its severity, and its control contribute a relation with NLR. Hypertension, and hyperlipidemia, both can be noticed with higher NLRs. In this rapid review we are going to assess the association between metabolic syndrome and NLR.

Ectopic Fat Depots and Cardiometabolic Burden: A Possible Dangerous Liaison in Women Planning Assisted Reproduction

Objective: We evaluated cardiometabolic burden in women planning assisted reproduction in order to identify subgroups at higher risk of pregnancy complications and cardiovascular disease. Materials and methods: In this cross-sectional study we investigated 60 infertile women with BMI≥25 kg/m² referred to the Center for Assisted Reproduction. All women underwent metabolic, anthropometric parameters and ultrasound evaluation of ectopic fat depots. Results: All women had waist ≥80 cm. We found that 93.3% of women had pathological subcutaneous, 58.3% visceral and 80% para-perirenal fat; all women had fatty liver. Visceral fat and severity of steatosis were significantly related to the presence of metabolic syndrome (OR =5.7; p=0.03).A significant negative correlation between low HDL-c and para-perirenal fat (p<0.0001), a significant positive correlation with fasting plasma glucose and para-perirenal fat (p=0.001) were found. We observed a significant positive correlation between visceral fat and hs-CRP (p=0.002), HOMA-IR (p=0.04) and triglycerides (p=0.002), a significant negative correlation with HDL-c (p=0.05). Conclusion: This study by highlighting a clinically "dangerous liaison" between ectopic fat depots and metabolic/inflammatory markers, might permit to identify women with a worse metabolic phenotype and encourage lifestyle changes for improving their general and reproductive health together.

Neck Circumference Cut-Off for Obesity and Metabolic Syndrome in Nigeria

Objective

Neck circumference (NC) is a novel tool for diagnosing cardiometabolic disorders. We aimed to determine the NC cut-off for obesity and metabolic syndrome (MS) prediction in Nigeria.

Methods

The current study was based on data analysis of 557 staff and students of Ekiti State University/Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, who took part in a cross-sectional health screening (August-December 2018). Body mass index (BMI), waist circumference (WC), WHpR (waist-to-hip ratio), WHtR (waist-to-height ratio), systolic and diastolic blood pressure (SBP, DBP) values were determined by standard protocol. Fasting glucose and lipid profile were assayed for, and MS was defined by the harmonized criteria. The predictive ability of NC to identify people with obesity and MS was determined with receiver operating characteristic (ROC) curves.

Results

In both men and women, NC had positive correlation (P<.001) with age, weight, BMI, WC, WHpR, WHtR, SBP and DBP. In men and women, the AUC of NC for all the anthropometric indices were significant (P<.0001). In men, the NC cut-off was 37cm for WHpR, 37.5cm for both BMI and WHtR, 38.3cm for WC, and 40.0cm for MS. In women, the NC cut-off for all the anthropometric indices (except WHpR) and MS was 33cm. In men, NC was as good as other obesity indices in predicting MS (P>.05 for differences in the AUC), but was inferior to BMI, WC and WHtR in women.

Conclusions

NC correlates with indices of adiposity and can serve as an alternate index for obesity and MS detection in Nigerians.

[Association between metabolic syndrome, socioeconomic status and quality of life in mexicans]

BACKGROUND

In Mexico there is little information regarding the link between metabolic syndrome (MetS), socioeconomic status (SES) and quality of life (QoL).

OBJECTIVE

To assess the association between subjects who are at high risk of developing MetS with SES and QoL.

MATERIAL AND METHODS

Patients attending UMF-2 IMSS or Centro Urbano-SSA Clínica-1 were asked to participate. Anthropometric measures were collected, the AMAI, SF12, and ESF-I questionnaire where apply for SES, QoL, and MetS, respectively. Association were determined by calculating Spearman's rho and the risk (odds ratio and 95% confidence-interval) was assessed using logistic regression.

RESULTS

The difference of SES (193 ± 53 vs. 124 ± 50) and QoL (86.3 ± 14.8 vs. 56.0±25.4) questionnaires were significantly between low-risk and high-risk groups, respectively (p < 0.001). There was a negative correlation between ESF-I and SES (rho = -0.623, p < 0.001) as well as the QoL (rho = -0.719, p < 0.001). MetS risk was augmented by decreasing SES (C+: OR = 6.4, 95%IC: 3.2-13.0; D: OR = 66.1, 95%IC: 23.2-188.3), whereas increasing QoL attenuated it (OR = 0.93, 95%CI: 0.91-0.94). However, QoL mitigated the effect of SES (C+: OR = 4.5, 95%IC: 2.1-9.6; D: OR = 11.9, 95%IC: 3.8-37.6).

CONCLUSIONS

Lower QoL and SES increased the risk of MetS in Central Mexico; however, improving the QoL can mitigated the effect SES has on developing MetS.

Chronic Liver Disease and Metabolic Comorbidities in Healthy Young Males Followed for 65 Years: The Manitoba Follow-up Study

BACKGROUND & AIMS

The prevalence of chronic liver disease (CLD) is largely derived from cross-sectional epidemiologic surveys. The goal of this long-term, prospective study was to document the lifetime risk of developing chronic liver disease and determine the impact of common metabolic conditions associated with metabolic syndrome (MetS) on the development and outcomes of CLD.

METHODS

3,983 air force men were enrolled in the Manitoba Follow-up Study in 1948. The comprehensive database on results of routine physicals and health encounters was examined for evidence of CLD and MetS. The joint relationship between CLD and components of MetS on mortality was examined using Cox proportional hazard model.

RESULTS

In 65 follow-up years, 5.2% of men developed CLD and 6.4% MetS. Hypertension was the strongest predictor of CLD (HR 2.958, 95% CI - 2.065 to 4.236, p < .0001), followed by insulin resistance /diabetes mellitus (IR/DM) (2.008, 95% CI - 1.332 to 3.027, p = .0009) and obesity (1.958, 95% CI - 1.419 to 2.703, p < .0001). Relative to men without MetS comorbidities, an increasing gradient of risk for CLD was apparent with increasing numbers of MetS components; the HR of 3.67, 5.97 and 14.3 for IR/DM, IR/DM + one component, and IR/DM + two or more components respectively. The relative risk of mortality in men with vs. without CLD was 3.33 (95% CI - 2.83 to 3.91, p < .0001) and 1.505 (95% CI - 1.31 to 1.73, p < .0001) in men with vs. without MetS.

CONCLUSIONS

CLD and MetS independently increase the relative risk of mortality; the magnitude of the effect is greater in CLD.

A Novel Humanized Model of NASH and Its Treatment With META4, A Potent Agonist of MET

BACKGROUND & AIMS

Nonalcoholic fatty liver disease is a frequent cause of hepatic dysfunction and is now a global epidemic. This ailment can progress to an advanced form called nonalcoholic steatohepatitis (NASH) and end-stage liver disease. Currently, the molecular basis of NASH pathogenesis is poorly understood, and no effective therapies exist to treat NASH. These shortcomings are due to the paucity of experimental NASH models directly relevant to humans.

METHODS

We used chimeric mice with humanized liver to investigate nonalcoholic fatty liver disease in a relevant model. We carried out histologic, biochemical, and molecular approaches including RNA-Seq. For comparison, we used side-by-side human NASH samples.

RESULTS

Herein, we describe a "humanized" model of NASH using transplantation of human hepatocytes into fumarylacetoacetate hydrolase-deficient mice. Once fed a high-fat diet, these mice develop NAFLD faithfully, recapitulating human NASH at the histologic, cellular, biochemical, and molecular levels. Our RNA-Seq analyses uncovered that a variety of important signaling pathways that govern liver homeostasis are profoundly deregulated in both humanized and human NASH livers. Notably, we made the novel discovery that hepatocyte growth factor (HGF) function is compromised in human and humanized NASH at several levels including a significant increase in the expression of the HGF antagonists known as NK1/NK2 and marked decrease in HGF activator. Based on these observations, we generated a potent, human-specific, and stable agonist of human MET that we have named META4 (Metaphor) and used it in the humanized NASH model to restore HGF function.

CONCLUSIONS

Our studies revealed that the humanized NASH model recapitulates human NASH and uncovered that HGF-MET function is impaired in this disease. We show that restoring HGF-MET function by META4 therapy ameliorates NASH and reinstates normal liver function in the humanized NASH model. Our results show that the HGF-MET signaling pathway is a dominant regulator of hepatic homeostasis.

The prevalence of metabolic syndrome parameters and their association with headache characteristics among migraineurs

Background: Migraine is associated with metabolic syndrome (MetS). There are evidences that components of MetS are more prevalent among migraine patients than non-migraineurs. Since both migraine and MetS are associated with a high risk of cardiovascular events, it is likely that the parameters of MetS increase the occurrence of cardiovascular disease (CVD) in migraineurs. The present research project was conducted for the purpose of investigating the relationship between MetS parameters and different items of migraine headaches. Methods: This descriptive-analytical, cross-sectional study was performed on 240 migraineurs [according to International Headache Society (HIS) II criteria] within the 17+ age range. The participants were selected via consecutive and convenience sampling method. The evaluated parameters for each subject included 2 arms: migraine characteristics (intensity, frequency of attacks, subtype, duration, and treatment regimen) and indices of MetS according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) report criteria [high-density lipoprotein-cholesterol (‎HDL-C), triglyceride (TG), fasting plasma glucose (FPG), height, waist circumference (WC), systolic and diastolic blood pressure (BP), and body mass index (BMI)]. All data were analyzed in SPSS software. Results: Total prevalence of MetS was 16.25% (39 patients). There was a statistically meaningful relationship between hypertriglyceridemia and gender (P = 0.021), hypertriglyceridemia and prophylactic antimigraine regimen (P = 0.022), hyperglycemia and age group (P = 0.010), hyperglycemia and the intensity of headache (P = 0.048), hyperglycemia and prophylactic treatment (P = 0.001), systolic hypertension and migraine subtype (P = 0.004), systolic hypertension and the duration of migraine disease (P = 0.005), diastolic hypertension and migraine subtype (P = 0.002), WC and gender (P = 0.001), WC and the intensity of headache (P = 0.028), WC and prophylactic medication (P = 0.017), HDL and gender (P = 0.001), HDL and the prophylactic regimen (P = 0.023), and MetS and gender (P = 0.005). The prevalence of MetS was increased with increase in the severity of migraine headache. Conclusion: Due to the relative increase in the prevalence of MetS in patients with more severe migraine, an evaluation of the mechanisms of MetS is recommended in this population.

Impact of the New Definition of Metabolic Associated Fatty Liver Disease on the Epidemiology of the Disease

BACKGROUND & AIMS

Recently, a group of hepatologists proposed to rename non-alcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) with modified diagnostic criteria. We aimed to study the impact of the new definition on the epidemiology of fatty liver disease.

METHODS

We randomly selected 1013 adults from the Hong Kong census database for clinical assessment, proton-magnetic resonance spectroscopy, and transient elastography. Five hundred sixty-five subjects without fatty liver at baseline underwent follow-up assessment. MAFLD was diagnosed as intrahepatic triglyceride content (IHTG) ≥5% and the presence of overweight/obesity, diabetes, or two other metabolic risk factors, with and without concomitant liver diseases. The diagnosis of NAFLD required the exclusion of concomitant liver diseases; metabolic factors were not considered.

RESULTS

The population prevalence of MAFLD and NAFLD was 25.9% (95% CI 23.2-28.7%) and 25.7% (95% CI 23.1-28.5%), respectively. Among 277 subjects with IHTG ≥5%, 247 (89.2%) fulfilled both the definitions of MAFLD and NAFLD. Fourteen subjects (5.1%) had IHTG ≥5% but did not meet the metabolic criteria of MAFLD. The incidence of MAFLD was 2.8 per 100 person-years at a median interval of 47 months (range 34-60 months). Among 78 subjects with incident NAFLD, 59 (75.6%) met the criteria of MAFLD; only one of the latter, a regular drinker, had liver stiffness ≥10 kPa.

CONCLUSIONS

The new definition of MAFLD does not significantly change the prevalence compared with NAFLD, but it may reduce the incidence by 25%. People with hepatic steatosis but not fulfilling the definition of MAFLD unlikely have significant liver disease.

Fruit Intake and Changes of Cardio-Metabolic Risk Factors in People with Obesity

BACKGROUND

This study aimed to explore the relationship between fruit intake, changes in fruit intake, and changes in cardiometabolic factors in people with obesity.

METHODS

A total of 21,270 subjects (8,718 men, 12,552 women) aged 40 years and over, from the Korean-based Genome and Epidemiology Study, were followed up for an average of 4.4 years. Fruit intake was assessed using a food frequency questionnaire at baseline and the second follow-up. The beta coefficient and confidence intervals for changes in cardiometabolic risk factors according to fruit consumption were calculated using a linear regression model.

RESULTS

In men, the abdominal circumference decreased with changes in fruit intake (P=0.029). Fruit intake and increased fruit intake in men were associated with a lower systolic blood pressure (P=0.012 and P=0.02, respectively) and lower triglyceride levels (P=0.002 and P<0.001, respectively). In women, abdominal circumference decreased with both fruit intake and increased fruit intake (P<0.001 and P=0.013, respectively). Systolic blood pressure and triglycerides tended to decrease only with fruit intake (P=0.048 and P<0.001, respectively). Unlike in men, fasting blood glucose tended to decrease in women with both fruit intake and increased fruit intake (P=0.011 and P=0.005, respectively).

CONCLUSION

Fruit intake and increased fruit intake may have beneficial effects on cardiometabolic risk factors among individuals who are obese.

C-Reactive Protein versus Erythrocyte Sedimentation Rate: Implications Among Patients with No Known Inflammatory Conditions

BACKGROUND

Measurements of C-reactive protein (CRP) concentration and erythrocyte sedimentation rate (ESR) are frequently ordered jointly in clinical practice.

AIM

To investigate the factors associated with discordances between CRP concentration and ESR in adults.

METHODS

We conducted a cross-sectional study of 1472 adults with no known inflammatory disorders (44.5% male; median age, 52 years; range, 18-91 years), randomly selected from a municipality in Spain. The participants underwent simultaneous measurements of ESR, serum CRP, and interleukin-6 concentrations. Alcohol consumption, smoking, and physical activity were evaluated by questionnaire. Body mass index (BMI) measurement and metabolic syndrome criteria were available for all participants.

RESULTS

Most (n = 1123, 74.9%) of the participants showed normal CRP and ESR values. Sixty-nine (4.6%) participants showed high CRP and ESR values. Seventy-two (4.8%) participants showed a discordant pattern of high ESR and normal CRP values, which was associated with age after adjusting for sex, alcohol consumption, physical activity, BMI, and the presence of metabolic syndrome (odds ratio [OR], 1.052; 95% CI, 1.034-1.071; P < .001). A total of 208 (13.8%) participants showed a discordant pattern of high CRP and normal ESR values, which was associated with BMI after adjusting for covariates (OR, 1.099; 95% CI, 1.064-1.136; P < .001). BMI appeared to be the main determinant of serum CRP concentrations in this population. Serum interleukin-6 concentrations were positively associated with the discordant pattern of high CRP and normal ESR values.

CONCLUSION

In this general adult population with no overt inflammatory disease, the discordant pattern of high ESR and normal CRP was associated with greater age, whereas the pattern of high CRP and normal ESR was associated with higher BMI.

Copeptin as a novel biomarker of the cardiometabolic syndrome

Arginine vasopressin (AVP), which is also called antidiuretic hormone (ADH), is a neurohormone synthetized from a pre-pro-hormone precursor in the supreoptic and paraventricular nuclei of the hypothalamus in response to increased plasma osmolality and decreased blood volume. AVP exerts a number of effects by binding to three different receptors - V1aR, V1bR and V2R. In recent years, it has been suggested that increased plasma concentration of AVP may play a causal role in the development of type 2 diabetes, the metabolic syndrome, renal dysfunction and cardiovascular disease by influencing glucose homeostasis and lipid metabolism through several possible mechanisms involving V1aR and V1bR. V1aR located in the liver is involved in hepatic glycogenolysis and gluconeogenesis. V1bR, found in the pituitary gland and pancreas mediates secretion of adrenocorticotrophic hormone (ACTH), insulin and glucagon. However, AVP's clinical use as a biomarker is limited due to its short half-life in plasma (16-20 minutes), small size and poor stability, which make direct measurement difficult. Copeptin, the biologically inactive, stable, C-terminal part of pro-vasopressin, is co-secreted with AVP in equimolar amounts and thus is considered an adequate and clinically useful surrogate marker of AVP. The aim of this review is to assess the current state of knowledge about the potential role of copeptin as a novel biomarker of the cardiometabolic syndrome on the basis of recent scientific literature published up to December 2020 and searches of the PubMed, Google Scholar, and Web of Science databases.

Uncurtaining the pivotal role of ABC transporters in diabetes mellitus

The metabolic disorders are the edge points for the initiation of various diseases. These disorders comprised of several diseases including diabetes, obesity, and cardiovascular complications. Worldwide, the prevalence of these disorders is increasing day by day. The world's population is at higher threat of developing metabolic disease, especially diabetes. Therefore, there is an impregnable necessity of searching for a newer therapeutic target to reduce the burden of these disorders. Diabetes mellitus (DM) is marked with the dysregulated insulin secretion and resistance. The lipid and glucose transporters portray a pivotal role in the metabolism and transport of both of these. The excess production of lipid and glucose and decreased clearance of these leads to the emergence of DM. The ATP-binding cassette transporters (ABCT) are important for the metabolism of glucose and lipid. Various studies suggest the key involvement of ABCT in the pathologic process of different diseases. In addition, the involvement of other pathways, including IGF signaling, P13-Akt/PKC/MAPK signaling, and GLP-1 via regulation of ABCT, may help develop new treatment strategies to cope with insulin resistance dysregulated glucose metabolism, key features in DM.

[Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research]

PURPOSE

This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR).

METHODS

A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test.

RESULTS

The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem.

CONCLUSION

The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

Effectiveness of Multi Interventional Package on Selected Parameters of Metabolic Syndrome among Women: A Pilot Study

PURPOSE

The purpose of the study was to compare the effectiveness of multi interventional package (MIP) and lifestyle interventions (LI) on physiological parameters of women with metabolic syndrome, to compare the effectiveness of MIP and LI on biochemical parameters of women with metabolic syndrome and to compare the effectiveness of MIP and LI on socio-psychological parameters of women with metabolic syndrome.

METHODS

A quasi experimental nonequivalent control group design with two experimental groups and one control group was used to collect data from 60 self-help group women. Samples were selected by multistage sampling. Reflexology foot massage, dietary modification, moderate intensity exercise and structured education were given to MIP group and dietary modification, moderate intensity exercise and structured education were given to LI group for 12 weeks. Control group received routine care. Demographic and clinical data sheets were used to collect basic information. Knowledge was assessed by a knowledge questionnaire. Physiological (weight, body mass index, waist circumference and blood pressure) and biochemical parameters (HDL, triglycerides and FBS) were assessed before and after the intervention.

RESULTS

The study found significant change in the physiological and biochemical parameters of metabolic syndrome as well as knowledge among the MIP group and LI group compared to the control group (p < .001).

CONCLUSION

MIP and LI are effective in controlling the parameters of metabolic syndrome. Hence the guidance may be provided to women with metabolic syndrome for adopting necessary lifestyle changes as well as reflexology foot massage to control the physiological and biochemical parameters of metabolic syndrome.