Prevalence of the metabolic syndrome in patients with diabetes mellitus

Cardiovascular risk factors in diabetic patients with and without metabolic syndrome: a study based on the Rafsanjan cohort study

Cardiovascular disease (CVD) is the leading cause of death and disability in people with diabetes mellitus (DM), since finding the correlation between DM and CVD risk factors can be effective in preventing the incidence of morbidity and mortality in patients. This study aimed to determine the prevalence of cardiovascular risk factors in people with and without metabolic syndrome (MtS) in DM. This cross-sectional study was part of the Rafsanjan Cohort Study as part of the comprehensive Persian (Prospective Epidemiological Research Studies in IRAN) on 35-70-year old adults with and without MtS in DM. Indicators of CVD risk factors, including gender, age, blood pressure, dyslipidemia, smoking, alcohol consumption, fasting blood sugar, creatinine, blood urea, waist circumference, body mass index, family history, physical inactivity, and fruit and vegetable consumption, were collected in the Persian Cohort Questionnaire. The data was analyzed by SPSS software version 22. The prevalence of MtS in 1933 participants was estimated to be 80% (95% confidence interval 78.1-81.8%). In the logistic regression model, smoking, alcohol consumption, and triglycerides were identified as the factors associated with MtS. Our results show that, based on our study, the prevalence of cardiovascular risk factors in DM was high. The suggested solutions in this field are to reduce smoking and alcohol consumption, as well as to control hypertension, hyperlipidemia, and being overweight.

Effects of combination of obesity, diabetes, and hypoxia on inflammatory regulating genes and cytokines in rat pancreatic tissues and serum

Background

Obesity and diabetes are becoming increasingly prevalent around the world. Inflammation, oxidative stress, insulin resistance, and glucose intolerance are linked to both obesity and type 2 diabetes, and these disorders are becoming major public health issues globally.

Methods

This study evaluated the effects of obesity, diabetes, and hypoxia on the levels of pro- and anti-inflammatory cytokines in rats. We divided 120 Wistar rats in two groups, male and female, each including six subgroups: control (CTRL), obese (high-fat diet (HFD)), diabetic (streptozotocin (STZ)-treated), hypoxic (HYX), obese + diabetic (HFD/STZ), and obese + diabetic + hypoxic (HFD/STZ/HYX). We examined the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL10, and leptin in pancreatic tissues and serum.

Results

No significant difference was observed in serum levels of cholesterol, triglycerides, and low-density lipoprotein (LDL) between HYX and CTRL in either sex. However, they were significantly increased, whereas high-density lipoprotein (HDL) was significantly decreased in HFD, STZ, HFD/STZ, and HFD/STZ/HPX compared with CTRL in both sexes. The expression of Tnf-α, Il6, and Lep was significantly upregulated in all subgroups compared with CTRL in both sexes. STZ and HYX showed no significant differences in the expression of these genes between sexes, whereas Tnf-α and Il6 were upregulated in male HFD, HFD/STZ, and HFD/STZ/HYX compared with females. Protein levels showed similar patterns. Combination subgroups, either in the absence or presence of hypoxia, frequently exhibited severe necrosis of endocrine components in pancreatic lobules. The combination of obesity, diabetes, and hypoxia was associated with inflammation, which was verified at the histopathological level.

An examination of the prevalence of metabolic syndrome in older adults in Ireland: Findings from The Irish Longitudinal Study on Ageing (TILDA)

Metabolic syndrome (MetS) consists of the cluster of central obesity, insulin resistance, hypertension and atherogenic dyslipidaemia. It is a risk factor for cardiovascular disease, diabetes, and mortality. The prevalence of MetS has not been described in older adults from a population-representative sample in a European country before. This study aimed to determine the prevalence of MetS in older adults in Ireland and examine the association between MetS and socio-demographic, health, and lifestyle factors. This study used data from a population aged ≥50 years from waves 1 and 3 of the Irish Longitudinal Study on Ageing. The prevalence of MetS using the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria were determined. Weighted logistic regression examined the association between MetS and age, sex, education, and physical activity. MetS status was determined at both waves with transitions examined. 5340 participants had complete data for MetS criteria at wave 1. 33% had MetS according to the ATPIII criteria (32.5%; 95% CI: 31.1, 34.0), with 39% according to the IDF criteria (39.3%; 95% CI: 37.8, 40.8). MetS was more prevalent with advancing age, among males, those with lower educational attainment and lower physical activity. 3609 participants had complete data for both waves– 25% of those with MetS at wave 1 did not have MetS at wave 3 but the overall number of participants with MetS increased by 19.8% (ATPIII) and 14.7% (IDF). MetS is highly prevalent in older adults in Ireland. 40% of the 1.2 million population aged ≥50 years in Ireland meet either the ATPIII or IDF criteria. Increasing age, male sex, lower educational attainment, and lower physical activity were all associated with an increased likelihood of MetS.

Prevalence of Metabolic Syndrome and its Components in Kanifing Municipality, The Gambia

Background

Metabolic syndrome (MetS) is a complex syndrome with clustering of interrelated risk factors for cardiovascular disease and diabetes. Its rising worldwide prevalence has been largely related to the increasing obesity. In The Gambia, the last and only time a MetS related study was conducted, and then reported, was 21 years. Therefore, there is need for evaluating the prevalence of MetS and its components in the country.

Objective

This study was aimed to evaluate the prevalence of MetS and its individual components in Kanifing Municipality (KM).

Methods

It was a cross-sectional study conducted at Kanifing General Hospital, Kanifing Municipality. Data obtained from each participants included anthropometric indices, blood pressure, fasting plasma glucose, triglyceride and high-density lipoprotein levels, and clinical information.

Results

One hundred and thirty-six participants were included in the analysis. The overall MetS prevalence was 54.4% with significant female predominance (female, 58%; male, 29.4%; P=0.025). The most predominant component among the study population was central obesity (raised WC) (72.8%). Hypertriglyceridemia was found to be the strongest predictor of MetS among our participants (OR: 118.13; 95% CI: 33.79-412.77; P < 0.001).

Conclusion

Our study discloses a very high prevalence of MetS among the participants, and a significant female predominance, with central obesity the commonest Mets component. The results suggest that hypertriglyceridemia is the strongest predictor of metabolic syndrome in our study participants.

An Overview of the Pathophysiology of Metabolic Changes and Their Sequence of Occurrence in Obese Diabetic Females: A Narrative Review

Obesity and diabetes both mediate their effects through insulin resistance and frequently co-exist. Insulin resistance is one of the key factors in the development of the metabolic syndrome. Adult females tend to develop obesity more frequently than males. One of the factors causing this difference is the pattern of changes that occur as females age from pre-menopausal to the post-menopausal stage, causing a change in the pattern of accumulation of fats. Several studies have explored and described the association between obesity and metabolic syndrome and their effect on type II diabetes. We conducted our literature search using PubMed and Google Scholar as our primary databases. We selected a total of 49 articles for review after applying the inclusion and exclusion criteria and removing the duplicate articles. We chose the full-text articles that were published in the English language only. The selected studies were randomized controlled trials and review papers. The reviewed articles showed that visceral fat, central obesity, and fasting blood sugar of post-menopausal is higher than in pre-menopausal women and needs adequate management. More studies are needed in the future to explore the patterns of the metabolic changes in obese females to provide early and better management of diabetes and prevent related complications.

Metabolic syndrome among type 2 diabetic patients in Sub-Saharan African countries: A systematic review and meta-analysis

BACKGROUND AND AIMS

Metabolic syndrome is one of the serious public health problems among type 2 diabetic patients. Despite a number of studies have been conducted, there is no overall estimation on the prevalence of metabolic syndrome among type 2 diabetic patients in Sub-Saharan African countries. Therefore, this study aimed to estimate the pooled prevalence of metabolic syndrome in patients with type 2 diabetes mellitus in Sub -Saharan African countries.

METHODS

PubMed, Web of Science, African Journals Online, Google Scholar, Scopus, and Wiley Online Library databases from inception to April 27, 2020 were searched to identify relevant studies. The I² statistic was used to check heterogeneity across the included studies. DerSimonian and Laird random-effects model was applied to estimate pooled effect size, and 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was deployed to determine the effect of a single study on the overall estimation. All statistical analyses were done using STATA™ Version 14 software.

RESULT

In this meta-analysis, a total of 23 studies with 6482 study participants were included. The estimated prevalence of metabolic syndrome in Sub-Saharan African countries was 59.62% (95% CI: 52.20, 67.03). Based on the subgroup analysis, the highest prevalence of metabolic syndrome (61.14%, 95% CI: 51.74, 70.53) was reported in Ethiopia. Additionally, the highest prevalence of metabolic syndrome was reported across studies using the diagnostic criteria of National Cholesterol Education Program Adult Treatment Panel III 64.8% (95% CI: 54.74, 74.86), followed by International Diabetic Federation (57.15%), and World health Organization (53.12%) definitions.

CONCLUSION

Almost two out of three type 2 diabetic patients in Sub-Saharan African countries have metabolic syndrome, which implies that its prevalence is high in patients with type 2 diabetes mellitus. Therefore, policymakers need to design efficient strategies and guideline to reduce and control the burden of metabolic syndrome and its impact among diabetic population.

A Comparison of the Prevalence of the Metabolic Syndrome among Sri Lankan Patients with Type 2 Diabetes Mellitus Using WHO, NCEP-ATP III, and IDF Definitions

Background

Presence of metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (type 2 DM) increases the risk of cardiovascular morbidity and mortality. Therefore, recognition of MetS in type 2 DM is important in initiating the appropriate preventive and therapeutic measures. The commonly used definitions have similarities and discrepancies. Aims of this study was to investigate the prevalence of MetS among patients with type 2DM using all three well known (WHO, IDF, and NCEP-ATP III) definitions and to identify the concordance and the difference of these three definitions.

Methods

This cross-sectional study included patients with type 2 DM who were followed up at the regional diabetes centre in Galle, Sri Lanka. A total of 2913 type 2 DM patients were recruited by convenient sampling method, and their clinical and biochemical data were collected.

Results

The mean age (SD) of the sample was 49.9 (10.2) years and the mean duration of diabetes was 5.04 (5.71). Prevalence of MetS was highest by WHO (70%) followed by IDF (44%) and NCEP-ATP III (29%) definitions. The prevalence was significantly higher in women according to all three definitions, and the difference was most marked with NCEP-ATP III and IDF definitions. Around 25% were identified as having MetS by all three definitions whereas around 45% were recognized with MetS by two definitions. While concordances between WHO with IDF (0.37, p < 0.001) and NCEP-ATP III (0.24, p < 0.001) criteria were poor, they were average (0.53, p < 0.001) between NCEP-ATP III and IDF criteria.

Conclusions

The prevalence of MetS among patients with type 2 DM can significantly be varied based on the definition used and the three definitions of MetS recognized different set of individuals. The highest prevalence of MetS was observed with WHO (70.6%) whereas lowest was observed with NCEP-ATP III definition.

A Descriptive Study of the Progression of the Metabolic Syndrome in Middle-Aged Chinese Population

This longitudinal study investigated the prevalence of the Metabolic Syndrome (MetS) in middle-aged (44–56 years) men and women in China. The presence of the components of the MetS was determined in a cohort of 643 persons born in 1956, 1960–1961, and 1964 in Shanxi Province China in 2008 and 2012. The rate of MetS in 2008 was 51.63% (95% CI [44.73, 58.48]) and 37.15% (95% CI [32.56, 41.92]) and in 2012 was 50.23% (95% CI [43.35, 57.10]) and 46.26% (95% CI [41.46, 51.11]) for men and women, respectively. Increased blood glucose and triglycerides and decreased high-density lipoprotein for women, and blood glucose and triglycerides for men were the components responsible for the development of MetS from 2008 to 2012. MetS develops differently between men and women. From age 44 to 56, the rate is unchanged among men and increasing among women.

Prevalence of dyslipidemia and hypertension in Indian type 2 diabetic patients with metabolic syndrome and its clinical significance

OBJECTIVES

The present study was designed to estimate the prevalence of dyslipidemia and hypertension based on the National Cholesterol Educational Programme Adult Treatment Panel III definition of metabolic syndrome (MetS). The study also focuses on prevalence for MetS with respect to the duration of disease in Gwalior-Chambal region of Madhya Pradesh, India.

METHODS

Type 2 diabetic patients (n = 700) were selected from a cross-sectional study that is regularly being conducted in the School of Studies in Biochemistry, Jiwaji University Gwalior, India. The period of our study was from January 2007 to October 2009. Dyslipidemia and hypertension were determined in type 2 diabetic patients with MetS as per National Cholesterol Educational Programme Adult Treatment Panel III criteria.

RESULTS

The mean age of the study population was 54 ± 9.3 years with 504 (72%) males and 196 (28%) females. The prevalence of MetS increased with increased duration of diabetes in females; however, almost constant prevalence was seen in the males. Notable increase in the dyslipidemia (64.1%) and hypertension (49%) in type 2 diabetic patients were seen. The steep increase in dyslipidemia and hypertension could be the reason for the growing prevalence of diabetes worldwide. The study also noted a close association between age and occurrence of MetS.

CONCLUSION

Individual variable of MetS appears to be highly rampant in diabetic population. Despite treatment, almost half of patients still met the criteria for MetS. Effective treatment of MetS components is required to reduce cardiovascular risk in diabetes mellitus hence accurate and early diagnosis to induce effective treatment of MetS in Indian population will be pivotal in the prevention of cardiovascular disease and type 2 diabetes.

Prevalence of metabolic syndrome in type 2 diabetes mellitus using NCEP-ATPIII, IDF and WHO definition and its agreement in Gwalior Chambal region of Central India

The aim of study was to determine the prevalence of metabolic syndrome (MetS) in people with type 2 diabetes mellitus (T2DM). National Cholesterol Education Program (NCEP) ATPIII Criteria, International Diabetes Federation and the World Health Organization (WHO) definitions were used in quantifying the metabolic syndrome and also the concordance between these three criteria's used for identifying metabolic syndrome.

METHODS

This cross-sectional study involved 700 type 2 diabetic subjects from the urban areas of Gwalior Chambal region (Central India). Subjects in the age group of 28- 87 yrs were included in the study. Type I diabetics, pregnant ladies and those with chronic viral and bacterial infections and serious metabolic disorders were excluded from the study. Fasting blood glucose, Blood lipids (T-cholesterol, triglyceride, HDL-cholesterol) were assessed and anthropometry blood pressure were measured from all the subjects.

RESULTS

The Prevalence of metabolic syndrome was found to be 45.8%, 57.7% and 28% following NCEP-ATPIII Criteria, IDF and WHO definitions, respectively. Using all the three definitions the prevalence was higher in women in all age groups. ATP III and IDF criteria showed good agreement (k 0.68) compared to ATP III with WHO (k 0.54) and IDF with WHO (k 0.34) criteria. Highest prevalence was observed following IDF definition.

CONCLUSIONS

A good agreement was observed between ATPIII and IDF criteria. Maximum prevalence of Metabolic syndrome was recorded when IDF criteria was followed. NCEP-ATPIII criteria for the diagnosis of MetS and this criterion reflected equal importance to the every variable and showed a good agreement between the different criteria used.

Metabolic syndrome among Sri Lankan adults: prevalence, patterns and correlates

Metabolic Syndrome (MS) increases the risk for Coronary Artery Disease, stroke and diabetes. MS is twice more common amongst South Asian immigrants in US compared to native Caucasians. There are no nationally representative studies on prevalence of MS from any of the South Asian countries. The present study aims to evaluate the prevalence of MS among Sri Lankan adults and investigates its relationships with socio-demographic, clinical and biochemical parameters. Data on MS and its associated details were obtained from a population-based cross-sectional study conducted between years 2005-2006. MS was defined according to the International Diabetes Federation criteria. A binary logistic regression analysis was performed using the dichotomous variable MS (0 = absent, 1 = present). The independent co-variants were: gender, age category, area of residence, ethnicity, level of education, income and physical activity. Sample size was 4,485 (Response rate-89.7%), 39.5% were males and mean age was 46.1 ± 15.1 years. The crude prevalence of MS was 27.1% (95% CI: 25.8-28.5), and age-adjusted prevalence was 24.3% (95% CI: 23.0-25.6). Prevalence in males and females were 18.4% (95% CI: 16.5-20.3) and 28.3% (95% CI: 26.6-30.0) respectively (p < 0.001). Urban adults (34.8% [95% CI: 31.8-37.9]) had a significantly higher prevalence than rural adults (21.6% [95% CI: 20.2-23.0]). Among ethnic groups, the highest prevalence of MS was observed in Sri Lankan Moors (43.0% [95% CI: 37.2-48.9]). In all adults, MS was observed in those with the highest level of education and monthly household income. Prevalence of MS in the different physical activity categories of the IPAQ were; 'inactive'-38.8% (95% CI 34.5-43.2), 'moderately active'-33.5% (95% CI 30.9-36.1) and 'active'-21.1% (95% CI 19.6-22.7). The results of the binary logistic regression analysis indicates that female gender (OR:1.7), increasing age, urban living (OR:1.7), Moor ethnicity (OR:2.6), secondary (OR:1.5) and tertiary levels of education (OR:2.3), monthly household income LKR 7,000-24,999 (OR:1.5) and >50,000 (OR:2.1), and physical inactivity (OR:1.6), all significantly increased risk of developing MS. MS is common among Sri Lankan adults affecting nearly one-fourth of the population. Female gender, increasing age, urban living, higher socio-economical status and physical inactivity were important associated factors.

Risk factors for metabolic syndrome in a cohort study in a north China urban middle-aged population

As China undergoes urbanization, lifestyles and disease profiles are changing. In this study, metabolic syndrome (MetS) was discovered in 53.5% and 42.7% of men and women, respectively. In 3 age cohorts (44, 48, and 52 years), prevalence of MetS among women was 33.3%, 41.4%, and 50.8%, respectively (χ(2) = 10.27, P = .006), whereas among men it was 51.5%, 56.3%, and 52.3%, respectively (χ(2) = 0.46, P = .796). The component contributing to the presence of MetS was increased waist circumference, especially among women. MetS among men results from higher rates of elevated triglycerides, blood pressure, and blood glucose when compared with women. Risk factors for MetS included less than 60 minutes of exercise a week (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.3-2.4) and rarely consuming milk (OR = 1.7, 95% CI = 1.2-2.3). Abstaining from or occasionally consuming alcohol (OR = 0.7, 95% CI = 0.4-1.1) and having parents with no chronic disease (OR = 0.4, 95% CI = 0.2-0.6) suggest increased protection against MetS.

The metabolic syndrome in Africa: Current trends

Metabolic syndrome is a clustering of several cardiovascular risk factors. Contrary to earlier thoughts, metabolic syndrome is no longer rare in Africa. The prevalence is increasing, and it tends to increase with age. This increase in the prevalence of metabolic syndrome in the continent is thought to be due to departure from traditional African to western lifestyles. In Africa, it is not limited to adults but is also becoming common among the young ones. Obesity and dyslipidemia seem to be the most common occurring components. While obesity appears more common in females, hypertension tends to be more predominant in males. Insulin resistance has remained the key underlying pathophysiology. Though pharmacologic agents are available to treat the different components of the syndrome, prevention is still possible by reverting back to the traditional African way of life.

Erectile dysfunction and testosterone screening with prostate specific antigen screening at age 40: are these three gender specific determinants additive for overall men's heath and do they improve traditional non-gender specific determinants to lessen cardiovascular risk and all-cause mortality?

AIMS

Assess support for a recommendation to add screening for both erectile dysfunction (ED) and hypogonadism to the initial medical evaluation of young-to-middle aged (≥ 40 years of age) men in light of recent guidelines suggesting prostate-specific antigen screening occur at that age.

METHODS

A search of literature published from 1998 to 2009 was performed. Search terms included: ED combined with coronary artery disease (CAD), metabolic syndrome and hypogonadism, hypogonadism and ED, hypogonadism, ED and mortality. Articles were evaluated according to the Center of Evidence-Based Medicine.

RESULTS

Both retrospective and prospective evaluations have demonstrated a strong relationship between ED, established cardiovascular risk factors, CAD and the potential occurrence of cardiovascular events. Low testosterone levels are associated with ED. Low serum total testosterone is an independent risk factor for both metabolic syndrome and type 2 diabetes and all-cause mortality.

CONCLUSION

Traditionally, ED and testosterone levels have been considered mainly, if not exclusively, in the context of sexual health. The results briefly summarised herein and other recent reviews suggest that ED and hypogonadism are signals of future all-cause mortality and overall health status and thus move these evaluations into the broader arena of public health. Screening for ED and hypogonadism provide 'gender-specific determinants' to assess general metabolic and cardiovascular health risks in men. It is the opinion of the authors that this screening be performed in addition to the well-established non-gender-specific screening tests of lipids, blood pressure, obesity and serum glucose.

Prevalence and gender distribution of the metabolic syndrome

BACKGROUND

The Metabolic syndrome (MetS) is a cardiovascular risk factor of public health significance and of recent has become a topical issue. The prevalence of diabetes mellitus (DM) is on the increase and with this scenario, a possible increase in burden of DM which may be largely attributed to cardiovascular complications is expected. The objective of this report is to determine the prevalence of the MetS and compare gender characteristics in subjects with type 2 DM.

METHODS

Subjects with type 2 DM were recruited from an urban hospital for the study. Clinical data was obtained by interviewing the patients and referring to their case folders. The anthropometric indices and blood pressure measurements were documented. Laboratory parameters analysed for included total cholesterol, high density and low density cholesterol, triglyceride and glycosylated haemoglobin. Statistical analysis included usage of Student's t test and chi square.

RESULTS

963 patients with type 2 DM aged between 35-85 years were recruited for the study. The main outcome measures included the prevalence of the metabolic syndrome and the gender differences of its components. The prevalence of the metabolic syndrome was 86%. The frequency of occurrence of the MetS was similar for men (83%) and women (86%) and increased with age in both sexes. The prevalence of MetS increased from 11% among participants aged 20 through 29 years to 89% in participants aged 70 through 79. In our patients with DM, the commonest occurring and least detected MetS defining parameters are central obesity and elevated triglyceride levels respectively. The components of the MetS that differed significantly in both sexes was HDL-C. The combination of the components of the MetS were comparable in both genders and 5.8% of the subjects with the MetS had all components of the MetS.

CONCLUSION

The prevalence of the MetS in type 2DM is high in both genders and increases with age thus posing a potential high cardiovascular risk in this group of patients. The modifiable risk factors for the MetS should be a focus point in the management of subjects with type 2 DM.