Association between leisure time physical activity and metabolic syndrome: a meta-analysis of prospective cohort studies

Cumulative associations between health behaviours, mental well-being, and health over 30 years

BACKGROUND

Both the number of risky health behaviours and the duration of exposure to these behaviours over time may increase the risk of later adverse outcomes. This study examined cumulative associations of risky health behaviours with both positive and negative aspects of mental well-being and health. It has a uniquely long follow-up period of over 30 years, from early adulthood to the beginning of late adulthood.

MATERIALS AND METHODS

The data were from the Jyväskylä Longitudinal Study of Personality and Social Development. The participants represent the Finnish age cohort born in 1959. This study utilized data collected at ages 27 (1986), 36 (1995), 42 (2001), 50 (2009), and 61 (2020-2021) (n = 206-326). Risk scores indicating the current number of risky behaviours of smoking, heavy alcohol consumption, and physical inactivity and their temporal accumulation over time were calculated. The associations of risk scores with mental well-being (depressive symptoms, psychological well-being) and health (self-rated health, number of metabolic risk factors) from age 36 onwards were analyzed with linear multilevel models adjusted for gender and education.

RESULTS

More current risky behaviours were associated with more depressive symptoms (B = 0.10, p = 0.032), lower psychological well-being (B = -0.10, p = 0.010), lower self-rated health (B = -0.45, p < 0.001), and more metabolic risk factors (B = 0.53, p = 0.013). The associations of temporal risk scores with the outcomes were even stronger (depressive symptoms: B = 0.38, p < 0.001; psychological well-being: B = -0.15, p = 0.046; self-rated health: B = -0.82, p < 0.001; metabolic risk factors: B = 1.49, p < 0.001). Among individual behaviours, the temporal risk score of alcohol consumption was negatively associated with most outcomes, while smoking was associated with poorer mental well-being and physical inactivity with poorer health.

CONCLUSIONS

The current and temporal accumulation of multiple risky health behaviours were associated with poorer mental well-being and health. Preventing these behaviours early in adulthood and midlife is crucial to avoid their accumulation and subsequent health risks.

Air pollution, greenspace, and metabolic syndrome in older Czech and Swiss populations

Background

The prevalence of metabolic syndrome (MetS) has increased rapidly, with considerable variation between European countries. The study examined the relationship between air pollutants, greenspace, and MetS and its components in the Czech and Swiss populations.

Methods

Cross-sectional data from the Czech Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) (n = 4,931) and the Swiss cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) (n = 4,422) cohorts included participants aged 44-73 years. MetS was defined as abdominal obesity plus two additional components (hypertension, diabetes, low high-density lipoprotein cholesterol, and elevated triglycerides). Annual mean concentrations of PM10, PM2.5, NO2, and greenspace (defined as the annual mean of normalized difference vegetation index within 500 m) were assigned to the individual residential level. We estimated odds ratios (OR) using multivariable logistic regressions with cluster-robust standard error, controlling for multiple confounders.

Results

The prevalence of MetS was significantly higher in the Czech (51.1%) compared with Swiss (35.8%) population as were the concentration means of PM10 and PM2.5. In HAPIEE, a 5 μg/m3 increase in PM2.5 was associated with 14% higher odds of MetS (OR = 1.14; 95% confidence interval [CI] = 1.01, 1.28). In SAPALDIA, no evidence was found for the associations between air pollutants and MetS (e.g. OR = 1.01; 95% CI = 0.90, 1.13 for PM2.5). No protective effects of normalized difference vegetation index on MetS were observed. Upon inspection of MetS components, PM2.5 and PM10 exposures were associated with higher odds of hypertension and elevated triglycerides in HAPIEE only, while PM2.5, PM10, and NO2 were associated with higher odds of diabetes in SAPALDIA only.

Conclusion

Individuals with higher exposures to PM2.5 may be at higher risk of MetS. The differential associations with MetS components between the cohorts deserve further investigation.

The interplay of physical activity and smoking with metabolic syndrome and its components in the STEPS survey

Metabolic syndrome (MetS) is a cluster of metabolic disorders associated with an increased risk of cardiovascular disease and type 2 diabetes. The aim of this study was to investigate the interaction between physical activity and smoking on the development of MetS and its components. In this repeated cross-sectional study, data from the Iranian STEPwise non-communicable disease risk factor surveillance (STEPS) surveys (2007, 2011, and 2016) were analyzed, which included 40,046 participants aged 25-64 years. Physical activity was categorized as low, moderate, or vigorous based on metabolic equivalents (MET) minutes per week. Smoking status was defined based on self-reported information as either a current smoker or a non-smoker. MetS was diagnosed using established criteria. Interactive association was analyzed using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI), and weighted logistic regression. The weighted prevalence of MetS was higher in the low physical activity group (34.32%) than in the current smokers group (26.63%). Positive interactions between low physical activity and smoking were observed for MetS (RERI = 0.23, AP = 0.25, SI = 0.23), abdominal obesity (RERI = 0.24, AP = 0.31, SI = 0.47) and high triglycerides (RERI = 0.19, AP = 0.19, SI = 0.12). Moderate/vigorous physical activity combined with smoking was associated with lower odds of abdominal obesity, hypertension and elevated fasting blood glucose, but higher odds of low HDL cholesterol. A physical inactivity appears to be a greater potential risk factor for MetS than smoking. The interaction between low physical activity and smoking exacerbates the odds of MetS and several of its components. Promoting physical activity and smoking cessation should be prioritized in MetS prevention and treatment strategies.

Association between the oxidative balance score and mortality in patients with metabolic syndrome

Anti-oxidant/Pro-oxidant oxidant imbalance leads to chronic inflammation and insulin resistance can lead to the development of metabolic syndrome (MetS). The oxidative balance score (OBS) is a tool for assessing oxidative stress associated with MetS risk. However, the association between OBS and mortality in patients with MetS remains unclear. This study analyzed 10,647 MetS patients from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). OBS were calculated using a combination of 16 dietary and 4 lifestyle factors. Multivariate Cox proportional hazards regression models, Kaplan-Meier survival analysis, restricted cubic splines (RCS), and subgroup analyses were used to evaluate the potential association between OBS and the risk of all-cause and cardiovascular mortality. Sensitivity analyses confirmed the robustness of the results. This study found that OBS was inversely associated with all-cause and cardiovascular mortality in patients with MetS, a result consistent across most subgroups. Both the Kaplan-Meier curve and RCS analysis supported these findings. Sensitivity analysis was used to verify the robustness of the results. Maintaining an antioxidant-based diet and lifestyle may help reduce the risk of all-cause and cardiovascular mortality in patients with MetS. These findings underscore the significance of incorporating antioxidant-rich dietary patterns and behavioral practices in strategies aimed at preventing and managing MetS.

Effect of Mediterranean diet and physical activity on healthcare professional depression, burnout and professional fulfillment during COVID-19

Objectives. The mental health of healthcare professionals, especially during the COVID-19 pandemic, is a critical concern. This study investigates the prevalence of burnout and professional fulfillment, depression and the relationship between physical activity and adherence to the Mediterranean diet with depression, burnout and professional fulfillment among healthcare professionals. Methods. Data were collected through a web-based survey of 567 healthcare professionals. Logistic regression analysis with age and sex adjustment was employed to analyze the results. Results. The prevalence of depression was 44%, burnout stood at 66% and professional fulfillment was reported at 28%. Adherence to the Mediterranean diet was linked to a reduced risk of depression (odds ratio [OR] 0.63, 95% confidence interval [CI] [0.41, 0.96], p = 0.033) and physical activity was also associated with a lower risk of depression (OR 0.49, 95% CI [0.32, 0.75], p = 0.001). Furthermore, adherence to the Mediterranean diet was associated with a reduced risk of burnout (OR 0.49, 95% CI [0.25, 0.98], p = 0.045). Conclusion. This study highlights the positive impact of physical activity and the Mediterranean diet as lifestyle factors on depression and burnout. These findings have implications for screening, follow-up and timely interventions to support the mental well-being of healthcare professionals.

Sleep: The silent hero in cardiometabolic health

The essential role of sleep in overall health is increasingly recognized, yet it remains underemphasized in both clinical and public health contexts. Despite extensive research linking poor sleep health to chronic conditions such as cardiovascular disease, type 2 diabetes, and cognitive decline, sleep health is not routinely assessed or integrated into standard care practices. Sleep problems, including insomnia, sleep apnea, and poor sleep quality, are prevalent globally, affecting over 30 % of the population and contributing to significant public health burdens like cardiometabolic disease, mental health disorders and multimorbidity. The economic implications are substantial, with insufficient sleep imposing significant societal and financial costs worldwide. Recognizing this, recent initiatives like the American Heart Association's inclusion of sleep in the Life's Essential 8 framework highlight the importance of sleep in cardiometabolic health. Integrating sleep into clinical and public health strategies is crucial, due to the wide-ranging impact of sleep on cardiometabolic health. Social, environmental, and demographic factors also play significant roles in sleep health, with lower socioeconomic groups and women often experiencing poorer sleep, further exacerbating health disparities. Adopting a life course approach and promoting healthy sleep behaviors early in life are essential for mitigating long-term cardiometabolic risks. Effective evidence-based strategies for improving sleep behaviors and cardiometabolic health, beyond addressing sleep disorders, include prioritizing sleep hygiene, managing stress, promoting physical activity, maintaining a healthy diet, and reducing substance use, all of which contribute to overall well-being. In conclusion, incorporating sleep health into routine cardiometabolic risk stratification, prevention, and management is essential for improving overall health outcomes.

Effects of weekend-focused exercise on obesity-related hormones and metabolic syndrome markers in male high school students

To examine the changes in obesity-related hormones and metabolic syndrome markers in male high school students with obesity following a weekend-focused moderate- or high-intensity exercise program at the recommended weekly physical activity level, or a program of regular exercise 3 times a week at moderate intensity, over a 10-week period. Forty-eight male high school students who were obese with a body fat percentage of ≥25% were randomly assigned to one of three groups: a regular moderate-intensity exercise group (n=17) that freely selected and performed moderate-intensity aerobic and resistance training exercises, every Monday, Wednesday, and Friday, for a total of 150-300 min/wk; a weekend-focused moderate-intensity exercise group (n=15) that freely selected and performed aerobic and resistance training exercises every Saturday for 150-300 min; and a week-end-focused high-intensity exercise group (n=16) that freely selected and performed aerobic and resistance training exercises every Sunday for 75-150 min. Insulin and leptin levels significantly decreased in all the groups, with the greatest reduction in the regular exercise group. Abdominal circumference and triglyceride levels significantly decreased in all the groups. Fasting glucose decreased only in the regular exercise group. High-density lipoprotein cholesterol significantly increased in both the regular and weekend-focused moderate-intensity exercise groups. No significant differences in adiponectin levels, and systolic and diastolic blood pressure were observed between the groups. A weekend-focused exercise program has health effects similar to those of regular exercise, highlighting the importance of meeting the recommended weekly physical activity levels.

Health-related quality of life in adults with metabolic syndrome: a multi-level analysis of family and individual level variation

PURPOSE

The current study aimed to investigate the associations between metabolic syndrome (MetS) with health-related quality of life (HRQoL) using multilevel analysis among the Iranian adult population.

METHODS

This cross-sectional study was conducted in the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were 6113 participants (3318 women and 2795 men) aged≥20 years of the TLGS seventh phase who had completed data on HRQoL and MetS. HRQoL was assessed using the short-form 12-item health survey V.2 and MetS defined based on the guidelines outlined in the Joint Interim Statement. The two-level model was fitted to assess the association between MetS and HRQoL.

RESULTS

The prevalence of MetS and its components was higher in men, and regardless of metabolic status, men exhibited higher HRQoL values. The deleterious impact of MetS on HRQoL was more pronounced in women, while the detrimental effects of MetS on men's HRQoL were confined to specific subscales. These results were obtained through multilevel analysis, considering both familial and individual variation levels. Moreover, our investigation highlighted the positive influence of leisure-time physical activity on both the physical and mental component summaries (PCS and MCS, respectively), regardless of gender. Education had a greater positive impact on PCS in both sexes. Additionally, a history of cardiovascular diseases was associated with a decline in mental and physical HRQoL, while age was linked to a decline in PCS and MCS, and smoking was associated with a decline in MCS.

CONCLUSION

This study revealed the significant influence of gender, as well as the unique characteristics and circumstances of individuals, on the relationship between MetS and HRQoL in a general population with low/middle income.

Sex differences in the prevalence of metabolic syndrome and associated factors in the general population of Mongolia: A nationwide study

The prevalence and factors associated with metabolic syndrome (MetS) between men and women in Mongolia were compared using secondary data from the STEPwise approach to non-communicable disease risk factor surveillance conducted in 2019. In total, 5,695 participants (2,577 males and 3,118 females) aged 18-69 years old were enrolled in the study. The prevalence of MetS was 37.4% in total and the prevalence was significantly higher in women (39.2%) than men (35.2%, P = 0.002). The most prevalent MetS components were abdominal obesity in women (74.2%) and high blood glucose levels in men (58.7%). All of the 2,128 participants who were categorized into MetS met the criteria of abdominal obesity. Factors associated with MetS included being 30-69 years old compared to 18-29 years old, low and moderate physical activity levels compared to high levels, history of hypertension and diabetes mellitus, and a high body mass index (overweight and obesity) compared to a normal body mass index in both sexes. Additional factors included Buryat ethnicity compared to Khalkh ethnicity, living in Ulaanbaatar, no education compared to primary education, higher monthly income, and currently drinking in men; and smoking and sufficient fruit and vegetable intake in women. Significant differences were observed between men and women in terms of the prevalence of MetS, components of MetS, and factors associated with MetS. To reduce MetS prevalence in Mongolia, sex-specific programs should be designed to promote health behavior, such as reducing alcohol consumption in men and smoking in women.

Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health

Objectives

To investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health.

Methods

This cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008-2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load.

Results

Significant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: -0.01 (-0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (-0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006).

Conclusions

A larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.

Prevalence of metabolic syndrome and its association with rapid weight loss among former elite combat sports athletes in Serbia

BACKGROUND

In terms of the potential influence of rapid weight loss (RWL) on the metabolic health of former combat sports athletes (CSA), the scientific literature is quite scarce. Therefore, the objective of the presented research was to determine the differences in metabolic syndrome (MetS) parameters and the prevalence of MetS between former athletes who performed RWL and athletes who did not.

METHODS

The sample of the presented study comprised 150 participants from Serbia, equally divided into two groups: 75 former athletes who had practiced combat sports and 75 ex-athletes of various other sports who did not practice RWL during their careers. The following parameters related to the MetS were evaluated: waist circumference, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, fasting glucose, and triglycerides. The oral glucose tolerance test (OGTT) was used to assess the participant's body response to sugar.

RESULTS

The RWL group had significantly higher both systolic (p < 0.001) and diastolic blood pressure (p < 0.001) compared to the group of athletes who did not practice weight reduction during their careers. Additionally, a tendency toward statistically significant differences between groups was recorded in the variable triglycerides (p = 0.069). Regarding OGTT, increased values of fasting blood glucose at the final measurement were revealed only in the RWL group (p = 0.003). The prevalence of MetS was substantially higher in CSA than in the control group (39.5% vs. 16.2%, respectively p = 0.002).

CONCLUSIONS

This study suggests that former elite CSA who used RWL during their sports career are susceptible to negative metabolic alterations at the end of their competitive period.

Leisure time physical activity: a protective factor against metabolic syndrome development

PURPOSE

Physical activity (PA) is a modifiable factor in preventing/treating cardiometabolic disease. However, no studies have yet compared specific moderate-to-vigorous PA (MVPA) domains with the risk of metabolic syndrome (MetS) in detail. Here, the present study was conducted to examine the impact of different MVPA domains (leisure-time PA (LTPA) vs. occupational PA (OPA) vs. total MVPA) on the risk of MetS in Korean adults.

MATERIALS AND METHODS

Data from the 2014 to 2021 Korea National Health and Nutrition Examination Survey were analyzed (N = 31,558). MetS was defined according to the criteria by revised NCEP/ATP-III. The domain-specific MVPA was assessed using the K-GPAQ. The LTPA and OPA status were classified into four categories: (1) 0 min/week, (2) 1 to 149 min/week, (3) 150 to 299 min/week, and 4) ≥ 300 min/week. In addition, the present study calculated total MVPA as a sum of OPA and LTPA and further classified it into six groups; (1) 0 min/week, (2) 1 to 149 min/week, (3) 150 to 299 min/week, (4) 300 to 449 min/week, (5) 450 to 599 min/week, 6) ≥ 600 min/week.

RESULTS

The ≥ 300 min/week and the 150 to 299 min/week of LTPA showed better outcomes in cardiometabolic disease risk factors and surrogate markers of insulin resistance compared with the 0 min/week of LTPA regardless of adiposity status. Risk of MetS in ≥ 300 min/week of LTPA was lower than in 0 min/week, 1 to 149 min/week, and 150 to 299. In addition, LTPA was significantly associated with a risk of the MetS in a curvilinear dose-response curve, however, no significant effects of a non-linear relationship between OPA and risk of the MetS.

CONCLUSIONS

Our findings showed that LTPA was associated with a risk of MetS with a dose-response curve, whereas no significant non-linear effects were found between OPA and the risk of MetS. Therefore, the MVPA domain is an independent factor of the risk of MetS.

Associations between residential greenness and air pollution and the incident metabolic syndrome in a Thai worker cohort

Increasing air pollution and decreasing exposure to greenness may contribute to the metabolic syndrome (MetS). We examined associations between long-term exposure to residential greenness and air pollution and MetS incidence in the Bangkok Metropolitan Region, Thailand. Data from 1369 employees (aged 52-71 years) from the Electricity Generating Authority of Thailand cohort from 2002 to 2017 were analyzed. The greenness level within 500 m of each participant's residence was measured using the satellite-derived Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). The kriging approach was used to generate the average concentration of each air pollutant (PM10, CO, SO2, NO2, and O3) at the sub-district level. The average long-term exposure to air pollution and greenness for each participant was calculated over the same period of person-time. Cox proportional hazards models were used to analyze the greenness-air pollution-MetS associations. The adjusted hazard ratio of MetS was 1.42 (95% confidence interval (CI): 1.32, 1.53), 1.22 (95% CI: 1.15, 1.30), and 2.0 (95% CI: 1.82, 2.20), per interquartile range increase in PM10 (9.5 μg/m3), SO2 (0.9 ppb), and CO (0.3 ppm), respectively. We found no clear association between NDVI or EVI and the incidence of MetS. On the contrary, the incident MetS was positively associated with NDVI and EVI for participants exposed to PM10 at concentrations more than 50 μg/m3. In summary, the incidence of MetS was positively associated with long-term exposure to air pollution. In areas with high levels of air pollution, green spaces may not benefit health outcomes.

Physical Activity Participation of Black and White Women during the First Year Postpartum: Results and Study Recruitment Strategies

Background: Little is known about how physical activity participation changes throughout the first year postpartum. This may be due to the difficulty in recruiting this population. The aims of this study were first to describe the recruitment methods and second to examine physical activity in the first year postpartum. Methods: Black and White women who gave birth to a singleton infant at ≥37 weeks gestation were recruited by a variety of strategies. At 6-8 weeks (baseline) and 4, 6, 9, and 12 months postpartum, women were instructed to wear an accelerometer for 7 days. Results: Active recruitment with interactions between staff and potential participants was more successful than non-active strategies for enrolling women. Throughout the first year postpartum, physical activity counts and light and moderate-to-vigorous physical activity increased from baseline (165.2 and 21.5 min, respectively) to 12 months (185.0 and 27.6 min, respectively). Sedentary time decreased from 775.3 min at baseline to 749.4 min per day at 12 months. In this sample, Black participants had lower physical activity (counts per minute per day) and greater sedentary time than White participants. Conclusions: Active strategies were more successful in recruiting women into the study. Of those who enrolled, physical activity levels increased over time. Identifying barriers to physical activity that may change over the postpartum period will help develop more targeted interventions to increase physical activity.

Role of gender in explaining metabolic syndrome risk factors in an Iranian rural population using structural equation modelling

Many factors can lead to an increase in the prevalence of metabolic syndrome (MetS) in different populations. Using an advanced structural equation model (SEM), this study is aimed to determine the most important risk factors of MetS, as a continuous latent variable, using a large number of males and females. We also aimed to evaluate the interrelations among the associated factors involved in the development of MetS. This study used data derived from the Fasa PERSIAN cohort study, a branch of the PERSIAN cohort study, for participants aged 35 to 70 years with 10,138 males and females. SEM was used to evaluate the direct and indirect effects, as well as gender effects of influencing factors. Results from the SEM showed that in females most changes in MetS are described by waist circumference (WC), followed by hypertension (HP) and triglyceride (TG), while in males most changes in MetS are described by WC, followed by TG then fasting blood glucose (FBG). Results from the SEM confirmed the gender effects of social status on MetS, mediated by sleep and controlled by age, BMI, ethnicity and physical activity. This study also shows that the integration of TG and WC within genders could be useful as a screening criterion for MetS in our study population.

Exercise-Induced Alternations of Adiponectin, Interleukin-8 and Indicators of Carbohydrate Metabolism in Males with Metabolic Syndrome

Adiponectin (ADIPO) and interleukin-8 (IL-8) are proteins that play a significant, albeit opposing, role in metabolic syndrome (MetS). The reported data on the effect of physical activity on the levels of these hormones in the population of people with MetS are conflicting. The aim of the study was to evaluate the changes in hormone concentrations, insulin-resistance indices and body composition after two types of training. The study included 62 men with MetS (age 36.6 ± 6.9 years, body fat [BF] = 37.53 ± 4.5%), randomly assigned to: an experimental group EG1 (n = 21) with aerobic exercise intervention, an experimental group EG2 (n = 21) with combined aerobic and resistance exercise intervention, both for 12 weeks, and a control group CG (n = 20) without interventions. Anthropometric measurements and body composition (fat-free mass [FFM], gynoid body fat [GYNOID]), as well as a biochemical blood analysis (adiponectin [ADIPO], interleukin-8 [IL-8], homeostatic model assessment-adiponectin (HOMA-AD) and homeostatic model assessment-triglycerides (HOMA-TG) were performed at baseline, and at 6 and 12 weeks of intervention and 4 weeks after the intervention (follow-up). Intergroup (between groups) and intragroup (within each group) changes were statistically evaluated. In the experimental groups EG1 and EG2, no significant changes were observed in the ADIPO concentration, but a decrease of GYNOID and insulin-resistance indices was confirmed. The aerobic training led to favorable changes in IL-8 concentration. The use of combined resistance and aerobic training led to improved body composition, decreased waist circumference and better insulin-resistance indices in men with MetS.

Longitudinal associations between physical activity and five risk factors of metabolic syndrome in middle-aged adults in Germany

BACKGROUND

We examined the longitudinal association between (change in) physical activity (PA) with new onset of five risk factors of metabolic syndrome among 657 middle-aged adults (mean age 44.1 (standard deviation (SD) 8.6) years) who were free of the respective outcome at baseline, in a longitudinal cohort study spanning over 29 years.

METHODS

Levels of habitual PA and sports-related PA were assessed by a self-reported questionnaire. Incident elevated waist circumference (WC), elevated triglycerides (TG), reduced high-density lipoprotein cholesterols (HDL), elevated blood pressure (BP), and elevated blood-glucose (BG) were assessed by physicians and by self-reported questionnaires. We calculated Cox proportional hazard ratio regressions and 95% confidence intervals.

RESULTS

Over time, participants developed (cases of incident risk factor; mean (SD) follow-up time) elevated WC (234 cases; 12.3 (8.2) years), elevated TG (292 cases; 11.1 (7.8) years), reduced HDL (139 cases; 12.4 (8.1) years), elevated BP (185 cases; 11.4 (7.5) years), or elevated BG (47 cases; 14.2 (8.5) years). For PA variables at baseline, risk reductions ranging between 37 and 42% for reduced HDL levels were detected. Furthermore, higher levels of PA (≥ 16.6 METh per week) were associated with a 49% elevated risk for incident elevated BP. Participants who increased PA levels over time, had risk reductions ranging between 38 and 57% for elevated WC, elevated TG and reduced HDL. Participants with stable high amounts of PA from baseline to follow-up had risk reductions ranging between 45 and 87% for incident reduced HDL and elevated BG.

CONCLUSIONS

PA at baseline, starting PA engagement, maintaining and increasing PA level over time are associated with favorable metabolic health outcomes.

Prevalence trends of metabolic syndrome in residents of postdisaster Fukushima: a longitudinal analysis of Fukushima Health Database 2012-2019

OBJECTIVES

The study aimed to evaluate the long-term metabolic risk profiles of Fukushima residents after the Great East Japan Earthquake of March 2011.

STUDY DESIGN

This was a cross-sectional and a longitudinal design.

METHODS

The Fukushima Health Database (FDB) contains 2,331,319 annual health checkup records of participants aged 40-74 years between 2012 and 2019. We checked the validity of the FDB by comparing the prevalence of metabolic factors with the National Database of Health Insurance Claims and Specific Health Checkups (NDB). We applied a regression analysis to determine the changes and project the trends of metabolic factors over the years.

RESULTS

Compared to the NDB, the prevalence of metabolic factors in Fukushima was higher than the country average from 2013 to 2018, and they showed the same trends as those from the FDB. The prevalence of metabolic syndrome (MetS) increased from 18.9% in 2012 to 21.4% in 2019 (an annual increase of 2.74%) in men and from 6.8 to 7.4% (an annual increase of 1.80%) in women in Fukushima. The standardized prevalence of MetS, being overweight, and diabetes is projected to continue increasing, with disparities among subareas being higher in evacuees than in non-evacuees. An annual decrease of 0.38-1.97% in hypertension was mainly observed in women.

CONCLUSIONS

The prevalence of metabolic risk is higher in Fukushima as compared to the country average. The increasing metabolic risk in subareas, including the evacuation zone, highlights the need to control MetS in Fukushima residents.

The role of insufficient sleep and circadian misalignment in obesity

Traditional risk factors for obesity and the metabolic syndrome, such as excess energy intake and lack of physical activity, cannot fully explain the high prevalence of these conditions. Insufficient sleep and circadian misalignment predispose individuals to poor metabolic health and promote weight gain and have received increased research attention in the past 10 years. Insufficient sleep is defined as sleeping less than recommended for health benefits, whereas circadian misalignment is defined as wakefulness and food intake occurring when the internal circadian system is promoting sleep. This Review discusses the impact of insufficient sleep and circadian misalignment in humans on appetite hormones (focusing on ghrelin, leptin and peptide-YY), energy expenditure, food intake and choice, and risk of obesity. Some potential strategies to reduce the adverse effects of sleep disruption on metabolic health are provided and future research priorities are highlighted. Millions of individuals worldwide do not obtain sufficient sleep for healthy metabolic functions. Furthermore, modern working patterns, lifestyles and technologies are often not conducive to adequate sleep at times when the internal physiological clock is promoting it (for example, late-night screen time, shift work and nocturnal social activities). Efforts are needed to highlight the importance of optimal sleep and circadian health in the maintenance of metabolic health and body weight regulation.

Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran

OBJECTIVES

Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran.

METHODS

This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CIn) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants.

RESULTS

The proportion of MetS in the sample was 41.1%. The CIn of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%).

CONCLUSIONS

Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.

The Effectiveness of Implementation of Healthy Living Community Movement in Overcoming Metabolic Syndrome Among Female Workers in East Kalimantan, Indonesia

The metabolic syndrome occurs in almost 25% of the world’s adult population. A workplace is an ideal place for implementing health interventions to reduce metabolic syndrome risk factor. One of the Indonesian government’s health programs to improve public health and prevent non-communicable diseases is called Healthy Living Community Movement (HLCM). This research aims to determine the effectiveness of HLCM implementation to overcome metabolic syndrome among female workers in Indonesia. This quasi-experimental study included 42 female workers with metabolic syndrome, which were divided into an intervention group and a control group. The intervention group was given an 8-weeks combination of health education and implementation of HLCM activities that consisted of fruit and vegetables provision as much as 400 grams per day and physical exercise for at least 150 minutes per week. The intervention for control group included only health education. Subjects’ parameters were measured and adherence to HLCM activities was evaluated by a questionnaire. Adherence to HLCM implementation was carried out by 52.4% of the subjects which resulted in a significant reduction in their waist circumference, systolic and diastolic blood pressure, and triglyceride levels (p < 0.05, respectively). After 8 weeks of interventions, 13 subjects (65%) from the intervention group were no longer included in the metabolic syndrome criteria, while in the control group only 2 subjects (10.5%) were not included. Therefore, the implementation of HLCM in the workplace is effective in overcoming the metabolic syndrome.

The joint association of physical activity and sedentary behavior with metabolic syndrome among urban men aged 60+ years in regional China

Objectives

Metabolic syndrome (MetS) is a major public health issue worldwide, which is preventable through physical activity (PA) promotion and sedentary behavior (SB) reduction. However, the joint association of PA and SB with MetS was not well-investigated, particularly in elderly people. This study aimed to examine separate and joint associations of PA and SB with MetS among elderly urban men in China.

Methods

In this cross-sectional study conducted in mid-2018, participants were urban men aged 60+ years randomly selected from in Nanjing of China. Exposure variables were PA and SB. The outcome variable was MetS. A participant was categorized as "having MetS" or "not having MetS" in the analysis. Independent variables were PA and SB, which were categorized as "sufficient PA or insufficient PA" and "shortened SB or prolonged SB", respectively. Mixed-effects logistics regression models were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the association of PA and SB with MetS.

Results

Totally, 5,520 from 5,792 eligible participants were randomly recruited and their mean age was 68.9 (standard deviation: 16.9) years. The prevalence of MetS was 30.8% (95%CI = 29.6%, 32.0%) among urban men aged 60+ years in the study. After adjustment for potential confounders, subjects with sufficient PA were less likely (OR = 0.77, 95%CI = 0.67, 0.88) to experience MetS, independently of SB, relative to their counterparts with insufficient PA, while a lower odds (OR = 0.74; 95%CI = 0.61, 0.89) of experiencing MetS was examined for participants with shortened SB, also independently of PA, compared to those with prolonged SB in the study. Furthermore, compared to participants with insufficient PA and prolonged SB, those either within categories of insufficient PA and shortened SB (OR = 0.81; 95%CI = 0.65, 0.99), sufficient PA and prolonged SB (OR = 0.80; 95%CI = 0.70, 0.92), or sufficient PA and shortened SB (OR = 0.41; 95%CI = 0.26, 0.63) were at significantly lower risk to experience MetS, respectively.

Conclusions

PA was negatively associated with MetS, and SB was positively linked to MetS, which were independent of each other. Moreover, sufficient PA and shortened SB might exert additively joint influence on MetS. This study has important implications that concurrent PA promotion and SB reduction shall be encouraged for people to optimize the effectiveness of MetS prevention.

Longitudinal association between physical activity and the risk of incident metabolic syndrome in middle-aged adults in Germany

We examined the longitudinal association between physical activity (PA) and the risk of incident metabolic syndrome (MetS) among middle-aged, community-dwelling adults, including 591 individuals (314 females; mean (SD) age, 43.8 (8.5) years) who were free of MetS at baseline. Habitual and sports-related PA was assessed by a self-reported questionnaire. MetS was defined based on HDL-cholesterols, triglycerides, glucose or HbA1c, blood pressure, and waist circumference. We calculated Cox proportional hazard ratios (HR) and 95% confidence intervals (CI) using regression analyses. Over a mean follow-up of 12.5 years, 205 participants developed incident MetS. Four different sports-related PA measures were associated with a decreased risk of incident MetS: (1) Engaging in ≥ 75 min/week (HR 0.71, 95% CI 0.53-0.94), (2) maintaining a continuously high amount from baseline to follow-up of ≥ 75 min/week (HR 0.66, 95% CI 0.46-0.94), (3) starting from < 150 min/week at baseline to ≥ 150 min/week at follow-up (HR 0.65, 95% CI 0.45-0.94), and (4) increasing from < 16.6 MET-hours/week at baseline to ≥ 16.6 MET-hours/week at follow-up (HR 0.47, 95% CI 0.31-0.71). Thus, maintaining, starting or increasing sports-related PA is associated with a lower risk of incident MetS.

Association of the "Weekend Warrior" and Other Physical Activity Patterns with Metabolic Syndrome in the South Korean Population

These days, it is not common for people to have time to do physical activities regularly because of their own work. So, they perform physical activities all at once, which is often called the "weekend warrior". Therefore, this study aimed to examine the association of the "weekend warrior" and other physical activity patterns with metabolic syndrome. Data from the Korea National Health and Nutrition Examination Survey were used, and 27,788 participants were included. The participants were divided into inactive, weekend warriors, and regularly active based on physical activity patterns. The risk of metabolic syndrome in each group was analyzed using multiple logistic regression. The inactive and weekend warrior groups showed a higher likelihood of developing metabolic syndrome than the regularly active groups (weekend warrior: odds ratio (OR) 1.29, confidence interval (CI) 1.02-1.65; inactive: OR 1.38, CI 1.25-1.53). According to the physical activity patterns, the weekend warrior group showed a dose-response relationship compared to the regularly active group (only moderate: OR 1.85, CI 1.25-2.72; only vigorous: OR 1.41, CI 0.93-2.14; both: OR 0.84, CI 0.56-1.27). This study found increasing the amount of physical activity and performing vigorous-intensity physical activity helped manage metabolic syndrome in the weekend warrior group.

Factors promoting collaboration between community sports leaders and guardians in urban areas of Japan: A cross-sectional study

Background

Community sports leaders (CSLs) are expected to play an important role in promoting regional sports in Japan. Increased opportunities for CSLs to work in schools and engage with guardians could encourage middle-aged adults to participate in regional sports activities. However, few CSLs work with guardians, and there is no evidence regarding what CSL characteristics encourage collaboration. The present study aimed to ascertain the aspects of coordination for CSLs collaborating with guardians in urban areas.

Methods

A self-administered questionnaire survey was mailed to all 1,489 CSLs through 59 municipalities using the CSL out of 62 in Tokyo, Japan, from July to November 2021. The questionnaire covered sociodemographic data, variables related to CSL activities, coordination functions, and experience collaborating with guardians. We conducted a binomial logistic regression analysis using experience collaborating with guardians as the dependent variable, coordination function as the explanatory variable, and gender, age, residence duration, years of CSL experience, and the number of activities as covariates.

Results

The analyzed sample comprised 478 CSLs. Binomial logistic regression analysis revealed a significant relationship between experience collaborating with guardians and the coordination function of internal/external CSL organizations, such as participation in non-CSL community activities, experience teaching and supporting their own children's sports, activity initiatives, number of times they used the school gymnasium, awareness of the regional sports plan, and cooperation with the chairman of the neighborhood association.

Conclusions

Collaboration with guardians was related to CSL's individual experience engaging in regional sports from parenting and community collaboration, such as participation in non-CSL community activities and their relationship with the chairman of the neighborhood association. CSL activities may have the potential to encourage middle-aged adults to participate in regional sports.

Use of video-based telehealth services using a mobile app for workers in underserved areas during the COVID-19 pandemic: A prospective observational study

BACKGROUND

The COVID-19 pandemic has limited face-to-face treatment, triggering a change in the structure of existing healthcare services. Unlike other groups, workers in underserved areas have relatively poor access to healthcare.

OBJECTIVE

This study aimed to investigate the effects of video-based telehealth services using a mobile personal health record (PHR) app for vulnerable workers with metabolic risk factors.

METHODS

A prospective observational study was conducted with 117 participants and 27 healthcare professionals for 16 weeks. Participants visited the research institution three times (at weeks 1, 8, and 16) and underwent health check-ups and used various features of the mobile PHR app. Healthcare professionals observed the participants's data using the monitoring system and performed appropriate interventions. The primary outcome measures were to evaluate the effects of services on changes in the participants' metabolic risk factors, and secondary outcome measures were to analyze changes in the participants' lifestyle and service satisfaction, and to observe service use through usage logs. One-way repeated measures ANOVA and Scheffé's test were performed to observe changes in participants' health status and lifestyle, and a paired t-test was performed to analyze changes in service satisfaction. Finally, in-depth interviews with healthcare professionals were performed using semi-structured questionnaires to understand service providers' perspectives after the end of the study.

RESULTS

Systolic blood pressure (F = 7.32, P <.001), diastolic blood pressure (F = 11.30, P <.001), body weight (F = 29.53, P <.001), BMI (F = 17.31, P <.001), waist circumference (F = 17.33, P <.001), fasting blood glucose (F = 5.11, P =.007), and triglycerides (F = 4.66, P =.01) showed significant improvements with time points, whereas high-density lipoprotein cholesterol (F = 3.35, P =.067) did not. The dietary score (F = 3.26, P =.04) showed a significant improvement with time points, whereas physical activity (F = 1.06, P =.34) did not. In terms of service satisfaction, only lifestyle improvement (P <.001) showed a significant difference. COVID-19 has affected the performance of healthcare professionals, thereby changing the perspectives toward healthcare technology services.

CONCLUSIONS

We evaluated the effectiveness of video-based telehealth services supporting workers' health status and lifestyle interventions using healthcare technologies such as the mobile PHR app, tele-monitoring, and video teleconsultation. Our results indicate that as a complementary means, its utility can be expanded in the field of occupational safety and health to overcome the limitations of face-to-face treatment due to COVID-19 in the future.

Acculturation, Physical Activity, and Metabolic Syndrome in Asian American Adults

INTRODUCTION

Asian Americans (AsAms) have a high prevalence of metabolic syndrome (MetS) and are one of the least physically active racial groups in America. The purpose of this study was to examine the relationship between MetS and moderate-to-vigorous physical activity (MVPA) among AsAm adults and whether acculturation modifies this relationship.

METHOD

Data were from 2,259 AsAms participating in the 2011-2016 National Health and Nutrition Examination Survey. Physical activity (PA) was self-reported as minutes of weekly MVPA. Acculturation included nativity, length of residency in America, and language preference. The International Diabetes Federation criteria was used to determine the presence of MetS.

RESULTS

About 64.4% of AsAms did not meet the PA recommendation (MVPA ≥150 min/week). The prevalence of MetS was 39.2%. The odds of having MetS were greater among AsAms who did not meet MVPA recommendations compared with those who did meet MVPA recommendations (odds ratio [OR] = 1.5, 95% confidence interval [CI] = [1.11, 2.07]). When stratified by acculturation, this association remained statistically significant in the groups who immigrated to America more than 15 years ago and who spoke English only.

CONCLUSION

MVPA reduces MetS risk in AsAm adults, especially among more acculturated AsAms. Culturally adapted programs are warranted to promote PA and adequate knowledge of disease prevention in this population.

Metals and risk of incident metabolic syndrome in a prospective cohort of midlife women in the United States

Exposure to metals may contribute to the development of metabolic syndrome (MetS); however, evidence from midlife women who are at greater risk of cardiometabolic disease is limited. We assessed the associations of 15 urinary metal concentrations with incident MetS in a prospective cohort of midlife women in the United States. The study population included 947 White, Black, Chinese and Japanese women, aged 45-56 years, free of MetS at baseline (1999-2000), who participated in the Study of Women's Health Across the Nation Multi-Pollutant Study. Fifteen metals were detected in almost all participants urine samples using inductively coupled plasma mass spectrometry at the baseline. Incident MetS was identified annually through 2017 as having at least three of the following five components: high blood pressure, impaired fasting glucose, abdominal obesity, high triglycerides, and poor high-density lipoprotein cholesterol. We used the Cox proportional hazards models to investigate the associations between individual metals and MetS incidence. The adjusted hazard ratios (HR) (95% CI) for MetS in associations with each doubling of urinary metal concentration were 1.14 (1.08, 1.23) for arsenic, 1.14 (1.01, 1.29) for cobalt, and 1.20 (1.06, 1.37) for zinc. We further evaluated the associations between metal mixtures and MetS using the elastic net penalized Cox model and summarized the results into the environmental risk score (ERS). Arsenic, barium, cobalt, copper, nickel, antimony, thallium, and zinc had positive weights, and cadmium, cesium, mercury, molybdenum, lead, and tin had negative weights in the construction of the ERS. The adjusted HR of MetS comparing 75th vs. 25th percentiles of the ERS was 1.45 (1.13, 1.87). These findings support the view that arsenic, cobalt, zinc, as well as metal mixtures, might influence the risks of incident MetS in midlife women.

The relationship between physical activity, body fatness and metabolic syndrome in urban South African school teachers: The sympathetic activity and ambulatory blood pressure in Africans study

BACKGROUND

 Globally, the prevalence of metabolic syndrome (MS) is rising because of increased levels of physical inactivity and obesity. In South Africa, information about teachers' physical activity (PA), body fatness and MS is limited.

AIM

 To assess the relationship between PA, body fatness and MS in urban South African teachers.

SETTING

 The study setting was in Dr Kenneth Kaunda District in the North West province of South Africa.

METHODS

 A cross-sectional study was conducted using secondary data drawn from the sympathetic activity and ambulatory blood pressure in Africans (SABPA) study of 216 teachers (aged 25-65 years). Variables included anthropometry, biochemical measurements, objectively measured PA and lifestyle behaviours.

RESULTS

 Twenty-nine percent of the total participants were classified with MS, with 46% in men compared to 13% in women; 33% were sedentary and 67% participated in light activity. A weak significant negative relationship was found between the mean 7-day awake metabolic equivalent of tasks (METs) and triglycerides (r = -0.29; p = 0.02) and gamma-glutamyl transferase (r = -0.25; p = 0.06), activity energy expenditure (r = -0.24; p = 0.06) and PA level (r = -0.23; p = 0.07). After adjusting for age, self-reported smoking and alcohol use or consumption, a weak significant negative relationship between mean 7-day awake METs and triglycerides (r = -0.28; p  0.01) was observed.

CONCLUSION

 In the teachers with MS, only one MS marker (triglycerides) showed a negative association with PA. Physical activity could therefore be beneficial in the regulation of triglycerides. Participation in regular PA could be beneficial in the regulation of triglycerides. Focused PA interventions in school teachers that advocate the benefits of PA and healthy lifestyle choices to reduce dietary fat intake (and alcohol) are recommended.

Use of biochemical markers for diabetes prevention in the new decade

Use of biochemical markers for diabetes prevention in the new decade. There is established evidence that type 2 diabetes mellitus is preceded by a phase, during which there is a cluster of conditions including raised triglycerides and lowered high-density lipoprotein cholesterol, raised fasting glucose, high blood pressure and central obesity. This cluster of risk factors for type 2 diabetes mellitus, constitutes the metabolic syndrome (MetS). Therefore, there is need to screen for this syndrome among the population for the primary prevention of type 2 diabetes mellitus which is a global public health problem. Despite the high prevalence of type 2 diabetes in Mauritius, research work on MetS is scarce. This study was thus undertaken with the primary objective to determine the prevalence of MetS among the employees of a public educational institution in Mauritius. A cross-sectional study which involved randomly identified employees was conducted. The participants were requested to fill in a survey questionnaire, undergo biometric measurements (waist circumference and blood pressure) and venous blood sample collection in a fasting condition. The blood tests included the determination of glucose, triglyceride and cholesterol levels. The 2009 International Diabetes Federation criteria were used for the diagnosis of MetS. The presence of any 3 of 5 risk factors, raised triglycerides, raised glucose, lowered high-density lipoprotein cholesterol, high blood pressure and central obesity constitutes a diagnosis of metabolic syndrome. Ethical clearance was obtained from the Department of Medicine Research Ethics Committee of the University of Mauritius. The prevalence of MetS was found to be 20.1% (40 participants), in the overall population, 31.4% in men (22 out of 70) and 13.95% in women (18 out of 129). The determination of any association by means of the Chi square tests showed there was a significant association between gender and MetS (p < 0.01). Educational level was also associated with the MetS (p < 0.05). Logistic regression analysis confirmed t\he significant association between MetS with gender (p < 0.01) where male gender was more associated with MetS than female. This study with the determination of the prevalence of the MetS among employees constituted the first step in the implementation of a structured workplace health intervention programme in Mauritius. We highlight the importance of workplace interventions with the involvement of a multi-disciplinary team of health professionals for the primary prevention of diabetes, through the screening for the MetS among employees.

Household-specific physical activity levels and energy intakes according to the presence of metabolic syndrome in Korean young adults: Korean National Health and nutrition examination survey 2016-2018

BACKGROUND

Participation in exercise, and dietary and nutritional intakes have an impact on the risk and prevalence of metabolic syndrome (MetS), but these effects may differ according to whether a person lives alone or in a multi-person household. We analyzed differences in physical activity (PA) levels and energy intake according to household-type and MetS presence among young adults, to investigate the relationships among these factors.

METHODS

Data of 3974 young adults (aged > 19 years and < 40 years) were obtained from the Korean National Health and Nutrition Examination Survey (2016-2018). We analyzed PA levels (occupational and recreational PA, and transport) and energy intake (total, carbohydrate, protein, and fat).

RESULTS

Logistic regression data showed that low PA levels and higher energy intake were associated with MetS incidence and its components in young adults, after adjusting for body mass index, smoking, household-type, and sex. Overall, there was no significant difference in PA level between the MetS and non-MetS group. The total energy intake was higher in the MetS than in the non-MetS group (p <  0.05). These results were similar to those found in multi-person households. In single-person households, the MetS group had significantly lower PA levels (p <  0.01) and total energy intake (p <  0.05) than the non-MetS group.

CONCLUSIONS

We found significant association among low PA levels, high energy intake, and MetS components in young Korean adults, but with patterns differing according to household type. Energy intake was higher in young adults with than those without MetS, who lived in multi-person households, while young adults with MetS who lived alone had lower PA levels and lower energy intake than those without MetS. These findings highlight the need for different approaches of implementing PA and nutrition strategies according to the type of household in order to prevent MetS.

The prevalence of health problems and their association with physical activity in caregivers of children with disabilities: 2018 National Health Interview Survey

BACKGROUND

Caregivers of children with disabilities often experience poor health. One way for caregivers to promote their own health may be to participate in physical activity (PA).

AIMS

The purpose of this study was to examine the association between PA and psychological and physical health problems in caregivers of children with disabilities.

METHODS

The 2018 National Health Interview Survey (NHIS) data were used, and 890 household representatives were identified as caregivers of children with disabilities. Based on the national PA guidelines, caregivers were classified into three groups: inactive (IA), aerobically active (AA), and aerobically and muscularly active (AMA).

RESULTS

Multivariable logistic regression indicated that the AMA group had a lower likelihood of reporting depression compared to the IA group (OR: 0.73 [95% confidence interval: 0.54, 0.98]). The AMA group also had a lower likelihood of reporting back pain and obesity compared to the IA group (OR:0.69 [95% confidence interval: 0.56, 0.84] and OR:0.63 [95% confidence interval: 0.52, 0.76], respectively).

CONCLUSIONS

The results of the current study suggest that caregivers of children with disabilities may benefit from PA, especially from the combination of aerobic and muscle-strengthening PA.

Metabolic Syndrome and Its Components among Taxi Drivers in the City of Tshwane, South Africa

The occupation of taxi driving predisposes drivers to health risks, including obesity, cardiovascular and metabolic disorders. Although individual components of metabolic syndrome (MetS) are documented, data is scarce on concurrent metabolic disturbances among commercial drivers. The prevalence of MetS and its components were determined in a cross-sectional study among taxi drivers (n = 362) in the City of Tshwane, South Africa. Sociodemographic, occupational, and lifestyle factors were assessed using a structured questionnaire. Anthropometry, blood pressure, and glucose were measured. MetS was defined based on BMI strata, hypertension, and glucose levels. Data was analyzed using SPSS. The mean age of taxi drivers was 42 ± 10.9 years. Overall prevalence of MetS was 17.1%, with higher prevalence observed among older taxi drivers (24.2%) and those with longer experience in the industry (22.9%). Individual components of MetS were obesity (36%), hypertension (36%) and diabetes (46%), while smoking (30%), alcohol use (59%), and physical inactivity (71%) were observed. MetS was associated with duration in the taxi industry, and family history of diabetes among taxi drivers. The presence of MetS and its components among taxi drivers calls for early identification of cardiometabolic risks in the taxi industry and efforts towards achieving a healthier workforce.

Metabolic syndrome and its association with changes in modifiable risk factors: Epifloripa aging study

Purpose

To estimate the prevalence of Metabolic Syndrome (MetS) and its association with changes in modifiable risk factors in older adults from southern Brazil.

Methods

A longitudinal study was performed with data from EpiFloripa Aging study. We defined MetS by the existence of three or more of the following risk factors for cardiovascular disease (CVD): waist circumference (WC) (≥ 92 cm in men and ≥ 87 cm in women); fasting glucose (≥100 mg/dl); decreased HDL cholesterol (<40 mg/dl in men and <50 mg/dl in women); hypertriglyceridemia (≥150 mg/dl) and blood pressure (≥130/85 mmHg). We evaluated the changes in modifiable risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and body mass index) between the two moments of the study (2009/10 and 2013/14). Directed acyclic graph and logistic regression models were used.

Results

Among the 599 participants, the prevalence of MetS was 64.0% (95% CI, 58.7-68.9). In the adjusted analysis, those who remained or became persons who are overweight (OR = 4.59; 95% CI: 3.05-6.89) and those who remained or became insufficiently active (OR = 1.92; 95% CI: 1.23-2.98) were more likely to present MetS.

Conclusion

Our findings suggest that being or becoming overweight and being or becoming insufficiently active are modifiable factors associated with MetS. These results highlight the need for developing preventive strategies for the observed risk indicators to mitigate the prevalence of MetS in older adults.

Association between behavioural risk factors and metabolic syndrome among adult population in India: A systematic review and meta-analysis of observational studies

AIMS

The impact of behavioural risk factors on the metabolic syndrome has not been well understood by the researchers. This information is important to the policymakers for developing effective strategies and implement relevant policies or programs. Hence, we undertook this meta-analysis to estimate the effect of behavioural risk factors on the burden of metabolic syndrome.

DATA SYNTHESIS

We conducted a search in the databases, such as PubMed Central, EMBASE, MEDLINE, and Cochrane library, and search engines, such as ScienceDirect and Google Scholar, from inception until March 2021. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of published studies. We carried out a meta-analysis with random-effects model and reported pooled odds ratio (OR) with 95% confidence interval (CI). In total, we analysed 30 studies with 41,090 participants. The majority of the studies had good to satisfactory quality as per NOS. Physical activity had a statistically significant association with the prevalence of metabolic syndrome (pooled OR = 1.57; 95%CI: 1.28 to 1.93, I2 = 91%). However, smoking (pooled OR = 0.96; 95%CI: 0.75 to 1.23, I2 = 90.5%) and alcohol (pooled OR = 1.00; 95%CI: 0.75 to 1.33, I2 = 90.8%) did not reveal a statistically significant association with the burden of metabolic syndrome.

CONCLUSION

Physical inactivity was found to be a significant risk factor for metabolic syndrome. Given the evidence, it is important that the clinicians and policymakers are alike to recommend regular physical activity among the patients and general population.

Individual and joint effects of metal exposure on metabolic syndrome among Chinese adults

Growing evidence suggests that metal exposure contributes to metabolic syndrome (MetS), but little is known about the effects of combined exposure to metal mixtures. This cross-sectional study included 3748 adults who were recruited from the Medical Physical Examination Center of Tongji Hospital, Wuhan, China. The levels of 21 metal(loid)s in urine were measured by inductively coupled plasma mass spectrometry. MetS was diagnosed according to National Cholesterol Education Program's Adult Treatment Panel III recommendations. Multivariate logistic regression model was uesd to explore the effects of single-metal and multi-metal exposures. The elastic net (ENET) regularization with an environmental risk score (ERS) was performed to estimate the joint effects of exposure to metal mixtures. A total of 636 participants (17%) were diagnosed with MetS. In single metal models, MetS was positively associated with zinc (Zn) and negatively associated with nickel (Ni). In multiple metal models, the associations remained significant after adjusting for the other metals. In the joint association analysis, the ENET models selected Zn as the strongest predictor of MetS. Compared to the lowest quartile, the highest quartile of ERS was associated with an elevated risk of MetS (OR = 3.72; 95% CI: 2.77, 5.91; P-trend < 0.001). Overall, we identified that the combined effect of multiple metals was related to an increased MetS risk, with Zn being the major contributor. These findings need further validation in prospective studies.

National trends in metabolic syndrome among adults in Mongolia from three cross-sectional surveys in 2009, 2013 and 2019

BACKGROUND AND AIM

Metabolic syndrome (MetS) may increase the risk of cardiometabolic diseases. The study aimed to estimate the proportion and associated factors of MetS among individuals (≥15 years) across three cross-sectional surveys in 2009, 2013 and 2019 in Mongolia.

METHOD

Cross-sectional data were analysed from 6,321 individuals (15-64/69 years, median age = 42 years) that participated in the 2009, 2013 or 2019 Mongolia STEPS surveys, and had complete MetS (harmonized definition) measurements.

RESULTS

Almost two in five participants (35.6%) had MetS, 33.3% in 2009, 35.3% in 2013, ad 37.0% in 2019 (p-for trend 0.023). In adjusted logistic regression analyses, older age was associated with MetS in 2009 and in 2019, male sex and higher education were associated with MetS in 2013, and urban residence was associated with MetS in 2009. Current tobacco use was associated with MetS in 2009 and 2019, moderate or high physical activity was protective against MetS in 2013 and 2019, while general overweight and obesity increased the odds of MetS in 2009, 2013, and 2019.

CONCLUSION

The study showed that almost two in five adults were identified as having MetS, which significantly increased from 2009 to 2019, and that several predictors of MetS were found.

The Role of Bioactive Compounds from Dietary Spices in the Management of Metabolic Syndrome: An Overview

Metabolic syndrome (MetS) is a combination of physiologically dysregulated parameters that can include elevated fasting blood glucose, high blood pressure, central obesity, increased triglyceride levels, insulin resistance, diabetes, elevated low density lipoprotein levels, and reduced high density lipoprotein levels in the blood. Effective clinical management of MetS is critical as it is strongly associated with long lasting and fatal complications in patients. Alongside standard care of lifestyle changes and medication, dietary supplements derived from herbal resources could be an alternative therapeutic strategy that is safe, efficient, culturally acceptable, and has few side effects. Of the dietary supplements, spicy foods have always been considered a great source of functional bioactive compounds. Herbal therapy is broadly used in many countries as a treatment or as a preventive measure in the management of MetS risk factors, including blood glucose, blood pressure, and blood lipid levels. Herein, an attempt is made to evaluate the recent studies in the management of MetS with herbal alternatives, and to explore the possibility of their use as therapeutic treatments or supplements.

The relationship of the built and food environments with the metabolic syndrome in the Athens metropolitan area: a sex-stratified spatial analysis in the context of the ATTICA epidemiological study

PURPOSE

The built and food environments are widely acknowledged to play an important role in defining human health by influencing, among others, behaviors such as nutrition habits and physical activities. The aim of this study was to identify the spatial variability of the sex-specific prevalence of the metabolic syndrome (MetS) and its environmental determinants in the Athens metropolitan area.

METHODS

Data on the prevalence of the MetS were provided by the ATTICA epidemiological study for 2749 participants, with complete data for geographical identification (1375 women [44 years old {SD = 14 years}] and 1374 men [45 years old {SD = 13 years}]), while socioeconomic, demographic, and environmental characteristics were provided by official national and international databases.

RESULTS

Approximately 20% of the people residing in the study area were diagnosed with MetS, with its prevalence being almost two times higher in men compared to women. Areas more extensively covered by green urban spaces and sports facilities were shown to have a lower prevalence of MetS, while greater density and availability of supermarkets and street markets were inversely related to MetS prevalence in both sexes. In addition, the present analysis revealed that the beneficial role of the built environment's characteristics on MetS prevalence was significantly stronger in the male population, while the preventive effect of the food environment's characteristics was almost 1.5 times stronger in the female population CONCLUSION: Although individualized prevention and treatment approaches are necessary to decrease the burden of MetS, environmental modifications that promote healthy behaviors represent an essential health approach.

Joint associations of aerobic-based physical activity and muscle-strengthening activities on metabolic syndrome

OBJECTIVES

The study aimed to examine whether simultaneously meeting the combined guidelines of accelerometer-assessed moderate to vigorous physical activity (MVPA) and self-reported muscle-strengthening activity (MSA) was associated with lower odds of metabolic syndrome (MetS) than meeting neither or 1 of the guidelines among the Koreans.

METHODS

This cross-sectional analysis included 1,355 participants from the Korea National Health and Nutrition Examination Survey (2014-2015). Logistic regression was used to analyze the associations across groups of MVPA-MSA guideline adherence (meeting neither [reference]; meeting MVPA only; meeting MSA only; meeting both MVPS and MSA) with MetS components (abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol [HDL-C], hypertension, and hyperglycemia). The odds ratios (ORs) were adjusted for covariates (e.g., sex, age, body mass index, and accelerometer wearing time).

RESULTS

MSA only significantly reduced the OR for abdominal obesity (OR, 0.34; 95% confidence interval [CI], 0.13 to 0.91). Meeting both MVPA and MSA reduced the OR for hypertriglyceridemia (OR, 0.59; 95% CI, 0.39 to 0.88) and low HDL-C (OR, 0.46; 95% CI, 0.31 to 0.68). Compared to meeting neither, MVPA only (OR, 0.63; 95% CI, 0.44 to 0.89) and both MVPA and MSA (OR, 0.46; 95% CI, 0.28 to 0.76) significantly reduced the OR for MetS.

CONCLUSIONS

Combined MVPA-MSA was more beneficially associated with MetS prevalence than MVPA only and MSA only. Considering that more than 85% of Korean adults do not meet both the MVPA and MSA guidelines, public health actions to promote adherence should be supported.

Exercise Training: The Holistic Approach in Cardiovascular Prevention

Nowadays, there are robust clinical and pathophysiological evidence supporting the beneficial effects of physical activity on cardiovascular (CV) system. Thus, the physical activity is considered a key strategy for CV prevention. In fact, exercise training exerts favourable effects on all risk factors for CV diseases (i.e. essential hypertension, type 2 diabetes mellitus, hypercholesterolemia, obesity, metabolic syndrome, etc…). In addition, all training modalities such as the aerobic (continuous walking, jogging, cycling, etc.) or resistance exercise (weights), as well as the leisure-time physical activity (recreational walking, gardening, etc) prevent the development of the major CV risk factors, or delay the progression of target organ damage improving cardio-metabolic risk. Exercise training is also the core component of all cardiac rehabilitation programs that have demonstrated to improve the quality of life and to reduce morbidity in patients with CV diseases, mostly in patients with coronary artery diseases. Finally, it is still debated whether or not exercise training can influence the occurrence of atrial and ventricular arrhythmias. In this regard, there is some evidence that exercise training is protective predominantly for atrial arrhythmias, reducing the incidence of atrial fibrillation. In conclusion, the salutary effects evoked by physical acitvity are useful in primary and secondary CV prevention.

Cardiovascular risk and functional burden at midlife: Prospective associations of isotemporal reallocations of accelerometer-measured physical activity and sedentary time in the CARDIA study

Cardiovascular risk and functional burden, or the accumulation of cardiovascular risk factors coupled with functional decline, may be an important risk state analogy to multimorbidity. We investigated prospective associations of sedentary time (ST), light intensity physical activity (LPA), and moderate to vigorous intensity physical activity (MVPA) with cardiovascular risk and functional burden at midlife. Participants were 1648 adults (mean ± SD age = 45 ± 4 years, 61% female, 39% Black) from Coronary Artery Risk Development in Young Adults (CARDIA) who wore accelerometers in 2005-2006 and 2015-2016. Cardiovascular risk and functional burden was defined as ≥2 cardiovascular risk factors (untreated/uncontrolled hypertension and hypercholesterolemia, type 2 diabetes, reduced kidney function) and/or functional decline conditions (reduced physical functioning and depressive symptoms). Prospective logistic regression models tested single activity, partition, and isotemporal substitution associations of accelerometer-measured ST, LPA, and MVPA with cardiovascular risk and functional burden 10 years later. In isotemporal models of baseline activity, reallocating 24 min of ST to MVPA was associated with 15% lower odds of cardiovascular risk and functional burden (OR: 0.85; CI: 0.75, 0.96). Reallocating 24 min of LPA to MVPA was associated with a 14% lower odds of cardiovascular risk and functional burden (OR: 0.86; CI: 0.75, 0.99). In longitudinal isotemporal models, similar beneficial associations were observed when 10-year increases in MVPA replaced time in ST or LPA. Findings suggest that maintaining an MVPA dose reflecting daily physical activity recommendations in early midlife is associated with lower odds of cardiovascular risk and functional burden later in midlife.

Conjoint Associations of Adherence to Physical Activity and Dietary Guidelines With Cardiometabolic Health: The Framingham Heart Study

Background

The conjoint associations of adherence to the recent physical activity and dietary guidelines with the metabolic syndrome (MetS) are incompletely understood.

Methods and Results

We evaluated 2379 FHS (Framingham Heart Study) Third Generation participants (mean age, 47 years; 54.4% women) attending examination cycle 2. We examined the cross‐sectional relations of adherence to the 2018 Physical Activity Guidelines for Americans (binary; moderate‐to‐vigorous physical activity ≥150 versus <150 min/wk) and 2015 Dietary Guidelines for Americans (binary; 2015 Dietary Guidelines for Americans Adherence Index ≥median versus <median [score, 62.1/100]) with prevalence of the MetS using generalized linear models. We also related adherence to guidelines with the incidence of MetS prospectively, using Cox proportional hazards regression with discrete time intervals. Adherence rates to the 2018 Physical Activity Guidelines for Americans (odds ratio [OR], 0.49; 95% CI, 0.40–0.60) and 2015 Dietary Guidelines for Americans (OR, 0.67; 95% CI, 0.51–0.90) were individually associated with lower odds of prevalent MetS, whereas conjoint adherence to both guidelines was associated with the lowest odds of MetS (OR, 0.35; 95% CI, 0.26–0.47) compared with the referent group (nonadherence to both guidelines). Adherence rates to the 2018 Physical Activity Guidelines for Americans (hazard ratio [HR], 0.66; 95% CI, 0.50–0.88) and 2015 Dietary Guidelines for Americans (HR, 0.68; 95% CI, 0.51–0.90) were associated with lower risk of MetS, prospectively. In addition, we observed a 52% lower risk of MetS in individuals who adhered to both guidelines compared with the referent group.

Conclusions

Maintaining both regular physical activity and a healthy diet in midlife may be required for optimal cardiometabolic health in later life.

Associations of Physical Activity and Sedentary Time with Metabolic Syndrome in Saudi Adult Males

Purpose

The association between objectively measured sedentary behavior and physical activity with metabolic syndrome (MetS) has been rarely investigated in Saudi Arabia. The purpose of the current study was to examine the association of objectively measured sedentary, light physical activity (LPA), and moderate-vigorous physical activity (MVPA) with MetS among Saudi adult males.

Materials and Methods

The study participants were 103 males from Riyadh, Saudi Arabia (mean age = 54.9 ± 10.6 years). Metabolic syndrome was defined based on having three or more of cardiometabolic risk factors. Triaxial accelerometers were used to measure the time spent on sedentary and physical activities across 7 days. A minimum four days with ≥10 hours of wearing time per day were considered a valid data. Binary logistics regression models were performed to examine the association of sedentary and physical activity levels with MetS vs no MetS. Model 1 was unadjusted, models 2, 3, and 4 were mutually controlled for sedentary, light, and MVPA intensities.

Results

About 38% of males in the present study were classified as having MetS as demonstrated by a significant (p<0.05) decrease in high-density lipoprotein cholesterol (HDL-C) and a significant (p<0.05) increase in body weight, body mass index (BMI), waist circumference (WC), systolic blood pressure, glucose, and triglycerides compared to those without MetS. In addition, low levels of LPA (less than 6.3 hours per day) were significantly associated with the risk of having MetS, independent of sedentary and MVPA (odds ratio (OR) 4.26-6.96). The results showed that the associations between sedentary tertiles and MetS were not statistically significant. Levels of MVPA were also not significantly associated with an increased risk of developing MetS in all models.

Conclusion

This study showed that low levels of LPA were significantly associated with the risk of having MetS in Saudi males from Riyadh city, independent of MVPA and sedentary time. The results suggest that future intervention studies should assess the positive effect of increasing levels of LPA in reducing the risk of developing MetS in males.

Incidence and regression of metabolic syndrome in a representative sample of the Spanish population: results of the cohort di@bet.es study

INTRODUCTION

Metabolic syndrome (MetS) is an important predictor of cardiovascular mortality. Identification of occurrence and regression trends of MetS could permit elaboration of preventive strategies with new targets. The objective of this study was to analyze the occurrence and regression rates of MetS and its associated factors in the representative cohort of Spain of the di@bet.es study.

RESEARCH DESIGN AND METHODS

The di@bet.es study is a prospective cohort where 5072 people representative of the Spanish population over 18 years of age were randomly selected between 2009 and 2010. Follow-up was a median of 7.5 (IQR 7.2-7.9) years, with 2408 (47%) participating subjects. A total of 1881 (78%) subjects had all the pertinent data available and were included in this study.

RESULTS

Of the 1146 subjects without baseline criteria for MetS, 294 (25.7%) developed MetS during follow-up, while of the 735 patients with prior MetS, 148 (20.1%) presented regression. Adjusted MetS incidence per 1000 person-years was 38 (95% CI 32 to 44), while regression incidence was 36 (95% CI 31 to 41). Regression rate was independently higher than incidence rate in the following: women, subjects aged 18-45, university-degree holders, patients without central obesity, without hypertension, as well as those with body mass index of <25 kg/m². Lower progression and higher regression rates were observed with an adapted 14-point Mediterranean Diet adherence screener questionnaire score of >11 in both groups and with >500 and>2000 MET-min/week of physical activity, respectively.

CONCLUSIONS

This study provides MetS incidence and regression rates, and identifies the target population for intervention strategies in Spain and possibly in other countries.

The Other Side of Alzheimer's Disease: Influence of Metabolic Disorder Features for Novel Diagnostic Biomarkers

Nowadays, the amyloid cascade hypothesis is the dominant model to explain Alzheimer's disease (AD) pathogenesis. By this hypothesis, the inherited genetic form of AD is discriminated from the sporadic form of AD (SAD) that accounts for 85-90% of total patients. The cause of SAD is still unclear, but several studies have shed light on the involvement of environmental factors and multiple susceptibility genes, such as Apolipoprotein E and other genetic risk factors, which are key mediators in different metabolic pathways (e.g., glucose metabolism, lipid metabolism, energetic metabolism, and inflammation). Furthermore, growing clinical evidence in AD patients highlighted the presence of affected systemic organs and blood similarly to the brain. Collectively, these findings revise the canonical understating of AD pathogenesis and suggest that AD has metabolic disorder features. This review will focus on AD as a metabolic disorder and highlight the contribution of this novel understanding on the identification of new biomarkers for improving an early AD diagnosis.

Prevalence and correlates of the metabolic syndrome in a cross-sectional community-based sample of 18-100 year-olds in Morocco: Results of the first national STEPS survey in 2017

BACKGROUND AND AIM

Metabolic syndrome (MetS) may be associated with diabetes and cardiovascular diseases. This investigation assessed prevalence and correlates of MetS among adults (18-100 years) in Morocco.

METHOD

Cross-sectional data with complete MetS measurements were analysed from 4555 18-100 year old individuals (median age = 40 years) that took part in the "2017 Morocco STEPS survey." MetS was classified using the harmonized definition.

RESULTS

Two in five participants (40.0%) had MetS, 31.9% among men and 48.0% among women. The average frequency of the five MetS components was 1.9 (1.3 = SD) among men and 2.5 (1.1 = SD) among women. In adjusted logistic and linear regression models, general overweight/obesity, older age, female sex, abnormal waist to hip ratio and low physical activity were associated with the prevalence of MetS and the greater average frequency of MetS components. In addition, in unadjusted analysis, higher education, never married, current smoking and current alcohol use were negatively and urban residence and sedentary behaviour were positively associated with MetS.

CONCLUSION

The study showed that two in five adults were identified as having MetS and that several predictors of MetS were found.

Epidemiology, risk factors across the spectrum of age-related metabolic diseases

BACKGROUND

Population aging is dynamic process of increasing proportion of older adults in the total population, which is an inescapable result of decline in fertility rate and extension in life expectancy. Inevitably, age-related metabolic diseases, for example obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, and nonalcoholic fatty liver disease, are becoming epidemic globally along with the demographic transition.

CONTENT

The review examines the literatures related to: 1) the epidemiology of age related metabolic diseases including obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, and nonalcoholic fatty liver disease; and 2) the risk factors of age related metabolic diseases including genetic factors, diet, smoking, Physical activity, intestinal microbiota and environmental factors.

CONCLUSION

Population aging is becoming epidemic worldwide, resulting in increasing incidence and prevalence of a serious of age-related metabolic diseases. Both genetic and environmental factors contribute to the diseases, thus interventions targeting on these factors may have beneficial effect on the development of age-related metabolic diseases.

The Effect of Domain-Specific Sitting Time and Exercise Habits on Metabolic Syndrome in Japanese Workers: A Cross-Sectional Study

The effects of domain-specific (i.e., occupational, leisure-time on workday, and holiday) sitting time (ST), and exercise on metabolic syndrome (MetS) development are insufficiently studied. The present study aimed to examine the single and combined effects of each domain-specific ST and exercise habits on MetS. The total and domain-specific STs of 5530 participants were collected using a validated questionnaire. The multiple logistic regression analyses determined the effects of each domain-specific ST and exercise habit on MetS. Of all participants, 7.8% had MetS. Odds ratios (ORs) for MetS were significant only in the group with the longest leisure-time ST on holidays (OR, 1.43; 95% confidence interval [CI], 1.12-1.83); we found no significant associations with any other domain-specific ST after statistical adjustment for confounders. The no-habitual-exercise group clearly had a higher risk for MetS (OR, 1.44; 95% CI, 1.15-1.80). The significantly higher ORs for MetS was shown in only the combined longer total ST (OR, 1.64; 95% CI, 1.12-2.39) and holiday ST (OR, 1.83; 95% CI, 1.30-2.59) with no habitual exercise. These findings suggested that accumulated daily total ST, particularly leisure-time ST on holidays with no-habitual exercise, can increase the risk of MetS and it could possibly be mitigated by habitual exercise.