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Krzyścin M, Sowińska-Przepiera E, Gruca-Stryjak K, Soszka-Przepiera E, Syrenicz I, Przepiera A, Bumbulienė Ž, Syrenicz A. Are Young People with Turner Syndrome Who Have Undergone Treatment with Growth and Sex Hormones at Higher Risk of Metabolic Syndrome and Its Complications? Biomedicines 2024; 12:1034. [PMID: 38790996 PMCID: PMC11118016 DOI: 10.3390/biomedicines12051034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Metabolic syndrome (MetS), characterized by visceral obesity, glucose abnormalities, hypertension and dyslipidemia, poses a significant risk of diabetes and cardiovascular disease. Turner syndrome (TS), resulting from X chromosome abnormalities, carries health complications. Despite growing evidence of an increased risk of MetS in women with TS, its prevalence and risk factors remain under investigation. These considerations are further complicated by the varying timing and dosages of treatment with growth hormone and sex hormones. METHODS We conducted a cross-sectional study comparing 44 individuals with TS with 52 age-matched control subjects. Growth hormone treatment in the study group was administered for varying lengths of time, depending on clinical response. We collected anthropometric, metabolic, endocrine and body composition data. Statistical analyses included logistic regression. RESULTS Baseline characteristics, including age, BMI and height, were comparable between the TS and control groups. Hormonally, individuals with TS showed lower levels of testosterone, DHEA-S, and cortisol, as well as elevated FSH. Lipid profiles indicated an atherogenic profile, and the body composition analysis showed increased visceral adipose tissue in those with TS. Other metabolic abnormalities were common in individuals with TS too, including hypertension and impaired fasting glucose levels. The risk of MetS components was assessed in subgroups according to karyotypes: monosomy 45X0 vs. other mosaic karyotypes. Logistic regression analysis showed a significant association between increased visceral adipose tissue in subjects with TS. Those with metabolic complications tended to have less muscle strength compared to those without these complications in both the study and control groups. CONCLUSIONS This study highlights the unique metabolic and cardiovascular risk profile of individuals with TS, characterized by atherogenic lipids, higher levels of visceral adipose tissue and increased metabolic abnormalities. These findings underscore the importance of monitoring metabolic health in individuals with TS, regardless of age, BMI or karyotype, and suggest the potential benefits of lifestyle modification, building more muscle strength, and weight control strategies. Further research is needed to better understand and address the metabolic challenges faced by women with TS.
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Affiliation(s)
- Mariola Krzyścin
- Pediatric and Adolescent Gynecology Clinic, Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Elżbieta Sowińska-Przepiera
- Pediatric and Adolescent Gynecology Clinic, Department of Gynecology, Endocrinology and Gynecological Oncology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Karolina Gruca-Stryjak
- Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 60-535 Poznań, Poland
- Centers for Medical Genetics GENESIS, ul. Dąbrowskiego 77a, 60-529 Poznań, Poland
| | - Ewelina Soszka-Przepiera
- II-nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, Al. Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Igor Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - Adam Przepiera
- Department of Urology and Urologic Oncology, Pomeranian Medical University in Szczecin, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Žana Bumbulienė
- Center for Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius University, Faculty of Medicine, LT-03101 Vilnius, Lithuania
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland
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Diego VP, Manusov EG, Mao X, Almeida M, Peralta JM, Curran JE, Mahaney MC, Göring H, Blangero J, Williams-Blangero S. Metabolic syndrome traits exhibit genotype-by-environment interaction in relation to socioeconomic status in the Mexican American family heart study. Front Genet 2024; 15:1240462. [PMID: 38495670 PMCID: PMC10940335 DOI: 10.3389/fgene.2024.1240462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Socioeconomic Status (SES) is a potent environmental determinant of health. To our knowledge, no assessment of genotype-environment interaction has been conducted to consider the joint effects of socioeconomic status and genetics on risk for metabolic disease. We analyzed data from the Mexican American Family Studies (MAFS) to evaluate the hypothesis that genotype-by-environment interaction (GxE) is an essential determinant of variation in risk factors for metabolic syndrome (MS). Methods: We employed a maximum likelihood estimation of the decomposition of variance components to detect GxE interaction. After excluding individuals with diabetes and individuals on medication for diabetes, hypertension, or dyslipidemia, we analyzed 12 MS risk factors: fasting glucose (FG), fasting insulin (FI), 2-h glucose (2G), 2-h insulin (2I), body mass index (BMI), waist circumference (WC), leptin (LP), high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG), total serum cholesterol (TSC), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Our SES variable used a combined score of Duncan's socioeconomic index and education years. Heterogeneity in the additive genetic variance across the SES continuum and a departure from unity in the genetic correlation coefficient were taken as evidence of GxE interaction. Hypothesis tests were conducted using standard likelihood ratio tests. Results: We found evidence of GxE for fasting glucose, 2-h glucose, 2-h insulin, BMI, and triglycerides. The genetic effects underlying the insulin/glucose metabolism component of MS are upregulated at the lower end of the SES spectrum. We also determined that the household variance for systolic blood pressure decreased with increasing SES. Conclusion: These results show a significant change in the GxE interaction underlying the major components of MS in response to changes in socioeconomic status. Further mRNA sequencing studies will identify genes and canonical gene pathways to support our molecular-level hypotheses.
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Affiliation(s)
- Vincent P. Diego
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Eron G. Manusov
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Xi Mao
- Department of Economics, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Marcio Almeida
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Juan M. Peralta
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Joanne E. Curran
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Michael C. Mahaney
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Harald Göring
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - John Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
| | - Sarah Williams-Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States
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Gutiérrez-Esparza G, Martinez-Garcia M, Ramírez-delReal T, Groves-Miralrio LE, Marquez MF, Pulido T, Amezcua-Guerra LM, Hernández-Lemus E. Sleep Quality, Nutrient Intake, and Social Development Index Predict Metabolic Syndrome in the Tlalpan 2020 Cohort: A Machine Learning and Synthetic Data Study. Nutrients 2024; 16:612. [PMID: 38474741 DOI: 10.3390/nu16050612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
This study investigated the relationship between Metabolic Syndrome (MetS), sleep disorders, the consumption of some nutrients, and social development factors, focusing on gender differences in an unbalanced dataset from a Mexico City cohort. We used data balancing techniques like SMOTE and ADASYN after employing machine learning models like random forest and RPART to predict MetS. Random forest excelled, achieving significant, balanced accuracy, indicating its robustness in predicting MetS and achieving a balanced accuracy of approximately 87%. Key predictors for men included body mass index and family history of gout, while waist circumference and glucose levels were most significant for women. In relation to diet, sleep quality, and social development, metabolic syndrome in men was associated with high lactose and carbohydrate intake, educational lag, living with a partner without marrying, and lack of durable goods, whereas in women, best predictors in these dimensions include protein, fructose, and cholesterol intake, copper metabolites, snoring, sobbing, drowsiness, sanitary adequacy, and anxiety. These findings underscore the need for personalized approaches in managing MetS and point to a promising direction for future research into the interplay between social factors, sleep disorders, and metabolic health, which mainly depend on nutrient consumption by region.
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Affiliation(s)
- Guadalupe Gutiérrez-Esparza
- Researcher for Mexico CONAHCYT, National Council of Humanities, Sciences and Technologies, Mexico City 08400, Mexico
- Clinical Research, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14080, Mexico
| | - Mireya Martinez-Garcia
- Department of Immunology, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14080, Mexico
| | - Tania Ramírez-delReal
- Center for Research in Geospatial Information Sciences, Aguascalientes 20313, Mexico
| | | | - Manlio F Marquez
- Department of Electrocardiology, National Institute of Cardiology 'Ignacio Chavez', Mexico City 14080, Mexico
| | - Tomás Pulido
- Cardiopulmonary Department, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14080, Mexico
| | - Luis M Amezcua-Guerra
- Department of Immunology, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14080, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City 14610, Mexico
- Center for Complexity Sciences, Universidad Nacional Autónoma de Mexico, Mexico City 04510, Mexico
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Reyes-Ortiz CA, Marín-Vargas E, Ocampo-Chaparro JM. Social determinants of health and metabolic syndrome in Colombian older adults. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00042-5. [PMID: 38413358 DOI: 10.1016/j.numecd.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND AND AIMS Social determinants of health (SDH) are critical in health outcomes. More insight is needed on the correlation between SDH and metabolic syndrome (MetS) in the aging population. This study assessed the association between SDH and MetS scores among older adults in Colombia. METHODS AND RESULTS This cross-sectional country-wide study includes a sample of 4085 adults aged ≥60 from the SABE Colombia Survey. MetS measurements were central obesity, hyperglycemia or diabetes, hypertriglyceridemia, arterial hypertension, and low HDL cholesterol (MetS score 0-5). SDH includes four levels: 1- general socioeconomic and environmental conditions; 2-social and community networks; 3- individual lifestyle; and 4-constitutional factors. In multivariate linear regression analysis, the SDH factors with greater effect sizes, calculated by Eta Squared, predicting higher MetS mean scores were women followed by low education, no alcohol intake, urban origin, and residing in unsafe neighborhoods. Two interactions: men, but not women, have lower MetS in safe neighborhoods compared to unsafe, and men, but not women, have lower MetS when having low education (0-5 years) compared to high (≥6). CONCLUSION Gender, education, alcohol intake, and origin have the greatest effect sizes on MetS. Education level and neighborhood safety modified the relationship between gender and MetS. Low-educated men or those residing in safe neighborhoods have lower MetS. Neighborhood environments and educational differences influencing MetS should be considered in future studies.
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Affiliation(s)
- Carlos A Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, FL, USA.
| | - Eliana Marín-Vargas
- Specialty Program in Geriatrics, Department of Family Medicine, School of Health, Gerontology and Geriatrics Research Group, Universidad del Valle, Cali, Colombia.
| | - José Mauricio Ocampo-Chaparro
- Specialty Program in Geriatrics, Department of Family Medicine, School of Health, Gerontology and Geriatrics Research Group, Universidad del Valle, Cali, Colombia.
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Ku B, Ghim S. Poor Physical Health in Caregivers of Children with ADHD or ASD and its Association with Health Risk Behaviours: NHIS 2016-2018. Int J Behav Med 2024:10.1007/s12529-023-10253-3. [PMID: 38172453 DOI: 10.1007/s12529-023-10253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is a dearth of evidence regarding physical health problems and health risk behaviours (e.g., drinking, physical inactivity, smoking, and suboptimal sleep behaviour) in caregivers of children with attention deficit hyperactivity disorder or autism spectrum disorder (CCAA). The purposes of the current study were to examine differences in physical health problems between CCAA and caregivers of children without attention deficit hyperactivity disorder and autism spectrum disorder (CCWAA) and to explore health risk behaviours associated with those problems. METHOD Data from the 2016-2018 National Health Interview Survey were used in the current study. 10 common physical health problems were compared between CCAA and CCWAA by using multivariable logistic regressions. In addition, in order to detect associated health risk behaviours, decision tree analysis was performed for physical health problems in CCAA. RESULTS Of the 10 physical health problems, caregivers of children with ADHD showed significantly higher likelihood of experiencing nine (arthritis, asthma, back pain, high cholesterol, diabetes, heart problems, hypertension, neck pain, obesity), compared to CCWAA. Caregivers of children with autism spectrum disorder (ASD) showed significantly higher likelihoods of experiencing two physical health problems compared to CCWAA. The decision tree analysis revealed that age (> 42 years), and suboptimal sleep behaviour (not 7-8 hours), and smoking (current smoker) were the frequent predictors for physical health problems in CCAA. CONCLUSION The results of the current study represent an important milestone in further investigating physical health problems in CCAA.
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Affiliation(s)
- Byungmo Ku
- Department of Special Physical Education, Sports Sciecne Buliding 8405, 134 Yongindaehak-ro, Samga-dong, Cheoin-gu, Yongin-si, Gyeonggi-do, South Korea
| | - Seungbeen Ghim
- Health Management and Policy, College of Health, Oregon State University, 97333, Corvallis, OR, USA.
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Mestre Font M, Busquets-Cortés C, Ramírez-Manent JI, Tomás-Gil P, Paublini H, López-González ÁA. Influence of Sociodemographic Variables and Healthy Habits on the Values of Insulin Resistance Indicators in 386,924 Spanish Workers. Nutrients 2023; 15:5122. [PMID: 38140381 PMCID: PMC10746000 DOI: 10.3390/nu15245122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) is an alteration of the action of insulin in cells, which do not respond adequately to this action, leading to an increase in blood glucose levels. IR produces a very diverse clinical picture and increases the cardiometabolic risk of the population that suffers from it. Among the factors that influence IR are genetics, unhealthy lifestyle habits, overweight, and obesity. The objective of this work was to determine how different sociodemographic variables and healthy habits influence the values of different scales that assess the risk of presenting IR in a group of Spanish workers. METHODS An observational, cross-sectional, descriptive study was carried out in 386,924 workers from different Spanish regions. Different sociodemographic variables and lifestyle habits were studied (age, social class, educational level, smoking, Mediterranean diet, physical exercise) along with their association with four scales to evaluate the risk of insulin resistance (TyG index, TyG-BMI, METS-IR, TG/HDL-c). To analyse the quantitative variables, Student's t test was used, while the Chi-squared test was used for the qualitative variables. A multinomial logistic regression analysis was performed, calculating the odds ratio with its 95% confidence intervals. The accepted level of statistical significance was set at p < 0.05. RESULTS In the multivariate analysis, all variables, except educational level, increased the risk of presenting high values on the IR risk scales, especially a sedentary lifestyle and low adherence to the Mediterranean diet. CONCLUSIONS Our results demonstrate an association between the practice of regular physical exercise and a reduction in the risk of IR; a strong role of the Mediterranean diet as a protective factor for IR; an association between aging and increased IR, which has also been suggested in other studies; and, finally, a relationship between a low socioeconomic level and an increase in IR.
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Affiliation(s)
- Miguel Mestre Font
- ADEMA-Health Group, Instituto Universitario en Ciencias de la Salud, University of Balearic Islands, 07122 Palma, Spain; (M.M.F.); (C.B.-C.); (P.T.-G.); (H.P.); (Á.A.L.-G.)
| | - Carla Busquets-Cortés
- ADEMA-Health Group, Instituto Universitario en Ciencias de la Salud, University of Balearic Islands, 07122 Palma, Spain; (M.M.F.); (C.B.-C.); (P.T.-G.); (H.P.); (Á.A.L.-G.)
| | - José Ignacio Ramírez-Manent
- ADEMA-Health Group, Instituto Universitario en Ciencias de la Salud, University of Balearic Islands, 07122 Palma, Spain; (M.M.F.); (C.B.-C.); (P.T.-G.); (H.P.); (Á.A.L.-G.)
- Familiy Medicine, Balearic Islands Health Service, 07003 Palma, Spain
| | - Pilar Tomás-Gil
- ADEMA-Health Group, Instituto Universitario en Ciencias de la Salud, University of Balearic Islands, 07122 Palma, Spain; (M.M.F.); (C.B.-C.); (P.T.-G.); (H.P.); (Á.A.L.-G.)
| | - Hernán Paublini
- ADEMA-Health Group, Instituto Universitario en Ciencias de la Salud, University of Balearic Islands, 07122 Palma, Spain; (M.M.F.); (C.B.-C.); (P.T.-G.); (H.P.); (Á.A.L.-G.)
| | - Ángel Arturo López-González
- ADEMA-Health Group, Instituto Universitario en Ciencias de la Salud, University of Balearic Islands, 07122 Palma, Spain; (M.M.F.); (C.B.-C.); (P.T.-G.); (H.P.); (Á.A.L.-G.)
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Weiss MC, Wang L, Sargis RM. Hormonal Injustice: Environmental Toxicants as Drivers of Endocrine Health Disparities. Endocrinol Metab Clin North Am 2023; 52:719-736. [PMID: 37865484 PMCID: PMC10929240 DOI: 10.1016/j.ecl.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
The toll of multiple endocrine disorders has increased substantially in recent decades, and marginalized populations bear a disproportionate burden of disease. Because of the significant individual and societal impact of these conditions, it is essential to identify and address all modifiable risk factors contributing to these disparities. Abundant evidence now links endocrine dysfunction with exposure to endocrine-disrupting chemicals (EDCs), with greater exposures to multiple EDCs occurring among vulnerable groups, such as racial/ethnic minorities, those with low incomes, and others with high endocrine disease burdens. Identifying and eliminating EDC exposures is an essential step in achieving endocrine health equity.
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Affiliation(s)
- Margaret C Weiss
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612, USA; College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Chicago, IL 60612, USA; Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, 835 South Wolcott, Suite E625, M/C 640, Chicago, IL 60612, USA
| | - Luyu Wang
- College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Chicago, IL 60612, USA; Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, 835 South Wolcott, Suite E625, M/C 640, Chicago, IL 60612, USA
| | - Robert M Sargis
- College of Medicine, University of Illinois at Chicago, 1853 West Polk Street, Chicago, IL 60612, USA; Division of Endocrinology, Diabetes, and Metabolism, University of Illinois at Chicago, 835 South Wolcott, Suite E625, M/C 640, Chicago, IL 60612, USA; Chicago Center for Health and Environment, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60612, USA; Section of Endocrinology, Diabetes, and Metabolism, Jesse Brown Veterans Affairs Medical Center, 820 South Damen, Chicago, IL 60612, USA.
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Pavithra H, Naik PR. Prevalence of Metabolic Syndrome and its Risk Factors among Adults in a Rural Area of Dakshina Kannada District. Indian J Community Med 2023; 48:861-866. [PMID: 38249709 PMCID: PMC10795886 DOI: 10.4103/ijcm.ijcm_743_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/02/2023] [Indexed: 01/23/2024] Open
Abstract
Background Metabolic syndrome (MS) consists of interconnected factors responsible for increased risk of cardiovascular diseases and development of type 2 diabetes mellitus. Early identification and treatment of components of MS leads to improved cardiovascular outcomes. Aims To determine the prevalence of metabolic syndrome among adults >18 years of age and to study the various socio-demographic and behavioral factors associated with MS. Methods and Material This was a cross-sectional study conducted among 280 adults of >18 years in a rural area of Dakshina Kannada district. Probability proportional to size and random sampling was used to select the study participants. Data was collected by interviews, anthropometry, blood investigations. Results Prevalence of MS was 33.9% and majority were females (71.8%). The mean age was 49.35 (±15.22) years. The prevalence (raised levels/on treatment) of hypertension, hyperlipidemia and hyperglycemia were 56.79% (systolic), 38.93% (diastolic), 38.57% (raised triglycerides), and 45% respectively. Majority of the subjects were obese (52.9%). Participants of 18-49 years age group had 2.30 times higher odds of having MS than ≥50 years age group (P value < 0.001). Female gender and low socio-economic status had 1.49- and 1.31-times higher odds of having MS respectively. Family history of diabetes and presence of co-morbidities had 1.20- and 1.02-times higher odds of developing MS. Conclusion There is a high prevalence of MS in rural areas. Intervention based on lifestyle modifications needs to be developed.
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Affiliation(s)
- H Pavithra
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Poonam R. Naik
- Department of Community Medicine, Yenepoya Medical College, Mangalore, Karnataka, India
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Ye Q, Wang Z, Deng T, Lou Q, Wu H, Tang W, Xu F. Association of socioeconomic status with metabolic syndrome and its components among adult population: a community-based cross-sectional study in Nanjing Municipality of China. BMJ Open 2023; 13:e074059. [PMID: 37844993 PMCID: PMC10582845 DOI: 10.1136/bmjopen-2023-074059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES To investigate the association of metabolic syndrome (MetS) and its components with socioeconomic status (SES) among general and gender-specific adult population in Nanjing municipality, China. DESIGN Cross-sectional study. PARTICIPANTS 13287 participants completed the survey. A participant: (1) must be a local registered resident, (2) aged 18+ years, (3) had no literal or physical/mental problems and (4) was not pregnant. STUDY MEASURES MetS was the outcome variable, which was defined based on the diagnostic criteria released by the Chinese Diabetes Society. SES was the main explanatory measure, which was indicated with educational attainment and family average income (FAI), separately. RESULTS The prevalence of MetS was 19.7% (95% CI=19.0% to 20.4%) among overall participants, and 24.6% (95% CI=23.5% to 25.6%) and 15.5% (95% CI=14.7% to 16.4%) for men and women, respectively. After controlling for potential confounders, participants with either college level (OR=0.51, 95% CI=0.43 to 0.60) or high school level education (OR=0.78, 95% CI=0.70 to 0.90) were at lower odds to experience MetS compared with those with primary education, while only those within upper FAI tertile were at significantly lower risk of MetS relative to their counterparts within lower FAI category (OR=0.85, 95% CI=0.76 to 0.97) among overall participants. Meanwhile, with respect to the five components of MetS, higher educational level predicted lower waist circumference (WC), triglycerides, systolic blood pressure (SBP) and diastolic blood pressure (DBP) and fasting glucose concentration among all participants. And higher FAI was associated with lower WC and SBP and DBP in women, and with lower SBP and DBP in men. CONCLUSIONS Education and FAI each were inversely associated with MetS and its components at the present stage of economic development in Nanjing Municipality of China. It has important public health implications that the tailored prevention strategies for MetS should be put into consideration of the intervention of MetS components and subgroups of people with different SES.
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Affiliation(s)
- Qing Ye
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
- Dept. of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
| | - Zhenglin Wang
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Tianrui Deng
- Dept. of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
| | - Qinglin Lou
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Haidi Wu
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Wei Tang
- Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Fei Xu
- Dept. of Epidemiology, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, Jiangsu, China
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Bishehsari F, Drees M, Adnan D, Sharma D, Green S, Koshy J, Giron LB, Goldman A, Abdel-Mohsen M, Rasmussen HE, Miller GE, Keshavarzian A. Multi-omics approach to socioeconomic disparity in metabolic syndrome reveals roles of diet and microbiome. Proteomics 2023; 23:e2300023. [PMID: 37525324 DOI: 10.1002/pmic.202300023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/02/2023]
Abstract
The epidemy of metabolic syndrome (MetS) is typically preceded by adoption of a "risky" lifestyle (e.g., dietary habit) among populations. Evidence shows that those with low socioeconomic status (SES) are at an increased risk for MetS. To investigate this, we recruited 123 obese subjects (body mass index [BMI] ≥ 30) from Chicago. Multi-omic data were collected to interrogate fecal microbiota, systemic markers of inflammation and immune activation, plasma metabolites, and plasma glycans. Intestinal permeability was measured using the sugar permeability testing. Our results suggest a heterogenous metabolic dysregulation among obese populations who are at risk of MetS. Systemic inflammation, linked to poor diet, intestinal microbiome dysbiosis, and gut barrier dysfunction may explain the development of MetS in these individuals. Our analysis revealed 37 key features associated with increased numbers of MetS features. These features were used to construct a composite metabolic-inflammatory (MI) score that was able to predict progression of MetS among at-risk individuals. The MI score was correlated with several markers of poor diet quality as well as lower levels of gut microbial diversity and abnormalities in several species of bacteria. This study reveals novel targets to reduce the burden of MetS and suggests access to healthy food options as a practical intervention.
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Affiliation(s)
- Faraz Bishehsari
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Drees
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
| | - Darbaz Adnan
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
| | - Deepak Sharma
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
| | - Stefan Green
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
| | - Jane Koshy
- The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Leila B Giron
- The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Aaron Goldman
- The Wistar Institute, Philadelphia, Pennsylvania, USA
| | | | | | - Gregory E Miller
- Institute for Policy Research and Dept of Psychology, Northwestern Univ, Evanston, Illinois, USA
| | - Ali Keshavarzian
- Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, Illinois, USA
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Hoveling LA, Lepe A, Boissonneault M, de Beer JAA, Smidt N, de Kroon MLA, Liefbroer AC. Educational inequalities in metabolic syndrome prevalence, timing, and duration amongst adults over the life course: a microsimulation analysis based on the lifelines cohort study. Int J Behav Nutr Phys Act 2023; 20:104. [PMID: 37667275 PMCID: PMC10478481 DOI: 10.1186/s12966-023-01495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Educational inequalities in metabolic syndrome (MetS) are a growing public health concern. Intervening on modifiable factors may help reduce these inequalities, but there is a need for evidence on the long-term impact of intervening on these factors. Thus, we simulate the development of educational inequalities in MetS across the life course and assess the impact of intervening on the modifiable factors that contribute to these inequalities. METHODS We used data from the prospective multigenerational Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation projects the development of educational inequalities in MetS between ages 18 and 65, and assesses the potential benefit of intervening on smoking, alcohol use, diet quality, and health literacy. FINDINGS The likelihood of ever experiencing MetS between ages 18 and 65 varies from 32.5% among high educated women to 71.5% among low educated men. On average, 27.6% more individuals with low education will ever experience MetS between ages 18 and 65 compared to those with high education. Additionally, individuals with low education generally will develop MetS 2.3 years earlier, and will spend an extra 2.6 years with MetS, compared to individuals with high education. Changes to smoking behaviours in individuals with low education produced the largest effect; it would reduce inequalities in prevalence, timing and duration by an average of 7.5%, 9.5%, and 6.9%, respectively. CONCLUSIONS Interventions targeting the modifiable factors included in this study, especially smoking, could help reduce the estimated educational inequalities in MetS over the life course.
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Affiliation(s)
- Liza A Hoveling
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands.
| | - Alexander Lepe
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands
| | - Michael Boissonneault
- Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW, University of Groningen, PO Box 11650, The Hague, 2502 AR, The Netherlands
| | - Joop A A de Beer
- Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW, University of Groningen, PO Box 11650, The Hague, 2502 AR, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Aart C Liefbroer
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, The Netherlands
- Netherlands Interdisciplinary Demographic Institute (NIDI)-KNAW, University of Groningen, PO Box 11650, The Hague, 2502 AR, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, De Boelelaan 1081, Amsterdam, 1081 HV, The Netherlands
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12
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Mohammadzadeh P, Moradpour F, Nouri B, Mostafavi F, Najafi F, Moradi G. Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults. Epidemiol Health 2023; 45:e2023083. [PMID: 37723842 PMCID: PMC10867515 DOI: 10.4178/epih.e2023083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/15/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVES The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population. METHODS We used data from 3,996 participants, aged 35 years to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components. RESULTS The prevalence of MetS was 34.44% (95% confidence interval [CI], 32.97 to 35.93). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components. CONCLUSIONS This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.
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Affiliation(s)
- Pardis Mohammadzadeh
- Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bijan Nouri
- Health Metrics and Evaluation Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farideh Mostafavi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
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13
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Dou X, Kim Y, Chu H. Prevalence of Metabolic Syndrome According to Physical Activity, Dietary Habits, Mental Status, Social Status, Health Behavior, and Obesity Phenotypes in Korean Adolescents: 2016-2021. Foods 2023; 12:3304. [PMID: 37685235 PMCID: PMC10486969 DOI: 10.3390/foods12173304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Environmental factors play a role in increasing or decreasing the risk of metabolic syndrome (MetS) in adolescents. We analyzed the impact of physical activity (PA), dietary habits, and mental and socioeconomic status on MetS prevalence in 2143 (boys: 1113, girls: 1030, age: 13-18 years) Korean middle- and high-school students. Metabolically healthy obesity and metabolically unhealthy normal weight were also evaluated. MetS occurred in 215 participants (10.0%), and boys had a higher MetS rate than girls. There was no significant difference in alcohol consumption and smoking experience between individuals with and those without MetS. The odds ratio (OR) for high-school students was 1.33 (95%CI, 1.001-1.789, p = 0.043) times that of middle-school students. Depression, low aerobic PA, and high sedentary time increased the ORs to 1.64 (95%CI, 1.059-2.539, p = 0.020), 1.52 (95%CI, 1.092-2.203, p = 0.003), and 1.86 (95%CI, 1.342-2.587, p < 0.001), respectively. Higher energy intake and low weekly breakfast consumption frequency yielded ORs of 1.46 (95%CI, 1.046-2.555, p = 0.025) and 1.70 (95%CI, 1.244-2.339, p = 0.011), respectively. Strength training, stress, suicidal ideation, dining out frequency, and household income did not impact MetS prevalence. Despite obesity, MetS decreased by 29.7% with high aerobic PA and 37.9% with high weekly breakfast consumption frequency. In conclusion, MetS risk was higher for men, individuals with depression, and high-school students. Low aerobic activity, high calorie intake, and low weekly breakfast consumption frequency increased MetS risk. Despite obesity, high aerobic activity, low sedentary time, and breakfast consumption was associated with lower MetS risk.
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Affiliation(s)
- Xiangxiang Dou
- Department of Sports Welfare Education, Woosuk University, Wanju 55338, Republic of Korea;
| | - Yonghwan Kim
- Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Republic of Korea
| | - Hyunsik Chu
- Department of Forest Leisure Sprots, Gangneung Yeoungdong University, Gangneung 25521, Republic of Korea
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14
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Hiramatsu Y, Ide H, Furui Y. Differences in the components of metabolic syndrome by age and sex: a cross-sectional and longitudinal analysis of a cohort of middle-aged and older Japanese adults. BMC Geriatr 2023; 23:438. [PMID: 37460963 PMCID: PMC10353138 DOI: 10.1186/s12877-023-04145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The prevalence of metabolic syndrome (MetS) in Japan, a super-aged society, is increasing and poses a major public health issue. Several studies have reported sex differences in the association between age and MetS prevalence. This study aimed to examine the association between age and the prevalence of MetS based on multiple screening criteria and MetS components by sex. METHODS We used 6 years of individual-level longitudinal follow-up data (June 2012 to November 2018; checkup year: 2012-2017) of middle-aged and older adults aged 40-75 years in Japan (N = 161,735). The Joint Interim Statement criteria, International Diabetes Federation criteria, and another set of criteria excluding central obesity were used as the screening criteria for MetS. The prevalence of MetS and MetS components was cross-sectionally analyzed according to sex and age. A longitudinal association analysis of age, MetS, and MetS components by sex was performed using a multilevel logistic model, adjusted for lifestyle- and regional-related factors. RESULTS Sex differences were observed in the prevalence and association of MetS and MetS components. In all age groups, the prevalence of central obesity was higher among women, and the prevalence of high blood pressure and fasting glucose was higher among men (P < 0.001). The prevalence of high triglyceride and low high-density lipoprotein cholesterol was higher among women aged > 60 years (P < 0.05). Based on the criteria of the Joint Interim Statement and International Diabetes Federation, the prevalence of MetS was higher among women than in men aged > 55 years (P < 0.001). Men had a higher prevalence of MetS without central obesity than women in all age groups (P < 0.001). The odds ratio for MetS and MetS components with aging was greater among women than in men. CONCLUSIONS Medical management should be based on the prevalence of MetS and its components according to sex and age. In particular, the high prevalence of MetS without central obesity in middle-aged and older Japanese men suggests that the adoption of the Joint Interim Statement criteria, which do not precondition central obesity, should be considered.
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Affiliation(s)
- Yuji Hiramatsu
- Healthcare Data Science Research Unit, Institute for Future Initiatives, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
- MCVP Division, AXA Life Insurance Co., Ltd, Tokyo, Japan.
| | - Hiroo Ide
- Healthcare Data Science Research Unit, Institute for Future Initiatives, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Yuji Furui
- Healthcare Data Science Research Unit, Institute for Future Initiatives, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
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15
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Greco G, Bickell NA, Lin S, Yagnik R, LeRoith D, Gallagher EJ. Subjective social status, race, and metabolic syndrome in women with breast cancer. Breast Cancer Res Treat 2023; 199:479-487. [PMID: 37087701 DOI: 10.1007/s10549-023-06949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/06/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE To evaluate the association of subjective social status (SSS) with metabolic syndrome (MetS) severity and its potential contribution to racial health disparities in women with breast cancer. METHODS Multicenter cross-sectional study (10 US hospitals) in women (n = 1206) with primary diagnosis of invasive breast cancer received during Mar/2013-Feb/2020. Participants, self-identified as non-Hispanic White or Black, underwent physical and laboratory examinations and survey questions assessing socioeconomic parameters, medical history, and behavioral risks. SSS was measured with the 10-rung MacArthur scale. MetS severity was measured with a validated Z-Score. Generalized linear mixed modeling was used to analyze the associations. Missing data were handled using multiple imputation. RESULTS Average age was 58 years. On average, the SSS of Black women, given equivalent level of income and education, was lower than the SSS of White women: 6.6 (6.1-7.0) vs 7.7 (7.54-7.79) among college graduates and 6.8 (6.4-7.2) vs 7.6 (7.5-7.8) among women in the high-income category (> $75,000). In multivariable analysis, after controlling for age, income, education, diet, and physical activity, increasing SSS was associated with a decrease in MetS-Z score, - 0.10 (- 0.16 to - 0.04) per every 2 rung increase in the MacArthur scale. CONCLUSION Black women with breast cancer rank their SSS lower than White women with breast cancer do at each level of income and education. As SSS is strongly associated with MetS severity these results identify potentially modifiable factors that contribute to racial disparities.
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Affiliation(s)
- Giampaolo Greco
- Department of Population Health Science and Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nina A Bickell
- Department of Population Health Science and Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sylvia Lin
- Department of Population Health Science and Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Radhi Yagnik
- Department of Population Health Science and Policy, Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Derek LeRoith
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, Box 1055, New York, NY, 10029, USA
| | - Emily J Gallagher
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Tisch Cancer Institute at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, Box 1055, New York, NY, 10029, USA.
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Ardekani AM, Vahdat S, Hojati A, Moradi H, Tousi AZ, Ebrahimzadeh F, Farhangi MA. Evaluating the association between the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, mental health, and cardio-metabolic risk factors among individuals with obesity. BMC Endocr Disord 2023; 23:29. [PMID: 36726099 PMCID: PMC9893576 DOI: 10.1186/s12902-023-01284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several previous investigations have examined the brain-protective role of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. However, more knowledge is needed about the MIND diet's other favorable impacts. The purpose of this study was to examine the relationship between the MIND diet, mental health, and metabolic markers in individuals with obesity. METHODS In this cross-sectional study, we included 339 individuals with obesity (BMI ≥ 30 kg/m2) aged 20-50 years. We utilized a semi-quantitative Food Frequency Questionnaire (FFQ), we assessed dietary intake, including 168 food items, and calculated the value of MIND. Metabolic syndrome (MetS) was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines. We assessed biochemical parameters using Enzymatic methods. Blood pressure and body composition were also determined. RESULTS Higher tertiles of the MIND diet score were associated with significantly higher energy intake, macronutrients, and brain-healthy food intakes (P < 0.001). Among the brain-unhealthy foods, only the intake of sweets and pastries was significantly lower in the highest versus lowest MIND tertiles. We also observed lower odds of stress (P < 0.05) and higher insulin sensitivity (P < 0.05) in the highest versus lowest MIND diet tertiles. We witnessed no significant changes in other parameters. CONCLUSION Lower stress levels and higher insulin sensitivity independent of some confounders like age, BMI, sex, and physical activity were associated with the highest tertile of MIND diet score.
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Affiliation(s)
- Abnoos Mokhtari Ardekani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Science & Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sahar Vahdat
- Isfahan Kidney Disease Research Center, Khorshid Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Hojati
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Moradi
- Faculty of Medicine, Belarusian State Medical University (BSMU), Minsk, Belarus
| | - Ayda Zahiri Tousi
- Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran
| | - Farnoosh Ebrahimzadeh
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahdieh Abbasalizad Farhangi
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Attar Neyshabouri St., Daneshgah Blvd., Tabriz, Iran.
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Soofi M, Najafi F, Soltani S, Karamimatin B. Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran. J Prev Med Public Health 2023; 56:50-58. [PMID: 36746422 PMCID: PMC9925283 DOI: 10.3961/jpmph.22.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/22/2022] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Karamimatin
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran,Corresponding author: Behzad Karamimatin, Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Dowlatabad Blvd, Kermanshah 6719851351, Iran E-mail:
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18
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Duan MJF, Zhu Y, Dekker LH, Mierau JO, Corpeleijn E, Bakker SJL, Navis G. Effects of Education and Income on Incident Type 2 Diabetes and Cardiovascular Diseases: a Dutch Prospective Study. J Gen Intern Med 2022; 37:3907-3916. [PMID: 35419742 PMCID: PMC9640500 DOI: 10.1007/s11606-022-07548-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Education and income, as two primary socioeconomic indicators, are often used interchangeably in health research. However, there is a lack of clear distinction between these two indicators concerning their associations with health. OBJECTIVE This study aimed to investigate the separate and combined effects of education and income in relation to incident type 2 diabetes and cardiovascular diseases in the general population. DESIGN AND PARTICIPANTS Participants aged between 30 and 65 years from the prospective Dutch Lifelines cohort study were included. Two sub-cohorts were subsequently created, including 83,759 and 91,083 participants for a type 2 diabetes cohort and a cardiovascular diseases cohort, respectively. MAIN MEASURES Education and income level were assessed by self-report questionnaires. The outcomes were incident type 2 diabetes and cardiovascular diseases (defined as the earliest non-fatal cardiovascular event). KEY RESULTS A total of 1228 new cases of type 2 diabetes (incidence 1.5%) and 3286 (incidence 3.6%) new cases of cardiovascular diseases were identified, after a median follow-up of 43 and 44 months, respectively. Low education and low income (<1000 euro/month) were both positively associated with a higher risk of incident type 2 diabetes (OR 1.24 [95%CI 1.04-1.48] and OR 1.71 [95%CI 1.30-2.26], respectively); and with a higher risk of incident cardiovascular diseases (OR 1.15 [95%CI 1.04-1.28] and OR 1.24 [95%CI 1.02-1.52], respectively); independent of age, sex, lifestyle factors, BMI, clinical biomarkers, comorbid conditions at baseline, and each other. Results from the combined associations of education and income showed that within each education group, a higher income was associated with better health; and similarly, a higher education was associated with better health within each income group, except for the low-income group. CONCLUSIONS Education and income were both independently associated with incident type 2 diabetes and cardiovascular diseases. The combined associations of these two socioeconomic indicators revealed that within each education or income level, substantial health disparities existed across strata of the other socioeconomic indicator. Education and income are two equally important socioeconomic indicators in health, and should be considered simultaneously in health research and policymaking.
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Affiliation(s)
- Ming-Jie F Duan
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Yinjie Zhu
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Louise H Dekker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, The Netherlands
| | - Jochen O Mierau
- Aletta Jacobs School of Public Health, University of Groningen, Groningen, The Netherlands
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Liu J, Zhang Y, Lavie CJ, Moran AE. Trends in Metabolic Phenotypes According to Body Mass Index Among US Adults, 1999-2018. Mayo Clin Proc 2022; 97:1664-1679. [PMID: 35691704 DOI: 10.1016/j.mayocp.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine the prevalence, distribution, and temporal trends of metabolic phenotypes that are jointly determined by obesity and metabolic health status among US adults, overall and in key population subgroups. PARTICIPANTS AND METHODS A nationally representative sample of civilian, noninstitutionalized US adults aged 20 years and older from the National Health and Nutrition Examination Survey between 1999-2000 and 2017-2018 were included. Metabolic phenotypes were characterized jointly by body mass index and metabolic health: metabolically healthy underweight, normal weight, overweight, and obese (MH-OB); and metabolically unhealthy underweight, normal weight, overweight, and obese (MU-OB). Metabolic health was defined using the 2009 joint scientific statement for metabolic syndrome from the International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity as having 2 or less components (primary analysis) or no components (secondary analysis) of the following: waist circumference of 102 cm or greater in men and 88 cm or greater in women, fasting plasma glucose level of 100 mg/dL or greater, blood pressure of 130/85 mm Hg or greater, triglyceride level of 150 mg/dL or greater, and high-density lipoprotein cholesterol level of less than 40 mg/dL in men and less than 50 mg/dL in women. RESULTS Of 19,941 adults, the mean age was 46.9 years; 10,005 (50.6%) were female. From 1999 to 2018, the prevalence in primary analysis declined from 33.2% (465465 of 1646) to 25.1% (454454 of 2058) (difference, -8.09%; 95% CI, -12.5% to -3.70%) for metabolically healthy normal weight, whereas it increased from 9.92% (178178 of 1646) to 14.1% (277277 of 2058) (difference, 4.17%; 95% CI, 1.13% to 7.21%) for MH-OB (both P<.001 for trend). The prevalence of metabolically healthy underweight and overweight remained stable at about 1.62% (298298 of 19,94119,941) (95% CI, 1.38% to 1.89%; P=.34 for trend) and 22.2% (4,275 of 19,941) (95% CI, 21.4% to 23.0%; P=.14 for trend), respectively. The prevalence declined from 3.77% (72 of 1646) to 2.10% (68 of 2058) (difference, -1.67%; 95% CI, -3.22% to -0.12%; P=.006 for trend) for metabolically unhealthy normal weight, whereas it increased from 19.0% (343 of 1646) to 26.4% (574 of 2058) (difference, 7.41%; 95% CI, 2.67% to 12.2%; P<.001 for trend) for MU-OB. The prevalence of metabolically unhealthy underweight and overweight remained stable at 0.06% (11 of 19,941) (95% CI, 0.03% to 0.15%; P=.84 for trend) and 11.2% (2528 of 19,941) (95% CI, 10.6% to 11.8%; P=.29 for trend), respectively. Persistent differences in the prevalence of metabolic phenotypes were identified across multiple sociodemographic subgroups. For example, the prevalence of MH-OB increased from 7.58% (53 of 754) to 12.0% (79 of 694) (P<.001 for trend) for non-Hispanic Whites and 12.2% (60 of 567) to 18.4% (76 of 493) for Hispanics (P=.01 for trend) and remained stable at 22.6% (756 of 3,825) for non-Hispanic Blacks (P=.62 for trend and P=.05 for interaction). Results in secondary analyses revealed similar patterns. CONCLUSION From 1999 to 2018, US adults experienced major increases in the prevalence of both MH-OB and MU-OB, largely due to decreases in MH-N. The prevalence of MU-OB increased across all subgroups, with higher values observed in older adults and those with lower education and income levels.
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Affiliation(s)
- Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY
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20
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Jeong S, Cho SI, Kong SY. Effect of income level on stroke incidence and the mediated effect of simultaneous diagnosis of metabolic syndrome diseases; a nationwide cohort study in South Korea. Diabetol Metab Syndr 2022; 14:110. [PMID: 35941692 PMCID: PMC9358809 DOI: 10.1186/s13098-022-00882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study aimed to determine whether a simultaneous diagnosis of main components of metabolic syndrome (MetS) (hypertension, diabetes mellitus, and dyslipidemia) plays a mediator between income level and stroke. METHODS We used the National Health Insurance Service National Sample Cohort database from 2006 to 2015. The mediator variables were the number of main MetS components diagnosed simultaneously (two or more/three or more). We used a weighting approach method of causal mediation analysis to apply counterfactual frameworks to the Cox proportional hazards regression model. RESULTS A total of 213,526 people were included with 1,690,665.3 person-years of followed up. Compared with the high-income group, the risk of being diagnosed with two or more components of MetS significantly increased in all other income groups [middle-income OR 1.05 (95% CI 1.02-1.08); low-income OR 1.09 (95% CI 1.05-1.12); Medical Aid beneficiaries OR 1.39 (95% CI 1.32-1.47)]. A lower level of income was significantly associated with a higher risk of stroke compared with the high-income group [middle-income HR 1.15 (95% CI 1.07-1.25); low-income HR 1.19 (95% CI 1.10-1.29); Medical Aid beneficiaries HR 1.63 (95% CI 1.48-1.80)]. In the Medical Aid beneficiaries, simultaneous diagnosis of the main metabolic components acted as a significant mediator between income levels and stroke incidence, with 26.6% mediated when diagnosed with two or more diseases and 21.1% when diagnosed with all three. CONCLUSIONS Co-diagnosis of MetS components played a significant mediator role between income level and stroke incidence.
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Affiliation(s)
- Seungmin Jeong
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
- Department of Preventive Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Gangwon Center for Infectious Diseases, Chuncheon, Republic of Korea
| | - Sung-Il Cho
- Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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21
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Krijnen HK, Hoveling LA, Liefbroer AC, Bültmann U, Smidt N. Socioeconomic differences in metabolic syndrome development among males and females, and the mediating role of health literacy and self-management skills. Prev Med 2022; 161:107140. [PMID: 35803357 DOI: 10.1016/j.ypmed.2022.107140] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/13/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Our aim was to investigate sex differences in the associations between socioeconomic position (SEP) and metabolic syndrome (MetS) development, and to what extent these associations are mediated by health literacy and self-management skills. METHODS A subsample (n = 88,384, 59.5% female) of the adult Lifelines Cohort Study was used. MetS development according to NCEP-ATPIII criteria was assessed on average 3.8 years after baseline. SEP-MetS associations were assessed for moderation by sex, and sex-stratified accordingly. Associations between SEP measures (education, income and occupational prestige), health literacy and self-management skills, and MetS development were investigated using logistic regression analyses. The mediating effects of health literacy and self-management skills on the SEP-MetS associations were investigated using the Karlson-Holm-Breen method. RESULTS Among males and females, respectively 9.4% and 7.1% developed MetS. For males, education was inversely associated with MetS development; health literacy (7.1%) and self-management skills (1.9%) mediated a proportion of these educational differences. For females, education, income and occupational prestige were inversely associated with MetS development; health literacy (respectively 5.9% and 6.4%) and self-management skills (respectively 4.1% and 3.7%) mediated a proportion of the educational and occupational differences in MetS development. Neither health literacy nor self-management skills mediated female income differences in MetS development. CONCLUSIONS Socioeconomic differences in MetS development differ between males and females. Both for males and females, health literacy and self-management skills mediated a small proportion of socioeconomic differences in MetS development.
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Affiliation(s)
- Hidde K Krijnen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Liza A Hoveling
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Aart C Liefbroer
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands; Netherlands Interdisciplinary Demographic Institute, PO Box 11650, 2502 AR The Hague, the Netherlands; Vrije Universiteit Amsterdam, Department of Sociology, De Boelelaan 1081, 1081 HV Amsterdam, the Netherlands.
| | - Ute Bültmann
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, PO Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Nynke Smidt
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands.
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22
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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23
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Jones EJ, Schreier HMC. First-generation College Students Have Greater Systemic Inflammation than Continuing-Generation College Students Following the Initial College Transition: A Brief Report. Ann Behav Med 2022; 57:86-92. [PMID: 35445688 PMCID: PMC9773364 DOI: 10.1093/abm/kaac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND First-generation college students ("first-gens") are often at a disadvantage socially and academically; whether they are at risk physiologically is unknown despite the well-established link between greater education and better long-term health. PURPOSE To examine whether first-gens have higher levels of cardiovascular disease (CVD) risk markers relative to continuing-generation college students ("continuing-gens"). METHODS A panel of CVD risk markers was assessed among 87 emerging adults (41 first-gens) twice over their first year of college. RESULTS Compared to continuing-gens, first-gens had greater systemic inflammation (composite of averaged z-scores for C-reactive protein and interleukin-6; B = 0.515, SE = 0.171, p = .003) during the fall but not spring semester (p > .05). Associations were independent of family home ownership and childhood adversity, even though first-gens were more likely to live in rental homes and reported riskier home environments. Lower childhood subjective social status (SSS) accounted for greater systemic inflammation among first-gens as evidenced by an indirect effect of college generation status on systemic inflammation through childhood SSS (a1b1 = 0.261, bootstrapped SE = 0.103, 95% boot CI [0.078, 0.482]). There were no differences in metabolic risk and latent virus regulation by college generation status in either semester (p > .10). CONCLUSIONS This is the first study to find that first-gens have higher levels of systemic inflammation than continuing-gens following the college transition and that childhood SSS may be one explanatory pathway. First-gens may benefit from university resources that address social class differences, which should be provided early on so that first-gens can reap the health-relevant benefits of higher education, at least in the short term.
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Affiliation(s)
| | - Hannah M C Schreier
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
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24
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Gangireddy VGR, Pilkerton C, Xiang J, Tinajero R, Ashcraft AM. Hepatic Fibrosis and Steatosis in Metabolic Syndrome. J Obes Metab Syndr 2022; 31:61-69. [PMID: 35283365 PMCID: PMC8987451 DOI: 10.7570/jomes21062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/29/2021] [Accepted: 12/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background Metabolic syndrome (MetS) is a group of factors associated with increased risks of cardiovascular disease and overall mortality. Nonalcoholic fatty liver disease (NAFLD) is a common disorder that has been shown to cause hepatic steatosis and fibrosis. The relationship between NAFLD and MetS appears to be bidirectional, but very few studies have examined the role of MetS in hepatic steatosis and fibrosis. The present study investigated the relationships between MetS and its components and the severity of hepatic fibrosis and steatosis, and fibrosis independent of steatosis. Methods The study was a cross-sectional population-based survey of 4,678 National Health and Nutrition Examination Survey participants from 2017 to 2018 in the United States. Hepatic fibrosis and steatosis were measured using liver elastography. The MetS components were assessed using demographic, examination, laboratory, and self-reported data. Results Using survey-weighted population estimates, 26% of the population had steatosis, 7.5% had fibrosis, and 3.3% had fibrosis without steatosis. The adjusted odds ratio for any level of steatosis was 4.12 times higher (95% confidence interval [CI], 3.16-5.37) and any level of fibrosis was 3.34 times higher (95% CI, 2.26-4.94) among participants with MetS than those without. The adjusted odds ratio for fibrosis without steatosis is 2.67 times higher (95% CI, 1.47-4.87) among participants with MetS than those without. Conclusion The presence of MetS significantly increases the risk of hepatic fibrosis and steatosis, providing evidence for MetS to be considered an additional independent risk factor for hepatic fibrosis together with other known etiologies.
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Affiliation(s)
| | - Courtney Pilkerton
- Department of Family Medicine, West Virginia University, Morgantown, WV, USA
| | - Jun Xiang
- Department of Family Medicine, West Virginia University, Morgantown, WV, USA
| | - Ruben Tinajero
- Department of Family Medicine, West Virginia University, Morgantown, WV, USA
| | - Amie M Ashcraft
- Department of Family Medicine, West Virginia University, Morgantown, WV, USA
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25
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Khotimchenko M, Brunk NE, Hixon MS, Walden DM, Hou H, Chakravarty K, Varshney J. In Silico Development of Combinatorial Therapeutic Approaches Targeting Key Signaling Pathways in Metabolic Syndrome. Pharm Res 2022; 39:2937-2950. [PMID: 35313359 DOI: 10.1007/s11095-022-03231-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Dysregulations of key signaling pathways in metabolic syndrome are multifactorial, eventually leading to cardiovascular events. Hyperglycemia in conjunction with dyslipidemia induces insulin resistance and provokes release of proinflammatory cytokines resulting in chronic inflammation, accelerated lipid peroxidation with further development of atherosclerotic alterations and diabetes. We have proposed a novel combinatorial approach using FDA approved compounds targeting IL-17a and DPP4 to ameliorate a significant portion of the clustered clinical risks in patients with metabolic syndrome. In our current research we have modeled the outcomes of metabolic syndrome treatment using two distinct drug classes. METHODS Targets were chosen based on the clustered clinical risks in metabolic syndrome: dyslipidemia, insulin resistance, impaired glucose control, and chronic inflammation. Drug development platform, BIOiSIM™, was used to narrow down two different drug classes with distinct modes of action and modalities. Pharmacokinetic and pharmacodynamic profiles of the most promising drugs were modeling showing predicted outcomes of combinatorial therapeutic interventions. RESULTS Preliminary studies demonstrated that the most promising drugs belong to DPP-4 inhibitors and IL-17A inhibitors. Evogliptin was chosen to be a candidate for regulating glucose control with long term collateral benefit of weight loss and improved lipid profiles. Secukinumab, an IL-17A sequestering agent used in treating psoriasis, was selected as a repurposed candidate to address the sequential inflammatory disorders that follow the first metabolic insult. CONCLUSIONS Our analysis suggests this novel combinatorial therapeutic approach inducing DPP4 and Il-17a suppression has a high likelihood of ameliorating a significant portion of the clustered clinical risk in metabolic syndrome.
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Affiliation(s)
- Maksim Khotimchenko
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA
| | - Nicholas E Brunk
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA
| | - Mark S Hixon
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA
| | - Daniel M Walden
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA
| | - Hypatia Hou
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA
| | - Kaushik Chakravarty
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA.
| | - Jyotika Varshney
- VeriSIM Life, 1 Sansome Street, Suite 3500, San Francisco, California, 94104, USA.
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26
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Aldridge E, Pathirana M, Wittwer M, Sierp S, Leemaqz SY, Roberts CT, Dekker GA, Arstall MA. Prevalence of Metabolic Syndrome in Women After Maternal Complications of Pregnancy: An Observational Cohort Analysis. Front Cardiovasc Med 2022; 9:853851. [PMID: 35360031 PMCID: PMC8963931 DOI: 10.3389/fcvm.2022.853851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Certain complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, intrauterine growth restriction, spontaneous preterm birth, and placental abruption, are established independent risk factors for premature cardiovascular disease in women. Metabolic syndrome, which is associated with an increased risk of cardiovascular disease, may be a suitable alternative to traditional cardiovascular risk calculators that underestimate risk in young women. This study aimed to investigate the prevalence of metabolic syndrome in women who experienced a complicated pregnancy 6 months earlier. Methods This observational study investigated the prevalence of metabolic syndrome as defined by the International Diabetes Federation in all eligible participants (n = 247) attending a postpartum lifestyle intervention clinic from August 2018 to June 2021 at the Lyell McEwin Hospital in Adelaide, South Australia. Results A total of 89 (36%) participants met the criteria for metabolic syndrome at a mean follow up time of 7 months postpartum. Almost 90% of the cohort were abdominally obese, and over two thirds of the total cohort met at least two of the criteria for metabolic syndrome. Conclusions Women with a prior history of one of the common major pregnancy complications are at high risk of future cardiovascular and metabolic disease, with many showing either metabolic syndrome or multiple risk factors at only 7 months postpartum. The results indicate that follow-up within 1 year postpartum is an appropriate time to commence preventative strategies, as many women are already showing early signs of disease.
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Affiliation(s)
- Emily Aldridge
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
- *Correspondence: Emily Aldridge
| | - Maleesa Pathirana
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Melanie Wittwer
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - Susan Sierp
- Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - Shalem Y. Leemaqz
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Claire T. Roberts
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Gustaaf A. Dekker
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Department of Obstetrics & Gynecology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - Margaret A. Arstall
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
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27
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Hao Z, Wang M, Zhu Q, Li J, Liu Z, Yuan L, Zhang Y, Zhang L. Association Between Socioeconomic Status and Prevalence of Cardio-Metabolic Risk Factors: A Cross-Sectional Study on Residents in North China. Front Cardiovasc Med 2022; 9:698895. [PMID: 35330947 PMCID: PMC8940519 DOI: 10.3389/fcvm.2022.698895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 02/09/2022] [Indexed: 11/20/2022] Open
Abstract
Studies have found associations between cardio-metabolic disorders and socioeconomic status (SES) in developed areas. However, little epidemiological data are available on residents of less developed areas in North China. A cross-sectional study that consisted of 2,650 adults randomly selected from local residents was conducted on a developing province, Hebei. SES was assessed in terms of education, personal income per year, and occupation. The association between SES and metabolic syndrome (MetS) was determined by multivariate logistic regression. The weighted prevalence of MetS was 26.8% among residents of Hebei province. The lower prevalence of MetS and abdominal obesity was associated with increase in SES groups. After adjustments regarding age, sex, body mass index, living area, smoking, salt intake, and family history of diabetes, odds ratio (OR) for elevated blood pressure (BP) of individuals with higher SES level was 0.71 [95% confidence interval (CI): 0.542–0.921] compared with those with lower SES level. Cardio-metabolic risk factors were commonly identified among residents of Hebei province in north China and were associated with SES conditions. This study indicated that from a public health perspective, more attention should be paid to screening of cardio-metabolic disorders in less developed areas.
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28
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Koo YS, Lee YJ, Park JM. Inverse Association of Serum Folate Level with Metabolic Syndrome and Its Components in Korean Premenopausal Women: Findings of the 2016–2018 Korean National Health Nutrition Examination Survey. Nutrients 2022; 14:nu14040880. [PMID: 35215533 PMCID: PMC8880562 DOI: 10.3390/nu14040880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
Research on the association of serum folate levels with metabolic syndrome (MetS) in premenopausal women is lacking. This study was aimed to investigate this association in 1730 premenopausal women using the 2016 to 2018 Korean National Health and Nutrition Examination Survey data. Participants’ mean age and BMI were 35.9 years and 22.7 kg/m2, respectively. Participants were divided into three groups according to serum folate tertiles. Odds ratios (OR) and 95% confidence intervals (CIs) for abdominal obesity, elevated blood pressure (BP), high fasting plasma glucose (FPG), high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), and MetS were calculated in multiple logistic regression models adjusted for possible confounders, by serum folate level tertiles. Prevalence of MetS (14.9, 11.0, and 8.6%); abdominal obesity (17.8, 16.0, and 11.4%); high TG (17.5, 14.0, and 11.1%); and low HDL-C (50.3, 44.6, and 42.5%) decreased with increasing folate level tertile. Prevalence of elevated BP (14.3, 12.0, and 11.7%) and high FPG (11.9, 15.8, and 13.0%) showed no significant differences according to serum folate level tertiles. The multivariate-adjusted ORs (95% CIs) for MetS, abdominal obesity, elevated BP, high TG, and low HDL-C in the highest folate level tertile were 2.17 (1.46–3.22), 1.80 (1.25–2.60), 1.77 (1.16–2.70), 1.90 (1.35–2.67), and 1.49 (1.14–1.94), respectively. The ORs for high FPG did not show significant differences according to serum folate level tertiles. In conclusion, serum folate levels were inversely associated with an increased risk of MetS in Korean premenopausal women. These results suggest that MetS can be prevented and managed by improving the serum folate levels in premenopausal women.
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Affiliation(s)
- Ye-Seul Koo
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (Y.-S.K.); (Y.-J.L.)
| | - Yong-Jae Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (Y.-S.K.); (Y.-J.L.)
| | - Jae-Min Park
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea; (Y.-S.K.); (Y.-J.L.)
- Department of Medicine, Graduate School of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2019-3480
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Jia J, Liu R, Wei W, Yu F, Yu X, Shen Y, Chen C, Cai Z, Wang C, Zhao Z, Wang D, Yang L, Yuan G. Monocyte to High-Density Lipoprotein Cholesterol Ratio at the Nexus of Type 2 Diabetes Mellitus Patients With Metabolic-Associated Fatty Liver Disease. Front Physiol 2022; 12:762242. [PMID: 34975521 PMCID: PMC8718696 DOI: 10.3389/fphys.2021.762242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Recently, monocyte to high-density lipoprotein cholesterol ratio (MHR) as a novel inflammatory biomarker has drawn lots of attention. This study was conducted in patients with type 2 diabetes mellitus (T2DM) to investigate the correlation between MHR and metabolic-associated fatty liver disease (MAFLD). Methods: Totally, 1,051 patients with T2DM from the Affiliated Hospital of Jiangsu University were enrolled and classified as MAFLD (n = 745) group and non-MAFLD (n = 306) group according to the MAFLD diagnostic criteria. In contrast, patients were also separated into four groups based on MHR quartiles. Anthropometric and biochemical measurements were performed. The visceral fat area (VFA) and subcutaneous fat area (SFA) of participants were measured by dual bioelectrical impedance. Fatty liver was assessed by ultrasonography. Results: The MHR level of subjects in the MAFLD group was statistically greater than that in the non-MAFLD group (P < 0.05). Meanwhile, MHR was higher in the overweight or obese MAFLD group compared with that in the lean MAFLD group (P < 0.05). The area under the ROC Curve (AUC) assessed by MHR was larger than that of other inflammatory markers (P < 0.01). The cutoff value of MHR was 0.388, with a sensitivity of 61.74% and a specificity of 56.54%. For further study, binary logistic regression analyses of MAFLD as a dependent variable, the relationship between MHR and MAFLD was significant (P < 0.01). After adjusting for many factors, the relationship still existed. In the four groups based on MHR quartiles, groups with higher values of MHR had a significantly higher prevalence of MAFLD (P < 0.05). The percentage of patients with obese MAFLD increased as the MHR level increased (P < 0.01). Among different quartiles of MHR, it showed that with the increasing of MHR, the percentage of patients with MAFLD who had more than four metabolic dysfunction indicators increased, which was 46.39, 60.52, 66.79, and 79.91%, respectively, in each quartile. Conclusion: Monocyte to high-density lipoprotein cholesterol ratio is a simple and practicable inflammatory parameter that could be used for assessing MAFLD in T2DM. T2DM patients with higher MHR have more possibility to be diagnosed as MAFLD. Therefore, more attention should be given to the indicator in the examination of T2DM.
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Affiliation(s)
- Jue Jia
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Ruoshuang Liu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Weiping Wei
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Fan Yu
- Department of Endocrinology and Metabolism, Jurong Hospital Affiliated to Jiangsu University, Zhenjiang, China
| | - Xiawen Yu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yirong Shen
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Caiqin Chen
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhensheng Cai
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chenxi Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhicong Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Dong Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Ling Yang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guoyue Yuan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Yamada T, Yamato Y, Hasegawa T, Yoshida G, Banno T, Arima H, Oe S, Mihara Y, Ushirozako H, Ide K, Watanabe Y, Matsuyama Y. Prevalence of Locomotive Dysfunction Exacerbating Systolic Blood Pressure and Abdominal Circumference: A Longitudinal Cohort Analysis. Metab Syndr Relat Disord 2021; 19:562-566. [PMID: 34613827 DOI: 10.1089/met.2021.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to investigate the influence of locomotive dysfunction (LD) on the future prevalence of metabolic syndrome (MetS) in community-dwelling people using propensity score matching (PSM). Materials and Methods: Two hundred and twenty-five volunteers (87 men and 138 women, mean age: 66.9 years) underwent a health screening program in 2012 and 2014. We extracted 92 volunteers with LD and 133 without LD in 2012. After performing 1:1 PSM using clinical variables, including age, sex, individual MetS components, and comorbidities between the two groups, we investigated the prevalence of MetS between the two groups (LD and non-LD) in 2014. Results: Seventy-three subjects were enrolled in each group. In 2012, the mean the 25-question Geriatric Locomotive Function Scale was 2.6 in the non-LD group and 13.4 in the LD group. The baseline prevalence of MetS was 9 (12.3%) in non-LD group and 8 (11%) in LD group. After 2 years, the prevalence of MetS in the LD group increased to 18 (24.7%), but only by 8 (11%) (P = 0.031) in the non-LD group. Among MetS components, waist circumference (84.9 vs. 82.5 cm) and systolic blood pressure (SBP) (145 vs. 140 mmHg) in the LD group were significantly higher than in the non-LD group (P = 0.047, P = 0.023). Conclusions: The longitudinal analysis showed that LD increases the prevalence of MetS and deteriorates SBP and abdominal circumference over 2 years.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Hoveling LA, Liefbroer AC, Bültmann U, Smidt N. Understanding socioeconomic differences in incident metabolic syndrome among adults: What is the mediating role of health behaviours? Prev Med 2021; 148:106537. [PMID: 33798530 DOI: 10.1016/j.ypmed.2021.106537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/04/2021] [Accepted: 03/28/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The incidence of metabolic syndrome (MetS) strongly varies by socioeconomic position (SEP), but little is known about the mediating role of health behaviours in this association. This study examines the associations between the SEP measures, education, income and occupational prestige, and incident MetS and whether the associations are mediated by health behaviours, including physical activity, smoking, alcohol intake and diet quality. METHODS A subsample (n = 85,910) of the adult Lifelines Cohort Study without MetS at baseline was used. MetS was measured at the second assessment (median follow-up time 3.8 years) defined according to the NCEP-ATPIII criteria. Direct associations between SEP, health behaviours and incident MetS were estimated using multivariable logistic regression analyses. The mediating percentages of health behaviours explaining the associations between SEP and incident MetS were estimated using the Karlson-Holm-Breen method. Analyses were independent of age, sex, the other SEP measures and follow-up time. RESULTS Education and occupational prestige were inversely associated with MetS. Income was not associated with MetS. Health behaviours explained only partly (13.8%) the association between education and MetS, with smoking as the strongest mediating factor (8.8%). Health behaviours played also a minor role (2.7%) in explaining occupational MetS differences, with physical activity as the strongest suppressing factor (-9.4%). CONCLUSION Individuals with more years of education or a higher occupational prestige had a lower risk to develop MetS. This was mainly because of non-smoking, less excessive alcohol intake and a higher diet quality. However, individuals with a higher SEP were more often physically inactive.
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Affiliation(s)
- Liza A Hoveling
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Aart C Liefbroer
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands; Netherlands Interdisciplinary Demographic Institute, PO Box 11650, 2502 AR The Hague, the Netherlands; Vrije Universiteit Amsterdam, Department of Sociology, De Boelelaan 1081, 1081 HV Amsterdam, the Netherlands
| | - Ute Bültmann
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Nynke Smidt
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700 RB Groningen, the Netherlands
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Santoso CMA, Ketti F, Bramantoro T, Zsuga J, Nagy A. Association between Oral Hygiene and Metabolic Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:2873. [PMID: 34203460 PMCID: PMC8269064 DOI: 10.3390/jcm10132873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Emerging evidence has linked poor oral hygiene to metabolic syndrome (MetS), but previously, no summary of evidence has been conducted on the topic. This systematic review and meta-analysis aims to evaluate the associations of oral hygiene status and care with MetS. A systematic search of the PubMed and Web of Science databases from inception to 17 March 2021, and examination of reference lists was conducted to identify eligible observational studies. A random-effects model was applied to pool the effects of oral hygiene status and care on MetS. Thirteen studies met the inclusion criteria and had sufficient methodological quality. Good oral hygiene status (OR = 0.30 (0.13-0.66); I2 = 91%), frequent tooth brushing (OR = 0.68 (0.58-0.80); I2 = 89%), and frequent interdental cleaning (OR = 0.89 (0.81-0.99); I2 = 27%) were associated with a lower risk of MetS. Only one study examined the association between dental visits and MetS (OR = 1.10 (0.77-1.55)). Our findings suggested that there might be inverse associations of oral hygiene status, tooth-brushing frequency, and interdental cleaning with MetS. However, substantial heterogeneity for tooth-brushing frequency and inconsistent results for oral hygiene status in subgroup analyses were observed. There was insufficient evidence for the association between dental visits and MetS. Further longitudinal studies are needed to investigate these associations.
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Affiliation(s)
- Cornelia Melinda Adi Santoso
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
- Doctoral School of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary
| | - Fera Ketti
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
| | - Taufan Bramantoro
- Department of Dental Public Health, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Judit Zsuga
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
| | - Attila Nagy
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
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Hoffmann MS, Brunoni AR, Stringaris A, Viana MC, Lotufo PA, Benseñor IM, Salum GA. Common and specific aspects of anxiety and depression and the metabolic syndrome. J Psychiatr Res 2021; 137:117-125. [PMID: 33677215 DOI: 10.1016/j.jpsychires.2021.02.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The associations of anxiety and depression with metabolic syndrome (MetS) are not consistent across studies. Anxiety and depression are highly correlated and traditional methods don't take the structure of this correlation into account. Our aim is to disentangle the relationship of these emotional conditions with MetS, using bifactor models, modelling both general and specific aspects between anxiety and depression. METHODS Bifactor models were tested using the baseline data from the Brazilian Longitudinal Study of Adult Health (n = 13,584). Anxiety and depression were accessed with the Clinical Interview Schedule - Revised. MetS was measured through assessment of its continuous components. RESULTS A bifactor S-1 model better represent the 14 CIS-R indicators, composed by an internalizing factor corresponding to depressive symptoms, anxiety, worry and the shared variance of all remaining CIS-R indicators, and also by residual variance explained by a somatic (e.g., fatigue and pain) and fear (e.g., panic and phobias) specific factors. Internalizing spectrum (β = 0.116; p < 0.001) and the fear specific factor (β = 0.060; p = 0.008) were associated with MetS after adjusting for confounders, whereas somatic specific factor was unlikely to be associated with MetS (β = 0.002; p = 0.934). CONCLUSIONS Anxiety and depression indicators were associated with MetS via a shared internalizing factor and also by a residual fear factor, but not by somatic residual factor. This finding has potential implications about shared biological and behavioral mechanisms that may link emotional conditions with MetS in adults.
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Affiliation(s)
- Mauricio Scopel Hoffmann
- Universidade Federal de Santa Maria, Departamento de Neuropsiquiatria, Avenida Roraima 1000, Santa Maria, 97105-900, Brazil; Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil; Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
| | - Andre Russowsky Brunoni
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000, São Paulo, Brazil.
| | - Argyris Stringaris
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Maria Carmen Viana
- Department of Social Medicine, Post-Graduate Program in Public Health, Federal University of Espírito Santo, Av. Maruípe, 1468, CEP 29047-105, Vitória, Brazil.
| | - Paulo Andrade Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000, São Paulo, Brazil.
| | - Isabela Martins Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, Brazil; Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, R Dr Ovidio Pires de Campos 785, 2o andar, 05403-000, São Paulo, Brazil.
| | - Giovanni Abrahão Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil; Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil; Universidade Federal do Rio Grande do Sul, Department of Psychiatry, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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Hosseinpour-Niazi S, Bakhshi B, Mirmiran P, Azizi F. Socioeconomic and lifestyle factors modifies the association between nut consumption and metabolic syndrome incidence. Clin Nutr 2021; 40:4055-4064. [PMID: 33642144 DOI: 10.1016/j.clnu.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 12/30/2020] [Accepted: 02/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS The aim of this study was to evaluate the association of nut consumption and its various types with metabolic syndrome (MetS) risk and to investigate whether lifestyle factors (physical activity and smoking status) and socioeconomic status (education and occupation) modulate the association of nut consumption and the risk of MetS. METHODS We prospectively studied 1915 participants of the Tehran Lipid and Glucose study, among whom 591 were diagnosed with MetS during 8.9 years of follow-up. Nut consumption and its various types were assessed using a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate Hazard Ratios (HRs) for MetS events across tertiles of nut consumption and its various types. Regarding interaction between nut consumption and physical activity levels, education levels, and smoking status on the risk of MetS, using joint classification, the effect modification of lifestyle factors and socioeconomic status on the association between nut consumption (<median and ≥ median) and risk of MetS was assessed by Cox regression. RESULTS Nut consumption was inversely associated with MetS risk in multivariable-adjusted models. The highest tertiles of the constituents of nuts including fiber, polyphenol, MUFA and PUFA reduced MetS risk compared with the lowest tertiles, after adjustment for confounders. Among various types of nuts, the multivariable-adjusted HRs of MetS were 0.78 (0.63-0.96) for walnuts, and 0.77 (0.63-0.94) for pistachios, compared with the lowest intake. Among adult population, consuming nuts higher than the median and having moderate to high physical activity levels resulted in significant reduction in the MetS risk (HRs: 0.74, CI: 0.55-0.98 for moderate and HRs: 0.63, CI: 0.47-0.86 for high physical activity level). Participants who did not smoke had lower risk of MetS regardless of their amount of nuts consumption (HRs: 0.67, CI: 0.47-0.94 for intakes < median and HRs: 0.71, CI: 0.53-0.93 for intakes ≥ median). Stratification based on education status resulted in reduction in the risk of MetS in participants consuming nuts ≥ median in both educated and not-educated group (HRs: 0.81, CI: 0.66-0.98 for the non-educated group and HRs: 0.63, CI: 0.47-0.84 for the educated group). CONCLUSIONS Incorporating nuts, especially walnuts, into dietary patterns reduced the risk of MetS, especially among individuals with more physical activity levels.
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Affiliation(s)
- Somayeh Hosseinpour-Niazi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Bakhshi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Predictors of Metabolic Syndrome in Adults and Older Adults from Amazonas, Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031303. [PMID: 33535582 PMCID: PMC7908119 DOI: 10.3390/ijerph18031303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/01/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Metabolic syndrome has been considered a factor of vulnerability and a major public health problem because it increases the risk of cardiovascular disease and type 2 diabetes. The present study from Amazonas, Brazil aimed to estimate the prevalence of the individual and general components of metabolic syndrome in adults and older adults and identify the independent predictors of metabolic syndrome. The sample of the present cross-sectional study comprised 942 participants (590 women), with a mean age of 59.8 ± 19.7 (range: 17.5 to 91.8). Blood pressure in men (62.5%), abdominal obesity in women (67.3%), and lower high-density lipoprotein cholesterol (HDL-C) in both (52.2% in men and 65.0% in women) were the most prevalent individual risk factors for metabolic syndrome. Women had a higher prevalence of abdominal obesity (p < 0.001), low HDL-C (p < 0.001), and metabolic syndrome (p < 0.001) than men; however, opposite results were seen in men for blood pressure (p < 0.001). The overall prevalence of metabolic syndrome was 47.5%. Advanced age, being female, having a higher body mass index, and a having lower educational level independently increased the odds of metabolic syndrome. Due to the association of metabolic syndrome with deterioration of health status and increased vulnerability, this study sustains the need for early public health interventions in the Amazonas region.
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Abstract
A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.
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Affiliation(s)
- Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jaakko Tuomilehto
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Oliveira LVA, Santos BNSD, Machado ÍE, Malta DC, Velasquez-Melendez G, Felisbino-Mendes MS. Prevalence of the Metabolic Syndrome and its components in the Brazilian adult population. CIENCIA & SAUDE COLETIVA 2020; 25:4269-4280. [PMID: 33175036 DOI: 10.1590/1413-812320202511.31202020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
We estimated the prevalence of the Metabolic Syndrome (MetS) and its components in the Brazilian population according to sociodemographic factors. This is a cross-sectional population-based study that used laboratory data from the National Health Survey. We estimated the prevalence of MetS and its components with 95% confidence intervals and the unadjusted and adjusted prevalence ratio (PR) with the Poisson regression. MetS prevalence ratio was 38.4%. High waist circumference (WC) (65.5%) and low HDL cholesterol (49.4%) were the most prevalent components, including in the youngest people. MetS and its components were more frequent among women (41.8%), individuals with low schooling (47.5%), and older adults (66.1%). In the adjusted analysis, females (PR = 1.16; 95% CI 1.08-1.24), older adults (PR = 3.69; 95% CI 3.26-4.17), and low schooling (PR = 1.32; 95% CI 1.17-1.49) were associated with MetS. MetS was prevalent in the Brazilian population, especially among women, individuals with low schooling, and older adults. High WC and low HDL cholesterol were the most prevalent components, with the aggravating high prevalence factor in young adults. These findings reveal the need to consider laboratory data for a more accurate analysis of this condition, which can be challenging at the national level.
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Affiliation(s)
- Laís Vanessa Assunção Oliveira
- Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Bruna Nicole Soares Dos Santos
- Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Ísis Eloah Machado
- Escola de Medicina, Universidade Federal de Ouro Preto. Ouro Preto MG Brasil
| | - Deborah Carvalho Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Gustavo Velasquez-Melendez
- Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
| | - Mariana Santos Felisbino-Mendes
- Escola de Enfermagem, Universidade Federal de Minas Gerais. Av. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
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