Prevalence of the metabolic syndrome among Turkish adults

Association between urbanization and metabolic syndrome in low- and middle-income countries: A systematic review and meta-analysis

AIMS

The prevalence of metabolic syndrome (MetS) is on the rise in an increasingly urbanized world. The study aimed to review the association between urbanization and MetS in low- and middle-income countries (LMICs).

DATA SYNTHESIS

A comprehensive search of five databases (MEDLINE, Web of Science, Scopus, EMBASE, and CENTRAL) was performed in January 2022 and updated in October 2022. Peer-reviewed studies that met the eligibility selection criteria were included. Search terms were used for the main concepts which are MetS, dietary patterns, and urbanization in LMICs. Study selection was done in two stages and in duplicate. Random effects models were used to calculate the overall pooled prevalence and main study-level characteristics. Out of 9,773 identified studies, nineteen were included in the systematic review and meta-analysis. The studies were done on 313,644 participants (149,616 urban and 164,028 rural). The pooled risk ratio (RR, 95% confidence interval) of MetS between urban and rural dwellers was RR = 1.24; 95%CI [1.15, 1.34] (I2 = 96.0%, P < 0.0001). A relatively higher prevalence of MetS among urban than rural residents has been observed, especially with the International Diabetes Federation criteria (RR = 1.54; 95%CI [1.21, 1.96]; I2 = 65.0%), and in the population in India (RR = 2.19; 95%CI = 1.24, 3.88, I2 = 85%). Overall, the role of dietary patterns in the development of MetS was inconsistent, and few studies showed a lower risk of MetS with adherence to recommended healthy dietary patterns.

CONCLUSIONS

There was an association between urbanization and the high prevalence of MetS. Interventions and policies to reduce the risk of MetS are needed.

Benign prostatic hyperplasia and metabolic syndrome; prevalence and association: a cross-sectional study in Syria

BACKGROUND

Benign Prostatic Hyperplasia (BPH) is considered the most common cause of lower urinary tract symptoms in men aged 40 years and older. BPH is related to sex steroids, but there are increasing studies investigating the relationship between the urinary symptoms and the metabolic syndrome. They still have inconsistent results; some reported a significant positive association, while others found no significant association. In this study, we aim to assess the prevalence rate of metabolic syndrome in BPH patients and whether there is an association between symptoms linked to BPH and metabolic syndrome in the Syrian community.

METHODS

The participants of this observational cross-sectional study were benign prostatic hyperplasia patients aged 40-year-old and older from Homs, Syria. An interview questionnaire was performed to collect data from all patients who visited the urology clinic of Homs Military Hospital in the period of January 10 to March 10, 2023. We used the International Prostate Symptom Score (IPSS) to assess the urinary symptoms, and we used the US National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) criteria to define the metabolic syndrome.

RESULTS

The final sample size was 426 patients. The overall prevalence of metabolic syndrome was 46.2%. Patients with metabolic syndrome had higher International Prostate Symptom Score compared to patients without metabolic syndrome (21 vs. 18, P < 0.001), and 59.3% of patients with metabolic syndrome suffered from severe symptoms compared to 36.2% of patients without metabolic syndrome who suffered from severe lower urinary tract symptoms (P < 0.001). There was a positive association between (waist circumference, diabetes, triglycerides) (P < 0.001), HDL (P = 0.014) and higher International Prostate Symptom Score. However, there was no statistically significant association between blood pressure and International Prostate Symptom Score (P = 0.879).

CONCLUSION

Our results showed that patients with metabolic syndrome had a higher International Prostate Symptom Score. This idea should be used to design a new benign prostatic hyperplasia/lower urinary tract symptoms treatment.

The Role of Different Methods in Defining Cardiometabolic Risk and Metabolic Syndrome in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine illnesses, often accompanied by visceral adiposity and metabolic syndrome (MetS). Visceral adiposity is an accurate predictor of MetS and cardiometabolic risk. This study aims to evaluate different anthropometric indices that can be used in PCOS and MetS risk assessment. A total of 66 women with PCOS (50%) and 66 controls (50%) were included, and clinical and biochemical parameters were evaluated. The body mass index (BMI), body shape index (ABSI), body roundness index (BRI), dysfunctional adiposity index (DAI), lipid accumulation (LAP) index, and visceral adiposity index (VAI) were calculated. The means of all indices were higher in the PCOS group (p < 0.05). The marker with the lowest discriminatory ability for PCOS and MetS was ABSI (AUC = 0.762 and AUC = 0.714, respectively, p = 0.000). According to the multivariate logistic regression model, the VAI and WC are strong predictors of PCOS (AUC, 98%; accuracy, 92%; sensitivity, 92%; and specificity, 91%), and WC, LAP index, and BRI are strong predictors of MetS (AUC, 0.95%; accuracy, 86%; sensitivity, 83%; and specificity, 88%). The use of different anthropometric indices in the detection of PCOS and MetS may allow for early diagnosis and treatment, and are simple and cost-effective.

Sağlıklı bir popülasyonda kardiyovasküler hastalık risk faktörleri bilgi düzeyi, Framingham skoru ve kardiyak belirteçlerin değerlendirilmesi

Amaç: Bu çalışmanın amacı eğitimli ve sağlıklı bir popülasyonun kardiyovasküler hastalık (KVH) bilgi düzeylerini değerlendirmek ve bunu günlük yaşama ne kadar aktardıklarını belirlemektir. Bu çalışmada üniversitemiz bünyesinde çalışan ve sağlıklı görünen katılımcılarda KVH farkındalığı değerlendirilmiş ve 10 yıllık kardiyovasküler hastalık gelişme riski (Framingham Skoru) hesaplanıp Nabız Dalga Hızı (NDH) ve labaratuvar parametreleri arasındaki ilişkilerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışma, Çukurova Üniversitesi bünyesinde çalışan sağlıklı 192 gönüllü katılımcı ile yapıldı. Katılımcıların farkındalığı kardiyovasküler hastalık risk faktörleri bilgi düzeyi ölçeği (KARRİF-BD) ile 10 yıllık KVH gelişim riski ise Framingham risk skoru ile değerlendirildi. NDH değerleri invaziv olmayan arteriografi cihazı kullanıldı. Tüm katılımcılardan kan örnekleri alındı. Bulgular: Tüm katılımcıların yaş ortalaması 45,3 ± 8,0 yıl (% 53,6 kadın) idi. Katılımcıların ortalama KARRİF-BD skoru 20,4 ± 4,0 ve Framingham skoru ortalaması 6,9±5,6 olarak bulundu. NDH ortalaması 7,9±1,5m/sn bulundu. Korelasyon analizlerinde NDH, hem ortalama KARRİF-BD skoru hem de Framingham skoru ile belirgin ilişkili bulundu. En yüksek KARRİF-BD puanına sahip olan katılımcılar aynı zamanda en yüksek Framingham puanına ve NDH' na sahipti. Sonuç: Eğitim ve bilgi düzeyi yüksek olmasına rağmen bu bilginin KVH risk faktörleri açısından günlük yaşama yansımadığı görülmektedir. Bilginin davranış ve risk faktörü düzeylerini etkilemesi için ulaşılması gereken KVH farkındalığı eşik düzeyi olup olmadığı konusunda daha ileri çalışmalara ihtiyaç vardır. Etkili koruma için, bilgi davranışsal danışmanlık müdahaleleri ile desteklenmelidir.

Profile of hypertension in Turkey: from prevalence to patient awareness and compliance with therapy, and a focus on reasons of increase in hypertension among youths

Hypertension is one of the most common noncommunicable chronic diseases and is an important risk factor for vascular complications. The prevalence of hypertension is very high worldwide, and it is still increasing in low- and middle-income countries. Although some improvements were reported in high-income countries in recent years, there is still much to do to overcome hypertension and its complications. Identically, hypertension is a severe public health issue in Turkey. Approximately one third of the adult population has got hypertension but almost half is unaware of the disease. Children and youths are also affected by the burden of hypertension. Increased body mass index and obesity frequently accompany hypertension in children and adolescents. Major contributors to the disease burden appears to be consumption of high amounts of dietary sodium, lack of appropriate physical activity, increasing weight and obesity. In the last decades, an improvement at disease awareness has been achieved but blood-pressure control rates are still low in Turkey. Traditional and natural products, including lemon juice and garlic, are very popular among patients with concerns regarding medications' side effects. Patients' adherence to therapy differs between regions and increases in parallel with high education level. Decreasing daily salt intake has been shown to reduce the prevalence of hypertension substantially and to prevent cardiovascular and cerebrovascular deaths in a cost effective manner in projection studies. Finally, improving education of patients, which has positive effects on disease awareness, treatment adherence, and blood-pressure control rates, should be considered.

Dietary Patterns and Their Association with Metabolic Syndrome and Their Components in Middle-Class Adults from Damascus, Syria: A Cross-Sectional Study

Prior to the 2016 crisis in Syria, a study conducted in Aleppo found the prevalence of metabolic syndrome to be 39.6%, which is known to be favoured by age and poor lifestyle (including physical inactivity and the consumption of hypercaloric foods, rich in saturated fats, concentrated carbohydrates, and salt), so the objective of this study was to identify the association of different dietary patterns with metabolic syndrome and their components. A cross-sectional analytical study was carried out in 104 adults aged 40 to 65 years who did not suffer from previous diseases. The sample was chosen from middle-class citizens of the city of Damascus who were contacted by telephone; they were explained about the study, the information that would be collected, and the studies that should be carried out in the clinical analysis laboratory of the Private University of Syria. A nutritional and food study was carried out using previously validated forms containing 62 items in which the food intake of the participants was studied. We apply principal component analysis and factor analysis to detect nutritional components and dietary patterns. Dietary pattern 3 (foods with simple carbohydrates and saturated fat) increased glucose levels, while dietary patterns 1 (high intake of calories, protein, and saturated fat) and 5 (fast food) increased serum triglyceride levels. In addition, pattern 1 (carbonated beverages, grains, chicken, and meat) was associated with elevated LDL cholesterol levels and the presence of the metabolic syndrome. The study findings suggest that the presence of metabolic syndrome and its components are associated with dietary patterns high in calories, protein, simple carbohydrates, and saturated fat.

Comparison of anthro-metabolic indicators for predicting the risk of metabolic syndrome in the elderly population: Bushehr Elderly Health (BEH) program

BACKGROUND

Metabolic syndrome (MetS) is a cluster metabolic disorder that includes central obesity, insulin resistance, hypertension, and dyslipidemia, and is highly associated with an increased risk of developing non-communicable diseases (NCDs). This study aimed to compare the reliability of anthro-metabolic indices [visceral adiposity index (VAI), body roundness index (BRI), and a body shape index (BSI), body adiposity index (BAI), lipid accumulation product (LAP), waist to hip ratio, and waist to height ratio] in predicting MetS in Iranian older people.

METHODS

This cross-sectional study was conducted based on the data of 2426 adults aged ≥60 years that participated in the second stage of the Bushehr Elderly Health (BEH) program, a population-based prospective cohort study being conducted in Bushehr, Iran. MetS was defined based on the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The receiver operating characteristic (ROC) curve analysis was used to assess predictive performance of anthro-metabolic indices and determine optimal cutoff values. Logistic regression analysis was applied to determine the associations between MetS and indices.

RESULTS

2426 subjects (48.1% men) with mean ± SD age of 69.34 ± 6.40 years were included in the study. According to ATP III criteria, 34.8% of men and 65.2% of women had MetS (P < 0.001). Of the seven examined indices, the AUCs of VAI and LAP in both genders were higher than AUCs of other anthro-metabolic indices. Also, in general population, VAI and LAP had the greatest predictive power for MetS with AUC 0.87(0.86-0.89) and 0.87(0.85-0.88), respectively. The lowest AUC in total population belonged to BSI with the area under the curve of 0.60(0.58-0.62). After adjusting for potential confounders (e.g. age, sex, education, physical activity, current smoking) in the logistic regression model, the highest OR in the total population was observed for VAI and LAP, which was 16.63 (13.31-20.79) and 12.56 (10.23-15.43) respectively. The lowest OR for MetS was 1.93(1.61-2.30) for BSI.

CONCLUSION

This study indicated that both VAI and LAP are the most valuable indices among the anthro-metabolic indices to identify MetS among the elderly in both genders. So, they could be used as proper assessment tools for MetS in clinical practice. However, the cost-benefit of these indices compared to the ATP III criteria need further studies.

The Association of Metabolic Syndrome Components with Anthropometric Measurements

Aim: This study aims to research the association of metabolic syndrome components with anthropometric measurements like arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, which are applied rarely. Methods: This cross-sectional study was conducted with 292 patients in November-December 2019. The arm circumference, neck circumference, waist circumference, hip circumference, waist-hip ratio, waist-to-height ratio, and body mass index measurements of the patients were made. Glucose, high-density lipoprotein, low-density lipoprotein, systolic, and diastolic blood pressure measurements were also recorded. The association between metabolic syndrome components and anthropometric measurements was analyzed. Results: Metabolic syndrome is diagnosed in 32.8% of the participants. According to body mass index, 18.6% of the patients were normal, 34.2% were overweight, and 47.2% were obese. There was a significant difference between the patients with and without metabolic syndrome in terms of laboratory parameters, blood pressure values, and anthropometric measurements. In the diagnosis of metabolic syndrome, optimal cut-off values for arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio were determined as 31.75 (AUC=0.703), 34.85 (AUC=0.763), 113.75 (AUC=0.757), 0.90 (AUC=0.701), 0.61 (AUC=0.769) for females while they were 35.75 (AUC=0.573), 39.75 (AUC=0.795), 111.5 (AUC=0.607), 0.96 (AUC=0.888), 0.61 (AUC=0.888) for males respectively. Conclusion: A significant correlation was detected between arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, and metabolic syndrome components. However, low-density lipoprotein was not correlated with neck circumference and high-density lipoprotein with waist-to-height ratio. Keywords: metabolic syndrome, anthropometric measurement, body mass index, obesity, lipid profile

Association between mesenteric panniculitis and non-neoplastic disorders

PURPOSE

To assess the relationship between MP and coexisting non-neoplastic disorders.

METHODS

Consecutive abdominal computed tomography (CT) scans of 4674 patients were evaluated retrospectively for CT features of MP between January 2017 and January 2018. Clinical findings of patients were analyzed. Four control patients were selected from our cohort for each MP patient such that they matched for age, gender and CT protocol. Statistical analysis was performed using a t, Mann-Whitney U, χ², or Fisher's test.

RESULTS

976 patients were excluded from the study due to the exclusion criteria and finally, 102/3698 patients were diagnosed with MP (mean age = 57.2 ± 12.5 years, 52% male). On CT, a hyperattenuated fatty mass (120/120), subcentimeter lymph nodes (117/120), congregation of mesenteric vessels (82/120) within the mass, a fat halo sign (28/120) and a pseudocapsule (88/120) were seen at the mesentery.The intra-observer agreement was almost perfect for the fatty mass and lymph nodes and moderate or substantial for other CT features (p < 0.001). The most prominent disorders were metabolic syndrome (MetS) and urogenital diseases in MP (45%, 37%, respectively) and control groups (31%, 26%, respectively). Between groups, no significant differences were found in the history of abdominal surgery, gastrointestinal and autoimmune diseases (p-value range 0.064-0.663); however, significant differences were found in the rates of vascular, urogenital diseases and MetS (p-value range 0.012-0.036).

CONCLUSION

MetS and urolithiasis were significantly more common in patients with MP than in those without MP. Therefore, there may be a clinically relevant association between these disorders. MetS may be a risk factor for MP and urolithiasis, and treatment of metabolic disorders should be undertaken to prevent these diseases.

The landscape of preventive cardiology in Turkey: Challenges and successes

Turkey, like many countries, is facing a growing burden of non-communicable disease (NCD)s and is among the countries with high cardiovascular mortality in Europe. Moreover, Turkey currently has the highest rate of premature cardiovascular disease (CVD) in Europe. During the last decades, Turkey made fundamental reforms in the health system to improve the treatment of risk factors to prevent CVD. The most outstanding success was in the area of tobacco control (13.4% decrease in smoking prevalence) and decreasing the salt consumption of the population (from 18 to 9.9 g/day) leading to a significant decrease in CVD mortality from 45% to 36.8% of all deaths. However, obesity and diabetes are increasing rapidly as a result of urbanization, low physical activity and unhealthy eating and the new generation is starting to take up smoking. The increase in cardiometabolic risk factors and aging of the population are expected to increase the number of CVD deaths. All CVD risk factors except smoking are significantly more prevalent in women. In addition, rare disease is a country specific problem with a significant contribution to the high rates of premature CVD in Turkey. Despite major improvements in management in acute coronary syndromes, sustained achievement in guideline recommended goals is suboptimal. In patients with a previous cardiovascular event smoking rate is 25.5%, 80.9% of these patients are overweight (BMI ≥25 kg/m²), 30% obese (BMI ≥30 kg/m²), and LDL‐cholesterol targets of 70 mg/dL are attained in only 18%. Herein, we scrutinize the achievements and challenges of Turkey in establishing a ‘National Heart Health Policy’ aiming to decrease the burden of CVD and its risk factors.

A nationwide study of metabolic syndrome prevalence in Iran; a comparative analysis of six definitions

Introduction

To integrate and execute a proper preventive plan and reduce the risk of non-communicable diseases (NCDs), policy makers need to have access to both reliable data and a unique definition of metabolic syndrome (MetS). This study was conducted on the data collected by cross-sectional studies of WHO’s STEPwise approach to surveillance of NCD risk factors (STEPs) to estimate the national and sub-national prevalence rates of MetS in Iran in 2016.

Materials and methods

The prevalence of MetS was estimated among 18,414 individuals aged ≥25 years living in urban and rural areas of Iran using various definition criteria; National Cholesterol Education Program Adult Treatment Panel III 2004 (ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), Joint Interim Statement (JIS). Regional IDF (RIDF) and JIS (RJIS) were defined using ethnicity-specific values of waist circumference for the country.

Results

National prevalence rate of MetS based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS criteria were 38.3% (95% CI 37.4–39.1), 43.5% (42.7–44.4), 40.9% (40.1–41.8), 47.6% (46.8–48.5), 32.0% (31.2–32.9), and 40.8% (40.0–41.7), respectively. The prevalence was higher among females, in urban residents, and those aged 65–69 years. MetS was expected to affect about 18.7, 21.3, 20.0, 23.3, 15.7, and 20.0 million Iranians, respectively, based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS. The two most common components noted in this population were reduced high-density lipoprotein cholesterol (HDL-C) levels and central obesity.

Conclusion

High prevalence rate of MetS among Iranian adults is alarming, especially among females, urban residents, and the elderly. The JIS definition criteria is more appropriate to determine higher number of Iranians at risk of NCDs. Proper management and prevention of MetS is required to adopt multiple national plans including lifestyle modifications, medical interventions, and public education on NCDs risk factors.

Association between TSH Values and GFR Levels in Euthyroid Cases with Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS) is associated with the risk of developing chronic kidney disease. Although the negative effects of high thyroid-stimulating hormone (TSH) values on glomerular filtration rate (GFR) levels have been known for years, the negative effects of increased TSH on GFR in euthyroid cases have been reported in recent years. This study was aimed at investigating the association between the effect of increased TSH values and estimated-GFR (eGFR) levels in euthyroid cases with MetS.

METHODS

For this hospital-based descriptive study, 191 MetS cases (123 females, 68 males) were evaluated. Those whose TSH was not within 0.5-4.5 uIU/mL, eGFR was <40 mL/min/1.73 m², and/or reported any thyroid/kidney disease were excluded. Partial correlation coefficients were calculated to investigate the relationship between the eGFR values and several other numerical variables while controlling for age and BMI in addition to the adjusted gender effect. Thereafter, the multiple linear regression analysis with a stepwise variable selection approach was used to reveal the independent factors that could affect the logarithmically transformed eGFR.

RESULTS

The median age was 52 (19-65) years, the median eGFR was 94.3 (41.3-194) mL/min/1.73 m², and the median TSH was 1.58 (0.50-4.50) uIU/mL in the whole group. Increased TSH even in the normal range was associated with eGFR after adjusting for age and body mass index (BMI), especially in females. The high age (b = -0.160, p=0.005), high BMI (b = -0.134, p=0.020), high TSH (b = -0.380, p < 0.01), and high uric acid (b = -0.348, p < 0.01) were found as significant predictors of the eGFR in MetS patients.

CONCLUSION

Independent of age and BMI, elevated TSH even in the euthyroid range showed an association with the eGFR in female MetS cases who had normal kidney functions. This correlation was stronger than the correlations between the eGFR and the MetS diagnostic parameters. These findings need further studies on the issue..

Does the Energy Restriction Intermittent Fasting Diet Alleviate Metabolic Syndrome Biomarkers? A Randomized Controlled Trial

The aim of this study was to determine the efficacy of an energy restriction intermittent fasting diet in metabolic biomarkers and weight management among adults with metabolic syndrome. This randomized controlled study was performed with metabolic syndrome patients, aged 18–65 years, at an academic institution in Istanbul, Turkey (n = 70). All participants were randomized to the Intermittent Energy Restriction (IER) intervention group and Continuous Energy Restriction (CER) control group. Biochemical tests including lipid profile, fasting plasma glucose, insulin, glycosylated hemoglobin Type A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), blood pressure, and body composition were evaluated at baseline and at the 12th week in diet interviews. Dietary intake was measured with the 24-h dietary recall method and dietary quality was evaluated with the Healthy Eating Index-2010. Changes in body weight (≈7% weight loss) and composition were similar in both groups. Blood pressure, total cholesterol, triglyceride, low-density lipoprotein (LDL), fasting glucose, and insulin at the 12th week decreased in both groups (p < 0.05). No significant differences were observed in metabolic syndrome biomarkers between the IER and CER groups. The energy-restricted intermittent fasting diet did not cause any deficiencies in macronutrient and fiber intake in the subjects. Healthy Eating Index (HEI) index scores were achieved similarly in both groups, and subjects’ dietary intakes were close to daily reference nutritional intake values. The technique used to achieve energy restriction, whether intermittent or continuous, appears to alleviate the metabolic syndrome biomarkers activated by weight loss.

Risk of cardiovascular events in patients with metabolic syndrome: Results of a population-based prospective cohort study (PURE Turkey)

Objective:

Metabolic syndrome (MetS) includes several cardiovascular (CV) risk factors. This study aimed to assess CV risk of MetS, contribution of its components to the risk, and whether MetS provides additional risk beyond its components.

Methods:

The Prospective Urban Rural Epidemiology (PURE) Turkey cohort included 3933 individuals aged between 35 and 70 years, with a median follow-up of 8.9 years. MetS was diagnosed as the presence of any of the following criteria: high blood pressure, high fasting plasma glucose, abdominal obesity, low HDL-cholesterol, or high triglycerides. The primary outcome was the composite of fatal CV events, non-fatal myocardial infarction, stroke or heart failure, adjusted for age, sex, smoking, family history of CV diseases, and LDL-cholesterol.

Results:

The primary outcome was more common in the MetS group [178 (9.2%) vs. 70 (3.5%); corresponding incidence rate of 11.3 vs. 4.2 per 1000 person-years; log-rank p<0.001]. Each component was significantly associated with the primary outcome; however, when the components were sequentially included in the model, abdominal obesity and high triglycerides did not provide additional risk on top of the other three components. The hazard ratio for MetS for the primary outcome was 2.12 (95% confidence interval 1.59–2.81, p<0.001), and the discriminative ability (c-statistics) of the models with MetS and the components was similar.

Conclusion:

MetS increases the risk of CV events more than two-fold. High blood pressure, high fasting plasma glucose, and low HDL-cholesterol are the top three components of MetS for CV risk. MetS and its components have a similar discriminative ability for CV events.

Are there any differences among psoriasis, psoriatic arthritis and rheumatoid arthritis in terms of metabolic syndrome and cardiovascular risk factors?

OBJECTIVE

Although the frequency of metabolic syndrome has been studied separately in psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA) patients, there is no study that compares the prevalence of metabolic syndrome in all three diseases. The purpose of this study is to evaluate the relationship between metabolic syndrome (MetS) and chronic low-grade inflammatory diseases, and to determine the frequency of MetS and insulin resistance in psoriasis and PsA as compared to RA.

METHODS

A total of 155 patients were included in this cross-sectional study. Fifty patients who were diagnosed with psoriasis, 55 PsA patients who were diagnosed according to the CASPAR criteria, and 50 seropositive RA patients who were diagnosed according to the ACR/EULAR 2010 classification criteria were included in this study. MetS was diagnosed by the 2005 criteria of International Diabetes Federation. The cardiovascular risk factors and parameters associated with MetS were evaluated.

RESULTS

The patients' mean age was significantly higher in the RA. MetS was determined in 33.5% of all patients and MetS and insulin resistance showed no significant difference among the three groups (psoriasis: 36%, PsA: 29%, RA: 36%; p: 0.684 and psoriasis: 70%, PsA: 64%, RA: 66%, respectively; p: 0.785). Triglyceride levels were higher in psoriasis and PsA as compared to the RA (psoriasis: 34%, PsA: 32.7%, RA: 16%, respectively; p: 0.045). The frequency of hypertension was 38% in the RA, which was higher than PsA and psoriasis (p: 0.011).

CONCLUSION

In all three groups, the prevalence of MetS was shown to be higher than the general population. The lack of difference between these groups may be due to the small number of patients, the retrospective study design, and the inequality of the population with respect to age and gender.

Awareness of cardiovascular risk factors among university students in Turkey

AIM

To determine the awareness of cardiovascular risk factors among university students in Turkey.

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in developed countries. The use of tobacco products and unhealthy diet are prominent habits that increase the risk of CVD.

METHODS

Healthy university students (n = 2450) aged between 18 and 22 years in Istanbul filled out the questionnaire about the awareness of CVD risk factors and participated in this cross-sectional study. They were asked several questions with regard to the importance of CVD risk factors.

FINDINGS

The leading responses for men and women were, respectively, high cholesterol (58.3; 72.3%), stress (58.8; 71.8%), hypertension (50; 64.2%), smoking (53.1; 58.7%), obesity (46.8; 64.3%), diabetes (41.7; 52.7%), inactivity (43.3; 47.8%), and CVD in family history (31.8; 44.4%). Unhealthy diet (9.7; 15.3%), exposure to second-hand cigarette smoking (24.4; 34%), and poor socioeconomic status (22.6; 22.3%) were also considered to be important. The study also revealed that men disregard the risk factors more frequently. Another comparison between body mass index groups revealed that obese subjects gave significantly lower importance to cardiovascular risk factors.

CONCLUSION

Observations indicate that awareness levels of CVD risk factors have to be improved among university students. It is emphasized that primary healthcare workers are very important in the screening of CVD risk factors in an opportunistic and systematic way and in providing consultancy on changing risky behaviors (diet, smoking, etc.). Therefore, it is of utmost importance that primary healthcare workers make interventions to reduce the risk level by determining the CVD risk.

What is the role of metabolic syndrome and obesity for postoperative atrial fibrillation after coronary bypass grafting?

BACKGROUND

Postoperative atrial fibrillation is the most common arrhythmia seen after cardiac surgery. We aimed to determine the effect of obesity and metabolic syndrome on postoperative atrial fibrillation, whether they are independent risk factors, and their effect level. We also analyzed the effect of atrial fibrillation on postoperative complications.

METHODS

In our clinic, 756 patients who underwent coronary artery bypass grafting between June 2010-September 2017 were evaluated retrospectively. Preoperatively, demographic characteristics, chronic diseases, body mass index, waist circumference measurements, and ejection fraction values of the cases were determined from file records. Perioperatively, cross-clamp and cardiopulmonary bypass times, intra-aortic balloon use, distal coronary bypass counts were determined. Postoperatively, complications, duration of intensive care unit and hospital stay, and mortality were evaluated. The patients were followed up with continuous 3-lead ECG monitorization on the postoperative first day and 12-lead ECG records once in a day on the remaining days. In the study, the first endpoint was the determination of atrial fibrillation and the second endpoint was the discharge time of the patient.

RESULTS

The rate of postoperative atrial fibrillation was 21.3%. Atrial fibrillation was seen in 33% of metabolic syndrome cases and in 38.5% of obese cases. Atrial fibrillation was seen in 23, 24 and 17% of cases using statin, ACE inhibitor and beta blocker, respectively. It was seen in 21% of smokers and 20% of the COPD cases. In the study, metabolic syndrome, diabetes mellitus, hypertension, and obesity, between the ages of 56-78 with Metabolic syndrome, were found to affect the development of postoperative atrial fibrillation (2.46), (2.3), (1.6), and (1.65) times, respectively. In cases with postoperative atrial fibrillation, infection and stroke were 1.45 and 8.85 times more frequent, respectively. Patients with metabolic syndrome were found to have 31% longer hospital stay, and 17% higher infection rate. In obese patients, hospitalization was 23.5% longer.

CONCLUSIONS

Metabolic syndrome and obesity were found to be two independent risk factors for postoperative atrial fibrillation. If causes and mechanisms of postoperative atrial fibrillation are identified in planned cardiovascular interventions, we believe that cost of hospitalization and morbidity will be reduced.

Genetic polymorphisms of the SHBG gene can be the effect on SHBG and HDL-cholesterol levels in Coronary Heart Disease: a case-control study

Sex hormone binding globulin (SHBG) level is positively associated with the high-density lipoprotein cholesterol (HDL-C) levels. The aim of this study was to investigate the effects of the SHBG gene variations (D356N, rs1799941, and P156L) on SHBG and HDL-C levels and Coronary Heart Disease (CHD) risk. The SHBG D356 N (rs6259,G > A), P156L (rs6258,C > T), and rs1799941(G > A) polymorphisms were determined in 131 male CHD patients and 55 male controls by PCR-RFLP and real-time PCR techniques. SHGB levels were measured by Electro-chemiluminescence immunoassay (ECLIA). In the patients who had SHBG levels lower than threshold 35 nmol/l value, the risk of being HDL-C levels lower than threshold 0.90 mmol/l value was observed statistically significant (p = 0.017; OR 2.522, 95% CI 1.170-5.438). The rs1799941 GG was associated with increased CHD risk when compared with the A allele carriers (GA + AA) (p = 0.019, OR 2.222, 95% CI 1.130-4.371). In addition, the rs1799941 GG genotype and D356 N N allele were associated with lower SHBG in the CHD group (p < 0.01). The logistic regression analysis also revealed the rs1799941 GG genotype was significantly associated with low SHBG in CHD patients. It was observed that Haplotype-1(rs1799941 G allele-P156L P allele-D356 N D allele) was associated with increased CHD risk, while Haplotype-2 (rs1799941 rare A allele-P156L C allele- D356 N G allele) was correlated with the decreased CHD risk (p = 0.0167). Our findings suggest that there is a positive correlation between SHBG and HDL-C levels in CHD patients, and this association might be affected by SHBG gene variations.

The Role of Visceral Adiposity Index Levels in Predicting the Presence of Metabolic Syndrome and Insulin Resistance in Overweight and Obese Patients

Background: To investigate visceral adiposity index (VAI) levels in obese patients with and without metabolic syndrome (MetS) and its relationship with insulin resistance (IR), and define cutoff value of VAI in the determination of patients with MetS and IR. Methods: Aged between 18 and 65, 92 patients with obesity were included. Levels of homeostasis model assessment of IR (HOMA-IR) and VAI were calculated. Results: Of 92 patients, HOMA-IR and VAI levels (P < 0.001 and P < 0.001, respectively) were found to be higher in 41 (44.6%) with MetS. The cutoff value of VAI in predicting MetS was found to be 2.205. The frequency of MetS was seen as 22.2% when VAI was below this value, but if over, was found to be 66%. There was a positive correlation between VAI and HOMA-IR levels. In 36 cases (39.1%) with HOMA-IR (≥2.5), VAI was detected to be higher than those without IR, and high-density lipoprotein-cholesterol levels were lower. The cutoff value of VAI in predicting IR was found to be 2.31. While the prevalence of IR was 23.4% in those with VAI of 2.31, IR frequency in patients with equal to or greater than 2.31 was determined as 55%. Conclusion: We found that MetS was present in almost half of overweight and obese individuals, and the cutoff values of VAI in predicting the presence of MetS and IR were 2.205 and 2.31, respectively. Our study was carried out in overweight and obese Turkish individuals, and we consider that further studies including normal weight individuals and larger population are required.

Awareness, Treatment and Control Rates of Hypertensive Patients in Ankara

Aim: It was aimed to evaluate the awareness levels of patients about hypertension, treatment and control rates. Methods: The descriptive study included 203 patients between ages of 35–80 with a previous diagnosis of hypertension to the primary care outpatient clinic of Ankara Numune Training and Research Hospital in September 2011-January 2012. A 42-item questionnaire was used and 19 questions were used to determine the level of awareness among them. Nine measurements were in the office by the researcher and 12 measurements at home by the patient. Results: 25.6% of the patients were males and 74.4% were females. The median age was 59 years (IQR=13). The section for scoring the awareness levels revealed following: 27.1% of patients were non-aware, 58.6% had a low level of awareness and 14.3% had a high level of awareness. 72.9% of the patients were aware, 93.1% were taking antihypertensive treatment, while 42.4% measured blood pressures both at home and at office are under control. Awareness level is related to diet, exercise, education, salt usage, blood pressure measurement frequency, doctor referral frequency, education and knowledge level about hypertension, blood pressure monitoring branch, antihypertensive treatment status, hypertension duration, number of antihypertensive drugs and regular usage rates; but hypertension control was only associated with salt use, antihypertensive treatment and number of antihypertensive drugs. Conclusion: Hypertension is a common problem in our country and as we have seen in our studies, awareness rates are insufficient. Although the treatment rates are high, the control rates are not sufficient. This suggests that patients' compliance with treatment is not at the desired level. The most important thing to do in this regard is to raise awareness by increasing public awareness about hypertension. In this respect, primary care physicians have a great responsibility.

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Background/aim

Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia.

Materials and methods

This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded.

Results

Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects.

Conclusion

SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.

Relationship between vasomotor symptoms and metabolic syndrome in postmenopausal women

Objective This study was performed to compare the vasomotor symptoms and bone mineral density of postmenopausal women with and without metabolic syndrome. Methods We performed a cross-sectional study of 200 postmenopausal women attending routine health check-ups at Marmara Faculty of Medicine Pendik Training and Research Hospital from June 2015 to December 2015. The vasomotor symptoms scored were hot flashes and night sweats. Metabolic syndrome was defined using the consensus criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Results Women with vasomotor symptoms had no metabolic syndrome and were younger than those without vasomotor symptoms. There was no significant difference in vasomotor symptoms between patients with osteopenia in the femoral neck, total femur, and spine and patients with normal bone mineral density. The vasomotor symptoms were similar between smokers and nonsmokers. Conclusion The presence of metabolic symptoms is inversely associated with metabolic syndrome in postmenopausal women. Lipid abnormalities and a high body mass index may be important metabolic components associated with these symptoms. No relationship is present between vasomotor symptoms and the bone mineral density of the spine, femoral neck, and total femur.

Is FGF23 effective on insulin resistance in individuals with metabolic syndrome?

Purpose

Metabolic syndrome (MetS) is a polymetabolic syndrome has high morbidity and mortality rates. Insulin resistance (IR) plays a key role in the increasing frequency of this situation and has been cited as being an important etiologic factor in MetS. In this study, the relationship between IR and fibroblast growth factor-23 (FGF23), was investigated in a population with MetS.

Materials and methods

Forty patients with diagnosis of MetS and 40 healthy volunteers with an equal number of males and females were included in the study and classified as patient group and control group. Blood samples were obtained after 12-h fasting period to study FGF23 and other parameters. MetS, defined according to the International Diabetes Federation (IDF) guidelines, FGF23 was studied by Enzyme-Linked ImmunoSorbent Assay (ELISA) method and IR was calculated using the homeostatic model assessment-insulin resistance (HOMA-IR) formula.

Results

There was a statistically significant difference in HOMA-IR between the patient and control group as expected, while levels of FGF23 were similar. According to gender, levels of FGF23 was statistically significantly higher in male patients compared with controls (p = 0.037). A relationship was not detected between HOMA-IR and FGF23 in the correlation analysis.

Conclusion

Although there are many studies suggesting the correlation between FGF23 and IR in different populations, we did not find any statistically significant relationship between IR and FGF23 levels in MetS in this study.

The Prevalence of Metabolic Syndrome and Its Related Factors among Adults in Palestine: A Meta-Analysis

Background

Metabolic syndrome (MetS)is increasingly becoming a challenging public health issue in Palestine. The current burden of MetS in the country is unknown. There has been limited research on the prevalence of MetS. This meta-analysis is the first to estimate the population prevalence of MetS and its related factors among adults in Palestine.

Methods

A PRISMA systematic search appraisal and meta-analysis were conducted. A systematic literature search of PubMed, Scopus and Google Scholar was conducted in December 2014 up to February 2015. Generic, methodological and statistical data was extracted from the eligible studies which reported MetS prevalence. A random effect meta-analysis was conducted on crude MetS prevalence rates. Heterogeneity was assessed by Cochran's Q and I² tests. Subgroup analyses were also performed according to the predefined criteria.

Results

The literature search yielded a total of 49 studies. Eight papers were included in the final analysis with sample size ranging 163 to 992. In addition, 2937 cases with MetS among people aged 15 years or more were estimated in Palestine between 2001 and 2014. There was high heterogeneity among studies (I² = 95.8% p<0.001). The prevalence of MetS was 37.0% among adult Palestinians population ranging from 17 to 59.5%. Subgroup analysis did not show source of heterogeneity based on subject's health status and MetS criteria.

Conclusion

Our meta-analysis clearly demonstrates that MetS is highly prevalent (37.0%) among Palestinian adults. The high prevalence of MetS in Palestine should be seriously considered and planners should take steps to reduce it.

Association of erythrocyte parameters with metabolic syndrome in the Pearl River Delta region of China: a cross sectional study

OBJECTIVE

Increasing studies have reported that erythrocyte parameters, including red blood cells (RBCs), haematocrit (HCT), haemoglobin (Hb) and red blood cell distribution width (RDW), are associated with metabolic syndrome (MetS) in adults worldwide. However, the association, stratified by sex, remains to be elucidated, particularly in the Pearl River Delta region of China. Therefore, our aim was to explore the association of erythrocyte parameters with MetS, stratified by sex, in the Pearl River Delta region of China.

METHODS

In this cross sectional study, 2161 men and 2511 women were enrolled. MetS was diagnosed using a modified version of the Adult Treatment Panel III criteria. Logistic regression analyses were performed to calculate adjusted ORs of erythrocyte parameters associated with MetS stratified by sex.

RESULTS

The prevalence of MetS was higher in women than in men (35.2%vs26.7%). RBC, HCT, Hb and RDW values increased linearly with the number of MetS components from 0 to 5 identified in both men and women. Among men, the ORs of MetS risk increased across the tertiles of Hb (Q2: OR=1.921, 95% CI=1.170 to 3.151; Q3: OR=1.992, 95%CI=1.198 to 3.312). Men in the highest tertiles of RDW had a 2.752-fold increased risk of suffering from MetS compared with those in the reference group. Among women, the ORs of MetS risk also increased across the tertiles of Hb (Q2: OR=1.538, 95%CI=1.008 to 2.348; Q3: OR=1.665, 95%CI=1.075 to 2.578). Women in the highest tertiles of RBC had a 1.718-fold increased risk of experiencing MetS compared with those in the reference group.

CONCLUSIONS

MetS was more prevalent in women than in men. The association between erythrocyte parameters and MetS differed between the sexes. RBC and Hb were identified as risk factors for MetS in women and Hb and RDW as risk factors in men.

Prevalence of metabolic syndrome and degree of cardiovascular disease risk in patients with Psoriatic Arthritis

OBJECTIVE

The aim of this study was to identify the prevalence of metabolic syndrome (MetS) and degree of cardiovascular disease (CVD) risk in patients with psoriatic arthritis (PsA).

MATERIAL AND METHODS

We performed a cross-sectional study on 102 adult patients with PsA and a control group of 102 patients with rheumatoid arthritis (RA). MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria. The Framingham risk scores of 10-year risk of CVDs and coronary heart disease (CHD) were also calculated.

RESULTS

The prevalence of MetS was higher in patients with PsA than in those with RA, according to the NCEP-ATP III (40.6% vs. 24.7%, respectively; p=0.019) and IDF (46.8% vs. 27.9%, respectively; p=0.05) criteria. The prevalence of MetS was higher in female patients with PsA (p=0.009) than in male patients. A significantly increased prevalence of hypertriglyceridemia was determined in patients with PsA (p=0.019). No significant difference existed between the two groups with respect to 10-year CVD (p=0.333) and CHD (p=0.798) risks. Additionally, there were no significant differences between the clinical subtypes of PsA with regard to MetS (p=0.229).

CONCLUSION

MetS prevalence increased in patients with PsA compared with those with RA, whereas the risks were similar for CVDs and CHD. For this reason, optimal protection measures should be taken and guidelines should be applied to achieve adequate metabolic control in patients with PsA.

Evidence for elevated (LIMK2 and CFL1) and suppressed (ICAM1, EZR, MAP2K2, and NOS3) gene expressions in metabolic syndrome

The metabolic syndrome (MetS) is a common multicomponent condition including abdominal obesity, dyslipidemia, hypertension, and hyperglycaemia. The aim of this study was to investigate the associations of the expression of a panel of signalling genes with the MetS in a Turkish population. A total of 54 MetS patients and 42 healthy controls with similar age and sex were included to this study. mRNA from blood samples was extracted, and real-time polymerase chain reaction was performed for gene expressions using a BioMark 96.96 dynamic array system. We observed marked increases in LIM kinase 2 (LIMK2) and cofilin 1 (CFL1) gene expressions in MetS patients. However, there were significant decreases in intercellular adhesion molecules 1 (ICAM1), ezrin (EZR), mitogen-activated protein kinase kinase 2 (MAP2K2), and nitric oxide synthase 3 (NOS3) gene expressions in MetS patients. Additionally, no marked changes were noted in other 15 genes studied. This is the first study to provide evidence that activation of LIMK2/CFL1 pathway may play an important role in MetS.

Insulin-like growth factor-1 deficiency and metabolic syndrome

Consistent evidence associates IGF-1 deficiency and metabolic syndrome. In this review, we will focus on the metabolic effects of IGF-1, the concept of metabolic syndrome and its clinical manifestations (impaired lipid profile, insulin resistance, increased glucose levels, obesity, and cardiovascular disease), discussing whether IGF-1 replacement therapy could be a beneficial strategy for these patients. The search plan was made in Medline for Pubmed with the following mesh terms: IGF-1 and "metabolism, carbohydrate, lipids, proteins, amino acids, metabolic syndrome, cardiovascular disease, diabetes" between the years 1963-2015. The search includes animal and human protocols. In this review we discuss the relevant actions of IGF-1 on metabolism and the implication of IGF-1 deficiency in the establishment of metabolic syndrome. Multiple studies (in vitro and in vivo) demonstrate the association between IGF-1 deficit and deregulated lipid metabolism, cardiovascular disease, diabetes, and an altered metabolic profile of diabetic patients. Based on the available data we propose IGF-1 as a key hormone in the pathophysiology of metabolic syndrome; due to its implications in the metabolism of carbohydrates and lipids. Previous data demonstrates how IGF-1 can be an effective option in the treatment of this worldwide increasing condition. It has to distinguished that the replacement therapy should be only undertaken to restore the physiological levels, never to exceed physiological ranges.

Metabolic syndrome does not impair the response to alfuzosin treatment in men with lower urinary tract symptoms: a double-blind, randomized, placebo-controlled study

OBJECTIVE

This study is a placebo-controlled comparison of the response to alfuzosin treatment for lower urinary tract symptoms (LUTS) in patients with and without metabolic syndrome (MetS).

MATERIAL AND METHODS

A total of 80 men with LUTS were included in the study. Patients had a maximum flow rate of <15 mL/sec, prostate volume of >20 mL, and International Prostate Symptom Score (IPSS) of >8. All eligible men (n=68) for evaluation were initially divided into two groups as MetS (n=34) and non-MetS (n=34) groups. Patients were further randomized to receive alfuzosin (10 mg/day) or placebo (n=17/group; a total of four groups). The outcome was measured at 12(th) week according to the changes from baseline in IPSS, quality of life (QoL) scores, maximum flow rate (Qmax), and postmictional residue.

RESULTS

Alfuzosin significantly improved LUTS in men with and without MetS compared with patients receiving placebo (p<0.05). Mean IPSS scores in treatment groups decreased significantly, whereas patients receiving placebo had no statistically significant difference (p>0.05). Similarly, alfuzosin treatment resulted in a significant increase in Qmax in patients with LUTS/benign prostatic enlargement when compared with patients in placebo group (p<0.05). Mean QoL scores measured by IPSS-QoL and QoL questionnaires also improved significantly in patients receiving alfuzosin for 3 months regardless of the presence of MetS (p<0.05).

CONCLUSION

Our results revealed that the presence of MetS in patients with LUTS did not impair the response to alfuzosin treatment.

Metabolic syndrome in drug-naïve and drug-free patients with schizophrenia and in their siblings

OBJECTIVES

We tested the hypothesis that metabolic disturbances in people with schizophrenia exist as a part of the schizophrenic syndrome, even when the antipsychotic drug effect is eliminated. We aimed to determine the prevalence of metabolic syndrome among patients with schizophrenia who were antipsychotic drug-naive or drug-free and their siblings for comparison with healthy controls.

METHODS

One-hundred-two patients with schizophrenia (drug-naïve or drug-free), 64 siblings and 70 age-matched healthy subjects were recruited for this case-control study. Metabolic syndrome was assessed based on Adult Treatment Panel (ATP) III, adapted ATP III and International Diabetes Federation criteria. Student's t-tests, chi-squared tests, Kruskal-Wallis tests and Bonferroni corrections were used as appropriate.

RESULTS

The diagnoses of metabolic syndrome and metabolic disturbances as a subsyndromal state were found to be significantly more frequent in patients and their siblings than in the controls. Low levels of high-density lipoprotein cholesterol and disturbances in blood pressure put the patient group at risk for metabolic syndrome even before they were exposed to antipsychotic drugs.

CONCLUSIONS

Although antipsychotic drugs have consistently been related to disturbances of glucose and lipid metabolism in patients with schizophrenia, this study showed that patients with schizophrenia and their siblings are already at a high risk for metabolic syndrome independent of any antipsychotic effects. These individuals should be monitored regularly following a diagnosis of schizophrenia.

The association between endometrial polyps and metabolic syndrome: a case-control study

BACKGROUND

Endometrial polyps are common benign gynaecologic disorders. The etiopathogenesis of this condition remains unclear, however obesity is an important risk factor for the development of endometrial polyps.

AIM

The aim of the study was to evaluate a possible association between endometrial polyps and clinical parameters of metabolic syndrome (MetS).

MATERIALS AND METHODS

Forty-five women with endometrial polyps (study group) and 45 without (control group) were included in this cross-sectional study. The main parameters evaluated between the groups were age, BMI (body mass index), waist circumference (WC), blood pressure, serum lipid profiles, fasting glucose levels and homeostatic model assessment of insulin resistance (HOMA-IR).

RESULTS

There was a significant difference between the groups in terms of BMI, WC, insulin levels and HOMA-IR (P < 0.05). The MetS was present in 32 (71.1%) of women in the study group and in 6 (13.3%) in the control group (P < 0.001). Logistic regression demonstrated that MetS was a significant risk factor for endometrial polyps. ROC curve analysis also showed that MetS was the most significant discriminative risk factor in the study group with an AUC of 0.789 (0.691-0.887; CI 95%).

CONCLUSION

Our study suggests that there may be a relationship between endometrial polyps, MetS and insulin resistance. Further studies are required to explain the role of this relationship in the pathogenesis of the disease.

Gastroesophageal reflux symptoms in Turkish people: a positive correlation with abdominal obesity in women

OBJECTIVE:

Metabolic syndrome (MetS) is increasing around the world due to abdominal obesity with altered eating habits and decreased physical activity. The aim of this study was to determine the risk factors for gastroesophagial reflux disease (GERD) symptoms and the prevalence of GERD in patients with MetS.

METHODS:

Five hundred patients (MetS, n=300 and the control group, n=200) were enrolled in the study. A detailed questionnaire reflux symptoms and behavioral habits was performed.

RESULTS:

Sixty percent of the subjects were with MetS. GERD rate was significantly higher in the group with MetS compared to subjects without MetS (50.7% vs 26%). Women were more likely to have GERD in both groups (62.6% of women and 28.6% of men ın the MetS group while corresponding rates were 37% vs 16.7% in the control group). Waist circumferences were found to be higher in female MetS patients with GERD.

CONCLUSION:

GERD is present approximately in every one of the two patients with MetS. Every patient who has MetS should be evaluated in terms of GERD symptoms.

Effects of maternal obesity on antenatal, perinatal and neonatal outcomes

OBJECTIVE

Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy.

METHODS

A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI) < 18.5 kg/m(2) was underweight, 18.5-24.9 kg/m(2) was normal weight, 25-29.9 kg/m(2) was overweight and ≥30 kg/m(2) was obese. The effects of obesity on fetal and maternal outcomes were investigated.

RESULTS

Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p < 0.01).

CONCLUSION

We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.

Metabolic syndrome: Risk factors among adults in Kingdom of Saudi Arabia

Background:

Metabolic syndrome (MetS) is a cluster of established cardiovascular risk factors that collectively increase predisposition to major chronic diseases, including heart diseases and diabetes mellitus. Citizens of developing countries such as Saudi Arabia are at risk for MetS as a result of industrialization and accessibility to fast foods. In this epidemiologic study, the kingdom-wide prevalence of MetS is determined.

Materials and Methods:

A total of 4578 Saudis aged 15-64 was randomly selected from 20 regions in Saudi Arabia. Anthropometrics were collected, and fasting blood samples collected to ascertain fasting blood glucose and lipid profile. Components of full MetS as defined by the International Diabetes Federation were used for screening.

Results:

The overall prevalence of MetS is 28.3%. Prevalence was significantly higher in males than in females (31.4 vs. 25.2%; P = 0.001). Prevalence of MetS was the highest in the northern and central region, and showed a parallel increase with age, and inversely with educational status. Region was also a significant contributor to MetS. Conclusion: Despite accumulating evidence of an epidemic, MetS remains largely unresolved in the kingdom. Aggressive public campaign should be launched, and policies implemented to control any future damage of MetS in the kingdom.

Relationships between IGF-1, schizophrenia, and treatment of metabolic syndrome

OBJECTIVES

The use of atypical antipsychotic drugs in patients with psychiatric illness may result in dyslipidemia, hypertension, glucose intolerance, and abdominal obesity, which are together referred to as metabolic syndrome (MS). To investigate any correlations among insulin-like growth factor-1 (IGF-1), schizophrenia, and MS, we examined the metabolic profiles of patients with schizophrenia taking atypical antipsychotics.

DESIGN

Patients with schizophrenia, their siblings, and controls participated in this study (N=50 in each group). The Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID I) and the Brief Psychiatric Rating Scale (BPRS) were administered to patients, and SCID I was administered to patients' siblings. We drew blood to measure IGF-1 levels and to determine the metabolic profiles of all participants; we also conducted anthropometric measurements.

RESULTS

There were no significant differences in IGF-1 levels between groups. By comparing IGF-1 levels with MS-related parameters, we found that IGF-1 levels were negatively correlated with triglyceride levels in the control group, and positively correlated with HDL levels in the patient group (Pearson's correlation: r=-0.291, P=0.04, and r=0.328, P=0.02, respectively). Compared to their siblings, patients with schizophrenia had a significantly different body mass index, waist circumference, and insulin resistance, and showed a trend toward a difference in glucose levels (ANOVA: P=0.004, P<0.0001, P=0.004, P=0.072, respectively).

CONCLUSION

A correlation between IGF-1 and MS may significantly influence future therapeutic strategies for MS. In order to determine the role of IGF-1 in schizophrenia, comprehensive longitudinal studies with first-episode drug-naive patients are needed.

Determining Information on Cardiology Disease Risk Factors of Disease in Women

In an attempt to decrease the rate of mortality from cardiovascular diseases, first cardiovascular risk factors should be controlled. This study was carried out to reveal the level of knowledge about cardiovascular disease risk factors in women who presented to a primary healthcare center in Erzurum, Turkey, and the prevalence of such risk factors. Our study is a descriptive one and its data were collected between February and April 2013. The study included 168 women who presented to Filiz Dolunay Family Healthcare Center and who met the criteria and agreed to participate in the study. It was found that 22.6% of the women did not exercise at all above normal range, 53.6% of them had weights above normal, 23.8% smoked, and 22% had hypertension, type 2 diabetes, cholesterol, or excess fat around their waist. It was concluded that, although women were knowledgeable, they did not put this into practice in their lives.

Clinical and laboratory parameters associated with metabolic syndrome in Turkish patients with psoriasis

OBJECTIVES

To assess clinical and laboratory parameters associated with metabolic syndrome in Turkish patients with moderate or severe plaque-type psoriasis and nonpsoriatic controls.

METHODS

Patients with moderate or severe plaque psoriasis (patient group) or with nonpsoriatic dermatological disease (controls) were included. Waist circumference, weight, height and arterial blood pressure were measured, together with fasting blood glucose, triglyceride, high density lipoprotein (HDL), fibrinogen, homocysteine and adiponectin levels. Metabolic syndrome was diagnosed using National Cholesterol Education Program-Adult Treatment Panel III criteria.

RESULTS

Out of 90 patients (50 with psoriasis; 40 controls), metabolic syndrome was more frequent in the patient group than in controls. In terms of metabolic syndrome parameters, only hypertension was more frequent in patients with psoriasis compared with controls. There was no statistically significant difference between the patient and control groups for obesity, hypertriglyceridaemia, HDL levels or hyperglycaemia. Fibrinogen levels were increased and adiponectin levels were decreased in the psoriasis group. No between-group difference in homocysteine levels was found.

CONCLUSION

In this small study, metabolic syndrome was found to be more frequently identified in Turkish patients with psoriasis than in controls; metabolic syndrome could lead to increased cardiovascular disease risk in patients with moderate to severe psoriasis.

Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008

Background

Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments.

Methods

The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35–84 years between 1995 and 2008.

Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35–84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards.

Results

Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.

Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall.

Conclusion

Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.

Controlling hypertension in Turkey: not a hopeless dream

Despite major progress in prevention, diagnosis, and treatment during the recent decades, hypertension remains the leading risk factor for cardiovascular disease and mortality throughout the world. The prevalence of hypertension in developing countries continues to rise reaching alarming rates. Several risk factors of hypertension appear to be more common in developing countries than in developed countries. In Turkey, hypertension is a prevalent condition affecting approximately 22.5 million individuals. Hypertension control (defined as blood pressure <140/90 mm Hg) rate increased from 8.1% in 2003 (first Prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study) to 28.7% in 2012 (PatenT 2 study). Meanwhile, rates of cardiovascular morbidity and mortality remained high in Turkey. Controlling risk factors such as hypertension, tobacco use, unhealthy diet, obesity, diabetes, hyperlipidemia, and physical inactivity can prevent most of the deaths from cardiovascular disease. It is also crucial for the public health system to have a hypertension education program aimed at reducing cardiovascular disease and prevention and control of hypertension promoting a healthy lifestyle in Turkey. Such a program could positively affect other lifestyle-related diseases as well. Importantly, cooperation among the components of the health system could contribute to improved outcomes in hypertensive populations.

Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease

Background

The aim of this study is to investigate the prevalence of metabolic syndrome (MetS), carotid intima media thickness (IMT), and serum C-reactive protein (CRP) levels in patients with chronic obstructive pulmonary disease (COPD), and the possible relationships among them.

Methods

Fifty stable COPD patients and 40 healthy controls were included in the study. The participants were further divided into four groups according to their smoking status. Pulmonary function tests were performed in COPD patients. Anthropometric measurements and blood chemistry analysis, serum CRP levels and carotid intima-media thickness (IMT) measurements were performed in all the study population.

Results

Prevalence of metabolic syndrome was 43% in COPD patients and 30% in the control group (p = 0.173). FEV₁% and FEV₁/FVC were higher in COPD patients with MetS (p = 0.001 and p = 0.014, respectively) compared to those without MetS. Prevalence of MetS was significantly different among the COPD patients with different stages (p = 0.017) with the highest value in stage 2 (59%). Carotid IMT was significantly higher in COPD patients than in control group (1.07 ± 0.25 mm and 0.86 ± 0.18 mm, respectively; p < 0.001). Serum CRP levels were not different in COPD patients and controls, however they were higher in individuals with MetS compared to those without MetS regardless of COPD presence (p = 0.02).

Conclusions

Early markers of atherogenesis, in terms of carotid IMT, were found to be higher in COPD patients than in healthy controls. MetS prevalence was observed to decrease as the severity of airflow obstruction increased. Therefore, screening COPD patients for these cardiovascular risk factors would be a novel approach even in absence of symptoms.

An Observational Study on the Association between Migraines and Tension Type Headaches in Patients Diagnosed with Metabolic Syndrome

Background. Our aim was to investigate the association between migraine, tension type headache, and metabolic syndrome. Methods. Presence of tension type headache and migraine was investigated in 120 patients diagnosed as metabolic syndrome. The severity of the headache was recorded according to the visual analog scale. Results. Mean age of the patients was 54.41 ± 11.60 years (range, 29-84 yrs). Diagnoses of tension type headache and migraine without aura were made for 39 (32.5%) and 18 (15%) patients, respectively. Mean age of migraine patients was significantly lower relative to the patients with tension type headache and no headache. Incidence of hypertriglyceridemia was significantly higher in migraine patients when compared with cases tension type headache and without headache. In the tension type headache group, requirement for analgesics decreased as HDL cholesterol levels increased, while need for analgesic drugs increased in line with higher diastolic blood pressures. In the migraine group duration of headache was found to be prolonged with decreasing HDL cholesterol levels. Conclusion. In patients presenting with headache, its association with metabolic syndrome should be considered, and the patients should be especially observed with respect to response to analgesic and the presence of hypertension and hyperlipidemia.

A Prospective Multicenter Clinical Trial of Chinese Herbal Formula JZQG (Jiangzhuoqinggan) for Hypertension

A prospective multicenter clinical trial was conducted to compare the beneficial effects of a Chinese herbal medicine formula Jiangzhuoqinggan (JZQG) and western antihypertension drug irbesartan. JZQG is mainly composed of rhubarb, coptis, cassia, and uncaria. A total of 240 patients with mild to moderate hypertension were enrolled in the trial. Patients were assigned into two groups after screening: JZQG group and the irbesartan group. After four weeks of treatment, we compared the changes in routine blood pressure, 24 h ambulatory blood pressure, and waist circumference. There was a significant reduction in systolic blood pressure and diastolic blood pressure in the JZQG group (both p < 0.01). There were no significant differences between the reduction of systolic and diastolic blood pressures in the two treatment groups. From the 24 h ambulatory blood pressure measurement, the JZQG group showed a greater reduction in both systolic and diastolic blood pressures (in both daytime and nighttime) than the irbesartan group. Furthermore, there was a significant difference in waist circumference in the JZQG group (1.51 cm reduction; P < 0.05) but not the irbesartan group (0.42 cm). Thus, the JZQG formula may have therapeutic value in patients with both hypertension and metabolic syndrome.

The relationship of metabolic syndrome with disease activity and the functional status in patients with rheumatoid arthritis

Background

The aim of this study is to investigate the frequency of metabolic syndrome (MS) in patients with rheumatoid arthritis (RA) and to determine the relationship between the clinical and laboratory parameters of RA and the components of the metabolic syndrome (MS).

Methods

Fifty-four patients with RA and 52 healthy individuals were enrolled in this study. The diagnosis of rheumatoid arthritis was based on the American College of Rheumatology criteria and the diagnosis of the metabolic syndrome was made according to the criteria set out in the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). The functional status and disease activity were also recorded in patients with RA.

Results

MS was diagnosed in 42.6% of the patients with RA and in 9.6% of the healthy controls. The systolic and diastolic blood pressure values were observed to be significantly higher in the patients with RA in comparison to the controls. Also, the frequency of MS was higher in the inferior functional group in relation to the higher functional group. A positive correlation was observed between the DAS28 scores and hypertension in patients with RA.

Conclusions

In this study, MS was more frequently detected in the patients with RA compared to the control group. Also, an inferior functional status in RA was also found to be associated with the presence of MS. Thus, the presence of MS in patients with RA may be associated with a higher cardiovascular risk.

Metabolic syndrome in collection and disposal of solid waste sector

OBJECTIVES

This study aims to assess the frequency and factors relevant to metabolic syndrome in workers employed in the collection and disposal of solid waste sector.

MATERIALS AND METHODS

This cross-sectional study was conducted in the major solid waste collecting and disposal company named İSTAÇ AŞ (İstanbul Environmental Protection and Waste Processing Corporation) in Istanbul, Turkey. All 715 male employees of the company were included in the study without sampling. The study was completed with 619 subjects. Since it was a small group, female workers were not taken into account in the study. Metabolic syndrome frequency was investigated according to the NCEP-ATP III criteria including the levels of systolic and diastolic blood pressure, waist perimeter, HDL, triglyceride, fasting blood glucose values.

RESULTS

Metabolic syndrome was present in 40.9% of participating employees. Metabolic syndrome was more common in those working in the excavation field (54.0%), such as caterpillar operators (56.5%), and less common in employees working in administrative offices, such as office staff or managers, who were under 35 years old and who had been working for less than 10 years (p < 0.05). Employees working in work stations other than administrative offices had a 2.60 times higher risk compared to those working in administrative offices.

CONCLUSIONS

Metabolic syndrome may be related to work station, job, age and period worked by the subjects.

Metabolic syndrome in the Middle East

Metabolic syndrome (MS) is a combination of medical disorders that, in concert, increase the risk of developing cardiovascular disease and diabetes. It affects about one in four people in the Middle East, and prevalence increases with age. The aim of current review is to discuss the prevalence of MS and its component in different regions in the Middle East. The recorded high prevalence of the MS and its key cardiovascular risk factors (15-60%) among Middle East population mandates the need for a national and international prevention programs to combat obesity, diabetes, hypertension, dyslipidemia, smoking and related comorbidities. Consideration of early prevention and control is of utmost importance.

Metabolic syndrome in female patients with overactive bladder

OBJECTIVE

To investigate the relevance of metabolic syndrome in the etiopathogenesis of overactive bladder in female patients. It has been shown that obesity has been associated with overactive bladder (OAB), and the metabolic syndrome and insulin resistance have been related to the annual growth rates of prostate and lower urinary tract symptoms.

METHODS

Female patients applying to our policlinics with OAB symptoms or other urologic complaints were enrolled in the study. The International Diabetes Federation criteria were used for the definition of the metabolic syndrome. The chi-square, Student t, and Mann-Whitney U tests and logistic regression analyses were used to compare differences in the variables.

RESULTS

The metabolic syndrome was diagnosed in 201 (64%) of 313 patients with OAB and 73 (35%) of 208 patients without OAB. The difference was statistically significant (P=.002). A larger waist circumference, greater body mass index, low high-density lipoprotein level, and incidence of hypertension were significantly greater statistically in the OAB group than in the controls.

CONCLUSION

The metabolic syndrome correlates highly with OAB in female patients. The metabolic syndrome can be an etiologic pathway for the onset of symptoms.