Metabolic syndrome components are associated with future medical costs independent of cardiovascular hospitalization and incident diabetes

Longitudinal economic burden of incident complications among metabolic syndrome populations

BACKGROUND

This study quantifies the longitudinal economic burden for a wide spectrum of incident complications, metabolic syndrome (MS)-related risk factors, and comorbidities in patients with MS.

METHODS

This retrospective study utilized linked data from the 2013 National Health Interview Survey and the 2012-2021 National Health Insurance Research Database to identify MS individuals and their characteristics. The incidence rate of each complication was calculated as the number of complication events in the study period divided by the total person-years during follow-up. The healthcare costs of complications were analyzed using a generalized estimating equation model to determine the cost impact of complications after adjustment for patients' characteristics. Sensitivity analyses on variables with high missing rates (i.e., cause of death, body mass index) were performed.

RESULTS

Among 837 identified MS individuals over 8.28 (± 1.35) years of follow-up, the most frequent complications were microvascular diseases (incidence rate for nephropathy/retinopathy/neuropathy: 6.49/2.64/2.08 events per 100 person-years), followed by cardiovascular diseases (2.47), peripheral vascular diseases (2.01), and cancers (1.53). Death was the costliest event (event-year cost per person: USD 16,429) and cancers were the most expensive complications (USD 9,127-11,083 for non-MS- and MS-related cancers). Developing non-MS/MS-related cancers, cardiovascular diseases, and obesity-related medical conditions increased annual costs by 273% (95% CI: 181-397%)/175% (105-269%), 159% (118-207%), and 140% (84-214%), respectively. Microvascular diseases had the lowest cost impact on annual costs (i.e., 27% [17-39%]/27% [11-46%]/24% [11-37%] increases for nephropathy/neuropathy/retinopathy, respectively). Having existing comorbidities increased annual costs by 20% (osteoarthritis) to 108% (depression). Having morbid obesity (i.e., body mass index ≥ 35 kg/m2) increased annual costs by 58% (30-91%).

CONCLUSIONS

The economic burden from costly incident complications (i.e., cardiovascular diseases, peripheral vascular diseases, cancers), MS-related risk factors (i.e., morbid obesity), and comorbidities (i.e., depression) highlight the urgent need for early intervention to prevent MS and its progression. The comprehensive cost estimates reported in this study can facilitate the parameterization of economic analyses to identify cost-effective interventions for these patients.

Enhancing Lifestyles in the Metabolic syndrome (ELM) multisite behavioral efficacy trial. Design and baseline cohort

BACKGROUND

Prevalence of metabolic syndrome (MetS) increased from one-quarter to one-third of the U.S. adult population over 8 years and is spreading to young adults and Asian and Hispanic Americans. Diagnosed when >3 out of 5 cardiometabolic risk factors are present, there is widespread agreement that its fundamental roots are in a lifestyle characterized by poor dietary quality and physical inactivity. Past lifestyle trials for MetS produce benefits that have limited sustainability, suggesting the need for new treatment approaches.

METHODS

This is the design and baseline cohort of the Enhancing Lifestyles in the Metabolic Syndrome (ELM) multi-site trial. The trial tests the hypothesis that a habit-based lifestyle treatment offered over 6 months, followed by 18 monthly maintenance contacts, can produce 4 new diet, physical activity, and mindfulness habits and, if so, sustained MetS remission. The design is an individually randomized, partially clustered group treatment trial of 618 participants with the MetS recruited from 5 sites in the U.S. and randomized to a small group lifestyle treatment or an enhanced standard of care education comparator. The primary outcome is MetS remission at 24 months. Secondary outcomes compare arms at 6, 15, and 24 months on MetS components, lifestyle targets, weight, body mass index, hemoglobin A1c, LDL cholesterol, medications, quality of life, psychosocial factors, and cost-effectiveness.

RESULTS

The cohort of 618 participants was recruited by screening 14,817 over 2.5 years (screening to enrollment ratio 24:1). Recruitment exceeded the target of 600 despite 2 COVID-19 pauses. The mean age was 55.5 years, 24.3% were male, 25.5% were a racial minority, 9.7% identified as Hispanic, and 83.0% were classified as obese (body mass index >30). The most common MetS components were abdominal obesity (97.7%) and elevated blood pressure or antihypertensive medication (86.2%).

CONCLUSIONS

The geographic, sociodemographic, and clinical diversity of the cohort, combined with rigorous behavioral efficacy trial methods, will provide a conclusive answer to the question of whether this habit-based lifestyle program can produce sustained 24-month remission of the MetS and thereby help to curb a significant and growing public health problem.

Plasma metabolic fingerprints for large-scale screening and personalized risk stratification of metabolic syndrome

Direct diagnosis and accurate assessment of metabolic syndrome (MetS) allow for prompt clinical interventions. However, traditional diagnostic strategies overlook the complex heterogeneity of MetS. Here, we perform metabolomic analysis in 13,554 participants from the natural cohort and identify 26 hub plasma metabolic fingerprints (PMFs) associated with MetS and its early identification (pre-MetS). By leveraging machine-learning algorithms, we develop robust diagnostic models for pre-MetS and MetS with convincing performance through independent validation. We utilize these PMFs to assess the relative contributions of the four major MetS risk factors in the general population, ranked as follows: hyperglycemia, hypertension, dyslipidemia, and obesity. Furthermore, we devise a personalized three-dimensional plasma metabolic risk (PMR) stratification, revealing three distinct risk patterns. In summary, our study offers effective screening tools for identifying pre-MetS and MetS patients in the general community, while defining the heterogeneous risk stratification of metabolic phenotypes in real-world settings.

Obesity and metabolic state are associated with increased healthcare resource and medication use and costs: a Finnish population-based study

AIM

To characterize healthcare resource (HCRU) and medication use and associated costs in individuals with obesity compared with individuals with normal weight or overweight in a population-based cohort of Finnish adults. The association between metabolic state and direct costs was also assessed.

METHODS

The study cohort included 5587 randomly selected individuals who participated in the national FinHealth 2017 health examination survey. Data on healthcare visits and hospital stays, including diagnoses (ICD-10), and purchases and costs of prescription medicines were collected from the nationwide registers by the Finnish Institute for Health and Welfare and Social Insurance Institution of Finland. The healthcare costs were calculated based on standard unit costs reported by the Finnish Institute for Health and Welfare.

RESULTS

The total annual direct costs were €2665 (SD €5673) and €1799 (SD €3874) per person with obesity and with normal weight or overweight, respectively. Obesity was associated with significantly increased total direct (age- and sex-adjusted cost rate ratio, RR, 1.356; p < 0.001), HCRU-related (1.273; p = 0.002), and medication (1.669; p < 0.001) costs. A vast majority (90%) of individuals with obesity were classified as metabolically unhealthy based on clinical measurements. The metabolically unhealthy state was associated with increased costs in individuals with obesity but not in individuals with normal weight or overweight.

CONCLUSION

Obesity is associated with a significant and complex direct cost burden to society, arising primarily from increased comorbidity. Metabolically healthy obesity is uncommon and obesity prevention and timely treatment should be of high priority to tackle the increasing burden of obesity.

Does Maintained Medical Aid Coverage Affect Healthy Lifestyle Factors, Metabolic Syndrome-Related Health Status, and Individuals' Use of Healthcare Services?

Concerns about the moral hazards and usage of universal health insurance require examination. This study aimed to analyze changes in lifestyle, metabolic syndrome-related health status, and individuals' tendency to use healthcare services according to changes in the eligibility status of medical aid recipients. This paper reports a retrospective cohort study that involved analyzing data from 2366 medical aid recipients aged 40 years or older who underwent national health screenings in 2012 and 2014. Of the recipients, 1606 participants continued to be eligible for medical aid (the "maintained" group) and 760 changed from being medical aid recipients to National Health Insurance (NHI) enrollees (the "changed" group). Compared to the "changed" group, the "maintained" group was less likely to quit smoking, more likely to begin smoking, less likely to reduce binge drinking to moderate drinking, and had a significant increase in blood glucose and waist circumference. Annual total medical expenses also increased significantly in the "maintained" group. Since the mere strengthening of healthcare coverage may lead to moral hazards and the failure to link individuals' tendency to use healthcare services and outcomes, establishing mechanisms is necessary to educate people about the health-related outcomes of maintaining a healthy lifestyle and ensure the appropriate use of healthcare services.

Effect of Yearly Exercise on Medication Expense and Benefit-Cost Ratio in Individuals with Metabolic Syndrome: A Randomized Clinical Trial

INTRODUCTION

Lifestyle modification through incorporation of exercise training could improve metabolic syndrome (MetS) clinical components (hypertension, dyslipidemia, hyperglycemia, and visceral abdominal obesity). We aimed to assess if long-term exercise training could restrain the increased pharmacological cost of the clinical management of the MetS.

METHODS

Medicine cost during a 5-yr-long randomized controlled exercise intervention trial was analyzed. After a per-protocol analysis, a group of 64 individuals 53 ± 2 yr old, with overweight (body mass index, 33.4 ± 0.9 kg·m -2 ) and MetS (3.6 ± 0.2 factors) were randomized to a training (4 months·yr -1 for 5 yr; EXERCISE, n = 25) or to a control group (CONTROL, n = 26). Subjects were studied on three occasions during the 5-yr follow-up. Participants continued their routine medication managed by their general practitioner. The main outcome is the 5-yr evolution of medication cost to treat MetS (hyperglycemia, hypertension, and hyperlipidemia). A secondary outcome is the benefit-cost ratio of the exercise intervention.

RESULTS

In CONTROL, medicine cost increased 160% from baseline ( P < 0.001), whereas in EXERCISE, it remained unchanged (33%; P = 0.25). After the 5-yr follow-up, medicine use was 60% and medicine cost 74% higher in CONTROL than EXERCISE ( P < 0.05 in both cases). However, MetS z score was similarly reduced over time in both groups ( P = 0.244 for group-time interaction). The number of prescribed medications increased after 5 yr in CONTROL (89%; P < 0.001), whereas it remained stable with yearly training (17%; P = 0.72 in EXERCISE). Ten-year atherosclerotic cardiovascular disease risk estimation increased only in CONTROL (15%; P = 0.05 for group-time interaction). The benefit in medicine savings (€153 per year and patient) triplicated the estimated cost (€50.8 per year and patient) of the exercise intervention.

CONCLUSIONS

A 5-yr-long supervised exercise training program in middle-age individuals with MetS prevents the need for increasing medicine use. The savings in pharmacological therapy outweighs the estimated costs of implementing the exercise program.

Overview of Nutraceuticals and Cardiometabolic Diseases following Socio-Economic Analysis

The importance of functional food and nutraceutical products to deal with cardiometabolic diseases (CMDs) and metabolic syndrome (MetS) has gained attention in the past few years. The aim of this narrative review is to highlight the potential and effectiveness of nutraceutical in the improvement of CMDs and MetS biomarkers, alongside their burden of disease and economic health expenditure. A science database search was conducted between May and June 2021. A total of 35 studies were included in this paper. We included male and female subjects, children, and adults, in good health or with cardiovascular or metabolic disease. CMDs and MetS have gradually become worldwide health problems, becoming two of the major causes of morbidity and mortality in western countries. The results indicate a positive link between daily consumption of nutraceutical products and an improvement in cardiometabolic and anthropometric biomarkers. In this paper we included a wide range of nutraceutical products. Most of them showed promising data, indicating that nutraceuticals could provide a new therapeutic treatment to reduce prevalence and pharmaceutical expenditures attributed to CMDs and MetS. Unfortunately, there is a huge vacuum of data on nutraceutical usage, savings, and burden reduction. Therefore, further clinical and pharmaco-economic research in the field is highly required.

Impact of synbiotic supplementation on cardiometabolic and anthropometric indices in patients with metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Probiotic and synbiotic products are being widely used by a large number of patients and clinicians; however, effects on cardiometabolic indices in patients with the metabolic syndrome remain unclear. This meta-analysis aimed to evaluate the effects of a synbiotic intervention on lipid profile, insulin resistance, blood pressure, anthropometric parameters, and inflammatory markers.

METHODS

We searched MEDLINE, Scopus, and Clarivate Analytics Web of Science by October 2021. Studies were selected if they reported the effectiveness of the synbiotic intervention on cardiometabolic and anthropometric indices. The weighted mean difference was calculated as the effect size using a random-effects model. Subgroup analyses were conducted to determine sources of heterogeneity. Dose-dependent effects were assessed using a dose-response meta-analysis of differences in means.

RESULTS

Five trials (1049 participants) were finally included in the meta-analysis. Synbiotic intervention significantly reduced serum insulin levels (WMD, -6.39 μU/mL; 95%CI, (-7.2 to -5.4); p = 0.001, I2 = 88.2%, N = 5), triglycerides (WMD, -20.3 mg/dl; 95%CI, (-32.7 to -7.8); p = 0.001, I2 = 87.7, N = 5), total cholesterol (WMD, -7.8 mg/dl; 95%CI, ( -12.5 to -3.02); p = 0.001; I2 = 66.7%, N = 5), low-density lipoprotein cholesterol (WMD, -9.02 mg/dl; 95%CI, (-10.8 to -7.2); p < 0.001, I2 = 0%, N = 5), waist circumference (WMD, -4.04 cm; 95%CI, ( -4.9 to -3.08), p < 0.001; I2 = 22.7%, N = 3), body weight (WMD, -4.3 kg; 95%CI, (-6.2 to -2.5); p = 0.001; I2 = 0%, N = 2), systolic blood pressure (WMD, -1.8 mmHg; 95% CI, (-2.8 to -0.7); p = 0.001; I2 = 0%, N = 3), and serum interleukin-6 concentrations (WMD, -0.2 pg/mL; 95%CI, (-0.3 to -0.08); p = 0.001, I2 = 39.8%, N = 2), and increased high-density lipoprotein cholesterol levels (WMD, 2.3 mg/dl; 95%CI, (0.2-4.4); p = 0.03; 03; I2 = 93.1%, N = 5). Synbiotic administration did not significantly affect fasting plasma glucose, homeostatic model assessment for insulin resistance, body mass index, diastolic blood pressure, heart rate, and serum C-reactive protein concentrations.

CONCLUSIONS

The present findings suggest that synbiotic intervention effectively improves cardiometabolic risk factors in patients with metabolic syndrome.

Kidney Adaptations Prevent Loss of Trace Elements in Wistar Rats with Early Metabolic Syndrome

Metabolic syndrome (MetS) represents a cluster of related metabolic abnormalities, including central obesity, hypertension, dyslipidemia, hyperglycemia, and insulin resistance. These metabolic derangements present significant risk factors for chronic kidney disease that carries to loss of essential micronutrients, which accelerates comorbidity apparition. The work aimed was to evaluate the trace element homeostasis regarding morphological adaptations and renal function in MetS early-onset. Fifty male Wistar rats were divided into two groups: (a) control group and (b) hypercaloric diet group that developed MetS early-onset after 3 months. Classical zoometric parameters do not show changes; however, biochemical modifications were observed such as hyperglycemia, protein glycation, insulin resistance, dyslipidemia, hyperinsulinemia, and hypoadiponectinemia. MetS early-onset group observed renal structural modifications, but no functional changes. The structural modifications observed were minimal glomerular injury, glomerular basement membrane thickening, as well as mesangial and tubular cells that showed growth and proliferation. In serum and kidney (cortex and medulla), the concentrations of Zn, Fe, Cr, Mg, Mn, Cu, Co, and Ni were no differences between the experimental groups, but excretory fractions of these were lower in the hypercaloric diet group. In conclusion, MetS early-onset coexist renal structural modification and a hyperreabsorptive activity of essential trace elements that avoid its loss; thus, the excretory fraction of oligo-elements could be used a biomarker of early renal injury caused by metabolic diseases in the clinical practice.

Pdgfrα-Cre mediated knockout of the aryl hydrocarbon receptor protects mice from high-fat diet induced obesity and hepatic steatosis

Aryl hydrocarbon receptor (AHR) agonists such as dioxin have been associated with obesity and the development of diabetes. Whole-body Ahr knockout mice on high-fat diet (HFD) have been shown to resist obesity and hepatic steatosis. Tissue-specific knockout of Ahr in mature adipocytes via adiponectin-Cre exacerbates obesity while knockout in liver increases steatosis without having significant effects on obesity. Our previous studies demonstrated that treatment of subcutaneous preadipocytes with exogenous or endogenous AHR agonists disrupts maturation into functional adipocytes in vitro. Here, we used platelet-derived growth factor receptor alpha (Pdgfrα)-Cre mice, a Cre model previously established to knock out genes in preadipocyte lineages and other cell types, but not liver cells, to further define AHR's role in obesity. We demonstrate that Pdgfrα-Cre Ahr-floxed (Ahrfl/fl) knockout mice are protected from HFD-induced obesity compared to non-knockout Ahrfl/fl mice (control mice). The Pdgfrα-Cre Ahrfl/fl knockout mice were also protected from increased adiposity, enlargement of adipocyte size, and liver steatosis while on the HFD compared to control mice. On a regular control diet, knockout and non-knockout mice showed no differences in weight gain, indicating the protective phenotype arises only when animals are challenged by a HFD. At the cellular level, cultured cells from brown adipose tissue (BAT) of Pdgfrα-Cre Ahrfl/fl mice were more responsive than cells from controls to transcriptional activation of the thermogenic uncoupling protein 1 (Ucp1) gene by norepinephrine, suggesting an ability to burn more energy under certain conditions. Collectively, our results show that knockout of Ahr mediated by Pdgfrα-Cre is protective against diet-induced obesity and suggest a mechanism by which enhanced UCP1 activity within BAT might confer these effects.

Phytosome Loading the Combined Extract of Mulberry Fruit and Ginger Protects against Cerebral Ischemia in Metabolic Syndrome Rats

The prevalence of ischemic stroke in metabolic syndrome (MetS) is continually increasing and produces a great impact on both qualities of life and annual healthcare budget. Due to the efficiency limitation of the current therapeutic strategy, the poor availability of polyphenol substances induced by the first pass effect and the beneficial effects of mulberry fruit and ginger on brain and MetS-related diseases together with the synergistic concept, the neuroprotective effect against ischemic stroke in MetS condition of phytosome containing the combined extract of mulberry fruit and ginger (PMG) has been considered. To explore the neuroprotective effect and possible underlying mechanism of PMG on brain damage in cerebral ischemic rat with MetS, male Wistar rats were induced MetS by high-carbohydrate high-fat diet (HCHF) for 16 weeks and subjected to the cerebral ischemia/reperfusion injury (CIRI) at the right middle cerebral artery (Rt. MCAO). PMG at doses of 50, 100, and 200 mg/kg were orally fed with for 21 days, and they were assessed brain damage, neurological deficit score, and the changes of oxidative stress markers, inflammatory markers, PPARγ expression, and epigenetic modification via DNMT-1 were performed. All doses of PMG significantly improved brain infarction, brain edema, and neurological deficit score. In addition, the reduction in DNMT-1, MDA level, NF-κB, TNFα, and C-reactive protein together with the increase in SOD, CAT, and GPH-Px activities, and PPARγ expression in the lesion brain were also observed. The current data clearly revealed the neuroprotective effect against cerebral ischemia with MetS condition. The possible underlying mechanism might occur partly via the suppression of DNMT-1 giving rise to the improvement of signal transduction via PPARγ resulting in the decreasing of inflammation and oxidative stress. In conclusion, PMG is the potential neuroprotectant candidate against ischemic stroke in the MetS condition. However, the clinical trial is still essential.

Predictive costs in medical care for Koreans with metabolic syndrome from 2009 to 2013 based on the National Health Insurance claims dataset

BACKGROUND/AIMS

Although metabolic syndrome has been associated with increasing medical costs worldwide, there have been no studies using a nationwide and longitudinal South Korean dataset. We investigated trends in subsidized medical costs among Korean adults with metabolic syndrome.

METHODS

This study was based on the National Sample Cohort database of South Korea. We used data of national health checkups in 2009 as well as data of subsidized prescription drugs and the Korean Classification of Disease diagnosis codes from claims in 2007 to 2008 to identify underlying diseases. We calculated the direct medical costs, which were subsidized by the Korean National Health Insurance, among 204,768 individuals older than 20 years from 2009 to 2013.

RESULTS

The proportion of subjects with metabolic syndrome was 27.2%. Direct medical costs for 5 years differed by a magnitude of 2.16 between subjects with and without metabolic syndrome. The costs increased by approximately 41.8% in the metabolic syndrome group in 5 years. Direct medical costs increased with every additional risk factor, even if a subject had less than three risk factors of metabolic syndrome. Metabolic syndrome per se and all of its components, except low serum high-density lipoprotein cholesterol level, resulted in a significant increase in medical costs.

CONCLUSION

The medical costs of subjects with metabolic syndrome were higher than that of those without metabolic syndrome and it increased with the number of risk factors. Further research using cumulative data of more than 10 years, including unsubsidized and indirect costs, is needed in the future.

Retrospective Examination of Class Attendance on Corporately Sponsored Weight Loss Programming: The Naturally Slim Experience

OBJECTIVE

To examine the effect of class participation in participants enrolled in a corporate sponsored commercial weight loss program.

METHODS

We examined 111,262 participants for percent weight loss (primary outcome) using general linear models and weight loss relative to class participation (secondary outcome).

RESULTS

We observed a significant trend (P < 0.001) for achieving significant weight loss for the entire cohort who lost 3.65% (99% CI, 3.62, 3.69) body weight. Individuals taking ≥4 classes (n = 87,346) lost 4.97% (99% CI, 4.53, 4.61). Those taking ≥9 classes (n = 74,525) achieved 4.95% (99% CI, 4.93, 5.01) weight loss. Similar patterns for men and women were observed within each analysis.

CONCLUSION

Overall, participants lost a clinically beneficial (≥3%) amount of weight following class participation and greater class attendance produced a greater weight loss percentage approaching clinical significance (≥5%).

The association between psychological stress and metabolic syndrome: A systematic review and meta-analysis

Literature suggests that occupational stress is associated with a higher risk of metabolic syndrome; yet less is known whether other sources of stress have similar effects. This review aims to examine whether the relationship between psychological stress and metabolic syndrome differs by sources of stress. Three databases (PubMed, Web of Science, and CINAHL) were searched for eligible articles; meta-analyses were conducted using the random effects model. After controlling for covariates, adults in the high-stress groups had 45% higher chance of having metabolic syndrome than adults in the low-stress groups (odds ratio [OR] = 1.450; 95% confidence interval [CI], 1.211-1.735; P < .001). The subsequent meta-analysis based on cross-sectional studies suggested that occupational stress showed the strongest effect (OR = 1.692; 95% CI, 1.182-2.424; P = .004), while perceived general stress showed the weakest effect (OR = 1.217; 95% CI, 1.017-1.457; P = .032). Unfortunately, there is a lack of longitudinal studies for subsequent meta-analysis based on sources of stress. There is a need for continued research to examine the long-term relationship between different sources of stress and the risk of metabolic syndrome. Traditional recommendations for preventing metabolic syndrome (eg, low-fat diet and exercise) may not achieve the best outcome if clinicians overlook patients' psychosocial stress.

Metabolic syndrome among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study

Metabolic syndrome and its associated morbidity and mortality have been well documented in adults with schizophrenia. However, data is lacking for their geriatric counterparts. We sought to investigate the frequency of screening and the prevalence of metabolic syndrome in older adults with schizophrenia, as well as its possible correlates, using the Cohort of individuals with schizophrenia Aged 55 years or more study (n = 353). We found that 42.2% (n = 149) of our sample was screened for metabolic syndrome. Almost half of those (n = 77; 51.7%) screened positive according to ATPIII criteria. Hypertension and abdominal obesity were the two most prevalent metabolic abnormalities. Screening was positively associated with male gender and urbanicity, and metabolic syndrome diagnosis was positively associated with cardiovascular disorders and consultation with a general practitioner (all p < 0.05). However, there were no significant associations of metabolic syndrome with socio-demographic or clinical characteristics, psychotropic medications, other medical conditions and other indicators of mental health care utilization. Our findings support that the prevalence of metabolic syndrome among older adults with schizophrenia spectrum disorder is high and screening is crucial mainly in those patients with hypertension and/or abdominal obesity. Factors at play might be different than those in the younger population.

Akkermansia muciniphila ameliorates the age-related decline in colonic mucus thickness and attenuates immune activation in accelerated aging Ercc1 -/Δ7 mice

BACKGROUND

The use of Akkermansia muciniphila as potential therapeutic intervention is receiving increasing attention. Health benefits attributed to this bacterium include an improvement of metabolic disorders and exerting anti-inflammatory effects. The abundance of A. muciniphila is associated with a healthy gut in early mid- and later life. However, the effects of A. muciniphila on a decline in intestinal health during the aging process are not investigated yet. We supplemented accelerated aging Ercc1 -/Δ7 mice with A. muciniphila for 10 weeks and investigated histological, transcriptional and immunological aspects of intestinal health.

RESULTS

The thickness of the colonic mucus layer increased about 3-fold after long-term A. muciniphila supplementation and was even significantly thicker compared to mice supplemented with Lactobacillus plantarum WCFS1. Colonic gene expression profiles pointed towards a decreased expression of genes and pathways related to inflammation and immune function, and suggested a decreased presence of B cells in colon. Total B cell frequencies in spleen and mesenteric lymph nodes were not altered after A. muciniphila supplementation. Mature and immature B cell frequencies in bone marrow were increased, whereas B cell precursors were unaffected. These findings implicate that B cell migration rather than production was affected by A. muciniphila supplementation. Gene expression profiles in ileum pointed toward a decrease in metabolic- and immune-related processes and antimicrobial peptide production after A. muciniphila supplementation. Besides, A. muciniphila decreased the frequency of activated CD80+CD273- B cells in Peyer's patches. Additionally, the increased numbers of peritoneal resident macrophages and a decrease in Ly6Cint monocyte frequencies in spleen and mesenteric lymph nodes add evidence for the potentially anti-inflammatory properties of A. muciniphila.

CONCLUSIONS

Altogether, we show that supplementation with A. muciniphila prevented the age-related decline in thickness of the colonic mucus layer and attenuated inflammation and immune-related processes at old age. This study implies that A. muciniphila supplementation can contribute to a promotion of healthy aging.

Metabolic Syndrome With Aortic Arterial Stiffness And First Hospitalization Or Mortality In Coronary Artery Disease Patients

PURPOSE

Metabolic syndrome (MetS) and aortic arterial stiffness (AS) are risk factors for future cardiovascular events. We evaluated their roles in first hospitalization or all-cause mortality prediction in coronary artery disease (CAD) patients.

PATIENTS AND METHODS

From January to December 2012, 115 CAD patients were enrolled from a single center and followed up for 5.5 years. The composite endpoint included hospitalization for unstable angina, myocardial infarction, revascularization, or heart failure and all-cause mortality. Patients with carotid-femoral pulse wave velocity > 10 m/s (measured using applanation tonometry) constituted the high AS group.

RESULTS

During a median 54-month follow-up, there were 43 (37.4%) and 11 (9.6%) hospitalization and mortality events, respectively. Overall, 41 (35.7%) and 70 (60.9%) patients were diagnosed with AS and MetS, respectively. CAD patients with high AS had higher diabetes and MetS percentages, were older, and had higher waist circumference and systolic blood pressure (SBP) but lower glomerular filtration rate than those with low AS. Multivariate logistic regression analysis revealed old age (P < 0.001), diabetes (P = 0.003), and high waist circumference (P = 0.044) and SBP (P = 0.007) as independent predictors of AS in CAD patients. Kaplan-Meier analysis showed that CAD patients with concurrent MetS and high AS had a higher risk for hospitalization (log rank test, P = 0.005) or developing all-cause mortality (log rank test, P = 0.002). Compared with CAD patients without MetS or AS, composite outcome development risk in those with both the conditions was 10.2-fold higher (P < 0.001); this risk was 6.54-fold higher in those with AS alone (P = 0.007).

CONCLUSION

In CAD patients, age, diabetes, and high waist circumference and SBP are the independent predictors of AS. Additionally, CAD patients with AS with and without MetS have a high first hospitalization or all-cause mortality development risk.

Prescription preferences in antipsychotics and attitude towards the pharmaceutical industry in Belgium

OBJECTIVES

The number of antipsychotic prescriptions are increasing rapidly worldwide, a trend which is mainly driven by the steep rise in second-generation antipsychotic (SGA) prescriptions. However, the success of SGA, compared with the older first-generation antipsychotics (FGAs), cannot be explained by evidence. Several studies concluded on equal efficacy of FGA and SGA on positive, negative and cognitive symptoms of schizophrenia. Next to that, the influence of the pharmaceutical industry on prescription behaviour has drawn considerable interest. Therefore, the relationship between antipsychotic prescription patterns and exposure to information directly provided by pharmaceutical companies was studied.

METHODS

A cross-sectional online survey, addressing psychiatrists, general practitioners (GPs) and trainees in Flanders, was carried out. Respondents were questioned about their prescription behaviour, opinion about efficacy of SGA versus FGA and the nature and frequency of their contact with the pharmaceutical industry. Using Spearman's rank correlations and χ² tests, the relationship between different variables and group differences were examined.

RESULTS

Psychiatrists, GPs and trainees in Flanders clearly favour olanzapine and risperidone, followed by quetiapine and aripiprazole above all other agents. This behaviour is supported by the conviction that SGAs have superior efficacy and a more benign side effect profile, compared with FGA. Frequent contact with drug representatives is correlated with a preference of SGA over FGA. 41% of the respondents acknowledge to be influenced by the pharmaceutical industry, which is more than that previously reported.

Retrospective Analysis of Annual Worksite Preventive Health Checkups on Hypertension and Metabolic Syndrome

OBJECTIVES

To examine worksite preventive care checkups on the prevalence of hypertension and metabolic syndrome (MetS).

METHODS

Participants (N = 9269) participated in four annual checkups, counseled, and referred for physician follow-up. Hypertension and MetS prevalence were examined using general linear models or chi-squared analyses.

RESULTS

Significant reductions in the prevalence of hypertension in men (20 to 39 years [20% vs. Y2 9%], 40 to 65 years [38% vs. 20%], 65+ years [38% vs. 24%]) and women (20 to 39 years [8% vs. 4%], 40 to 65 years [23% vs. 11%], 65+ years [29% vs. 15%]), continuing through Y4. MetS followed a similar, yet attenuated pattern, with significance noted in men: (40 to 65 years; Y1 [48%] vs. Y2 [38%]; 65+ years [Y1 [42%] vs. Y3 [40%]]), and women (40 to 65 years group [Y1 [36%] vs. Y3 [32%]]; 65+ years [Y1 [41%] vs. Y3 [38%]]).

CONCLUSION

Preventive care checkups concurrent with physician referral may significantly help reduce hypertension and MetS in the workplace.

Existence of a Strong Correlation of Biomarkers and miRNA in Females with Metabolic Syndrome and Obesity in a Population of West Virginia

Objectives: Metabolic syndrome causes complications like cardiovascular disease and type 2 diabetes mellitus (T2DM). As metabolic syndrome develops, altered levels of cytokines and microRNAs (miRNA) are measurable in the circulation. We aimed to construct a panel detecting abnormal levels of cytokines and miRNAs in patients at risk for metabolic syndrome. Methods: Participants included 54 patients from a Family Medicine Clinic at Marshall University School of Medicine, in groups of: Control, Obese, and Metabolic Syndrome (MetS). Results: Serum levels of leptin, adiponectin, leptin: adiponectin ratio, IL-6, six miRNAs (320a, 197-3p, 23-3p, 221-3p, 27a-3p, and 130a-3p), were measured. Among the three groups, leptin, and leptin: adiponectin ratio, and IL-6 levels were highest in MetS, and levels in Obese were greater than Control (p>0.05). Adiponectin levels were lower in Obese compared to Control, but lowest in MetS (p<0.05). MiRNAs levels were lowest in MetS, and levels in Obese were lower than Control (p>0.05). Conclusion: Our results support the clinical application of biomarkers in diagnosing early stage MetS, which will enable attenuation of disease progression before onset of irreversible complications. Since West Virginians are high-risk for developing MetS, our biomarker panel could reduce the disease burden on our population.

Evaluation of a Voluntary Work Site Weight Loss Program on Hypertension

OBJECTIVES

The aim of this study was to examine the effect of a worksite weight loss program hypertension.

METHODS

Participants [N = 5998; body mass index (BMI) 34 ± 7 m/kg, 33% hypertensive] participating in a 10-week weight loss program were examined for hypertension prevalence within categories of (1) weight gain, or loss (2) less than 3%, (3) 3% to 5%, (4) 5% to 10%, and (5) more than 10% using general linear models or Chi-square analyses.

RESULTS

We observed a significant dose-response trend for the reduced prevalence of hypertension at follow-up (P-for-trend < 0.001). Baseline versus follow-up comparisons showed those gaining weight (28% vs 25%, adjres. = 2.5) or losing less than 3% (31% vs 25% adjres. = 2.9) were significantly more likely to present with hypertension at follow-up. Those losing 5% to 10% (33% vs 19%, adjres. = -3.2) or more than 10% (39% vs 17%, adjres. = -3.2) were significantly more likely to present without hypertension.

CONCLUSION

Weight loss more than 5% significantly reduced workplace hypertension, while gaining weight increased its likelihood.

Rationale and design of the Baptist Employee Healthy Heart Study: a randomized trial assessing the efficacy of the addition of an interactive, personalized, web-based, lifestyle intervention tool to an existing health information web platform in a high-risk employee population

Background

Metabolic syndrome (MetS) and diabetes confer a high risk for developing subsequent cardiovascular disease (CVD). Persons with MetS constitute 24–34 % of the employee population at Baptist Health South Florida (BHSF), a self-insured healthcare organization. The Baptist Employee Healthy Heart Study (BEHHS) aims to assess the addition of a personalized, interactive, web-based, nutrition-management and lifestyle-management program to the existing health-expertise web platform available to BHSF employees in reducing and/or stabilizing CVD and lifestyle risk factors and markers of subclinical CVD.

Methods/design

Subjects with MetS or Type II Diabetes will be recruited from an employee population at BHSF and randomized to either an intervention or a control arm. The intervention arm will be given access to a web-based personalized diet-modification and weight-modification program. The control arm will be reminded to use the standard informational health website available and accessible to all BHSF employees. Subjects will undergo coronary calcium testing, carotid intima-media thickness scans, peripheral arterial tonometry, and advanced lipid panel testing at visit 1, in addition to lifestyle and medical history questionnaires. All tests will be repeated at visits 2 and 4 with the exception of the coronary calcium test, which will only be performed at baseline and visit 4. Visit 3 will capture vitals, anthropometrics, and responses to the questionnaires only.

Conclusion

Results of this study will provide information on the effectiveness of personalized, web-based, lifestyle-management tools in reducing healthcare costs, promoting healthy choices, and reducing cardiovascular risk in an employee population. It will also provide information about the natural history of carotid atherosclerosis and endothelial dysfunction in asymptomatic but high-risk populations.

Trial registration

ClinicalTrials.gov registry, NCT01912209. Registered on 3 July 2013.

Blood-Based Biomarkers for Metabolic Syndrome

Metabolic syndrome (MetS) is a constellation of factors increasing the risk of type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and cancer. MetS diagnosis is cumbersome and the precise diagnosis differs throughout the world. Efforts are underway to find MetS biomarkers that could all be analysed in a single blood sample. Here we review recent advances, including progress on circulating exosomes and microvesicles and their molecular contents, as well as DNA, RNAs, and proteins taken directly from blood samples. While additional research is now warranted to advance upon these findings, there is reason for optimising that such blood-based entities will be beneficial for MetS diagnosis and will help reduce risk of T2DM, CVD, and cancers, contributing both societal and economic benefit.

Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome

Objective

To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome.

Data sources

PubMed database for English-language studies with no start date restrictions and with an end date of September 2014.

Methods

A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences. There were 106 studies that formed the basis of this analysis.

Conclusions

Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death. These consequences result in significant economic burden. Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea.

Implications for practice

Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies. Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed.

Metabolic Syndrome Prevalence and Correlates in a Worksite Wellness Program

The purpose of this study was to examine the prevalence of metabolic syndrome among faculty and staff who participated in a university wellness program. In addition, this study identified common correlates of metabolic syndrome in the participating employee population. Knowledge of behaviors and characteristics of individuals with metabolic syndrome is essential when developing health promotion strategies for them. Metabolic syndrome is unique in that it results from a clustering of risk factors that are difficult to address, and each additional risk factor increasingly affects health and well-being. A targeted, comprehensive approach is needed to counteract individual's predisposition to metabolic syndrome. This research identified the association between employees' metabolic risks and their demographic, physical, and psychosocial characteristics in an effort to determine metabolic syndrome prevalence, develop population-specific interventions, and decrease the risk of metabolic syndrome among workers.

Weight-loss strategies used by baby boomer men: a mixed methods approach

BACKGROUND

Baby Boomer men (those born in 1946-1964) are becoming obese at an earlier age compared to previous generations. The present study aimed to identify weight-loss strategies used by Baby Boomer men, to determine whether those strategies varied by weight status and to explore their dieting experiences.

METHODS

The study used a cross-sectional survey of 211 men and 20 in-depth interviews.

RESULTS

Men had a mean (SD) body mass index (BMI) of 29.35 (5.07) kg m(-2), with 82% being overweight or obese. Fifty-six percent were currently trying to lose weight. Healthy weight-loss strategies included reducing portions, increasing physical activity, cutting back on fried foods, cutting back on sweets, cutting back on alcohol, using meal replacement drinks/bars and joining a weight-loss programme. Unhealthy strategies included skipping meals and using over-the-counter 'diet pills'. Men who reduced portions, skipped meals, cut back on sweets, joined a weight-loss programme and used diet pills had significantly higher BMIs than men who said they did not (P < 0.05 for all). Interviews revealed that older men struggle to lose weight, 'I've been struggling for the last 2-3 years'. 'The last time I really tried to lose weight I stayed on the diet for just a day or two'. Wives were considered essential to their weight management success.

CONCLUSIONS

Men used a do-it-yourself weight-loss approach using both healthy and unhealthy strategies. Obese men were more likely to use unhealthy practices than overweight men.

Challenges and Opportunities in Scaling-Up Nutrition in Healthcare

Healthcare continues to be in a state of flux; conventionally, this provides opportunities and challenges. The opportunities include technological breakthroughs, improved economies and increasing availability of healthcare. On the other hand, economic disparities are increasing and leading to differing accessibility to healthcare, including within affluent countries. Nutrition has received an increase in attention and resources in recent decades, a lot of it stimulated by the rise in obesity, type 2 diabetes mellitus and hypertension. An increase in ageing populations also has meant increased interest in nutrition-related chronic diseases. In many middle-income countries, there has been an increase in the double burden of malnutrition with undernourished children and overweight/obese parents and adolescents. In low-income countries, an increased evidence base has allowed scaling-up of interventions to address under-nutrition, both nutrition-specific and nutrition-sensitive interventions. Immediate barriers (institutional, structural and biological) and longer-term barriers (staffing shortages where most needed and environmental impacts on health) are discussed. Significant barriers remain for the near universal access to healthcare, especially for those who are socio-economically disadvantaged, geographically isolated, living in war zones or where environmental damage has taken place. However, these barriers are increasingly being recognized, and efforts are being made to address them. The paper aims to take a broad view that identifies and then comments on the many social, political and scientific factors affecting the achievement of improved nutrition through healthcare.

Elderly women with metabolic syndrome present higher cardiovascular risk and lower relative muscle strength

Objective:

To compare the metabolic, anthropometric, arterial blood pressure, and muscle strength parameters of elderly women with and without metabolic syndrome.

Methods:

A case-control study with 27 (67.3±4.8 years of age, 31.0±5.0kg/m²) elderly women with metabolic syndrome and 33 (68.8±5.6 years of age, 27.2±5.3kg/m²) sedentary control elderly women. They were submitted to an evaluation of body composition by means of dual-energy X-ray absorptiometry and muscle strength testing with 10 maximal repetitions of knee extension.

Results:

When compared to the elderly women without metabolic syndrome, those with the metabolic syndrome had higher levels for body mass (72.2±13.5 versus 63.4±14.6kg, p=0.03), body mass index (31.0±5.0 versus 27.2±5.3kg/m^2, p=0.007), fat mass (30.9±9.9 versus 24.4±8.5kg, p=0.01), systolic arterial pressure (125.1±8.2 versus 119.3±8.7mmHg, p=0.01), diastolic arterial pressure (75.5±6.9 versus 71.4±6.7mmHg, p=0.03), mean arterial pressure (92.5±6.2 versus 87.1±6.7mmHg, p=0.004), blood glucose (103.8±19.1 versus 91.1±5.9mg/dL, p=0.001), triglycerides (187.1±70.2 versus 116.3±36.7mg/dL, p=0.001), and creatine kinase (122.6±58.6 versus 89.8±32.5U/L, p=0.01); lower levels were found for fat-free mass (55.9±5.8 versus 59.3±6.7%; p=0.05), HDL-C (40.7±5.0 versus 50.5±10.1mg/dL, p=0.001), and relative muscle strength (0.53±0.14 versus 0.62±0.12, p=0.01).

Conclusion:

Elderly women with metabolic syndrome have a higher cardiovascular risk and less relative muscle strength when compared to those without metabolic syndrome. Relative muscle strength may be related to the cardiovascularr risk factors of the metabolic syndrome.

Tumor necrosis factor- α and interleukin-6: potential interorgan inflammatory mediators contributing to destructive periodontal disease in obesity or metabolic syndrome

Obesity has become a worldwide health burden in the last two decades. Obesity has been associated with increased comorbidities, such as coronary artery disease, diabetes, and destructive periodontal disease. Obesity is also part of a group of risk factors occurring together in an individual, which is referred to as metabolic syndrome. Clinical studies have shown higher risk for destructive periodontal disease in obesity and metabolic syndrome. However, the role of obesity and metabolic syndrome in the onset and development of destructive periodontal disease has not yet been fully understood. In this review, we discuss a working model, which focuses on interorgan inflammation as a common etiological factor for destructive periodontal disease associated with obesity and metabolic syndrome. Specifically, we suggest that elevated levels of tumor necrosis factor- α (TNF- α ) or interleukin 6 (IL-6)--both adipokines and known risk factors for destructive periodontal disease--in obesity and metabolic syndrome contribute to the onset and development of destructive periodontal disease. The connections between destructive periodontal disease and systemic conditions, such as obesity or metabolic syndrome, are complex and potentially multidirectional. This review largely focuses on TNF- α and IL-6, inflammatory mediators, as potential common risk factors and does not exclude other biological mechanisms.

Efficacy of vitamin D3-fortified-yogurt drink on anthropometric, metabolic, inflammatory and oxidative stress biomarkers according to vitamin D receptor gene polymorphisms in type 2 diabetic patients: a study protocol for a randomized controlled clinical trial

BACKGROUND

Development of type 2 diabetes mellitus (T2DM) is determined by the interactions of genetic and environmental factors. This study was designed to evaluate the possible role of VDR single nucleotide polymorphisms (SNPs) on different aspects of diabetic host response (anthropometric, metabolic, oxidative stress and inflammatory) to daily intake of vitamin D through fortified yogurt drink for 12 weeks.

METHODS/DESIGN

This study comprises two parts: (i) a case-control study; and (ii) an intervention trial. In the first part, VDR polymorphisms (Taq1, FokI, Apa1, Bsm1, and Cdx2) are determined in 350 T2DM patients and 350 non-diabetic subjects. In the second part, the possible effects of daily intake of two servings of vitamin D3-fortified yogurt drink (FYD; 500 IU vitamin D/250 mL) on some selected metabolic (including insulin resistance), inflammatory and oxidative stress biomarkers in 135 T2DM patients are assessed. To relate the resulted changes in the biomarkers to vitamin D replenishment, another group of diabetic patients (n = 45) are also included in the study who receive 2 servings of plain yogurt drink (PYD) a day. The primary outcome is serum level of 25(OH) D, which it is expected to be elevated only in FYD group. Secondary outcomes include improvements in glycemic, metabolic, inflammatory and oxidative stress biomarkers in FYD group compared to PYD group. Three VDR FokI polymorphisms are determined only in FYD group followed by comparison of changes in the biomarkers among these genotypic variants.

DISCUSSION

The present study, at least in part, elucidates the discrepancies in the results of different vitamin D-diabetes studies pertaining to the genetic variations of the population. If VDR polymorphisms are found to influence the response to our intervention, then knowing distribution of VDR polymorphisms in both diabetic and non-diabetic populations can give a picture of the proportion of the community in whom up to 1000 IU/d vitamin D may not be effective enough to improve insulin resistance and related morbidities. Therefore, they should ideally receive further nutritional support according to their genotype.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01236846.