Metabolic Syndrome Prevalence among Armed Forces Personnel (Military Personnel and Police Officers): A Systematic Review and Meta-Analysis

Impact of night sentry duties on cardiometabolic health in military personnel

This article examines the study by Lin et al, which explores the effects of night sentry duties on cardiometabolic health in military personnel. The research identifies significant correlations between the frequency of night shifts and negative cardiometabolic outcomes, such as elevated resting pulse rates and lowered levels of high-density lipoprotein cholesterol. These outcomes underscore the health risks linked to partial sleep deprivation, a common challenge in military environments. The editorial highlights the clinical significance of these findings, advocating for the implementation of targeted health interventions to mitigate these risks. Strategies such as structured sleep recovery programs and lifestyle modifications are recommended to improve the health management of military personnel engaged in nocturnal duties. By addressing these issues, military health management can better safeguard the well-being and operational readiness of its personnel.

Risk factors for adverse health in military and law enforcement personnel; an umbrella review

BACKGROUND

A better understanding of adverse health and underlying risk factors in the context of military and law enforcement is essential to developing future preventative strategies. We conducted an umbrella review to provide an overview of the current literature regarding risk factors for adverse health in military and law enforcement populations.

METHODS

We systematically searched the literature for systematic reviews and meta-analyses regarding risk factors for adverse health in military or law enforcement populations. We critically appraised the studies that matched our inclusion criteria, extracted the adverse health outcomes and underlying risk factors, and narratively synthesised the findings.

RESULTS

This umbrella review included 34 systematic reviews that covered data from 43 countries. We identified twenty-six adverse health outcomes and 220 underlying risk factors. The adverse health outcomes covered in the included systematic reviews were one infectious disease (Heliobacter pylori infection); two endocrine, nutritional, or metabolic diseases (metabolic syndrome and obesity); seven mental, behavioural, or neurodevelopmental disorders (adjustment disorder, alcohol misuse, anxiety, depression, poor mental health, PTSD, and stress); two diseases of the nervous system (insomnia and sleep-disordered breathing); one disease of the ear or mastoid process (noise-induced hearing loss); eight diseases of the musculoskeletal system and connective tissue (cervical spine injuries, injuries, lower extremity injuries, musculoskeletal injuries, neck pain, rhabdomyolysis, and stress fractures); one symptom, signs and abnormal clinical and laboratory findings, not elsewhere classified (suicidal ideation); three injuries, poisonings, or other consequences of external causes (concussion, heat illness, and suicide); and one factor influencing health status and contact with health services (burnout). Of the 220 identified risk factors, 136 were modifiable, and the most frequently reported were female sex, older age, lower functional movement screen scores, maladaptive coping, lack of social support, and neuroticism.

CONCLUSION

This umbrella review identified twenty-six adverse health outcomes and their underlying risk factors in military and law enforcement populations. Hereby, this study provides potential starting points for preventing adverse health in these populations. It also identifies a broad lack of systematic reviews investigating mental, behavioural, or neurodevelopmental disorders in military populations and diseases of the musculoskeletal system and connective tissue in law enforcement populations.

PROSPERO REGISTRATION NUMBER

CRD42022378123.

The effects of jujube (Ziziphus jujube) on metabolic and mental health outcomes in patients with metabolic syndrome: A randomized controlled trial

OBJECTIVES

The effects of jujube (Ziziphus jujube) consumption on metabolic and mental health outcomes in subjects diagnosed with metabolic syndrome (MetS) is unknown and remains to be examined. Hence, we carried out a parallel-group, randomized controlled trial to investigate this issue.

METHODS

Eligible participants were randomly assigned to the intervention (n = 30) or the control (n = 30) groups to receive either jujube or a placebo for eight weeks. Subjects were provided with 30 g dried jujube powder or placebo and were asked to consume half of the powder at 10 a.m. and the rest at 4 p.m. Lipid profile, fasting blood glucose (FBG), waist circumference (WC), and blood pressure were evaluated as primary outcomes. Secondary outcomes collected were mental health measures (e.g., depression, anxiety, and stress).

RESULTS

Jujube consumption failed to decrease FBG, total cholesterol, low-density lipoprotein cholesterol, and blood pressure, as well as depression and anxiety scores (P > 0.05). However, the between-group comparison revealed a significant improvement in WC (- 3.98 vs. - 0.51, P = 0.01), triglyceride (TG) (- 24.96 vs. - 0.73, P = 0.03), and high-density lipoprotein cholesterol (HDL-C) (2.83 vs. 0.40, P = 0.01) in the jujube group compared to the placebo. In addition, compared to the control group, jujube consumption led to a significant improvement in the score of stress (- 5.80 vs. - 2.86, P = 0.01).

CONCLUSION

Jujube consumption only had beneficial effects on WC, TG, and HDL-C in subjects with MetS. However, the current study has methodological weaknesses in blinding and herb purity/potency testing, which should be addressed in future studies.

Sugar-Sweetened Beverage Consumption and Implications for Aviation Preflight Indoctrination Students

BACKGROUND: Research has shown that excessive sugar-sweetened beverage (SSB) consumption has been associated with being overweight and obese and the military is not immune to this disorder. Being overweight/obese is one of the characteristics that comprise a condition known as Metabolic Syndrome (MetS). The global prevalence of MetS in the military population is estimated to be 21%, which varies depending upon the armed forces type and specialty. The purpose of this study is to identify the subset of the aviation population that may develop MetS at some future point and to put forth suggestions on how best to combat this and maintain operational readiness.METHODS: Data were collected by means of an anonymous 44-item survey administered and completed by 302 students enrolled in Aviation Preflight Indoctrination at the Naval Air Station Base in Pensacola, FL.RESULTS: Results indicated that 70.86% of students reported SSB consumption, with 95.3% preferring caffeinated to decaffeinated SSBs. 11.7% of personnel met the "at risk criteria" of consuming SSBs four times per week or greater (four 12-oz cans or more per week).DISCUSSION: Findings from this study indicate that approximately 11.7% of aviation pilots or flight officers are "at risk" of developing MetS. Given that it takes up to 4 yr to train a new fighter pilot, this could become a significant readiness issue on par with the impact seen with pilots leaving the services through natural attrition.Sather TE. Sugar-sweetened beverage consumption and implications for aviation preflight indoctrination students. Aerosp Med Hum Perform. 2024; 95(1):25-28.

The Prevalence of Metabolic Syndrome and Its Components in Firefighters: A Systematic Review and Meta-Analysis

Previous studies consistently report a high prevalence of cardiovascular disease (CVD) risk factors among firefighters. However, the clustering of CVD risk factors, defined as metabolic syndrome (MetSyn), has received little attention by comparison. Therefore, the aim of this study was to estimate the pooled prevalence of MetSyn among firefighters. Using combinations of free text for 'firefighter' and 'metabolic syndrome', databases were searched for eligible studies. Meta-analyses calculated weighted pooled prevalence estimates with 95% confidence intervals (CI) for MetSyn, its components and overweight/obesity. Univariate meta-regression was performed to explore sources of heterogeneity. Of 1440 articles screened, 25 studies were included in the final analysis. The pooled prevalence of MetSyn in 31,309 firefighters was 22.3% (95% CI: 17.7-27.0%). The prevalences of MetSyn components were hypertension: 39.1%; abdominal obesity: 37.9%; hypertriglyceridemia: 30.2%; dyslipidemia: 30.1%; and hyperglycemia: 21.1%. Overweight and obesity prevalence rates in firefighters were 44.1% and 35.6%, respectively. Meta-regression revealed that decreased risk of bias (RoB) score and increased body mass index (BMI) were positively associated with an increase in MetSyn prevalence. Since one in five firefighters may meet the criteria for MetSyn, novel interventions should be explored to both prevent MetSyn and reduce the onset of CVD risk factors.

Comparison of brown adipose tissue activation detected by infrared thermography in men with vs without metabolic syndrome

BACKGROUND

Brown adipose tissue (BAT) high density of mitochondria and its thermogenic characteristics promote the dissipation of chemical energy in the form of heat, increasing body caloric expenditure, decreasing plasma levels of lipids and glucose (GL). This makes BAT a potential therapeutic target of Metabolic Syndrome (MetS). Position Emission Tomography Scanning (PET-CT) is the gold standard for estimating BAT, but it has several limitations, including high cost and high emission of radiation. On the other hand, Infrared Thermography (IRT) is considered a simpler, cheaper and non-invasive method to detect BAT.

OBJECTIVE

The aim of this study was to compare BAT activation through IRT and cold stimulation in men diagnosed without and with MetS.

METHODS

Sample of 124 (35.3 ± 9.4 years old) men was evaluated of body composition, anthropometric measurements and dual X-ray absorptiometry (DXA) hemodynamics, biochemical tests and body skin temperature acquisition. The Student t-test with subsequent effect size by (d) Cohen and two-way repeated measures ANOVA with Tukey post-hoc comparisons were conducted. Level of significance was p < 0.05.

RESULTS

There was significant interaction between group factor (MetS) vs group moment (BAT activation) in supraclavicular skin temperatures right side (maximum (F_(1,122) = 10.4, p < 0.002, η² = 0.062), mean (F_(1.122) = 13.0, p < 0.001, η² = 0.081) and minimal (F_(1,122) = 7.9, p < 0.006, η² = 0.052)) and left side maximum (F_(1,122) = 7.7, p < 0.006, η² = 0.048), mean (F_(1.122) = 13.0, p < 0.037, η² = 0.007) and minimal (F_(1,122) = 9.8, p < 0.002, η² = 0.012)). The MetS risk factor group didn't present significant increase of SCV temperature BAT after cold stimulation.

CONCLUSION

Men diagnosed with MetS risk factors seem to activate less BAT, when exposed to cold stimulation, compared to group without MetS risk factor.

Health, Safety, and Wellness Concerns Among Law Enforcement Officers: An Inductive Approach

Background: Although studies have assessed the impact of occupational risk factors on the health of law enforcement officers (LEO's), few have involved (LEO's) as informants in ways that allow their points of view to be heard directly. Thus, the objective of this study is to explore the occupational health, safety, and wellness (OHSW) concerns of (LEO's). Methods: (LEO's) working in Quebec, Canada were invited to answer an open-ended question regarding their OHSW concerns. Using a multi-stage content analysis, the collected answers were analyzed and coded by two members of the research team to identify the most recurrent concerns of (LEO's). Findings: Five themes relating to the OHSW concerns of (LEO's) were identified, namely, the work schedule, occupational stress, work equipment, workplace health promotion, and operational risks. Furthermore, our analyses highlighted differences in the concerns of (LEO's) based on their level of experience and sex. Conclusions/Application to Practice: This study addresses a gap in the literature on the OHSW concerns from the perspective of (LEO's). Overall, our results support that the work schedule and occupational stress associated with law enforcement are the two most recurrent concerns of (LEO's). Thus, the results of this study further stress the need for police organizations to implement strategies and policies, which could mitigate the deleterious effects of these hazards on the overall wellness of (LEO's).

Incidence and risk factors of metabolic syndrome among Royal Thai Army personnel

Metabolic Syndrome is a clustering of obesity, hyperglycemia/insulin resistance, dyslipidemia, and hypertension. We aimed to determine the incidence of metabolic syndrome among Royal Thai Army (RTA) personnel and its risk factors. We conducted a retrospective cohort study using data from 2017 to 2021. Metabolic syndrome was defined by NCEP ATP III (2005 Revision). A total of 98,264 participants were enrolled in the present study. The overall incidence rate of metabolic syndrome was 3.7 per 100 person-year (95% CI 3.7–3.8). The statistically significant risk factors for metabolic syndrome included male sex (aHR 1.40; 95% CI 1.29–1.51), age > 35 years, current alcohol consumption, and no exercise. When stratified by sex, the incidence rate of metabolic syndrome among participants aged ≥ 45 years was higher than those aged < 35 years with aHR 6.34; 95% CI 6.01–6.70 for males and aHR 9.59; 95% CI 7.55–12.19 for females. Our data demonstrated that metabolic syndrome is a common health issue, especially among RTA personnel over 35 years. Alcohol consumption and sedentary behavior played an essential role in facilitating metabolic syndrome in this study population and are potential targets for intervention to enhance primary prevention of the sequelae of metabolic syndrome.

Magnitude of metabolic syndrome in Gondar town, Northwest Ethiopia: A community-based cross-sectional study

Background

Metabolic syndrome (MetS) is becoming a major public health problem globally; it is clear that the burden of MetS is rapidly increasing the rates of non-communicable diseases (NCD). In Ethiopia studies done so far have shown a large disparity in magnitude of the prevalence of MetS and were mainly institution-based studies. Therefore, this study assess the prevalence of MetS among adults who are residing in Gondar city using Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) assessment tool. The findings are imperative to developing and strengthening national NCD prevention and control programs.

Methods

This study was conducted in Gondar city Northwest Ethiopia in 2018. It employs a community-based cross-sectional study design among 3,227 individuals 18 years of age or older. Data was collected using the WHO stepwise tool, lipid profile, blood pressure (BP), waist circumference (WC) body mass index (BMI), fasting blood glucose levels (FG), and anthropometric measurements. The prevalence estimation was made along with a 95% confidence interval (CI). The Kappa statistic was used to analyze the statistical agreement between ATP III and IDF definitions of the MetS. Stratified analysis was also performed for description and analysis components using ATP III and IDF as an outcome.

Result

Of the total study participants (3227), 3059 (94.8%) were included in the final analysis and 52.5% were female. The mean (±SD) age of the study participant was 40.8 years (16.2 ±SD). The overall prevalence of MetS using ATP III was 11.2% [95%CI: 10.1, 12.3] and using IDF was 11.9% [95%CI: 10.8, 13.2]. The sex-specific proportion was high in females rather than males irrespective of the criteria. The overall level of agreement between ATP III and IDF prevalence was 91.7% and the Kappa statistics was 0.594. Older age, low-density lipoprotein cholesterol, body mass index, being female, born in an urban area, consumption of an alcoholic drink in the preceding 30 days, and non-fasting practice was significantly associated with MetS.

Conclusion and recommendation

There was a higher prevalence of metabolic syndrome among females than males irrespective of metabolic syndrome diagnostic criteria. This also shows good agreement between ATP III and IDF. Being female, urban birthplace, frequent alcohol consumption in the last 30 days, and non-fasting practice are factors associated with higher rates of metabolic syndrome. Hence, awareness campaigns, physical exercise, and nutrition education intervention should be undertaken to promote health behavioral practice.

Gender Differences in the Prevalence of Metabolic Syndrome Among Taiwanese Air Force Personnel: A Population-Based Study

BACKGROUND

Authors of several studies have reported differences in the prevalence of metabolic syndrome (MetS) between men and women. However, information is lacking on gender difference among military personnel.

OBJECTIVE

The aim of this study was to examine the prevalence of MetS and its component abnormalities among Taiwanese Air Force personnel by gender and age groups.

METHODS

A population-based study was conducted including 14 872 Taiwanese Air Force personnel. Data were retrieved from the military's Health Management Information System. Analyses were performed using Student t test, χ test, and linear-by-linear χ test. Statistical significance was defined as P < .05.

RESULTS

The MetS prevalence was 14.0% (15.1% in men and 5.3% in women). Metabolic syndrome was associated with age for both men and women (both Ptrend < .001), with a greater prevalence of MetS in men aged 18 to 44 years than in women, but not in the age group of 45 years or older. In men, MetS was most prevalent in those with increased waist circumference (78.2%), followed by those with elevated blood pressure (75.6%). By contrast, in women, it was most prevalent in those with increased waist circumference (86.5%), followed by those with reduced high-density lipoprotein cholesterol (84.3%).

CONCLUSIONS

Our findings suggest that military nurses and other health providers should consider the gender- and age-based MetS prevalence trend among Taiwanese Air Force personnel when designing interventions to identify vulnerable subgroups at a high risk of MetS. Health management programs should be adapted to minimize metabolic risks.

Cut-Off Points of Visceral Adipose Tissue Associated with Metabolic Syndrome in Military Men

Visceral adipose tissue (VAT) has high metabolic activity and secretes a larger number of adipokines that are related to the inflammatory process. Quantifying VAT could estimate the risk of developing Metabolic Syndrome (MetS). This study was designed to determine the VAT cut-off points assessed by DXA associated with MetS in military men. In total, 270 (37.5 ± 6.9 years) military men from the Brazilian Army (BA) participated in the study. Anthropometric measurements, assessment of body composition by dual X-ray absorptiometry (DXA), hemodynamics and biochemical tests were performed. The Student’s t test, independent samples, Person’s correlation, ROC curve, Youden Index and positive (PPV) and negative predictive value (NPV) were used. The MetS prevalence was 27.4%, which means that 74 (38.0 ± 7.3 years) military men had at least three risk factors of MetS present. The cutoff point of VAT with the highest balance between sensitivity (77.0%) and specificity (69.9%) was 1025.0 cm³ (1086.0 g). An area on the ROC curve was 0.801 (p < 0.000), which was very good precision. VAT ≥ 1025.0 cm³ (1086.0 g) is associated with the risk factors of MetS and is, therefore, a predictor of the disease with good indicators of sensitivity and specificity and a robust indicator of MetS.

Determinants of metabolic syndrome: a population survey at Bizerte military garrison in 2015-2017

Introduction:

Metabolic syndrome (MetS) is a worldwide major public health problem. In Tunisia, few studies have focused on MetS in general population and in military setting in particular.

Aim: To determine the prevalence of the MetS in a military population at Bizerte garrison (Tunisia) and to identify its associated factors.

Methods:

An analytical cross sectional study was conducted in Bizerte military garrison during the period 2015-2017. The study population was the active military persons who were presents during the time of the survey and assigned at the three main navy, air force and army units of Bizerte garrison. The adopted definition for the diagnosis of MetS was the International Diabetes Federation 2005 (IDF 2005). Multivariate analysis using a binary logistic regression model to identify independent factors to MetS (variable of interest) was performed. Data entry and analysis were performed using SPSS 20.0 Software.

Results:

During the study period, 2500 active military were enrolled among them 2418 men. The mean age was 36.6 ± 9.1 years [20.0 – 59.0]. The prevalence of MetS was 17.7%. MetS was significantly higher among participants aged 40 and above, (23.8% vs 13.1%), single (21.6% vs 13.7%), diabetic (38.5% vs 15.5%), and assigned in the air force (23.1% vs 14.6%) compared to the rest of the study population. The independent factors identified in multivariate analysis were age, armed forces' affiliation and marital status.

Conclusion:

The prevalence of MetS in our military population was relatively high despite of the medical criteria imposed before incorporation. Population and targeted approach are needed to prevent this scourge and to protect from the complications.

Shift Work Adaptation Among Police Officers: The BCOPS Study

Few studies have examined shiftwork adaptation among police officers or potential differences in disease biomarkers among adapted and maladapted shiftworkers. This study characterized shiftwork adaptation among 430 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Police officers working fixed night shifts with symptoms characteristic of adaptation and maladaptation were identified using latent class analysis (n = 242). Two approaches were applied, one with police-specific symptoms and another using more general symptoms as shiftwork adaptation indicators. Biomarkers of inflammation, heart rate variability, and cardiometabolic risk were then compared between shiftwork adaptation groups, and with officers working day shifts, after adjusting for confounding. When analyses included police-specific symptoms, maladapted shiftworkers (n = 73) had more self-reported stress, sleep disturbances, fatigue, and less social support than adapted shiftworkers (n = 169). Using more general symptoms, maladapted officers (n = 56) reported more stress and depression, and less social support than adapted officers (n = 186). In police-specific models, adjusted (least-squares) means (± standard error) of circulating interleukin-6 (IL-6) concentrations in maladapted officers (0.8 ± 0.1 ln[pg/ml]) were modestly elevated relative to adapted shiftworkers (0.7 ± 0.1 ln[pg/ml], p = .09) and relative to permanent day workers (0.5 ± 0.1 ln[pg/ml], p ≤ 0.01), and leptin levels in maladapted officers (9.6 ± 0.1 ln[pg/ml]) exceeded those in the adapted (9.4 ± 0.1 ln[pg/ml], p ≤ 0.01) and day shift groups (9.4 ± 0.1 ln[pg/ml], p = .03). In the general model, adjusted mean tumor necrosis factor-alpha (TNF-α) concentrations among maladapted officers (5.6 ± 0.23 pg/ml) exceeded the adapted (4.8 ± 0.2 pg/ml, p ≤ 0.01) and day workers (5.0 ± 0.2 pg/ml, p = .04), and insulin among maladapted officers was higher (2.4 ± 0.1 ln[uu/ml]) than the adapted group (1.8 ± 0.1 ln[uu/ml], p = .03). No differences were observed for the other biomarkers. The results suggest that maladaptation among police officers working fixed night shifts may lead to increases in leptin, insulin, IL-6, and TNF-α; however, the cross-sectional design and possible residual confounding preclude interpretation of cause and effect. Prospective studies are planned to further characterize the relationship between shiftwork maladaptation and biomarkers of chronic disease risk in this police officer cohort.

Cardiorespiratory Fitness Is Associated with a Reduced Cardiovascular Risk in Occupational Groups with Different Working Conditions: A Cross-Sectional Study among Police Officers and Office Workers

Several studies reported a high prevalence of cardiovascular risk factors among police officers and office workers, and adequate cardiorespiratory fitness was reported to have protective effects in reducing cardiovascular risk. Therefore, the present study aimed to evaluate the effects of cardiorespiratory fitness on reducing cardiovascular risk factors in these occupational groups. This cross-sectional study enrolled 101 male participants (55 police officers and 46 office workers). Cardiorespiratory fitness was assessed via spiroergometry. Cardiovascular risk factors were also examined, and the 10-year cardiovascular risk and heart/vascular age were reported using the Framingham risk score. In both groups, higher cardiorespiratory fitness was associated with lower cardiovascular risk factors. Police officers and office workers with higher cardiorespiratory fitness demonstrated significantly lower values in BMI, waist circumference, body fat percentage, diastolic resting blood pressure, heart rate, triglycerides and total cholesterol values, and 10-year cardiovascular risk and heart/vascular age (all factors p < 0.0077, age adjusted). Police officers and office workers mostly presented low levels of cardiorespiratory fitness: 60% of police officers and 58% of office workers were considered “not fit and obese”. Despite different working conditions, both occupational groups had a high rate of low cardiorespiratory fitness levels and showed no differences in their cardiovascular risk profiles. In both groups, cardiorespiratory fitness reduced cardiovascular risk factors, but there was no difference in the influence of cardiorespiratory fitness on cardiovascular risk factors.

The Effects of Hydro-Alcoholic Extract of Fenugreek Seeds on the Lipid Profile and Oxidative Stress in Fructose-Fed Rats

Background

Metabolic syndrome (MetS) is a complex clinical disorder that can lead to an increase in oxidative stress. Patients with this syndrome are at risk of diabetes and cardiovascular disease. The Trigonella foenum-graecum L. (fenugreek) plant has many therapeutic effects, including anti-diabetic and antioxidant. The present study aimed to investigate the effects of the hydro-alcoholic extract of fenugreek seeds (HEFS) on dyslipidemia and oxidative stress due to high-fructose diet-induced MetS.

Methods

In this experimental study, to induce MetS, animals received water containing 20% fructose for 8 weeks. After induction of MetS, 48 male Wistar rats (200?250 g) were randomized into six groups. HEFS was administered to animals at doses of 100 and 200 mg/kg orally for 4 weeks. Animal blood samples were collected to measure biochemical and antioxidant parameters of fasting plasma glucose (FPG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), malondialdehyde (MDA), glutathione peroxidase (GPX), catalase (CAT), and total antioxidant capacity (TAC).

Results

The findings showed that the serum levels of FPG, TC, LDL-C, TG, and MDA were significantly reduced in HEFS-exposed groups compared with the control group (P<0.05). Also, significant increases in HDL-C, GPX, CAT, and TAC levels (P<0.05) were observed.

Conclusion

Our results revealed that treatment with HEFS increases the levels of antioxidant enzymes, decreases FPG level, and at the same time, modifies the lipid profile in MetS. Therefore, HEFS may help to alleviate the risk of some chronic complications of this disease.