Association of the metabolic syndrome with mortality and major adverse cardiac events: A large chronic kidney disease cohort

Risk stratification of metabolic disorder-associated kidney disease

During the last 20 years, the disease burden attributable to metabolic disorders increased by 49.4%. Metabolic disorders are established risk factors for both chronic kidney disease (CKD) and cardiovascular disease (CVD). A concept of cardiovascular-kidney-metabolic (CKM) syndrome has recently been proposed to underscore the pathophysiological interrelatedness of the metabolic risk factors, CKD, and CVD. Two major adverse outcomes of the metabolic disorder-associated kidney disease are cardiovascular disease and, to a less extent, kidney failure. This review aims to briefly summarize the traditional metabolic risk factors for kidney disease; to introduce the concept of CKM health; to present the methods for risk assessment for CKD progression and CVD, with focus on validated and clinically applicable prediction tools; and to discuss the key gaps in the current tools for the risk stratification. In summary, in general clinical settings, the CKM health and associated risk in patients with the metabolic disorder-associated kidney disease can be assessed by combining the CKM staging model, the CKD Prognosis Consortium equations for CKD progression, and the Predicting Risk of CVD Events (PREVENT) equations for CVD. More efficient risk prediction tools, potentially incorporating multimodal data, are needed for more accurate and early identification of individuals at high risk and better personalized management of the disease.

Dynamic changes in metabolic syndrome components and chronic kidney disease risk: a population-based prospective cohort study

OBJECTIVE

To investigate the relationships between dynamic changes in metabolic syndrome (MetS) components and chronic kidney disease (CKD) risk.

METHODS

Data from the UK Biobank, including baseline assessments from 2006 to 2010, repeat assessments in 2012-2013, and linked national health records, were analyzed. MetS components consisted of abdominal obesity, elevated blood pressure (BP), fasting blood glucose (FBG), serum uric acid (SUA), and lipid abnormalities. The Kaplan-Meier method and log-rank test were used to analyze CKD incidence and group differences. Cox regression models assessed the association between dynamic changes in MetS components and CKD risk.

RESULTS

The study enrolled 455,060 participants (45.7% male, 18.4% aged 65 years or older) with a median follow-up of 12.68 years. Those with MetS had a significantly higher 10-year CKD cumulative incidence probability of CKD than those without MetS (4.14% VS 1.14%). Multivariate analysis showed all baseline metabolic abnormalities were linked to CKD risk with HRs from 1.40(1.35-1.45) to 1.85 (1.78-1.92), and MetS strongly associated with CKD (HR: 2.31). CKD risk rose with more MetS components and progression stages. Notably, with FBG being the exception, the four MetS components that shifted from normal at baseline to abnormal at follow - up were associated with elevated CKD risk, with HRs (95% CI) ranging from 1.21 (1.00-1.48) to 1.73 (1.34-2.24). Participants with high baseline SUA, even if it normalized at follow - up, still faced a 1.30 - fold higher CKD risk (95% CI: 1.25-1.35), distinct from other components. For those developing one and ≥ 2 new MetS components at follow - up, the CKD risk HRs (95% CI) were 1.49 (1.00-2.35) and 2.26 (1.21-4.24) respectively.

CONCLUSION

MetS and its component changes are significantly associated with CKD risk, in a dose - response pattern. Incorporating SUA into MetS assessments enhances risk identification, especially noting females' higher susceptibility to elevated SUA. Dynamic monitoring of MetS components is crucial for assessing and predicting CKD risk.

CLINICAL TRIAL NUMBER

Not applicable.

Role of CD33 basophils in mediating the effect of lipidome on chronic kidney disease: A 2-sample, 2-variable, bidirectional Mendelian randomization analysis

This study aimed to investigate the causal relationship between lipidomes and chronic kidney disease (CKD) and identify and quantify the role of immune cells as a potential mediator. Using summary-level data from a genome-wide association study, a 2-sample Mendelian randomization (MR) analysis of genetically predicted lipidomes (7174 cases) and CKD (406,745 cases) was performed. Furthermore, we used 2-step MR to quantitate the proportion of the effect of immune cells traits-mediated lipidomes on CKD. The MR analysis revealed a causal relationship between lipidomes and CKD, with different lipidomes either increasing or decreasing the risk of CKD. Immune cells may serve as intermediaries in the pathway from lipidomes to CKD. Our study indicates that CD33 on basophils accounts for 3.23% of the reduced risk associated with triacylglycerol (53:3) levels in CKD. In conclusion, our study has identified a causal relationship between lipidomes and CKD, as well as the mediating role of CD33 on basophils. However, other risk factors like potential mediators require further investigation. In clinical practice, particular attention should be paid to lipidomic changes, especially triacylglycerol, in patients with CKD.

Association between dietary inflammatory index and cardiovascular-kidney-metabolic syndrome risk: a cross-sectional study

BACKGROUND

Dietary inflammation has been linked to various diseases. The dietary inflammatory index (DII) is a tool used to assess the inflammatory potential of a diet. The aim of this study was to explore the relationship between the DII and the risk of developing cardiovascular-kidney-metabolic syndrome (CKMS) in a U.S.

POPULATION

METHODS

Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2020, which included 24,071 participants, were analyzed. CKMS was defined as the coexistence of cardiometabolic syndrome (CMS) and chronic kidney disease (CKD). The DII was calculated on the basis of the anti-inflammatory and pro-inflammatory scores of foods and nutrients. Weighted multivariable logistic regression models were used to estimate the associations between the DII and the risk of developing CKMS. Restricted cubic spline (RCS) regression was conducted to test nonlinear relationships. Subgroup analyses were performed by sex, age, race, smoking status, and alcohol consumption status.

RESULTS

After adjusting for confounders, compared with those of the lowest quartile of the DII, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for higher DII quartiles were 1.17 (0.93-1.47), 1.43 (1.13-1.81), and 1.76 (1.42-2.18), respectively. Each one-unit increase in the DII was associated with a 12% greater risk of developing CKMS (OR: 1.12, 95% CI: [1.08, 1.18]). RCS regression indicated a significant nonlinear positive association between the DII and the risk of developing CKMS.

CONCLUSIONS

This study revealed a nonlinear positive association between the DII and the risk of developing CKMS in the U.S.

POPULATION

Further longitudinal studies are needed to establish causality and explore the underlying biological mechanisms involved.

Associations of metabolic variabilities and cardiovascular outcomes according to estimated glomerular filtration rate in chronic kidney disease: a nationwide observational cohort study

BACKGROUND

The impact of baseline estimated glomerular filtration rate (eGFR) on the risk of adverse outcomes according to metabolic parameter variabilities in chronic kidney disease has rarely been investigated.

METHODS

We conducted a retrospective nationwide cohort study using the National Health Insurance System data in Korea from 2007 to 2013 to identify individuals with three or more health screenings. The metabolic components variability was defined as intraindividual variability between measurements using the variability independent of the mean. The metabolic variability score was defined as the total number of high-variability metabolic components. Multivariable-adjusted Cox regression analysis was conducted to evaluate the risks of all-cause mortality, myocardial infarction, and ischemic stroke.

RESULTS

During a mean follow-up of 6.0 ± 0.7 years, 223,531 deaths, 107,140 myocardial infarctions, and 116,182 ischemic strokes were identified in 9,971,562 patients. Low eGFR categories and higher metabolic variability scores were associated with a higher risk of adverse outcomes. The degree of association between metabolic variability and adverse outcomes was significantly larger in those with low eGFR categories than in those with preserved eGFR (p for interaction < 0.001). Representatively, those with high metabolic variability in the eGFR of <15 mL/min/1.73 m2 group showed a prominently higher risk for all-cause mortality (adjusted hazard ratio [aHR], 5.28; 95% confidence interval [CI], 4.02-6.94) when the degree was compared to the findings in those with preserved (eGFR of ≥60 mL/min/1.73 m2) kidney function (aHR, 2.55; 95% CI, 2.41-2.69).

CONCLUSION

The degree of adverse association between metabolic variability and poor prognosis is accentuated in patients with impaired kidney function.

Metabolic syndrome including both elevated blood pressure and elevated fasting plasma glucose is associated with higher mortality risk: a prospective study

BACKGROUND

Metabolic syndrome (MetS) encompasses a collection of metabolic abnormalities. This study aims to determine which combination of MetS components has the highest mortality risk, and to investigate the causal relationships between MetS components and longevity.

METHODS

Prospective analyses were conducted on 340,196 participants from the MJ cohort at baseline, and 121,936 participants had follow-up MetS information. We defined MetS according to the NCEP ATP III criteria. The study's outcomes included mortality from cardiovascular disease (CVD), cancer, and all causes combined. We employed Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals. Multivariable Mendelian randomization (MVMR) was employed to infer causality using the genetic data of MetS components and longevity.

RESULTS

Elevated blood pressure (BP) was the initial split for all-cause mortality, cancer mortality, and CVD mortality. Participants with MetS, especially those with elevated BP and elevated fasting plasma glucose (FPG), had higher mortality risks than those with other types of MetS. In the MJ cohort, participants with elevated BP and FPG (BG-type MetS) had a 44% (HR = 1.44, 95% CI = 1.37-1.51), 73% (HR = 1.73, 95% CI = 1.62-1.84), and 34% (HR = 1.34, 95% CI = 1.27-1.42) increased risk of all-cause mortality, cancer mortality, and CVD mortality, respectively, compared with non-BG-type MetS (12%, 24%, 5%). The highest mortality rate and mortality risk were observed in participants with BG-type MetS at baseline and follow-up (mortality rate/1000 person years = 9.73, 95% CI = 8.81-10.74; HR = 1.52, 95% CI = 1.35-1.72). SBP and FPG increases that were genetically proxied to a 1-standard deviation higher level decreased the probabilities of living to the 90th percentile age by 41% (OR = 0.59, 95% CI = 0.40-0.86) and 32% (OR = 0.68, 95% CI = 0.48-0.98) in MVMR, respectively.

CONCLUSIONS

Individuals with BG-type MetS are at a higher risk of death than those with other types of MetS. Therefore, these individuals should be targeted to improve MetS outcomes.

Association between visceral fat area and metabolic syndrome in individuals with normal body weight: insights from a Chinese health screening dataset

BACKGROUND

Metabolic syndrome (MetS) is increasingly diagnosed in individuals with normal body weight, and visceral fat emerges as a significant risk factor. However, the relationship between visceral fat area (VFA) and MetS within this population remains inadequately explored, and the diagnostic threshold for MetS in normal-weight individuals is yet to be established.

METHODS

This study used a cross-sectional design combined with longitudinal cohort analysis. Data were collected from 5,944 normal-weight participants who underwent health screenings at Henan Provincial People's Hospital of China between October 2018 and October 2024. VFA was measured via multislice computed tomography scanning, and VFA-based tertile categorization was applied among the participants. The relationship between VFA and MetS was examined using univariate and multivariate logistic regression analyses. Nonlinear relationship was investigated by restricted cubic spline (RCS) modeling, and diagnostic accuracy was determined by receiver operating characteristic (ROC) curve analysis. Furthermore, data from individuals who completed three or more screenings were used to construct Kaplan-Meier survival curves for MetS events, with significance tested using the log-rank method.

RESULTS

Among the individuals with a normal BMI, elevated VFA was associated with a high incidence of MetS. After the adjustment for confounders, VFA was significantly associated with MetS risk [odds ratio (OR) = 1.13, 95% confidence interval (CI): 1.12-1.25]. The subjects in the highest VFA tertile showed significantly elevated MetS risk (OR = 30.33; 95% CI: 19.00-48.43, P < 0.001) versus those in the lowest tertile. The RCS model demonstrated a nonlinear, positive association between VFA and MetS risk (P for nonlinearity < 0.001), with risk escalation slowing down when the VFA exceeded 100 cm². ROC analysis showed that VFA had the highest diagnostic accuracy for MetS compared with other abdominal fat measures (AUC = 0.844, sensitivity = 0.839, specificity = 0.793, and accuracy = 0.785). In a longitudinal subset of 398 normal-weight participants followed for 6 years, 106 MetS cases occurred, with cumulative incidence rising as VFA increased (log-rank test, P < 0.001).

CONCLUSION

VFA shows an independent, nonlinear, positive association with MetS risk among normal-weight individuals, with a threshold effect at 100 cm². VFA = 162.85 cm² may serve as an accurate and effective predictor for MetS in this population.

Association of estimated glucose disposal rate with metabolic syndrome prevalence and mortality risks: a population-based study

BACKGROUND

Insulin resistance (IR) is a central pathophysiological factor in metabolic syndrome (MetS) and an essential driver of cardiovascular disease (CVD) and mortality. The estimated glucose disposal rate (eGDR) is a reliable marker of IR and has been associated with CVD prognosis. This study aims to examine the relationship between eGDR, MetS, and their predictive roles in clinical outcomes.

METHODS

Data from the NHANES (2001-2018) were utilized, with a cross-sectional design applied to evaluate the association between eGDR and MetS prevalence, and a cohort design employed for mortality follow-up. Weighted logistic regression models were used to examine the association between eGDR and MetS. Weighted Cox proportional hazard models were applied to assess the link between eGDR and both all-cause and CVD mortality. To examine the non-linear associations between the eGDR, MetS, and mortality outcomes, restricted cubic spline (RCS) analysis was applied. Additionally, the predictive performance of eGDR, and other IR indices (TyG, HOMA-IR), for mortality was assessed using the C-statistic.

RESULTS

A robust negative association between eGDR and MetS prevalence was found, following full covariate adjustment (p < 0.001). The core findings were consistent across subgroups (all p < 0.001). Cox regression analysis indicated that in individuals with MetS, each standard deviation (SD) increment in eGDR was associated with an 11% and 18% decrement in the risk of all-cause and CVD mortality, respectively. RCS analysis displayed a non-linear association between eGDR and MetS prevalence, while a linear association between eGDR and mortality. The C-statistic showed that eGDR, compared to the TyG index and HOMA-IR, significantly improved predictive power for all-cause mortality (p = 0.007).

CONCLUSION

eGDR is strongly associated with MetS and predicts all-cause and CVD mortality in individuals with MetS. Compared to TyG and HOMA-IR, eGDR offers superior predictive value for all-cause mortality, highlighting its potential as a useful tool in clinical risk assessment.

The association between handgrip strength and metabolic syndrome: A large prospective Chinese cohort study

OBJECTIVES

Many studies have explored the association between handgrip strength and metabolic syndrome; however, the findings are inconsistent due to the different types of indicators used to assess handgrip strength (absolute vs. relative handgrip strength). This prospective cohort study aimed to simultaneously investigate the associations of both absolute and relative handgrip strength with metabolic syndrome, and to compare the predictive abilities of these two measures among Chinese adults.

METHODS

Cox proportional hazards regression models were used to analyze 15,820 participants (49.7 % men) living in Tianjin, China. Handgrip strength was measured using a handheld dynamometer. Relative handgrip strength was normalized to body weight (kg).

RESULTS

During the 6-year follow-up, there were 3385 incident cases of metabolic syndrome. The fully adjusted hazards ratios (95 % confidence interval) of the incidence of metabolic syndrome for increasing quartiles of relative handgrip strength were: 1.000 (reference), 0.871(0.780, 0.973), 0.675(0.602, 0.757), 0.454(0.401, 0.513) in men and 1.000 (reference), 0.830(0.714, 0.966), 0.561(0.471, 0.668), and 0.369(0.301, 0.452) in women (both P for trend <0.0001). The optimal cut-off of relative handgrip strength to predict incident metabolic syndrome was 0.563 kg/kg in men (sensitivity = 64.3 %, specificity = 55.6 %) and 0.436 kg/kg in women (sensitivity = 57.0 %, specificity = 69.3 %).

CONCLUSIONS

This large cohort study showed that higher relative handgrip strength, but not absolute handgrip strength, was associated with a lower risk of metabolic syndrome. Although handgrip strength may not be highly sensitive in screening for metabolic syndrome, it remains a valuable predictive tool due to its convenience, ease of measurement, and cost-effectiveness.

Roles of serum uric acid on the association between arsenic exposure and incident metabolic syndrome in an older Chinese population

Growing evidences showed that heavy metals exposure may be associated with metabolic diseases. Nevertheless, the mechanism underlying arsenic (As) exposure and metabolic syndrome (MetS) risk has not been fully elucidated. So we aimed to prospectively investigate the role of serum uric acid (SUA) on the association between blood As exposure and incident MetS. A sample of 1045 older participants in a community in China was analyzed. We determined As at baseline and SUA concentration at follow-up in the Yiwu Elderly Cohort. MetS events were defined according to the criteria of the International Diabetes Federation (IDF). Generalized linear model with log-binominal regression model was applied to estimate the association of As with incident MetS. To investigate the role of SUA in the association between As and MetS, a mediation analysis was conducted. In the fully adjusted log-binominal model, per interquartile range increment of As, the risk of MetS increased 1.25-fold. Compared with the lowest quartile of As, the adjusted relative risk (RR) of MetS in the highest quartile was 1.42 (95% confidence interval, CI: 1.03, 2.00). Additionally, blood As was positively associated with SUA, while SUA had significant association with MetS risk. Further mediation analysis demonstrated that the association of As and MetS risk was mediated by SUA, with the proportion of 15.7%. Our study found higher As was remarkably associated with the elevated risk of MetS in the Chinese older adults population. Mediation analysis indicated that SUA might be a mediator in the association between As exposure and MetS.

Nonlinear relationship between serum Klotho and chronic kidney disease in US adults with metabolic syndrome

Background

Current evidence regarding the effects of serum Klotho among patients with metabolic syndrome (MetS) is scarce. This study explored the relationship between serum Klotho levels and the odds of chronic kidney disease (CKD) in middle-aged and older populations with MetS.

Materials and methods

This cross-sectional study analyzed data from 4870 adults aged 40-79 years who participated in the National Health and Nutrition Survey (NHANES) from 2007 to 2016. CKD was identified at urinary albumin to creatinine ratio (UACR) of 30 mg/g or higher and/or an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. Measurement of serum Klotho concentration was determined via enzyme-linked immunosorbent assay (ELISA) and subsequently divided into four quartiles (Q1-Q4). The NHANES criteria were followed in calculating the sampling weights. Multivariable logistic regression models were employed to assess the correlation between Klotho and CKD, while generalized linear models with cubic spline functions and smooth curve fitting were utilized to detect any nonlinear relationship. Additionally, subgroup analysis and a range of sensitivity analyzes were conducted.

Results

Results showed that a nonlinear L-shaped relationship existed between serum Klotho levels and CKD risk, with the lowest prevalence observed at 9.63-9.94 pg/mL Klotho concentrations. With a two-segment linear regression model, an inflection point of 9.88 pg/mL was noted. Hypertension status was identified as an interaction mediator (P interaction = 0.006). Sensitivity analysis showed stable results.

Conclusions

A nonlinear L-shaped relationship exists between serum Klotho levels and risks of CKD among middle-aged and older adults with MetS, with the lowest prevalence observed at 9.63 to 9.94 pg/mL Klotho concentrations. Our findings, if replicated, underscore the need to estimate the optimal serum Klotho concentrations and the consequential inverse relationship, thus implying the potential of Klotho as both a serum biomarker and a possible preventive or therapeutic intervention.

Association of insulin resistance with chronic kidney disease in individuals without diabetes in a community population in South China

BACKGROUND

To explore the relationship of insulin resistance (IR) with chronic kidney disease (CKD) in individuals without diabetes.

METHODS

We performed a cross-sectional survey among 2142 community-based participants without diabetes from southern China from June to October 2012 and excluded the incomplete data. We divided all the participants into four groups according to the quartiles of homeostasis model assessment of IR (HOMA-IR). Logistic regression models were used to explore the associations of IR with CKD in these subjects.

RESULTS

In the unadjusted model, compared with the quartile one group, IR was significantly associated with CKD (odds ratio [OR] = 2.24, P < 0.001; OR = 4.46, P < 0.001) in the quartile three and four groups, and the association was still significant (OR = 2.08, P = 0.005; OR = 3.89, P < 0.001 ) after adjusting for potential confounders (including age, current smoker, current alcohol use, physical inactivity, education level, systolic blood pressure, diastolic blood pressure, serum triglyceride, and body mass index). The area under the receiver operating characteristic curve (95% confidence interval) of HOMA-IR for diagnosing CKD was 0.67 (0.64, 0.71). The cut-off value was 2.5, the sensitivity was 75.2%, and the specificity was 56.4%.

CONCLUSIONS

IR is associated with Chronic Kidney Disease (CKD) in participants without diabetes. It has been proposed that CKD patients may benefit from reducing their insulin resistance.

Metabolic Syndrome and Socioeconomic Status in Association with Chronic Kidney Disease: A Cross-Sectional Study in Ningbo, China

Background

Metabolic syndrome (MS) and low socioeconomic status (SES) may increase the risk for chronic kidney disease (CKD). This study aimed to investigate the prevalence of MS and CKD and the association between MS, SES, and CKD among adults in Ningbo, a city in Eastern China.

Methods

A cross-sectional survey of 3212 adults was conducted between July 2019 and February 2021 in Ningbo. MS was defined as the presence of three or more risk factors: elevated blood pressure, reduced high-density lipoprotein (HDL) cholesterol, elevated triglycerides, elevated plasma glucose, and abdominal obesity. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or the occurrence of albuminuria. SES was stratified according to personal education and income levels. Multivariate logistic regression was used to analyze the relationships among MS, sociodemographic factors, and CKD.

Results

The age- and sex-adjusted prevalence of CKD was 9.1% (95% CI: 8.3-10.0), the prevalence of eGFR less than 60 mL/min/per 1·73 m² was 2.5% (95% CI 2.0-3.0) and that of albuminuria was 7.9% (95% CI 7.0-8.7), and the adjusted prevalence of MS was 23.1% (95% CI 21.7-24.4). MS components, including elevated blood pressure, elevated fasting glucose, abdominal obesity, elevated serum triglyceride, or reduced serum HDL-C, were independent risk factors for CKD, and the adjusted prevalence of CKD proportionally increased with the number of MS-defined parameters. Participants with MS had 2.43-fold increased odds of developing CKD compared with those without MS. In addition, age, female sex, low SES including low educational level and low income were associated with increased odds of occurrence of albuminuria and CKD.

Conclusion

The prevalence of metabolic syndrome and chronic kidney disease is high among adults in Ningbo. Metabolic syndrome and low socioeconomic status are associated with the high risk of developing chronic kidney disease.

Cystatin C Is a Predictor for Long-Term, All-Cause, and Cardiovascular Mortality in US Adults With Metabolic Syndrome

OBJECTIVE

This study examined the relationship between cystatin C (CysC) levels and all-cause, cardiovascular disease (CVD), and cancer mortality in US metabolic syndrome (MetS) patients.

METHODS

The 1999-2002 National Health and Nutrition Examination Survey (NHANES) prospective cohort research included 1980 MetS participants. To assess CysC levels and all-cause, CVD, and cancer mortality, fitted curves, Kaplan-Meier survival curves, Cox regression analysis, and receiver operating characteristic curves were performed.

RESULTS

During a mean follow-up of 15.3 ± 5.4 years, a total of 819 deaths occurred. The fitted and Kaplan-Meier survival curves revealed that greater CysC levels were linked to higher all-cause, CVD, and cancer mortality rates (P < .05). After adjusting for variables, CysC level was associated with all-cause, CVD, and cancer mortality at 1.63 (1.42-1.88), 1.53 (1.19-1.95), and 1.53 (1 ∼ 2.32), respectively (P < .05). Tertile models showed consistent results: high CysC Tertile participants showed higher risk of all-cause mortality (HR 1.87; 1.43-2.45), CVD mortality (HR 1.97, 1.15 ∼ 3.38), and cancer mortality (HR 1.72, 1.01 ∼ 2.91) compared to those in the lowest tertile (P < .05). Subgroup studies by sex and other characteristics confirmed the findings. CysC demonstrated the higher predictive efficacy across mortality outcomes, followed by eGFR, outperforming urea nitrogen, creatinine, uric acid, and C-reactive protein. CysC alone exhibited substantial predictive value for all-cause (AUC 0.773; P < .05) and CVD mortality (AUC 0.726; P < .05). Combining CysC with age enhanced predictive value for all-cause mortality to 0.861 and CVD mortality to 0.771 (P < .05).

CONCLUSION

MetS patients with elevated CysC levels have a higher risk of all-cause, CVD, and cancer death. CysC may predict MetS all-cause and CVD mortality.

Comparison of Incidence of Metabolic Syndrome and Five Obesity- and Lipid-Linked Indicators for Predicting Metabolic Syndrome Among Normal-Weight and Overweight Adults

Purpose

Metabolic syndrome (MetS) is an increasingly prevalent issue in China's public health landscape. Few studies have investigated the metabolic syndrome (MetS) in overweight people. We proposed to analyze and contrast the occurrence of MetS in normal-weight and overweight individuals and identify potential indicators for forecasting MetS in adults in Zhejiang Province.

Methods

This cohort study included 359 adults aged 40-65 years and followed up for five years in Zhejiang Province. The study assessed the predictive capabilities of five indicators linked to obesity and lipid levels, namely body mass index (BMI), waist-to-height ratio (WHtR), triglyceride-glucose index (TyGi), and their combined indices (TyG-BMI, TyG-WHtR). The evaluation was done employing the area under the Receiver Operating Characteristic (ROC) Curve (AUC). DeLong test was applied to compare area under different ROC curves.We evaluated the relationships between five variables and MetS using multivariate logistic regression.

Results

In normal-weight individuals, the five-year cumulative incidence of MetS was 21.85%, but in overweight people, it was 60.33%. After adjusting for confounding factors, BMI, WHtR, TyGi, TyG-BMI, and TyG-WHtR were independently linked to MetS in normal-weight individuals, while BMI, TyGi, TyG-BMI, and TyG-WHtR were independently linked to MetS in overweight individuals. In normal-weight individuals, the WHtR (AUC=0.738 and optimal threshold value =0.469) and TyG-WHtR (AUC=0.731 and optimal threshold value =4.121) had the larger AUC, which was significantly greater than that of the different three indicators. The TyG-BMI (AUC=0.769 and optimal threshold value = 211.099) was the best predictor of MetS in overweight individuals.

Conclusion

The five-year cumulative incidence of MetS in overweight people was approximately triple that of normal-weight people in Zhejiang Province. In the overweight population, the TyG-BMI performed better than the other indices in predicting MetS. WHtR and TyG-WHtR outperformed BMI, TyGi, and TyG-BMI in anticipating MetS in a normal-weight population.

Chemotherapy and Metabolic Syndrome: A Comprehensive Review of Molecular Pathways and Clinical Outcomes

Cancer therapies, notably chemotherapy, have significantly improved survival rates and quality of life for many patients. However, chemotherapy's cytotoxic effects also impact normal cells, leading to adverse effects, including metabolic disturbances. This paper explores the link between chemotherapy and metabolic syndrome, a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases and type 2 diabetes. Understanding the predictors, such as specific chemotherapy regimens, patient characteristics, comorbid conditions, lifestyle factors, and genetic variations, is crucial for formulating personalized care plans and preventive strategies. Research indicates that older age, female gender, pre-existing diabetes, and baseline obesity are significant predictors of metabolic syndrome in cancer patients. Chemotherapy-induced molecular changes, including insulin resistance, dyslipidemia, chronic inflammation, oxidative stress, and tissue fibrosis, contribute to the development of this syndrome. Effective management strategies require a multidisciplinary approach, incorporating lifestyle interventions, pharmacological treatments, and regular monitoring. This paper underscores the importance of personalized medicine in mitigating the risks associated with metabolic syndrome and improving long-term health outcomes for cancer survivors. Future research directions include longitudinal studies to track metabolic health over time, mechanistic studies to uncover the molecular pathways involved, and the development of integrative therapies. By adopting comprehensive care models, healthcare providers can enhance the overall quality of life for cancer survivors, addressing both cancer and metabolic health challenges.

Chronic kidney disease combined with metabolic syndrome is a non-negligible risk factor

Metabolic syndrome (MetS) is a group of conditions characterized by hypertension (HTN), hyperglycaemia or insulin resistance (IR), hyperlipidaemia, and abdominal obesity. MetS is associated with a high incidence of cardiovascular events and mortality and is an independent risk factor for chronic kidney disease (CKD). MetS can cause CKD or accelerate the progression of kidney disease. Recent studies have found that MetS and kidney disease have a cause-and-effect relationship. Patients with CKD, those undergoing kidney transplantation, or kidney donors have a significantly higher risk of developing MetS than normal people. The present study reviewed the possible mechanisms of MetS in patients with CKD, including the disorders of glucose and fat metabolism after kidney injury, IR, HTN and the administration of glucocorticoid and calcineurin inhibitors. In addition, this study reviewed the effect of MetS in patients with CKD on important target organs such as the kidney, heart, brain and blood vessels, and the treatment and prevention of CKD combined with MetS. The study aims to provide strategies for the diagnosis, treatment and prevention of CKD in patients with MetS.

Patient Characteristics and Outcomes of Hospitalized Chronic Kidney Disease Patients with and without Type 2 Diabetes Mellitus: Observations from the German Claims Data-Based Cohort of the CaReMe-CKD Multinational Study

Introduction

Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease (CKD) globally. Both conditions substantially worsen patients' prognosis. Current data on German in-hospital CKD cohorts are scarce. The multinational CaReMe study was initiated to evaluate the current epidemiology and healthcare burden of cardiovascular, renal and metabolic diseases. In this substudy, we share real-world data on CKD inpatients stratified for coexisting T2DM derived from a large German hospital network.

Methods

This study used administrative data of inpatient cases from 89 Helios hospitals from 01/01/2016 to 28/02/2022. Data were extracted from ICD-10-encoded discharge diagnoses and OPS-encoded procedures. The first case meeting a previously developed CKD definition (defined by ICD-10- and OPS-codes) was considered the index case for a particular patient. Subsequent hospitalizations were analysed for readmission statistics. Patient characteristics and pre-defined endpoints were stratified for T2DM at index case.

Results

In total, 48,011 patients with CKD were included in the present analysis (mean age ± standard deviation, 73.8 ± 13.1 years; female, 44%) of whom 47.9% had co-existing T2DM. Patients with T2DM were older (75 ± 10.6 vs 72.7 ± 14.9 years, p < 0.001), but gender distribution was similar to patients without T2DM. The burden of cardiovascular disease was increased in patients with T2DM, and index and follow-up in-hospital mortality rates were higher. Non-T2DM patients were characterised by more advanced CKD at baseline. Patients with T2DM had consistently higher readmission numbers for all events of interest, except for readmissions due to kidney failure/dialysis, which were more common in non-T2DM patients.

Conclusion

In this study, we present recent data on hospitalized patients with CKD in Germany. In this CKD cohort, nearly half had T2DM, which substantially affected cardiovascular disease burden, rehospitalization frequency and mortality. Interestingly, non-diabetic patients had more advanced underlying renal disease, which affected renal outcomes.

Single high-dose intravenous injection of Wharton's jelly-derived mesenchymal stem cell exerts protective effects in a rat model of metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS) is a significant epidemiological problem worldwide. It is a pre-morbid, chronic and low-grade inflammatory disorder that precedes many chronic diseases. Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) could be used to treat MetS because they express high regenerative capacity, strong immunomodulatory properties and allogeneic biocompatibility. This study aims to investigate WJ-MSCs as a therapy against MetS in a rat model.

METHODS

Twenty-four animals were fed with high-fat high-fructose (HFHF) diet ad libitum. After 16 weeks, the animals were randomised into treatment groups (n = 8/group) and received a single intravenous administration of vehicle, that is, 3 × 106 cells/kg or 10 × 106 cells/kg of WJ-MSCs. A healthy animal group (n = 6) fed with a normal diet received the same vehicle as the control (CTRL). All animals were periodically assessed (every 4 weeks) for physical measurements, serum biochemistry, glucose tolerance test, cardiovascular function test and whole-body composition. Post-euthanasia, organs were weighed and processed for histopathology. Serum was collected for C-reactive protein and inflammatory cytokine assay.

RESULTS

The results between HFHF-treated groups and healthy or HFHF-CTRL did not achieve statistical significance (α = 0.05). The effects of WJ-MSCs were masked by the manifestation of different disease subclusters and continuous supplementation of HFHF diet. Based on secondary analysis, WJ-MSCs had major implications in improving cardiopulmonary morbidities. The lungs, liver and heart show significantly better histopathology in the WJ-MSC-treated groups than in the untreated CTRL group. The cells produced a dose-dependent effect (high dose lasted until week 8) in preventing further metabolic decay in MetS animals.

CONCLUSIONS

The establishment of safety and therapeutic proof-of-concept encourages further studies by improving the current therapeutic model.

Causal effects of sleep traits on metabolic syndrome and its components: a Mendelian randomization study

PURPOSE

Previous observational studies have suggested an association between sleep disturbance and metabolic syndrome (MetS). However, it remains unclear whether this association is causal. This study aims to investigate the causal effects of sleep-related traits on MetS using Mendelian randomization (MR).

METHODS

Single-nucleotide polymorphisms strongly associated with daytime napping, insomnia, chronotype, short sleep, and long sleep were selected as genetic instruments from the corresponding genome-wide association studies (GWAS). Summary-level data for MetS were obtained from two independent GWAS datasets. Univariable and multivariable MR analyses were conducted to investigate and verify the causal effects of sleep traits on MetS.

RESULTS

The univariable MR analysis demonstrated that genetically predicted daytime napping and insomnia were associated with increased risk of MetS in both discovery dataset (OR daytime napping = 1.630, 95% CI 1.273, 2.086; OR insomnia = 1.155, 95% CI 1.108, 1.204) and replication dataset (OR daytime napping = 1.325, 95% CI 1.131, 1.551; OR insomnia = 1.072, 95% CI 1.046, 1.099). For components, daytime napping was positively associated with triglycerides (beta = 0.383, 95% CI 0.160, 0.607) and waist circumference (beta = 0.383, 95% CI 0.184, 0.583). Insomnia was positively associated with hypertension (OR = 1.101, 95% CI 1.042, 1.162) and waist circumference (beta = 0.067, 95% CI 0.031, 0.104). The multivariable MR analysis indicated that the adverse effect of daytime napping and insomnia on MetS persisted after adjusting for BMI, smoking, drinking, and another sleep trait.

CONCLUSION

Our study supported daytime napping and insomnia were potential causal factors for MetS characterized by central obesity, hypertension, or elevated triglycerides.

Machine learning model for cardiovascular disease prediction in patients with chronic kidney disease

Introduction

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). This study aimed to develop CVD risk prediction models using machine learning to support clinical decision making and improve patient prognosis.

Methods

Electronic medical records from patients with CKD at a single center from 2015 to 2020 were used to develop machine learning models for the prediction of CVD. Least absolute shrinkage and selection operator (LASSO) regression was used to select important features predicting the risk of developing CVD. Seven machine learning classification algorithms were used to build models, which were evaluated by receiver operating characteristic curves, accuracy, sensitivity, specificity, and F1-score, and Shapley Additive explanations was used to interpret the model results. CVD was defined as composite cardiovascular events including coronary heart disease (coronary artery disease, myocardial infarction, angina pectoris, and coronary artery revascularization), cerebrovascular disease (hemorrhagic stroke and ischemic stroke), deaths from all causes (cardiovascular deaths, non-cardiovascular deaths, unknown cause of death), congestive heart failure, and peripheral artery disease (aortic aneurysm, aortic or other peripheral arterial revascularization). A cardiovascular event was a composite outcome of multiple cardiovascular events, as determined by reviewing medical records.

Results

This study included 8,894 patients with CKD, with a composite CVD event incidence of 25.9%; a total of 2,304 patients reached this outcome. LASSO regression identified eight important features for predicting the risk of CKD developing into CVD: age, history of hypertension, sex, antiplatelet drugs, high-density lipoprotein, sodium ions, 24-h urinary protein, and estimated glomerular filtration rate. The model developed using Extreme Gradient Boosting in the test set had an area under the curve of 0.89, outperforming the other models, indicating that it had the best CVD predictive performance.

Conclusion

This study established a CVD risk prediction model for patients with CKD, based on routine clinical diagnostic and treatment data, with good predictive accuracy. This model is expected to provide a scientific basis for the management and treatment of patients with CKD.

Impact of Age 70 years or Older on Donors for Living-Donor Kidney Transplantation

Introduction

Kidney transplantation (KT) involving elderly living kidney donors (LKDs) is becoming more frequent because of a profound organ shortage. The efficacy of KT involving grafts obtained from LKDs aged 70 years or older has been reported. However, the safety of donor nephrectomy in LKDs aged 70 years or older, including that associated with changes in the estimated glomerular filtration rate (eGFR), has not been investigated. This study investigated the outcomes of LKDs aged 70 years or older after donor nephrectomy.

Methods

This single-center, retrospective cohort study included 1226 LKDs who underwent donor nephrectomy between January 2008 and December 2020. LKDs were stratified into the following age groups: 30 to 49 years (244 LKDs), 50 to 69 years (803 LKDs), and 70 to 89 years (179 LKDs). Surgical outcomes, postoperative eGFR changes, end-stage renal disease (ESRD) rates, and mortality rates were compared among these groups.

Results

No significant difference in surgical outcomes was identified among the groups. LKDs aged 70 to 89 years experienced the lowest eGFR changes at all time points and the lowest eGFR improvement; however, ESRD was not identified in any group during the observation period. Mortality was the highest among LKDs aged 70 to 89 years compared to the other age groups.

Conclusion

Surgical outcomes, eGFR changes, and ESRD incidences can support the safety of donor nephrectomy in LKDs aged 70 years or older. Considering the advanced age, the high mortality rates in LKDs aged 70 years or older could be considered acceptable.

Diagnostic Accuracy of Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Identifying Metabolic Syndrome and Its Components in Older Adults: A Systematic Review and Meta-Analysis

Background

Although numerous studies have indicated the utility of waist-to-height ratio (WHtR) in early screening for individuals with adverse cardiometabolic health, there is controversy on using WHtR as a one-size-fits-all approach, including in older adults.

Objectives

Our study aims to identify the pooled diagnostic accuracy of WHtR in screening for metabolic syndrome (MetS) and its components among older adults.

Methods

A systematic review of observational studies was performed using 4 databases. A diagnostic meta-analysis with a random effects model was conducted, and the pooled area under the summary receiver operating characteristic curve, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (dOR) of each outcome compared with WHtR, body mass index (BMI), and waist circumference (WC) were calculated, with sex-stratified analysis.

Results

A total of 17 studies with 74,520 participants were included. As reflected by the dOR, WHtR (7.65; 95% CI: 6.00, 9.75) performed better than BMI (5.17; 95% CI: 4.75, 5.62) and WC (5.77; 95% CI: 4.60, 7.25) in screening for MetS among older adults and was potentially better among males. For hyperglycemia, hypertension, and dyslipidemia, the performances of WHtR, BMI, and WC were comparable.

Conclusion

More studies focusing on older adults are still needed to determine the cutoff values of WHtR to screen for MetS.The search strategy was registered in PROSPERO as CRD42022350379.

17-year follow-up of association between telomere length and all-cause mortality, cardiovascular mortality in individuals with metabolic syndrome: results from the NHANES database prospective cohort study

BACKGROUND

The relationship between leukocyte telomere length (LTL) and mortality risk in individuals with metabolic syndrome (MetS) remains poorly understood. This study aimed to investigate the association between telomere length and long-term all-cause mortality, and cardiovascular disease (CVD) mortality, in individuals with MetS in the United States.

METHODS

A total of 1980 participants with MetS aged 18 years or older from the National Health and Nutrition Examination Survey (NHANES) prospective cohort study (1999-2002) were included in this cohort study. Medical records review was used to identify the cause of deaths as of December 2018. We employed Kaplan-Meier curves, fitted curves, and Cox proportional hazards regression models to estimate hazard ratios (HRs) for all-cause and CVD mortality, stratified by tertiles of LTL.

RESULTS

Over a median follow-up of 17.75 years of participants with metabolic syndrome, 819 deaths occurred, including 231 cardiovascular deaths. After adjusting for multiple covariates, participants with shorter telomere length had a significantly higher risk of all-cause mortality (HR, 1.33; 95% CI, 1.11-1.6) and CVD mortality (HR, 1.36; 95% CI, 0.96-1.93) compared with those in the highest tertile of telomere length. All-cause mortality (P < 0.001) and cardiovascular disease mortality (P = 0.028) followed a similar pattern across tertiles of telomere length.

CONCLUSION

In individuals with MetS, shorter telomere length is associated with increased risks of death from cardiovascular disease and all causes. The underlying mechanisms and clinical implications of these findings require additional investigation.

Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study

BACKGROUND

Metabolic syndrome (MetS) is prevalent in patients with end-stage kidney disease, and kidney transplantation is expected to modify the metabolic status. However, whether changes in metabolic status at the time of transplantation affect recipient outcomes remains unclear.

METHODS

We analyzed 4187 recipients registered in a nationwide prospective cohort from 2014 to 2020. MetS was defined as the presence of three or more components of the metabolic syndrome. Patients were classified based on the pre- and post-transplant MetS status: MetS-free, MetS-developed, MetS-recovered and MetS-persistent. Study outcomes were occurrence of death-censored graft loss and a composite of cardiovascular events and death.

RESULTS

Among recipients without pre-transplant MetS, 19.6% (419/2135) developed post-transplant MetS, and MetS disappeared in 38.7% (794/2052) of the recipients with pre-transplant MetS. Among the four groups, the MetS-developed group showed the worst graft survival rate, and the MetS-persistent group had a poorer composite event-free survival rate. Compared with the MetS-free group, the MetS-developed group was associated with an increased risk of graft loss [adjusted hazard ratio (aHR) 2.35; 95% confidence interval (CI) 1.17-4.98] and the risk of graft loss increased with increasing numbers of dysfunctional MetS components. MetS-persistent was associated with increased risks of cardiovascular events and death (aHR 2.46; 95% CI 1.12-5.63), but changes in the number of dysfunctional MetS components was not.

CONCLUSION

Kidney transplantation significantly alters the metabolic status. Newly developed MetS after transplantation was associated with an increased risk of graft loss, whereas persistent MetS exposure before and after transplantation was associated with increased risks cardiovascular events and patient survival.

Research on the relationship between common metabolic syndrome and meteorological factors in Wuhu, a subtropical humid city of China

As climate conditions deteriorate, human health faces a broader range of threats. This study aimed to determine the risk of death from metabolic syndrome (MetS) due to meteorological factors. We collected daily data from 2014 to 2020 in Wuhu City, including meteorological factors, environmental pollutants and death data of common MetS (hypertension, hyperlipidemia and diabetes), as well as a total number of 15,272 MetS deaths. To examine the relationship between meteorological factors, air pollutants, and MetS mortality, we used a generalized additive model (GAM) combined with a distributed delay nonlinear model (DLNM) for time series analysis. The relationship between the above factors and death outcomes was preliminarily evaluated using Spearman analysis and structural equation modeling (SEM). As per out discovery, diurnal temperature range (DTR) and daily mean temperature (T mean) increased the MetS mortality risk notably. The ultra low DTR raised the MetS mortality risk upon the general people, with the highest RR value of 1.033 (95% CI: 1.002, 1.065) at lag day 14. In addition, T mean was also significantly associated with MetS death. The highest risk of ultra low and ultra high T mean occured on the same day (lag 14), RR values were 1.043 (95% CI: 1.010, 1.077) and 1.032 (95% CI: 1.003, 1.061) respectively. Stratified analysis's result showed lower DTR had a more pronounced effect on women and the elderly, and ultra low and high T mean was a risk factor for MetS mortality in women and men. The elderly need to take extra note of temperature changes, and different levels of T mean will increase the risk of death. In warm seasons, ultra high RH and T mean can increase the mortality rate of MetS patients.

Analysis of the association between glomerular filtration rate, proteinuria and metabolic syndrome in chronic kidney patients based on longitudinal data

Chronic kidney disease (CKD) is a group of chronic diseases caused by kidney damage from multiple causes. Metabolic syndrome (MS) manifests as dysfunction of endothelial cells and chronic functional inflammatory states, and may be involved in pathological changes related to renal impairment. Based on longitudinal data analysis of the association between estimated glomerular filtration rate (eGFR), proteinuria and MS in patients with CKD, this study aims to provide new ideas for the pathophysiological mechanism of CKD and a theoretical basis for the early prevention and effective intervention of MS-related kidney damage. A total of 126 patients with CKD were divided into non-MS group and MS group. According to the eGFR level, 126 patients with CKD were divided into G1 group, G2 group, G3a group, G3b group, G4 group and G5 group. Serum markers such as eGFR, urine protein, and triglycerides (TG) were collected. The correlation between eGFR, urine protein and MS-related indexes was analysed, and the risk factors affecting CKD complicated by MS were analysed. In patients with CKD, the levels of urine protein, abdominal circumference, TG, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose (FPG) were increased with the course of the disease, but the levels of eGFR and high density lipoprotein (HDL-C) were decreased (p < 0.05). Abdominal circumference, TG, SBP, DBP, FP were significantly negatively correlated with eGFR, but HDL-C was positively correlated with eGFR (p < 0.05). Diabetes, hyperlipidemia, UA, and SBP were independent risk factors affecting CKD complicated MS, and eGFR were independent protective factors (p < 0.05). The combination of diabetes, hyperlipidemia, UA, SBP, and eGFR exhibited higher prediction value for the CKD patients complicated by MS. There was a certain correlation between between MS components with eGFR and urinary protein in patients with CKD. The early intervention treatment of MS was helpful in delaying the development of CKD and reducing proteinuria.

Associations of perchlorate, nitrate, and thiocyanate with metabolic syndrome and its components among US adults: A cross-sectional study from NHANES

Perchlorate, nitrate and thiocyanate are common endocrine disruptors. Herein, this study was undertaken to evaluate the associations between perchlorate, nitrate, and thiocyanate exposures (alone or in combination) and risk of metabolic syndrome (MetS) among adults, which has not been explored so far. Analytical data were extracted from different datasets in the National Health and Nutrition Examination Survey (NHANES) database. Multivariate logistic regression models were constructed to investigate the associations between perchlorate, nitrate, and thiocyanate exposures, and the prevalence of MetS. Subsequently, odds ratios (OR) and their corresponding 95 % confidence intervals (CIs) were adopted to represent the magnitude of the effect size. We performed a series of subgroup analyses and sensitivity analyses as well. Moreover, three commonly used mixture modeling strategies [Weighted quantile sum (WQS) regression, quantile-based g-computation (Qgcomp), and Bayesian kernel machine regression (BKMR)] were utilized to evaluate the joint mixture effect on MetS. This study included 12,007 participants in the subsequent analyses. After adjustment for confounding factors, higher levels of perchlorate, and thiocyanate concentrations were significantly associated with the risk of MetS (OR = 1.15, 95%CI:1.00, 1.32; OR = 1.21, 95%CI:1.04, 1.41, respectively). Analyses of WQS and Qgcomp showed that a quartile increase in chemical mixture was correlated with the occurrence of MetS with ORs of 1.07 (95%CI: 0.99, 1.16) and 1.07 (95%CI: 1.00, 1.14), respectively. This positive association was mainly driven by perchlorate and thiocyanate. Analysis of BKMR revealed that perchlorate, nitrate, and thiocyanate mixture was positively associated with the risk of MetS while perchlorate, and thiocyanate were major predictors in the mixture. In summary, our study reveals positive relationships between perchlorate, thiocyanate and MetS. Co-exposure to perchlorate, nitrate and thiocyanate is positively associated with the risk of MetS, with perchlorate and thiocyanate contributing the most to the overall mixture effect.

Non-insulin-based insulin resistance indices for predicting all-cause mortality and renal outcomes in patients with stage 1-4 chronic kidney disease: another paradox

Non-insulin-based insulin resistance (IR) indices serve as the indicators of metabolic syndrome (MetS) but have limited value for predicting clinical outcomes. Whether the obesity paradox affects the predictive value of these indicators in patients with chronic kidney disease (CKD) remains unknown. We investigated whether MetS and non-insulin-based IR indices can predict all-cause mortality and renal outcomes in a prospective observational study with stage 1-4 CKD Asians (N = 2,457). These IR indices were associated with MetS. A Cox regression model including body mass index (BMI) revealed an association between MetS and renal outcomes. Among the IR indices, only high triglyceride-glucose (TyG) index was associated with adverse renal outcomes: the hazard ratio of Q4 quartile of the TyG index was 1.38 (1.12-1.70). All-cause mortality was marginally associated with MetS but not high IR indices. Low TyG and TyG-BMI indices as well as low BMI and triglyceride were paradoxically associated with increased risks of clinical outcomes. The triglyceride-to-high-density lipoprotein cholesterol ratio and metabolic score for IR indices were not associated with clinical outcomes. In conclusion, MetS and TyG index predict renal outcome and obesity paradox affects the prediction of IR indices in patients with stage 1-4 CKD.

The eGFR Decline as a Risk Factor for Metabolic Syndrome in the Korean General Population: A Longitudinal Study of Individuals with Normal or Mildly Reduced Kidney Function

Metabolic syndrome (MS) is a risk factor for the development and progression of chronic kidney disease (CKD). However, it is unclear whether decreased renal function affects MS. Through a longitudinal study, we investigated the effect of estimated glomerular filtration rate (eGFR) changes on MS in participants with an eGFR above 60 mL/min/1.73 m2. A cross-sectional (n = 7107) and a 14-year longitudinal study (n = 3869) were conducted to evaluate the association between MS and eGFR changes from the Korean Genome and Epidemiology Study data. The participants were categorized by their eGFR levels (60–75, 75–90, and 90–105 versus ≥ 105 mL/min/1.73 m2). In a cross-sectional analysis, the MS prevalence was significantly increased with a decline in the eGFR in a fully adjusted model. The odds ratio of individuals with an eGFR of 60–75 mL/min/1.73 m2 was observed to be the highest (2.894; 95% confidence interval (CI), 1.984–4.223). In the longitudinal analysis, incident MS significantly increased with an eGFR decline in all the models, with the highest hazard ratio in the lowest eGFR group (1.803; 95% CI, 1.286–2.526). In joint interaction analysis, all covariates showed a significant joint effect with an eGFR decline on the incident MS. MS incidents are associated with eGFR changes in the general population without CKD.

High risk of renal outcome of metabolic syndrome independent of diabetes in patients with CKD stage 1-4: The ICKD database

AIMS

To investigate whether metabolic syndrome (MetS) could predict renal outcome in patients with established chronic kidney disease (CKD).

MATERIALS AND METHODS

We enroled 2500 patients with CKD stage 1-4 from the Integrated CKD care programme, Kaohsiung for delaying Dialysis (ICKD) prospective observational study. 66.9% and 49.2% patients had MetS and diabetes (DM), respectively. We accessed three clinical outcomes, including all-cause mortality, RRT, and 50% decline in estimated glomerular filtration rate events.

RESULTS

The MetS score was positively associated with proteinuria, inflammation, and nutrition markers. In fully adjusted Cox regression, the hazard ratio (HR) (95% confidence interval) of MetS for composite renal outcome (renal replacement therapy, and 50% decline of renal function) in the DM and non-DM subgroups was 1.56 (1.15-2.12) and 1.31 (1.02-1.70), respectively, while that for all-cause mortality was 1.00 (0.71-1.40) and 1.27 (0.92-1.74). Blood pressure is the most important component of MetS for renal outcomes. In the 2 by 2 matrix, compared with the non-DM/non-MetS group, the DM/MetS group (HR: 1.62 (1.31-2.02)) and the non-DM/MetS group (HR: 1.33 (1.05-1.69)) had higher risks for composite renal outcome, whereas the DM/MetS group had higher risk for all-cause mortality (HR: 1.43 (1.09-1.88)).

CONCLUSIONS

MetS could predict renal outcome in patients with CKD stage 1-4 independent of DM.

High Triglyceride-Glucose Index is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up

The triglyceride-glucose (TyG) index is calculated from fasting triglycerides and fasting glucose levels and is an indicator of insulin resistance. The present study investigates whether the TyG index has a role in predicting clinical outcomes in cases of acute coronary syndrome (ACS). This retrospective study included 646 patients with ST-elevation myocardial infarction (STEMI) and 1048 patients with non-ST-elevation myocardial infarction (NSTEMI). The association between major adverse cardiac events (MACEs) that developed in-hospital and at 60 months of follow-up and TyG index values were compared. Patients were divided into 2 groups: TyG index values of ≥8.65 and <8.65. During the hospital stay and 60 months of follow-up, 303 MACEs occurred. In both the STEMI and NSTEMI groups, as the TyG index increased, an increase was observed in MACE rates. MACE rates were also found to be highest in the group with TyG index ≥8.65 (P < .001). TyG index, C-reactive protein, and age were independent predictors of MACEs in both the NSTEMI and STEMI groups. The present study found a significant association between higher TyG index values and increased risk of MACEs in ACS patients. The TyG index may prove useful to predict clinical outcomes in ACS patients.

Metabolic Syndrome and Obesity-Related Indices Are Associated with Rapid Renal Function Decline in a Large Taiwanese Population Follow-Up Study

A rapid decline in renal function can cause many complications, and therefore it is important to detect associated risk factors. Few studies have evaluated the associations among obesity-related indices and metabolic syndrome (MetS) with renal function decline. This longitudinal study aimed to explore these relationships in a large cohort of Taiwanese participants. The studied obesity-related indices were waist-to-height ratio (WHtR), A body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), body roundness index (BRI), conicity index (CI), body mass index (BMI), body adiposity index (BAI) and abdominal volume index (AVI). We included 122,068 participants in the baseline study, of whom 27,033 were followed for a median of four years. The baseline prevalence of MetS was 17.7%. Multivariable analysis showed that the participants with MetS and high VAI, WHtR, WHR, LAP, CI, BRI, BMI, BAI, AVI, and ABSI values were significantly associated with a high baseline estimated glomerular filtration rate (eGFR) (all p < 0.001). In addition, the participants with MetS (p < 0.001), high WHtR (p = 0.007), low LAP (p < 0.001), high BRI (p = 0.002), high CI (p = 0.002), high AVI (p = 0.001), high VAI (p = 0.017), and high ABSI (p = 0.013) were significantly associated with a low △eGFR, indicating a rapid decline in renal function. These results showed associations between MetS and high values of obesity-related indices except LAP with high baseline eGFR and rapid decline in kidney function. These findings suggest that screening for MetS and obesity may help to slow the decline in renal function in high-risk populations.

Metabolic Syndrome-Related Kidney Injury: A Review and Update

Metabolic syndrome (MetS) includes visceral obesity, hyperglycemia, dyslipidemia, and hypertension. The prevalence of MetS is 20-25%, which is an important risk factor for chronic kidney disease (CKD). MetS causes effects on renal pathophysiology, including glomerular hyperfiltration, RAAS, microalbuminuria, profibrotic factors and podocyte injury. This review compares several criteria of MetS and analyzes their differences. MetS and the pathogenesis of CKD includes insulin resistance, obesity, dyslipidemia, inflammation, oxidative stress, and endothelial dysfunction. The intervention of MetS-related renal damage is the focus of this article and includes controlling body weight, hypertension, hyperglycemia, and hyperlipidemia, requiring all components to meet the criteria. In addition, interventions such as endoplasmic reticulum stress, oxidative stress, gut microbiota, body metabolism, appetite inhibition, podocyte apoptosis, and mesenchymal stem cells are reviewed.

Serum Low-Density Lipoprotein Cholesterol and Cardiovascular Disease Risk Across Chronic Kidney Disease Stages (Data from 1.9 Million United States Veterans)

In the general population, elevated low-density lipoprotein (LDL) cholesterol levels are an important risk factor for cardiovascular disease (CVD) and mortality; however, the association of LDL with mortality risk and cardiovascular events are less clear in chronic kidney disease (CKD). We sought to examine the relationship of LDL with mortality and rates of atherosclerotic cardiovascular disease (ASCVD) and non-atherosclerotic cardiovascular-related (non-ASCVD) hospitalizations across CKD stages. Our analytical cohort consisted of 1,972,851 United States veterans with serum LDL data between 2004 and 2006. Associations of LDL with all-cause and cardiovascular mortality across CKD stages were evaluated using Cox proportional hazard models with adjustment for demographics, comorbid conditions, smoking status, prescription of statins and non-statin lipid-lowering drugs, body mass index, albumin, high-density lipoprotein, and triglycerides. Associations between LDL and ASCVD and non-ASCVD hospitalizations were estimated using negative binomial regression models across CKD stages. The cohort consisted of 5% female, 14% Black, 29% diabetic, 33% statin-users, and 44% current smokers, with a mean patient age of 64 ± 14 years. Patients with high LDL (≥160 mg/dL) had a higher risk of all-cause and cardiovascular mortality as well as ASCVD and non-ASCVD hospitalization rates across all CKD stages compared with the reference (LDL 70 to <100 mg/dL). The associations with all-cause and cardiovascular mortality and ASCVD hospitalization rate were attenuated at higher CKD stages. These trends were reversed with amplification of the association of high LDL with non-ASCVD hospitalization at higher CKD stages. In conclusion, associations of LDL with mortality and both ASCVD and non-ASCVD hospitalizations are modified according to kidney disease stage.

Inflammatory markers are associated with the progression of gestational diabetes to metabolic syndrome

The progression of gestational diabetes mellitus (GDM) to metabolic syndrome (MetS) is associated with systemic inflammation. The aim of this study was to compare the levels of inflammatory markers in former GDM patients with and without MetS. Medical records were screened retrospectively for patients who were diagnosed with GDM 10 (±2) years ago. Former GDM patients were invited to the hospital for an assessment of their current health status. Of 52 women with former GDM, 27 (52%) had MetS. C-reactive protein (CRP), interleukin-6 and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in the MetS group while adiponectin was significantly lower (p < .001, p = .037, p = .002 and p = .013, respectively). There was no significant difference in plasma levels of visfatin and tumour necrosis factor-α. Interleukin-6, CRP, PAI-1 and adiponectin may be used as biomarkers to detect MetS in the pre-clinical phase. With timely diagnosis, early interventions can be implemented. IMPACT STATEMENTWhat is already known on this subject? The progression of 'gestational diabetes mellitus' to 'metabolic syndrome' is associated with systemic inflammation. Up to half of cases with former gestational diabetes mellitus (GDM) eventually progress to metabolic syndrome (MetS).What do the results of this study add? Interleukin-6, C-reactive protein, plasminogen activator inhibitor-1 and adiponectin may be used as biomarkers to detect MetS in the pre-clinical phase.What are the implications of these findings from clinical practice and/or further research? The progression of GDM to MetS is associated with systemic inflammation. Potential therapies should therefore target this inflammatory state. Interleukin-6, C-reactive protein, plasminogen activator inhibitor-1 and adiponectin may be used as biomarkers to detect MetS in the pre-clinical phase. With timely diagnosis, early interventions and lifestyle changes can be implemented to prevent morbidity and mortality associated with full-blown MetS.

PCSK9 and Cardiovascular Disease in Individuals with Moderately Decreased Kidney Function

Background and objectives: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of lipid homeostasis. Studies investigating the association between PCSK9 and cardiovascular disease in large cohorts of CKD patients are limited. Design, setting, participants, and measurements: The association of PCSK9 concentrations with prevalent and incident cardiovascular disease was investigated in 5,138 Caucasians of the German Chronic Kidney Disease study with a median follow-up of 6.5 years. Inclusion criteria were eGFR of 30-60 mL/min/1.73 m² or an eGFR>60 mL/min/1.73m² in the presence of overt proteinuria (urine albumin-creatinine ratio >300mg/g or equivalent). Prevalent cardiovascular disease was defined as history of non-fatal myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, carotid arteries interventions and stroke. Incident major adverse cardiovascular disease events included death from cardiovascular causes, acute non-fatal myocardial infarction and non-fatal stroke. Results: Median PCSK9 concentration in the cohort was 285 ng/mL (interquartile range 231-346 ng/mL). There was no association between PCSK9 concentrations and baseline eGFR and albuminuria. With each 100 ng/ml increment of PCSK9, the odds for prevalent cardiovascular disease (n=1,284) was 1.22-fold (95%CI 1.12-1.34, p<0.001) higher in a model with extended adjustment for major confounders. This association was stronger in non-statin than statin-users (p-value for interaction=0.009). During follow-up 474 individuals experienced a major adverse cardiovascular disease event and participants in PCSK9 quartiles 2 to 4 had a 32%-47% higher risk compared to quartile 1 (p<0.05). Subgroup analysis revealed this association was restricted to those participants who already had cardiovascular disease at baseline (all HR>1.75, p<0.05). In addition, PCSK9 showed a valuable gain in classification accuracy both for prevalent cardiovascular disease (NRI=0.27, 95%CI:0.20-0.33) and incident major adverse cardiovascular disease events during follow-up (NRI=0.10, 95%CI:0.008-0.21) when added to an extended adjustment model. Conclusions: Our findings reveal no relation of PCSK9 with baseline eGFR and albuminuria, but a significant association between higher PCSK9 concentrations and risk of cardiovascular disease independent of traditional risk factors including LDL-cholesterol levels.

Metabolic syndrome and the risk of adverse cardiovascular events in patients with myocardial infarction with non-obstructive coronary arteries

BACKGROUND AND AIMS

Metabolic syndrome (MeS) is recognized as a significant predictor of poor outcomes in coronary artery disease. However, its prognostic implications in myocardial infarction with non-obstructive coronary arteries (MINOCA) have not been examined. We aimed at investigating the role of MeS on the clinical outcomes in MINOCA patients.

METHODS AND RESULTS

Patients diagnosed with MINOCA between 2015 and 2019 were included. MeS was defined according to modified NCEP-ATPIII criteria. The primary endpoint was major adverse cardiovascular events (MACE). Cox regression analysis was used to evaluate the correlation between MeS and the hazard of MACE. The integrated discrimination improvement (IDI) and net reclassification index (NRI) were performed to assess MeS incremental predictive value. Of 281 MINOCA patients, 83 (29.5%) patients satisfied the MeS criteria. During a median follow-up duration of 28 months, MINOCA patients with MeS had a notably higher rate of MACE than those without MeS (30.1% vs. 17.6%, respectively P = 0.020). Cox regression analysis revealed that MeS was associated with an increased hazard of MACE (adjusted HR 2.126; 95% CI: 1.193-3.787, P = 0.010). When each component of MeS was analyzed as a categorized variable separately, only high fasting blood glucose and BMI ≥25 kg/m² were associated with an increased hazard of MACE. Moreover, MeS had an incremental predictive ability for MACE when added to a model with clinical risk factors.

CONCLUSION

MeS is relatively common in patients with MINOCA. The presence of MeS significantly increased the hazard of MACE among the MINOCA population.

Metabolic Syndrome Components and Chronic Kidney Disease in a Community Population Aged 40 Years and Older in Southern China: A Cross-Sectional Study

PURPOSE

To investigate the correlation between metabolic syndrome components and chronic kidney disease (CKD) among a community population aged 40 years and older in Southern China.

PATIENTS AND METHODS

From December 2017 to March 2018, 1969 participants (male n = 715, female n = 1254) aged 40 years and older were recruited in Southern China for a cross-sectional survey. A logistic regression model was established to analyze the correlation between metabolic syndrome components and CKD.

RESULTS

Among the 1969 subjects, 407 (20.7%) were CKD patients, including 152 males (prevalence rate 21.3%) and 255 females (prevalence rate 20.3%). Anthropometric data (waist circumference, age, systolic and diastolic blood pressure), serum/plasma data (serum creatinine, serum uric acid, fasting plasma glucose, C-reactive protein, serum triglyceride), urinary and other findings (body mass index, waist-to-hip and waist-to-height ratios, urinary albumin to creatinine ratio, homeostasis model assessment of insulin resistance) were significantly higher in patients with than without CKD (P < 0.05). Metabolic syndrome and at least some of its components were statistically significant risk factors for CKD in models with and without adjustment for diabetes, obesity and hypertension.

CONCLUSION

Metabolic syndrome and its single or combined components are independently associated with CKD in community populations aged 40 years and older. The correlation between some components and CKD remained significant in both non-diabetic and non-obese subjects. Correlations between components of metabolic syndrome and CKD show that it is feasible and necessary to carry out targeted screening and intervention tests in people aged 40 and over.

Longitudinal impact of metabolic syndrome and depressive symptoms on subsequent functional disability among middle-aged and older adults in China

BACKGROUND

Few studies examining the impact of metabolic syndrome and depressive symptoms on subsequent functional disability are available.

OBJECTIVES

To determine the impact of baseline metabolic syndrome and depressive symptoms on subsequent functional disability.

METHODS

This study used data from the 2011 baseline and 2013, 2015 and 2018 follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS). Functional status was assessed by activities of daily living (ADLs) and instrumental ADLs (IADLs). Analyses were restricted to middle-aged and older adults (≥50 years) free of functional disability at baseline. Metabolic syndrome, depressive symptoms, and covariates were measured at baseline. New-onset ADL and IADL disability were obtained in follow-up measurements. Competitive risks based on survival analysis were conducted to examine the impact of baseline metabolic syndrome and depressive symptoms on subsequent functional disability after covariates were controlled.

RESULTS

Baseline depressive symptoms significantly predicted functional disability over a 7-year follow-up after adjusting for covariates (Hazard ratio [HR] = 1.54, 95% confidence intervals [CI] = 1.40-1.70 for ADL disability; HR=1.36, 95% CI=1.25-1.48 for IADL disability). Metabolic syndrome significantly predicted ADL disability (HR=1.25, 95% CI=1.14-1.38) but not IADL disability (HR=1.02, 95% CI=0.94-1.10). No significant additive interaction between metabolic syndrome and depressive symptoms on functional disability was found.

CONCLUSION

The current study found that baseline depressive symptoms were significantly associated with both ADL and IADL disabilities, while metabolic syndrome significantly predicted ADL disability. In addition, some indications showed that the effect in those with both conditions was greater than the sum of the effects separately.