Metabolic syndrome in Thai adolescents and associated factors: the Thai National Health Examination Survey V (NHES V)

Serum Iron Levels, Dietary Iron Intake, and Supplement Use in Relation to Metabolic Syndrome in Adolescents: A Cross-Sectional Study

The objective of this study was to investigate the potential associations between serum iron levels, dietary iron intake, and iron supplementation, and the prevalence of metabolic syndrome (MetS) in adolescents A cross-sectional analysis was conducted, utilizing data from adolescents participating in the 2003-2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) pertaining to serum iron, dietary iron, and iron supplementation were derived through multivariate logistic regression models. Additionally, a restricted cubic spline (RCS) regression model was applied to explore the nonlinear relationship between dietary iron and serum iron concerning MetS. The study encompassed 4858 American adolescents aged 12 to 19, among whom 413 (8.5%) manifested MetS. The study cohort exhibited an average age of 15.52 years, comprising 2551 males (52.51%) and 2307 females (47.49%). Relative to individuals in the lowest serum iron quartile, those in the highest quartile for serum iron (OR = 0.33, 95% CI 0.21-0.50), the highest quartile for dietary iron (OR = 0.53, 95% CI 0.32-0.89), and those utilizing iron supplements (OR = 0.61, 95% CI 0.37-0.99) evinced a diminished prevalence of MetS, even post adjustment for potential confounding variables. A non-linear relationship was discerned between serum iron and MetS, exhibiting a statistically significant negative correlation when serum iron concentrations exceeded the inflection point (serum iron = 8.66 µmol/L, P for nonlinear < 0.001). This investigation reveals that higher levels of serum iron, increased dietary iron intake, and the use of iron supplements are linked to a lower prevalence of MetS in US adolescents. These findings suggest that dietary modifications could play a role in promoting the health of adolescents.

Associations between residential greenness and air pollution and the incident metabolic syndrome in a Thai worker cohort

Increasing air pollution and decreasing exposure to greenness may contribute to the metabolic syndrome (MetS). We examined associations between long-term exposure to residential greenness and air pollution and MetS incidence in the Bangkok Metropolitan Region, Thailand. Data from 1369 employees (aged 52-71 years) from the Electricity Generating Authority of Thailand cohort from 2002 to 2017 were analyzed. The greenness level within 500 m of each participant's residence was measured using the satellite-derived Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI). The kriging approach was used to generate the average concentration of each air pollutant (PM10, CO, SO2, NO2, and O3) at the sub-district level. The average long-term exposure to air pollution and greenness for each participant was calculated over the same period of person-time. Cox proportional hazards models were used to analyze the greenness-air pollution-MetS associations. The adjusted hazard ratio of MetS was 1.42 (95% confidence interval (CI): 1.32, 1.53), 1.22 (95% CI: 1.15, 1.30), and 2.0 (95% CI: 1.82, 2.20), per interquartile range increase in PM10 (9.5 μg/m3), SO2 (0.9 ppb), and CO (0.3 ppm), respectively. We found no clear association between NDVI or EVI and the incidence of MetS. On the contrary, the incident MetS was positively associated with NDVI and EVI for participants exposed to PM10 at concentrations more than 50 μg/m3. In summary, the incidence of MetS was positively associated with long-term exposure to air pollution. In areas with high levels of air pollution, green spaces may not benefit health outcomes.

The Association of Sociodemographic Variables and Unhealthy Behaviors With Limitations in Activities of Daily Living Among Thai Older Adults: Cross-sectional Study and Projected Trends Over the Next 20 Years

BACKGROUND

Extended life spans have led to an increase in the number of older people and an increase in the prevalence of disability among people older than 60 years of age.

OBJECTIVE

This study aims to investigate the association of sociodemographic variables and unhealthy behaviors with limitations in activities of daily living (ADL) among Thai older adults. The study also projects the number of older individuals likely to experience ADL limitations in the next 20 years.

METHODS

We performed sex-specific multinomial logistic regression analysis based on the 5th Thai National Health Examination Survey in 2014 to investigate the association between sociodemographic variables and health behaviors with ADL limitations among Thai older adults. Age- and sex-specific prevalence estimates of ADL limitations were obtained by applying the same models. These estimates were combined with population projections up to 2040 from the Office of the National Economic and Social Development Board, Thailand, to generate projections of older individuals with ADL limitations.

RESULTS

Age and physical activity were significant factors for both sexes, with age positively associated with the level of ADL limitations and low physical activity associated with an increased relative probability of mild or moderate to severe ADL limitations compared to individuals with no ADL limitation (1.2-2.2 times). Other variables such as education, marital status, diabetes, hypertension, smoking, alcohol consumption, and having a fruit- and vegetable-based diet showed significant associations, but the results varied regarding sex and levels of ADL limitations. This study also projected the number of older adults with mild and moderate to severe ADL limitations over the next 20 years from 2020 to 2040, revealing an increase of 3.2 and 3.1 times, respectively, along with a significant increase in men compared to that in women.

CONCLUSIONS

This study identified age and physical activity as significant factors associated with ADL limitations in older adults, while other factors showed varying associations. Over the next 2 decades, projections suggest a significant increase in the number of older adults with ADL limitations, particularly men. Our findings emphasize the importance of interventions to reduce ADL limitations, and health care providers should consider various factors impacting them.

2022 Thai Hypertension Society guidelines on home blood pressure monitoring

In 2021, the Universal Health Coverage Payment Scheme of Thailand approved home blood pressure monitoring (HBPM) devices for reimbursement. National utilization of HBPM devices will begin in 2022. This article provides the recommendations for HBPM from the Thai Hypertension Society. In this report, the authors review the benefits of HBPM and recommend confirming the diagnosis of hypertension by HBPM. Devices for HBPM should be the automated and validated upper arm cuff devices. HBPM should be ideally done for seven consecutive days before each clinic visit and take at least two readings (1 min apart) in the morning and before going to bed. The average blood pressure (BP) of 125-134/75-84 mmHg is classified as high normal BP and hypertension is BP of 135/85 mmHg or more. Target BP levels depend on the age of the patients; that is, < 125/75 mmHg for patients aged 18-65 years old, and <135/85 mmHg for patients over 65 years of age.

Prevalence of Metabolic Syndrome and Its Components in Urban Cambodia: A Cross-Sectional Study

Background

The incidence of noncommunicable diseases, such as cardiovascular diseases and diabetes mellitus, is increasing in Cambodia. Urbanization and lifestyle changes due to rapid economic development have affected the components of metabolic syndrome (MetS). This study aimed to determine the prevalence of MetS, MetS components, and health status among Cambodians living in urban areas.

Methods

This cross-sectional study enrolled adult Cambodians (age ≥ 20 years) who underwent a health checkup at a Japanese hospital in Phnom Penh. MetS was defined based on the harmonized diagnostic definition from the joint interim statement.

Results

Among the 6090 (3174 men and 2916 women) participants who were enrolled in the study, the prevalence of MetS was 60.1% in men and 52.4% in women. The prevalence of elevated blood pressure was 73.2% in men and 65.3% in women, and was the highest MetS component in both men and women. In contrast, the lowest prevalence rates were observed for abdominal obesity (44.8%) in men and for high triglyceride levels (33.5%) in women. The MetS group showed a significantly higher proportion of patients with hypertension, diabetes, dyslipidemia, and obesity compared with the non-MetS group.

Conclusion

The high prevalence of MetS in this study was attributed to urbanization, as in economically developed countries. It is necessary to explore the lifestyle habits of Cambodians that contribute to MetS and to develop preventive measures to reduce the incidence and prevalence of MetS.

Adiposity measures in screening for metabolic syndrome among Chinese children and adolescents

BACKGROUND

Existing various and complicated metabolic syndrome (MetS) definitions have contributed to the difficulty in assessing MetS in children and adolescents, and therefore it is urgently needed to develop a convenient and effective screening tool for pediatric MetS. This study aimed to identify the optimal adiposity measure to screen for pediatric MetS.

METHODS

The cross-sectional data was collected from 8,150 children and adolescents aged 7-17 y living in southern China. Anthropometric indices, blood lipids, and serum glucose were determined. Results of two commonly used MetS definitions were compared: International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP-ATP) modified by Cook. Receiver operating characteristic curve analyses were performed and areas under the curve (AUCs) were calculated to determine the optimal index for MetS screening.

RESULTS

MetS prevalence assessed by NCEP-ATP was significantly higher than that by IDF (6.2% vs. 1.5%, p<0.001). Waist-to-height ratio (WHtR) showed the highest screening power for MetS defined by both IDF and NCEP-ATP (AUC 0.932 and 0.900, respectively), and its optimal cut-off point was 0.48 by both IDF and NCEP-ATP definition (sensitivity 0.944 and 0.847, specificity 0.800 and 0.830, respectively), regardless of age or sex. When taking sex diversity into account, the optimal WHtR cut-off point was 0.49 (IDF) or 0.50 (NCEP-ATP) in boys, and 0.46 (both definitions) in girls.

CONCLUSIONS

Among children and adolescents aged 7-17 y in southern China, a WHtR greater than 0.48 can be a simple but effective screening tool for MetS.

COVID-19 and screen-based sedentary behaviour: Systematic review of digital screen time and metabolic syndrome in adolescents

Aim

The COVID-19 pandemic has prompted governments around the globe to implement various restriction policies, including lockdown, social distancing, and school closures. Subsequently, there has been a surge in sedentary behaviour particularly screen time (ST) together with a significant decline in physical activity that was more marked amongst children and adolescents. Excessive screen exposure in adolescents has been correlated with cardio-metabolic risk factors including obesity, hypertension, high cholesterol, and glucose intolerance that may have adverse morbidity and mortality implications in adulthood. Thus, the current study aimed to synthesize the literature on the relationship between ST of various types and the risk of metabolic syndrome (MetS) in adolescents in the context of the COVID-19 pandemic.

Methods

In August 2021, a systematic search of the literature was undertaken using electronic databases: PubMed, PsycINFO, and the Cochran library. Studies were considered if they met the following key eligibility criteria: (i) Measure of ST as an exposure (TV, computer, videogames, internet, smartphone, tablet), using quantified duration/frequency either self-reported or observed; (ii) Measure of MetS as an outcome with standard definition and/or criteria required to establish MetS diagnosis. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias.

Results

A total of ten studies met the inclusion criteria, and the majority were cross sectional studies. Most studies met fair bias scoring. Overall, the review revealed considerable evidence that suggests a significant negative association between ST and components of MetS among adolescents with dose-response association.

Conclusion

During the pandemic, screen usage may become more prevalent through periods of school closures, lockdowns, social isolation, and online learning classes. Public health policies and health promotion strategies targeting parents are needed to raise awareness of the adverse health effects associated with screen-based sedentary behaviour as a precursor of NCDs. Parent or home focused interventions might be effective in limiting adolescents’ screen exposure, alternatively substituted with an appropriate level of physical activity.

PROSPERO registration number

PROSPERO 2021 CRD42021272436.

A Cross-Sectional Study of Serum Ferritin Levels in Vietnamese Adults with Metabolic Syndrome

BACKGROUND

Metabolic syndrome is one of the most common public health concerns in the 21st century. Several previous studies have shown an association between increased serum ferritin levels and other components of metabolic syndrome and the risk of metabolic syndrome. They conclude that ferritin can be viewed as a predictor of metabolic syndrome risk. This study investigates some main features of metabolic syndrome and the serum ferritin levels in a Vietnamese adult cohort with metabolic syndrome.

METHODS

A descriptive cross-sectional study was conducted on 207 patients who were treated at the General Internal Medicine-Geriatric Department, Hue Central Hospital, from May 2018 to August 2020. Patients were divided into two groups: the study group (104 patients with metabolic syndrome) and the control group (103 patients without metabolic syndrome and no serum ferritin-mediated disease). The metabolic syndrome was diagnosed by a joint interim statement of the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute/World Heart Federation/International Atherosclerosis Society/International Association for the Study of Obesity in 2009.

RESULTS

Hypertriglyceridemia-hypertension-hyperglycemia (50.9%) is the most common combination of metabolic syndrome components. The mean serum ferritin concentration was 391.62±181.97ng/mL and 124.55±63.95ng/mL in the metabolic syndrome and control groups, respectively. In the metabolic syndrome group, increased ferritin concentration accounted for 86.54% for men, the mean serum ferritin concentration was 453.064 ± 161.75ng/mL (increased ferritin concentration accounted for 96.15%) for women; the mean serum ferritin concentration was 330.17 ± 181.71 ng/mL (increased ferritin concentration accounted for 86.54%).

CONCLUSION

The serum ferritin level is significantly increased in Vietnamese patients with metabolic syndrome.