Determinants of Metabolic Syndrome Among Patients Receiving Anti-Retro-Viral Treatment in A Tertiary Hospital, Central Ethiopia: Unmatched Case-Control Study

Purpose

Scaling up antiretroviral treatment (ART) reduces morbidity and mortality among people living with HIV/AIDS (PLHA). This success is challenged by the constellation of interrelated metabolic disorders such as metabolic syndrome (MetS). Given the changing ART regimens and schedules, increasing patient age and methodological limitations, existing evidence regarding the determinants of MetS remains inconclusive. Therefore, in the current study, we aimed to identify the determinants of MetS in patients receiving ART at a tertiary hospital in central Ethiopia.

Patient and Methods

We conducted an unmatched case-control study that included 393 patients with a case-to-control ratio of 1 to 2. Data were collected by interviewing patients, reviewing charts, physical examinations, and laboratory testing. The data were entered into Epi-Info version 7.2 and analyzed using SPSS version 26. A binary logistic regression analysis was used to identify the determinants of MetS. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to estimate the strength of the association between MetS and its determinants. Statistical significance was set at p-value < 0.05.

Results

In this study, higher odds of developing MetS were identified among patients aged 40-60 years (AOR 3.75; 95% CI: 1.66-8.49) and those older than 60 years (AOR 6.18; 95% CI: 2.12-17.95) than among those aged < 40 years. Similarly, higher odds were observed among patients who frequently consumed animal source foods than among those who consumed cereals or vegetables (AOR, 1.94; 95% CI, 1.03-3.63), those who had HIV lipodystrophy (AOR 1.73; 95% CI: 1.05-2.86), those who were treated with stavudine (AOR 3.08; 95% CI: 1.89-5.04), and those who were treated with zidovudine (AOR 1.71, 95% CI: 1.02-2.88) compared to their counterparts.

Conclusion

Older age, diet from animal sources, exposure to zidovudine or stavudine, and the presence of lipodystrophy were independent determinants of MetS.

Prevalence and Risk Factors of Metabolic Syndrome: A Prospective Study on Cardiovascular Health

Background and objectives: This article highlights the relationship between metabolic syndrome and cardiovascular disease, providing a comprehensive overview of its risk factors and prevalence. Metabolic syndrome, characterized by a cluster of interconnected risk factors, significantly increases the risk of developing cardiovascular disease and type II diabetes. Materials and methods: This study, conducted over a one-year period, involved 117 patients aged between 30 and 79 years old. Various parameters were analyzed, such as gender, age, education level, provenance from urban or rural environment, smoking, alcohol consumption, dietary aspects, physical activity, and their contribution to the appearance of metabolic syndrome. Central adiposity and high blood pressure emerged as prominent elements of the condition. Results: The findings underscore the importance of a healthy lifestyle in the prevention and management of metabolic syndrome. Encouraging regular physical activity, maintaining a balanced diet, rich in fresh vegetables and fruits, and avoiding harmful behaviors, such as smoking or alcohol consumption, are essential in reducing the risk of metabolic syndrome and its associated cardiovascular complications. Conclusions: The study highlights the need for public health initiatives, as well as individualized preventive strategies to combat the rising prevalence of metabolic syndrome. Through promoting awareness of its risk factors and implementing effective interventions, healthcare professionals can contribute to better cardiovascular health worldwide. Further research in this area will continue to enhance our understanding of metabolic syndrome and refine preventive and therapeutic approaches for its management.

Developmental exposure to indoor flame retardants and hypothalamic molecular signatures: Sex-dependent reprogramming of lipid homeostasis

Polybrominated diphenyl ethers (PBDEs) are a class of flame-retardant organohalogen pollutants that act as endocrine/neuroendocrine disrupting chemicals (EDCs). In humans, exposure to brominated flame retardants (BFR) or other environmentally persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) and novel organophosphate flame retardants has been associated with increasing trends of diabetes and metabolic disease. However, the effects of PBDEs on metabolic processes and their associated sex-dependent features are poorly understood. The metabolic-disrupting effects of perinatal exposure to industrial penta-PBDE mixture, DE-71, on male and female progeny of C57BL/6N mouse dams were examined in adulthood. Dams were exposed to environmentally relevant doses of PBDEs daily for 10 weeks (p.o.): 0.1 (L-DE-71) and 0.4 mg/kg/d (H-DE-71) and offspring parameters were compared to corn oil vehicle controls (VEH/CON). The following lipid metabolism indices were measured: plasma cholesterol, triglycerides, adiponectin, leptin, and liver lipids. L-DE-71 female offspring were particularly affected, showing hypercholesterolemia, elevated liver lipids and fasting plasma leptin as compared to same-sex VEH/CON, while L- and H-DE-71 male F1 only showed reduced plasma adiponectin. Using the quantitative Folch method, we found that mean liver lipid content was significantly elevated in L-DE-71 female offspring compared to controls. Oil Red O staining revealed fatty liver in female offspring and dams. General measures of adiposity, body weight, white and brown adipose tissue (BAT), and lean and fat mass were weighed or measured using EchoMRI. DE-71 did not produce abnormal adiposity, but decreased BAT depots in L-DE-71 females and males relative to same-sex VEH/CON. To begin to address potential central mechanisms of deregulated lipid metabolism, we used RT-qPCR to quantitate expression of hypothalamic genes in energy-regulating circuits that control lipid homeostasis. Both doses of DE-71 sex-dependently downregulated hypothalamic expression of Lepr, Stat3, Mc4r, Agrp, Gshr in female offspring while H-DE-71 downregulated Npy in exposed females relative to VEH/CON. In contrast, exposed male offspring displayed upregulated Stat3 and Mc4r. Intestinal barrier integrity was measured using FITC-dextran since it can lead to systemic inflammation that leads to liver damage and metabolic disease, but was not affected by DE-71 exposure. These findings indicate that maternal transfer of PBDEs disproportionately endangers female offspring to lipid metabolic reprogramming that may exaggerate risk for adult metabolic disease.

Correlation of systemic metabolic inflammation with knee osteoarthritis

PURPOSE

The aim of this study was to analyze local and systematic inflammatory status in knee osteoarthritis (KOA), focusing on intra-articular and remote adipose tissue depots, and to explore its potential association with metabolic syndrome (MetS).

METHODS

Patients (n = 27) with end-stage KOA were enrolled in the study and samples from infrapatellar fat pad (IFP), synovium, subcutaneous adipose tissue (SAT), synovial fluid (SF), and serum were collected. In homogenates from the tissues, mRNA expression of developmental endothelial locus-1 (DEL-1) was determined. Interleukin 6 (IL-6) and interleukin 8 (IL-8) were measured in tissues and SF and serum samples by enzyme-linked immunosorbent assay.

RESULTS

Fifteen patients fulfilled MetS criteria (w-MetS group) and 12 did not (non-MetS). In the entire population, IL-6 levels were significantly higher in IFP compared to synovium (median (interquartile range), 26.05 (26.16) vs. 15.75 (14.8) pg/mg of total protein, p = 0.043), but not to SAT (17.89 (17.9) pg/mg); IL-8 levels were significantly higher in IFP (17.3 (19.3) pg/mg) and SAT (24.2 (26) pg/mg) when compared to synovium (8.45 (6.17) pg/mg) (p = 0.029 and < 0.001, respectively). Significantly higher IL-6 concentrations in SF were detected in w-MetS patients compared to non-MetS (194.8 (299) vs. 64.1 (86.9) pg/ml, p = 0.027). Finally, DEL-1 mRNA expression was higher in IFP compared to synovium (eightfold, p = 0.019).

CONCLUSIONS

Our findings support the critical role of IFP in knee joint homeostasis and progression of KOA. Furthermore, in KOA patients w-MetS, SAT is thought to play an important role in intra-knee inflammation via secretion of soluble inflammatory mediators, such as IL-6.

Canine Geriatric Syndrome: A Framework for Advancing Research in Veterinary Geroscience

Biological aging is the single most important risk factor for disease, disability, and ultimately death in geriatric dogs. The effects of aging in companion dogs also impose significant financial and psychological burdens on their human caregivers. The underlying physiologic processes of canine aging may be occult, or early signs of aging may be ignored because of the misconception that biological aging is natural and therefore inevitable. The ability to detect, quantify, and mitigate the deleterious processes of canine aging would greatly enhance veterinary preventative medicine and animal welfare. In this paper we propose a new conceptual framework for aging in dogs, the Canine Geriatric Syndrome (CGS). CGS consists of the multiple, interrelated physical, functional, behavioral, and metabolic changes that characterize canine aging as well as the resulting clinical manifestations, including frailty, diminished quality of life, and age-associated disease. We also identify potential key components of a CGS assessment tool, a clinical instrument that would enable veterinarians to diagnose CGS and would facilitate the development and testing of interventions to prolong healthspan and lifespan in dogs by directly targeting the biological mechanisms of aging. There are many gaps in our knowledge of the mechanisms and phenotype of aging in dogs that must be bridged before a CGS assessment tool can be deployed. The conceptual framework of CGS should facilitate identifying these gaps and should stimulate research to better characterize the processes and effects of aging in dogs and to identify the most promising preventative strategies to target these.

The Effects of Cardiometabolic Factors on the Association Between Serum Uric Acid and Chronic Kidney Disease in Chinese Middle-Aged and Older Population: A Mediation Analysis

INTRODUCTION

To explore whether dyslipidemia, hyperglycemia or hypertension has mediating effect on the association between serum uric acid (SUA) and the development of chronic kidney disease (CKD).

METHODS

We conducted a mediation analysis to explore the potential mediating effects of systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) on the association between SUA and estimated glomerular filtration rate (eGFR). The data were obtained from China Health and Retirement Longitudinal Study (CHARLS), covering 5,762 individuals.

RESULTS

SUA had a negative dose-response total effect on eGFR (β -3.11, 95% CI -3.40 to -2.82, P-value<0.001). The linear regression between SUA and seven potential mediators indicated that blood glucose (β 0.80, 95% CI 0.18 to 1.42, P-value=0.012), TG (β 10.01, 95% CI 8.22 to 11.79, P-value<0.001), TC (β 2.64, 95% CI 1.83 to 3.45, P-value<0.001), HDL-C (β -0.27, 95% CI -0.52 to -0.02, P-value=0.034) and LDL-C (β 1.15, 95% CI 0.49 to 1.80, P-value=0.001) all had significant dose-response association with SUA, but SBP and DBP showed no significant association with SUA. In terms of the association between potential mediators and eGFR, only TG (β 0.003, 95% CI -0.001 to 0.01, P-value=0.117) and HDL-C (β 0.01, 95% CI -0.02 to 0.04, P-value=0.444) did not have significant linear association with eGFR. The linear regression showed that SUA was directly associated with eGFR (P-value<0.001).

CONCLUSIONS

This study supported that the association between SUA and the risk of CKD was not mediated by hypertension, hyperglycemia or dyslipidemia.

Detecting time-evolving phenotypic topics via tensor factorization on electronic health records: Cardiovascular disease case study

OBJECTIVE

Discovering subphenotypes of complex diseases can help characterize disease cohorts for investigative studies aimed at developing better diagnoses and treatments. Recent advances in unsupervised machine learning on electronic health record (EHR) data have enabled researchers to discover phenotypes without input from domain experts. However, most existing studies have ignored time and modeled diseases as discrete events. Uncovering the evolution of phenotypes - how they emerge, evolve and contribute to health outcomes - is essential to define more precise phenotypes and refine the understanding of disease progression. Our objective was to assess the benefits of an unsupervised approach that incorporates time to model diseases as dynamic processes in phenotype discovery.

METHODS

In this study, we applied a constrained non-negative tensor-factorization approach to characterize the complexity of cardiovascular disease (CVD) patient cohort based on longitudinal EHR data. Through tensor-factorization, we identified a set of phenotypic topics (i.e., subphenotypes) that these patients established over the 10 years prior to the diagnosis of CVD, and showed the progress pattern. For each identified subphenotype, we examined its association with the risk for adverse cardiovascular outcomes estimated by the American College of Cardiology/American Heart Association Pooled Cohort Risk Equations, a conventional CVD-risk assessment tool frequently used in clinical practice. Furthermore, we compared the subsequent myocardial infarction (MI) rates among the six most prevalent subphenotypes using survival analysis.

RESULTS

From a cohort of 12,380 adult CVD individuals with 1068 unique PheCodes, we successfully identified 14 subphenotypes. Through the association analysis with estimated CVD risk for each subtype, we found some phenotypic topics such as Vitamin D deficiency and depression, Urinary infections cannot be explained by the conventional risk factors. Through a survival analysis, we found markedly different risks of subsequent MI following the diagnosis of CVD among the six most prevalent topics (p < 0.0001), indicating these topics may capture clinically meaningful subphenotypes of CVD.

CONCLUSION

This study demonstrates the potential benefits of using tensor-decomposition to model diseases as dynamic processes from longitudinal EHR data. Our results suggest that this data-driven approach may potentially help researchers identify complex and chronic disease subphenotypes in precision medicine research.

Duration and stability of metabolically healthy obesity over 30 years

BACKGROUND

Obese adults who are free from metabolic risk factors may develop risk factors over time. Our objective was to characterize development of obesity and duration of metabolically healthy obese (MHO) over 30 years.

METHODS

Participants in CARDIA who developed obesity (BMI ≥ 30 kg/m2) at follow-up exams during years 7, 10, 15, 20, 25, and 30 were analyzed. MHO was defined as obese and having 0 or 1 risk factor: ≥SBP/DBP 130/85 mmHg; fasting glucose ≥100 mg/dL/5.55 mmol/L; fasting triglycerides (≥150 mg/dL/1.69 mmol/L); and HDL-C (men <40 mg/dL/1.036 mmol/L, women <50 mg/dL/1.295 mmol/L) or on any medication(s) for these conditions. MHO duration (years) and obesity duration (years) were estimated for each subsequent time-point; and an overall cumulative duration was also calculated over available follow-up. MHO duration (%) was approximated as MHO duration ÷ obesity duration. Stable MHO was defined as 100% MHO duration over follow-up, while transient MHO was defined as <1-99%. Chi-squared tests were used to compare proportions by sex and race across obesity phenotypes. Multivariable-adjusted ANCOVA, adjusting for baseline BMI, age, race, and sex, was used to analyze obesity duration in all individuals who developed obesity, and also compare MHO duration (%) across race and sex in transient MHO individuals.

RESULTS

Of the 987 eligible participants who developed obesity, 51% were African American (AA), 56% were women. Higher percentages of AA were classified as transient MHO, and higher proportions of females were MHO (both p < 0.0001). Obesity duration (years) was higher in transient MHO compared with stable MHO (mean difference: 6.2 ± 0.5 years, p < 0.0001). Of those with transient MHO, African Americans (51.4 ± 1.6%) were more likely to have longer MHO duration compared to Caucasians (44.4 ± 1.9%, p = 0.005).

CONCLUSION

MHO status can be a transient phenotype which differs by sex and race. Future studies are needed to explore modifiable lifestyle/behavioral predictors associated with longer MHO duration.

Propionate-Producing Consortium Restores Antibiotic-Induced Dysbiosis in a Dynamic in vitro Model of the Human Intestinal Microbial Ecosystem

Metabolic syndrome is a growing public health concern. Efforts at searching for links with the gut microbiome have revealed that propionate is a major fermentation product in the gut with several health benefits toward energy homeostasis. For instance, propionate stimulates satiety-inducing hormones, leading to lower energy intake and reducing weight gain and associated risk factors. In (disease) scenarios where microbial dysbiosis is apparent, gut microbial production of propionate may be decreased. Here, we investigated the effect of a propionogenic bacterial consortium composed of Lactobacillusplantarum, Bacteroidesthetaiotaomicron, Ruminococcusobeum, Coprococcuscatus, Bacteroidesvulgatus, Akkermansiamuciniphila, and Veillonellaparvula for its potential to restore in vitro propionate concentrations upon antibiotic-induced microbial dysbiosis. Using the mucosal simulator of the human intestinal microbial ecosystem (M-SHIME), we challenged the simulated colon microbiome with clindamycin. Addition of the propionogenic consortium resulted in successful colonization and subsequent restoration of propionate levels, while a positive effect on the mitochondrial membrane potential (ΔΨ_m) was observed in comparison with the controls. Our results support the development and application of next generation probiotics, which are composed of multiple bacterial strains with diverse functionality and phylogenetic background.

Pathways to ethnic differences in obesity: The role of migration, culture and socio-economic position in the UK

Previous research has identified ethnic differences in abdominal obesity but has not fully explored the pathways that explain these ethnic differences, which may relate to individual and contextual characteristics. This research identifies ethnic differences in waist circumference for eight ethnic groups in England, before and after accounting for a range of individual-level and area-level factors. Three key pathways to obesity are explored: migration status, cultural characteristics, and socio-economic characteristics. Data come from four years of the Health Survey for England (1998, 1999, 2003 and 2004) and linked area-level data from the 2001 Census. The total sample size is 27,946. Multi-level modelling methods are used to account for individual-level and area-level factors. The results show that migration status has a strong association with ethnic differences in waist circumference - in particular, waist circumference increases with length of time since migration to the UK. Cultural characteristics and socio-economic characteristics are also associated with ethnic differences in waist circumference, but not to the same extent as migration status. The strong association between migration status and waist circumference is partly attenuated by cultural characteristics and partly by socio-economic inequality. However, there is still a strong association between migrant status and waist circumference that remains unexplained.

Association of Pigment Epithelium Derived Factor With von Willebrand Factor and Plasminogen Activator Inhibitor 1 in Patients With Type 2 Diabetes

To compare circulating pigment epithelium derived factor (PEDF) levels in type 2 diabetes patients (T2D) with and without metabolic syndrome (MetS+/-) to healthy controls and assess PEDF association with plasminogen activator inhibitor-1 (PAI-1) and von Willebrand factor (vWF) as markers of endothelial dysfunction. Fifty T2D individuals and forty healthy controls were included. PEDF, PAI-1, vWF, anthropological parameters, lipids, and markers of insulin resistance were investigated in all subjects. Compared to controls only MetS+ diabetics had higher PEDF levels [14.2 (10.2-16.0) mg/l vs. 11.1 (8.6-14.4) mg/l; p<0.05]. PEDF significantly correlated: positively with body mass index (ρ=0.25), smoking (ρ=0.21), C-reactive protein (ρ=0.22), triglycerides (ρ=0.38), non-HDL-cholesterol (ρ=0.39), apolipoprotein B (ρ=0.38), fasting glucose (ρ=0.22), glycated hemoglobin (ρ=0.24), C-peptide (ρ=0.28), insulin (ρ=0.26); and negatively with HDL-cholesterol (ρ=-0.42) and apolipoprotein A1 (ρ=-0.27). Independent association of PEDF with vWF in T2DMetS- subjects was found. Significantly elevated PEDF in T2DMet+ patients and its association with adverse metabolic profile confirmed PEDF as a marker of insulin resistance. Negative independent association of PEDF with vWF in T2DMetS- patients may reveal its angio-protective role.

Adipokine Dysregulation and Insulin Resistance with Atherosclerotic Vascular Disease: Metabolic Syndrome or Independent Sequelae?

Adipokine dysregulation and insulin resistance are two hallmark sequelae attributed to the current clinical definition of metabolic syndrome (MetS) that are also linked to atherosclerotic vascular disease. Here, we critically discuss the underlying pathophysiological mechanisms and the interplay between the two sequelae. Adipokine dysregulation is involved with decreased nitric oxide, vascular inflammation, and insulin resistance in itself to promote atherosclerosis. Insulin resistance is involved with endothelial dysfunction by direct and indirect mechanisms that also promote vascular inflammation and atherosclerosis. These mechanisms are discussed in atherosclerosis irrespective of MetS, and to evaluate the possibility of synergism in MetS. High retinol-binding protein-4 (RBP-4) and low cholesterol efflux in MetS may provide evidence of possible synergism and elevated atherosclerotic risk. An adverse adipokine panel that includes fetuin-A and adiponectin can potentially assess atherosclerotic risk in even those without MetS. Genetic possibilities may exist in atherosclerotic vascular diseases secondary to insulin resistance.

Creatine Kinase Is a Marker of Metabolic Syndrome in Qatari Women With and Without Polycystic Ovarian Syndrome

Objective: To correlate features of metabolic syndrome with creatine kinase (CK) in women with and without polycystic ovary syndrome (PCOS). Design: Comparative cross-sectional analysis. Methods: Demographic and metabolic data from Qatari women aged 18-40 years from the Qatar Biobank (97 diagnosed with PCOS, 563 controls). The primary outcome was the association between plasma CK and features of metabolic syndrome. Results: CK increased when the waist circumference was >80 cm (p < 0.015) and when associated with 2 or more features of the metabolic syndrome (p < 0.01). CK correlated with BMI (p < 0.003) but not with waist/hip ratio. Overall, CK did not differ between PCOS and controls, rising equally in both as body mass index (BMI) increased. C reactive protein (CRP) was higher in obese PCOS (P < 0.05) compared to controls, but did not correlate with CK (p > 0.05). Conclusion: CK was associated with an increase in BMI, waist circumference >80 cm and 2 or more features of the metabolic syndrome, in accord with the central role of type II skeletal muscle fibers in energy metabolism and obesity. CK was, however, independent of the PCOS phenotype.

Lipids: a personal view of the past decade

The past decade has witnessed considerable progress in the field of lipids. New drugs have been "rapidly" developed and some of these drugs have already been evaluated in event-based large trials. This evidence has led to the guidelines recommending new, more aggressive treatment goals for low-density lipoprotein cholesterol (LDL-C) levels. Although LDL-C remains the principal goal for cardiovascular disease (CVD) risk reduction, there has also been considerable interest in other lipid variables, such as high-density lipoprotein cholesterol, triglycerides, and lipoprotein(a). Statin intolerance is now considered a very important topic in daily clinical practice. This has resulted in more attention focusing on non-statin drugs [e.g., ezetimibe and proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors] and statin-related side effects. The latter mainly involve muscles, but there is also a need to consider other adverse effects associated with statin use (e.g., new onset diabetes). New specific areas of statin use have attracted interest. For example, statin-loading before procedures (e.g., coronary stenting), the prevention of stroke, and the treatment of non-alcoholic fatty liver disease (NAFLD). Statins will remain the most widely used drugs to treat dyslipidaemia and decrease CVD risk. However, we also need to briefly consider some other lipid-lowering drugs, including those that may become available in the future.

Relative hypocortisolism is associated with obesity and the metabolic syndrome in recurrent affective disorders

BACKGROUND

Cardiovascular disease (CVD) is one of the main causes of excess deaths in affective disorders. Affective disorders are associated with increased frequencies of CVD risk-factors such as obesity, dyslipidemia, and metabolic syndrome. Stress-induced chronic cortisol excess has been suggested to promote obesity and metabolic syndrome. Chronic stress with frequent or persisting hypothalamic-pituitary-adrenal-axis (HPA-axis) hyperactivity may, over time, lead to a state of low HPA-axis activity, also denoted hypocortisolism. A low-dose weight-adjusted dexamethasone-suppression-test (DST) is considered to be a sensitive measure of hypocortisolism.

METHODS

245 patients with recurrent depression or bipolar disorder and 258 controls participated in a low-dose DST and were also examined with regard to metabolic status.

RESULTS

Patients with hypocortisolism (low post-DST cortisol) compared with patients without hypocortisolism (normal or high post-DST cortisol) exhibited increased odds ratios (OR) for obesity (OR=4.0), overweight (OR=4.0), large waist (OR=2.7), high LDL (OR=4.2), low HDL (OR=2.4), high LDL/HDL ratio (OR=3.3), high TC/HDL ratio (OR=3.4) and metabolic syndrome (OR=2.0). A similar pattern but less pronounced was also found in the control sample.

LIMITATIONS

The cross sectional study design and absence of analyses addressing lifestyle factors.

CONCLUSIONS

Our findings suggest that a substantial portion of the metabolic disorders and cardiovascular risk factors seen in recurrent affective disorders are found among individuals exhibiting hypocortisolism. This might indicate that long-term stress is a central contributor to metabolic abnormalities and CVD mortality in recurrent affective disorders.

Changes in Waist Circumference and the Incidence of Type 2 Diabetes in Community-Dwelling Men and Women: The Suita Study

Backgrounds

The association between weight gain and the incidence of type 2 diabetes is well known. The aim of our study was to investigate the relationship between change in waist circumference (WC) and type 2 diabetes incidence.

Methods

The participants in the Suita Study, a population-based cohort study in an urban area of Japan, underwent a baseline survey between 1989 and 1994 (Exam 1) and were examined at follow-up every 2 years. We performed a 9.3-year cohort study of 946 men and 1327 women with no history of diabetes who underwent Exam 1 and Exam 2 (between 1997 and 1999). Participants were stratified by sex and median WC at Exam 1, and, in each stratum, participants were further classified into three categories by tertile of WC change per year between Exam 1 and Exam 2. Hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes incidence were calculated by Cox proportional hazard models. The endpoints were first diagnosis of type 2 diabetes or March 2011.

Results

During follow-up, 287 participants developed type 2 diabetes. In both sexes with median WC or higher, participants in the highest tertile of WC change had a significantly higher risk of developing type 2 diabetes. Multivariable adjusted HRs were 1.84 (95% CI, 1.10–3.08) in men and 2.30 (95% CI, 1.31–4.04) in women. No significant association was observed among participants with WC below median.

Conclusions

Preventing WC gain is important in preventing type 2 diabetes in the Japanese population, especially among individuals with a relatively high WC.

Relationship between decayed teeth and metabolic syndrome: data from 4716 middle-aged male Japanese employees

Background

Epidemiological findings regarding the relationship between decayed teeth (DT) and metabolic syndrome (MetS) are scarce. We evaluated the relationship of DT with MetS, obesity, and MetS components in early middle-aged male Japanese employees.

Methods

We cross-sectionally analyzed dental and medical health checkup results from a total of 4716 participants aged 42 or 46 years. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for age, breakfast consumption frequency, drinking habits, smoking status, and physical activity.

Results

Significant differences in the prevalence of MetS, obesity determined by body mass index, and the components of MetS between participating men with and without DT were detected (all P < 0.01). The adjusted OR of MetS was 1.41 (95% CI, 1.14–1.74) for those with 1 or 2 DT, and 1.66 (95% CI, 1.28–2.16) for those with ≥3 DT (P for trend = 0.01), and this significant relationship was observed even in those without periodontal pocket formation (P for trend = 0.03) or missing teeth (P for trend = 0.02). DT was significantly related to overweight/obesity and the MetS components of hypertension, dyslipidemia, and hyperglycemia, with adjusted ORs of 1.35 (95% CI, 1.19–1.53), 1.22 (95% CI, 1.07–1.39), 1.18 (95% CI, 1.03–1.34), and 1.33 (95% CI, 1.13–1.56), respectively. In addition, even in non-overweight/non-obese men, DT was found to be related to dyslipidemia and hyperglycemia, though with marginal significance (P < 0.05).

Conclusions

Our findings suggest that having DT is related to MetS in early middle-aged Japanese men directly and through obesity and is independent of health behaviors, periodontal condition, and tooth loss.

A prospective, longitudinal study of metabolic syndrome in patients with bipolar disorder and schizophrenia

BACKGROUND

Although cross sectional studies have evaluated the prevalence of metabolic syndrome (MetS) in patients with bipolar patients (BPAD), data from longitudinal studies are limited.

AIM

To assess the prevalence of MetS in patients with BPAD, to observe the change in prevalence rate over a period of 6 months, to assess the prevalence of sub-threshold MetS (i.e., patients fulfilling one or two criteria of MetS) and to compare patients with BPAD and schizophrenia on the above mentioned parameters.

METHODOLOGY

Seventy five patients with BPAD and 53 patients with schizophrenia were initially evaluated for MetS and then followed up for a period of 6 months.

RESULTS

According to consensus definition, prevalence of MetS at baseline was 40% in BPAD group and 32% in schizophrenia group. Over 6 months of follow-up the prevalence of MetS increased by 8% and 9.4% in the BPAD and the schizophrenia groups respectively. There was no significant difference between the two groups on any of the assessments. Another 28-32% of patients in the BPAD group also fulfilled two criteria and 13-17% fulfilled at least one criterion of MetS at different points of assessment. Similarly, 19-26% of the patients with schizophrenia met at least two and 23-26% of the patients fulfilled at least one criterion of MetS.

LIMITATION

The study was limited by small sample size, inclusion and the relatively short follow-up period.

CONCLUSION

40% patients with BPAD and 32% with schizophrenia have MetS and the prevalence of MetS increases by 8-9.4% over 6 months.

Acute improvement in insulin resistance after laparoscopic Roux-en-Y gastric bypass: is 3 days enough to correct insulin metabolism?

BACKGROUND

Although medium- to long-term improvement in insulin resistance and T2DM after Roux-en-Y gastric bypass (RYGB) is well documented, few studies have analyzed the acute effects after surgery. Understanding these effects might help explain the physiologic adjustments after surgery and help in managing insulin resistance and controlling the hypoglycemic treatment for bariatric patients.

METHODS

We recruited a prospective cohort of 55 consecutive female patients that underwent primary laparoscopic RYGB between January and June/2011. Blood samples were collected preoperatively and at the first, third, and fifth post-operative days after an overnight fast.

RESULTS

There was a significant increase in homeostasis model assessment for insulin resistance (HOMA-IR) on day 1 (2.36 vs 3.12; p = 0.032), followed by a rapid decrease from day 3 onward (3.12 vs 1.70; <0.001). We found a statistically significant difference (p < 0.05) at all time points compared with baseline. HOMA-IR levels at POD5 were 47 % lower than baseline values and were not significantly different from values at 6 months (1.24 vs 0.93; p = 0.09). The blood levels of glucose and insulin closely matched those of HOMA-IR.

CONCLUSIONS

RYGB results in a rapid improvement in insulin resistance and a clinically significant decrease in fasting glucose and insulin levels. This improvement is significant at the 3rd post-operative day, and by the 5th day, patients express insulin resistance levels that are similar to those expressed at 6 months after surgery. This work highlights the acute metabolic impact of surgery. Understanding the behavior of insulin and glucose after surgery might improve our knowledge of the pathophysiology of diabetes and lead to novel therapies and tailored surgical approaches.

Effect of age on the association between waist-to-height ratio and incidence of cardiovascular disease: the Suita study

Background

Waist-to-height ratio (WHtR) has been shown to be a useful screening tool for metabolic syndrome and cardiovascular disease (CVD). We investigated the association of WHtR with CVD incidence by age group.

Methods

We conducted a 13.0-year cohort study of Japanese adults (2600 men and 2888 women) with no history of CVD. WHtR was calculated as waist circumference (cm) (WC) divided by height (cm). We stratified participants by sex and age group (30–49, 50–69, ≥70 years). Using the Cox proportional hazards model, we calculated hazard ratios (HRs) and 95% CIs for CVD in relation to WHtR quartile for participants aged 50 to 69 years and 70 years or older.

Results

Men aged 50 to 69 years in the highest quartile had significantly increased risks of CVD and coronary heart disease as compared with the lowest quartile; the HRs (95% CI) were 1.82 (1.13–2.92) and 2.42 (1.15–5.12), respectively. Women aged 50 to 69 years in the highest quartile had a significantly increased risk of stroke (HR, 2.43; 95% CI, 1.01–5.85). No significant results were observed in men or women aged 70 years or older. The likelihood ratio test showed that the predictive value of WHtR was greater than that of WC among men aged 50 to 69 years.

Conclusions

The association between WHtR and CVD risk differed among age groups. WHtR was useful in identifying middle-aged Japanese at higher risk of CVD and was a better predictor than WC of CVD, especially in men.

Relationships between physical fitness, physical activity, smoking and metabolic and mental health parameters in people with schizophrenia

Low physical fitness has been recognised as a prominent behavioural risk factor for cardiovascular diseases (CVD) and metabolic syndrome (MetS), and as an independent risk factor for all-cause mortality. No studies have systematically assessed physical fitness compared with a matched health control group in patients with schizophrenia. Eighty patients with schizophrenia and 40 age-, gender- and body mass index (BMI)-matched healthy volunteers were included. All participants performed an Eurofit test battery and filled out the International Physical Activity Questionnaire. Patients additionally had a fasting metabolic laboratory screening and were assessed for psychiatric symptoms. Patients with schizophrenia demonstrated significant differences from controls in whole body balance, explosive leg muscle strength, abdominal muscular endurance, and running speed. Inactive patients scored worse on most Eurofit items than patients walking for at least 30min per day. Low physical fitness was associated with illness duration, smoking, the presence of MetS and more severe negative, depressive and cognitive symptoms. Less physically active patients who smoke and suffer from high levels of negative, depressive and/or cognitive symptoms might benefit from specific rehabilitation interventions aimed at increasing physical fitness.

Prevalence of atherosclerosis-related risk factors and diseases in the Philippines

BACKGROUND

We conducted a survey in 2008 to measure the prevalence of lifestyle-related diseases and risk factors in Philippine adults.

METHODS

Stratified multistage sampling was used to cover the entire Philippine population of adults aged 20 years or older. Using health questionnaires, anthropometric measurements, and blood examinations, the prevalences of atherosclerosis-related risk factors and diseases were determined. Survey results were compared with those obtained in 2003.

RESULTS

Out of 7700 eligible subjects, 64% to 93.7% responded to different survey items. Age-adjusted hypertension prevalence was 24.6% at a single visit and 20.6% when corrected for true prevalence. The prevalence of diabetes was 3.9% on the basis of fasting blood glucose (FBG), 5.2% by FBG and history, and 6.0% when 2-hour post-load plasma glucose level was determined. The prevalence of dyslipidemia was 72.0% and the prevalence of smoking was 31%. The prevalence of obesity was 4.9% by body mass index (BMI), and 10.2% and 65.6% by waist-hip ratio (WHR) in men and women, respectively. The prevalences of coronary, cerebrovascular, and peripheral arterial diseases were 1.1%, 0.9%, and 1.0%, respectively.

CONCLUSIONS

The prevalences of risk factors for atherosclerosis were higher in 2008 than in 2003, although the increase in diabetes was not significant and smoking decreased. These findings indicate a need for active collaborative intervention by all government agencies and medical societies in the Philippines.