Does the metabolic syndrome exist?

Risk Assessment for Cardiovascular Disease Using the Framingham Risk Score and Globorisk Score Among Newly Diagnosed Metabolic Syndrome Patients

Purpose

The presence of metabolic syndrome (MetS) is linked to an increased risk of cardiovascular disease (CVD) development. In this study, CVD risk was calculated among individuals with newly diagnosed MetS using the Framingham Risk Score (FRS) and Globorisk Score. The FRS and Globorisk score are particularly relevant in predicting CVD risk as these scores include key MetS-related risk factors like blood pressure, cholesterol levels, and age.

Patients and Methods

A community-based cross-sectional study was conducted at various sites in Karachi, Pakistan, from February 2022 to August 2022. Newly diagnosed cases of MetS with no physical disability, known illness, and not taking any regular medication were recruited. MetS was defined based on the definition of International Diabetes Federation. The major outcome was 10-year risk for CVD using the FRS and Globorisk Score.

Results

Of 304 patients, 59.2% were classified as low risk according to FRS, while 20.4% were classified as moderate and high risk each. Using the Globorisk score, 44.6% of 224 patients were classified as low risk, 34.4% as moderate risk, and 21.0% as high risk. A moderate positive correlation was observed between the two CVD risk scores (r = 0.651, 95% CI 0.58-0.71). Both risk scores have reported age, gender, and current smokers as significant risk factors in predicting CVD in 10-years (P < 0.05).

Conclusion

The outcome of both CVD risk scores predicted moderate-to-high risk of CVD in 10-years in almost half of the newly diagnosed patients with MetS. In particular, the risk of development of CVD in 10-years in newly diagnosed MetS is higher with increasing age, in male gender, and current smokers.

Curcumin supplementation improves biomarkers of oxidative stress and inflammation in conditions of obesity, type 2 diabetes and NAFLD: updating the status of clinical evidence

Oxidative stress and inflammation remain the major complications implicated in the development and progression of metabolic complications, including obesity, type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD). In fact, due to their abundant antioxidant and anti-inflammatory properties, there is a general interest in understanding the therapeutic effects of some major food-derived bioactive compounds like curcumin against diverse metabolic diseases. Hence, a systematic search, through prominent online databases such as MEDLINE, Scopus, and Google Scholar was done focusing on randomized controlled trials (RCTs) reporting on the impact of curcumin supplementation in individuals with diverse metabolic complications, including obesity, T2D and NAFLD. Summarized findings suggest that curcumin supplementation can significantly reduce blood glucose and triglycerides levels, including markers of liver function like alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with T2D and NAFLD. Importantly, this effect was consistent with the reduction of predominant markers of oxidative stress and inflammation, such as the levels of malonaldehyde (MDA), tumor necrosis factor-alpha (TNF-α), high sensitivity C-reactive protein (hs-CRP) and monocyte chemoattractant protein-1 (MCP-1) in these patients. Although RCTs suggest that curcumin is beneficial in ameliorating some metabolic complications, future research is still necessary to enhance its absorption and bioavailability profile, while also optimizing the most effective therapeutic doses.

The role of oxidant-antioxidant markers and resistin in metabolic syndrome elderly individuals

In elderly, hormones and oxidant-antioxidant interplay are suggested to mediate biochemical balance between adipose tissue to other tissues. Thus the study attempts to explore metabolic traits, plasma resistin, and oxidant-antioxidant markers in metabolic syndrome (MetS) in comparison to non-metabolic syndrome (non-MetS) elderly individuals. A total of 541 healthy elderly Caucasians, with no acute and/or chronic disorders were invited. After taking into account inclusion/exclusion criteria's the MetS was defined as the presence of three out of five abnormal findings and allowed to divided groups into: non-metabolic syndrome, non-MetS (n = 25, median age 69.0 years), and newly diagnosed MetS (n = 29; median age 70.5 years) individuals. Glucose, plasma lipids, resistin (Res), thiobarbituric acid-reacting substances (TBARS), total antioxidant status (TAS), and Cu,Zn-superoxide dismutase (SOD-1) were measured. The MetS had higher resistin than non-MetS (p < 0.04). The linear correlation (all at p < 0.05) showed correlation for Res&triacylglycerols (R = 0.44), and for Res&diastolic blood pressure (R = -0.58) and for SOD-1&fasting glucose (R = -0.34) in MetS, while in the non-MetS group fasting glucose correlates with Res (R = 0.58) and with TAS (R = -0.43). The multiple regression analysis (alone and in combination) showed that independently from other factors resistin correlated positively with fasting glucose (β = 0.37; R = 0.58; R2 = 0.23; p < 0.01) in all investigated elderly participants. In the MetS resistin correlated negatively with diastolic blood pressure (β = -0.68; R = 0.80; R2 = 0.53; p = 0.0004) moreover in that group TAS correlated negatively with HDL-C (β = -0.71; R = 0.72; R2 = 0.37; p = 0.01). While age correlated negatively with systolic blood pressure (β = -0.60; R = 0.62; R2 = 0.14; p = 0.03) independently from other factors in the non-MetS group. Various metabolic factors contribute to maintain serum resistin and oxidant-antioxidant balance in the elderly people in the presence or absence of MetS. Resistin may serve as a predictor of MetS in the elderly, while strong antioxidant defense interactions in older individuals may indicate good health.

The association of serum uric acid with metabolic syndrome and its components-From a single-clinical centre in China

BACKGROUND AND OBJECTIVES

Increasing evidence suggests that uric acid (UA) levels may play a role in the MetS. The purpose of this study was the association of serum uric acid with metabolic syndrome and its components from a single-clinical centre in China.

SUBJECTS AND METHODS

We retrospectively analysed the physical examination information of patients at the Health Checkup Centre of the Beijing Friendship Hospital, Capital Medical University in 2018. MetS was defined as ≥3 of the risk factors according to the revised Harmonised criteria. Statistical analyses were performed using the SPSS statistical software package, version 22.0 (IBM Corporation, Armonk, NY, USA).

RESULTS

A total of 36 663 subjects were retrospectively analysed. The incidence of MetS was 23.6% amongst the study participants and 38.9% in subjects with HUA. The incidence of HUA was 33.3% in the MetS group. Higher SUA levels were correlated with an increased risk of having full MetS, hypertriglyceridemia and low HDL-C after adjustment (all P < .001 for the trend). Only in males higher SUA levels correlated with an increased risk of being overweight. Individuals with the highest quartile of SUA had no significant association with having HP in males, and a significant association between SUA levels and hypertension was only seen in the highest quartile of females. Males with the highest quartile of SUA (Q4) and females with the higher quartiles of SUA (Q3 and Q4) had no significant association with having hyperglycemia.

CONCLUSION

The incidence of HUA was increased in the MetS group consisting of Chinese patient subjects living in Beijing. SUA is strongly associated with full MetS as well as hypertriglyceridemia and low HDL-C. The relationship between HUA and an overweight BMI, HP and hyperglycemia varied by gender.

Hypertriglyceridemia is associated with platelet hyperactivation in metabolic syndrome patients

BACKGROUND AND OBJECTIVES

Metabolic syndrome (MetS) is an independent risk factor for cardiovascular disease (CVD), in which platelet hyperactivation plays a pivotal role. The purpose of this study was to evaluate platelet function in MetS patients using Platelet Function Analyzer-100 (PFA-100) and to explore the risk factors for platelet hyperactivity in MetS.

SUBJECTS AND METHODS

We investigated participants who were enrolled for health check-up in our department. Routine physical examinations and fasting blood sample tests were performed when participants visited the hospital. MetS was defined as ≥3 of the risk factors according to the Harmonised criteria: central obesity, hypertension (HP), hypertriglyceridemia, low high density lipoprotein cholesterol and hyperglycaemia. Participants were divided into a MetS group (≥3), normal control (NC) group (0) and non-MetS group (1-2) according to the numbers of the five risk factors. Platelet function was tested by PFA-100, which measures the time taken for blood to occlude an aperture (closure time [CT]). All continuous data were compared using Student's t test or Mann-Whitney U test according to the data distribution. Categorical data were compared using the chi-square test. Logistic regression was used to investigate the independent risk marker for PFA-100 CT values.

RESULTS

A total of 831 participants (611 males and 220 females) was included in our subject. The MetS group had significantly shorter CT values compared with the NC group (106 (52-181) s vs 111 (70-210) s, P < .05) and the non-MetS Group (106 (52-181) s vs 113 (73-197) s, P < .05). Higher body mass index, hypertriglyceridemia and HP were correlated with shorter CT values (P < .05). Logistic regression analyses indicated that hypertriglyceridemia was an independent risk marker for shorter PFA-100 CT values (P < .05).

CONCLUSION

Our results indicate the presence of platelet hyperactivation in MetS patients and that hypertriglyceridemia is an independent risk marker for it. Triglyceride-lowering treatment may reduce CVD risk in MetS individuals.

Abdominal obesity and hypertension are correlated with health-related quality of life in Taiwanese adults with metabolic syndrome

OBJECTIVE

Metabolic syndrome (MetS) gains more attention due to high prevalence of obesity, diabetes and hypertension among adults. Although obesity, diabetes and hypertension can certainly compromise health-related quality of life (HRQoL), the correlations of sociodemographic factors, quality of life and MetS remains unclear. This study aims to investigate the association between HRQoL and MetS in an Asian community of the sociodemographic characteristics.

RESEARCH DESIGN AND METHODS

We performed a cross-sectional study by recruiting 2588 Taiwanese patients aged ≥30 years between August 2015 and August 2017. Sociodemographic data and anthropometric variables were obtained from medical records and physical examination. Meanwhile, HRQoL was assessed by 36-Item Short-Form Health Survey questionnaires.

RESULTS

The overall prevalence of MetS was 32.8%. Multivariate analysis revealed that age ≥65 years (OR=1.987, p<0.001), body mass index (BMI) ≥24 kg/m² (OR=7.958, p<0.001), low educational level (OR=1.429, p=0.014), bad self-perceived health status (OR=1.315, p=0.01), and betel nut usage (OR=1.457, p=0.048) were associated with the development of MetS. For patients with MetS, the physical and mental health domains of HRQoL are negatively correlated with abdominal obesity and hypertension, respectively.

CONCLUSIONS

Adult MetS in Taiwan was associated with certain sociodemographic factors including older age, high BMI, low educational level, bad self-perceived health status, and betel nut use. Abdominal obesity and hypertension was correlated with HRQoL in patients with MetS.

The Circadian Syndrome: is the Metabolic Syndrome and much more!

The Metabolic Syndrome is a cluster of cardio-metabolic risk factors and comorbidities conveying high risk of both cardiovascular disease and type 2 diabetes. It is responsible for huge socio-economic costs with its resulting morbidity and mortality in most countries. The underlying aetiology of this clustering has been the subject of much debate. More recently, significant interest has focussed on the involvement of the circadian system, a major regulator of almost every aspect of human health and metabolism. The Circadian Syndrome has now been implicated in several chronic diseases including type 2 diabetes and cardiovascular disease. There is now increasing evidence connecting disturbances in circadian rhythm with not only the key components of the Metabolic Syndrome but also its main comorbidities including sleep disturbances, depression, steatohepatitis and cognitive dysfunction. Based on this, we now propose that circadian disruption may be an important underlying aetiological factor for the Metabolic Syndrome and we suggest that it be renamed the 'Circadian Syndrome'. With the increased recognition of the 'Circadian Syndrome', circadian medicine, through the timing of exercise, light exposure, food consumption, dispensing of medications and sleep, is likely to play a much greater role in the maintenance of both individual and population health in the future.

Aerobic Training Associated with Arginine Supplementation Reduces Collagen-Induced Platelet Hyperaggregability in Rats under High Risk to Develop Metabolic Syndrome

BACKGROUND

Increased platelet response is seen in individuals with metabolic syndrome. Previous reports have shown that arginine supplementation and aerobic exercise training enhance vascular nitric oxide (NO) activity and inhibit platelet hyperaggregability; however, the effects of their association remain unknown.

AIM

To investigate whether arginine supplementation and aerobic exercise association may exert beneficial effects, reducing platelet hyperaggregability in rats under high risk to develop metabolic syndrome.

METHODS

Wistar rats were divided into two groups: control (C) and fructose (F - water with 10% of fructose). After two weeks, the F group was subdivided into four groups: F, the same as before; fructose + arginine (FA - 880 mg/kg/day of L-arginine by gavage); fructose + training (FT); and fructose + arginine + training (FTA). Treatment lasted for eight weeks.

RESULTS

The fructose administration was able to increase the collagen-induced platelet aggregation (27.4 ± 2.7%) when compared to the C group (8.0 ± 3.4%). Although the arginine supplementation (32.2 ± 6.3%) or aerobic training (23.8 ± 6.5%) did not promote any change in platelet collagen-induced hyperaggregability, the association of arginine supplementation and aerobic exercise promoted an inhibition of the platelet hyperaggregability induced by fructose administration (13.9 ± 4.4%) (P < 0.05). These effects were not observed when ADP was employed as an agonist. In addition, arginine supplementation associated with aerobic exercise promoted a decrease in interleukin-6 (IL-6) and interleukin-8 (IL-8) serum levels when compared to the fructose group, demonstrating an anti-inflammatory effect.

CONCLUSIONS

Our data indicate an important role of arginine supplementation associated with aerobic exercise, reducing platelet hyperaggregability and inflammatory biomarker levels in rats under high risk to develop metabolic syndrome.

Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus

BACKGROUND

Women with gestational diabetes mellitus (GDM) are at greater risk of metabolic syndrome (MetS). We studied the association between second-trimester retinal microvasculature and 5-year MetS incidence in women with GDM.

METHODS

A total of 142 mothers with GDM were recruited and followed up 5years after delivery. Retinal photography was performed at 26-28weeks gestation and metabolic outcomes were assessed at the 5-year postpartum follow-up visit. GDM and MetS were defined based on World Health Organization (WHO) guidelines and Adults Treatment Panel (ATP) III guidelines, respectively. Modified-Poisson regression was applied to study the association between second-trimester retinal microvasculature and incident 5-year maternal MetS, after adjusting for major confounders. Area under the curve (AUC) was calculated based on the final model.

RESULTS

Our prospective cohort reported a 9.2% incidence rate of 5-year MetS among women with GDM. After adjusting for maternal age, ethnicity, college degree, pre-pregnancy BMI and fasting glucose at 26-28week gestation, each 10μm widening in retinal venular caliber was associated with an increased relative risk of 1.6 (95% confidence interval [CI]: 1.0, 2.8) in incident MetS. In addition to traditional risks of pre-pregnancy BMI and fasting glucose level at 26-28week gestation, retinal venular caliber mildly increased the prediction of 5-year maternal MetS by 1.8%.

CONCLUSIONS

Second-trimester retinal venular widening was associated with incident 5-year maternal MetS in women with GDM. Our study suggests that mother with GDM at risk of future MetS development may have already presented retinal microvascular abnormalities during pregnancy.

Metabolic syndrome, inflammation and atherothrombosis

Extensive research of the past decades altered our traditional concept about the genesis of atherosclerosis fundamentally. Today, the crucial role of inflammation in the formation and progression of atherosclerotic plaques is indisputable. Patients at high risk for developing cardiovascular disease, owing to poor diet, obesity and low physical activity have been shown to exhibit a particular inflammatory pattern.

Therefore, the present review highlights the crosslink between the metabolic syndrome (MetS), adipose tissue, adipokines and selected inflammatory cytokines in the context of atherothrombosis and cardiovascular disease.

Obesity or obesities? Controversies on the association between body mass index and premature mortality

Obesity is still defined on the basis of body mass index (BMI) and BMI in itself is generally accepted as a strong predictor of overall early mortality. However, an inverse association between BMI and mortality has been reported in patients with many disease states and in several clinical settings: hemodialysis, cardiovascular diseases, hypertension, stroke, diabetes, chronic obstructive pulmonary disease, surgery, etc. This unexpected phenomenon is usually called obesity-survival paradox (OP). The contiguous concepts of metabolically healthy obesity (MHO, a phenotype having BMI ≥ 30 but not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance, HOMA, <2.5) and metabolically obese normal weight (MONW, normal-weight individuals displaying obesity-related phenotypic characteristics) have received a great deal of attention in recent years. The interactions that link MHO, MONW and OP with body composition, fat distribution, aging and cardiorespiratory fitness are other crucial areas of research. The article is an introductory narrative overview of the origin and current use of the concepts of MHO, MONW and OP. These phenomena are very controversial and appear as a consequence of the frail current diagnostic definition of obesity based only on BMI. A new commonly established characterization and classification of obesities based on a number of variables is needed urgently.

Prevalence of metabolic syndrome among Iranian occupational drivers

AIMS

Compared with other members of a society, drivers are under more periodic and constant surveillance due mainly to this fact that their type of work requires them to spend most of their times in a sedentarily position. The recent survey had done to evaluate the prevalence of Met Syn among professional drivers in northeast area of Iran.

MATERIALS AND METHODS

To evaluate the prevalence of Met Syn among long-haul drivers, 1018 male drivers were studied. Definition of Met Syn was based on ATP III, IDF and AHA. The statistical tests were composed of chi-square and independent t tests.

RESULTS AND CONCLUSION

The participants' mean age was 42.17±10.65 years. The prevalence of Met Syn according to ATP III, IDF and AHA criteria was 26.1%, 35.2% and 31.6% respectively. 6.6% of drivers were impaired fasting glucose. The drivers with the bus, minibus, taxi formed the greatest number of smokers (82.9%) among all drivers (p=0.023). The average of body mass index (BMI) was 26.2±4.06. The most prevalence of Mets according to IDF criteria were observed in drivers of heavy vehicles and also the ones of passenger vehicles, with 36.7% and 43.9% respectively. Based on high prevalence of Met Syn and other risk factors in this study, and considering these factors, should be more careful about this point. It is recommended to control risk factors such as, control of high BMI and TG, LDL, waist circumfernce, education.

Regular exercise training reverses ectonucleotidase alterations and reduces hyperaggregation of platelets in metabolic syndrome patients

BACKGROUND

Alterations in the activity of ectonucleotidase enzymes have been implicated in cardiovascular diseases, whereas regular exercise training has been shown to prevent these alterations. However, nothing is known about it relating to metabolic syndrome (MetS). We investigated the effect of exercise training on platelet ectonucleotidase enzymes and on the aggregation profile of MetS patients.

METHODS

We studied 38 MetS patients who performed regular concurrent exercise training for 30 weeks. Anthropometric measurements, biochemical profiles, hydrolysis of adenine nucleotides in platelets and platelet aggregation were collected from patients before and after the exercise intervention as well as from individuals of the control group.

RESULTS

An increase in the hydrolysis of adenine nucleotides (ATP, ADP and AMP) and a decrease in adenosine deamination in the platelets of MetS patients before the exercise intervention were observed (P<0.001). However, these alterations were reversed by exercise training (P<0.001). Additionally, an increase in platelet aggregation was observed in the MetS patients (P<0.001) and the exercise training prevented platelet hyperaggregation in addition to decrease the classic cardiovascular risks.

CONCLUSIONS

An alteration of ectonucleotidase enzymes occurs during MetS, whereas regular exercise training had a protective effect on these enzymes and on platelet aggregation.

Which insulin resistance-based definition of metabolic syndrome has superior diagnostic value in detection of poor health-related quality of life? Cross-sectional findings from Tehran Lipid and Glucose Study

Background

The superiority of the diagnostic power of different definitions of metabolic syndrome (MetS) in detecting objective and subjective cardiovascular outcomes is under debate. We sought to compare diagnostic values of different insulin resistance (IR)-based definitions of MetS in detecting poor health-related quality of life (HRQoL) in a large sample of Tehranian adults.

Methods

This cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study on a total sample of 742 individuals, aged ≥ 20 years. Metabolic syndrome was defined according to the World Health Organization (WHO), the European Group for the study of Insulin Resistance (EGIR), and the American Association of Clinical Endocrinology (AACE). Health-related quality of life was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis and Receiver Operating Characteristic (ROC) curve were used to investigate the impact of the three IR-based definitions of MetS on HRQoL and compare their discriminative powers in predicting poor HRQoL.

Results

Compared with other definitions, the WHO definition identified more participants with MetS (41.8 %). Although the AACE definition had higher adjusted odds ratios for reporting poor physical HRQoL (OR: 1.95; CI: 0.84–4.53 and OR: 1.01; CI: 0.55–1.85 in men and women respectively) and mental HRQoL (OR: 0.97; CI: 0.41–2.28 and OR: 1.00; CI: 0.56–1.79 in men and women respectively), none of the three studied definitions were significantly associated with poor physical or mental HRQoL in either gender; nor did ROC curves show any significant difference in the discriminative powers of IR-based definitions in detecting poor HRQoL in either gender.

Conclusions

None of the three studied IR-based definitions of MetS could significantly detect poor HRQoL in the physical or mental domains, indicating no significant superior diagnostic value for any of these definitions.

Host response, obesity, and oral health

Proper food choices are part of preventing or reducing the risk of dental caries and periodontal disease. A significant association has been proven between oral diseases and the incidence of systemic diseases. Obesity, just like smoking, is one of the major risk factors for oral disease and is a serious social problem that has reached epidemic proportions in many developed countries. The results of studies on periodontitis confirm the relationship between the values of body mass index (BMI) and the prevalence of periodontal diseases. Adipose tissue is an active endocrine organ and it performs many important functions in the body, such as thermal isolation and protection, storage, and secretion. Many cytokines are secreted proportionally to the amount of fat present and are actively involved in the metabolism of the whole system, including the functioning of the immune system. Therefore, obesity may alter the response of the host to the antigens derived from bacterial plaque, and thus cause disturbances in the inflammatory response in the course of periodontal disease.

Diagnostic values of different definitions of metabolic syndrome to detect poor health status in Iranian adults without diabetes

AIMS

This study aimed to compare the diagnostic impact of four definitions of the metabolic syndrome for detection of poor health status in adults without diabetes living in Tehran.

METHODS

A representative sample of 950 individuals (64% women), aged ≥ 20 years, participants of the Tehran Lipid and Glucose Study in 2005-2007, were recruited for the study. Health status was assessed using the Iranian version of the 36-item Short Form Health Survey. We assessed the detectability of poor health status by definitions of the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation, the American Heart Association/National Heart, Lung, and the Blood Institute and the Joint Interim Statement.

RESULTS

Compared with other definitions, the Joint Interim Statement identified more participants (46.9%) having the metabolic syndrome. Using the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation and the Joint Interim Statement, the metabolic syndrome was significantly related to poor physical health status, even after adjustment for confounding variables, in women, but not in men. None of the four definitions of the metabolic syndrome was related to the mental health status in either gender. The receiver operating characteristic curves showed no significant difference in the discriminative power of the metabolic syndrome definitions in detecting poor health status in either gender. However, women showed a higher area under the curve for all definitions, in comparison with men.

CONCLUSION

There was no difference in the four different definitions of the metabolic syndrome in detecting poor health status among Iranian adults.

Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort

BACKGROUND

The metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS.

METHODS

The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed (<15 months) SLE patients from 30 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected according to a standardised protocol. MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Univariate and backward stepwise multivariate logistic regression were used to assess the relationship of individual variables with MetS.

RESULTS

We studied 1686 patients, of whom 1494 (86.6%) had sufficient data to determine their MetS status. The mean (SD) age at enrolment and disease duration was 35.2 years (13.4) and 24.1 weeks (18.0), respectively. MetS was present at the enrolment visit in 239 (16%). In backward stepwise multivariable regression analysis, higher daily average prednisolone dose (mg) (OR 1.02, 95% CI 1.00 to 1.03), older age (years) (OR 1.04, 95% CI 1.03 to 1.06), Korean (OR 6.33, 95% CI 3.68 to 10.86) and Hispanic (OR 6.2, 95% CI 3.78 to 10.12) ethnicity, current renal disease (OR 1.79, 95% CI 1.14 to 2.80) and immunosuppressant use (OR 1.81, 95% CI 1.18 to 2.78) were associated with MetS.

CONCLUSIONS

Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity are associated with MetS in SLE patients. Balancing disease control and minimising corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.

Prevalence of metabolic syndrome in obese Chilean children and association with gene variants of the leptin-melanocortin system

Metabolic syndrome (MS) related to adult type 2 diabetes mellitus and cardiovascular disease is prevalent among obese children/adolescents. Genetic variants of the leptin-melanocortin system have been associated with components of MS. The aim of our study is to estimate the prevalence of MS (according to Cook's criteria) in a Chilean cross-sectional sample of 259 obese children (47.1% girls, aged 6-12 years), and to assess the association between common genetic variants of leptin-melanocortin pathway genes (LEP, LEPR, POMC, MC3R and MC4R) with components of the MS using logistic regression. We observed an overall MS prevalence of 26.3% (32.2% in girls and 21.1% in boys) in obese Chilean children. No associations were detected between genetic variants of leptin-melanocortin genes and MS components. MS prevalence among our obese children sample is similar to those previously described in Chile, demonstrating the increased risk of diseases in adulthood that obese children carry.

Gender differences in the prevalence of metabolic syndrome and its components among adults with disabilities based on a community health check up data

Metabolic syndrome is highly prevalent in society gradually and has important implications for public health in recent years. The present study aims to examine the gender effect on the prevalence of metabolic syndrome among adults with disabilities. A cross-sectional study was conduct to analyze annual health check-up chart of 419 people with disabilities whose age ≥ 20 years in east Taiwan. We used to diagnose the metabolic syndrome was defined by the Taiwan Bureau of Health Promotion as the presence of three or more of the following five components: abdominal obesity, high blood pressure, high fasting glucose level, high triglyceride level, and low high-density lipoprotein cholesterol level. The results showed that the prevalence of metabolic syndrome was 19.3% in the study subjects (16.8% in men and 23.1% in women; p = 0.110). Our study also indicated that the genders were significantly different in the followings (men vs. women): abdominal obesity (33.2% vs. 50.9%; p<0.001), high blood pressure (36.4% vs. 23.7%; p = 0.006), high fasting glucose level (18.4 vs. 14.8%; p = 0.334), high triglyceride level (24.0% vs. 14.2%; p = 0.014) and HDL-C (21.6% vs. 35.5%; p = 0.002) among the sample. To prevent the metabolic syndrome occurrence and consequences, the study suggests that the health authorities should put greater efforts to address the metabolic syndrome components, particularly in higher rates of obesity-related health conditions to avoid significant health and health care costs in the future.

[Trends and current questions of cardiovascular prevention in primary health care]

Although an impressive progress has been achieved in the treatment of cardiovascular diseases, they are at the top of the mortality statistics in Hungary. Prevention of these diseases is an essential task of the primary health care. Cardiovascular prevention is carried out at primary, secondary and tertiary levels using risk group and population preventive strategies. The two main tasks of primary cardiovascular prevention are health promotion and cardiovascular disease prevention, and its main programs are ensuring healthy nutrition, improving physical training and accomplishing an anti-smoking program. The essential form of secondary prevention is the screening activity of the primary health care. The majority of cardiovascular risk factors can be discovered during the doctor-patient consultation, but laboratory screening is needed for assessing metabolic risks. The official screening rules of the cardiovascular risk factors and diseases are based on diagnostic criteria of the metabolic syndrome; however, nowadays revealing of global cardiometabolic risks is also necessary. In patients without cardiovascular diseases but with risk factors, a cardiovascular risk estimation has to be performed. In primary care, there is a possibility for long term follow-up and continuous care of patients with chronic diseases, which is the main form of the tertiary prevention. In patients with cardiovascular diseases, ranking to cardiovascular risk groups is a very important task since target values of continuous care depend on which risk group they belong to. The methods used during continuous care are lifestyle therapy, specific pharmacotherapy and organ protection with drugs. Combined health education and counselling is the next element of the primary health care prevention; it is a tool that helps primary, secondary and tertiary prevention. Changes needed for improving cardiovascular prevention in primary care are the following: appropriate evaluation of primary prevention, health education and counselling, renewal of the cardiovascular screening system based on the notion of global cardiometabolic risk, creating a unified cardiovascular prevention guideline, and operating primary care cardiovascular prevention within the framework of an integrated prevention system.

Connexin-dependent signaling in neuro-hormonal systems

The advent of multicellular organisms was accompanied by the development of short- and long-range chemical signalling systems, including those provided by the nervous and endocrine systems. In turn, the cells of these two systems have developed mechanisms for interacting with both adjacent and distant cells. With evolution, such mechanisms have diversified to become integrated in a complex regulatory network, whereby individual endocrine and neuro-endocrine cells sense the state of activity of their neighbors and, accordingly, regulate their own level of functioning. A consistent feature of this network is the expression of connexin-made channels between the (neuro)hormone-producing cells of all endocrine glands and secretory regions of the central nervous system so far investigated in vertebrates. This review summarizes the distribution of connexins in the mammalian (neuro)endocrine systems, and what we know about the participation of these proteins on hormone secretion, the life of the producing cells, and the action of (neuro)hormones on specific targets. The data gathered since the last reviews on the topic are summarized, with particular emphasis on the roles of Cx36 in the function of the insulin-producing beta cells of the endocrine pancreas, and of Cx40 in that of the renin-producing juxta-glomerular epithelioid cells of the kidney cortex. This article is part of a Special Issue entitled: The Communicating junctions, composition, structure and characteristics.

Metabolic syndrome, insulin resistance and kidney function in non-diabetic individuals

BACKGROUND

Metabolic syndrome has been recently identified as a risk factor for chronic kidney disease (CKD). Since the five individual components of the metabolic syndrome have also been identified as risk factors for CKD, the metabolic syndrome diagnosis may represent an aggregate of CKD risk factors. On the other hand, the components of the metabolic syndrome are also associated with insulin resistance, which may directly mediate the increased CKD risk.

METHODS

This study was a cross-sectional evaluation of the relationship between metabolic syndrome, insulin resistance and estimated glomerular filtration rate (eGFR) in 574 non-diabetic individuals. Insulin resistance was directly quantified using the insulin suppression test, and the metabolic syndrome components were measured. eGFR was calculated using the three validated estimation equations: the Chronic Kidney Disease Epidemiology Collaboration equation, the Mayo quadratic equation and the Modification of Diet in Renal Disease study equation.

RESULTS

While CKD prevalence was higher and mean eGFR was lower in individuals who met the metabolic syndrome criteria compared with those who did not, we did not observe a significant relationship between insulin resistance and eGFR. Of all of the components of the metabolic syndrome, only hypertension was significantly associated with CKD prevalence [odds ratio (95% confidence interval), 3.5 (1.2-10.1), P=0.02].

CONCLUSION

Although CKD is more common among individuals with the metabolic syndrome, insulin resistance is not a common factor.

Metabolic syndrome, insulin resistance and kidney function in non-diabetic individuals

BACKGROUND

Metabolic syndrome has been recently identified as a risk factor for chronic kidney disease (CKD). Since the five individual components of the metabolic syndrome have also been identified as risk factors for CKD, the metabolic syndrome diagnosis may represent an aggregate of CKD risk factors. On the other hand, the components of the metabolic syndrome are also associated with insulin resistance, which may directly mediate the increased CKD risk.

METHODS

This study was a cross-sectional evaluation of the relationship between metabolic syndrome, insulin resistance and estimated glomerular filtration rate (eGFR) in 574 non-diabetic individuals. Insulin resistance was directly quantified using the insulin suppression test, and the metabolic syndrome components were measured. eGFR was calculated using the three validated estimation equations: the Chronic Kidney Disease Epidemiology Collaboration equation, the Mayo quadratic equation and the Modification of Diet in Renal Disease study equation.

RESULTS

While CKD prevalence was higher and mean eGFR was lower in individuals who met the metabolic syndrome criteria compared with those who did not, we did not observe a significant relationship between insulin resistance and eGFR. Of all of the components of the metabolic syndrome, only hypertension was significantly associated with CKD prevalence [odds ratio (95% confidence interval), 3.5 (1.2-10.1), P=0.02].

CONCLUSION

Although CKD is more common among individuals with the metabolic syndrome, insulin resistance is not a common factor.

An analysis of the metabolic syndrome phenotype in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is associated with an increased risk of coronary heart disease (CHD) not fully explained by classic risk factors. Metabolic syndrome (MetS) is associated with an increased risk of CHD in the general population and whilst its prevalence is increased in SLE, its phenotypic expression may differ. We studied 200 women with SLE and 100 controls and compared the prevalence of MetS and its individual components. We examined whether any SLE features were associated with MetS and whether MetS in SLE patients was associated with carotid plaque. Patients with SLE were more likely to meet the MetS criteria (age-adjusted OR 2.1 (1.1-3.8)). However, this was not due to increased central obesity (median waist circumference 84 cm vs. 82 cm, p = 0.65) but rather increased prevalence of hypertension (p <0.01) and low HDL-cholesterol (p = 0.01). In a multivariable analysis, age, disease duration, low complement C3 and corticosteroid use ever, were associated with the presence of MetS in SLE. Overall MetS was not associated with the presence of carotid plaque in either SLE or controls. We have shown that MetS is more prevalent in SLE, but the lupus-MetS phenotype reflects risk factor changes driven by disease activity and steroid exposure, rather than obesity. Reliance on clinical measures of central obesity to consider MetS in SLE is not reliable and continued attention to individual CHD risk factors is recommended.

Metabolic syndrome, impaired fasting glucose and obesity, as predictors of incident diabetes in 14 120 hypertensive patients of ASCOT-BPLA: comparison of their relative predictability using a novel approach

AIMS

To evaluate, in hypertensive patients, whether the metabolic syndrome is a better predictor of new-onset diabetes compared with impaired fasting glucose, obesity or its other individual components alone, or collectively.

METHODS

Cox models were developed to assess the risk of new-onset diabetes associated with the metabolic syndrome after adjusting for a priori confounders (age, sex, ethnicity and concomitant use of non-cardiovascular medications), its individual components and other determinants of new-onset diabetes. Area under receiver operator curves using the metabolic syndrome or models of impaired fasting glucose were compared, and the ability of these models to correctly identify those who (after 5-years of follow-up) would or would not develop diabetes was assessed.

RESULTS

The metabolic syndrome adjusted for a priori confounders and its individual components, and further adjusted for other determinants, was associated with significantly increased risk of new-onset diabetes [1.19 (1.00-1.40), P = 0.05 and 1.22 (1.03-1.44), P = 0.02, respectively]. The discriminative ability of the metabolic syndrome model [area under receiver operating curve: 0.764 (0.750-0.778)] was significantly better than the model of impaired fasting glucose [0.742 (0.727-0.757)] (P < 0.001). The metabolic syndrome correctly allocates the risk of new-onset diabetes in a significantly higher proportion of patients (62.3%) than impaired fasting glucose status (37.7%) (P < 0.001). The presence of both the metabolic syndrome and impaired fasting glucose were associated with an approximately 9-fold (7.47-10.45) increased risk of new-onset diabetes. Among normoglycaemic patients, the metabolic syndrome was also associated with significantly increased risk of new-onset diabetes, after adjusting for BMI and a priori confounders [1.66 (1.29-2.13)].

CONCLUSIONS

Both impaired fasting glucose and the metabolic syndrome predict the risk of new-onset diabetes; however, the metabolic syndrome is a better predictor than impaired fasting glucose in assigning the risk of new-onset diabetes in hypertensive patients, and among those with normoglycaemia.

[Prevalence of metabolic syndrome estimated with the new World Health Organization recommendations. The HERMEX study]

OBJECTIVES

The unification of criteria for the diagnosis of metabolic syndrome, together with the subsequent World Health Organization (WHO) proposal to eliminate diabetes and cardiovascular diseases from the diagnostic criteria, will change estimates of the known prevalence of this syndrome. The aim of this study was to determine the prevalence of metabolic syndrome in a health area of Badajoz (Spain) using the latest consensus criteria and eliminating diabetes and cardiovascular disease.

METHODS

We performed a cross-sectional population-wide study of randomly selected individuals aged between 25 and 79 years old in a health area of Badajoz. In all patients, data on their history of cardiovascular risk factors were gathered, waist circumference and blood pressure were measured and a fasting blood sample was collected. The prevalence of metabolic syndrome, following recent criteria, was compared by age and gender.

RESULTS

We recruited 2,833 individuals (46.5% men). The mean age was 51.2 years The prevalence of metabolic syndrome was 33.6% and was significantly higher in men (36.7% vs 30.9%; p < 0.001). The prevalence of metabolic syndrome fell significantly after exclusion of patients with diabetes or cardiovascular disease (20.8%; p < 0.001). The difference in prevalence between the distinct criteria was significant for the whole population and by sex (p < 0.000). A significant difference in prevalence between genders was observed from the age of 45-54 years in men and 55-64 years in women

CONCLUSIONS

The prevalence of metabolic syndrome in a health area of Badajoz is among the highest reported in population-based studies in Spain. Although estimates of the prevalence are decreased by the new international recommendations, a considerable proportion of the young population requires preventive measures.

Rhesus macaques develop metabolic syndrome with reversible vascular dysfunction responsive to pioglitazone

BACKGROUND

The metabolic syndrome (MetS) is a constellation of clinical features that include central obesity, hypertension, atherogenic dyslipidemia, and insulin resistance. However, the concept remains controversial; it has been debated whether MetS represents nothing more than simultaneous co-occurrence of individual risk factors or whether there are common shared pathophysiological mechanisms that link the individual components.

METHODS AND RESULTS

To investigate the emergence of metabolic and cardiovascular components during the development of MetS, we identified MetS-predisposed animals (n=35) in a large population of rhesus macaques (Macaca mulatta, 12.7±2.9 years old, n=408), acclimated them to standardized conditions, and monitored the progression of individual component features over 18 months. In 18 MetS animals with recently developed fasting hyperinsulinemia, central obesity, hypertension, and atherogenic dyslipidemia, we found that individual metabolic and cardiovascular components track together during the transition from pre-MetS to onset of MetS; MetS was associated with a 60% impairment of flow-mediated dilation, establishing the mechanistic link with vascular dysfunction. Pioglitazone treatment (3 mg/kg body weight/d for 6 weeks), a peroxisome proliferator-activated receptor γ agonist, reversibly improved atherogenic dyslipidemia and insulin resistance and fully restored flow-mediated dilation with persistent benefits.

CONCLUSIONS

Coemergence of metabolic and cardiovascular components during MetS progression and complete normalization of vascular dysfunction with peroxisome proliferator-activated receptor γ agonists suggest shared underlying mechanisms rather than separate processes, arguing for the benefit of early intervention of MetS components. Predictive nonhuman primate (NHP) models of MetS should be highly valuable in mechanistic and translational studies on the pathogenesis of MetS in relation to cardiovascular disease and diabetes mellitus.

Insulin resistance in obesity as the underlying cause for the metabolic syndrome

The metabolic syndrome affects more than a third of the US population, predisposing to the development of type 2 diabetes and cardiovascular disease. The 2009 consensus statement from the International Diabetes Federation, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity, and the National Heart, Lung, and Blood Institute defines the metabolic syndrome as 3 of the following elements: abdominal obesity, elevated blood pressure, elevated triglycerides, low high-density lipoprotein cholesterol, and hyperglycemia. Many factors contribute to this syndrome, including decreased physical activity, genetic predisposition, chronic inflammation, free fatty acids, and mitochondrial dysfunction. Insulin resistance appears to be the common link between these elements, obesity and the metabolic syndrome. In normal circumstances, insulin stimulates glucose uptake into skeletal muscle, inhibits hepatic gluconeogenesis, and decreases adipose-tissue lipolysis and hepatic production of very-low-density lipoproteins. Insulin signaling in the brain decreases appetite and prevents glucose production by the liver through neuronal signals from the hypothalamus. Insulin resistance, in contrast, leads to the release of free fatty acids from adipose tissue, increased hepatic production of very-low-density lipoproteins and decreased high-density lipoproteins. Increased production of free fatty acids, inflammatory cytokines, and adipokines and mitochondrial dysfunction contribute to impaired insulin signaling, decreased skeletal muscle glucose uptake, increased hepatic gluconeogenesis, and β cell dysfunction, leading to hyperglycemia. In addition, insulin resistance leads to the development of hypertension by impairing vasodilation induced by nitric oxide. In this review, we discuss normal insulin signaling and the mechanisms by which insulin resistance contributes to the development of the metabolic syndrome.

The association between Helicobacter pylori infection and insulin resistance: a systematic review

BACKGROUND

Helicobacter pylori infection has been associated with diverse extradigestive morbidity, including insulin resistance (IR) syndrome. The aim of this systematic review was to summarize the epidemiologic evidence concerning the association between H. pylori infection and IR quantitative indexes.

MATERIALS AND METHODS

A computerized literature search in PubMed electronic databases and Cochrane Central Register of Controlled Trials was performed.

RESULTS

Nine studies reporting data on 2120 participants were finally eligible for this systematic review. Seven of them were cross-sectional studies and two were nonrandomized, open-label, controlled trials investigating the effect of H. pylori eradication on IR. Homeostatic model of assessment insulin resistance (HOMA-IR) was used in all studies to quantify IR. There seems to be a trend toward a positive association between H. pylori infection and HOMA-IR, strengthened by regression analysis in one study. However, there was significant heterogeneity between studies regarding the method(s) of H. pylori infection diagnosis based on and the study populations. The studies for the effect of H. pylori eradication on HOMA-IR revealed conflicting results.

CONCLUSIONS

Although data seem to indicate a potential association between H. pylori infection and IR, further studies are needed to strengthen this association and to clarify whether there is a causative link between them. If a causal link is confirmed in the future, this may have a major impact on the pathophysiology and management of IR syndrome, including type 2 diabetes mellitus and nonalcoholic fatty liver disease.

Psychological distress predicts the development of the metabolic syndrome: a prospective population-based study

OBJECTIVE

To examine prospectively the association of psychological distress with the development of the metabolic syndrome (MetS) and the potential influence of demographic characteristics, health behaviors, and inflammation in this association.

METHODS

A total of 466 (n = 185 males; 281 females) subjects, aged 36 to 56 years, and free of MetS at baseline, participated in a population-based study from 1997 to 1998 and again from 2004 to 2005. Mean observation time was 6.4 years. Various clinical, biochemical, and behavioral factors were measured at baseline, including assessment of psychological distress using the 12-item General Health Questionnaire. The development of MetS was measured at follow-up based on National Cholesterol Education Program criteria.

RESULTS

Subjects with high psychological distress at baseline (General Health Questionnaire scores, 4-12) were more than twice as likely to develop MetS than those with low psychological distress (odds ratio, 2.18; 95% confidence interval, 1.30-3.64). Adjustments for 1) age, gender, and sociodemographic variables; 2) health behaviors (smoking, alcohol use, and leisure time physical activity); and 3) C-reactive protein in the analysis diminished the odds of developing MetS in the distressed group (odds ratio, 1.87; 95% confidence interval, 1.83 and 1.81, respectively); however, the association remained statistically significant (p = .025-.038).

CONCLUSIONS

Psychological distress at baseline increases the risk of developing MetS during follow-up. This association remained robust after adjusting for age, gender, sociodemographic variables, baseline health behaviors, and C-reactive protein. These prospective findings are evidence of a significant association between psychological distress and the development of MetS.

Causal diagrams, information bias, and thought bias

Information bias might be present in any study, including randomized trials, because the values of variables of interest are unknown, and researchers have to rely on substitute variables, the values of which provide information on the unknown true values. We used causal directed acyclic graphs to extend previous work on information bias. First, we show that measurement is a complex causal process that has two components, ie, imprinting and synthesizing. Second, we explain how the unknown values of a variable may be imputed from other variables, and present examples of valid and invalid substitutions for a variable of interest. Finally, and most importantly, we describe a previously unrecognized bias, which may be viewed as antithetical to information bias. This bias arises whenever a variable does not exist in the physical world, yet researchers obtain “information” on its nonexistent values and estimate nonexistent causal parameters. According to our thesis, the scientific literature contains many articles that are affected by such bias.

Contribution of animal models to the understanding of the metabolic syndrome: a systematic overview

The metabolic syndrome (MetS) is one of the most important challenges to public health and biomedical research. Animal models of MetS, such as leptin-deficient obese mice, obese spontaneously hypertensive rats, JCR: LA-cp rats and the Ossabaw and Göttingen minipigs, have contributed to our understanding of the pathophysiological basis and the development of novel therapies. For a complex disease syndrome, no animal model can be expected to serve all needs of research. Although each animal model has limitations and strengths, used together in a complementary fashion, they are essential for research on the MetS and for rapid progress in understanding the aetiology and pathogenesis towards a cure. The purpose of this review is to assess how current animal models contributed to our knowledge of the human MetS, and to systematically evaluate the strengths and weaknesses of the currently available 78 animal models from 11 species.

The multi-systemic nature of diabetes mellitus: Genotype or phenotype?

BACKGROUND

This article discusses factors which materially influence the diagnosis, prevention and treatment of diabetes mellitus but which may be overlooked by the prevailing biomedical paradigm. That cognition can be mathematically linked to the function of the autonomic nervous system and physiological systems casts new light upon the mechanisms responsible for homeostasis and origins of disease. In particular, it highlights the limitations of the reductionist biomedical approach which considers mainly the biochemistry of single pathologies rather than considering the neural mechanisms which regulate the function of physiological systems, and inherent visceral organs; and which are subsequently manifest as biochemistries of varying degrees of complexity and severity. As a consequence, histopathological tests are fraught with inherent limitations and many categories of drugs are significantly ineffective.

AIMS

Such limitations may be explained if disease (in particular diabetes mellitus) has multiple origins, is multi-systemic in nature and, depending upon the characteristics of each pathology, is influenced by genotype and/or phenotype.

RESULTS

This article highlights the influence of factors which are not yet considered re. the aetiology of diabetes mellitus e.g. the influence of light and sensory input upon the stability of the autonomic nervous system; the influence of raised plasma viscosity upon rates of reaction; the influence of viruses and/or of modified live viruses given in vaccinations; systemic instability, in particular the adverse influence of drinks and lack of exercise upon the body's prevailing pH and its subsequent influence upon levels of magnesium and other essential trace elements.

CONCLUSIONS

This application of the top-down systems biology approach may provide a plausible and inclusive explanation for the nature and occurrence of diabetes mellitus.

WITHDRAWN: Is it "science"… or is it "turf" guarding?

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Metabolic syndrome is associated with learning and recall impairment in middle age

AIMS

To determine whether middle-aged individuals with metabolic syndrome, both with and without type 2 diabetes, exhibit cognitive impairments, and to determine the role of each metabolic syndrome component in those associations.

METHODS

143 participants were drawn from ongoing studies of normal aging. Metabolic syndrome was diagnosed in 73 participants (age: 60.4 +/- 8.4 years), who were contrasted with 70 age- and education-matched controls.

RESULTS

Metabolic syndrome was associated with reductions in recall (p = 0.006), lower overall intellectual functioning (p = 0.013), and nearly significant reductions in learning (p = 0.066) and executive functioning (p = 0.050). These effects were only marginally attenuated when controlling for type 2 diabetes diagnosis. Of the 5 components of the metabolic syndrome, insulin resistance was the only significant predictor of variance in learning and recall. In addition, the number of metabolic syndrome criteria met was inversely associated with cognitive performance.

CONCLUSIONS

These results indicate that impairments in cognitive functioning associated with metabolic syndrome and type 2 diabetes may begin as early as middle age and are primarily due to insulin resistance. These results demonstrate the importance of screening at-risk adults for insulin resistance in order to initiate lifestyle modifications to reverse or prevent these cognitive changes.