Physical activity in metabolic syndrome

Prevalence of metabolic syndrome in ankylosing spondylitis: a multi national meta-analysis study

BACKGROUND

Ankylosing spondylitis (AS) is a chronic inflammatory disease associated with an increased risk of metabolic syndrome (MetS), a cluster of cardiometabolic risk factors. However, the prevalence of MetS in AS remains uncertain. This meta-analysis estimates the global prevalence of MetS in AS patients and identifies factors contributing to its variability.

METHODS

A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted for studies published up to January 18, 2024. A random-effects model was used to estimate pooled prevalence, while meta-regression and subgroup analyses explored sources of heterogeneity.

RESULTS

Seventeen studies meeting the eligibility criteria were included. The pooled prevalence of MetS in AS patients was 15.5% (95% confidence interval [CI]: 10.9-20.8%). The highest prevalence was reported in Africa (37.0%) and the lowest in Asia (8.0%). Variability in AS diagnostic criteria influenced prevalence estimates, with the highest MetS rates found in studies using the Assessment of SpondyloArthritis International Society (ASAS) criteria (37.0%). Meta-regression identified significant associations between MetS prevalence and older age (β = 0.04, P < 0.01), higher body mass index (β = 0.09, P < 0.01), triglyceride levels (β = 0.01, P < 0.01), waist circumference (β = 0.03, P < 0.01), diastolic blood pressure (β = 0.04, P = 0.02) and disease activity, measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (β = 0.03, P = 0.02). Erythrocyte sedimentation rate was significantly correlated with MetS prevalence (β = 0.01, P = 0.04), while C-reactive protein was not (β = -0.01, P = 0.12).

CONCLUSION

MetS is a prevalent comorbidity in AS, significantly influenced by inflammation, obesity, and disease activity. Given its strong association with cardiovascular risk, routine metabolic screening should be incorporated into AS management. Clinicians should adopt an integrated approach that includes lifestyle modifications, targeted therapies, and careful cardiovascular risk assessment to mitigate long-term complications. Standardized diagnostic criteria for MetS in AS are needed to improve risk stratification and patient outcomes.

The Relationships Between Lifestyle Behaviors, Health Perceptions, and Psychosocial Outcomes of Metabolic Syndrome Severity

Purpose

The prevalence of metabolic syndrome (MetS) continues to increase. The severity of MetS can be defined by the number of components or, more recently, a continuous MetS severity score (MetSSS). However, studies that examine lifestyle factors predictive of MetS severity, in general, are lacking. This study aims to compare lifestyle behaviors (eg, physical activity and diet), health perceptions (eg, overall and mental health perceptions), and psychosocial outcomes (eg, perceived stress and social support) among people with a varied number of MetS components and to evaluate associations with MetSSS.

Patients and Methods

This cross-sectional study utilized baseline data from a randomized controlled trial of 618 participants with MetS recruited from 5 different sites across the US We collected data using accelerometers, standard questionnaires, bloodwork, and doing physical measurements. We used a series of separate linear regression models (unadjusted and adjusted) to evaluate differences in lifestyle behaviors, health perceptions, and psychosocial factors between people with 3, 4, and 5 MetS components. We conducted additional linear regression models (unadjusted and adjusted) to assess the association between these same variables and a continuous MetSSS.

Results

Lifestyle behaviors, health perceptions, and psychosocial factors were not different among people with 3, 4, and 5 MetS components. However, in the adjusted models, a lower MetSSS was associated with more average daily steps (β = -631.69, p < 0.001), healthier overall health perception (β = -0.14, p = 0.014), more social support for physical activity from friends (β = -0.89, p = 0.011) and more social support for healthy eating from friends (β = -0.42, p = 0.015).

Conclusion

The MetSSS was shown to be more sensitive to modifiable lifestyle factors compared to the number of MetS components, indicating the importance of using the MetSSS in lifestyle interventions targeting MetS to achieve MetS remission.

Changing the triglyceride diagnostic criteria of metabolic syndrome for African Americans

The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular disease and type 2 diabetes mellitus. Studies show that there is a paradoxical relationship in African Americans however, as they experience a higher rate of cardiovascular disease and type 2 diabetes mellitus despite having a lower prevalence of metabolic syndrome when compared to whites. The triglyceride paradox, an unusual phenomenon in which African Americans consistently express a more normal triglyceride status even when having conditions known to be characterized by high triglyceride levels, is believed to account for this paradoxical relationship. In this manuscript, we review the history and pathophysiology of metabolic syndrome while also discussing the importance of the triglyceride paradox in explaining the inverse relationship that exists between metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus in African Americans. In addition, we advocate for decreasing the triglyceride cutoff value when diagnosing metabolic syndrome in this population to more precisely determine who is at risk for developing type 2 diabetes mellitus and cardiovascular disease.

The Role of Plant-Based Nutrition and Exercise in Metabolic Syndrome: A Narrative Review

BACKGROUND/OBJECTIVES

Metabolic syndrome (MetS) is a prevalent health condition characterized by central obesity, insulin resistance, hypertension, and dyslipidemia, increasing the risk of cardiovascular disease and type 2 diabetes. Lifestyle interventions, particularly plant-based nutrition and exercise, are essential for managing MetS. While both strategies are well-documented independently, their synergistic effects remain less explored. This narrative review integrates findings from both domains to evaluate their combined impact on metabolic syndrome. The review examines the individual and combined impacts of plant-based nutrition and exercise on MetS-related metabolic dysfunction.

METHODS

A comprehensive review of 114 peer-reviewed studies was conducted to assess the role of plant-based diets and structured physical activity in improving insulin sensitivity, lipid profiles, inflammation, and weight management. Studies investigating the mechanisms through which dietary components and exercise modalities influence metabolic health were analyzed, along with behavioral and psychological factors affecting long-term adherence.

RESULTS

Plant-based diets, particularly those high in fiber, polyphenols, and healthy fats, improve glucose metabolism, reduce inflammation, and enhance cardiovascular health. Exercise complements these benefits by increasing insulin sensitivity, promoting fat oxidation, and improving lipid metabolism. When combined, plant-based nutrition and exercise provide superior metabolic outcomes, including greater reductions in visceral adiposity, improved endothelial function, and enhanced glycemic control.

CONCLUSIONS

Plant-based nutrition and structured exercise are effective strategies for managing MetS. Their synergistic effects highlight the importance of integrated lifestyle interventions for long-term metabolic health.

The interplay of physical activity and smoking with metabolic syndrome and its components in the STEPS survey

Metabolic syndrome (MetS) is a cluster of metabolic disorders associated with an increased risk of cardiovascular disease and type 2 diabetes. The aim of this study was to investigate the interaction between physical activity and smoking on the development of MetS and its components. In this repeated cross-sectional study, data from the Iranian STEPwise non-communicable disease risk factor surveillance (STEPS) surveys (2007, 2011, and 2016) were analyzed, which included 40,046 participants aged 25-64 years. Physical activity was categorized as low, moderate, or vigorous based on metabolic equivalents (MET) minutes per week. Smoking status was defined based on self-reported information as either a current smoker or a non-smoker. MetS was diagnosed using established criteria. Interactive association was analyzed using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI), and weighted logistic regression. The weighted prevalence of MetS was higher in the low physical activity group (34.32%) than in the current smokers group (26.63%). Positive interactions between low physical activity and smoking were observed for MetS (RERI = 0.23, AP = 0.25, SI = 0.23), abdominal obesity (RERI = 0.24, AP = 0.31, SI = 0.47) and high triglycerides (RERI = 0.19, AP = 0.19, SI = 0.12). Moderate/vigorous physical activity combined with smoking was associated with lower odds of abdominal obesity, hypertension and elevated fasting blood glucose, but higher odds of low HDL cholesterol. A physical inactivity appears to be a greater potential risk factor for MetS than smoking. The interaction between low physical activity and smoking exacerbates the odds of MetS and several of its components. Promoting physical activity and smoking cessation should be prioritized in MetS prevention and treatment strategies.

Southeast Asian, African, and Middle East Expert Consensus on Structured Physical Activity-Dance, Exercise, and Sports

Physical inactivity (PIA) is a pressing public health issue globally, contributing significantly to the rise of non-communicable diseases (NCD), such as cardiovascular disease and type 2 diabetes. The World Health Organization emphasises the importance of regular physical activity (PA) for preventing and managing NCDs. Initiatives to promote active living have gained momentum, ranging from community programs to workplace wellness campaigns, all focused on reducing sedentary lifestyles in modern society. Structured Physical Activity-Dance, Exercise, and Sports (SPADES) has emerged as an innovative approach to addressing PIA and promoting holistic health. After thoroughly reviewing existing literature from PubMed and Google Scholar databases, a panel of experts developed consensus statements through in-depth discussions, and the strength of concurrence on these statements was voted on using a Likert scale. The panel reached a consensus on the best strategies for PA, dance, exercise, sports, and key factors to consider during PA. This consensus targets individuals with metabolic diseases, particularly in regions like South Asia, East Africa, the Gulf, and Latin America, where these conditions are highly prevalent. The SPADES guidelines emphasise overcoming the barriers people with metabolic disorders face in achieving adequate PA, providing tailored recommendations to improve health outcomes for this population.

Physical activity, sedentary behavior, and metabolic syndrome in adults with arthritis: cross-sectional and Mendelian randomization analysis

This study examined the relationship between moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), and metabolic syndrome, employing both cross-sectional and Mendelian randomization methods to enhance causal inference. The cross-sectional analysis included adults aged 20 years and older with arthritis (n=4,227) from the National Health and Nutrition Examination Survey and assessed the associations between MVPA, SB, and metabolic syndrome. Mendelian randomization analysis used genome-wide association studies to validate causal relationships, employing instrumental variables selected from single nucleotide polymorphisms linked to accelerometer-based physical activity (fraction of time with accelerations >425 milli-gravities) and SB. The primary Mendelian randomization methods included inverse variance weighting and Bayesian Weighted Mendelian Randomization. Sensitivity analyses, including Mendelian Randomization-Egger intercept test, the weighted median method, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier, were conducted to ensure result robustness. Cross-sectional analysis revealed a significant association between higher levels of MVPA and reduced SB with a lower prevalence of metabolic syndrome. Participants in the high MVPA/low SB group demonstrated lower odds of metabolic syndrome (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.29-0.56), hypertension (OR, 0.55; 95% CI, 0.40-0.75), fasting glucose (OR, 0.52; 95% CI, 0.35-0.77), and waist circumference (OR, 0.34; 95% CI, 0.22-0.54). Mendelian randomization analysis confirmed a causal relationship, showing that physical activity decreases risk factors for metabolic syndrome, while SB exacerbates them. This study emphasizes the critical roles of regular physical activity and reduced SB in mitigating the risk of metabolic syndrome, especially among older adults with arthritis.

Micro-gyms as a catalyst for healthy aging in university and healthcare settings: applications for the Semmelweis-EUniWell Workplace Health Promotion Model Program

Europe is experiencing a significant demographic shift, with aging populations posing economic and social challenges due to increased healthcare costs and a higher prevalence of age-related diseases. Hungary, in particular, faces these challenges acutely due to higher morbidity and mortality rates from a range of chronic age-related diseases and behavioral risk factors. Addressing these issues requires innovative approaches to promote healthy aging. Semmelweis University, the largest healthcare provider and leading health sciences university in the region, is developing a comprehensive healthy aging program. A critical pillar of this program is the Semmelweis-EUniWell Workplace Health Promotion Model Program, a pioneering initiative aimed at tackling unhealthy aging within Hungary's workforce by leveraging the workplace as a platform for health promotion. Central to this program's goal of combating sedentary lifestyles-a significant contributor to age-related health issues-is the innovative use of micro-gyms and motivational interviewing. Micro-gyms, with their compact size and accessibility, provide convenient exercise opportunities, while motivational interviewing fosters intrinsic motivation and personalized counseling to encourage sustained physical activity. Through concerted efforts and innovative approaches, including the implementation of micro-gyms, the Semmelweis-EUniWell Workplace Health Promotion Model Program aims to set a benchmark for workplace health promotion, fostering a healthier and more resilient aging population in Hungary. This program not only enhances the well-being of employees at Semmelweis University and its EUniWell partner institutions but also catalyzes broader transformations in workplace health promotion and healthy aging nationwide.

Increase in Brain-Derived Neurotrophic Factor After Cycling Exercise Resisting Electrically Stimulated Antagonist Muscle Contractions in Overweight Japanese People: A Randomized, Controlled, Single-Blind, Crossover Trial

BACKGROUND

A hybrid training system (HTS) combining antagonist muscle electrical stimulation and voluntary muscle contraction has been developed using electrically stimulated eccentric antagonist muscle contractions. The exercise method that combines a conventional cycle ergometer with HTS (HERG) adds additional exercise intensity to the conventional cycle ergometer through electrical stimulation. Exercise-induced brain-derived neurotrophic factor (BDNF) production appears to have neuroprotective effects and contributes to improved metabolic regulation. Changes in BDNF after exercise are related to exercise intensity. Therefore, combining a cycle ergometer with electrical stimulation may be an effective approach.

PURPOSE

The purpose of this study was to evaluate the effect of the HERG on BDNF secretion.

PARTICIPANTS AND METHODS

Fourteen healthy adults participated in the study. The participants performed two types of exercise at the anaerobic threshold: HERG and a cycling ergometer alone (CERG). A comparative study using a 2×2 crossover method was conducted to examine the differences in BDNF and lactate levels after HERG and CERG. A linear mixed model was used to compare changes in BDNF between HERG and CERG.

RESULTS

Both HERG and CERG significantly increased BDNF and lactate levels after exercise. In overweight individuals with a BMI of 25 or higher, the change in BDNF levels after HERG was significantly greater than after CERG [ΔBDNF: 5500.96±7965.83 ng/ml, 1921.29±5308.22 ng/ml, respectively; p=0.0339]. There was no significant difference in the change in lactate levels after exercise between HERG and CERG (p=0.8632).

CONCLUSION

In overweight individuals, HERG increased post-exercise serum BDNF levels more than ergometer exercise alone, despite the exercise intensity remaining the same at the anaerobic threshold. The exercise method that combines the HERG may be a useful form of exercise for overweight individuals.

Comparison of body mass index and physical activity levels of e-sportsmen

Background

This study examines the relationship between body mass index (BMI) and physical activity levels in e-sports players. Focusing on the sedentary lifestyle and health risks associated with prolonged sitting and low physical activity, the study highlights critical challenges within the e-sports community.

Methods

Data was collected from 136 e-sports players on popular gaming platforms such as FIFA, Valorant, CS: GO and League of Legends. Physical activity levels were assessed using the International Physical Activity Questionnaire (Short Form) and participants' health status was assessed using BMI classifications.

Results

The results showed a significant inverse relationship between BMI and physical activity, with obese e-sports players having significantly lower activity levels and longer periods of sedentary behavior than their peers. Male e-sports players had higher levels of physical activity than females, reflecting biological, social and cultural factors that influence physical activity behavior.

Discussion

The study highlights the need for measures such as training programs, ergonomic adjustments and awareness campaigns to increase physical activity and reduce health risks among e-sports players. These findings provide valuable insights into the health effects of e-sports participation and emphasize the importance of promoting an active lifestyle to counteract the detrimental effects of prolonged sitting and inactivity. By filling gaps in the existing literature, this study contributes to the understanding of e-sports players' health behaviors and offers practical recommendations for promoting healthier habits in this growing population.

A perspective on intermittent fasting and cardiovascular risk in the era of obesity pharmacotherapy

Intermittent fasting has been linked to metabolic health by improving lipid profiles, reducing body weight, and increasing insulin sensitivity. However, several randomized clinical trials have shown that intermittent fasting is not more effective than standard daily caloric restriction for short-term weight loss or cardiometabolic improvements in patients with obesity. Observational studies also suggest cardiovascular benefits from extended rather than reduced eating windows, and indicate that long-term intermittent fasting regimens may increase the risk of cardiovascular disease mortality. In this perspective, we discuss evidence that may support potential adverse effects of intermittent fasting on cardiovascular health through the loss of lean mass, circadian misalignment and poor dietary choices associated with reward-based eating. Given the ongoing revolution in obesity pharmacotherapy, we argue that future research should integrate anti-obesity medications with dietary strategies that confer robust benefits to cardiometabolic health, combine exercise regimens, and consider genetic factors to personalize obesity treatment. Comprehensive approaches combining diet, pharmacotherapy, and lifestyle modifications will become crucial for managing obesity and minimizing long-term cardiovascular risk.

The Power of Movement: Linking Physical Activity with Nutritional Health and Blood Sugar Balance in a Dalmatian Type 2 Diabetic Population

BACKGROUND AND OBJECTIVES

Regular physical activity (PA) and Mediterranean diet (MeDi) adherence independently improve glycemic control and clinical outcomes in type 2 diabetes mellitus (T2DM). This study examined the associations between PA, body composition (BC), MeDi adherence, and glycemic control in Dalmatian T2DM patients.

MATERIALS AND METHODS

A cross-sectional study was conducted at the University Hospital of Split (November-December 2023) during an open call for T2DM patients. Data collected included blood/urine samples, blood pressure, BC, and anthropometrics. MeDi adherence and PA were assessed via the Mediterranean Diet Service Score and the International PA Questionnaire-Short Form.

RESULTS

Among 252 participants (median age: 67 years, IQR: 60-73; 51.6% women; median T2DM duration: 10 years, IQR: 6-20), PA levels were low (31.4%, N = 79), moderate (45.2%, N = 114), and high (23.4%, N = 59), with uniformly low MeDi adherence across groups. Low PA was associated with higher body mass index (BMI) and lower phase angle (PhA). PA negatively correlated with fat mass (FM; %) and visceral adiposity. Positive BMI predictors included FM (kg), total body water, visceral fat level, and PhA, while fat-free mass, intracellular water, and FM (%) were negative predictors. The estimated glomerular filtration rate was the only positive predictor of the total metabolic equivalent of the task score.

CONCLUSIONS

PA enhances BC and metabolic health, but inadequate MeDi adherence limits these benefits in the T2DM population. To optimize glucose control and health outcomes, public health initiatives must emphasize MeDi adherence and a combination of aerobic and resistance training.

An IL-6 promoter variant (-174 G/C) augments IL-6 production and alters skeletal muscle transcription in response to exercise in mice

Interleukin-6 (IL-6) is produced and secreted by skeletal muscle cells during exercise and plays an important role in mediating metabolic responses to exercise. The promoter region of the IL-6 gene contains a common genetic variant (-174 G/C, rs1800795), which may alter responses to exercise training. To isolate the impact of this gene variant on exercise-induced IL-6 expression and skeletal muscle transcription responses following exercise, we generated knock-in mice with a GG or variant CC genotype for the murine homolog of rs1800795. The overall gross metabolic phenotype of resting mice was similar between genotypes; however, following acute treadmill running, the variant CC genotype was associated with a greater increase in skeletal muscle Il6 mRNA and circulating IL-6. Furthermore, we observed that mice with the variant CC genotype exhibited sex-specific differences in skeletal muscle master metabolism regulatory genes and had greater increases in genes controlling mitochondrial biogenesis in skeletal muscle post exercise. However, there was no effect of genotype on exercise-induced skeletal muscle glycogen depletion, circulating free fatty acids, blood glucose and lactate production, or exercise-responsive gene expression in subcutaneous fat. These findings suggest that the IL-6 promoter variant -174 G/C may result in enhanced skeletal muscle adaptations in response to exercise training and could mean that individuals with the "C" allele may more readily gain improvements in metabolic health in response to exercise training.NEW & NOTEWORTHY Interleukin-6 (IL-6) is produced and secreted by skeletal muscle during exercise and mediates metabolic responses to exercise. A common variant in the IL-6 promoter region (-174G/C) may alter responses to exercise training. Mice with the variant "CC" genotype exhibited higher skeletal muscle IL-6 mRNA and circulating IL-6 levels post exercise, as well as altered skeletal muscle gene transcription. This suggests that this variant might enhance muscle adaptations to exercise, potentially benefiting metabolic health.

Insulin resistance and vigorous physical activity mediates the relationship between waist circumference and metabolic syndrome in Korean children

BACKGROUND

Little is known about how physical activity (PA) and insulin resistance (IR) influence the impact of obesity on metabolic syndrome in pediatric populations.

OBJECTIVES

This cross-sectional observational study aimed to investigate the mediating effects of PA and IR on the relationship between waist circumference (WC) and continuous metabolic syndrome (cMetS) risk scores in children.

METHODS

A total of 1008 children aged 7-12 years (535 girls and 473 boys) were recruited from our local elementary schools. PA, body mass index (BMI), WC, and percent body fat were measured. cMetS risk scores were calculated by summing the standardized residuals for mean arterial pressure, triglycerides, fasting blood glucose, and high-density lipoprotein cholesterol.

RESULTS

Mediation analysis showed a significant indirect effect of WC on cMetS scores through insulin (β= 0.270, 95 % confidence interval [CI = 0.234-0.306) and vigorous PA (β= 0.007, 95 % CI = 0.001-0.015). The direct effect of WC on cMet scores in the presence of the two mediators was significant (β= 0.193, 95 % CI = 0.040-0.066).

CONCLUSION

Our study findings suggest that while WC is the primary determinant of cMetS scores, fasting insulin and vigorous PA partially mediate the association between the two parameters in this study population.

Metabolic syndrome therapy in pediatric age - between classic and modern. From diets to pipeline drugs

The metabolic syndrome, made up of the sum of the entities that define it (obesity, hypertension, dyslipidemias and non-alcoholic hepatic steatosis) has gained an important place in the research of the last decades. This aspect is mainly due to the complexity of management in pediatric practice. The main directions in his approach therefore bring together the concern of counteracting the noise or systemic, of the multiple intercurrents at the physiopathological level, as well as the negative imprint exerted on the quality of life. Its appearance and evolution are currently controversial topics, but the influence of genetic predisposition and lifestyle (diet, physical activity, psychological balance) are certainties. Considering the escalation of the incident at the global level, it is self-evident that it is necessary to know the pathogenesis and practice countermeasures for prophylactic or therapeutic purposes. The present work aims to summarize general aspects related to the metabolic syndrome encountered in pediatric age, with an emphasis on complementary therapeutic perspectives and their effectiveness, by analyzing the latest data from the specialized literature, accessed with the help of international databases (e.g., PubMed, Web of Science, Scopus, Embase, Google Scholar).

Association between moderate-to-vigorous physical activity and chronic disease risk in adults and elderly: insights from the UK Biobank study

Background

This study aimed to determine the associations between different intensities of moderate to vigorous physical activity (MVPA) and the incidence of chronic diseases, and to assess the risk levels associated with these activities over time.

Methods

A prospective cohort study (UK Biobank Activity Project) with data collected between June 2013 and December 2015 included 59,896 adults (mean age = 59.68; male = 38.03%) free from chronic diseases. Participants were categorized into tertiles based on their weekly MVPA: lowest (<224 min for males, <143 min for females), medium (224-444 min for males, 143-308 min for females), and highest (≥444 min for males, ≥308 min for females), stratified by gender. The mean onset of chronic disease symptoms occurred at 3.57 years, with participants followed up during this period. Wearable accelerometry data were used to quantify MVPA levels.

Findings

Lowest tertile of MVPA were significantly correlated with increased risks of chronic disease (24%-110% increased risk) based on odds ratios (ORs), with dose-response relationship observed. In males with the lowest tertile of MVPA, significant associations were identified with type 2 diabetes mellitus (T2DM) (OR = 1.90; CI: 1.44-2.51), neurodegenerative disease (OR = 1.80; CI: 1.19-2.71), metabolic syndrome (OR = 1.34; CI: 1.18-1.53), hypertension (OR = 1.27; CI: 1.12-1.44), and atherosclerotic cardiovascular disease (ASCVD) (OR = 1.24; CI: 1.03-1.49). In females, the lowest tertile of MVPA levels were associated with increased risks of neurodegenerative disease (OR = 2.10; CI: 1.36-3.24), T2DM (OR = 1.88; CI: 1.37-2.58), cerebrovascular disease (OR = 1.61; CI: 1.12-2.29), ASCVD (OR = 1.58; CI: 1.23-2.03), metabolic syndrome (OR = 1.49; CI: 1.32-1.69), and hypertension (OR = 1.44; CI: 1.29-1.61). Longitudinally, the lowest tertile of MVPA in males showed elevated risks for neurodegenerative disease (HR = 2.13; CI: 1.24-3.66), T2DM (HR = 1.83; CI: 1.30-2.57), hypertension (HR = 1.33; CI: 1.15-1.53), metabolic syndrome (HR = 1.32; CI: 1.14-1.54), and ASCVD (HR = 1.29; CI: 1.03-1.61). In females, the lowest tertile of MVPA was associated with similar risks for ASCVD (HR = 1.59; CI: 1.16-2.20), T2DM (HR = 1.57; CI: 1.08-2.29), hypertension (HR = 1.53; CI: 1.34-1.74), and metabolic syndrome (HR = 1.50; CI: 1.29-1.73).

Conclusion

Using wearable accelerometry data, this study demonstrated the quantifiable risks of chronic diseases and their development, highlighting the importance of MVPA.

Male infertility and obesity

PURPOSE OF REVIEW

The increasing rate of obesity is having an adverse impact on male reproduction.

RECENT FINDINGS

The negative effect of reactive oxygen species on male reproductive tissues and the age of onset of obesity are new areas of research on male infertility.

SUMMARY

This review highlights how obesity impairs male reproduction through complex mechanisms, including metabolic syndrome, lipotoxicity, sexual dysfunction, hormonal and adipokine alterations as well as epigenetic changes, and how new management strategies may improve the reproductive health of men throughout life.

Impact of Body Mass Index and Anthropometric Measures on Cardiorespiratory Fitness in Non-obese Adult Males: A Cross-Sectional Observational Study

Introduction Cardiorespiratory fitness (CRF) is a key health indicator for assessing optimal physical function and overall well-being. Exploring the early impact of body mass index (BMI) and anthropometric measures on CRF in non-obese individuals is essential for identifying risk factors and guiding preventive strategies to address weight-related health challenges. This study aims to investigate the impact of BMI and anthropometric measures on CRF, focusing on maximal oxygen uptake (VO2max) and metabolic equivalents (METs) in non-obese adult males.  Methods This cross-sectional study included 108 non-obese male participants aged 18-40 years, categorized by BMI into three groups: underweight, normal weight, and overweight. Anthropometric assessments, including height, weight, waist circumference, hip circumference, and skinfold thickness, were conducted. CRF was evaluated by measuring VO2max and METs. Statistical analysis was performed using one-way analysis of variance (ANOVA) for between-group comparisons, followed by Tukey's post hoc test for pairwise analysis and Pearson's correlation to examine associations between anthropometric measures and fitness parameters. Results Significant differences in VO2max (p < 0.001) and METs (p = 0.013) were found across the BMI categories. Fair negative correlations were observed between BMI and both VO2max (r = -0.382, p < 0.001) and METs (r = -0.384, p < 0.001). Additionally, waist circumference and waist-to-hip ratio showed significant poor negative correlations with these fitness measures, while body density exhibited a fair positive correlation with VO2max (r = 0.37, p < 0.001). Conclusion The findings suggest that higher BMI is associated with reduced CRF, as indicated by lower VO2max and MET values, even within the non-obese category. Additionally, waist circumference, waist-to-hip ratio, and body density significantly influence these measures. These results highlight the importance of incorporating these crucial anthropometric factors into health strategies aimed at improving CRF in those with higher BMI, regardless of obesity status.

Metabolic syndrome among patients with type 2 diabetes in Jordan: A cross-sectional study

Metabolic syndrome is a major public health problem worldwide and an independent predictor of cardiovascular disease in patients with type 2 diabetes (T2DM). This study aimed to determine the prevalence of metabolic syndrome and its individual components among Jordanian patients with T2DM. A cross-sectional design was conducted among T2DM patients at the National Center for Diabetes, Endocrinology and Genetics in Jordan. Data were collected using a structured questionnaire and clinical data extracted from medical records. The National Cholesterol Education Program-Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) diagnostic criteria were used to define metabolic syndrome. Among 1017 participants aged between 22 and 90 years, the overall prevalence of IDF defined metabolic syndrome was 84.2% (72.5% and 96.2% among males and females, respectively). Using ATP III criteria, overall prevalence was 79.1% (77.4% and 80.8% among males and females, respectively). Advancing age, female gender, nonadherence to a diet regimen, sedentary lifestyle or insufficient physical activity, and duration of diabetes ≥10 years were significantly associated with increased odds of metabolic syndrome, regardless of the definition used. Current smoking status and family history of cardiovascular diseases were significantly associated with increased likelihood of ATP III defined metabolic syndrome. The prevalence of metabolic syndrome among Jordanian patients with T2DM is extremely high. The main modifiable risk factors of metabolic syndrome among these patients include nonadherence to a diet regimen, insufficient physical activity, being overweight/obese and smoking. It is recommended that healthcare providers counsel patients on the importance of maintaining physical activity, smoking cessation, and adherence to a diet regimen.

High-intensity interval training for cardiometabolic health in adults with metabolic syndrome: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To assess the effectiveness of high-intensity interval training (HIIT) compared with traditional moderate-intensity continuous training (MICT) and/or non-exercise control (CON) for modification of metabolic syndrome (MetS) components and other cardiometabolic health outcomes in individuals with MetS.

DESIGN

Systematic review and meta-analysis DATA SOURCES: Five databases were searched from inception to March 2024.

STUDY APPRAISAL AND SYNTHESIS

Meta-analyses of randomised controlled trials (RCTs) comparing HIIT with MICT/CON were performed for components of MetS (waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and fasting blood glucose (BG)) and clinically relevant cardiometabolic health parameters. Subgroup moderator analyses were conducted based on the intervention duration and HIIT volume.

RESULTS

Out of 4819 studies, 23 RCTs involving 1374 participants were included (mean age: 46.2-67.0 years, 55% male). HIIT significantly improved WC (weighted mean difference (WMD) -4.12 cm, 95% CI -4.71 to -3.53), SBP (WMD -6.05 mm Hg, 95% CI -8.11 to -4.00), DBP (WMD -3.68 mm Hg, 95% CI -5.70 to -1.65), HDL-C (WMD 0.12 mmol/L, 95% CI 0.04 to 0.20), TG (WMD -0.34 mmol/L, 95% CI -0.41 to -0.27) and BG (WMD -0.35 mmol/L, 95% CI -0.54 to -0.16) compared with CON (all p<0.01). HIIT approaches demonstrated comparable effects to MICT across all parameters. Subgroup analyses suggested that HIIT protocols with low volume (ie, <15 min of high-intensity exercise per session) were not inferior to higher volume protocols for improving MetS components.

CONCLUSION

This review supports HIIT as an efficacious exercise strategy for improving cardiometabolic health in individuals with MetS. Low-volume HIIT appears to be a viable alternative to traditional forms of aerobic exercise.

Metabolic syndrome

The metabolic syndrome (MetS) is a multiplex modifiable risk factor for cardiovascular disease, type 2 diabetes mellitus and other health outcomes, and is a major challenge to clinical practice and public health. The rising global prevalence of MetS, driven by urbanization, sedentary lifestyles and dietary changes, underlines the urgency of addressing this syndrome. We explore the complex underlying mechanisms, including genetic predisposition, insulin resistance, accumulation of dysfunctional adipose tissue and ectopic lipids in abdominal obesity, systemic inflammation and dyslipidaemia, and how they contribute to the clinical manifestations of MetS. Diagnostic approaches vary but commonly focus on abdominal obesity (assessed using waist circumference), hyperglycaemia, dyslipidaemia and hypertension, highlighting the need for population-specific and phenotype-specific diagnostic strategies. Management of MetS prioritizes lifestyle modifications, such as healthy dietary patterns, physical activity and management of excess visceral and ectopic adiposity, as foundational interventions. We also discuss emerging therapies, including new pharmacological treatments and surgical options, providing a forward-looking perspective on MetS research and care. This Primer aims to inform clinicians, researchers and policymakers about MetS complexities, advocating for a cohesive, patient-centred management and prevention strategy. Emphasizing the multifactorial nature of MetS, this Primer calls for integrated public health efforts, personalized care and innovative research to address this escalating health issue.

Iron Homeostasis-Related Parameters and Hepcidin/Ferritin Ratio: Emerging Sex-Specific Predictive Markers for Metabolic Syndrome

Metabolic syndrome (MetS) is a worldwide public health challenge. Accumulating evidence implicates elevated serum ferritin and disruptions in iron metabolism as potential elements linked to an increased risk of MetS. This study investigates the relationship between iron homeostasis-including hepcidin levels, serum iron concentration, unsaturated iron-binding capacity (UIBC), and the hepcidin/ferritin (H/F) ratio-and MetS. In this descriptive cross-sectional study, 209 participants aged 24-70 were categorized into two groups: 103 with MetS and 106 without MetS. All participants underwent medical assessment, including anthropometric measures, indices of glycemic control, lipid profiles, and iron-related parameters. Participants were further stratified by the Homeostasis Model Assessment-Insulin Resistance index into three subgroups: insulin-sensitive (IS) (<1.9), early insulin resistance (EIR) (>1.9 to <2.9), and significant insulin resistance (SIR) (>2.9). Notable increments in serum ferritin and hepcidin were observed in the SIR group relative to the IS and EIR groups, with a significant association between metabolic parameters. The UIBC and serum ferritin emerged as significant predictors of MetS, particularly in men, with an area under the curve (AUC) of 0.753 and 0.792, respectively (p ≤ 0.001). In contrast, hepcidin was notably correlated with MetS in women, with an AUC of 0.655 (p = 0.007). The H/F ratio showed superior predictive capability for MetS across both sexes (at cutoff level = 0.67). Among women, this ratio had an AUC of 0.639 (p = 0.015), and for men, it had an AUC of 0.792 (p < 0.001). Hypertension proved an independent risk factor for MetS, affirming its role in metabolic dysregulation. The findings highlight a significant interconnection between iron homeostasis parameters and MetS, with sex-specific variations underscoring the importance of personalized diagnostic criteria. The crucial role of the H/F ratio and the UIBC as emerging predictive markers for MetS indicates their potential utility in identifying at-risk individuals. Further longitudinal research is essential to establish causality and explore the interplay between these biomarkers and MetS.

The Prevalence of Obesity and Metabolic Syndrome among Polish Women without Pre-Existing Cardiovascular Conditions and Diabetes: A Multicenter Study in Poland

Background: A very prevalent problem worldwide is not only the high prevalence of chronic conditions but also the high frequency of their underdiagnosis and unhealthy lifestyles, both resulting in the development and inadequate treatment of civilization diseases. Therefore, the aim of this study was to assess the prevalence of abnormal metabolic parameters among Polish women aged >35 years who have not yet been diagnosed with cardiovascular diseases, diabetes or chronic kidney disease, as well as evaluate their lifestyles and look for relationships between individual lifestyle parameters and metabolic abnormalities. Methods: This was a multicenter, cross-sectional, observational study conducted on a group of women aged ≥ 35 years without previous cardiovascular disease, diabetes or chronic kidney disease. As part of the study, patients had anthropometric measurements and laboratory tests performed (serum glucose, total cholesterol, LDL, HDL, non-HDL cholesterol and triglycerides) and completed the HLPCQ (the Healthy Lifestyle and Personal Control Questionnaire). Obesity was defined as BMI ≥ 30 kg/m2. Abdominal obesity was defined as a waist circumference ≥ 88 cm. Results: The study included 672 women considered healthy. In the analyzed group of women, 20.6% met the criteria for a diagnosis of obesity based on BMI, and 36.8% were diagnosed with abdominal obesity. In addition, 16.8% of the women had an abnormal fasting blood glucose result. Moreover, 46.4% of the women's blood pressure measurements were above the normal range, and as many as 57.7% of the women had abnormal non-HDL levels. In addition, 150 women met the criteria for a diagnosis of metabolic syndrome. These conditions were far more common in women diagnosed with obesity. Physical activity was associated with a reduced risk of developing obesity and metabolic syndrome. Conclusions: The underdiagnosis of chronic conditions in the study population is high. More than 20% of women met the criteria for a diagnosis of metabolic syndrome, the prevalence of which was significantly higher in patients with obesity. A healthy lifestyle was associated with a reduced risk of developing metabolic syndrome and its individual components. It is necessary to actively search for chronic conditions in patients, which requires the involvement of not only healthcare system employees but also government representatives.

Dietary niacin Intake and its association with all-cause and cardiovascular mortality rates in individuals with metabolic syndrome

BACKGROUND

Individuals with metabolic syndrome face elevated cardiovascular and mortality risks, and there is ongoing debate regarding the cardiovascular effects of niacin and its impact on the prognosis of metabolic syndrome.

EXPOSURE

Levels of dietary niacin intake based on 24-hour dietary recall.

METHODS

Kaplan-Meier survival curves were used to compare survival status among quartiles of dietary niacin intake. Weighted Cox proportional hazards models and restricted cubic splines were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of all-cause and CVD mortality associated with the exposure.

RESULTS

This cohort study included 8,744 participants, and during a median follow-up period of 106 months, 1,552 (17.7%) deaths were recorded, with 511 attributed to cardiovascular disease. Kaplan-Meier curves comparing quartiles of dietary niacin intake showed significant differences in both all-cause and cardiovascular mortality rates (log-rank p < 0.001). In the fully adjusted model, the highest quartile of dietary niacin intake was associated with HRs of 0.68 (95% CI: 0.54, 0.87, P = 0.002) for all-cause mortality and 0.63 (95% CI: 0.39, 0.78, P < 0.001) for cardiovascular mortality.

CONCLUSION

The results of this cohort study suggest that higher dietary niacin intake is associated with reduced cardiovascular and all-cause mortality risks in the metabolic syndrome population. Furthermore, there appears to be a dose-response relationship between dietary niacin intake and the risks of all-cause and cardiovascular mortality.

Chronotype and metabolic syndrome in midlife: findings from the Northern Finland Birth Cohort 1966

Evening chronotype is known to be associated with various chronic diseases and cardiovascular risk factors. Metabolic syndrome is a group of conditions that together raise the risk of coronary heart disease, diabetes, stroke, and other serious health problems. Only a few studies have been published on the association between chronotype and metabolic syndrome in unselected population data, with conflicting results. The aim of this study was to evaluate the association between chronotype and metabolic syndrome at population level by using unselected Northern Finland Birth cohort 1966 (NFBC1966) database. The study population consists of participants with NFBC66 (n = 5,113, 57% female) at the age of 46 yr old. Chronotype was determined with shortened Morningness-Eveningness Questionnaires and expressed as morning (44%), intermediate (44%), and evening types (12%). Metabolic syndrome was determined according to the definition of International Diabetes Federation. One-way ANOVA, Kruskal-Walli's test, and χ2 tests were used to compare the chronotype groups, followed by logistic regression analysis (adjusted with alcohol consumption, smoking, marital status, level of education, and leisure-time physical activity). In women, the prevalence of metabolic syndrome was statistically significantly higher in the evening type group: 23, 24, and 34% for morning, intermediate, and evening groups, respectively (P < 0.001). In logistic regression analysis, evening chronotype was associated with higher risk of having metabolic syndrome (OR 1.5; CI 95% 1.2 to 2.0). In this population-based birth cohort study, the evening chronotype was independently associated with higher prevalence of metabolic syndrome in women.NEW & NOTEWORTHY Only a few studies have been conducted on the association between chronotype and metabolic syndrome in unselected population data, with conflicting results. In this population-based cohort study of 5,113 participants, the evening chronotype associated with metabolic syndrome in women when there was no such association in men. The result supports a previous South Korean population study of 1,620 participants, in which the association was also found in women, but not in men.

Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review

Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.

Metabolic Syndrome Among People Living With HIV on Dolutegravir and Efavirenz-Based Antiretroviral Therapy in Ethiopia: A Comparative Cross-Sectional Study

PURPOSE

This study aimed to assess the burden of metabolic syndrome among people living with HIV (PLWH) on dolutegravir (DTG)- and efavirenz (EFV)-based regimens.

METHODS

A hospital-based comparative cross-sectional study design was implemented from May 5, 2022, to August 5, 2022.

RESULTS

The overall prevalence of metabolic syndrome was 18.6% (32/172) for all regimens, with 25.6% (22/86) for the DTG- and 11.6% (10/86) for the EFV-based regimens (P = .019). Body mass index ≥ 25 kg/m2 (adjusted odds ratio [AOR] = 3.04; 95% confidence interval [CI]: 1.13-8.14), CD4 count ≥ 500 cells/mm3 (AOR = 3.01; 95% CI: 1.09-8.28), insufficient physical activity (AOR = 2.60; 95% CI: 1.00-6.72), and DTG-based regimen (AOR = .86; 95% CI: 1.14-7.20) were associated with metabolic syndrome.

CONCLUSION

The prevalence of metabolic syndrome was significantly higher among PLWH on DTG-based regimens. This signifies that DTG-treated patients should be advised on lifestyle adjustments to prevent the development of metabolic syndrome.