Alterations of cardiometabolic risk profile in polycystic ovary syndrome: 13 years follow-up in an unselected population

PURPOSE

Cardiometabolic risk factors are common in women with polycystic ovary syndrome (PCOS) during reproductive years. The aim of this study was to determine the impact of aging on cardiometabolic risk of the syndrome by examining women who had previously been diagnosed to have PCOS or to be healthy in an unselected population in 2009.

PARTICIPANTS

Forty-one women with PCOS who were diagnosed and phenotyped according to the Rotterdam criteria and 43 age- and body mass index (BMI)-matched healthy women from the same unselected cohort.

METHODS

All participants were evaluated by structured interview, physical examination, anthropometric, hormonal and biochemical measurements. Additionally, body composition analyses and echocardiographic assessments of 30 women with PCOS and 30 control women were conducted at 13 years of follow-up.

RESULTS

There was no difference between the patient and the control groups in terms of anthropometric and body composition measures and metabolic parameters. Echocardiographic assessment showed similar systolic functions, strain measurements and epicardial fat measurements between the groups. PCOS patients still had higher levels of total testosterone, free androgen index (FAI) and dehydroepiandrosterone sulfate (DHEAS) levels compared to controls. Epicardial fat thickness showed positive correlations with BMI, total and truncal body fat, homeostatic model assessment for insulin resistance (HOMA-IR) and free androgen index (FAI).

CONCLUSIONS

Aging women with PCOS in the population have higher androgen levels and similar cardiometabolic risk profile compared to age- and BMI-matched healthy women. Epicardial fat thickness, a marker of cardiometabolic risk, appear to be associated with hyperandrogenism. Further research is needed on larger community-based cohorts where older patients are assessed with a longer follow-up.

Weight gain during nutritional rehabilitation post-childhood malnutrition may influence the associations between adulthood desaturases activity and anthro-cardiometabolic risk factors

BACKGROUNDS & AIMS

Childhood malnutrition is a major global health problem with long-term sequelae, including non-communicable diseases (NCDs). Mechanisms are unknown but may involve metabolic programming, resulting from "short-term" solutions to optimise survival by compromising non-priority organs. As key players in lipid metabolism, desaturases have been shown to be predictive of NCDs. We hypothesised that the association between specific desaturase activities and NCD risk determinants (including body composition, serum glucose, insulin levels, and blood pressure) are influenced by childhood post-malnutrition weight gain.

METHODS

278 Afro-Caribbean adults with well-documented clinical history of severe malnutrition in childhood were studied. Extensive metabolic analyses including body composition (DXA), fasting serum glucose and lipidomics (n = 101), and fasting serum insulin (n = 83) were performed in malnutrition survivors and matched community controls (n = 90). Established lipid ratios were used as proxies of desaturase activities: CE 16:1/CE 16:0 for stearoyl-CoA desaturase (SCD1), LysoPC 20:4/20:3 for fatty acid desaturase 1 (FADS1), and LysoPC 20:3/18:2 for FADS2.

RESULTS

Compared to community controls, adult malnutrition survivors (mean ± SD) age 28.3 ± 7.8 and BMI 23.6 ± 5.2 had higher SCD1 and FADS1 activity, (B ± SE) 0.07 ± 0.02 and 0.7 ± 0.08, respectively, but lower FADS2 activities (B ± SE) -0.05 ± 0.01, adjusted for sex and age (p < 0.0005). SCD1 was positively associated with adult BMI and body fat percentage, and negatively associated with lean mass and height. Stratification based on weight gain during nutritional rehabilitation among malnutrition survivors might signal the potential associations between weight gain during that critical period, desaturase activities, and some of adult metabolic parameters, with the lowest tertiles (slowest catch-up weight gain) performing more similarly to controls.

CONCLUSIONS

In adult survivors of early-life severe acute malnutrition, desaturase activity is associated with markers of NCD risk, especially adiposity. These associations seem to be strengthened by faster weight gain during nutritional rehabilitation.

Cardiorespiratory fitness and metabolic risk in Chinese population: evidence from a prospective cohort study

BACKGROUND

Studies on the association between estimated cardiorespiratory fitness (CRF) and changes in metabolic risk in the Chinese population are limited. This study aims to examine the associations between CRF and changes in metabolic risk.

SUBJECTS AND METHODS

We included 4,862 and 2,700 participants recruited from 28 provinces in the China Health and Retirement Longitudinal Study (CHARLS) in the baseline (Wave 1) and follow-up (Wave 4) analyses, respectively. CRF was calculated using sex-specific longitudinal non-exercise equations. Metabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) levels. The metabolic score was calculated as the number of changes in the above metabolic indicators above the 75th percentile of the distribution of changes (equal to or below the 25th percentile for HDL-C).

RESULTS

In the baseline analysis, CRF was negatively associated with SBP, DBP, TG, and FPG, and positively correlated with HDL-C after adjusting for age, smoking status, and drinking status (all P < 0.0001) in both males and females. In the follow-up analysis, higher baseline CRF was significantly related to a decrease in SBP, DBP, TG, FPG, and metabolic score (all P < 0.0005), and increased HDL-C (P < 0.0001) after further adjustment for corresponding baseline metabolic indicators. The associations remained significant after stratification by sex, except for the changes in HDL-C levels in females. Furthermore, improved CRF was associated with favorable changes in DBP, TG, HDL-C, FPG, and metabolic scores in all populations and males. Significant associations between changes in CRF and DBP, TG, and FPG levels were found in females.

CONCLUSION

Higher baseline CRF and improved CRF were associated with favorable changes in metabolic indicators.

Metabolic disease and the liver: A review

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver disease worldwide, with an estimated prevalence of 31% in Latin America. The presence of metabolic comorbidities coexisting with liver disease varies substantially among populations. It is acknowledged that obesity is boosting the type 2 diabetes mellitus "epidemic," and both conditions are significant contributors to the increasing number of patients with MASLD. Non-alcoholic steatohepatitis represents a condition of chronic liver inflammation and is considered the most severe form of MASLD. MASLD diagnosis is based on the presence of steatosis, noninvasive scores and altered liver tests. Noninvasive scores of liver fibrosis, such as serum biomarkers, which should be used in primary care to rule out advanced fibrosis, are simple, inexpensive, and widely available. Currently, guidelines from international hepatology societies recommend using noninvasive strategies to simplify case finding and management of high-risk patients with MASLD in clinical practice. Unfortunately, there is no definite pharmacological treatment for the condition. Creating public health policies to treat patients with risk factors for MASLD prevention is essential.

Sex Differences in Diet and Physical Activity Behaviors Among Racial/Ethnic Minority Adolescents with High Metabolic Risk

Certain dietary and physical activity (PA) behaviors may differentially predispose male and female adolescents to obesity and diabetes; however, sex differences in dietary and PA behaviors and in factors that impact these behaviors (e.g., self-efficacy, social support) in this population remain unknown. Using data from a community-based adolescent diabetes prevention intervention conducted in East Harlem in New York City, we examined sex differences in baseline characteristics including clinical measurements, lifestyle behaviors, and behavioral determinants. Among 147 overweight/obese adolescents aged 13-19 years, 61.9% were girls, 69.7% were of Hispanic ethnicity, 24.8% were non-Hispanic Black, and 60.5% were diagnosed with prediabetes. Boys had higher metabolic risk scores than girls (3.8 vs. 3.3, p = 0.002) despite girls reporting more perceived barriers to healthy eating and PA. Boys reported doing more moderate to vigorous PA but also had more sedentary behaviors than girls. Boys reported higher self-efficacy and more peer support for PA. Girls reported more depressive symptoms and were more likely to compare their body images to those in magazines/social media. Overall, among a sample of urban adolescents with high metabolic risk, we found significant sex differences in many dietary and PA behaviors and related factors, which could be used to inform tailored strategies for weight management to reduce cardiometabolic risk among youth from similar high-risk populations.

Instructing Use of an Effective Strategy Improves Recognition Memory in Healthy Adults

OBJECTIVES

Age-related memory decrements correlate with metacognitive declines, including knowledge and deployment of effective mnemonic encoding strategies. However, whether imparting such strategy suffices for mitigating memory differences is unclear.

METHOD

In a longitudinal study of 276 healthy adults aged 18-79 years, we tested associative and working memory, and assessed beliefs regarding mnemonic strategies. Testing was repeated every 2 years, 5 times. Starting with the third occasion, we instructed participants to use an effective mnemonic strategy (sentence generation). Using continuous-time dynamic modeling, we assessed changes in the item and associative recognition, intervention effects, and their relations with age, sex, meta-memory beliefs, working memory, and metabolic health.

RESULTS

Younger age, better working memory, and stronger belief in effective mnemonic strategies predicted better recognition, whereas instructional intervention attenuated associative memory deficits, with some persistence over time.

DISCUSSION

The present findings show merely imparting effective strategies holds promise for mitigating age-related associative memory deficits.

The global burden of disease attributable to metabolic risks in 204 countries and territories from 1990 to 2019

AIM

Our study aimed to survey the burden of disease attributed to metabolic risks (MRs) and secondary MR from 1990 to 2019.

METHODS

Using methodological framework of the Global Burden of Disease Study 2019, we reported the global number, age-standardized rate and population attributable fraction of deaths and disability adjusted life years related to MRs and secondary MR. Furthermore, we analyzed the global burden caused by MRs and secondary MR in detail by gender, age, region, country, disease and Socio-demographic Index level.

RESULTS

The number (million) of deaths and DALYs caused by MRs was 18.6 and 462.8 in 2019, with an increase of 43.6 % and 75.0 % since 1990. However, the ASR of deaths and DALYs attributed to MRs had a decrease of 23.3 % and 17.0 % since 1990. The burden caused by MRs and secondary MR raised with age, and the burden was the heaviest in low - and middle-income countries, especially in Middle East & North Africa. For diseases, the heaviest burden attributed to MRs was observed in ischemic heart disease, followed by stroke.

CONCLUSION

The burden of disease attributed to MRs has continued to rise in the past 30 years, particularly for men and low-middle SDI regions. Therefore, the government should take corresponding actions to reduce the impact of MRs on population health.

Influence of Waist Circumference Measurement Site on Visceral Fat and Metabolic Risk in Youth

Although the rate of childhood obesity seems to have plateaued in recent years, the prevalence of obesity among children and adolescents remains high. Childhood obesity is a major public health concern as overweight and obese youth suffer from many co-morbid conditions once considered exclusive to adults. It is now well demonstrated that abdominal obesity as measured by waist circumference (WC) is an independent risk factor for cardiovascular disease and metabolic dysfunction in youth. Despite the strong associations between WC and cardiometabolic risk factors, there is no consensus regarding the optimal WC measurement sites to assess abdominal obesity and obesity-related health risk in children and adolescents. Currently, the WC measurement site that provides the best reflections of visceral fat and the best correlations with cardiometabolic risk factors is unclear. The purpose of this review is to explore whether WC measurement sites influence the relationships between WC, visceral fat, and cardiometabolic risk factors in children and adolescents.

A systematic review of prevalence of metabolic syndrome in occupational groups - Does occupation matter in the global epidemic of metabolic syndrome?

Many occupations can influence the development of metabolic syndrome (MetS). This systematic review aims to evaluate studies on MetS prevalence in different occupational groups from different countries. An integrative review of the literature was conducted within the PubMed and Web of Science databases between January 2005 and February 2022. Only studies with over 3000 subjects that presented data about the prevalence of MetS in different occupational groups were included. The classification of occupational groups was based on the statistical category of economic activities in the European Community (EC). Of a total of 1942 screened records, ten studies were included, showing that MetS is a common health (main) risk factor in all occupational groups. However, the prevalence of MetS varies between nationalities, between and within occupational groups, and between genders. The reasons for this variation appear complex and supported by several causal explanations. The prevalence of MetS was highest among women in a group of Korean skilled agricultural, forestry, and fishery workers (Prevalence: 39.2%). Similarly, among men, the highest prevalence was found in Korean equipment, machine operating, and assembling workers (Prevalence: 35.4%). Male information and communication technology professionals from the Netherlands (Prevalence: 6.2%) and Spanish female catering and hospitality, personal, and security service workers (Prevalence: 5.9%) had the lowest rates of MetS. Overall, the results indicated that valid data on this topic are insufficient, and more randomized controlled trials are needed. Moreover, the different definitions of MetS complicate the accurate comparison between studies, paving the way to achieving consensus on a universal definition of MetS.

COVID-19 Outcomes in Minority Ethnic Groups: Do Obesity and Metabolic Risk Play a Role?

PURPOSE OF REVIEW

Globally, minority ethnic groups have been at higher risk of COVID-19 mortality and morbidity than majority populations. This review outlines factors that may interact to create these inequalities and explores the hypothesis that differing levels of cardio-metabolic risk, according to ethnic group, play a role.

RECENT FINDINGS

Two UK Biobank studies have reported that the body mass index is more strongly associated with an increased risk of COVID-19 infection and mortality in minority ethnic populations than in White populations. A study of UK patients found that the strongest association between obesity and adverse COVID-19 outcomes was in people of Black ethnicity. Differences in the prevalence of obesity and its metabolic sequelae have been shown to partly mediate ethnic inequalities in COVID-19 outcomes, although not always consistently. It is possible that ethnic differences in the consequences of obesity may explain some of the remaining disparity in COVID-19 risk.

Recent advances in lean NAFLD

As the predominant type of chronic liver disease, the growing prevalence of nonalcoholic fatty liver disease (NAFLD) has become a concern worldwide. Although obesity plays the most pivotal role in NAFLD, approximately 10-20% of individuals with NAFLD who are not overweight or obese (BMI < 25 kg/m2, or BMI < 23 kg/m2 in Asians) have "lean NAFLD." Lean individuals with NAFLD have a lower prevalence of diabetes, hypertension, hypertriglyceridemia, central obesity, and metabolic syndrome than nonlean individuals with NAFLD, but higher fibrosis scores and rates of cardiovascular morbidity and all-cause mortality in advanced stages. The pathophysiological mechanisms of lean NAFLD remain poorly understood. Studies have shown that lean NAFLD is more correlated with factors such as environmental, genetic susceptibility, and epigenetic regulation. This review will examine the way in which the research progress and characteristic of lean NAFLD, and explore the function of epigenetic modification to provide the basis for the clinical treatment and diagnosis of lean NAFLD.

Sex and race define the effects of adverse childhood experiences on self-reported BMI and metabolic health biomarkers

BACKGROUND

Adverse childhood experiences (ACEs) are an independent risk factor for chronic diseases, including type 2 diabetes, stroke and ischemic heart disease. However, the effect of ACEs considering sex and race are not often reported in cohorts showing multiracial composition, with power to evaluate effects on underrepresented populations.

AIM

To determine how sex and race affected the association of combined and individual ACEs with metabolic health biomarkers in the Southern Community Cohort Study (2012-2015).

METHODS

Self-reported data were analyzed from ACE surveys performed during the second follow-up of a cohort comprised by over 60% of Black subjects and with an overall mean age of 60 years.

RESULTS

BMI steadily increased with cumulative ACEs among Black and White women, but remained relatively stable in White men with ≥ 4 ACEs. Contrary, Black men showed an inverse association between ACE and BMI. Secondary analysis of metabolic outcomes showed that physical abuse was correlated with a 4.85 cm increase in waist circumference in Black subjects. Total cholesterol increased among individuals with more than 4 ACEs. In addition, increases in HbA1c were associated with emotional and maternal abuse in Black women and sexual abuse in White women.

CONCLUSIONS

BMI is strongly associated with cumulative ACEs in women regardless the race, while waist circumference is strongly associated with ACEs in Black individuals, which combined with reduced BMI may indicate increased central adiposity in Black men. Our study suggests that sex and race influence the contribution of certain ACEs to impair metabolic health.

Skeletal mass indices are inversely associated with metabolically unhealthy phenotype in overweight/obese and normal-weight men: a population-based cross-sectional study

Muscle mass may play an important role in the metabolic profile of individuals with or without excess weight. Metabolic phenotypes classify individuals as healthy or unhealthy based on certain metabolic conditions. We investigated the association between skeletal mass indices (SMI) and the metabolically unhealthy phenotype in normal-weight and overweight/obese adults. A total of 660 adults aged 20 to 59 years were assessed by a population-based cross-sectional study. Muscle mass of the limbs or appendicular lean mass (ALM) adjusted for weight (SMIweight) and BMI (SMIBMI) was used to evaluate SMI. Logistic regression was employed to estimate the association between SMIweight, SMIBMI and metabolic phenotypes of normal-weight and overweight/obese individuals. Metabolically unhealthy individuals were older in both sexes. Metabolically unhealthy men had lower SMI values and higher fat percentage than metabolically healthy men. SMIweight was inversely associated with the metabolically unhealthy phenotype, both in normal-weight men (OR 0·49, 95 % CI 0·24, 0·99, P = 0·04) and in overweight/obese men (OR 0·32, 95 % CI 0·16, 0·64, P = 0·001). SMIBMI was inversely associated with the metabolically unhealthy phenotype in overweight/obese men (OR 0·36, 95 % CI 0·18, 0·72, P = 0·004), but not in normal-weight men (OR 0·70, 95 % CI 0·34, 1·43, P = 0·33). Among women, SMI showed no significant association with the phenotypes. In conclusion, the SMI are inversely associated with the metabolically unhealthy phenotype in men, especially among overweight/obese men.

Relationship Between Elevated Hair Mercury Levels, Essential Element Status, and Metabolic Profile in Overweight and Obese Adults

The objective of the present study was to evaluate hair essential and trace element levels and metabolic risk markers in overweight and obese subjects in relation to body mercury burden. According to 2 × 2 factorial design a total of 440 adults were distributed to four groups: (i) low-Hg normal-weight subjects (n = 114); (ii) high-Hg normal weight subjects (n = 113); (iii) low-Hg overweight (BMI > 25) subjects (n = 110); (iv) high-Hg overweight (BMI > 25) subjects (n = 110). Hg-exposed groups consisted of subjects characterized by frequent seafood consumption (> 4 times/week) subsequently evaluated by hair analysis (> 0.58 μg/g). Dietary-exposed subjects were characterized by a more than 3-fold higher hair Hg content irrespectively of body weight values. Both low-Hg and high-Hg overweight subjects were characterized by significantly higher ALT activity, as well as elevated serum glucose, LDL, and triglyceride levels as compared to the respective groups of normal weight subjects. High Hg body burden had a more significant effect on metabolic parameters in overweight and obese adults. Particularly, high-Hg overweight subjects were characterized by significantly higher serum creatinine and uric acid levels, as well as increased GGT and CK activity as compared to low-Hg overweight counterparts. In addition, hair Mg, Mn, and Sr content in high-Hg overweight subjects was significantly lower than that in low-Hg normal weight and overweight examinees. In turn, high Hg levels in overweight subjects were associated with significantly higher hair Se and Zn levels when compared to unexposed overweight adults. Generally, the obtained data demonstrate that increased hair Hg levels in overweight and obese subjects is associated with adverse metabolic profile. It is proposed that observed metabolic alterations may be at least partially mediated by Hg-associated disturbances in essential trace element and mineral metabolism.

Exploring new treatment options for polycystic ovary syndrome: Review of a novel antidiabetic agent SGLT2 inhibitor

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age associated with long-term metabolic and cardiovascular consequences. A plethora of symptoms and their severity differentiate on an individual level, giving the syndrome numerous phenotypes. Due to menstrual cycle abnormalities, women suffer from irregular menstrual bleeding, difficulty in conception, and infertility. Furthermore, the risk of pregnancy complications such as gestational diabetes mellitus, hypertensive disorders of pregnancy, and preterm birth are higher in women with PCOS than in the general population. Often, women with PCOS have comorbidities such as dyslipidemia, obesity, glucose intolerance or diabetes type 2, non-alcoholic fatty liver disease, and metabolic syndrome, which all influence the treatment plan. Historic insulin-sensitizing agents, although good for some of the metabolic derangements, do not offer long-term cardiovascular benefits; therefore, new treatment options are of paramount importance. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors, a new class of antidiabetic agents with beneficial cardiovascular, bodyweight, and antihyperglycemic effects, although not approved for the treatment of PCOS, might be an attractive therapeutic addition in the PCOS armamentarium. Namely, recent studies with SGLT-2 inhibitors showed promising improvements in anthropometric parameters and body composition in patients with PCOS. It is important to further explore the SGLT-2 inhibitors potential as an early therapeutic option because of the PCOS-related risk of metabolic, reproductive, and psychological consequences.

What Happens After Menopause? (WHAM): A prospective controlled study of cardiovascular and metabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy

OBJECTIVE

To prospectively measure cardiometabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) compared to a similar age comparison group, and the effects of Hormone Therapy (HT) on cardiometabolic risk.

METHODS

Prospective observational study of 95 premenopausal women planning RRBSO and 99 comparisons who retained their ovaries. At baseline and 12 months, blood pressure (BP), Body Mass Index (BMI), waist and hip circumference, fasting total, HDL and LDL cholesterol, triglycerides, high-sensitivity C-reactive protein, glucose and insulin were measured and HOMA-IR was calculated. Chi-square tests, t-tests and adjusted logistic regression models were used to compare groups.

RESULTS

Baseline cardiometabolic phenotypes were similar between groups but more RRBSO participants were overweight/obese with higher waist/hip ratios. By 12 months, BP and cardiometabolic phenotypes were largely unchanged. Paired t-tests showed statistically significant increases in BMI (p = 0.037) and weight (p = 0.042) and larger increases in waist circumference (p < 0.001) and waist-hip ratio (p = 0.009) after RRBSO vs comparisons. However, these were not significant when adjusted for baseline values. After RRBSO 60% initiated Hormone Therapy (HT). Paired t-tests demonstrated that non-HT users had a significantly greater mean increase in waist circumference of 4.3 cm (95% CI 2.0-6.5) compared to 1.3 cm in HT users (95% CI -0.2-2.7, p < 0.001), which remained significant when adjusted for baseline values (p = 0.02). At 12 months, mean waist circumference was 2.94 cm greater in non-HT users compared to HT users.

CONCLUSIONS

Cardiometabolic risk markers are largely unchanged 12 months after RRBSO. Hormone Therapy after RRBSO may prevent against an increase in waist circumference.

Young Adults

BACKGROUND

Subjective social status (SSS) has shown inverse relationships with cardiometabolic risk, but intersectionalities of race/ethnicity and sex may indicate more nuanced relationships.

PURPOSE

To investigate associations of SSS with cardiometabolic risk markers by race/ethnicity and sex.

METHODS

Data were from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (n = 4,847; 24-32 years), which collected biological cardiometabolic risk markers. A 10-step ladder captured SSS; respondents indicated on which step they perceived they stood in relation to other people in the U.S. higher values indicated higher SSS (range: 1-10). We tested the relationship between SSS and individual markers using generalized least square means linear regression models, testing three-way interactions between SSS, race/ethnicity, and sex (p < .10) before stratification.

RESULTS

SSS-race/ethnicity-sex interactions were significantly associated with waist circumference (p ≤ .0001), body mass index (BMI; p ≤ .0001), systolic blood pressure (SBP; p ≤ .0001), diastolic blood pressure (DBP; p = .0004), and high-density lipoprotein cholesterol (HDL-C; p = .07). SSS was associated with waist circumference (β [SE]: -1.2 (0.4), p < .05) and BMI (-0.6 [0.2], p < .01) for non-Hispanic White females, compared with males; with HDL-C among non-Hispanic White (0.2 [0.1]; p < .05) and Hispanic (0.3 (0.1); p < .05) females, compared with males; with SBP for non-Hispanic Asian (1.7 [0.8]; p < .05) and Multiracial (1.8 [0.8]; p < .05), versus White, females; and with DBP for non-Hispanic Black (0.8 [0.3]; p < .01), versus White, males.

CONCLUSIONS

SSS was differentially related to cardiometabolic risk markers by race/ethnicity and sex, suggesting intersectional aspects. Clinical and research applications of SSS should consider race/ethnicity- and sex-specific pathways influencing cardiometabolic risk.

Cardiometabolic Risk in Polycystic Ovary Syndrome: Current Guidelines

Polycystic ovary syndrome is a common endocrine disorder in reproductive-aged women and is associated with an increased risk of metabolic abnormalities, including obesity, impaired glucose tolerance, diabetes, dyslipidemia, metabolic syndrome, venous thromboembolism, and subclinical atherosclerosis. Clinicians and patients alike need to be aware of these increased risks as well as new international guidelines that recommend frequent screening and active management of metabolic abnormalities. Given that the data on risk of cardiovascular events, such as myocardial infarction and stroke, in women with PCOS is mixed, future large-scale, longitudinal studies are needed to clarify these potential risks.

Dietary and metabolic risk of neuropsychiatric disorders: insights from animal models

Neuropsychiatric disorders are major causes of the global burden of diseases, frequently co-occurring with multiple co-morbidities, especially obesity, type 2 diabetes mellitus, non-alcoholic fatty liver disease and its various risk factors in the metabolic syndrome. While the determining factors of neuropsychiatric disorders are complex, recent studies have shown that there is a strong link between diet, metabolic state and neuropsychiatric disorders, including anxiety and depression. There is no doubt that rodent models are of great value for preclinical research. Therefore, this article focuses on a rodent model of chronic consumption of high-fat diet (HFD), and/or the addition of a certain amount of cholesterol or sugar, meanwhile, summarising the pattern of diet that induces anxiety/depressive-like behaviour and the underlying mechanism. We highlight how dietary and metabolic risk influence neuropsychiatric behaviour in animals. Changes in dietary patterns, especially HFD, can induce anxiety- or depression-like behaviours, which may vary by diet exposure period, sex, age, species and genetic background of the animals used. Furthermore, dietary patterns significantly aggravate anxiety/depression-like behaviour in animal models of neuropsychiatric disorders. The mechanisms by which diet induces anxiety/depressive-like behaviour may involve neuroinflammation, neurotransmitters/neuromodulators, neurotrophins and the gut-brain axis. Future research should be focused on elucidating the mechanism and identifying the contribution of diet and diet-induced metabolic risk to neuropsychiatric disorders, which can form the basis for future clinical dietary intervention strategies for neuropsychiatric disorders.

Metabolic and satiating effects and consumer acceptance of a fibre-enriched Leberkas meal: a randomized cross-over trial

PURPOSE

The Western diet is poor in dietary fibre and previous efforts to increase fibre intake were not successful. The aim of this study was to develop sensorically appealing, fibre-enriched convenience foods. As a showcase, we prepared a fibre-enriched, fat-reduced Leberkas served in a roll and compared the reformulated product with the standard product.

METHODS

The design was a randomized, single-blinded cross-over study. A Leberkas meal enriched with 19.2 g of wheat fibre and resistant dextrin as well as fat- and energy-reduced (30% less calories) was served to 20 middle-aged healthy volunteers (10 male, 10 female) and compared to the standard product in a random order. Blood was repeatedly taken over a 4 h period to measure metabolic parameters as well as satiety hormones, such as glucagon-like-peptide 1, cholecystokinin, peptide YY. Satiety and consumer acceptance of the fibre-enriched meal were assessed by visual analogue scales and a questionnaire.

RESULTS

The fibre-enriched meal showed very small significant effects at only single time points in postprandial blood glucose (at 120 min, p = 0.050) and glucose_AUC fibre 22,079 ± 2819, standard 22,912 ± 3583 (p = 0.030). The profiles of satiety hormones were comparable between both meals. No differences in subjective satiation, taste and consumer acceptance were observed between the two products, despite a marked reduction in fat and energy content of the reformulated product.

CONCLUSION

It is possible to enrich a popular convenience product with dietary fibre and to markedly reduce energy content without loss of sensory qualities or satiety suggesting that development and promotion of healthier convenience foods may be a useful strategy to tackle obesity and other diet-related diseases.

[Perioperative nutritional supplementation-what is really evidence based?]

For patients undergoing major surgery, perioperative management according to an early recovery after surgery (ERAS) protocol focusing on early oral food intake is the strategy of choice. So-called perioperative nutritional (artificial) support now seems to be very traditional and outdated. Nevertheless, even in an overweight and obese society the prevalence of combined malnutrition and/or sarcopenia should not be underestimated. This results in the necessity for identification of patients at metabolic risk and the indications for nutritional therapy. This article provides a review of the current concepts of perioperative nutritional supplementation and discusses the available evidence and guideline recommendations.

Body fat distribution and circulating adipsin are related to metabolic risks in adult patients with newly diagnosed growth hormone deficiency and improve after treatment

OBJECTIVE

The relationships between body fat distribution, the adipokine adipsin and metabolic risks were assessed in patients with adult growth hormone deficiency (AGHD) before and after growth hormone (GH) treatment.

METHODS

Sixty newly diagnosed AGHD patients were included in our study, 24 of whom were evaluated after at least one year of GH treatment. Anthropometric parameters, glucolipid metabolism and the adipokine adipsin were measured. Visceral adipose tissue (VAT) and body composition were evaluated using a dual-energy X-ray-absorptiometry (DXA) scanner.

RESULTS

At baseline, the higher VAT group had worse glucolipid metabolism parameters. Basal GH was negatively associated with VAT (r=-0.277, p = 0.045), while minimal correlations were found with fat mass depots, such as limbs and trunk fat (all p > 0.05). Adipsin was correlated with total body fat (r = 0.543, p < 0.001), VAT (r = 0.563, p < 0.001) and insulin resistance (r = 0.353, p = 0.006). The effect of GH administration on fat distribution was mainly reflected in the reduction in VAT. Partial improvements were found in lipid profiles, including increased high-density lipoprotein (HDL) and decreases in triglycerides (TGs) and lipoprotein(a), while glucose metabolism showed little change. The adipsin level also decreased significantly. The best predictors of VAT at baseline were trunk fat and IGF-I, and after treatment, VAT was predicted by decreased adipsin and an increase in lean mass.

CONCLUSIONS

(1) VAT is an important metabolic risk factor for AGHD patients. (2) GH treatment decreased body fat predominantly in the visceral and central fat depots. (3) The lipid profiles partially improved after treatment, while glucose metabolism showed little change.

Association of C-reactive protein and metabolic risk with cognitive effects of lurasidone in patients with schizophrenia

BACKGROUND

Accumulating evidence has implicated insulin resistance and inflammation in the pathophysiology of cognitive impairments associated with neuropsychiatric disorders. This post-hoc analysis based on a placebo-controlled trial investigated the effect of inflammation (indexed by CRP) and metabolic risk factors on cognitive performance in patients with schizophrenia treated with lurasidone.

METHODS

Acutely exacerbated patients with schizophrenia were randomized to lurasidone (80 or 160 mg/day), quetiapine XR 600 mg/day, or placebo. A wide range CRP test and a cognitive assessment using the CogState computerized battery were performed at baseline and week 6 study endpoint. Associations between log-transformed CRP, high density lipoprotein (HDL), homeostatic model assessment of insulin resistance (HOMA-IR) and treatment response were evaluated.

RESULTS

CRP combined with HDL, triglyceride-to-HDL (TG/HDL) ratio, or HOMA-IR at study baseline were significant moderators of the improvement in cognitive performance associated with lurasidone 160 mg/day (vs. placebo) treatment (p < .05). Greater placebo-corrected treatment effect size on the CogState composite score was observed for patients in the lurasidone 160 mg/day treatment group who had either low CRP and high HDL (d = 0.43), or low CRP and low HOMA-IR (d = 0.46). Interactive relationships between CRP, HDL, TG/HDL, HOMA-IR and the antipsychotic efficacy of lurasidone or quetiapine XR were not significant. There were no significant associations between antipsychotic treatment and changes in CRP level at study endpoint.

CONCLUSIONS

Findings of this post-hoc analysis based on a placebo-controlled trial in patients with schizophrenia suggest that baseline CRP level combined with measures of metabolic risk significantly moderated the improvement in cognitive performance associated with lurasidone 160 mg/day (vs. placebo) treatment. Our findings underscore the importance of maintaining a low metabolic risk profile in patients with schizophrenia.

A fructose-based meal challenge to assess metabotypes and their metabolic risk profile: A randomized, crossover, controlled trial

OBJECTIVES

The first aim of this study was to determine the metabolic type of individuals based on the postprandial metabolic response after the ingestion of a meal challenge that was high protein and either high glucose (high GI) or fructose (low GI). The second aim was to compare the baseline characteristics between the different metabolic types (metabotypes). The third aim was to assess whether the inclusion of fructose or glucose in a high-protein breakfast modulated the glucose, insulin, and TG response over a 4-h period.

METHODS

The study included 46 Asian women with a body mass index between 17 and 28 kg/m² in a randomized crossover design. Metabolic typing was based on the assessment of the postprandial glycemic, insulin and triacylglycerol (TG) response after the ingestion of two high-protein meal challenges either high in fructose or glucose. Baseline characteristics were compared between the different metabolic types. Baseline and 4-h postprandial blood samples were collected and glucose, insulin, and TG levels were analyzed. Cluster analysis was used to phenotype the participants in distinct groups. Baseline characteristics including anthropometry, glycemic, and lipid profiles and resting metabolic rate were compared among the metabolic types.

RESULTS

Cluster analysis revealed that women could be grouped into three metabolic types based on postprandial glucose, insulin, and TG response after the fructose meal challenge: cluster 1 with an average glucose + high TG response (highTG; n = 12), cluster 2 with a high glucose + average TG response (highGLU; n = 8), and cluster 3 with an average glucose + average TG response (Avg; n = 26). Post hoc analysis revealed significantly greater waist-to-hip ratio and a worse lipid profile for the highTG cluster and a higher fasting blood glucose, body mass index, fat percentage, and hip circumference in the highGLU cluster.

CONCLUSIONS

Three metabolic types with a distinct metabolic response could be distinguished after a high fructose meal. The results suggest a different risk profile and may indicate why some people develop diabetes in an obesogenic environment. Improved metabolic-type assessments will enable us to develop and optimize nutritional and medical interventions for individuals with differing diabetes risk.

High levels of adiponectin attenuate the detrimental association of adiposity with insulin resistance in adolescents

BACKGROUND AND AIM

This study aimed to: i) examine the differences in insulin resistance (IR) across adiposity levels; and ii) ascertain whether high levels of adiponectin attenuate the detrimental association of adiposity with IR in adolescents.

METHODS AND RESULTS

A total of 529 adolescents aged 12-18 years participated in this cross-sectional study (267 girls). Anthropometry and body adiposity parameters [body mass index (BMI), sum of skinfolds, body fat percentage (BF %) by bio-impedance analysis and waist circumference (WC)], were measured according to standardized procedures and categorized into age- and sex-specific quartiles. Socioeconomic status, pubertal stage and lifestyle determinants (Mediterranean diet adherence and cardiorespiratory fitness) were gathered and used as confounders. Serum adiponectin and IR (homeostasis model assessment of insulin resistance [HOMA-IR] estimated from fasting serum insulin and glucose were assessed. Analysis of covariance (ANCOVA) showed that HOMA-IR increased in a linear fashion throughout the quartiles of all adiposity measures (p < 0.001 for all), independently of age, sex, pubertal stage, socioeconomic status, adherence to the Mediterranean diet and cardiorespiratory fitness. Two-way ANCOVA showed that adolescents in the higher quartile of adiposity for BF%, BMI, WC and skinfolds sum (Q4) presented the highest adiponectin levels, and had 0.77 Standard Deviation (SD), 0.8 SD, 0.85 SD and 0.8 SD lower HOMA-IR, respectively (p < 0.01) than their low adiponectin group counterparts, after adjustments for potential confounders.

CONCLUSION

Higher adiponectin levels may attenuate the detrimental association between adiposity and IR, particularly in subjects with higher adiposity.

Can environmental pollutant bisphenol A increase metabolic risk in polycystic ovary syndrome?

BACKGROUND

Bisphenol A (BPA), a widespread industrial substance is recognized as endocrine disrupting chemical and therefore could be associated with polycystic ovary syndrome (PCOS) related metabolic disturbances.

PATIENTS

In this study 29 women of reproductive age with diagnosed PCOS were enrolled.

METHODS

BPA in urine samples was analyzed by gas chromatography-mass spectrometry.

RESULTS

BPA was detected in urines of 48.28% participants. The waist-to-height ratio (WtHR) was statistically significant higher in PCOS BPA+ in comparison to PCOS BPA- women (p = 0.046). PCOS BPA+ women had 6.88 times (95%Cl 1.3481-35.0600, z = 2.319, p = 0.020) higher risk for waist circumference above 80 cm and 4.95 odds (95%Cl 1.0169-24.096, z = 1.981, p = 0.048) to have WtHR over 0.5 when compared to PCOS BPA-. Statistically significant positive association between BPA urine concentrations and insulin serum levels (p = 0.038) was obtained. BPA urine values were associated with elevated HOMA-IR values and reduced HDL levels with moderate significance (p = 0.079 and p = 0.061, respectively). Also, there was 3.75 times (95%Cl 0.7936-17.7203, z = 1.668, p = 0.095) higher risk for PCOS BPA+ women to have testosterone levels above reference values.

CONCLUSION

The obtained results suggested that the BPA exposition in PCOS women was followed by increased metabolic risk through promotion of obesity, especially the visceral type, hyperinsulinemia, insulin resistance, dyslipidemia and elevated androgen levels.

Effect of time-restricted feeding on metabolic risk and circadian rhythm associated with gut microbiome in healthy males. Br J Nutr. 2020;123:1216-1226. [PMID: 31902372 DOI: 10.1017/s0007114519003428]

Time-restricted feeding (TRF) confers protection against nutritional challenges that predispose obesity and metabolic risks through involvement of circadian locomotor output cycles protein kaput genes and gut microbiome, but the underlying mechanism is not clearly understood. Therefore, the present study examined the effects of TRF on metabolic markers and circadian rhythm associated with gut microbiota in healthy males. Two groups (TRF, n 56; non-TRF, n 24) of male adults were enrolled. The TRF group provided blood at pre-TRF and post-TRF, while non-TRF one time after 25 d of trial. Serum lipid and liver profiles were determined. Real time-PCR was applied for circadian and inflammatory gene expression. The 16S rRNA genes were sequenced on the Illumina Miseq v3 platform to comprehensively catalogue the composition and abundance of bacteria in stool. We showed that TRF ameliorated the serum lipid and liver profiles of the individuals. In the TRF group, gut microbial richness was significantly enhanced, with enrichment of Prevotellaceae and Bacteroideaceae. TRF enhanced circadian gene expression probably by activation of sirtuin-1, which is positively associated with gut microbiome richness. TRF could be a safe remedy for the prevention of metabolic diseases related to dyslipidaemia, as it regulates circadian rhythm associated with gut microbiome modulation.

Lipidomic profiling identifies signatures of metabolic risk

BACKGROUND

Metabolic syndrome (MetS), the clustering of metabolic risk factors, is associated with cardiovascular disease risk. We sought to determine if dysregulation of the lipidome may contribute to metabolic risk factors.

METHODS

We measured 154 circulating lipid species in 658 participants from the Framingham Heart Study (FHS) using liquid chromatography-tandem mass spectrometry and tested for associations with obesity, dysglycemia, and dyslipidemia. Independent external validation was sought in three independent cohorts. Follow-up data from the FHS were used to test for lipid metabolites associated with longitudinal changes in metabolic risk factors.

RESULTS

Thirty-nine lipids were associated with obesity and eight with dysglycemia in the FHS. Of 32 lipids that were available for replication for obesity and six for dyslipidemia, 28 (88%) replicated for obesity and five (83%) for dysglycemia. Four lipids were associated with longitudinal changes in body mass index and four were associated with changes in fasting blood glucose in the FHS.

CONCLUSIONS

We identified and replicated several novel lipid biomarkers of key metabolic traits. The lipid moieties identified in this study are involved in biological pathways of metabolic risk and can be explored for prognostic and therapeutic utility.

Correlations of neck circumference with body composition and cardiometabolic risk factors in Arab women

BACKGROUND

Neck circumference (NC) is a relatively unused index of upper body adiposity. The present study aims to analyze the associations of NC with anthropometric measures of obesity, as well as cardiovascular and metabolic risks in Arab women.

METHODS

This cross-sectional study included 623 women (aged 18-70 years) recruited from different primary care centers in Riyadh, Saudi Arabia. NC, waist circumference (WC), body mass index (BMI), blood pressure, and metabolic and serological markers were measured in all participants. Covariance and regression analyses were used to evaluate the associations between NC and cardiometabolic risk factors.

RESULTS

The correlation coefficients of NC and WC with the clinical indices were highly significant (p < 0.01). Overall, the NC was positively correlated with all cardiometabolic markers except total cholesterol and LDLc (p < 0.001). Interestingly, NC was associated with cardiometabolic risk factors independent of other anthropometric indices.

CONCLUSION

NC is significantly and independently associated with cardiometabolic risk factors in Arab women.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Acanthosis Nigricans in the Knuckles of Infants: A Novel Clinical Marker of High Metabolic Risk

INTRODUCTION

Acanthosis nigricans (AN) is an early clinical sign of insulin resistance (IR) primarily in adults. The prevalence and association of AN and IR in infants, however, remains uncertain. We aimed to describe the prevalence of AN and its association with IR in a group of Latin-American infants.

METHODS

We studied a random sample of 227 healthy infants between 9 and 24 months of age. After a complete clinical history was obtained and a physical examination was performed, fasting plasma glucose and serum insulin were measured. Three blinded evaluators assessed AN in each patient. Infants with AN were categorized as cases. The HOMA-IR index cutoffs of ≥ 90th and ≥ 95th percentiles were considered IR.

RESULTS

There were 49 infants with AN (21.6%) (cases) and 178 without AN (78.4%) (controls). Cases had a significantly higher mean serum insulin, fasting plasma glucose, and HOMA-IR levels of 3.67 ± 2.56 µU/ml vs. 2.42 ± 1.45 µU/ml, P = 0.005; 84.2 ± 12.6 mg/dL vs. 77 ± SD 9.9 mg/dL, P ≤ 0.001; HOMA-IR 0.77 ± 0.54 vs. 0.46 ± 0.28, P ≤ 0.001, respectively. More cases than controls presented HOMA-IR levels ≥ 95th percentile (cases 18.4%; controls 0.5%, P ≤ 0.001) and ≥ 90th percentile (cases 32.7%; controls 1.6%, P ≤ 0.001). AN in the knuckles had a high sensitivity and a negative predictive value (NPV) for detecting patients with HOMA-IR levels above the 95th percentile (sensitivity 90%; NPV 99.4%) and above the 90th percentile (sensitivity 84.2%; NPV 98.3%).

CONCLUSION

AN in the knuckles is a prevalent, non-invasive, costless, and reliable screening clinical tool that can be used for early detection of infants with IR and a high metabolic risk.

Effect of α-linolenic acid on vascular function and metabolic risk markers during the fasting and postprandial phase: A randomized placebo-controlled trial in untreated (pre-)hypertensive individuals

BACKGROUND

Only a limited number of studies have examined the vascular and postprandial effects of α-linolenic acid (ALA, C18:3n-3). Therefore, we performed a well-controlled trial focusing specifically on the effects of ALA on vascular function and metabolic risk markers during the fasting and postprandial phase in untreated (pre-)hypertensive individuals.

METHODS

In a double-blind randomized, placebo-controlled parallel study, 59 overweight and obese adults (40 men and 19 women, aged 60 ± 8 years) with a high-normal blood pressure or mild (stage I) hypertension consumed daily either 10 g of refined cold-pressed flaxseed oil, providing 4.7 g ALA (n = 29), or 10 g of high-oleic sunflower (control) oil (n = 30) for 12 weeks.

RESULTS

As compared with the high-oleic oil control, intake of flaxseed oil did not change brachial artery flow-mediated vasodilation, carotid-to-femoral pulse wave velocity, retinal microvascular calibers and plasma markers of microvascular endothelial function during the fasting and postprandial phase. Fasting plasma concentrations of free fatty acid (FFA) and TNF-α decreased by 58 μmol/L (P = 0.02) and 0.14 pg/mL (P = 0.03), respectively. No differences were found in other fasting markers of lipid and glucose metabolism, and low-grade systemic inflammation. In addition, dietary ALA did not affect postprandial changes in glucose, insulin, triacylglycerol, FFA and plasma inflammatory markers after meal intake.

CONCLUSION

A high intake of ALA, about 3-5 times the recommended daily intake, for 12 weeks decreased fasting FFA and TNF-α plasma concentrations. No effects were found on other metabolic risk markers and vascular function during the fasting and postprandial phase in untreated high-normal and stage I hypertensive individuals.

Body composition of New Zealand-born term babies differs by ethnicity, gestational age and sex

BACKGROUND

Body composition provides important information on nutrition and future metabolic risk. New Zealand has a diverse ethnic population for which there are no newborn body composition data.

AIM

To determine body composition in a cohort of New Zealand-born term babies.

STUDY DESIGN

Observational study.

SUBJECTS

Healthy, term infants between 37⁺⁰ and 41⁺⁶ weeks' gestation in two hospitals in Auckland, New Zealand.

OUTCOME MEASURES

Body composition by air displacement plethysmography and anthropometry measured within 5 days of birth. Parent-identified ethnicity was prioritised according to Ministry of Health criteria. Data were analysed using t-test, ANOVA with Tukey post-hoc tests, quantile regression and are mean(SD).

RESULTS

440 babies (54% male) were included. Pacific Island/Māori (PI/M) were heavier at birth than Asian/Middle Eastern/Latin American/African (Asian+) babies (3403(506) vs 3181(485) g, p < .05). PI/M and European (E) babies were longer with larger head and waist circumferences than Asian+ babies (all p < .05). Absolute fat mass (FM) was not different amongst ethnicities (E, 365(156), PI/M, 347(183), Asian+, 357(188) g) but PI/M babies had significantly lower FM% than Asian+ (9.8(4.3) vs 10.9(4.5) %, p < .05). Fat-free mass (FFM) was greater in PI/M (3056(400) g) than E (2952(345) g (p < .05) and both PI/M and E had greater FFM than Asian+ (2824(363) g, p < .05). Early term babies had less FFM than term and late-term babies (2732(370), 3012(352), 3173(302)g, p < .001) respectively.

CONCLUSIONS

Asian+ babies were the smallest babies with the least FFM yet had similar FM and the highest FM%, indicative of a thin, fat phenotype from birth.

Perirenal fat thickness is associated with metabolic risk factors in patients with chronic kidney disease

Background

Adipose tissue accumulation in specific body compartments has been associated with diabetes, hypertension and dyslipidemia. Perirenal fat (PRF) may lead to have direct lipotoxic effects on renal function and intrarenal hydrostatic pressure. This study was undertaken to explore the association of PRF with cardiovascular risk factors and different stages of chronic kidney disease (CKD).

Methods

We studied 103 patients with CKD of different stages (1 to 5). PRF was measured by B-mode renal ultrasonography in the distal third between the cortex and the hepatic border and/or spleen.

Results

The PRF thickness was greater in CKD patients with impaired fasting glucose than in those with normal glucose levels (1.10 ± 0.40 cm vs. 0.85 ± 0.39 cm, P < 0.01). Patients in CKD stages 4 and 5 (glomerular filtration rate [GFR] < 30 mL/min/1.73 m²) had the highest PRF thickness. Serum triglyceride levels correlated positively with the PRF thickness; the PRF thickness was greater in patients with triglyceride levels ≥ 150 mg/dL (1.09 ± 0.40 cm vs. 0.86 ± 0.36 cm, P < 0.01). In patients with a GFR < 60 mL/min/1.73 m², uric acid levels correlated positively with the PRF thickness (P < 0.05).

Conclusion

In CKD patients, the PRF thickness correlated significantly with metabolic risk factors that could affect kidney function.

Sugar in mind: Untangling a sweet and sour relationship beyond type 2 diabetes

It is widely recognised that type 2 diabetes (T2D) represents a major disease burden but it is only recently that its role in neurodegeneration has attracted more attention. This research has shown that T2D is associated with impaired cerebral health, cognitive decline and dementia. However, the impact on the brain of progressive metabolic changes associated with the pre-clinical development of the disease is less clear. The aim of this review is to comprehensively summarise how the emergence of risk factors and co-morbid conditions linked to the development of T2D impact cerebral health. Particular attention is directed at characterising how normal but elevated blood glucose levels in individuals without T2D contribute to neurodegenerative processes, and how the main risk factors for T2D including obesity, physical activity and diet modulate these effects. Where available, evidence from the animal and human literature is contrasted, and sex differences in risk and outcomes are highlighted.

Changes in objectively measured physical activity after a multidisciplinary lifestyle intervention in children with abdominal obesity: a randomized control trial

Background

Physical activity (PA) is associated with changes in body composition that affect insulin sensitivity and leptin levels. Few studies have assessed the effect of lifestyle interventions on changes in objectively measured PA levels in obese children. To evaluate the effects of a multidisciplinary lifestyle intervention on anthropometric indices, biochemical parameters and accelerometer measured PA in abdominal obese children.

Methods

A randomized control trial was performed in 106 children and adolescents with abdominal obesity. Participants were randomly assigned to usual or intensive care group for 8-week. PA was measured by accelerometry over four days including, at least, two weekdays in all participants. Both groups were encouraged to accumulate an extra time of 200 min per week in their PA.

Results

At baseline, 75% of subjects do not fulfill the WHO recommendation of being more than 60 min/day on moderate-to-vigorous PA (MVPA). The intensive care group achieved a significant reduction in anthropometric indexes compared to the usual care but no significant change was found in biochemical or PA parameters. Both groups achieved a significant reduction in light PA. Interestingly, intensive care participants significantly increased MVPA in 5.5 min/day. Moreover, an inverse association between changes in MVPA and leptin levels was found.

Conclusion

The two lifestyle intervention reduced anthropometric indexes and lowered light PA in abdominal obese children. No significant differences were observed between intensive care and usual care in regard to PA. Intensive care participants significantly increase physical activity (MVPA) and, changes in MVPA were inversely associated with changes in leptin levels after the intervention.

Trial registration

ClinicalTrials.gov, Identifier: NCT03147261. Registered 10 May 2017. Retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1468-9) contains supplementary material, which is available to authorized users.

The association between subclinical inflammation and abnormal glucose and lipid metabolisms in normal-weight Korean individuals

BACKGROUNDS AND AIMS

We aimed to reveal the association between subclinical inflammation and metabolic risk factors and to determine the difference in the association between normal-weight and obese Korean individuals.

METHODS AND RESULTS

Data collected from the Korean National Health and Nutrition Examination Survey (KNHANES) 2015, conducted from January to December 2015, were analyzed. Overall, 4620 subjects were examined and divided into two subgroups: 2987 and 1633 subjects in the normal-weight and obese groups, respectively. The prevalence of obesity in the study population was 34.5% (n = 1633). After multivariate adjustment, impaired fasting glucose (IFG) (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05-1.42, P = 0.010), high triglyceride (TG) levels (OR 1.29, 95% CI 1.13-1.47, P < 0.001), and low high-density lipoprotein-cholesterol (HDL-C) levels (OR 1.47, 95% CI 1.31-1.64, P < 0.001) were significantly associated with increased high-sensitivity C-reactive protein (hs-CRP) levels in the normal-weight group but not in the obesity group.

CONCLUSION

Subclinical inflammation was associated with IFG, high TG levels, and low HDL-C levels in normal-weight Korean individuals. Prospective and biochemical research is necessary to clarify the role of subclinical systemic inflammation in individuals with normal body weight and its impact on insulin resistance and abnormal lipid metabolism, which promote the incidence of metabolic syndrome and cardiovascular disease.

Is waist circumference more strongly associated with metabolic risk factors than waist-to-height ratio in Asians?

OBJECTIVES

Differential distribution of fats can vary among ethnic groups and thus have varying effects on metabolic risk. Measuring metabolic risk of individuals using simple anthropometric measurements is essential to replace current invasive methods of obtaining blood samples. Waist-to-height ratio (WHtR) has been advocated as the best simple anthropometric measurement, but, because of the high visceral fat of Asians, there has been speculation as to the possibility of using only waist circumference (WC) to measure metabolic risk. The aim of this study was to compare the performance of WC and WHtR in terms of their association with measures of obesity and metabolic risk factors (e.g., homeostasis model assessment for insulin resistance, low-density lipoprotein, triacylglycerol, and ratio of triacylglycerol to high-density lipoprotein) and to obtain an optimal cutoff value for one anthropometric measurement.

METHODS

The study was performed on healthy Asian Chinese (N = 527) men (n = 209) and women (n = 318) who participated in a cross-sectional study conducted at the Clinical Nutrition Research Centre located in Singapore. Association of WC and WHtR with metabolic risk factors was obtained using Spearman's rank correlation coefficient. Optimal cutoff value was obtained using receiver operating characteristic curve.

RESULTS

WC and WHtR performed equally well in both sexes in terms of their strength of association between metabolic risk factors. Receiver operating characteristic curve analysis showed that 73.5 cm (in women) and 82.5 cm (in men) were the optimal WC cutoff values to identify insulin resistance.

CONCLUSION

It is suggested that WC is a simpler anthropometric measurement that has strong association with an individual's metabolic risk level.

Systemic inflammation as a predictor of brain aging: Contributions of physical activity, metabolic risk, and genetic risk

Inflammatory processes may contribute to risk for Alzheimer's disease (AD) and age-related brain degeneration. Metabolic and genetic risk factors, and physical activity may, in turn, influence these inflammatory processes. Some of these risk factors are modifiable, and interact with each other. Understanding how these processes together relate to brain aging will help to inform future interventions to treat or prevent cognitive decline. We used brain magnetic resonance imaging (MRI) to scan 335 older adult humans (mean age 77.3 ± 3.4 years) who remained non-demented for the duration of the 9-year longitudinal study. We used structural equation modeling (SEM) in a subset of 226 adults to evaluate whether measures of baseline peripheral inflammation (serum C-reactive protein levels; CRP), mediated the baseline contributions of genetic and metabolic risk, and physical activity, to regional cortical thickness in AD-relevant brain regions at study year 9. We found that both baseline metabolic risk and AD risk variant apolipoprotein E ε4 (APOE4), modulated baseline serum CRP. Higher baseline CRP levels, in turn, predicted thinner regional cortex at year 9, and mediated an effect between higher metabolic risk and thinner cortex in those regions. A higher polygenic risk score composed of variants in immune-associated AD risk genes (other than APOE) was associated with thinner regional cortex. However, CRP levels did not mediate this effect, suggesting that other mechanisms may be responsible for the elevated AD risk. We found interactions between genetic and environmental factors and structural brain health. Our findings support the role of metabolic risk and peripheral inflammation in age-related brain decline.

The association between high-sensitivity C-reactive protein and metabolic risk factors in black and white South African women: a cross-sectional study

Background

High-sensitivity C-reactive protein (hsCRP) is associated with metabolic risk, however it is unclear whether the relationship is confounded by racial/ethnic differences in socioeconomic status (SES), lifestyle factors or central adiposity. The aims of the study was, (1) to investigate whether hsCRP levels differ by race/ethnicity; (2) to examine the race/ethnic-specific associations between hsCRP, HOMA-IR and serum lipids [total cholesterol (TC), triglycerides (TG), high-density lipoproteins (HDL-C) and low-density lipoproteins (LDL-C)]; and (3) to determine whether race/ethnic-specific associations are explained by SES, lifestyle factors or waist circumference (WC).

Methods

The convenience sample comprised 195 black and 153 white apparently health women, aged 18-45 years. SES (education, assets and housing density) and lifestyle factors (alcohol use, physical activity and contraceptive use) were collected by questionnaire. Weight, height and WC were measured, and fasting blood samples collected for hsCRP, glucose, insulin, and lipids.

Results

Black women had higher age- and BMI-adjusted hsCRP levels than white women (p = 0.047). hsCRP was associated with HOMA-IR (p < 0.001), TG (p < 0.001), TC (p < 0.05), HDL-C (p < 0.05), and LDL-C (p < 0.05), independent of age and race/ethnicity. The association between hsCRP and lipids differed by race/ethnicity, such that hsCRP was positively associated with TG and LDL-C in white women, and inversely associated with HDL-C in black women. Higher hsCRP was also associated with higher TC in white women and lower TC in black women. Furthermore, when adjusting for SES and lifestyle factors, the associations between hsCRP, and TC and TG, remained, however the associations between hsCRP, and HDL-C and LDL-C, were no longer significant.

Conclusion

Although circulating hsCRP may identify individuals at increased metabolic risk, the heterogeneity in these associations between racial/ethnic groups highlights the need for prospective studies investigating the role of hsCRP for risk prediction in different populations.

Beneficial association between active travel and metabolic syndrome in Latin-America: A cross-sectional analysis from the Chilean National Health Survey 2009-2010

BACKGROUND

There is limited evidence on potential health benefits of active travel, independently of leisure-time physical activity (PA), with metabolic syndrome (MetS) in Latin-America.

OBJECTIVE

To investigate the relationship between active travel and metabolic syndrome (MetS) and its components in a national representative sample of Chilean adults.

METHODS

Cross-sectional study of 2864 randomly selected adults' participants enrolled in the 2009-2010 Chilean National Health Survey (CNHS). Self-reported PA was obtained with the validated Global PA Questionnaire and classifying participants into insufficiently active (<150min/week) or active (≥150min/week). MetS was diagnosed from the modified Adult Treatment Panel (ATP) III criteria with national-specific abdominal obesity cut points. Multilevel logistic regression analysis was applied to estimate associations of travel PA with MetS and its components at a regional level, adjusted for socio-demographic characteristics and other types of PA.

RESULTS

46.2% of the sample engaged in 150min/week of active travel and the prevalence of MetS was 33.7%. Mets was significantly lower among active travel participants. Active travel was associated with lower odds of MetS (OR 0.72; 95%CI 0.61-0.86), triglycerides (OR 0.77; 95%CI 0.64-0.92) and abdominal obesity (OR 0.82; 95%CI 0.69-0.97) after controlling for socio-demographics and other types of PA.

CONCLUSION

Active travel was negatively associated with MetS, triglycerides and abdominal obesity. Efforts to increase regional active travel should be addressed as a measure to prevent and reduce the prevalence of MetS and disease burden in middle income countries.

Intermittent nocturnal hypoxia and metabolic risk in obese adolescents with obstructive sleep apnea

PURPOSE

There is conflicting data regarding the independent associations of obstructive sleep apnea (OSA) with metabolic risk in obese youth. Previous studies have not consistently addressed central adiposity, specifically elevated waist to height ratio (WHtR), which is associated with metabolic risk independent of body mass index.

OBJECTIVE

The objective of this study was to determine the independent effects of the obstructive apnea-hypopnea index (OAHI) and associated indices of nocturnal hypoxia on metabolic function in obese youth after adjusting for WHtR.

METHODS

Subjects had standardized anthropometric measurements. Fasting blood included insulin, glucose, glycated hemoglobin, alanine transferase, and aspartate transaminase. Insulin resistance was quantified with the homeostatic model assessment. Overnight polysomnography determined the OAHI and nocturnal oxygenation indices.

RESULTS

Of the 75 recruited subjects, 23% were diagnosed with OSA. Adjusting for age, gender, and WHtR in multivariable linear regression models, a higher oxygen desaturation index was associated with a higher fasting insulin (coefficient [standard error] = 48.076 [11.255], p < 0.001), higher glycated hemoglobin (coefficient [standard error] = 0.097 [0.041], p = 0.02), higher insulin resistance (coefficient [standard error] = 1.516 [0.364], p < 0.001), elevated alanine transferase (coefficient [standard error] = 11.631 [2.770], p < 0.001), and aspartate transaminase (coefficient [standard error] = 4.880 [1.444], p = 0.001). However, there were no significant associations between OAHI, glucose metabolism, and liver enzymes.

CONCLUSION

Intermittent nocturnal hypoxia rather than the OAHI was associated with metabolic risk in obese youth after adjusting for WHtR. Measures of abdominal adiposity such as WHtR should be considered in future studies that evaluate the impact of OSA on metabolic health.

Population attributable fractions for Type 2 diabetes: an examination of multiple risk factors including symptoms of depression and anxiety

BACKGROUND

Population attributable fractions (PAFs) are frequently used to quantify the proportion of Type 2 diabetes cases due to single risk factors, an approach which may result in an overestimation of their individual contributions. This study aimed to examine Type 2 diabetes incidence associated with multiple risk factor combinations, including the metabolic syndrome, behavioural factors, and specifically, depression and anxiety.

METHODS

Using data from the population-based HUNT cohort, we examined incident diabetes in 36,161 Norwegian adults from 1995 to 2008. PAFs were calculated using Miettinen's case-based formula, using relative risks estimated from multivariate regression models.

RESULTS

Overall, the studied risk factors accounted for 50.5% of new diabetes cases (78.2% in men and 47.0% in women). Individuals exposed to both behavioural and metabolic factors were at highest risk of diabetes onset (PAF = 22.9%). Baseline anxiety and depression contributed a further 13.6% of new cases to this combination. Men appeared to be particularly vulnerable to the interaction between metabolic, behavioural and psychological risk factors.

CONCLUSION

This study highlights the importance of risk factor clustering in diabetes onset, and is the first that we know of to quantify the excess fraction of incident diabetes associated with psychological risk factor interactions.

Waist circumference and waist:height ratio percentiles using LMS method in Chilean population

BACKGROUND AND AIMS

The concern over the weight gain problem continues to grow among both the international scientific community and public health authorities, since overweight and obesity prevalence rates continue to increase worldwide. In Chile, two out of three people are overweight, whereas 25% of the adult population is obese. Abdominal fat, has been linked to the development of a number of metabolic disorders. Waist circumference (WC) and the waist:height ratio (WHtR) have recently been evidenced as good predictors of metabolic risk for both adults and children. Thus, the present work aims at establishing smoothed centile charts and LMS tables for WC and WHtR for Chilean adults based on data from the National Health Survey-ENS, in order to have reliable information for identifying groups at risk.

METHODS AND RESULTS

A sample of 4788 subjects aged 15-75 years old (mean age 46 ± 18 years old) was considered. Body weight, height, and WC were measured and Body Mass Index (BMI) and WHtR were also determined. Percentiles were calculated using the L (curve Box-Cox), M (curve median), S (curve coefficient of variation) method. In the obese group the WC cutoff values were 99.75 cm and 92.35 cm for men and women, respectively. The cutoff point for WHtR was 0.59 for both obese men and women.

CONCLUSION

The study shows, for the first time, reference values for WC and WHtR for Chilean adults.

Basal (18)F-FDG PET/CT in follicular lymphoma: A comparison of metabolic and clinical variables in the prognostic assessment

AIM

To analyze the relationship of clinical variables related to prognosis and tumor burden, with metabolic variables obtained in the staging (18)F-FDG PET/CT, and their value in the prognosis in follicular lymphoma (FL).

METHODS

82 patients with FL, a (18)F-FDG PET/CT at diagnosis and a follow-up for a minimum of 12 months, were retrospectively enrolled in the present study. Clinical variables (Tumor grade, Follicular Lymphoma International Prognostic Index (FLIPI) and Tumor burden) were evaluated. Metabolic variables such as SUVmax in the highest hypermetabolic lesion, extralymphatic locations, number of involved lymph node locations, bone marrow (BM) involvement, PET stage and diameter of the biggest hypermetabolic lesion, were analyzed in order to establish a PET score and classify the studies in low, intermediate and high metabolic risk. Clinical and metabolic variables (included metabolic risk) were compared. The relation among all variables and disease-free survival (DFS) was studied.

RESULTS

The 28% of patients had a high-grade tumor. The 30.5% had FLIPI risk low, 29.3% intermediate y 40.2% high. The 42.7% presented a high tumor burden. The PET/CT was positive in 94% of patients. The tumor grade did not show significant relation with metabolic variable. FLIPI risk and tumor burden showed statistical relations with the SUV max and the PET score (p<0.008 and p=0.003 respectively). With respect to DFS, significant differences were detected for the PET stage and FLIPI risk (p=0.015 and p=0.047 respectively). FLIPI risk was the only significant predictor in Cox regression analysis, with a Hazard Ratio of 5.13 between high risk and low risk.

CONCLUSION

The present research highlights the significant relation between metabolic variables obtained with FDG PET/CT and clinical variables although their goal as an independent factor of prognosis was not demonstrated in the present work.

The Effect of a Community-Based Exercise Program on Inflammation, Metabolic Risk, and Fitness Levels Among Persons Living with HIV/AIDS

The human immunodeficiency virus (HIV) pandemic remains a top national health priority. Chronic inflammation may be a critical component in the disease course of HIV as C-reactive protein (CRP) is elevated and associated with increased mortality. This study examined the effect of 3 months of combined aerobic and resistance exercise training among a diverse cohort of HIV-infected men and women. The fixed effect of time for CRP was found to be non-significant (F[1,57.3] = 1.7, p = 0.19). There was a significant fixed effect for time for upper body (F[1,51.6] = 18.1, p < 0.05) and lower body strength (F[1,48.0] = 15.7, p < 0.05) and significant declines in diastolic blood pressure (p = 0.002) and waist circumference (p = 0.027). Though levels of CRP were not impacted after 3 months training, participants demonstrated a significant increase in muscular strength as well as beneficial changes in metabolic risk factors. Future studies should focus on determining the optimal exercise intervention length and mode to reduce inflammation among individuals living with HIV.

Can a pharmacy intervention improve the metabolic risks of mental health patients? Evaluation of a novel collaborative service

Background

The pressure on healthcare services worldwide has driven the incorporation of disease state management services within community pharmacies in developed countries. Pharmacists are recognised as the most accessible healthcare professionals, and the incorporation of these services facilitates patient care. In Australia, the opportunity to manage pharmacy patients with mental illness has been underutilised, despite the existence of service models for other chronic conditions. This paper is an independent evaluation of a novel service developed by a community pharmacy in Perth, Western Australia. The service represents collaboration between a nurse practitioner and community pharmacy staff in the management of mental health patients with metabolic risks.

Methods

We applied practice service standards for Australian community pharmacies to develop an evaluation framework for this novel service. This was followed by semi-structured interviews with staff members at the study pharmacy to explore service processes and procedures. Descriptive analysis of interviews was supplemented with analysis of patients’ biometric data. All data were evaluated against the developed framework.

Results

The evaluation framework comprised 13 process, 5 outcomes, and 11 quality indicators. Interview data from eight staff members and biometric data from 20 community-dwelling mental health patients taking antipsychotics were evaluated against the framework. Predominantly, patients were managed by the pharmacy’s nurse practitioner, with medication management provided by pharmacists. Patients’ biometric measurements comprised weight, blood pressure, blood glucose levels, lipid profiles and management of obesity, smoking, hypertension and diabetes. Positive outcomes observed in the patient data included weight loss, smoking cessation, and improved blood pressure, blood glucose and lipid levels.

Conclusions

The developed framework allowed effective evaluation of the service, and may be applicable to other pharmacy services. The metabolic clinic met key process, quality and outcomes indicators. The positive patient outcomes may assist in securing further funding.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1406-6) contains supplementary material, which is available to authorized users.

Plasma fatty acid patterns reflect dietary habits and metabolic health: A cross-sectional study

SCOPE

Using pattern analysis, we investigated the relationship between plasma fatty acid patterns, dietary intake, and biomarkers of metabolic health using data from the Irish National Adult Nutrition Survey.

METHODS AND RESULTS

Plasma fatty acid patterns were derived from 26 plasma fatty acids using k-means cluster analysis. Four clusters were identified, each with a distinct fatty acid profile. Cluster 1 included high proportions of linoleic acid (LA) and low proportions of stearic acid (SA); cluster 2 was higher in n-3 polyunsaturated fatty acids and SA; the profile of cluster 3 was higher in very-long-chain saturated fatty acid (VLCSFA) and lower in α-linolenic acid (ALA) (cluster 3); while cluster 4 was higher in fatty acids related to de novo lipogenesis and 20:3n-6 and lower in LA (cluster 4). In general, cluster 4 was associated with adverse metabolic profile and higher metabolic risk (p < 0.033). Clusters 2 and 3 were associated with healthier and protective phenotypes (p < 0.033).

CONCLUSION

Distinct fatty acid patterns were identified which were related to demographics, dietary habits, and metabolic profile. A pattern higher in VLCSFA and lower in ALA was associated with healthier metabolic outcome.

Occupation and metabolic syndrome: is there correlation? A cross sectional study in different work activity occupations of German firefighters and office workers

BACKGROUND

The treatment and prevention of the metabolic syndrome (MetS) is currently one of the major challenges in medicine. The impact of working conditions on metabolic risk has not been adequately studied. Our objective was to compare the prevalence of MetS and metabolic risk in two extremely different occupational groups: firefighters and office workers.

METHODS

A total of 143 male subjects (97 firefighters and 46 office workers) from Germany participated in the study. Anthropometric characteristics, metabolic risk parameters as well as laboratory parameters were collected. MetS was diagnosed according to criteria of the International Diabetes Federation.

RESULTS

Sedentary occupation showed a significant tendency towards obesity. Abdominal waist circumference was significantly greater in office workers than in firefighters [5.08 CI (1.44-8.71), p = 0.007]. Concerning metabolic risk factors, abnormal HDL, triglycerides, BMI, blood pressure and waist circumference values were more frequently found in office workers than in firefighters. The MetS was detected in almost 33 % of office workers as compared with only 14 % in firefighters (p = 0.015). Regarding MetS in an international comparison, the prevalence of MetS in German office workers was high and in firefighters it was extremely low.

CONCLUSIONS

Sedentary occupation as an office worker is associated with a high risk of MetS. Both groups need to be made aware of the metabolic risks, and health promoting concepts such as corporate sports activities or education in healthy nutrition need to be implemented to counteract the development of the MetS and cardiovascular risk factors.

[Waist-to-height ratio is an indicator of metabolic risk in children]

INTRODUCTION

Abdominal fat, particularly visceral, is associated with a high risk of metabolic complications. The waist-height ratio (WHtR) is used to assess abdominal fat in individuals of all ages.

OBJECTIVE

To determine the ability of the waist-to-height ratio to detect metabolic risk in mexican schoolchildren.

PATIENTS AND METHOD

A study was conducted on children between 6 and 12 years. Obesity was diagnosed as a body mass index (BMI) ≥ 85th percentile, and an ICE ≥0.5 was considered abdominal obesity. Blood levels of glucose, cholesterol and triglycerides were measured. The sensitivity, specificity, positive predictive and negative value, area under curve, the positive likelihood ratio and negative likelihood ratio of the WHtR and BMI were calculated in order to identify metabolic alterations. WHtR and BMI were compared to determine which had the best diagnostic efficiency.

RESULTS

Of the 223 children included in the study, 51 had hypertriglyceridaemia, 27 with hypercholesterolaemia, and 9 with hyperglycaemia. On comparing the diagnostic efficiency of WHtR with that of BMI, there was a sensitivity of 100% vs. 56% for hyperglycaemia, 93 vs. 70% for cholesterol, and 76 vs. 59% for hypertriglyceridaemia. The specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and area under curve were also higher for WHtR.

CONCLUSIONS

The WHtR is a more efficient indicator than BMI in identifying metabolic risk in mexican school-age.