The metabolic syndrome

Personal, occupational and cardiovascular risk factors associated with elevated blood pressure in Brazilian firefighters: a cross-sectional study

OBJECTIVE

Our study evaluated the prevalence of hypertension in a population of Brazilian firefighters and the association of elevated blood pressure (BP) with personal, occupational, and cardiovascular risk factors.

DESIGN

This was a cross-sectional study.

SETTING

Our study was based on health inspections of the Military Fire Brigade of the Espírito Santo State, Brazil, performed in 2019.

PARTICIPANTS

The study participants were 859 male Brazilian firefighters.

OUTCOME MEASURES

Data collected included sociodemographic (age, ethnicity, educational level, health insurance coverage), occupational (city of work, type of current activity, main operational activity), lifestyle (smoking and alcohol consumption), and health status (fasting glucose, total cholesterol and triglycerides, blood pressure, and anthropometric composition). All firefighters in the pre-hypertension and hypertension range and/or using antihypertensive medication were considered as having BP above normal, and the association of this outcome with sociodemographic, occupational, lifestyle, and health status variables was analysed by a logistic regression model.

RESULTS

We found that 45.6% of firefighters presented elevated BP levels. A higher chance of elevated BP was observed for firefighters with high school (1.5; 95% confidence interval (CI) 1.02 to 2.19) and postgraduate (1.54; 95% CI 1.03 to 2.30) educational levels, those self-declared as black (1.98; 95% CI 1.03 to 3.78), those working in countryside cities (ie, locations outside the metropolitan circuit; 2.32; 95% CI 1.14 to 4.71), and those with hypertriglyceridemia (1.92; 95% CI 1.19 to 3.11), hyperglycaemia (1.5; 95% CI 1.01 to 2.22), and central obesity (2.34; 95% CI 1.47 to 3.70).

CONCLUSION

We found an association between elevated BP and personal, occupational, and cardiovascular risk factors. Awareness of risk factors may grant implementation of more effective intervention and prevention strategies.

Proteostasis Decline and Redox Imbalance in Age-Related Diseases: The Therapeutic Potential of NRF2

Nuclear factor erythroid 2-related factor 2 (NRF2) is a master regulator of cellular homeostasis, overseeing the expression of a wide array of genes involved in cytoprotective processes such as antioxidant and proteostasis control, mitochondrial function, inflammation, and the metabolism of lipids and glucose. The accumulation of misfolded proteins triggers the release, stabilization, and nuclear translocation of NRF2, which in turn enhances the expression of critical components of both the proteasomal and lysosomal degradation pathways. This process facilitates the clearance of toxic protein aggregates, thereby actively maintaining cellular proteostasis. As we age, the efficiency of the NRF2 pathway declines due to several factors including increased activity of its repressors, impaired NRF2-mediated antioxidant and cytoprotective gene expression, and potential epigenetic changes, though the precise mechanisms remain unclear. This leads to diminished antioxidant defenses, increased oxidative damage, and exacerbated metabolic dysregulation and inflammation-key contributors to age-related diseases. Given NRF2's role in mitigating proteotoxic stress, the pharmacological modulation of NRF2 has emerged as a promising therapeutic strategy, even in aged preclinical models. By inducing NRF2, it is possible to mitigate the damaging effects of oxidative stress, metabolic dysfunction, and inflammation, thus reducing protein misfolding. The review highlights NRF2's therapeutic implications for neurodegenerative diseases and cardiovascular conditions, emphasizing its role in improving proteostasis and redox homeostasis Additionally, it summarizes current research into NRF2 as a therapeutic target, offering hope for innovative treatments to counteract the effects of aging and associated diseases.

The relationship between dietary inflammatory index and all-cause and cardiovascular disease-related mortality in adults with metabolic syndrome: a cohort study of NHANES

Objective

This study aims to investigate the correlation between dietary inflammatory index (DII) and mortality resulting from all-cause and cardiovascular diseases (CVD) in adults affected by metabolic syndrome (MetS).

Methods

The focus of this study was to analyze the information of 13,751 adults who had been diagnosed with MetS. DII scores were computed based on a 24-hour dietary intake at the start of the study. By implementing both the Cox regression analysis and restricted cubic spline(RCS) analysis, we examined the correlation between DII score and mortality.

Results

After a mean follow-up duration of 114 months, a total of 2,343 individuals (representing 13.45% of the sample) died, with 639 fatalities attributed to CVD. The degrees of dietary inflammation were classified into three groups based on DII scores: low, medium, and high-grade. The mortality rates for each tertile of DII were 11.55%, 13.96%, and 15.05%, respectively. In comparison to participants with T1, the multivariate-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for participants with T3 were 1.16 (95% CI: 1.01-1.34) regarding mortality caused by any reason, and 1.26 (95% CI: 0.95-1.68) for mortality related to CVD. Through the use of the Kaplan-Meier survival curve and RCS, it was observed that individuals in the high DII tertile had an increased likelihood of death compared to those in the low DII tertile.

Conclusion

Our findings provide validation of the theory that diets high in inflammatory substances contribute to elevated mortality rates for all causes and CVD-related deaths in individuals diagnosed with MetS.

Association between lymphocyte to high-density lipoprotein cholesterol ratio and insulin resistance and metabolic syndrome in US adults: results from NHANES 2007-2018

BACKGROUND

Insulin resistance (IR) and metabolic syndrome (MetS) are significant global health challenges that increase the risk of various chronic diseases. The lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR) has emerged as a novel inflammatory metabolic marker. The present study focused on evaluating the association between the LHR and both IR and MetS.

METHODS

We analyzed data from 14,779 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (2007-2018). To investigate the relationship between LHR and both IR and MetS, we conducted multivariable logistic regression analyses. The reliability of the results was validated through both stratified and sensitivity analyses. Furthermore, we thoroughly examined possible nonlinear associations by implementing a restricted cubic spline in conjunction with a threshold effect analysis.

RESULTS

Compared to the lowest LHR quartile, individuals in the highest quartile indicated significantly increased prevalence of IR (odds ratio = 3.72, 95% confidence intervals: 3.01-4.59) and MetS (odds ratio = 11.38, 95% confidence intervals: 8.85-14.63) in fully adjusted models. Subgroup analyses demonstrated that the association between the LHR and IR remained consistent across all subgroups, with no significant interaction effect observed. However, the association between LHR and MetS was more pronounced in female participants. Restricted cubic spline analyses revealed nonlinear associations between LHR and both IR and MetS. The threshold effect analyses identified inflection points at 0.055 for these non-linear relationships.

CONCLUSIONS

An elevated LHR was positively associated with the prevalence of IR and MetS, indicating its promising role in early screening and disease prevention through biological monitoring.

Correlation between estimated glucose disposal rate, insulin resistance, and cardiovascular mortality among individuals with metabolic syndrome: a population-based analysis, evidence from NHANES 1999-2018

BACKGROUND

Estimated glucose disposal rate (eGDR), is an index of insulin resistance. It is intimately correlated with inflammation and endothelial dysfunction, both of which are contributory factors in the pathogenesis of cardiovascular disease (CVD) and premature mortality. This study aims to explore the correlation between eGDR and both all-cause and CVD-related mortality in adults with metabolic syndrome (MetS).

METHODS

A total of 8215 subjects with MetS screened from the National Health and Nutrition Examination Survey (NHANES) during the period from 1999 to 2018 were evaluated for the predictive value of eGDR for CVD and all-cause mortality.

RESULTS

Over a median follow-up for 8.3 years, a total of 1537 all-cause deaths (18.7%) and 467 CVD-related deaths (5.7%) were recorded. Logistic regression analyses revealed a significant inverse correlation between eGDR and the risk of having CVD (OR:0.845, 95%CI:0.807-0.884, p < 0.01). Multivariate Cox regression analysis and restricted cubic splines analysis demonstrated that eGDR is non-linearly correlated with both the mortality of CVD (HR: 0.906, 95% CI: 0.850-0.967, p = 0.003) and all-cause mortality (HR: 0.944, 95% CI: 0.912-0.977, p = 0.001), with an identified inflection point at 5.918. Further subgroup analyses indicated a more pronounced correlation between eGDR and all-cause mortality in individuals under 60 years old (HR: 0.893, 95%CI:0.823-0.970) or those with obesity (HR:0.891, 95%CI:0.839-0.946). Mediation analysis revealed that neutrophil to lymphocyte ratio mediated 8.9% of the correlation between eGDR and all-cause mortality.

CONCLUSION

This study demonstrates, for the first time, that a decrease in eGDR is associated with an increased risk of all-cause and CVD mortality in adults with MetS. The eGDR indices could serve as surrogate biomarkers for monitoring patients with MetS.

Prevalence of metabolic syndrome and its components in Iran: an updated meta-analysis

BACKGROUND

Considering, the changes in lifestyle during the last decade the main aim of this study was to investigate the pooled prevalence of metabolic syndrome (MetS) and its components in Iran.

METHODS

For implementing a comprehensive search strategy related to the objectives of the present meta-analysis, all international databases like PubMed (Medline), Scopus, Embase, Web of Sciences (Elsevier), and CINHAL were searched up to January 2024. The quality of the final selected studies was evaluated according to the Joanna Briggs Institute Critical Appraisal (JBI) tool for analytical cross-sectional studies. The subgroup analysis was performed based on gender, province, area, criteria of diagnosis, and components of metabolic syndrome. All of the analyses were carried out in STATA version 17.

RESULTS

Among 2,034 relevant primary studies, 194 articles were entered into the meta-analysis. the prevalence of MetS in Iran was assessed using various criteria. The overall pooled prevalence was (31%, 95% CI: 28-34%), with a higher occurrence in females and individuals aged over 65 years. The central region, particularly Qom, reported the highest prevalence, while Tehran had the lowest. Low HDL cholesterol and waist circumference were the most common MetS components. The study provides critical data for health policy and intervention strategies in Iran.

CONCLUSION

Higher rates in females and the elderly and the predominance of low HDL cholesterol and waist circumference as MetS components call for targeted public health interventions. These insights are pivotal for formulating strategic health policies to mitigate MetS and its impact on the Iranian population.

Association between triglyceride glucose index-related indices and kidney stones in adults based on NHANES 2007-2020

Background

The triglyceride-glucose (TyG) index and related indices, including the triglyceride-glucose body mass index (TyG-BMI), triglyceride-glucose waist circumference (TyG-WC), and triglyceride-glucose waist-to-height ratio (TyG-WHtR), are increasingly recognized as valuable markers of insulin resistance (IR). This study aimed to assess the associations between these TyG-related indices and kidney stones.

Methods

This cross-sectional study analyzed data from 10,824 participants obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2020. Weighted logistic regression models were employed to evaluate the associations between TyG-related indices and kidney stones, with adjustments for potential confounding factors. Subgroup analyses and smooth curve fittings were performed to further examine these associations, while receiver operating characteristic (ROC) curves were used to compare the predictive performance of each index.

Results

All TyG-related indices demonstrated significant positive associations with kidney stones when analyzed as continuous variables. The odds ratios (OR) with 95% confidence intervals (CI) were 1.0040 (1.0028, 1.0052) for TyG-BMI, 1.0015 (1.0011, 1.0020) for TyG-WC, and 1.3305 (1.2277, 1.4419) for TyG-WHtR. Similar trends were observed in subgroup and smooth curve analyses. When stratified into tertiles, higher tertiles of each TyG-related index were associated with increased odds of kidney stones. TyG-WC demonstrated the strongest predictive capability for kidney stones (AUC = 0.6158), followed closely by TyG-WHtR (AUC = 0.6156) and TyG-BMI (AUC = 0.5949), with TyG showing the lowest AUC (0.5815).

Conclusion

This study identified significant positive associations between TyG-related indices and kidney stone formation. Among these indices, TyG-WHtR exhibited the highest predictive power for identifying kidney stone risk.

Activation of lysosomal Ca2+ channels mitigates mitochondrial damage and oxidative stress

Elevated levels of plasma-free fatty acids and oxidative stress have been identified as putative primary pathogenic factors in endothelial dysfunction etiology, though their roles are unclear. In human endothelial cells, we found that saturated fatty acids (SFAs)-including the plasma-predominant palmitic acid (PA)-cause mitochondrial fragmentation and elevation of intracellular reactive oxygen species (ROS) levels. TRPML1 is a lysosomal ROS-sensitive Ca2+ channel that regulates lysosomal trafficking and biogenesis. Small-molecule agonists of TRPML1 prevented PA-induced mitochondrial damage and ROS elevation through activation of transcriptional factor EB (TFEB), which boosts lysosome biogenesis and mitophagy. Whereas genetically silencing TRPML1 abolished the protective effects of TRPML1 agonism, TRPML1 overexpression conferred a full resistance to PA-induced oxidative damage. Pharmacologically activating the TRPML1-TFEB pathway was sufficient to restore mitochondrial and redox homeostasis in SFA-damaged endothelial cells. The present results suggest that lysosome activation represents a viable strategy for alleviating oxidative damage, a common pathogenic mechanism of metabolic and age-related diseases.

Risk factors for atraumatic isolated subscapularis tear: glenoid retroversion

BACKGROUND

Subscapularis tendon (SSC) tears have recently become an area of current research focus. However, the risk factors for atraumatic isolated SSC tears, particularly anatomical factors, remain poorly determined. Therefore, the purpose of this study was to identify the associated factors contributing to isolated SSC tears.

METHODS

This study involved single shoulders of 605 subjects drawn from a cohort of rural residents. The inclusion criteria required each subject to sign an informed consent document and to have a complete clinical evaluation. The exclusion criteria comprised the absence of a complete magnetic resonance imaging study, current medication use that might have affected serum lipid levels, a history of shoulder trauma or surgery, and the presence of osteoarthritis, calcific tendinitis, frozen shoulder, or superior or posterosuperior rotator cuff tear. Diagnoses of isolated SSC tear were based on magnetic resonance imaging findings. Logistic regression analysis was conducted using demographic, physical, social, anatomical, comorbidities, and serological parameters. Anatomical variables included the supraspinatus fossa glenoid angle on axial (SGAX), a method to measure glenoid version, coracohumeral distance on axial and sagittal plans, and coracoid index. When multicollinearity among studied variables was detected, separate multivariable analyses were performed to address this issue, with each analysis including only one of those multicollinear variables along with the other significant variables obtained from univariate analyses.

RESULTS

Among anatomical variables, coracohumeral distance on axial and sagittal planes, as well as the coracoid index, did not show significant associations. However, SGAX, an index of glenoid version, was found to be significantly associated with atraumatic isolated SSC tears. Greater glenoid retroversion is significantly associated with atraumatic isolated SSC tears, along with age, waist circumference, dominant side involvement, manual labor, diabetes, metabolic syndrome, and biceps tendon injury (P ≤ .013).

CONCLUSIONS

The SGAX, serving as an index for glenoid version, is an independently associated factor for atraumatic isolated subscapularis tendon tears, with greater glenoid retroversion being an anatomical risk factor for these tears, along with overuse-related factors such as dominant-side involvement and manual labor, as well as metabolic factors such as obesity, diabetes, metabolic syndrome, and biceps tendon injury.

Prospective association between handgrip strength in childhood and the metabolic syndrome score and insulin resistance indices in adolescence: an analysis based on the Ewha Birth and Growth Study

OBJECTIVES

Low handgrip strength (HGS) in children and adolescents might be associated with the risk of metabolic syndrome (MetS) and insulin resistance. This study prospectively evaluated the association between HGS in childhood and MetS in adolescence.

METHODS

Based on data from the Ewha Birth and Growth Study, this study analyzed HGS at ages 7 to 9 and metabolic indices at ages 13 to 15. In total, 219 participants were analyzed. The risk of MetS was evaluated using the continuous metabolic syndrome score (cMetS), and insulin resistance was assessed using fasting blood insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Relative HGS in childhood was determined by dividing HGS by body weight and categorized as sex-specific quartiles.

RESULTS

This study found an inverse association between relative HGS levels in childhood and MetS and insulin resistance in adolescence. For each 1-group increase in relative HGS quartiles, cMetS (standarard [Std] β=-0.64, p<0.01), HOMA-IR (Std β=-0.21, p<0.01), and fasting blood insulin (Std β=-0.21, p<0.01) all decreased on average. These associations remained significant even after adjusting for confounding factors.

CONCLUSIONS

Our study showed a prospective association between HGS in childhood and the risk of MetS and insulin resistance in adolescence. It provides significant epidemiological evidence, emphasizing the importance of efforts to increase muscle strength from a young age to mitigate the risk of MetS and insulin resistance in adolescence.

Genetic influences, lifestyle and psychosocial aspects in relation to metabolically healthy obesity and conversion to a metabolically unhealthy state

AIMS

About 10%-30% of individuals with obesity are metabolically healthy, but the specific characteristics of the metabolically healthy obesity (MHO) phenotype remain unclear. We aimed to examine how physical activity, education, depressive symptoms and genetic predisposition to obesity differ between individuals with MHO and those with metabolically unhealthy obesity (MUO), and whether these factors predict stability in MHO or conversion to a metabolically unhealthy state.

MATERIALS AND METHODS

We retrieved data on 9809 individuals with obesity from the Health and Retirement Study collected between 2006 and 2016. We compared how physical activity, education, depressive symptoms and a polygenic score for higher body mass index (BMI) (PGSBMI) differed cross-sectionally between MHO and MUO using logistic regression. We then examined if the same factors predict conversion to a metabolically unhealthy state over 4 years in individuals with MHO.

RESULTS

Individuals with MHO had higher physical activity (odds ratio [OR] = 0.81), higher education (OR = 0.83) and lower depressive symptoms (OR = 1.14) compared to those with MUO but did not differ in the PGSBMI. The associations were slightly attenuated in mutually adjusted models. None of the factors were associated with conversion from MHO to a metabolically unhealthy state. However, a higher PGSBMI indicated 24% lower risk of conversion to a metabolically unhealthy state (p = 0.07).

CONCLUSIONS

Physical activity, education and depressive symptoms differed between MHO and MUO, even when mutually adjusted for, but did not predict conversion from a metabolically healthy to unhealthy state. Although not statistically significant, the results indicated that those with genetically predicted high BMI are more likely to maintain MHO and not convert to a metabolically unhealthy state.

Longitudinal Association of Changes in Metabolic Syndrome with Cognitive Function: 12-Year Follow-up of the Guangzhou Biobank Cohort Study

BACKGRUOUND

The association of changes in metabolic syndrome (MetS) with cognitive function remains unclear. We explored this association using prospective and Mendelian randomization (MR) studies.

METHODS

MetS components including high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides were measured at baseline and two follow-ups, constructing a MetS index. Immediate, delayed memory recall, and cognitive function along with its dimensions were assessed by immediate 10- word recall test (IWRT) and delayed 10-word recall test (DWRT), and mini-mental state examination (MMSE), respectively, at baseline and follow-ups. Linear mixed-effect model was used. Additionally, the genome-wide association study (GWAS) of MetS was conducted and one-sample MR was performed to assess the causality between MetS and cognitive function.

RESULTS

Elevated MetS index was associated with decreasing annual change rates (decrease) in DWRT and MMSE scores, and with decreases in attention, calculation and recall dimensions. HDL-C was positively associated with an increase in DWRT scores, while SBP and FPG were negatively associated. HDL-C showed a positive association, whereas WC was negatively associated with increases in MMSE scores, including attention, calculation and recall dimensions. Interaction analysis indicated that the association of MetS index on cognitive decline was predominantly observed in low family income group. The GWAS of MetS identified some genetic variants. MR results showed a non-significant causality between MetS and decrease in DWRT, IWRT, nor MMSE scores.

CONCLUSION

Our study indicated a significant association of MetS and its components with declines in memory and cognitive function, especially in delayed memory recall.

Endoscopic indicators of insulin resistance: associations with erosive esophagitis and regular arrangement of collecting venules (RAC)

INTRODUCTION

Insulin resistance is a key factor in metabolic syndrome. Identifying indicators of insulin resistance through endoscopic findings could be valuable in assessing a patient's systemic metabolic status. Thus, we conducted a retrospective study to investigate the association between endoscopic findings and insulin resistance.

METHODS

We reviewed 1,070 patients who underwent screening endoscopy with a rapid urease test at Bundang Jesaeng General Hospital from February 2023 to June 2023. Patients were classified based on insulin resistance using the Homeostatic Model Assessment for Insulin Resistance (HOMAIR). Propensity score matching was performed to adjust for baseline characteristics.

RESULTS

After matching, 420 patients without insulin resistance and 210 with insulin resistance were selected. Endoscopic findings showed a significant association between insulin resistance and the presence of erosive esophagitis (p = 0.040). Furthermore, the severity of erosive esophagitis was positively correlated with the degree of insulin resistance, as indicated by an increased HOMAIR. Multivariate analysis showed that erosive esophagitis significantly increased the risk of insulin resistance, while the presence of regular arrangement of collecting venules (RAC) was associated with a lower risk of insulin resistance.

CONCLUSION

Insulin resistance is significantly associated with specific endoscopic findings, particularly erosive esophagitis and the absence of RAC, suggesting associations that may be useful in guiding further research into endoscopic indicators of metabolic complications. Moreover, we observed a proportional relationship between the severity of erosive esophagitis and the degree of insulin resistance. Further research is needed to explore these associations.

Active-matrix extended-gate field-effect transistor array for simultaneous detection of multiple metabolites

With the deepening understanding of diseases, increasing attention has been paid to personalized healthcare and precise diagnosis, which usually depend on the simultaneous monitoring of multiple metabolites, therefore requiring biological sensing systems to possess high sensitivity, specificity, throughput, and instant monitoring capabilities. In this work, we demonstrated the active-matrix extended-gate field-effect transistor (AMEGFET) array that can perform instant analysis of various metabolites in small amounts of body fluids collected during routine physiological activities. The extended gate electrodes of the AMEGFETs comprise ordered mesoporous carbon fibers loaded with both oxidoreductase enzymes for specific metabolites and platinum nanoparticles. By selecting customized electrode combinations, the AMEGFET array can monitor the concentrations of metabolites closely associated with chronic diseases and lifestyles, such as glucose, uric acid, cholesterol, ethanol, and lactate. The switch function of AMEGFET not only simplifies the readout circuitry for large-scale arrays but also avoids the mutual interferences among sensing units. The high flexibility and scalability make the AMEGFET array widely applicable in establishing high-throughput sensing platforms for biomarkers, providing highly efficient technical support for proactive health and intelligent healthcare.

Serum CA19-9 as a predictor of incident metabolic syndrome in obese middle-aged and older men: A 9-year cohort study

BackgroundThe status of carbohydrate antigen 19-9 (CA19-9) in metabolic syndrome (MetS) is unknown.ObjectiveTo investigate the association between serum CA19-9 levels and incident metabolic syndrome in obese middle-aged and older men.MethodsFrom 2007 to 2015, 1,750 participants were retrospectively reviewed. Health checkup data were obtained, and participants were divided into three groups based on CA19-9 levels. Various parameters including BMI, waist circumference, blood pressure, and biochemical parameters were measured. Cox regression analysis was used to assess the association between CA19-9 levels and incident MetS. The MetS diagnostic criteria were based on the National Cholesterol Education Program Adult Treatment Panel III guidelines.ResultsThe highest CA19-9 tertile was associated with an increased risk of incident MetS, high systolic blood pressure, high waist circumference, high fasting plasma glucose, low high-density lipoprotein, and high triglyceride levels. The observation period was 9 years, during which 328 (18.7%) new-onset MetS cases were identified. Subgroup analysis showed increased risk among individuals in the highest CA19-9 tertile who were obese, male, and ≥ 50 years old.ConclusionsThere is a positive correlation between serum CA19-9 levels and incident metabolic syndrome in obese middle-aged and older men.

Determinants and prevalence of metabolic syndrome among the adult population in Hargeisa, Somaliland: A community-based cross-sectional study

BACKGROUND

Metabolic syndrome (met-s) is a medical condition that includes abdominal obesity, hyperlipidemia, high blood glucose, and high blood pressure. It is associated with a high risk of developing cardiovascular diseases and type 2 diabetes mellitus. The condition was believed to be a challenge mostly faced by developed nations. A few studies conducted showed that met-s is increasing and becoming more common in Africa, where it was considered rare. The study aimed to assess the determinants and prevalence of met-s among the adult population in Hargeisa town, Somaliland, in 2023.

METHODS

A community-based cross-sectional study among 498 adults living in all eight districts of Hargeisa, was carried out from August to September 2023. The sample size was divided proportionally by the number of households in selected sub-districts. Systematic random sampling was employed to select the households in the sub-districts. One adult from each household was selected and assessed. Data were collected using the STEPwise approach of the World Health Organization. The data were analysed using International Diabetic Federation (IDF) criteria for metabolic syndrome with SPSS version 25. Bivariate and multivariate analyses using logistic regression were performed.

RESULT

In total, 498 adults participated in the study. The prevalence of met-s was 26.7% in IDF (males 11% vs. females 38.9%). Being of an advanced age of 45-54 years (AOR = 3.6, CI 1.17-11.27), 55-64 years (AOR = 6.1, CI 1.88-19.83), >64 (AOR = 9.1 CI 2.41-34.92), being a woman (AOR = 10.8, CI 5.3-21.8), being overweight or obese (AOR = 4.5, CI 2.5-8), sedentary behavior (AOR = 3.5, CI 1.6-7.5), and lack of physical exercise (AOR = 0.39, CI 0.17-0.88) were significantly associated with met-s.

CONCLUSION

The met-s was predominant in our findings. Community-based prevention strategies and actions are necessary if the met-s and its potential consequences are needed to be mitigated.

The Effects of Novel Co-Amorphous Naringenin and Fisetin Compounds on a Diet-Induced Obesity Murine Model

BACKGROUND/OBJECTIVE

In recent studies, it has been shown that dietary bioactive compounds can produce health benefits; however, it is not known whether an improvement in solubility can enhance their biological effects. Thus, the aim of this work was to study whether co-amorphous (CoA) naringenin or fisetin with enhanced solubility modify glucose and lipid metabolism, thermogenic capacity and gut microbiota in mice fed a high-fat, high-sucrose (HFSD) diet.

METHODS

Mice were fed with an HFSD with or without CoA-naringenin or CoA-fisetin for 3 months. Body weight, food intake, body composition, glucose tolerance, hepatic lipid composition and gut microbiota were assessed.

RESULTS

CoA-naringenin demonstrated significant reductions in fat-mass gain, improved cholesterol metabolism, and enhanced glucose tolerance. Mice treated with CoA-naringenin gained 45% less fat mass and exhibited improved hepatic lipid profiles, with significant reductions seen in liver triglycerides and cholesterol. Additionally, both CoA-flavonoids increased oxygen consumption (VO2), contributing to enhanced energy expenditure and improved metabolic flexibility. Thermogenic activation, indicated by increased UCP1 and PGC-1α levels, was observed with CoA-fisetin, supporting its role in fat oxidation and adipocyte size reduction. Further, both CoA-flavonoids modulated gut microbiota, restoring diversity and promoting beneficial bacteria, such as Akkermansia muciniphila, which has been linked to improved metabolic health.

CONCLUSIONS

These findings suggest that co-amorphous naringenin or fisetin offers promising applications in improving solubility, metabolic health, and thermogenesis, highlighting the potential of both as therapeutic agents against obesity and related disorders.

Tryptophan Ameliorates Metabolic Syndrome by Inhibiting Intestinal Farnesoid X Receptor Signaling: The Role of Gut Microbiota-Bile Acid Crosstalk

Background and Aims: Metabolic syndrome (MS) is a progressive metabolic disease characterized by obesity and multiple metabolic disorders. Tryptophan (Trp) is an essential amino acid, and its metabolism is linked to numerous physiological functions and diseases. However, the mechanisms by which Trp affects MS are not fully understood. Methods and Results: In this study, experiments involving a high-fat diet (HFD) and fecal microbiota transplantation (FMT) were conducted to investigate the role of Trp in regulating metabolic disorders. In a mouse model, Trp supplementation inhibited intestinal farnesoid X receptor (FXR) signaling and promoted hepatic bile acid (BA) synthesis and excretion, accompanied by elevated levels of conjugated BAs and the ratio of non-12-OH to 12-OH BAs in hepatic and fecal BA profiles. As Trp alters the gut microbiota and the abundance of bile salt hydrolase (BSH)-enriched microbes, we collected fresh feces from Trp-supplemented mice and performed FMT and sterile fecal filtrate (SFF) inoculations in HFD-treated mice. FMT and SFF not only displayed lipid-lowering properties but also inhibited intestinal FXR signaling and increased hepatic BA synthesis. This suggests that the gut microbiota play a beneficial role in improving BA metabolism through Trp. Furthermore, fexaramine (a gut-specific FXR agonist) reversed the therapeutic effects of Trp, suggesting that Trp acts through the FXR signaling pathway. Finally, validation in a finishing pig model revealed that Trp improved lipid metabolism, enlarged the hepatic BA pool, and altered numerous glycerophospholipid molecules in the hepatic lipid profile. Conclusion: Our studies suggest that Trp inhibits intestinal FXR signaling mediated by the gut microbiota-BA crosstalk, which in turn promotes hepatic BA synthesis, thereby ameliorating MS.

Associations of Cumulative Adulthood, Childhood and Life-long Insulin with Adulthood Retinal Microvasculature

CONTEXT

Exogenous insulin is reported to have both vasodilatory and vasoconstrictive effects on the microvasculature. Little is known about the associations of long-term endogenous insulin exposure with microvasculature.

OBJECTIVE

To test the hypothesis that long-term exposure to high insulin levels in childhood and adulthood is associated with adverse changes in retinal microvasculature in adulthood in a population without diabetes.

METHODS

We analyzed data derived from the longitudinal Cardiovascular Risk in Young Finns Study (YFS). The first cross-sectional study was conducted in 1980, and participants were followed for 31 years from childhood to adulthood with frequent follow-up visits. Fundus photos were taken in 2011, and microvascular outcome measures were derived in participants at the age of 34-49 years (n=1684). After exclusion of individuals with diabetes or missing insulin measures, 1166 participants formed the population of the present study. Cumulative exposure as the area under the curve (AUC) for adulthood (10-year exposure between 2001 and 2011), and childhood (exposure between ages 6-18 years) insulin and other cardiovascular risk factors were determined. Additionally, adulthood and childhood cumulative AUCs were summarized to construct life-long AUCs.

RESULTS

Higher adulthood, childhood and life-long exposure for cumulative insulin was associated with decreased retinal arteriolar diameter when adjusted for age and sex, and further for cumulative conventional cardiovascular risk factors.

CONCLUSIONS

Cumulative childhood, adulthood and life-long insulin are associated with decreased retinal arteriolar diameter in adulthood in a population of participants without diabetes, independently of conventional cardiovascular risk factors.

Elevated circulating HHIP levels in patients with metabolic syndrome

Abnormal fat accumulation can lead to metabolic syndrome (MetS), increasing the risk of diabetes and cardiovascular disease in MetS patients. Early identification of MetS risk is essential for effective disease prevention. Using bioinformatics methods, we sought biomarkers for MetS. After analyzing the GSE9624 and GSE15524 datasets, we identified three commonly differentially expressed genes: COX7A1, PRR12, and HHIP. Subsequently, we validated the expression of these DEGs using the GSE65540 dataset. Quantitative PCR and immunoblotting confirmed significantly elevated HHIP expression in the adipose tissue of HFD-fed and ob/ob mice. Furthermore, a population-based cohort study demonstrated that serum HHIP levels were significantly greater in MetS patients than in healthy controls and were correlated with all MetS components. Receiver operating characteristic (ROC) curve analysis confirmed the robust predictive capacity of HHIP levels for metabolic syndrome, with an area under the curve (AUC) of 0.72 (95 % confidence interval: 0.68-0.78, P < 0.001). Binary logistic regression showed that the serum HHIP concentration was significantly associated with MetS even after adjusting for anthropometric and lipid profile variables. In conclusion, our findings demonstrate that changes in HHIP expression are significantly associated with adverse MetS indicators, indicating that HHIP can serve as a new biomarker for the diagnosis of MetS.

Dysregulation of c-Jun (JUN) and FBJ murine osteosarcoma viral oncogene homolog B (FOSB) in obese people and their predictive values for metabolic syndrome

The incidences of metabolic syndrome (MetS), denoting insulin resistance-associated various metabolic disorders, are increasing. This study aimed to identify new biomarkers for predicting MetS and provide a novel diagnostic approach. Herein, the expression profiles of c-Jun (JUN) and FBJ murine osteosarcoma viral oncogene homolog B (FOSB) in individuals with obesity and patients with MetS from the Gene Expression Omnibus database. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to evaluate the messenger RNA levels of JUN and FOSB in the peripheral blood of healthy volunteers (lean and obese) and patients with MetS (lean and obese), along with that in the adipose tissue and peripheral blood of obese mouse model. Furthermore, receiver operating characteristic (ROC) curve and logistic regression analyses were performed to determine the diagnostic value of JUN and FOSB in MetS. The expression profiles and RT-qPCR results showed that JUN and FOSB were highly expressed in individuals with obesity, obese mouse models, and patients with MetS. The ROC analysis results showed an area under the curve values of 0.872 and 0.879 for JUN, 0.802 and 0.962 for FOSB, and 0.946 and 0.979 for JUN-FOSB in the lean group and the group with obesity, respectively, in predicting MetS. Logistic regression analysis showed that the p-values of both JUN and FOSB as MetS-affecting factors were <0.05. Altogether, the findings of this study indicate that both JUN and FOSB, abnormally expressed in individuals with obesity, are good biomarkers of MetS.

The Effect of a cognitive behavioral program based on an interactive application on serum glucose levels and HbA1C of family members of patients with type 2 diabetes: a study protocol for a randomized clinical trial

Background

The families of diabetics are more likely to have diabetes. Therefore, paying attention to those households and seeking to change the way of life of those households can save diabetes to a high extent. The present study aimed to investigate the impact of cognitive-behavioral applications primarily based on interactive software on serum glucose levels and HbA1C of a family member of sufferers with kind 2 diabetes.

Methods

In the present randomized clinical trial, families of diabetic patients meeting the inclusion criteria will be divided into intervention and control groups by simple random sampling. In the laboratory, 10 cc of blood samples will be taken from the participants for the tests of total cholesterol, triglyceride, fasting blood sugar, GTT, HDL-c, LDL-c, and HbA1c. Then, both groups complete the International Physical Activity Questionnaire, Adolescence Food Habit Checklist, and Glover Nilsson Smoking Behavioral Questionnaire (GN-SBQ). The intervention group will provided with a training package of lifestyle change based on a cognitive-behavioral program in the form of an application during eight sessions of 45 min in 8 weeks. Then, the laboratory tests and questionnaires will be completed again 6 and 12 months after the intervention. Data will be analyzed using statistical tests.

Discussion

If an application-based cognitive-behavioral program changes the lifestyle, serum glucose levels, and HbA1C, it can be recommended to families of diabetics.

Association of heavy metals and bio-elements blood level with metabolic syndrome: a systematic review and meta-analysis of observational studies

Background and objectives

The literature has reported heavy metals might alter the physiological and biochemical functions of body organs and cause several health problems. So, the present systematic review and meta-analysis aimed to investigate the association of blood levels of essential or non-essential metals with metabolic syndrome (MetS).

Methods

In this systematic review, some international databases including PubMed, Embase, Scopus, and Web of Science were searched up to February 2024. All observational studies which assessed the association of three heavy metals (cadmium, mercury, lead) and bio-elements (chromium, iron, manganese, and magnesium, copper) with the risk of MetS were included. There was no limitation in the time of publication and language. A random-effects meta-analysis was performed to estimate the pooled effect sizes. Possible sources of heterogeneity were explored by meta-regression analysis.

Results

Totally, 29 studies were eligible for meta-analysis. Our results showed that increased level of cadmium (pooled OR: 1.24, 95% CI: 1.05, 1.46) and mercury (pooled OR: 1.22, 95% CI: 1.08, 1.38) significantly increased the risk of MetS. In contrast, increased level of chromium significantly reduced the risk of developing MetS (pooled OR: 0.68, 95% CI: 0.56, 0.83). Moreover, association between lead, iron, copper, magnesium, and manganese with MetS was not statistically significant (P > 0.05). However, elevated lead levels in men increased the odds of MetS.

Conclusion

Our results show a significant association between blood levels of some heavy metals, including cadmium, mercury, and lead, with increased odds of MetS. On the other hand, chromium as a biometal decreased the odds of MetS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01500-9.

Exploring tryptophan metabolism: The transition from disturbed balance to diagnostic and therapeutic potential in metabolic diseases

The rapidly rising prevalence of metabolic diseases has turned them into an escalating global health concern. By producing or altering metabolic products, the gut microbiota plays a pivotal role in maintaining human health and influencing disease development. These metabolites originate from the host itself or the external environment. In the system of interactions between microbes and the host, tryptophan (Trp) plays a central role in metabolic processes. As the amino acid in the human body that must be obtained through dietary intake, it is crucial for various physiological functions. Trp can be metabolized in the gut into three main products: The gut microbiota regulates the transformation of 5-hydroxytryptamine (5-HT, serotonin), kynurenine (Kyn), and various indole derivatives. It has been revealed that a substantial correlation exists between alterations in Trp metabolism and the initiation and progression of metabolic disorders, including obesity, diabetes, non-alcoholic fatty liver disease, and atherosclerosis, but Trp metabolites have not been comprehensively reviewed in metabolic diseases. As such, this review summarizes and analyzes the latest research, emphasizing the importance of further studying Trp metabolism within the gut microbiota to understand and treat metabolic diseases. This carries potential significance for improving human health and may introduce new therapeutic strategies.

Metabolic Syndrome Is Associated With Poor Prognosis in Patients With Breast Cancer Receiving Neoadjuvant Therapy

PURPOSE

Few studies with a large sample size are available on patients with metabolic syndrome (MetS) receiving neoadjuvant treatment (NAT) for breast cancer. This study aimed to investigate the impact of MetS on the prognosis of patients with breast cancer undergoing NAT.

METHODS

The data of patients with breast cancer receiving NAT at our center from January 2017 to December 2019 were retrospectively analyzed. A chi-square test and logistic regression model were applied to ascertain the factors associated with MetS and pathological complete response (pCR). The Cox proportional risk model was employed for univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS).

RESULTS

Of the 910 patients enrolled, 164 (18.0%) were diagnosed with MetS, 568 (62.4%) with stage II, and 342 (37.6%) with stage III. Postmenopausal status (p = 0.045) and stage III (p = 0.009) were associated with a higher incidence rate of MetS. MetS was associated with a lower pCR rate (p = 0.027). The 5-year DFS (83.7% vs. 73.1%, p = 0.001) and OS (92.8% vs. 85.5%, p = 0.001) of the non-MetS group were significantly better than those of the MetS group. In premenopausal women, the DFS (p = 0.001) and OS (p = 0.025) of the non-MetS group were significantly better than those of the MetS group. No significant differences were noted in DFS (p = 0.270) or OS (p = 0.078) between the two groups in postmenopausal women. In the Cox proportional risk model, MetS acted as an independent factor associated with DFS (HR = 1.705, 95% CI: 1.201-2.421, p = 0.003) and OS (HR = 1.874, 95% CI: 1.149-3.055, p = 0.012).

CONCLUSION

MetS was associated with poor prognosis in patients with breast cancer receiving NAT. Hence, close attention should be paid to patients with breast cancer who have MetS.

Impaired IL-27 signaling aggravates macrophage senescence and sensitizes premature ovarian insufficiency induction by high-fat diet

Premature ovarian insufficiency (POI) critically affects female reproductive health, with obesity being a significant and recognized risk factor. Interleukin-27 (IL-27), known for its role in immune modulation and inflammation, has garnered attention in metabolic syndrome research. Nonetheless, the role of these immunometabolic factors on the initiation of POI remains to be unraveled. Our investigation delves into the influence of impaired IL-27 signaling on POI induction, particularly under the challenge of a high-fat diet (HFD). We analyzed patients' serum profiles and established a correlation of increased serum triglycerides with decreased IL-27 levels in POI cases. Experiments on C57BL/6 mice lacking the IL-27 receptor alpha (Il27ra-/-) revealed that when subjected to HFD, these mice developed hallmark POI symptoms. This includes escalated lipid deposition in both liver and ovarian tissues, increased ovarian macrophages cellular aging, and diminished follicle count, all pointing to compromised ovarian function. These findings unveil a novel pathway wherein impaired IL-27 signaling potentiates the onset of POI in the presence of HFD. Understanding the intricate interplay between IL-27, metabolic alterations, and immune dysregulation sheds light on potential therapeutic avenues for managing POI, offering hope for improved reproductive health outcomes.

Prevalence of Subclinical Hypothyroidism in a Non-Diabetic Young Female Population and Its Impact on Diabetes and Cardiometabolic Risk

BACKGRUOUND

We evaluated the influence of subclinical hypothyroidism (SCH) on insulin resistance (IR), cardiometabolic risk, and obesity in childbearing-age women without diabetes.

METHODS

This cross-sectional investigation included 282 women, aged 18 to 35 years, from rural and suburban Sri Lanka. Anthropometric and biochemical parameters, including IR and lipid/thyroid profiles, were recorded. Data were compared between SCH and euthyroidism (EU) for controls (normal weight) and cases (overweight/obese).

RESULTS

The overall rates of SCH, EU, IR, and metabolic syndrome (MetS) were 40.42%, 59.57%, 73.40%, and 24.46%, respectively. Both controls and cases included individuals with SCH; overall, 168 participants (59.57%) had EU, while 114 (40.42%) exhibited SCH. IR was significantly associated with SCH in both weight groups (P<0.05). Among those with SCH, the odds ratios (ORs) for IR were >2 (95% confidence interval [CI], 0.45 to 3.87) in controls and >6 (95% CI, 3.52 to 8.41) in cases. Similarly, the ORs for MetS were >1 (95% CI, 0.38 to 4.16) in controls and >11 (95% CI, 8.73 to 15.01) in cases. Dyslipidemia and hypertriglyceridemia were significantly more prevalent in the SCH group (P<0.05). Women with SCH exhibited higher mean values for all obesity indices compared to their EU counterparts, surpassing normal thresholds (P<0.05). Among obesity measures, visceral adiposity index (VAI) demonstrated the highest area under the curve and sensitivity for assessing SCH and cardiovascular disease (CVD) risk.

CONCLUSION

SCH must be identified and managed in young women to help prevent diabetes and cardiometabolic disorders. VAI may aid in precisely detecting SCH and CVD.

Inverted U-Shaped Association of Soluble Transferrin Receptor Concentrations with Risks of Cardiovascular Diseases in Overweight Individuals: A Cross-Sectional Study

Background

Iron metabolism may play a role in cardiovascular disease (CVD) pathogenesis. The association between iron metabolism and CVD has yet to be fully investigated. This study evaluated whether iron metabolism was associated with CVD risk and whether the body mass index (BMI) of US adults varied the association.

Methods

A cross-sectional study was performed using the National Health and Nutrition Examination Survey (NHANES), conducted from 2017 to 2018. Generalized additive models (GAMs) and multivariable logistic regression were adopted to analyze the association between iron metabolism (serum iron (SI), serum ferritin (SF), transferrin saturation (TSAT), and soluble transferrin receptor (sTfR)) and CVD risk. Further, stratified analysis was conducted to identify patients with high CVD risk.

Results

Participants with CVD tended to have significantly increased levels of sTfR (p < 0.001) and decreased levels of TSAT (p < 0.001) and SI (p < 0.001). After adjusting for confounding factors, sTfR levels had a significant positive association with CVD risk (Q1 as reference, Q4 odds ratio (OR) 2.1, 95% CI 1.54-2.87, p < 0.001). Notably, the association between sTfR and CVD risk differed in the BMI subgroup (p for interaction < 0.05). We identified an inverted U-shaped relationship between sTfR and the CVD risk in the group of overweight individuals (non-linear p < 0.001). When the sTfR level was below the turning point (sTfR = 5.35 mg/L), a per unit increase in the sTfR level was correlated with a 78% greater adjusted OR of CVD risk (OR, 1.78 [1.44, 2.19]).

Conclusions

Increased sTfR levels were non-linearly related to the CVD risk in the overweight population.

Serum uric acid and mortality in metabolic dysfunction-associated steatotic liver disease: Subgroup differences

BACKGROUND AND AIMS

This study aims to investigate the association between serum uric acid (SUA) and both the risk and long-term mortality of dysfunction-associated steatotic liver disease (MASLD), and to explore differences between the pure MASLD and metabolic and alcohol related/associated liver disease (MetALD) subgroups.

METHODS AND RESULTS

We included 11,675 participants from the Third National Health and Nutrition Examination Survey, with matched mortality data up to 2019. Logistic regression and Cox proportional hazards regression evaluated the relationship between SUA and both the risk and mortality of MASLD. Non-linear correlations and threshold effects were explored using restricted cubic splines and a two-piecewise Cox proportional hazards model. We found that SUA was positively associated with the risk of MASLD [odds ratio (OR): 1.19, 95 % confidence interval (CI) 1.12-1.27]. For pure MASLD, SUA showed a positive association with all-cause mortality [<4.7 mg/dL: hazard ratio (HR): 1.34, 95 % CI 1.04-1.73; ≥4.7 mg/dL: HR: 1.08, 95 % CI 1.02-1.15] and cardiovascular mortality (HR: 1.12, 95 % CI 1.02-1.22). For MetALD, there was an inverse J-shaped relationship (threshold: 6.6 mg/dL) between SUA and all-cause mortality. Below the threshold, SUA was negatively correlated with all-cause mortality (HR: 0.42, 95 % CI 0.19-0.93), but no association was found above it (HR: 0.81, 95 % CI 0.54-1.21). Additionally, no association was observed between SUA and cardiovascular mortality.

CONCLUSIONS

SUA serves as an independent predictor of the risk and all-cause mortality of MASLD. The relationship between SUA and both all-cause and cardiovascular mortality differs between the pure MASLD and MetALD subgroups.

Metabolic syndrome and symptom burden in allogeneic hematopoietic stem cell transplantation survivors

INTRODUCTION

Allogeneic hematopoietic stem cell transplantation (HCT) improves survival of patients with hematologic malignancies. A growing responsibility exists to identify and address long-term morbidity and symptom burden. We investigated metabolic syndrome and symptom burden in adult HCT survivors.

METHODS

We analzyed adults with hematologic disorders who were treated with allogeneic HCT at our institution from June 2018-November 2022. We used standard criteria for metabolic syndrome with body mass index (BMI) as a surrogate for waist circumference. We assessed symptom burden using the National Comprehensive Cancer Network Survivorship Assessment. The Short Physical Performance Battery and Short Blessed Test were used to investigate physical function and cognition, respectively.

RESULTS

A total of 152 patients were included. Median age was 61 years, 59% were male, and the most common disorder was acute myeloid leukemia (48%). 64 patients developed metabolic syndrome post-transplant. The most commonly affected symptom domains were fatigue (51%), sleep (45%), and cognitive function (42%). Additionally, 34% and 7% of patients had objectively impaired functional capacity and cognition, respectively.

CONCLUSION

Recipients of allogeneic HCT have a high incidence of metabolic syndrome, symptom burden, and impaired physical function.

Metabolic dysfunction, rather than obesity, is a risk factor for chronic kidney disease in Chinese population

BACKGROUND

Metabolic dysfunction and obesity are closely related to chronic kidney disease (CKD). However, studies on the relationship between various metabolic syndrome-body mass index (MetS-BMI) phenotypes and the risk of CKD in the Chinese population have not yet been explored.

MATERIALS AND METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 were analyzed in this study. This study enrolled 12,054 participants. Participants were divided into six distinct groups according to their MetS-BMI status. Across the different MetS-BMI groups, the odd ratios (ORs) for CKD were determined using multivariable logistic regression models.

RESULTS

The prevalence of CKD was higher in metabolically unhealthy groups than in the corresponding healthy groups. Moreover, the fully adjusted model showed that all metabolically unhealthy individuals had an increased risk of developing CKD compared to the metabolically healthy normal weight group (OR = 1.62, p = 0.002 for the metabolically unhealthy normal weight group; OR = 1.55, p < 0.001 for the metabolically unhealthy overweight group; and OR = 1.77, p < 0.001 for the metabolically unhealthy obesity group.

CONCLUSIONS

This study is the first to evaluate the relationship between the MetS-BMI phenotype and renal prognosis in the Chinese population. Individuals with normal weights are at different risk of developing CKD depending on their different metabolic phenotypes.

Periodontal Disease and Metabolic Syndrome in Women at Prior High Risk for Gestational Diabetes

OBJECTIVES

This study aimed to assess the association between periodontal disease and metabolic syndrome (MetS) among women at prior high risk for gestational diabetes with the hypothesis that women with MetS show more signs of periodontal disease than women without MetS.

MATERIAL AND METHODS

A total of 112 women from an original study cohort of 348 women at high risk of gestational diabetes were examined 4-6 years postpartum. Diagnosis of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. Insulin resistance was approximated by the homeostatic model assessment for insulin resistance. Full-mouth examinations and panoramic radiographs provided the total dental index, number of teeth, and decayed, missing, and filled teeth index. Clinical examination assessed bleeding on probing, probing depth, visible plaque index, signs of infection, and clinical attachment levels. The periodontal inflammatory burden index (PIBI) was also calculated. Information on oral health habits, symptoms, and individual opinions on oral health was collected through questionnaires.

RESULTS

Five years after delivery, 21% of the women had MetS, and they had more gingivitis compared to those without MetS (bleeding on probing: 52% and 44%, p = 0.011). Women with MetS tended to have more periodontitis than those without (39% and 25%, p = 0.13). A high PIBI correlated with insulin resistance (partial correlation of PIBI and homeostatic model assessment for insulin resistance: 0.25 p < 0.05).

CONCLUSIONS

Periodontal disease was associated with insulin resistance and MetS in women at prior high risk of developing gestational diabetes.

Association of life's essential 8 with prevalence and all-cause mortality of chronic kidney disease among US adults: Results from the National Health and Nutrition Examination Survey (2015-2018)

Background and Objectives

The association between chronic kidney disease (CKD) and cardiovascular disease has been previously evaluated. This study aimed to evaluate the association between the American Heart Association's Life's Essential 8 (LE8) and the prevalence and all-cause mortality of CKD in a nationally representative population of adults in the US.

Methods

This retrospective analysis included participants from the National Health and Nutrition Examination Survey spanning 2015-2018. We used multivariable survey logistic regression model to calculate the adjusted odds ratios (AORs) of the LE8 score for the prevalence of CKD. Survey-weighted Cox proportional hazards models were used to calculate the adjusted hazards ratios (AHRs) of the LE8 score for the risk of all-cause mortality among participants with CKD.

Results

Of the 8907 included participants, 789 had stage 3 to 5 CKD, and 8118 were in the non-CKD group. The adjusted prevalence rate of CKD was 10.7% in the low LE8 score group, and lower in the moderate (7.9%) and high (7.7%) LE8 score groups. Compared with low LE8 scores, moderate LE8 score (adjusted odds ratio [AOR] 0.628, 95% confidence interval [CI]: 0.463 to 0.853, P = 0.004) and high LE8 scores (AOR 0.328, 95% CI: 0.142 to 0.759, P = 0.011) were associated with lower prevalence rates of CKD. A similar association was found for health factors scores. Additionally, an increase in the LE8 score was associated with a lower risk of all-cause mortality (adjusted hazard ratio [AHR] 0.702, 95% CI: 0.594 to 0.829, P < 0.001).

Conclusion

The results of this study suggest the association of higher LE8 and its subscale scores with a lower prevalence and all-cause mortality of CKD.

Obesity and hormonal influences on asthma: Mechanisms, management challenges, and emerging therapeutic strategies

Obesity and hormone dysregulation, common comorbidities of asthma, not only influence asthma risk and onset but can also complicate its management. The pathobiologic characteristics of obesity, such as insulin resistance and metabolism alterations, can impact lung function and airway inflammation while highlighting potential opportunities for therapeutic intervention. Likewise, obesity alters immune cell phenotypes and corticosteroid pharmacokinetics. Hormones such as sex hormones, incretins, and thyroid hormones can also affect asthma. This review highlights the mechanisms underlying obesity-related asthma and hormonal pathologies while exploring potential therapeutic strategies and the need for more research and innovative approaches in managing these comorbid conditions.

Effects of intermittent fasting combined with physical exercise on cardiometabolic outcomes: systematic review and meta-analysis of clinical studies

CONTEXT

Different intermittent fasting (IF) protocols have been proven to be efficient in improving cardiometabolic markers, but further research is needed to examine whether or not combining IF regimens plus physical exercise is superior to control diets (ie, nonfasting eating) plus physical exercise in this setting.

OBJECTIVE

The aim of this study was to determine whether or not combining IF plus exercise interventions is more favorable than a control diet plus exercise for improving cardiometabolic health outcomes.

DATA SOURCE

PubMed, Scopus, and Web of Science were comprehensively searched until April 2023.

DATA EXTRACTION

Electronic databases were searched for clinical trials that determined the effect of IF plus exercise vs a control diet plus exercise on body weight, lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides, and total cholesterol), and systolic and diastolic blood pressure (SBP and DBP, respectively). Analyses were conducted for IF plus exercise vs a nonfasting diet plus exercise to calculate weighted mean differences (WMDs).

DATA ANALYSIS

The meta-analysis included a total of 14 studies, with a total sample of 360 adults with or without obesity. The duration ranged from 4 to 52 weeks. IF plus exercise decreased body weight (WMD = -1.83 kg; P = 0.001), LDL (WMD = -5.35 mg/dL; P = 0.03), and SBP (WMD = -2.99 mm Hg; P = 0.003) significantly more than a control diet plus exercise. HDL (WMD = 1.57 mg/dL; P = 0.4) and total cholesterol (WMD = -2.24 mg/dL; P = 0.3) did not change significantly for IF plus exercise vs a control diet plus exercise, but there was a trend for reducing triglycerides (WMD = -13.13 mg/dL; P = 0.07) and DBP (WMD = 2.13 mm Hg; P = 0.05), which shows clinical magnitude.

CONCLUSION

IF plus exercise improved some cardiometabolic outcomes (body weight, blood pressure, and lipid profile) compared with a control diet plus exercise.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023423878.

Association between large neutral amino acids and white matter hyperintensities in middle-aged adults at varying metabolic risk

This investigation delves into the interplay between large neutral amino acids (LNAA) and metabolic syndrome (MetS) in midlife adults, examining their collective influence on brain structure. While LNAA, such as tryptophan and phenylalanine, are known to bolster cognition in youth, these relationships often reverse later in life. Our study hypothesized an earlier reversal of these benefits in middle-aged adults with MetS, potentially signaling premature brain aging. Eighty participants between 40-61 years underwent MetS component quantification, LNAA measurement via high-performance liquid chromatography, and brain imaging to evaluate white matter hyperintensities (WMH) volume and medial temporal lobe (MTL) cortical thickness. Our linear regression analyses, adjusting for sex, age, and education, revealed that phenylalanine levels moderated the relationship between MetS and WMH volume (F(6, 69) = 3.134, p < 0.05, R2 = 0.214), suggesting the brain impact of MetS may be partly due to phenylalanine catabolism byproducts. LNAA metabolites did not significantly modulate the MetS-MTL cortical thickness relationship. These findings suggest that better understanding of the role of phenylalanine in the pathogenesis of cerebrovascular disease in midlife may be essential to developing early interventions to protect cognitive health. Further research is crucial to elucidate the longitudinal influence of LNAA and MetS on brain health, thereby informing strategies to mitigate cognitive decline.

Investigation of the relationship between atherogenic index, anthropometric characteristics, and 10-year risk of metabolic syndrome: a population-based study

BACKGROUND

People with metabolic syndrome (MetS) are at a higher risk of coronary artery disease, diabetes mellitus, stroke, osteoarthritis, and some types of cancers. Finding markers which are available and inexpensive are most useful for the prediction of MetS. The present study aimed to determine the relationship between atherogenic index and anthropometric indicators and the 10-year risk of MetS.

METHODS

During the 10-year follow-up on Mashhad stroke and heart atherosclerotic disorder (MASHAD study), 4684 subjects who did not MetS at baseline were recruited in this study. The anthropometric indices and atherogenic index including atherogenic index of plasma (AIP), Castelli's risk index I and II (CRI-I, CRI-I), and atherogenic coefficient (AC) were measured. SPSS-23 was used for all statistical analyses.

RESULT

Among subjects who did not have MetS at baseline 1599 cases (34.1%) developed MetS. The anthropometric and lipid indices were significantly elevated in patients with MetS compared to the healthy ones (p < 0.001). It was revealed that an increase of one unit in AIP and AC can raise the risk of MetS 22.7% (OR: 1.227 (95% CI, 1.166-1.291)) and 37.7% (OR: 1.377 (95% CI, 1.291-1.468)), respectively. Moreover, increasing one unit of WHtR decreases the risk of MetS by 8.5% (OR: 0.915 (95% CI, 0.886-0.946)).

CONCLUSION

The results of this longitudinal study showed that increasing AC and AIP could enhance the risk of MetS. The present study also indicated that AC and AIP are useful predictors in the clinical setting for identifying individuals with MetS in the Iranian adult population.

Triglycerides and HDL Cholesterol Mediate the Association Between Waist Circumference and Hyperuricemia in Normal-Weight Men

Purpose

Hyperuricemia has traditionally been associated with obesity and dyslipidemia. However, the relationship between waist circumference (WC) and hyperuricemia in normal-weight men is still unclear, particularly regarding the roles of triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). The aim of this research was to explore the mediating roles of TG and HDL-C in the association between WC and hyperuricemia in normal-weight men.

Methods

A retrospective observational study was conducted among normal-weight men (18.5 ≤ BMI < 24 kg/m2) aged ≥ 18 years who underwent health checkups in Nanjing from 2021-2023. Relationships between WC, blood lipids, and hyperuricemia were investigated by multivariable regression models and mediation analysis.

Results

We enrolled 35,984 participants, with an overall hyperuricemia prevalence of 24.2%. The research found a significant positive association between WC and hyperuricemia in normal-weight men (P < 0.001). For hyperuricemia across rising WC quartiles, with WC divided as follows: Q1 (59 ≤ WC < 77 cm), Q2 (77 ≤ WC < 81 cm), Q3 (81 ≤ WC < 85 cm), and Q4 (85 ≤ WC ≤ 107 cm), the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were 1.00 (reference), 1.09 (1.01, 1.18), 1.26 (1.15, 1.37), and 1.34 (1.22, 1.46), respectively (all P < 0.001). The mediation analysis indicated that WC had a significant total effect on hyperuricemia (Coefficient = 0.0046, 95% CI: 0.0028, 0.0070, P < 0.001), with significant indirect effects mediated through TG and HDL-C, contributing mediation proportions of 22.3% and 18.3%, respectively (both P < 0.05).

Conclusion

Elevated WC is associated with an increased likelihood of hyperuricemia in normal-weight men. TG and HDL-C play substantial mediating roles in this association. These findings suggest that monitoring WC and lipid profiles in normal-weight men could help identify those at higher risk of hyperuricemia, even in the absence of general obesity.

The impact of substituting clarified butter with canola oil on the components of metabolic syndrome, fatty liver index, and insulin resistance among individuals diagnosed with metabolic syndrome: a quasi-experimental study

Purpose

Clarified butter, contain harmful saturated and beneficial trans-fatty acids. Canola oil is a promising alternative to other oils for reducing saturated fat intake. This trial aimed to investigate the effects of replacing clarified butter with canola oil in patients with metabolic syndrome on various metabolic syndrome components, fatty liver index (FLI), and insulin resistance.

Methods

In this trial, 42 individuals with metabolic syndrome referred to the clinic in Imam Khomeini University Hospital in Urmia, Iran, were enrolled. The participants, who commonly consumed (3 to 8 serving per day) clarified butter, were instructed to follow a healthy diet and replace their consumption of clarified butter with an equivalent amount of canola oil for 3 months. To compare the differences of outcomes in the group, the paired samples T-test and cohen's d effect size were applied. To analyze the changes in dietary intakes and Metabolic equivalent of task (MET), repeated measures of ANOVA was used.

Results

There was a significant decrease in fasting blood sugar (FBS) (< 0.001), triglyceride (TG) (0.003), and anthropometric measurements (< 0.001). Furthermore, significant reductions were observed in total cholesterol (TC) (< 0.001), low-density lipoprotein (LDL) (0.009), gamma-glutamyl transferase (GGT) levels (0.003), FLI (< 0.001), insulin levels (0.007), and homeostatic model assessment for insulin resistance (HOMA-IR) (0.002), and increase in quantitative insulin-sensitivity check index (QUICKI) (< 0.001). Unfavorably, there was a significant reduction in the high-density lipoprotein (HDL) (< 0.001).

Conclusion

The replacement of clarified butter with canola oil demonstrated potential benefits in improving metabolic syndrome.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01453-z.

Prediction of metabolic syndrome following a first pregnancy

BACKGROUND

The prevalence of metabolic syndrome is rapidly increasing in the United States. We hypothesized that prediction models using data obtained during pregnancy can accurately predict the future development of metabolic syndrome.

OBJECTIVE

This study aimed to develop machine learning models to predict the development of metabolic syndrome using factors ascertained in nulliparous pregnant individuals.

STUDY DESIGN

This was a secondary analysis of a prospective cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study [nuMoM2b-HHS]). Data were collected from October 2010 to October 2020, and analyzed from July 2023 to October 2023. Participants had in-person visits 2 to 7 years after their first delivery. The primary outcome was metabolic syndrome, defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, which was measured within 2 to 7 years after delivery. A total of 127 variables that were obtained during pregnancy were evaluated. The data set was randomly split into a training set (70%) and a test set (30%). We developed a random forest model and a lasso regression model using variables obtained during pregnancy. We compared the area under the receiver operating characteristic curve for both models. Using the model with the better area under the receiver operating characteristic curve, we developed models that included fewer variables based on SHAP (SHapley Additive exPlanations) values and compared them with the original model. The final model chosen would have fewer variables and noninferior areas under the receiver operating characteristic curve.

RESULTS

A total of 4225 individuals met the inclusion criteria; the mean (standard deviation) age was 27.0 (5.6) years. Of these, 754 (17.8%) developed metabolic syndrome. The area under the receiver operating characteristic curve of the random forest model was 0.878 (95% confidence interval, 0.846-0.909), which was higher than the 0.850 of the lasso model (95% confidence interval, 0.811-0.888; P<.001). Therefore, random forest models using fewer variables were developed. The random forest model with the top 3 variables (high-density lipoprotein, insulin, and high-sensitivity C-reactive protein) was chosen as the final model because it had the area under the receiver operating characteristic curve of 0.867 (95% confidence interval, 0.839-0.895), which was not inferior to the original model (P=.08). The area under the receiver operating characteristic curve of the final model in the test set was 0.847 (95% confidence interval, 0.821-0.873). An online application of the final model was developed (https://kawakita.shinyapps.io/metabolic/).

CONCLUSION

We developed a model that can accurately predict the development of metabolic syndrome in 2 to 7 years after delivery.

Impact of intensive hypertension criteria on multimorbidity prevalence and patterns in a multi-ethnic Chinese population

Background

The impact of intensive hypertension criteria on multimorbidity prevalence and patterns remains understudied. We investigated the prevalence and patterns of multimorbidity using both the current (140/90 mmHg) and intensive (130/80 mmHg) hypertension criteria within a multi-ethnic Chinese population.

Methods

Data were obtained from the baseline survey of the Regional Ethnic Cohort Study in Northwest China, conducted from June 2018 to May 2019, which enrolled adults aged 35-74 years from five provinces. A total of 114,299 participants were included in this study. Multimorbidity was defined as the presence of at least two chronic diseases or conditions from a list of 26, ascertained through self-report and physical examination. Agglomerative hierarchical cluster analysis was employed to identify multimorbidity patterns. A hypertension-related multimorbidity pattern was identified and further analyzed. The prevalence of multimorbidity and hypertension-related pattern were analyzed in different subgroups, and subgroup cluster analyses were conducted stratified by sex, age, and ethnicity.

Results

Applying the intensive 130/80 mmHg hypertension criteria resulted in an increase in multimorbidity prevalence from 17.6% (20,128 participants) to 21.7% (24,805 participants) compared to the 140/90 mmHg criteria. Four distinct multimorbidity patterns were consistently identified: cardiometabolic, digestive-bone-kidney, respiratory, and mental-cancer. Hypertension consistently clustered within the cardiometabolic pattern alongside diabetes, acute myocardial infarction, angina, and stroke/TIA, with relatively stable proportions observed even under the 130/80 mmHg threshold.

Conclusion

The revision of hypertension criteria significantly expands the population identified as having multimorbidity, without altering the identified multimorbidity patterns. Hypertension commonly co-occurs within the cardiometabolic cluster. These findings highlight the need for improved treatment and management strategies specifically targeting cardiometabolic multimorbidity.

Metabolic syndrome among type 2 Diabetes Mellitus patients in Ethiopia: a systematic review and meta-analysis

Introduction

The prevalence of metabolic syndrome among type 2 diabetes mellitus patients was inconsistent in Ethiopia. Therefore, we aimed to pool the prevalence of metabolic syndrome among type 2 diabetes mellitus patients using a systematic review and meta-analysis.

Methods

PubMed, EMBASE, and Cochrane Library databases were systematically searched for relevant articles from January 2023 to January 2024. In addition, a manual search was conducted using published articles' reference lists. The random-effects model was used to pool prevalence from individual studies. All analysis was performed using R software.

Results

A total of nine articles met the inclusion criteria and were included in the analysis. The participants' average age was 59.8 ± 3.84 years old. The pooled prevalence of MetS in T2DM patients was 53% (95% CI: 47-58). A significant heterogeneity was found across the included studies (P < 0.001, I2 = 92%). Based on diagnostic criteria, the prevalence of MetS in T2DM patients was 49% (95% CI: 43-56), 57% (95% CI: 47-67), 57% (95% CI: 43-77), and 44% (95% CI: 20-58) based on IDF, NCEP-ATP II, 2009 harmonized, and WHO criteria. By gender, the prevalence of MetS in T2DM patients was 48% (95% CI: 28-68) for females and 32% (95% CI: 17-49) for males.

Conclusion

This study found that over half of type 2 diabetes mellitus patients in Ethiopia are affected by metabolic syndrome, with a higher prevalence observed in females compared to males. The NCEP-ATP II and 2009 harmonized criteria consistently yielded similar prevalence rates of metabolic syndrome. These findings highlight the importance of educating T2DM patients on preventing and managing cardiovascular disease and its related complications.

The predictive power of conventional and novel obesity indices in identifying metabolic syndrome among the southern Iranian populations: findings from PERSIAN cohort study

BACKGROUND

Metabolic syndrome (MetS) contributes to an increased risk of cardiovascular diseases. Traditional metrics like body mass index (BMI) have limitations in discerning fat distribution. The purpose of this study was to evaluate the diagnostic accuracy of traditional and novel anthropometric indices in metabolic syndrome and its components in the south coast of Iran.

METHODS

In this cross-sectional study, 2694 adults aged 35 to 70 were included. Comprehensive anthropometric and biochemical data were collected and analyzed. There were eight anthropometric indices evaluated in this study, including a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body roundness index (BRI), abdominal volume index (AVI), weight-adjusted waist index (WWI) and waist-height ratio (WHtR).

RESULTS

WHtR (AUC: 0.766 for males, 0.799 for females), BRI (AUC: 0.766 for males, 0.799 for females), and AVI (AUC: 0.769 for males, 0.793 for females) were the best predictors of MetS. ABSI had the weakest correlation with metabolic variables.

CONCLUSIONS

AVI, WHtR, BRI, and WHR were superior to other measures as anthropometric indexes for determining MetS and its components. The study contributes valuable insights into the utility of traditional and novel metrics in clinical practice, highlighting the need for standardized diagnostic approaches and further research in diverse populations.

Causal associations of Helicobacter pylori infection and metabolic syndrome: insights from a two-sample Mendelian randomization study

BACKGROUND

Helicobacter pylori (Hp) infection and metabolic syndrome (MetS) have a high prevalence of co-morbidities and both pose a significant threat to human health and survival. It has been suggested that Hp infection affects the development of MetS in the host, but the causal relationship between the two has not been confirmed.

METHODS

We conducted a two-sample Mendelian randomization study to investigate the causal effect of Hp infection with MetS and its components. Summary statistics for exposure factors (Hp infection) were obtained from the GWAS Catalog (anti-Hp IgG, n = 8,735; Hp VacA antibody levels, n = 1,571; Hp GroEL antibody levels, n = 2,716; Hp OMP antibody levels, n = 2,640). Summary statistics for outcome factors (MetS) were obtained from the most comprehensive genome-wide association study (GWAS) currently available (n = 291,107) as well as from the components of MetS: fasting glucose (n = 46,186), hypertension (n = 461,880), serum triglycerides (n = 115,082), waist circumference (n = 21,949), and high-density lipoprotein (n = 400, 754). The inverse-variance weighted (IVW) method was used as the primary MR method and the robustness of the results was assessed through sensitivity analyses.

RESULTS

MR analysis showed that anti-Hp IgG levels were positively correlated with waist circumference (β = 0.08, P = 0.012), and GroEL antibody levels showed an opposite correlation with HDL levels (β= -0.03, P = 0.025) and TG (β = 0.02, P = 0.045). In contrast, OMP antibodies levels were positively correlated with both HDL and FBG (β = 0.064, P = 0.037 and β = 0.09, P = 0.003). In the estimation of IVW as the main causal method, VacA antibody level was positively associated with hypertension level and negatively associated with TG (β = 0.02, P = 0.008 and β= -0.02, P = 0.007). Meanwhile, the results of sensitivity analyses showed no heterogeneity or significant level pleiotropy.

CONCLUSIONS

Our study suggests that there is a causal effect between Hp infection and Mets diagnosis and its composition, and further studies are needed to understand the mechanism of its influence.

Moderate-intensity continuous training and high-intensity interval training alleviate glycolipid metabolism through modulation of gut microbiota and their metabolite SCFAs in diabetic rats

Glucose and lipid metabolism disorders are typical of diabetic patients and are important factors leading to macrovascular and microvascular complications. The aim of this study was to understand the effects of different exercises on glycolipid metabolism in diabetic rats and the role of gut flora in metabolic maintenance. We measured glycolipid metabolic indices and short-chain fatty acids (SCFAs) content and sequenced and analyzed gut microbes after 8 weeks of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) programs in type 2 diabetic rats(T2DM). We found that Enterococcaceae, Enterococcus, Subdoligranulum, Kurthia, Bacillales, and Planococcaceae may be key bacterial taxa related to T2DM and that both programs of exercise regulated the intestinal flora of rats with T2DM, improved their glycolipid metabolism, increased the abundance of SCFA-producing intestinal bacteria, and it was found that the PWY-5676 and P163-PWY pathways which are closely related to production of SCFAs were significantly upregulated in the exercise groups. Notably, MICT appeared to be more effective than HIIT in increasing the homogeneity of rat intestinal flora, enriching species, and increasing acetic acid and butyric acid content. These results suggest that exercise improves glycolipid metabolism in diabetic rats, which may be attributed to alterations in the structure of their intestinal flora.

Role of sleeve gastrectomy in improving metabolic syndrome: an overview

Metabolic syndrome (MetS) presents a global health challenge characterized by cardiometabolic risk factors like central obesity, elevated blood pressure, dyslipidemia, and high fasting glucose levels. Despite lifestyle interventions and medications, the increasing prevalence of MetS calls for effective treatments. Sleeve gastrectomy (SG) has emerged as a promising intervention. This review examines the role of SG in improving MetS outcomes, drawing from a PubMed/Medline literature search. It highlights SG's multifaceted metabolic effects, including hormonal changes and improved insulin sensitivity, contributing to improved metabolic outcomes. Additionally, SG leads to significant weight loss and effectively addresses comorbidities like hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM), with low rates of early morbidity and mortality. However, long-term studies indicate that Roux-en-Y gastric bypass (RYGB) provides more sustained weight loss and superior resolution of metabolic comorbidities, whereas SG is associated with fewer early complications and a lower risk of nutritional deficiencies. In conclusion, SG offers a valuable option for managing MetS, providing significant weight loss and comorbidity improvement. Nevertheless, potential long-term complications, such as gastroesophageal reflux disease (GERD) and suboptimal weight response, emphasize careful patient selection and monitoring.

Multifaceted Aspects of Dysfunctional Myelopoiesis in Cancer and Therapeutic Perspectives with Focus on HCC

Myelopoiesis provides for the formation and continued renewal of cells belonging primarily to the innate immune system. It is a highly plastic process that secures the response to external and internal stimuli to face acute and changing needs. Infections and chronic diseases including cancer can modulate it by producing several factors, impacting proliferation and differentiation programs. While the lymphocytic compartment has attracted major attention due to the role of adaptive immunity in anticancer immune response, in recent years, research has found convincing evidence that confirms the importance of innate immunity and the key function played by emergency myelopoiesis. Due to cancer's ability to manipulate myelopoiesis to its own advantage, the purpose of this review is to outline myelopoiesis processes within the tumor microenvironment and suggest possible therapeutic lines of research to restore the physiological functioning of the host's immune system, with a special outlook on hepatocellular carcinoma (HCC).

Natural Bioactive Compounds: Emerging Therapies for Hyperuricemia

Hyperuricemia is a crucial feature of metabolic syndrome, characterized by elevated uric acid that causes urate crystal deposits in joints, kidneys, and subcutaneous tissues, resulting in gout and hyperuricemic nephropathy. The primary causes of uric acid metabolism disorder include overproduction and reduced excretion. The majority of uric acid in human body is derived from the breakdown of purine nucleotides. Overproduction of uric acid can result from increased concentration or activity of xanthine oxidase, the key enzyme responsible for uric acid synthesis. Alterations in the activity of proteins responsible for uric acid reabsorption and excretion can also affect serum uric acid. Many bioactive compounds derived from natural plants have been shown to inhibit xanthine oxidase activity to reduce uric acid production, modulate the activity of transport proteins to promote uric acid excretion, or alleviate oxidative stress and inflammation through various signaling pathways. These properties have garnered significant attention from researchers. In this paper, we first introduce the pathophysiological mechanisms of hyperuricemia, then summarize bioactive compounds with urate-lowering effects, and discuss their potential applications in treating hyperuricemia and its complications.

Magnesium Depletion Score and Metabolic Syndrome in US Adults: Analysis of NHANES 2003 to 2018

CONTEXT

The association between magnesium status and metabolic syndrome (MetS) remains unclear.

OBJECTIVE

This study aimed to examine the relationship between kidney reabsorption-related magnesium depletion score (MDS) and MetS among US adults.

METHODS

We analyzed data from 15 565 adults participating in the National Health and Nutrition Examination Survey (NHANES) 2003 to 2018. MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III report. The MDS is a scoring system developed to predict the status of magnesium deficiency that fully considers the pathophysiological factors influencing the kidneys' reabsorption capability. Weighted univariate and multivariable logistic regression were used to assess the association between MDS and MetS. Restricted cubic spline (RCS) analysis was conducted to characterize dose-response relationships. Stratified analyses by sociodemographic and lifestyle factors were also performed.

RESULTS

In both univariate and multivariable analyses, higher MDS was significantly associated with increased odds of MetS. Each unit increase in MDS was associated with approximately a 30% higher risk for MetS, even after adjusting for confounding factors (odds ratio 1.31; 95% CI, 1.17-1.45). RCS graphs depicted a linear dose-response relationship across the MDS range. This positive correlation remained consistent across various population subgroups and exhibited no significant interaction by age, sex, race, adiposity, smoking status, or alcohol consumption.

CONCLUSION

Higher urinary magnesium loss as quantified by MDS may be an independent linear risk factor for MetS in US adults, irrespective of sociodemographic and behavioral factors. Optimizing magnesium nutritional status could potentially confer benefits to patients with MetS.

Health-related quality of life in adults with metabolic syndrome: a multi-level analysis of family and individual level variation

PURPOSE

The current study aimed to investigate the associations between metabolic syndrome (MetS) with health-related quality of life (HRQoL) using multilevel analysis among the Iranian adult population.

METHODS

This cross-sectional study was conducted in the framework of the Tehran Lipid and Glucose Study (TLGS). Participants were 6113 participants (3318 women and 2795 men) aged≥20 years of the TLGS seventh phase who had completed data on HRQoL and MetS. HRQoL was assessed using the short-form 12-item health survey V.2 and MetS defined based on the guidelines outlined in the Joint Interim Statement. The two-level model was fitted to assess the association between MetS and HRQoL.

RESULTS

The prevalence of MetS and its components was higher in men, and regardless of metabolic status, men exhibited higher HRQoL values. The deleterious impact of MetS on HRQoL was more pronounced in women, while the detrimental effects of MetS on men's HRQoL were confined to specific subscales. These results were obtained through multilevel analysis, considering both familial and individual variation levels. Moreover, our investigation highlighted the positive influence of leisure-time physical activity on both the physical and mental component summaries (PCS and MCS, respectively), regardless of gender. Education had a greater positive impact on PCS in both sexes. Additionally, a history of cardiovascular diseases was associated with a decline in mental and physical HRQoL, while age was linked to a decline in PCS and MCS, and smoking was associated with a decline in MCS.

CONCLUSION

This study revealed the significant influence of gender, as well as the unique characteristics and circumstances of individuals, on the relationship between MetS and HRQoL in a general population with low/middle income.