Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999-2006

Raised TSH is associated with endothelial dysfunction in Metabolic Syndrome: A case control study

INTRODUCTION

Endothelial dysfunction has been considered as one of the important factors in pathogenesis of Metabolic Syndrome (Met S). Subclinical hypothyroidism (SCH) has also been reported to be associated with Met S. The aim of our study is to evaluate the association of raised TSH with mediators of endothelial dysfunction in Met S with Subclinical hypothyroidism as compared to healthy controls.

METHODS

Study population consisted of 100 subjects, out of which 50 were cases of Met S and 50 were healthy controls. Met S group were further divided into two, based on the presence & absence of SCH. Serum insulin, T3, T4, TSH were measured by chemiluminescence based immunoassay (CLIA). Serum nitric oxide (NO) levels were measured by Modified Griess's method and serum endothelin-1 (ET-1) levels were measured by ELISA.

RESULTS

Out of 50 cases of Met S, SCH was diagnosed in 22. The mean serum TSH levels were significantly higher in Met S cases as compared to healthy controls (5.7 ± 1.2 μIU/mL vs. 2.3 ± 1.6 μIU/mL, P <0.0001). Mean serum NO levels were significantly lower in Met S cases as compared to healthy control (15.4 ± 10 μM vs. 21 ± 10 μM, p = 0.009). Mean serum ET-1 levels were significantly higher in Met S cases as compared to healthy controls (2.68 ± 1.7 fmol/mL vs. 2.1 ± 0.84 fmol/mL, p = 0.011). On Pearson's correlation analysis, TSH showed positive correlation with ET-1 (r = 0.341, p = 0.001) and negative correlation with NO (r = -0.331, p = 0.001). Binary logistic regression analysis showed that TSH, NO and ET-1 has significant odd's ratio for predicting Met S.

CONCLUSION

Met S cases were screened for thyroid abnormalities and found to have 44% of SCH along with co-existing endothelial dysfunction. Raised TSH in SCH could cause endothelial dysfunction which may lead to Met S and associated co-morbidities. Present study gives new insight in linking endothelial dysfunction and raised TSH in Met S. Therefore, Met S cases should be screened for SCH and treated appropriately to attenuate endothelial dysfunction and associated comorbidities in Met S.

Does Metabolic Syndrome Increase the Risk of Postoperative Complications in Patients Undergoing Colorectal Cancer Surgery?

BACKGROUND

Metabolic syndrome is associated with poorer postoperative outcomes after various abdominal operations. However, the impact of metabolic syndrome on outcomes after colorectal cancer surgery remains poorly described.

OBJECTIVE

The purpose of this study was to determine the association between metabolic syndrome and short-term postoperative outcomes in patients undergoing elective colorectal cancer surgery.

DESIGN

This was a retrospective cohort study.

SETTINGS

This study used a national multicenter database.

PATIENTS

Adult patients who underwent elective colectomy for colorectal cancer from 2010 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database.

MAIN OUTCOME MEASURES

Thirty-day postoperative mortality and morbidity, unplanned reoperation, unplanned readmission, operative time, and length of stay were measured.

RESULTS

A total of 91,566 patients were analyzed; 7603 (8.3%) had metabolic syndrome. On unadjusted analysis, metabolic syndrome was associated with an increased risk of 30-day overall morbidity, pulmonary complications, renal complications, septic complications, cardiac complications, wound complications, blood transfusion, longer length of stay, and unplanned readmissions. On multivariable analysis, metabolic syndrome remained significantly associated with renal complications (OR = 1.44 (95% CI, 1.29-1.60)), superficial surgical site infection (OR = 1.46 (95% CI, 1.32-1.60)), deep surgical site infection (OR = 1.40 (95% CI, 1.15-1.70)), wound dehiscence (OR = 1.47 (95% CI, 1.20-1.80)), and unplanned readmissions (HR = 1.24 (95% CI, 1.15-1.34)). The risks of overall morbidity, cardiac and septic complications, and prolonged length of stay for laparoscopic procedures were significantly associated with diabetes mellitus rather than metabolic syndrome as a composite entity.

LIMITATIONS

This study was limited by its retrospective design and inability to analyze outcomes beyond 30 days.

CONCLUSIONS

Patients with metabolic syndrome undergoing elective surgery for colorectal cancer have an increased risk of 30-day postoperative renal complications, wound complications, and unplanned hospital readmissions. A multidisciplinary approach involving lifestyle modifications and pharmacologic interventions to improve the components of metabolic syndrome should be implemented preoperatively for these patients. See Video Abstract at http://links.lww.com/DCR/A909.

Influence of daily fresh pear consumption on biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome: a randomized controlled trial

Previous research suggests potential for fresh pears as a functional food for promoting cardiometabolic health. The purpose of this randomized, open-label, placebo-controlled, crossover clinical trial was to evaluate the influence of daily fresh pear consumption on blood pressure (primary outcome) and other biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome (MetS). Forty men and women aged 45-65 years with MetS were included and randomly assigned to receive either two medium-sized fresh pears (Pear) or a calorie-matched control drink (Control) per day for each 12-week treatment period, each separated by a 4-week washout period. After 12 weeks of daily fresh pear consumption, systolic blood pressure tended to be reduced (130 ± 2 mmHg vs. 134 ± 2 mmHg at baseline, P = 0.07) and pulse pressure was significantly reduced (51 ± 1 vs. 54 ± 1 at baseline, P < 0.05). At 12 weeks, leptin concentrations were lower in the Pear group than Control (52.5 [7.6, 120.5] ng dL-1vs. 53.4 [5.0, 120.5] ng dL-1, respectively, P < 0.05), and there was a significant group by time interaction (P < 0.05). Leptin concentrations were significantly reduced at 12 weeks compared to baseline in the Pear group (52.5 [7.6, 120.5] ng dL-1vs. 54.8 [6.4, 120.5] ng dL-1 at baseline, P < 0.05) but not in the Control group. Waist circumference was significantly reduced at 12 weeks in the Pear group (107.7 ± 2.0 cm vs. 108.4 ± 2 cm at baseline, P < 0.05) with a trend for a group by time interaction (P < 0.1), and significantly lower in the Pear group than Control (108.1 ± 2.0 cm vs. 108.8 ± 2 cm, P < 0.05) at 6 weeks with a significant group by time interaction (P < 0.05). Conversely, values were significantly increased at 6 weeks (108.8 ± 2 cm vs. 108.3 ± 2.0 cm at baseline, P < 0.05) in the Control group and sustained at 12 weeks. Waist-to-hip ratio was significantly reduced (0.92 ± 0.01 vs. 0.93 ± 0.01 at baseline, P < 0.05) at 12 weeks in the Pear group, and significantly lower than Control at 6 weeks (0.93 ± 0.01 vs. 0.93 ± 0.01, respectively, P < 0.05) and 12 weeks (0.92 ± 0.01 vs. 0.93 ± 0.01, P < 0.05). These findings suggest that daily fresh pear consumption may promote modest improvements in cardiometabolic health in middle-aged/older adults with MetS. This trial was registered at clinicaltrials.gov as NCT02228837.

Telemonitoring-supported exercise training, metabolic syndrome severity, and work ability in company employees: a randomised controlled trial

BACKGROUND

Metabolic syndrome is a predisposing factor for cardiovascular and metabolic disease, but also has socioeconomic relevance by affecting the health and productivity of workers. We tested the effect of regular telemonitoring-supported physical activity on metabolic syndrome severity and work ability in company employees.

METHODS

This was a prospective, randomised, parallel-group, and assessor-blind study done in workers in the main Volkswagen factory (Wolfsburg, Germany). Volunteers with diagnosed metabolic syndrome according to American Heart Association/National Heart, Lung, and Blood Institute criteria were randomly assigned (1:1) to a 6-month lifestyle intervention focusing on regular exercise (exercise group), or to a waiting-list control group, using a computer-based assignment list with variable block length. Participants in the exercise group received individual recommendations for exercise at face-to-face meetings and via a smartphone application, with the aim of doing 150 min physical activity per week. Activities were supervised and adapted using activity-monitor data, which were transferred to a central database. Participants in the control group continued their current lifestyle and were informed about the possibility to receive the supervised intervention after study completion. The primary outcome was the change in metabolic syndrome severity (metabolic syndrome Z score) after 6 months in the intention-to treat population. This trial is registered with ClinicalTrials.gov, number NCT03293264, and is closed to new participants.

FINDINGS

543 individuals were screened between Oct 10, 2017, and Feb 27, 2018, of whom 314 (mean age 48 years [SD 8]) were randomly assigned to receive the intervention (n=160; exercise group) or to a waiting list (n=154; control group). The mean metabolic syndrome Z score for the exercise group was significantly reduced after the 6-month intervention period (0·93 [SD 0·63] before and 0·63 [0·64] after the intervention) compared with the control group (0·95 [0·55] and 0·90 [0·61]; difference between groups -0·26 [95% CI -0·35 to -0·16], p<0·0001). We documented 11 adverse events in the exercise group, with only one event (a twisted ankle) regarded as directly caused by the intervention.

INTERPRETATION

A 6-month exercise-focused intervention using telemonitoring systems reduced metabolic syndrome severity. This form of intervention shows significant potential to reduce disease risk, while also improving mental health, work ability, and productivity-related outcomes for employees at high risk for cardiovascular and metabolic disease.

FUNDING

Audi BKK health insurance and the German Research Foundation through the Cluster of Excellence REBIRTH.

Neighborhood Racial Diversity and Metabolic Syndrome: 2003-2008 National Health and Nutrition Examination Survey

This study investigated the independent association between neighborhood racial/ethnic diversity and metabolic syndrome among US adults, and focused on how this association differed across individual and neighborhood characteristics (i.e., race/ethnicity, sex, age, urbanity, neighborhood poverty). Objectively-measured biomarker data from 2003 to 2008 National Health and Nutrition Examination Survey were linked to census-tract profiles from 2000 decennial census (N = 10,122). Multilevel random intercept logistic regression models were estimated to examine the contextual effects of tract-level racial/ethnic diversity on individual risks of metabolic syndrome. Overall, more than 20% of the study population were identified as having metabolic syndrome, although the prevalence also varied across demographic subgroups and specific biomarkers. Multilevel analyses showed that increased racial/ethnic diversity within a census tract was associated with decreased likelihood of having metabolic syndrome (OR 0.71, 95% CI 0.52-0.96), particularly among female (OR 0.64; 95% CI 0.43-0.96), young adults (OR 0.60; 95% CI 0.39-0.93), and residents living in urban (OR 0.67; 95% CI 0.48-0.93) or poverty neighborhoods (OR 0.54; 95% CI 0.31-0.95). The findings point to the potential benefits of neighborhood racial/ethnic diversity on individual health risks.

Cross-Sectional Association of Metabolic Syndrome and Its Components with Serum Testosterone Levels in a Korean-Screened Population

Purpose

We evaluated the associations of metabolic syndrome (MetS) and its components with testosterone levels in the Korean population.

Materials and Methods

This cross-sectional study was performed among 6,967 adult (age≥20 years) men who attended health screening during 2006 to 2015. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. Associations were evaluated using unconditional logistic regression.

Results

The estimated age-adjusted prevalence of MetS in adult and middle-aged (≥40 years) Korean men was 27.5% and 30.6%, respectively. Quartile analysis showed that high serum testosterone levels were significantly associated with a low risk of MetS (highest vs. lowest quartile, odds ratio=0.528; p_trend<0.001), with an approximately 13% reduction in MetS risk per 1 ng/mL increment of serum testosterone levels. After considering covariates such as age and body mass index (BMI), the reduction in MetS risk was attenuated but remained significant (7% reduced risk per 1 ng/mL). Testosterone levels were inversely correlated with all MetS components, including hyperglycemia (r=−0.041), increased body size (r=−0.093), increased triglyceride levels (r=−0.090), decreased high-density lipoprotein cholesterol levels (r=−0.030), and elevated blood pressure (r=−0.071, all p<0.05). Among them, elevated triglyceride levels and blood pressure were independently associated with low serum testosterone levels, even after adjustment for age and BMI.

Conclusions

Serum testosterone levels were inversely associated with MetS in Korean men. This association was attenuated after adjustment for age and BMI but remained significant. Among MetS components, increased triglyceride levels and elevated blood pressure were independently associated with testosterone levels, regardless of obesity.

Siah2 modulates sex-dependent metabolic and inflammatory responses in adipose tissue to a high-fat diet challenge

Background

The obesity-related risk of developing metabolic syndrome is higher in males than in females of reproductive age, likely due to estrogen-mediated reduced adipose tissue inflammation and fibrosis with hypertrophied adipocytes. Depletion of the ubiquitin ligase Siah2 reduced white adipose tissue inflammation and improved glucose metabolism in obese male mice. Siah2 is a transcriptional target of estrogen, but data is lacking about the effect of Siah2 on adipose tissue of females. We therefore evaluated the impact of Siah2 deficiency on white and brown adipose tissue in females of reproductive age.

Methods

Body composition, adipose tissue morphology, brown adipose tissue gene, and protein expression and adipocyte sizing were evaluated in wild-type and Siah2KO female and male mice fed a low-fat or high-fat diet. Glucose and insulin tolerance, fasting glucose, insulin, fatty acids and triglycerides, and gene expression of inflammation markers in perigonadal fat were evaluated in wild-type and Siah2KO female mice. Microarray analysis of brown fat gene expression was carried out in both sexes. Statistical analysis was assessed by unpaired two-tailed t test and repeated measures ANOVA.

Results

Siah2 deficiency improves glucose and insulin tolerance in the presence of hypertrophied white adipocytes in high-fat-fed female mice with percent fat comparable to male mice. While previous studies showed Siah2KO reduces the white adipose tissue inflammatory response in male mice, the response in females is biased toward the upregulation of M2-like markers in white adipose tissue. In contrast, loss of Siah2 leads to increased whitening of brown fat in males, but not in females. This corresponded to increased expression of markers of inflammation (F4/80, Ccl2) and thermogenic genes (Pgc1alpha, Dio2, Ucp-1) and proteins (PGC-1α, UCP-1) in females. Contrary to expectations, increased expression of thermogenic markers in females was coupled with a downregulation of ERalpha and ERRgamma protein levels.

Conclusions

The most striking sex-related effect of Siah2 deficiency is reduced whitening of brown fat in high-fat-fed females. Protection from accumulating unilocular adipocytes in the brown fat corresponds to increased expression of thermogenic genes and proteins in female, but not in male mice. These results raise the possibility that Siah2 contributes to the estrogen-related effects on brown fat function in males and females.

Electronic supplementary material

The online version of this article (10.1186/s13293-019-0233-y) contains supplementary material, which is available to authorized users.

Investigating Possible Trans/Intergenerational Associations With Obesity in Young Adults Using an Exposome Approach

Animal experiments demonstrate ways in which an exposure in one generation can be reflected in a variety of outcomes in later generations. In parallel human observational studies have shown associations between grandparental and parental exposures to cigarette smoking and/or nutrition and growth and survival of the grandchild. These studies have controlled for just a few confounders selected ad hoc. Here we use an exposome approach (using all available measures of exposure) to determine trans/inter-generational factors that may be important in studying environmental factors associated with fat mass in young human adults. The study takes advantage of the rich data available in the Avon Longitudinal Study of Parents and Children (ALSPAC). We test associations with features of grandparents (G0) and the childhood of the parents (G1) of 24-year olds (G2). We hypothesized that intergenerational associations would be revealed, particularly with exposure to cigarette smoke, and that these would vary with the sexes of all three generations. The study exposome analyzed 172 exposures to the maternal line and 182 to the paternal line. A series of stepwise regression analyses reduced the initial 40 unadjusted factors (P < 0.05) to eight independent features on the maternal line, and of 26 on the paternal line to five. We found strong associations between the father starting to smoke cigarettes regularly before age 11 and increased fat mass in his adult children (unadjusted = +7.82 [95% CI +2.75, +12.90] Kg; adjusted = +11.22 [+5.23, +17.22] Kg); this association was stronger in male offspring. In addition, when the paternal grandmother had smoked in pregnancy her adult granddaughters, but not grandsons had elevated mean fat mass (interaction with sex after adjustment, P = 0.001). The exposome technique identified other factors that were independently associated with fat mass in young adults. These may be useful in identifying appropriate confounders in other more proximal analyses, but also may identify features that may be on epigenetic pathways leading to increased fat mass in subsequent generations. We acknowledge that the results need to be replicated in other cohorts and encourage further linkage of outcomes with previous generational exposures, particularly along the paternal line.

A Tale of Three Gorges in the Yangtze River: Comparing the Prevalence of Metabolic Syndrome According to ATPIII, WHO, and IDF Criteria and the Association with Vascular Health in Modernizing China

BACKGROUND

Metabolic syndrome (MS) is associated with atherosclerotic diseases. The prevalence of MS according to the Adult Treatment Panel III (ATPIII), World Health Organization (WHO), and International Diabetes Federation (IDF) criteria are variable but increasing in western countries and modernizing China. This study aimed to evaluate the prevalence of MS according to these three criteria, in farmers or ex-farming residents in three-gorges territories undergoing rapid lifestyle changes.

METHODS

We compared 95 residents (ex-farmers) in Wu Shan (WS) (28.4% men, aged 49.7 ± 9 years) resettled uphill for 3-5 years, and 87 age- and gender-matched farmers in Da Chang (DC) (27.6% men, aged 48.8 ± 10 years) before migration. MS and other traditional risk factors were assessed and carotid intima-media thickness (IMT) measured.

RESULTS

Ninety-nine percent of WS residents were retired or adopted nonfarming jobs. Compared with DC farmers, WS ex-farmers had higher waist circumference, low density lipoprotein-cholesterol, and triglycerides (P < 0.0001), but their blood pressures, HDL-cholesterol, and fasting glucose were similar. MS were identified in 43.2% (IDF), 36.8% (WHO), and 29.5% (ATPIII) respectively in WS ex-farmers, compared with 17.2%, 13.8%, and 11.5% respectively in DC farmers. Carotid IMT was significantly higher in WS ex-farmers (0.74 ± 0.16 mm) than in DC farmers (0.64 ± 0.11 mm) (P < 0.0001). On multivariate regression analysis, prevalence of MS was correlated with job nature (beta = 0.425, P < 0.0001). Carotid IMT was better correlated with IDF MS criteria (beta = 0.208, P = 0.021), independent of age and WS location (regression adjusted R² = 0.444, F-value 12.0, P < 0.0001), but not with the ATPIII or WHO criteria.

CONCLUSIONS

IDF MS criteria is more sensitive, better correlates with atherosclerosis surrogate, and accordingly is more readily applicable to modernizing China.

Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome

BACKGROUND CONTEXT

Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted.

PURPOSE

To elucidate potential association between SEL and metabolic syndrome.

STUDY DESIGN

An observational study used data of a medical checkup.

PATIENT SAMPLE

We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study.

OUTCOME MEASURES

The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated.

METHODS

The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated.

RESULTS

The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5-9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm² (OR=4.8, 95% CI=1.5-15.3) and hypertension (OR=3.5, 95% CI=1.1-11.8) were observed to be independently associated with SEL.

CONCLUSION

This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome.

Immunomodulatory nanogels overcome restricted immunity in a murine model of gut microbiome-mediated metabolic syndrome

Biomaterials-based nanovaccines, such as those made of poly(lactic-co-glycolic acid) (PLGA), can induce stronger immunity than soluble antigens in healthy wild-type mouse models. However, whether metabolic syndrome can influence the immunological responses of nanovaccines remains poorly understood. Here, we first show that alteration in the sensing of the gut microbiome through Toll-like receptor 5 (TLR5) and the resulting metabolic syndrome in TLR5 ^-/- mice diminish the germinal center immune response induced by PLGA nanovaccines. The PLGA nanovaccines, unexpectedly, further changed gut microbiota. By chronically treating mice with antibiotics, we show that disrupting gut microbiome leads to poor vaccine response in an obesity-independent manner. We next demonstrate that the low immune response can be rescued by an immunomodulatory Pyr-pHEMA nanogel vaccine, which functions through TLR2 stimulation, enhanced trafficking, and induced stronger germinal center response than alum-supplemented PLGA nanovaccines. The study highlights the potential for immunomodulation under gut-mediated metabolic syndrome conditions using advanced nanomaterials.

Fetal and childhood malnutrition during the Korean War and metabolic syndrome in adulthood

OBJECTIVES

Koreans experienced unexpected shortages of food and refugee life during the Korean War (1950-1953). In the present study, we used the Korean War as a natural experiment for early life malnutrition with the aim of evaluating the risk for metabolic syndrome in adulthood according to participant exposure status during the Korean War.

METHODS

We used data from 25 708 participants from the fourth through seventh Korean National Health and Nutrition Examination Survey, a nationally representative database of Korea. By years of birth, we divided the study participants into non-exposed (1959-1963 and 1954-1958), fetal-exposed (1951-1953), early childhood-exposed (1946-1950), late-childhood-exposed (1941-1945), and adolescent-exposed (1936-1940) groups according to participants' ages during the Korean War. We calculated the risk for metabolic syndrome in adult life using logistic regression analysis.

RESULTS

Compared with the non-exposed group, women exposed to the Korean War while in utero and during early childhood were associated with increased risk for abdominal obesity and elevated triacylglycerol levels, whereas men showed low high-density lipoprotein cholesterol levels. Fetal and early childhood exposure increased the risk for metabolic syndrome in adults compared with the non-exposed group (fetal-exposed men: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.93-1.76; fetal-exposed women: OR, 1.35; 95% CI, 1.01-1.80; early-childhood-exposed men OR, 1.25; 95% CI, 0.82-1.90; and early-childhood-exposed women OR, 1.41; 95% CI, 0.97-2.06).

CONCLUSIONS

Fetal and early childhood experiences during the Korean War were associated with increased risk for some components of metabolic syndrome. The present study suggested that early life malnutrition due to the Korean War may be associated with metabolic syndrome in later life.

Prevalence of the metabolic syndrome between 1999 and 2014 in the United States adult population and the impact of the 2007-2008 recession: an NHANES study

To document changes in prevalence of the metabolic syndrome (MetS) in the United States adult population between 1999 and 2014 and to explore how variations in the dietary intakes explain changes in MetS prevalence and its components over time. A total of 38 541 individuals (aged 20-85 years; National Health and Nutrition Examination Survey 1999-2014) were studied. Outcome variables were MetS, waist circumference (WC), plasma high-density lipoprotein cholesterol (HDL-c), triglycerides, fasting glucose (FG) levels, resting systolic and diastolic blood pressure, dietary intakes (total daily energy, carbohydrates, proteins, fats, sodium, and alcohol intakes), the poverty income ratio (PIR) and sociodemographic data (age, sex, ethnicity). Overall, the prevalence of the MetS significantly increased between 1999 and 2014 (27.9% to 31.5%). High plasma FG levels and high WC increased between 1999 and 2014, while the prevalence of the other components of MetS decreased or remained stable. Interestingly, a significant peak in MetS prevalence was observed in 2007-2008 compared with 1999-2006 (34.4% vs 27.6%), accompanied by a concomitant increase in WC and plasma FG levels, as well as a decrease in plasma HDL-c. Finally, significant decreases were observed for the PIR, total daily energy intake, sodium, and all macronutrient intakes in 2007-2008 compared with 1999-2006 (all P < 0.01). Results showed that the MetS prevalence significantly increased between 1999 and 2014 in the United States adult population, with a peak in 2007-2008. Interestingly, the 2007-2008 peak in MetS prevalence was accompanied by decreases in the PIR, total daily energy, and macronutrients intakes, suggesting potential impact of the 2007-2008 recession.

FNDC5: A novel player in metabolism and metabolic syndrome

Half a decade ago, transmembrane protein fibronectin type III domain-containing protein 5 (FNDC5) was found to be cleaved as a novel myokine irisin, which burst into prominence for browning of white adipose tissue during exercise. However, FNDC5, the precursor of irisin, has been paid relatively little attention compared with irisin despite evidence that FNDC5 is associated with the metabolic syndrome, which accounts for one-fourth of the world's adult population and contributes to diabetes, cardiovascular disease and all-cause mortality. Besides N-terminal and C-terminal sequences, the FNDC5 protein contains an irisin domain and a short transmembrane region. FNDC5 has shown to be widely distribute in different tissues and is highly expressed in heart, brain, liver, and skeletal muscle. Clinical studies have demonstrated that FNDC5 is essential for maintaining metabolic homeostasis and dysregulation of FNDC5 will lead to systemic metabolism imbalance and the onset of metabolic disorders. Growing evidence has suggested that FNDC5 gene polymorphisms are related to health and disease in different human populations. Additionally, FNDC5 has been found relevant to the regulation of metabolism and metabolic syndrome through diverse upstream and downstream signaling pathways in experimental studies. The present review summarizes the characteristics, clinical significance, and molecular mechanisms of FNDC5 in metabolic syndrome and proposes a novel concept that FNDC5 is activated by forming a putative ligand-receptor complex. Knowledge about the role of FNDC5 may be translated into drug development and clinical applications for the treatment of metabolic disorders.

Association of antioxidant status and inflammatory markers with metabolic syndrome in Thais

BACKGROUND

An oxidant/antioxidant disequilibrium has been suggested as having a role in the pathogenesis of some diseases. Metabolic syndrome (MS) is significantly associated with cardiovascular disease and type 2 diabetes. The pathogenesis of MS is complex and not well understood. The purposes of the present study were to compare enzymatic and non-enzyme antioxidants, anthropometric, hematological, and biochemical findings between subjects with MS and without MS and to evaluate the relationship between antioxidant status and hematological parameters with the components of MS.

METHODS

Metabolic syndrome was assessed by using the modified National Cholesterol Education Program, Adult Treatment Panel III criteria. Three hundred Thais, 124 with MS and 176 without MS, were included in the study. Each subject was tested for erythrocyte superoxide dismutase (SOD), glutathione peroxidase, (GPX), catalase (CAT), albumin and vitamin C levels, and hematological findings.

RESULTS

Subjects with MS had lower SOD and CAT levels than those without MS (p < 0.01). Subjects with MS had lower vitamin C and albumin levels than those without MS (p < 0.05). The hematological findings were not significantly different between those with and without MS except the white blood cell (WBC) count which was significantly higher in those with MS. SOD and CAT levels were significantly positively associated with HDL-C levels and negatively associated with components of MS. After adjusting for potential covariates, we found lower SOD and vitamin C levels and higher WBC counts were significantly associated with MS (p < 0.05).

CONCLUSIONS

These findings suggest an alteration in antioxidant status and an increase in inflammatory markers are associated with MS and its components among Thais; subjects with MS may be more likely to have oxidative stress problems.

Association of HIV-infection, antiretroviral treatment and metabolic syndrome with large artery stiffness: a cross-sectional study

Background

Effective combined antiretroviral therapy (cART) has improved life expectancy among people living with HIV-1 infection. Treated HIV-1infection increases the prevalence of metabolic syndrome (MS). Despite sub-Saharan Africa having among the highest rates of HIV-1 infection, the effects of MS in HIV-1-infected individuals on cardiovascular risk is poorly explored. The aim of the study was to assess whether MS and/or HIV-1 treatment correlates with large elastic artery stiffness in HIV-1-infected patients treated with first-line cART.

Methods

The study sample comprised of 102 subjects free of cardiovascular disease and major risk factors divided into two groups based on HIV-1 infection, treatment, and MS status: HIV-1⁺/cART⁺/MS⁺ (n = 12); HIV-1⁺/cART⁻/MS⁺ (n = 16); HIV-1⁻/ MS⁺ (n = 10); HIV-1⁺/cART⁺/MS⁻ (n = 42); HIV-1⁺/cART⁻/MS⁻ (n = 32); HIV-1⁻/ MS⁻ (n = 39). MS was established according the International Diabetes Federation definition. Large artery stiffness was measured using applanation tonometry to assess aortic pulse wave velocity (aPWV) and aortic augmentation index at heart rate of 75 bpm (AIx@HR75). cART included lamivudine/zidovudine and nevirapine or efavirenz.

Results

The prevalence of MS in the HIV-1-infected patients was 28%. There were no significant differences in aPWV in the non-MS groups. However, in subjects with MS, aPWV was significantly higher in the HIV-1 cART patients (9.0 ± 1.9 m/s) compared with both controls (7.5 ± 1.8 m/s; P = 0.018) and untreated HIV-1 patients (7.7 ± 1.3 m/s; P = 0.023), and these differences remained after adjustment for blood pressure and sex. Aortic PWV was significantly elevated (P = 0.009) in HIV-1 cART patients with MS compared to their counterparts without MS. Untreated HIV-1 patients with MS also demonstrated increased aPWV compared to their counterparts without MS (P = 0.05). Aortic AIx@HR75 was, on average, ~ 5% higher in HIV-1 cART patients with MS (28.3 ± 62% compared with untreated HIV-1 patients with MS (23.5 ± 9%; P = 0.075). Sub-group multivariate analysis identified MS as an independent predictor of increased aPWV in HIV-1 cART patients.

Conclusions

Our study established that presence of MS in HIV-1 patients on treatment was associated with increased aPWV and hence increased arterial stiffness in sub-Saharan African HIV-1 patients on first-line cART.

Gender-specific considerations in physical activity, thermogenesis and fat oxidation: implications for obesity management

With current 'one-size-fits-all' obesity prevention and management strategies proving largely ineffective, the focus has shifted towards a more tailored, individualized approach. However, investigation of the mechanisms underlying inter-individual variability in metabolic profile and response to intervention often yield conflicting results. Indeed, it is perhaps surprising that despite at least a century of recognition that sex hormones influence metabolism, firm conclusions regarding the effects of the menstrual cycle, hormonal contraception and menopause on many aspects of energy expenditure and substrate utilization remain to be drawn. In this review, we examine current evidence relating to gender-specific considerations in the promotion of physical activity, thermogenesis and fat oxidation for body-weight regulation, including the relationship between sex hormone status and non-exercise activity thermogenesis - an energy expenditure compartment that is often overlooked in favour of traditional exercise/sport physical activities yet presents a viable target in the search for effective weight management.

Menopause and metabolic syndrome in the Middle East countries; a systematic review and meta-analysis study

INTRODUCTION

Metabolic syndrome (MetS) prevalence that is associated with increasing risk of diabetes and cardiovascular diseases (CVD) has accelerated with age. Since, menopause is known as a partial cause of CVD accelartion with againg among women, determining the prevalence of MetS is important in this condition. We aimed to assess critically the prevalence rate of MetS among menopaused women in the Middle East Countries in this systematic review meta-analysis study.

METHODS & MATERIALS

International webdata bases including Scopus, ISI web of Science and PubMed were systematically searched using Medical Subject Headings terms from January 2000 to February 2017. We included all cross-sectional conducted in the Middle East that reported prevalence of MetS in menopause status regardless of MetS definition. Quality assessment was considered for each included study. The pooled prevalence of MetS based on the Adult Treatment Panel III (ATP III) was estimated using random effect method due to between-study heterogeneity by STATA software, version 11.0 (StataCorp, USA).

RESULTS

Within 60 studies, 21 and 17 studies were included in qualitative synthesis and meta-analysis respectively. The prevalence of MetS among menopaused women was estimated 54.87% (95% CI: 53.76-55.97) in the Middle East countries. In sub-group analysis based on country the prevalence rate of MetS in Iran and Turkey was estimated 58.78% (95% CI: 57.54-60.02), and 39.02% (95% CI: 36.57-41.47), respectively.

CONCLUSIONS

MetS was highly prevalent as an alarming sign among menopaused women in the Middle East countries. Thus, it is an emergency requirement to promote healthy lifestyle. Also, early detection and treatment of women who reach menopause and are at great risk of developing MetS is necessary for prevention of diabetes and CVD in the region.

The Association Between Metabolic Syndrome and Serum Concentrations of Micronutrients, Inflammation, and Oxidative Stress Outside of the Clinical Reference Ranges: A Cross-Sectional Study

BACKGROUND

Clinical reference ranges are often used to assess nutritional status, but whether having lower or higher than the current clinical reference range for micronutrients, inflammation, and oxidative stress is related to metabolic syndrome (MetS) is not known. Our objectives are to estimate the odds of having MetS outside of established clinical references, and to identify any effect modifications by sex have for these relationships.

METHODS

Data from the 2005 to 2006 National Health and Nutrition Examination Survey were used (≥20 years; N = 2049) with MetS defined utilizing the harmonized criteria from the Joint Interim Statement. The odds of having MetS in individuals with lower or higher than the clinical reference range for the serum concentrations of micronutrient antioxidants, inflammation, and oxidative stress were estimated following adjustments for age, sex, ethnicity, education, income, smoking, alcohol intake, recreational physical activity, and BMI.

RESULTS

Having lower than the clinical reference range for carotenoids and vitamin C [odds ratios (95% confidence interval): 1.37 (1.05-1.78) and 1.39 (1.01-1.90), respectively] was associated with significantly greater odds of MetS. By contrast, having higher than the clinical reference range for vitamins A and E, uric acid, and γ-glutamyl transferase (GGT) [2.10 (1.50-2.92), 2.36 (1.78-3.13), 2.65 (1.54-4.57), and 2.08 (1.61-2.69), respectively] was associated with higher odds of MetS, whereas higher levels of vitamins B12 were protective [0.64 (0.42-0.98]. Sex moderated these relationships for carotenoids, vitamin A, C, E, uric acid, C-reactive protein, and GGT.

CONCLUSIONS

Lower carotenoids and vitamin C and higher vitamins A and E, uric acid, and oxidative stress were associated with a greater likelihood of MetS, whereas higher vitamin B12 was protective. Further research is necessary to replicate these findings in a prospective setting to confirm the importance of the overall and sex-specific findings.

The Effect of Chronic Inflammation and Oxidative and Endoplasmic Reticulum Stress in the Course of Metabolic Syndrome and Its Therapy

Metabolic syndrome (MetS) is highly associated with a modern lifestyle. The prevalence of MetS has reached epidemic proportion and is still rising. The main cause of MetS and finally type 2 diabetes occurrence is excessive nutrient intake, lack of physical activity, and inflammatory cytokines secretion. These factors lead to redistribution of body fat and oxidative and endoplasmic reticulum (ER) stress occurrence, resulting in insulin resistance, increase adipocyte differentiation, and much elevated levels of proinflammatory cytokines. Cellular therapies, especially mesenchymal stem cell (MSC) transplantation, seem to be promising in the MetS and type 2 diabetes treatments, due to their immunomodulatory effect and multipotent capacity; adipose-derived stem cells (ASCs) play a crucial role in MSC-based cellular therapies. In this review, we focused on etiopathology of MetS, especially on the crosstalk between chronic inflammation, oxidative stress, and ER stress and their effect on MetS-related disease occurrence, as well as future perspectives of cellular therapies. We also provide an overview of therapeutic approaches that target endoplasmic reticulum and oxidative stress.

Dietary Fatty Acids Sustain the Growth of the Human Gut Microbiota

While a substantial amount of dietary fats escape absorption in the human small intestine and reach the colon, the ability of resident microbiota to utilize these dietary fats for growth has not been investigated in detail. In this study, we used an in vitro multivessel simulator system of the human colon to reveal that the human gut microbiota is able to utilize typically consumed dietary fatty acids to sustain growth. Gut microbiota adapted quickly to a macronutrient switch from a balanced Western diet-type medium to its variant lacking carbohydrates and proteins. We defined specific genera that increased in their abundances on the fats-only medium, including Alistipes, Bilophila, and several genera of the class Gammaproteobacteria In contrast, the abundances of well-known glycan and protein degraders, including Bacteroides, Clostridium, and Roseburia spp., were reduced under such conditions. The predicted prevalences of microbial genes coding for fatty acid degradation enzymes and anaerobic respiratory reductases were significantly increased in the fats-only environment, whereas the abundance of glycan degradation genes was diminished. These changes also resulted in lower microbial production of short-chain fatty acids and antioxidants. Our findings provide justification for the previously observed alterations in gut microbiota observed in human and animal studies of high-fat diets.IMPORTANCE Increased intake of fats in many developed countries has raised awareness of potentially harmful and beneficial effects of high fat consumption on human health. Some dietary fats escape digestion in the small intestine and reach the colon where they can be metabolized by gut microbiota. We show that human gut microbes are able to maintain a complex community when supplied with dietary fatty acids as the only nutrient and carbon sources. Such fatty acid-based growth leads to lower production of short-chain fatty acids and antioxidants by community members, which potentially have negative health consequences on the host.

PPARα-independent action against metabolic syndrome development by fibrates is mediated by inhibition of STAT3 signalling

OBJECTIVES

Metabolic syndrome (MS) is the concurrence of at least three of five medical conditions: obesity, high blood pressure, insulin resistance, high serum triglyceride (TG) and low serum high-density lipoprotein levels. While fibrates are used to treat disorders other than the lowering serum TG, the mechanism by which fibrates decrease MS has not been established.

METHODS

In this study, wild-type and Ppara-null mice fed a medium-fat diet (MFD) were administered gemfibrozil and fenofibrate for 3 months respectively, to explore the effect and action mechanism.

KEY FINDINGS

In Ppara-null mice, MFD treatment increased body weight, adipose tissue, serum TG and impaired glucose tolerance. These phenotypes were attenuated in two groups treated with gemfibrozil and fenofibrate. The STAT3 pathway was activated in adipose and hepatic tissues in positive control, and inhibited in groups treated with gemfibrozil and fenofibrate. The above phenotypes and inflammation were not observed in any wild-type group. In 3T3-L1 adipogenic stem cells treated with high glucose, STAT3 knockdown greatly decreased the number of lipid droplets.

CONCLUSIONS

Low dose of clinical fibrates was effective against MS development independent of PPARα, and this action was mediated by STAT3 signalling inhibition in adipose tissue and, to a lesser extent, in hepatic tissues.

Basal cortisol levels and metabolic syndrome: A systematic review and meta-analysis of observational studies

OBJECTIVE

To perform a qualitative synthesis (systematic review) and quantitative analysis (meta-analysis) to summarize the evidence regarding the relationship between basal cortisol levels and metabolic syndrome (MetS) in adults.

METHODS

A systematic search was performed in the PubMed, Embase, and PsycINFO databases for observational studies on the association between basal cortisol levels and MetS. The quality of individual studies was assessed by the Newcastle-Ottawa score. A random effects model was used to report pooled quantitative results and the I2 statistic was used to assess heterogeneity. Egger's and Begg's tests were used to evaluate publication bias.

RESULTS

Twenty-six studies (19 cross-sectional and seven case-control) met the inclusion criteria for the systematic review. The majority was classified as having a low risk of bias and used established criteria for the diagnosis of MetS. Twenty-one studies provided data on basal cortisol levels as continuous values and were included in the meta-analysis; they comprised 35 analyses and 11,808 subjects. Pooled results showed no significant difference in basal cortisol levels between subjects with and without MetS (standardized mean difference [SMD] = 0.02, 95% confidence interval [CI]=-0.11 to 0.14). There was high heterogeneity between the studies when all comparisons were considered (I2 = 83.1%;p < 0.001). Paradoxically, meta-analysis of studies evaluating saliva samples showed no significantly lower basal cortisol levels among subjects with MetS (SMD=-0.18, 95% CI=-0.37 to 0.01), whereas those studies that evaluated serum samples (SMD = 0.11, 95% CI=-0.02 to 0.24) and urine samples (SMD = 0.73, 95% CI=-0.40 to 1.86) showed no significantly higher basal cortisol levels among subjects with MetS. In the subgroup and meta-regression analyses, a significant difference in basal cortisol levels was observed according to study design, population base, age, gender, cortisol level assessment method, and study quality.

CONCLUSION

This systematic review and meta-analysis does not reveal any association between basal cortisol levels and MetS based on results of observational studies. The results of a random-effect meta-analysis showed no significant difference in basal cortisol levels between subjects with and without MetS. The present findings should be considered in order to help future studies.

Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients

OBJECTIVE

To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine.

METHODS

Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed.

RESULTS

Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of individuals, cardio-metabolic risk factors were untreated or under-treated.

CONCLUSIONS

Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.

Beyond Race/Ethnicity: Skin Color and Cardiometabolic Health Among Blacks and Hispanics in the United States

We investigated whether darker interviewer-ascribed skin color is associated with worse cardiometabolic health among young adult Blacks and Hispanics in the United States. Our sample was comprised of 2,128 non-Hispanic Blacks and 1603 Hispanics aged 24-32, who were in high school in the United States in 1994. We used logistic and OLS regression to predict obesity, hypertension, diabetes, and cardiometabolic risk. We tested the interaction between Hispanic immigrant generation and ascribed skin color. Darker ascribed skin color predicted worse cardiometabolic health among both young adult Blacks and Hispanics. Among Hispanics, the associations were strongest among third and higher generation respondents. Our findings suggest that among US Blacks and Hispanics how individuals are perceived by others via their skin color is significantly associated with their health and well-being. Gradients in cardiometabolic health in young adulthood will likely contribute to gradients in cardiovascular disease and all-cause mortality later in life.

Identification of an obesity index for predicting metabolic syndrome by gender: the rural Chinese cohort study

BACKGROUND

To compare the accuracy of different obesity indexes, including waist circumference (WC), weight-to-height ratio (WHtR), body mass index (BMI), and lipid accumulation product (LAP), in predicting metabolic syndrome (MetS) and to estimate the optimal cutoffs of these indexes in a rural Chinese adult population.

METHODS

This prospective cohort involved 8468 participants who were followed up for 6 years. MetS was defined by the International Diabetes Federation, American Heart Association, and National Heart, Lung, and Blood Institute criteria. The power of the 4 indexes for predicting MetS was estimated by receiver operating characteristic (ROC) curve analysis and optimal cutoffs were determined by the maximum of Youden's index.

RESULTS

As compared with WHtR, BMI, and LAP, WC had the largest area under the ROC curve (AUC) for predicting MetS after adjusting for age, smoking, drinking, physical activity, and education level. The AUCs (95% CIs) for WC, WHtR, BMI, and LAP for men and women were 0.862 (0.851-0.873) and 0.806 (0.794-0.817), 0.832 (0.820-0.843) and 0.789 (0.777-0.801), 0.824 (0.812-0.835) and 0.790 (0.778-0.802), and 0.798 (0.785-0.810) and 0.771 (0.759-0.784), respectively. The optimal cutoffs of WC for men and women were 83.30 and 76.80 cm. Those of WHtR, BMI, and LAP were approximately 0.51 and 0.50, 23.90 and 23.00 kg/m2, and 19.23 and 20.48 cm.mmol/L, respectively.

CONCLUSIONS

WC as a preferred index over WHtR, BMI, and LAP for predicting MetS in rural Chinese adults of both genders; the optimal cutoffs for men and women were 83.30 and 76.80 cm.

CRISPR/Cas9-mediated Angptl8 knockout suppresses plasma triglyceride concentrations and adiposity in rats

Angiopoietin-like protein (ANGPTL)8 is a liver- and adipocyte-derived protein that controls plasma triglyceride (TG) levels. Most animal studies have used mouse models. Here, we generated an Angptl8 KO rat model using a clustered regulatory interspaced short palindromic repeat (CRISPR)/CRISPR-associated protein 9 (Cas9) (CRISPR/Cas9) system to clarify the roles of ANGPTL8 in glucose and lipid metabolism. Compared with WT rats, Angptl8 KO rats had lower body weight and fat content, associated with impaired lipogenesis in adipocytes; no differences existed between the groups in food intake or rectal temperature. Plasma TG levels in both the fasted and refed states were significantly lower in KO than in WT rats, and an oral fat tolerance test showed decreased plasma TG excursion in Angptl8 KO rats. Higher levels of lipase activity in the heart and greater expression of genes related to β-oxidation in heart and skeletal muscle were observed in Angptl8 KO rats. However, there were no significant differences between KO and WT rats in glucose metabolism or the histology of pancreatic β-cells on both standard and high-fat diets. In conclusion, we demonstrated that Angptl8 KO in rats resulted in lower body weight and plasma TG levels without affecting glucose metabolism. ANGPTL8 might be an important therapeutic target for obesity and dyslipidemia.

Sedentary Occupation Workers Who Meet the Physical Activity Recommendations Have a Reduced Risk for Metabolic Syndrome: A Cross-Sectional Study

OBJECTIVE

We tested the hypothesis that sedentary occupation workers who meet the physical activity recommendations present a lower risk for metabolic syndrome (MetS) than their nonactive counterparts.

METHODS

A cross-sectional study involving 502 sedentary occupation workers. Physical activity level was self-reported. MetS was defined by International Diabetes Federation criteria.

RESULTS

The active group showed lower odds for MetS [odds ratio (OR) 0.52, 95% confidence interval (95% CI) 0.27 to 0.98], abdominal obesity (OR 0.36, 95% CI 0.16 to 0.82), elevated blood pressure (OR 0.47, 95% CI 0.26 to 0.84), and reduced high-density lipoprotein cholesterol (OR 0.54, 95% CI 0.31 to 0.93) than the sedentary group after adjustments for age, time in job, body mass index, and tobacco use.

CONCLUSIONS

Sedentary occupation workers who meet the physical activity recommendations have a reduced risk for MetS.

Partner relationship satisfaction, partner conflict, and maternal cardio-metabolic health in the year following the birth of a child

Intimate partner relationship quality during the child-bearing years has implications for maternal health. The purpose of this study was to test whether partner satisfaction, partner conflict, and their interaction predicted maternal cardio-metabolic health at 12-months postpartum. Women were recruited in 5 U.S. sites. Partner conflict and satisfaction were measured at 6-months postpartum, and cardio-metabolic indicators (blood pressure, waist-hip ratio, glycosylated hemoglobin, total cholesterol:HDL ratio) were assessed at 6- and 12-months. Cardio-metabolic indices were scored continuously (CM risk) and using clinical risk cutoffs (CM scores). A significant conflict-by-satisfaction interaction emerged for the CM risk, b(SE) = .043 (.016), p = .006, and CM scores, b(SE)= .089 (.028), p = .002, such that when partner satisfaction was low, low partner conflict was associated with poorer postpartum cardio-metabolic health. This is the first study to examine close relationships and cardio-metabolic health during the child-bearing years, an issue warranting further attention.

Prevalence of metabolic syndrome risk factors and their relationships with renal function in Chinese centenarians

As the first time, this study was to investigate the prevalence of metabolic syndrome (MetS) risk factors and explore their relationships with renal function in Chinese centenarians. China Hainan Centenarian Cohort Study was performed in 18 cities and counties of Hainan Province. Home interview, physical examination and blood analysis were performed in 874 centenarians following standard procedures. Prevalence of MetS was 15.6% (136 centenarians). There were 229 centenarians with abdominal obesity (26.2%), 645 centenarians (73.8%) with hypertension, 349 centenarians with dyslipidemia (39.9%) and 92 centenarians with diabetes mellitus (10.5%). In multivariate linear regression, age, smoking, waist circumstance (WC), systolic blood pressure (SBP) and triglyceride levels were inversely and diastolic blood pressure (DBP) levels were positively associated with glomerular filtration rate levels (P < 0.05 for all). This study reported low prevalence of MetS risk factors and demonstrated that age, smoking, abdominal obesity (WC), hypertension (SBP and DBP) and triglyceride levels were independently associated with renal function in Chinese centenarians. This study provided reliable data about Chinese centenarians, analyzed significant relationships between Mets risk factors and renal function, and explained possible reason (low prevalence of MetS and its risk factors) and mechanism (interrelationship of age, Mets risk factors with renal function) of longevity.

Dairy food consumption is associated with a lower risk of the metabolic syndrome and its components: a systematic review and meta-analysis

A systematic review and a meta-analysis of observational studies were performed to assess the dose–response relationship between specific types of dairy foods and the risk of the metabolic syndrome (MetS) and its components. Studies of dairy foods and the risk of the MetS and its components published up to June 2016 were searched using PubMed, EMBASE and a reference search. Random-effects models were used to estimate the pooled relative risks (RR) with 95 % CI. Finally, ten cross-sectional studies, two nested case–control studies and twenty-nine cohort studies were included for the analysis. In a dose–response analysis of cohort studies and cross-sectional studies, the pooled RR of the MetS for a one-serving/d increment of total dairy food (nine studies) and milk (six studies) consumption (200 g/d) were 0·91 (95 % CI 0·85, 0·96) and 0·87 (95 % CI 0·79, 0·95), respectively. The pooled RR of the MetS for yogurt (three studies) consumption (100 g/d) was 0·82 (95 % CI 0·73, 0·91). Total dairy food consumption was associated with lower risk of MetS components, such as hyperglycaemia, elevated blood pressure, hypertriacylglycerolaemia and low HDL- cholesterol. A one-serving/d increment of milk was related to a 12 % lower risk of abdominal obesity, and a one-serving/d increment of yogurt was associated with a 16 % lower risk of hyperglycaemia. These associations were not significantly different by study design, study location or adjustment factors. This meta-analysis showed that specific types of dairy food consumption such as milk and yogurt as well as total dairy food consumption were inversely related to risk of the MetS and its components.

Higher risk of hepatocellular carcinoma in Hispanic patients with hepatitis C cirrhosis and metabolic risk factors

The effect of metabolic syndrome on chronic liver diseases other than non-alcoholic fatty liver disease has not been fully elucidated. Our goal was to evaluate if metabolic syndrome increased the risk of liver-related complications, specifically hepatocellular carcinoma (HCC) and decompensation, in cirrhotic chronic hepatitis C (CHC) patients. We conducted a retrospective cohort study of 3503 consecutive cirrhotic CHC patients seen at Stanford University from 1997–2015. HCC developed in 238 patients (8-year incidence 21%) and hepatic decompensation in 448 patients (8-year incidence 61%). The incidence of HCC and decompensation increased with Hispanic ethnicity, diabetes, and number of metabolic risk factors. Multivariate Cox regression analysis demonstrated that, independent of HCV therapy and cure and other background risks, Hispanic ethnicity with ≥2 metabolic risk factors significantly increased the risk of HCC and hepatic decompensation. There was no interaction between Hispanic ethnicity and metabolic risk factors. All in all, metabolic risk factors significantly increase the risk of liver-related complications in cirrhotic CHC patients, especially HCC among Hispanics. As the prevalence of metabolic syndrome increases globally, targeted health interventions are needed to help curb the effects of metabolic syndrome in CHC patients.

Cardiorespiratory Fitness Is Inversely Associated With Clustering of Metabolic Syndrome Risk Factors: The Ball State Adult Fitness Program Longitudinal Lifestyle Study

Objective

The focus of this study was the association between the metabolic syndrome (MetSyn) and cardiorespiratory fitness (CRF) defined as maximal oxygen uptake (VO_2max). Although previous research has shown a relationship between MetSyn and CRF, most studies are based on less objective measures of CRF and different cardiometabolic risk factor thresholds from earlier guidelines.

Participants and Methods

The metabolic markers included in the present study were central obesity, elevated plasma triglycerides, elevated fasting high-density lipoprotein cholesterol, impaired fasting plasma glucose, hypertension, or pharmacologic treatment for diagnosed hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, or diabetes. A cohort of 3636 adults (1629 women, 2007 men; mean ± SD age, 44.7±12.3 years) completed CRF and metabolic risk factor assessment between January 1, 1971, and November 1, 2016. The CRF was defined as a measured VO_2max from a cardiopulmonary exercise test on a treadmill, with a respiratory exchange ratio value of 1.0 or more.

Results

Prevalence of MetSyn (≥3 factors) was 26% (n=953) in the cohort, with men having a greater likelihood for MetSyn compared with women (P<.001). The difference in VO_2max between those individuals with MetSyn and those without was approximately 2.3 (2.0-2.5) metabolic equivalents. Logistic regression analyses showed a significant inverse and graded association between quartiles of CRF and MetSyn for the group overall (P<.001), with odds ratios (95% CI) using the lowest fitness group as the referent group of 0.67 (0.55-0.81), 0.41 (0.34-0.51), and 0.10 (0.07-0.14) for VO_2max (P<.001). The sex-specific odds ratios were 0.25 (0.18-0.34), 0.05 (0.02-0.10), and 0.02 (0.01-0.09) for women and 0.43 (0.31-0.59), 0.19 (0.14-0.27), and 0.03 (0.02-0.05) for men (P<.001).

Conclusion

These results with current risk factor thresholds and a large number of women demonstrate that low VO_2max is associated with MetSyn.

Does Metabolic Syndrome Determine Severity and Disability of Chronic Low Backache?

Introduction:

Obesity may be associated with more severe and disabling low backache (LBA) due to alteration in biomechanics, but there are no such studies from developing countries.

Aims:

We report the frequency of metabolic syndrome (MS) in chronic LBA (CLBA) and its association with severity and disability of CLBA.

Subjects and Methods:

Consecutive patients with CLBA attending to the neurology service from October 2015 to February 2016 were included in the study. Clinical and demographic parameters were recorded. Routine biochemical test was done. The severity of pain was assessed by a 0–10 Numeric Rating Scale (NRS) and disability by Oswestry Disability Index (ODI) version 2. Comparison of variables was done by Chi-square or independent t-test and correlation by Karl Pearson or Spearman's rank correlation test.

Results:

Seventy-none (39.3%) patients had MS as per the International Diabetic Federation (IDF) criteria and 68 (33.8%) as per the National Cholesterol Education Program Adult Treatment Panel III criteria. Abdominal obesity was the most common (171 [85.1%]) feature of MS. The patients with MS had longer duration of sitting work and did less frequently exercise. The NRS score (6.95 ± 1.06 vs. 6.65 ± 0.95; P = 0.04) and ODI score (54.91 ± 8.42 vs. 51.89 ± 8.54; P = 0.01) were higher in CLBA patients with MS compared to those without MS.

Conclusion:

About 40% patients with CLBA have metabolic syndrome, and they have more severe pain and disability.

Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome

BACKGROUND AND AIMS

Exercise is beneficial to individuals with metabolic syndrome (MetS). An understudied group, who represent the majority of the MetS population, are individuals who have not developed diabetes. This review examined aerobic, resistance and combined (aerobic + resistance) exercise for cardiovascular risk factors in MetS without diabetes.

METHODS

Eight electronic databases were searched up to September 2017 for randomised controlled trials >4 weeks in duration that compared an exercise intervention to the non-exercise control in MetS without diabetes. MetS criteria, cardiorespiratory fitness and cardiovascular risk factors were meta-analysed in a random effects model.

RESULTS

Eleven studies with 16 interventions were included (12 aerobic, 4 resistance). Aerobic exercise significantly improved waist circumference -3.4 cm (p < 0.01), fasting glucose -0.15 mmol/L (p = 0.03), high-density cholesterol 0.05 mmol/L (p = 0.02), triglycerides -0.29 mmol/L (p < 0.01), diastolic blood pressure -1.6 mmHg (p = 0.01), and cardiorespiratory fitness 4.2 ml/kg/min (p < 0.01), among other outcomes. No significant effects were determined following resistance exercise possibly due to limited data. Sub-analyses suggested that aerobic exercise progressed to vigorous intensity, and conducted 3 days/week for ≥12 weeks offered larger and more widespread improvements.

CONCLUSIONS

Aerobic exercise following current guidelines offers widespread benefits to individuals with MetS without diabetes. More studies on resistance/combined exercise programs in MetS are required to improve the quality of evidence.

Clinical and Body Compositional Factors Associated with Metabolic Syndrome in Obese Koreans: A Cross-Sectional Study

BACKGROUND

Obesity and metabolic syndrome (MetS) are increasing rapidly worldwide, but metabolically healthy population exists. Thus, this study evaluated the proportion of obesity and MetS and investigated clinical and body compositional factors associated with MetS in obese Koreans.

METHODS

This cross-sectional observational study enrolled subjects from the Korea National Health and Nutrition Examination Survey (n = 15,408). Obesity was defined by body mass index (BMI) cutoff points of 25 and 27.5 kg/m². Clinical and laboratory parameters were compared by MetS presence and factors associated with insulin resistance or MetS in obese subjects were evaluated by multivariate or logistic regression analyses.

RESULTS

The proportion of obesity was 29.7% at a BMI cutoff point of 25 kg/m² and 10.4% at 27.5 kg/m². The proportion of MetS was greater in obese population and increased with higher obesity cutoff point, where men were more prevalent than women. The subjects with MetS showed higher age, glycated hemoglobin, insulin resistance, liver enzymes, and ferritin compared with metabolically healthy population in both obese genders. Factors associated with insulin level or presence of MetS were high trunk fat percentage, trunk-to-limb fat ratio, and trunk-to-leg fat ratio, but low limb fat percentage and leg fat percentage. Among body composition indices, trunk-to-limb fat ratio and trunk-to-leg fat ratio showed significantly high odds ratios for MetS in both obese genders regardless of BMI cutoff points.

CONCLUSIONS

MetS in obese population concurrently increased with higher obesity cutoff point. Higher age, insulin resistance, liver enzymes, ferritin, and higher proportion of truncal fat mass-to-limb or leg fat mass significantly contribute to MetS, where trunk-to-limb fat ratio and trunk-to-leg fat ratio could be helpful in identifying and preventing MetS in the obese Korean population.

Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD

NAFLD is a global epidemic. The prevalence of NAFLD is 20-30% in North America, northern Europe, Australia, Japan, India and China. It is crucial that patients with NAFLD receive an assessment for their risk of advanced fibrosis, which increases the risk of hepatocellular carcinoma and other complications of cirrhosis. Risk stratification that is efficient, cost-effective, patient-centred and evidence-based is one of the most important issues facing clinicians who care for those with liver disease. Given patients' preference to avoid liver biopsy, noninvasive alternatives to assess liver fibrosis are in high demand. The most accurate noninvasive methods are based on liver elastography. Research on these techniques - which include vibration-controlled transient elastography (VCTE), magnetic resonance elastography (MRE), shear-wave elastography and acoustic radiation force impulse - has proliferated. Unfortunately, the literature has not kept pace with clinical practice. There is limited guidance for how clinicians should anticipate and manage the pitfalls of these tests. Furthermore, guidance is unavailable for clinicians regarding the optimal incorporation of VCTE, MRE or the emerging elastographic techniques into their clinical strategy, particularly for patients with NAFLD. In this Review, we summarize the available evidence, highlight gaps to address in further research and explore optimization of these techniques in clinical practice.

HOMBRE: A randomized controlled trial to compare two approaches to weight loss for overweight and obese Latino men (Hombres con Opciones para Mejorar el Bienestar y bajar el Riesgo de Enfermedades crónicas; men with choices to improve well-being and decrease chronic disease risk)

Latino men bear a disproportionate burden of obesity, diabetes, and cardiovascular disease.However, limited behavioral lifestyle intervention research has focused on Latino men. This trial compares two approaches to weight loss for overweight and obese Latino men: 1) HOMBRE is a culturally adapted intervention that provides individual choice of either self-directed online videos, coach-facilitated in-person groups, and coach-facilitated online groups; and 2) a minimal intensity intervention that uses online videos with a coach available, if solicited by the participant.Latino men with a Body Mass Index (BMI) of ≥27 kg/m2 and one or more cardiometabolic risk factors (n = 424) will be randomly assigned to receive one of the two approaches.The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guides the planned evaluations.The primary aim is to determine the effectiveness of the HOMBRE intervention (the "E" in RE-AIM) on clinically significant weight loss (≥5% of baseline weight) at 18 months. We hypothesize that a significantly higher proportion of HOMBRE participants will maintain ≥5% of weight loss compared with those in the minimal intensity intervention.Secondary aims are to determine the effectiveness of HOMBRE on cardiometabolic risk factors (e.g., blood pressure, waist circumference), health behaviors (e.g., diet and physical activity), and psychosocial well-being (e.g., quality of life and depressive symptoms) and to evaluate the other attributes of RE-AIM. These findings have real word applicability with value to clinicians, patients, and other decision makers considering effective diabetes prevention programs for Latino men in primary care.

Dietary Total Antioxidant Capacity and Dietary Polyphenol Intake and Prevalence of Metabolic Syndrome in Polish Adults: A Nationwide Study

Specific classes and subclasses of polyphenols have been studied for their potential effects on noncommunicable diseases, but studies on association between dietary polyphenol intake (DPI) and dietary total antioxidant capacity (DTAC) and MetS (metabolic syndrome) are scarce. Therefore, the aim of this study was to determine associations between DTAC and DPI and the prevalence of MetS and its components in the Polish adult population. Subjects (5690) were participants of the Polish National Multicentre Health Examination Survey (WOBASZ II study) performed in 2013-2014. MetS was defined according to the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Daily food consumption was assessed by 24-hour dietary recall. DTAC and DPI were evaluated using the data of food consumption and antioxidant potential of foods, measured by FRAP (ferric reducing antioxidant potential) method, and total polyphenol content in foods, measured by Folin-Ciocalteu assay. Logistic regression models were used to assess the relationship between DTAC and DPI and MetS and its components. Crude, age-adjusted, and multivariable-adjusted models were performed. This study demonstrated that in Polish women, high DPI and high DTAC were significantly associated with a reduced odds ratio for the prevalence of MetS components, such as elevated blood pressure and diabetes. In contrast, in men, high DPI and high DTAC did not have the potential to alleviate MetS components.

The Antiepileptic Ketogenic Diet Alters Hippocampal Transporter Levels and Reduces Adiposity in Aged Rats

Nutritional ketosis is induced by high fat/low carbohydrate dietary regimens, which produce high levels of circulating ketone bodies, shifting metabolism away from glucose utilization. While ketogenic diets (KD) were initially introduced to suppress seizures, they are garnering attention for their potential to treat a myriad of neurodegenerative and metabolic disorders that are associated with advanced age. The feasibility and physiological impact of implementing a long-term KD in old animals, however, has not been systematically examined. In this study, young and aged rats consumed a calorically- and nutritionally-matched KD or control diet for 12 weeks. All KD-fed rats maintained higher levels of BHB and lower levels of glucose relative to controls. However, it took the aged rats longer to reach asymptotic levels of BHB compared to young animals. Moreover, KD-fed rats had significantly less visceral white and brown adipose tissue than controls without a loss of lean mass. Interestingly, the KD led to significant alterations in protein levels of hippocampal transporters for monocarboxylates, glucose, and vesicular glutamate and gamma-aminobutyric acid. Most notably, the age-related decline in vesicular glutamate transporter expression was reversed by the KD. These data demonstrate the feasibility and potential benefits of KDs for treating age-associated neural dysfunction.

Pathways of Health and Human Capital from Adolescence into Young Adulthood

Social inequalities in health and human capital are core concerns of sociologists, but little research examines the developmental stage when such inequalities are likely to emerge-the transition to adulthood. With new data and innovative statistical methods we conceptually develop, and empirically operationalize, pathways of physical health and human capital accumulation from adolescence into young adulthood, using an autoregressive cross-lagged structural equation model. Results reveal that pathways of health and human capital accumulate at differential rates across the transition to adulthood; evidence of cross-lagged effects lend support for both social causation and health selection hypotheses. We then apply this model to assess the presence of social inequality in metabolic syndrome-the leading risk factor of cardiovascular disease in the U.S. Findings document social stratification of cardiovascular health that is robust to both observed and unobserved social and health selection mechanisms. We speculate that this social stratification will only increase as this cohort ages.

Mind-Body Therapies for African-American Women at Risk for Cardiometabolic Disease: A Systematic Review

Background

A major determinant in cardiometabolic health is metabolic syndrome (MetS), a cluster of symptoms that portend the development of cardiovascular disease (CVD). As mind-body therapies are thought to help in lowering physiological and environmental CVD risk factors including blood pressure and psychological stress, they may also be beneficial for the primary prevention of CVD.

Objectives

To synthesize and summarize existing knowledge on the effectiveness of mind-body therapies on MetS outcomes in African-American (AA) women, a US subpopulation at high risk for CVD.

Search Methods

A systematic search of eight databases was conducted in order to identify published papers addressing the topic. We included trials involving AA adult women, ages 18–64, and we included RCTs that involved multifactorial interventions. Outcomes of interest were MetS, chronic disease, and CVD risk factors (blood pressure, blood lipids, blood glucose, BMI, waist circumference, and mental health domains). Two authors independently selected trials for inclusion, extracted data, and assessed risks of bias.

Main Results

We identified five trials for inclusion in this review. One study reported outcomes associated with the full MetS symptom cluster. The included trials were small, short term, and at high risk of bias. All interventions lasted at least 6 weeks.