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Wong THT, George ES, Abbott G, Daly RM, Georgousopoulou EN, Tan SY. Nut and seed consumption is inversely associated with metabolic syndrome in females but not males: findings from the 2005-2018 NHANES data. Eur J Nutr 2023; 62:2415-2427. [PMID: 37115204 PMCID: PMC10421777 DOI: 10.1007/s00394-023-03157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To assess the association between nut and seed consumption, both combined and separately, and metabolic syndrome and its components, including fasting glucose, triglycerides, high-density lipoprotein (HDL) cholesterol, central obesity, and blood pressure. METHODS This cross-sectional analysis used data from 22,687 adults (aged ≥ 18 years) involved in seven cycles (2005-2018) of the National Health and Nutrition Examination Survey (NHANES). Habitual nut and seed intakes were estimated by the Multiple Source Method using data from two 24-h dietary recalls. Metabolic syndrome was ascertained using biochemical data and self-reported medication use. Sex-specific effect estimates were obtained using logistic and linear regressions adjusting for lifestyle and socioeconomic confounders. RESULTS Compared to non-consumers, female, but not male, habitual consumers of either nuts or seeds had lower odds of having metabolic syndrome (OR: 0.83, 95% CI 0.71, 0.97). Both nut intake alone and seed intake alone were inversely associated with high fasting glucose and low HDL-cholesterol in females compared to non-consumers. When restricted to habitual consumers only, the combined intake of nuts and seeds at 6 g/day was associated with the lowest triglycerides and highest HDL-cholesterol in females. Combined consumption of nuts and seeds up to one ounce-equivalent (15 g) per day, but not in higher intake levels, was inversely associated with metabolic syndrome, high fasting glucose, central obesity, and low HDL-cholesterol in females. CONCLUSIONS Nut and seed consumption, both separately or combined, below 15 g/day was inversely associated with metabolic syndrome and its component conditions in females but not males.
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Affiliation(s)
- Tommy H T Wong
- School of Public Health, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Elena S George
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | | | - Sze-Yen Tan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
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152
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Zakynthinos GE, Tsolaki V, Oikonomou E, Vavouranakis M, Siasos G, Zakynthinos E. Metabolic Syndrome and Atrial Fibrillation: Different Entities or Combined Disorders. J Pers Med 2023; 13:1323. [PMID: 37763092 PMCID: PMC10533132 DOI: 10.3390/jpm13091323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Obesity, hypertension, insulin resistance, and dyslipidemia are all clusters of an entity called "Metabolic Syndrome". The global trends of this syndrome's incidence/prevalence continue to increase reciprocally, converting it into a massive epidemic problem in the medical community. Observing the risk factors of atrial fibrillation, a medical condition that is also converted to a scourge, almost all parts of the metabolic syndrome are encountered. In addition, several studies demonstrated a robust correlation between metabolic syndrome and the occurrence of atrial fibrillation. For atrial fibrillation to develop, a combination of the appropriate substrate and a trigger point is necessary. The metabolic syndrome affects the left atrium in a multifactorial way, leading to atrial remodeling, thus providing both the substrate and provoking the trigger needed, which possibly plays a substantial role in the progression of atrial fibrillation. Due to the remodeling, treatment of atrial fibrillation may culminate in pernicious sequelae, such as repeated catheter ablation procedures. A holistic approach of the patient, with simultaneous treatment of both entities, is suggested in order to ensure better outcomes for the patients.
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
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153
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Huang O, Wu D, Ji M. Early pregnancy exposure of maternal triglyceride levels and its effects on birth weight. J Pediatr Endocrinol Metab 2023; 36:753-760. [PMID: 37434499 DOI: 10.1515/jpem-2023-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the early pregnancy exposure of maternal triglyceride (mTG) and its effects on birth weight, which was an important indicator for nutritional status of newborns, and even its long-term health. METHODS A retrospective cohort study was designed to investigate the relationship between mTG in early pregnancy and birth weight. Totally 32,982 women who had a singleton pregnancy and underwent serum lipids screening during early pregnancy were included in this study. Logistic regressions were used to evaluate the correlations between mTG levels and small for gestational age (SGA) or large for gestational age (LGA), and the restricted cubic spline models were applied to explore the dose-response relationship. RESULTS The increased mTG levels during early pregnancy decreased the risk of SGA and increased the risk of LGA. The high mTG (>90th, 2.05 mM) was showed associated with higher risk of LGA (AOR, 1.35; 95 %CI, 1.20 to 1.50), and lower risk of SGA (AOR, 0.78; 0.68 to 0.89). Lower risk of LGA (AOR, 0.81; 0.70 to 0.92) was found in those cases of low mTG (<10th, 0.81 mM), but no correlation was found between low mTG levels and the risk of SGA. The results remained robust after excluding women with high or low body mass index (BMI) and pregnancy complications. CONCLUSIONS This study suggested that early pregnancy exposure of mTG were related to the occurrence of SGA and LGA. mTG levels higher than 2.05 mM (>90th) were suggested to be avoid because of its risk for LGA, while mTG lower than 0.81 mM (<10th) showed its benefits for ideal birthweight range.
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Affiliation(s)
- Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Dandan Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, P.R. China
| | - Min Ji
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- School of Medicine, The International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, P.R. China
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154
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Ben-Assayag H, Brzezinski RY, Berliner S, Zeltser D, Shapira I, Rogowski O, Toker S, Eldor R, Shenhar-Tsarfaty S. Transitioning from having no metabolic abnormality nor obesity to metabolic impairment in a cohort of apparently healthy adults. Cardiovasc Diabetol 2023; 22:226. [PMID: 37633936 PMCID: PMC10463945 DOI: 10.1186/s12933-023-01954-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION The global prevalence of metabolic syndrome and its association with increased morbidity and mortality has been rigorously studied. However, the true prevalence of "metabolic health", i.e. individuals without any metabolic abnormalities is not clear. Here, we sought to determine the prevalence of "metabolically healthy" individuals and characterize the "transition phase" from metabolic health to development of dysfunction over a follow-up period of 5 years. METHODS We included 20,507 individuals from the Tel Aviv Sourasky Medical Center Inflammation Survey (TAMCIS) which comprises apparently healthy individuals attending their annual health survey. A second follow-up visit was documented after 4.8 (± 0.6) years. We defined a group of metabolically healthy participants without metabolic abnormalities nor obesity and compared their characteristics and change in biomarkers over time to participants who developed metabolic impairment on their follow-up visit. The intersections of all metabolic syndrome components and elevated high sensitivity C-reactive protein (hs-CRP) were also analyzed. RESULTS A quarter of the cohort (5379 individuals, (26.2%) did not fulfill any metabolic syndrome criteria during their baseline visit. A total of 985 individuals (12.7% of returning participants) developed metabolic criteria over time with hypertension being the most prevalent component to develop among these participants. Individuals that became metabolically impaired over time demonstrated increased overlap between metabolic syndrome criteria and elevated hs-CRP levels. The group that became metabolically impaired over time also presented higher delta values of WBC, RBC, liver biomarkers, and uric acid compared with participants who were consistently metabolically impaired. LDL-C (low-density lipoprotein cholesterol) delta levels were similar. CONCLUSIONS Roughly one-quarter of apparently healthy adults are defined as "metabolically healthy" according to current definitions. The transition from health to metabolic dysfunction is accompanied with active inflammation and several non-metabolic syndrome biomarkers. Aggressive screening for these biomarkers, blood pressure and hs-CRP might help identify apparently healthy individuals at increased risk of developing metabolic syndrome over time.
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Affiliation(s)
- Hadas Ben-Assayag
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Rafael Y Brzezinski
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - David Zeltser
- Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itzhak Shapira
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Ori Rogowski
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
| | - Sharon Toker
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Roy Eldor
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel
- Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shani Shenhar-Tsarfaty
- Department of Internal Medicine "C", "D" & "E", Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
- Affiliated with Sackler Faculty of Medicine, The Tel Aviv University, Tel Aviv, Israel.
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155
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Choo JM, Murphy KJ, Wade AT, Wang Y, Bracci EL, Davis CR, Dyer KA, Woodman RJ, Hodgson JM, Rogers GB. Interactions between Mediterranean Diet Supplemented with Dairy Foods and the Gut Microbiota Influence Cardiovascular Health in an Australian Population. Nutrients 2023; 15:3645. [PMID: 37630835 PMCID: PMC10459086 DOI: 10.3390/nu15163645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
The impact of a Mediterranean diet on the intestinal microbiome has been linked to its health benefits. We aim to evaluate the effects of a Mediterranean diet supplemented with dairy foods on the gut microbiome in Australians at risk of cardiovascular disease. In a randomised controlled cross-over study, 34 adults with a systolic blood pressure ≥120 mmHg and with risk factors for cardiovascular disease were randomly allocated to a Mediterranean diet with 3-4 daily serves of dairy foods (Australian recommended daily intake (RDI) of 1000-1300 mg per day (MedDairy)) or a low-fat (LFD) control diet. Between each 8-week diet, participants underwent an 8-week washout period. Microbiota characteristics of stool samples collected at the start and end of each diet period were determined by 16S rRNA amplicon sequencing. MedDairy-associated effects on bacterial relative abundance were correlated with clinical, anthropometric, and cognitive outcomes. No change in the overall faecal microbial structure or composition was observed with either diet (p > 0.05). The MedDairy diet was associated with changes in the relative abundance of several bacterial taxa, including an increase in Butyricicoccus and a decrease in Colinsella and Veillonella (p < 0.05). Increases in Butyricicoccus relative abundance over 8 weeks were inversely correlated with lower systolic blood pressure (r = -0.38, p = 0.026) and positively correlated with changes in fasting glucose levels (r = 0.39, p = 0.019), specifically for the MedDairy group. No significant associations were observed between the altered taxa and anthropometric or cognitive measures (p > 0.05). Compared to a low-fat control diet, the MedDairy diet resulted in changes in the abundance of specific gut bacteria, which were associated with clinical outcomes in adults at risk of CVD.
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Affiliation(s)
- Jocelyn M. Choo
- Microbiome Research and Host Health, Lifelong Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (J.M.C.); (G.B.R.)
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Karen J. Murphy
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Alexandra T. Wade
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Yanan Wang
- CSIRO MOSH-Future Science Platform, Health & Biosecurity, Adelaide, SA 5001, Australia;
| | - Ella L. Bracci
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Courtney R. Davis
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; (A.T.W.); (E.L.B.); (C.R.D.)
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Kathryn A. Dyer
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia;
| | - Jonathan M. Hodgson
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia;
- Medical School, University of Western Australia, 35 Stirling Highway, Perth, WA 6000, Australia
| | - Geraint B. Rogers
- Microbiome Research and Host Health, Lifelong Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; (J.M.C.); (G.B.R.)
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
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156
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Zhang X, Zhang J, Liu F, Li W, Zhang T, Fang B, Zhang Z, Xie Q, Yang Y, Li X. Prognostic Nutritional Index (PNI) as a Predictor in Patients with Metabolic Syndrome and Heart Failure. Diabetes Metab Syndr Obes 2023; 16:2503-2514. [PMID: 37614379 PMCID: PMC10443633 DOI: 10.2147/dmso.s420924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
Purpose There is a lack of research on nutritional status and poor prognosis in patients with metabolic syndrome and heart failure. This study evaluated the relationship between nutritional status as defined by the PNI and adverse outcomes in patients with metabolic syndrome and heart failure. Methods A total of 1048 heart failure patients with metabolic syndrome admitted to the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2019 were consecutively. PNI was used to assess their nutritional status. Results A total of 51.0% of the patients were in the nonmalnutrition group (PNI≥45), 27.9% were in the mild malnutrition group (40≤PNI<45), and 21.1% of patients were in the malnutrition group (PNI<40). At 36 months of follow-up, after adjusting for other confounding factors, malnutrition (PNI<40) was independently associated with all-cause death (HR: 1.787, 95% CI: 1.451-2.201, P<0.001) and cardiovascular death (HR: 1.837, 95% CI: 1.467-2.301, P<0.001). PNI showed additional prognostic predictive value when included in the established risk factor model, both for all-cause death (AUC: 0.620, 95% CI: 0.579-0.661, P<0.001) and cardiovascular death (AUC: 0.596, 95% CI: 0.555-0.636, P<0.001). Conclusion In patients with metabolic syndrome and heart failure, malnutrition assessed by PNI is an independent predictor for all-cause death and cardiovascular death, and PNI is negatively correlated with the occurrence of adverse outcomes.
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Affiliation(s)
- Xuehe Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Jixin Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Wenling Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Tong Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Binbin Fang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Zhiyang Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Qian Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yining Yang
- Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
| | - Xiaomei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
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157
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Park HM, Han TH, Kwon YJ, Lee JH. Oxidative balance score inversely associated with the prevalence and incidence of metabolic syndrome: analysis of two studies of the Korean population. Front Nutr 2023; 10:1226107. [PMID: 37654473 PMCID: PMC10466805 DOI: 10.3389/fnut.2023.1226107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pro-oxidant/antioxidant imbalances leading to chronic inflammation and insulin resistance can contribute to the development of metabolic syndrome (MetS). Oxidative Balance Score (OBS), a comprehensive measure of exposure to pro- and anti-oxidants, represents an individual's total oxidative balance. This study aimed to evaluate the association between OBS and MetS using two large datasets. Methods We analyzed data from 2,735 adults older than 19 years from the 2021 Korean National Health and Nutritional Examination Survey (KNHANES) and 5,807 adults aged 40-69 years from the Korean Genome and Epidemiology Study (KoGES). In each dataset, OBS was categorized into sex-specific tertiles (T). Results In KNHANES, the odds ratios and 95% confidence intervals for prevalent MetS in T3, compared to T1, were 0.44 (0.29-0.65) in men and 0.34 (0.23-0.50) in women after adjusting for confounders. In KoGES, the hazard ratios and 95% confidence intervals for incident MetS in T3, compared to T1, were 0.56 (0.48-0.65) in men and 0.63 (0.55-0.73) in women after adjusting for confounders. Conclusion OBS appears to be inversely related to MetS, which suggests that adopting lifestyle behaviors that decrease oxidative stress could be an important preventive strategy for MetS.
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Affiliation(s)
- Hye-Min Park
- Primary Care Research Center, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Tea-Hwa Han
- Health-IT Center, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | - Yu-Jin Kwon
- Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jun-Hyuk Lee
- Department of Family Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
- Department of Medicine, Hanyang University School of Medicine, Seoul, Republic of Korea
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158
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Arrue A, Olivas O, Erkoreka L, Alvarez FJ, Arnaiz A, Varela N, Bilbao A, Rodríguez JJ, Moreno-Calle MT, Gordo E, Marín E, Garcia-Cano J, Saez E, Gonzalez-Torres MÁ, Zumárraga M, Basterreche N. Multilocus Genetic Profile Reflecting Low Dopaminergic Signaling Is Directly Associated with Obesity and Cardiometabolic Disorders Due to Antipsychotic Treatment. Pharmaceutics 2023; 15:2134. [PMID: 37631349 PMCID: PMC10459305 DOI: 10.3390/pharmaceutics15082134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Treatment with second-generation antipsychotics (SGAs) can cause obesity and other cardiometabolic disorders linked to D2 receptor (DRD2) and to genotypes affecting dopaminergic (DA) activity, within reward circuits. We explored the relationship of cardiometabolic alterations with single genetic polymorphisms DRD2 rs1799732 (NG_008841.1:g.4750dup -> C), DRD2 rs6277 (NG_008841.1:g.67543C>T), COMT rs4680 (NG_011526.1:g.27009G>A), and VNTR in both DRD4 NC_000011.10 (637269-640706) and DAT1 NC_000005.10 (1392794-1445440), as well as with a multilocus genetic profile score (MLGP). A total of 285 psychiatric patients treated with SGAs for at least three months were selected. Cardiometabolic parameters were classified according to ATP-III and WHO criteria. Blood samples were taken for routinely biochemical assays and PCR genotyping. Obesity (BMI, waist (W)), high diastolic blood pressure (DBP), and hypertriglyceridemia (HTG) were present in those genetic variants related to low dopaminergic activity: InsIns genotype in rs1799732 (BMI: OR: 2.91 [1.42-5.94]), DRD4-VNTR-L allele (W: OR: 1.73 [1.04-2.87]) and 9R9R variant in DAT1-VNTR (W: OR: 2.73 [1.16-6.40]; high DBP: OR: 3.33 [1.54-7.31]; HTG: OR: 4.38 [1.85-10.36]). A low MLGP score indicated a higher risk of suffering cardiometabolic disorders (BMI: OR: 1.23 [1.05-1.45]; W: OR: 1.18 [1.03-1.34]; high DBP: OR: 1.22 [1.06-1.41]; HTG: OR: 1.20 [1.04-1.39]). The MLGP score was more sensitive for detecting the risk of suffering these alterations. Low dopaminergic system function would contribute to increased obesity, BDP, and HTG following long-term SGA treatment.
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Affiliation(s)
- Aurora Arrue
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Neurochemical Research Unit, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48903 Barakaldo, Spain
| | - Olga Olivas
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Bizkaia Mental Health Network, Zaldibar Hospital, Osakidetza Basque Health Service, 48250 Zaldibar, Spain
| | - Leire Erkoreka
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Department of Psychiatry, Galdakao-Usánsolo University Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
- Department of Neurosciences, Faculty of Medicine and Dentistry, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Francisco Jose Alvarez
- Research Unit, Cruces University Hospital, Osakidetza Basque Health Service, 48903 Barakaldo, Spain
| | - Ainara Arnaiz
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Erandio Mental Health Center, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48950 Erandio, Spain
| | - Noemi Varela
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Uribe Mental Health Center, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48990 Getxo, Spain
| | - Ainhoa Bilbao
- Animal Research Facility, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Jose-Julio Rodríguez
- Department of Neurosciences, Faculty of Medicine and Dentistry, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Functional Neuroanatomy, BioCruces Bizkaia Health Research Institute, Ikerbasque Basque Foundation for Science, 48903 Barakaldo, Spain
| | - María Teresa Moreno-Calle
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Department of Psychiatry, Galdakao-Usánsolo University Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
| | - Estibaliz Gordo
- Bizkaia Mental Health Network, Zamudio Hospital, Osakidetza Basque Health Service, 48170 Zamudio, Spain
| | - Elena Marín
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Bizkaia Mental Health Network, Bermeo Hospital, Osakidetza Basque Health Service, 48370 Bermeo, Spain
| | - Javier Garcia-Cano
- Alternatives to Hospitalization in Bilbao, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48903 Bilbao, Spain
| | - Estela Saez
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Department of Psychiatry, Galdakao-Usánsolo University Hospital, Osakidetza Basque Health Service, 48960 Galdakao, Spain
| | - Miguel Ángel Gonzalez-Torres
- Department of Neurosciences, Faculty of Medicine and Dentistry, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
- Integrative Research Group in Mental Health, BioCruces Bizkaia Health Research Institute, 48013 Bilbao, Spain
- Department of Psychiatry, Basurto University Hospital, Osakidetza Basque Health Service, 48013 Bilbao, Spain
| | - Mercedes Zumárraga
- Mental Health Network Group, BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain; (O.O.); (L.E.)
- Neurochemical Research Unit, Bizkaia Mental Health Network, Osakidetza Basque Health Service, 48903 Barakaldo, Spain
| | - Nieves Basterreche
- Functional Neuroanatomy, BioCruces Bizkaia Health Research Institute, Ikerbasque Basque Foundation for Science, 48903 Barakaldo, Spain
- Integrative Research Group in Mental Health, BioCruces Bizkaia Health Research Institute, 48013 Bilbao, Spain
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159
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Amini Kahrizsangi M, Jafari F, Najam W, Safarpour AR, Fattahi MR, Nouri M, Ghalandari H, Askarpour M, Hamidian Shirazi M, Amini MR, Akbarzadeh M. Adherence to a healthy diet and odds of metabolic syndrome: A cross-sectional study. Clin Nutr ESPEN 2023; 56:180-186. [PMID: 37344071 DOI: 10.1016/j.clnesp.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a major health concern around the world. Dietary factors, including diet quality, play a significant role in its pathophysiology. Healthy Eating Index (HEI) is a tool used as a valid measurement of the individual's diet quality. We aimed at investigating the relationship between diet quality as assessed by HEI-2015 and the risk of MetS and its components in a cross-sectional sample of suburban individuals from PERSIAN Kavar cohort study (PKCS), Fars province, Iran. METHODS 2225 individuals meeting the eligibility criteria participated in the study. The relevant data were obtained from the baseline phase of PKCS. MetS was defined according to cut-offs presented by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). HEI-2015 was calculated for the included individuals. Odds ratios were estimated. P-values <0.05 were considered as significant. RESULTS The overall prevalence of MetS was 27.3%. Individuals with lower HEI-2015 scores had higher odds for MetS and its components. We observed that those who were categorized as the top HEI-2015 tertile had 42% (OR: 0.58; 95% CI: 0.38-0.90) lower odds of high blood pressure in the overall population. Also, the odds of high serum triacylglycerol was lower (OR: 0.72; 95% CI: 0.57-0.90) in those with the highest HEI-2015 scores. CONCLUSION We found that higher dietary quality measured by HEI will decrease the risk of developing MetS, hypertension, and hypertriglyceridemia among Iranian adults. However, future interventional studies are required to further elucidate the issue.
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Affiliation(s)
- Masoud Amini Kahrizsangi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Jafari
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX, United States
| | - Wasiuddin Najam
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, Lubbock, TX, United States
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Ghalandari
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moein Askarpour
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Hamidian Shirazi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Amini
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Akbarzadeh
- Department of Community Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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160
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Jumare J, Dakum P, Sam-Agudu N, Memiah P, Nowak R, Bada F, Oguama U, Odonye G, Adebiyi R, Cairo C, Kwaghe V, Adebamowo C, Abimiku A, Charurat M. Prevalence and characteristics of metabolic syndrome and its components among adults living with and without HIV in Nigeria: a single-center study. BMC Endocr Disord 2023; 23:160. [PMID: 37507703 PMCID: PMC10375691 DOI: 10.1186/s12902-023-01419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Persons living with HIV (PLHIV) now live longer due to effective combination antiretroviral therapy. However, emerging evidence indicates that they may be at increased risk for some cardiometabolic disorders. We compared the prevalence of metabolic syndrome (MetS) and its component disorders between persons living with and without HIV in Nigeria. METHODS This was a cross-sectional analysis of baseline data from a prospective cohort study of non-communicable diseases among PLHIV along with age- and sex-matched persons without HIV (PWoH) at the University of Abuja Teaching Hospital Nigeria. We collected sociodemographic and clinical data, including anthropometric measures and results of relevant laboratory tests. MetS was defined using a modification of the third report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) criteria. RESULTS Of the 440 PLHIV and 232 PWoH, women constituted 50.5% and 51.3% respectively. The median age of the PLHIV was 45 years while that of the PWoH was 40 years. The prevalence of MetS was 30.7% (95% CI: 26.4%, 35.2%) and 22.8% (95% CI: 17.6%, 28.8%) among the PLHIV and PWoH respectively (P = 0.026). Independent associations were found for older age (P < 0.001), female sex (P < 0.001), family history of diabetes (P < 0.001), family history of hypertension (P = 0.013) and alcohol use (P = 0.015). The prevalence of component disorders for PLHIV versus PWoH were as follows: high blood pressure (22.3% vs 20.3%), prediabetes (33.8% vs 21.1%), diabetes (20.5% vs 8.2%), high triglycerides (24.5% vs 17.2%), low HDL-Cholesterol (51.1% vs 41.4%), and abdominal obesity (38.4% vs 37.1%). Adjusting for age and sex, prediabetes, diabetes, and low HDL-Cholesterol were significantly associated with HIV status. Duration on antiretroviral therapy, protease inhibitor-based regimen, CD4 count, and viral load were associated with some of the disorders mostly in unadjusted analyses. CONCLUSION We found a high burden of MetS and its component disorders, with significantly higher prevalence of dysglycemia and dyslipidemia among PLHIV as compared to PWoH. Integration of strategies for the prevention and management of MetS disorders is needed in HIV treatment settings.
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Affiliation(s)
- Jibreel Jumare
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria.
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Nadia Sam-Agudu
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Peter Memiah
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Rebecca Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Florence Bada
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Uzoamaka Oguama
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - George Odonye
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Ruxton Adebiyi
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Cristiana Cairo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Vivian Kwaghe
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, and Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Alash'le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- International Research Center of Excellence, Institute of Human Virology Nigeria, Federal Capital Territory, Abuja, Nigeria
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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161
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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162
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Fu Z, Lv J, Gao X, Zheng H, Shi S, Xu X, Zhang B, Wu H, Song Q. Effects of garlic supplementation on components of metabolic syndrome: a systematic review, meta-analysis, and meta-regression of randomized controlled trials. BMC Complement Med Ther 2023; 23:260. [PMID: 37481521 PMCID: PMC10362699 DOI: 10.1186/s12906-023-04038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/14/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Garlic (Allium sativum), the underground bulb of the Allium genus, has been consumed on Earth for thousands of years. Many clinical trials of garlic supplementation on components of metabolic syndrome (MetS) have emerged in recent years, but there is no consensus on the effect. This meta-analysis aimed at systematically evaluating the effect of garlic supplementation on components of MetS. METHODS In this meta-analysis, we searched Pubmed, Embase, Cochrane, Medline, Web of Science databases, and clinical trials online sites from inception to November 1, 2022, with language restrictions to English. We engaged participants > 18 years and eligible for the clinical diagnosis of MetS or those with metabolic disorders and garlic was the only intervention. Outcomes included waist circumference, and body mass index, triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, blood pressure, and fasting blood glucose. Meta-regression and subgroup analyses were conducted based on six covariates (total sample size, the mean age, the mean dose, the duration of intervention, the oral form of garlic, and the dietary intervention). RESULTS Results from 19 RCTs were included engaging 999 participants. Compared to placebo, garlic significantly reduced TG [SMD (95%CI) = -0.66 (-1.23, -0.09)], TC [SMD (95%CI) = -0.43 (-0.86, -0.01)], LDL [SMD (95%CI) = -0.44(-0.88, -0.01)], DBP [SMD (95%CI) = -1.33 (-2.14, -0.53)], BMI [SMD (95%CI) = -1.10(-1.90, -0.20)], and WC [SMD (95%CI) = -0.78(-1.09, -0.47)]. Meta-regression showed age and sample size are potential effect modifiers. CONCLUSION According to the results of meta-analysis, the modulatory effect of garlic on some MetS components is evident. More high-quality, large-scale RCTs are needed to confirm iat based on the high heterogeneity and potential publication bias of the current data. TRIAL REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373228 , ID: CRD42022373228.
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Affiliation(s)
- Zhenyue Fu
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Jiayu Lv
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiya Gao
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Haoran Zheng
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Shuqing Shi
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xia Xu
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bingxuan Zhang
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huaqin Wu
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qingqiao Song
- Department of General Internal Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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163
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Bertoluci MC, Silva Júnior WS, Valente F, Araujo LR, Lyra R, de Castro JJ, Raposo JF, Miranda PAC, Boguszewski CL, Hohl A, Duarte R, Salles JEN, Silva-Nunes J, Dores J, Melo M, de Sá JR, Neves JS, Moreira RO, Malachias MVB, Lamounier RN, Malerbi DA, Calliari LE, Cardoso LM, Carvalho MR, Ferreira HJ, Nortadas R, Trujilho FR, Leitão CB, Simões JAR, Dos Reis MIN, Melo P, Marcelino M, Carvalho D. 2023 UPDATE: Luso-Brazilian evidence-based guideline for the management of antidiabetic therapy in type 2 diabetes. Diabetol Metab Syndr 2023; 15:160. [PMID: 37468901 PMCID: PMC10354939 DOI: 10.1186/s13098-023-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond glycemic control. In this context, Brazil and Portugal defined a joint panel of four leading diabetes societies to update the guideline published in 2020. METHODS The panelists searched MEDLINE (via PubMed) for the best evidence from clinical studies on treating T2D and its cardiorenal complications. The panel searched for evidence on antidiabetic therapy in people with T2D without cardiorenal disease and in patients with T2D and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or diabetic kidney disease (DKD). The degree of recommendation and the level of evidence were determined using predefined criteria. RESULTS AND CONCLUSIONS All people with T2D need to have their cardiovascular (CV) risk status stratified and HbA1c, BMI, and eGFR assessed before defining therapy. An HbA1c target of less than 7% is adequate for most adults, and a more flexible target (up to 8%) should be considered in frail older people. Non-pharmacological approaches are recommended during all phases of treatment. In treatment naïve T2D individuals without cardiorenal complications, metformin is the agent of choice when HbA1c is 7.5% or below. When HbA1c is above 7.5% to 9%, starting with dual therapy is recommended, and triple therapy may be considered. When HbA1c is above 9%, starting with dual therapyt is recommended, and triple therapy should be considered. Antidiabetic drugs with proven CV benefit (AD1) are recommended to reduce CV events if the patient is at high or very high CV risk, and antidiabetic agents with proven efficacy in weight reduction should be considered when obesity is present. If HbA1c remains above target, intensification is recommended with triple, quadruple therapy, or even insulin-based therapy. In people with T2D and established ASCVD, AD1 agents (SGLT2 inhibitors or GLP-1 RA with proven CV benefit) are initially recommended to reduce CV outcomes, and metformin or a second AD1 may be necessary to improve glycemic control if HbA1c is above the target. In T2D with HF, SGLT2 inhibitors are recommended to reduce HF hospitalizations and mortality and to improve HbA1c. In patients with DKD, SGLT2 inhibitors in combination with metformin are recommended when eGFR is above 30 mL/min/1.73 m2. SGLT2 inhibitors can be continued until end-stage kidney disease.
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Affiliation(s)
- Marcello Casaccia Bertoluci
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Departamento de Medicina Interna da Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS, 90035-007, Brazil.
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil.
| | - Wellington S Silva Júnior
- Disciplina de Endocrinologia, Departamento de Medicina I, Universidade Federal Maranhão, São Luís, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Fernando Valente
- Faculdade de Medicina do ABC, Santo André, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Levimar Rocha Araujo
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Ruy Lyra
- Universidade Federal de Pernambuco, Recife, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - João Jácome de Castro
- Serviço de Endocrinologia do Hospital Universitário das Forças Armadas, Lisbon, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - João Filipe Raposo
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Paulo Augusto Carvalho Miranda
- Clínica de Endocrinologia e Metabologia da Santa Casa Belo Horizonte, Belo Horizonte, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Cesar Luiz Boguszewski
- Divisão de Endocrinologia (SEMPR), Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Alexandre Hohl
- Departamento de Clínica Médica da Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Rui Duarte
- Associação Protectora dos Diabéticos de Portugal, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - João Eduardo Nunes Salles
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - José Silva-Nunes
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Jorge Dores
- Centro Hospitalar e Universitário de Santo António, Lisbon, Portugal
- Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Miguel Melo
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de Coimbra, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - João Roberto de Sá
- Faculdade de Medicina do ABC, Santo André, Brazil
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - João Sérgio Neves
- Cardiovascular R&D Centre (UnIC@RISE), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de São João, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Rodrigo Oliveira Moreira
- Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil
- Faculdade de Medicina, Centro Universitário Presidente Antônio Carlos (UNIPAC/JF), Juiz de Fora, Brazil
- Faculdade de Medicina, Centro Universitário de Valença (UNIFAA), Valença, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | | | - Rodrigo Nunes Lamounier
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Domingos Augusto Malerbi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Luis Eduardo Calliari
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- Sociedade Brasileira de Diabetes (SBD), São Paulo, Brazil
| | - Luis Miguel Cardoso
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Maria Raquel Carvalho
- Hospital CUF, Tejo, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Hélder José Ferreira
- Clínica Grupo Sanfil Medicina, Coimbra, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Rita Nortadas
- Associação Protectora dos Diabéticos de Portugal, Lisbon, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Fábio Rogério Trujilho
- Faculdade de Medicina da UniFTC, Salvador, Brazil
- Centro de Diabetes e Endocrinologia da Bahia (CEDEBA), Salvador, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - Cristiane Bauermann Leitão
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Departamento de Medicina Interna da Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS, 90035-007, Brazil
- Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), Rio de Janeiro, Brazil
| | - José Augusto Rodrigues Simões
- Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Mónica Isabel Natal Dos Reis
- Unidade Integrada de Diabetes Mellitus do Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
- Sociedade Portuguesa de Diabetologia (SPD), Lisbon, Portugal
| | - Pedro Melo
- Serviço de Endocrinologia, Hospital Pedro Hispano, Matosinhos, Portugal
- Unidade de Endocrinologia, Instituto CUF, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Mafalda Marcelino
- Serviço de Endocrinologia do Hospital Universitário das Forças Armadas, Lisbon, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
| | - Davide Carvalho
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo (SPEDM), Lisbon, Portugal
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Li H, Wang Y, Xue Y, Li Y, Wu H, Wu J. Association of demographics, cardiovascular indicators and disability characteristics with 7-year coronary heart disease incident in persons with disabilities. BMC Public Health 2023; 23:1370. [PMID: 37461023 DOI: 10.1186/s12889-023-16297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Previous studies had demonstrated that disability increases mortality in patients with coronary heart disease (CHD). However, for people who had been disabled but do not have baseline cardiovascular disease, there is still limited data on how they might develop CHD. This study aimed to investigate the incidence and predictors of CHD in people with disabilities. METHODS We conducted a 7-year retrospective study utilizing data from the Shanghai Comprehensive Information Platform for Persons with Disabilities Rehabilitation. Subjects aged over 18 years with at least four annual complete electronic health records were included. The primary outcome was CHD, defined as ischemic heart disease or myocardial infarction. Kaplan-Meier analysis and log-rank tests were used to compare cumulative CHD for sub-populations, stratified by age, gender, and the classification of disabilities. Cox regression was used to identify the potentially important factors. RESULTS Out of 6419 persons with disabilities, 688 CHD cases (mean age 52.95 ± 7.17 years, male 52.2%) were identified, with a cumulative incidence of 10.72% and an incidence density of 15.15/1000 person-years. The incidence density of CHD is higher in the male gender, people over 45 years, and those with physical disabilities. Male (HR = 1.294, 95% CI, 1.111-1.506), hypertension (HR = 1.683, 95% CI, 1.405-2.009), diabetes mellitus (HR = 1.488, 95% CI, 1.140-1.934), total cholesterol (HR = 1.110, 95% CI, 1.023-1.204), and physical disabilities (HR = 1.122, 95% CI, 1.019-1.414) were independently associated with CHD. CONCLUSION The findings indicate that the incidence of CHD differs across disability categories rather than the severity of disability. People with physical disabilities had significantly higher risks for the development of CHD. The underlying physiological and pathological factors need to be further studied.
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Affiliation(s)
- Husheng Li
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yiyan Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yan Xue
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, No. 2209, Guangxing Road, Songjiang District, Shanghai, 201619, China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, No. 2209, Guangxing Road, Songjiang District, Shanghai, 201619, China
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, No. 2209, Guangxing Road, Songjiang District, Shanghai, 201619, China.
| | - Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, No. 1200, Cailun Road, Pudong New District, Shanghai, 201203, China.
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165
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Crocco P, Vecchie D, Gopalkrishna S, Dato S, Passarino G, Young ME, Nagareddy PR, Rose G, De Luca M. Syndecan-4 as a genetic determinant of the metabolic syndrome. Diabetol Metab Syndr 2023; 15:156. [PMID: 37461091 PMCID: PMC10351106 DOI: 10.1186/s13098-023-01132-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Syndecan-4 (SDC4) is a member of the heparan sulfate proteoglycan family of cell-surface receptors. We and others previously reported that variation in the SDC4 gene was associated with several components of the metabolic syndrome, including intra-abdominal fat, fasting glucose and triglyceride levels, and hypertension, in human cohorts. Additionally, we demonstrated that high fat diet (HFD)-induced obese female mice with a Sdc4 genetic deletion had higher visceral adiposity and a worse metabolic profile than control mice. Here, we aimed to first investigate whether the mouse Sdc4 null mutation impacts metabolic phenotypes in a sex- and diet-dependent manner. We then tested whether SDC4 polymorphisms are related to the metabolic syndrome (MetS) in humans. METHODS For the mouse experiment, Sdc4-deficient (Sdc4-/-) and wild-type (WT) mice were treated with 14-weeks of low-fat diet (LFD). Body composition, energy balance, and selected metabolic phenotypes were assessed. For the human genetic study, we used logistic regression models to test 11 SDC4 SNPs for association with the MetS and its components in a cohort of 274 (113 with MetS) elderly subjects from southern Italy. RESULTS Following the dietary intervention in mice, we observed that the effects of the Sdc4 null mutation on several phenotypes were different from those previously reported in the mice kept on an HFD. Nonetheless, LFD-fed female Sdc4-/- mice, but not males, displayed higher levels of triglycerides and lower insulin sensitivity at fasting than WT mice, as seen earlier in the HFD conditions. In the parallel human study, we found that carriers of SDC4 rs2228384 allele C and rs2072785 allele T had reduced risk of MetS. The opposite was true for carriers of the SDC4 rs1981429 allele G. Additionally, the SNPs were found related to fasting triglyceride levels and triglyceride glucose (TyG) index, a reliable indicator of insulin resistance, with sex-stratified analysis detecting the association of rs1981429 with these phenotypes only in females. CONCLUSIONS Altogether, our results suggest that SDC4 is an evolutionary conserved genetic determinant of MetS and that its genetic variation is associated with fasting triglyceride levels in a female-specific manner.
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Affiliation(s)
- Paolina Crocco
- Department of Biology, Ecology, and Earth Sciences, University of Calabria, Rende, 87036, Italy
| | - Denise Vecchie
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Sreejit Gopalkrishna
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Serena Dato
- Department of Biology, Ecology, and Earth Sciences, University of Calabria, Rende, 87036, Italy
| | - Giuseppe Passarino
- Department of Biology, Ecology, and Earth Sciences, University of Calabria, Rende, 87036, Italy
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Prabhakara R Nagareddy
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Giuseppina Rose
- Department of Biology, Ecology, and Earth Sciences, University of Calabria, Rende, 87036, Italy.
| | - Maria De Luca
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
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166
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Xu W, Zhang Z, Hu K, Fang P, Li R, Kong D, Xuan M, Yue Y, She D, Xue Y. Identifying Metabolic Syndrome Easily and Cost Effectively Using Non-Invasive Methods with Machine Learning Models. Diabetes Metab Syndr Obes 2023; 16:2141-2151. [PMID: 37484515 PMCID: PMC10361460 DOI: 10.2147/dmso.s413829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The objective of this study was to employ machine learning (ML) models utilizing non-invasive factors to achieve early and low-cost identification of MetS in a large physical examination population. Patients and Methods The study enrolled 9171 participants who underwent physical examinations at Northern Jiangsu People's Hospital in 2009 and 2019, to determine MetS based on criteria established by the Chinese Diabetes Society. Non-invasive characteristics such as gender, age, body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were collected and used as input variables to train and evaluate ML models for MetS identification. Several ML models were used for MetS identification, including logistic regression (LR), k-nearest neighbors algorithm (k-NN), naive bayesian (NB), decision tree (DT), random forest (RF), artificial neural network (ANN), and support vector machine (SVM). Results Our ML models all showed good performance in the 10-fold cross-validation except for the SVM model. In the external validation, the NB model exhibited the best performance with an AUC of 0.976, accuracy of 0.923, sensitivity of 98.32%, and specificity of 91.32%. Conclusion This study proposed a new non-invasive method for early and low-cost identification of MetS by using ML models. This approach has the potential to serve as a highly sensitive, convenient, and cost-effective tool for large-scale MetS screening.
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Affiliation(s)
- Wei Xu
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Zikai Zhang
- Department of Oncology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Kerong Hu
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Ping Fang
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Ran Li
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Dehong Kong
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Miao Xuan
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Yang Yue
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
| | - Dunmin She
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Department of Endocrinology, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Ying Xue
- Department of Endocrinology and Metabolism, Tongji Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
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Shao Q, Li J, Wu Y, Liu X, Wang N, Jiang Y, Zhao Q, Zhao G. Enhanced Predictive Value of Lipid Accumulation Product for Identifying Metabolic Syndrome in the General Population of China. Nutrients 2023; 15:3168. [PMID: 37513586 PMCID: PMC10383986 DOI: 10.3390/nu15143168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this research was to evaluate the lipid accumulation product (LAP)'s accuracy and predictive value for identifying metabolic syndrome (MS) in the general Chinese population compared with other obesity indicators. Baseline survey information from a population-based cohort study carried out in Shanghai's Songjiang District was used in this research. Odds ratios (OR) and a 95% confidence interval (CI) were obtained by logistic regression. The ability of each variable to detect MS was assessed using the receiver operating characteristic curve (ROC). The optimum cut-off point for each indicator was selected using Youden's index. The survey involved 35,446 participants in total. In both genders, the prevalence of MS rose as the LAP increased (p < 0.001). The LAP's AUC was 0.901 (95%CI: 0.895-0.906) in males and 0.898 (95%CI: 0.893-0.902) in females, making it substantially more predictive of MS than other variables (BMI, WC, WHR, WHtR). The optimal cutoff point of the LAP for men and women was 36.04 (Se: 81.91%, Sp: 81.06%) and 34.95 (Se: 80.93%, Sp: 83.04%). The Youden index of the LAP was 0.64 for both sexes. Our findings imply that the LAP, compared to other obesity markers in China, is a more accurate predictor of MS.
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Affiliation(s)
- Qi Shao
- Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China; (Q.S.); (X.L.); (N.W.); (G.Z.)
| | - Jing Li
- Zhongshan Community Health Center, Shanghai 201613, China;
| | - Yiling Wu
- Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China; (Y.W.); (Y.J.)
| | - Xing Liu
- Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China; (Q.S.); (X.L.); (N.W.); (G.Z.)
| | - Na Wang
- Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China; (Q.S.); (X.L.); (N.W.); (G.Z.)
| | - Yonggen Jiang
- Songjiang District Center for Disease Control and Prevention, Shanghai 201600, China; (Y.W.); (Y.J.)
| | - Qi Zhao
- NHC Key Laboratory of Health Technology Assessment, Department of Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Genming Zhao
- Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China; (Q.S.); (X.L.); (N.W.); (G.Z.)
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168
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Bennett WC, Collins KA, Johnson JL, Slentz CA, Willis LH, Bales CW, Huffman KM, Kraus WE. Effects of exercise amount and intensity versus a combined exercise and lifestyle intervention on metabolic syndrome in adults with prediabetes: a STRRIDE-PD randomized trial. Front Physiol 2023; 14:1199763. [PMID: 37520827 PMCID: PMC10375017 DOI: 10.3389/fphys.2023.1199763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/16/2023] [Indexed: 08/01/2023] Open
Abstract
The purpose of this secondary analysis was to determine what portion of the effects of a Diabetes Prevention Program-like intervention on metabolic syndrome (MetS) could be achieved with exercise alone, as well as to determine the relative importance of exercise intensity and amount to the total exercise effect on MetS. Sedentary, overweight adults with prediabetes were randomly assigned to one of four 6-month interventions: 1) low-amount/moderate-intensity (10 kcal/kg/week at 50% peak V ˙ O 2 ); 2) high-amount/moderate-intensity (16 kcal/kg/week at 50% peak V ˙ O 2 ); 3) high-amount/vigorous-intensity (16 kcal/kg/week at 75% peak V ˙ O 2 ); or 4) diet (7% weight loss) plus low-amount/moderate-intensity (10 kcal/kg/week at 50% peak V ˙ O 2 ). The primary outcome of this secondary analysis was change in the MetS z-score. A total of 130 participants had complete data for all five Adult Treatment Panel (ATP) III MetS criteria. The diet-and-exercise group statistically outperformed the MetS z-score and the ATP III score compared to the exercise alone group. Aerobic exercise alone achieved 24%-50% of the total effect of the combined diet-and-exercise intervention on the MetS score. Low-amount moderate-intensity exercise quantitatively performed equal to or better than the interventions of high-amount moderate-intensity or high-amount vigorous-intensity exercise in improving the MetS score. The combined diet-and-exercise intervention remains more efficacious in improving the MetS z-score. However, all three exercise interventions alone showed improvements in the MetS z-score, suggesting that a modest amount of moderate-intensity exercise is all that is required to achieve approximately half the effect of a diet-and-exercise intervention on the MetS. Clinical Trial Registration: clinicaltrials.gov, identifier NCT00962962.
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Affiliation(s)
- William C. Bennett
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Katherine A. Collins
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Johanna L. Johnson
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Cris A. Slentz
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Leslie H. Willis
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - Connie W. Bales
- Divison of Geriatrics, Department of Medicine, Durham VA Medical Center, Duke University School of Medicine, Durham, NC, United States
| | - Kim M. Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
| | - William E. Kraus
- Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States
- Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
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169
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You M, Ruan CC, Yang Q, Hobkirk JP, Gao P. Editorial: The regulatory role of metabolic organ-secreted factors in the development of cardiovascular diseases. Front Cardiovasc Med 2023; 10:1246912. [PMID: 37522082 PMCID: PMC10374298 DOI: 10.3389/fcvm.2023.1246912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Mei You
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Chongqing Institute of Hypertension, Army Medical University, Chongqing, China
| | - Cheng-Chao Ruan
- State Key Laboratory of Medical Neurobiology, Shanghai Key Laboratory of Bioactive Small Molecules, Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Qiuhua Yang
- Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | | | - Peng Gao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Chongqing Institute of Hypertension, Army Medical University, Chongqing, China
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170
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Ulloque-Badaracco JR, Al-Kassab-Córdova A, Hernandez-Bustamante EA, Alarcon-Braga EA, Huayta-Cortez M, Carballo-Tello XL, Seminario-Amez RA, Herrera-Añazco P, Benites-Zapata VA. Association of apolipoproteins and lipoprotein(a) with metabolic syndrome: a systematic review and meta-analysis. Lipids Health Dis 2023; 22:98. [PMID: 37420190 DOI: 10.1186/s12944-023-01860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND & AIMS Apolipoproteins and lipoprotein(a) are associated with various cardiometabolic diseases, including insulin resistance, diabetes mellitus, hypertension, dyslipidemia, among others. This systematic review and meta-analysis was conducted to evaluate the association of these markers with metabolic syndrome (MetS). METHODS We ran a systematic search through PubMed, Scopus, Embase, Ovid/Medline, and Web of Science on March 15, 2023. No language or date restrictions were applied. The only synthesised effect measure reported was the odds ratio (OR) with its corresponding 95% confidence interval (95% CI). We utilised the random-effects model for the quantitative synthesis. RESULTS We analysed 50 studies (n = 150 519) with different definitions for MetS. Increased ApoB values were associated with MetS (OR = 2.8; 95% CI: 2.44-3.22; p < 0.01, I2 = 99%). Decreased ApoA1 values were associated with MetS (OR = 0.42; 95% CI: 0.38-0.47; p < 0.01, I2 = 99%). Increased values of the ApoB/ApoA1 ratio were associated with MetS (OR = 4.97; 95% CI: 3.83-6.44; p < 0.01, I2 = 97%). Decreased values of Lp(a) were associated with MetS (OR = 0.89; 95% CI: 0.82-0.96; p < 0.01; I2 = 92%). CONCLUSIONS Increased values of ApoB and ApoB/ApoA1 ratio are associated with MetS, while decreased values of ApoA1 and Lp(a) are associated with MetS. These findings suggest that these lipid markers may serve as potential indicators for identifying subjects at risk of developing MetS. However, further research is required to elucidate the underlying mechanisms of these associations.
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Affiliation(s)
| | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Enrique A Hernandez-Bustamante
- Grupo Peruano de Investigación Epidemiológica, Unidad Para La Generación Y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de La Universidad Nacional de Trujillo, Trujillo, Peru
| | | | - Miguel Huayta-Cortez
- Facultad de Ciencias de La Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Rosa A Seminario-Amez
- Facultad de Ciencias de La Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Percy Herrera-Añazco
- Universidad Privada del Norte, Trujillo, Peru
- Red Peruana de Salud Colectiva, Lima, Peru
| | - Vicente A Benites-Zapata
- Vicerrectorado de Investigación, Unidad de Investigación Para La Generación Y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
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Byeon WJ, Lee SJ, Khil TG, Jeong AY, Han BD, Sohn MS, Choi JW, Kim YH. Association between a Marine Healing Program and Metabolic Syndrome Components and Mental Health Indicators. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1263. [PMID: 37512073 PMCID: PMC10384087 DOI: 10.3390/medicina59071263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Metabolic syndrome is a growing health concern globally, and its prevalence continues to increase. This study investigated whether a marine healing program could improve metabolic syndrome indicators and mental health in adults with a metabolic syndrome and those at risk of developing it. Materials and Methods: This study enrolled 30 participants who were assigned to either the experimental or control groups. The duration of the study was set at 4 weeks. Both groups received metabolic syndrome management education, and the experimental group additionally participated in two marine healing programs. Anthropometric indicators, biochemical indicators, and mental health indicators were collected before and after the intervention. Results: The findings indicate that the experimental group had significantly lower systolic blood pressure, triglycerides, and body weight, as well as higher levels of high-density lipoprotein (HDL-C) and uric acid. Mental health indicators (Hospital Anxiety and Depression Scale and quality of life measures) additionally showed improvement. Pre-post comparisons between the experimental group and the control group showed that the experimental group had significantly decreased by 1.05 kg in body weight, whereas the control group increased by 0.29 kg in body weight. In addition, HDL-C decreased by 0.91 mg/dL in the control group and increased by 3.7 mg/dL in the experimental group. Conclusions: Overall, these results suggest that marine healing programs could improve metabolic syndrome indicators such as body weight and HDL-C better than the control treatment.
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Affiliation(s)
- Woo-Jin Byeon
- Department of Public Health, Graduate School, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sung-Jae Lee
- Department of Integrative Medicine, College of Medicine, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Tae-Gyu Khil
- Department of Integrative Medicine, College of Medicine, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Ah-Young Jeong
- Department of Integrative Medicine, College of Medicine, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Byoung-Duck Han
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Min-Sung Sohn
- Department of Health and Medical Sciences, Cyber University of Korea, 161 Jeongneung-ro, Seongbuk-gu, Seoul 02708, Republic of Korea
| | - Jae-Wook Choi
- Department of Preventive Medicine, College of Medicine, Korea University, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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172
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Liu Y, Zang B, Shao J, Ning N, He L, Ma Y. Predictor of cognitive impairment: metabolic syndrome or circadian syndrome. BMC Geriatr 2023; 23:408. [PMID: 37403015 DOI: 10.1186/s12877-023-03996-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/24/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND It was reported that metabolic syndrome increases the risk for cognitive impairment and circadian rhythm may influence cognition behavior. Identifying the potential risk factors is essential to screen individuals with neuronal dysfunction, neuronal loss, and cognitive decline and prevent cognitive impairment and dementia development. METHODS We clarified participants by the presence of metabolic syndrome (MetS) and circadian syndrome (CircS) and employed three multivariable Generalized Estimating Equation (GEE) models to control the potential confounding factors and estimate the β values for cognitive function using as referents those had neither MetS nor CircS at baseline. The cognitive function consists of episodic memory and executive function was estimated via the modified Telephone Interview for Cognitive Status (TICS) every two years until 2015. RESULTS The mean age of the participants was 58.80 (8.93) years and 49.92% (male). The prevalence of MetS and CircS was 42.98% and 36.43%, respectively. 1,075 (11.00%) and 435 (4.45%) participants had either MetS or CircS alone and 3,124 (31.98%) had both CircS and MetS. Participants with both MetS and CircS compared with normal had a significantly decreased cognitive function score during the 4-years cohort (β = -0.32, 95% CI: -0.63, -0.01) with the complete model, as well as among participants who suffered from CircS alone (β = -0.82, 95% CI: -1.47, -0.16), while not among participants with MetS alone (β = 0.13, 95% CI: -0.27, 0.53). Specifically, compared with the normal population a significantly lower score was discovered in the episodic memory (β = -0.51, 95% CI: -0.95, -0.07), while slightly lower in executive function (β = -0.33, 95% CI: -0.68, -0.01) among individuals with CircS alone. CONCLUSIONS Individuals with CircS alone or both MetS and CircS have a high risk of cognitive impairment. The association was even stronger in participants with CircS alone than those with both MetS and CircS, suggesting CircS probably have a stronger association with cognitive functioning than MetS and could be a better predictor for cognitive impairment.
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Affiliation(s)
- Yang Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Boying Zang
- Department of Preventive Medicine, School of Public Heath, North China University of Science and Technology, Tangshan, Hebei, China
| | - Jinang Shao
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Ning Ning
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China
| | - Lixia He
- Division of Molecular and Cellular Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, 02215, USA.
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning Province, China.
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173
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Bravo MA, Fang F, Hancock DB, Johnson EO, Harris KM. Long-term air pollution exposure and markers of cardiometabolic health in the National Longitudinal Study of Adolescent to Adult Health (Add Health). ENVIRONMENT INTERNATIONAL 2023; 177:107987. [PMID: 37267730 PMCID: PMC10664021 DOI: 10.1016/j.envint.2023.107987] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Air pollution exposure is associated with cardiovascular morbidity and mortality. Although exposure to air pollution early in life may represent a critical window for development of cardiovascular disease risk factors, few studies have examined associations of long-term air pollution exposure with markers of cardiovascular and metabolic health in young adults. OBJECTIVES By combining health data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) with air pollution data from the Fused Air Quality Surface using Downscaling (FAQSD) archive, we: (1) calculated multi-year estimates of exposure to ozone (O3) and particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) for Add Health participants; and (2) estimated associations between air pollution exposures and multiple markers of cardiometabolic health. METHODS Add Health is a nationally representative longitudinal cohort study of over 20,000 adolescents aged 12-19 in the United States (US) in 1994-95 (Wave I). Participants have been followed through adolescence and into adulthood with five in-home interviews. Estimated daily concentrations of O3 and PM2.5 at census tracts were obtained from the FAQSD archive and used to generate tract-level annual averages of O3 and PM2.5 concentrations. We estimated associations between average O3 and PM2.5 exposures from 2002 to 2007 and markers of cardiometabolic health measured at Wave IV (2008-09), including hypertension, hyperlipidemia, body mass index (BMI), diabetes, C-reactive protein, and metabolic syndrome. RESULTS The final sample size was 11,259 individual participants. The average age of participants at Wave IV was 28.4 years (range: 24-34 years). In models adjusting for age, race/ethnicity, and sex, long-term O3 exposure (2002-07) was associated with elevated odds of hypertension, with an odds ratio (OR) of 1.015 (95% confidence interval [CI]: 1.011, 1.029); obesity (1.022 [1.004, 1.040]); diabetes (1.032 [1.009,1.054]); and metabolic syndrome (1.028 [1.014, 1.041]); PM2.5 exposure (2002-07) was associated with elevated odds of hypertension (1.022 [1.001, 1.045]). CONCLUSION Findings suggest that long-term ambient air pollution exposure, particularly O3 exposure, is associated with cardiometabolic health in early adulthood.
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Affiliation(s)
- Mercedes A Bravo
- Global Health Institute, School of Medicine, Duke University, Durham, NC, USA.
| | - Fang Fang
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Dana B Hancock
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Eric O Johnson
- GenOmics and Translational Research Center, RTI International, Research Triangle Park, NC, USA; Fellow Program, RTI International, Research Triangle Park, NC, USA
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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174
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Walls KM, Hong KU, Hein DW. Induction of glucose production by heterocyclic amines is dependent on N-acetyltransferase 2 genetic polymorphism in cryopreserved human hepatocytes. Toxicol Lett 2023; 383:192-195. [PMID: 37423373 PMCID: PMC10528954 DOI: 10.1016/j.toxlet.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
Heterocyclic amines (HCAs) are mutagenic compounds found in cooked meat. Recent epidemiological studies reported significant associations between dietary HCA exposure and insulin resistance and type II diabetes, and we recently reported that HCAs induce insulin resistance and glucose production in human hepatocytes. It is well known that HCAs require hepatic bioactivation by cytochrome P450 1A2 (CYP1A2) and N-acetyltransferase 2 (NAT2). NAT2 expresses a well-defined genetic polymorphism in humans that, depending on the combination of NAT2 alleles, correlates to rapid, intermediate, or slow acetylator phenotype that exhibits differential metabolism of aromatic amines and HCAs. No previous studies have examined the role of NAT2 genetic polymorphism in the context of HCA-mediated induction of glucose production. In the present study, we assessed the effect of three HCAs commonly found in cooked meat (2-amino-3,4-dimethylimidazo[4,5-f]quinoline [MeIQ], 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline [MeIQx], and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine [PhIP]) on glucose production in cryopreserved human hepatocytes with slow, intermediate, or rapid NAT2 acetylator phenotype. HCA treatment did not affect glucose production in slow NAT2 acetylator hepatocytes, while a slight increase in glucose production was observed in intermediate NAT2 acetylators treated with MeIQ or MeIQx. However, significant increases in glucose production were observed in rapid NAT2 acetylators following each HCA. The current findings suggest that individuals who are rapid NAT2 acetylators may be at a greater risk of developing hyperglycemia and insulin resistance following dietary exposure to HCAs.
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Affiliation(s)
- Kennedy M Walls
- Department of Pharmacology & Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Kyung U Hong
- Department of Pharmacology & Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - David W Hein
- Department of Pharmacology & Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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175
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Cao T, Tong C, Halengbieke A, Ni X, Tang J, Zheng D, Guo X, Yang X. Serum uric acid to creatinine ratio and metabolic syndrome in middle-aged and elderly population: Based on the 2015 CHARLS. Nutr Metab Cardiovasc Dis 2023; 33:1339-1348. [PMID: 37248143 DOI: 10.1016/j.numecd.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIMS Serum uric acid to creatinine ratio (SUA/Cr) may be associated with metabolic syndrome (MS). Here, we investigated the correlation between SUA/Cr and MS in Chinese residents aged ≥ 45 years. METHODS AND RESULTS Data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS) database. MS was diagnosed using the Chinese Diabetes Society 2017 criteria. We grouped the population according to SUA/Cr quartiles and compared the index differences between groups. We used spearman correlation analysis and binary logistic regression. The possible dose-response association of SUA/Cr with MS were analyzed using restricted cubic spline model. Of 12,946 included participants, 3370 (26.0%) had MS, and 1900 (56.4%) were female. After adjusting for multiple confounders, binary logistic regression analysis showed that compared with Quartile 1, the odds ratio (95% confidence interval) of the MS risk was 1.29 (1.09-1.52), 1.47 (1.25-1.74), and 1.80 (1.53-2.12) in Quartiles 2, 3, and 4, respectively. The restricted cubic spline model indicated a significant nonlinear dose-response association (Poverall < 0.001, Pnon-linearity = 0.029) between SUA/Cr and strength of MS prevalence association; MS risk began increasing when SUA/Cr > 6.22. CONCLUSIONS A significant positive correlation existed between SUA/Cr and MS risk in Chinese individuals aged ≥ 45 years, which may be a new predictive marker for MS risk.
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Affiliation(s)
- Tengrui Cao
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Chao Tong
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Aheyeerke Halengbieke
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Xuetong Ni
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Jianmin Tang
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Deqiang Zheng
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
| | - Xinghua Yang
- School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, NO.10 Xitoutiao, Youanmen, Fengtai District, Beijing 100069, China.
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176
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Costo-Muriel C, Calderón-García JF, Rico-Martín S, Galán-González J, Escudero-Sánchez G, Sánchez-Bacaicoa C, Rodríguez-Velasco FJ, Santano-Mogena E, Fonseca C, Muñoz-Torrero JFS. Relationship between the novel and traditional anthropometric indices and subclinical atherosclerosis evaluated by carotid intima-media thickness (c-IMT). Front Nutr 2023; 10:1170450. [PMID: 37457970 PMCID: PMC10348712 DOI: 10.3389/fnut.2023.1170450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Over the last few years, novel anthropometric indices have been developed as an alternative to body mass index (BMI) and other traditional anthropometric measurements to enhance the estimate of fat proportion and its relationship to a future cardiovascular event. The purpose of this study was to investigate the association of carotid intima-media thickness (c-IMT) estimated by Doppler ultrasound with current anthropometric indices (traditional and novel). Methods A cross-sectional study was conducted on a total of 789 Spanish patients. Traditional (BMI, WHR, and WHtR) and new (WWI, AVI, ABSI, BRI, BAI, CUN-BAE, and CI) anthropometric indices were determined, and carotid Doppler ultrasound was performed to evaluate c-IMT (≥0.90 mm). Results Most of the anthropometric indices analyzed were significantly higher among patients with pathological c-IMT, except for BMI, BAI, and CUN-BAE. In multiple linear regression analysis, c-IMT was positively related to ABSI, AVI, BRI, CI, and WWI but not to CUN-BAE, BAI, or traditional anthropometric indices. Similarly, in univariate analysis, all indices were associated with a c-IMT of ≥0.90 mm (p < 0.05), except BMI, BAI, and CUN-BAE; however, only ABSI (adjusted OR: 1.61; 95% CI: 1.08-2.40; p = 0.017), CI (adjusted OR: 1.73; 95% CI: 1.15-2.60; p = 0.008), and WWI (adjusted OR: 1.74; 95% CI: 1.14-2.64; p = 0.009) were significantly associated in multivariate analysis. Finally, CI, ABSI, and WWI provided the largest AUC, and BMI and CUN-BAE showed the lowest AUC. Conclusion ABSI, CI, and WWI were positively associated with pathological c-IMT (≥0.90 mm), independent of other confounders.
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Affiliation(s)
- Clara Costo-Muriel
- Department of Internal Medicine, Hospital Comarcal de la Axarquía, Málaga, Spain
| | - Julián F. Calderón-García
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - Sergio Rico-Martín
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | | | | | | | | | - Esperanza Santano-Mogena
- Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
| | - César Fonseca
- Department of Nursing, University of Évora, Evora, Portugal
- Department of Nursing, Comprehensive Health Research Centre (CHRC), Evora, Portugal
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177
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Zhao Y, Liang X, Wang J, Baima K, Nima Q, Gao Y, Yin J, Liu Q, Zhao X. Association between pregnancy termination history and metabolic syndrome in southwestern Chinese women: modification effect of physical activity. Hum Reprod 2023:dead124. [PMID: 37366630 DOI: 10.1093/humrep/dead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
STUDY QUESTION Is there a relationship between pregnancy termination history and metabolic syndrome (MetS), and if so, is the relationship moderated by physical activity (PA)? SUMMARY ANSWER Induced abortion, and both miscarriage and induced abortion, increased the risk of MetS, while leisure PA attenuated the effects of induced abortion, and both miscarriage and induced abortion, on the risk of MetS. WHAT IS KNOWN ALREADY Pregnancy termination history is a risk factor for cardiovascular disease, but studies on women's history of pregnancy termination and MetS are limited. PA is a preventive behavior for MetS, but its modification effect on any association between pregnancy termination history and MetS is unknown. STUDY DESIGN, SIZE, DURATION The cross-sectional study included 53 702 women (age range of 30-79 years old) from southwestern China who participated in the China Multi-Ethnic Cohort (CMEC) study from May 2018 to September 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants self-reported both the number and type of pregnancy termination. PA was assessed primarily by asking participants about the cumulative time they spent doing PA either as their occupation, transportation, housework, and leisure activity in the past year. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. MAIN RESULTS AND THE ROLE OF CHANCE After adjusting for all confounders, the risk of MetS was significantly increased in women who experienced induced abortion alone, and both miscarriage and induced abortion, with odds ratios (ORs) of 1.08 (95% CI = 1.03-1.13) and 1.20 (95% CI = 1.08-1.33), respectively. A dose-response relationship was observed between the number of induced abortions and MetS, with the risk increasing by 3.0% for every additional induced abortion (OR = 1.03, 95% CI = 1.01-1.05). Leisure PA had a significant modification effect on the relationship between pregnancy termination history and MetS, as leisure PA attenuates the negative effects of induced abortion on MetS. LIMITATIONS, REASONS FOR CAUTION Causality cannot be established in this study. Information on pregnancy termination and PA was collected by self-report, which might be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS A history of induced abortion was associated with an increased risk of MetS, and the risk increased with the number of induced abortions. Leisure PA attenuated the negative effect of induced abortion on MetS, whereas occupational and transportation PA amplified the negative effect of induced abortion on glucose. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Key R&D Program of China (grant no.: 2017YFC0907300) and the National Nature Science Foundation of China (grant no.: 82273745). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ying Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xian Liang
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Junhua Wang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Kangzhuo Baima
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- School of Medicine, Tibet University, Lhasa, China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Yang Gao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Jianzhong Yin
- Baoshan College of Traditional Chinese Medicine, Baoshan, China
- Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming, China
| | - Qiaolan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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178
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Besseau S, Sartori E, Larnier P, Paillard F, Laviolle B, Mahé G. Impact of dietary intervention on eating behavior after ischemic stroke. Front Nutr 2023; 10:1067755. [PMID: 37426187 PMCID: PMC10325571 DOI: 10.3389/fnut.2023.1067755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Ischemic stroke is a major health issue. Currently, the relationship between dietary patterns and the occurrence of cardiovascular diseases including stroke is established, but the effect of systematic dietary intervention on dietary changes in ischemic stroke patients is unknown. Our objective was to compare changes in the dietary pattern of ischemic stroke patients who received a systematic diet intervention with changes in the dietary pattern of ischemic stroke patients who did not receive a systematic dietary intervention during their hospitalization. Methods In this before-and-after study, two groups of patients with ischemic stroke were compared: Group 1 included 34 patients admitted with an ischemic stroke without a systematic dietray intervention; Group 2 included 34 patients admitted with an ischemic stroke with a systematic dietary intervention. Dietary patterns were assessed by a validated food frequency questionnaire of 19 questions (from a previously validated questionnaire of 14 questions), at the onset of stroke and at 6 months after stroke. This questionnaire allows the calculation of different scores as follows: global food score, saturated fatty acids score (SFA), unsaturated fatty acids score (UFA), fruit and vegetable score, and alcohol score. Results Score changes were more important in group 2 than in group 1 for the global food score (7.4 ± 7 vs. 1.9 ± 6.7, p = 0.0013), the fruit and vegetable score (2 ± 2.6 vs. 0.6 ± 2.2, p = 0.0047), and the UFA score (1.8 ± 2.7 vs. 0.1 ± 3.3, p = 0.0238), whereas no significant differences were observed for the SFA score (-3.9 ± 4.9 vs. -1.6 ± 6, p = 0.1779) and the alcohol score (-0.4 ± 1.5 vs. -0.3 ± 1.1, p = 0.6960). Conclusion This study showed that systematic dietary intervention during hospitalization improves the dietary patterns of ischemic stroke patients. The impact on the recurrence of ischemic stroke or cardiovascular events after dietary pattern changes needs to be studied.
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Affiliation(s)
- Samuel Besseau
- Department of Family Medicine, Faculty of Medicine of Rennes, Rennes, France
| | - Eric Sartori
- Department of Neurology, Hospital of Lorient, Lorient, France
| | - Pauline Larnier
- Vascular Medicine Unit, CHU Rennes, University Hospital, Rennes, France
| | - François Paillard
- Cardiovascular Prevention Centre, University Hospital, Rennes, France
| | | | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, University Hospital, Rennes, France
- Univ Rennes, Rennes, France
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179
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Van Hoang D, Inoue Y, Fukunaga A, Nakagawa T, Honda T, Yamamoto S, Okazaki H, Yamamoto M, Miyamoto T, Gommori N, Kochi T, Shirasaka T, Eguchi M, Ogasawara T, Yamamoto K, Konishi M, Katayama N, Kabe I, Dohi S, Mizoue T. Metabolic syndrome and the risk of severe cancer events: a longitudinal study in Japanese workers. BMC Cancer 2023; 23:555. [PMID: 37328825 DOI: 10.1186/s12885-023-11026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is associated with cancer risk; however, little is known regarding its relationship with the risk of cancer-related premature death and long-term sick leave (LTSL), which can lead to a substantial loss in working years. The present study aimed to quantify the all-site and site-specific associations between MetS and the risk of severe cancer events (a composite outcome of LTSL and mortality due to cancer) in a large working population in Japan. METHODS We recruited 70,875 workers (59,950 men and 10,925 women), aged 20-59 years, who attended health check-ups in 2011 (10 companies) and 2014 (2 companies). All workers underwent follow up for severe cancer events until March 31, 2020. MetS was defined in accordance with the Joint Interim Statement. Cox regression models were used to quantify the association between baseline MetS and severe cancer events. RESULTS During 427,379 person-years of follow-up, 523 participants experienced the outcome consisting of 493 LTSLs of which 124 eventually resulted in death, and 30 deaths without taking LTSL. The adjusted hazard ratios (HR) (95% confidence intervals [CI]) for composite severe events due to all-site, obesity-related, and non-obesity-related cancer among those with vs. without MetS were 1.26 (1.03, 1.55), 1.37 (1.04, 1.82), and 1.15 (0.84, 1.56), respectively. In cancer site-specific analyses, MetS was associated with an increased risk of severe events due to pancreatic cancer (HR, 2.06; 95% CI, 0.99-4.26). When mortality was treated solely as the endpoint, the association was significant for all-site (HR, 1.58; 95% CI, 1.10-2.26), and obesity-related (HR, 1.59; 95% CI, 1.00-2.54) cancer. Additionally, a greater number of MetS components was associated with a greater risk of both severe cancer events and cancer-related mortality (P trend < 0.05). CONCLUSION Among Japanese workers, MetS was associated with an increased risk of severe cancer events, especially those due to obesity-linked cancer.
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Affiliation(s)
- Dong Van Hoang
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo, 1628655, Japan.
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo, 1628655, Japan
| | - Ami Fukunaga
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo, 1628655, Japan
| | - Tohru Nakagawa
- Hitachi Health Care Center, Hitachi, Ltd, Ibaraki, Japan
| | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd, Ibaraki, Japan
| | | | | | | | | | - Naoki Gommori
- East Japan Works (Keihin), JFE Steel Corporation, Keihin, Kanagawa, Japan
| | | | | | | | | | - Kenya Yamamoto
- Division of Chemical Information, National Institute of Occupational Safety and Health, Kiyose, Kanagawa, Japan
| | - Maki Konishi
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo, 1628655, Japan
| | - Nobumi Katayama
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo, 1628655, Japan
| | | | | | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Toyama 1-21-1, Shinjuku-ku, Tokyo, 1628655, Japan
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You A, Li Y, Shen C, Fan H, He J, Liu Z, Xue Q, Zhang Y, Zheng L. Associations of non-traditional cardiovascular risk factors and body mass index with metabolic syndrome in the Chinese elderly population. Diabetol Metab Syndr 2023; 15:129. [PMID: 37322514 DOI: 10.1186/s13098-023-01047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/29/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS), a clustering of traditional cardiovascular risk factors (CVRF), is currently one of the major global public health burdens. However, associations between MetS and non-traditional CVRF represented by uric acid (UA), homocysteine (HCY) and hypersensitive C-reactive protein (HsCRP) have not been well explored in the elderly population, especially when considering body mass index (BMI). METHODS Participants from the Shanghai Elderly Cardiovascular Health (SHECH) study cohort in 2017 were analyzed. MetS was defined using the modified American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Logistic regression models were used to assess associations of non-traditional CVRF, BMI with MetS. RESULTS Of the 4360 participants analyzed, 2378 (54.5%) had MetS, the mean (SD) UA was 331 (86) µmol/L, and the median (IQR) HCY and HsCRP were 15 (13-18) µmol/L and 1.0 (0.5-2.1) mg/L, respectively. Participants with higher non-traditional CVRF tended to have a higher significant risk of MetS (P < 0.001), which did not changed substantially in most population subgroups (P-interaction > 0.05). BMI mediated 43.89% (95%CI: 30.38-57.40%), 37.34% (95% CI: 13.86-60.83%) and 30.99% (95%CI: 13.16-48.83%) of associations of hyperuricemia (HUA), hyperhomocysteinemia (HHCY) and high HsCRP (HHsCRP) with MetS, respectively. Abnormal non-traditional CVRF combined with overweight/obesity greatly increased MetS risk (adjusted OR(95%CI): HUA + Overweight: 5.860(4.059-8.461); 6.148(3.707-10.194); HHCY + Overweight: 3.989(3.107-5.121); HHCY + Obese: 5.746(4.064-8.123); HHsCRP + Overweight: 4.026(2.906-5.580); HHsCRP + Obese: 7.717(4.508-13.210)). CONCLUSIONS In the Chinese elderly population, HUA, HHCY, and HHsCRP were all significantly and independently associated with MetS, supporting the potential of focusing on non-traditional CVRF interventions for preventing and controlling MetS. BMI played moderate mediating roles in associations between non-traditional CVRF and MetS, and abnormal non-traditional CVRF combined with overweight/obesity had significant synergistic effects on MetS risk, highlighting the importance of better weight management in the elderly population.
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Affiliation(s)
- Aijun You
- Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, 200092, China
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Changhai Clinical Research Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yaxin Li
- Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, 200092, China
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Chaonan Shen
- Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, 200092, China
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Institute of Integrated Traditional Chinese and Western Medicine for Cardiovascular Chronic Diseases, Tongji University School of Medicine, Shanghai, 200120, China
| | - Huimin Fan
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Institute of Integrated Traditional Chinese and Western Medicine for Cardiovascular Chronic Diseases, Tongji University School of Medicine, Shanghai, 200120, China
| | - Jia He
- Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, 200092, China
- Department of Health Statistics, Faculty of Health Service, Naval Medical University, Shanghai, 200433, China
- Changhai Clinical Research Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zhongmin Liu
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
- Institute of Integrated Traditional Chinese and Western Medicine for Cardiovascular Chronic Diseases, Tongji University School of Medicine, Shanghai, 200120, China
| | - Qian Xue
- Changhai Clinical Research Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Yuzhen Zhang
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
- Institute of Integrated Traditional Chinese and Western Medicine for Cardiovascular Chronic Diseases, Tongji University School of Medicine, Shanghai, 200120, China.
| | - Liang Zheng
- Department of Epidemiology and Public Health, Tongji University School of Medicine, Shanghai, 200092, China.
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
- Institute of Integrated Traditional Chinese and Western Medicine for Cardiovascular Chronic Diseases, Tongji University School of Medicine, Shanghai, 200120, China.
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181
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Liu Y, Zhu B, Zhou W, Du Y, Qi D, Wang C, Cheng Q, Zhang Y, Wang S, Gao C. Triglyceride-glucose index as a marker of adverse cardiovascular prognosis in patients with coronary heart disease and hypertension. Cardiovasc Diabetol 2023; 22:133. [PMID: 37296406 PMCID: PMC10257289 DOI: 10.1186/s12933-023-01866-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index has been proposed as a potential predictor of adverse prognosis of cardiovascular diseases (CVDs). However, its prognostic value in patients with coronary heart disease (CHD) and hypertension remains unclear. METHODS A total of 1467 hospitalized patients with CHD and hypertension from January 2021 to December 2021 were included in this prospective and observational clinical study. The TyG index was calculated as Ln [fasting triglyceride level (mg/dL) × fasting plasma glucose level (mg/dL)/2]. Patients were divided into tertiles according to TyG index values. The primary endpoint was a compound endpoint, defined as the first occurrence of all-cause mortality or total nonfatal CVDs events within one-year follow up. The secondary endpoint was atherosclerotic CVD (ASCVD) events, including non-fatal stroke/transient ischemic attack (TIA) and recurrent CHD events. We used restricted cubic spline analysis and multivariate adjusted Cox proportional hazard models to investigate the associations of the TyG index with primary endpoint events. RESULTS During the one-year follow-up period, 154 (10.5%) primary endpoint events were recorded, including 129 (8.8%) ASCVD events. After adjusting for confounding variables, for per standard deviation (SD) increase in the TyG index, the risk of incident primary endpoint events increased by 28% [hazard ratio (HR) = 1.28, 95% confidence interval (CI) 1.04-1.59]. Compared with subjects in the lowest tertile (T1), the fully adjusted HR for primary endpoint events was 1.43 (95% CI 0.90-2.26) in the middle (T2) and 1.73 (95% CI 1.06-2.82) in highest tertile (T3) (P for trend = 0.018). Similar results were observed in ASCVD events. Restricted cubic spline analysis also showed that the cumulative risk of primary endpoint events increased as TyG index increased. CONCLUSIONS The elevated TyG index was a potential marker of adverse prognosis in patients with CHD and hypertension.
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Affiliation(s)
- Yahui Liu
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Binbin Zhu
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Weicen Zhou
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Yao Du
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Datun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Chenxu Wang
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Qianqian Cheng
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - You Zhang
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Shan Wang
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
- Henan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, 451464, China.
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182
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Brown PDS, Ketter N, Vis-Dunbar M, Sakakibara BM. Clinical effects of Emblica officinalis fruit consumption on cardiovascular disease risk factors: a systematic review and meta-analysis. BMC Complement Med Ther 2023; 23:190. [PMID: 37296402 DOI: 10.1186/s12906-023-03997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 05/13/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Emblica officinalis (EO) fruit consumption has been found to have a beneficial effect on cardiovascular disease (CVD) physiological risk factors in preliminary clinical intervention trials; however, questions remain regarding the overall effectiveness of EO on CVD risk. The purpose of this systematic review and meta-analysis is to: 1) systematically describe the clinical research examining EO; and 2) quantitatively assess the effects of EO on CVD physiological risk factors. METHODS The Pubmed, Embase, Web of Science, and Google Scholar electronic platforms were searched for relevant randomized controlled trials (RCTs) published until April 7, 2021. Studies were included if they involved adults (age ≥ 18 years) ingesting a form of EO fruit; included blood lipids, blood pressure, and/or inflammatory biomarkers as outcomes; had clearly defined intervention and control treatments with pre- and post-intervention data; were peer-reviewed; and were written in English. Studies were excluded if they compared EO with another risk reduction intervention without a usual care control group. RCTs were assessed for methodological quality using the Cochrane risk-of-bias version 2 (ROB2) tool, qualitatively described, and quantitatively evaluated using random and fixed effect meta-analysis models. RESULTS A total of nine RCTs (n = 535 participants) were included for review. Included studies followed parallel-group (n = 6) and crossover (n = 3) designs, with EO dosage ranging from 500 mg/day to 1500 mg/day, and treatment duration ranging from 14 to 84 days. Meta-analyses revealed EO to have a significant composite effect at lowering low-density lipoprotein cholesterol (LDL-C; Mean difference (MD) = -15.08 mg/dL [95% Confidence interval (CI) = -25.43 to -4.73], I2 = 77%, prediction interval = -48.29 to 18.13), very low-density lipoprotein cholesterol (VLDL-C; MD = -5.43 mg/dL [95% CI = -8.37 to -2.49], I2 = 44%), triglycerides (TG; MD = -22.35 mg/dL [95% CI = -39.71 to -4.99], I2 = 62%, prediction interval = -73.47 to 28.77), and high-sensitivity C-reactive protein (hsCRP; MD = -1.70 mg/L [95% CI = -2.06 to -1.33], I2 = 0%) compared with placebo. CONCLUSIONS Due to statistical and clinical heterogeneity in the limited number of clinical trials to date, the promising effects of EO on physiologic CVD risk factors in this review should be interpreted with caution. Further research is needed to determine if EO offers an efficacious option for primary or secondary prevention of CVD as either monotherapy or adjunct to evidence-based dietary patterns and/or standard pharmacotherapy.
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Affiliation(s)
- Paul D S Brown
- Southern Medical Program, Faculty of Medicine, University of British Columbia Okanagan Campus, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Nicole Ketter
- Department of Biology, Irving K. Barber Faculty of Science, University of British Columbia Okanagan Campus, 3187 University Way, ASC 413, Kelowna, BC, V1V 1V7, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia Okanagan Campus, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Mathew Vis-Dunbar
- Southern Medical Program, Faculty of Medicine, University of British Columbia Okanagan Campus, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Brodie M Sakakibara
- Southern Medical Program, Faculty of Medicine, University of British Columbia Okanagan Campus, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Centre for Chronic Disease Prevention and Management, University of British Columbia Okanagan Campus, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 , Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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183
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Lee YA, Song SW, Kim SH, Kim HN. Associations between Dietary Patterns and Metabolic Syndrome: Findings of the Korean National Health and Nutrition Examination Survey. Nutrients 2023; 15:2676. [PMID: 37375580 DOI: 10.3390/nu15122676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Metabolic syndrome (MetS) is a multifactorial cluster of metabolic disorders related to cardiovascular disease and type 2 diabetes mellitus. Diet and dietary patterns are significant factors in the development and management of MetS. The associations between dietary patterns (i.e., high-carbohydrate [HCHO], high-fat [HF], and high-protein [HP] diets) and the prevalence of MetS in Koreans were examined using data from the Korean National Health and Nutrition Examination Survey, collected between 2018 and 2020. The study included data from 9069 participants (3777 men and 5292 women). The percentage of participants with MetS was significantly higher in the HCHO diet group than in the normal diet group in women. Women with HCHO diet were positively associated with elevated blood pressure and triglyceride levels based on a comparison with the normal diet group (p = 0.032 and p = 0.005, respectively). Men with an HF diet were negatively associated with elevated fasting glucose levels based on a comparison with the normal diet group (p = 0.014). Our findings showed that HCHO intake was strongly associated with a higher risk of MetS, especially elevated blood pressure and triglyceride levels in women, and an HF diet was negatively associated with elevated fasting glucose levels in men. Further prospective studies of the impact of dietary carbohydrate, fat, and protein proportions on metabolic health are needed. The optimal types and proportions of these dietary components, as well as the underlying mechanisms through which suboptimal proportions can lead to MetS, should also be investigated.
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Affiliation(s)
- Yun-Ah Lee
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang-Wook Song
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Se-Hong Kim
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Ha-Na Kim
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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184
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López-Lluch G. Coenzyme Q-related compounds to maintain healthy mitochondria during aging. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2023; 136:277-308. [PMID: 37437981 DOI: 10.1016/bs.apcsb.2023.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Mitochondrial dysfunction is one of the main factors that affects aging progression and many age-related diseases. Accumulation of dysfunctional mitochondria can be driven by unbalanced mito/autophagy or by decrease in mitochondrial biosynthesis and turnover. Coenzyme Q is an essential component of the mitochondrial electron transport chain and a key factor in the protection of membrane and mitochondrial DNA against oxidation. Coenzyme Q levels decay during aging and this can be considered an accelerating factor in mitochondrial dysfunction and aging progression. Supplementation with coenzyme Q is successful for some tissues and organs but not for others. For this reason, the role of coenzyme Q in systemic aging is a complex picture that needs different strategies depending on the organ considered the main objective to be addressed. In this chapter we focus on the different effects of coenzyme Q and related compounds and the probable strategies to induce endogenous synthesis to maintain healthy aging.
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Affiliation(s)
- Guillermo López-Lluch
- Centro Andaluz de Biología del Desarrollo, CABD-CSIC, CIBERER, Instituto de Salud Carlos III, Universidad Pablo de Olavide, Sevilla, Spain.
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185
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Tharrey M, Malisoux L, Klein O, Bohn T, Perchoux C. Urban densification over 9 years and change in the metabolic syndrome: A nationwide investigation from the ORISCAV-LUX cohort study. Soc Sci Med 2023; 331:116002. [PMID: 37478660 DOI: 10.1016/j.socscimed.2023.116002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
A growing body of evidence suggests that urban densification may be protective against obesity, type 2 diabetes, and cardiometabolic diseases, yet studies on how built environmental features relate to metabolic syndrome (MetS) and its components are scarce. This longitudinal study examines the associations of baseline urban density and densification over 9 years with MetS and MetS components, among 510 participants enrolled in both waves of the ORISCAV-LUX study (2007-2017) in Luxembourg. A continuous MetS score (siMS) was calculated for each participant. Six features of residential built environments were computed around participants' home address: street connectivity, population density, density of amenities, street network distance to the nearest bus station, density of public transport stations, and land use mix. A composite index of urban densification (UDI) was calculated by averaging the six standardized built environment variables. Using adjusted generalized estimating equation (GEE) models, one-SD increase in UDI was associated with a worsening of the siMS score (β = 0.07, 95% CI: 0.02, 0.13), higher triglyceride levels (β = 0.05, 95% CI: 0.02, 0.09), and lower HDL-c levels (β = -1.29, 95% CI: -2.20, -0.38). The detrimental effect of UDI on lipid levels was significant only for participants living in dense areas at baseline. Higher baseline UDI, as well as increased UDI over time among movers, were also associated with greater waist circumference. There were no associations between UDI, fasting plasma glucose and systolic blood pressure. Sex and neighborhood socio-economic status did not moderate the associations between UDI and the cardiometabolic outcomes. Overall, we found limited evidence for an effect of urban densification on MetS and its components. Understanding urban dynamics remains a challenge, and more research investigating the independent and joint health effect of built environment features is needed to support urban planning and design that promote cardiometabolic health.
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Affiliation(s)
- Marion Tharrey
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg; Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Laurent Malisoux
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Olivier Klein
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
| | - Torsten Bohn
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Camille Perchoux
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research, Esch/Alzette, Luxembourg
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186
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Lin Z, Chan YH, Cheung BMY. Dissecting Relations between Depression Severity, Antidepressant Use, and Metabolic Syndrome Components in the NHANES 2005-2020. J Clin Med 2023; 12:3891. [PMID: 37373586 PMCID: PMC10299566 DOI: 10.3390/jcm12123891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
We aimed to dissect the complex relations between depressive symptoms, antidepressant use, and constituent metabolic syndrome (MetS) components in a representative U.S. population sample. A total of 15,315 eligible participants were included from 2005 to March 2020. MetS components were defined as hypertension, elevated triglycerides, reduced high-density lipoprotein cholesterol, central obesity, and elevated blood glucose. Depressive symptoms were classified as mild, moderate, or severe. Logistic regression was used to evaluate the relationship between depression severity, antidepressant use, individual MetS components and their degree of clustering. Severe depression was associated with the number of MetS components in a graded fashion. ORs for severe depression ranged from 2.08 [95%CI, 1.29-3.37] to 3.35 [95%CI, 1.57-7.14] for one to five clustered components. Moderate depression was associated with hypertension, central obesity, raised triglyceride, and elevated blood glucose (OR = 1.37 [95%CI, 1.09-1.72], 1.82 [95%CI, 1.21-2.74], 1.63 [95%CI, 1.25-2.14], and 1.37 [95%CI, 1.05-1.79], respectively). Antidepressant use was associated with hypertension (OR = 1.40, 95%CI [1.14-1.72]), raised triglyceride (OR = 1.43, 95%CI [1.17-1.74]), and the presence of five MetS components (OR = 1.74, 95%CI [1.13-2.68]) after adjusting for depressive symptoms. The depression severity and antidepressant use were associated with individual MetS components and their graded clustering. Metabolic abnormalities in patients with depression need to be recognized and treated.
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Affiliation(s)
- Ziying Lin
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China
| | - Yap-Hang Chan
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China
- Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
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187
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Moghadam-Ahmadi A, Soltani N, Ayoobi F, Jamali Z, Sadeghi T, Jalali N, Vakilian A, Lotfi MA, Khalili P. Association between metabolic syndrome and stroke: a population based cohort study. BMC Endocr Disord 2023; 23:131. [PMID: 37280576 DOI: 10.1186/s12902-023-01383-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
Both metabolic syndrome (MetS) and stroke are associated with increased risk of mortality. Here, we aimed to assess the prevalence of MetS among adults using three definitions (Adult Treatment Panel III (ATP-III), International Diabetes Federation (IDF) and IDF ethnic specific cut-off for Iranian criteria) and its association with stroke. We performed a cross-sectional study of a total of 9991 adult participants of Rafsanjan Cohort Study (RCS), as part of the Prospective epidemiological research studies in Iran (PERSIAN cohort study). The MetS prevalence was evaluated in participants according to the different criteria. Multivariate logistic regression analyses were conducted to assess the association between three definitions of MetS with stroke. We found that MetS was significantly associated with higher odds of stroke according to NCEP-ATP III (odds ratio (OR): 1.89, 95% confidence interval (CI) 1.30-2.74), international IDF (OR:1.66, 95% CI: 1.15-2.40) and Iranian IDF (OR:1.48, 95% CI: 1.04-2.09) after adjusted for variables confounders. Furthermore, after adjustment, in receiver operating characteristic (ROC) curve, the AUROC was 0.79 (95% CI = 0.75-0.82), 0.78(95% CI = 0.74-0.82) and 0.78(95% CI = 0.74-0.81) for presence of MetS according to NCEP-ATP III, international IDF and Iranian IDF, respectively. ROC analyses revealed that all of these three criteria for MetS are "moderately accurate" for the identification of increased stroke risk.In conclusion, our results showed that MetS was associated with increased odds of stroke. Our findings implicate the importance of early identification, treatment, and ultimately prevention of the metabolic syndrome.
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Affiliation(s)
- Amir Moghadam-Ahmadi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neuro-immunology Research Scholar, Jefferson Hospital for Neuroscience, Thomas Jefferson University, Philadelphia, PA, US
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Narjes Soltani
- Physiology-Pharmacology Research Center, Rafsanjan University of Medical Science, Rafsanjan, Iran
| | - Fatemeh Ayoobi
- Occupational Safety and Health Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Zahra Jamali
- Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Clinical Research Development Unit (CRDU), Niknafs Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tabandeh Sadeghi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Pediatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Nazanin Jalali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Alireza Vakilian
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohammad Amin Lotfi
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital (CRDU), Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of internal Medicine, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Parvin Khalili
- Department of Epidemiology, School of Public Health, Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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188
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Šebeková K, Staruchová M, Mišľanová C, Líšková A, Horváthová M, Tulinská J, Lehotská Mikušová M, Szabová M, Gurecká R, Koborová I, Csongová M, Tábi T, Szökö É, Volkovová K. Association of Inflammatory and Oxidative Status Markers with Metabolic Syndrome and Its Components in 40-to-45-Year-Old Females: A Cross-Sectional Study. Antioxidants (Basel) 2023; 12:1221. [PMID: 37371951 DOI: 10.3390/antiox12061221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/19/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Oxidative stress and sterile inflammation play roles in the induction and maintenance of metabolic syndrome (MetS). This study cohort included 170 females aged 40 to 45 years who were categorized according to the presentation of MetS components (e.g., central obesity, insulin resistance, atherogenic dyslipidemia, and elevated systolic blood pressure) as controls not presenting a single component (n = 43), those with pre-MetS displaying one to two components (n = 70), and females manifesting MetS, e.g., ≥3 components (n = 53). We analyzed the trends of seventeen oxidative and nine inflammatory status markers across three clinical categories. A multivariate regression of selected oxidative status and inflammatory markers on the components of MetS was performed. Markers of oxidative damage (malondialdehyde and advanced-glycation-end-products-associated fluorescence of plasma) were similar across the groups. Healthy controls displayed lower uricemia and higher bilirubinemia than females with MetS; and lower leukocyte counts, concentrations of C-reactive protein, interleukine-6, and higher levels of carotenoids/lipids and soluble receptors for advanced glycation end-products than those with pre-MetS and MetS. In multivariate regression models, levels of C-reactive protein, uric acid, and interleukine-6 were consistently associated with MetS components, although the impacts of single markers differed. Our data suggest that a proinflammatory imbalance precedes the manifestation of MetS, while an imbalance of oxidative status accompanies overt MetS. Further studies are needed to elucidate whether determining markers beyond traditional ones could help improve the prognosis of subjects at an early stage of MetS.
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Affiliation(s)
- Katarína Šebeková
- Institute of Molecular Biomedicine, Medical Faculty, Comenius University in Bratislava, 83303 Bratislava, Slovakia
| | - Marta Staruchová
- Institute of Biology, Medical Faculty, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Csilla Mišľanová
- Institute of Nutrition, Faculty of Nursing and Medical Professional Studies, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Aurélia Líšková
- Department of Immunology and Immunotoxicology, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Mira Horváthová
- Department of Immunology and Immunotoxicology, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Jana Tulinská
- Department of Immunology and Immunotoxicology, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Miroslava Lehotská Mikušová
- Department of Immunology and Immunotoxicology, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Michaela Szabová
- Department of Immunology and Immunotoxicology, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
| | - Radana Gurecká
- Institute of Molecular Biomedicine, Medical Faculty, Comenius University in Bratislava, 83303 Bratislava, Slovakia
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University in Bratislava, 83303 Bratislava, Slovakia
| | - Ivana Koborová
- Institute of Molecular Biomedicine, Medical Faculty, Comenius University in Bratislava, 83303 Bratislava, Slovakia
| | - Melinda Csongová
- Institute of Molecular Biomedicine, Medical Faculty, Comenius University in Bratislava, 83303 Bratislava, Slovakia
| | - Tamás Tábi
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, 1085 Budapest, Hungary
| | - Éva Szökö
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, 1085 Budapest, Hungary
| | - Katarína Volkovová
- Institute of Biology, Medical Faculty, Slovak Medical University in Bratislava, 83303 Bratislava, Slovakia
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189
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Park HY, Yeom IS, Kim YJ. Telehealth interventions to support self-care of stroke survivors: An integrative review. Heliyon 2023; 9:e16430. [PMID: 37292367 PMCID: PMC10245159 DOI: 10.1016/j.heliyon.2023.e16430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/11/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023] Open
Abstract
Background Self-care is essential for stroke survivors to recover from neurological disorders caused by stroke and to prevent recurrences. Self-care behaviors are activities that individuals undertake to prevent recurrence and complications, and have a positive effect on the quality of life of patients. Telehealth is an emerging technology through which self-care intervention can be provided from a distance. Review-based research is needed to determine the value and development of telehealth-based self-care interventions for stroke survivors. Objective Based on the middle range theory of self-care of chronic illness, to provide an effective guide when developing telehealth self-care interventions for stroke survivors by comprehensively understanding telehealth interventions to support self-care of stroke survivors. Methods An integrative review, this study was performed in accordance with Whittemore and Knafl's stages of an integrative review (problem identification, literature search, data evaluation, data analysis, and presentation of the results). The key search terms included combinations of concepts related to stroke survivors and self-care, and telehealth. The research year of searched publications was not limited, and five electronic databases (PubMed, Ovid-MEDLINE, Ovid-EMBASE, CINAHL and Cochrane Library) were searched. Results Four attributes were identified that represented telehealth's functions that appeared to be associated with a self-care intervention for stroke survivors. These included introducing the concept of interaction, monitoring, education, and store and forward. These self-care interventions were found to influence the behaviors of stroke survivors' self-care maintenance (physical activity and treatment adherence), self-care monitoring (blood pressure, healthy behaviors, health diet, psychological well-being, glucose control, and depression), and self-care management (sense of control, healthcare resource utilization, social integration, and support). Conclusions The results of this study can provide a guide for developing effective telehealth self-care intervention by identifying the attributes of telehealth self-care intervention for stroke survivors.
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Affiliation(s)
- Ha-Young Park
- Department of Nursing, Kyungbok University, Namyangju, South Korea
| | - In-Sun Yeom
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, /50-1 Yeonse-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yoo-Jin Kim
- National Evidence-based Healthcare Collaborating Agency, South Korea
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190
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Cesena FY, Kashiwagi NM, Minanni CA, Santos RD. Determining Percentiles of Atherosclerotic Cardiovascular Risk According to Sex and Age in a Healthy Brazilian Population. Arq Bras Cardiol 2023; 120:e20220552. [PMID: 37403871 PMCID: PMC10344368 DOI: 10.36660/abc.20220552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/28/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Expressing the risk of atherosclerotic cardiovascular disease (ASCVD) as percentiles of the distribution according to sex and age may provide a better perception of the risk. OBJECTIVES To determine percentiles of the 10-year ASCVD risk distribution according to sex and age in a sample of the Brazilian population; to characterize individuals at low 10-year risk but high risk percentile. METHODS We analyzed individuals aged 40 to 75 years who underwent routine health evaluations from 2010 to 2020. Persons with known clinical ASCVD, diabetes mellitus, chronic kidney disease, or LDL-cholesterol ≥ 190 mg/dL were excluded. The 10-year ASCVD risk was calculated by the ACC/AHA pooled cohort equations. Local polynomial regression was used to determine risk percentiles. Two-sided p-values < 0.050 were considered statistically significant. RESULTS Our sample comprised 54,145 visits (72% male, median age [interquartile range] 48 [43, 53] years). We constructed sex-specific graphs plotting age against ASCVD risk corresponding to the 10th, 25th, 50th, 75th, and 90th percentiles. Most males up to 47 years and females up to 59 years above the 75th percentile had a 10-year risk < 5%. Individuals at low 10-year risk and risk percentile ≥ 75th had a high prevalence of excess weight and median (interquartile range) LDL-cholesterol levels 136 (109, 158) mg/dL (males) and 126 (105, 147) mg/dL (females). CONCLUSIONS We established ASCVD risk percentiles according to sex and age in a large sample of the Brazilian population. This approach may increase risk awareness and help identify younger persons at low 10-year risk who may benefit from more aggressive risk factor control.
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Affiliation(s)
- Fernando Yue Cesena
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Nea Miwa Kashiwagi
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Carlos Andre Minanni
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Raul D. Santos
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
- InCorFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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191
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Angelico F, Baratta F, Coronati M, Ferro D, Del Ben M. Diet and metabolic syndrome: a narrative review. Intern Emerg Med 2023; 18:1007-1017. [PMID: 36929350 DOI: 10.1007/s11739-023-03226-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/11/2023] [Indexed: 03/18/2023]
Abstract
Metabolic syndrome (MetS) is a highly prevalent condition defined by the presence of at least three out of five risk factors including central obesity, increased fasting glucose, high blood pressure, and dyslipidaemia. Metabolic syndrome is associated with a 2-fold increase in cardiovascular outcomes and a 1.5-fold increase in all-cause mortality. Excess energy intake and Western dietary pattern may influence the development of metabolic syndrome. By contrast, both Mediterranean diet (Med-diet) and Dietary Approaches to Stop Hypertension (DASH) diet, with or without calorie restriction, have positive effects. For the prevention and management of MetS, it is recommended to increase the daily intake of fiber-rich and low-glycaemic-index foods and the consumption of fish and dairy products, especially yogurt and nuts. Moreover, it is advisable to consume a large variety of unprocessed cereals, legumes, and fruit. Finally, it is suggested to replace saturated fatty acids with monounsaturated and polyunsaturated fatty acids and to limit the consumption of free sugars to less than 10% of the total energy intake. The aim of this narrative review is to analyze current evidence on the different dietary patterns and nutrients that may affect prevention and treatment of MetS and to discuss the underlying pathophysiological mechanisms.
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Affiliation(s)
- Francesco Angelico
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Policlinico Umberto 1, 00161, Rome, Italy
| | - Francesco Baratta
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Policlinico Umberto 1, 00161, Rome, Italy.
| | - Mattia Coronati
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Policlinico Umberto 1, 00161, Rome, Italy
| | - Domenico Ferro
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Policlinico Umberto 1, 00161, Rome, Italy
| | - Maria Del Ben
- Department of Clinical Internal, Anaesthesiological and Cardiovascular Sciences, I Clinica Medica, Sapienza University of Rome, Policlinico Umberto 1, 00161, Rome, Italy
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Quesada O, Lauzon M, Buttle R, Wei J, Suppogu N, Cook-Wiens G, Reis SE, Shaw LJ, Sopko G, Handberg E, Pepine CJ, Noel Bairey Merz C. Fitness attenuates long-term cardiovascular outcomes in women with ischemic heart disease and metabolic syndrome. Am J Prev Cardiol 2023; 14:100498. [PMID: 37181803 PMCID: PMC10172715 DOI: 10.1016/j.ajpc.2023.100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] Open
Abstract
Background The prevalence of metabolic syndrome continues to increase steadily while fitness remains relatively low. The contribution of fitness on longer-term cardiovascular outcomes and mortality in individuals with cardiovascular disease and metabolic syndrome remains unknown. Design Women's Ischemia Syndrome Evaluation (WISE) prospective cohort (enrolled 1996-2001) of women undergoing invasive coronary angiography with signs/symptoms of ischemic heart disease. Methods Investigated the association of fitness, defined as >7METs measured by self-reported Duke Activity Status Index (DASI), and both metabolic syndrome (ATPIII criteria) and dysmetabolism (ATPIII criteria and/or treated diabetes) with long-term cardiovascular outcomes and all-cause mortality risk. Results Among the 492 women followed for a median of 8.6 years (range 0-11 years), 19.5% were fit-metabolically healthy (reference), 14.4% fit-metabolic syndrome, 29.9% unfit-metabolically healthy, and 36.2% unfit-metabolic syndrome. Compared to reference, MACE risk was 1.52-fold higher in fit-metabolic syndrome women (HR 1.52, 95% CI 1.03-2.26) and 2.42-fold higher in unfit-metabolic syndrome women (HR 2.42, 95% CI 1.30-4.48). Compared to reference, mortality risk was 1.96-fold higher in fit-dysmetabolism (HR 1.96, 95% CI 1.29-3.00) and 3-fold higher in unfit-dysmetabolism women (HR 3.0, 95% CI 1.66-5.43). Conclusions In a high risk cohort of women with signs/symptoms of ischemic heart disease, unfit-metabolically healthy and fit-metabolically unhealthy women were at higher risk of long-term MACE and mortality compared to fit-metabolically healthy women; and women who were unfit and metabolically unhealthy were at the highest risk. Our study demonstrates that metabolic health and fitness play an important role in long term outcomes that warrants further investigation. Registration https://www.clinicaltrials.gov/ct2/show/NCT00000554 (NCT00000554).
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Affiliation(s)
- Odayme Quesada
- Women's Heart Center, Heart and Vascular Institute, The Christ Hospital, Cincinnati, OH, USA
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marie Lauzon
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rae Buttle
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nissi Suppogu
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Galen Cook-Wiens
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Leslee J. Shaw
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eileen Handberg
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Corresponding author at: 127 S. San Vicente Blvd, Suite A3600, Los Angeles, CA 90048.
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193
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Silva AI, Direito M, Pinto-Ribeiro F, Ludovico P, Sampaio-Marques B. Effects of Intermittent Fasting on Regulation of Metabolic Homeostasis: A Systematic Review and Meta-Analysis in Health and Metabolic-Related Disorders. J Clin Med 2023; 12:jcm12113699. [PMID: 37297894 DOI: 10.3390/jcm12113699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
Intermittent fasting (IF) is an emerging dietetic intervention that has been associated with improved metabolic parameters. Nowadays, the most common IF protocols are Alternate-Day Fasting (ADF) and Time-Restricted Fasting (TRF), but in this review and meta-analysis we have also considered Religious Fasting (RF), which is similar to TRF but against the circadian rhythm. The available studies usually include the analysis of a single specific IF protocol on different metabolic outcomes. Herein, we decided to go further and to conduct a systematic review and meta-analysis on the advantages of different IF protocols for metabolic homeostasis in individuals with different metabolic status, such as with obesity, diabetes mellitus type 2 (T2D) and metabolic syndrome (MetS). Systematic searches (PubMed, Scopus, Trip Database, Web of Knowledge and Embase, published before June 2022) of original articles in peer-review scientific journals focusing on IF and body composition outcomes were performed. Sixty-four reports met the eligibility criteria for the qualitative analysis and forty-seven for the quantitative analysis. Herein, we showed that ADF protocols promoted the major beneficial effects in the improvement of dysregulated metabolic conditions in comparison with TRF and RF protocols. Furthermore, obese and MetS individuals are the most benefited with the introduction of these interventions, through the improvement of adiposity, lipid homeostasis and blood pressure. For T2D individuals, IF impact was more limited, but associated with their major metabolic dysfunctions-insulin homeostasis. Importantly, through the integrated analysis of distinct metabolic-related diseases, we showed that IF seems to differently impact metabolic homeostasis depending on an individual's basal health status and type of metabolic disease.
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Affiliation(s)
- Ana Inês Silva
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4806-909 Guimarães, Portugal
| | - Manuel Direito
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4806-909 Guimarães, Portugal
| | - Filipa Pinto-Ribeiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4806-909 Guimarães, Portugal
| | - Paula Ludovico
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4806-909 Guimarães, Portugal
| | - Belém Sampaio-Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4806-909 Guimarães, Portugal
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194
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Hadaegh F, Abdi A, Kohansal K, Hadaegh P, Azizi F, Tohidi M. Gender differences in the impact of 3-year status changes of metabolic syndrome and its components on incident type 2 diabetes mellitus: a decade of follow-up in the Tehran Lipid and Glucose Study. Front Endocrinol (Lausanne) 2023; 14:1164771. [PMID: 37305040 PMCID: PMC10248400 DOI: 10.3389/fendo.2023.1164771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background The aim of this study was to examine the gender differences in the association between status changes of metabolic syndrome (MetS) and its components, using Joint Interim Statement (JIS) criteria, with the risk of type 2 diabetes mellitus (T2DM) among an urban population. Methods The study included 4,463 Iranian adult participants (2,549 women) aged ≥20 years. Based on status changes of MetS and its components during 3 years, subjects were categorized into four groups: MetS-free (reference), MetS-developed, MetS-recovery, and MetS-stable. A similar categorization was applied to MetS components. Multivariable Cox regression models were used for estimating hazard ratios (HRs) and women-to-men ratios of HRs (RHRs). Results During a median follow-up of 9.3 years, 625 T2DM events (351 women) occurred. Compared with the reference, the HRs of the MetS-developed, -recovery, and -stable groups among men for incident T2DM were 2.90, 2.60, and 4.92; the corresponding values for women were 2.73, 2.88, and 5.21, respectively (all p-values < 0.01), without significant gender difference in these relationships. In both genders, the fasting plasma glucose (FPG) component, regardless of the change in status, was strongly and significantly associated with incident T2DM with HRs ranging from 2.49 to 9.42; a similar association was also found for high waist circumference (WC)-recovery and -stable groups, with HRs ranging from 1.58 to 2.85 (p-values ≤ 0.05). Regarding gender differences, the development and persistence of high blood pressure (BP) status exposed men to greater T2DM risk than women with women-to-men RHRs of 0.43 (0.26-0.72) and 0.58 (0.39-0.86), respectively. Moreover, stable low levels of high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG) levels conferred higher T2DM risk in women than in men, with women-to-men RHRs of 1.67 (0.98-2.86) and 1.44 (0.98-2.14), respectively (both p-values = 0.06). Conclusion Among Tehranian adults, in both genders, all status changes of MetS, even those recovered from MetS, have a higher risk of T2DM compared to those who never had MetS. Also, all statuses of high FPG, in addition to recovered and stable high WC, were strongly associated with T2DM risk. Specifically, men with stable or developed high BP and women with stable dyslipidemic status were at differentially increased risk of incident T2DM.
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Affiliation(s)
- Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Abdi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Karim Kohansal
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parto Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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195
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Hardy DS, Garvin JT, Mersha TB. Analysis of ancestry-specific polygenic risk score and diet composition in type 2 diabetes. PLoS One 2023; 18:e0285827. [PMID: 37220136 DOI: 10.1371/journal.pone.0285827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Carbohydrate and protein dietary proportions have been debated as to whether higher or lower levels are optimal for diabetes metabolic control. OBJECTIVE The objective of this study was to investigate the associations, interactions, and mediational relationships between a polygenic risk score (PRS), carbohydrate and protein intake, and physical activity level on type 2 diabetes (T2DM) by genetic ancestry, in European Americans and African Americans. A secondary objective examined the biological pathways associated with the PRS-linked genes and their relationships to dietary intake. METHODS We performed a cross-sectional study in 9,393 participants: 83.3% European Americans and 16.7% African Americans from 7-NHLBI Care studies obtained from the database of Genotypes and Phenotypes. The main outcome was T2DM. Carbohydrate and protein intake derived from food frequency questionnaires were calculated as percent calories. Data were analyzed using multivariable generalized estimation equation models to derive odds ratios (OR) and 95% confidence intervals (CI). Ancestry-specific PRSs were constructed using joint-effects Summary Best Linear Unbiased Estimation in the train dataset and replicated in the test dataset. Mediation analysis was performed using VanderWeele's method. RESULTS The PRS in the highest tertile was associated with higher risk of T2DM in European Americans (OR = 1.25;CI = 1.03-1.51) and African Americans (OR = 1.54;1.14-2.09). High carbohydrate and low protein intake had lower risks of T2DM when combined with the PRS after adjusting for covariates. In African Americans, high physical activity combined with the high PRS and high protein diet was associated with a 28% lower incidence of T2DM when compared to low physical activity. In mediational models in African Americans, the PRS-T2DM association was mediated by protein intake in the highest tertile by 55%. The top PRS tertile had the highest magnitude of risks with metabolic factors that were significantly associated with T2DM, especially in European Americans. We found metabolic pathways associated with the PRS-linked genes that were related to insulin/IGF and ketogenesis/ketolysis that can be activated by moderate physical activity and intermittent fasting for better T2DM control. CONCLUSIONS Clinicians may want to consider diets with a higher portion of carbohydrates than protein, especially when the burden of high-risk alleles is great in patients with T2DM. In addition, clinicians and other medical professionals may want to emphasize the addition of physical activity as part of treatment regimen especially for African Americans. Given the metabolic pathways we identified, moderate physical activity and intermittent fasting should be explored. Researchers may want to consider longitudinal or randomized clinical trials to determine the predictive ability of different dietary patterns to inhibit T2DM in the presence of obesity and an elevated PRS.
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Affiliation(s)
- Dale S Hardy
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Jane T Garvin
- College of Nursing, Walden University, Minneapolis, MN, United States of America
| | - Tesfaye B Mersha
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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196
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Honarvar M, Masoumi S, Mehran L, Khalili D, Amouzegar A, Azizi F. Development and validation of a continuous metabolic syndrome severity score in the Tehran Lipid and Glucose Study. Sci Rep 2023; 13:7529. [PMID: 37160960 PMCID: PMC10170075 DOI: 10.1038/s41598-023-33294-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
Metabolic syndrome (MetS), defined as the coexistence of interrelated cardiometabolic risk factors, is limited by ignoring the severity of the disease and individuals with a pre-metabolic state. We aimed to develop the first age- and sex-specific continuous MetS severity score in the adult population using confirmatory factor analysis (CFA) based on the MetS components in the Middle East. Using data from the population-based Tehran Lipid and Glucose Study (TLGS) I and II datasets, we conducted CFA of the single factor MetS on 8933 adults (20-60 years old) totally, and in age and sex subgroups. We allowed for different factor loadings across the subgroups to formulate age- and sex-specific continuous MetS severity score equations. Thereafter, we validated these equations in the dataset of TLGS III participants. Triglyceride had the highest factor loading across age and sex subgroups, indicating the most correlation with MetS. Except for women aged 40-60 years, waist circumference was the second most significant factor contributing to MetS. Systolic blood pressure was more closely related to MetS in women than in men. Systolic blood pressure and fasting plasma glucose had the weakest correlation with MetS among the 40-60 age group. Moreover, as women age, the contribution of fasting plasma glucose to MetS tended to decline, while it remained relatively constant in men. The resulting MetS severity score was correlated with age and homeostasis model assessment of insulin resistance. Furthermore, the continuous MetS severity score well predicted the traditional MetS according to receiver operating characteristic analysis in the validation dataset. The age- and sex-specific continuous MetS severity score for the West Asian adult population provides a tangible quantitative measure of MetS enabling clinicians to screen and monitor the individuals at risk and assess their metabolic trends.
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Affiliation(s)
- Mohammadjavad Honarvar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Safdar Masoumi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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197
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van Loon SLM, Gensen C, Nienhuijs SW, Biter LU, Klaassen RA, van 't Hof G, Faneyte IF, Scharnhorst V, Boer AK. The Metabolic Health Index Identifies Patients That Will Benefit From Metabolic Surgery. J Surg Res 2023; 285:211-219. [PMID: 36696708 DOI: 10.1016/j.jss.2022.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/17/2022] [Accepted: 10/16/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Metabolic syndrome is a modern world's major health hazard related to comorbidities like type 2 diabetes and cardiovascular disease. Bariatric surgery is well known to lower this health risk in patients with obesity. There is a need for an objective measure to assess the intended reduction in health hazard and indirectly the eligibility for bariatric surgery. The Metabolic Health Index (MHI) quantitatively summarizes the cumulative impact of the metabolic syndrome on health status on a scale from 1 to 6. This study describes the use of the MHI as a supportive tool in the decision for and outcome assessment of bariatric surgery. METHODS The general usability of the MHI was tested by extending its application to patient data of five other bariatric centers in the Netherlands. Retrospective laboratory and national bariatric quality registry data of 11,501 patients were collected. RESULTS The quantification of (improvement in) metabolic health burden as measured by the MHI was independent of the dataset that was used to derive the MHI model. Patients with MHI > 2.8 prior to surgery improved significantly more in MHI 12 mo after surgery compared to patients with MHI ≤ 2.8 (1.1 compared to 0.4 MHI points, respectively; P < 0.001). CONCLUSIONS The MHI is robust between centers and is suitable for general use in clinical decision-making. As changes in MHI over time reflect metabolic health alterations, it is suitable as an outcome measure of surgery. An MHI cut-off value of 2.8 helps to predict the likelihood of significant improvement after surgery, independent of body mass index and known metabolic comorbidities.
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Affiliation(s)
- Saskia L M van Loon
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Carmen Gensen
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - René A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Gerhard van 't Hof
- Department of Surgery, Bariatric Center SW Netherlands, Bergen op Zoom, the Netherlands
| | - Ian F Faneyte
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Volkher Scharnhorst
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Arjen-Kars Boer
- General Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Expert Center Clinical Chemistry, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
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198
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Pakdeechote P, Poasakate A, Prasatthong P, Potue P, Khamseekaew J, Maneesai P. Mitigation effect of galangin against aortic dysfunction and hypertrophy in rats with metabolic syndrome. Heliyon 2023; 9:e16500. [PMID: 37251824 PMCID: PMC10213349 DOI: 10.1016/j.heliyon.2023.e16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Vascular alterations induced by a high-fat diet (HFD) are involved in the development of hypertension. Galangin, a flavonoid, is the major active compound isolated from galangal and propolis. The objective of this study was to investigate the effect of galangin on aortic endothelial dysfunction and hypertrophy, and the mechanisms involved in HFD-induced metabolic syndrome (MS) in rats. Male Sprague-Dawley rats (220-240 g) were separated into three groups: control + vehicle, MS + vehicle, and MS + galangin (50 mg/kg). Rats with MS received HFD plus 15% fructose solution for 16 weeks. Galangin or vehicle was orally administered daily for the final four weeks. Galangin reduced body weight and mean arterial pressure in HFD rats (p < 0.05). It also reduced circulating fasting blood glucose, insulin, and total cholesterol levels (p < 0.05). Impaired vascular responses to the exogenous acetylcholine observed in the aortic ring of HFD rats were restored by galangin (p < 0.05). However, the response to sodium nitroprusside did not differ between the groups. Galangin enhanced the expression of the aortic endothelial nitric oxide synthase (eNOS) protein and increased circulating nitric oxide (NO) levels in the MS group (p < 0.05). Aortic hypertrophy in HFD rats was alleviated by galangin (p < 0.05). Increases in tumour necrosis factor-alpha (TNF-α), interleukin (IL)-6 levels, angiotensin-converting enzyme activity and angiotensin II (Ang II) concentrations in rats with MS were suppressed in galangin treated group (p < 0.05). Furthermore, galangin reduced the upregulation of angiotensin II type I receptor (AT1R) and transforming growth factor-beta (TGF-β) expression in rats with MS (p < 0.05). In conclusion, galangin alleviates metabolic disorders and improves aortic endothelial dysfunction and hypertrophy in the MS group. These effects were consistent with increased NO availability, reduced inflammation, and suppressing Ang II/AT1R/TGF-β signalling pathway.
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Affiliation(s)
- Poungrat Pakdeechote
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Anuson Poasakate
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Patoomporn Prasatthong
- Department of Health Science, Faculty of Science and Technology, Nakhon Sawan Rajabhat University, Nakhon Sawan 60000, Thailand
| | - Prapassorn Potue
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Juthamas Khamseekaew
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Putcharawipa Maneesai
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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199
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Paquette M, Bernard S, Cariou B, Hegele RA, Genest J, Trinder M, Brunham LR, Béliard S, Baass A. Metabolic syndrome predicts cardiovascular risk and mortality in familial hypercholesterolemia. J Clin Lipidol 2023; 17:376-383. [PMID: 37003850 DOI: 10.1016/j.jacl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The association between familial hypercholesterolemia (FH) and premature atherosclerotic cardiovascular disease (ASCVD) is well established. Several risk factors other than the cumulative low-density lipoprotein cholesterol (LDL-C) have been shown to modulate the severity of the phenotype in these patients. However, the effect of the metabolic syndrome (MetS) on ASCVD risk in FH remains to be determined. OBJECTIVES The objective was to study the association between the presence of MetS and the incidence of different ASCVD endpoints and all-cause mortality. METHODS This prospective follow up study used data from 5 independent FH cohorts from Europe and North America. We analysed data of 2401 adult heterozygous FH without history of a prior ASCVD event (21,139 person-years of follow-up). Multivariate Cox proportional hazards regression was used to estimate the association between MetS and the incidence of the different endpoints. RESULTS The prevalence of MetS was 14% in the study population. The presence of MetS was a significant predictor of incident 10-year ASCVD after adjustment for traditional cardiovascular risk factors (HR 2.07, 95% CI 1.34-3.19), as well as of 10-year major adverse cardiovascular event (MACE) (HR 4.59, 95% CI 2.27-9.30), 10-year myocardial infarction (MI) (HR 4.29, 95% CI 1.91-9.63), and 30-year all-cause mortality (HR 4.87, 95% CI 1.99-11.89). CONCLUSION Our findings suggests that FH patients with MetS, have an increased cardiovascular risk that is independent from LDL-C and other traditional risk factors. Future studies are required to determine the most appropriate strategy to reduce the cardiovascular burden associated with MetS in this population.
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Affiliation(s)
- Martine Paquette
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec H2W 1R7, Canada (Drs Paquette, Bernard, and Baass)
| | - Sophie Bernard
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec H2W 1R7, Canada (Drs Paquette, Bernard, and Baass); Department of Medicine, Division of Endocrinology, Université de Montreal, Montreal, Québec H3T 1J4, Canada (Dr Bernard); Research Centre of the Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, Québec H2 × 0A9, Canada (Dr Bernard)
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes F-44000, France (Dr Cariou)
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5C1 and N6A 5K8, Canada (Dr Hegele)
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Montreal, Québec H4A 3J1, Canada (Dr Genest)
| | - Mark Trinder
- Faculty of Medicine, University of British Columbia, Centre for Heart and Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia V6Z 1Y6, Canada (Drs Trinder, and Brunham)
| | - Liam R Brunham
- Faculty of Medicine, University of British Columbia, Centre for Heart and Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia V6Z 1Y6, Canada (Drs Trinder, and Brunham)
| | - Sophie Béliard
- Aix Marseille University, INSERM, INRAE, C2VN, Department of Nutrition, Metabolic Diseases, Endocrinology, La Conception Hospital, Marseille, 13005, France (Dr Béliard)
| | - Alexis Baass
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec H2W 1R7, Canada (Drs Paquette, Bernard, and Baass); Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, Québec H3G 2M1, Canada (Dr Baass).
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200
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Asghar S, Asghar S, Shahid S, Fatima M, Bukhari SMH, Nadeem Siddiqui S. Metabolic Syndrome in Type 2 Diabetes Mellitus Patients: Prevalence, Risk Factors, and Associated Microvascular Complications. Cureus 2023; 15:e39076. [PMID: 37323312 PMCID: PMC10268561 DOI: 10.7759/cureus.39076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background The chronic macro and microvascular complications of diabetes mellitus pose serious health challenges. Metabolic syndrome (MetSy) is characterized by central obesity, glucose intolerance, hyperinsulinemia, low high-density lipoproteins (HDLs), high triglycerides (TGs), and hypertension. MetSy precedes or accompanies diabetes, and it has been linked to an increased risk of cardiovascular disease and premature death. This study aimed to estimate prevalence, identify risk factors, and evaluate associated microvascular complications among MetSy patients with type 2 diabetes mellitus (T2DM). Methodology Over the period of March 20, 2022, to March 31, 2023, a prospective cohort study was conducted at the Outdoor Clinic and Medicine Department of Sheikh Zayed Hospital, Rahim Yar Khan. Based on the International Diabetes Federation MetSy criteria, a total of 160 patients fulfilling the inclusion criteria were selected. A special proforma was used to obtain sociodemographic, clinical, and laboratory variables of MetSy in diabetic participants. Blood pressure and anthropometric measurements such as waist circumference (WC) and body mass index (BMI) were measured. Fasting venous blood was collected to analyze biochemical variables such as fasting blood sugar (FBS), TG, and high-density lipoprotein-cholesterol (HDL-C). The microvascular complications of T2DM were established using fundus ophthalmoscopy and neurological and kidney function assessments with the help of laboratory tests. These variables were matched between MetSy and no MetSy groups along with the presence or absence of diabetes microvascular complications. This information was analyzed based on these assessments and patient interviews. Results Of the 160 T2DM patients, the mean age was 52 years with a predominance of females (51.8%) in the 50-59-year age group (56.8%). The average BMI for females was 29.38 ± 0.54 kg/m², and 32 (20%) had obesity. Females exhibited a large WC of 93.52 ± 1.58 cm, and 48 of 83 females had reported diabetes microvascular complications. A significant p-value was observed for hypertension, high TG, low HDL-C, large WC, obesity, BMI, age, and female gender on comparing diabetics with metabolic syndrome (MetSy+) and those without metabolic syndrome (MetSy-). The prevalence of microvascular complications in T2DM patients with MetSy+ was 52.5% compared with 47.5% in MetSy-. The prevalence of diabetic retinopathy was 24.9% (95% confidence interval (CI) = 20.3%-29.6%), nephropathy was 16.8% (95% CI = 12.8%-20.7%), and neuropathy was 10.8% (95% CI = 7.4%-13.3%). Conclusions The prevalence of MetSy observed among T2DM patients was 65%, with married obese females in the 50-59-year age group being more likely to be affected than males. Hypertension, poor glycemic control, high TG, low HDL-C, and greater anthropometric waist measurements and BMI were additional risk factors that tended to increase the MetSy burden in T2DM. Diabetic retinopathy, nephropathy, and neuropathy were the most prevalent microvascular complications of diabetes, and immediate attention is needed to stop their detrimental effects. Longer uncontrolled diabetes, increasing age, and hypertension were independent predictors of microvascular complications. To further reduce the risks of complications that threaten healthy aging and prognosis for these patients, MetSy screening, health education, and better diabetic management are crucial.
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Affiliation(s)
- Shoaib Asghar
- Internal Medicine, Shaikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Sohaib Asghar
- Gastroenterology, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, GBR
| | - Salman Shahid
- Internal Medicine, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Mishal Fatima
- Internal Medicine, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | | | - Simra Nadeem Siddiqui
- Emergency Medicine, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, GBR
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