Cardiovascular morbidity and mortality associated with the metabolic syndrome

Short-Term, Equipment-Free High Intensity Interval Training Elicits Significant Improvements in Cardiorespiratory Fitness Irrespective of Supervision in Early Adulthood

Introduction: Serious health implications from having low levels of cardiorespiratory fitness (CRF) and being overweight in young adulthood are carried forward into later life. High-intensity interval training (HIIT) is a time-effective, potent stimulus for improving CRF and indices of cardiometabolic health. To date, few studies have investigated the use of equipment-free HIIT or the impact of supervision for improving CRF via HIIT. Methods: Thirty healthy young adults (18-30 y) were randomised to 4 weeks (12 sessions) equipment-free, bodyweight based supervised laboratory HIIT (L-HIIT), unsupervised home HIIT (H-HIIT) or no-intervention (CON). Utilised exercises were star jumps, squats and standing sprints. Measurements of CRF (anaerobic threshold (AT) and VO₂peak), blood pressure (BP), body mass index (BMI), blood glucose and plasma insulin by oral glucose tolerance test (OGTT), and muscle architecture were performed at baseline and after the intervention. Results: When compared to the control group, both HIIT protocols improved CRF (AT: L-HIIT mean difference compared to the control group (MD) +2.1 (95% CI: 0.34-4.03) ml/kg/min; p = 0.02; H-HIIT MD +3.01 (1.17-4.85) ml/kg/min; p = 0.002), VO₂peak: L-HIIT (MD +2.94 (0.64-5.25) ml/kg/min; p = 0.01; H-HIIT MD +2.55 (0.34-4.76) ml/kg/min; p = 0.03), BMI (L-HIIT MD -0.43 (-0.86 to 0.00) kg/m²; p = 0.05; H-HIIT: MD -0.51 (-0.95 to -0.07) kg/m²; p = 0.03) and m. vastus lateralis pennation angle (L-HIIT MD 0.2 (0.13-0.27)°; p < 0.001; H-HIIT MD 0.17 (0.09 to 0.24)°; p < 0.001). There was no significant change in BP, blood glucose or plasma insulin in any of the groups. Conclusions: Four weeks time-efficient, equipment-free, bodyweight-based HIIT is able to elicit improvements in CRF irrespective of supervision status. Unsupervised HIIT may be a useful tool for counteracting the rise of sedentary behaviours and consequent cardiometabolic disorders in young adults.

Cardiac, Macro-, and Micro-Circulatory Abnormalities in Association With Individual Metabolic Syndrome Component: The Northern Shanghai Study

Objective: This study investigated the association of metabolic syndrome (MS) and its components with cardiac, macro-, and micro-circulatory abnormalities in an elderly Chinese population.

Methods: This cross-sectional study was conducted using data for 1,958 participants from the Northern Shanghai Study aged over 65 years without a history of cardiovascular disease. MS was defined according to the National Cholesterol Education Program Adult Treatment Panel III in 2005 (NCEPIII 2005). Asymptomatic cardiovascular impairment parameters, including the left ventricle mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial index (ABI), carotid intima-media thickness (CIMT), arterial plaque, and urinary albumin–creatinine rate (UACR), were evaluated.

Results: LVMI, E/Ea, cf-PWV, and the proportion of UACR > 30 mg/g exhibited increasing trends while ABI exhibited a decreasing trend according to the number of MS components (all p for trend < 0.01). Logistic regression analysis revealed that MS was significantly associated with LV hypertrophy (LVH), LV diastolic dysfunction, arteriosclerosis, and microalbuminuria (all p < 0.001). Central obesity and high blood pressure were associated with all cardiovascular abnormalities (all p < 0.05), whereas elevated plasma glucose was associated with arteriosclerosis and microalbuminuria (both p < 0.001). In addition, high triglyceride levels were associated with microalbuminuria (p < 0.05).

Conclusions: MS is significantly associated with cardiac, macro-, and micro-circulatory abnormalities in elderly Chinese. Moreover, the presence of individual MS components may have specific prognostic significance.

Allostatic load, metabolic syndrome and self-rated health in overweight/obese Non-Hispanic White, non-Hispanic Black and Mexican American adults

AIM

This study examined the associations of high allostatic load (h_ALS) and metabolic syndrome (MetS) with and self-rated poor health (SRPH) in overweight/obese non-Hispanic White (NHW), non-Hispanic Black (NHB), and Mexican American (MA) adults.

METHODS

The 2015-16 and 2017-18 US National Health and Nutrition Examination Survey data (n = 4403) were used for this study.

RESULTS

Rates of h_ALS in overweight/obese NHW, NHW, and MA participants were 56.9%, 58.8%, and 51.9%, respectively (P < .05). The corresponding rates for MetS were 26.9%, 31.9%, and 46.5%, respectively. High ALS was associated with 2.19 (95% CI: 1.87-4.59), 1.82 (1.42-2.58), and 1.47 (95% CI: 1.08-1.64) increased odds of SRPH in overweight/obese NHW, NHB, and MA, respectively, after adjusting for age, education, gender, income, lifestyle behaviors, and marital status. The corresponding values for MetS were 1.86 (95% CI: 1.54-2.40), 2.77 (95% CI: 1.36-5.63), and 1.22 (95% CI: 1.06-2.32), respectively.

CONCLUSIONS

The effect of h_ALS on SRPH was much stronger in NHW, while the effect of MetS was strongest among NHB overweight/obese adults. The result of this study provides further evidence in favor of race/ethnic-tailored interventions, including education and weight control to reduced risks of bodywear and tear and SRPH.

Metabolic Syndrome Severity Score for Predicting Cardiovascular Events: A Nationwide Population-Based Study from Korea

BACKGROUND

Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population.

METHODS

From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve.

RESULTS

Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III.

CONCLUSION

The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

Serum vitamin D levels in relation to metabolic syndrome: A systematic review and dose-response meta-analysis of epidemiologic studies

Several epidemiological studies examined the association of serum vitamin D with metabolic syndrome (MetS), but the findings were inconsistent. We conducted a systematic review and dose-response meta-analysis to quantify the association between blood vitamin D levels and MetS in adults. A systematic search up to December 2020 was conducted in MEDLINE (PubMed), ISI (Web of Science), Scopus, and Google Scholar databases for epidemiological studies that assessed the relation of serum 25-hydroxyvitamin D (as the exposure) and MetS (as the outcome) in adults. Eligible cross-sectional studies were restricted to those with representative populations. Finally, 43 studies were included in the analysis (38 cross-sectional, one nested case-control, and four cohorts studies). Combining 41 effect sizes from 38 cross-sectional studies included 298,187 general adult population revealed that the highest level of serum vitamin D, compared with the lowest level, was significantly related to a 43% decreased odds of MetS in developed countries (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.49-0.65) and 40% in developing countries (OR: 0.60; 95% CI: 0.52-0.70). Linear dose-response analysis (including 222,175 healthy individuals and 39,308 MetS patients) revealed that each 25 nmol/L increase in serum vitamin D level was significantly associated with a 15% decreased odds of MetS (OR: 0.85; 95% CI: 0.80-0.91); however, we found no significant nonlinear association. Meta-analysis of five prospective studies with 11,019 participants revealed no significant relation (relative risk [RR]: 0.70; 95% CI: 0.37-1.32). This meta-analysis indicated an inverse association between serum vitamin D concentrations and risk of MetS in general adult populations in cross-sectional studies in a dose-response manner. However, no significant association was found in a small number of cohorts. More prospective studies are needed to confirm the causality of this relationship.

Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis

BACKGROUND

Young people with psychosis are at high risk of developing cardiometabolic disorders; however, there is no suitable cardiometabolic risk prediction algorithm for this group. We aimed to develop and externally validate a cardiometabolic risk prediction algorithm for young people with psychosis.

METHODS

We developed the Psychosis Metabolic Risk Calculator (PsyMetRiC) to predict up to 6-year risk of incident metabolic syndrome in young people (aged 16-35 years) with psychosis from commonly recorded information at baseline. We developed two PsyMetRiC versions using the forced entry method: a full model (including age, sex, ethnicity, body-mass index, smoking status, prescription of a metabolically active antipsychotic medication, HDL concentration, and triglyceride concentration) and a partial model excluding biochemical results. PsyMetRiC was developed using data from two UK psychosis early intervention services (Jan 1, 2013, to Nov 4, 2020) and externally validated in another UK early intervention service (Jan 1, 2012, to June 3, 2020). A sensitivity analysis was done in UK birth cohort participants (aged 18 years) who were at risk of developing psychosis. Algorithm performance was assessed primarily via discrimination (C statistic) and calibration (calibration plots). We did a decision curve analysis and produced an online data-visualisation app.

FINDINGS

651 patients were included in the development samples, 510 in the validation sample, and 505 in the sensitivity analysis sample. PsyMetRiC performed well at internal (full model: C 0·80, 95% CI 0·74-0·86; partial model: 0·79, 0·73-0·84) and external validation (full model: 0·75, 0·69-0·80; and partial model: 0·74, 0·67-0·79). Calibration of the full model was good, but there was evidence of slight miscalibration of the partial model. At a cutoff score of 0·18, in the full model PsyMetRiC improved net benefit by 7·95% (sensitivity 75%, 95% CI 66-82; specificity 74%, 71-78), equivalent to detecting an additional 47% of metabolic syndrome cases.

INTERPRETATION

We have developed an age-appropriate algorithm to predict the risk of incident metabolic syndrome, a precursor of cardiometabolic morbidity and mortality, in young people with psychosis. PsyMetRiC has the potential to become a valuable resource for early intervention service clinicians and could enable personalised, informed health-care decisions regarding choice of antipsychotic medication and lifestyle interventions.

FUNDING

National Institute for Health Research and Wellcome Trust.

The Association of Metabolic Syndrome Components with Anthropometric Measurements

Aim: This study aims to research the association of metabolic syndrome components with anthropometric measurements like arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, which are applied rarely. Methods: This cross-sectional study was conducted with 292 patients in November-December 2019. The arm circumference, neck circumference, waist circumference, hip circumference, waist-hip ratio, waist-to-height ratio, and body mass index measurements of the patients were made. Glucose, high-density lipoprotein, low-density lipoprotein, systolic, and diastolic blood pressure measurements were also recorded. The association between metabolic syndrome components and anthropometric measurements was analyzed. Results: Metabolic syndrome is diagnosed in 32.8% of the participants. According to body mass index, 18.6% of the patients were normal, 34.2% were overweight, and 47.2% were obese. There was a significant difference between the patients with and without metabolic syndrome in terms of laboratory parameters, blood pressure values, and anthropometric measurements. In the diagnosis of metabolic syndrome, optimal cut-off values for arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio were determined as 31.75 (AUC=0.703), 34.85 (AUC=0.763), 113.75 (AUC=0.757), 0.90 (AUC=0.701), 0.61 (AUC=0.769) for females while they were 35.75 (AUC=0.573), 39.75 (AUC=0.795), 111.5 (AUC=0.607), 0.96 (AUC=0.888), 0.61 (AUC=0.888) for males respectively. Conclusion: A significant correlation was detected between arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, and metabolic syndrome components. However, low-density lipoprotein was not correlated with neck circumference and high-density lipoprotein with waist-to-height ratio. Keywords: metabolic syndrome, anthropometric measurement, body mass index, obesity, lipid profile

Combined Effect of Lead Exposure and Allostatic Load on Cardiovascular Disease Mortality-A Preliminary Study

This study explores the combined effect of lead (Pb) exposure and an index of chronic physiological stress on cardiovascular disease mortality using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2008 linked to 1999-2014 National Death Index data. Chronic physiological stress was measured using the allostatic load (AL) index, which was formed by analyzing markers from the cardiovascular, inflammatory, and metabolic systems, with Pb levels, assessed using blood lead levels (BLL). The dataset was analyzed with statistical techniques to explore (a) the relationship between Pb exposure and AL, and (b) the combined role of Pb and AL on cardiovascular disease mortality. Results indicated that AL was more elevated in those with BLLs above the 50th percentile in the US population and that those with elevated AL were more likely to have high BLL. Finally, the interaction of AL and BLL significantly increased the likelihood of cardiovascular disease mortality. These findings highlight the need for considering the totality of exposures experienced by populations to build holistic programs to prevent Pb exposure and reduce stressors to promote optimal health outcomes and reduce cardiovascular mortality risk.

Prognostic Impact of Metabolic Syndrome in Patients With Heart Failure: A Meta-Analysis of Observational Studies

Background: The metabolic syndrome (MS) is significantly associated with the risk of incident heart failure (HF). However, there are still great controversies about the impact of MS on the prognosis in patients with established HF. This meta-analysis aimed to ascertain the effect of MS on the prognosis in patients with HF.

Methods: We searched multiple electronic databases, including PubMed, Opengrey, EMBASE, and Cochran Library, for potential studies up to February 15, 2021. Observational studies that reported the impact of MS on the prognosis in patients with established HF were included for meta-analysis.

Results: Ten studies comprising 18,590 patients with HF were included for meta-analysis. The median follow-up duration of the included studies was 2.4 years. Compared with HF patients without MS, the risk of all-cause mortality and cardiovascular mortality was not increased in HF with MS (HR = 1.04, 95% CI = 0.88–1.23 for all-cause mortality; HR = 1.66, 95% CI = 0.56–4.88 for cardiovascular mortality, respectively). However, there was a significant increase in composited cardiovascular events in the HF patients with MS compared with those without MS (HR = 1.73, 95% CI = 1.23–2.45).

Conclusions: In patients with established HF, the presence of MS did not show an association on the risk of all-cause mortality or cardiovascular mortality, while it may increase the risk of composite cardiovascular events.

Nerve Growth Factor, Stress and Diseases

Stress is a constant threat for homeostasis and is represented by different extrinsic and intrinsic stimuli (stressors, Hans Selye's "noxious agents"), such as aggressive behavior, fear, diseases, physical activity, drugs, surgical injury, and environmental and physiological changes. Our organisms respond to stress by activating the adaptive stress system to activate compensatory responses for restoring homeostasis. Nerve Growth Factor (NGF) was discovered as a signaling molecule involved in survival, protection, differentiation, and proliferation of sympathetic and peripheral sensory neurons. NGF mediates stress with an important role in translating environmental stimuli into physiological and pathological feedbacks since NGF levels undergo important variations after exposure to stressful events. Psychological stress, lifestyle stress, and oxidative stress are well known to increase the risk of mental disorders such as schizophrenia, major depressive disorders, bipolar disorder, alcohol use disorders and metabolic disorders such as metabolic syndrome. This review reports recent works describing the activity of NGF in mental and metabolic disorders related to stress.

Energy Expenditure of Level Overground Walking in Young Adults: Comparison With Prediction Equations

BACKGROUND

The purpose of this study was to investigate the accuracy of the published prediction equations for determining level overground walking energy cost in young adults.

METHODS

In total, 148 healthy young adults volunteered to participate in this study. Resting metabolic rate and energy expenditure variables at speeds of 4, 5, and 6 km/h were measured by indirect calorimetry, walking energy expenditure was estimated by 3 published equations.

RESULTS

The gross and net metabolic rate per mile of level overground walking increased with increased speed (all P < .01). Females were less economical than males. The present findings revealed that the American College of Sports Medicine and Pandolf et al equations significantly underestimated the energy cost of overground walking at all speeds (all P < .01) in young adults. The percentage mean bias for American College of Sports Medicine, Pandolf et al, and Weyand et al was 12.4%, 16.8%, 1.4% (4 km/h); 21.6%, 15.8%, 7.1% (5 km/h); and 27.6%, 12%, 6.6% (6 km/h). Bland-Altman plots and prediction error analysis showed that the Weyand et al was the most accurate in 3 existing equations.

CONCLUSIONS

The Weyand et al equation appears to be the most suitable for the prediction of overground walking energy expenditure in young adults.

Metabolic Syndrome in Commercial Truck Drivers: Prevalence, Associated Factors, and Comparison With the General Population

INTRODUCTION

Commercial motor vehicle drivers, such as truck drivers, experience unique health, lifestyle, and occupational challenges directly associated with their profession.

METHODS

All participants in this multistate cross-sectional study completed questionnaire measurements. Participants were categorized with metabolic syndrome (MetS) if they had at least three of the five modified criteria used in the joint scientific statement on metabolic syndrome.

RESULTS

Overall MetS prevalence was 52.4% (n = 428) of the 817 participants. Prevalence of MetS criteria were waist circumference (n = 634, 77.0%), low HDL cholesterol (n = 580, 71.0%), elevated triglycerides (n = 552, 67.6%), elevated blood pressure (n = 175, 21.2%), and elevated hemoglobin A1c (n = 97, 11.9%). Truck drivers were 2.7 times more likely to have MetS compared to the general working population.

CONCLUSION

Truck drivers in the United States have a high prevalence of MetS compared to the general working population.

An observational study of the prevalence of metabolic syndrome in treatment-experienced people living with HIV in Singapore

Background

While the use of combination antiretroviral therapy (cART) has conferred significant reduction in morbidity and mortality, there are growing concerns about the metabolic complications of antiretroviral regimens in HIV-infected patients. The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) among people living with HIV (PLHIV) in Singapore.

Methods

We conducted a retrospective study using the clinical database maintained by the Clinical HIV Programme at the National Centre for Infectious Diseases, Singapore. Treatment-experienced PLHIV on follow-up during 2015–2017 were included. MetS was defined as having three or more of the following five abnormalities: hypertriglyceridemia, HDL hypocholesterolemia, hypertension, obesity, and diabetes.

Results

A total of 2,231 PLHIV were included in this study. 93.9% were men, and the median age at latest follow-up was 48 years. The median duration of HIV infection and duration of exposure to cART was 6.8 years and 5.7 years, respectively. All had been exposed to nucleoside reverse transcriptase inhibitors (NRTIs) as the first line of treatment, 93.9% to non-NRTIs, 28.6% to protease inhibitors (PIs) and 12.8% to integrase strand transfer inhibitors. The most common metabolic abnormality among PLHIV was HDL hypocholesterolemia (60.2%) followed by hypertriglyceridemia (45.5%). Of all the 2,231 individuals, 68.8% had at least one component of MetS. The overall prevalence of MetS was 23.6% (95% confidence interval 21.9%–25.4%). Of the 526 with MetS, the most common combination was HDL hypocholesterolemia, hypertriglyceridemia and hypertension (51.0%), followed by HDL hypocholesterolemia, hypertriglyceridemia, hypertension and diabetes (25.1%). Compared with PLHIV without MetS, a significantly higher proportion of those with MetS were ever on protease inhibitors (33.5% vs. 27.1%).

Conclusion

MetS is common in PLHIV. In view of the progressive aging of HIV-infected population and long-term use of cART, regular monitoring for metabolic abnormalities, surveillance of drug effects and behavioural interventions are needed to optimize management and prevention of metabolic disorders in PLHIV.

Non-alcoholic fatty liver disease, insulin resistance, metabolic syndrome and their association with vascular risk

The prevalence of non-alcoholic fatty liver disease (NAFLD), one of the most common liver diseases, is rising. About 25% of adults worldwide are probably affected by NAFLD. Insulin resistance (IR) and fat accumulation in the liver are strongly related. The association between NAFLD, metabolic syndrome (MetS) and IR is established, but an independent impact of NAFLD on vascular risk and progression of cardiovascular (CV) disease (CVD) still needs to be confirmed. This narrative review considers the evidence regarding the link between NAFLD, IR and CVD risk. There is strong evidence for a "concomitantly rising incidence" of NAFLD, IR, MetS and CVD but there is no definitive evidence regarding whether NAFLD is, or is not, an independent and significant risk factor the development of CVD. There are also considerations that type 2 diabetes mellitus (T2DM) may be a common link between NAFLD/non-alcoholic steatohepatitis (NASH) and CVD. NAFLD may be associated with widespread abnormal peri-organ or intra-organ fat (APIFat) deposition (e.g. epicardial adipose tissue) which may further contribute to CV risk. It is clear that NAFLD patients have a greater CV risk (independent or not) which needs to be addressed in clinical practice.

Potential of Beetroot and Blackcurrant Compounds to Improve Metabolic Syndrome Risk Factors

Metabolic syndrome (MetS) is a group of metabolic abnormalities, which together lead to increased risk of coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM), as well as reduced quality of life. Dietary nitrate, betalains and anthocyanins may improve risk factors for MetS and reduce the risk of development of CHD and T2DM. Beetroot is a rich source of dietary nitrate, and anthocyanins are present in high concentrations in blackcurrants. This narrative review considers the efficacy of beetroot and blackcurrant compounds as potential agents to improve MetS risk factors, which could lead to decreased risk of CHD and T2DM. Further research is needed to establish the mechanisms through which these outcomes may occur, and chronic supplementation studies in humans may corroborate promising findings from animal models and acute human trials.

Leptin in Atherosclerosis: Focus on Macrophages, Endothelial and Smooth Muscle Cells

Increasing adipose tissue mass in obesity directly correlates with elevated circulating leptin levels. Leptin is an adipokine known to play a role in numerous biological processes including regulation of energy homeostasis, inflammation, vascular function and angiogenesis. While physiological concentrations of leptin may exhibit multiple beneficial effects, chronically elevated pathophysiological levels or hyperleptinemia, characteristic of obesity and diabetes, is a major risk factor for development of atherosclerosis. Hyperleptinemia results in a state of selective leptin resistance such that while beneficial metabolic effects of leptin are dampened, deleterious vascular effects of leptin are conserved attributing to vascular dysfunction. Leptin exerts potent proatherogenic effects on multiple vascular cell types including macrophages, endothelial cells and smooth muscle cells; these effects are mediated via an interaction of leptin with the long form of leptin receptor, abundantly expressed in atherosclerotic plaques. This review provides a summary of recent in vivo and in vitro studies that highlight a role of leptin in the pathogenesis of atherosclerotic complications associated with obesity and diabetes.

Association of breastfeeding and risk of metabolic syndrome and its components in postmenopausal parous women: Korea national health and nutrition examination survey (2010 ~ 2016)

Background

Understanding the relationship between breastfeeding (BF) and metabolic syndrome (Mets) is important for maternal long-term health benefits and disease prevention. This study aimed to examine the association between BF and Mets and its components among postmenopausal parous Korean women.

Methods

This cross-sectional study on 10,356 Korean women used nationally representative data from the KNHANES from 2010 to 2016. Anthropometric, laboratory data and manual BP were measured. A multivariate logistic regression analysis was conducted to examine the association of BF with Mets and its components after adjusting for potential confounding variables. A p-value < 0.05 was to be considered statistically significant.

Results

Mets was present in 42% of the study participants. The BF group had low household income and education level. The prevalence of Mets in the BF group was higher than that in the non-BF group (42.69% vs. 34.76%, p <  0.001). BF was associated with increased risk of Mets (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.18–1.65, p <  0.001). The BF group was at higher risks for diabetes (OR: 1.5, 95%CI: 1.14–1.98), hypertension (OR: 1.32, 95%CI: 1.03–1.68), hypertriglyceridemia (OR: 1.42, 95%CI: 1.02–1.99) and low high-density lipoprotein cholesterol (OR: 1.32, 95%CI: 1.06–1.65).

Conclusion

In this study, BF did not affect decreasing the prevalence of Mets and its components.

Comparison of the triglyceride glucose index and blood leukocyte indices as predictors of metabolic syndrome in healthy Chinese population

Triglyceride glucose (TyG) index and inflammatory markers are reported to have a positive association with metabolic syndrome (MetS). However, no previous study has assessed the value of TyG index and inflammatory markers as predictors of metabolic syndrome in the same study. This study looks at the comparison of the triglyceride index and blood leukocyte indices as predictors of metabolic syndrome in the Chinese population. The study cohort involved 1542 Chinese population without metabolic syndrome. The subjects underwent comprehensive routine health examination in 2011 and returned for a follow-up examination in 2016. Metabolic syndrome was defined according to Chinese Diabetes Society criteria, using body mass index for the replacement of waist circumference. TyG index, total leukocytes, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio (NLR) were measured. Adjust d logistic models were used to assess the relationship between TyG index, blood leukocyte indices, and incident MetS. Receiver operating characteristic (ROC) curves were performed to determine the predictive value of TyG index and blood leukocyte indices for MetS. Results from multivariate logistic regression analysis showed that, in the adjusted model, the subjects with the highest quartile of TyG index and neutrophils had a 3.894- and 1.663-fold increased incidence of MetS (P < 0.0001 and P = 0.027), respectively. No significant association was observed between total leukocytes, lymphocytes, NLR with incident MetS. ROC analysis showed that the AUC of TyG index and neutrophils were 0.674 and 0.568 for incident MetS, respectively. TyG index rather than blood leukocyte indices may have the strongest predictive value in MetS development over a 5-year period.

Influence of Stress, Gender, and Minority Status on Cardiovascular Disease Risk in the Hispanic/Latino Community: Protocol for a Longitudinal Observational Cohort Study

BACKGROUND

Hispanic/Latino sexual and gender minorities (SGM) are the fastest growing ethnic group of SGM in the United States. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among Hispanics/Latinos. SGM inequities in CVD risk have been identified as early as young adulthood, and minority stress has been identified as a potential mediator. Yet, the small number of ethnic or racial minority participants in SGM studies have precluded the examination of the intersections of sexual orientation, gender identity, and race and ethnicity.

OBJECTIVE

Minority stress models conceptualize relationships between stressors in minority groups and health outcomes. In this study, we will (1) examine the influence of sexual orientation and gender identity on CVD risk among all Hispanic Community Health Study/Study of Latinos (HCHS/SOL) participants at visit 3 (2021-2024; N~9300); (2) model pathways from sexual orientation and gender identity to CVD risk through stigma, discrimination, and stress in a 1:2 matched subcohort of SGM and non-SGM participants at visit 3 (n~1680); and (3) examine the influence of resilience factors on sexual orientation or gender identity and CVD risk relationships among subcohort participants at visit 3 (n~1680).

METHODS

This study will leverage existing data from the parent HCHS/SOL study (collected since 2008) while collecting new data on sexual orientation, gender identity, stigma, discrimination, stress, coping, social support, and CVD risk. Data analysis will follow the SGM minority stress model, which states that excess stigma against SGM populations leads to minority stress that increases CVD risk. In this model, coping and social support serve as resilience factors that can mitigate the impact of minority stress on CVD risk. Cross-sectional and longitudinal regression models as well as structural equation models will be used to test these relationships.

RESULTS

This study was funded by the National Heart, Lung, and Blood Institute in March 2020. Recruitment is scheduled to begin in the first quarter of 2021 and continue through 2024.

CONCLUSIONS

Understanding the influence of stigma-induced stress on CVD risk among Hispanic/Latino SGM has significant implications for the development of culturally specific CVD risk reduction strategies. Study findings will be used to build on identified Hispanic/Latino cultural strengths to inform adaptation and testing of family and community acceptance interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28997.

Metabolic syndrome and cognitive performance across the adult lifespan

Metabolic Syndrome (MetS) is associated with increased rates of mortality and increased risk for developing dementia. Changes in brain structure and cognitive functioning have been reported within the literature. However, research examining cognitive performance in individuals with MetS is limited, inconclusive, and focuses primarily on older cohorts. As such, the effect of MetS on cognitive functioning earlier in the lifespan is unclear. This study aimed to investigate cognitive performance in young, middle-aged, and older adults with multiple metabolic and vascular risk factors in a sample of community dwelling participants (N = 128). Participants were administered a comprehensive neuropsychological battery and self-report measures. As expected, older adults performed more poorly than young and middle-aged adults across most assessments. Relative to controls, individuals with MetS reported greater hunger and disinhibited eating. MetS participants performed more poorly on Color-Word Interference: Inhibition. Additionally, when weight was accounted for, there was a significant relationship between MetS and select executive functioning tasks in middle-aged adults. These findings suggest that aspects of executive functioning may be impaired in MetS and could be further impacted by excess weight in middle-age. Future studies aimed at investigating potential causal relationships between metabolic and vascular risk factors, disinhibited eating, and executive dysfunction may provide insight into effective intervention targets to prevent MetS.

Risk factors predicting the development of diabetes mellitus and metabolic syndrome following gestational diabetes mellitus

Background/aim

To determine risk factors associated with the development of insulin resistance, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) in gestational diabetes mellitus (GDM) patients 10 years after giving birth.

Materials and methods

Medical records of patients with former GDM were screened. Eligible patients were invited to the hospital to obtain information about their present health status. Patients with pregestational diabetes and patients with multiple pregnancies were excluded. A total of 67 women formed the study group. American Diabetes Association (ADA) and International Diabetes Federation (IDF) criteria were used to define T2DM and MetS, respectively.

Results

A total of 27 patients developed diabetes (40.3%) and 35 patients (52%) developed MetS. T2DM developed, on average, 4.8 years after delivery. There was a significant difference between diabetic and nondiabetic patients in terms of insulin use during pregnancy (P < 0.001). Women who developed diabetes within 10 years after giving birth were observed to have significantly higher fasting plasma glucose on oral glucose tolerance test during their pregnancy (P = 0.007). Current and pregestational body mass indices had a significant effect on the development of MetS (P = 0.003 and P = 0.027, respectively).

Conclusion

In this long-term study, we found that patients with high fasting plasma glucose (FPG) and insulin requirement during pregnancy are at an increased risk of developing T2DM, while pregestational obesity is predictive of progression to MetS. Identifying and targeting high-risk individuals may delay and possibly prevent T2DM and MetS.

First approach to distinguish between cardiac and arteriosclerotic emboli of individual stroke patients applying the histological THROMBEX-classification rule

Endovascular treatment of strokes caused by large vessel occlusion enables the histopathological investigation of the retrieved embolus, possibly providing a novel opportunity to contribute to the diagnostic workup of etiology and to define secondary prevention measures in strokes with uncertain genesis. We aimed to develop a classification rule based on pathophysiological considerations and adjustment to reference thrombi for distinction between cardiac and arteriosclerotic emboli and to validate this classification rule on a patient cohort. From 125 patients with stroke due to large vessel occlusion and thrombectomy, 82 patients with known etiology (55 cardioembolic and 27 arterioembolic strokes) were included. The corresponding emboli were histologically evaluated by two raters blinded to the etiology of stroke by means of a novel classification rule. Presumed etiology and classification results were compared. Agreement concerning cardiac emboli was 72.2% (95% CI: 58.4–83.5) for rater I and 78.2% (95% CI: 65.0–88.2) for rater II. Agreement concerning arteriosclerotic emboli was 70.4% (95% CI: 49.8–86.3) for rater I and 74.1% (95% CI: 53.7–88.9) for rater II. Overall agreement reached 71.6% (95% CI: 60.5–81.1) for rater I and 76.8% (95% CI: 66.2–85.4) for rater II. Within the limits of generally restricted accuracy of histological evaluations, the classification rule differentiates between cardiac and arteriosclerotic emboli of acute ischemic stroke patients. Further improvement is needed to provide valuable complementary data for stroke etiology workup.

A considerable proportion of metabolic syndrome-free adults from Bratislava Region, Slovakia, display an increased cardiometabolic burden

Although the dichotomous classification of metabolic syndrome (MS) enables the classification of individuals as MS-free or presenting MS, it is inconvenient for assessing cardiometabolic risk in MS-free individuals. Continuous MS score allows for estimation of cardiometabolic burden even in MS-free subjects. We used the scores to estimate the proportion of MS-free subjects on high cardiometabolic risk. A total of 876 subjects (62% females) of Central European descent, aged 20-81 years, were included. International Diabetes Federation (IDF) criteria were employed to classify MS. Continuous scores were calculated. We used the receiver operating characteristics (ROC) analysis to estimate the cutoff value to determine the proportion of MS-free subjects on increased risk. Using the waist circumference, 38% of males and 23% of females presented MS. ROC area under the curves (90%-98%) showed an acceptable performance of both scores to classify the presence of MS. Up to 18% of MS-free males and up to 10% of females displayed continuous score ≥ the relevant cutoff point. The waist-to-height ratio performed similar results. Both continuous scores were proven credible for assessing cardiometabolic risk in MS-free subjects. Clinically, this is important for earlier intervention. Despite minor differences between waist circumference and waist-to-height ratio, it would be appropriate to objectify it using reference population. Novelty: The first study using Z-MSS/siMSS (population-specific Z-score/continuous score of MS) to estimate cardiometabolic risk in Slovak adults. A proportion of MS-free Slovak adults is on high cardiometabolic risk. Difference between using waist circumference and the waist-to-height ratio does not seem to be major in our cohort.

Association between Adherence to SSRI Treatment and Mortality among Individuals with Metabolic Syndrome Components

INTRODUCTION

Depression and anxiety have been associated with type 2 diabetes mellitus and metabolic syndrome, major causes of cardiovascular morbidity and mortality. The effect of antidepressants in this association is unknown. This study aimed to examine the association between adherence to selective serotonin receptor inhibitors (SSRIs) and all-cause mortality among individuals with metabolic syndrome components (hypertension, obesity, and diabetes mellitus).

METHODS

Data on 201 777 patients who were prescribed SSRIs during the years 2008-2011 were analyzed retrospectively. Adherence was measured using prescription purchase records. The moderating effect of SSRI and statin adherence on the association between metabolic syndrome load and mortality hazard risk (HR) during the study period were analyzed. The Cox-proportional hazard model adjusted to background variables was used to this end.

RESULTS

During the study period, the maximal metabolic load was associated with mortality HR=1.89 (95% CI: 1.79-2) compared to participants without metabolic risk factors. A slight reduction in mortality HR was demonstrated among those with low and moderate SSRI adherence rates. Adherence to statins was negatively associated with the risk of mortality across all levels of adherence. A significant association (r=0.214, p<0.01) was found between adherence to statins and adherence to SSRIs, with higher rates of adherence to statins across all metabolic load categories.

DISCUSSION

While a high metabolic load is associated with a higher risk of mortality, adherence to SSRIs only partially moderated the risk of mortality, in contrast to the protective effect of statins. Adherence differences to statins and SSRIs among individuals prescribed both medications merit further investigation.

Effects of Nigella sativa oil supplementation on selected metabolic parameters and anthropometric indices in patients with coronary artery disease: A randomized, double-blind, placebo-controlled clinical trial

Various metabolic parameters are risk factors related to the amplified risk of atherosclerotic cardiovascular disease. A wide variety of data exist on Nigella sativa (NS) and metabolic parameters. The current study is designed to examine NS supplementation on lipid profile, blood pressure, glycemic control, anthropometric indices, and insulin resistance in individuals with coronary artery disease (CAD). In a randomized, double-blind, placebo-controlled clinical trial, 60 patients with CAD received either 2 g of NS oil or sunflower oil as a placebo for 8 weeks. Biochemical and anthropometric measurements were assessed. NS significantly reduced weight (-1.82 Kg; 95% C, [2.72, 4.13]), body mass index (-0.67 kg/m² ; 95% C, [0.33, 1.01]), waist circumference (-2.15 cm; 95% C, [1.06, 3.23]), hip circumference (-1.26 cm; 95% C, [0.61, 1.910]), waist-to-hip ratio (0.008; 95%C, [0.001, 0.01]), systolic (-9.52 mmHg; 95% C, [7.14, 11.9]), diastolic blood pressure (-8.26 mmHg; 95% C, [4.89, 11.62]), and fasting blood glucose (FBS) (-4.32 mg/dl; 95% C, [-0.51, 9.15]) as compared with the placebo group. The results indicate a potential beneficiary effect of NS on the metabolic parameters in CAD patients including improvements in anthropometric indices, blood pressure, and FBS.

Metabolic syndrome and adipokine levels in systemic lupus erythematosus and systemic sclerosis

Introduction

Aims of study were to evaluate the prevalence of metabolic syndrome (MetS) in systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) patients and to evaluate serum level of adipokines in SLE and SSc patients with and without MetS.

Methods

Fifty SLE patients and 85 SSc patients were enrolled. The diagnosis of MetS was made according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III. Clinical assessment and serum levels of adiponectin and resistin were evaluate in SLE and SSc patients.

Results

Prevalence of MetS was significantly (p<0.0001) higher in SLE patients than SSc patients (36% vs 10.6%). Median values of resistin were significantly (p<0.001) higher in SLE patients with MetS than SLE patients without MetS [4.01 ng/mL (2.7–4.5) vs 1.92 ng/mL (1.2–3)]. Median values of adiponectin were significantly (p<0.05) lower in SLE patients with MetS than SLE patients without MetS [5.64 ng/mL (4.96–8) vs 8.38 ng/mL (6.54–11.01)]. Systemic Lupus Erythematosus Activity Index [8 (6–12) vs 10 (6–13), p<0.01] and Systemic Damage Index [2 (1–3) vs 2 (0–3), p<0.001] were significantly higher in MetS patients than in patients without MetS.

In SSc, the median value of disease severity scale was significantly higher (p<0.05) in MetS patients than in patients without MetS [7 (5–7) vs 5 (3–6)].

Conclusion

Prevalence of MetS is higher in SLE patients. In SLE patients, MetS showed an association with adipokine levels and inflammation/activity disease scores. In SSc patients, MetS was associated with severity of disease.

Key Points • Prevalence of metabolic syndrome is higher in SLE patients than SSc patients. • Resistin is higher in SLE patients with metabolic syndrome. • Adineponectin is lower in SLE patients with metabolic syndrome. • Disease severity scale is higher in SSc patients with metabolic syndrome.

Late adverse effects and quality of life in survivors of testicular germ cell tumour

Currently, ~95% of patients with testicular germ cell tumour (TGCT) are cured, resulting in an increasing number of TGCT survivors. Although cured, these men face potential late adverse effects and reduced quality of life. Survivors face a twofold increased risk of second malignant neoplasms after chemotherapy and radiotherapy, with evidence of dose-dependent associations. For survivors managed with surveillance or treated with radiotherapy, the risk of cardiovascular disease (CVD) is comparable to the risk in the general population, whereas treatment with chemotherapy increases the risk of life-threatening CVD, especially during treatment and after 10 years of follow-up. Other adverse effects are organ-related toxicities such as neuropathy and ototoxicity. Pulmonary and renal impairment in patients with TGCT treated with chemotherapy is limited. Survivors of TGCT might experience psychosocial distress including anxiety disorders, fear of cancer recurrence and TGCT-specific issues, such as sexual dysfunction. Late adverse effects can be avoided in most patients with stage I disease if followed on a surveillance programme. However, patients with disseminated disease can experience toxicities associated with radiotherapy and chemotherapy, and/or adverse effects related to surgery for residual disease. The severity of adverse effects increases with dose of both chemotherapy and radiotherapy. This Review discusses the most recent data concerning the late adverse effects of today's standard treatments for TGCT.

Trigger finger is associated with risk of incident cardiovascular disease in individuals with type 2 diabetes: a retrospective cohort study

INTRODUCTION

Trigger finger is one of the complications affecting the upper extremity in patients with diabetes. Diabetes is also a well-known risk factor that predisposes individuals to cardiovascular diseases (CVDs). This retrospective cohort study aimed to establish the association between trigger finger and the patients with incident CVD with type 2 diabetes.

MATERIALS AND METHODS

Trigger finger was diagnosed by palpating a thickened tendon during flexion or on the manifestation of a locking phenomenon during extension or flexion of either finger. The relationship between trigger finger and other clinical parameters or complications of diabetes was examined by a comparative analysis. Cox regression analysis was used to evaluate the association between trigger finger and incidence of CVD. We calculated the propensity scores using sex, body mass index, age, smoking status, duration of diabetes, estimated glomerular filtration rate, hypertension, dyslipidemia, and hemoglobin A1c as the number of patients with incident CVD during the follow-up period was low.

RESULTS

Among the 399 patients with type 2 diabetes, 54 patients had trigger finger. Patients with trigger finger were significantly older in age and had been suffering from diabetes for a longer duration. They also displayed worse renal function and glycemic control, along with a higher incidence of hypertension, neuropathy and nephropathy. During the average 5.66±1.12 years of follow-up, a total of 18 incidents occurred. According to the Cox regression analysis, trigger finger was shown to be associated with enhanced risk of the incidence of CVD after adjustment for the covariates (adjusted HR=3.33 (95% CI 1.25 to 8.66), p=0.017).

CONCLUSIONS

Trigger finger is associated with the risk of incident CVD in patients with type 2 diabetes. Thus, clinicians must consider these factors at the time of diagnosis of such patients.

Serum Uric Acid concentration is associated with insulin resistance and impaired insulin secretion in adults at risk for Type 2 Diabetes

AIMS

Insulin resistance (IR) predisposes to type 2 diabetes mellitus (T2DM). Although previous studies have associated serum uric acid concentration with IR in T2DM, its association with impaired insulin secretion and beta-cell dysfunction in subjects at risk for developing T2DM remains uncertain. Thus, we aimed to analyze the association of serum uric acid concentration with IR using surrogate insulin resistance/secretion and beta-cell function indices in subjects at risk for developing T2DM.

METHODS

This is a cross-sectional study that included 354 subjects who underwent an oral glucose tolerance test who had at least two risk factors for T2DM without any chronic disease.

RESULTS

Participants were 51±8 years old, 72.2% were women, had a mean body mass index of 29.9±6.5kg/m² and mean serum uric acid concentration of 5.7±1.3mg/dL. HOMA-IR, first-phase insulin secretion (S1Ph_OGTT), second-phase insulin secretion (S2Ph_OGTT), Matsuda and disposition indices were significantly correlated with serum uric acid concentrations (r=0.239, r=0.225, r=0.201, r=-0.287, r=-0.208; respectively). After multiple linear regression analysis, serum uric acid concentration was independently associated with HOMA-IR (β=0.283), HOMA-B (β=0.185), S1Ph_OGTT (β=0.203), S2Ph_OGTT (β=0.186), and Matsuda Index (β=-0.322). A serum uric acid concentration of 5.5mg/dL had the best sensitivity/sensibility to identify subjects with IR (HOMA-IR ≥2.5).

CONCLUSIONS

Serum uric acid concentration is significantly associated with IR and impaired insulin secretion, but not with beta-cell dysfunction, in subjects at risk for developing T2DM.

Complications associated with laparoscopic sleeve gastrectomy - a review

Laparoscopic sleeve gastrectomy (LSG) is an essential bariatric procedure performed in obese patients, which provides significant weight loss and has a positive impact on obesity-related diseases. However, as with any surgical procedure, it carries the risk of complications. The complications that can arise in patients following LSG are divided into acute (diagnosed within 30 days after the surgery) and late. Early complications that require rapid management include haemorrhage (intraluminal or extraluminal), leak in the staple line, and abscess formation. Late complications include gastric stenosis, nutrient deficiencies, mediastinal pouch migration, and the development or exacerbation of gastroesophageal reflux diseases. In this review, we present the basic information about most common complications following LSG, and their symptoms, diagnostic tools, and management.

The product of waist and neck circumference outperforms traditional anthropometric indices in identifying metabolic syndrome in Chinese adults with type 2 diabetes: a cross-sectional study

BACKGROUND

Traditional anthropometric indices are used in diagnosing metabolic syndrome (MetS). This study aimed to propose a novel index, a product of waist and neck circumferences (PWNC), and compared its value with traditional anthropometric parameters in identifying the presence of MetS in Chinese adults with type 2 diabetes mellitus (T2DM).

METHODS

From September 2017 to June 2019, a total of 2017 Chinese adults with T2DM from the National Metabolic Management Center were included and categorized into a MetS group (1575 cases) and a non-MetS group (442 cases). Demographic and metabolic characteristics were compared between the two groups, and logistic regression analysis was performed for MetS. Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC), neck circumference (NC) and PWNC were assessed by constructing receiver operating characteristic (ROC) curves, and the area under the ROC curves was compared by DeLong's test.

RESULTS

Compared with the non-MetS group, men and women with MetS had higher blood pressure; higher levels of fasting plasma glucose, fasting insulin, and triglycerides (TGs); lower levels of high-density lipoprotein cholesterol (HDL-C); elevated homeostasis model assessment of insulin resistance (HOMA-IR); and higher BMI, WHR, WC, NC and PWNC (all P < 0.01). Logistic regression showed that PWNC, HDL-C, TGs, HOMA-IR, systolic blood pressure, hypertension and hypotensors were independent risk factors for MetS (all P < 0.01). PWNC, WC, NC, WHR and BMI displayed significant values in the ROC for MetS (all P < 0.01), while the area under the curve for PWNC was larger than that for traditional anthropometric parameters (WC, WHR and BMI) in both men and women (all P < 0.01).

CONCLUSION

PWNC outperformed traditional anthropometric parameters in identifying the presence of MetS in Chinese adults with T2DM.

Low-volume high-intensity interval training for cardiometabolic health

High-intensity interval training (HIIT) is characterised by short bouts of high-intensity submaximal exercise interspersed with rest periods. Low-volume HIIT, typically involving less than 15 min of high-intensity exercise per session, is being increasingly investigated in healthy and clinical populations due to its time-efficient nature and purported health benefits. The findings from recent trials suggest that low-volume HIIT can induce similar, and at times greater, improvements in cardiorespiratory fitness, glucose control, blood pressure, and cardiac function when compared to more traditional forms of aerobic exercise training including high-volume HIIT and moderate intensity continuous training, despite requiring less time commitment and lower energy expenditure. Although further studies are required to elucidate the precise mechanisms of action, metabolic improvements appear to be driven, in part, by enhanced mitochondrial function and insulin sensitivity, whereas certain cardiovascular improvements are linked to increased left ventricular function as well as greater central and peripheral arterial compliance. Beyond the purported health benefits, low-volume HIIT appears to be safe and well-tolerated in adults, with high rates of reported exercise adherence and low adverse effects.

Sex-based differences in and risk factors for metabolic syndrome in adults aged 40 years and above in Northeast China: Results from the cross-sectional China national stroke screening survey

OBJECTIVES

Low levels of income and education are risk factors for metabolic syndrome in the population of Northeast China, which has a high incidence of metabolic syndrome and cardiovascular diseases. This study aimed to determine sex-based differences associated with the prevalence of and risk factors for metabolic syndrome among people older than 40 years in Northeast China; this has not been previously investigated.

DESIGN

This study analysed a portion of the large sample data of the national cross-sectional screening of China from 2016. Metabolic syndrome was defined as the presence of any three of the following five risk factors: abnormal waist circumference; high levels of triglycerides, high-density lipoprotein cholesterol or fasting plasma glucose; and elevated blood pressure. Multiple regression analysis was used to investigate sex-based differences in the prevalence of, and risk factors for metabolic syndrome.

SETTING

The study was conducted in Dehui City, Jilin Province, China.

PARTICIPANTS

A total of 4052 participants with complete questionnaire information and laboratory examination results were included.

RESULTS

The prevalence of metabolic syndrome was 50.1% overall (38.4% in men and 57.9% in women; p<0.001). High body mass index and hip circumference were associated with metabolic syndrome in both sexes. In addition, physical inactivity (OR and 95% CI 1.44 (1.06 to 1.97); p=0.022) in men and advanced age (OR and 95% CI 1.54 (1.15 to 2.04); p=0.003) in women were factors associated with metabolic syndrome. Women with junior high school education or above and living in rural areas were less likely to have metabolic syndrome. For men, education and rural or urban living had no association with metabolic syndrome.

CONCLUSIONS

The risk factors for metabolic syndrome have similarities and differences in different sexes; thus, the prevention and treatment of metabolic syndrome should be based on these sex differences.

Association of metabolic syndrome with mobility in the older adults: a Korean nationwide representative cross-sectional study

We aimed to examine whether metabolic syndrome (MetS) is associated with mobility in the older adults, using the timed up and go (TUG) test which is one of the most widely used tests for evaluating mobility. This is population-based study with the National Health Insurance Service-National Health Screening Cohort database of National Health Information Database. Participants included were those who completed the TUG as part of the National Screening Program for Transitional Ages. An abnormal TUG result was defined as a time ≥ 10 s. Multiple logistic regression models were used to assess the associations between MetS and TUG results. We constructed three models with different levels of adjustment. Furthermore, we conducted a stratified analysis according to the risk. Among the 40,767 participants included, 19,831 (48.6%) were women. Mean TUG value was 8.34 ± 3.07 s, and abnormal TUG test results were observed in 4,391 (10.8%) participants; 6,888 (16.9%) participants were categorised to have MetS. The worst TUG test results were obtained in participants with three or four MetS features, and a J-shaped relationship of each MetS feature, except triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C), with TUG test was found. Participants with MetS had 18% higher likelihood of showing abnormal TUG test results in a fully adjusted model (adjusted odds ratio 1.183, 95% confidence interval 1.115-1.254). The stratified analysis revealed that participants with central obesity, high blood pressure, and normal HDL-C and TG were more likely to have abnormal TUG times. Participants with MetS had a higher risk of exhibiting abnormal TUG results, and except for HDL-C and TG, all other MetS features had a J-shaped relationship with TUG. Preventive lifestyle such as lower carbohydrate and higher protein intake, and endurance exercise is needed.

Functional Autoreactive Anti-β2 Adrenergic Antibodies May Contribute to Insulin Resistance Profile in Patients with Chronic Chagas Disease

Potential activation of β2 adrenergic receptors (β2AR) by specific autoreactive antibodies (Abs) that arise during the host reaction to Trypanosoma cruzi, could contribute to the elevated prevalence of metabolic disturbances described in patients with chronic Chagas disease (CCD). This study aimed to determine the prevalence of anti-β2AR Abs in patients with CCD, as well as the correlation of these Abs with the presence of glucose and lipid metabolism disturbances, in order to explore their association with an insulin resistance profile. Additionally, we tested the functional effects of anti-β2AR Abs employing an in vitro bioassay with neuroendocrine cells expressing β2AR. A clinical and metabolic evaluation including an OGTT was performed in 80 CCD patients and 40 controls. Anti-β2AR Abs were measured by an in-house-developed ELISA, and the β2 adrenergic activity of affinity-purified IgG fractions from patient’ sera were assayed in CRE-Luc and POMCLuc transfected AtT-20 cells. A higher proportion of dysglycemia (72.5% vs. 37.5%; p = 0.001) was observed in the CCD group, accompanied by increased HOMA2-IR (p = 0.019), especially in subjects with Abs (+). Anti-β2AR Abs reactivity (7.01 (2.39–20.5); p = 0.0004) and age >50 years (3.83 (1.30–11.25); p = 0.014) resulted as relevant for IR prediction (AUC: 0.786). Concordantly, Abs (+) CCD patients showed elevated metabolic risk scores and an increased prevalence of atherogenic dyslipidemia (p = 0.040), as compared to Abs (−) patients and controls. On functional bioassays, Abs exerted specific and dose-dependent β2-agonist effects. Our findings suggest that anti-β2AR Abs may induce the activation of β2AR in other tissues besides the heart; furthermore, we show that in patients with CCD these Abs are associated with an insulin resistance profile and atherogenic dyslipidemia, providing biological plausibility to the hypothesis that adrenergic activation by anti-β2AR Abs could contribute to the pathogenesis of metabolic disturbances described in CCD patients, increasing their cardiovascular risk.

Association of Metabolic Syndrome and Asthma Status; A Prospective Study from Guilan Province-Iran

INTRODUCTION

Asthma is defined as a chronic inflammatory airway disease. Recent studies have shown the association between metabolic syndrome and deterioration of the lung functions in patients with asthma. The aim of this study was to evaluate the relation between metabolic syndrome and asthma status.

METHODS

In this prospective cross-sectional study, 160 asthmatic patients attending Razi hospital in Guilan province, were divided equally into two groups of 80 patients. The case group was contained asthmatic patient with metabolic syndrome and the control group contain asthmatic patient without metabolic syndrome. Blood pressure, height, weight, waist circumferences, fasting blood glucose and lipid profiles were measured by standard methods. Asthma severity was determined based on clinical symptoms and GINA criteria. To evaluate pulmonary function parameters, spirometry was performed for the patients.

RESULTS

Pulmonary function test including FEF, FVC and FEV1 were significantly lower in the case group compared to control group (P < 0.05). Also, a significant negative correlation was found between waist circumference, cardiovascular risk factors (including diabetes, hypertriglyceridemia, hypertension) with spirometric indices (P < 0.05).

CONCLUSION

Metabolic syndrome causes major declines of pulmonary parameters in asthma patients, thus controlling metabolic syndrome might improve symptoms of asthma.

Contribution of RAGE axis activation to the association between metabolic syndrome and cancer

Far beyond the compelling proofs supporting that the metabolic syndrome represents a risk factor for diabetes and cardiovascular diseases, a growing body of evidence suggests that it is also a risk factor for different types of cancer. However, the involved molecular mechanisms underlying this association are not fully understood, and they have been mainly focused on the individual contributions of each component of the metabolic syndrome such as obesity, hyperglycemia, and high blood pressure to the development of cancer. The Receptor for Advanced Glycation End-products (RAGE) axis activation has emerged as an important contributor to the pathophysiology of many clinical entities, by fueling a chronic inflammatory milieu, and thus supporting an optimal microenvironment to promote tumor growth and progression. In the present review, we intend to highlight that RAGE axis activation is a crosswise element on the potential mechanistic contributions of some relevant components of metabolic syndrome into the association with cancer.

Influence of sex and menopausal status on the relationship between metabolic syndrome and coronary artery calcification: a Chinese community-based cross-sectional study

OBJECTIVE

To evaluate the association between metabolic syndrome and coronary artery calcification according to different sex and menopausal status.

METHODS

This cross-sectional study included 2,704 adults from the Jidong community (Tangshan, China) recruited from July 2013 to August 2014. Adults aged ≥40 years with no cardiovascular disease and with coronary artery calcification score data were included. Metabolic syndrome was defined according to the 2005 International Diabetes Federation standard. Coronary artery calcification score was determined using the Agatston method. The associations between metabolic syndrome and coronary artery calcification prevalence were evaluated using logistic regression.

RESULTS

In the multivariable regression analysis, metabolic syndrome was associated with coronary artery calcification (odds ratio: 1.34, 95% confidence interval: 1.04-1.71, P = 0.021). When stratified by sex, metabolic syndrome was positively associated with coronary artery calcification prevalence in female participants (odds ratio: 2.79, 95% confidence interval: 1.96-3.96, P < 0.001), whereas no association was observed in male participants. Furthermore, metabolic syndrome was associated with a higher prevalence of coronary artery calcification (P < 0.001) independent of adjustment for covariates in postmenopausal women than in premenopausal women, and coronary artery calcification prevalence increased with an increase in conditions related to metabolic syndrome.

CONCLUSIONS

Our findings indicate that metabolic syndrome in postmenopausal women is associated with a higher prevalence of coronary artery disease than in premenopausal women and men.

Sleep Duration and the Risk of Metabolic Syndrome in Adults: A Systematic Review and Meta-Analysis

Objective: Epidemiological studies have reported inconsistent findings for the association between sleep duration and metabolic syndrome. We aimed to clarify the effects of short and long sleep durations on metabolic syndrome in adults by performing a meta-analysis. Methods: Adopting random-effects models, this study analyzed the effects of short and long sleep durations based on data from prospective cohort studies and cross-sectional studies retrieved from four electronic databases from inception to May 2020. Results: We collected data from 235,895 participants included in nine prospective cohort studies and 340,492 participants included in 27 cross-sectional studies. In cohort studies, short sleep duration was associated with an increased risk of metabolic syndrome (RR, 1.15; 95% CI, 1.05-1.25, I 2 = 63.1%, P < 0.001) compared with normal sleep duration. While long sleep duration was not associated with new-onset metabolic syndrome (RR, 1.02, 0.85-1.18, I 2 = 38.0%, P = 0.491). In cross-sectional studies, both short (OR, 1.06, 95% CI, 1.01-1.11, I 2 = 66.5%, P < 0.001) and long (OR, 1.11, 95% CI, 1.04-1.17, I 2 = 73.8%, P < 0.001) sleep durations were associated with a high prevalence of metabolic syndrome. Conclusions: Only a short sleep duration was associated with an increased risk of metabolic syndrome. Future studies should address whether the association is casual and modifiable.

Adipose Tissue T Regulatory Cells: Implications for Health and Disease

Obesity dramatically increases the risk of numerous conditions, including type 2 diabetes mellitus and other components of the metabolic syndrome. Pro-inflammatory changes that occur in adipose tissue are critical to the pathogenesis of these obesity-induced complications. Adipose tissue is one of the body's largest endocrine organs, and the cells that comprise the adipose tissue immunoenvironment secrete multiple factors (including adipokines and cytokines) that impact systemic metabolism. In particular, immunosuppressive regulatory T cells (Tregs) decline in obesity, partly in response to its complex interaction with adipocytes, and this decline contributes to disruption of the typical homeostasis observed in lean adipose tissue. Although the regulation of Treg differentiation, function, and enrichment is incompletely understood, factors including various cell-surface co-stimulatory molecules, certain lipid species, and cytokines such as PPARγ, adiponectin, and leptin are important mediators. It is also clear that there may be depot-specific differences in Tregs, rendering adipose tissue Tregs distinct from lymphoid or circulating Tregs, with implications on maintenance and functionality. While most of these findings are derived from studies in murine models, comparatively little is known about the human adipose tissue Treg signature, which requires further investigation.

Stress kinases in the development of liver steatosis and hepatocellular carcinoma

Non-alcoholic fatty liver disease (NAFLD) is an important component of metabolic syndrome and one of the most prevalent liver diseases worldwide. This disorder is closely linked to hepatic insulin resistance, lipotoxicity, and inflammation. Although the mechanisms that cause steatosis and chronic liver injury in NAFLD remain unclear, a key component of this process is the activation of stress-activated kinases (SAPKs), including p38 and JNK in the liver and immune system. This review summarizes findings which indicate that the dysregulation of stress kinases plays a fundamental role in the development of steatosis and are important players in inducing liver fibrosis. To avoid the development of steatohepatitis and liver cancer, SAPK activity must be tightly regulated not only in the hepatocytes but also in other tissues, including cells of the immune system. Possible cellular mechanisms of SAPK actions are discussed.

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Hepatic JNK triggers steatosis and insulin resistance, decreasing lipid oxidation and ketogenesis in HFD-fed mice.

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Decreased liver expression of p38α/β in HFD increases lipogenesis.

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Hepatic p38γ/δ drive insulin resistance and inhibit autophagy, which may lead to steatosis.

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Macrophage p38α/β promote cytokine production and M1 polarization, leading to lipid accumulation in hepatocytes.

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Myeloid p38γ/δ contribute to cytokine production and neutrophil migration, protecting against steatosis, diabetes and NAFLD.

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JNK1 and p38γ induce HCC while p38α blocks it. However, deletion of hepatic JNK1/2 induces cholangiocarcinoma.

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SAPK are potential therapeutic target for metabolic disorders, steatohepatitis and liver cancer.

Antiobesity Effect of Novel Probiotic Strains in a Mouse Model of High-Fat Diet-Induced Obesity

Obesity is one of the major causes of the development of metabolic diseases, particularly cardiovascular diseases and type-2 diabetes mellitus. Increased lipid accumulation and abnormal adipocyte growth, which is an increase in cell numbers and differentiation, have been documented as major pathological characteristics of obesity. Thus, the inhibition of adipogenic differentiation prevents and suppresses obesity. Recently, specific probiotic strains have been known to regulate lipid metabolism in vitro and/or in vivo. Previously, we demonstrated that Lactobacillus johnsonni 3121 and Lactobacillus rhamnosus 86 could act as novel probiotic strains and reduce cholesterol levels. Moreover, both strains significantly reduced lipid accumulation and inhibited adipocyte differentiation by downregulating the adipogenic transcription factor in 3T3-L1 adipocytes. Therefore, L. johnsonni 3121 and L. rhamnosus 86 were selected for in vivo evaluation of their anti-obesity effects using a high-fat diet-induced obese mouse model. Daily oral administration of L. johnsonni 3121 and L. rhamnosus 86 for 12 weeks significantly improved serum lipid profile and downregulated the expression of genes related to adipogenesis and lipogenesis in epididymal white adipose tissue of high-fat diet fed obese mice (p < 0.05). Fecal analysis also suggested that the two probiotic strains could normalize the altered obesity-related gut microbiota in high-fat diet-fed obese mice. These results collectively demonstrate that oral administration of L. johnsonni 3121 and L. rhamnosus 86 could prevent obesity, thereby improving metabolic health.

Unraveling the link between metabolic syndrome and abdominal aortic calcification

BACKGROUND & AIMS

Over the last few decades, the prevalence of metabolic syndrome (MetS) has gradually increased. As we know, many prior studies have connected MetS with diabetes, coronary heart disease, and cardiovascular disease. Abdominal aortic calcification (AAC) is a good marker of morbidity and mortality of vascular disease, as its degree may be associated with the severity of coronary artery calcification and disease. The aim of this article is to investigate the connection between MetS and AAC.

METHODS AND RESULTS

This retrospective observational study included 2731 participants aged 58 years from the National Health and Nutrition Examination Survey (NHANES) (2013-2014). We used Dual-Energy X-ray Absorptiometry to define the degree of AAC. We defined MetS according to the National Cholesterol Education Program Adult Treatment Panel III definition. A total of 2731 participants with complete data were included for data analysis. In the fully adjusted model, an increase in the severity of AAC with the number of MetS components was still significant with βvalues of AAC Total 24 Score 0.498 (95% confidence interval (CI): 0.018,0.978), 1.016 (95% CI: 0.514,1.519) and 1.426 (95% CI: 0.916,1.937) respectively in 2, 3 and ≧ 4 components. Additionally, associations were observed between MetS components, including blood pressure, HDL and glucose with βvalues of AAC Total 24 Score 0.332(95% CI: 0.069, 0.595), 0.652(95% CI: 0.380, 0.925) and 0.534 (95% CI: 0.285, 0.783) after fully adjusted, respectively.

CONCLUSION

The results indicated that, in the US adult population, a greater number of components of MetS were significantly associated with AAC. Among the components of metabolic syndrome, the blood pressure, HDL and blood sugar were observed apparent association with AAC.

Metabolic syndrome and its factors are associated with noncalcified coronary burden in psoriasis: An observational cohort study

BACKGROUND

Psoriasis is associated with a heightened risk of cardiovascular disease and higher prevalence of metabolic syndrome.

OBJECTIVE

Investigate the effect of metabolic syndrome and its factors on early coronary artery disease assessed as noncalcified coronary burden by coronary computed tomography angiography in psoriasis.

METHODS

This cross-sectional study consisted of 260 participants with psoriasis and coronary computed tomography angiography characterization. Metabolic syndrome was defined according to the harmonized International Diabetes Federation criteria.

RESULTS

Of the 260 participants, 80 had metabolic syndrome (31%). The metabolic syndrome group had a higher burden of cardiometabolic disease, systemic inflammation, noncalcified coronary burden, and high-risk coronary plaque. After adjusting for Framingham risk score, lipid-lowering therapy, and biologic use, metabolic syndrome (β = .31; P < .001) and its individual factors of waist circumference (β = .33; P < .001), triglyceride levels (β = .17; P = .005), blood pressure (β = .18; P = .005), and fasting glucose (β = .17; P = .009) were significantly associated with noncalcified coronary burden. After adjusting for all other metabolic syndrome factors, blood pressure and waist circumference remained significantly associated with noncalcified coronary burden.

LIMITATIONS

Observational nature with limited ability to control for confounders.

CONCLUSIONS

In psoriasis, individuals with metabolic syndrome had more cardiovascular disease risk factors, systemic inflammation, and noncalcified coronary burden. Efforts to increase metabolic syndrome awareness in psoriasis should be undertaken to reduce the heightened cardiovascular disease risk.

Gestational and childhood exposure to per- and polyfluoroalkyl substances and cardiometabolic risk at age 12 years

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) may adversely influence cardiometabolic risk. However, few studies have examined if the timing of early life PFAS exposure modifies their relation to cardiometabolic risk. We examined the influence of gestational and childhood PFAS exposure on adolescents' cardiometabolic risk.

METHODS

We quantified concentrations of four PFAS (perfluorooctanoate [PFOA], perfluorooctane sulfonate [PFOS], perfluorononanoate [PFNA], and perfluorohexane sulfonate [PFHxS]) in sera collected during pregnancy, at birth, and at ages 3, 8, and 12 years from 221 mother-child pairs in the HOME Study (enrolled 2003-06, Cincinnati, Ohio). We measured cardiometabolic risk factors using physical examinations, fasting serum biomarkers, and dual-energy X-ray absorptiometry scans at age 12 years. Cardiometabolic risk summary scores were calculated by summing age- and sex-standardized z-scores for individual cardiometabolic risk factors. We used multiple informant models to estimate covariate-adjusted associations of serum PFAS concentrations (log2-transformed) at each visit with cardiometabolic risk scores and their individual components, and tested for differences in associations across visits.

RESULTS

The associations of serum PFOA concentrations with cardiometabolic risk scores differed across visits (P for heterogeneity = 0.03). Gestational and cord serum PFOA concentrations were positively associated with cardiometabolic risk scores (βs and 95% confidence intervals [95% CIs]: gestational 0.8 [0.0, 1.6]; cord 0.9 [-0.1, 1.9] per interquartile range increase). These positive associations were primarily driven by homeostatic model assessment for insulin resistance index (β = 0.3 [0.1, 0.5]) and adiponectin to leptin ratio (β = -0.5 [-1.0, 0.0]). Other individual cardiometabolic risk factors associated with gestational PFOA included insulin and waist circumference. Gestational and cord PFHxS were also associated with higher cardiometabolic risk scores (βs: gestational 0.9 [0.2, 1.6]; cord 0.9 [0.1, 1.7]).

CONCLUSION

In this cohort of children with higher gestational PFOA exposure, fetal exposure to PFOA and PFHxS was associated with unfavorable cardiometabolic risk in adolescence.

Practitioner observations of oral nicotine use in elite sport: You snus you lose

The elite sport environment is one where athletes strive to find a competitive edge, through improved recovery modalities, cognitive performance or physical capacity. Due to this, non-scientifically evidenced and/or pseudo-scientific alternative remedies are ever popular. Snus (an oral tobacco based product containing the highly addictive compound nicotine) is one alternative 'physical and psychological performance enhancer', purported to act as a 'mental and physical booster', 'relaxative' and even as an 'appetite suppressor'. Despite snus having serious adverse health effects, along with no proven benefit to physical or mental performance, observations by the authors working in professional sport, along with several reports in the mainstream media, would suggest that the use of snus in elite sport appears to be increasing. Perhaps most worrying, the use of snus has been reported to be prevalent within younger athletes. It is crucial that athletes are fully educated with regards to the health implications of snus and other oral tobacco-based products, whilst practitioners should be aware of its growing prevalence in sport with strategies in place to discourage its use.

Decreased peripheral perfusion measured by perfusion index is a novel indicator for cardiovascular death in patients with type 2 diabetes and established cardiovascular disease

Cardiovascular disease (CVD) is still the major cause of mortality in patients with type 2 diabetes. Despite of recent therapies, mortality and resources spent on healthcare due to CVD is still important problem. Thus, appropriate markers are needed to predict poor outcomes. Therefore, we investigated the role of peripheral perfusion as an indicator for cardiovascular death in patients with type 2 diabetes and established CVD. This retrospective cohort study included 1080 patients with type 2 diabetes and history of CVD recruited from the outpatient clinic at Matsushita Memorial Hospital in Osaka, Japan. Peripheral perfusion is assessed using the perfusion index (PI), which represents the level of circulation through peripheral tissues. The median age and PI values were 74 years (range: 67-79 years) and 2.6% (range: 1.1-4.3%), respectively. During follow-up duration, 60 patients died due to CVD. The adjusted Cox regression analysis demonstrated that the risk of developing cardiovascular death was higher in the first quartile (Hazard ratio, 6.23; 95% CI, 2.28 to 22.12) or second quartile (Hazard ratio, 3.04; 95% CI, 1.46 to 6.85) of PI than that in the highest quartile (fourth quartile) of PI. PI (per 1% decrease) was associated with the development of cardiovascular death (Hazard ratio, 1.39; 95% CI, 1.16 to 1.68). PI could be a novel indicator of cardiovascular death in patients with type 2 diabetes and established CVD.

Changes in metabolic syndrome status affect the incidence of end-stage renal disease in the general population: a nationwide cohort study

Few studies have investigated the impact of a change in metabolic syndrome (MetS) components on clinical renal outcomes in the general population. Using nationally representative data from the Korean National Health Insurance System, 13,310,924 subjects who underwent two health examinations over 2 years and were free from end-stage renal disease (ESRD) from 2009 to 2012 were followed to the end of 2016. The subjects were divided into four groups according to the change in MetS components between the two visits over 2 years: no MetS (–/–), post-MetS (–/+), pre-MetS (+/–), and both MetS (+/+). After a median follow up of 5.11 years, 18,582 incident ESRD cases were identified. In the multivariate adjusted model, the hazard ratio (HR) and 95% confidence interval (CI) for the development of ESRD in the both-MetS (+/+) group compared with the no-MetS (–/–) group was 5.65 (95% CI, 5.42–5.89), which was independent of age, sex, and baseline estimated glomerular filtration rate. Additionally, the HR for the pre-MetS (+/–) group versus the no-MetS (–/–) group was 2.28 (2.15–2.42). In subgroup analysis according to renal function, the impact of a change in MetS on the incidence of ESRD was more pronounced in individuals with advanced renal dysfunction. Subjects with resolved MetS components had a decreased risk of ESRD, but not as low as those that never had MetS components. This provides evidence supporting the strategy of modulating MetS in the general population to prevent the development of ESRD.

Regional functional and structural abnormalities within the aorta as a potential driver of vascular disease in metabolic syndrome

NEW FINDINGS

What is the central question of this study? Is aortic dysfunction, a significant contributor to cardiovascular disease in metabolic syndrome, expressed uniformly across both the thoracic and abdominal aorta? What is the main finding and its importance? Our study shows that, in the setting of metabolic syndrome, functional and structural deficits in the aorta are differentially expressed along its length, with the abdominal portion displaying more extensive vascular abnormalities. It is, therefore, likely that early interventional strategies targeting the abdominal aorta might alleviate cardiovascular pathologies driven by the metabolic syndrome.

ABSTRACT

The extent of vascular dysfunction associated with metabolic syndrome might vary along the length of the aorta. In this study, we investigated regional functional and structural changes in the thoracic and abdominal aorta of a rat model of metabolic syndrome, namely, high-fat diet (HFD) streptozotocin-induced diabetes mellitus (HFD-D). Four-week-old male Wistar albino rats were fed with either HFD or control diet (CD) for 10 weeks. At week 6, 40 mg/kg streptozotocin and its vehicle were injected i.p. into HFD and CD groups, respectively. At the end of the feeding period, rats were euthanised and aortic segments collected for assessment of vascular functional responses and histomorphometry. Tail-cuff systolic blood pressures (154 ± 6  vs. 110 ± 4 mmHg) and areas under the curve for oral glucose and i.p. insulin tolerance tests were greater in HFD-D versus CD rats. Abdominal aortic vasoconstriction in response to noradrenaline and KCl was greater in HFD-D compared with CD rats. Thoracic vasoconstrictor responses to noradrenaline, but not KCl, were greater in the HFD-D group. Abdominal, but not thoracic, endothelium-dependent vasorelaxation in response to acetylcholine was blunted in HFD-D relative to CD rats; however, nitric oxide-dependent vasorelaxation in HFD-D rats was impaired in both thoracic and abdominal segments. The abdominal aorta of HFD-D rats showed deranged interlamellar spacing and increased lipid plaque deposition. In conclusion, vascular dysfunction in metabolic syndrome is expressed differentially along the length of the aorta, with the abdominal aorta exhibiting increased susceptibility to vasoconstrictors and greater deficits in endothelium-dependent relaxation. These vascular functional abnormalities could potentially underlie the development of hypertensive cardiovascular disease associated with the metabolic syndrome.

Biological age and lifestyle in the diagnosis of metabolic syndrome: the NHIS health screening data, 2014-2015

Metabolic syndrome (MS) is diagnosed using absolute criteria that do not consider age and sex, but most studies have shown that the prevalence of MS increases with age in both sexes. Thus, the evaluation of MS should consider sex and age. We aimed to develop a new index that considers the age and sex for evaluating an individual's relative overall MS status. Data of 16,518,532 subjects (8,671,838 males and 7,846,694 females) who completed a validated health survey of the National Health Insurance Service of the Republic of Korea (2014‒2015) were analyzed to develop an MS-biological age model. Principal component score analysis using waist circumference, pulse pressure, fasting blood sugar, triglyceride levels, and high-density lipoprotein level, but not age, as independent variables were performed to derive an index of health status and biological age. In both sexes, the age according to the MS-biological age model increased with rising smoking and alcohol consumption habits and decreased with rising physical activity. Particularly, smoking and drinking affected females, whereas physical activity affected males. The MS-biological age model can be a supplementary tool for evaluating and managing MS, quantitatively measuring the effect of lifestyle changes on MS, and motivating patients to maintain a healthy lifestyle.