Education-based, lifestyle intervention programs with unsupervised exercise improve outcomes in adults with metabolic syndrome. A systematic review and meta-analysis

Health Effects of Electrolyzed Hydrogen Water for the Metabolic Syndrome and Pre-Metabolic Syndrome: A 3-Month Randomized Controlled Trial and Subsequent Analyses

We studied the effect of three months' use of electrolyzed hydrogen water (EHW, Electrolyzed Hydrogen Water conditioner produced by Nihon Trim Co., Ltd.) on metabolic and pre-metabolic syndrome groups. This research was carried out jointly by Susaki City; Nihon Trim Co., Ltd.; and Kochi University as part of a local revitalization project with health as a keyword. A randomized, placebo-controlled, double-blind, parallel-group trial was conducted to evaluate the clinical impact of EHW on participants who suffered from metabolic syndrome or pre-metabolic syndrome. EHW was produced via electrolysis using a commercially available apparatus (Nihon Trim Co., Ltd., Osaka, Japan). During exercise, oxidative stress increases, and active oxygen species increase. In this study, we examined 181 subjects with metabolic syndrome or pre-metabolic syndrome. Among the group that drank EHW for 3 months, those who also engaged in a high level of physical activity showed a significant difference in waist circumference reduction. Although no significant difference was observed, several positive results were found in the participants who engaged in a high level of physical activity. Urinary 8-OHdG, urinary nitrotyrosine, HbA1c, and blood glucose levels increased in the filtered water (FW) group but decreased in the EHW group. High-sensitivity CRP increased less in the EHW group. 8-Isoprostane decreased more in the EHW group. In subgroup analysis, the EHW group showed a significantly greater reduction in waist circumference than the FW group only when controlled for high physical activity. Based on the result, we suggest that, among participants in the study who suffered from metabolic syndrome and pre-metabolic syndrome in which the level of active oxygen species is said to be higher than in healthy subjects, the group that consumed EHW and also engaged in a high level of physical activity experienced a suppressed or reduced increase in active oxygen species.

Plant-Based Diets and Metabolic Syndrome Components: The Questions That Still Need to Be Answered-A Narrative Review

Metabolic syndrome (MetS) is defined as the co-occurrence of at least three of the following metabolic disorders: abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), high blood glucose, and hypertension. The treatment of MetS involves lifestyle changes, including following an appropriate diet. In addition to weight reduction, it is crucial to search for optimal nutritional patterns that are highly effective in optimizing other MetS markers, such as glucose and lipid metabolism, and reducing blood pressure. To date, the effects of a Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) diet on MetS have been extensively evaluated. Recent epidemiological studies suggest that plant-based diets (PBDs) may be effective in treating MetS; however, there is still a lack of experimental data. This review aims to analyze the potential benefits of different PBDs on MetS determinants based on the available studies. The findings may help personalize dietary interventions and improve patient care for those with MetS.

Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study

BACKGROUND

Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China.

OBJECTIVE

We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS.

METHODS

We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp).

RESULTS

Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality.

CONCLUSIONS

The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.

Association of tea and coffee consumption with the risk of all-cause and cause-specific mortality among individuals with metabolic syndrome: a prospective cohort study

BACKGROUND

The relationship between tea and coffee consumption and mortality among patients with metabolic syndrome (MetS) remains barely explored. Herein, this study aimed to examine the association between tea and coffee consumption and the likelihood of all-cause and cause-specific mortality in patients with MetS.

METHODS

A total of 118,872 participants with MetS at baseline from the UK Biobank cohort were included. Information on tea and coffee consumption was obtained during recruitment using a touchscreen questionnaire. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were determined using Cox proportional hazards models.

RESULTS

During a median follow-up of 13.87 years, 13,666 deaths were recorded, with 5913, 3362, and 994 deaths from cancer, cardiovascular diseases (CVD), and respiratory disease (RD), respectively. This research showed a significant inverse association between tea intake and the risk of all-cause and cancer mortality, the respective HRs (95% CI) for consuming tea 2 vs. 0 cup/day were 0.89 (0.84-0.95), and 0.91 (0.83-0.99), and tea intake ≥ 4 cups/day could reduce CVD mortality by 11% (HR 0.89; 95% CI 0.81-0.98). The U-shaped nonlinear association between coffee intake and all-cause/CVD mortality was examined (all p-nonlinear < 0.001). The HRs (95% CI) for coffee consumption 1 vs. 0 cup/day were 0.93 (0.89-0.98) and 0.89 (0.80-0.99), and for ≥ 4 vs. 0 cup/day were 1.05 (1.01-1.11) and 1.13 (1.03-1.25), respectively. Notably, the combined intake of tea and coffee presented a protective effect against all-cause mortality (HR < 1).

CONCLUSIONS

The importance of daily tea and moderate coffee consumption in individuals with MetS to optimise health benefits are highlighted.

Heterogenous subtypes of health literacy among individuals with Metabolic syndrome: a latent class analysis

Objective To explore the heterogenous subtypes and the associated factors of health literacy among patients with metabolic syndrome.Methods A cross-sectional study was conducted, and 337 patients with metabolic syndrome were recruited from Sir Run Run Shaw Hospital in Zhejiang Province from December 2021 to February 2022. The Social Support Questionnaire, Short version of the Health Literacy Scale European Questionnaire (HLS-EU-Q16), and MacArthur Scale of Subjective Social Status were used for investigation. Latent class analysis (LCA) was performed to explore the heterogenous subtypes of health literacy among Metabolic syndrome patients. Univariate analysis and logistic regression were used to identify the predictors of the latent classes.Results The findings of LCA suggested that three heterogeneous subtypes of health literacy among individuals with metabolic syndrome were identified: high levels of health literacy, moderate levels of health literacy, and low levels of health literacy. The multinomial logistic regression results indicated that compared with low levels of health literacy class, the high levels of health literacy class were predicted by age (OR 0.932, 95%CI[0.900-0.966]), socio-economic status (OR 1.185, 95%CI[1.058-1.328]), and social support (OR 1.065, 95%CI[1.012-1.120]). Compared with low levels of health literacy class, the moderate levels of health literacy class were predicted by age (OR 0.964, 95%CI[0.934-0.995]), socio-economic status (OR 1.118, 95%CI[1.006-1.242]), male (OR 0.229, 95%CI[0.092-0.576]).Conclusion The levels of health literacy among patients with metabolic syndrome can be divided into three heterogenous subtypes. The results can inform policy-makers and care professionals to design targeted interventions for different subgroups among patients with metabolic syndrome who are male, at older age, have less social support, and with disadvantaged socio-economic status to improve health literacy.

The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis

BACKGROUND

Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs.

METHODS

Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis.

RESULTS

Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence.

CONCLUSION

The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.

Association of serum 25-hydroxyvitamin D with the incidence of 16 cancers, cancer mortality, and all-cause mortality among individuals with metabolic syndrome: a prospective cohort study

PURPOSE

The relationship between vitamin D levels and cancer incidence and mortality in individuals with metabolic syndrome (MetS) remains poorly explored. Herein, we aimed to determine the association between 25-hydroxyvitamin D [25(OH)D] concentrations and the risk of 16 cancer incidence types and cancer/all-cause mortality in patients with MetS.

METHODS

We enrolled 97,621 participants with MetS at recruitment from the UK Biobank cohort. The exposure factor was baseline serum 25(OH)D concentrations. The associations were examined using Cox proportional hazards models, which were displayed as hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

Over a median follow-up period of 10.92 years for cancer incidence outcomes, 12,137 new cancer cases were recorded. We observed that 25(OH)D concentrations were inversely related to the risk of colon, lung, and kidney cancer, and HRs (95% CI) for 25(OH)D ≥ 75.0 vs. < 25.0 nmol/L were 0.67 (0.45-0.98), 0.64 (0.45-0.91), and 0.54 (0.31-0.95), respectively. The fully adjusted model revealed a null correlation between 25(OH)D and the incidence of stomach, rectum, liver, pancreas, breast, ovary, bladder, brain, multiple myeloma, leukemia, non-Hodgkin lymphoma, esophagus, and corpus uteri cancer. Over a median follow-up period of 12.72 years for mortality outcomes, 8286 fatalities (including 3210 cancer mortalities) were documented. An "L-shaped" nonlinear dose-response correlation was detected between 25(OH)D and cancer/all-cause mortality; the respective HRs (95% CI) were 0.75 (0.64-0.89) and 0.65 (0.58-0.72).

CONCLUSION

These findings emphasize the importance of 25(OH)D in cancer prevention and longevity promotion among patients with MetS.

The effects of an integrated exercise and cardiovascular health education programme on community-dwelling older adults at risk of atherosclerotic cardiovascular diseases: A study protocol for a randomised controlled trial

BACKGROUND

Although older adults are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), the effect of an integrated exercise and cardiovascular health education programme based on self-efficacy theory has not been well investigated among older adults. This study aims at examining the effect of this programme on community-dwelling older adults at risk of ASCVD concerning physical activity level, exercise self-efficacy and ASCVD risk profile.

METHODS

A parallel two-arm randomised controlled trial with pretest-posttest design will be performed among 190 Chinese community-dwelling adults aged 60 or above in elderly community centres of the Guangdong-Hong Kong-Macao Greater Bay Area. Eligible participants will be randomised by computerised generation. Experimental group will receive a 12-week integrated exercise and cardiovascular health education programme, which comprises a one-hour group-based health education talk conducted at Week 1, a booklet, a lecture video, a tailor-made exercise video, and a booster intervention by text messaging starting from Week 1 to Week 12. Control group will receive placebo intervention including a talk on basic health issues, a lecture video and corresponding leaflet. The outcomes will be investigated through self-report questionnaires and physiological evaluations at baseline, Week 12, Week 24, and Week 36. Physical activity level, exercise self-efficacy and ASCVD risk profile will be assessed, with physical activity level at Week 24 considered the primary outcome. The main intervention effect (group differences on continuous outcome variables) will be examined via Generalized Estimating Equations with identity link.

DISCUSSION

This study findings will provide clues to the effect of the integrated exercise and cardiovascular health education programme, which is theoretically underpinned with self-efficacy theory, in older adults at risk of ASCVD. It will also enhance the quality of community health education by providing insight into the effective teaching strategies targeting older adults.

TRIAL REGISTRATION

This study has been registered on ChinicalTrial.gov (Trial ID: NCT05434273).

Meta-analysis of the intervention effects of taekwondo on metabolic syndrome indicators

Objective: To quantify the effect of taekwondo as an intervention on the indicators of metabolic syndrome and identify an intervention plan with the optimal effects. Methods: Combining the Cnki.net, Wanfang, PubMed, Web of Science, Embase, KISS, RISS, and DBPIA databases, this paper retrieved relevant references in Chinese, English, and Korean, applied Review Manager 5.4 software to evaluate the methodological quality of the included references according to the Cochrane manual, and utilized Comprehensive Meta-Analysis version 3.7 to perform statistical analyses. Result: A total of 45 references and 1079 related subjects were included in the analysis. The results of the meta-analysis showed that taekwondo has a beneficial effect on all indicators of metabolic syndrome (Hedges' g [effect size] = -0.615, -0.672, -0.497, -0.785, -0.591, and 0.435; p < 0.05). Subgroup analysis revealed the superior intervention effect of taekwondo on metabolic syndrome in women compared to men, middle-aged and elderly compared to other age groups, and abnormal metabolic syndrome indicators compared to normal values. Moreover, the best results were obtained for longer intervention durations-12 weeks-three times per week, for 40-50 min per session. In addition, the combination of intervention types (poomsae, kick, and taekwondo gymnastics) showed optimal effects. The exercise intensity should consider the characteristics of the intervention object and be generally set to medium or high intensity. Conclusion: Taekwondo can effectively improve metabolic syndrome, as evidenced by decreased body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and triglyceride (TG) levels and increased high-density lipoprotein cholesterol (HDL-C) level. Taekwondo had the greatest effect on quinquagenarian women with abnormal levels of metabolic syndrome indicators. To maximize the intervention effect of taekwondo on metabolic syndrome, an exercise prescription of high-intensity poomsae, kick, and taekwondo gymnastics performed in 40-50 min sessions, three times weekly for 12 weeks is recommended.

Determinants of Non-Adherence to Exercise or Physical Activity in People with Metabolic Syndrome: A Mixed Methods Review

BACKGROUND

Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS.

METHODS

Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively.

RESULTS

Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants.

CONCLUSION

A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions.

Behavior Change Techniques Improve Adherence to Physical Activity Recommendations for Adults with Metabolic Syndrome: A Systematic Review

BACKGROUND

Exercise and physical activity interventions improve short-term outcomes for people with metabolic syndrome, but long-term improvements are reliant on sustained adherence to lifestyle change for effective management of the syndrome. Effective ways of improving adherence to physical activity and exercise recommendations in this population are unknown. This systematic review aims to determine which interventions enhance adherence to physical activity and/or exercise recommendations for people with metabolic syndrome.

METHODS

Electronic databases MEDLINE, PubMed, CINAHL, SPORTdiscuss and ProQuest were searched to July 2022. Risk of bias was assessed using the Cochrane risk of bias tool and overall certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation approach.

RESULTS

Four randomized controlled trials with 428 participants (mean age 49-61 years) were included. There was very low certainty evidence from two trials that goal setting interventions may improve adherence to physical activity recommendations over three to six months. There was low certainty evidence from two trials that self-monitoring and feedback interventions increased adherence to physical activity interventions over 12 months for people with metabolic syndrome.

CONCLUSION

Clinicians and researchers may consider using behavior change strategies such as goal setting, monitoring and feedback in interventions for people with metabolic syndrome to increase adherence to physical activity and exercise recommendations over 3 to 12 months, but high-quality evidence is lacking.

Association of a Healthy Lifestyle with All-Cause, Cause-Specific Mortality and Incident Cancer among Individuals with Metabolic Syndrome: A Prospective Cohort Study in UK Biobank

This study investigated the association between a healthy lifestyle with all-cause, cause-specific mortality, and cancer incidence among individuals with metabolic syndrome (MetS). Healthy lifestyle scores were created based on MetS management guidelines, including never/quitting smoking, moderate drinking, good sleep, healthy diet, sufficient exercise, social support, and less sedentary behaviour. Weighted healthy lifestyle scores were further constructed and classified into three groups: unfavourable (lowest quintile), intermediate (quintiles 2−4), and favourable (highest quintile) lifestyles. We included 87,342 MetS participants from the UK Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariate-adjusted Cox proportional hazards regression. During a median follow-up of 12.54 years, 6739 deaths were reported; during a median follow-up of 10.69 years, 10,802 new cancer cases were documented. We found a favourable lifestyle was inversely associated with all-cause mortality (HR: 0.57; 95%CI: 0.53−0.62), cause-specific mortality from respiratory disease, cancer, digestive disease, cardiovascular disease (HR < 1; p-trend < 0.001), and overall cancer incidence (HR: 0.84; 95% CI: 0.79−0.90). Our results indicate that adherence to healthy lifestyles is associated with lower overall cancer incidence and all-cause mortality risk among MetS individuals. However, causality cannot be made due to the nature of observational studies.

Understanding the hidden epidemic of metabolic syndrome in people accessing community rehabilitation: a cross-sectional study of physical activity, dietary intake, and health literacy

PURPOSE

To determine the prevalence of metabolic syndrome in patients attending outpatient community rehabilitation in Melbourne, Australia and to compare health literacy, physical activity, and dietary intake of people with and without metabolic syndrome.

MATERIALS AND METHODS

A cross-sectional, multi-centre, observational study of adults (n = 193) presenting to rehabilitation with various health complaints. Metabolic syndrome was determined according to the International Diabetes Federation joint consensus worldwide definition. Health literacy was assessed using the Rapid Estimate of Adult literacy in Medicine (REALM) and the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Physical activity was assessed using accelerometers and dietary intake was assessed using a food frequency questionnaire.

RESULTS

One hundred and twenty three participants (64%) had metabolic syndrome. Of these, only three (2%) knew they had it. People with metabolic syndrome scored lower on health literacy (S-TOFHLA MD -2.10, 95% confidence interval (CI) -3.98 to -0.22) and took 1311 (95%CI 375 to 2246) fewer daily steps than those without metabolic syndrome. There were no differences in dietary intake.

CONCLUSIONS

Metabolic syndrome is a prevalent and under-recognised condition in community rehabilitation. Community healthcare professionals and health services may need to consider a broader approach to management including lifestyle assessment and intervention of patients with various conditions. Implications for rehabilitationAlmost two-thirds of adults in community rehabilitation had underlying, undetected metabolic syndrome.Adults with metabolic syndrome completed less objectively measured physical activity and had lower health literacy levels than those without metabolic syndrome.A broader approach to management may need to be considered in community rehabilitation where patients presenting for rehabilitation of various conditions would likely benefit from lifestyle assessment and intervention.

Summary of the best evidence of diet and physical activity management in patients with metabolic syndrome

To evaluate and summarize the evidence of diet and physical activity management in patients with metabolic syndrome (MS). BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) database, Agency for Healthcare Research and Quality (AHRQ) network, National Institute for Health and Clinical Excellence (NICE) network, Scottish Intercollegiate Guidelines Network (SIGN), Guidelines International Network (GIN), Medlive, Registered Nurses' Association of Ontario (RNAO) network, American Diabetes Association (ADA) network, New Zealand Guideline Group (NZGG) network, Canadian medical association clinical practice guidelines network, PubMed, EmBase, Web of Science, CINAHL, Cochrane Library, CNKI, China Science and Technology Journal Database, Wanfang Knowledge Data Service Platform and Chinese biomedical database were searched systematically to obtain guidelines, evidence summary, expert consensus, best practice information book, clinical decision-making, recommended practice, and systematic review on diet and physical activity management in patients with MS. The retrieval period is from the establishment of database to November 2021. Two researchers with evidence-based medicine background evaluated the quality and evidence level of the included literature. A total of 36 articles met the criteria, including 3 guidelines, 5 expert consensus, 1 clinical decision and 27 systematic reviews. We summarized 49 pieces of evidence related to diet and physical activity in patients with MS, involving 15 aspects, namely diet goals, diet patterns, diet time, carbohydrate intake, fat intake, fiber intake, salt intake, fruits, vegetables and grains intake, coffee intake, effects of diet, principle of physical activity, intensity, form, time of physical activity, effects of physical activity, physical activity prescription of patients with MS and cardiovascular disease, and the joint effects of diet and physical activity. Diet and physical activity management can effectively improve the health outcomes of patients with MS. Health professionals should choose and apply the best evidence with consideration of the clinical situation and patient preference.

Prevalence of Metabolic Syndrome and Insulin Resistance in a Sample of Adult ADHD Outpatients

BACKGROUND

High prevalence of Metabolic Syndrome (MS) was found in patients with schizophrenia and bipolar disorders. Insulin Resistance (IR) seems to mediate MS role in developing cardiometabolic consequences.

AIMS

To investigate the prevalence of MS, and the role of MS components and IR surrogate indexes in determining MS in adult ADHD outpatients.

METHODS

In the present cross-sectional study, MS, defined according to the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III), and IR surrogate indexes were assessed on a consecutive sample of adult ADHD outpatients. Logistic regression analysis was performed to evaluate the effect of each ATP III component and IR surrogate index in determining MS.

RESULTS

Seventeen out of 158 patients (10.8%, 95%CI = 0.064/0.167) fulfilled the ATP-III criteria for MS. A comprehensive comparison with prevalence in the reference population was hindered by the lack of patients over 60 in the study sample, however under this age no significant differences were found. Among MS components, blood triglycerides level (OR = 1.02, 95%CI=1.01/1.03, p = 0.001) was the main predictor for MS, followed by diastolic blood pressure (OR = 1.08, 95%CI=1.01/1.16, p = 0.024) and waist circumference (OR = 1.06, 95%CI=1.01/1.13, p = 0.029). Lipid Accumulation Product (LAP, OR = 1.0006, 95%CI=1.0003/1.0009, p < 0.001) outperformed Triglyceride-Waist Circumference (TG-WC, OR=1.03, 95%CI=1.01/1.04, p < 0.001) in predicting MS.

CONCLUSIONS

More attention should be paid not only to MS but also to each ATP III component of MS and LAP in ADHD patients both at first assessment and during follow-up process.

Insomnia in older adult females is highly associated with metabolic syndrome

PURPOSE

The aim of this study is to investigate the relationships between insomnia and metabolic syndrome among Taiwanese older adults.

METHODS

This cross-sectional study enrolled participants aged over 60 years from outpatient clinics between July and September 2018. Demographic characteristics of all participants and questionnaire data for sleep duration, use of hypnotic agents, baseline activities of daily living, 5 items of the geriatric depression scale, comorbidities, medications, and risk of obstructive sleep apnea were obtained. Insomnia was defined by scores of questionnaires of the Chinese version of the Athens Insomnia Scale higher or equal to 6 points. Metabolic syndrome was diagnosed according to criteria of the National Cholesterol Education Program Adult Treatment Panel III. Multivariable forward stepwise logistic regression analysis was applied to investigate independent associations between insomnia and metabolic syndrome before and after stratifying by gender.

RESULTS

Among the 336 participants (mean age 74.9 ± 8.5 years, female 49.1%), 63.1% participants had metabolic syndrome, with significantly higher prevalence among females than males (males 56.7%; females 69.7%). Participants with metabolic syndrome had higher rates of insomnia (34.0% vs. 21.8%, P = 0.018). The significant associations between insomnia and metabolic syndrome disappeared after adjusting for all covariates. However, insomnia was independently associated with metabolic syndrome in older females (adjusted OR 2.614, 95% CI 1.011-6.763, P = 0.048) after adjusting for all covariates.

CONCLUSIONS

Insomnia is significantly associated with metabolic syndrome among older female adults. These findings suggest that gender may play a role in the pathogenesis of insomnia and metabolic syndrome in older adults.

External Validation of the Prognostic Prediction Model for 4-Year Risk of Metabolic Syndrome in Adults: A Retrospective Cohort Study

PURPOSE

A prediction model for 4-year risk of metabolic syndrome in adults was previously developed and internally validated. However, external validity or generalizability for this model was not assessed so it is not appropriate for clinical application. We aimed to externally validate this model based on a retrospective cohort.

PATIENTS AND METHODS

A retrospective cohort design and a temporal validation strategy were used in this study based on a dataset from 1 January 2015 to 31 December 2018. Multiple imputation was used for missing values. Model performance was evaluated by using discrimination, calibration (calibration plot, calibration slope, and calibration intercept), overall performance (Brier score), and decision curve analysis.

RESULTS

In external validation, the C-statistic was 0.782 (95% CI, 0.771-0.793). The calibration plot shows good calibration, calibration slope was 1.006 (95% CI, -0.011-1.063), and calibration intercept was -0.045 (95% CI, -0.113-0.022). Brier score was 0.164.The discrimination and calibration of the prediction model were good in temporal external validation.

CONCLUSION

The discrimination and calibration of the prediction model were satisfactory in the temporal external validation. However, clinicians should be aware that this prediction model was developed and validated in a tertiary setting. It is strongly recommended that further studies validate this model in international cohorts and large, prospective cohorts in different institutions.