Recent advances in metabolic syndrome and cardiovascular disease

Acculturation, Dietary Behaviors, and Macronutrient Intake Among Mexican Americans With Prediabetes: The Starr County Diabetes Prevention Initiative

PURPOSE

The purpose of the study was to examine the influences of sex and acculturation on dietary behaviors, macronutrient intake, and dietary quality in participants enrolled in a diabetes prevention initiative in Starr County, Texas.

METHODS

Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed-acculturation (country of origin, years in Starr County, language and food preferences), depressive symptoms (Patient Health Questionnaire-9), healthy eating self-efficacy (Weight Efficacy Lifestyle Questionnaire-Short Form), diet quality (USDA Healthy Eating Index), fat avoidance (Fat Avoidance Scale, Spanish version), and macronutrients. Descriptive statistics and univariate analysis of covariance were used to examine differences based on acculturation, controlling for sex.

RESULTS

Participants were predominantly female (73%) and, on average, 51 years of age. Language and food preferences favored Spanish language and Hispanic foods, respectively. The majority (71%) was born in Mexico but had resided in Starr County for 33 years, on average. Depressive symptoms were moderate, and eating self-efficacy scores suggested low confidence in making healthy food choices, particularly for saturated fats. Spanish language preference was associated with worse dietary habits. The mean dietary quality score was lower than the national average (54 vs 59 nationally); females had slightly higher dietary quality than males and a higher mean fat avoidance score, although differences were not clinically significant. Intakes of carbohydrate, saturated fats, and cholesterol were higher than recommended daily allowances.

CONCLUSIONS

The overall preference for speaking Spanish and the influence of language on dietary intake should inform future dietary interventions. Accommodating cultural norms and food preferences remain major challenges to improving dietary quality among the diverse Hispanic ethnic groups.

Sphingomyelin profiling in patients with diabetes could be potentially useful as differential diagnostics biomarker: A pilot study

PURPOSE

Autoimmune diabetes (AD) in adults includes both the classical form of type 1 diabetes mellitus (T1DM) and latent autoimmune diabetes in adults (LADA). LADA shares clinical and metabolic features with type 1 and type 2 diabetes mellitus (T2DM). Ceramide (Cer) levels negatively correlate with insulin sensitivity in humans and animal models. However, only a few studies have focused on other sphingolipids, including sphingomyelin (SM). Therefore, we determined sphingolipids in patients with newly diagnosed diabetes as possible diagnostic biomarkers.

MATERIALS AND METHODS

We evaluated sphingolipids in a cohort of 59 adults with newly diagnosed diabetes without prior hypoglycemic pharmacotherapy to distinguish diabetes mellitus types and for precise LADA definition. All patients with newly diagnosed diabetes were tested for the concentrations of individual Cer and SM species by gas-liquid chromatography. The study included healthy controls and patients with T1DM, T2DM and LADA.

RESULTS

SM species were significantly altered in patients with newly diagnosed diabetes compared to healthy controls. SM-C16:0, C16:1, -C18:0, -C18:1, -C18:2, -C18:3, -C20:4, and -C22:6 species were found to be significantly elevated in LADA patients. In contrast, significant differences were observed for Cer species with saturated acyl chains, especially Cer-C14:0, -C16:0, -C18:0 (AD and T2DM), -C22:0, and -C24:0 (T1DM). Following ROC analysis, SM-C16:0, and particularly -C18:1, and -C20:4 may be supportive diagnostic markers for LADA.

CONCLUSION

SM profiling in patients with newly diagnosed diabetes could be potentially helpful for differential diagnosis of LADA, T1DM, and T2DM in more challenging cases.

Association between shift work and risk of metabolic syndrome: A systematic review and meta-analysis

AIMS

A comprehensive assessment of the association of shift work with risk of metabolic syndrome (MetS) through a systematic review and meta-analysis has not been reported. We aimed to evaluate the relationship from observational studies.

DATA SYNTHESIS

We searched PubMed, Embase, and Web of Science databases from inception to December 16, 2020. Articles were chosen according to established inclusion criteria. Studies with data on men and women and different types of shift work were treated as independent studies. Relative risks (RRs) and 95% confidence intervals (CIs) were pooled by using random-effects models with heterogeneity (I²) > 50%; otherwise, a fixed-effects model was used. A total of 7192 articles was searched from PubMed, Embase and Web of science. Finally, we included 23 articles (38 studies) in this meta-analysis. The pooled RRs and 95% CI of MetS risk with shift work, 1-shift work, 2-shift work, and 3-shift work versus non-shift work were 1.30 (95% CI 1.19-1.41), 0.95 (95% CI 0.82-1.11), 1.19 (95% CI 0.91-1.56) and 1.17 (95% CI 1.00-1.37), respectively. The results from subgroup analyses stratified by sex, age, and region supported our overall findings that shift work is a risk factor for MetS.

CONCLUSIONS

This meta-analysis suggests that shift work increases risk of MetS. Higher risk of MetS was found in the shift workers who were 2-shift or 3-shift or women or Asian workers.

Prolonged multimodal fasting modulates periodontal inflammation in female patients with metabolic syndrome: A prospective cohort study

AIM

To determine the potential anti-inflammatory effect of a multimodal periodic fasting programme on surrogate parameters of periodontal inflammation in hospitalized patients diagnosed for metabolic syndrome (MetS).

MATERIAL AND METHODS

A total of 47 patients were recruited and hospitalized in an integrative ward for an intensified two-week multimodal fasting, diet and lifestyle programme. Patients were periodontally examined at baseline (t1), after the 2-week fasting protocol (t2) and, subsequently, 4 months after fasting (t3). The following parameters were determined: periodontal screening index (PSI), bleeding on probing (BOP), gingival crevicular fluid volume (GCF), plaque index (PI), C-reactive protein (CRP), blood pressure (BP), waist circumference (WC), fasting glucose (FGLU), triglycerides (TRG), high-density lipoprotein (HDL) and HbA1c.

RESULTS

A total of 28 female and 8 male patients fulfilled the defined criteria for MetS and were analysed separately by gender. At t2, BOP and GCF were reduced when compared to t1 (median: t2 = 39; t1 = 33.1%; p < .001 and t2 = 73.9; t1 = 59.3 Periotron units p = .02, respectively). BOP reduction correlated to FGLU (R = .37, p = .049) and weight reduction (R = .4, p = .04).

CONCLUSION

This study showed for the first time that clinically supervised periodic fasting in female patients with MetS may facilitate the reduction of periodontal inflammation.

Exercise and caloric restriction improve cardiovascular and erectile function in rats with metabolic syndrome

The aim of this study is to examine the possible benefits of exercise and caloric restriction (CR) on cardiovascular hemodynamics, erectile function, and antioxidant system in metabolic syndrome (MS). Sixty male Spraque-Dawley rats were divided into five groups; control, MS, MS + CR, MS + exercise (EXC), and MS + CR + EXC. To induce MS, 10% fructose solution was applied for 3 months. Thereafter, in CR groups calorie was restricted 40% and in EXC groups swimming was performed for 6 weeks. Body weight, blood glucose, and blood pressure (BP) levels were measured before and after MS induction and at the end of the experiment. After decapitation, tumor necrosis factor (TNF)-α, adiponectin (ADP), and plasminogen activator inhibitor (PAI)-1 levels were investigated in blood, oxidative stress parameters were examined in heart, aorta, and corpus cavernosum (CC) tissues. Isometric contraction in isolated tissue bath was studied in aorta and CC tissues. Animals subjected to exercise and CR had decreased BP and blood glucose levels. Impaired contraction-relaxation responses in MS group were improved with exercise and CR. MS-induced increase in TNF-α, PAI-1, malondialdehyde (MDA), and decrease in ADP, glutathione (GSH), and superoxide dismutase (SOD) were normalized with exercise and CR. Exercise and CR may be beneficial against changes in cardiovascular hemodynamics caused by MS.

Shift work and metabolic syndrome: A multi-center cross-sectional study on females of reproductive age

Shift work during reproductive age can be a risk factor for metabolic syndrome. The present study evaluated the association between shift work and metabolic syndrome during reproductive age. This multi-center cross-sectional correlational study was performed between September 2017 and May 2018. A total of 419 female shift and day workers were purposively recruited to the study from three central cities in Mazandaran, Iran. To diagnose metabolic syndrome based on the National Cholesterol Education Program Adult Treatment Panel III guidelines, the anthropometric measures, blood pressure, and levels of serum triglyceride, high-density lipoprotein and fasting blood sugar were taken. Data were analyzed using the independent-sample t, Chi-square and the Fisher's exact tests as well as the logistic regression analysis. Among the 419 participants, 28 were excluded during the study. The total prevalence of metabolic syndrome was 16.3%, and its prevalence among shift workers and day workers was 17.3 and 14.9%, respectively. The most prevalent components of metabolic syndrome were low serum level of high-density lipoprotein and abdominal obesity. Following adjustments for the effects of potential cofounders, the logistic regression analysis revealed that the odds of metabolic syndrome among shift workers was ~2 times greater than day workers (odds ratio, 1.83; 95% confidence interval, 0.088-3.79), although this association was statistically insignificant (P=0.10). The results of the current study suggest that shift work is associated with a greater risk of metabolic syndrome for women. The most important components of metabolic syndrome are low serum level of high-density lipoprotein and abdominal obesity, which are attributable to limited physical activity and high occupational stress. The risk of metabolic syndrome among female shift workers of reproductive age may be reduced through strategies, including awareness raising, dietary educations and provision of physical activity facilities in the workplace.

Effectiveness of workplace diabetes prevention programs: A systematic review of the evidence

PURPOSE

The primary purpose is to review diabetes workplace interventions and the degree to which they improve diabetes-related outcomes in employees diagnosed with or at risk for T2DM.

METHODS

Three electronic databases and ancestry searches were used to identify peer reviewed articles published in English from 2000 to June 2017.

RESULTS

The number of participants represented by the 22 selected studies, excluding one large outlier, was 4243. On average, the samples were 57% female and ethnically diverse. Interventions-healthy eating behaviors, physical activity, and/or monitoring and self-managing diabetes and cardiovascular risk factors-were delivered in group sessions of fewer than 20 employees. Programs involved 1-h weekly sessions held during lunch hour or at other times during the workday for 12 to 24 weeks. Study outcomes, commonly measured at 6 and/or 12 months, were consistently positive.

CONCLUSION

The literature search uncovered beginning evidence that workplace interventions hold promise for preventing diabetes and/or its complications. More rigorous, creatively designed, workplace studies, are needed for employees at high-risk for developing diabetes.

PRACTICE IMPLICATIONS

Implications include the need for employer education about the benefits of employer support for such programs and attention to motivational strategies so employees will take full advantage of programs that are offered.

Metabolic syndrome, endocrine disruptors and prostate cancer associations: biochemical and pathophysiological evidences

This review summarizes the main pathophysiological basis of the relationship between metabolic syndrome, endocrine disruptor exposure and prostate cancer that is the most common cancer among men in industrialized countries. Metabolic syndrome is a cluster of metabolic and hormonal factors having a central role in the initiation and recurrence of many western chronic diseases including hormonal-related cancers and it is considered as the worlds leading health problem in the coming years. Many biological factors correlate metabolic syndrome to prostate cancer and this review is aimed to focus, principally, on growth factors, cytokines, adipokines, central obesity, endocrine abnormalities and exposure to specific endocrine disruptors, a cluster of chemicals, to which we are daily exposed, with a hormone-like structure influencing oncogenes, tumor suppressors and proteins with a key role in metabolism, cell survival and chemo-resistance of prostate cancer cells. Finally, this review will analyze, from a molecular point of view, how specific foods could reduce the relative risk of incidence and recurrence of prostate cancer or inhibit the biological effects of endocrine disruptors on prostate cancer cells. On the basis of these considerations, prostate cancer remains a great health problem in terms of incidence and prevalence and interventional studies based on the treatment of metabolic syndrome in cancer patients, minimizing exposure to endocrine disruptors, could be a key point in the overall management of this disease.

Changes in Serum Sphingomyelin After Roux-en-Y Gastric Bypass Surgery Are Related to Diabetes Status

Metabolic surgery is superior to lifestyle intervention in reducing weight and lowering glycemia and recently suggested as treatment for type 2 diabetes mellitus. Especially Roux-en-Y gastric bypass (RYGB) has been focus for much research, but still the mechanisms of action are only partly elucidated. We suggest that several mechanisms might be mediated by sphingolipids like sphingomyelin. We measured serum sphingomyelin before and up to 2 years after RYGB surgery in 220 patients, divided before surgery in one non-diabetic subgroup and two diabetic subgroups, one of which contained patients obtaining remission of type 2 diabetes after RYGB, while patients in the other still had diabetes after RYGB. Pre- and postoperative sphingomyelin levels were compared within and between groups. Sphingomyelin levels were lower in diabetic patients than in non-diabetic patients before surgery. Following RYGB, mean sphingomyelin concentration fell significantly in the non-diabetic subgroup and the preoperative difference between patients with and without diabetes disappeared. Changes in diabetic subgroups were not significant. Relative to bodyweight, an increase in sphingomyelin was seen in all subgroups, irrespective of diabetes status. We conclude that RYGB has a strong influence on sphingomyelin metabolism, as seen reflected in changed serum levels. Most significantly, no differences between the two diabetic subgroups were detected after surgery, which might suggest that patients in both groups still are in a "diabetic state" using the non-diabetic subgroup as a reference.

White Paper AGA: POWER - Practice Guide on Obesity and Weight Management, Education, and Resources

The epidemic of obesity continues at alarming rates, with a high burden to our economy and society. The American Gastroenterological Association understands the importance of embracing obesity as a chronic, relapsing disease and supports a multidisciplinary approach to the management of obesity. Because gastrointestinal disorders resulting from obesity are more frequent and often present sooner than type 2 diabetes mellitus and cardiovascular disease, gastroenterologists have an opportunity to address obesity and provide an effective therapy early. Patients who are overweight or obese already fill gastroenterology clinics with gastroesophageal reflux disease and its associated risks of Barrett's esophagus and esophageal cancer, gallstone disease, nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, and colon cancer. Obesity is a major modifiable cause of diseases of the digestive tract that frequently goes unaddressed. As internists, specialists in digestive disorders, and endoscopists, gastroenterologists are in a unique position to play an important role in the multidisciplinary treatment of obesity. This American Gastroenterological Association paper was developed with content contribution from Society of American Gastrointestinal and Endoscopic Surgeons, The Obesity Society, Academy of Nutrition and Dietetics, and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, endorsed with input by American Society for Gastrointestinal Endoscopy, American Society for Metabolic and Bariatric Surgery, American Association for the Study of Liver Diseases, and Obesity Medicine Association, and describes POWER: Practice Guide on Obesity and Weight Management, Education and Resources. Its objective is to provide physicians with a comprehensive, multidisciplinary process to guide and personalize innovative obesity care for safe and effective weight management.

Metabolic syndrome contributes to renal injury mediated by hyperoxaluria in a murine model of nephrolithiasis

Metabolic syndrome (MS) individuals have a higher risk of developing chronic kidney disease through unclear pathogenic mechanisms. MS has been also related with higher nephrolithiasis prevalence. To establish the influence of MS on renal function, we designed a murine model of combined metabolic syndrome and hyperoxaluria. Four groups of male Sprague-Dawley rats were established: (1) control group (n = 10) fed with standard chow; (2) stone former group (SF) (n = 10) fed with standard chow plus 0.75% ethylene glycol administered in the drinking water; (3) metabolic syndrome group (MS) (n = 10), fed with 60% fructose diet; (4) metabolic syndrome + stone former group (MS + SF) (n = 10), 60% fructose diet and 0.75% EG in the drinking water. MS group showed a significant injury to renal function when hyperoxaluria was induced. It was demonstrated by a significant decrease of creatinine clearance (p < 0.001), with higher tubular damage (34.3%, CI 95% 23.9-44.7, p < 0.001), produced by deposition of crystals, and increased tubular synthesis of osteopontin as a response to tubular damage. Induction of hyperoxaluria in rats with MS causes severe morphological alterations with a significant impairment of renal function. This impairment is not produced in rats without MS. Therefore, this model can be useful for the study of the influence of MS in stone formation.

A working paradigm for the treatment of obesity in gastrointestinal practice

Obesity is a chronic, relapsing, multi-factorial disease characterized by abnormal or excessive adipose tissue accumulation that may impair health and increase disease risks. Despite the ever-increasing prevalence and economic and societal burden, the current approaches to treat obesity are not standardized or generally effective. In this manuscript, we describe a current working paradigm developed by a consensus approach for the multidisciplinary treatment of obesity in the GI practice. Obesity should be managed as a continuum of care focusing on weight loss, weight loss maintenance and prevention of weight regain. This approach needs to be disseminated throughout the health care system, coordinated by a multidisciplinary team and include gastroenterologists who are in a unique position to address obesity. Gastroenterologists are in the front line of managing the morbidity resulting from obesity, and have expertise in use of the essential tools to manage obesity: nutrition, pharmacology, endoscopy and surgery.

How significant is the association between metabolic syndrome and prevalence of colorectal neoplasia?

The incidence and prevalence of metabolic syndrome (MS) and colorectal cancer (CRC) has been rising in developed countries. The association between these two diseases has been widely studied and reported. Less evidence is available about the relationship between MS and CRC precancerous lesions (adenomatous polyps, adenomas). The aim of this paper is to present an overview of our scientific understanding of that topic and its implication in clinical practice. One of the principal goals of current CRC secondary prevention efforts is to detect and remove the precancerous lesions in individuals with an average CRC risk to prevent the development of invasive cancer. MS is not currently considered a high-risk CRC factor and is therefore not included in the guidelines of organized screening programs. However, in light of growing scientific evidence, the approach to patients with MS should be changed. Metabolic risk factors for the development of adenomas and cancers are the same - obesity, impaired glucose tolerance, dyslipidemia, hypertension, cardiovascular diseases and diabetes mellitus type 2. Therefore, the key issue in the near future is the development of a simple scoring system, easy to use in clinical practice, which would identify individuals with high metabolic risk of colorectal neoplasia and would be used for individual CRC secondary prevention strategies. Currently, such scoring systems have been published based on Asian (Asia-Pacific Colorectal Screening Score; APCS) and Polish populations.

Circulating miRNA in patients with non-alcoholic fatty liver disease and coronary artery disease

Background

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and coronary artery disease (CAD) is the cardiac manifestation of metabolic syndrome. NAFLD is strongly linked to CAD and hepatic steatosis is an independent risk factor for CAD and cardiac mortality. The pathogenic mechanism underlying this association remains poorly understood. In this study, we explored expression of circulating microRNAs (miRNAs) in patients with NAFLD and associated CAD.

Results

When compared to patients with NAFLD without CAD, patients with NAFLD and CAD had lower circulating levels of miR-132 (0.24±0.16 vs 0.30±0.11, p=0.03), while the circulating levels of miR-143 were higher (0.96±0.90 vs 0.64±0.77, p=0.02). The levels in circulation demonstrated trends opposite to previously observed intracellular levels in patients with CAD. In obese patients with NAFLD, lower circulating levels of miR-145 (1.42±1.00 vs 2.41±1.80), miR-211 (41.26±20.40 vs 57.56±25.45), miR-146a (2.13±1.40 vs 2.90±1.36) and miR-30c (6.92±4.99 vs 11.0±6.92) were detected when compared to lean patients with NAFLD. For miR-161 (0.59±1.19 vs 0.15±0.14) and miR-241 (0.28±0.29 vs 0.16±0.13), higher circulatory levels were detected in the obese patients with NAFLD. These observations suggest altered circulating levels of miRNAs that may serve to balance intracellular levels of miRNA in target tissues. Additional studies examining paired samples of target and producing tissues as well as respective plasma samples will help delineate the regulatory circuits governing the secretion and the uptake of miRNA in multitissue diseases.

Review of the pathophysiological aspects involved in urological disease associated with metabolic syndrome

INTRODUCTION

Metabolic syndrome is a constellation of disorders that includes insulin resistance, central obesity, arterial hypertension and hyperlipidaemia. These disorders can have implications for the genitourinary apparatus.

OBJECTIVES

To conduct a review on the pathophysiological aspects that explain the relationship between metabolic syndrome and sexual dysfunction, lower urinary tract syndrome, prostate cancer and stone disease.

METHODS

We performed a qualitative, narrative literature review through a literature search on PubMed of articles published between 1997 and 2015, using the terms pathophysiology, metabolic syndrome, endothelial dysfunction, lipotoxicity, mitochondrial dysfunction, kidney stones, hypogonadism, erectile dysfunction, lower urinary tract syndrome and prostate cancer.

SYNTHESIS OF THE EVIDENCE

Metabolic syndrome constitutes an established complex of symptoms, defined as the presence of insulin resistance, central obesity, hypertension and hyperlipidaemia. Endothelial dysfunction secondary to lipotoxicity generates an inflammatory state, which involves renal cell metabolism, vascularisation of the pelvis and androgen production. These facts explain the relationship between metabolic syndrome, nephrolithiasis, lower urinary tract syndrome, hypogonadism and erectile dysfunction in men.

CONCLUSIONS

Strategies such as proper diet, regular exercise, insulin treatment, testosterone-replacement therapy, therapy with antioxidants and free-radical inhibitors and urological treatments classically used for lower urinary tract syndrome have shown promising results in this syndrome.

High prevalence of metabolic syndrome in patients with psoriasis in Lebanon: a prospective study

BACKGROUND

Psoriasis is a chronic inflammatory disease that affects not only the skin but also other organs as well. Genetic factors play an important role in individual predisposition. Lately, a positive association has been confirmed between psoriasis and metabolic syndrome (MBS), in western as well as in Middle Eastern countries.

AIM

Assess the prevalence of MBS in Lebanese patients with psoriasis and the differential effect according to types and disease severity.

METHODS

This was a case-control study including 150 psoriasis patients and 150 age- and gender-matched controls admitted to the dermatology clinics at the American University of Beirut-Medical Center, a tertiary care center in Beirut. Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI). Blood samples were collected from fasting subjects and tested for glucose, HDL cholesterol, triglycerides, and C-reactive protein (CRP). Multivariate binary logistic regression models were built to assess the relationship between MBS and psoriasis, after adjustment for smoking as a possible confounding variable.

RESULTS

Patients with psoriasis were two times more likely to have MBS as compared to controls (35.3% vs 18.0%, P < 0.001) with an odds ratio (OR) of 2.4. All components of MBS were more prevalent in psoriasis patients than in controls. PASI score was greater in patients with MBS than those without MBS (10.5 ± 11.5 vs. 7.0 ± 8.1, P = 0.05). MBS prevalence tended to be higher in the inverse type than in others (52.2% versus 32.3%; P = 0.06) and in patients with nail pitting versus those without (45.3% vs. 28.2%; P = 0.03).

CONCLUSIONS

This was the first study to assess the prevalence of MBS in Lebanese subjects with psoriasis and, to our knowledge, the first study that showed a higher likelihood of MBS in patients with inverse psoriasis and with nail pitting.

Culturally tailored diabetes prevention in the workplace: focus group interviews with Hispanic employees

PURPOSE

The purpose was to conduct focus groups with Hispanic employees to obtain input into adaptation of previous DSME interventions for use as a workplace diabetes prevention program.

METHODS

From a list of interested Hispanic employees who attended a local health fair (n = 68), 36 were randomly selected to participate in focus groups held during supper mealtime breaks. An experienced bilingual moderator directed the sessions, using interview guidelines developed by the research team.

RESULTS

Participants' ages ranged from 22 to 65 years (mean = 50.4, n = 36, SD = 10.7), 7 males and 29 females attended, and 53% had type 2 diabetes mellitus (T2DM). Employees expressed a keen interest in diabetes classes and recommended a focus on preparing healthier Hispanic foods. Primary barriers to promoting healthier lifestyles were work schedules; many employees worked 2 part-time or full-time jobs. Administrators and direct supervisors of the employees were highly supportive of a workplace diabetes prevention program.

CONCLUSIONS

The consistent message was that a workplace program would be the ideal solution for Hispanic employees to learn about diabetes and healthy behaviors, given their busy schedules, family responsibilities, and limited resources. If found to be effective, such a workplace program would be generalizable to other service employees who have disproportionate diabetes rates.

Metabolic syndrome is associated with atrial electrical and mechanical dysfunction

OBJECTIVE

In this study, we aimed to investigate the left atrial (LA) electrical and mechanical functions in patients with metabolic syndrome (MetS).

SUBJECTS AND METHODS

The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays (EDs) were measured with tissue Doppler imaging. P-wave dispersion (Pd) was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method.

RESULTS

Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS (10.3 ± 6.3, 21.0 ± 11.5 and 41.7 ± 10.8) than in controls (7.4 ± 5.5, 12.3 ± 10.4 and 29.2 ± 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively). The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volume and left ventricular early diastolic (E) wave velocity/late diastolic (A) wave velocity (E/A) ratios were independent correlates of interatrial ED (p = 0.002, p = 0.001 and p = 0.025, respectively).

CONCLUSIONS

This study showed that intra-atrial and interatrial EDs and Pd were prolonged and LA mechanical functions were impaired in patients with MetS.

Improving residents' clinical approach to obesity: impact of a multidisciplinary didactic curriculum

BACKGROUND/OBJECTIVES

Obesity has been declared a 21st century pandemic by WHO. Yet surveys reveal physicians-in-training are uncomfortable managing obesity. One major barrier is the lack of residency education on obesity management. This study incorporates an obesity-specific didactic curriculum into an internal medicine (IM) residency programme and assesses its impact on residents' knowledge, attitudes, practice behaviours, and clinical outcomes in patients with obesity.

METHODS

The intervention consisted of four, 1 h, obesity-specific lectures in the University of Florida Resident Noon Conference. Lectures were taught by multidisciplinary experts and offered to 75 IM residents every 2 weeks from 5 November 2010 to 17 December 2010. Impact on IM residents' knowledge and attitudes was assessed by a pre- and post-intervention Obesity Awareness Questionnaire (OAQ). IM residents' clinical performance was assessed by chart reviews of 238 patients with body mass index >25 kg/m(2) in residents' clinics 4 months pre- and 6 months post-intervention for three clinical outcomes and seven practice behaviours on obesity management. Pre- and post-intervention outcomes were compared via paired t tests (quantitative data) or McNemar's test (binary data).

RESULTS

Mean lecture attendance was 25/75 residents (33%) per lecture. Survey response was 67/75 residents (89%) pre-OAQ and 63/75 residents (84%) post-OAQ. While most attitudes remained unchanged, IM residents gained significant confidence in exercise counselling, safety of bariatric surgery, and patients' weight loss potential; they were more likely to address obesity in the plan and referrals to bariatric surgery. Clinical outcomes and IM residents' knowledge demonstrated no improvement.

CONCLUSIONS

Our brief lecture-based curriculum has the potential to improve IM residents' attitudes and practice behaviours towards obesity. The lack of improvement in clinical outcomes and resident knowledge prompts the need for multimodal, longitudinal curricula with experiential application of obesity medicine.

Immunosuppression: trends and tolerance?

Advances in pharmacologic immunosuppression are responsible for the excellent outcomes experienced by recipients of liver transplants. However, long-term follow-up of these patients reveals an increasing burden of morbidity and mortality that is attributable to these drugs. The authors summarize the agents used in contemporary liver transplantation immunosuppression protocols and discuss the emerging trend within the community to minimize or eliminate these agents from use. The authors present recently published data that may provide the foundation for immunosuppression minimization or tolerance induction in the future and review studies that have focused on the utility of biomarkers in guiding immunosuppression management.

Association between the serum concentration of triiodothyronine with components of metabolic syndrome, cardiovascular risk, and diet in euthyroid post-menopausal women without and with metabolic syndrome

PURPOSE

To determine the association between the serum concentration of triiodothyronine (T3) with components of metabolic syndrome (MetS), cardiovascular risk (CVR), and diet in euthyroid post-menopausal women without and with MetS.

METHODS

A cross-sectional study was performed in 120 voluntary women of an indigenous population from Tlaxcala-México. Euthyroid status was assessed measuring the serum concentration of thyrotropin (TSH) and thyroid hormones, while that of estradiol was measured to confirm the postmenopausal condition. MetS was diagnosed using the American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (AHA/NHLBI) criterion. Estimation of CVR was calculated based on the Framingham scale. Diet components were evaluated based on survey applications. Correlations, logistic regression analyses, ANOVA or Kruskall-Wallis, and chi-square tests were used to determine significant differences (P ≤ 0.05) between women without MetS and women with MetS having different serum concentrations of T3.

RESULTS

Triiodothyronine was positively correlated with insulin but negatively correlated with glucose, high-density lipoprotein cholesterol (HDL-C), and CVR. Compared to women without MetS, women with MetS and low-normal T3 concentration showed a high risk for hyperglycemia and moderate/high risk for CVR. In contrast, a high-normal T3 concentration increased the risk to have a big waist circumference, a high concentration of HDL-C, and insulin resistance. Diet analysis showed a high grade of malnutrition in women from all groups. The intake of calories was positively affected by the T3 concentration, albeit it did not affect the extent of malnutrition.

CONCLUSIONS

In contrast to concentrations of TSH, total thyroxin (T4), and free T4, the concentration of serum T3 was strongly correlated with cardio-metabolic variables in euthyroid postmenopausal women. In comparison to women without MetS, a high-normal serum concentration of T3 in women with MetS is positively associated with reduced glycaemia and CVR but negatively related to body mass index (BMI), insulin, insulin resistance, and HDL-C. Although the analyzed population had a nutritional deficiency, both calories and iron intake were positively affected by the T3 concentration. Our results suggest the necessity of health programs monitoring T3 in old people in order to treat hyperglycemia, cardio-metabolic components, and the ageing anorexia.

Cardiovascular depression in rats exposed to inhaled particulate matter and ozone: effects of diet-induced metabolic syndrome

BACKGROUND

High ambient levels of ozone (O3) and fine particulate matter (PM2.5) are associated with cardiovascular morbidity and mortality, especially in people with preexisting cardiopulmonary diseases. Enhanced susceptibility to the toxicity of air pollutants may include individuals with metabolic syndrome (MetS).

OBJECTIVE

We tested the hypothesis that cardiovascular responses to O3 and PM2.5 will be enhanced in rats with diet-induced MetS.

METHODS

Male Sprague-Dawley rats were fed a high-fructose diet (HFrD) to induce MetS and then exposed to O3, concentrated ambient PM2.5, or the combination of O3 plus PM2.5 for 9 days. Data related to heart rate (HR), HR variability (HRV), and blood pressure (BP) were collected.

RESULTS

Consistent with MetS, HFrD rats were hypertensive and insulin resistant, and had elevated fasting levels of blood glucose and triglycerides. Decreases in HR and BP, which were found in all exposure groups, were greater and more persistent in HFrD rats compared with those fed a normal diet (ND). Coexposure to O3 plus PM2.5 induced acute drops in HR and BP in all rats, but only ND rats adapted after 2 days. HFrD rats had little exposure-related changes in HRV, whereas ND rats had increased HRV during O3 exposure, modest decreases with PM2.5, and dramatic decreases during O3 plus PM2.5 coexposures.

CONCLUSIONS

Cardiovascular depression in O3- and PM2.5-exposed rats was enhanced and prolonged in rats with HFrD-induced MetS. These results in rodents suggest that people with MetS may be prone to similar exaggerated BP and HR responses to inhaled air pollutants.

Impact of weight loss and maintenance with ad libitum diets varying in protein and glycemic index content on metabolic syndrome

OBJECTIVES

We investigated the effects of weight loss and maintenance with diets that varied with regard to protein content and glycemic index (GI) on metabolic syndrome (MetSyn) status.

METHODS

Secondary analyses were performed within the Diet, Obesity and Genes (DiOGenes) study (2006-2008), a randomized controlled dietary intervention. Nine hundred and thirty-eight overweight and obese adults from eight European countries entered an 8-wk low-calorie-diet period. Seven hundred and seventy-three adults who lost at least 8% of their body weights were randomized to one of five ad libitum diets for 6 mo: 1) low-protein (LP)/low-GI (LGI); 2) LP/high-GI (HGI); 3) high-protein (HP)/LGI; 4) HP/HGI; and 5) control diet. MetSyn prevalence and a standardized MetSyn score were assessed at baseline, after the low-calorie diet, and after the intervention.

RESULTS

Weight loss among participants while on the low-calorie diet significantly reduced MetSyn prevalence (33.9% versus 15.9%; P < 0.001) and MetSyn score (-1.48 versus -4.45; P < 0.001). During weight maintenance, significant changes in MetSyn score were observed between the groups, with the highest increase detected in the LP/HGI group (P = 0.039, partial η(2) = 0.023). Protein, GI, and their interaction did not have isolated effects on study outcomes.

CONCLUSIONS

Neither protein nor GI affected MetSyn status in this sample of European overweight and obese adults. However, a diet with a combination of an increased protein-to-carbohydrate ratio with low-GI foods had beneficial effects on MetSyn factors.

The Association between Shift Work and the Metabolic Syndrome in Female Workers

OBJECTIVE

This study aimed to determine identify any association between shift work and the metabolic syndrome by comparing the prevalence rates of the metabolic syndrome in shift work groups and daytime work groups for female workers.

METHODS

Based on data from health examinations carried out from April to December of 2012, we selected as our subjects 254 female workers from the Daegu area Dyeing Industrial Complex. We diagnosed the metabolic syndrome using the examination results, and information about age, whether or not they did shift work, job type, smoking habits, drinking habits, exercise habits, and past medical history was collected through self-administered questionnaire surveys and face-to-face interviews. The variables found in a univariate analysis to be significant in the occurrence of the metabolic syndrome - age, drinking habits, exercise habits, and shift work - were included in a logistic regression analysis of the risk of the metabolic syndrome for female workers.

RESULTS

The prevalence rates of the metabolic syndrome for the total group of study subjects was 11.8%, for daytime workers was 2.8%, and for shift workers was 15.3%. A logistic regression analysis of the odds of the metabolic syndrome for female workers was conducted that included factors associated with the occurrence of the metabolic syndrome: age, drinking habits, exercise habits, and shift work. The results revealed that the odds ratio of the metabolic syndrome in the shift work group, 6.30 (95% CI 1.24-32.15), was significantly higher when compared with the daytime work group.

CONCLUSION

Shift work appears to have an association with the metabolic syndrome in female workers. Accordingly, we believe that the attention of government agencies and business owners is needed together with the individual practice of health behaviors to manage the metabolic syndrome for the prevention of cardiovascular disease in female shift workers.

Dysregulation of the autonomic nervous system predicts the development of the metabolic syndrome

CONTEXT

Stress is suggested to lead to metabolic dysregulations as clustered in the metabolic syndrome. Although dysregulation of the autonomic nervous system is found to associate with the metabolic syndrome and its dysregulations, no longitudinal study has been performed to date to examine the predictive value of this stress system in the development of the metabolic syndrome.

OBJECTIVE

We examined whether autonomic nervous system functioning predicts 2-year development of metabolic abnormalities that constitute the metabolic syndrome.

DESIGN

Data of the baseline and 2-year follow-up assessment of a prospective cohort: the Netherlands Study of Depression and Anxiety was used.

SETTING

Participants were recruited in the general community, primary care, and specialized mental health care organizations.

PARTICIPANTS

A group of 1933 participants aged 18-65 years.

MAIN OUTCOME MEASURES

The autonomic nervous system measures included heart rate (HR), respiratory sinus arrhythmia (RSA; high RSA reflecting high parasympathetic activity), pre-ejection period (PEP; high PEP reflecting low sympathetic activity), cardiac autonomic balance (CAB), and cardiac autonomic regulation (CAR). Metabolic syndrome was based on the updated Adult Treatment Panel III criteria and included high waist circumference, serum triglycerides, blood pressure, serum glucose, and low high-density lipoprotein (HDL) cholesterol.

RESULTS

Baseline short PEP, low CAB, high HR, and CAR were predictors of an increase in the number of components of the metabolic syndrome during follow-up. High HR and low CAB were predictors of a 2-year decrease in HDL cholesterol, and 2-year increase in diastolic and systolic blood pressure. Short PEP and high CAR also predicted a 2-year increase in systolic blood pressure, and short PEP additionally predicted 2-year increase in diastolic blood pressure. Finally, a low baseline RSA was predictive for subsequent decreases in HDL cholesterol.

CONCLUSION

Increased sympathetic activity predicts an increase in metabolic abnormalities over time. These findings suggest that a dysregulation of the autonomic nervous system is an important predictor of cardiovascular diseases and diabetes through dysregulating lipid metabolism and blood pressure over time.

Abnormal amounts of intracellular calcium regulatory proteins in SHRSP.Z-Leprfa/IzmDmcr rats with metabolic syndrome and cardiac dysfunction

Metabolic syndrome is known to increase the risk of abnormal cardiac structure and function, which are considered to contribute to increased incidence of cardiovascular disease and mortality. We previously demonstrated that ventricular hypertrophy and diastolic dysfunction occur in SHRSP.Z-Leprfa/IzmDmcr (SHRSP fatty) rats with metabolic syndrome. The aim of this study was to investigate the possible mechanisms underlying abnormal heart function in SHRSP fatty rats. The amount of sarcoplasmic reticulum Ca2+-ATPase (SERCA) 2a, phospholamban (PLB) protein, and Ser16-phosphorylated PLB was decreased in cardiomyocytes from SHRSP fatty rats compared with those from control Wistar–Kyoto rats at 18 weeks of age, and the PLB-to-SERCA2a ratio was increased. Left ventricular developed pressure was unchanged, and coronary flow rate and maximum rate of left ventricular pressure decline (−dP/dt) was decreased in SHRSP fatty rats. Treatment with telmisartan reversed the abnormalities of PLB amount, coronary flow rate, and −dP/dt in SHRSP fatty rats. These results indicate that abnormal amounts of intracellular Ca2+ regulatory proteins in cardiomyocytes, leading to reduced intracellular Ca2+ reuptake into the sarcoplasmic reticulum, may play a role in the diastolic dysfunction in SHRSP fatty rats and that these effects are partially related to decreased coronary circulation. Telmisartan may be beneficial in protecting against disturbances in cardiac function associated with metabolic syndrome.

Obesity in bipolar disorder: an overview

Bipolar disorder (BD) is associated with obesity, overweight, and abdominal obesity, and BD individuals with obesity have a greater illness burden. Factors related to BD, its treatment, and the individual may all contribute to BD's association with obesity. Management strategies for the obese BD patient include use of medications with better metabolic profiles, lifestyle interventions, and adjunctive pharmacotherapy for weight loss. Obesity-related psychiatric and medical comorbidities should also be assessed and managed. Bariatric surgery may be an option for carefully selected patients. Greater research into the theoretical underpinnings and clinical management of the BD-obesity connection is needed.

Shiftwork and metabolic dysfunction

Many of the health problems that are more prevalent among shiftworkers are thought to be linked to their heightened susceptibility to metabolic syndrome, i.e., the association of even moderate degrees of visceral obesity, dyslipidemia, abnormal blood pressure, and serum glucose levels in the same individual. Although previous studies have identified associations between shiftwork and metabolic syndrome, there is relatively little evidence to date of how the risk of developing it varies as a function of exposure to shiftwork. The current study seeks to confirm earlier findings of an association between shiftwork exposure and metabolic dysfunction, and to examine the impact of exposure duration, while adjusting for a number of covariates in the analyses. The analyses were based on data from VISAT, a study involving the measurement of physiological, behavioral, and subjective outcomes from 1757 participants, 989 being current or former shiftworkers. The sample comprised employed and retired wage earners, male and female, who were 32, 42, 52, and 62 yrs old. The first analysis sought to confirm previous findings of an association between exposure to shiftwork and the risk of developing metabolic syndrome. It indicated that participants who were or who had previously been shiftworkers (i.e., working schedules that involved rotating shifts; not being able to go to bed before midnight; having to get up before 05:00 h; or being prevented from sleeping during the night) were more likely to exhibit symptoms of metabolic syndrome, after adjusting for age, sex, socioeconomic status, smoking, alcohol intake, perceived stress, and sleep difficulty (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.03-3.08). The results suggest the association between shiftwork and metabolic syndrome cannot be fully accounted for by either higher levels of strain or increased sleep difficulty among shiftworkers, although it remains a possibility that either one or both of these factors may have played a contributing role. The second analysis addressed the issue of duration of exposure to shiftwork. Participants with >10 yrs' experience of working rotating shifts were more likely to exhibit symptoms of metabolic syndrome than participants without exposure to shiftwork, i.e., dayworkers, even after adjusting for age and sex (OR 1.96; 95% CI 1.03-3.75). Thus, the current study confirms the association between shiftwork exposure and metabolic syndrome. It also provides new information regarding the time course of the development of the illness as function of exposure duration, although this was only examined in relation to rotating shiftwork. It is concluded that those responsible for monitoring workers' health should pay particular attention to indices of metabolic dysfunction in workers who have been exposed to shiftwork for >10 yrs.

The metabolic syndrome and progression of carotid atherosclerosis over 13 years. The Tromsø study

Background

The metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease. In this study, we examine if metabolic syndrome predicts progression of atherosclerosis over 13 years.

Methods

Participants were 1442 men and 1532 women in the population-based Tromsø Study who underwent carotid ultrasound examinations at baseline in the 4^th (1994–5) and at follow-up in the 6^th survey (2007–8). Of these, 278 men and 273 women fulfilled the criteria for the MetS, defined according to a modified version of the National Cholesterol Education Program Adult Treatment Panel III (NCEP, ATPIII). Carotid atherosclerosis was assessed as total plaque area (TPA) and mean intima-media thickness (IMT) at follow-up and as change in IMT and TPA from baseline to follow-up. Associations between MetS and its components and carotid atherosclerosis were assessed in linear regression models adjusted for age, total cholesterol and daily smoking, stratified by sex.

Results

IMT and TPA levels at follow-up (p < 0.0001) and progression of TPA (p = 0.02) were higher in the MetS group compared to the non-MetS group. In stepwise multivariable models, MetS was associated with TPA (β = 0.372 mm², p = 0.009) and IMT (β = 0.051 mm, p < 0.0001) in men, and with IMT (β = 0.045 mm, p = 0.001) in women after 13 years of follow-up, but not with progression of IMT or TPA. In analyses stratified by age, MetS predicted progression of IMT (β = 0.043 mm, p = 0.046) and TPA (β = 1.02 mm^2, p = 0.002) in men below 50 years of age. Hypertension was predictive of follow-up TPA and IMT in both genders and of progression of TPA in women. Impaired glucose tolerance was associated with follow up levels of IMT and TPA as well as progression in IMT in men. None of the other components of MetS were associated with progression of atherosclerosis.

Conclusions

Subjects with MetS had higher levels of IMT and TPA at follow up than those without MetS. Mets predicted progression of IMT and TPA in those below 50 years of age, but not in other age groups, indicating that MetS may be involved in the initiation of the atherosclerotic process.

Metabolic syndrome and coronary heart disease among Spanish male workers: a case-control study of MESYAS

BACKGROUND AND AIMS

In Spain, the incidence of coronary heart disease is below that expected based on the burden of classic cardiovascular risk factors present in the population. Whether the risk associated with metabolic syndrome is lower in Spain deserves to be investigated. This study evaluates the association of incident clinical coronary heart disease with metabolic syndrome and each of its individual defining components in a sample of Spanish working males.

METHODS AND RESULTS

Among the workers of a factory (MESYAS registry), 208 incident cases of coronary heart disease (between 1981 and 2005) were age-matched with 2080 healthy workers visited in 2004-2005. Metabolic syndrome was characterized using modified criteria of the joint consensus definition (2009). Metabolic syndrome was strongly associated with coronary heart disease (OR = 4.03; 95% CI: 2.98, 5.45) and the risk seemed to be fully explained by metabolic syndrome components (OR = 0.84, p = 0.54 after adjustment). Odds ratios for the independent effects of the diagnostic criteria were: hypertriglyceridemia (OR = 3.39, p < 0.001), hyperglycemia (OR = 2.70, p < 0.001), low HDL cholesterol (OR = 2.35, p < 0.001), hypertension (OR = 1.49, p = 0.016) and overweight (OR = 1.07, p = 0.678). Young workers showed a higher risk associated with metabolic syndrome.

CONCLUSION

The risk associated with metabolic syndrome is fully explained by its components considered independently. The risk of coronary heart disease in a Spanish male working population is considerably increased among those with metabolic syndrome, by a factor similar to that described for other countries. Public health measures to prevent a rise in the prevalence of metabolic syndrome are advisable to minimize cardiovascular disease rate in Spain.

Blood lipid levels, lipid-lowering medications, and the incidence of atrial fibrillation: the atherosclerosis risk in communities study

BACKGROUND

Several cardiovascular risk factors have been associated with the risk of atrial fibrillation (AF). Limited and inconsistent evidence exists on the association of blood lipid levels and lipid-lowering medication use with AF risk.

METHODS AND RESULTS

We analyzed 13 969 participants (25% African American, 45% men) free of AF at baseline from the Atherosclerosis Risk in Communities study. Fasting high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides, and total cholesterol were measured at baseline (1987-1989) and each of 3 follow-up visits. The incidence of AF was ascertained through 2007. The association of the use of statins and other lipid-lowering medications with AF was estimated in 13 044 Atherosclerosis Risk in Communities participants attending visit 2 (1990-1992), adjusting for covariates from the previous visit. During a median follow-up of 18.7 years, there were 1433 incident AF cases. Multivariable hazard ratios (HRs) and 95% CIs of AF associated with a 1-SD increase in lipid levels were as follows: HDLc, 0.97 (0.91-1.04); LDLc, 0.90 (0.85-0.96); total cholesterol, 0.89 (0.84-0.95); and triglycerides, 1.00 (0.96-1.04). Participants taking lipid-lowering medications had an adjusted HR (95% CI) of AF of 0.96 (0.82-1.13) compared with those not taking medications, whereas those taking statins had an adjusted HR of 0.91 (0.66-1.25) compared with those taking other lipid-lowering medications.

CONCLUSIONS

Higher levels of LDLc and total cholesterol were associated with a lower incidence of AF. However, HDLc and triglycerides were not independently associated with AF incidence. No association was found between the use of lipid-lowering medications and incident AF.

Advantages and disadvantages of hyperbaric oxygen treatment in mice with obesity hyperlipidemia and steatohepatitis

The effect of hyperbaric oxygen treatment (HBOT) was examined using MSG mice, which are an animal model of obesity, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease. Nineteen MSG male mice were divided into HBOT treated and control groups at 12 weeks of ages. The HBOT group was treated with hyperbaric oxygen from 12 to 14 weeks (first phase) and then from 16 to 18 weeks (second phase). Interestingly, the body weight of the HBOT group was significantly lower (P < 0.01) than that of the control group. In contrast, the serum lipid level did not show significant changes between the two groups. As for the effects of increasing oxidative stress, the liver histology of the HBOT group showed severer cellular damage and aberrant TNF-α expression. HBOT has the advantage of improving obesity in patients with metabolic syndrome, but the fault of causing organ damage by increasing oxidative stress.

Establishment of a Beagle dog model of obesity and type 2 diabetes

AIM: To establish a big animal model of obesity and type 2 diabetes for further investigation of surgical or endoscopic interventional therapy of this disease.

METHODS: Ten healthy adult male Beagle dogs were randomly and equally divided into two groups: control group and model group. The control group was feed a standard diet during the whole experiment (16 wk), while the model group was feed a high-fat hypercaloric diet. At week 8, the model group was intravenously injected with small dose of streptozotocin (STZ). The body mass, length, fasting blood glucose, intravenous glucose tolerance test (IVGTT), and lipid were measured regularly.

RESULTS: At week 8, the average body mass (16.9 kg ± 0.8 kg vs 14.8 kg ± 1.03 kg, P < 0.01), Lee index (P < 0.05), serum insulin and c-peptide (both P < 0.01) were significantly higher in the model group than in the control group. One week after STZ injection, in the model group, the fast blood glucose was significantly higher than that in the control group (P < 0.05), IVGTT-2 h glucose was significantly higher than the pre-injection value (143 mg/dL ± 7.4 mg/dL vs 127 mg/dL ± 4.2 mg/dL, P < 0.05), and serum insulin and c-peptide decreased significantly (P < 0.01). Eight weeks after STZ injection, in the model group, the fast blood glucose was significantly higher than that in the control group (P < 0.01), and IVGTT-2h glucose was significantly higher than the pre-injection value (323 mg/dL ± 12.1 mg/dL vs 127 mg/dL ± 4.2 mg/dL, P < 0.01). All Beagle dogs were confirmed to have type 2 diabetes, and no Beagle dogs died during the experimental period.

CONCLUSION: A high-fat hypercaloric diet combined with intravenous injection of small dose of STZ can induce obesity and type 2 diabetes in Beagle dogs. This animal model mimics the nature history and metabolic characteristics of human type 2 diabetes and can be used for further investigation of surgical or endoscopic interventional therapy of obesity and type 2 diabetes.

Stepwise relationship between components of metabolic syndrome and risk of colorectal adenoma in a Taiwanese population receiving screening colonoscopy

BACKGROUND/PURPOSE

Metabolic syndrome (MS) is a cluster of diseases related to insulin resistance and is an important cardiovascular risk factor. In addition, MS has been linked to some malignancies, including colorectal cancer. Colon adenoma is a well-established pre-malignant lesion of colorectal cancer. The aim of this study was to determine the effect of various components of MS on the risk of colorectal adenoma.

METHODS

From October 2004 to April 2006, 3106 subjects who had undergone complete colonoscopy for health examinations at the hospital were enrolled. MS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III definition for South Asians and Chinese. Multivariate logistic regression was used to analyze the association between components of MS and colorectal adenoma.

RESULTS

Of the 3106 subjects, the mean age was 47.1 ± 10.8 years and there were 397 (13%) subjects with pathologically proven colorectal adenoma. Male sex, old age (=50 years), current smokers, and abdominal obesity were associated with increasing risk of colorectal adenoma. MS was associated with increased risk of colorectal adenoma (odds ratio: 1.71, 95% confidence interval: 1.34-2.71), and this risk increased with the number of metabolic components. Multiple and synchronous adenomas of the proximal and distal colon were positively associated with MS.

CONCLUSION

Subjects with metabolic syndrome have increased risk of developing colorectal adenoma. Screening colonoscopy for prevention of colorectal adenoma might be warranted when abdominal obesity or more than three components of MS are present.

Rosiglitazone reduces blood pressure in female Dahl salt-sensitive rats

Postmenopausal women (PMW) are at greater risk for salt-sensitive hypertension and insulin resistance than premenopausal women. Peroxisome-proliferator-activated receptor-gamma (PPARgamma) agonists reduce blood pressure (BP) and insulin resistance in humans. As in PMW, ovariectomy (OVX) increases salt sensitivity of BP and body weight in Dahl salt-sensitive (DS) rats. This study addressed whether rosiglitazone (ROSI), a PPARgamma agonist, attenuates salt-sensitive hypertension in intact (INT) and OVX DS rats, and if so, whether insulin resistance, nitric oxide (NO), oxidative stress, and/or renal inflammation were contributing mediators. Telemetric BP was similar in OVX and INT on low salt diet (0.3% NaCl), but was higher in OVX than INT on high salt (8% NaCl). ROSI reduced BP in OVX and INT on both low and high salt diet, but only attenuated salt sensitivity of BP in OVX. Nitrate/nitrite excretion (NO(x); index of NO) was similar in INT and OVX on low salt diet, and ROSI increased NO(x) in both groups. High salt diet increased NO(x) in all groups but ROSI only increased NO(x) in OVX rats. OVX females exhibited insulin resistance, increases in body weight, plasma leptin, cholesterol, numbers of renal cortical macrophages, and renal MCP-1 and osteopontin mRNA expression compared to INT. ROSI reduced cholesterol and macrophage infiltration in OVX, but not INT. In summary, PPARgamma activation reduces BP in INT and OVX females, but attenuates the salt sensitivity of BP in OVX only, likely due to increases in NO and in part to reductions in renal resident macrophages and inflammation.

Surgical treatment of morbid obesity and type 2 diabetes mellitus: current situation and future prospects

Along with social progress and life style transformation, morbid obesity, type 2 diabetes mellitus, and metabolic syndrome are increasingly becoming a great threat to human health. Because conventional conservative treatment has little effect on these diseases, they were considered incurable before. However, surgery shows good results in the treatment of these diseases and has therefore revolutionized their treatment. This review aims to elucidate the therapeutic mechanisms of surgery for morbid obesity and 2 diabetes mellitus and to discuss the current situation and future prospects of surgical treatment of these diseases.

Increased sympathetic and decreased parasympathetic activity rather than changes in hypothalamic-pituitary-adrenal axis activity is associated with metabolic abnormalities

CONTEXT

Stress is suggested to lead to metabolic dysregulations as clustered in the metabolic syndrome, but the underlying biological mechanisms are not yet well understood.

OBJECTIVE

We examined the relationship between two main str systems, the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, with the metabolic syndrome and its components.

DESIGN

The design was baseline data (yr 2004-2007) of a prospective cohort: the Netherlands Study of Depression and Anxiety (NESDA).

SETTING

The study comprised general community, primary care, and specialized mental health care.

PARTICIPANTS

This study included 1883 participants aged 18-65 yr.

MAIN OUTCOME MEASURES

Autonomic nervous system measures included heart rate, respiratory sinus arrhythmia (RSA; high RSA reflecting high parasympathetic activity), and preejection period (PEP; high PEP reflecting low sympathetic activity). HPA axis measures included the cortisol awakening response, evening cortisol, and a 0.5 mg dexamethasone suppression test as measured in saliva. Metabolic syndrome was based on the updated Adult Treatment Panel III criteria and included high waist circumference, serum triglycerides, blood pressure, serum glucose, and low high-density lipoprotein cholesterol.

RESULTS

RSA and PEP were both independently negatively associated with the presence of the metabolic syndrome, the number of metabolic dysregulations as well as all individual components except high-density lipoprotein cholesterol (all P < 0.02). Heart rate was positively related to the metabolic syndrome, the number of metabolic dysregulations, and all individual components (all P < 0.001). HPA axis measures were not related to metabolic syndrome or its components.

CONCLUSION

Our findings suggest that increased sympathetic and decreased parasympathetic nervous system activity is associated with metabolic syndrome, whereas HPA axis activity is not.

[Prevalence of metabolic syndrome and consistency in its diagnosis in type 2 diabetic patients in Spain]

OBJECTIVE

To determine the prevalence of metabolic syndrome, the degree of consistency among World Health Organization (WHO), The Third Report National Cholesterol Education Program (NCEP-ATP III) and the International Diabetes Federation (IDF) diagnostic criteria and the relationship with cardiovascular risk in a Spanish population of patients with type 2 diabetes.

MATERIAL AND METHODS

This descriptive, epidemiologic, multicenter and cross-sectional study included 1259 patients with type 2 diabetes. The primary variable was diagnosis of metabolic syndrome according to WHO, NCEP-ATP III and IDF criteria.

RESULTS

The prevalence of metabolic syndrome was 71.5% (WHO), 78.2% (NCEP-ATP III), and 89.5% (IDF). The prevalence of metabolic syndrome was higher in sedentary diabetic patients (WHO=79.3%, NCEP-ATP III=86.2%, and IDF=93.9) than in those who exercised moderately (WHO=61.4%, NCEP-ATP III=73.2%, and IDF=85.5%, [p<0.001]). The percentage of patients with metabolic syndrome and moderate/high cardiovascular risk was 38.9% (WHO), 33.6% (NCEP-ATP III), and 30.1%, (IDF). Consistency among WHO, NCEP-ATP III and IDF criteria was low. Only comparison of WHO vs NCEP-ATP III criteria was acceptable (k=0.52 [0.46-0.58]).

CONCLUSIONS

The prevalence of metabolic syndrome in patients with type 2 diabetes in Spain is high, even when the low consistency among WHO, NCEP-ATP III and IDF criteria is considered. A standard definition of metabolic syndrome, according to routine clinical practice, is needed. Cardiovascular risk is greater when OMS and NCEP-ATP III criteria are used for the diagnosis of metabolic syndrome compared with IDF criteria.

Noninvasive assessment of the prevalence and characteristics of coronary atherosclerotic plaques by multidetector computed tomography in asymptomatic type 2 diabetic patients at high risk of significant coronary artery disease: a preliminary study

BACKGROUND

There is a need to identify diabetic patients at risk of cardiovascular events before symptom onset.

AIMS

To evaluate the prevalence and characteristics of coronary atherosclerotic plaques in asymptomatic type 2 diabetic patients with coronary risk factors but without known coronary artery disease, using multidetector computed tomography.

METHODS

High-resolution 40-slice coronary computed tomography was performed prospectively in 42 consecutive type 2 diabetic patients (mean age 62 years; range 50-77 years; 28 men) with over one or more carotid atherosclerotic plaque and no coronary artery disease symptoms. Computed tomography data were evaluated for calcium score and the presence of coronary plaques. Plaque type, distribution, extensive character and obstructive nature were determined per patient for each segment.

RESULTS

No plaques were detected in 11 (26.2%) patients. Atherosclerotic plaques were detected in 31 (73.8%) patients. A total of 147 coronary segments with plaque were identified, of which 11 (7.5%) contained hypodense plaques, 28 (19%) mixed plaques and 108 (73.5%) calcified plaques. Hypodense plaques were noted in 4/15 (26.7%) patients without coronary calcifications. Most calcified and hypodense plaques resulted in lumen narrowing of less than 50%; most mixed plaques resulted in lumen narrowing greater than 50%. Obstructive disease was detected in 9/11 patients with a high calcium score (>400).

CONCLUSION

This preliminary study demonstrates that a high proportion of asymptomatic type 2 diabetic patients present without coronary plaques detectable by multidetector computed tomography, despite concomitant carotid atherosclerotic lesions. Computed tomography seems to detect a high proportion of plaques compared with conventional angiography in these specific patients.