Validity of the ATP III diagnostic criteria for the metabolic syndrome in an elderly Italian Caucasian population

Metabolic syndrome and risk of death in older adults with major psychiatric disorders: Results from a 5-year prospective multicenter study

OBJECTIVES

No study has explored the association of individual components of metabolic syndrome with mortality in older patients with psychiatric disorders. In this report, we examined whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders.

METHODS

We used data from a multicenter 5-year prospective cohort, including 634 in- and out-patients with schizophrenia, bipolar or major depressive disorder. Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality (e.g., infections), suicide and accident.

RESULTS

122 participants (44.0%) were diagnosed with metabolic syndrome at baseline. In the full sample, there was no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, for the subpopulation of older adults with major depressive disorder, metabolic syndrome was significantly associated with increased all-cause and disease-related mortality after adjustment for age, sex and smoking status (p = 0.032 and p = 0.036, respectively). There was a significant interaction between metabolic syndrome and psychiatric diagnoses indicating that in participants with major depressive disorder, metabolic syndrome had a significantly greater effect on all-cause mortality (p = 0.025) and on disease-related mortality (p = 0.008) than in participants with either bipolar disorder or schizophrenia.

CONCLUSIONS

Our findings do not support an association between metabolic syndrome and increased mortality in older patients with major psychiatric disorders. Several explanations are discussed, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The latter hypothesis could also explain the significant association between metabolic syndrome and mortality in the depressive subgroup, where a ceiling effect is yet to be reached, given the less marked premature mortality in depressive patients compared to those with bipolar disorder or schizophrenia.

Waist-to-height ratio and the conicity index are associated to cardiometabolic risk factors in the elderly population

The purpose of this study was to determine and compare a magnitude of the association between anthropometric indicators with risk of cardiometabolic risk in the elderly. This is a cross-sectional study with 402 elderly people attended by the Family Health Strategy in the city of Viçosa-MG. Risk factors for excess body fat, hypertension, blood glucose and serum lipid changes. An association between conicity index (CI) and waist-to-height ratio (WtHR) with cardiometabolic risk factors was assessed by multiple linear regression analysis. Sample was composed of 60.4% of women and 36.3% of overweight elderly. The connectivity index and a waist-to-height ratio were higher in 57.2% and 88.1% in the elderly, respectively. The results showed that the increase in body fat, diastolic blood pressure, triglycerides, glycemia and reduction of HDL-cholesterol are related to higher values of anthropometric indices evaluated. However, the waist-to-height ratio presented a greater magnitude of association with the cardiometabolic risk factors than the connectivity index.

Recent advances in the role of cortisol and metabolic syndrome in age-related degenerative diseases

The metabolic syndrome (MetS) presents an increasing prevalence in elderly people. A significant role in MetS is played by the stress response and cortisol. The hypothalamic-pituitary-adrenal (HPA) axis activity is increased by central (loss of hippocampal glucocorticoid receptors) and peripheral (11β-hydroxysteroid dehydrogenase type 1, 11β-HSD1, hyperactivity) mechanisms. The HPA hyperactivity has been found in chronic diseases affecting the endocrine (abdominal obesity with MetS, type 2 diabetes), cardiovascular (atherosclerosis, essential hypertension), and nervous systems (dementia, depression), in aging. A novel therapeutic approach (11β-HSD1 inhibition) is promising in treating the HPA axis hyperactivity in chronic diseases with MetS. A large-scale national clinical trial (AGICO, AGIng, and COrtisol study) has been proposed by our group to evaluate the role of cortisol and MetS in the main pathologies of aging (vascular and degenerative dementia, cardiovascular diseases, type 2 diabetes, abdominal obesity).

Neuroprotective effect of anthocyanins on acetylcholinesterase activity and attenuation of scopolamine-induced amnesia in rats

Anthocyanins are a group of natural phenolic compounds responsible for the color to plants and fruits. These compounds might have beneficial effects on memory and have antioxidant properties. In the present study we have investigated the therapeutic efficacy of anthocyanins in an animal model of cognitive deficits, associated to Alzheimer's disease, induced by scopolamine. We evaluated whether anthocyanins protect the effects caused by SCO on nitrite/nitrate (NOx) levels and Na(+),K(+)-ATPase and Ca(2+)-ATPase and acetylcholinesterase (AChE) activities in the cerebral cortex and hippocampus (of rats. We used 4 different groups of animals: control (CTRL), anthocyanins treated (ANT), scopolamine-challenged (SCO), and scopolamine+anthocyanins (SCO+ANT). After seven days of treatment with ANT (200mgkg(-1); oral), the animals were SCO injected (1mgkg(-1); IP) and were performed the behavior tests, and submitted to euthanasia. A memory deficit was found in SCO group, but ANT treatment prevented this impairment of memory (P<0.05). The ANT treatment per se had an anxiolytic effect. AChE activity was increased in both in cortex and hippocampus of SCO group, this effect was significantly attenuated by ANT (P<0.05). SCO decreased Na(+),K(+)-ATPase and Ca(2+)-ATPase activities in hippocampus, and ANT was able to significantly (P<0.05) prevent these effects. No significant alteration was found on NOx levels among the groups. In conclusion, the ANT is able to regulate cholinergic neurotransmission and restore the Na(+),K(+)-ATPase and Ca(2+)-ATPase activities, and also prevented memory deficits caused by scopolamine administration.

Prevalence, components, and correlates of metabolic syndrome (MetS) among elderly Muscovites

The goal of this study is to estimate the prevalence of MetS, together with its components and correlates, among elderly Russians. Our population-based sample included randomly selected residents of Moscow aged 55 and older: 955 women with an average age of 67.6, and 833 men with an average age of 68.9. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). The prevalence of MetS was found to be 41.7% in women and 26.8% in men. It tended to decrease with age in men, but not in women. MetS was inversely related to education in women, but not in men. The most prevalent individual components of MetS were as follows: hypertension (64.4%), abdominal obesity (55%), and decreased high density lipoprotein cholesterol (HDL C) (46%) for women; and hypertension (71%) and fasting hyperglycemia (35.2%) for men. An elevated level of triglycerides (TG) was the rarest MetS component, affecting 23.5% of women and 22.1% of men. The higher female prevalence of MetS was attributable to abdominal obesity. MetS was found to be associated with markers of insulin resistance (IR), low-grade inflammation, and insufficient fibrinolysis. Although the metabolic burden is an important contributor to high levels of ill-health and cardiovascular mortality among elderly Russians (especially women), it does not explain why cardiovascular mortality is much higher in Russia than in other industrialized countries.

Metabolic syndrome (MS) in elderly: a cross sectional survey

This study was conducted to determine the prevalence of metabolic syndrome (MS) in Turkish elderly. All data were collected in a cross-sectional based survey on 266 elderly aged above 65 years living in capital city of Turkey, Ankara. MS was defined according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP ATP III) criteria. In the total sample of participants, the 61.7% (n=164) of the group has been diagnosed as MS. High blood pressure (BP) and waist circumference (WC) and low high density lipoprotein cholesterol (HDL-C) were the criteria of MS with highest prevalence in both gender. In addition female participants have higher systolic blood pressure (93.4%) and WC (79.1%) and lower HDL-C (69.2%) than the men (74.4%, 31.1% and 52.2% respectively). Weight correlated significantly with triglyceride (TG) and MS (p<0.001). WC was the anthropometric variable which had the highest correlation with the MS (r=0.338, p<0.001). Our study indicates that MS is highly prevalent in the elderly people particularly among women. Our findings may be helpful in formulating public health policies and prevention strategies focus on elderly population.

Endothelial dysfunction evaluated by flow mediated dilation is strongly associated to metabolic syndrome in the elderly

This study was carried out to assess whether endothelial dysfunction, evaluated by flow-mediated dilation (FMD), is related to the occurrence of the Metabolic Syndrome (MetS) in old age. Eighty patients (25 men and 55 women), mean age 74.1±7.4 years (range 65-99 yrs) were studied. Information on all subjects, medical history and regular medications was obtained. Subjects underwent a clinical examination and laboratory tests. The presence of MetS was evaluated according to the revised NCEP-ATP III criteria. An ultrasound vascular examination (US) of the carotid and brachial arteries was performed in all patients. Intima-media thickness (IMT), presence of plaques (PL), endothelium-dependent (EDV) and -independent vasodilation (EIDV) were also evaluated. Patients were divided into two groups according to the presence/absence of MetS. Significant differences were found between MetS and non MetS patients in: EDV (p<0.01), EIDV (p<0.05) and Homeostatic model assessment index (HOMA) (p<0.02), but not in IMT or PL. MetS was significantly associated with FMD reduction (R 0.4, p<0.005) independently of all possible confounding factors other than EIDV, IMT and PL.

Prevalence of metabolic syndrome and factors associated with its components in Chinese adults

The purpose of this study was to assess the prevalence of metabolic syndrome (MetS) and its components among middle-aged and elderly adults in Jiangsu province, China. Moreover, factors associated with MetS were also assessed. A population-based cross-sectional survey was conducted with 4 randomly selected areas including both urban and rural areas from Jiangsu province, China. After the procedure, 3914 adults aged 35 to 74 years were included in the study. Metabolic syndrome was defined by the modified National Cholesterol Education Program Adult Treatment Panel III report. Data were collected by interviewer-administered questionnaire, biophysical assessment, and biochemical examination. Crude and age-standardized prevalence of MetS was 31.5% and 30.5%, respectively. Prevalence rate increased significantly with age in female but not in male subjects, whereas this was true for both sexes with increased body mass index. High blood pressure was the most prevalent component of MetS (45.2%), followed by elevated triglycerides (40.1%) and low high-density lipoprotein cholesterol (40.1%). Multivariate ordinal regression analysis revealed that women had significantly higher risk of MetS than men (odds ratio = 1.72, P < .001). Older age, living in urban area, income, family history of diabetes, and family history of hypertension were positively associated with MetS risk. However, higher education and tea drinking everyday were found to be negatively associated with MetS (P < .05). Moreover, substantial agreement (kappa = 0.79) was found between the International Diabetes Federation and modified Adult Treatment Panel III criteria among 3 comparisons of MetS definitions. Metabolic syndrome was highly prevalent in middle-aged and elderly Chinese population in Jiangsu province. Community-based strategies for diet and lifestyle modifications are strongly suggested, especially in women and the elderly.

Metabolic syndrome and target organ damage: role of blood pressure

A growing body of evidence indicates that the clustering of metabolic and hemodynamic abnormalities characterizing the metabolic syndrome is associated with a prevalence of subclinical damage in a variety of organs, such as left ventricular hypertrophy, thickening or atherosclerotic plaques of carotid arteries, microalbuminuria and deranged renal function. This is clinically relevant since these markers of target organ damage are associated with an increased risk of cardiovascular fatal and nonfatal events. The contribution of the metabolic syndrome to target organ damage in hypertensives is presumably responsible for a substantial increase in cardiovascular fatal and nonfatal events. Thus, target organ damage should be routinely searched for in hypertensives with metabolic syndrome in order to define initial therapeutic strategies and to monitor treatment-induced protection.

Vascular risk factors, alcohol intake, and cognitive decline

Since the therapeutic options currently available have demonstrated limited efficacy, the search for preventive strategies for cognitive decline and dementia is mandatory. A possible role of vascular and lifestyle-related factors was recently proposed for age-related changes of cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer's disease, AD) or vascular origin. At present, cumulative evidence suggested that vascular risk factors may be important in the development of mild cognitive impairment (MCI), dementia, and AD. Among vascular-related factors, metabolic syndrome has been associated with the risk of cognitive decline and overall dementia. Moderate alcohol drinking has been proposed as a protective factor against MCI and dementia in several longitudinal studies, but contrasting findings also exist. However, in most cases, these were only observational studies, and results are awaited from large multicenter randomized clinical trials in older persons. At present, vascular risk factor management, lifestyle changes, and drugs could be employed together to delay the onset of dementia syndromes.