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Wollesen B, Herden M, Lamberti N, Giannaki CD. Defining and reporting exercise intensity in interventions for older adults: a modified Delphi process. Eur Rev Aging Phys Act 2024; 21:3. [PMID: 38302886 PMCID: PMC10835929 DOI: 10.1186/s11556-024-00337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Many exercise studies, including older adults, do not report all relevant exercise characteristics. Especially the description of exercise intensity is missing and mostly not controlled. This leads to difficulties in interpreting study results and summarizing the evidence in systematic reviews or meta-analyses. Therefore, the aim of the present Delphi study was to gain recommendations about the categorization of exercise intensity and for the conducting and reporting of characteristics in future intervention studies with older adults by experts in exercise science and physiology. METHODS Two hundred ninety-seven international interdisciplinary participants from an EU COST action were invited to participate in three rounds of online questionnaires in April/May 2023. Up to N = 93 experts participated in each round. Round 1 included open-ended questions to solicit possible recommendations and categorizations for light, moderate, vigorous, and high intensity. In round 2, the experts rated their agreement using Likert scales (1-10) on the revealed categories and recommendations. Clusters with a higher average rating of M = 8.0 were summarized into round 3. In the final round, the results were presented for a final rating of agreement (based on a simple majority > 50%). RESULTS In round 1 a total of 416 qualitative statements were provided from thirteen questions. From round 1 to round 3, a total of 38 items were excluded, with 205 items retained for the final consensus. In round three 37 participants completed the whole questionnaire. The experts showed overall agreement on the final categorizations with 6.7 to 8.8 out of 10 points on the Likert scale. They also showed broad consensus on the relevance of reporting exercise intensity and the recommendations for future conducting and reporting of study results. However, exercise types such as yoga, balance, and coordination training led to conflicting results for categorization into light or moderate. DISCUSSION AND IMPLICATIONS The results of the current survey can be used to classify the intensity of exercise and suggest a practical approach that can be adopted by the scientific community and applied when conducting systematic reviews and meta-analysis articles when vital and objective information regarding exercise intensity is lacking from the original article.
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Affiliation(s)
- Bettina Wollesen
- Institute of Human Movement Science, University of Hamburg, Hamburg, Germany.
| | - Mona Herden
- Institute of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Christoforos D Giannaki
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Samal SK, Leander K, Vikström M, Griesbaum L, de Faire U, Frostegård J. Antibodies against malondialdehyde among 60-year-olds: prediction of cardiovascular disease. Sci Rep 2023; 13:15011. [PMID: 37697019 PMCID: PMC10495339 DOI: 10.1038/s41598-023-42264-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/07/2023] [Indexed: 09/13/2023] Open
Abstract
Malondialdehyde (MDA) is generated in oxidized LDL. It forms covalent protein adducts, and is recognized by antibodies (anti-MDA). We previously studied IgM anti-MDA, and here we focus on IgG, IgG1 and IgG2 anti-MDA in predicting cardiovascular disease (CVD). We determined, by ELISA, anti-MDA in a 7-year follow-up of 60-year-old men and women from Stockholm County (2039 men, 2193 women). We identified 210 incident CVD cases (defined as new events of myocardial infarction (MI), and hospitalization for angina pectoris) and ischemic stroke, and 620 age- and sex-matched controls. IgG anti-MDA was not associated with CVD. Median values only differed significantly for IgG1 anti-MDA among men, with lower levels among cases than controls (p = 0.039). High IgG1 anti-MDA (above 75th percentile) was inversely associated with CVD risk after adjustment for smoking, body mass index, type 2 diabetes, hyperlipidemia, and hypertension, (OR and 95% CI: 0.59; 0.40-0.89). After stratification by sex, this association emerged in men (OR and 95% CI: 0.46; 0.27-0.77), but not in women. IgG2 anti-MDA were associated with protection in the whole group and among men though weaker than IgG1 anti-MDA. IgG2 anti-MDA above the 75th percentile was associated with an increased risk of MI/angina in women (OR and 95% CI: 2.57; (1.08-6.16)). IgG1 and less so IgG2 anti-MDA are protection markers for CVD and MI/angina in the whole group and among men. However, IgG2 anti-MDA was a risk marker for MI/angina among women. These findings could have implications for both prediction and therapy.
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Affiliation(s)
- Shailesh Kumar Samal
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 17165, Stockholm, Sweden
| | - Karin Leander
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Griesbaum
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 17165, Stockholm, Sweden
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 17165, Stockholm, Sweden.
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Schillemans T, Donat-Vargas C, Lindh CH, de Faire U, Wolk A, Leander K, Åkesson A. Per- and Polyfluoroalkyl Substances and Risk of Myocardial Infarction and Stroke: A Nested Case-Control Study in Sweden. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:37007. [PMID: 35285690 PMCID: PMC8919955 DOI: 10.1289/ehp9791] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are widespread and persistent pollutants that have been associated with elevated cholesterol levels. However, data on incident cardiovascular disease (CVD) is lacking. OBJECTIVES We investigated the association of exposure to PFAS with risk of myocardial infarction and stroke and, subsidiary, with baseline blood lipids. METHODS This population-based nested case-control study included first incident myocardial infarction and stroke cases with matched controls from two Swedish cohorts: the Swedish Mammography Cohort-Clinical (SMC-C) and the Cohort of 60-year-olds (60YO). Baseline blood sampling occurred during 2003-2009 and 1997-1999 with follow-up through 2017 and 2014 for the SMC-C and the 60YO, respectively. Eight plasma PFAS concentrations were measured using targeted liquid chromatography-triple quadrupole mass spectrometry. Five of these were quantifiable in both cohorts; individual values and their standardized sum were categorized into tertiles based on the controls. First incident myocardial infarction (n=345) and ischemic stroke (n=354) cases were ascertained via linkage to the National Inpatient Register and the Cause of Death Register. Controls were randomly selected from each cohort after matching for age, sex, and sample date. Baseline blood lipids were measured in plasma or serum after overnight fasting. RESULTS Among the 1,528 case-control subjects, the mean (standard deviation) age was 66 (7.7) y and 67% of them were women. In multivariable-adjusted analyses, the third tertile of the standardized sum of five PFAS associated with higher cholesterol and lower triglyceride levels among controls at baseline (n=631). The corresponding results were odds ratios=0.70 [95% confidence interval (CI): 0.53, 0.93] for CVD, 0.60 (95% CI: 0.39, 0.92) for myocardial infarction, and 0.83 (95% CI: 0.46, 1.50) for stroke. DISCUSSION This study indicated that exposure to PFAS, although associated with increased cholesterol levels, did not associate with an increased risk of myocardial infarction, stroke, or their composite end point. The findings improve our knowledge on potential health effects of environmental contaminants in the CVD context. https://doi.org/10.1289/EHP9791.
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Affiliation(s)
- Tessa Schillemans
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Carolina Donat-Vargas
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Department of Preventive Medicine and Public Health, School of Medicine, Campus of International Excellence, Universidad Autónoma de Madrid y Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Christian H. Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Ulf de Faire
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Alicja Wolk
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Karin Leander
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
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Lee EB, Hong S, Min J, Park DH, Cho W, Suh SH, Lee HD, Lee HJ, Kimm H, Jee SH, Kang ES, Lee DH, Jeon JY. Association between domain-specific physical activity and diabetes in Korean adults. Sci Rep 2021; 11:13066. [PMID: 34158561 PMCID: PMC8219728 DOI: 10.1038/s41598-021-92560-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
This study aimed to investigate the association between domain-specific physical activity (PA) and diabetes in Korean adults. We analyzed 26,653 men and women (aged > 18 years) from the Korea National Health and Nutrition Examination Survey (2014–2018). PA was measured using a validated Global PA Questionnaire. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for various confounders. Transport PA accounted for the majority of total PA (46%, men; 58%, women), followed by leisure-time PA (30%; 22%) and work PA (24%; 20%). In men, ORs (95% CI) of diabetes comparing ≥ 600 metabolic task of equivalent (MET)-min/week vs. no activity were 0.82 (0.71–0.95) for leisure-time PA, 0.85 (0.75–0.96) for transport PA, and 0.88 (0.78–0.99) for leisure-time + transport PA. In women, ORs (95% CI) of diabetes comparing the same groups were 0.73 (0.60–0.89) for leisure-time PA, 0.97 (0.85–1.10) for transport PA, and 0.88 (0.78–1.00) for leisure-time + transport PA. However, work PA showed no association with diabetes. In conclusion, leisure-time PA was inversely associated with diabetes in both men and women, while transport PA was inversely associated only in men. But work PA was not associated with diabetes in Korean adults.
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Affiliation(s)
- Eun-Byeol Lee
- Department of Sport Industry Studies, Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea.,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea
| | - Sunghyun Hong
- Department of Sport Industry Studies, Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
| | - Jihee Min
- Department of Sport Industry Studies, Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
| | - Dong-Hyuk Park
- Department of Sport Industry Studies, Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
| | - Wonhee Cho
- Department of Sport Industry Studies, Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea
| | - Sang-Hoon Suh
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.,Department of Physical Education, Yonsei University, Seoul, South Korea
| | - Hae-Dong Lee
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.,Department of Physical Education, Yonsei University, Seoul, South Korea
| | - Han-Joo Lee
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.,Department of Physical Education, Yonsei University, Seoul, South Korea
| | - Heejin Kimm
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.,Graduate School of Public Health, Institute for Health Promotion, Yonsei University, Seoul, South Korea
| | - Sun Ha Jee
- Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea.,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.,Graduate School of Public Health, Institute for Health Promotion, Yonsei University, Seoul, South Korea
| | - Eun Seok Kang
- Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Justin Y Jeon
- Department of Sport Industry Studies, Yonsei University, 50 Yonseiro, Seodaemun-gu, Seoul, 03722, South Korea. .,Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, South Korea. .,Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, South Korea.
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Abstract
PURPOSE OF REVIEW The incidence of urolithiasis has shown a prominent increase in the last two to three decades and evidence-based data have clearly indicated the certain role of obesity and overweight in both children and adults. As a certain component of metabolic syndrome, 'obesity' has been found to have a significant impact on the urinary metabolic risk factors which may be important in stone formation. In this present review article, we aimed to evaluate the possible association between obesity and urolithiasis and related risk factors. The epidemiology, pathophysiology, and management of stone disease in obese cases will be discussed in detail. RECENT FINDINGS The possible influence of overweight/obesity on the metabolic stone-forming risk factors has been subjected to several studies which in turn well demonstrated the increased risk of stone formation in this population. Although the exact underlying mechanisms are still to be outlined, some certain pathogenetic factors, namely, changes in urinary pH and increased excretion of some urinary stone components have been well demonstrated. Given this increased risk status, these cases require a more comprehensive workup for urolithiasis. Appropriate metabolic evaluation-based medical therapy alongside dietary recommendations will be effective in preventing stone formation. SUMMARY Patients suffering from obesity problem have particular risk factors for urolithiasis when compared with their normal-weight counterparts. All efforts should be taken to increase the awareness of this problem and necessary precautions with well-planned treatment plan are the main tasks for urologists.
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Lindblad BE, Håkansson N, Wolk A. Metabolic syndrome and some of its components in relation to risk of cataract extraction. A prospective cohort study of men. Acta Ophthalmol 2019; 97:409-414. [PMID: 30353683 PMCID: PMC6587757 DOI: 10.1111/aos.13929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/21/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relationship between metabolic syndrome and some of its components with the incidence of cataract extraction. METHODS A population-based prospective cohort with a total of 45 049 men, aged 45-79 years, from the Cohort of Swedish Men completed in 1997 a self-administered questionnaire concerning anthropometric measurements and lifestyle factors. The men were followed from 1 January 1998 through 31 December 2012, and the cohort was matched with registers of cataract extraction. The main outcome measure was incident cases of age-related cataract extraction. RESULTS Over the 15-years of follow-up, 7573 incident cases of cataract extraction were identified. After controlling for potential confounders, the association between single components of metabolic syndrome, abdominal adiposity, diabetes and hypertension and risk of cataract extraction was rate ratio (RR): 1.04; 95% confidence interval (CI): 0.99-1.10, RR: 1.77; 95% CI: 1.64-1.92 and RR: 1.06; 95% CI 1.00-1.13, respectively. The risk of cataract extraction increased with increasing numbers of metabolic syndrome components (p < 0.0001). Men aged 65 years or younger at baseline with all three components of the metabolic syndrome had a relative risk of 2.43 (95% CI: 1.95-3.01) for cataract extraction. CONCLUSION In this cohort of middle-aged and elderly men, metabolic syndrome with the combination of abdominal adiposity, diabetes and hypertension was associated with an increased risk for cataract extraction, especially among men aged 65 years or younger. These findings put emphasis on the importance of weight control and healthy lifestyle behaviours in order to prevent cataract.
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Affiliation(s)
| | - Niclas Håkansson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
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7
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Laguzzi F, Risérus U, Marklund M, Vikström M, Sjögren P, Gigante B, Alsharari ZD, Hellénius ML, Cederholm T, Frumento P, de Faire U, Leander K. Circulating fatty acids in relation to alcohol consumption: Cross-sectional results from a cohort of 60-year-old men and women. Clin Nutr 2017; 37:2001-2010. [PMID: 29032841 DOI: 10.1016/j.clnu.2017.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/01/2017] [Accepted: 09/09/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Alcohol consumption is considered to affect circulating fatty acids (FAs) but knowledge about specific associations is limited. We aimed to assess the relation between alcohol consumption and serum FAs in 60-year-old Swedish men and women. METHODS In a random sample of 1917 men and 2058 women residing in Stockholm county, cross-sectional associations between different categories of alcohol consumption and FAs were assessed using linear regression; β1 coefficients with 95% confidence interval (CI) were calculated. Self-reported alcohol consumption was categorized as none, low (≤9.9 g/day) (reference), moderate (10-29.9 g/day) and high (≥30 g/day). Moderate alcohol consumption was further subdivided into consumption of beer, wine, liquor and their combinations. Thirteen serum cholesterol ester FAs were measured by gas chromatography and individual FAs were expressed as percentage of total FAs. RESULTS Increasing alcohol consumption was associated to linear increase of saturated myristic acid, monounsaturated FAs and n-6 polyunsaturated (PUFA) arachidonic acid, whereas linear decrease was noted for saturated pentadecanoic acid and for n-6 PUFA linoleic acid. With non-linear associations, increasing alcohol consumption also associated to decreased saturated stearic acid, n-6 PUFA dihomo-gamma-linolenic acid, and n-3 PUFA docosahexaenoic acid and increased saturated palmitic acid, n-6 PUFA gamma-linolenic acid and n-3 PUFA eicosapentaenoic acid. Among types of beverages, wine consumption was associated with n-6 PUFA arachidonic acid (β1 0.59; 95% CI: 0.30;0.88) and the n-3 PUFAs eicosapentaenoic acid (β1 0.54; 95% CI: 0.30;0.78), and docosahexaenoic acid (β1 0.06; 95% CI: 0.00;0.12). CONCLUSIONS These findings may give important basis for further investigations to better understand biological mechanisms behind the dose-dependent associations between alcohol consumption and health outcomes observed in many previous studies.
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Affiliation(s)
- F Laguzzi
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden.
| | - U Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - M Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - M Vikström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden
| | - P Sjögren
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - B Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital University, 182 88 Stockholm, Sweden
| | - Z D Alsharari
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - M-L Hellénius
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - T Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Box 609, 751 25 Uppsala, Sweden
| | - P Frumento
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden
| | - U de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden; Cardiology Unit, Department of Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - K Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 171 77 Stockholm, Sweden
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Frostegård J, Su J, Sing S, Hua X, Vikström M, Leander K, Gigante B, de Faire U, Frostegård AG. IgM antibodies to oxidized phosphatidylserine as protection markers in cardiovascular disease among 60-year olds. PLoS One 2017; 12:e0171195. [PMID: 28430795 PMCID: PMC5400230 DOI: 10.1371/journal.pone.0171195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 01/18/2017] [Indexed: 12/25/2022] Open
Abstract
Objective Phosphatidylserine is exposed on apoptotic cells and is prone to oxidation (OxPS). Here we analyze the association of IgM antibodies against OxPS (anti-OxPS) with the risk of cardiovascular disease (CVD). Methods Among sixty-year olds from Stockholm County in Sweden, previously screened for cardiovascular risk factors (2039 men, 2193 women), there were 210 incident CVD-cases identified during a 5-year follow-up. Using a nested case-control design, 622 age- and sex-matched controls were selected. Odds ratios (OR) with 95% intervals (CI) were calculated by conditional logistic regression. IgM anti-OxPS was measured by ELISA. Phagocytosis of apoptotic Jurkat-cells by macrophages was studied by flow cytometry. Results Anti-OxPS levels were lower among cases (median (interquartile range): 80.7 (60.9–101.0 vs. 84.6 (65.8–109.6); p = 0.047); among men (76.6 (55.8–99.2) vs. 82.0 (63.1–105.1); p = 0.022) and among women 89.6 (72.3–110.1) vs. 89.8 (69.9–114.4); p = 0.79). After adjustment for smoking, BMI, diabetes mellitus type II, hypercholesterolaemia and hypertension, and dividing into quartiles, using the highest quartile (quartile 4) as reference, quartile 3 was associated with a OR of 1.74 (CI 1.08–2.81). Quartiles 2 and 1 had similar associations, the later reaching statistical significance. Among men associations were stronger whereas no significant associations were observed in women. The OR of MI/angina comparing quartile 3 with quartile 4 was 2.31 (CI 1.30–4.11). The OR for quartile 2 and 1, respectively, were similar as for quartile 3. Total IgM increased uptake of apoptotic cells, which was reversed if incubated with OxPS. Conclusions IgM anti-OxPS is a novel potential protection marker for CVD, in particular in men. Increased phagocytosis of dying/dead cells could be one potential underlying mechanism.
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Affiliation(s)
- Johan Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Jun Su
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sudhir Sing
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Xiang Hua
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiovascular Clinical Science, Danderyds Hospital, Stockholm Sweden
| | - Ulf de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Solna, Sweden
| | - Anna G. Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Different Types of Physical Activity and Fitness and Health in Adults: An 18-Year Longitudinal Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1785217. [PMID: 28466006 PMCID: PMC5390631 DOI: 10.1155/2017/1785217] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/15/2017] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study is to examine the relationship between different types of daily life physical activity (PA) and physical fitness (PF) and health throughout adulthood. Methods. A total of 723 men and women, aged 28–76 years, participated 1681 times during four measurement points from 1992 to 2010 in this study. We assessed self-reported PA, anthropometrics, physical health status (HS), and PF in each study year. Hierarchical linear modeling (HLM) was used to analyze the measures. Results. PF and HS worsened with increasing age while sports activity (SA) declined. The modeling showed that sex, age, and SES play important roles concerning PA, PF, and HS. Athletes show higher HS and HF than nonathletes. Habitual activity (HA) also showed a positive relationship with PF and HS, but effects were lower than for SA. Work related activity (WRA) showed no meaningful relationship with PF or HS. Conclusions. Comparable amounts of PA can lead to different effects on PF or HS. Our findings underline the importance of contexts, content, and purposes of PA when health or fitness benefits are addressed. Simply moving your body is not enough.
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Thiagarajan D, Frostegård AG, Singh S, Rahman M, Liu A, Vikström M, Leander K, Gigante B, Hellenius ML, Zhang B, Zubarev RA, de Faire U, Lundström SL, Frostegård J. Human IgM Antibodies to Malondialdehyde Conjugated With Albumin Are Negatively Associated With Cardiovascular Disease Among 60-Year-Olds. J Am Heart Assoc 2016; 5:JAHA.116.004415. [PMID: 27998914 PMCID: PMC5210446 DOI: 10.1161/jaha.116.004415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Malondialdehyde (MDA) is generated during lipid peroxidation as in oxidized low‐density lipoprotein, but antibodies against oxidized low‐density lipoprotein show variable results in clinical studies. We therefore studied the risk of cardiovascular disease (CVD) associated with IgM antibodies against MDA conjugated with human albumin (anti‐MDA). Methods and Results In a 5‐ to 7‐year follow‐up of 60‐year‐old men and women from Stockholm County previously screened for cardiovascular risk factors (2039 men, 2193 women), 209 incident CVD cases (defined as new events of coronary heart disease, fatal and nonfatal myocardial infarction, ischemic stroke, and hospitalization for angina pectoris) and 620 age‐ and sex‐matched controls were tested for IgM anti‐MDA by ELISA. Antibody peptide/protein characterization was done using a proteomics de novo sequencing approach. After adjustment for smoking, body‐mass index, type 2 diabetes mellitus, hyperlipidemia, and hypertension, an increased CVD risk was observed in the low IgM anti‐MDA percentiles (below 10th and 25th) (odds ratio and 95% CI: 2.0; 1.19–3.36 and 1.67; 1.16–2.41, respectively). Anti‐MDA above the 66th percentile was associated with a decreased CVD risk (odds ratio 0.68; CI: 0.48–0.98). After stratification by sex, associations were only present among men. IgM anti‐MDA levels were lower among cases (median [interquartile range]: 141.0 [112.7–164.3] versus 147.4 [123.5–169.6]; P=0.0177), even more so among men (130.6 [107.7–155.3] versus 143.0 [120.1–165.2]; P=0.001). The IgM anti‐MDA variable region profiles are distinctly different and also more homologous in their content (correlates strongly with fewer peptides) than control antibodies (not binding MDA). Conclusions IgM anti‐MDA is a protection marker for CVD. This finding could have diagnostic and therapeutic implications.
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Affiliation(s)
- Divya Thiagarajan
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna G Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sudhir Singh
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mizanur Rahman
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anquan Liu
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiovascular Clinical Science, Danderyds Hospital Karolinska Institutet, Stockholm, Sweden
| | - Mai-Lis Hellenius
- Department of Medicine, Karolinska University Hospital, Solna, Sweden
| | - Bo Zhang
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Roman A Zubarev
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Solna, Sweden
| | - Susanna L Lundström
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Frostegård
- Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden .,Division of Emergency Medicine, Karolinska University Hospital, Huddinge, Sweden
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11
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Xiao J, Wu CL, Gao YX, Wang SL, Wang L, Lu QY, Wang XJ, Hua TQ, Shen H, Cai H. Prevalence of metabolic syndrome and its risk factors among rural adults in Nantong, China. Sci Rep 2016; 6:38089. [PMID: 27901076 PMCID: PMC5128865 DOI: 10.1038/srep38089] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/03/2016] [Indexed: 02/06/2023] Open
Abstract
The prevalence of metabolic syndrome (MS) varies worldwide due to genetic and environmental factors. A population-based cross-sectional study, with 37,582 participants recruited in Nantong, China in 2007-2008 (stage I) and 2013 (stage II). Socio-demographic, lifestyle factors, disease history and fasting blood sample were collected. The prevalence of MS was much higher in 2013 (42.6%) than that in 2007-2008 (21.6%), which was significantly higher in older people in both stages. Participants with two or more familial history of diseases were associated with a higher MS prevalence compared to those who didn’t have familial history of diseases. Total physical activity (PA) was associated with 24 and 19% decreased risk of MS in men and women. Occupational PA in moderate and vigorous intensity was associated with a 25%-45% decreased risk of MS. Female smokers who smoked more than 10 cigarettes per day or over 25 years were associated with 96 and 74% increased MS risk, respectively. The highest quartile of rice wine consumption was associated with a lower risk of MS with OR of 0.63 in women, compared with female non-drinkers. These findings indicated that PA and rice wine are two protective factors in MS prevention in rural areas of East China.
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Affiliation(s)
- Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Chuan-Li Wu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Yue-Xia Gao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Shu-Lan Wang
- Rugao Center for Diseases Prevention and Control, Nantong, Jiangsu, P.R. China
| | - Lei Wang
- Rugao Center for Diseases Prevention and Control, Nantong, Jiangsu, P.R. China
| | - Qing-Yun Lu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Xiao-Jian Wang
- Department of Chronic Disease and Prevention, Center for Disease Control and Prevention of Haian, Nantong, Jiangsu, P.R. China
| | - Tian-Qi Hua
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Huan Shen
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
| | - Hui Cai
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China.,Division of Epidemiology, Vanderbilt University Medical Center, 2525 West End Avenue, 6th floor, Nashville, TN, 37203-1738, USA
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12
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Kuwahara K, Honda T, Nakagawa T, Yamamoto S, Akter S, Hayashi T, Mizoue T. Leisure-time exercise, physical activity during work and commuting, and risk of metabolic syndrome. Endocrine 2016; 53:710-21. [PMID: 26951053 DOI: 10.1007/s12020-016-0911-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/26/2016] [Indexed: 01/06/2023]
Abstract
Data are limited regarding effect of intensity of leisure-time physical activity on metabolic syndrome. Furthermore, no prospective data are available regarding effect of occupational and commuting physical activity on metabolic syndrome. We compared metabolic syndrome risk by intensity level of leisure-time exercise and by occupational and commuting physical activity in Japanese workers. We followed 22,383 participants, aged 30-64 years, without metabolic syndrome until 2014 March (maximum, 5 years of follow-up). Physical activity was self-reported. Metabolic syndrome was defined by the Joint Statement criteria. We used Cox regression models to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of metabolic syndrome. During a mean follow-up of 4.1 years, 5361 workers developed metabolic syndrome. After adjustment for covariates, compared with engaging in no exercise, the HRs (95 % CIs) for <7.5, 7.5 to <16.5, and ≥16.5 metabolic equivalent hours of exercise per week were 0.99 (0.90, 1.08), 0.99 (0.90, 1.10), and 0.95 (0.83, 1.08), respectively, among individuals engaging in moderate-intensity exercise alone; 0.93 (0.75, 1.14), 0.81 (0.64, 1.02), and 0.84 (0.66, 1.06), among individuals engaging in vigorous-intensity exercise alone; and 0.90 (0.70, 1.17), 0.74 (0.62, 0.89), and 0.81 (0.69, 0.96) among individuals engaging in the two intensities. Higher occupational physical activity was weakly but significantly associated with lower risk of metabolic syndrome. Walking to and from work was not associated with metabolic syndrome. Vigorous-intensity exercise alone or vigorous-intensity combined with moderate-intensity exercise and worksite intervention for physical activity may help prevent metabolic syndrome for Japanese workers.
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Affiliation(s)
- Keisuke Kuwahara
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan.
- Teikyo University Graduate School of Public Health, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
| | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd., 4-3-16 Ohse-cho, Hitachi, Ibaraki, Japan
| | - Tohru Nakagawa
- Hitachi Health Care Center, Hitachi, Ltd., 4-3-16 Ohse-cho, Hitachi, Ibaraki, Japan
| | - Shuichiro Yamamoto
- Hitachi Health Care Center, Hitachi, Ltd., 4-3-16 Ohse-cho, Hitachi, Ibaraki, Japan
| | - Shamima Akter
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Hayashi
- Hitachi Health Care Center, Hitachi, Ltd., 4-3-16 Ohse-cho, Hitachi, Ibaraki, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
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13
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Ryu H, Kim Y, Lee J, Yoon SJ, Cho JH, Wong E, Jung J. Office Workers' Risk of Metabolic Syndrome-Related Indicators: A 10-Year Cohort Study. West J Nurs Res 2016; 38:1433-1447. [PMID: 27330047 DOI: 10.1177/0193945916654134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the study is to assess the relationship between the prevalence of metabolic syndrome-related risk factors and work tenure among office workers. A 10-year cohort analysis was conducted using employees' health examinations given to new employees within 1 or 2 years of joining the firm and every 5 years thereafter. Age-adjusted odds ratios (95% confidence interval [CI], p < .05) were calculated based on a contrast test with general estimating equations. Specifically, the age-adjusted odds ratios and CIs of those with 20 ± 1 years of work, compared with those with 1 to 2 years of work, were as follows: triglycerides (≥150 mg/dl) 3.01 (2.11, 4.28), waist circumference (male ≥90 cm) 2.70 (1.63, 4.45), and fasting glucose (≥100 mg/dl) 2.67 (1.78, 4.01). The findings of the relationship between metabolic syndrome risk and work tenure as well as the baseline health data of new employees provide a foundation for developing a workplace health management system.
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Affiliation(s)
- Hosihn Ryu
- 1 Korea University, Seoul, Republic of Korea
| | - Youngnam Kim
- 2 Daewoo International Corporation, Seoul, Republic of Korea
| | | | | | | | - Erica Wong
- 4 University of Michigan, Ann Arbor, MI, USA
| | - Jiyeon Jung
- 1 Korea University, Seoul, Republic of Korea
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14
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Leander K, Mälarstig A, Van't Hooft FM, Hyde C, Hellénius ML, Troutt JS, Konrad RJ, Öhrvik J, Hamsten A, de Faire U. Circulating Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Predicts Future Risk of Cardiovascular Events Independently of Established Risk Factors. Circulation 2016; 133:1230-9. [PMID: 26896437 DOI: 10.1161/circulationaha.115.018531] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The secreted protein proprotein convertase subtilisin/kexin type 9 (PCSK9) is a promising new target for lowering plasma low-density lipoprotein cholesterol and preventing cardiovascular disease (CVD). The relationship between circulating PCSK9 and incident CVD in the general population is unknown. We investigated whether serum PCSK9 concentration is associated with incident CVD in a prospective cohort study of 4232 men and women 60 years of age at the time of recruitment. METHODS AND RESULTS Incident CVD was recorded by matching to national registries. After 15 years of follow-up, a total of 491 incident events (fatal and nonfatal myocardial infarctions, unstable angina, deaths from coronary heart disease, fatal and nonfatal ischemic strokes) were recorded. Cox proportional hazards model was used to calculate hazard ratios with 95% confidence intervals. Baseline serum PCSK9 concentration predicted incident CVD; concentration in quartile 4 compared with quartile 1 was associated with a hazard ratio of 1.69 (95% confidence interval, 1.30-2.19) after adjustment for sex. Further adjustment for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, lipoprotein(a), triglycerides, hypertension, diabetes mellitus, smoking, overweight, obesity, physical inactivity, and statin use resulted in a decrease in the hazard ratio to 1.48 (95% confidence interval, 1.12-1.95). CONCLUSIONS Serum PCSK9 concentration is associated with future risk of CVD even after adjustments for established CVD risk factors. Further studies are needed to confirm this observation.
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Affiliation(s)
- Karin Leander
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.).
| | - Anders Mälarstig
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Ferdinand M Van't Hooft
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Craig Hyde
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Mai-Lis Hellénius
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Jason S Troutt
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Robert J Konrad
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - John Öhrvik
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Anders Hamsten
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
| | - Ulf de Faire
- From the Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden (K.L., U.d.F.); Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine (A.M., F.M.v.H., J.Ö., A.H.) and Department of Medicine (M.-L.H.), Solna, Karolinska Institutet, Stockholm, Sweden; Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden (A.M.); Research Statistics, Pfizer Worldwide R&D, Cambridge, MA (C.H.); Lilly Research Laboratories, Eli Lilly and Co, Indianapolis, IN (J.S.T., R.J.K.); and Cardiology Unit, Karolinska University Hospital, Stockholm, Sweden (U.d.F.)
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15
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Xiao J, Wu C, Xu G, Huang J, Gao Y, Lu Q, Hua T, Cai H. Association of physical activity with risk of metabolic syndrome: findings from a cross-sectional study conducted in rural area, Nantong, China. J Sports Sci 2016; 34:1839-48. [PMID: 26853182 DOI: 10.1080/02640414.2016.1140221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The prevalence of metabolic syndrome increases rapidly worldwide, and its association with physical activity (PA) varies with race and lifestyles. Little is known about the association in rural China. The Nantong Metabolic Syndrome Study recruited 13,505 female and 6997 male participants in 2007 and 2008. Socio-demographic characteristics, and physiological and behavioural data were collected. Logistic regression model was applied to estimate associations of metabolic syndrome and its components with different PAs. The overall metabolic syndrome prevalence was 21.6% in current study. Increasing total PA or moderate-to-vigorous-intensity occupational PA was associated with decreasing 5%-60% risk of having metabolic syndrome and abnormal metabolic syndrome components in both genders. An association between leisure-time PA and blood pressure was found in men, but no associations between leisure-time PA and metabolic syndrome components were found in women. Commuting PA, such as walking and taking bus, by bicycle and walking only, was associated with decrease of 20%-45% risk of several abnormal metabolic syndrome components in women. This study provides information for future investigation into the nature of these associations so that recommendations can be developed to reduce the prevalence of metabolic syndrome and its components among rural population in China.
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Affiliation(s)
- Jing Xiao
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
| | - Chuanli Wu
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
| | - Guangfei Xu
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
| | - Jianping Huang
- b Department of Chronic Disease and Prevention , Nantong Center for Disease Control and Prevention , Nantong , Jiangsu , P.R. China
| | - Yuexia Gao
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
| | - Qingyun Lu
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
| | - Tianqi Hua
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
| | - Hui Cai
- a Department of Epidemiology and Medical Statistics , School of Public Health, Nantong University , Nantong , Jiangsu , P.R. China
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16
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Liu Y, Huang J, Xu G, He S, Zhang J, Wang X, Cai H, Shen Y. Prevalence and Determinants of Metabolic Syndrome-identified by Three Criteria among Men in Rural China: A Population-based Cross-sectional Study Conducted during 2007-2008. J Nutr Health Aging 2016; 20:574-82. [PMID: 27102798 DOI: 10.1007/s12603-015-0615-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to estimate MS prevalence according to three criteria and its risk factors among men in rural China. DESIGN Cross-sectional study. SETTING The Nantong Metabolic Syndrome Study (NMSS) was conducted during 2007-2008 in Nantong, China. PARTICIPANTS 6997 male participants aged 18-74 years. MEASUREMENTS In person interviews, blood glucose and lipid measurements were accomplished. RESULTS The prevalence of MS was 12.86%, 8.55% and 15.28% according to IDF, ATPIII and ATPIII-modified criteria, respectively. The IDF and ATP III-modified criteria agreed only moderately with ATP III criteria (κ= 0.56 and 0.68), whereas ATP III-modified and the IDF criteria agreed perfectly (κ= 0.90). Vigorous occupational physical activity was associated with a low prevalence of MS with Odds ratio (OR) of 0.58 (95% confidence interval (CI): 0.45-0.74). Beer drinkers (alcohol ≤ 6.2 g/day) and rice wine drinkers (alcohol ≤ 9.0 g/day) had about 34% and 33% low risks of developing MS respectively, compared with non-drinkers. OR of MS was 1.95 (95% CI: 1.39-2.73) in men who had familial history of at least two diseases, including hypertension and diabetes, compared with men without familial history of those diseases. CONCLUSIONS Our data suggested that MS is highly prevalent among men in rural China. Family history of diabetes and hypertension is a risk factor in MS development. Physical activity, rice wine and beer consumption are associated with a significantly lower risk.
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Affiliation(s)
- Y Liu
- Yi Shen, Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, China 226019 E-mail: ; Hui Cai, Department of Medicine, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, USA E-mail:
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17
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The Use of Kernel Density Estimation to Examine Associations between Neighborhood Destination Intensity and Walking and Physical Activity. PLoS One 2015; 10:e0137402. [PMID: 26355848 PMCID: PMC4565552 DOI: 10.1371/journal.pone.0137402] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 08/17/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how the distribution of destinations is related to activity. Kernel density estimation is a spatial analysis technique that accounts for the location of features relative to each other. Using kernel density estimation, this study sought to investigate whether individuals who live near destinations (shops and service facilities) that are more intensely distributed rather than dispersed: 1) have higher odds of being sufficiently active; 2) engage in more frequent walking for transport and recreation. METHODS The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Destinations within these areas were geocoded and kernel density estimates of destination intensity were created using kernels of 400m (meters), 800m and 1200m. Using multilevel logistic regression, the association between destination intensity (classified in quintiles Q1(least)-Q5(most)) and likelihood of: 1) being sufficiently active (compared to insufficiently active); 2) walking≥4/week (at least 4 times per week, compared to walking less), was estimated in models that were adjusted for potential confounders. RESULTS For all kernel distances, there was a significantly greater likelihood of walking≥4/week, among respondents living in areas of greatest destinations intensity compared to areas with least destination intensity: 400m (Q4 OR 1.41 95%CI 1.02-1.96; Q5 OR 1.49 95%CI 1.06-2.09), 800m (Q4 OR 1.55, 95%CI 1.09-2.21; Q5, OR 1.71, 95%CI 1.18-2.48) and 1200m (Q4, OR 1.7, 95%CI 1.18-2.45; Q5, OR 1.86 95%CI 1.28-2.71). There was also evidence of associations between destination intensity and sufficient physical activity, however these associations were markedly attenuated when walking was included in the models. CONCLUSIONS This study, conducted within urban Melbourne, found that those who lived in areas of greater destination intensity walked more frequently, and showed higher odds of being sufficiently physically active-an effect that was largely explained by levels of walking. The results suggest that increasing the intensity of destinations in areas where they are more dispersed; and or planning neighborhoods with greater destination intensity, may increase residents' likelihood of being sufficiently active for health.
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Olsson SJG, Börjesson M, Ekblom-Bak E, Hemmingsson E, Hellénius ML, Kallings LV. Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial. BMC Public Health 2015; 15:687. [PMID: 26193882 PMCID: PMC4509721 DOI: 10.1186/s12889-015-2036-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 07/07/2015] [Indexed: 12/05/2022] Open
Abstract
Background The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults. Methods Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m2; and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL. Results At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): −2.4 to 23.3]) vs (median: 0.0 [IQR: −4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95 % CI 1.00–5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: −1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL. Conclusions PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model. Trial registration ClinicalTrials.gov NCT02320760.
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Affiliation(s)
- Sven J G Olsson
- Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences Stockholm (GIH), Box 5626, 114 86, Stockholm, Sweden.
| | - Mats Börjesson
- Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences Stockholm (GIH), Box 5626, 114 86, Stockholm, Sweden. .,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Elin Ekblom-Bak
- Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences Stockholm (GIH), Box 5626, 114 86, Stockholm, Sweden.
| | - Erik Hemmingsson
- Department of Medicine, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Mai-Lis Hellénius
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Lena V Kallings
- Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences Stockholm (GIH), Box 5626, 114 86, Stockholm, Sweden.
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Hastert TA, Gong J, Campos H, Baylin A. Physical activity patterns and metabolic syndrome in Costa Rica. Prev Med 2015; 70:39-45. [PMID: 25445330 PMCID: PMC4341893 DOI: 10.1016/j.ypmed.2014.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/03/2014] [Accepted: 11/10/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether total physical activity or activity patterns are associated with metabolic syndrome and its components. METHODS Participants include 1994 controls from a case-control study of non-fatal myocardial infarction in Costa Rica (1994-2004). Physical activity was assessed via self-administered questionnaire and patterns were identified using principal components analysis. Metabolic syndrome was assessed via blood samples and anthropometry measurements from in-home study visits. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using log binomial regression. Adjusted least squares means of metabolic syndrome components were calculated by quintile of total activity and pattern scores. RESULTS Four activity patterns were identified: rest/sleep, agricultural, light indoor activity, and manual labor. Total activity was not associated with metabolic syndrome. Metabolic syndrome prevalence was 20% lower in participants with the highest scores on the agricultural job pattern compared to those with the lowest (PR: 0.80, 95% CI: 0.68-0.94). Higher total activity was associated with lower triglycerides and lower HDL cholesterol. Higher scores on each pattern were inversely associated with metabolic syndrome components, particularly waist circumference and fasting blood glucose. CONCLUSIONS Patterns or types of physical activity may be more strongly associated with metabolic syndrome and its components than total activity levels.
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Affiliation(s)
- Theresa A Hastert
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States; Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States.
| | - Jian Gong
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Hannia Campos
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States; Centro Centroamericano de Población, Universidad de Costa Rica, Costa Rica
| | - Ana Baylin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States; Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States
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Miedel C, Leander K, de Faire U, Gigante B. Pulse pressure is not an independent predictor of incident atrial fibrillation in 60-year-old men and women. Ann Med 2015; 47:679-86. [PMID: 26555440 DOI: 10.3109/07853890.2015.1100321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To evaluate if pulse pressure (PP) is a risk predictor for atrial fibrillation (AF) in a longitudinal study of 60-year-old men and women from Stockholm (n = 4,232), free from AF at baseline, with primary end-point incident AF. METHODS AF diagnoses were obtained from the national hospital discharge register. The estimated risk of AF associated with increasing PP values was calculated according to PP values above median (>52.5 mmHg) and according to 1-SD increase (14 mmHg) in PP, using a crude and an adjusted Cox proportional hazard regression model. RESULTS During a mean follow-up of 13.6 years, 286 incident AF cases were recorded. The number of AF cases increased significantly with increasing PP quartile in men but not in women. PP values above median were associated with increased AF risk (crude HR 1.63, 95% CI 1.28-2.06; p < 0.001), but risk estimates were attenuated after adjustment for common AF risk factors. When PP was entered in the Cox regression model as a continuous variable, the risk of AF did not change by 1-SD PP increase (adjusted HR 1.04, 95% CI 0.91-1.20; p = 0.560). CONCLUSIONS PP seems not to be associated with incident AF in a Swedish population of 60-year-old men and women.
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Affiliation(s)
- Charlotte Miedel
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Karin Leander
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Ulf de Faire
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.,b Department of Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Bruna Gigante
- a Unit of Cardiovascular Epidemiology , Institute of Environmental Medicine, Karolinska Institutet , Stockholm , Sweden.,c Division of Cardiovascular Medicine, Department of Clinical Sciences , Danderyd's Hospital Karolinska Institutet , Stockholm , Sweden
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Wong YV, Cook P, Somani BK. The association of metabolic syndrome and urolithiasis. Int J Endocrinol 2015; 2015:570674. [PMID: 25873954 PMCID: PMC4385647 DOI: 10.1155/2015/570674] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/21/2015] [Accepted: 02/24/2015] [Indexed: 12/11/2022] Open
Abstract
There has been an increasing prevalence of kidney stones over the last 2 decades worldwide. Many studies have indicated a possible association between metabolic syndrome and kidney stone disease, particularly in overweight and obese patients. Many different definitions of metabolic syndrome have been suggested by various organizations, although the definition by the International Diabetes Federation (IDF) is universally considered as the most acceptable definition. The IDF definition revolves around 4 core components: obesity, dyslipidemia, hypertension, and diabetes mellitus. Several hypotheses have been proposed to explain the pathophysiology of urolithiasis resulting from metabolic syndrome, amongst which are the insulin resistance and Randall's plaque hypothesis. Similarly the pathophysiology of calcium and uric acid stone formation has been investigated to determine a connection between the two conditions. Studies have found many factors contributing to urolithiasis in patients suffering from metabolic syndrome, out of which obesity, overweight, and sedentary lifestyles have been identified as major etiological factors. Primary and secondary prevention methods therefore tend to revolve mainly around lifestyle improvements, including dietary and other preventive measures.
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Affiliation(s)
- Yee V. Wong
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Paul Cook
- Department of Biochemical Pathology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
- *Bhaskar K. Somani:
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Park SK, Larson JL. The relationship between physical activity and metabolic syndrome in people with chronic obstructive pulmonary disease. J Cardiovasc Nurs 2014; 29:499-507. [PMID: 24165700 PMCID: PMC4032377 DOI: 10.1097/jcn.0000000000000096] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The prevalence of metabolic syndrome has been reported to be 20% to 50% in people with chronic obstructive pulmonary disease (COPD). Because such people are sedentary and physically inactive, they are at risk of metabolic syndrome. The extent of this problem, however, is not fully understood. OBJECTIVES This study examined the relationship of sedentary time and physical activity to metabolic syndrome and the components of metabolic syndrome in a population-based sample of people with COPD. METHODS This was a secondary analysis of existing cross-sectional data. Subjects with COPD (n = 223) were drawn from the National Health and Nutrition Examination Survey data set (2003-2006). Physical activity was measured by accelerometry. Waist circumference, triglyceride level, high-density lipoprotein cholesterol level, blood pressure, and fasting glucose level were used to describe metabolic syndrome. Descriptive and inferential statistics were used for analysis. RESULTS Fifty-five percent of the sample had metabolic syndrome. No significant differences in sedentary time and level of physical activity were found in people with COPD and metabolic syndrome and people with COPD only. However, those with a mean activity count of greater than 240 counts per minute had a lower prevalence of metabolic syndrome. Waist circumference and glucose level were significantly associated with the time spent in sedentary, light, and moderate to vigorous physical activity. CONCLUSION Metabolic syndrome is highly prevalent in people with COPD, and greater physical activity and less sedentary time are associated with lower rates of metabolic syndrome. This suggests that interventions to decrease the risk of metabolic syndrome in people with COPD should include both reducing sedentary time and increasing the time and intensity of physical activity.
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Affiliation(s)
- Soo Kyung Park
- Soo Kyung Park, PhD, RN Assistant Professor, School of Nursing, Korea University, Seoul. Janet L. Larson, PhD, RN Professor, School of Nursing, University of Michigan, Ann Arbor
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Prevalence of undiagnosed cardiovascular risk factors and 10-year CVD risk in male steel industry workers. J Occup Environ Med 2014; 56:535-9. [PMID: 24806566 DOI: 10.1097/jom.0000000000000146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence of undiagnosed cardiovascular disease (CVD) in a cohort of male steelworkers in South Wales, UK. METHODS Male steel industry workers (n = 221) with no prior diagnosis of CVD or diabetes accepted a CVD risk assessment within the work environment. Demographic, anthropometric, family, and medical histories were all recorded and capillary blood samples obtained. The 10-year CVD risk was predicted using the QRISK2-2012 algorithm. RESULTS Up to 81.5% of workers were either overweight or obese. More than 20% of workers were found to have diastolic hypertension, high total cholesterol, and/or a total cholesterol/high-density lipoprotein ratio of six or more. Over one quarter of workers assessed had an increased 10-year CVD risk. CONCLUSIONS Despite a physically demanding occupation, risk assessment in the workplace uncovered significant occult factors in CVD risk in a sample of male heavy industry workers.
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Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol 2013; 3:1-58. [PMID: 23720280 DOI: 10.1002/cphy.c110062] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Metabolic syndrome (MS) is a collection of cardiometabolic risk factors that includes obesity, insulin resistance, hypertension, and dyslipidemia. Although there has been significant debate regarding the criteria and concept of the syndrome, this clustering of risk factors is unequivocally linked to an increased risk of developing type 2 diabetes and cardiovascular disease. Regardless of the true definition, based on current population estimates, nearly 100 million have MS. It is often characterized by insulin resistance, which some have suggested is a major underpinning link between physical inactivity and MS. The purpose of this review is to: (i) provide an overview of the history, causes and clinical aspects of MS, (ii) review the molecular mechanisms of insulin action and the causes of insulin resistance, and (iii) discuss the epidemiological and intervention data on the effects of exercise on MS and insulin sensitivity.
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Affiliation(s)
- Christian K Roberts
- Exercise and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing, University of California at Los Angeles, Los Angeles, California, USA.
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Ekblom-Bak E, Ekblom B, Vikström M, de Faire U, Hellénius ML. The importance of non-exercise physical activity for cardiovascular health and longevity. Br J Sports Med 2013; 48:233-8. [DOI: 10.1136/bjsports-2012-092038] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
Abstract
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Casper JM, Harrolle MG. Perceptions of Constraints to Leisure Time Physical Activity among Latinos in Wake County, North Carolina. Am J Health Promot 2013; 27:139-42. [DOI: 10.4278/ajhp.110401-arb-145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Examine and compare constraints to physical activity (PA) among Latinos based on age, gender, income, and self-reported leisure time PA (LTPA). Design. Cross-sectional survey. Partnered with a North Carolina nonprofit advocacy organization who recruited community leaders (promotores) to administer the survey to Latino constituents. Setting. Latino communities in Wake County, North Carolina. Subjects. Respondents (N = 457) were mostly women (58%), with a mean age of 34 years (SD = 11), low income (70% < $39K/year); 78% were born outside the United States, with a majority from Mexico (52%). Measures. Sociodemographics; Stanford Brief PA Survey; constraints on PA were measured with 20 items assessing seven constructs (accessibility, facilities, knowledge, partners, psychologic, safety, and time). Analysis. Descriptive statistics, reliability analysis, confirmatory factor analysis, t-tests, and analysis of variance. Results. Half of the sample was inactive. Eighty-one percent indicated that they would like to be more active and perceived lack of accessibility, partners, and knowledge of PA resources as the most constraining factors. Respondents in low-income categories cited significantly higher psychological and accessibility constraints. Inactive LTPA respondents perceived significantly higher constraints overall, with knowledge and accessibility having the largest effect sizes. No differences were found based on age and gender. Conclusions. This study highlighted that among Latinos, there may be an opportunity to increase activity levels by targeting knowledge about PA resources, increasing access to opportunities for PA, and enhancing the social environment for PA. Such efforts that target these constraints to increase PA may ultimately improve health.
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Su J, Hua X, Vikström M, Leander K, Gigante B, Hellenius ML, de Faire U, Frostegård J. Low levels of IgM antibodies to oxidized cardiolipin increase and high levels decrease risk of cardiovascular disease among 60-year olds: a prospective study. BMC Cardiovasc Disord 2013; 13:1. [PMID: 23294904 PMCID: PMC3560105 DOI: 10.1186/1471-2261-13-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/23/2012] [Indexed: 12/18/2022] Open
Abstract
Background Antibodies against cardiolipin (aCL) are associated with increased risk of cardiovascular disease (CVD). We here determine the role of antibodies against oxidized CL (aOxCL). Methods One third of sixty-year olds from the Stockholm County were screened (2039 men, 2193 women), where 211 incident CVD-cases and 633 age- and sex-matched controls were identified (5–7 year follow-up). Antibodies were determined by ELISA and uptake of oxLDL in macrophages by FACScan. Results IgM aOxCL was lower among CVD cases than controls (p=0.024). aOxCL-levels were divided in quartiles with the highest quartile set as the reference group. After adjustment for smoking, BMI, type II diabetes, hypercholesterolaemia and hypertension, an increased risk was determined in the lowest quartile of IgM aOxCL (OR: 1.80, CI: 1.12–2.91, p=0.0159); OR for men in the lowest quartile was 2.46 (CI 1.34–4.53, p=0.0037) for CVD and for stroke: 12.28 (CI: 1.48-101.77, p=0.02). IgG aOxCL levels did not differ between quartiles in CVD-risk. High levels of IgM aOxCL (reaching significance above 86th) and IgG aOxCL (above 95th percentile) were associated with decreased risk of CVD (OR: 0.485, CI: 0.283-0.829; p=0.0082 and OR: 0.23, CI: 0.07-0.69; p=0.0091). aCL were not associated with CVD. oxCL but not CL competed out uptake of OxLDL in macrophages, and aOxLDL recognized oxCL but not CL. In contrast to aCL, aOxCL was not dependent on co-factor Beta2-glycoprotein-I. Conclusions aOxCL is a novel risk/protection marker for CVD, with therapeutic implications. OxCL competes with oxLDL for uptake in macrophages and the possibility that aOxCL inhibits such uptake by interfering with same or similar epitopes in oxCL and oxLDL should be further studied.
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Affiliation(s)
- Jun Su
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, 17177 Stockholm, Sweden
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The roles of aerobic exercise training and suppression IL-6 gene expression by RNA interference in the development of insulin resistance. Cytokine 2013; 61:394-405. [PMID: 23294974 DOI: 10.1016/j.cyto.2012.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 10/30/2012] [Accepted: 11/27/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To demonstrate the hypothesis that aerobic exercise training inhibits the development of insulin resistance through IL-6 and probe into the possible molecular mechanism about it. METHODS Rats were raised with high-fat diets for 8 weeks to develop insulin resistance, and glucose infusion rates (GIRs) were determined by hyperinsulinemic-euglycemic clamping to confirm the development of insulin resistance. Aerobic exercise training (the speed and duration time in the first week were respectively 16 m/min and 50 min, and speed increased 1m/min and duration time increased 5 min every week following it) and/or IL-6shRNA plasmid injection (rats received IL-6shRNA injection via the tail vein every two weeks) were adopted during the development of insulin resistance. The serum IL-6, leptin, adiponectin, fasting blood glucose, fasting serum insulin, GIR, IL-6 gene expression levels, p-p38 in various tissues and p-STAT3/t-STAT3 ratio in the liver were measured. RESULTS Rats fed with high-fat diets for 8 weeks were developed insulin resistance and the IL-6mRNA levels of IL-6shRNA injection groups in various tissues were significantly lower than those of control group (P<0.05), respectively. The development of insulin resistance in exercise rats significantly decreased, however, compared with that, the GIR of exercise rats injected by IL-6shRNA was lower (P<0.05). The IL-6mRNA levels were highest in the fat tissue and lowest in the skeletal muscles in all the rats. The serum adiponectin levels decreased (P<0.05) following the development of insulin resistance, and it increased (P<0.05) when the rats were intervened by aerobic exercise training for 8 weeks at the same time. However, there were not significant differences when serum leptin concentrations were compared (P>0.05). The p-p38 significantly increased in the rats fed with high-fat diets, however, p-p38 of the exercise high-fat diets rats in the liver and fat tissues significantly decreased than that (P<0.05). The changes of p-p38 in exercise rats injected by IL-6shRNA were irregular. The activation of STAT3 in the liver significantly increased (P<0.05) following the development of insulin resistance, and it decreased (P<0.05) when the rats were intervened by aerobic exercise training for 8 weeks at the same time, and the gene silencing of IL-6 did not have effects on the activation of STAT3 in the liver (P>0.05). CONCLUSIONS In conclusion, aerobic exercise training prevented the development of insulin resistance through IL-6 to a certain degree. The gene expression and secretion of IL-6 could inhibit the development of insulin resistance. The mechanism of the effects were possibly related with elevating the levels of serum adiponectin, and/or inhibiting the activation of STAT3 in the liver and p38MAPK in the skeletal muscles, liver and fat tissues.
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Schmidt C, Bergström GM. The Metabolic Syndrome Predicts Cardiovascular Events: Results of a 13-Year Follow-Up in Initially Healthy 58-Year-Old Men. Metab Syndr Relat Disord 2012; 10:394-9. [DOI: 10.1089/met.2012.0048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Caroline Schmidt
- The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Department of Molecular and Clinical Medicine, the Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
| | - Göran M.L Bergström
- The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Department of Molecular and Clinical Medicine, the Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
- Institution for Neuroscience and Physiology, Department for Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden
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Laursen AH, Kristiansen OP, Marott JL, Schnohr P, Prescott E. Intensity versus duration of physical activity: implications for the metabolic syndrome. A prospective cohort study. BMJ Open 2012; 2:e001711. [PMID: 23045359 PMCID: PMC3488727 DOI: 10.1136/bmjopen-2012-001711] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 08/21/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To explore the relative importance of leisure time physical activity (LTPA), walking and jogging on risk of developing the metabolic syndrome (MS). DESIGN A prospective cohort study. SETTING The Copenhagen City Heart Study. PARTICIPANTS 10 135 men and women aged 21-98 years who attended an initial examination in 1991-1994 and were re-examined after 10 years. OUTCOME MEASURES The association of LTPA, jogging, walking speed and walking volume with MS at baseline and at 10-year follow-up was investigated by multiple logistic regression analyses. RESULTS Baseline prevalence of MS was 20.7% in women and 27.3% in men. In both women and men, MS prevalence was associated with lower LTPA and walking speed and was lower in joggers compared to non-joggers. In subjects free of MS at baseline, 15.4% had developed MS at 10-year follow-up. Risk of developing MS was reduced in subjects with moderate or high LTPA, higher walking speed and in joggers whereas a higher volume of walking was not associated with reduced risk. After multiple adjustment, odds ratio (OR) of developing MS in moderate/high LTPA was 0.71 (95% CI 0.50 to 1.01), fast walking speed 0.51 (0.33 to 0.80) and joggers 0.60 (0.37 to 0.95) and walking >1 h daily 1.22 (0.91 to 1.65). CONCLUSIONS Our results confirm the role of physical activity in reducing MS risk and suggest that intensity more than volume of physical activity is important.
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Affiliation(s)
- Adam Hoegsbro Laursen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Ole P Kristiansen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark
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Simioni P, Spiezia L. Reprint of: Factor VIIa-AT complex plasma levels and arterial thrombosis. Thromb Res 2012; 130:141. [DOI: 10.1016/j.thromres.2012.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022]
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Sjögren P, Sierra-Johnson J, Kallings LV, Cederholm T, Kolak M, Halldin M, Brismar K, de Faire U, Hellénius ML, Fisher RM. Functional changes in adipose tissue in a randomised controlled trial of physical activity. Lipids Health Dis 2012; 11:80. [PMID: 22721353 PMCID: PMC3475078 DOI: 10.1186/1476-511x-11-80] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/09/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A sedentary lifestyle predisposes to cardiometabolic diseases. Lifestyle changes such as increased physical activity improve a range of cardiometabolic risk factors. The objective of this study was to examine whether functional changes in adipose tissue were related to these improvements. METHODS Seventy-three sedentary, overweight (mean BMI 29.9 ± 3.2 kg/m2) and abdominally obese, but otherwise healthy men and women (67.6 ± 0.5 years) from a randomised controlled trial of physical activity on prescription over a 6-month period were included (control n = 43, intervention n = 30). Detailed examinations were carried out at baseline and at follow-up, including fasting blood samples, a comprehensive questionnaire and subcutaneous adipose tissue biopsies for fatty acid composition analysis (n = 73) and quantification of mRNA expression levels of 13 candidate genes (n = 51), including adiponectin, leptin and inflammatory cytokines. RESULTS At follow-up, the intervention group had a greater increase in exercise time (+137 min/week) and a greater decrease in body fat mass (-1.5 kg) compared to the control subjects (changes of 0 min/week and -0.5 kg respectively). Circulating concentrations of adiponectin were unchanged, but those of leptin decreased significantly more in the intervention group (-1.8 vs -1.1 ng/mL for intervention vs control, P < 0.05). The w6-polyunsaturated fatty acid content, in particular linoleic acid (18:2w6), of adipose tissue increased significantly more in the intervention group, but the magnitude of the change was small (+0.17 vs +0.02 percentage points for intervention vs control, P < 0.05). Surprisingly leptin mRNA levels in adipose tissue increased in the intervention group (+107% intervention vs -20% control, P < 0.05), but changes in expression of the remaining genes did not differ between the groups. CONCLUSIONS After a 6-month period of increased physical activity in overweight elderly individuals, circulating leptin concentrations decreased despite increased levels of leptin mRNA in adipose tissue. Otherwise, only minor changes occurred in adipose tissue, although several improvements in metabolic parameters accompanied the modest increase in physical activity.
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Affiliation(s)
- Per Sjögren
- Atherosclerosis Research Unit,, Department of Medicine, (Solna) Karolinska Institutet,, Stockholm, Sweden
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Justo Sierra-Johnson
- Atherosclerosis Research Unit,, Department of Medicine, (Solna) Karolinska Institutet,, Stockholm, Sweden
- Cardiovascular Division, Mayo Clinic, Rochester, MN, USA
| | - Lena V Kallings
- Department of Sport and Health Sciences, Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Unit of Cardiology, Department of Medicine, (Solna) Karolinska Institutet, Stockholm, Sweden
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Kolak
- Atherosclerosis Research Unit,, Department of Medicine, (Solna) Karolinska Institutet,, Stockholm, Sweden
| | - Mats Halldin
- Institute of Environmental Medicine, Division of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Brismar
- Rolf Luft Research Center for Diabetes and Endocrinology, , Department of Molecular Medicine and Surgery, Karolinska Institutet, , Stockholm, Sweden
| | - Ulf de Faire
- Institute of Environmental Medicine, Division of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Mai-Lis Hellénius
- Unit of Cardiology, Department of Medicine, (Solna) Karolinska Institutet, Stockholm, Sweden
| | - Rachel M Fisher
- Atherosclerosis Research Unit,, Department of Medicine, (Solna) Karolinska Institutet,, Stockholm, Sweden
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Wagner A, Dallongeville J, Haas B, Ruidavets JB, Amouyel P, Ferrières J, Simon C, Arveiler D. Sedentary behaviour, physical activity and dietary patterns are independently associated with the metabolic syndrome. DIABETES & METABOLISM 2012; 38:428-35. [PMID: 22721723 DOI: 10.1016/j.diabet.2012.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/14/2012] [Accepted: 04/14/2012] [Indexed: 11/16/2022]
Abstract
AIM This study assessed the independent relationships of daily sitting time, levels of work and leisure-time physical activity (PA), and dietary patterns of patients with the metabolic syndrome (MetS). METHODS This population-based, cross-sectional study included 3090 French subjects aged 35-64 years. Daily time spent sitting and PA levels were assessed by an interview-administered questionnaire, while dietary patterns were identified using the factorial method of principal component analysis. Independent associations of lifestyle behaviours with the MetS were assessed by multivariable logistic-regression models adjusted for age, centre, educational level, smoking status, total calorie intake, heart rate and menopausal status. RESULTS The multivariable-adjusted ORs [95% CI] for MetS in the fourth quartile of sitting time and leisure-time PA were 1.65 [1.11-2.44] (P for trend < 0.01) and 0.58 [0.40-0.84] (P for trend < 0.001), respectively, for men, and 2.35 [1.41-3.92] (P for trend < 0.01) and 0.52 [0.33-0.82] (P for trend < 0.01), respectively, for women. Work PA was not favourably related to the MetS, particularly in women. An 'energy-dense' dietary pattern was independently associated with higher ORs for the MetS in both genders. However, accounting for body mass index (BMI) weakened the associations, which otherwise remained significant for leisure-time PA and the energy-dense dietary pattern in men, suggesting that BMI may be a potential mediator of these relationships. CONCLUSION This study demonstrated a dose-response association between sitting time, an energy-dense dietary pattern and the MetS, together with a graded inverse association between leisure-time PA and the MetS. In addition to the usual advice for PA and healthy eating, limiting the amount of time spent sitting should also be promoted through public-health initiatives.
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Affiliation(s)
- A Wagner
- Department of Epidemiology and Public Health, EA 3430, University of Strasbourg, Faculty of Medicine, 4, rue Kirschleger, 67085 Strasbourg cedex, France.
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Cai H, Huang J, Xu G, Yang Z, Liu M, Mi Y, Liu W, Wang H, Qian D. Prevalence and determinants of metabolic syndrome among women in Chinese rural areas. PLoS One 2012; 7:e36936. [PMID: 22590636 PMCID: PMC3349636 DOI: 10.1371/journal.pone.0036936] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/13/2012] [Indexed: 12/22/2022] Open
Abstract
Background and Aims Metabolic syndrome (MS) is prevalent in recent years but few data is reported in the rural areas in China. The aim of this study was to examine MS prevalence and its risk factors among women in rural China. Methods and Results The Nantong Metabolic Syndrome Study (NMSS), a population based cross-sectional study, was conducted during 2007–2008 in Nantong, China. In person interviews, blood glucose and lipid measurements were completed for 13,505 female participants aged 18–74 years. The International Diabetes Federation (IDF), the US Third Report of the National Cholesterol Education Program, the Adult Treatment Panel (ATPIII) and modified ATPIII for Asian population has determined three criteria of MS. These criteria for MS were used and compared in this study. The prevalence of MS was 22.0%, 16.9% and 23.3% according to IDF, ATPIII and ATPIII-modified criteria, respectively. Levels of agreement of these criteria for MS were above 0.75. We found that vigorous-intensity of occupational physical activity was associated with a low prevalence of MS with OR of 0.76 (95% confidence interval (CI): 0.63–0.91). Rice wine drinkers (alcohol >12.8 g/day) had about 34% low risks of developing MS with OR of 0.66 (95% CI: 0.48–0.91), compared with non-drinkers. Odds ratio of MS was 1.81 (95% CI: 1.15–2.84) in women who smoked more than 20 pack-years, compared to non-smokers. Odds ratio of MS was 1.56 (95% CI: 1.25–1.95) in women who had familial history of diseases, including hypertension, diabetes and stroke, compared to women without familial history of those diseases. Conclusion MS is highly prevalent among women in rural China. Both physical activity and rice wine consumption play a protective role, while family history and smoking are risk factors in MS development. Educational programs should be established for promoting healthy lifestyles and appropriate interventions in rural China.
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Affiliation(s)
- Hui Cai
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, China.
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Friedrich N, Thuesen B, Jørgensen T, Juul A, Spielhagen C, Wallaschofksi H, Linneberg A. The association between IGF-I and insulin resistance: a general population study in Danish adults. Diabetes Care 2012; 35:768-73. [PMID: 22374641 PMCID: PMC3308317 DOI: 10.2337/dc11-1833] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE IGF-I has an almost 50% amino acid sequence homology with insulin and elicits nearly the same hypoglycemic response. Studies showed that low and high IGF-I levels are related to impaired glucose tolerance and to a higher risk of type 2 diabetes. The aim of the current study was to evaluate the association between IGF-I level and insulin resistance in a Danish general population. RESEARCH DESIGN AND METHODS Included were 3,354 adults, aged 19-72 years, from the cross-sectional Health2006 study. The homeostasis model assessment of insulin resistance (HOMA-IR) was used as the index to estimate insulin resistance. Serum IGF-I levels were determined by an immunoassay and grouped into quintiles (Q1-Q5). Linear or multinomial logistic regression analyses were performed. RESULTS In the study population, 520 subjects (15.5%) had increased HOMA-IR values above 2.5. After adjustment for age, sex, physical activity, and waist-to-height ratio, a U-shaped association between IGF-I and HOMA-IR was found. Low IGF-I (Q1: odds ratio [OR] 1.65 [95% CI 1.16-2.34], P < 0.01) as well as high IGF-I (Q5: 1.96 [1.38-2.79], P < 0.01) levels were related to a higher odds of increased HOMA-IR values compared with subjects with intermediate (Q3) IGF-I levels. These associations remained statistically significant after the exclusion of subjects with type 2 diabetes and by using the updated computer HOMA2-IR model. CONCLUSIONS Low- and high-normal IGF-I levels are both related to insulin resistance. The biological mechanism of this complex phenomenon has to be elucidated in more detail for future risk stratification.
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Affiliation(s)
- Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
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Rupps E, Haenle MM, Steinacker J, Mason RA, Oeztuerk S, Steiner R, Kratzer W. Physical exercise in southern Germany: a cross-sectional study of an urban population. BMJ Open 2012; 2:e000713. [PMID: 22403342 PMCID: PMC3298833 DOI: 10.1136/bmjopen-2011-000713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the degree of physical exercise and self-assessment of physical fitness (PF) and their relationship to health- and behaviour-specific factors in a randomly selected sample of an urban population in southern Germany. DESIGN Cross-sectional study. SETTING In the southern German city of Leutkirch. PARTICIPANTS 2187 subjects randomly selected from the registry of inhabitants. Of the selected group, aged 18-65 years, 52.1% were women and 47.9% men. PRIMARY AND SECONDARY OUTCOME MEASURES Participants were asked how many hours per week they spent on physical exercise and sports. They were also asked to rate their own performance and/or PF. RESULTS Overall, 38.9% of the participants reported no physical exercise. Men reported a higher level of physical exercise than did women. Less exercise was reported by subjects with diabetes, high body mass index and waist-to-hip ratio and by those who were underweight. Alcohol consumption, smoker status and higher educational level showed a positive association with physical exercise. A negative trend with respect to moderate physical exercise was observed for those with metabolic syndrome, diabetes, hypertension and hepatic steatosis, but this was statistically significant only for subjects with diabetes. In both men and women, there was a relationship between self-assessed 'good' PF and high physical exercise. CONCLUSIONS The data show that a large proportion of the study population is not physically active; specific risk groups (overweight subjects, older subjects, smokers or subjects with low educational level) are even less active. The data suggest that there is a great potential for measures promoting physical exercise in these groups.
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Affiliation(s)
- Elli Rupps
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Mark Martin Haenle
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Juergen Steinacker
- Department of Internal Medicine II, Division of Sports and Rehabilitation, University Hospital Ulm, Ulm, Germany
| | - Richard Andrew Mason
- Department of Veterans Affairs Medical Center, Louis Stokes Cleveland, Brecksville, Ohio, USA
| | - Suemeyra Oeztuerk
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Ronald Steiner
- Department of Internal Medicine II, Division of Sports and Rehabilitation, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
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Halldin M, Fahlstadius P, de Faire U, Vikström M, Hellénius ML. The metabolic syndrome and left ventricular hypertrophy – the influence of gender and physical activity. Blood Press 2011; 21:153-60. [DOI: 10.3109/08037051.2012.641267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Simioni P, Spiezia L. Factor VIIa-AT complex plasma levels and arterial thrombosis. Thromb Res 2011; 128:507. [PMID: 21995975 DOI: 10.1016/j.thromres.2011.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 11/28/2022]
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Silveira A, Scanavini D, Boquist S, Ericsson CG, Hellénius ML, Leander K, de Faire U, Ohrvik J, Woodhams B, Morrissey JH, Hamsten A. Relationships of plasma factor VIIa-antithrombin complexes to manifest and future cardiovascular disease. Thromb Res 2011; 130:221-5. [PMID: 21925715 DOI: 10.1016/j.thromres.2011.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 08/15/2011] [Accepted: 08/30/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low levels of free activated coagulation factor VII (VIIa) are normally present in plasma to prime the coagulation of blood in normal hemostasis and during thrombus formation. VIIa also circulates in inactive form, in complex with antithrombin (VIIaAT) formed when VIIa is bound to tissue factor (TF). This study evaluated VIIaAT in relation to cardiovascular disease (CVD). METHODS We determined the plasma VIIaAT concentration in samples from the Stockholm Coronary Atherosclerosis Risk Factor (SCARF) study, a population-based case-control study of myocardial infarction (MI) and in samples from the Stockholm study of 60-years-old individuals, a prospective study of CVD. VIIaAT was measured with a sandwich ELISA that captures the complex between a monoclonal antibody to VIIa and a polyclonal antibody to AT. RESULTS In the SCARF study (200 post-MI cases, 340 controls), VIIaAT was statistically significantly associated with patient status [odds ratio (95% confidence interval (CI)] 1.51 (1.09-2.08), p=0.0126). The case-control differences were however small, with VIIaAT values that largely overlap between the two groups. When a nested case-control design (211 incident CVD cases and 633 matched controls) was applied on 5- to 7-year follow-up results of the Stockholm prospective study of 60-year-olds, plasma VIIaAT concentration was not associated with incident CVD (odds ratio (95% CI) 1.001 (0.997-1.005), p=0.5447). CONCLUSIONS Plasma VIIaAT concentration had no predictive value for future CVD in our study population. Slightly increased plasma VIIaAT concentrations observed after MI may reflect processes that occur in connection with the acute event when TF and VIIa availability is increased.
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Affiliation(s)
- Angela Silveira
- Cardiovascular Genetics Group, Atherosclerosis Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Gallagher EJ, Leroith D, Karnieli E. The metabolic syndrome--from insulin resistance to obesity and diabetes. Med Clin North Am 2011; 95:855-73. [PMID: 21855696 DOI: 10.1016/j.mcna.2011.06.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In today's society with the escalating levels of obesity, diabetes, and cardiovascular disease, the metabolic syndrome is receiving considerable attention and is the subject of much controversy. Greater insight into the mechanism(s) behind the syndrome may improve our understanding of how to prevent and best manage this complex condition.
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Affiliation(s)
- Emily Jane Gallagher
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1055, New York, NY 10029-6574, USA
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Bergström G, Behre C, Schmidt C. Increased Leisure-Time Physical Activity is Associated With Lower Prevalence of the Metabolic Syndrome in 64-Year Old Women With Impaired Glucose Tolerance. Angiology 2011; 63:297-301. [DOI: 10.1177/0003319711414867] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The metabolic syndrome (MetS) is characterized by a cluster of factors that confer an increased risk of cardiovascular morbidity as well as mortality. It is established that physical activity (PA) has a protective role in cardiovascular morbidity and mortality, mainly through favorable effects on traditional risk factors such as body mass and blood pressure. We assessed the prevalence of MetS in a population-based sample of 64-year-old women with impaired glucose tolerance (IGT) with respect to leisure-time PA (LTPA). The results showed an inverse linear association ( P < .05) between LTPA and MetS in this group. In conclusion, this study suggests that an increased PA level has an important role in preventing MetS in women with IGT.
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Affiliation(s)
- Göran Bergström
- The Wallenberg Laboratory at Sahlgrenska Center for Cardiovascular and Metabolic Research, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - CarlJohan Behre
- The Wallenberg Laboratory at Sahlgrenska Center for Cardiovascular and Metabolic Research, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caroline Schmidt
- The Wallenberg Laboratory at Sahlgrenska Center for Cardiovascular and Metabolic Research, The Sahlgrenska University Hospital, Gothenburg, Sweden
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Abstract
The risk of developing both metabolic syndrome and type 2 diabetes mellitus (T2DM) is inversely associated with regular exercise training (ET). Excess weight is also strongly associated with increased risk of both metabolic syndrome and T2DM. There is strong evidence that even a moderate amount of weight loss achieved through changes in diet and ET can greatly reduce the risk of developing T2DM. For the purpose of general health, exercise programs should have both aerobic and resistance training components. The 2008 federal physical activity (PA) guidelines recommend obtaining at least 150 minutes per week of moderate-intensity PA, 75 minutes per week of vigorous-intensity PA, or a combination of the 2. In addition, all individuals should strive for at least 2 days per week of resistance training activity. For the purpose of weight loss, the combination of ET and reduced energy intake has been found to be more effective than either alone.
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Affiliation(s)
- Tim Church
- Laboratory of Preventive Medicine Research, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA.
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Gavrila D, Salmerón D, Egea-Caparrós JM, Huerta JM, Pérez-Martínez A, Navarro C, Tormo MJ. Prevalence of metabolic syndrome in Murcia Region, a southern European Mediterranean area with low cardiovascular risk and high obesity. BMC Public Health 2011; 11:562. [PMID: 21752307 PMCID: PMC3152535 DOI: 10.1186/1471-2458-11-562] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 07/14/2011] [Indexed: 12/14/2022] Open
Abstract
Background Metabolic syndrome (MS) is associated with subsequent appearance of diabetes and cardiovascular disease. As compared to other Spanish regions, Murcia (southern Spain) registers increased obesity as well as cardiovascular morbidity and mortality. The aim of this study was to assess the prevalence of MS and its components, awareness of obesity as a health risk and associated lifestyles. Methods A population-based, cross-sectional study was conducted in 2003, covering a sample of 1555 individuals 20 years and over. MS was defined according to the Revised National Cholesterol Education Program Adult Treatment Panel III (R-ATPIII), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. Both low (94/80) and high (102/88) waist circumference (WC) thresholds were considered. Results Prevalence of MS was 27.2% (95%CI: 25.2-29.2), 32.2% (95%CI: 30.1-34.3) and 33.2% (95%CI: 31.2-35.3) according to the R-ATPIII, IDF and JIS94/80 respectively. It increased with age until reaching 52.6% (R-ATPIII) or 60.3% (JIS94/80) among persons aged 70 years and over, and was higher in persons with little or no formal education (51.7% R-ATPIII, 57.3% JIS94/80). The most common risk factors were hypertension (46.6%) and central obesity (40.7% and 66.1% according to high and low WC cut-off points respectively). Although most persons were aware that obesity increased health risks, regular exercise was very unusual (13.0% centrally obese, 27.2% non-centrally obese). Adherence to dietary recommendations was similar among centrally obese and non-centrally obese subjects. Conclusions Prevalence of MS is high in our population, is comparable to that found in northern Europe and varies with the definition used. Adherence to preventive recommendations and to adequate weight promotion is very low. In the absence of a specific treatment for MS, integrated intervention based on a sustained increase in physical activity and changes in diet should be reinforced.
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Affiliation(s)
- Diana Gavrila
- Department of Epidemiology, Regional Authority for Health & Consumer Affairs (Consejería de Sanidad y Consumo), Murcia, Spain.
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Behre CJ, Bergström G, Schmidt CB. Increasing leisure time physical activity is associated with less prevalence of the metabolic syndrome in healthy middle-aged men. Angiology 2011; 62:509-12. [PMID: 21441232 DOI: 10.1177/0003319711398863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The metabolic syndrome (MetS) is characterized by a constellation of factors that confer an increased risk for cardiovascular morbidity and mortality. It is well-known that physical activity (PA) has a protective role on cardiovascular morbidity and mortality, mainly through its favorable effects on traditional risk factors such as body mass and blood pressure (BP). We assessed the prevalence of MetS in a population-based sample of 58-year-old men with respect to leisure-time PA and also to occupational PA. The results showed an inverse linear association (P < .05) between leisure time physical activity (LTPA) and MetS in this group. In conclusion, this study suggests that PA has an important role in controlling MetS.
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Affiliation(s)
- Carl Johan Behre
- Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
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Dalle Grave R, Calugi S, Centis E, El Ghoch M, Marchesini G. Cognitive-behavioral strategies to increase the adherence to exercise in the management of obesity. J Obes 2011; 2011:348293. [PMID: 21052533 PMCID: PMC2968119 DOI: 10.1155/2011/348293] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 10/05/2010] [Indexed: 12/31/2022] Open
Abstract
Physical activity plays a major role in the development and management of obesity. High levels of physical activity provide an advantage in maintaining energy balance at a healthy weight, but the amount of exercise needed to produce weight loss and weight loss maintenance may be difficult to achieve in obese subjects. Barriers to physical activity may hardly be overcome in individual cases, and group support may make the difference. The key role of cognitive processes in the failure/success of weight management suggests that new cognitive procedures and strategies should be included in the traditional behavioral treatment of obesity, in order to help patients build a mindset of long-term weight control. We reviewed the role of physical activity in the management of obesity, and the principal cognitive-behavioral strategies to increase adherence to exercise. Also in this area, we need to move from the traditional prescriptive approach towards a multidisciplinary intervention.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating & Weight Disorder, Villa Garda Hospital, Via Monte Baldo, 89, 37016 Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating & Weight Disorder, Villa Garda Hospital, Via Monte Baldo, 89, 37016 Garda, Verona, Italy
| | - Elena Centis
- Unit of Metabolic Diseases & Clinical Dietetics, “Alma Mater” University of Bologna, Policlinico S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy
| | - Marwan El Ghoch
- Department of Eating & Weight Disorder, Villa Garda Hospital, Via Monte Baldo, 89, 37016 Garda, Verona, Italy
| | - Giulio Marchesini
- Unit of Metabolic Diseases & Clinical Dietetics, “Alma Mater” University of Bologna, Policlinico S. Orsola, Via Massarenti, 9, 40138 Bologna, Italy
- *Giulio Marchesini:
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Affiliation(s)
- Yun Jun Yang
- Department of Family Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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48
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Risérus U, de Faire U, Berglund L, Hellénius ML. Sagittal abdominal diameter as a screening tool in clinical research: cutoffs for cardiometabolic risk. J Obes 2010; 2010:757939. [PMID: 20798888 PMCID: PMC2925288 DOI: 10.1155/2010/757939] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 12/27/2009] [Accepted: 02/03/2010] [Indexed: 11/17/2022] Open
Abstract
Background. Waist girth and BMI are commonly used as markers of cardiometabolic risk. Accumulating data however suggest that sagittal abdominal diameter (SAD) or "abdominal height" may be a better marker of intra-abdominal adiposity and cardiometabolic risk. We aimed to identify cutoffs for SAD using a cardiometabolic risk score. Design. A population-based cross-sectional study. Methods. In 4032 subjects (1936 men and 2096 women) at age 60, different anthropometric variables (SAD, BMI, waist girth, and waist-to-hip ratio) were measured and cardiometabolic risk score calculated. ROC curves were used to assess cutoffs. Results. Among men SAD showed the strongest correlations to the majority of the individual risk factors; whereas in women SAD was equal to that of waist girth. In the whole sample, the area under the ROC curve was highest for SAD. The optimal SAD cutoff for an elevated cardiometabolic risk score in men was approximately 22 cm (95%CI; 21.6 to 22.8) and in women approximately 20 cm (95%CI; 19.4 to 20.8). These cutoffs were similar if the Framingham risk score was used. Conclusions. These cutoffs may be used in research and screening to identify "metabolically obese" men who would benefit from lifestyle and pharmacological interventions. These results need to be verified in younger age groups.
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Affiliation(s)
- U. Risérus
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 75185 Uppsala, Sweden
- *U. Risérus:
| | - U. de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute and Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden
| | - L. Berglund
- Uppsala Clinical Research Center (UCR), Uppsala University, 75183 Uppsala, Sweden
| | - M. -L. Hellénius
- Department of Medicine, Karolinska Institute, Karolinska University Hospital, 17176 Stockholm, Sweden
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Cho ER, Shin A, Kim J, Jee SH, Sung J. Leisure-Time Physical Activity is Associated with a Reduced Risk for Metabolic Syndrome. Ann Epidemiol 2009; 19:784-92. [DOI: 10.1016/j.annepidem.2009.06.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 06/08/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022]
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de Faire U, Su J, Hua X, Frostegård A, Halldin M, Hellenius ML, Wikström M, Dahlbom I, Grönlund H, Frostegård J. Low levels of IgM antibodies to phosphorylcholine predict cardiovascular disease in 60-year old men: effects on uptake of oxidized LDL in macrophages as a potential mechanism. J Autoimmun 2009; 34:73-9. [PMID: 19726160 DOI: 10.1016/j.jaut.2009.05.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 05/20/2009] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We here determine the role of IgM antibodies against phosphorylcholine (anti-PC) in prediction of cardiovascular disease (CVD) and on macrophage uptake of Oxidized LDL (OxLDL). METHODS From a screening of 4232 subjects, 60-year-old (2039 men and 2193 women), 211 incident cases of CVD (myocardial infarction, ischemic stroke, or hospitalized angina pectoris) and 633 age- and sex-matched controls were identified through a 5-7 year follow-up. Serum levels of IgM anti-PC was determined by ELISA. Anti-PC was extracted from pooled human IgM and the effect of anti-PC on the uptake of OxLDL was studied by FACScan. RESULTS Relative risks (RR) with 95% confidence intervals (CI) by quartiles of anti-PC levels with quartile 4 set as the reference value (RR = 1.0) and adjusted for smoking, BMI, type II diabetes, hypercholesterolaemia, and high blood pressure yielded an excess risk for CVD only for those within the lowest quartile of anti-PC values with an RR of 1.37 (CI 0.87-2.16). However, for men stronger associations were noted with increasing multivariately adjusted RRs from quartile 4 to quartile 1. Subjects within quartile 1 (values below 29.7 U/ml) had a significantly increased RR of 1.96 (CI 1.09-3.55). Further adjustments for hsCRP gave essentially the same results. No excess risk was noted for women. Specific anti-PC could be extracted from IgM and these antibodies inhibited macrophage uptake of OxLDL. CONCLUSIONS Low IgM anti-PC could be a novel risk marker for CVD among men. One possible mechanism could be inhibition of uptake of oxLDL in macrophages.
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Affiliation(s)
- Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, S-171 77 Stockholm, Sweden.
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