Effects of a lifestyle modification programme to reduce the number of risk factors for metabolic syndrome: a randomised controlled trial

Factors Associated with Prevention of Metabolic Syndrome Among Middle-Aged Postmenopausal Korean Women: A Study Based on the Information, Motivation, Behavioral Skills (IMB) Model

Purpose

Metabolic syndrome (MetS) is a significant risk factor for cardiovascular disease. Middle-aged women, in particular, have been reported to have significantly increased cardiovascular disease rates after menopause; however, their adherence to health behaviors is lower than that of other populations. This study examined the factors associated with health behaviors for MetS prevention based on the Information-Motivation-Behavior skills model and described the relationships between the components of the model in middle-aged women.

Patients and Methods

This investigative study used an online self-report questionnaire survey that included 241 middle-aged postmenopausal women aged 45-64 years. The collected data were analyzed using descriptive statistics with SPSS 28.0, independent t-tests, one-way ANOVA, and Pearson's correlation coefficient. Multiple regression analysis was used to examine the relationships among the variables.

Results

After controlling for age, time since menopause, and comorbidities, knowledge of MetS, social support, self-efficacy, and attitudes explained 42% of the variance in health behaviors for MetS prevention (F=18.38, p<0.001). Among these variables, self-efficacy (β=0.33, p<0.001), attitudes toward health behaviors (β=0.26, p<0.001), and knowledge of MetS (β=0.13, p=0.005) had a significant impact on health behaviors for MetS prevention.

Conclusion

Significant associations were found between knowledge, self-efficacy, and attitudes toward health behaviors for MetS prevention among middle-aged women. The results of this study suggest that it is essential for healthcare provider to consider the components of the Information-Motivation-Behavior skills model when developing interventions aimed at improving health behaviors for MetS prevention among middle-aged postmenopausal women.

Effects of alpha lipoic acid supplementation on serum lipid profile in patients with metabolic syndrome: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Alpha lipoic acid (ALA) is considered a strong antioxidant with anti-inflammatory properties. Moreover, a number of previous studies have shown its lipid-lowering properties. Therefore, we designed this study to investigate the effects of ALA on lipid profile in patients with metabolic syndrome (MetS), which can lead to an increased risk of cardiovascular disease (CVD) and premature mortality.

METHODS

A total 46 patients with MetS were randomly divided into two groups. They received either 600 mg ALA (n = 23) or 600 mg placebo (n = 23) for 12 weeks. The body weight, height, body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and blood pressure (BP) were assessed at baseline of the study. Physical activity level and dietary intake were assessed at baseline and end of the study. Serum lipid profile including triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were measured before and after 12 weeks of intervention.

RESULTS

Baseline characteristics were similar in the ALA and placebo groups (P > 0.05). However, there were statistically significant differences in plasma levels of TG (-36.82 ± 42.48 versus 6.15 ± 25.04 mg/dl, P = 0.001) and TC (-8.91 ± 20.65 versus 10.84 ± 22.97 mg/dl, P = 0.01) after 12 weeks between the ALA group and the placebo group. Yet, there were no statistically significant differences in plasma levels of HDL-C and LDL-C after 12 weeks between the ALA group and the placebo group.

CONCLUSION

The results suggest that daily supplementation of 600 mg ALA for 12 weeks may improve the lipid profile in patients with MetS.

Predictors of Health Promotion Behaviors Among Working Adults at Risk for Metabolic Syndrome

BACKGROUND

Metabolic syndrome has a high global prevalence, affecting 26% of South Koreans. Lifestyle modifications have shown benefits in studies involving health behavior enhancement, specifically through workplace eating and exercise interventions. However, workplace interventions focusing on health behaviors have been inadequately explored.

OBJECTIVES

This study examined factors affecting health promotion behaviors of workers at high risk of metabolic syndrome by applying Theory of Planned Behavior constructs (attitude, subjective norm, perceived behavioral control, and intention).

METHODS

This correlational cross-sectional study collected survey data from 164 hotel workers in South Korea. The study applied factor analysis and structural equation modeling for the data analysis.

RESULTS

Analysis revealed five health promotion behaviors: exercise, making healthy food choices, avoiding fatty foods, eating a nutritious and balanced diet, and eating regular moderate meals. Participants were grouped as total participants, those with one risk factor and those with two risk factors. In the total group, four behaviors were influenced by perceived behavioral control: exercise, making healthy food choices, eating a nutritious and balanced diet, and eating regular moderate meals. In the one risk factor group, intention and attitude influenced the eating regular moderate meals behavior, and two other behaviors were influenced by perceived behavioral control: exercise and eating a nutritious and balanced diet; in the two risk factors group, only perceived behavioral control directly affected exercise.

DISCUSSION

Perceived behavioral control was a key predictor of health behaviors, and theory constructs partially explained behaviors. Perceived behavioral control influenced four behaviors and influenced exercise in all three groups. Also, theory constructs showed a greater effect on behaviors in the one risk factor group than in the two risk factor group, indicating that participants with one risk factor more effectively managed their behaviors on their own and with health care providers' support. Occupational health providers should conduct early assessments of workers showing metabolic syndrome risk factors to identify their particular risks, intention, and behaviors. As the number of risk factors affects behaviors and perceived behavioral control primarily influences exercise, these findings should be incorporated in metabolic syndrome interventions.

Association Between Eating Speed and Metabolic Syndrome: A Systematic Review and Meta-Analysis

Objective: This review aimed to systematically summarize and meta-analyze the association between eating speed and metabolic syndrome (MetS). Methods: Following the Preferred Reporting Items for Systematic Reviews, and Meta Analyses (PRISMA) guidelines, four electronic databases (PubMed, Web of Science, MEDLINE, and EMBASE) were searched until March 2021 to identify eligible articles based on a series of inclusion and exclusion criteria. Heterogeneity was examined using I ² statistics. Using random-effects models, the pooled odds ratios (ORs), and 95% CIs were calculated to evaluate the association between eating speed with MetS and its components, including central obesity, blood pressure (BP), high-density lipoprotein cholesterol (HDL), triglyceride (TG), and fasting plasma glucose (FPG). Results: Of the 8,500 original hits generated by the systematic search, 29 eligible studies with moderate-to-high quality were included, involving 465,155 subjects. The meta-analysis revealed that eating faster was significantly associated with higher risks of MetS (OR = 1.54, 95% CI: 1.27-1.86), central obesity (OR = 1.54, 95% CI: 1.37-1.73), elevated BP (OR = 1.26, 95% CI: 1.13-1.40), low HDL (OR = 1.23, 95% CI: 1.15-1.31), elevated TG (OR = 1.29, 95% CI: 1.18-1.42), and elevated FPG (OR = 1.16, 95% CI: 1.06-1.27) compared to eating slowly. Conclusions: The results of the review indicated that eating speed was significantly associated with MetS and its components. Interventions related to decreasing eating speed may be beneficial for the management of MetS. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021242213, identifier: CRD42021242213.

Development, Implementation, and Evaluation of an Educational Package to Control the Biomedical Profile of Metabolic Syndrome

Background:

Unhealthy lifestyle behaviors are a major concern in the development of metabolic syndrome (MetS). This study aimed to develop, implement, and evaluate a lifestyle education package as a strategy to control the biomedical components of MetS

Methods:

A total of 72 women and men (aged 18–68 y) with MetS were selected through randomized sampling. They were classified into 2 groups: an intervention group that received a lifestyle educational package with close follow-ups and a control group that received only usual care. Anthropometric indices, blood pressure, lipid profiles, and fasting blood sugar were assessed at baseline and after 3 months.

Results:

The lifestyle-modification program was associated with a modest weight loss (2 ± 0.4 kg; P < 0.001), a significant reduction in waist circumference (2.3 ± 0.9 cm; P < 0.001) and the hip circumference (1 ± 0.3 cm; P < 0.001), and a sharp decrease in diastolic blood pressure (5.3 ± 1.4 mm Hg; P < 0.001), compared with the baseline values in the intervention group. Additionally, according to the one-way MANOVA analysis, 33.8% of the changes in MetS components were attributable to the educational intervention (P < 0.001, F = 5.27).

Conclusions:

Improvement in lipid profile and anthropometric measures suggest that a lifestyle package based on multivariable health education is an acceptable method.

Novel Organic Mineral Complex Prevents High-Fat Diet-Induced Changes in the Gut and Liver of Male Sprague-Dawley Rats

Diet-induced obesity and metabolic syndrome are associated with the onset of gastrointestinal diseases, such as hepatic steatosis and gut inflammation. Prior research shows that a proprietary soil-derived organic mineral complex (OMC) prevents hyperglycemia, endotoxemia, and liver injury in rats fed a high-fat diet (HFD) for 10 weeks. The aim of this study was to further examine the effects of OMC on the liver and gastrointestinal health of these rats. Six-week-old male Sprague-Dawley rats (n = 36) were divided into two dietary groups: Chow or HFD fed for 10 weeks. Animals were further divided (n = 6/group) and administered 0, 0.6, or 3.0 mg/mL OMC in their drinking water. The 10-week HFD resulted in significant liver fat accumulation. Both OMC doses prevented hepatic increases in the glycation end product Nε-(carboxymethyl)lysine (CML) induced by HFD (p < 0.05). Low-dose OMC was associated with higher expression of occludin in the small intestine of rats fed either diet (two-way ANOVA, p < 0.042). Linear discriminant analysis (LDA) effect size (LEfSe) indicated significant differences in fecal microbial composition of untreated HFD-fed rats in comparison to untreated Chow rats at 10 weeks (LDA score > 2.0 : 18). After 10 weeks, untreated HFD-fed rats were also more abundant in bacteria associated with obesity and metabolic disease in comparison to corresponding week 0 samples (LDA score > 2.0 : 31), 10-week untreated Chow (LDA > 2.0 : 18), or 10-week OMC-treated HFD-fed rats (0.6 mg/mL; LDA > 2.0 : 80, 3.0 mg/mL; LDA > 2.0 : 8). Low-dose OMC prevented the HFD-induced increase in the Firmicutes-to-Bacteroidetes (F/B) ratio (p < 0.0416). Study animals treated with OMC exhibited no significant changes in the gut microbiota at week 10, although gut inflammatory biomarkers were not significantly altered by diet or OMC treatment. These results indicate that OMC supplementation ameliorates glycosylation reactions and modifies HFD-induced alterations in the intestinal microbiota.

Association Between Moderate-to-Vigorous Physical Activity and the Risk of Major Adverse Cardiovascular Events or Mortality in People With Various Metabolic Syndrome Status: A Nationwide Population-Based Cohort Study Including 6 Million People

Background A population-scale evidence for the association between moderate-to-vigorous physical activity (MV-PA) and risks of major adverse cardiovascular event (MACE) or all-cause mortality in people with various metabolic syndrome (MetS) status is warranted. Methods and Results We performed a nationwide retrospective cohort study based on the claims database of South Korea. We included people who received ≥3 national health screenings from 2009 to 2013 without a previous MACE history. We determined the MetS status of 6 108 077 people: MetS-chronic (N=864 063), MetS-developed (N=348 163), MetS-recovery (N=348 313), and MetS-free (N=4 547 538). The exposure was self-reported MV-PA frequencies. The outcome was incident MACEs or all-cause mortality. The incidence rate ratios (IRR) were calculated with adjustments for clinical/demographic characteristics. During the median follow-up of 4.28 years, 78 770 and 51 840 people experienced MACEs or died, respectively. Those who engaged in MV-PA had a significantly lower risk of MACEs or all-cause mortality than those not engaged in MV-PA in every spectrum of MetS. Even among those who were free from MetS (for MACEs, IRR 0.94 [0.92-0.97], for all-cause mortality, IRR 0.85 [0.82-0.87]) or who had already recovered from MetS (for MACEs, IRR 0.89 [0.84-0.95], for all-cause mortality, IRR 0.74 [0.68-0.81]), 1 to 2 days per week of MV-PA were significantly associated with lower risk of the adverse outcomes when compared with not being engaged in MV-PA. Those who were engaged in MV-PA more frequently also had significantly lower risks of MACEs or all-cause mortality. Conclusions This nationwide study suggests that MV-PA may be recommended to the general population regardless of recent MetS status.

Pharmacological Primary Prevention of Diabetes Mellitus Type II: A Narrative Review

The evolving epidemic of type 2 diabetes mellitus has challenged health-care professionals. It stands among the leading causes of mortality in the present world. It warrants new and versatile approaches to improve mortality and the associated huge quality-adjusted life years lost to it once diagnosed. A possible venue to lower the incidence is to assess the safety and efficacy of various diabetes prevention strategies. Diet and exercise have a well-developed role in the prevention of weight gain and, ultimately, diabetes mellitus type II in high-risk individuals. However, high-risk individuals can also benefit from adjunct pharmacotherapy. In light of this information, we decided to conduct a systematic review of randomized controlled trials. This article summarizes the evidence in the literature on the pharmacological prevention of diabetes in high-risk individuals.

Development and Validation of Prediction Model for Risk Reduction of Metabolic Syndrome by Body Weight Control: A Prospective Population-based Study

Several studies have reported that weight control is of paramount importance in reducing the risk of metabolic syndrome. Nevertheless, this well-known association does not provide any practical information on how much weight loss in a given period would reduce the risk of metabolic syndrome in individuals in a personalized setting. This study aimed to develop and validate a risk prediction model for metabolic syndrome in 2 years, based on an individual’s baseline health status and body weight after 2 years. We recruited 3,447 and 3,874 participants from the Ansan and Anseong cohorts of the Korean Genome and Epidemiology Study, respectively. Among the former, 8636 longitudinal observations of 2,412 participants (70%) and 3,570 of 1,034 (30%) were used for training and internal validation, respectively. Among the latter, all 15,739 observations of 3,874 participants were used for external validation. Compared to logistic regression, Gaussian Naïve Bayes, random forest, and deep neural network, XGBoost showed the highest performance (area under curve of 0.879) and a significantly enhanced calibration of the predictive score with the prevalence rate. The model was ported onto an application to provide the 2-year probability of developing metabolic syndrome by simulating selected target body weights, based on an individual’s baseline health profiles. Further prospective studies are required to determine whether weight-control programs could lead to favorable health outcomes.

Association between intensive health guidance focusing on eating quickly and metabolic syndrome in Japanese middle-aged citizens

PURPOSE

The purpose of this intervention study was to investigate whether intensive health guidance focusing on eating quickly can prevent metabolic syndrome (MetS) more effectively than standard routine guidance in Japanese citizens living in rural areas.

METHODS

This controlled, non-randomized, intervention study analyzed 141 participants with MetS at baseline. Participants in the intervention group received health guidance focusing on eating quickly and standard health guidance about MetS in accordance with the guidelines of the Ministry of Health, Labour and Welfare in Japan, whereas participants in the control group received only standard health guidance about MetS. The primary study outcome was the prevalence of MetS at a 1-year follow-up.

RESULTS

At 1-year follow-up, the prevalence of MetS in the intervention group was significantly lower than that in the control group (p = 0.003). The decreases in body weight, body mass index, waist circumference and triglycerides from baseline to 1 year were significantly greater in the intervention group than in the control group (p < 0.05).

CONCLUSION

Intensive health guidance focusing on eating quickly is more effective for improving MetS than standard Japanese health guidance alone.

LEVEL OF EVIDENCE

Level II, Evidence obtained from well-designed controlled trials without randomization. TRIAL REGISTRY NAME, REGISTRATION IDENTIFICATION NUMBER, AND URL FOR THE REGISTRY: UMIN, UMIN000030600, http://www.umin.ac.jp/ctr/index-j.htm.

Altered Risk for Cardiovascular Events With Changes in the Metabolic Syndrome Status: A Nationwide Population-Based Study of Approximately 10 Million Persons

BACKGROUND

Population-scale evidence for the association between dynamic changes in metabolic syndrome (MetS) status and alterations in the risk for major adverse cardiovascular events (MACE) is lacking.

OBJECTIVE

To investigate whether recovery from or development of MetS in a population is associated with an altered risk for MACE.

DESIGN

Nationwide cohort study.

SETTING

An analysis based on the National Health Insurance Database of Korea.

PARTICIPANTS

A total of 27 161 051 persons who received national health screenings from 2009 to 2014 were screened. Those with a history of MACE were excluded. We determined the MetS status of 9 553 042 persons using the following harmonizing criteria: MetS-chronic (n = 1 486 485), MetS-developed (n = 587 088), MetS-recovery (n = 538 806), and MetS-free (n = 6 940 663).

MEASUREMENTS

The outcome was the occurrence of MACE, including acute myocardial infarction, revascularization, and acute ischemic stroke, identified from the claims database. The incidence rate ratios (IRRs) were calculated with adjustments for body mass index, comorbidity scores, previous metabolic variables, and other clinical or demographic variables.

RESULTS

At a median follow-up of 3.54 years, the MetS-recovery group (incidence rate, 4.55 per 1000 person-years) had a significantly lower MACE risk (adjusted IRR, 0.85 [95% CI, 0.83 to 0.87]) than that of the MetS-chronic group (incidence rate, 8.52 per 1000 person-years). The MetS-developed group (incidence rate, 6.05 per 1000 person-years) had a significantly higher MACE risk (adjusted IRR, 1.36 [CI, 1.33 to 1.39]) than that of the MetS-free group (incidence rate, 1.92 per 1000 person-years). Among the MetS components, change in hypertension was associated with the largest difference in MACE risk.

LIMITATION

Limited assessment of mortality and short follow-up.

CONCLUSION

Recovery from MetS was significantly associated with decreased risk for MACE, whereas development of MetS was associated with increased risk.

PRIMARY FUNDING SOURCE

Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea.

Metabolic syndrome status over 2 years predicts incident chronic kidney disease in mid-life adults: a 10-year prospective cohort study

We investigated whether changes in MetS status over two years modify the 10-year risk of CKD and proteinuria. A prospective cohort study was conducted in 7,251 subjects without CKD at baseline. We categorized subjects according to MetS status over two years: non-MetS (no MetS at either visit), intermittent MetS (positive for MetS at one assessment), and persistent MetS (positive for MetS at two assessments). The hazard ratio (HR) of new-onset CKD over 10-year was calculated using Cox models. During the 10-year follow-up period, 923 (12.7%) developed CKD. Compared to the non-MetS group, the fully adjusted HR for new-onset CKD was the highest in the persistent MetS group (HR, 1.53; 95% CI, 1.23-1.90), followed by the intermittent MetS group (HR, 1.29; 95% CI, 1.04-1.59) (P for trend <0.001). The HR for developing proteinuria was 1.79 (95% CI, 1.15-2.79) in the persistent MetS group and 0.70 (95% CI, 0.42-1.19) in the intermittent MetS group when the non-MetS group was considered as the reference group. Temporal changes in MetS status over two years influenced the 10-year risk of incident CKD and proteinuria. Our findings suggest that monitoring and strictly controlling MetS are important in preventing renal function decline.