Metabolic syndrome pathophysiology: the role of adipose tissue

Metabolic dysfunction, rather than obesity, is a risk factor for chronic kidney disease in Chinese population

BACKGROUND

Metabolic dysfunction and obesity are closely related to chronic kidney disease (CKD). However, studies on the relationship between various metabolic syndrome-body mass index (MetS-BMI) phenotypes and the risk of CKD in the Chinese population have not yet been explored.

MATERIALS AND METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 were analyzed in this study. This study enrolled 12,054 participants. Participants were divided into six distinct groups according to their MetS-BMI status. Across the different MetS-BMI groups, the odd ratios (ORs) for CKD were determined using multivariable logistic regression models.

RESULTS

The prevalence of CKD was higher in metabolically unhealthy groups than in the corresponding healthy groups. Moreover, the fully adjusted model showed that all metabolically unhealthy individuals had an increased risk of developing CKD compared to the metabolically healthy normal weight group (OR = 1.62, p = 0.002 for the metabolically unhealthy normal weight group; OR = 1.55, p < 0.001 for the metabolically unhealthy overweight group; and OR = 1.77, p < 0.001 for the metabolically unhealthy obesity group.

CONCLUSIONS

This study is the first to evaluate the relationship between the MetS-BMI phenotype and renal prognosis in the Chinese population. Individuals with normal weights are at different risk of developing CKD depending on their different metabolic phenotypes.

White adipose tissue as a target for cadmium toxicity

Cadmium (Cd) is a widespread heavy metal known as a toxic environmental pollutant. Cd exposure is threatening due to its bioaccumulation trait in living systems that exceeds 35 years without a beneficial biological role. Acute exposure to high Cd doses was reported to impact adipose tissue (AT) function adversely. The main aim of this study is to investigate the effect of low-dose chronic Cd exposure on the genes involved in adipose tissue (AT) functions. Adult male Sprague-Dawley rats were exposed to a low Cd dose (15 mg/kg B.W./day) for 10 weeks. Then, three AT depots-subcutaneous AT (SUB-AT), abdominal AT (AB-AT), and retroperitoneal AT (REtrop-AT) were excised for Cd accumulation measures and gene expression analysis. Adiponectin and leptin gene expression levels were investigated as markers for adipocytes function and homeostasis. Our results showed that Cd accumulated in all the tested adipose depots, but SUB-AT was found to be the depot to most accumulate Cd. Also, it was exhibited that chronic exposure to low Cd doses altered the gene expression of adipocytokines. The levels of adiponectin and leptin mRNA expression were downregulated in all tested AT-depots after Cd exposure. The significant adverse effect on SUB-AT compared to other depots indicates different responses based on AT depots location toward Cd exposure. Collectively, these results suggest a toxic effect of Cd that influenced adipocyte function.

Transition of Metabolic Phenotypes and Risk of Atrial Fibrillation According to BMI: Kailuan Study

Objective

Atrial fibrillation (AF) is associated with both obesity and its metabolic consequences. However, there is a paucity of information on whether the dynamic change of metabolic health and obesity phenotypes affect the risk of AF. We aimed to prospectively examine the association between metabolic health and its change over time and AF risk across body mass index (BMI) categories.

Methods

A total of 58,483 participants without history of cancer, and cardiovascular diseases from the Kailuan study were included in the present study. Transition of metabolic phenotypes was evaluated between 1st survey (2006–2007) and the 2nd survey (2008–2009). The hazard ratios (HRs) and 95% confidence intervals (CIs) for AF were assessed by Cox proportional hazards regression.

Results

During a median follow-up of 3 years, we documented 580 cases of AF. Compared with metabolically healthy individuals with normal weight, the multivariable-adjusted hazard ratios for metabolically healthy and unhealthy overweight/obese were 1.27 (95% CI: 1.01, 1.59) and 1.37 (95% CI: 1.09, 1.72), respectively. However, when transition was taken into account, overweight/obese people who maintained metabolically healthy status were not associated with increased long-term risk (HR, 1.11;95% CI: 0.70, 1.78), whereas participants who converted from metabolically healthy overweight/obese status to an unhealthy phenotype had higher AF risk than those who maintained metabolically healthy normal weight (HR 1.59, 95% CI: 1.11, 2.26). When BMI and metabolically healthy status were updated over the course of the study, significant short-term elevations in AF risk were associated with individuals with stable MU-OW/OB status.

Conclusion

In this community-based cohort study, metabolically healthy overweight/obese individuals have increased risks of AF. Obesity remains a risk factor for AF independent of major metabolic factors. Our data further suggested that metabolic phenotype was a dynamic condition, and maintenance of metabolic health and normal weight might alleviate the risk of AF.

Perilipin Genetic Variation Correlated with Obesity and Lipid Profile in Metabolic Syndrome

BACKGROUND: Perilipin is very important for the regulation of the deposition and mobilization of fats. The human perilipin gene (PLIN) is near the locus for risk of obesity and hypertriglyceridemia. The PLIN gene is thought to be involved in the occurrence of metabolic syndrome. AIM: The aim of this research is to determine the role of variations of the PLIN gene (PLN4 11482 G>A) as a risk factor for component of metabolic syndrome. METHODS: This study involved a total of 160 subjects consisting of 80 with metabolic syndrome and 80 controls. Genotype analysis was done with the polymerase chain reaction-restriction fragment length polymorphism method. The data were analyzed with t-tests to compare the subjects’ characteristics between metabolic syndrome groups and controls. Risk factors of PLIN genotypes were calculated with odds ratio and multivariate regression analysis was used to determine the role of the PLIN gene with each biochemical characteristic. RESULTS: The result was significant differences between the characteristics of the metabolic syndrome subjects with controls (p < 0.05). There was no difference in genotypes between patients with metabolic syndrome and controls. The multivariate analysis of the genetic role with biochemical components showed the PLIN gene in AA carriers as a risk factor for metabolic syndrome compare GA+GG, risk of obesity, and hypercholesterolemia with p < 0.05. CONCLUSION: It can be concluded that PLIN variation has a role in the incidence of metabolic syndrome, especially in relation to obesity and hypercholesterolemia. Further study is needed to determine the role of other gene variations as a risk factor for metabolic syndrome.

Irisin regulates thermogenesis and lipolysis in 3T3-L1 adipocytes

BACKGROUND

Adipose tissue plays a pivotal role in the development and progression of the metabolic syndrome which along with its complications is an epidemic of the 21st century. Irisin is an adipo-myokine secreted mainly by skeletal muscle and targeting, among others, adipose tissue. In brown adipose tissue it upregulates uncoupling protein-1 (UCP1) which is responsible for mitochondrial non-shivering thermogenesis.

METHODS

Here we analyzed the effects of irisin on the metabolic activity of 3T3-L1 derived adipocytes through a mitochondrial flux assay. We also assessed the effects of irisin on the intracellular signaling through Western Blot. Finally, the gene expression of ucp1 and lipolytic genes was examined through RT-qPCR.

RESULTS

Irisin affects mitochondrial respiration and lipolysis in a time-dependent manner through the regulation of PI3K-AKT pathway. Irisin also induces the expression of UCP1 and the regulation of NF-κB, and CREB and ERK pathways.

CONCLUSION

Our data supports the role of irisin in the induction of non-shivering thermogenesis, the regulation of energy expenditure and lipolysis in adipocytes.

GENERAL SIGNIFICANCE

Irisin may be an attractive therapeutic target in the treatment of obesity and related metabolic disorders.

Liraglutide suppresses obesity and promotes browning of white fat via miR-27b in vivo and in vitro

Objective

To investigate the effect of liraglutide on the browning of white fat and the suppression of obesity via regulating microRNA (miR)-27b in vivo and in vitro.

Methods

Sprague-Dawley rats were fed a high-fat (HF) diet and 3T3-L1 pre-adipocytes were differentiated into mature white adipocytes. Rats and mature adipocytes were then treated with different doses of liraglutide. The mRNA and protein levels of browning-associated proteins, including uncoupling protein 1 (UCP1), PR domain containing 16 (PRDM16), CCAAT enhancer binding protein β (CEBPβ), cell death-inducing DFFA-like effector A (CIDEA) and peroxisome proliferator-activated receptor-γ-coactivator 1α (PGC-1α), were detected using quantitative real-time polymerase chain reaction and Western blotting.

Results

Liraglutide decreased body weight and reduced the levels of blood glucose, triglyceride and low-density lipoprotein cholesterol in HF diet-fed rats. Liraglutide increased the levels of UCP1, PRDM16, CEBPβ, CIDEA and PGC-1α in vivo and vitro. The levels of miR-27b were upregulated in HF diet-fed rats, whereas liraglutide reduced the levels of miR-27b. In vitro, overexpression of miR-27b decreased the mRNA and protein levels of UCP1, PRDM16, CEBPβ, CIDEA and PGC-1α. Transfection with the miR-27b mimics attenuated the effect of liraglutide on the browning of white adipocytes.

Conclusion

Liraglutide induced browning of white adipose through regulation of miR-27b.

Pharmacopuncture of Taraxacum platycarpum extract reduces localized fat by regulating the lipolytic pathway

Localized fat deposits are associated with health and aesthetic problems that mainly affect a large proportion of individuals. Recently, bioactive constituents of TP have been reported to affect lipid metabolism. In this study, we performed a network pharmacological analysis to assume potential lipolytic effects of TP and investigated the actual lipolytic effects of TP extract injection on local body fat and its underlying mechanism. Using the genes related to active compounds of TP, the network was constructed. Through the Functional Enrichment Analysis, Lipid Metabolism and Fatty Acid Metabolism were expected to be affiliated with the network, which implied possible lipolytic effects of TP. On the comparison between TP network and Obesity-related Gene Sets, about three-fourths of elements were in common with the gene sets, which indicated a high relevance between TP and obesity. Based on the genes in lipolysis-related pathways, Perilipin, CGI-58, ATGL, HSL and MGL were selected to identify the actual lipolytic effects of TP. TP injection reduced the inguinal fat weight. Also, the diameter of the adipocytes was decreased by the TP treatment in HFD-induced obese mice. In addition, TP suppressed lipid accumulation in differentiated 3T3-L1 adipocytes. Moreover, because the expression of Perilipin was increased, CGI-58, ATGL, HSL and MGL were markedly decreased. Furthermore, glycerol release was down-regulated by the TP treatment. TP exerted its lipolytic effects by regulating the lipolysis machinery through stimulation of lipases. Based on the present findings, TP is expected to be a potent component of injection lipolysis for removing localized body fat.

Relationship of obesity, low-density lipoprotein cholesterol and myocardial perfusion in patients with risk factors and without atherosclerotic cardiovascular diseases

Aim. In the retrospective study, to identify the relationship between body mass index (BMI), low-density lipoprotein cholesterol (LDL-C) levels and myocardial perfusion in patients without established atherosclerotic cardiovascular diseases.

Material and methods. The study included 534 patients with cardiovascular risk factors but without established coronary artery disease, diabetes, myocardial infarction or coronary revascularization. In 76 of them, stress/rest myocardial perfusion single-photon emission computed tomography (SPECT) was performed.

Results. The relationship between BMI and LDL-C levels is described by a quadratic (r2=0,21, p<0,001) function or a linear spline kinked in BMI of 27 kg/m2 (r=0,51, -0,46 — before and after this value, respectively; p<0,001). According to SPECT, focal stable and transient left ventricular myocardial perfusion abnormalities were not detected. However, there was a direct linear correlation between the heterogeneity of rest myocardial perfusion (ohet) and BMI (r=0,43, p<0,001), ohet and waist circumference (r=0,40, p<0,001), as well as between ohet and LDL-C (r=0,44, p<0,001).

Conclusion. The relationship between BMI and LDL-C levels can be explained by endocrine dysfunction of adipose tissue, which disturbs the synthesis and metabolism of atherogenic lipoproteins. Obesity and increased LDL-C levels affect myocardial perfusion both by aggravating coronary atherogenesis and by microcirculatory disorders. Rest myocardial perfusion SPECT can be a method of screening for myocardial disorders caused by both diffuse atherosclerosis and metabolic syndrome.

Phytosterols: Nutritional Health Players in the Management of Obesity and Its Related Disorders

Obesity and its related disorders, such as diabetes and cardiovascular risk, represent an emerging global health issue. Even though genetic factors seem to be the primary actors in the development and progression of these diseases, dietary choices also appear to be of crucial importance. A healthy diet combined with physical activity have been shown to ameliorate glycaemic levels and insulin sensitivity, reduce body weight and the risk of chronic diseases, and contribute to an overall improvement in quality of life. Among nutrients, phytosterols have become the focus of growing attention as novel functional foods in the management of metabolic disorders. Phytosterols are natural plant compounds belonging to the triterpene family and are structurally similar to cholesterol. They are known for their cholesterol-lowering effects, anti-inflammatory and antioxidant properties, and the benefits they offer to the immune system. The present review aims to provide an overview of these bioactive compounds and their therapeutic potential in the fields of obesity and metabolic disorders, with special attention given to oxidative stress, inflammatory status, and gut dysbiosis, all common features of the aforementioned diseases.

Association between adherence to the Mediterranean diet and renal function biomarkers and cardiovascular risk factors among diabetic patients with nephropathy

BACKGROUND AND AIM

Although the relationship between a Mediterranean diet (Med diet) and cardiovascular disease (CVD) risk factors has been widely established, no reports exist regarding this association in patients with Diabetes Nephropathy (DN). The aim of this study was to determine the association between level of adherence to a Med diet and renal and CVD risk factors among patients with DN.

STUDY DESIGN

A cross-sectional study.

METHODS

The current study was conducted in 270 patients with DN. A validated food frequency questionnaire was used to assess dietary intake. The Med diet score was determined based on the eight characteristics of a traditional Med diet. Anthropometrics, fasting blood glucose (FBS), total cholesterol (TC), low-density lipoproteins (LDL-c), triacylglycerol (TG), hemoglobin A1C (HbA1c), creatinine (Cr) and blood urea nitrogen (BUN) were detected using standard methods. Kidney function was estimated using the Modification of Diet in Renal Disease (MDRD) formula for estimated glomerular filtration rate (eGFR).

RESULTS

In fully-adjusted models, high serum TC and diastolic blood pressure (DBP) were reduced in participants that demonstrated a greater adherence to a Med diet, but did not reach statistical significance (OR: 0.20; 95% CI: 0.01, 5.52; P = 0.299; OR: 0.81; 95% CI: 0.28, 2.36; P = 0.667). Waist circumference (WC) was non-significantly lower in male participants (OR: 0.91; 95% CI: 0.27, 3.05; P = 0.889). Greater compliance with a Med diet showed a non-significant reduced risk for increased bodyweight (OR: 0.82; 95% CI: 0.23, 2.85; P = 0.730) and obesity (OR: 0.45; 95% CI: 0.03, 6.06; P = 0.493).

CONCLUSION

Adherence to a Med diet was not significantly associated with cardiovascular risk factors and renal function among patients with Diabetes Nephropathy.

SMRT Regulates Metabolic Homeostasis and Adipose Tissue Macrophage Phenotypes in Tandem

The Silencing Mediator of Retinoid and Thyroid Hormone Receptors (SMRT) is a nuclear corepressor, regulating the transcriptional activity of many transcription factors critical for metabolic processes. While the importance of the role of SMRT in the adipocyte has been well-established, our comprehensive understanding of its in vivo function in the context of homeostatic maintenance is limited due to contradictory phenotypes yielded by prior generalized knockout mouse models. Multiple such models agree that SMRT deficiency leads to increased adiposity, although the effects of SMRT loss on glucose tolerance and insulin sensitivity have been variable. We therefore generated an adipocyte-specific SMRT knockout (adSMRT-/-) mouse to more clearly define the metabolic contributions of SMRT. In doing so, we found that SMRT deletion in the adipocyte does not cause obesity-even when mice are challenged with a high-fat diet. This suggests that adiposity phenotypes of previously described models were due to effects of SMRT loss beyond the adipocyte. However, an adipocyte-specific SMRT deficiency still led to dramatic effects on systemic glucose tolerance and adipocyte insulin sensitivity, impairing both. This metabolically deleterious outcome was coupled with a surprising immune phenotype, wherein most genes differentially expressed in the adipose tissue of adSMRT-/- mice were upregulated in pro-inflammatory pathways. Flow cytometry and conditioned media experiments demonstrated that secreted factors from knockout adipose tissue strongly informed resident macrophages to develop a pro-inflammatory, MMe (metabolically activated) phenotype. Together, these studies suggest a novel role for SMRT as an integrator of metabolic and inflammatory signals to maintain physiological homeostasis.

U-shaped association between low-density lipid cholesterol and diabetes mellitus in patients with hypertension

Background

The magnitude and direction of association of low-density lipid cholesterol (LDL-C) with diabetes mellitus (DM) might differ by hypertensive status, but there is limited epidemiological evidence in China.

Methods

We examined the association between LDL-C levels and DM in 9892 participants with hypertension using logistic regression. Participants were stratified into three groups according to LDL-C levels (desirable, borderline high or high), then further divided into quartiles. Restricted cubic spline regression models, subgroup analysis and interaction tests were also conducted to evaluate the shape of association.

Results

After adjusting for covariates, lower LDL-C had a significant and inverse association with the likelihood of DM in all participants (OR: 0.944, 95% CI = 0.893, 0.998). In participants with desirable LDL-C concentrations (< 3.4 mmol/L), LDL-C protected against DM (OR = 1.240, 95% CI = 1.076, 1.429 per 1 mmol/L decrease). In participants with higher LDL-C concentrations (> 4.1 mmol/L), LDL-C increased the DM likelihood (OR = 1.536, 95% CI = 1.126, 2.096 per 1 mmol/L increase). Restricted cubic spline regression also found a U-shaped association between LDL-C levels and DM prevalence.

Conclusions

There was a U-shaped association between LDL-C levels and DM in Chinese patients with hypertension.

Electronic supplementary material

The online version of this article (10.1186/s12944-019-1105-5) contains supplementary material, which is available to authorized users.

Cocoa Flavanols: Natural Agents with Attenuating Effects on Metabolic Syndrome Risk Factors

The interest in cacao flavanols is still growing, as bioactive compounds with potential benefits in the prevention of chronic diseases associated with inflammation, oxidative stress and metabolic disorders. Several analytical methodologies support that the flavanols in cacao-derived products can be absorbed, have bioactive properties, and thus can be responsible for their beneficial effects on human health. However, it must be considered that their biological actions and underlying molecular mechanisms will depend on the concentrations achieved in their target tissues. Based on the antioxidant properties of cacao flavanols, this review focuses on recent advances in research regarding their potential to improve metabolic syndrome risk factors. Additionally, it has included other secondary plant metabolites that have been investigated for their protective effects against metabolic syndrome. Studies using laboratory animals or human subjects represent strong available evidence for biological effects of cacao flavanols. Nevertheless, in vitro studies are also included to provide an overview of these phytochemical mechanisms of action. Further studies are needed to determine if the main cacao flavanols or their metabolites are responsible for the observed health benefits and which are their precise molecular mechanisms.

Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation

Background

Small dense LDL cholesterol (sdLDL-c) has been established to be highly associated with metabolic disorder. However, the relationship between circulating sdLDL-c and the presence of metabolic syndrome (MetS) has not been fully established.

Methods

A total of 1065 Chinese males (45.07 ± 11.08 years old) without diabetes and general obesity was recruited into a population-based, cross-sectional study. The MetS was defined based on the updated National Cholesterol Education Program/ Adult Treatment Panel III criteria for Asian Americans. Serum sdLDL-c concentration was measured by a homogeneous assay method and its relationship with MetS and its traits was investigated.

Results

Serum sdLDL-c concentrations increased gradually with increasing numbers of MetS components (p < 0.001) and the proportion of patients with MetS increased gradually with increasing sdLDL-c levels (p for trend< 0.001). For the second, third, and fourth sdLDL-c quartiles versus the first, the OR (95% CI) for MetS were 4.47(2.41,8.28), 5.47(2.97,10.07) and 8.39(4.58,15.38) (p < 0.001 for trend) after multivariate adjustment. The stratified analysis conducted according to LDL-c levels showed that the OR between serum sdLDL-c levels and MetS was greater in those LDL-c levels lower than 3.3 mmol/L (OR = 22.97; 95% CI, 7.64-69.09) than in those LDL-c levels higher than 3.3 mmol/L (OR = 17.49; 95% CI, 4.43-68.98). Mediation analysis showed sdLDL-c mediated 38.6% of the association of waist circumference with triglycerides, while the association between sdLDL-c and MetS components did not mediate by hsCRP.

Conclusions

This study found that high sdLDL-c concentrations were associated with the presence of MetS independently of central obesity and inflammation.

Adrenomedullin 2/intermedin: a putative drug candidate for treatment of cardiometabolic diseases

Adrenomedullin (ADM) 2/intermedin (IMD) is a short peptide that belongs to the CGRP superfamily. Although it shares receptors with CGRP, ADM and amylin, ADM2 has significant and unique functions in the cardiovascular system. In the past decade, the cardiovascular effect of ADM2 has been carefully analysed. In this review, progress in understanding the effects of ADM2 on the cardiovascular system and its protective role in cardiometabolic diseases are summarized.

LINKED ARTICLES

This article is part of a themed section on Spotlight on Small Molecules in Cardiovascular Diseases. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.8/issuetoc.

A Critical Examination of the Use of Trained Health Coaches to Decrease the Metabolic Syndrome for Participants of a Community-Based Diabetes Prevention and Management Program

The epidemic of obesity and diabetes in the United States poses major challenge to the prevention and management of chronic diseases. Furthermore, when this is viewed in other components of the metabolic syndrome (i.e., the burden of high cholesterol and hypertension), the prevalence of the metabolic syndrome continues to rise in the USA continued challenge is how to deal with this epidemic from a medical and public health standpoint. Community Based Participatory Research (CBPR) is a unique approach and offers a novel perspective for answering this challenge. A critical set of goals for CBPR is to address health disparities and social inequalities while getting community members engaged in all aspects of the research process. Utilizing the West Virginia Diabetes Prevention and Management Program and trained Health Coaches as a model, we discuss topics of consideration related to CBPR, involving trained health coaches, optimizing early adoption of healthy lifestyle behaviors, and enhancing participation. Through careful project planning and design, questions regarding disparities increasing susceptibility and preventive efforts within the community can be addressed successfully. These topics are part of a broader integration of theories such as participatory research, community engagement, and outcomes measurement. The understanding of the pathophysiology and epidemiology of the metabolic syndrome can help frame an appropriate strategy for establishing long-term community-wide changes that promote health. In order to continue to improve investigations for preventing the metabolic syndrome, it will be necessary to have aggressive efforts at the individual and population level for developing culturally sensitive programs that start early and are sustainable in practical environments such as the workplace. In this comprehensive review, we will discuss practical considerations related to project design, implementation, and how to measure effectiveness in regards to reducing the burden of the metabolic syndrome.

Metabolic syndrome in pediatrics

The ever growing prevalence of childhood obesity is being accompanied by an increase in the pediatric population of diseases once believed to be exclusive of the adulthood such as the metabolic syndrome (MS). The MS has been defined as the link between insulin resistance, hypertension, dyslipidemia, impaired glucose tolerance, and other metabolic abnormalities associated with an increased risk of atherosclerotic cardiovascular diseases in adults. In this review, we will discuss the peculiar aspects of the pediatric MS and the role of novel molecules and biomarkers in its pathogenesis.

Abdominal wall fat index in neonates: correlation with birth size

Low birth weight is associated with obesity in later life and a more central fat distribution has a positive correlation with cardiovascular disease. However, the correlation between visceral adiposity in newborns and birth size is unknown. We measured the visceral adiposity in 118 newborns using the abdominal wall fat index (AFI), ratio between the maximum thickness of preperitoneal and the minimum thickness of subcutaneous fat evaluated by ultrasound. There was a weak negative correlation between AFI and birth weight (r = -0.197; P = 0.033) but not with birth length (r = -0.118; P = 0.201), body mass index (r = -0.138; P = 0.176) and abdominal circumference (r = 0.063; P = 0.497). In conclusion, we suggest that AFI is a useful parameter for evaluating the fat distribution in newborns and that visceral adiposity has a weak negative correlation with birth weight.

An overview of the genomics of metabolic syndrome

PURPOSE

This article provides a brief overview of the diagnostic criteria and genomic risk factors for the components of metabolic syndrome (MetS).

ORGANIZING CONSTRUCTS

Contributions of cardiovascular, obesity, and diabetes genomic risk factors to the development of MetS as reported in the literature have been reviewed.

FINDINGS

The genomic risk factors for the development of MetS are strongly linked to the genomic risk factors that make up the components of the disease. Many of the cardiovascular and renal genomic risk factors for MetS development are similar to those found in the development of hypertension and dyslipidemia. Obesity may act as a master trigger to turn on the gene expression changes necessary for the other components of the disease. Studies in the genomics of type 2 diabetes show a number of overlapping genes and polymorphisms that influence both the development of diabetes and MetS.

CONCLUSIONS

Although health practitioners now have some insights into the genomics of risk factors associated with MetS, the overall understanding of MetS remains inadequate. Clinical applications based on some of the discussed genomic risk factors are being developed but are not yet available for the diagnosis and treatment of MetS.

CLINICAL RELEVANCE

A broad knowledge of the genomic contributions to disease processes will enable the clinician to better utilize genomics to assess and tailor management of patients.