The dysmetabolic syndrome

The Metabolic Syndrome, a Human Disease

This review focuses on the question of metabolic syndrome (MS) being a complex, but essentially monophyletic, galaxy of associated diseases/disorders, or just a syndrome of related but rather independent pathologies. The human nature of MS (its exceptionality in Nature and its close interdependence with human action and evolution) is presented and discussed. The text also describes the close interdependence of its components, with special emphasis on the description of their interrelations (including their syndromic development and recruitment), as well as their consequences upon energy handling and partition. The main theories on MS's origin and development are presented in relation to hepatic steatosis, type 2 diabetes, and obesity, but encompass most of the MS components described so far. The differential effects of sex and its biological consequences are considered under the light of human social needs and evolution, which are also directly related to MS epidemiology, severity, and relations with senescence. The triggering and maintenance factors of MS are discussed, with especial emphasis on inflammation, a complex process affecting different levels of organization and which is a critical element for MS development. Inflammation is also related to the operation of connective tissue (including the adipose organ) and the widely studied and acknowledged influence of diet. The role of diet composition, including the transcendence of the anaplerotic maintenance of the Krebs cycle from dietary amino acid supply (and its timing), is developed in the context of testosterone and β-estradiol control of the insulin-glycaemia hepatic core system of carbohydrate-triacylglycerol energy handling. The high probability of MS acting as a unique complex biological control system (essentially monophyletic) is presented, together with additional perspectives/considerations on the treatment of this 'very' human disease.

Cardiovascular and metabolic health is associated with functional brain connectivity in middle-aged and older adults: Results from the Human Connectome Project-Aging study

Several cardiovascular and metabolic indicators, such as cholesterol and blood pressure have been associated with altered neural and cognitive health as well as increased risk of dementia and Alzheimer's disease in later life. In this cross-sectional study, we examined how an aggregate index of cardiovascular and metabolic risk factor measures was associated with correlation-based estimates of resting-state functional connectivity (FC) across a broad adult age-span (36-90+ years) from 930 volunteers in the Human Connectome Project Aging (HCP-A). Increased (i.e., worse) aggregate cardiometabolic scores were associated with reduced FC globally, with especially strong effects in insular, medial frontal, medial parietal, and superior temporal regions. Additionally, at the network-level, FC between core brain networks, such as default-mode and cingulo-opercular, as well as dorsal attention networks, showed strong effects of cardiometabolic risk. These findings highlight the lifespan impact of cardiovascular and metabolic health on whole-brain functional integrity and how these conditions may disrupt higher-order network integrity.

Molecular Mechanisms for the Vicious Cycle between Insulin Resistance and the Inflammatory Response in Obesity

The comprehensive anabolic effects of insulin throughout the body, in addition to the control of glycemia, include ensuring lipid homeostasis and anti-inflammatory modulation, especially in adipose tissue (AT). The prevalence of obesity, defined as a body mass index (BMI) ≥ 30 kg/m², has been increasing worldwide on a pandemic scale with accompanying syndemic health problems, including glucose intolerance, insulin resistance (IR), and diabetes. Impaired tissue sensitivity to insulin or IR paradoxically leads to diseases with an inflammatory component despite hyperinsulinemia. Therefore, an excess of visceral AT in obesity initiates chronic low-grade inflammatory conditions that interfere with insulin signaling via insulin receptors (INSRs). Moreover, in response to IR, hyperglycemia itself stimulates a primarily defensive inflammatory response associated with the subsequent release of numerous inflammatory cytokines and a real threat of organ function deterioration. In this review, all components of this vicious cycle are characterized with particular emphasis on the interplay between insulin signaling and both the innate and adaptive immune responses related to obesity. Increased visceral AT accumulation in obesity should be considered the main environmental factor responsible for the disruption in the epigenetic regulatory mechanisms in the immune system, resulting in autoimmunity and inflammation.

Syntheses, in vitro, and in silico studies of rhodanine-based schiff bases as potential α-amylase inhibitors and radicals (DPPH and ABTS) scavengers

A two-step reaction method was used to synthesize a series of rhodanine-based Schiff bases (2-33) that were characterized using spectroscopic techniques. All compounds were assessed for α-amylase inhibitory and radical scavenging (DPPH and ABTS) activities. In comparison to the standard acarbose (IC₅₀ = 9.08 ± 0.07 µM), all compounds demonstrated good to moderate α-amylase inhibitory activity (IC₅₀ = 10.91 ± 0.08-61.89 ± 0.102 µM). Compounds also demonstrated significantly higher DPPH (IC₅₀ = 10.33 ± 0.02-96.65 ± 0.03 µM) and ABTS (IC₅₀ = 12.01 ± 0.12-97.47 ± 0.13 µM) radical scavenging activities than ascorbic acid (DPPH, IC₅₀ = 15.08 ± 0.03 µM; ABTS, IC₅₀ = 16.09 ± 0.17 µM). The limited structure-activity relationship (SAR) suggests that the position and nature of the substituted groups on the phenyl ring have a vital role in varying inhibitory potential. Among the series, compounds with an electron-withdrawing group at the para position showed the highest potency. Kinetic studies revealed that the compounds followed a competitive mode of inhibition. Molecular docking results are found to agree with experimental findings, showing that compounds reside in the active pocket due to the main rhodanine moiety.

Cardiovascular risk and protective factors in adults with and without diabetes mellitus (Italy, 2016-19)

BACKGROUND

Cardiovascular (CV) diseases are a major cause of the disease burden worldwide and contribute substantially to health care costs, in particular in people with diabetes. Their incidence can be reduced by multi-factorial interventions. This study intends to describe the occurrence of CV risk and protective/preventive factors in the adult population resident in Italy, to better target public health interventions.

METHODS

Data collected in 2016-19 from adults aged 18-69 years, participating in the Italian Behavioural Risk Factor Surveillance System (PASSI) based on a cross-sectional design, were used. The frequency of CV risk/protective factors was estimated in people with and without diabetes. The contribution of socioeconomic level (SEL) to CV risk was also explored.

RESULTS

Among 129 989 respondents, 4.7% received a diagnosis of diabetes. Many CV risk factors were significantly more frequent in people with diabetes, who often presented multiple risk factors. At the same time, they adopted protective behaviours and received treatments and preventive interventions more often than those without diabetes. Relevant disparities were observed between SEL groups in diabetic people, with the least advantaged showing a worse risk profile.

CONCLUSIONS

Adults resident in Italy with diabetes are exposed to CV risk factors more often than those without diabetes. However, they show an increased attention to control these factors and receive more frequent health care, although less than ideal in absolute terms. There is an opportunity to reduce the important CV disease burden in the population through preventive/health promotion targeted interventions, prioritizing people with diabetes and of lower SEL.

Body Composition and Biological Functioning in Polish Perimenopausal Women with Type 2 Diabetes

BACKGROUND AND OBJECTIVES

The aim was to compare body composition and levels of biochemical blood parameters and identify relationships between biochemical parameters and body composition of women with type 2 diabetes and healthy ones, both in perimenopausal period (172 women aged between 45 and 65 come from the West Pomeranian Voivodeship, Poland).

MATERIALS AND METHODS

The study consisted of an interview, body composition analysis with Jawon Medical IOI-353 (Yuseong, South Korea) analyser and venous blood biochemical analysis (lipid profile, levels of glucose, insulin, CRP, glycated haemoglobin).

RESULTS

The vast majority of body composition measurements varied between study and control groups in a statistically significant way (p < 0.05) except protein and soft lean mass of the torso. Statistically significant differences between the two groups have been observed in case of all biochemical parameters (p < 0.001).

CONCLUSIONS

Body composition of women suffering from type 2 diabetes significantly varied from body composition of healthy women. Results of the first group were characterised by higher values, especially in case of general parameters, abdominal area, content of adipose tissue and soft tissues. Relationship between body composition and biochemical results may be observed, especially in level of triglycerides, CRP and insulin. Higher concentrations of these parameters were associated with increased values of majority of body composition measurements regardless of type 2 diabetes incidence.

Analysis of the Impact of Type 2 Diabetes on the Psychosocial Functioning and Quality of Life of Perimenopausal Women

Menopause is a natural period resulting from the decrease in hormonal activity of the ovaries. Growing hormonal deficiencies and changes in the body influence a variety of functions in women, leading to depression and decreased quality of life. The relationship between body composition, the severity of depressive and climacteric symptoms and the quality of life of women with type 2 diabetes and healthy women in the perimenopausal period was studied. Statistically significant differences were observed between the study and control groups regarding all body composition parameters except for protein and the content of torso soft tissues (p < 0.05). In both the study and control groups, resulting symptoms were significantly correlated with numerous body composition parameters (e.g., body mass, fat tissue mass, minerals, abdominal circumference), while symptoms of depression were significantly correlated with similar parameters only in the control group. A statistically relevant relationship was observed between the study and control groups with respect to quality of life in certain domains. The quality of life of women suffering from type 2 diabetes was worse compared with healthy women. Analysis of body composition showed significant differences between healthy women and those with type 2 diabetes. Healthy women showed a tendency to establish a link between body composition and depressiveness.

Thiazolidinedione-induced effects beyond glycaemic control

The thiazolidinediones exert their insulin sensitising effect by binding to the nuclear receptors (transcription factors) peroxisome proliferator activated receptor (PPAR) γ and, to varying degrees, to PPARα. Several different genes are activated by thiazolidinediones, many of which contribute to the increase in insulin sensitivity (eg. an increase in glucose uptake and utilisation, a decrease in gluconeogenesis and in insulin-antagonistic cytokines, such as tumour necrosis factor α). Activation of other genes indirectly reduces insulin resistance by, for example, increasing free fatty acid (FFA) uptake and oxidation resulting in lower circulating FFA levels. The action of thiazolidinediones at PPARγ is generally responsible for their insulin sensitising effects while action at PPARα contributes to their lipid lowering effects. Therefore, the relative affinities of the different thiazolidinediones for PPARγ and PPARα will also lead to a different spectrum of actions for each agent.

Impact of anthropometric cut-off values in determining the prevalence of metabolic alterations

BACKGROUND

The prevalence of obesity has increased worldwide in parallel with associated metabolic disturbances such as diabetes and non-alcoholic fatty liver disease.

OBJECTIVE

The objective of this article is to underscore discrepancies in the standard anthropometric cut-off values and the presence of metabolic disturbances including diabetes and non-alcoholic fatty liver disease caused by biological and ethnic variations.

MATERIALS AND METHODS

We performed a literature review regarding the diagnosis and prevalence of obesity, diabetes, metabolic syndrome and non-alcoholic fatty liver disease and about the different available indicators to define obesity.

RESULTS

There is an ongoing epidemic of these chronic diseases, partially attributed to the increased prevalence of obesity. The available markers to indicate adiposity are imperfect, and the selection of accurate cut-off points is still not clear.

CONCLUSION

Methods to quantify adiposity that are useful in clinical practice should be developed to better classify individuals and to reflect metabolic risk more appropriately.

Fructose Containing Sugars at Normal Levels of Consumption Do Not Effect Adversely Components of the Metabolic Syndrome and Risk Factors for Cardiovascular Disease

The objective of the current study was to explore our hypothesis that average consumption of fructose and fructose containing sugars would not increase risk factors for cardiovascular disease (CVD) and the metabolic syndrome (MetS). A randomized, double blind, parallel group study was conducted where 267 individuals with BMI between 23 and 35 kg/m² consumed low fat sugar sweetened milk, daily for ten weeks as part of usual weight-maintenance diet. One group consumed 18% of calories from high fructose corn syrup (HFCS), another group consumed 18% of calories from sucrose, a third group consumed 9% of calories from fructose, and the fourth group consumed 9% of calories from glucose. There was a small change in waist circumference (80.9 ± 9.5 vs. 81.5 ± 9.5 cm) in the entire cohort, as well as in total cholesterol (4.6 ± 1.0 vs. 4.7 ± 1.0 mmol/L, p < 0.01), triglycerides (TGs) (11.5 ± 6.4 vs. 12.6 ± 8.9 mmol/L, p < 0.01), and systolic (109.2 ± 10.2 vs. 106.1 ± 10.4 mmHg, p < 0.01) and diastolic blood pressure (69.8 ± 8.7 vs. 68.1 ± 9.7 mmHg, p < 0.01). The effects of commonly consumed sugars on components of the MetS and CVD risk factors are minimal, mixed and not clinically significant.

C-Peptide Is a Sensitive Indicator for the Diagnosis of Metabolic Syndrome in Subjects from Central Mexico

BACKGROUND

Metabolic Syndrome (MetS) is associated with elevated risk for developing diabetes and cardiovascular disease. A key component of MetS is the development of insulin resistance (IR). The homeostatic model assessment (HOMA) model can determine IR by using insulin or C-peptide concentrations; however, the efficiency of insulin and C-peptide to determine MetS has not been compared. The aim of the study was to compare the efficiency of C-peptide and insulin to determine MetS in Mexicans.

METHODS

Anthropometrics, glucose, insulin, C-peptide, triglycerides, and high-density lipoproteins were determined in 156 nonpregnant females and 114 males. Subjects were separated into normal or positive for MetS. IR was determined by the HOMA2 calculator using insulin or C-peptide. Correlations were calculated using the Spearman correlation coefficient (ρ). Differences between correlations were determined by calculating Steiger's Z. The sensitivity was determined by the area under receiver operating characteristics curve (AUC) analysis.

RESULTS

Independent of the MetS definition [Adult Treatment Panel III (ATP III), International Diabetes Federation (IDF), or World Health Organization (WHO)], C-peptide and insulin were significantly higher in MetS subjects (P < 0.05). C-peptide and insulin correlated with all components of MetS; however, for waist circumference, waist-to-hip ratio, and fasting plasma glucose, C-peptide correlated better than insulin (P < 0.05). Moreover, C-peptide (AUC = 0.72-0.78) was a better marker than insulin (AUC = 0.62-0.72) for MetS (P < 0.05). Finally, HOMA2-IR calculated with C-peptide (AUC = 0.80-0.84) was more accurate than HOMA2-IR calculated with insulin (AUC = 0.68-0.75, P < 0.05) at determining MetS.

CONCLUSION

C-peptide is a strong indicator of MetS. Since C-peptide has recently emerged as a biomolecule with significant importance for inflammatory diseases, monitoring C-peptide levels will aid clinicians in preventing MetS.

"Adolescent metabolic phenotypes and early adult metabolic syndrome: Tehran lipid and glucose study"

OBJECTIVE

To investigate the predictive role of adolescent metabolic phenotypes in development of early adult metabolic syndrome (MetS).

STUDY DESIGN

A group of 1446 adolescents (44.8% boys), participants of the Tehran Lipid and Glucose Study, with a mean (SD) of age 14.6 (2.2) years, followed for 10.4 years. Logistic regression models were developed to evaluate the predictive power of different metabolic phenotypes for adult MetS. Moreover, areas under the receiver operating characteristic (ROC) curve were estimated to compare the prediction power of metabolic phenotypes for adult MetS.

RESULTS

The prevalence of MetS was 14.6% (29.7% and 2.4% for adult males and females, respectively) at the end of follow up. The most frequent metabolic phenotype in adolescent was high TGs/low HDL-C (23.7%), while the prevalence of high TGs/high WC was 10.4% and the other phenotypes were less than 10%. After adjustment for baseline BMI Z-Score and BMI change, high TGs/low HDL-C (OR: 1.70, 95%CI: 1.23-2.37), high WC/high BP (OR: 1.75., 95%CI: 1.08-2.84), high BP/low HDL-C (OR:1.68, 95%CI: 1.05-2.60) and high WC/low HDL-C (OR: 2.41, 95% CI: 1.37-4.23) phenotypes were associated with adult MetS. However, their AUCs were significantly lower than overweight or obesity.

CONCLUSION

Some combinations of metabolic abnormalities in adolescence predict early adult MetS, independent of baseline BMI Z-Score and BMI change. However, the discriminative power of these phenotypes was weak, in comparison to adolescent overweight or obesity.

Blood serum levels of CART peptide in patients with schizophrenia on clozapine monotherapy

CART (cocaine- and amphetamine-regulated transcript) is an endogenous inhibitor of food intake. We compared fasting serum CART levels in subjects with schizophrenia on clozapine monotherapy (n=24) with sex- and age-matched healthy controls (n=24). CART levels were higher in the clozapine group (262.76±359.91 vs. 90.40±169.90 pg/mL). CART levels were higher in subjects with metabolic syndrome compared to subjects without metabolic syndrome in the clozapine group (415.63±416.93 vs. 122.62±237.17 pg/mL, n=12 and 12, respectively) and in the whole study group (377.73±401.09 vs. 88.58±172.35 pg/mL, n=16 and 32, respectively). In the control group CART levels were higher in subjects with total body fat lower than the target maximum compared to subjects with total body fat below the target maximum (121.71±154.91 vs. 66.32±182.96 pg/mL, n=14 and 10, respectively). CART levels did not correlate with age, weight, BMI, abdominal, waist and hip circumferences, WHR, blood pressure, laboratory tests, clozapine dose, antipsychotic or clozapine treatment duration, body composition, and markers of insulin resistance in the study group. Further studies are required to confirm whether increased levels of circulating CART are compensatory in response to treatment-induced weight gain and abdominal obesity or a primary feature of schizophrenia.

Survey of the relationship between metabolic syndrome and myocardial infarction in hospitals of Urmia University of medical sciences

BACKGROUND & AIM

The aim of this study was to determine the relationship between metabolic syndrome and myocardial infarction in patients admitted to the hospitals of Urmia University of medical sciences.

METHODS

A case-control study population consisted of 172 patients with heart failure who were admitted to Seyedolshohada Hospital. In this method, the researchers present in the units and along with demographic questionnaire of patients, laboratory results needed for the survey (fasting blood glucose, triglycerides and HDL) with waist circumference size, blood pressure, height and weight were examined. Data after collection were analyzed using SPSS statistical software.

RESULTS

In this study of 172 patients with myocardial infarction, 56 patients (38.4%) patients were females and 112 (17.9%) were males. 1.2% of the patients were single, 84.8% were married, 0.6 were divorced and 13.5% were widowed, 116 patients (67.4%) with features of metabolic syndrome and 56 patients (32.6%) were lacking. In this study, females with myocardial infarction had more metabolic syndrome than males and in people whom relatives have a history of heart disease and also people who are overweight as well as obesity and also have features of metabolic syndrome and mean profiles of HDL, LDL, BMI, fasting blood glucose, triglyceride and waist circumference in males compared to males is higher. However, history of smoking, average number of cigarettes used per day, height and weight of males is higher than females. Other findings indicate a significant relationship between age and sex and having or not having a family history of heart failure, having or not having history of certain drugs and BMI of patient with metabolic syndrome. But a significant relationship was not found between the marital status, education, residence, income, previous history of heart disease, PCI, LDL, history of drug use, type of infarction, the extent of ejection and location with syndrome patients. In terms of survival, because none of the subjects in the study period had expired, this extent was not quantifiable.

CONCLUSION

Considering the high prevalence of this disorder in Iran and that the high incidence of serious effects imposes on the health care system and that these disorders are somewhat flexible, effort towards lifestyle changes particularly healthy diets, physical activity, weight management and blood pressure, especially in women should be considered. 

Periodontal disease and metabolic syndrome: a qualitative critical review of their association

BACKGROUND

Metabolic syndrome (MetS) is a conglomerate of several physical conditions/diseases that, as a group, increases the risk of mortality resulting from development of T2DM and cardiovascular diseases (CVD). These conditions/diseases include glucose intolerance/insulin resistance, hypertension, obesity, and dyslipidemia. The results from epidemiological studies suggest that there is an association between metabolic syndrome (MetS) and periodontitis, it is therefore important to understand the current status of the association and a possible contribution of periodontitis to MetS.

OBJECTIVE

This review will qualitatively analyze published papers on the association of MetS and periodontitis/periodontal disease to clarify the current status of the association and suggest future directions for studies which may unravel the causal relationship between them.

RESULTS

Of 309 papers related to MetS and periodontitis, 26 are original research papers that investigated the relationship/association between periodontal disease and MetS. Criteria used to assess periodontitis and MetS as well as overall study designs and patient recruitment criteria varied greatly among these studies.

CONCLUSION

All these studies demonstrated a positive association between periodontal disease and MetS. However, due to the heterogeneity of criteria to assess periodontitis and MetS and also paucity of longitudinal studies, it is difficult to determine the relative contribution of periodontitis to MetS. Age and the number of positive components of MetS appear to strengthen the relationship, however, incidence of each disease entity increases with ageing. Thus, mechanistic studies are also necessary to unravel the inter-relationship between periodontitis and MetS. In this regard, a use of animal models will be helpful as they are more uniform in regards to genetic background and have minimum confounding factors. Finally, development of accurate, quantitative assessment of gingival inflammation are necessary in order to determine the influence of periodontal disease on the development of MetS and its components.

Obesity and Cardiac Function - The Role of Caloric Excess and its Reversal

Obesity is recognized as an independent and increasingly prevalent risk factor for cardiovascular morbidity and mortality. This stems in part from the contribution of obesity towards insulin resistance and diabetes, which associate with premature atherosclerosis, enhanced thrombogenicity and activation of systemic inflammatory programs with resultant cardiovascular dysfunction. This review will focus on the more direct mechanisms underpinning obesity-associated cardiac pathophysiology including the metabolic consequences of lipid accumulation in the myocardium and the consequences of direct systemic effects of lipid toxicity. Furthermore, there is growing recognition that metabolic intermediates, which may be perturbed with caloric excess, may play an important role in intracellular signal transduction and on the post-translational control of metabolic functioning within the heart. As strategies to reverse obesity appear to have ameliorative cardiac effects, surgical and therapeutic approaches to facilitate weight reduction this will also be discussed.

Dietary management of the metabolic syndrome - one size fits all?

Diagnosis of metabolic syndrome includes a set of laboratory and physical findings, including central adiposity, elevated TAG, reduced HDL-cholesterol, hypertension and elevated fasting glucose or insulin resistance. While definitions have varied slightly, from a practical point of view, identifying dietary and lifestyle factors, including low levels of physical activity, are important in designing a diet and exercise programme that can help individuals with the metabolic syndrome to reduce the associated detrimental health consequences. Specific features of the metabolic syndrome require intervention, whether dietary or otherwise, to move towards normal ranges. It is important to remember that no one size or treatment fits all. While central obesity is perceived as the hallmark of the metabolic syndrome, other features need to be treated independently if they do not respond to lifestyle change. The future may hold treatments for the metabolic syndrome that involve modulation of inflammation.

The role of fitness in the association between fatness and cardiometabolic risk from childhood to adolescence

BACKGROUND

Fatness and fitness both influence cardiometabolic risk.

OBJECTIVE

The purpose of this study was to investigate whether childhood fatness and increasing fatness from childhood to adolescence are associated with cardiometabolic risk during adolescence and how fitness affects this association.

SUBJECTS AND METHODS

Of 565 adolescents (283 boys and 282 girls) from the TRacking Adolescents Individual Life Survey (TRAILS) data on anthropometric parameters (age 11 and 16), metabolic parameters, and fitness (age 16) were available. Body mass index and skinfolds were used as measures for fatness. Increasing fatness was calculated by subtracting Z-scores for fatness at age 11 from Z-score fatness at age 16. Cardiometabolic risk was calculated as the average of the standardized means of mean arterial pressure, fasting serum triglycerides, high-density lipoprotein-cholesterol, glucose, and waist circumference. Insulin resistance was calculated by homeostasis model assessment-insulin resistance (HOMA-IR). Fitness was estimated as maximal oxygen consumption (VO(2) max) during a shuttle run test.

RESULTS

Boys showed a higher clustered cardiometabolic risk when compared to girls (p < 0.01). Childhood fatness (age 11) and increasing fatness were independently associated with cardiometabolic risk during adolescence. In boys, high fitness was related to a reduced effect of increasing fatness on clustered cardiometabolic risk. Childhood fatness, increasing fatness, and fitness were independently associated with HOMA-IR. Moreover, in boys this association was dependent of fatness.

CONCLUSIONS

Childhood fatness and increasing fatness are associated with increased cardiometabolic risk and HOMA-IR during adolescence, but a good fitness attenuates this association especially in fat boys.

Lifestyle management in the metabolic syndrome

Type 2 diabetes and metabolic syndrome are two of the fastest growing public health problems in both developed and developing countries. Cardiovascular disease is the most prevalent complication of type 2 diabetes and the metabolic syndrome. Overweight, obesity, or weight gain has been shown to be an important risk factor for the development of type 2 diabetes and an important component of the metabolic syndrome. Physical inactivity is another important risk factor for the development of type 2 diabetes. Data from prospective studies have shown that at least 30 min/day of moderate to vigorous physical activity can prevent type 2 diabetes. Moderate or high levels of physical fitness are effective in preventing type 2 diabetes. Results from clinical trials have indicated that lifestyle changes, including dietary modification and increase in physical activity, can prevent type 2 diabetes. Analyses from prospective studies have confirmed that healthy diets are effective and safe ways to prevent type 2 diabetes and the metabolic syndrome. Public health messages, health care professionals, and the health care system should aggressively promote physical activity and responsible nutritional habits during occupation, leisure time, and daily life and prevent overweight and obesity.

Rat chromosome 8 confers protection against dyslipidemia caused by a high-fat/low-carbohydrate diet

BACKGROUND/AIMS

Recent studies have highlighted the importance of gene by diet interactions in contributing to risk factors of metabolic syndrome. We used a consomic rat panel, in which a chromosome of the Brown Norway (BN) strain is introgressed onto the background of the Dahl salt-sentitive (SS) strain, to test the hypothesis that these animals will be useful for dissecting gene by diet interactions involved in metabolic syndrome.

METHODS

We placed the parental SS and BN strains on a low-fat/high-carbohydrate (LF) or high-fat/low-carbohydrate (HF) diet for 22 weeks and measured several indices of metabolic syndrome. We then investigated the effect of diet in eight consomic rat strains.

RESULTS

We show that the HF diet resulted in significantly increased levels of fasting plasma cholesterol and triglycerides in the SS strain, with no effect in the BN. Both strains responded to the HF diet with slight increases in body weight. SSBN8 was the only consomic strain that resembled that of the BN, with low levels of fasting cholesterol and triglycerides even on the HF diet.

CONCLUSIONS

These results indicate that BN chromosome 8 harbors a gene or genes that confer protection against dyslipidemia caused by the HF diet.

Systems medicine and metabolic modelling

Several complex diseases are caused by the malfunction of human metabolism, and deciphering the underlying molecular mechanisms can elucidate their aetiology. Systems biology is an integrative approach combining experimental and computational biology to identify and describe the molecular mechanisms of complex biological systems. Systems medicine has the potential to elucidate the onset and progression of complex metabolic diseases through the use of computational approaches. Advances in biotechnology have resulted in the provision of high-throughput data, which provide information about different metabolic processes. The systems medicine approach can utilize such data to reconstruct genome-scale metabolic models that can be used to study the function of specific enzymes and pathways in the context of the complete metabolic network. In this review, we outline the importance of genome-scale models in systems medicine and discuss how they may contribute towards the development of personalized medicine.

Early adversity and adult health outcomes

Adversity in childhood has effects on mental and physical health, not only in childhood but across the lifespan. A chief task of our research has been to define the pathways by which childhood experience has these surprising health outcomes, often decades later. The concept of allostatic load, which refers to dysregulations across major biological regulatory systems that have cumulative interacting adverse effects over time, provides a mechanism for understanding these relations and defining specific pathways. To chart these pathways, we examine early childhood socioeconomic status, family environment, and genetic predispositions as antecedents to socioemotional functioning/psychological distress; and neural responses to threat that have downstream effects on major stress regulatory systems, ultimately culminating in risks to mental and physical health outcomes. This integrative approach to investigating the impact of childhood experience on adult health outcomes illustrates the significance of multilevel integrative approaches to understanding developmental psychopathology more generally.

Alcohol and macronutrient intake patterns are related to general and central adiposity

BACKGROUND/OBJECTIVES

Alcohol and dietary fat have high energy densities and may therefore be related to body weight and fat deposition. We studied associations between alcohol and macronutrient intake patterns and general and central adiposity.

SUBJECTS/METHODS

A population-based cross-sectional study of 524 men and 611 women. The participants answered a dietary questionnaire describing habitual food consumption including intake of alcoholic beverages. Macronutrient intake was analysed in relation to anthropometric measures and dual energy X-ray absorptiometry determined body fat.

RESULTS

In women, total alcohol intake was negatively associated with body fat percentage (β:-0.67, P<0.01). In men, total alcohol intake was positively associated with sagittal abdominal diameter (SAD) (β: 0.28, P=0.01). In addition, positive associations were found between intake of alcohol from spirits and body fat percentage (β: 1.17, P<0.05), SAD (β: 0.52, P<0.05) and waist circumference (β: 2.29, P=0.01). In men, protein intake was positively associated with body mass index (BMI) (β: 0.03, P=0.001), body fat percentage (β: 0.04, P<0.05), SAD (β: 0.02, P=0.01) and waist circumference (β: 0.09, P<0.01). Also in men only, negative associations between fat intake and BMI (β: -0.03, P<0.01), SAD (β: -0.02, P<0.05) and waist circumference (β: -0.05, P<0.05) were found.

CONCLUSIONS

Alcohol intake was inversely associated to relative body fat in women whereas spirits consumption was positively related to central and general obesity in men. Macronutrient intakes, particularly protein and fat, were differently associated with obesity indicators in men versus women. This may reflect a differential effect by gender, or differential obesity related reporting errors in men and women.

Increasing incidence of gestational diabetes mellitus in Louisiana, 1997-2009

BACKGROUND

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Although long-term trends are available at the national level, they are less clear for population subgroups, especially those with middle or low income and also at high risk of obesity.

METHOD

We conducted a retrospective study among women aged 15-50 years with live deliveries between January 1, 1997, and December 31, 2009, at the Louisiana State University Health Care Services Division hospital system. Pregnancies and GDM cases were identified by using ICD-9 code from the Louisiana State University Hospital-Based Longitudinal Study database. The annual incidence of GDM and its standard error (SE) were calculated and stratified by age group and race.

RESULTS

A total of 2751 GDM incident cases were identified among 62,685 pregnancies between 1997 and 2009. The crude incidence of GDM increased from 4.1% in 1997 to 4.4% in 2009 (increased by 7.3%), and the age-standardized incidence of GDM increased from 5.8% to 7.5% (increased by 29.3%). The incidence of GDM increased with age and reached a peak at 35-39 years of age and then declined in women who were 40-50 years old. Among the three studied races, Asians had significantly higher incidence of GDM than whites and African Americans.

CONCLUSIONS

The incidence of GDM increased in most years from 1997 to 2009 and reached a peak in 2002 in the women served by Louisiana State University Health Care Services Division hospitals. GDM has become an important public health problem, particularly among women aged 35-39 years.

Differences in the body composition and biochemistry in women grouped as normal-weight, overweight and obese according to body mass index and their relation with cardiometabolic risk

Morbidity of obesity-related diseases tends to increase due to a rise in the body mass index (BMI). We aimed to investigate how the body composition and biochemical parameters change while BMI increases in adult women were categorized as so: as normal weight, overweight and obese. Our objectives are to study the effects of those changes in the development of metabolic disturbances and to find out which parameters are the most sensitive to predict cardiometabolic risks. Three hundred and twenty two records of adult women (mean age: 38.62±12.71 year) who admitted to our unit concerning about losing or preserving their weights, were analyzed in the study. All patients had undergone anthropometric measurements and body composition analyses as well as some biochemical tests. Body composition analyses were performed by means of the Bioelectrical Impedance Analyzer (BIA). Increase in BMI significantly increased the body fat, blood sugar, insulin, triglyceride and uric acid levels. BMI and circumference of the waist were significantly and negatively correlated with the ratio of body water and lean mass/fat mass. However they were positively correlated with the ratio of fat mass and basal metabolism. Furthermore, it was also found that BMI and circumference of the waist were significantly and positively correlated with level of fasting blood sugar, insulin, triglyceride, homeostasis model assessment insulin resistance (HOMA-IR), uric acid and fibrinogen levels, and negatively correlated with high density lipoprotein (HDL) cholesterol level. In multiple regression analyses, circumference of waist measurements was significantly correlated with insulin, triglyseride and HDL, whereas the correlation between BMI and these parameters was not found significant. Total body fat mass (as %) showed significant correlation only with HDL-C level. It could be said that obesity which is a disorder that causes many health complications and affects the quality of life in the short and long term could be prevented or cured by keeping negative environmental conditions under control. According to our results, visceral adipose tissue (VAT) measurement was thought to be more related for metabolic and cardiovascular disorders rather than BMI. We also propose to test fasting blood glucose, insulin, triglyceride, HDL, fibrinogen, homocystein (HOM) levels along with VAT measurements to predict more truly about not only global cardiometabolic risk but also dementia in later life.

Nutritional correlates and dynamics of diabetes in the Nile rat (Arvicanthis niloticus): a novel model for diet-induced type 2 diabetes and the metabolic syndrome

Background

The prevalence of Metabolic Syndrome and related chronic diseases, among them non-insulin-dependent (type 2) diabetes mellitus, are on the rise in the United States and throughout the world. Animal models that respond to environmental stressors, such as diet, are useful for investigating the outcome and development of these related diseases.

Objective

Within this context, growth and energy relationships were characterized in the Nile rat, an exotic African rodent, as a potential animal model for diet-induced type 2 diabetes mellitus and Metabolic Syndrome.

Methods

Compiled data from several studies established the relationship between age, body weight gain (including abdominal adiposity), food and water consumption, and blood glucose levels as determinants of diabetes in male and female Nile rats. Glucose Tolerance Testing, insulin, HbA1c, blood pressure measurements and plasma lipids further characterized the diabetes in relation to criteria of the Metabolic Syndrome, while diet modification with high-fat, low-fiber or food restriction attempted to modulate the disease.

Results

The Nile rat fed lab chow demonstrates signs of the Metabolic Syndrome that evolve into diet-induced non-insulin-dependent (type 2) diabetes mellitus characterized by hyperinsulinemia with rising blood glucose (insulin resistance), abdominal adiposity, and impaired glucose clearance that precedes increased food and water intake, as well as elevated HbA1c, marked elevation in plasma triglycerides and cholesterol, microalbuminuria, and hypertension. Males are more prone than females with rapid progression to diabetes depending on the challenge diet. In males diabetes segregated into early-onset and late-onset groups, the former related to more rapid growth and greater growth efficiency for the calories consumed. Interestingly, no correlation was found between blood glucose and body mass index (overall adiposity) in older male Nile rats in long term studies, whereas blood glucose and the perirenal fat pad, as well as liver and kidney weight, were positively related to early-onset diabetes. Rats weaned early (4-5 wks) and challenged with a high-fat Western-type diet developed diabetes faster, and body fat accumulation was more apparent, whereas food restriction curtailed it.

Conclusion

The Nile rat fed typical rodent diets develops hyperinsulinemia that precedes hyperglycemia (insulin resistance) leading to diet-induced type 2 diabetes associated with hypertriglyceridemia, hypercholesterolemia, and hypertension. Dietary modulation affected growth rate (weight gain and central adiposity) to impact disease progression. This rodent model represents a novel system of gene-diet interactions affecting energy utilization that can provide insight into the prevention and treatment of the type 2 diabetes and Metabolic Syndrome.

Role of adipokines in complications related to obesity: a review

Worldwide, the prevalence of overweight and obesity and associated complications is increasing. Cardiovascular complications are the most important factor determining survival and influencing clinical management. However, obesity is also associated with an increased risk of metabolic syndrome, type 2 diabetes, cancer and other diseases. The development of complications depends on the amount of body fat and its endocrine function. The hormones (leptin, adiponectin, resistin) and cytokines (TNF alpha, IL-6, PAI-1) produced by the adipose tissue are the link between obesity and obesity-related complications. The present article discusses the structure, function and clinical significance of adipokines.

Global metabolic consequences of the chromogranin A-null model of hypertension: transcriptomic detection, pathway identification, and experimental verification

Chromogranin A (CHGA) has a crucial role in formation of regulated secretory granules in neuroendocrine tissues and is also a prohormone that is proteolytically processed into peptides with diverse and complex actions. CHGA and several of its peptide products, including catestatin and pancreastatin, are implicated in pathogenesis of essential hypertension, insulin resistance, and the metabolic syndrome. The Chga knockout mouse (Chga KO) displays severe hypertension coupled with reduction in size, number, and density of regulated secretory granules. We performed genome-wide transcriptome profiling in Chga KO adrenal gland and liver for insight into biochemical and physiological systems altered in this monogenic mouse model of hypertension. Adrenal gene expression pathway prediction of enhanced insulin sensitivity (P = 0.03) in Chga KO was confirmed with glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) measurements: blood glucose was normal in Chga KO, blood insulin was reduced 4.5-fold (P < 0.0001), and HOMA-IR was decreased 3.8-fold (P < 0.002). Remarkably, such observations conclusively dissociate fundamental features of the metabolic syndrome in this monogenic hypertension model. Exogenous pancreastatin treatment restored insulin sensitivity in the Chga KO to near-normal levels. Gene expression predictions of decreased adrenal cholesterol biosynthesis (P < 0.001) and increased hepatic cholesterol biosynthesis (P < 0.001) were verified with tissue total cholesterol assays: Chga KO adrenal cholesterol decreased 1.8-fold (P = 0.039) and hepatic cholesterol increased 1.8-fold (P = 0.018). Transcriptional regulatory network prediction identified sets of transcription factors that may provide insight into the unclear mechanistic links among CHGA, cholesterol, insulin sensitivity, and the metabolic syndrome. These experiments demonstrate, for the first time, that genetic variation at the CHGA locus impacts insulin sensitivity and tissue cholesterol levels in an intact, living organism. The Chga KO may constitute a unique model for studying the relationship between the CHGA locus and disease phenotypes of the metabolic syndrome.

Androgen deficiency and atherosclerosis: The lipid link

The relationship between androgen deficiency and atherosclerosis is complex, poorly understood, and remains controversial. The aim of this review is to evaluate the data in the literature to determine if androgen deficiency modulates lipid profiles and contributes to atherosclerosis development or progression. Studies in animals and humans suggest that androgen deficiency is associated with increased triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C). Although the effects of androgen deficiency on high-density lipoprotein cholesterol (HDL-C) remains controversial, recent data suggest that androgen therapy is associated with increased levels of HDL-C and may improve reverse cholesterol transport. Animal studies suggested that androgen deprivation adversely affect lipid profiles and this was reversed by androgen treatment. Furthermore, androgen treatment of hypogonadal men significantly improved lipid profiles. Emerging data indicate that androgens play an important role in lipid metabolism. Therefore androgens are critical in the prevention and progression of atherosclerosis. Androgen deficiency contributes to increased TGs, TC, LDL-C and reduced HDL-C while androgen treatment results in a favorable lipid profile, suggesting that androgens may provide a protective effect against the development and/or progression of atherosclerosis.

Gestational diabetes mellitus: all Asians are not alike

OBJECTIVE

To estimate the prevalence of gestational diabetes mellitus (GDM) prevalence estimates for subgroups of US Asian and Pacific Islander (API) women by using data from 2005 and 2006 birth certificates.

METHODS

Using 2005-2006 natality files from states that implemented the revised 2003 US birth certificate, which differentiates between GDM and preexisting diabetes (2005: 12 states; 2006: 19 states), we calculated age-adjusted GDM prevalence estimates for API mothers who delivered singleton infants.

RESULTS

Among 3,108,877 births, US APIs had a substantially higher age-adjusted prevalence of GDM (6.3%) than whites (3.8%), blacks (3.5%), or Hispanics (3.6%). Among API subgroups, age-adjusted GDM prevalence varied significantly, from 3.7% among women of Japanese descent to 8.6% among women of Asian Indian descent. Foreign-born APIs had significantly higher GDM rates than US-born APIs except among women of Japanese and Korean ancestry.

CONCLUSION

Overall, US API women have the highest risk for GDM among all US racial/ethnic groups. However, APIs are a heterogeneous group by genetic background, culture, and diet and other lifestyle behaviors. Our findings imply that, whenever possible, API subgroups should be evaluated separately in health research.

Significant association of metabolic syndrome with silent brain infarction in elderly people

A silent brain infarction (SBI) can predict clinical overt stroke or dementia. Studies focusing on the elderly population, where SBI is most common, are sparse. We examined the associations between SBI and metabolic syndrome (MetS) in healthy elderly individuals. Neurologically healthy subjects (1,254 persons, 723 males) aged > or =65 years who underwent brain MRI were evaluated. MetS was diagnosed following the AHA/NHLBI-2005 criteria. We examined associations between full syndrome (at least three of the five conditions) as well as its components and SBI while controlling for possible confounders. One hundred and ninety-seven subjects (15.7%) were found to have one or more SBIs on MRI. Age (1-year difference) was found to be significantly related to SBI prevalence (OR 1.09; 95% CI 1.05-1.12). MetS was significantly associated with SBI (OR 1.68; 95% CI 1.15-2.44). The component model of MetS showed a strong significance between elevated blood pressure (OR 1.89; 95% CI 1.23-2.91) and SBI. Subjects exhibiting more components of MetS showed more prevalent SBI and multiple SBIs. MetS was found to be significantly associated with SBI in neurologically healthy elderly people. The positive trend between the number of MetS components and SBI could be used as a diagnostic tool to predict and prevent future stroke.

Individual and neighborhood socioeconomic status characteristics and prevalence of metabolic syndrome: the Atherosclerosis Risk in Communities (ARIC) Study

OBJECTIVE

The objective of this study was to examine the association of individual socioeconomic status (iSES) and neighborhood SES (nSES) on the prevalence of metabolic syndrome (MetS) in the Atherosclerosis Risk in Communities Study (1987-1999).

METHODS

Participants included 2932 black and 9777 white men and women aged 45 to 64 years without diabetes at baseline. Total combined family income for the past 12 months and six census tract socioeconomic measures combined into a composite index were used to quantify iSES and nSES, respectively. Poisson regression was used to assess associations of the joint contribution of iSES and nSES on the MetS, stratified by gender and race and adjusting for multiple covariates. For analyses that included nSES, hierarchical modeling techniques were used.

RESULTS

Using 2005 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults criteria, MetS was identified in 40% of black women, 30% of white women, 28% of black men, and 35% of white men. Among black and white men, there was no association between MetS and iSES or nSES. In contrast, after adjustment for risk factors, black and white women with low (L)-iSES and medium (M)-iSES were more likely to have MetS than those with high (H)-iSES. Similar but weaker patterns were noted for L-nSES and M-nSES.

CONCLUSIONS

In summary, both iSES and nSES were independently associated with an increased prevalence of MetS among women but not men. Efforts aimed at understanding the causes of these gender differences may offer insight into avenues for reducing the prevalence of the MetS and its chronic disease sequelae.

The relationships of leptin, adiponectin levels and paraoxonase activity with metabolic and cardiovascular risk factors in females treated with psychiatric drugs

OBJECTIVES

The aim of this study was to investigate serum leptin, adiponectin and paraoxonase1 levels in adult females receiving pharmacotherapy for various psychiatric disorders.

METHODS

The study group consisted of 32 obese females (mean age 40.53 +/- 11.00 years, mean body mass index 35.44 +/- 5.33 kg/m(2)) who were receiving treatment for psychiatric disorders, and the control group included 22 obese females (mean age 35.95 +/- 9.16 years, mean body mass index 30.78 +/- 3.33 kg/m(2)) who were free of psychiatric disorders. Analyses were performed using a bioelectrical impedance device. Fasting blood samples were obtained for complete blood count and various biochemical tests, including determination of leptin, adiponectin and paraoxonase1 activity.

RESULTS

Body mass index, waist and hip circumference, body fat percentage, fasting blood glucose, insulin, glycosylated hemoglobin, homeostasis model assesement of insulin resistance, alanine transaminase, aspartate tarnsaminase, and leptin levels were significantly higher in the study group than in controls. Although body weight was positively correlated with leptin levels in both groups, body weight was negatively correlated with adiponectin levels in the control group and positively correlated with adiponectin levels in the study group. In the study group, body mass index and hip circumference correlated positively with leptin levels, hip circumference correlated positively with adiponectin levels, and waist to hip ratio correlated positively with paraoxonase levels. In the control group, body mass index as well as waist and hip circumferences were positively correlated with leptin levels. Weight, body mass index, and hip circumference were also negatively correlated with the adiponectin/leptin ratio in the control group.

CONCLUSION

This study indicates a higher risk for obesity-related disorders, particularly metabolic syndrome, diabetes and cardiovascular disease, in patients treated with psychiatric drugs.

Association of insulin sensitivity and glucose tolerance with the c.825C>T variant of the G protein beta-3 subunit gene

The risk of macrovascular complications of diabetes mellitus is greatly enhanced by the presence of high blood pressure. In addition, hypertension and diabetes share insulin resistance as a common pathophysiological mechanism. Despite evidence for a common molecular genetic background of insulin resistance, glucose intolerance, and hypertension, few candidate genes have been shown to influence all of these features simultaneously. We examined the association of insulin sensitivity with the c.825C>T variant of the g-protein beta-3 subunit (GNB3), a candidate gene of hypertension, in families of Mexican-American hypertensive patients.

METHODS

One hundred eighty subjects enrolled in a family study of Mexican-American hypertensive patients were recruited from hypertension clinics in Los Angeles. Subjects underwent pretreatment blood pressure recording, an oral glucose tolerance test, euglycemic hyperinsulinemic clamp, and anthropometric measurements. DNA from peripheral blood leukocytes was genotyped by polymerase chain reaction and restriction enzyme digest with BseD1 (GNB). Statistical analysis was performed by transmission disequilibrium testing.

RESULTS

In carriers of the T-allele, blood glucose was significantly lower [(mean+S.D.) fasting: 96.7+22.9 vs. 106.7+51.7mg/dl, P=.009; oral glucose tolerance test (oGTT) 120 min: 131.7+48.7 vs. 137.8+64.9 mg/dl, P=.036], and insulin sensitivity was significantly higher (229.0+108.7 vs. 188.5+94.2 mg/kg per minute, P=.037) than in homozygous carriers of the C-allele. Blood pressure did not differ significantly between the phenotypes.

CONCLUSION

In a Mexican-American hypertensive population, we found evidence for higher insulin sensitivity in carriers of the T allele of the c.825C>T variant of GNB3.

Dyslipidaemia as a predictor of hypertension in middle-aged men

AIMS

Dyslipidaemia and hypertension are features of the metabolic syndrome, but the role of dyslipidaemia in the development of hypertension is less clear. We assessed the association of dyslipidaemia with incident hypertension during a 7-year follow-up in a population-based cohort of middle-aged men without hypertension at baseline.

METHODS AND RESULTS

In all, 88 of 311 men developed hypertension during the follow-up. A 1-SD increment in triglyceride concentrations was associated with a 1.6-fold [95% CI(confidence interval) 1.2-2.3] increased risk of developing hypertension, independently of features related to the metabolic syndrome. In separate multivariable models, the triglyceride content of high-density lipoprotein (HDL) cholesterol and apolipoprotein B concentrations were also associated with new-onset hypertension. In a stepwise backwards logistic regression model, concentrations of low-density lipoprotein (LDL) cholesterol [odds ratio (OR) 1.3, 95% CI 1.0-1.7 for a 1-SD change] and triglyceride content of HDL cholesterol (OR) 1.5, 95% CI 1.1-1.9) were positively associated with incident hypertension, whereas HDL concentrations (OR 0.7, 95% CI 0.5-0.9) seemed protective. In factor analyses, elevated triglyceride levels and related disturbances in lipid and cholesterol metabolism were associated with new-onset hypertension.

CONCLUSION

Dyslipidaemia characteristic of the metabolic syndrome predicts the development of hypertension during a 7-year follow-up of eastern Finnish men, independently of features related to insulin resistance. The recognition of dyslipidaemia and initiation of lifestyle treatment even in the absence of hypertension is likely to reduce the long-term burden of cardiovascular disease.

Metabolic syndrome traits in long-term survivors of pediatric sarcoma

PURPOSE

The metabolic syndrome (MS), a cluster of central obesity, dyslipidemia, hyperglycemia, and hypertension, conveys an increased risk of type 2 diabetes and cardiovascular disease. This cross-sectional study investigated the prevalence of metabolic syndrome traits (MST) in long-term survivors of pediatric sarcoma (SARC) who received multi-modality therapy (MMT).

METHODS

Thirty-two SARC survivors (predominantly Ewings; median age 36.5; median age at MMT 15) underwent body composition, activity, and psychosocial analysis. Serum endocrine and inflammatory parameters and urine beta(2)-microglobulin (B2M) were evaluated. The prevalence of MST was compared to age- and gender-matched U.S. population data.

RESULTS

SARC survivors were more likely to have two or more MST (OR 2.38 95% CI: [1.14, 5.04]). Analysis of individual MST demonstrated higher prevalence of hypertension (OR 2.61 95% CI: [1.20, 5.59]), hypertriglyceridemia (OR 3.63 95% CI: [1.75, 7.60]), and male visceral abdominal obesity (20-39 years old OR 4.63 95% CI: [0.91, 21.63], 40-59 years old OR infinity). Survivors 18-39 years old had a higher prevalence of the MS (OR 4.29 95% CI: [1.50, 11.21]), defined as three or more MST. Plasminogen activator inhibitory activity (P = 0.016) and B2M (P = 0.027) increased with increasing numbers of MST. In males, total testosterone declined (P = 0.0027) as the number of MST increased. Average (P = 0.014) and maximum (P = 0.021) activity levels decreased as the number of MST increased.

CONCLUSION

After a median follow up of 17 years, adult SARC survivors of MMT had an increased prevalence of MST, especially those less than 40 years old. The development of MST in this population was associated with decreased testosterone and activity levels.

Glycated haemoglobin as a predictor for metabolic syndrome in non-diabetic Korean adults

AIMS

With increasing prevalence of diabetes mellitus and metabolic syndrome (MS), the importance of early detection of insulin resistance is emphasized. However, a simple and practical method of measurement is not readily available. Therefore, we examined the sensitivity and specificity of HbA(1c) for predicting impaired fasting glucose (IFG) and MS and its association with cardiovascular risk factors, particularly in the normal range of HbA(1c) levels in non-diabetic Korean subjects.

METHODS

In 40,155 participants (median age 40 years) participating in a medical check-up programme, analysis of the distribution of HbA(1c) and its association with various cardiovascular risk factors was performed. In 22,465 selected participants, an analysis was conducted of the ability of HbA(1c) to predict MS and IFG. Anthropometric measurements were made in all subjects and fasting glucose, lipid profiles and HbA(1c) were measured. The presence of MS was defined according to the definitions of the Adult Treatment Panel III (ATP III) guideline and the new International Diabetes Federation (IDF) guideline. Patients with diabetes were excluded from the study.

RESULTS

The incidence of MS was 12.2% according to ATP III criteria and 7.6% according to IDF criteria. When subjects were grouped by quartile of HbA(1c), cardiovascular risk factors significantly increased as the HbA(1c) increased. An HbA(1c) of 5.45% predicted the presence of MS (ATP III: sensitivity/specificity 57.4/64.3%, area under the curve 64.8%; IDF: sensitivity 60.2/63.4%, area under the curve 66.1%) and fasting blood glucose > or = 5.6 mmol/l (sensitivity/specificity 53.7/70%, area under the curve 66.1%). When the analyses were done separately by gender, female subjects showed higher cut-off of HbA(1c) for the prediction of MS (5.55% for both ATP III and IDF criteria).

CONCLUSIONS

HbA(1c) increased as cardiovascular risk factors increased and HbA(1c) of 5.45% predicted the presence of MS. HbA(1c) might be a predictive measure of IFG and MS, and also cardiovascular risk factors in the Korean population.

Triplet repeat in the Repin1 3'-untranslated region on rat chromosome 4 correlates with facets of the metabolic syndrome

BACKGROUND

Congenic and subcongenic rat strains confirmed the quantitative trait loci (QTLs) for facets of the metabolic syndrome between 60.53 and 77.11 Mb on chromosome 4. The analysis of candidate genes in this region favoured the replication initiator 1 (Repin1) characterized by a SNP in the coding region and a triplet repeat (TTT) in the 3'-untranslated region (3'UTR).

METHODS

We analysed nine rat strains (BB/OK, SHR, F344, BN, DA, LEW, hHTg, WOKW, and their founders WOK-F) and four wild rats on DNA (sequencing) and RNA level (gene expression in blood, liver, subcutaneous, and epididymal adipocytes). In addition, the rats were phenotypically characterized in order to link the rat phenotype to genotype differences in the QTL on chromosome 4.

RESULTS

Wild rats were heterozygous for the SNP (C/T), whereas all the inbred strains were homozygous. The shortest triplet repeat was found in SHR (5) and the highest was found in hHTg and WOKW (11), which developed metabolic disorders. The repeat number correlated with most phenotypic traits studied. Using linear multiple regression analysis with repeat size as the dependent variable and considering all the data of this study, it was clearly demonstrated that not only VLDL cholesterol and serum insulin but also the expression of Repin1 in the liver is significantly associated with the repeat size of the 3'UTR.

CONCLUSIONS

It is concluded that the triplet repeat expansion in 3'UTR is involved in metabolic alterations as found in hHTg and WOKW rats and that the functional unknown gene, Repin1, could be a novel candidate gene for the development of facets of the metabolic syndrome.

Stroke-Independent Association Between Metabolic Syndrome and Functional Dependence, Depression, and Low Quality of Life in Elderly Community-Dwelling Brazilian People

OBJECTIVES

Metabolic syndrome (Met.S) is a risk factor for stroke, dementia, and ischemic heart disease (IHD). It is unclear whether Met.S is an independent risk factor for functional dependence, depression, cognitive impairment, and low health-related quality of life (HRQoL) in a population free of clinical stroke.

DESIGN

Cross-sectional.

SETTING

Two communities in southern Brazil.

PARTICIPANTS

Four hundred twenty people aged 60 and older.

MEASUREMENTS

An adapted (body mass index > or =30 kg/m(2) and blood pressure > or =140/90) Adult Treatment Panel III definition was used in diagnosing Met.S. Depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised) and Mini-Mental State Examination were evaluated along with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). HRQoL was measured using a visual analogue scale (0-10). All values were adjusted for age, sex, and presence of IHD.

RESULTS

Forty (9.5%) subjects had a stroke and were excluded from the final analysis. Met.S was present in 37.4% of the stroke-free population. Met.S was significantly and independently associated with 2.24 times as much ADL dependence, 2.39 times as much IADL dependence, a 2.12 times higher risk of depression, a 2.27 times higher likelihood of cognitive impairment, and a 1.62 times higher chance of low self-perceived HRQoL (all P<0.05). Adjustment for its own components reduced the strength of the above associations but did not eliminate their statistical significance. If Met.S were removed from this population, dependence, depression, cognitive impairment, and low QoL would be reduced 15.0% to 21.4%.

CONCLUSION

Met.S was significantly associated with functional dependence, depression, cognitive impairment, and low HRQoL, and its effects were independent of clinical stroke, IHD, and its own individual components.

Ciprofibrate Treatment Decreases Non-high Density Lipoprotein Cholesterol and Triglycerides and Increases High Density Lipoprotein Cholesterol in Patients With Frederickson Type IV Dyslipidemia Phenotype

OBJECTIVE

The combination of hypertriglyceridemia and low high density lipoprotein (HDL) cholesterol is one of the most common lipid abnormalities. Thus, the aim of this study was to determine the effects of ciprofibrate on lipid profile in patients with Frederickson's type IV dyslipidemia phenotype.

RESEARCH DESIGN AND METHODS

Seventy-five patients with type IV dyslipidemia were assigned at random to 1 of 2 therapeutic options: group A (control), American Heart Association (AHA) Step II diet and physical activity; and group B, AHA diet, physical activity, and ciprofibrate 100 mg daily for 8 weeks. The lipid profile of all patients was determined at baseline and after therapeutic intervention.

RESULTS

Patients in group B (treated with ciprofibrate) compared with group A (control) had significantly higher reductions in total cholesterol (downward arrow 14.2% vs. downward arrow 4.8%; P < 0.02), triglycerides (downward arrow 38.0% vs. downward arrow 21.6%; P < 0.007), very low density lipoprotein cholesterol (downward arrow 38.0% vs. downward arrow 21.6%; P < 0.007), non-HDL cholesterol (downward arrow 20.5% vs. downward arrow 7.1%; P < 0.007), and total cholesterol/high density cholesterol ratio (downward arrow 25.6% vs. downward arrow 9.4%; P < 0.01). The ciprofibrate group had a significantly higher increase in HDL cholesterol levels compared with the other group (upward arrow 25.0% vs. upward arrow 9.6%, P < 0.02).

CONCLUSIONS

Ciprofibrate treatment effectively reduced triglyceride-rich particles and non-HDL cholesterol, and significantly increased HDL cholesterol, proving its effectiveness in patients with low HDL cholesterol and type IV Frederickson's hyperlipidemia.

Prevalence of the metabolic syndrome in Asian women with polycystic ovary syndrome: using the International Diabetes Federation criteria

BACKGROUND

Since insulin resistance and compensatory hyperinsulinemia are the major causes of the metabolic syndrome (MS) and are also the main pathophysiology of polycystic ovary syndrome (PCOS), PCOS women are at risk of MS. The aim of the present cross-sectional study was to determine the prevalence of MS in Asian women with PCOS using the International Diabetes Federation (IDF) criteria and to define the risk factors.

METHODS

One hundred and seventy women with PCOS were enrolled in the study from September 3, 2002 to June 14, 2005. A 75-g oral glucose tolerance test with plasma glucose and serum insulin levels was performed. Also, blood samples were examined for fasting triglycerides, high-density lipoprotein cholesterol and adiponectin levels.

RESULTS

The mean (+/-standard deviation) age, body mass index (BMI) and waist-to-hip ratio were 28.8+/-5.9 years, 27.1 +/- 7.0 kg/m(2) and 0.85+/-0.06, respectively. The prevalence of MS was 35.3%. Age, BMI, waist circumference and all metabolic parameters were higher in PCOS women with MS than in those without MS. MS prevalence increased with age, BMI and insulin resistance as determined by homeostasis model assessment (HOMA-IR), but not with adiponectin after BMI adjustment.

CONCLUSIONS

According to the IDF criteria, one-third of the PCOS women had MS. This study also showed that age, BMI and HOMA-IR are important risk factors for MS.

Prognostic value of the metabolic syndrome for long-term outcomes in patients undergoing percutaneous coronary intervention

BACKGROUND

The prevalence of metabolic syndrome (MS), regarded as an important risk factor for coronary artery disease, is growing. However, the relationship between MS and long-term outcomes after percutaneous coronary intervention (PCI) in the Japanese patient population remains unknown.

METHODS AND RESULTS

Seven-hundred and forty-eight consecutive patients who underwent PCI were assessed. Patients were categorized by the presence or absence of MS using the NCEP-ATPIII definition (for obesity, a body mass index >or=25 kg/m(2) was used). Kaplan-Meier estimation and Cox proportional hazards model were used for unadjusted and adjusted analyses for all cause mortality and cardiac events. The progress of 318 (42.5%) patients with MS and 430 (57.5%) patients without MS was analyzed. The mean follow-up was 12.0+/-3.6 years. Overall, there were 88 (11.8%) deaths from all causes, and there were no significant differences between the 2 groups. The occurrence of cardiac events was significantly higher in the MS group than that in the no MS group (25.5% vs 15.6%, hazard ratio 2.23; 95% confidence interval 1.59-3.11; p<0.001).

CONCLUSIONS

The presence of MS significantly increased the risks of subsequent cardiac events among patients who underwent PCI.

Resistin impairs basal and insulin-induced glycogen synthesis by different mechanisms

In the present study, we investigated the mechanisms by which resistin (100 nM, 1 h) affects glycogen synthesis in L6 skeletal muscle cells. The activity of glycogen synthase, the major enzyme in glycogen synthesis, is determined by both its covalent phosphorylation and allostery through intracellular glucose-6-phosphate. Covalent phosphorylation of glycogen synthase was not altered by resistin and, accordingly, phosphorylation of GSK-3alpha/beta and Akt remained unchanged. The rate of glucose-6-phosphate formation, however, was decreased by resistin both in the absence and presence of insulin; in the absence of insulin, resistin decreased glucose-6-phosphate formation by reducing hexokinase type I activity without affecting glucose uptake; by contrast, in the presence of insulin, resistin decreased glucose-6-phosphate formation by reducing the Vmax of glucose uptake without changing hexokinase type I activity. In conclusion, short-term resistin incubation impairs glycogen synthesis by reducing the rate of glucose-6-phosphate formation involving, however, differential mechanisms in basal and insulin-stimulated states.