Results of Expert Meetings: Obesity and Cardiovascular Disease. Obesity, the metabolic syndrome, and cardiovascular disease

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.

Steatotic liver disease is the most important somatic determinant of quality of life in patients with obesity: A cross-sectional study

BACKGROUND AND AIMS

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are often comorbid and stigmatized. This can negatively affect quality of life (QOL). Other studies have primarily used the Chronic Liver Disease Questionnaire (CLDQ), which focuses on liver-related symptoms, to characterize QOL, but most MASLD patients have only mild liver disease, and CLDQ might overlook QOL issues pertaining to them. We aimed to determine the impact of metabolic dysfunction-associated steatohepatitis (MASH) on QOL in obese patients using a 136-item generic QOL questionnaire.

METHODS

We included participants with BMI ≥ 35 kg/m2 who all fully answered the sickness impact profile (SIP, range 0-100, normal = 3.4, 100 = worst) and had a liver biopsy to diagnose MASLD. Sociodemographics, comorbidity and biometric data were obtained from all participants.

RESULTS

Of 176 (mean age 45.9 years, 70% female, 12.6 years of education), 132 had no-MASH and 44 MASH. On stepwise multivariable regression analysis, divorce (p = .011), unemployment (p < .003) and hepatic steatosis (p = .01) were associated with poor overall QOL. No other somatic comorbidity was associated. MASH patients more frequently than no-MASH reported physical discomfort (48% vs. 30%, p = .04), inability to do daily activities (29% vs. 54%, p = .006) and attention problems (32% vs. 57%, p = .003).

CONCLUSION

MASLD severity was the only somatic determinant of QOL in patients with obesity in this cohort, and a large fraction reported debilitating symptoms. Patients and caregivers should consider the limitations this poses when planning interventions.

Relationships between white blood cell count and insulin resistance, glucose effectiveness, and first- and second-phase insulin secretion in young adults

The Increasing prevalence of type 2 diabetes mellitus (T2DM) has been observed in younger adults. Insulin resistance [IR], decreased first-, second-phase insulin secretion, and glucose effectiveness (GE) (IR, first phase insulin secretion [FPIS], second phase insulin secretion [SPIS], and GE), denoted as diabetes factors (DF), are core for developing T2DM. A body of evidence has shown that inflammation contributes to the development of diabetes. In the present study, our goals were first, evaluate the relationships between white blood cell (WBC) count and, second, examine the relative tightness between the 4 DFs to WBC count. Thus, the pathophysiology of T2DM in Chinese young men could be more understood.21112 non-obese males between 18 to 27 years old were recruited (mean age: 24.3 ± 0.017), including 1745 subjects with metabolic syndrome. DFs were calculated by the published equations by our groups as follows:The association between DFs and WBC count was analyzed using a simple correlation. The r-values of the simple correlation are regarded as the tightness of the relationships.Higher WBC, FPIS, SPIS, IR, age, BMI, blood pressure, FPG, TG, Cholesterol, low-density lipoprotein cholesterol and lower HDL-C and GE were observed in subjects with metabolic syndrome. A similar trend was seen across the quartiles of WBC levels. Among the 4 DFs, GE has the highest r-value (r = -0.093, P < .001), followed by IR (r = 0.067, P < .001), SPIS (r = 0.029, P < .001) and FPIS (r = 0.027, P < .001).Elevated WBC count is significantly associated with all the 4 DFs and the relative order of the tightness, from the highest to the lowest, are GE, IR, SPIS, and FPIS in Chinese young men.

Diet-derived nutrient patterns and components of metabolic syndrome: a cross-sectional community- based study

BACKGROUND

Metabolic syndrome (MetS) is one of the main public health problems worldwide. Although some relations between dietary intakes and MetS have been found, few studies have focused on association between dietary nutrients interactions and the risk of the MetS and its components. The aim of the present study was to examine the association between nutrient patterns and MetS and its components among Iranian adult population.

METHODS

A total of 588 subjects (aged 18-64 years, 271 males and 317 females) enrolled in the cross sectional study. Dietary consumption was evaluated using an 80-item food frequency questionnaire (FFQ). Biochemical assessments including fasting blood sugar (FBS), aspartate aminotransferase (AST), alanine amino transferase (ALT) and serum lipids were performed by enzymatic methods. Nutrient patterns were obtained by factor analysis procedure using principal component method. Multinational logistic regression analysis was used to evaluate the association between nutrient patterns and MetS and its components.

RESULTS

Three nutrient patterns explaining 53.66% of the variance in dietary nutrients intake, were recognized in the current study. Animal-sourced nutrient pattern was significantly associated with the higher odds of MetS and high triglyceride (TG) levels. Plant-sourced nutrient pattern (high intake of fiber, carbohydrate, vitamins B₆, B₃, C, B₁, E, D, magnesium, potassium, and linoleic acid) was significantly associated with lower risk of MetS and lower blood pressure (p < 0.05). Third nutrient pattern (mixed-source) was significantly related to higher risk of MetS, high waist circumference (WC) and high systolic blood pressure (SBP).

CONCLUSION

This present study confirms the important effect of nutrients and their patterns on MetS risk. Our results suggest that adherence to the nutrient pattern rich in fiber, carbohydrate, vitamins D, B₆, B₃, C, B₁, E, magnesium, potassium, linoleic acid, and docosahexaenoic acid (DHA) is associated with a lower risk of MetS, while animal- and mixed-sourced nutrient patterns are positively associated with greater odds of MetS; However, further longitudinal and interventional studies are required to make a clear conclusion.

Protective Effect of Hepatitis B Against Metabolic Syndrome in Patients with Nonalcoholic Fatty Liver Disease But Not in Normal Individuals

Background: Both hepatitis B (HB) and nonalcoholic fatty liver disease (NAFLD) are related to metabolic syndrome (MetS); however, this relationship remains controversial. In this study, we determined the effects of NAFLD and HB infection on the risk of MetS among elderly individuals. Methods: In total, 24,500 individuals aged >65 years were enrolled; they were classified into four groups: normal individuals (N), patients with only HB infection without abnormal echogenicity (HB-alone), patients with only abnormal echogenicity or fatty liver alone (FL-alone), and patients with both HB infection and abnormal echogenicity (HB-FL). Results: After adjustment for age, compared with group N, men and women with NAFLD (FL-alone and HB-FL) had a significantly higher risk of MetS, whereas no significant difference was observed in the incidence of MetS between groups HB-alone and N. However, group HB-FL had a lower risk of MetS than did group FL-alone. HB infection (HB-alone and HB-FL) was associated with a lower risk of high triglycerides (TGs) and fasting plasma glucose (FPG) than HB infection absence (groups N and FL-alone) in men and women. Lower risk of TG derangement was observed in group HB-alone than in group N. In addition, both men and women in group HB-FL had a lower risk of TG and FPG abnormalities than in group FL-alone, whereas a decrease in incidence of high waist circumference and blood pressure was observed only in men. Conclusion: HB infection protects against MetS development, only in patients with HB infection and NAFLD, but not in normal individuals. Additional studies are warranted to clarify the pathogenesis.

Prevention of 4-hydroxynonenal-induced lipolytic activation by carnosic acid is related to the induction of glutathione S-transferase in 3T3-L1 adipocytes

Induction of 4-hydroxynonenal (4-HNE), a major lipid peroxidation aldehyde, is observed in patients with obesity and type 2 diabetes mellitus. The lipolytic response by 4-HNE has been linked to insulin resistance. In this study, we investigated the effects of carnosic acid (CA) on 4-HNE-induced lipolysis and the inhibition of β-oxidation in 3T3-L1 adipocytes. The results indicated that cells pretreated with CA reduced 4-HNE-mediated free fatty acid (FFA) release. Furthermore, CA reversed the inhibition of phosphorylation of Tyr⁶³² of insulin receptor substrate-1 (IRS-1) and Akt and the phosphorylation of Ser³⁰⁷ of IRS-1. CA inhibited 4-HNE-induced phosphorylation of protein kinase A (PKA) and hormone-sensitive lipase (HSL), and reversed the suppression by 4-HNE of phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (p < 0.05). Pretreatment of cells with forskolin (a cAMP agonist) and compound C (an AMPK inhibitor) reversed these effects, respectively (p < 0.05). In human subcutaneous adipocytes, CA also attenuated 4-HNE-induced FFA release and the phosphorylation of PKA and HSL (p < 0.05). Moreover, CA increased the protein expression of glutathione S-transferase (GST) A and M. Pretreatment with ethacrynic acid, a GST inhibitor, prevented the 4-HNE-conjugated proteins suppression, the PKA and HSL phosphorylation reduction, and the FFA release inhibition by CA (p < 0.05).

CONCLUSION

The attenuation by CA of the lipolytic response by 4-HNE is likely related to the induction of GST, which in turn reduced 4-HNE-conjugated proteins and decreased the activation of the PKA/HSL pathway. The observed effects may explain how CA improves 4-HNE-induced insulin resistance.

Effect of body mass index on diabetogenesis factors at a fixed fasting plasma glucose level

Aim

The present study evaluated the relative influence of body mass index (BMI) on insulin resistance (IR), first-phase insulin secretion (FPIS), second-phase insulin secretion (SPIS), and glucose effectiveness (GE) at a fixed fasting plasma glucose level in an older ethnic Chinese population.

Methods

In total, 265 individuals aged 60 years with a fasting plasma glucose level of 5.56 mmol/L were enrolled. Participants had BMIs of 20.0–34.2 kg/m². IR, FPIS, SPIS, and GE were estimated using our previously developed equations. Pearson correlation analysis was conducted to assess the correlations between the four diabetogenesis factors and BMI. A general linear model was used to determine the differences in the percentage of change among the four factor slopes against BMI.

Results

Significant correlations were observed between BMI and FPIS, SPIS, IR, and GE in both women and men, which were higher than those reported previously. In men, BMI had the most profound effect on SPIS, followed by IR, FPIS, and GE, whereas in women, the order was slightly different: IR, followed by FPIS, SPIS, and GE. Significant differences were observed among all these slopes, except for the slopes between FPIS and SPIS in women (p = 0.856) and IR and FPIS in men (p = 0.258).

Conclusions

The contribution of obesity to all diabetes factors, except GE, was higher than that reported previously. BMI had the most profound effect on insulin secretion in men and on IR in women in this 60-year-old cohort, suggesting that lifestyle modifications for obesity reduction in women remain the most important method for improving glucose metabolism and preventing future type 2 diabetes mellitus.

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study

OBJECTIVE

This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents.

METHODS

This nationwide study was conducted in 2015 among 4200 students aged 7-18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case-control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used.

RESULTS

The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01-1.66), elevated blood pressure (OR 1.35; 95% CI 1.01-1.81) and MetS (OR 1.33; 95% CI 1.02-1.74). The two other dietary patterns were not associated with MetS and its components.

CONCLUSION

Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits.

Association of obesity with healthcare utilization and costs in a Medicare population

OBJECTIVES

To examine the association of obesity with healthcare resource utilization and costs in a Medicare population.

METHODS

This study was a retrospective cohort study using Humana Medicare Advantage (MA) claims data. Body mass index (BMI) was assessed using ICD-9-CM status codes (V85 hierarchy) that have been validated in the data source to classify patients into BMI categories: normal (N), overweight (Ow), obese class I (ObI), obese class II (ObII), and obese class III (ObIII). Healthcare resource utilization (HRU) and costs were determined based on claims data. Descriptive statistics were used to examine baseline characteristics and HRU across BMI classes. Multivariable analysis was used to examine the association between BMI class and outcome measures.

RESULTS

Among the 172,866 patients aged ≥65 years that were identified, BMI distribution was: N, 21%; Ow 37%; ObI, 24%, ObII, 10%; and ObIII, 9%. Inpatient, emergency department and outpatient utilization increased with greater BMI level, and greater BMI level was associated with higher total healthcare, medical and pharmacy costs. Greater prevalence of several cardiometabolic conditions, total medication use, and use of specific medication classes was observed with increasing BMI class.

CONCLUSIONS

Greater BMI was associated with greater HRU and costs and observed increase in prevalence of cardiometabolic conditions. These results reflect an urgent need to address the epidemic of obesity and the resulting excessive clinical and economic burden on the healthcare system.

How coffee affects metabolic syndrome and its components

Metabolic syndrome, with its increasing prevalence, is becoming a major public health problem throughout the world. Many risk factors including nutrition play a role in the emergence of metabolic syndrome. Of the most-consumed beverages in the world, coffee contains more than 1000 components such as caffeine, chlorogenic acid, diterpenes and trigonelline. It has been proven in many studies that coffee consumption has a positive effect on chronic diseases. In this review, starting from the beneficial effects of coffee on health, the relationship between coffee consumption and metabolic syndrome and its components has been investigated. There are few studies investigating the relationship between coffee and metabolic syndrome, and the existing ones put forward different findings. The factors leading to the differences are thought to stem from coffee variety, the physiological effects of coffee elements, and the nutritional ingredients (such as milk and sugar) added to coffee. It is reported that consumption of coffee in adults up to three cups a day reduces the risk of Type-2 diabetes and metabolic syndrome.

The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine

Study Design

Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures.

Purpose

The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco.

Overview of Literature

Diabetes, obesity, and smoking tobacco are comorbid conditions known to individually have effect on degenerative disc disease. Most studies have only been on a small populous scale. No study has yet to investigate the combination of these conditions within a large patient cohort nor have they reviewed the combination of these conditions on degenerative disc disease.

Methods

A retrospective analysis of insurance billing codes within the nationwide Humana insurance database was performed, using PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA), to identify trends among patients diagnosed with lumbar disc degenerative disease with and without the associated comorbidities of obesity, diabetes, and/or smoking tobacco. Patients billed for a comorbidity diagnosis on the same patient record as the lumbar disc degenerative disease diagnosis were compared over time to patients billed for lumbar disc degenerative disease without a comorbidity. There were no sources of funding for this manuscript and no conflicts of interest.

Results

The total number and prevalence of patients (per 10,000) within the database diagnosed with lumbar disc degenerative disease increased by 241.4% and 130.3%, respectively. The subsets of patients within this population who were concurrently diagnosed with either obesity, diabetes, tobacco use, or a combination thereof, was significantly higher than patients diagnosed with lumbar disc degenerative disease alone (p <0.05 for all). The number of patients diagnosed with lumbar disc degenerative disease and smoking rose significantly more than patients diagnosed with lumbar disc degenerative disease and either diabetes or obesity (p <0.05). The number of patients diagnosed with lumbar disc degenerative disease, smoking and obesity rose significantly more than the number of patients diagnosed with lumbar disc degenerative disease and any other comorbidity alone or combination of comorbidities (p <0.05).

Conclusions

Diabetes, obesity and cigarette smoking each are significantly associated with an increased diagnosis of lumbar degenerative disc disease. The combination of smoking and obesity had a synergistic effect on increased rates of lumbar degenerative disc disease. Patient education and preventative care is a vital goal in prevention of degenerative disc disease within the general population.

Performance of waist circumference and proposed cutoff levels for defining overweight and obesity in Nigerians

Background:

Waist circumference (WC) is a simple tool for measuring central obesity in routine clinic settings. Gender- and ethnic-specific optimal cutoff points for WC are encouraged for populations lacking such data.

Objectives:

To derive WC cutoff values, predictive of overweight and obesity in Nigerians and to evaluate the performance of currently recommended values.

Subjects and Methods:

Apparently, healthy urban dwellers from six cities spread across Nigeria were selected for this cross-sectional study. Biophysical profiles such as blood pressure and anthropometric indices were measured according to the World Health Organization's STEPs instrument protocol. Receiver operating characteristics curve analysis was used to determine the optimal cutoff levels using the decision rule of maximum (sensitivity + specificity). The level of significance was set at P < 0.05.

Results:

A total of 6089 subjects (3234 males and 2855 females) were recruited for the study. WC demonstrated a high area under the curve in both genders. Selected cutoff points ranged from 83 to 96 cm with high sensitivities and specificities.

Conclusions:

The currently recommended gender-specific WC cutoff values proved inappropriate in this study group, but WC remains a reliable tool for measuring obesity.

Identification of Impaired Second-Phase Insulin Secretion in Various Degrees of Glucose Tolerance in a Chinese Population

AIM

Impaired insulin sensitivity and insulin secretion (ISEC) are major pathophysiologies of type 2 diabetes (T2DM). ISEC has two phases: the first and second phases (second ISEC). In this study, we derived equations to identify patients with second ISEC deficiency (ISEC-D).

METHODS

Data from 96 patients, namely 19 with a normal fasting plasma glucose (FPG) level, 21 with prediabetes, and 56 with T2DM, were enrolled. They underwent a modified low-dose graded glucose infusion test, which was originally proposed by Polonsky et al. The test results were interpreted as the slopes of the changes of plasma insulin against the glucose levels, which were considered second ISEC. Patients with the lowest quartile of the slopes were defined as having ISEC-D. We built three models: Model 0: FPG, Model 1: FPG + waist circumference, and Model 2: Model 1 + fasting plasma insulin. The area under the receiver operating characteristic (aROC) curve was used to determine the predictive power of these models.

RESULTS

Among the metabolic syndrome components, FPG had the largest aROC curve (78.2%). Although aROC curves of Models 1 and 2 (85.2% and 91.5%, respectively) were higher than the aROC curve of FPG, no difference was observed between Models 1 and 0. By contrast, the aROC curve of Model 2 was higher compared with Model 1.

CONCLUSIONS

FPG showed the largest aROC curve. Model 2 had the highest predictive power, which could identify patients with ISEC-D with a sensitivity and specificity of 94.3% and 82.6%, respectively. These two models could be conveniently used in daily practice.

Metabolic syndrome in drug-nave Chinese patients with insulin-sensitive and insulin-resistant type 2 diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) is characterized by impaired insulin sensitivity (Si) and insulin secretion. Previous studies may have underestimated differences in the incidence of risk factors in insulin-sensitive diabetes mellitus (IS-DM) and insultin-resistant diabetes mellitus (IR-DM) patients and have not been conducted in the Chinese population.

OBJECTIVES

We explored differences in metabolic risk factors between Chinese patients with newly diagnosed, insulin-resistant (IR) and insulin-sensitive (IS) T2DM.

DESIGN

Cross-sectional study.

SETTING

Cardinal Tien Hospital, Taiwan in 2011.

METHODS

All participants received a frequently sampled intravenous glucose tolerance test. The acute insulin response after a glucose load (AIRg), Si, disposition index (DI), and glucose effectiveness (GE) were determined. Using the median Si value from 90 people without diabetes as a cutoff (1.19.10-4 mU/L/min), patients were divided into two groups, IS-DM and IR-DM. Multivariate regression analysis was used to examine the independent influence of MetS components on Si and AIRg.

MAIN OUTCOME MEASURE(S)

Insulin sensitivity.

RESULTS

We enrolled 122 participants. In addition to higher probabilities of having MetS, IR-DM patients had a significantly higher body mass index (BMI), AIRg, and GE but a lower DI than IS-DM patients. Si correlated with BMI and triglycerides, and AIRg correlated with BMI and high-density lipoprotein cholesterol. BMI was the only component related to Si in the multivariate analysis. Furthermore, the AIRg was associated with BMI and fasting plasma glucose. Because BMI was the most critical factor, a cutoff value (25.0 kg/m2) was obtained from the receiver operating characteristic curve for predicting IR-DM. It showed a sensitivity and specificity of 60.8% and 60.9%, respectively.

CONCLUSIONS

IR-DM patients had more MetS components than IS-DM patients. In Chinese patients obesity is the most critical factor for discriminating IR-DM from IS-DM. Patients with a BMI higher than 25 kg/m2 were prone to develop IR-DM.

LIMITATIONS

The size of our study cohort was relatively small, which may weaken the statistical power of the study.

Identification of Normal Blood Pressure in Different Age Group

The concept of using single criterion of normal blood pressure with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg for all ages is still disputable. The aim of the study is to identify the cutoff value of normotension in different age and sex groups.Totally, 127,922 (63,724 men and 64,198 women) were enrolled for the analysis. Finally, four fifths of them were randomly selected as the study group and the other one fifths as the validation group. Due the tight relationship with comorbidities from cardiovascular disease (CVD), metabolic syndrome (MetS) was used as a surrogate to replace the actual cardiovascular outcomes in the younger subjects.For SBP, MetS predicted by our equation had a sensitivity of 55% and specificity of 67% in males and 65%, 83% in females, respectively. At the same time, they are 61%, 73% in males and 73%, 86% in females for DBP, respectively. These sensitivity, specificity, odds ratio, and area under the receiver operating characteristic curve from our equations are all better than those derived from the criteria of 140/90 or 130/85 mmHg in both genders.By using the presence of MetS as the surrogate of CVD, the regression equations between SBP, DBP, and age were built in both genders. These new criteria are proved to have better sensitivity and specificity for MetS than either 140/90 or 130/85 mmHg. These simple equations should be used in clinical settings for early prevention of CVD.

Levels of the first-phase insulin secretion deficiency as a predictor for type 2 diabetes onset by using clinical-metabolic models

AIMS

Type 2 diabetes mellitus (T2DM) is characterized by both decreased insulin sensitivity and impaired insulin secretion. The 2 phases of insulin secretion are the first-phase insulin secretion (1st ISEC) and the second-phase insulin secretion. In this study, we tried to build clinical-metabolic models to predict the 1st ISEC deficiency (ISEC-D) in non-diabetic subjects so that early intervention could be started.

DESIGN AND SETTINGS

A cross-sectional study was conducted in the clinical research department of a hospital in Taiwan from 2010 to 2011.

METHODS

A total of 89 subjects without diabetes were enrolled in the study, including 49 with normal glucose tolerance and 40 pre-diabetes. A frequently sampled intravenous glucose tolerance test was done to determine insulin sensitivity and acute insulin response after the glucose load, which is regarded as the 1st ISEC. Subjects with the lowest tertile of the 1st ISEC were defined as ISEC-D. From the simplest to the most complex, 3 models were build: Model 0: fasting plasma glucose (FPG); Model 1: FPG + body mass index (BMI) + High-density lipoprotein cholesterol (HDL-C); Model 2: Model 1+ fasting plasma insulin (FPI). The area under the receiver-operating characteristic curve (aROC curve) was used to determine the predictive power among these models. An optimal cut-off value was also determined.

RESULTS

Among metabolic syndrome (MetS) components (FPG, BMI, and HDL-C), FPG had the greatest aROC curve (70.9%). Moreover, the aROC curves of Models 1 and 2 were all significantly greater than that of FPG (80.4% and 82.3%, respectively). Their aROC curves were also greater than that of the homeostasis model assessment b-cell (HOMA-b) function, which is the most commonly used method to evaluate b-cell function.

CONCLUSION

By using only MetS components, ISEC-D could be predicted with an acceptable sensitivity of 84.0% and a specificity of 74.0%. However, after adding FPI into the Model, the predictive power of Model 2 did not increase. These model-derived MetS components could be widely used in clinical settings and early detection of non-diabetic subjects with high risk for T2DM.

The estimation of first-phase insulin secretion by using components of the metabolic syndrome in a chinese population

Aims. There are two phases of insulin secretion, the first (FPIS) and second phase (SPIS). In this study, we built equations to predict FPIS with metabolic syndrome (MetS) components and fasting plasma insulin (FPI). Methods. Totally, 186 participants were enrolled. 75% of participants were randomly selected as the study group to build equations. The remaining 25% of participants were selected as the external validation group. All participants received a frequently sampled intravenous glucose tolerance test, and acute insulin response after the glucose load (AIRg) was obtained. The AIRg was considered as FPIS. Results. When MetS components were only used, the following equation was built: log (FPIS) = 1.477 - 0.119 × fasting plasma glucose (FPG) + 0.079 × body mass index (BMI) - 0.523 × high-density lipoprotein cholesterol (HDL-C). After FPI was added, the second equation was formulated: log (FPIS) = 1.532 - 0.127 × FPG + 0.059 × BMI - 0.511 × HDL-C + 0.375 × log (FPI), which provided a better accuracy than the first one. Conclusions. Using MetS components, the FPIS could be estimated accurately. After adding FPI into the equation, the predictive power increased further. We hope that these equations could be widely used in daily practice.

High plasma homocysteine increases risk of metabolic syndrome in 6 to 8 year old children in rural Nepal

Little attention has been given to the association of plasma homocysteine (Hcy) and metabolic syndrome (MetS) in children. We have evaluated the risk of MetS with plasma Hcy in a cohort of 6 to 8 year old rural Nepalese children, born to mothers who had participated in an antenatal micronutrient supplementation trial. We assessed Hcy in plasma from a random selection of n = 1000 children and determined the relationship of elevated Hcy (>12.0 μmol/L) to MetS (defined as the presence of any three of the following: abdominal adiposity (waist circumference ≥ 85th percentile of the study population), high plasma glucose (≥85th percentile), high systolic or diastolic blood pressure (≥90th percentile of reference population), triglyceride ≥ 1.7 mmol/L and high density lipoprotein < 0.9 mmol/L.) and its components. There was an increased risk of low high-density lipoproteins (HDL), [odds ratios (OR) = 1.77, 95% confidence intervals (CI) = 1.08–2.88; p = 0.020], high blood pressure [OR = 1.60, 95% CI = 1.10–2.46; p = 0.015] and high body mass index (BMI) [OR = 1.98, 95% CI = 1.33–2.96; p = 0.001] with elevated Hcy. We observed an increased risk of MetS (OR = 1.75, 95% CI = 1.06–2.90; p = 0.029) with elevated Hcy in age and gender-adjusted logistic regression models. High plasma Hcy is associated with increased risk of MetS and may have implications for chronic disease later in life.

Avocado oil supplementation modifies cardiovascular risk profile markers in a rat model of sucrose-induced metabolic changes

The purpose of this study was to evaluate the effects of avocado oil administration on biochemical markers of cardiovascular risk profile in rats with metabolic changes induced by sucrose ingestion. Twenty-five rats were divided into five groups: a control group (CG; basic diet), a sick group (MC; basic diet plus 30% sucrose solution), and three other groups (MCao, MCac, and MCas; basic diet plus 30% sucrose solution plus olive oil and avocado oil extracted by centrifugation or using solvent, resp.). Glucose, total cholesterol, triglycerides, phospholipids, low- and high-density lipoproteins (LDL, HDL), very low-density lipoprotein (VLDL), lactic dehydrogenase, creatine kinase, and high sensitivity C-reactive protein concentration were analyzed. Avocado oil reduces TG, VLDL, and LDL levels, in the LDL case significantly so, without affecting HDL levels. An effect was exhibited by avocado oil similar to olive oil, with no significant difference between avocado oil extracted either by centrifugation or solvent in myocardial injury biochemical indicators. Avocado oil decreased hs-CRP levels, indicating that inflammatory processes were partially reversed. These findings suggested that avocado oil supplementation has a positive health outcome because it reduces inflammatory events and produces positive changes in the biochemical indicators studied, related to the development of metabolic syndrome.

Obesity and dyslipidemia in South Asians

Obesity and dyslipidemia are emerging as major public health challenges in South Asian countries. The prevalence of obesity is more in urban areas than rural, and women are more affected than men. Further, obesity in childhood and adolescents is rising rapidly. Obesity in South Asians has characteristic features: high prevalence of abdominal obesity, with more intra-abdominal and truncal subcutaneous adiposity than white Caucasians. In addition, there is greater accumulation of fat at “ectopic” sites, namely the liver and skeletal muscles. All these features lead to higher magnitude of insulin resistance, and its concomitant metabolic disorders (the metabolic syndrome) including atherogenic dyslipidemia. Because of the occurrence of type 2 diabetes, dyslipidemia and other cardiovascular morbidities at a lower range of body mass index (BMI) and waist circumference (WC), it is proposed that cut-offs for both measures of obesity should be lower (BMI 23–24.9 kg/m² for overweight and ≥25 kg/m² for obesity, WC ≥80 cm for women and ≥90 cm for men for abdominal obesity) for South Asians, and a consensus guideline for these revised measures has been developed for Asian Indians. Increasing obesity and dyslipidemia in South Asians is primarily driven by nutrition, lifestyle and demographic transitions, increasingly faulty diets and physical inactivity, in the background of genetic predisposition. Dietary guidelines for prevention of obesity and diabetes, and physical activity guidelines for Asian Indians are now available. Intervention programs with emphasis on improving knowledge, attitude and practices regarding healthy nutrition, physical activity and stress management need to be implemented. Evidence for successful intervention program for prevention of childhood obesity and for prevention of diabetes is available for Asian Indians, and could be applied to all South Asian countries with similar cultural and lifestyle profiles. Finally, more research on pathophysiology, guidelines for cut-offs, and culturally-specific lifestyle management of obesity, dyslipidemia and the metabolic syndrome are needed for South Asians.

Rice-eating pattern and the risk of metabolic syndrome especially waist circumference in Korean Genome and Epidemiology Study (KoGES)

Background

Metabolic syndrome poses a serious health threat in Asian countries. Rice is a staple food in Korea, and carbohydrate intake is associated with the risk of MetS. We hypothesized that various rice-eating patterns in a carbohydrate-based diet would have different effects on the risk of MetS.

Methods

Participants were 26,006 subjects enrolled in the Korean Genome and Epidemiology Study between 2004 and 2006. They were classified into four dietary patterns - white rice, rice with beans, rice with multi-grains, and mixed based on their food frequency questionnaire responses. We compared metabolic risk traits according to the rice-eating patterns.

Results

Nutrients consumption and the presence of MetS risk factors differed according to rice-eating patterns. In men odds ratio(OR) for central obesity was slightly elevated in mixed group(1.18). In women, the risk for central obesity and abnormal fasting glucose were lower in the rice with beans group (adjusted OR =0.79, 0.83 respectively) and central obesity in rice with multi-grains(adjusted OR=0.91) than the white rice group. In postmenopausal women, ORs for central obesity (0.78) and abnormal fasting glucose (0.75) in the rice with beans group and ORs for central obesity (0.83), abnormal HDL-cholesterol (0.87) and MetS(0.85) in the rice with multi-grains group was lower than those in white rice group. In premenopausal women, the risk for central obesity (OR=0.77) was reduced in the rice with beans group.

Conclusion

The risk for MetS was lower in the rice with beans and rice with multi-grains groups compared with the white rice group, particularly in postmenopausal women.

Tobacco and metabolic syndrome

Tobacco is a leading contributor to morbidity and mortality globally. Metabolic syndrome is a constellation of abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance (with and without glucose intolerance), pro-inflammatory state, and pro-thrombotic state. Tobacco use is associated with various core components of metabolic syndrome. It has been found to play a causal role in various pathways leading on to development this condition, the current article discusses various facets of this association.

Obesity in older adults: epidemiology and implications for disability and disease

Obesity is a worldwide problem with increasing prevalence and incidence in both developed and developing countries. In older adults, excess weight is associated with a higher prevalence of cardiovascular disease, metabolic disease, several important cancers, and numerous other medical conditions. Obesity has also been associated with increased functional limitations, disability, and poorer quality of life. Additionally, obesity has been independently associated with all-cause mortality. The obesity epidemic has important social and economic implications, representing an important source of increased public health care costs. The aim of this review is to report the epidemiology of obesity worldwide, and the implications of obesity on disability and chronic diseases in older adults.

Insulin dysfunction and allostatic load in bipolar disorder

Bipolar disorder (BD) is associated with substantial morbidity, as well as premature mortality. Available evidence indicates that 'stress-sensitive' chronic medical disorders, such as cardiovascular disease, obesity and Type 2 diabetes mellitus, are critical mediators and/or moderators of BD. Changes in physiologic systems implicated in allostasis have been proposed to impact brain structures and neurocognition, as well as medical comorbidity in this population. For example, abnormalities in insulin physiology, for example, insulin resistance, hyperinsulinemia and central insulinopenia, are implicated as effectors of allostatic load in BD. Insulin's critical role in CNS physiological (e.g., neurotrophism and synaptic plasticity) and pathophysiological (e.g., neurocognitive deficits, pro-apoptosis and amyloid deposition) processes is amply documented. This article introduces the concept that insulin is a mediator of allostatic load in the BD and possibly a therapeutic target.

Renin angiotensin system polymorphisms in patients with metabolic syndrome (MetS)

BACKGROUND

The genes associated with hypertension could be genetic risk factors for metabolic syndrome (MetS).

AIM

To determine the frequency of M235T and T174M-AGT, I/D-ACE and A1166C-AGTR1 in hypertensive patients with MetS and to evaluate the relationship between these polymorphisms and central obesity and dyslipidemia, respectively.

MATERIALS AND METHODS

We performed AGT, AGTR1 and ACE genotyping in 56 hypertensive women (24 with MetS) and 71 normotensive women using PCR-RFLP methods and PCR, respectively.

RESULTS

Hypertensive patients carrying the mutated TT235, MM174 and DD genotypes had an 1.53 (p=0.56), 1.78 (p=0.52) and 1.28 (p=0.78)-fold increased risk to develop MetS. Hypertensive carriers of both mutated TT235 and MM174 or TT235 and D/D or TT235 and CC+AC genotypes had an 8.15 (p=0.04), 4.83 (p=0.04) and 10.53 (p=0.05)-fold increased risk to develop MetS. Hypertensive patients with MetS and TT, D/D or CC genotypes had higher body mass index compared to hypertensive patients without MetS (p</=0.05 for all the genotypes). Hypertensive patients with MetS and TT235, MM174, D/D or CC1166 genotypes had higher triglyceride levels, lower HDL-cholesterol levels and higher waist circumference compared to hypertensive patients without MetS (p</=0.05, except for the association between CC1166 and HDL-cholesterol level).

CONCLUSIONS

The effect of the T174M, I/D and A1166C polymorphisms on MetS may depend on the M235T polymorphism. Among hypertensive subjects with MetS, the presence of TT235, MM174, DD and CC1166 genotypes could be a risk factor for central obesity and dyslipidemia.

Risk factors for development of cardiovascular complications in patients with chronic renal disease and diabetic nephropathy

INTRODUCTION

Cardiovascular diseases are the most frequent causes of morbidity and mortality in patients with chronic renal disease. The aim of our paper is to evaluate the risk factors of cardiovascular complications in patients with various stages of chronic renal disease (CRD), with or without diabetes mellitus (DM).

PATIENTS AND METHODS

The study included 98 patients with different stages of the CRD, with creatinine clearance <60 ml/min/1.73m2, and laboratory parameters monitored: homocysteine, BNP, cholesterol, LDL, HDL, HbA1c, Body Mass Index (BMI). First group comprised 49 patients with DM, age 50-82 years, M 28/F 21. Second group comprised 49 patients without DM, age 35-80 years, M 18/F 31. The IMT (intima media thickness) was measured by B-mode ultrasonography, and all patients had echocardiography examination done by 2D Doppler ultrasonography.

RESULTS

The IMT values in diabetic patients had statistically significant positive correlation with homocysteine values of r=0.9393, p<0.034, and cholesterol r=0.289, p<0.05, compared to non-diabetics. A significant negative correlation was found between the ejection fraction (EF) and BMI in both groups, more prominent in non-diabetics r=0.289, p<0.044 (diabetics r=0.162, p>0.05). 47.4% of diabetics had arteriosclerotic changes on carotid arteries, 8.5% had stenosis of ACC, and 22.0% had rhythm abnormalities on ECG. A positive correlation between IMT and BMI was found in diabetics, but was not statistically significant r=0.111, p>0.05. In the diabetics group a significantly higher (p<0.05) values of BNP, HbA1c, proteinuria, BMI, and cholesterol were found, and significantly lowered EF (p<0.0001).

CONCLUSION

Risk factors for cardiovascular complications in patients with DM are various, and the most pronounced significance was found in the values of homocysteine, BNP and cholesterol.

Metabolic syndrome and cardiovascular disease in South Asians

This review discusses the prevalence of metabolic syndrome and cardiovascular disease in the South Asian population, evaluates conventional and emerging risk factors, and reinforces the need for ethnic-specific redefinition of guidelines used to diagnose metabolic syndrome. We reviewed recent and past literature using Ovid Medline and PubMed databases. South Asians represent one of the largest and fastest growing ethnic groups in the world. With this growth, a dramatic rise in the rates of acute myocardial infarction and diabetes is being seen in this population. Potential etiologies for this phenomenon include dietary westernization, poor lifestyle measures, adverse body fat patterning, and genetics. While traditional risk factors for diabetes and cardiovascular disease should not be overlooked, early metabolic syndrome has now been shown in the South Asian pediatric population, suggesting that "metabolic programming" and perinatal influences may likely play a substantial role. Health care practitioners must be aware that current guidelines used to identify individuals with metabolic syndrome are underestimating South Asian individuals at risk. New ethnic-specific guidelines and prevention strategies are discussed in this review and should be applied by clinicians to their South Asian patients.

Tubular microsurgery for lumbar discectomies and laminectomies in obese patients: operative results and outcome

STUDY DESIGN

This is a retrospective single-center case study involving 115 obese and nonobese patients who underwent minimally invasive lumbar surgery between 2004 and 2007.

OBJECTIVE

The purpose of this study was to evaluate the effect of minimally invasive spinal surgery in obese and nonobese patients by operative results and patient outcomes.

SUMMARY OF BACKGROUND DATA

Spinal surgery in obese patients is associated with increased complications, blood loss, and operative times. The potential benefits of minimally invasive lumbar surgery in obese patients are discussed.

METHODS

All patients underwent 1-level lumbar microdiscectomy or laminectomy using tubular retractors. Data were collected on patient demographics, comorbidities, smoking habits, operative results, and clinical outcomes, and compared for obese and nonobese patients. Operative results included operative times, blood loss, length of stay, and perioperative complications. Clinical outcomes were assessed by using pre- and postoperative visual analog scale and Macnab outcome criteria at most recent follow-up.

RESULTS

In this study, 31% of 115 patients were classified as obese. Obese patients tended to undergo surgery at a younger age. Obesity, comorbidities, and age did not have an impact on patient outcome at a mean follow-up of 15.9 months. No significant differences were seen between obese versus nonobese patients in terms of incision lengths, operative time, blood loss, and complication rates. In obese patients, all parameters and operative results compared favorably to reported historical results of patients undergoing open lumbar surgery. Overall, favorable outcome was seen in 92% and 84% of obese and nonobese lumbar microdiscectomy patients, respectively, and in 75% of laminectomy patients. Postoperative visual analog scale did not show any significant difference.

CONCLUSION

This is the first study comparing operative results from tubular microsurgery between obese and nonobese patients. No major differences were detected in outcome, operative and perioperative data including complication rates. With tubular microsurgery, obese patients experienced the same or equally beneficial outcome, compared to nonobese patients, while incision lengths, blood loss, operative times, and length of stay were less when compared to open procedures. Other comorbidities and age had no significant impact on perioperative complications and clinical outcome.

Association Between Rectosigmoid Adenomas and Cardiovascular Risk Factors: A Hospital-based, Cross-sectional Study

Introduction: Little was known about the association between colorectal adenomas and cardiovascular risk factors in Taiwan. The aim of this study was to assess the association between rectosigmoid adenomas and related factors. Materials and Methods: This was a hospital-based, cross-sectional study. We analysed subjects receiving self-referred health examinations at 1 medical centre in Taiwan between 2001 and 2004. In total, 4413 subjects were enrolled in this study. There were 2444 men (55.4%) and 1969 women (44.6%). The mean age was 49.3 ±12.3 years (range, 20 to 87). All subjects underwent a 60-cm flexible sigmoidoscopic examination and laboratory survey. Adjusted odds ratio (OR) and 95% confidence interval (CI) were expressed using a multivariate logistic regression analysis. Results: In the final model, increasing age (OR, 1.05; 95% CI, 1.03-1.06), hypertriglyceridemia (OR, 1.49; 95% CI, 1.07-2.07), and alcohol consumption (OR, 2.11; 95% CI, 1.47-3.04) were the risk factors for rectosigmoid adenomas in men. Increasing age was the only risk factor for rectosigmoid adenomas in women (OR, 1.03; 95% CI, 1.01-1.06). Conclusion: Age, hypertriglyceridemia and alcohol consumption are associated with rectosigmoid adenomas in men, and only age is significantly associated with rectosigmoid adenomas in women. Key words: Alcohol, Cardiovascular, Hypertriglyceridemia

A traditional rice and beans pattern is associated with metabolic syndrome in Puerto Rican older adults

The prevalence of metabolic syndrome was approximately 50% for Puerto Rican elders living in Massachusetts. Diet is known to be associated with metabolic syndrome. Little information exists regarding the dietary intakes of Puerto Ricans. We aimed to characterize the dietary patterns of 1167 Puerto Ricans (45-75 y) using principal components analysis and to further examine associations with metabolic syndrome. Factor solutions were examined for robustness using a random split sample. Adjusted means for metabolic syndrome components were calculated for factor quintiles. Logistic regression models examined associations between factors, metabolic syndrome, and its components. Analyses were also performed excluding subjects with diabetes. "Meat and French fries," "traditional," and "sweets" patterns emerged as most meaningful. A meat and French fries pattern was associated with higher blood pressure (systolic P-trend = 0.03 and diastolic < 0.001) and waist circumference (P-trend = 0.04). The traditional pattern was associated with lower HDL concentrations (P-trend = 0.007) and a higher likelihood of metabolic syndrome [odds ratio (OR): 1.7, 95% CI: 1.04, 2.7]). The sweets pattern was associated with lower HDL concentrations (P-trend < 0.001) and higher waist circumference (P-trend < 0.05). After excluding individuals with diabetes, the sweets pattern was no longer associated with fasting serum glucose and was associated with metabolic syndrome (OR: 1.8, 95% CI: 1.03, 3.3). Dietary patterns were significantly associated with metabolic syndrome and its components. More research is needed to make appropriate nutritional recommendations for this high-risk population.

Characteristics of reference intervals of metabolic factors in healthy Japanese: a proposal to set generation- and gender-specific diagnostic criteria for metabolic syndrome

AIM

To verify the clinical diagnostic criteria for metabolic syndrome (MetS-Criteria) for Japanese (Japanese-Criteria) from the viewpoint of reference intervals (RIs) of metabolic factors.

METHODS

In healthy subjects selected from 1,379 males and 1,528 females aged 20-65 years, generation-and gender-specific RIs of metabolic factors were determined. Then, from the upper or lower limits of the RIs, new MetS-Criteria were tentatively set (New-Criteria).

RESULTS

RIs of some metabolic factors were associated with gender- and/or generation-specific differences. In both genders, the New-Criteria for subjects in their 40s and over (older adults) were comparable to the Japanese-Criteria, whereas the New-Criteria for these in their 30s and less (younger adults) were not. Levels of cut-off values in the New-Criteria for younger adults were mostly between those of the Japanese-Criteria and recently established MetS-Criteria for adolescents. The prevalence of metabolic syndrome estimated by the Japanese-Criteria and the New-Criteria well corresponded in older adults but significantly differed in younger adults.

CONCLUSION

MetS-Criteria prepared on gender- and generation-specific bases may be necessary. The Japanese-Criteria, which may still have room for minor changes, seem to be valid at least for older adults; however, new MetS-Criteria should be established for younger adults.

Felodipine downregulates serum interleukin-18 levels in rats with fructose-induced metabolic syndrome

OBJECTIVE

Human studies suggest that calcium-channel blockers have cardiovascular protection besides reducing blood pressure, and interleukin-18 (IL-18) levels which are elevated in obese population are associated with metabolic syndrome (MetS). The purpose of this research was to study the change of serum IL-18 levels and the effect of felodipine on it in high-fructose diet-fed rats.

METHODS

In this research, 30 Wistar male rats were randomized into 3 groups. A control group (no.=12) was fed with normal feeds, and high-fructose diet was given to a fructose group and a flodioine group (no.=9 in each group). All animals were fed for a period of 32 weeks, during which body weight and systolic blood pressure (BP) were measured once every 4 weeks. Felodipine (5 mg/kg/d) was then administered by gavage daily for 6 weeks to the felodipine group. Before and after treatment with felodipine, fasting plasma lipid, blood glucose, plasma insulin, and serum IL-18 were detected.

RESULTS

Body weight, systolic BP, triglycerides, fasting insulin, and the R-value of homeostasis model (HOMA-R) were significantly increased in high-fructose rats (p<0.01). Serum IL-18 levels were elevated and had significant positive correlation with HOMA-R in rats with fructose-induced MetS (p<0.01). We also found that felodipine may decrease HOMA-R and serum IL-18 levels besides reducing blood pressure (p<0.05, p<0.01).

CONCLUSION

IL-18 plays an important role in the development of MetS, while felodipine exerts an anti-inflammatory effect on rats with fructose-induced MetS by downregulating serum IL-18 levels.

Inverse association between insulin resistance and frequency of milk consumption in low-income Argentinean school children

OBJECTIVE

To determine the association between milk consumption, lifestyle, components of the metabolic syndrome, and insulin resistance in school children.

STUDY DESIGN

Students (n = 365 [175M]) age 10 +/- 2.3 years from 2 poor suburbs of Buenos Aires were examined for body mass index, waist circumference, blood pressure, and Tanner stage in April 2007. Fasting concentrations of lipids, insulin, and glucose were determined. Mothers completed questionnaires about their children's lifestyle.

RESULTS

Approximately 14.0% of the children were obese, and 12.1% were overweight by use of norms from the Centers for Disease Control and Prevention. Half were at Tanner I. Mean values of waist circumference, systolic blood pressure, insulin resistance, and insulin were higher as subjects consumed more glasses of milk. Multiple regression analysis with insulin resistance as the dependent variable showed that there was a significant and positive association with triglyceridemia (beta = 0.007) and waist circumference (beta = 0.024), and a negative association with milk consumption (beta = -0.135) adjusted for blocks walked daily, TV viewing, soft drink consumption, parental educational level, sex, age, high-density lipoprotein (HDL) cholesterol, and systolic blood pressure (R(2) = 0.27).

CONCLUSIONS

Increased milk consumption was associated with greater insulin sensitivity, suggesting that it might reduce the risk of type 2 diabetes.

The impact of metabolic syndrome on insulin sensitivity, glucose sensitivity, and acute insulin response after glucose load in early-onset type 2 diabetes mellitus: Taiwan Early-Onset Type 2 Diabetes Cohort Study

Diabetic patients with metabolic syndrome (MetS) have higher lifetime risks for cardiovascular disease, especially in early-onset type 2 diabetes mellitus (EODM). Increased insulin resistance (IR) and impaired insulin secretion are important pathophysiologies in diabetic patients. Therefore, the effects of MetS on IR and insulin secretion in EODM were investigated. Forty-eight EODM (mean age, 22.8 +/- 0.6 years) patients were enrolled in this study. Two grouping criteria were used: the first was whether the patient had MetS or not (MetS+ or Met-, with 31 and 17 patients, respectively); and the second was the number of MetS components each group had, that is, MetS (1,2) with 1 to 2, MetS (3) with 3, and MetS (4,5) with 4 to 5 components (17, 17, and 14 patients in each group, respectively). A frequently sampled intravenous glucose tolerance test was performed to measure insulin sensitivity, glucose sensitivity, acute insulin response after glucose load, and disposal index. Severe IR was noted with both homeostasis model assessment and frequently sampled intravenous glucose tolerance test both in MetS+ and MetS-. However, significantly higher acute insulin response after glucose load and disposal index were noted in MetS+ and MetS (4,5) than in Met-, MetS (1,2), and MetS (3), respectively. Early-onset type 2 diabetes mellitus patients with MetS had similar IR to those without MetS. This may be due to early deterioration of insulin action in these subjects. In addition, insulin secretion was higher in subjects with more MetS components, suggesting that EODM patients with MetS had better preserved ability of beta-cell compensation for IR than those without MetS.

Effects of prenatal dexamethasone treatment on postnatal physical, endocrine, and social development in the common marmoset monkey

The prophylactic treatment of diagnosed preterm delivery with synthetic glucocorticoids, such as dexamethasone (DEX), is commonplace. Long-term effects of such treatment are not well understood. In the present study, we exposed pregnant common marmosets (Callithrix jacchus), small-bodied monkeys that are therefore advantageous for long-term primate studies, to daily repeated DEX (5 mg/kg orally) either during early (d 42-48) or late (d 90-96) pregnancy (gestation period of 144 d). Relative to control, we investigated DEX effects in terms of maternal endocrinology (plasma cortisol and estrogen titers) and offspring physical growth, plasma and urinary ACTH and cortisol titers, and social and maintenance behaviors from birth to weaning. Both DEX treatments resulted in markedly reduced maternal plasma cortisol titers during treatment and reduced estimated gestation period. Both treatments were without effects on neonate morphometric measurements and basal hypothalamic-pituitary-adrenal axis activity. Early DEX treatment resulted in increased infant body weight at postnatal d 56 and 84, co-occurring at the behavioral level with increased time spent in eating solid food, a mobile state, solitary play, and exhibiting tail hair piloerection. The constellation of physical and behavioral effects of early DEX suggests interesting parallels with the human metabolic syndrome, providing primate support that the latter is causally associated with the fetal environment, including prenatal programming. This novel primate in vivo evidence for postnatal effects of prenatal synthetic glucocorticoid exposure indicates the importance of improved understanding of this acute clinical treatment in terms of its long-term effects on offspring well-being.

Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women

BACKGROUND

Although individual foods and nutrients have been associated with the metabolic syndrome, whether dietary patterns identified by factor analysis are also associated with this syndrome is not known.

OBJECTIVE

We aimed to evaluate the association of major dietary patterns characterized by factor analysis with insulin resistance and the metabolic syndrome among women.

DESIGN

Usual dietary intakes were assessed in a cross-sectional study of 486 Tehrani female teachers aged 40-60 y. Anthropometric and blood pressure measurements were performed, and fasting blood samples were taken for biomarker assessment. The metabolic syndrome was defined according to Adult Treatment Panel III guidelines, and insulin resistance was defined as the highest quartile of the homeostasis model assessment scores.

RESULTS

We identified 3 major dietary patterns by factor analysis: the healthy dietary pattern, the Western dietary pattern, and the traditional dietary pattern. After control for potential confounders, subjects in the highest quintile of healthy dietary pattern scores had a lower odds ratio for the metabolic syndrome (odds ratio: 0.61; 95% CI: 0.30, 0.79; P for trend < 0.01) and insulin resistance (0.51; 0.24, 0.88; P for trend < 0.01) than did those in the lowest quintile. Compared with those in the lowest quintile, women in the highest quintile of Western dietary pattern scores had greater odds for the metabolic syndrome (1.68; 1.10, 1.95; P for trend < 0.01) and insulin resistance (1.26; 1.00, 1.78; P for trend < 0.01). Higher consumption of traditional dietary pattern was significantly associated only with abnormal glucose homeostasis (1.19; 1.04, 1.59; P < 0.05).

CONCLUSION

Significant associations exist between dietary patterns identified by factor analysis, the metabolic syndrome, and insulin resistance.