The metabolic syndrome: time to get off the merry-go-round?

Evidence-based screening, clinical care and health education recommendations for Alaska Native peoples with prediabetes living in southcentral Alaska: findings from the Alaska EARTH follow-up study

Pre-diabetes (pre-DM) is a strong predictor of diabetes (DM) over time. This study investigated how much of the recent increase in pre-DM identified among Alaska Native (AN) peoples living in urban southcentral Alaska may be due to changes in diagnostic methods. We used clinical and demographic data collected at baseline between 2004 and 2006 and at follow-up collected between 2015 and 2017 from the urban southcentral Alaska Education and Research Towards Health (EARTH) cohort. We used descriptive statistics and logistic regression to explore differences in demographic and clinical variables among the identified pre-DM groups. Of 388 participants in the follow-up study, 243 had A1c levels indicating pre-DM with only 20 demonstrating pre-DM also by fasting blood glucose (FBG). Current smoking was the sole predictor for pre-DM by A1c alone while abdominal obesity and elevated FBG-predicted pre-DM by A1c+FBG. No participants had an elevated FBG without an A1c elevation. A substantial portion of the rise in pre-DM found among urban southcentral AN peoples in the EARTH follow-up study was due to the addition of A1c testing. Pre-DM by A1c alone should be used to motivate behavioural changes that address modifiable risk factors, including smoking cessation, physical activity and weight management.

Molecular Insights of Nonalcoholic Fatty Liver Disease Pathogenesis

Nonalcoholic fatty liver disease (NAFLD) is now the most prevalent chronic liver disease. Many hepatic abnormalities are associated with NAFLD such as nonalcoholic steatohepatitis, progressive fibrosis, cirrhosis, and liver failure. Moreover, the pathogenesis of NAFLD has numerous etiologies and can be explained due to the existence of several of stimulus that act simultaneously on genetically susceptible patients. These stimuli include obesity, diabetes, and insulin resistance. In addition, identifying the role of gut microbiota on NAFLD progression has been illustrated. In this review, we clarified the several factors that lead to the development of NAFLD and identify those who are most at risk of developing liver end-stage disease. Highlighting the noninvasive diagnostic NAFLD markers could be helpful in the disease prevention and treatment approaches.

Equine Metabolic Syndrome: A Complex Disease Influenced by Multifactorial Genetic Factors

Equine metabolic syndrome (EMS) has become an important issue in modern veterinary medicine and is linked to the common, extremely painful, most-of-the-time performance-terminating hoof laminitis. The growing knowledge in the field of genetic background, inducing environmental factors, diagnosis, treatment and maintenance of affected equines led us to summarise the available information to be used not only for scientific purposes but for fieldwork. In horses, the clinical presentation of EMS includes: obesity or local fat deposition, bilateral lameness or hoof rings attributed to ongoing or previous (pasted) laminitis with the key feature of the occurrence of insulin dysregulation, disturbing the homeostasis within insulin, glucose and lipid metabolism. The management of EMS is based on dietary and fitness discipline; however, intensive research is ongoing in the field of regenerative medicine to develop modern and promising therapies.

Body Fat Distribution in Lean Individuals with Metabolic Abnormalities

Objective: Obesity, defined as body mass index (BMI) >30 kilogram/m² is associated with metabolic derangements, but lean individuals with BMI <25 kilogram/m² may also have metabolic abnormalities. This study was conducted to evaluate fat distribution in metabolically unhealthy lean (MUL) individuals. Methods: Adults with BMI 18.5-24.9 kilogram/m² had their body composition evaluated with dual-energy X-ray absorptiometry. Metabolic data were obtained from their medical records. Patients with ≥2 components of the metabolic syndrome (MetS) were considered MUL and those with ≤1 component metabolically healthy lean (MHL). Multivariable logistic regression was used to analyze the association between metabolic abnormalities and anthropometric indexes. Results: The study includes 119 subjects; 69 in MHL and 50 in the MUL group. Two groups had comparable total body fat, fat mass index, and appendicular lean mass. Indices of visceral fat were associated with increased odds of being MUL (odds ratio with 95% confidence interval): visceral adipose tissue 1.75 (1.13-2.73), trunk-to-legs fat ratio 2.28 (1.30-4.00), trunk-to-limb fat ratio 2.43 (1.37-4.32), android-to-gynoid fat ratio 1.80 (1.07-3.03), and visceral-to-total fat percentage 1.80 (1.07-3.05). Conclusion: Metabolically unhealthy subjects had increased truncal distribution of body fat without an increase in total body fat. Body morphometry in MUL was similar to that of obese individuals with MetS.

Prevalence of Metabolic Syndrome and Insulin Resistance in a Sample of Adult ADHD Outpatients

BACKGROUND

High prevalence of Metabolic Syndrome (MS) was found in patients with schizophrenia and bipolar disorders. Insulin Resistance (IR) seems to mediate MS role in developing cardiometabolic consequences.

AIMS

To investigate the prevalence of MS, and the role of MS components and IR surrogate indexes in determining MS in adult ADHD outpatients.

METHODS

In the present cross-sectional study, MS, defined according to the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (ATP III), and IR surrogate indexes were assessed on a consecutive sample of adult ADHD outpatients. Logistic regression analysis was performed to evaluate the effect of each ATP III component and IR surrogate index in determining MS.

RESULTS

Seventeen out of 158 patients (10.8%, 95%CI = 0.064/0.167) fulfilled the ATP-III criteria for MS. A comprehensive comparison with prevalence in the reference population was hindered by the lack of patients over 60 in the study sample, however under this age no significant differences were found. Among MS components, blood triglycerides level (OR = 1.02, 95%CI=1.01/1.03, p = 0.001) was the main predictor for MS, followed by diastolic blood pressure (OR = 1.08, 95%CI=1.01/1.16, p = 0.024) and waist circumference (OR = 1.06, 95%CI=1.01/1.13, p = 0.029). Lipid Accumulation Product (LAP, OR = 1.0006, 95%CI=1.0003/1.0009, p < 0.001) outperformed Triglyceride-Waist Circumference (TG-WC, OR=1.03, 95%CI=1.01/1.04, p < 0.001) in predicting MS.

CONCLUSIONS

More attention should be paid not only to MS but also to each ATP III component of MS and LAP in ADHD patients both at first assessment and during follow-up process.

Psychological Stress and Functional Endometrial Disorders: Update of Mechanism Insights

The human endometrium plays a vital role in providing the site for embryo implantation and maintaining the normal development and survival of the embryo. Recent studies have shown that stress is a common factor for the development of unexplained reproductive disorders. The nonreceptive endometrium and disturbed early maternal-fetal interaction might lead to infertility including the repeated embryo implantation failure and recurrent spontaneous abortion, or late pregnancy complications, thereby affecting the quality of life as well as the psychological status of the affected individuals. Additionally, psychological stress might also adversely affect female reproductive health. In recent years, several basic and clinical studies have tried to investigate the harm caused by psychological stress to reproductive health, however, the mechanism is still unclear. Here, we review the relationship between psychological stress and endometrial dysfunction, and its consequent effects on female infertility to provide new insights for clinical therapeutic interventions in the future.

Biological effects of stevia, sucralose and sucrose in citrus-maqui juices on overweight subjects

BACKGROUND

In the last few years there has been emerging interest in substituting added sugars from juices with other sweeteners to make them healthier. But their long-term effects have been poorly evaluated. The aim of this study is to evaluate the effect of the addition of stevia, sucralose and sucrose (control) to maqui-citrus beverages on antioxidant and inflammatory status.

METHODS

a 3-arm parallel, randomized and triple blind clinical trial was performed in overweight subjects (n = 138), who consumed the test beverage (330 mL day-1) for 60 days. The following markers were determined: antioxidant status (ORAC, homocysteine, and oxidized LDL), safety parameters (ALP, AST, ALT, and total bilirubin), lipid profile (total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides) and inflammatory biomarkers (IL-6, TNF-α, and IL-10).

RESULTS

The homocysteine levels significantly increased after consumption of sucralose (27%, p = 0.001) and sucrose (40%, p = 0.006). A significant increase in the IL-10 concentration after consumption of the stevia sweetened beverage, and in ORAC values (21%) in subjects with lower basal antioxidant status were observed. The HDL and total cholesterol levels significantly increased after consumption of sucralose (p = 0.039) and sucrose (p = 0.001), respectively. No changes in triglycerides, LDL or oxidized LDL were observed.

CONCLUSIONS

Oxidative stress and an inflammatory response were observed after consumption of these sweetened beverages, with the exception of stevia, which produced an anti-inflammatory response. The possible antioxidative effects of this polyphenol-rich beverage may only benefit those individuals with poorer antioxidant status. Many randomized controlled trials at normal levels of consumption using commonly consumed sweeteners are necessary to clarify their roles in health.

Circular RNAs in metabolism and metabolic disorders

Metabolic syndrome (MetS) is a serious health condition triggered by hyperglycemia, dyslipidemia, and abnormal adipose deposition. Recently, circular RNAs (circRNAs) have been proposed as key molecular players in metabolic homeostasis due to their regulatory effects on genes linked to the modulation of multiple aspects of metabolism, including glucose and lipid homeostasis. Dysregulation of circRNAs can lead to metabolic disorders, indicating that circRNAs represent plausible potential targets to alleviate metabolic abnormalities. More recently, a series of circulating circRNAs have been identified to act as both essential regulatory molecules and biomarkers for the progression of metabolism-related disorders, including type 2 diabetes mellitus (T2DM or T2D) and cardiovascular disease (CVD). The findings of this study highlight the function of circRNAs in signaling pathways implicated in metabolic diseases and their potential as future therapeutics and disease biomarkers.

Metabolic Syndrome: the Influence of Adipokines on the L-Arginine-NO Synthase-Nitric Oxide Signaling Pathway

Metabolic syndrome includes the following symptoms: obesity, hyperlipidemia, hypertension, insulin resistance, and cardiovascular disease. The purpose of this review is to elucidate the role of adipokines in the regulation of the L-arginine-NO-synthas-NO signaling pathway in the pathogenesis of metabolic syndrome. The main questions raised in the review are: how adipokine secretion changes, how the level of their receptors is regulated, and which signaling pathways are involved in the transmission of adipokine signals when coupled to the L-arginine-NO-synthase-NO signaling cascade. Adipokines are peptide hormones that transmit a signal from adipose tissue to targets in the brain, blood vessels, liver, pancreas, muscles, and other tissues. Some adipokines have anti-inflammatory and insulin-sensitive effects: adiponectin, omentin, adipolin, chemerin, progranulin. Others have the negative inflammatory effect in the development ofmetabolic syndrome: visfatin, vaspin, apelin. Adipokines primarily regulate the expression and activity of endothelial NO-synthase. They either activate an enzyme involving 5-AMP protein kinase or Akt kinase, increasing its activity and synthesis of NO in the tissues of healthy patients: adiponectin, adipolin, omentin, or inhibit the activity of eNOS, which leads to a decrease in NO-synthase and suppression of mRNA bioavailability: vaspin, visfatin, apelin in metabolic syndrome, and a decrease in its activity leads to dissociation and endothelial dysfunction. It should be noted that the bioavailability of NO formed by NO-synthase is affected at many levels, including: the expression ofNO-synthase mRNA and its protein; the concentration of L-arginine; the level of cofactors of the reaction; and to detect the maximum activity of endothelial NO-synthase, dimerization of the enzyme is required, posttranslational modifications are important, in particular, phosphorylation of endothelial NO-synthase by serine 1177 with the participation of 5-AMP protein kinase, Akt kinase and other kinases. It should be noted that the participation of adiponectin, omentin, and kemerin in the regulation of the L-arginine-NO-synthase-NO cascade in metabolic syndrom opens up certain opportunities for the development of new approaches for the correction of disorders observed in this disease. The review analyzes the results of research searching in PubMed databases, starting from 2001 and up to 2020 using keywords and adipokine names, more than half of the references of the last 5 years. 

Association between metabolic syndrome, hepatic steatosis, and testosterone deficiency: evidences from studies with men and rodents

Testosterone is the predominant androgen in men and the lack of it can be a trigger to the development of the metabolic syndrome. Here we review the relationship between testosterone deficiency, metabolic syndrome, and hepatic steatosis reported by studies with men and rodents. The prevalence of metabolic syndrome and testosterone deficiency is higher among older subjects. Low total and free testosterone levels were positively associated with disturbs on energy metabolism, changes in body fat distribution, and body composition. Studies reported visceral fat accumulation in men with hypogonadism and castrated rats. Despite some contradictions, the association between higher adiposity, low testosterone, and metabolic syndrome was a common point among the studies. Few studies evaluated the hepatic steatosis and found an association with hypogonadism. Most of the studies with rodents combined the castration with a high-fat diet to study metabolic disturbs. The importance of proper levels of testosterone for energy metabolism homeostasis in men was also underlined by studies that investigated the metabolic effects of testosterone replacement therapy and androgen deprivation therapy.

Plasma metabolomics are associated with metabolic syndrome: A targeted approach

OBJECTIVES

Advances in metabolomic tools have allowed us to gain a more comprehensive understanding of metabolic syndrome (MetS). The aim of this study was to evaluate the association between plasma metabolomic profiles and MetS.

METHODS

For this study, adults without diabetes, chronic kidney disease, stroke, heart disease, or cancer and with full metabolomics, biochemical, and dietetic data available, representing a subsample of the Health Survey of Sao Paulo study (ISA-Capital; N = 130), were included. The joint interim statement consensus criteria were used for diagnosing MetS. Absolute quantification (µmol/L) of blood metabolites was achieved by targeted quantitative profiling of annotated metabolites by electrospray ionization tandem mass spectrometry in plasma samples. Mean differences in the compounds for MetS were evaluated by linear regression adjusted for confounding factors.

RESULTS

Serine was inversely associated with MetS (β = -15.04; P = 0.014). In glycerophospholipids with acyl-alkyl bonds, there was an inverse association with MetS, including phosphatidylcholine (PC) ae C42:5 (β = -0.15; P = 0.040), PC ae C44:5 (β = -0.15; P = 0.046), PC ae C40:4 (β = -0.21; P = 0.014) and PC ae C44:4 (β = -0.04; P = 0.032).

CONCLUSION

Plasma metabolomic profiles were associated with MetS, especially the amino acid serine and some acyl-alkyl PCs.

The metabolic syndrome - What is it and how should it be managed?

A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.

Association between eating behavior, anthropometric and biochemical measurements, and peptide YY (PYY) hormone levels in obese adolescents in outpatient care

Objective To evaluate the eating behavior of obese adolescents and its association with biochemical, anthropometric and peptide YY (PYY) measures. Methods Fifty-one obese adolescents received counseling for weight management at 12 monthly appointments. Fasting serum PYY levels, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), insulin and glucose levels, waist circumference (WC) and results from the Three-Factor Eating Questionnaire (TFEQ-21) were assessed. Results Over one year there was a significant increase in PYY levels (p = 0.026), reduction in TC (p = 0.003), TG (p = 0.022), BMI (p = 0.002), BMI z-score (p < 0.001) and WC (p = 0.003). During this period there was a decrease in the uncontrolled eating score (UE), illustrating that adolescents displayed more self-control (p = 0.008) at the end of the study; however, this result was independent of BMI and BMI z-score (p = 0.407). The reduction in UE was associated with a significant improvement in insulin levels (rs = 0.326; p = 0.020). The reduction in UE was also associated with lower levels of blood glucose (r = 0.332; p = 0.017), and the increase of cognitive restriction, with the reduction of insulin insulin (rs = -0.294; p = 0.036) and TG (r = -0.368; p = 0.008) and an increase in Cognitive Restraint. Conclusions Our results show that after a year of monitoring weight loss, adolescents had more controlled eating behaviors, increased PYY levels, and reduced weights.

Metabolic Syndrome: conceptual analysis in the nursing context

OBJECTIVE

to analyze the metabolic syndrome concept and to identify its essential features, antecedents, and outcomes within the context of nursing.

METHOD

conceptual analysis, based on the methodological steps of a model. We carried out an integrative review by accessing four databases online: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, and Índice Bibliográfico Español en Ciencias de la Salud.

RESULTS

the essential features most frequently involved the diagnostic criteria of metabolic syndrome. Inadequate nutrition and physical inactivity were highlighted as the most common antecedents of the syndrome, and the outcomes were occurrences of cardiovascular disease and diabetes mellitus type 2. As implication, we highlight relevant empirical data to the broad definition of the concept.

CONCLUSION

we could analyze the concept under study regarding essential features, antecedents, and outcomes, operationally defining it as a potential nursing phenomenon, which demands health care focusing on reducing risks and morbidity and mortality for cardiovascular diseases.

HOMA-IR: An independent predictor of advanced liver fibrosis in nondiabetic non-alcoholic fatty liver disease

BACKGROUND AND AIM

Although non-alcoholic fatty liver disease (NAFLD) is common in the general population, identifying patients with advanced fibrosis remains a challenge. We investigated whether the homeostasis model assessment parameter of insulin resistance (HOMA-IR), an index of IR and one of the most important metabolic factors, is an independent predictive factor for advanced fibrosis in nondiabetic patients with NAFLD.

METHODS

This was a retrospective, cross-sectional multicenter study. We included 361 patients with biopsy-proven NAFLD who had not been diagnosed with type 2 diabetes mellitus: 175 (48%) were women and 48 (13%) had advanced fibrosis. We used simple random sampling; the sampling ratio of the estimation and validation groups was 7:3. A logistic model was constructed for both the estimation and validation groups. The explanatory variables were age ≥ 49 years, sex (women), body mass index ≥ 26.7 kg/m² , the presence of hypertension, presence of dyslipidemia, fasting plasma glucose level ≥ 98 mg/dL, fasting immune reactive insulin level ≥ 12.0 μU/mL, and HOMA-IR ≥ 2.90. The median HOMA-IR of the patients was 2.88 (interquartile range: 2.1-4.8).

RESULTS

In the estimation group, univariate and multivariate analyses showed that age, dyslipidemia, and HOMA-IR were independent predictors of advanced fibrosis. In the validation group, only age and HOMA-IR were found to be independent predictors of advanced fibrosis.

CONCLUSIONS

Homeostasis model assessment parameter of insulin resistance was an independent predictor of advanced liver fibrosis in nondiabetic patients with NAFLD. Given that most patients with NAFLD are nondiabetic, it is important to set goals with respect to improving IR to subsequently reduce liver fibrosis.

The Circadian Syndrome: is the Metabolic Syndrome and much more!

The Metabolic Syndrome is a cluster of cardio-metabolic risk factors and comorbidities conveying high risk of both cardiovascular disease and type 2 diabetes. It is responsible for huge socio-economic costs with its resulting morbidity and mortality in most countries. The underlying aetiology of this clustering has been the subject of much debate. More recently, significant interest has focussed on the involvement of the circadian system, a major regulator of almost every aspect of human health and metabolism. The Circadian Syndrome has now been implicated in several chronic diseases including type 2 diabetes and cardiovascular disease. There is now increasing evidence connecting disturbances in circadian rhythm with not only the key components of the Metabolic Syndrome but also its main comorbidities including sleep disturbances, depression, steatohepatitis and cognitive dysfunction. Based on this, we now propose that circadian disruption may be an important underlying aetiological factor for the Metabolic Syndrome and we suggest that it be renamed the 'Circadian Syndrome'. With the increased recognition of the 'Circadian Syndrome', circadian medicine, through the timing of exercise, light exposure, food consumption, dispensing of medications and sleep, is likely to play a much greater role in the maintenance of both individual and population health in the future.

From syndrome X to cardiometabolic risk: clinical and public health implications

Although the first description of a syndrome defined by the co-existence of atherogenic and diabetogenic metabolic abnormalities is debated in the literature, it was Gerald Reaven who proposed, in his landmark 1988 Banting award lecture, that a significant proportion of individuals (with diabetes or not) were characterised by insulin resistance causing prejudice to cardiovascular health. However, Reaven was influenced by seminal observations made more than 50 years earlier by Himsworth who proposed that there were two forms of diabetes (insulin resistant v. insulin sensitive). Reaven went further in proposing the theory that insulin resistance was the most prevalent cause of CVD associated with metabolic abnormalities that he named syndrome X. Because there was a syndrome X documented in cardiology, the term evolved to insulin resistance syndrome. As Reaven could also find insulin-resistant individuals in non-obese subjects, he did not include obesity as a feature of syndrome X. Imaging studies then revealed that excess adipose tissue in the abdominal cavity, a condition described as visceral obesity, was the form of overweight/obesity associated with insulin resistance and its related abnormalities. As obesity risk assessment and management remain largely based on body weight (BMI) and weight loss, it is proposed that our clinical approaches and public health messages should be revisited. First, patients should be educated about the importance of monitoring their waistline as a crude index of abdominal adiposity. Secondly, public health approaches focussing on 'lifestyle vital signs' including achieving healthy waistlines rather than healthy body weights should be developed.

Higher adiponectin concentrations are associated with reduced metabolic syndrome risk independently of weight status in Brazilian adolescents

OBJECTIVE

To evaluate the association between adiponectin concentrations and metabolic syndrome (MetS) risk and to investigate if this association is independent of weight status in adolescents.

METHODS

Adiponectin concentrations and MetS risk were assessed in 4546 Brazilian adolescents (12-17 years old) enrolled in The Study of Cardiovascular Risks in Adolescents ("ERICA"), a cross-sectional multicenter study in Brazil. For analyses, adiponectin was categorized in sex and age-specific quartiles and MetS risk was expressed as a continuous score, calculated as the average of the standardized values (z-score) of the five MetS components. Multiple linear regression models were used to investigate the association between the quartiles of adiponectin and MetS risk.

RESULTS

Adiponectin was inversely associated with waist circumference and log-transformed triglycerides, and positively associated with HDL-c. We also observed an inverse association between adiponectin concentrations and MetS risk. After adjustment for sociodemographic variables, physical activity, skipping breakfast and body mass index (BMI), higher quartiles of adiponectin remained inversely associated with waist circumference and MetS risk. A direct association between adiponectin and HDL-c was also observed. In further analysis, the sample was stratified by weight status and an inverse association between quartiles of adiponectin and MetS risk was observed in both normal weight and overweight/obese adolescents.

CONCLUSION

Higher adiponectin concentrations were independently and inverse associated with MetS risk in Brazilian adolescents, even after adjusting for BMI. These results were similar in normal weight and overweight/obese adolescents, suggesting that adiponectin may play a role in early development of MetS.

Anti-Inflammatory Effects of Resveratrol: Mechanistic Insights

Inflammation is the principal response invoked by the body to address injuries. Despite inflammation constituting a crucial component of tissue repair, it is well known that unchecked or chronic inflammation becomes deleterious, leading to progressive tissue damage. Studies over the past years focused on foods rich in polyphenols with anti-inflammatory and immunomodulatory properties, since inflammation was recognized to play a central role in several diseases. In this review, we discuss the beneficial effects of resveratrol, the most widely investigated polyphenol, on cancer and neurodegenerative, respiratory, metabolic, and cardiovascular diseases. We highlight how resveratrol, despite its unfavorable pharmacokinetics, can modulate the inflammatory pathways underlying those diseases, and we identify future opportunities for the evaluation of its clinical feasibility.

The Association Between Metabolic Syndrome, Obesity-Related Outcomes, and ADHD in Adults With Comorbid Affective Disorders

OBJECTIVE

ADHD may predispose to obesity, a metabolic syndrome component. Affective disorders are also associated with MetSyn and ADHD. This study examined whether ADHD confers any added risk of MetSyn and obesity-related associations in a large sample with varying stages of affective disorders.

METHOD

Participants included 2,303 adults from the Netherlands Study of Depression and Anxiety. Three groups were compared (controls, those with depressive/anxiety disorders without ADHD; and those with depressive/anxiety disorders and ADHD) for presence of MetSyn risk factors, body mass index, and waist-hip ratio. ADHD symptoms were identified by using a T-score > 65 (Conners Adult ADHD Rating Scale).

RESULTS

Multivariable analyses were additionally adjusted for sociodemographic, lifestyle, health factors, and affective disorders. Analyses showed no significant association between MetSyn, obesity-related variables, and comorbid ADHD. High Inattention and Hyperactivity/Impulsivity symptoms were not associated with MetSyn.

CONCLUSION

This study did not confirm that MetSyn and obesity-related parameters are increased in comorbid ADHD.

Metabolic syndrome severity is significantly associated with future coronary heart disease in Type 2 diabetes

Background

The severity of the metabolic syndrome (MetS) is significantly associated with future coronary heart disease (CHD) among individuals without baseline Type 2 diabetes. However, the validity of assessing MetS severity among individuals with diabetes is unknown.

Objective

To assess for differences in MetS severity by timing of Type 2 diabetes diagnosis and to assess for associations between MetS severity and future CHD among individuals with diabetes.

Methods

We analyzed data from participants of the Atherosclerosis Risk in Communities study, including 1419 with- and 7241 without diabetes, followed during 4 visits and adjudicated CHD diagnoses over a 20-year period. We used Cox-regression techniques to assess hazard ratios (HR) of CHD based on a sex- and race/ethnicity-specific MetS-severity Z-score (standard MetS score) and a similar MetS-severity score formulated without incorporating glucose as a component of MetS (no-glucose MetS score).

Results

For both the standard- and no-glucose MetS-severity scores, scores were highest in the baseline-diabetes group, lowest in the never-diabetes group and intermediate in the incident-diabetes groups. Among participants with diabetes, increasing MetS-severity score at baseline was associated with incident CHD, using both the standard MetS score (HR 1.29, 95% confidence interval [CI] 1.21, 1.39) and the no-glucose score (HR 1.42, CI 1.24, 1.62) (both p < 0.001). For the baseline-diabetes group, this relationship remained significant when Visit 2 Hemoglobin-A_1c was included in the model, both for the standard MetS score (HR 1.21, CI 1.09, 1.34; p < 0.001) and the no-glucose score (HR 1.25, CI 1.04, 1.51; p = 0.02).

Conclusions

MetS severity appears to provide an estimate of metabolic disarray in the setting of diabetes and is predictive of future CHD events beyond HbA1c. Identifying MetS severity among individuals with diabetes may help in identifying those at higher risk, who could then receive further preventative treatment.

Electronic supplementary material

The online version of this article (10.1186/s12933-017-0647-y) contains supplementary material, which is available to authorized users.

Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and a clinical decision algorithm for high risk patients

There is ongoing scientific interest regarding comorbidities associated with the metabolic syndrome (MeTS). MeTS comprises a combination of parameters that predispose individuals to the development of type 2 diabetes and cardiovascular disease (CVD). Three or more of the following criteria are necessary: fasting glucose > 110 mg/dl (5.6 mmol/l), hypertriglyceridemia > 150 mg/dl (1.7 mmol/l), HDL levels < 40 mg/dl (men)/< 50 mg/dl (women), blood pressure > 130/85 mmHg, waist circumference (values for Mediterranean populations > 94 cm (men)/> 89 cm (women). In this review we attempted to summarize relevant data by searching dermatological literature regarding associations between various skin conditions and MeTS. A multitude of studies was retrieved and a further goal of the present article is to present plausible mechanistic connections. The severity of skin conditions like psoriasis has been linked with MeTS. Parameters of MeTS like insulin resistance are present in patients with early onset androgenic alopecia, hidradenitis suppurativa acne and rosacea. Since MeTS can lead to CVD and type 2 diabetes early detection of patients would be very important. Also therapeutic intervention on MeTS could lead to improvement on the severity of skin conditions. This reciprocal relationship between skin diseases and MeTS in our opinion holds great interest for further investigation.

Genetics of metabolic syndrome: potential clues from wild-derived inbred mouse strains

The metabolic syndrome (MetS) is a complex constellation of metabolic abnormalities including obesity, abnormal glucose metabolism, dyslipidemia, and elevated blood pressure that together substantially increase risk for cardiovascular disease and Type 2 diabetes. Both genetic and environmental factors contribute to the development of MetS, but this process is still far from understood. Human studies have revealed only part of the underlying basis. Studies in mice offer many strengths that can complement human studies to help elucidate the etiology and pathophysiology of MetS. Here we review the ways mice can contribute to MetS research. In particular, we focus on the information that can be obtained from studies of the inbred strains, with specific focus on the phenotypes of the wild-derived inbred strains. These are newly derived inbred strains that were created from wild-caught mice. They contain substantial genetic variation that is not present in the classical inbred strains, have phenotypes of relevance for MetS, and various mouse strain resources have been created to facilitate the mining of this new genetic variation. Thus studies using wild-derived inbred strains hold great promise for increasing our understanding of MetS.

Fructose-induced inflammation and increased cortisol: A new mechanism for how sugar induces visceral adiposity

Traditionally, the leading hypothesis regarding the development of obesity involves caloric imbalance, whereby the amount of calories consumed exceeds the amount of calories burned which causes obesity. Another hypothesis for why we get fat has surfaced in the last decade which is the idea that the overconsumption of added sugars and refined carbohydrates induce insulin resistance and high insulin levels causing obesity. While insulin is a fat-storing hormone, this hypothesis does not explain visceral adiposity, or why certain people are found to have fat stored in and around their organs. We propose a new mechanism for body fattening, particular visceral adiposity. This hypothesis involves the overconsumption of fructose, which leads to inflammation in all cells that metabolize it rapidly. When fructose is metabolized in subcutaneous adipocytes, the subsequent inflammation leads to an increase in intracellular cortisol in order to help squelch the inflammation. Unfortunately, the increase in intracellular cortisol leads to an increased flux of fatty acids out of the subcutaneous adipocytes allowing more substrate for fat storage into visceral fat tissue. Moreover fructose-induced inflammation in the liver also leads to increased intracellular cortisol via an upregulation of 11-B hydroxysteroid dehydrogenase type 1 causing increased fat storage in the liver (i.e., fatty liver). In essence, the fructose-induced inflammatory cortisol response causes "thin on the outside, fat on the inside" (TOFI). Furthermore, fructose in the brain, either from fructose uptake via the blood brain barrier or endogenous formation from glucose via the polyol pathway stimulates an increased release of cortisol causing hepatic gluconeogenesis leading to overall insulin resistance and further body fattening. This review paper will discuss in detail the hypothesis that fructose-induced inflammation and cortisol activation causes visceral adiposity.

The Association Between BXO and Obesity in Boys Undergoing Circumcision

This study investigated whether boys with balanitis xerotica obliterans (BXO) have increased rates of obesity compared with boys with no concern for BXO (NCB). Boys ≤18 years old with circumcision pathology–confirmed BXO were compared with an age-matched group who had NCB during circumcision. Boys with BXO were found to have a mean body mass index of 70.64 percentile for age compared with 52.43 percentile in age-matched controls (P = .0005). The rate of obesity was significantly higher in boys with BXO (42%) compared with 12.4% in boys with NCB (odds ratio = 5.12; 95% CI = 2.6 to 10.06). Given the increasing rates of childhood obesity and the long-term health consequences of both BXO and obesity, special attention should be paid to this population. Further research is needed to determine if BXO in obese children may represent an early indicator of a systemic disease process where intervention may be warranted.

Prevalence of Metabolic Syndrome in individuals with Type 2 Diabetes Mellitus

OBJECTIVE

to identify the prevalence of Metabolic Syndrome and its components in a population of patients with type 2 Diabetes Mellitus.

METHOD

a cross-sectional study was conducted with 201 diabetic patients. A descriptive analysis and Chi-square and Fisher's exact tests ( p <0.05) were performed.

RESULTS

the majority of participants were females and overweight, with a mean age of 63.1 years and a low level of education, and categorized as physically inactive. Of all individuals investigated, 50.7% were diagnosed with Metabolic Syndrome and 92% had at least one of the syndrome components with values beyond those recommended.

CONCLUSION

it is essential to take preventive actions and develop studies that help to identify the factors associated with this syndrome.

Pharmacokinetics and tolerability of MB12066, a beta-lapachone derivative targeting NAD(P)H: quinone oxidoreductase 1: two independent, double-blind, placebo-controlled, combined single and multiple ascending dose first-in-human clinical trials

MB12066 is a molecule derived from β-lapachone that shown effects on obesity in previous studies. The present studies were conducted to evaluate the tolerability and pharmacokinetics (PK) of MB12066 after the oral administration of single and multiple doses to healthy volunteers. The study comprised 2 independent, randomized, double-blind, placebo-controlled, combined single and multiple ascending dose first-in-human clinical trials to evaluate the safety, tolerability and PK of MB12066 in healthy Korean volunteers. Subjects were randomly assigned to receive a single 10, 30, 100, 150, 200, 300 or 400 mg of MB12066 and multiple 100 or 200 mg of MB12066. The subjects’ vital signs, 12-lead electrocardiograms, clinical laboratory tests, adverse event statuses, and physical examinations were assessed during the study. Blood and urine samples were collected to determine the concentration of MB12066 from predose to 72 hours after the single administration and from predose to 96 hours postdose of day 7 after the multiple administration. NADH:quinone oxidoreductase 1 genotyping was performed to analyze the association between genetic polymorphisms and PK. MB12066 was well tolerated after oral administration of single and multiple doses. The systemic exposure to MB12066 after a single administration tended to increase in a dose-dependent manner in the dose range of 30–200 mg. The overall fraction of MB12066 excreted unchanged in urine was <1% of the administered dose. A significant relationship was observed between NADH:quinone oxidoreductase 1 polymorphisms and exposure to MB12066 after multiple administrations, but the result was not conclusive because of the small number of subjects. A single dose of MB12066 within the dose range of 10–400 mg and multiple doses of 100 and 200 mg of MB12066 were safe and tolerated in healthy subjects. Additionally, MB12066 was mainly eliminated through metabolism in humans.

High, but not low, exercise volume shifts the balance of renin-angiotensin system toward ACE2/Mas receptor axis in skeletal muscle in obese rats

Metabolic syndrome is a cluster of metabolic risk factors that is linked to central obesity, elevated blood pressure, insulin resistance (IR), and dyslipidemia, where the renin-angiotensin system (RAS) may provide a link among them. This study aimed to evaluate volume exercise effects comparing low vs. high volume of chronic aerobic exercise on RAS axes in skeletal muscle in a diet-induced obesity (DIO) rat model. For this, male Wistar-Kyoto rats were fed a standard chow (SC) diet or a high-fat (HF) diet for 32 wk. Animals receiving the HF diet were randomly divided into low exercise volume (LEV, 150 min/wk) and high exercise volume (HEV, 300 min/wk) at the 20th week. After 12 wk of aerobic treadmill training, the body mass and composition, blood pressure, glucose and lipid metabolism, RAS axes, insulin signaling, and inflammatory pathway were performed. HEV slowed the body mass gain, reduced intra-abdominal fat pad and leptin levels, improved total and peripheral body composition and inflammatory cytokine, reduced angiotensin II type 1 receptor expression, and increased Mas receptor protein expression compared with the HF animals. Sedentary groups (SC and HF) presented lower time to exhaustion and maximal velocity compared with the LEV and HEV groups. Both exercise training groups showed reduced resting systolic blood pressure and heart rate, improved glucose tolerance, IR, insulin signaling, and lipid profile. We conclude that the HEV, but not LEV, shifted the balance of RAS toward the ACE2/Mas receptor axis in skeletal muscle, presenting protective effects against the DIO model.

A Proteomics Based Approach Reveals Differential Regulation of Visceral Adipose Tissue Proteins between Metabolically Healthy and Unhealthy Obese Patients

Obesity and the metabolic disorders that constitute metabolic syndrome are a primary cause of morbidity and mortality in the world. Nonetheless, the changes in the proteins and the underlying molecular pathways involved in the relevant pathogenesis are poorly understood. In this study a proteomic analysis of the visceral adipose tissue isolated from metabolically healthy and unhealthy obese patients was used to identify presence of altered pathway(s) leading to metabolic dysfunction. Samples were obtained from 18 obese patients undergoing bariatric surgery and were subdivided into two groups based on the presence or absence of comorbidities as defined by the International Diabetes Federation. Two dimensional difference in-gel electrophoresis coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was carried out. A total of 28 proteins were identified with a statistically significant difference in abundance and a 1.5-fold change (ANOVA, p ≤ 0.05) between the groups. 11 proteins showed increased abundance while 17 proteins were decreased in the metabolically unhealthy obese compared to the healthy obese. The differentially expressed proteins belonged broadly to three functional categories: (i) protein and lipid metabolism (ii) cytoskeleton and (iii) regulation of other metabolic processes. Network analysis by Ingenuity pathway analysis identified the NFκB, IRK/MAPK and PKC as the nodes with the highest connections within the connectivity map. The top network pathway identified in our protein data set related to cellular movement, hematological system development and function, and immune cell trafficking. The VAT proteome between the two groups differed substantially between the groups which could potentially be the reason for metabolic dysfunction.

Metabolic syndrome and benign prostatic hyperplasia: An update

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities related to central adiposity and insulin resistance. Its importance is increasingly recognized as it associates with increased risks of metabolic and cardiovascular diseases. These metabolic aberrations of MetS may lead to development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in men. A 26.5%-55.6% prevalence of MetS in men with LUTS was reported in worldwide studies. Although the exact biological pathway is not clear yet, insulin resistance, increased visceral adiposity, sex hormone alterations and cellular inflammatory reactions played significant roles in the related pathophysiological processes. Clinician should recognize the cardiovascular and metabolic impacts of MetS in men with LUTS, early risk factors optimization and use of appropriate medical therapy may possibly alter or slower the progression of LUTS/BPH, and potentially avoid unnecessary morbidities and mortalities from cardiovascular and metabolic diseases for those men.

Increased serum brain-derived neurotrophic factor in male schizophrenic patients with metabolic syndrome

Increased prevalence of metabolic syndrome was found in patients with schizophrenia. Brain-derived neurotrophic factor (BDNF) was involved in energy metabolism and the pathophysiology of schizophrenia, but differently in males and females. We aimed to investigate the serum BDNF levels in patients with schizophrenia with and without metabolic syndrome.Patients with schizophrenia were recruited. Their demographic data were collected. Metabolic profiles and serum BDNF levels were measured. Clinical symptoms were evaluated with Positive and Negative Syndrome Scale. Metabolic syndrome was determined with the criteria provided by Ministry of Health and Welfare of Taiwan. Framingham Risk Score (FRS) for estimate of 10-year risk for coronary heart disease was provided by National Institutes of Health.Of the 81 participants, 40.7% had metabolic syndrome. Those with metabolic syndrome had higher FRS. Using analysis of covariance adjusted for age and body mass index, male patients with schizophrenia with metabolic syndrome had higher serum BDNF levels than those without (4.6 ± 4.7 vs 3.3 ± 3.8 ng/mL, P = .022). No statistical difference was found between female patients with and without metabolic syndrome.Significant differences of serum BDNF levels were found between male patients with schizophrenia with and without metabolic syndrome, but not in females. This finding suggested the gender difference behind the mechanism of BDNF in metabolic syndrome in schizophrenia.

Nutritional status and metabolic profile in neurologically impaired pediatric surgical patients

BACKGROUND

Malnutrition is reported in pediatric neuromotor disability and impacts the child's health. We described the nutritional and metabolic status in neurologically impaired (NI) children undergoing surgery.

METHODS

Anthropometry, body composition, hormonal and nutritional evaluations were performed in 44 NI subjects (13.7±8.0 years). Energy needs were calculated by Krick's formula. Metabolic syndrome (MS) was defined applying the following criteria (≥3 defined MS): fasting blood glucose >100 mg/dL and/or homeostasis model assessment for insulin resistance (HOMA-IR) >97.5th percentile, trygliceride level >95th percentile, high-density lipoprotein (HDL)-cholesterol level <5th percentile, systolic/diastolic pressure >95th percentile; whilebody mass index - standard deviation score (BMI-SDS) <2 and biochemical malnutrition markers (≥2) defined undernutrition.

RESULTS

Energy intake was not adequate in 73.8% of the patients; no correlation between energy intake and BMI was noted. Undernutrition was noted in 34.1% of patients and MS in 11.36% of subjects. Fifty percent of the patients presented with insulin resistance, which was not related to BMI, body composition or other MS components.

CONCLUSIONS

Nutritional and metabolic monitoring of disabled children and young adults is recommended to prevent adverse outcomes associated with malnutrition.

Excessive consumption of fructose causes cardiometabolic dysfunctions through oxidative stress and inflammation

A rapid rise in obesity, as well as physical inactivity, in industrialized countries is associated with fructose-consumption-mediated metabolic syndrome having a strong association with cardiovascular disease. Although insulin resistance is thought to be at the core, visceral obesity, hypertension, and hypertriglyceridemia are also considered important components of this metabolic disorder. In addition, various other abnormalities such as inflammation, oxidative stress, and elevated levels of uric acid are also part of this syndrome. Lifestyle changes through improved physical activity, as well as nutrition, are important approaches to minimize metabolic syndrome and its deleterious effects.

Longitudinal association of antidepressant medication use with metabolic syndrome: Results of a 9-year follow-up of the D.E.S.I.R. cohort study

OBJECTIVE

To examine longitudinal associations between antidepressant medication use and the metabolic syndrome (MetS).

METHODS

5014 participants (49.8% were men) from the D.E.S.I.R. cohort study, aged 30-65 years at baseline in 1994-1996, were followed over 9 years at 3-yearly intervals (1997-1999, 2000-2002, and 2003-2005). Antidepressant use and MetS, defined by the National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP-ATP III) and the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) criteria, were assessed concurrently at four medical examinations.

RESULTS

In fully-adjusted longitudinal logistic regression analyses based on generalized estimating equations, antidepressant users had a 9% (p=0.011) and a 6% (p=0.036) greater annual increase in the odds of having the MetS defined by NCEP-ATP III and AHA/NHLBI criteria respectively. Sex-specific analyses showed that this association was confined to men only. When the different types of antidepressant were considered, men who used selective serotonin reuptake inhibitors (SSRIs), imipramine type antidepressants or "other" antidepressants had a 52% (p=0.028), 31% (p=0.011), and 16% (p=0.016) greater annual increase in the odds of having the MetS over time compared to non-users, respectively. These associations depended on the definition of the MetS.

CONCLUSIONS

Our longitudinal data showed that antidepressant use was associated with an increased odds of having the MetS in men but not in women and this was mainly for SSRIs, imipramine type and "other" antidepressants. People on antidepressants may need to be checked regularly for the elements of the metabolic syndrome treatable by change in diet, physical activity and/or by medication therapy.

Comparison of coronary heart disease risk among four diagnostic definitions of metabolic syndrome

PURPOSE

Metabolic syndrome (MetS) is now well known as one of the major risk factors for coronary heart disease (CHD). Currently, there are several methods used to define MetS. The aim of this study was to determine to what extent current MetS definition reflects CHD risk using the probability of CHD in 10 years based on Framingham risk score algorithms.

METHODS

A total of 7575 adults, aged 16-93 years (2532 men and 5043 women), were recruited. We conducted a cross-sectional health survey in China using MetS criteria from four different definitions: modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), Chinese and Japanese.

RESULTS

Differences in the prevalence of MetS by each definition were small in males (22.9-25.9 %), whereas in females, MetS was three times more prevalent using the IDF definition (29.1 %) versus the Japanese definition (9.7 %). Framingham risk scores in participants with MetS were significantly higher than in those without MetS by all definition criteria (p < 0.001). The CHD risk scores for participants with MetS by each definition showed similar values in males (range 11.5-12.1 %) with no significant differences among definitions. Conversely, in females with MetS the risk score for CHD was low (range 3.5-4.3 %) by each MetS definition.

CONCLUSIONS

These findings suggest that further studies are required to establish appropriate criteria of MetS in females.

Dysfunctional adipose tissue and low-grade inflammation in the management of the metabolic syndrome: current practices and future advances

The ongoing worldwide obesity epidemic makes the metabolic syndrome an increasingly important entity. In this review, we provide a short background on the metabolic syndrome, we discuss recent developments in the three main options that have been identified for intervention in the metabolic syndrome, i.e. lifestyle and surgical and pharmacological interventions, and we focus on different views in the literature and also include our own viewpoints on the metabolic syndrome. In addition, we discuss some emerging treatment targets for adipose tissue dysfunction and low-grade inflammation, i.e. activation of the inflammasome and the complement system, and consider some selected opportunities for intervention in these processes.

In Vivo Interrelationship between Insulin Resistance and Interferon Gamma Production: Protective and Therapeutic Effect of Berberine

This research was conducted to investigate if there is a relation between insulin resistance incidence and inhibition of interferon gamma production or not. Firstly, insulin resistance was induced by high fat diet (HFD) intake for 6 weeks. Secondly, berberine was used as protective/curative compound for insulin resistance. Results revealed that feeding rats HFD for 6 weeks developed features of insulin resistance (IR) syndrome. These features presented in increased body weight, hyperglycemia, hyperinsulinemia, hypercholesterolemia (with increased LDL-cholesterol and decreased HDL-cholesterol), and hypertriglyceridemia. Level of antioxidant enzymes in HFD group was higher than in normal one. Also there was an increasing in level of proinflammatory cytokines as interleukin- (IL-) 6 and IL-12 in HFD group. Feeding rats HFD for 6 weeks also decreased level of interferon gamma (IFN-γ). The decreased level of IFN-γ has been shown to predict infection with infectious diseases especially viral infection. Treatment and protection with berberine 50 mg/kg/day for 2 weeks were found to be effective against the features of insulin resistance syndrome, improved levels of insulin resistance parameters, lipid profile, antioxidant enzymes, proinflammatory cytokines, and IFN-γ.

Obesity or obesities? Controversies on the association between body mass index and premature mortality

Obesity is still defined on the basis of body mass index (BMI) and BMI in itself is generally accepted as a strong predictor of overall early mortality. However, an inverse association between BMI and mortality has been reported in patients with many disease states and in several clinical settings: hemodialysis, cardiovascular diseases, hypertension, stroke, diabetes, chronic obstructive pulmonary disease, surgery, etc. This unexpected phenomenon is usually called obesity-survival paradox (OP). The contiguous concepts of metabolically healthy obesity (MHO, a phenotype having BMI ≥ 30 but not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance, HOMA, <2.5) and metabolically obese normal weight (MONW, normal-weight individuals displaying obesity-related phenotypic characteristics) have received a great deal of attention in recent years. The interactions that link MHO, MONW and OP with body composition, fat distribution, aging and cardiorespiratory fitness are other crucial areas of research. The article is an introductory narrative overview of the origin and current use of the concepts of MHO, MONW and OP. These phenomena are very controversial and appear as a consequence of the frail current diagnostic definition of obesity based only on BMI. A new commonly established characterization and classification of obesities based on a number of variables is needed urgently.

Mild Hyperbaric Oxygen Inhibits Growth-related Decrease in Muscle Oxidative Capacity of Rats with Metabolic Syndrome

Aim: We examined the effects of mild hyperbaric oxygen on the properties of the soleus muscle in rats with metabolic syndrome.

Methods: Five-week-old metabolic syndrome (SHR/NDmcr-cp, cp/cp) rats were divided into normobaric (CP) and mild hyperbaric oxygen (CP-H) groups (n = 5/group). In addition, 5-week-old Wistar rats were assigned as the normobaric control (WR) group (n = 5). The CP-H group was exposed to 1.25 atmospheres absolute with 36% oxygen for 3 h daily for 16 weeks. Succinate dehydrogenase (SDH) activity and mRNA levels of peroxisome proliferator-activated receptor γ coactivator-1α (Pgc-1α) in the soleus muscle were examined. The fiber type composition, cross-sectional areas, and SDH staining intensity in the soleus muscle were also examined.

Results: The CP-H group showed lower fasting and nonfasting blood glucose, glycated hemoglobin, total cholesterol, triglyceride, insulin, and systolic blood pressure levels; higher adiponectin levels; and higher SDH activity and mRNA levels of Pgc-1α in the muscle than the CP group. Compared with the CP group, the CP-H group had a lower percentage of type I fibers and observed type IIA fibers in the muscle. The CP-H group also had higher SDH staining intensity of type I and type IIC fibers in the muscle than the CP group. No differences in these values were observed in the muscles of the WR and CP-H groups.

Conclusion: Mild hyperbaric oxygen inhibited growth-related increase in blood glucose levels and decrease in muscle oxidative capacity of rats with metabolic syndrome because of improved oxidative metabolism.

Synaptic plasticity and depression: new insights from stress and rapid-acting antidepressants

Depression is a common, devastating illness. Current pharmacotherapies help many patients, but high rates of a partial response or no response, and the delayed onset of the effects of antidepressant therapies, leave many patients inadequately treated. However, new insights into the neurobiology of stress and human mood disorders have shed light on mechanisms underlying the vulnerability of individuals to depression and have pointed to novel antidepressants. Environmental events and other risk factors contribute to depression through converging molecular and cellular mechanisms that disrupt neuronal function and morphology, resulting in dysfunction of the circuitry that is essential for mood regulation and cognitive function. Although current antidepressants, such as serotonin-reuptake inhibitors, produce subtle changes that take effect in weeks or months, it has recently been shown that treatment with new agents results in an improvement in mood ratings within hours of dosing patients who are resistant to typical antidepressants. Within a similar time scale, these new agents have also been shown to reverse the synaptic deficits caused by stress.

Fasting serum insulin levels and insulin resistance are associated with blood rheology in Japanese young adults without diabetes

Objectives

To evaluate fasting serum insulin levels and insulin resistance, and their association with blood rheology, in Japanese young adults without diabetes.

Methods

Blood samples were analysed and blood rheology was estimated using haematological parameters. Whole blood passage time was measured using a Hitachi MC-FAN^© microchannel array flow analyser.

Results

Out of 151 subjects (mean age, 24.1 ± 1.5 years), fasting serum insulin levels and insulin resistance (using homeostasis model assessment-estimated insulin resistance [HOMA-IR]), were positively correlated with longer whole blood passage times and higher values for haematocrit (Hct), haemoglobin (Hb), fibrinogen, body weight, body mass index (BMI), triglycerides, and low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, and were negatively correlated with HDL-C. Whole blood passage time correlated with body weight, BMI, LDL-C/HDL-C ratio, Hct, Hb, white blood cell (WBC) count, platelet count, fibrinogen, fasting serum insulin levels, and HOMA-IR. Multiple regression analysis revealed that whole blood passage time was independently associated with Hct, fibrinogen levels, and WBC count.

Conclusions

Fasting serum insulin levels and insulin resistance were associated with blood rheology, and may influence blood rheology by modulating haematological parameters and lipid parameters in young adults without diabetes.

Association of adiponectin and metabolic syndrome in adolescents: the caspian- III study

Background

This study aimed to investigate the associations between metabolic syndrome (Mets) and adiponectin concentrations in Iranian adolescents.

Methods

This study was conducted as a sub-study of a national school- based surveillance program in 10–18 year- old students from 27 provinces in Iran. Plasma adiponectin was measured in 180 randomly selected participants. Metabolic syndrome (Mets) was defined based on the Adult Treatment Panel III (ATP- III) criteria modified for the pediatric age group. Multiple logistic regression analyses were used to evaluate the association between adiponectin and cardiometabolic risk factors.

Results

The median of adiponectin concentrations was significantly lower among participants with Mets [2.95 μg/ml (interquartile range 2.72–3.30)] compared with subjects without Mets [4.55 μg/ml (interquartile range 3.02–5.75)]. Adiponectin showed significant negative association with higher number of Mets components (P- trend < 0.05). Significant correlations were observed between adiponectin concentrations and metabolic parameters, except blood pressure.

Significant inverse association existed between adiponectin levels and presence of Mets (OR, 0.21; 95%CI: 0.10–0.45; p < 0.001). In multivariate models, this association remained significant after adjustment for other risk factors (OR, 0.18; 95%CI: 0.07–0.47; p < 0.001.

Conclusions

Adiponectinhas inverse association with cardiometabolic parameters in Iranian adolescents, and it is a determinant of Mets independent of other risk factors. These findings can be used in comparison with other ethnic groups. Further longitudinal studies are necessary to assess the clinical impact of such inverse association.

Metabolic syndrome and incident peripheral artery disease - the Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

We evaluated whether metabolic syndrome (MetS) is associated with an increased incidence of lower extremity peripheral artery disease (PAD) in community dwelling people free of clinical cardiovascular disease at baseline. We assessed whether higher levels of inflammatory biomarkers may mediate the association of MetS with incident PAD.

METHODS

MetS was defined at baseline as the presence of three or more of the following components: elevated waist circumference, triglycerides ≥150 mg/dL, reduced high-density lipoprotein (HDL) cholesterol, blood pressure ≥130/85 mm Hg or taking blood pressure medication, and fasting glucose ≥100 mg/dL and <126 mg/dL. People with diabetes were excluded. Incident New PAD was defined among people with a normal ankle brachial index (ABI) at baseline (i.e. baseline ABI of 0.90 to 1.40) and consisted of one of the following outcomes during 3-year follow-up: ABI decline to < 0.90 combined with a decline ≥0.15 or medical record confirmed PAD outcome. Multivariable Poisson regression was used to estimate the association between MetS and incident PAD.

RESULTS

Among 4817 participants without PAD at baseline, 1382 (29%) had MetS. Adjusting for age, sex, race, smoking, physical activity, low-density lipoprotein cholesterol, baseline ABI, and other confounders, 23/1382 (1.7%) people with MetS developed PAD vs. 30/3435 (0.87%) people without MetS (risk ratio = 1.78 [95% Confidence Interval (CI), 1.04 to 2.82], P = 0.031). Adjusting for C-reactive protein, fibrinogen, or interleukin-6 did not attenuate this association.

CONCLUSION

People free of clinical cardiovascular disease with MetS are at increased risk for PAD. Our findings suggest that this association is not mediated by inflammation.