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

Association Between Metabolic Syndrome and Health-Related Quality of Life in Older Adults: Findings from the IRanian Longitudinal Study on Ageing

Objectives: There are some studies without consensus on the association between metabolic syndrome (MetS) and health-related quality of life (HRQoL) and few studies among elderly participants; therefore, the aim of this study is evaluating the association between MetS and HRQoL between elderly participants after adjusting for possible confounding factors. Methods: A cross-sectional analysis was conducted with the data from baseline phase of the IRanian Longitudinal Study on Ageing. The MetS diagnosis was conducted based on the National Cholesterol Education Program Adult Treatment Panel III guidelines. The participants were 3452 subjects aged ≥60 years with and without MetS. The Prospective Epidemiological Research Studies in Iran version of the SF-12 questionnaire was used to examine subjects' perspectives on their well-being and general health level. The association between MetS and HRQoL was evaluated through multivariable linear regression model after adjusting for possible covariates. Results: MetS independently had an inverse association with subscales of HRQoL including physical functioning, physical problems, general health, social functioning, and emotional problems, even after fully adjusting for studied confounding factors. An inverse association was also observed between MetS and both mental component summary and physical component summary in the fully adjusted model. Conclusion: Older adults with MetS had a relatively worse physical and mental HRQoL in comparison with individuals without MetS. Independent of any underlying factors, the inverse association of MetS with HRQoL emphasizes the necessity of routine screening and treatment of MetS in older populations.

Depression and NAFLD risk: A meta-analysis and Mendelian randomization study

BACKGROUND

Both depression and nonalcoholic fatty liver disease (NAFLD) have a high global prevalence. Growing evidence suggests an association between depression and NAFLD, while the association remains unclear. Thus, in this study, we aimed to explore the effect of depression on the risk of developing NAFLD.

METHODS

The meta-analysis examined the association between depression and the risk of NAFLD by including observational studies. Relevant studies were searched in PubMed, Embase, the Cochrane Library, and Web of Science. Then a two-sample Mendelian randomization (MR) analysis was performed to explore causal association using genetic instruments identified from a genome-wide association study.

RESULTS

Six eligible studies were included in the meta-analysis, involving 289,22 depression cases among 167,554 participants. Meta-analysis showed a significant association between depression and a higher risk of developing NAFLD (OR = 1.14, 95 % CI: [1.05, 1.24], P = 0.002). However, we found no convincing evidence supporting a causal role of genetically predicted depression with NAFLD risk (OR = 0.861, 95 % CI: [0.598, 1.238], P = 0.420).

LIMITATIONS

The insufficient number of included studies, the use of summary-level data, and restrictions on population sources are the major limiting factors.

CONCLUSIONS

Meta-analysis and MR analysis demonstrated inconsistent results on the relationship between depression and a high risk of developing NAFLD. Specifically, meta-analysis confirmed that depression increases the risk of developing NAFLD, while MR analysis did not support a causal association between genetically determined depression and the risk of NAFLD.

Sex- and Age-Specific Associations Between Metabolic Syndrome and Future Functional Disability in the Japanese Older Population

Whether the association between metabolic syndrome (MetS) and functional disability differs depending on sex or age remains unknown. To determine the association between MetS and functional disability in older people separately by sex and age groups. A total of 11 083 participants (4407 men and 6676 women) aged 65 years or over without functional disability were enrolled. MetS was defined according to the revised NCEP ATP III guidelines. Functional disability was defined by a new certification in the long-term care insurance in Japan. Cox proportional hazards models were used to assess the risk of functional disability with adjustment for possible confounding factors. Over the mean observation period of 10.5 years, 1282 men and 2162 women experienced functional disability. For those aged 65 to 74 years, HRs (95% CIs) for functional disability in the MetS group were 1.33 (1.07-1.66) in men and 1.15 (1.000-1.32) in women. For those aged 75 years or older, there was no significant association in men or women. In subjects with a severe care need level, there was a marginal significant association in men aged 65 to 74 years. Among the MetS components that independently increased the risk of functional disability were glucose intolerance and elevated blood pressure (men and women aged 65-74 years), obesity (women aged 65-74 years), and glucose intolerance (women aged 75 years or older). MetS contributed to an increase in a high risk of future functional disability among individuals aged 65 to 74 years. In this age group, improvement of lifestyle, health promotion and interventions for MetS from middle age may prevent future functional disability.

Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury

PURPOSE OF REVIEW

Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure.

RECENT FINDINGS

PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250-300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI.

SUMMARY

To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250-300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.

Milk kefir drink may not reduce depression in patients with non-alcoholic fatty liver disease: secondary outcome analysis of a randomized, single-blinded, controlled clinical trial

BACKGROUND

Depression is prevalent among individuals with non-alcoholic fatty liver disease (NAFLD) and can cause poor health outcomes. Moreover, a solid bilateral association between NAFLD and depression has been shown, which may alleviate by kefir consumption. Thus, we aimed to investigate the effect of milk kefir drinks on the depression status of individuals with NAFLD.

METHODS

In a secondary outcome analysis of a randomized, single-blinded, controlled clinical trial, 80 adults with grades 1 to 3 of NAFLD were included in an 8-week intervention. Participants were randomly assigned to Diet or Diet + kefir groups to either follow a low-calorie diet or a low-calorie diet along with a 500 cc milk kefir drink daily. The participants' demographic, anthropometric, dietary, and physical data were recorded before and after the study. Depression status was assessed using the Persian format of the second version of the Beck Depression Inventory (BDI-II-Persian) at the baseline and after 8 weeks of intervention.

RESULTS

Overall, 80 participants aged 42.87 ± 10.67 years were included in the analysis. The data on the baseline demographic, dietary, and physical activity of the groups were not significantly different. During the study, participants in Diet + Kefir group had a significantly decreased energy (P = 0.02), carbohydrate (P = 0.4), and fat consumption (P = 0.4). However, during the study, the depression score was not significantly reduced in the Diet group, the Diet + Kefir group showed a significant reduction in depression (P = 0.02). However, between-group analyses for changes in depression were not significant (P = 0.59).

CONCLUSION

Consumption of milk kefir drink for 8 weeks may not reduce depression symptoms in adults with NAFLD.

TRIAL REGISTRATION

The trial was registered at IRCT.ir as IRCT20170916036204N6 (August 2018).

Linking Nonalcoholic Fatty Liver Disease and Brain Disease: Focusing on Bile Acid Signaling

A metabolic illness known as non-alcoholic fatty liver disease (NAFLD), affects more than one-quarter of the world's population. Bile acids (BAs), as detergents involved in lipid digestion, show an abnormal metabolism in patients with NAFLD. However, BAs can affect other organs as well, such as the brain, where it has a neuroprotective effect. According to a series of studies, brain disorders may be extrahepatic manifestations of NAFLD, such as depression, changes to the cerebrovascular system, and worsening cognitive ability. Consequently, we propose that NAFLD affects the development of brain disease, through the bile acid signaling pathway. Through direct or indirect channels, BAs can send messages to the brain. Some BAs may operate directly on the central Farnesoid X receptor (FXR) and the G protein bile acid-activated receptor 1 (GPBAR1) by overcoming the blood-brain barrier (BBB). Furthermore, glucagon-like peptide-1 (GLP-1) and the fibroblast growth factor (FGF) 19 are released from the intestine FXR and GPBAR1 receptors, upon activation, both of which send signals to the brain. Inflammatory, systemic metabolic disorders in the liver and brain are regulated by the bile acid-activated receptors FXR and GPBAR1, which are potential therapeutic targets. From a bile acid viewpoint, we examine the bile acid signaling changes in NAFLD and brain disease. We also recommend the development of dual GPBAR1/FXR ligands to reduce side effects and manage NAFLD and brain disease efficiently.

Depression and non-alcoholic fatty liver disease: Association and potential mechanisms

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and is closely related to the high incidence of obesity, metabolic syndrome, type 2 diabetes, arteriosclerotic cardiovascular disease, and colorectal tumor. Depression is a common mental disorder that is characterized by high incidence, high recurrence rate, high disability rate, and high suicide rate, which has serious harm to patients' physical and mental health, reduce the quality of life of patients. In recent years, as more and more attention has been paid to mental health of NAFLD patients, the relationship between NAFLD and depression has become one of the hot research topics. Studies have shown that the incidence of depression in NAFLD patients is higher than that in non-NAFLD patients, and the incidence of NAFLD in depressed patients is also higher. Some research results have been published on the mechanism of comorbidity between the two. This paper reviews the research progress on the correlation and common mechanism between NAFLD and depression, aiming to lay a foundation for further research on the comorbidities of NAFLD and depression, and provide a basis and research direction for the diagnosis and treatment of patients with both comorbidities.

Depression and Metabolic Syndrome: A Narrative Review

We reviewed the literature to investigate the relationship between depression and metabolic syndrome. Major depressive disorder is characterized by a low mood or a loss of interest for longer than two weeks. Metabolic syndrome describes multiple metabolic risk factors including obesity, insulin resistance, dyslipidemia, and hypertension. We divided our findings into environmental, genetic, epigenetic, and biological pathway links between depression and the different aspects of metabolic syndrome. We found various sources linking obesity and metabolic syndrome genetically, environmentally, biological pathway-wise, and, while not fully explored, epigenetically. Diabetes and depression were also found to be linked environmentally with both conditions increasing the risk of the other. Depression was also shown to be linked to cardiovascular complications as it increased the risk of occurrence of such complications in healthy people. These findings have led us to believe that there is a link between depression and metabolic syndrome on various levels, especially obesity.

Association between smell and taste dysfunction and obesity and metabolic syndrome in older adults

Background: Obesity and metabolic syndrome (MS) are prevalent and associated with negative health outcomes in the elderly. There is a need to identify risk factors for these diseases in this population. Methodology: The 2013-14 National Health and Nutrition Examination Survey was used in this study. Adults aged 60 or under were categorized into normosmia, hyposmia, anosmia, and combined anosmia + hyposmia using the Pocket Sniff Test. Taste was evaluated using quinine and NaCl solutions. Multivariate logistic regression models were used to characterize associations between smell and taste status and obesity and MS. Results: In univariate obesity analysis, normosmia, combined anosmia + hyposmia, and 0.32M NaCl taste dysfunction were significant. 0.32M NaCl taste dysfunction remained significant in multivariate analysis. MS was significantly associated with only tongue tip quinine dysfunction in univariate and multivariate analyses. Conclusions: Salty taste dysfunction was found to be negatively associated with obesity while bitter taste dysfunction was found to be positively associated with MS.

Changes in metabolic syndrome affect the health-related quality of life of community-dwelling adults

Metabolic syndrome (MetS) is associated with cardiovascular diseases, type 2 diabetes, chronic renal diseases, and all-cause mortality. Furthermore, MetS is associated with poor health-related quality of life (HRQOL). However, the impact of dynamic changes in MetS on changes in the HRQOL was not previously explored. This was an eight-year, prospective cohort study in which 906 middle-aged adults from Shipai, Taipei in northern Taiwan were enrolled during 2009–2010 (baseline). Of those sampled, 427 participants completed the follow-up investigation after 8 years. The HRQOL was measured using the Short Form Health Survey (SF-36). Other variables including age, sex, marital status, level of education, smoking, alcohol consumption, baseline body mass index, and changes in physical activity were adjusted. Compared with adults who never experienced MetS, adults with persistent MetS had a negative change in mental HRQOL (β − 4.20, 95% CI − 7.54 to − 0.86, p = 0.01). The negative changes of persistent MetS on the HRQOL were in the domains of vitality and mental health (β − 4.42, 95% CI − 8.10 to − 0.73 and β − 3.47, 95% CI − 6.90 to − 0.04, respectively). Women and overweight adults were vulnerable to the detrimental effects of persistent MetS. For better HRQOL, more resources should be devoted to reversing MetS in public health.

Is Fatty Liver Associated With Depression? A Meta-Analysis and Systematic Review on the Prevalence, Risk Factors, and Outcomes of Depression and Non-alcoholic Fatty Liver Disease

Background and Aims: Both non-alcoholic fatty liver disease (NAFLD) and depression have a high global prevalence which is projected to increase further. While studies exploring the association have been done, there are conflicting data. This study aims to assess the prevalence and association between depression and NAFLD.

Methods: Medline and Embase were searched from inception to March 3, 2020. Meta-analysis of proportions using the generalized linear mix model was conducted to analyze the pooled prevalence of depression in NAFLD patients. Risk factors for depression in NAFLD patients were evaluated in conventional pairwise meta-analysis.

Results: Ten studies involving 2,041,752 NAFLD patients were included. Pooled prevalence of depression was 18.21% (CI: 11.12–28.38%) in patients with NAFLD and 40.68% (CI: 25.11–58.37%) in patients with non-alcoholic steatohepatitis (NASH). NAFLD resulted in significantly higher risk of development of depression (OR: 1.29, CI: 1.02–1.64, p = 0.03). NASH patients had a significantly higher risk of depression compared with NAFLD patients (RR: 2.83, CI: 2.41–3.32, p < 0.001). Diabetes, body mass index (BMI), female sex, smoking, and history of pulmonary disease were significant risk factors for depression in NAFLD patients.

Conclusion: This study demonstrated a high prevalence of depression in NAFLD patients and a significant association between both conditions. Furthermore, patients with NASH had a significantly higher risk of depression compared with those with NAFLD. Diabetes, BMI, history of lung disease or smoking, and female gender were significant risk factors. Further studies investigating the pathophysiological mechanism underlying depression and NAFLD are needed.

The role of metabolic syndrome in late-life depression over 6 years: The NESDO study

BACKGROUND

Metabolic syndrome (MetS) has been associated with both early- and late-life depression. This study investigated whether baseline MetS and its individual components are associated with the course of depression over six years among older persons with a formal depression diagnosis.

METHODS

Data were used from 378 older persons with a depressive disorder from the Netherlands Study of Depression in Old age (NESDO) with a 6-year follow-up. A formal depression diagnosis according to DSM-IV-TR criteria was ascertained with the Composite International Diagnostic Interview. Severity of depressive symptoms was assessed with the Inventory of Depressive Symptomatology at 6-month intervals. Metabolic syndrome (MetS) was defined according the modified National Cholesterol Education Programme - Adult Treatment Panel III criteria. Primary outcome was time to remission from depression. We applied cox regression analysis for the primary outcome and linear mixed models for secondary analyses.

RESULTS

Neither MetS nor its individual components were associated with time to remission from depression (MetS: HR = 1.03; 95% CI = 0.74 - 1.44; p = 0.85), or with depression severity (MetS: B = 0.02; SE = 0.04; p = 0.64) and course of depressive symptoms (MetS: B = -0.01; SE = 0.01; p = 0.23) over 6-years follow-up.

LIMITATIONS

Attrition was relatively high (46.8%). Furthermore, we only had information on formal depression diagnosis at baseline, 2-year, and 6-year follow-up.

CONCLUSIONS

We found no evidence for an effect of baseline presence of metabolic dysregulation on the course of formally diagnosed depression in older persons. Metabolic syndrome in depressed patients should be clinically monitored for other reasons than predicting chronicity or severity of depression.

Exposure to polycyclic aromatic hydrocarbons and risk of disability among an elderly population

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants. Exposure to PAHs is associated with several adverse health outcomes. However, no previous study has examined the relationship between PAH exposure and functional dependence in an elderly population. Our aim was to examine whether PAH exposure was associated with functional dependence including total disability, activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) in an elderly population. A total of 5816 elderly adults from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2006 were examined. PAH exposure was measured by urinary biomarkers. Functional dependence was assessed by 19 structured questions. The association between PAH exposures with functional dependence was performed by using a multivariable linear regression model. After adjusting for pertinent variables, positive associations were observed between the total number of disabilities and 2-naphthalene and 1-pyrene quartiles (all P_trend < 0.05). There was a dose-dependent relationship between 1-pyrene quartiles and all functional dependence domains, and the higher quartile of 1-pyrene was more closely associated with functional impairment (all P_trend < 0.05). PAH exposure is associated with functional dependence in American elderly adults. Future research is needed to bring to light the pathophysiological underlying mechanisms related to these findings.

Predictors of metabolic syndrome in community-dwelling older adults

Objectives

The metabolic syndrome has been associated with a variety of individual variables, including demographics, lifestyle, clinical measures and physical performance. We aimed to identify independent predictors of the prevalence and incidence of metabolic syndrome in a large cohort of older adults.

Methods

The Longitudinal Aging Study Amsterdam is a prospective cohort including community-dwelling adults aged 55–85 years. Metabolic syndrome was defined according to criteria of the National Cholesterol Education Program Adult Treatment Panel III. The incidence of metabolic syndrome was calculated over a period of three years. Stepwise backward logistic regression analyses were used to identify predictors, including variables for demographics, lifestyle, clinical measures and physical performance, both in a cross-sectional cohort (n = 1292) and a longitudinal sub-cohort (n = 218).

Results

Prevalence and incidence of metabolic syndrome were 37% (n = 479) and 30% (n = 66), respectively. Cross-sectionally, heart disease (OR: 1.91, 95% CI: 1.37–2.65), peripheral artery disease (OR: 2.13, 95% CI: 1.32–3.42), diabetes (OR: 4.74, 95% CI: 2.65–8.48), cerebrovascular accident (OR: 1.92, 95% CI: 1.09–3.37), and a higher Body Mass Index (OR: 1.32, 95% CI: 1.26–1.38) were significant independent predictors of metabolic syndrome. Longitudinally, Body Mass Index (OR: 1.16, 95% CI: 1.05–1.27) was an independent predictor of metabolic syndrome.

Conclusion

Four age related diseases and a higher Body Mass Index were the only predictors of metabolic syndrome in the cross-sectional cohort, despite the large variety of variables included in the multivariable analysis. In the longitudinal sub-cohort, a higher Body Mass Index was predictive of developing metabolic syndrome.

Health-Related Quality of Life in Tehran Lipid and Glucose Study

CONTEXT

Beyond the objective outcomes of metabolic syndrome (MetS), the association between this syndrome and its patient-centered outcomes need to be investigated in Middle-Eastern countries. This report aims to summarize the Tehran lipid and glucose study (TLGS) findings regarding the association between MetS and health-related quality of life (HRQoL) and its influential factors through the past decade.

EVIDENCE ACQUISITION

The current review has been conducted on the TLGS published data regarding different aspects of the association between MetS and HRQoL in adult participants through the last decade. To assess HRQoL, the Iranian version of short form health survey (SF-36) was used. To define MetS the most commonly used insulin resistance (IR)-and waist circumference (WC) - based MetS definitions have been applied in the publications reviewed.

RESULTS

As a whole, MetS was a determinant of poor physical HRQoL only in women (OR: 1.78; 95% CI: 1.21 - 2.61), particularly in those with more component of MetS (P < 0.001). Results further showed that only reproductive aged women with MetS were more likely to report poor PCS compared to those without MetS even after adjusting for age (OR: 1.7, 95% CI: 1.0 - 3.0; P < 0.05). Different structures of MetS and physical HRQoL constructs in men and women as well as age and smoking with significant gender-specific effects on mental HRQoL were factors responsible for the gender specific pattern observed. Considering the duration of MetS, only women with intermittent MetS indicated higher risk for reporting poor PCS (OR: 2.75, 95% CI: 1.19 - 6.37; P < 0.001) compared to those without MetS. The observed sex-specific pattern used to detect poor HRQoL in those with MetS was confirmed by all WC-based definitions except for the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definition. However, none of IR-based definitions could detect poor physical and mental HRQoL in either gender.

CONCLUSIONS

In summary, in the TLGS population, the association between MetS and HRQoL followed a sex specific pattern, mainly significant only in women and in the physical aspect.

Disability and Its Influencing Factors among the Elderly in a County, Guangxi Province, China

Objectives: This study aims to understand the disability status of the elderly residents of a County (Guangxi Province, China) and explore its influencing factors. Methods: Respondents consisted of 2300 elderly people aged 60 and above from three townships in the county we studied. The Activities of Daily Living (ADL) Scale was used to assess the disability of the elderly sample. Chi-square test was applied to compare the disability rate among the elderly with different demographic characteristics. The graph showed the disability rates of ADL, six items of Physical Activities of Daily Living (PADL) and eight items of Instrumental Activities of Daily Living (IADL) at different ages. Binary logistic regression was used to analyze the influencing factors of disability rate among the elderly. Results: The disability rates of ADL, PADL, and IADL in the elderly were 43.4%, 11.6%, and 42.4%, respectively. As with the increase in age, the disability rates of ADL, IADL, PADL, and their 14 items gradually increased (p < 0.05), with walking, using the telephone, and using public vehicles having higher disability rates than other items. The influencing factors of ADL disability were gender (OR = 0.579, 95%CI = 0.441⁻0.759), age (OR = 2.270, 95%CI = 1.867⁻2.759; OR = 4.719, 95%CI = 2.998⁻7.429; OR = 6.249, 95%CI = 3.667⁻10.648), educational level (OR = 2.844, 95%CI = 2.076⁻3.897; OR = 1.677, 95%CI = 1.246⁻2.230), and having metabolic syndrome (MetS) (OR = 1.298, 95%CI = 1.044⁻1.613). Compared with ADL, the influencing factor of PADL disability was gender, whereas that of IADL disability was whether someone had MetS. Conclusions: With age, the possibility of ADL, PADL, and IADL damage in the elderly is higher. Gender, age, educational level, the number of chronic diseases, and whether someone has MetS might be the influencing factors of disability. Interventions should be taken from a variety of sources specific to the content of each entry.

Depression and metabolic syndrome in the older population: A review of evidence

BACKGROUND

Metabolic syndrome (MetS) has been shown to be associated with depression in older adults but the results are mixed. We summarized and evaluated the association between depression and MetS in people aged 60 years or over.

METHODS

Relevant published studies from January 1997 to July 2017 were identified by searching two electronic databases: PubMed/Medline and EMBASE. Observational studies were considered.

RESULTS

Twelve studies were included in the systematic review. Depression seemed to be related with MetS in the majority of the studies (10/12 = 83.3%). As far as the longitudinal studies are concerned, the onset of depression was related to MetS in 2 out of 3 studies (66.6%), while a relation between chronicity of depression and MetS was reported (1 study). Regarding cross-sectional studies, 7 out of 9 (77.7%) concluded that there was a positive association between depression and MetS. Mixed evidence was found among studies concerning the association between depression and the individual components of MetS. Four out of ten studies (40%) reported that depression was significantly associated with the waist circumference, a component of MetS.

LIMITATIONS

There was a high degree of heterogeneity between studies regarding their design. Only studies written in English, from peer-reviewed journals were included.

CONCLUSIONS

Depression seemed to be significantly associated with MetS in people aged 60 years or over. Among the components of MetS, abdominal obesity seemed to be associated more strongly and consistently with depression. The direction of the causality and mechanisms underlying the relationship are still largely unknown.

Metabolic syndrome and disability in Chinese nonagenarians and centenarians

BACKGROUND

Little is known about the relationship between metabolic syndrome (MetS) and disability in the oldest old.

AIMS

To investigate the possible association between MetS and disability among community-dwelling older adults aged ≥ 90 years.

METHODS

This was a secondary analysis of a cross-sectional study. MetS was defined by the International Diabetes Federation Criteria. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities were evaluated using the physical self-maintenance scale and the Lawton-Brody IADL scale, respectively.

RESULTS

We included 725 participants (mean age: 93.8 ± 3.1 years). The prevalence of MetS was 13.0% in women and 9.8% in men, respectively. In women, ADL and IADL disabilities were more prevalent in the MetS group compared with the non-MetS group (ADL: 43.1 vs. 30.6%, p = 0.044; IADL: 73.8 vs. 59.8%, p = 0.030). After adjusting for relevant confounders, participants with MetS was associated with an increased risk of either ADL (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.22-3.45) or IADL disability (OR 2.12, 95% CI 1.31-4.78) compared with those without MetS. In men, similar results were found with respect to the prevalence of ADL or IADL disability and the adjusted ORs, but the results were not statistically significant.

CONCLUSION

MetS is associated with an increased risk of either ADL or IADL disability in a study population of long-lived adults, especially in women.

Fitness Is Independently Associated with Central Hemodynamics in Metabolic Syndrome

PURPOSE

Fit individuals with metabolic syndrome (MetS) have lower mortality risk compared with less fit counterparts, despite the presence of obesity as a component of the syndrome. To understand the importance of fitness in treating this condition, we examined the association of fitness and fatness with central hemodynamic indices that are known independent predictors of cardiovascular events.

METHODS

Sixty-eight individuals with MetS participated in this cross-sectional study. Central hemodynamics is calculated from radial applanation tonometry and comprised aortic reservoir pressure, backward pressure wave (Pb), reflection magnitude (RM), and augmentation index at 75 bpm (AIx75). Cardiorespiratory fitness (CRF) and body fat percentage (BF%) were determined via indirect calorimetry during maximal exercise testing and dual-energy x-ray absorptiometry, respectively.

RESULTS

CRF was inversely associated with aortic reservoir pressure (r = -0.29, P = 0.02), Pb (r = -0.42, P < 0.001), RM (r = -0.48, P < 0.001), and AIx75 (r = -0.65, P < 0.001). BF% was also correlated with AIx75 (r = 0.37, P < 0.05) and RM (r = 0.36, P < 0.005) but at a weaker association compared with CRF. Multiple regression analysis revealed CRF as a predictor of aortic reservoir pressure (β = -0.52, P = <0.01), Pb (β = -0.41, P < 0.03), and AIx75 (β = -0.45, P = 0.01), independent of BF% and other confounding factors.

CONCLUSIONS

CRF predicts central hemodynamics independent of BF% and other confounding factors. This suggests that CRF improvement may be a higher priority when compared with fat loss for lowering the risk of cardiovascular mortality in MetS individuals.

The metabolic syndrome and 10-year cognitive and functional decline in very old men. A population-based study

OBJECTIVES

To describe longitudinal relationships of metabolic syndrome (MetS) to cognitive decline and functional disability in a sample of older non-institutionalized men.

METHODS

data from 1991 to 2000 of the Italian cohorts of the Finland, Italy, the Netherlands, Elderly (FINE) study, were used. Global cognitive function and functional disability, defined as limitations in mobility, basic (ADLs) and instrumental activities of daily living (IADLs) were screened in 1991 and 2000. MetS was defined according to the NCEP ATP-III criteria.

RESULTS

The study sample consisted of 195 men, baseline age 76.1±3.1years. Baseline MetS was prospectively associated with greater 10-year cognitive and functional decline in ADLs and IADLs. After multiple adjustment including age, education, marital status, ApoE ε4 allele, cerebrovascular disease and initial cognitive and depressive status, MetS predicted cognitive decline (B=-1.684, 95%CI=-2.202 to -1.167, p<0.001) and risk of IADLs (OR=1.09, 95% CI=1.01-1.20, p=0.048) and ADLs disability (OR=1.35, 95%CI=1.12-1.62, p<0.001). Interestingly, such associations were not attributable to individual altered components of MetS nor to their sum. Incident disability in ADLs and IADLs were not explained by parallel decline in cognitive function.

CONCLUSIONS

MetS as an entity was associated with accelerated cognitive and functional decline in a population-based sample of very old men.

Metabolic syndrome and quality of life: a systematic review

Objectives:

to present currently available evidence to verify the association between metabolic syndrome and quality of life.

Method:

Cochrane Library, EMBASE, Medline and LILACS databases were studied for all studies investigating the association with metabolic syndrome and quality of life. Two blinded reviewers extracted data and one more was chosen in case of doubt.

Results:

a total of 30 studies were included, considering inclusion and exclusion criteria, which involved 62.063 patients. Almost all studies suggested that metabolic syndrome is significantly associated with impaired quality of life. Some, however, found association only in women, or only if associated with depression or Body Mass Index. Merely one study did not find association after adjusted for confounding factors.

Conclusion:

although there are a few studies available about the relationship between metabolic syndrome and quality of life, a growing body of evidence has shown significant association between metabolic syndrome and the worsening of quality of life. However, it is necessary to carry out further longitudinal studies to confirm this association and verify whether this relationship is linear, or only an association factor.

Components of the metabolic syndrome and depressive symptoms in community-dwelling older people: the Bambuí Cohort Aging Study

Objective:

To investigate the moderating effect of an increasing number of clustered metabolic syndrome (MetS) components on the association between MetS and depressive symptoms in a population-based cohort of older adults in Brazil.

Methods:

This analysis used data from the Bambuí Cohort Aging Study. Participants in this cross-sectional study comprised 1,469 community-dwelling older people aged ≥ 60 years. Analyses were performed to assess both the association between depressive symptoms and each individual MetS component and the association between depressive symptoms and clustering of an increasing number of MetS components.

Results:

High triglyceride level was the individual component that showed the strongest association with depressive symptoms (odds ratio [OR]: 1.47; 95% confidence intervals [95%CI] 1.19-1.81; p < 0.0001). Only the presence of three MetS components was associated with depressive symptoms (OR = 1.53; 95%CI 1.05-2.23; p = 0.025). No graded association was detected between increasing number of clustered MetS components and depressive symptoms.

Conclusions:

Increasing the number of MetS components did not impact the association with depressive symptoms. The association between high triglyceride level and depressive symptoms highlights the relevance of lipid metabolism abnormalities for the emergence of depressive symptoms in older adults.

Components of Metabolic Syndrome and the Risk of Disability among the Elderly Population

The direct relationship between metabolic syndrome (MetS) and function disability has not been established. The aim of the present study was to investigate the relationship between MetS and functional disability in the elderly. This retrospective observational study included 1,778 participants aged 60–84 years from the National Health and Nutrition Examination Survey (1999–2002). Impairments in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) were assessed. Additionally, the associations between the features of MetS and disability were evaluated. MetS was associated with a high prevalence of functional dependence in ADL, IADL, LSA, LEM, and GPA. After adjusting for potential confounders, a high number of MetS components was found to be associated with increased disability (P = 0.002). Additionally, associations were observed between MetS components, including abdominal obesity and high triglycerides levels, and functional dependence in ADL, IADL, LSA, LEM, and GPA (all, P < 0.05). A linear increase in disability might be associated with the number of MetS components in an elderly population. Additionally, MetS abnormalities, particularly abdominal obesity and high triglycerides levels, might be highly predictive of functional dependence in the elderly.

Major depressive disorder and cardiometabolic disease risk among sub-Saharan African adults

OBJECTIVE

We sought to evaluate the extent to which major depressive disorder (MDD) is associated with cardiometabolic diseases and risk factors.

METHODS

This was a cross-sectional epidemiologic study of 1924 employed adults in Ethiopia. Structured interview was used to collect sociodemographic data, behavioral characteristics and MDD symptoms using a validated Patient Health Questionnaire-9 (PHQ-9) depression scale. Fasting blood glucose, insulin, C-reactive protein, and lipid concentrations were measured using standard approaches. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

A total of 154 participants screened positive for MDD on PHQ-9 (8.0%; 95% CI: 6.7-9.2%). Among women, MDD was associated with more than 4-fold increased odds of diabetes (OR=4.14; 95% CI: 1.03-16.62). Among men the association was not significant (OR=1.12; 95% CI: 0.63-1.99). Similarly, MDD was not associated with metabolic syndrome among women (OR=1.51; 95% CI: 0.69-3.29) and men (OR=0.61; 95% CI: 0.28-1.34). Lastly, MDD was not associated with increased odds of systemic inflammation.

CONCLUSION

The results of our study do not provide convincing evidence that MDD is associated with cardiometabolic diseases among Ethiopian adults. Future studies need to evaluate the effect of other psychiatric disorders on cardiometabolic disease risk.

Prevalence of metabolic syndrome and its association with physical capacity, disability, and self-rated health in Lifestyle Interventions and Independence for Elders Study participants

OBJECTIVES

To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self-rated health in older adults at high risk of mobility disability, including those with and without diabetes mellitus.

DESIGN

Cross-sectional analysis.

SETTING

Lifestyle Interventions and Independence for Elders (LIFE) Study.

PARTICIPANTS

Community-dwelling sedentary adults aged 70 to 89 at high risk of mobility disability (Short Physical Performance Battery (SPPB) score ≤9; mean 7.4 ± 1.6) (N = 1,535).

MEASUREMENTS

Metabolic syndrome was defined according to the 2009 multiagency harmonized criteria; outcomes were physical capacity (400-m walk time, grip strength, SPPB score), disability (composite 19-item score), and self-rated health (5-point scale ranging from excellent to poor).

RESULTS

The prevalence of MetS was 49.8% in the overall sample (83.2% of those with diabetes mellitus, 38.1% of those without). MetS was associated with stronger grip strength (mean difference (Δ) = 1.2 kg, P = .01) in the overall sample and in participants without diabetes mellitus and with poorer self-rated health (Δ = 0.1 kg, P < .001) in the overall sample only. No significant differences were found in 400-m walk time, SPPB score, or disability score between participants with and without MetS, in the overall sample or diabetes mellitus subgroups.

CONCLUSION

Metabolic dysfunction is highly prevalent in older adults at risk of mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, or self-reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high-risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group.

Metabolic syndrome and functional ability in older age: the InCHIANTI study

BACKGROUND & AIMS

Metabolic syndrome (MetS) is associated with incident disability in middle-aged subjects. We evaluated the association of MetS with functional ability in an older population.

METHODS

We enrolled 1155 participants aged 65+, derived from the InCHIANTI study, and followed for 3 years. MetS was diagnosed according to the National Cholesterol Education Program's ATP-III criteria. Functional ability was estimated using the Katz's activities of daily living (ADLs), and the Lawton and Brody for the instrumental activities of daily living (IADLs) scales. The association between disability and MetS at baseline and after follow-up was assessed by logistic regression.

RESULTS

At baseline, MetS was associated with reduced probability of ADLs disability among participants aged 74+ (OR = .33, 95% CI = .14-.77; p = .010), but not in younger (5.08, 95% CI = .88-29.24; p = .069). Also, MetS was associated with reduced probability of incident ADLs disability (OR = .61, 95% CI .41-.91; p = .016), but neither with prevalent, nor incident IADLs disability.

CONCLUSIONS

In older persons, MetS is associated with reduced probability of prevalent and incident ADLs disability. Whether older persons with MetS should receive treatment and whether the current diagnostic criteria for MetS apply to older individuals need further investigation.

Lack of association of body composition and functionality variables with metabolic syndrome in the elderly

BACKGROUND

The aging process causes alterations in body composition (decrease in lean mass and increase in fat mass), diminution of functionality (strength, mobility, and physical performance), and an increased prevalence of chronic diseases such as metabolic syndrome and obesity. The aim of this study was to investigate the association of body composition and functionality with metabolic syndrome in the elderly.

METHODS

A cross-sectional study was conducted in the Outpatient Clinic of the Geriatric Service of Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul (PUCRS) involving 74 patients (14 males and 60 females). The patients were separated into two groups: Group 1=elderly with metabolic syndrome [through the National Cholesterol Education Program Adult Treatment Panel III (NECP ATP III) criteria; n=34], group 2=elderly without metabolic syndrome (n=40). The variables evaluated included age, gender, body composition (circumferences, skinfold thickness, BMI, muscle and fat thickness and muscle mass), functional variables [hand grip strength, Timed Up and Go Test (TUGT), and Sit-to-Stand Test].

RESULTS

The results showed that elderly individuals with metabolic syndrome had a higher mean of the anthropometric measures (except abdominal skinfold thickness) compared to subjects without metabolic syndrome (P<0.005). We observed significant differences for muscle mass index (higher, P=0.029), TUGT (longer time, P=0.008), and hand grip strength (lower, P=0.015) in elderly with metabolic syndrome compared with subjects without metabolic syndrome. However, when these variables were adjusted for gender, age, and body mass index (BMI), none showed a significant association with metabolic syndrome.

CONCLUSION

We did not observe associations among metabolic syndrome, body composition, and functionality variables.

Diagnostic values of different definitions of metabolic syndrome to detect poor health status in Iranian adults without diabetes

AIMS

This study aimed to compare the diagnostic impact of four definitions of the metabolic syndrome for detection of poor health status in adults without diabetes living in Tehran.

METHODS

A representative sample of 950 individuals (64% women), aged ≥ 20 years, participants of the Tehran Lipid and Glucose Study in 2005-2007, were recruited for the study. Health status was assessed using the Iranian version of the 36-item Short Form Health Survey. We assessed the detectability of poor health status by definitions of the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation, the American Heart Association/National Heart, Lung, and the Blood Institute and the Joint Interim Statement.

RESULTS

Compared with other definitions, the Joint Interim Statement identified more participants (46.9%) having the metabolic syndrome. Using the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation and the Joint Interim Statement, the metabolic syndrome was significantly related to poor physical health status, even after adjustment for confounding variables, in women, but not in men. None of the four definitions of the metabolic syndrome was related to the mental health status in either gender. The receiver operating characteristic curves showed no significant difference in the discriminative power of the metabolic syndrome definitions in detecting poor health status in either gender. However, women showed a higher area under the curve for all definitions, in comparison with men.

CONCLUSION

There was no difference in the four different definitions of the metabolic syndrome in detecting poor health status among Iranian adults.

Prevalence of metabolic syndrome in COPD patients and its consequences

Background

The prevalence of metabolic syndrome in COPD patients and its impact on patient related outcomes has been little studied. We evaluated the prevalence of metabolic syndrome and clinical and functional characteristics in patients with COPD and healthy subjects.

Methods

228 COPD patients and 156 healthy subjects were included. Metabolic syndrome was defined using criteria of the IDF. In all patients spirometry, body composition, functional exercise performance, and mood and health status were assessed. Groups were stratified for BMI and gender.

Results

Metabolic syndrome was present in 57% of the COPD patients and 40% of the healthy subjects. After stratification for BMI, presence of metabolic syndrome in patients with a BMI ≥25 kg/m² was higher than in healthy peers. Patients with metabolic syndrome and a BMI <25 kg/m² had higher BMI, fat free mass index and bone mineral density, and a lower 6MWD than the BMI matched patients without metabolic syndrome. Spirometry, maximal ergometry, mood and health status, and blood gases were not different between those groups. In COPD patients with metabolic syndrome self-reported co-morbidities and medication use were higher than in those without.

Conclusion

Metabolic syndrome is more prevalent in overweight or obese COPD patients than in BMI matched healthy subjects. Metabolic syndrome did not additionally impact patients' functional outcomes, but did impact the prevalence of co-morbidities.

Is persistence of metabolic syndrome associated with poor health-related quality of life in non-diabetic Iranian adults? Tehran Lipid and Glucose Study

AIMS/INTRODUCTION

Previous research showed the association between health-related quality of life and metabolic syndrome (MetS). The present study aimed to examine the impact of persistence of MetS on health-related quality of life in non-diabetic Iranian adults.

MATERIALS AND METHODS

This was a cross-sectional study. A representative sample of 643 non-diabetic individuals (67% female), aged ≥20 years, who participated in the Tehran Lipid and Glucose Study in 2005-2007 were recruited for the study, and categorized into four groups, those without, with transient, with intermittent and with persistent MetS. Health-related quality of life was assessed using the Iranian version of the Short Form Health Survey. MetS was diagnosed using the Joint Interim Statement criteria.

RESULTS

Women with transient, intermittent and persistent MetS scored lower on the Physical Component Summary than those without the syndrome (51.03 ± 1.41, 48.16 ± 1.46 and 46.58 ± 1.29 vs 52.18 ± 1.20) after adjusting for potential confounders (P = 0.04). In women, there was also a significant decreasing trend in the scores of bodily pain (P for trend = 0.006) and general health (P for trend = 0.005) across the study groups. Compared with women without MetS, the odds ratio of reporting poor health-related quality of life for women with intermittent MetS was 2.75 (95% confidence interval 1.19-6.37, P = 0.01). Among men, however, no significant difference was observed in any of the health-related quality of life domains.

CONCLUSIONS

Compared with women without, with transient and with persistent MetS, those with intermittent MetS reported poorer physical health-related quality of life.

Metabolic syndrome and disability: findings from the prospective three-city study

BACKGROUND

Metabolic syndrome (MetS) is a potentially reversible cause of disability in the elderly people. The published literature suggests that the MetS-disability association is likely to be complex, depending on co-existing risk factors and with possible variation for each of the specific MetS components. Further evidence is needed to understand the specific consequences of the MetS as a whole and as a function of its components.

METHODS

Prospective analyses included data from 6,141 participants (60.9% women) aged 65 and older from the Three-City cohort. Mixed logistic models were used to determine associations between MetS (National Cholesterol Education Program Adult Treatment Panel III criteria) and 7-year incident disability measured as social restriction, mobility limitations (Rosow and Breslau scale), and limitations in instrumental and basic activities of daily living.

RESULTS

MetS was associated with incident social restriction (odds ratio = 1.55, 95% CI: 1.14-2.09), limited mobility (odds ratio = 1.52, 95% CI: 1.21-1.90), and instrumental activities of daily living limitations (odds ratio = 1.62, 95% CI: 1.24-2.10) after adjustment for a range of potential sociodemographic, health behavior, and health status confounders at baseline. These associations were independent of chronic conditions, including cardiovascular disease and dementia. There was evidence of associations between MetS components: central obesity, high triglycerides, and elevated fasting glucose and incidence of limitations in mobility and instrumental activities of daily living.

CONCLUSIONS

Our results suggest that the increased risk of mobility and instrumental activities of daily living limitations in the elderly people associated with MetS is over and above that associated with its components.

Falls and functional capacity in the oldest old dwelling in the community

The aim was to verify the association between falls and functional capacity in the oldest old dwelling in the community. This is a community-based cross-sectional study. The population was comprised of elderly citizens aged greater than 80 years, residing in the urban area of Lafaiete Coutinho, in the state of Bahia, Brazil. Data collection was carried out in January of 2011. It was based on home life, using a questionnaire capturing sociodemographic data, fall occurrences and functional capacity utilizing the Katz scale. Data analysis was done through Poisson regression, adopting a significance level of 5%. Ninety-four elderly citizens were interviewed, with an average age of 86.1 years (±6,39); 59.6% of the participants were female. The fall prevalence was 27. 7% and 19. 6% of the participants were classified as dependent for activities of daily living. A strong association was identified between falls and functional activities (RP=2.08; 1.17 - 3.70). Results showed a significantly higher proportion of falls among the functionally dependent oldest old than among the independent elderly.

Metabolic syndrome predicts poor health-related quality of life in women but not in men: Tehran Lipid and Glucose Study

OBJECTIVE

To compare health-related quality of life (HRQOL) in those with and without metabolic syndrome in a general Iranian population.

METHODS

This was a cross-sectional study of HRQOL conducted in a sample of individuals with and without metabolic syndrome using the data obtained from the Tehran Lipid and Glucose Study (TLGS) and information specifically collected for the present investigation. Metabolic syndrome was defined according to the adult treatment panel III (ATPIII) and HRQOL was assessed using the Short Form Health Survey (SF-36). Logistic regression analyses were performed for the whole sample and both sexes while adjusting for potential confounders in order to estimate odds ratios for predicting HRQOL in this population.

RESULTS

In all, 950 participants with (n = 361) and without (n = 589) metabolic syndrome were studied. The mean age of participants was 46.5 +/- 14.4 years. In women, but not in men, metabolic syndrome had an independent role in predicting poor HRQOL. With increase in the number of metabolic syndrome components, there was a significant decreasing trend in women's physical component summary scores.

CONCLUSIONS

The results indicate that metabolic syndrome is associated with poor HRQOL in women but not in men, and the association is formed mainly in relation to physical rather than mental health.

How does metabolic syndrome affect the functional ambulation in stroke patients?

BACKGROUND/AIMS

Metabolic syndrome (MetS) is a risk factor for stroke. However, the role of MetS in stroke rehabilitation has not been assessed. The aim of this study was to evaluate the impact of MetS on rehabilitation from stroke.

MATERIALS AND METHODS

A total of 337 consecutive patients with subacute stroke and 220 age-matched healthy controls were studied. The diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Ambulation levels were evaluated using the Functional Ambulation Classification (FAC) measure. The correlation between MetS and FAC was investigated. The regression analysis included presence of hypertriglyceridemia, high fasting glucose, low high-density lipoprotein cholesterol, hypertension, abdominal obesity, MetS, and age ≯65 years.

RESULTS

The prevalence of MetS in the control group and the ischemic and hemorrhagic stroke groups was 33.2% (n = 73), 59.8% (n = 156), and 68.4% (n = 52), respectively. MetS prevalence was significantly higher in stroke groups compared with the control group (P < .001). FAC and MetS were significantly and negatively correlated in the stroke groups (P < .001, rho = -0.387, for hemorrhagic stroke;P < .001, rho = -0.379, for ischemic stroke). Multivariable logistic regression analysis demonstrated that diastolic tension, MetS presence, and age were found to be independent risk factors for FAC in ischemic stroke groups.

CONCLUSIONS

MetS is associated with worse functional ambulation for both ischemic and hemorrhagic stroke patients. Aggressive rehabilitation can be advocated in the presence of MetS in ischemic stroke patients.

Functional impairment but not metabolic syndrome is associated with depression in older Taiwanese: results from the Social Environment and Biomarkers of Aging Study

OBJECTIVES

This study examined the association of metabolic syndrome, metabolic disorders and functional impairment with depression in older (≥54 years) adults.

DESIGN

A cross-sectional study.

SETTING

Data of this study were from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan (2000).

PARTICIPANTS

A national representative sample of persons 54 years of age or older in Taiwan (N = 1023).

RESULTS

Results showed that the presence of any number of metabolic disorders without functional impairment was not associated with depression. However, the presence of functional impairment regardless of the number of metabolic disorder was associated with a significantly higher risk of depression after adjusting for confounding factors (OR = 5.13, 95% CI = 2.13-12.36) (p<0.05). The presence of a basic Activities of Daily Living (ADL) dependency was significantly associated with a 1.45 times higher likelihood of depression (OR = 1.45, 95% CI = 1.17-1.79) (p<0.05).

CONCLUSIONS

Results suggest that functional impairment, but not metabolic syndrome or metabolic disorders, is associated with depression in older adults. Metabolic syndrome/disorders do not necessarily affect patient's psychological health unless it is accompanied with functional impairment.

[Tendencies of studies addressing the eldest individuals of aged population in the community: a (inter)national systematic review]

The purpose of this study was to identify and analyze the tendencies and types of studies published in Brazil and abroad, involving elders aged>80 years, living in the community. A systematic review of national literature was performed using the LILACS and SciELO databases, and PUBMED and EMBASE for international literature, covering publications of the last two decades. Twelve national and 162 international references were selected. Biological sciences were the prevalent area both at the national (50%) and international (74.1%) levels. All national studies were observational, 91.7% of which were cross-sectional. Of the international studies, 93.3% were observational, 48.1% of which were cross-sectional and 37.6% were cohort studies. The United States were the country responsible for 41.4% of all international publications. Brazil and China were the only developing countries with international publications. Despite the significant number of international scientific publications as of 2005, this fact has not been observed at the national level.

Major depression and the metabolic syndrome

The aim of this study is to characterize the relationship between major depression and the metabolic syndrome in a large community based sample of Australian men and women aged 26-90 years. A lifetime history of major depression was assessed by telephone interview following the DSM-III-R. A current history of metabolic syndrome was assessed following the United States National Cholesterol Education Program Adult Treatment Panel III (NCEP AP-III) guidelines 1 to 3 years later. Logistic regression was used to estimate the association between depression and the metabolic syndrome, and its component criteria, controlling for age, sex and alcohol dependence. There was no association between a lifetime history of major depression and the presence of the metabolic syndrome. There was a weak association between depression and low high-density lipoprotein cholesterol but not with other component criteria of the metabolic syndrome. Despite calls for interventions directed at depression to reduce the onset of the metabolic syndrome there are important failures to replicate in large samples such as this, no consensus regarding the threshold at which depression may pose a significant risk even allowing for heterogeneity across populations, and no consensus regarding confounders that may explain inter-study differences. The absence of any dosage effect of depression on the associated risk for the metabolic syndrome in other unselected samples does not support a direct causal relationship. The call for intervention studies on the basis of the currently published evidence base is unwarranted.

Metabolic syndrome and depressive symptoms among Japanese men and women

OBJECTIVES

Evidence is limited on the relation between metabolic syndrome and depressive symptoms. The aim of this cross-sectional study was to investigate the association between metabolic syndrome and depressive symptoms in a Japanese working population.

METHODS

The study subjects comprised 458 municipal employees (age range 21-67 years) from two municipal offices in Japan. A modified version of the criteria of the National Cholesterol Education Program Adult Treatment Panel III was used to define metabolic syndrome. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES_D) scale.

RESULTS

Depressive symptoms (CES_D ≥ 16) in both the male and female subjects were not significantly associated with metabolic syndrome nor with each component of metabolic syndrome. In men, high fasting glucose was associated with increased prevalence of severe depressive state (CES_D ≥ 23).

CONCLUSIONS

Metabolic syndrome may not be associated with depressive status among Japanese employees.

Causes of decreased activity of daily life in elderly patients who need daily living care

AIM

The causes of decreased activity of daily life (ADL) in elderly patients include cerebrovascular diseases, bone fracture by falls, and dementia. The present study was conducted among elderly patients with decreased ADL who were hospitalized in nursing wards in order to investigate the causes of becoming early bedridden and to determine precautionary measures against decreased ADL.

METHODS

The study subjects were 224 elderly patients with decreased ADL (mean age: 83.3 ± 8.0 years) and 49 outpatients without decreased ADL (mean age: 76.8 ± 5.3 years). Current age, age at the start of ADL decrease, medical history and history of smoking were investigated.

RESULTS

In the groups with decreased ADL, current age and the age of becoming bedridden in non-diabetic versus diabetic groups were 84.7 ± 7.9 versus 80.3 ± 7.5 and 82.7 ± 8.3 versus 77.6 ± 8.0 years, respectively, both showing significantly lower values in the diabetic group (P < 0.05). Multiple regression analysis revealed that sex difference and diabetes were the factors determining the age of becoming early bedridden. Diabetic patients with smoking habit were significantly younger than diabetic and non-diabetic patients without smoking habit.

CONCLUSION

Sex difference, smoking habit and presence of diabetes mellitus are independent risk factors of becoming early bedridden. Therefore, the major targets of medical care among elderly should be diabetic men with a smoking habit to lower the risks of decreased ADL.

Gender differences among middle-aged Koreans for health-related quality of life related to metabolic syndrome

PURPOSE

The influence of metabolic syndrome (MS) on quality of life has not been studied much among Asians, especially Koreans. This study compared the association between MS and health-related quality of life (HRQL) by gender for middle-aged Koreans.

METHODS

We used data containing 2,264 adults between the ages of 40 and 59 years who participated in the 2005 Korean National Health and Nutrition Examination Surveys. The criteria for MS were defined by the National Cholesterol Education Program Adult Treatment Panel III. HRQL was measured by the EQ-5D preference score. Good health status was defined as having higher scores than the mean EQ5D preference score. We used logistic regression methods to adjust for socioeconomic covariates and survey sample design.

RESULTS

The mean EQ-5D preference score was significantly lower in women with MS compared to women without MS (0.81 vs. 0.88), but this was not the case for men (0.92 vs. 0.92). These consistent results were observed after adjusting for socioeconomic covariates. In multiple logistic analyses, women with MS had a lower likelihood of having good health status compared to women without MS (OR = 0.60, 95% CI 0.38-0.96). For men, there was no difference.

CONCLUSIONS

Our study identified a nationally representative health preference score for MS in Korean middle-aged men and women while highlighting a gender difference that merits more research (i.e., MS appeared to have a significant negative impact for women's HRQL, but not for men). At the very least, future studies should consider gender differences when addressing quality of life among patients with MS.

Depressive morbidity and gender in community-dwelling Brazilian elderly: systematic review and meta-analysis

BACKGROUND

Although studies indicate that community-dwelling elderly have a lower prevalence of major depression compared with younger age groups, prevalence estimates in Brazil show that clinically significant depressive symptoms (CSDS) and depression are frequent in the older population. However, a systematic review and meta-analysis of prevalence of and factors associated with depressive disorders and symptoms in elderly Brazilians has not previously been reported. The aims were (i) to perform a survey of studies dating from 1991 to 2009 on the prevalence of depressive disorders and CSDS in elderly Brazilians residing in the community; (ii) to determine depression prevalence and identify associated factors; and (iii) develop a meta-analysis to indicate the combined prevalence and the influence of gender on depressive morbidity in this population.

METHODS

Studies were selected from articles dated between January 1991 and May 2009, extracted from Medline, LILACS and SciELO databases.

RESULTS

A total of 17 studies were found, 13 with CSDS, 1 with major depression alone and 3 with major depression and dysthymia, involving the evaluation of 15,491 elderly people. The average age of participants varied between 66.5 and 84.0 years. Prevalence rates of 7.0% for major depression, 26.0% for CSDS, and 3.3% for dysthymia were found. The odds ratios for major depression and CSDS were greater among women. There was a significant association between major depression or CSDS and cardiovascular diseases.

CONCLUSION

The review indicates greater prevalence of both major depression and CSDS compared to rates reported in the international literature, while the prevalence of dysthymia was found to be similar. The high prevalence of CSDS and its significant association with cardiovascular diseases reinforces the importance of evaluating subthreshold depressive symptoms in the elderly in the community.

White matter fractional anisotropy is related to processing speed in metabolic syndrome patients: a case-control study

Background

Metabolic Syndrome (MetSd) is a cluster of vascular risk factors that may influence cerebrovascular pathology during aging. Recently, microstructural white matter (WM) changes detected by diffusion tensor imaging (DTI) and processing speed deficits have been reported in MetSd patients. We aimed to test the relationship between WM alteration and cognitive impairment in these patients.

Methods

The sample comprised 38 subjects (19 patients aged between 50 and 80 years old, and 19 controls). All patients fulfilled National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria for MetSd. Speed of information processing was measured by the Symbol Digit Modalities Test (SDMT) and reaction time (RT) on the Continuous Performance Test (CPT-II) and the Grooved Pegboard Test (GPT). DTI images were acquired in a 3 Tesla Siemens Trio scanner. Voxelwise statistical analysis of the fractional anisotropy (FA) data was performed using the Tract-Based Spatial Statistics part of the FMRIB Software Library. A correlation analysis was performed between processing speed variables and FA values.

Results

There was a larger proportion of slow subjects (percentile below 25^th) in the patient group (Chi² = 7.125 p = 0.008). FA values correlated positively with SDMT in anterior and posterior parts of the corpus callosum, and RT CPT-II correlated negatively with FA values in the anterior corpus callosum (p < 0.05 corrected) in the patient group.

Conclusion

We found significant correlations between WM alterations and cognitive impairment in MetSd patients, especially in the frontal lobe. These findings highlight the importance of MetSd prevention and control due to its association with structural and functional damage in the central nervous system.

Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use

OBJECTIVE

The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn.

METHOD

We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use.

RESULTS

Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06-4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21-4.36, P = 0.01), independent of depression severity.

CONCLUSION

The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia.

Metabolic syndrome and its components in individuals undergoing rehabilitation after stroke

BACKGROUND AND PURPOSE

: Individuals participating in stroke rehabilitation are in jeopardy of future vascular events, including a second stroke. Nevertheless, vascular risk assessment is often overlooked in this population. Metabolic syndrome (MetS) may be a useful construct for risk assessment because of its predictive ability in distinguishing patients who are at high risk of future morbidity. This study documented the prevalence of MetS and its components in stroke rehabilitation patients. In addition, clinical characteristics of subgroups with and without MetS were compared.

METHODS

: Health records of 200 adult patients who had participated in inpatient stroke rehabilitation were reviewed. The prevalence and extent of clustering of the five components of MetS-obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol, and insulin resistance-were examined.

RESULTS

: Of the total sample, 61% had MetS and 97% had at least one MetS component, with hypertension and low high-density lipoprotein cholesterol being the most prevalent. The number of comorbidities, number of prescription drugs, and history of coronary heart disease were positively related to the presence of MetS. The components were predicted by a single underlying factor, providing support for the validity of using the MetS construct to assess vascular risk in this population.

DISCUSSION AND CONCLUSIONS

: Awareness of the high prevalence of MetS in individuals undergoing stroke rehabilitation should motivate physical therapists and other rehabilitation clinicians to intervene to prevent the recurrence of vascular events. Early screening for this high-risk condition and implementation of targeted interventions to reduce future vascular morbidity should become priorities in stroke rehabilitation.

Incidence and risk factors for the metabolic syndrome in an urban South European population

OBJECTIVE

To estimate the incidence of the metabolic syndrome in a Portuguese sample and to evaluate its specific risk factors.

METHODS

During a follow-up evaluation (May 2005-September 2008) of a Portuguese community cohort, 1377 participants were eligible for this study. Data on social, demographic, personal and family medical history and behavioral characteristics (including alcohol consumption and smoking habits) were collected. The metabolic syndrome was defined according to the AHA/NHLBI criteria Crude incidence rates were calculated for the total sample, by sex and age classes, and Poisson generalized linear models were used, with the default log link and offset in the variable time.

RESULTS

The incidence rate of metabolic syndrome in this population was 47.2 /1000 person-years (95% CI: 41.2-53.9), similar in females and in males. The incidence of metabolic syndrome increased with age and in less educated participants. No significant association was observed between the occurrence of metabolic syndrome and the behavioral characteristics evaluated. High waist circumference presented the strongest association with the occurrence of the metabolic syndrome, even after adjustment for other confounders (IRR=1.68; 95% CI: 1.47-1.93).

CONCLUSION

Older and less educated participants had a higher syndrome incidence. In this population, central obesity was the strongest predictor of metabolic syndrome.

No association of depression and anxiety with the metabolic syndrome: the Norwegian HUNT study

OBJECTIVE

To examine the associations of depression and anxiety with the metabolic syndrome.

METHOD

Cross-sectional study of 9571 participants aged 20-89 years in the Nord-Trøndelag Health Study (HUNT 2). We assessed anxiety and depression with the Hospital Anxiety and Depression Scale and the metabolic syndrome with the International Diabetes Federation criteria.

RESULTS

Despite generous statistical power and use of both continuous and categorical approaches, we found no association between anxiety or depression and the metabolic syndrome in models adjusted for age, gender, educational level, smoking, physical activity and pulse rate. When adjusted for age and gender only, we found a weak positive association for depression when a continuous measure was used, but not at the case level. The findings were similar across sexes, and robust for exclusion of cardiovascular disease and antidepressants.

CONCLUSION

In this largest study to date we found no association of anxiety and depression with the metabolic syndrome.