Prevalence of metabolic syndrome in urban India

Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India

Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.

Common Yoga Protocol Increases Peripheral Blood CD34+ Cells: An Open-Label Single-Arm Exploratory Trial

Purpose

Physical inactivity can be a cause of various lifestyle disorders including atherosclerosis, diabetes, hypertension, and cardiovascular diseases (CVDs). Lifestyle modification by the inclusion of Yoga and similar activities has shown beneficial effects on disease prevention and psychological management. However, the molecular mechanism at the cellular level is unknown. This study aims to identify the molecular response at systemic level generated after three months of Common Yoga Protocol (CYP) practice.

Methods

A total of 25 healthy adult females were recruited for this study (25 to 55 years). After the drop out of 6 participants at baseline and 2 participants after 1 month; blood samples of 17 participants were assessed. Blood samples were assessed for lipid profile, CD34+ cell enumeration and angiogenesis markers (ie, VEGF, Angiogenin and BDNF) at baseline (before intervention), after one month and after three months of Common Yoga Protocol (CYP) practice. The psychological health of the participants was assessed at baseline and after three months of CYP practice. The psychological tests used were General Health Questionnaire (GHQ), State-Trait Anxiety Inventory (STAI), Trail Making Test A & B, Digit symbol test, Digit symbol substitution test.

Results

After 3 months of intervention, blood samples of 17 participants were collected and following results were reported (1) percentage of CD34+ cells increased significantly after 3 months of CYP practice (from 18.18±7.32 cells/μL to 42.48±18.83 cells/μL) (effect size: W, 0.40; 95% CI, p = 0.001) (2) neurogenesis marker, ie, BDNF showed a significant change with time after 3 months of CYP intervention (effect size: W, 0.431, 95% CI; p = 0.002), (3) HDL showed an increasing trend (non-significant) after three months of CYP practice (53.017±1.28 mg/dl to 63.94±5.66 mg/dl) (effect size: W, 0.122; 95% CI; p = 0.126) (4) General Health score (10.64 ± 3.53 to 6.52 ± 3.12) (effect size: d, 0.98; 95% CI; p = 0.001) along with visual and executive function improved (69.94±26.21 to 61.88±28.55 (time taken in seconds)) (effect size: d, 0.582; 95% CI; p = 0.036), also stress and anxiety showed reduction (effect size: d, 0.91; 95% CI; p = 0.002) (5) a significant positive correlation was found between: HDL with VEGF (r = 0.547, p = 0.023) and BDNF (r = 0.538, p = 0.039) after 3 months of intervention; also, a significant positive correlation was found between VEGF with BDNF (r = 0.818, p ≤ 0.001) and Angiogenin (r = 0.946, p ≤ 0.001), also, BDNF was also positively correlated with Angiogenin (r = 0.725, p = 0.002) at both 1 month and 3 months after intervention. Also, VEGF and BDNF showed a significantly negative correlation with stress and anxiety questionnaire after the intervention.

Conclusion

The current study provides insights into the molecular response to CYP practice at systemic level. The results suggest that CYP practice indeed increased CD34+ cells in peripheral blood and BDNF also showed a significant change after the intervention. An overall improvement in general health and psychology of the participants was also observed.

A cross-sectional study to correlate antioxidant enzymes, oxidative stress and inflammation with prevalence of hypertension

AIMS

Hypertension a multifactorial consequence of environmental factors, life style and genetics is the well-recognized risk factor contributing to coronary heart diseases. The antioxidant imbalance, excessive reactive oxygen species (ROS) leads to oxidative stress which is pivotal in progression of hypertension. The present study aims to understand the complex interaction between oxidative stress, inflammation and antioxidant system which is crucial to maintain cellular homeostasis which further can exaggerate hypertension pathophysiology.

MATERIALS AND METHODS

The metabolic profile of hypertensive and normotensive subjects from Malwa region, Punjab was compared by estimating lipid profile, cardiac, hepatic and renal markers. The oxidative stress markers (protein carbonyls and lipid peroxidation), inflammatory markers (Nitric oxide, Myeloperoxidase and advanced oxygen protein products), and antioxidant enzymes (Superoxide Dismutase, Catalase, and Total Antioxidant Capacity) were analyzed.

KEY FINDINGS

It is observed that the metabolic markers are altered in hypertensive subjects which further these subjects showed increased oxidative, inflammatory profile and compromised antioxidant status when compared with normotensive subjects. Co-relation analysis validated the involvement of inflammation and oxidative stress in impaired endothelial function and vital organ damage.

SIGNIFICANCE OF STUDY

These markers may act as early indicators of hypertension which usually do not show any physical symptoms, thus can be diagnosed and treated at the earliest. The current study suggests that disturbed homeostasis, a consequence of altered interaction between antioxidant system and inflammatory events raises the oxidative stress levels which eventually leads to hypertension and associated complications. These indicators can serve as early indicators of future chronic complications of hypertension.

Efficacy of Ḥammām-i-yābis (dry bath) in metabolic syndrome: a single arm, open-labelled clinical trial

OBJECTIVES

This study intended to evaluate the efficacy of Ḥammām-i-yabis (dry bath) in metabolic syndrome as primary objective and perceived improvement and changes in quality of life as secondary objective.

METHODS

The study was designed as single arm, open-labelled, pre and post without control clinical trial comprising 30 diagnosed cases of metabolic syndrome belonging to 20-50 years of age of either sex. The enrolled patients were exposed to the dry heat of Ḥammām-i-yābis for 15 min at a temperature of 60 degree centigrade on every third day for a duration of 30 days (a total of 10 sittings). Objective parameters comprising systolic and diastolic blood pressure and waist circumference were assessed on every follow up, while other objective parameters (FBS, HDL and Serum Triglycerides) were assessed before and after the study.

RESULTS

Significant statistical difference was observed in objective parameters. Two tailed paired Student's t-test, (for pre and post) and repeated measure ANOVA (for 0, 15th and 30th day) were used to find the significance of mean change in study parameters. No significant adverse change appeared in safety parameters.

CONCLUSIONS

Ḥammām-i-yābis was found effective, safer, more feasible and less expensive regimenal modality for the patients of metabolic syndrome.

The impact of lifestyle stressors, menstrual pattern, and cardiometabolic risk factors on young females with cholelithiasis

BACKGROUND

Lifestyle and nutritional transitions in the society driven by globalization have led to the rising burden of cholelithiasis. The present study was done to assess the impact of lifestyle, stress, menstrual pattern, and cardiometabolic risk factors on young females with cholelithiasis.

MATERIALS AND METHODS

A hospital-based case-control study was conducted on young females of 18-45 years. Cases and age-matched controls were compared on their lifestyle parameters like demography, marital status, occupation, educational status, family income, stress along with menstrual pattern, cardiometabolic parameters like anthropometric measures, blood pressure (BP), fasting blood sugar (FBS), and lipid profile. Chi-square test and unpaired t-test were used for the analysis of data using SPSS software, and P < 0.05 was considered statistically significant.

RESULTS

The majority of the cases were from rural areas, married, homemakers leading a comparatively sedentary lifestyle consuming more red meat, less literate, and belonged to a lower economic group with significantly more stress compared to controls. The age of menarche, neither the regularity nor irregularity of the menstrual cycle (regular cycle 21-35 days), showed any difference, but cases had significantly more pregnancies and usage of oral contraceptives compared to controls. Waist-height ratio, systolic BP, FBS, triglyceride, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) were significantly higher in cases. Cases had a 14.4 times more risk of developing metabolic syndrome when compared with controls.

CONCLUSION

Married, rural, less literate Indian women leading a sedentary lifestyle, consuming more of red meat, and soft drinks with increased psychosomatic stress are more prone to develop cholelithiasis. Women who use hormonal contraceptives have increased occurrence of cholelithiasis and they were more prone to develop metabolic syndrome. The need for the hour is health education, to implement simple lifestyle changes, thereby decreasing the incidence of cholelithiasis in young females.

ChaiQi Decoction Alleviates Vascular Endothelial Injury by Downregulating the Inflammatory Response in ApoE-Model Mice

Metabolic syndrome (MetS) is a pathological state of metabolic disorders that primarily occur in human proteins, fats, and carbohydrates. It is a complex cluster of core metabolic disorder syndromes including obesity, hyperglycemia, dyslipidemia, and hypertension, and vascular endothelial injury, occurring over time. The currently available treatment options cannot effectively manage MetS. In our previous research, we revealed ChaiQi decoction (CQD) as an effective prescription for improving MetS; however, the specific mechanism remains unclear. Herein, we assessed the efficacy and mechanism of CQD in ApoE gene knockout (ApoE-) mice. Mice were administered with CQD daily for 12 weeks, and the measurement of their body weight was taken monthly. To evaluate the metabolic levels of mice, we determined the fasting blood glucose (FBG), fasting serum insulin (FINS), insulin resistance index (IRI), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels. Furthermore, immunohistochemical analysis was adopted to determine the expression of ICAM-1 and VCAM-1 in vascular endothelium, while an optical microscope was adopted to observe the pathological morphology of abdominal aorta in mice. Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) levels were determined using the ELISA method, whereas Western blotting was used to determine nuclear factor- (NF-) κB p65. Of note, intragastric CQD administration ameliorated ApoE-model mice, as evidenced by reduced levels of FBG, FINS, IRI, TG, TC, and LDL-C. Furthermore, CQD alleviated vascular endothelial injury and regularized the structure of the abdominal aorta by downregulating the expressions of proinflammatory cytokines TNF-α, IL-6, ICAM-1, VCAM-1, and NF-κB p65. Overall, these findings advocated that CQD ameliorates metabolic levels and vascular endothelial injury in mice by downregulating the inflammatory response and thus may be utilized as a novel MetS therapy.

Prevalence of metabolic syndrome among adult population in India: A systematic review and meta-analysis

OBJECTIVE

This review was done to determine the prevalence of metabolic syndrome (MS) among adult general population in India. We also wanted to find the gender, setting, and region-wide distribution of MS in India.

METHODS

We conducted systematic searches in various databases including Medline, ScienceDirect, Cochrane library and Google Scholar from inception until August 2019. We included studies conducted in India reporting the prevalence of MS among adults aged 18 years or more. We used the Newcastle Ottawa scale to assess the quality of included studies. We carried out a meta-analysis with random-effects model and reported pooled prevalence with 95% confidence intervals (CIs). We used the Funnel plot to assess publication biases.

RESULTS

In total, we analysed 113 data from 111 studies with 133,926 participants. Majority of the included studies (76 out of 111) had low risk of bias. We found significant heterogeneity among the included studies (p<0.001). We also found a symmetrical funnel plot indicating an absence of publication bias. The prevalence of MS among adult population in India was 30% (95%CI: 28%-33%). There was a steady increase in the burden across the age groups from 13% (18-29 years group) to 50% (50-59 years). We also found that people living in urban areas (32%; 95%CI: 29%-36%) had higher prevalence when compared to tribal (28%; 95%CI: 21%-36%) or rural adults (22%; 95%CI: 20%-25%). Gender distribution of MS showed that the females had higher prevalence (35%; 95%CI: 31%-38%) when compared to males 26% (95%CI: 22%-29%).

CONCLUSION

Almost one in three adults in India suffer from MS. Females, people living in urban areas and in northeast region had higher prevalence of MS. Development and implementation of policies and protocols for the screening of MS would enable us in early diagnosis and treatment with special focus towards the vulnerable and high-risk groups.

Prevalence and correlates of metabolic syndrome among rural women in Mysore, India

Aims

Metabolic Syndrome (MetS) is a strong predictor of Coronary Heart Disease (CHD). Studies in urban India have found about one-third of Indians suffer from MetS. Less is known about the prevalence of MetS in rural areas, where 70% of the population reside. This study examined the prevalence of Metabolic Syndrome in a population of rural women in India.

Methods

Data were gathered in a community-based study of 500 rural and tribal women residing in the Mysore district, between the age of 30–59 years. The study used the WHO STEPS approach, in which information on demographics and behavioral risk factors were collected. Along with anthropometric measurements, blood pressure, blood glucose, lipids were measured. A harmonized definition of MetS recommended by International Diabetes Federation Task Force on Epidemiology and Prevention was used in this study.

Results

Three out of five study participants were found to have MetS (47.1%, n = 223). Of those, 56.5% met 3 of the 5 criteria, 32.2% met 4 criteria, and 11.2% met all 5 criteria. Among the entire sample, low HDL was the most prevalent criterion (88.4%), followed by elevated glucose (57.9%), elevated triglycerides (49.3%), elevated BP (41.5%), and increased waist circumference (15.3%). In this sample, women with METS were generally older (p < 0.001), housewives (p = 0.001), that consumed salty highly processed foods (p = 0.020) and had low physical activity (p = 0.015).

Conclusions

This study showed a high prevalence of MetS in rural women. There is a compelling need for interventions aimed at reducing CHD risk factors in this population.

Association Between Metabolic Syndrome and Diabetes Mellitus According to International Diabetic Federation and National Cholesterol Education Program Adult Treatment Panel III Criteria: a Cross-sectional Study

Purpose

Lifestyle changes in diabetes mellitus leads to metabolic syndrome, thus resulting in a hike in micro and macrovascular complications in diabetes mellitus patients. The main objective of the study was to identify the occurrence of metabolic syndrome and to evaluate the gender-associated difference in each component of metabolic syndrome by using International Diabetic Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)criteria.

Methods

This is a cross-sectional study conducted in 350 type II diabetes mellitus patients. All the study participants within 30-80 years were enrolled. Subjects with type I DM and pregnant women were excluded from the study.

Results

The occurrence of metabolic syndrome among the diabetic population was found to be 42.28% and 28.85% using the IDF and the NCEP ATP III criteria respectively. It was observed that the prevalence was found to be higher in females than males as per IDF and NCEP ATP III criteria and was found to be statistically significant (p < 0.001). Central obesity elevated blood pressure, and reduced high-density lipoprotein was significantly higher in female patients. The most frequently occurring risk factor in this study population was central obesity followed by hypertension. A comparative analysis of IDF and NCEP ATP III criteria implies that when compared to diabetes patients without metabolic syndrome, all the metabolic risk elements were significantly higher in diabetes patients with metabolic syndrome.

Conclusions

This study concluded that the occurrence of metabolic syndrome was dreadfully high among the diabetic population, especially among female subjects.

Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver

Background/Aims

Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease.

Methods

Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan.

Results

In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively.

Conclusions

Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.

Metabolic syndrome and its correlates: A cross-sectional study among adults aged 18-49 years in an Urban Area of West Bengal

Background

The prevalence of metabolic syndrome (MetS) is increasing dramatically of late, across all ages irrespective of gender, socioeconomic status, and ethnicity. People with MetS have twice the likelihood of developing and dying from cardiovascular disease and more than seven times the risk of developing diabetes.

Objectives

This study was undertaken to determine the prevalence of MetS among adults who were in their first three decades of adulthood and to find out the risk factors of MetS among them.

Methods

This was a community based cross-sectional study among 388 subjects aged 18-49 years selected by multistage random sampling in an area of Kolkata, India, from November 2016 to October 2018 over 2 years. Data collection was done using a structured questionnaire along with anthropometry, blood pressure measurement, and relevant blood tests. Physical activity was classified by the International Physical Activity Questionnaire Short-Form questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (version 16.0), and descriptive statistics were calculated as frequency and percentage. Logistic regression was done to determine the strength of association between MetS and different risk factors.

Results

The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females), and female gender, poor economic status, sedentary lifestyle, poor diet, and addiction of tobacco were found to be the risk factors of MetS in the final model using multivariable logistic regression.

Conclusion

This research revealed the high prevalence of MetS in the community. The effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been employed to curtail the epidemic of MetS.

Epidemiology, risk factors across the spectrum of age-related metabolic diseases

BACKGROUND

Population aging is dynamic process of increasing proportion of older adults in the total population, which is an inescapable result of decline in fertility rate and extension in life expectancy. Inevitably, age-related metabolic diseases, for example obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, and nonalcoholic fatty liver disease, are becoming epidemic globally along with the demographic transition.

CONTENT

The review examines the literatures related to: 1) the epidemiology of age related metabolic diseases including obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, and nonalcoholic fatty liver disease; and 2) the risk factors of age related metabolic diseases including genetic factors, diet, smoking, Physical activity, intestinal microbiota and environmental factors.

CONCLUSION

Population aging is becoming epidemic worldwide, resulting in increasing incidence and prevalence of a serious of age-related metabolic diseases. Both genetic and environmental factors contribute to the diseases, thus interventions targeting on these factors may have beneficial effect on the development of age-related metabolic diseases.

Double Burden of Underweight and Overweight among Women in South and Southeast Asia: A Systematic Review and Meta-analysis

The double burden of malnutrition (DBM) is characterized by the coexistence of underweight and overweight individuals in a population. The objective of this study was to assess the level of DBM, as well as its main determinants, in women in South and Southeast Asia. We searched scientific literature databases, including PubMed, EMBASE, CINAHL, and Google Scholar; gray literature; and reference lists from primary research published between 1969 and September 30, 2017. In total, 128 studies met our inclusion criteria, representing data of ∼5 million women >15 y of age from South and Southeast Asia. The findings show that prevalence rates of underweight and overweight varied by study from 7.0% to 61.0% and 1.0% to 64.0%, respectively. For the total study period, the pooled prevalence of underweight and overweight was 28% (95% CI: 25%, 31%) and 17% (95% CI: 15%, 19%) in South Asia, respectively, and 20% (95% CI: 15%, 26%) and 20% (95% CI: 15%, 24%) in Southeast Asia, respectively. In both regions, underweight was more prevalent in rural areas, among women of the youngest age group (15-19 y), and among those in the poorest wealth quintile. In contrast, overweight was higher in urban areas, among women of older age, and among those in the wealthiest households. This study also found that prevalence of overweight has recently exceeded that for underweight in this population.

A Study on the Prevalence of Metabolic Syndrome and its Components among Adults Aged 18-49 Years in an Urban Area of West Bengal

Context:

Metabolic syndrome (MetS) is recognized as a major epidemic of the 21^st century. People with MetS have twice the likelihood of developing and dying from cardiovascular diseases and more than seven times the risk of developing diabetes.

Aims:

This study was undertaken to determine the prevalence of MetS and its components among adults who were in their first three decades of adulthood.

Settings and Design:

This was a community-based cross-sectional study among 388 subjects aged 18–49 years selected by multistage random sampling in an area of Kolkata, India.

Subjects and Methods:

Data collection was done using a structured questionnaire along with anthropometry, blood pressure (BP) measurement, and relevant blood tests. Physical activity was classified by The International Physical Activity Questionnaire-Short Form questionnaire.

Statistical Analysis Used:

Data were analyzed using the SPSS software version 16.0 and descriptive statistics were calculated as frequency and percentage.

Results:

The prevalence of MetS was 44.6% (35.4% in males and 55.6% in females) and prevalence of central obesity, elevated fasting plasma glucose, raised triglyceride, raised BP, and reduced high-density lipoprotein cholesterol were 68.6%, 41.5%, 36.1%, 45.1%, and 64.9%, respectively, among the study participants.

Conclusions:

This research revealed the high prevalence of MetS and its components in the community. Effective primordial and primary level of prevention along with prevailing secondary or tertiary level of prevention should have been implemented to curtail the epidemic of MetS.

A clinical study on Virechana Karma (therapeutic purgation) over the gut flora with special reference to obesity

BACKGROUND

Altered gut flora is associated with the pathogenesis of both intestinal and extra‑intestinal disorders. Aetiology of obesity is associated with mechanisms such as short chain fatty acid production, stimulation of hormones, chronic low‑grade inflammation, lipoprotein and bile acid metabolism and increased endocannabinoid. Receptor system tone have been suggested to explain the role of gut microbiota of obesity. The Panchakarma (Ayurvedic purification methods) claims the management of metabolic disorders hence this work provides the target specific evidence for the clinical studies. The proposed project is aimed to explore the particular molecular mechanism and, to make this therapy more evidence based. Hence, it was hypothesized that Panchakarma‑based intervention such as Virechana Karma (therapeutic purgation) may influence microbiota and help in the management of the obesity.

MATERIALS AND METHODS

The study was conducted to explore the effect of Virechana Karma over the gut flora; therefore, total of 19 patients with Madhyama Koshtha diagnosed with obesity were included and received the intervention. Before and after Virechana, a stool sample was collected and processed for the enterobacterial repetitive intergenic consensus ‑polymerase chain reaction to find the changes over the facultative aerobic bacteria.

RESULTS

It was found that Virechana is effective in the management of the obesity as it helps to reduce colonization of aerobic bacteria. After Virechana and after follow‑up also, it showed the correction of the gut flora dysbiosis, thus initiated the weight loss mechanism in the body, resulting in diminution in the signs and symptoms of obesity.

CONCLUSION

Virechana is effective in the management of the obesity due to reduction in the Escherichia coli colonization and is effective over the gut flora dysbiosis.

Sex Hormone Levels - Estradiol, Testosterone, and Sex Hormone Binding Globulin as a Risk Marker for Atherosclerotic Coronary Artery Disease in Post-menopausal Women

CONTEXT

Sex hormones levels determine the risk of occurrence of coronary artery disease (CAD) in post-menopausal (PM) women.

AIMS

To investigate the relationship between sex hormones (estradiol and testosterone)/sex hormone binding globulin (SHBG) and cardiovascular risk factors in PM women. In addition, we learned the association between these sex hormones/SHBG and the occurrence of atherosclerotic CAD event in PM women.

SETTINGS AND DESIGN

Cross-sectional case- control study.

SUBJECTS AND METHODS

Subjects recruited in the present study were from the cardiology outpatient clinic or Emergency department Guwahati Medical College and Hospital, Assam. The subjects were grouped into two categories after appropriate exclusion criteria: Cases - PM women with documented CAD (n = 40) and controls - Healthy PM women (n = 30). The medical history, clinical examination, and investigations including serum estradiol, total testosterone, SHBG, free testosterone index (FTI), high-sensitivity C-reactive protein (hs-CRP), lipid profile, carotid intima-media thickness (CIMT), fasting plasma glucose (FPG), and postprandial plasma glucose (PPPG) were done and analyzed.

STATISTICAL ANALYSIS USED

Pearson correlation between sex hormones and CAD risk factors was done. The association between sex hormones and CAD risk factors among PM women was analyzed by multiple logistic regression. The statistical significance was set at the 0.05 level.

RESULTS

The mean age of all the subjects was 62.27 ± 6.9 years. Among the cases, a significant positive correlation was found between total testosterone/FTI and waist circumference, W/H ratio, triglyceride levels, hs-CRP, and CIMT (P < 0.01). In addition, a significant negative correlation was found between total testosterone and FTI with high-density lipoprotein-cholesterol levels (P < 0.01). The multiple logistic regression analysis showed that total testosterone levels (P < 0.01) and SHBG (P < 0.01) are independently associated with the occurrence of atherosclerotic CAD in PM.

CONCLUSION

We conclude that increased serum testosterone levels and low SHBG in PM women are associated with the development of atherosclerotic cardiovascular risk factors.

Prevalence of metabolic syndrome in Gwalior region of Central India: A comparative study using NCEP ATP III, IDF and Harmonized criteria

BACKGROUND

The aim of this study is to determine the prevalence of Metabolic syndrome (MetS) in the people of Gwalior. Three criteria viz., National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, International Diabetes Federation (IDF) criteria and Harmonized criteria for MetS were employed to assess the prevalence of metabolic syndrome in this region, their concordance with respect to this population was recorded.

METHODS

The cross-sectional study involved the people, who had attended the Diabetes clinic at the Centre for Translational Research, Jiwaji University during 2015-2017. A total of 1190 participants within the age group of 20-79 years of either gender were included in the study. Anthropometric parameters, blood pressure, blood glucose and lipid profile of all subjects were assessed. Student's 't' test, Kappa statistics and Binary logistic regression model were used to analyze the data.

RESULTS

The percentage of prevalent MetS was found to be 72.7, 50.2 and 53.9 following Harmonized criteria, NCEP ATPIII and IDF criteria respectively. The prevalence was found to be maximum in centrally obese female population, aged between 51 and 60 years with the presence of hyperglycemia and reduced HDL- C. Harmonized and IDF criteria showed good agreement (κ 0.85). Regression analysis showed that, high body mass index, hypertension and dyslipedimia were the most critical predictive risk factors of MetS.

CONCLUSIONS

Maximum prevalence of MetS was recorded when the Harmonized criteria was followed. A good agreement was observed between Harmonized vs. IDF criteria. MetS if detected early especially in apparently healthy subjects; paves way for preventive measures to be designed in order to avert the incidence of diabetes and other risks related to cardio vascular disease.

Fasting and glucose induced thermogenesis in response to three ambient temperatures: a randomized crossover trial in the metabolic syndrome

BACKGROUND/OBJECTIVES

Cold exposure increases thermogenesis and could improve insulin sensitivity. We hypothesized a blunted response in the metabolic syndrome (MetS).

SUBJECTS/METHODS

Twenty older adults 59 ± 10.4 years (with MetS, MetS+, n = 9; without MetS, MetS-, n = 11) completed a randomized crossover design of 3.5 h exposures to 20, 25 and 27 °C on three visits. After an hour's rest at the desired temperature, resting metabolic rate (RMR), respiratory quotient (RQ), forearm to fingertip gradients (FFG), and in the ear temperature (IET) were measured over 30 min. An oral glucose tolerance test followed, and serial measurements were continued for 2 h. Venous blood was sampled for clinical chemistry, irisin, and fibroblast growth factor 21(FGF21). A mixed model ANCOVA adjusted data for age, gender, fat mass, fat-free mass and seasonality.

RESULTS

There was a significant MetS×temperature interaction where adjusted RMR was significantly higher in MetS+ compared to MetS- by 12% at 20 °C and by 6% at 25 °C, but similar at 27 °C. FFG increased and IET decreased with decreasing temperature to the same extent in both groups. Fasting irisin and FGF21 did not vary with temperature but the former was significantly higher in MetS-. Adjusted postprandial RQ and insulin to glucose ratios were significantly higher at 20 °C relative to 25 °C. Partial correlation analysis of differences between 27 and 20 °C indicated significant positive relationships between fasting as well as postprandial RQ and the respective changes in irisin and FGF21.

CONCLUSIONS

There could be an upward shift of the TNZ in MetS+, but this needs reevaluation.

Interplay between proteins and metabolic syndrome-A review

Metabolic syndrome is characterized by hypertension; hyperglycemia; hypertriglyceridemia; reduced high-density lipoprotein cholesterol levels and abdominal obesity. Abundant data suggest that, compared with other people, patients meeting these diagnostic criteria have a greater risk of having substantial clinical consequences, the two most prominent of which are the development of diabetes mellitus and coronary heart disease. The metabolic syndrome is a health issue of epidemic proportions. Its prevalence in the world continues to increase, hand in hand with that of obesity. Protein, on the other hand, is the foundation of cell-building, especially in muscle tissue. The body needs protein to build not only muscle cells, but the cells of major organs, skin and red blood cells. For people with metabolic syndrome, one of the other functions of protein is to slow down the absorption of carbohydrates. When proteins are consumed with carbohydrates, it takes longer for the digestive system to break down that meal. This means that the sugar created from those carbohydrates is released at a slower rate, preventing spikes in both blood sugar and insulin. As the understanding of the metabolic syndrome evolves, it is likely that more comprehensive therapeutic options will become available.

Prevalence of metabolic syndrome and associated risk factors among geriatric population living in a high altitude region of rural Uttarakhand, India

Introduction:

Metabolic syndrome (MetS) is responsible for 2.5-fold increase in cardiovascular mortality and a 5-fold higher risk of developing diabetes.

Materials and Methods:

A community-based cross-sectional study was conducted during 2015–2016 in District Nainital. A list of all villages was developed. From this list, thirty villages were identified using population proportionate to size sampling method. From each village, thirty geriatric subjects (GSs) were selected. The study population included 979 GSs aged 60 years and above. The data were collected on anthropometry, blood pressure, blood glucose, and lipid profile from all the enrolled subjects. The prevalence of MetS was estimated using International Diabetes Federation criteria. Univariate and multivariate analysis was done to identify factors associated with MetS.

Results:

The prevalence of MetS was found to be 28.6%. Step-wise multivariate logistic regression analysis found that female gender, higher income, and body mass index ≥25 were significant and independent risk factors of MetS amongst GP.

Conclusion:

There is a need for screening of GP living in high altitude region so that efforts can be initiated to prevent complications of MetS.

Prevalence of Metabolic Syndrome Markers among Women at 1-year Postpartum as per Prepregnancy Body Mass Index Status: A Longitudinal Study

INTRODUCTION

Maternal body composition (BC) changes during lactation. Increased prepregnancy obesity is associated with poor obstetric outcomes. The aim was to study changes in maternal BC postpartum (PP) to 1-year PP with reference to their prepregnancy body mass index (BMI) status.

METHODS

The study design was a 1-year follow-up study. Sixty-five apparently healthy primiparous women (28.6 ± 3.4 years delivered full-term infants) were randomly selected from December 2010 to June 2013 and postclassified on the basis of their prepregnancy BMI status. Anthropometry, sociodemographic status, physical activity, diet, clinical examination, biochemical tests, and BC at total body (dual energy X-ray absorptiometry, GE, Lunar DPX) were collected using standardized protocols.

RESULTS

Forty-one women were classified in Group A with normal prepregnancy BMI (20.4 ± 2.0 kg/m²) and 24 women in Group B with overweight/obese (OW/OB) prepregnancy BMI (26.1 ± 1.9 kg/m²). At 1 year, 75% of women returned to normal BMI in Group A, whereas all 100% of women from Group B remained in OW category at 1-year PP. Nearly 43% of Group B women showed the presence of at least two metabolic syndrome risk factors as compared to 36% in Group A at 1 year.

CONCLUSION

Women with OW/OB prepregnancy BMI accumulated higher visceral fat with a higher prevalence of metabolic risk factors at 1-year PP. Our study underlines the importance of maintaining BMI status in reference range in reproductive years.

Association of Metabolic Syndrome in Chronic Plaque Psoriasis Patients and their Correlation with Disease Severity, Duration and Age: A Case Control Study from Western Maharashtra

INTRODUCTION

Psoriasis is a chronic systemic inflammatory disease where the skin and the joints are the primary targets. Despite the fact that psoriasis carries minimal risk of mortality, it is associated with significant morbidity which may have a significant impact on quality of life of patients. Globally, psoriasis has been reported to be associated with Metabolic Syndrome (MS) including obesity, dyslipidemia, diabetes and hypertension. Association of MS and its various components with psoriasis has been consistently reported in various studies, but there is a paucity of data on this association from the Indian subcontinent.

AIM

To compare the prevalence of MS in patients with psoriasis and controls and to determine association of MS with age of patient, severity and duration of psoriasis.

MATERIALS AND METHODS

A hospital based case control study on 95 psoriasis patients and 95 age and sex matched controls. MS was diagnosed by the presence of three or more of the South Asian Modified National Cholesterol Education Program's Adult Panel III SAM-NCEP criteria. Clinical, biometric and necessary laboratory evaluations were performed. Statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS version 16.0). Data was compared between cases and controls using unpaired t-test and chi-square test and odds ratio with 95% confidence interval.

RESULTS

MS was significantly more common in psoriatic patients than in controls (38.9%vs 21.05%, odds ratio 2.39, 95% confidence interval, 1.26-4.55; p-value=0.007). Psoriatic patients had higher prevalence of hypertriglyceridemia (45.2%vs.11.5%), decreased HDL cholesterol (27.3%vs.4.2%), abdominal obesity (32.6% vs.15.7%) and elevated blood pressure (18.9%vs.5.2%) whereas no association observed for elevated blood sugar level (12.6%vs.5.2%). MS was present in psoriasis cohort irrespective of severity and duration of psoriasis. (p-value 0.123, 0.596 respectively). MS was more prevalent in elderly individuals with psoriasis (51.1%vs.28% p-value=0.008; Odds ratio 3.12, 95% confidence interval 1.32-7.35).

CONCLUSION

Significant association between psoriasis and MS was noted and it was independent of disease duration and severity. Elderly psoriatic patients were more prone for developing MS. We suggest that all patients of psoriasis, irrespective of disease, duration and severity, should be screened for MS to prevent significant morbidity and mortality associated with it.

"Metabolic Syndrome and Its Risk Determinants in Sikkim": A Glimpse from a Hospital Study

Sikkim has been reported to have the highest percentage of Diabetes Mellitus and Hypertension in the country. The study aimed to focus its precursor termed 'Metabolic Syndrome' (MetS) with special attention to its risk determinants as a measure to promote awareness in preventing the rise in number of these non communicable diseases in the state with only 6,10,577 inhabitants. Of 361 participants, 33.5% were diagnosed MetS as per the harmonized MetS criteria, 64.5% deemed non-MetS comprised of participants with "2 Risk", "1 Risk" and "0 Risk" for MetS, however not enough (3 or more) to be categorized as MetS. A "large WC + elevated BP + raised FBS"; "large WC + elevated BP" and "large WC" were the different types of risk combinations found frequently in the "3 Risk", "2 Risk" and "1 Risk" category respectively. MetS was most common among the females and highly found in 51-60 years of age. Ethnically "Bhutia/Lepcha/Tamang/Sherpa" were diagnosed with highest percentage of MetS followed by "Nepalese" and "Others". The chief contributing factor to compose MetS in the female population was a large WC. We conclude, Diabetes and Hypertension are indeed prevailing in Sikkim and that the presence of either an increased waist circumference or an elevated blood pressure mandates a check for the remaining four risk factors for MetS, rendering worthwhile to keep an account of MetS risk types by stratification to comprehend the influence of socio-cultural and ethno-geographical factors in causing MetS.

Prevalence of Metabolic Syndrome Among People Living with HIV in Developing Countries: A Systematic Review

Metabolic syndrome (MS) is a group of components associated with cardiovascular disease and type 2 diabetes mellitus. The prevalence of MS in the HIV population is increasing in epidemic proportions globally. However, the magnitude and characteristics of MS are not fully elucidated in developing countries. The aim of this systematic review was to assess the prevalence of MS and its components among people living with HIV (PLWH) in developing countries. Searches were carried out in MEDLINE, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, other web sources, and by hand search. Articles were restricted to English language studies reporting on the prevalence of MS among PLWH in developing countries. Eighteen articles were included in the review. The studies were divided into Africa, South America, and Asia regions. The most frequent criterion used in the review was the National Cholesterol Education Program: Adult Treatment Program III 2001 definition. The prevalence of MS among PLWH ranged from 8.4% to 47% across the developing regions and comparable to the overall prevalence across the developed regions (7.8-52.2%). The mean prevalence was 30.5%, 21.5%, and 21.4% in Africa, Asia, and South America, respectively. The most frequent component observed was low high-density lipoprotein cholesterol (50.1%). This systematic review provides an essential overview on the distribution of MS in the HIV population across the developing regions. As these prevalences were comparably high in the developed regions, this review highlights the need for more robust research in developing countries.

Metabolic Syndrome among Secondary School Teachers: Exploring the Ignored Dimension of School Health Programme

INTRODUCTION

The rising trend of obesity, insulin resistance, metabolic abnormalities, pro atherogenic factors are important determinants of both the non-communicable diseases and metabolic syndrome. Employees especially school teachers have chronic stress which predisposes them to metabolic syndrome (MS). Thus, increasing the possibility of premature mortality due to CVD and T2DM and escalating the health care cost is affecting their families.

AIM

To assess the prevalence and the risk factors influencing metabolic syndrome among secondary school teachers.

MATERIALS AND METHODS

A cross-sectional study among secondary school teachers of Mysore city. A self administered, pretested and structured questionnaire based on the WHO Steps Approach for NCD evaluation. Data was analysed in SPSS version 20, chi-square test for categorical variables and t-test for continuous variable was applied along with logistic regression analysis to determine the independent predictors of MS.

RESULTS

The prevalence of MS was 115 (38.3%). It increased from 6 (14.3%) in 21-30 years to 40(56.3%) in > 50 years age group. However, 144(48.0%) had '≤ two risk factors, 121(40.3%) had ≥ 3 risk factors and 7(2.3%) had all the five risk factor.

CONCLUSION

All components of MS were statistically significant in their association with the metabolic syndrome disease complex. The School health programme can be utilised as an opportunity to screen the teachers and provide primary preventive care.

The co-occurrence of anemia and cardiometabolic disease risk demonstrates sex-specific sociodemographic patterning in an urbanizing rural region of southern India

BACKGROUND/OBJECTIVES

To determine the extent and sociodemographic determinants of anemia, overweight, metabolic syndrome (MetS) and the co-occurrence of anemia with cardiometabolic disease risk factors among a cohort of Indian adults.

SUBJECT/METHODS

Cross-sectional survey of adult men (n=3322) and nonpregnant women (n=2895) aged 18 years and older from the third wave of the Andhra Pradesh Children and Parents Study that assessed anemia, overweight based on body mass index, and prevalence of MetS based on abdominal obesity, hypertension and blood lipid and fasting glucose measures. We examined associations of education, wealth and urbanicity with these outcomes and their co-occurrence.

RESULTS

The prevalence of anemia and overweight was 40% and 29% among women, respectively, and 10% and 25% among men (P<0.001), respectively, whereas the prevalence of MetS was the same across sexes (15%; P=0.55). The prevalence of concurrent anemia and overweight (9%), and anemia and MetS (4.5%) was highest among women. Household wealth was positively associated with overweight and MetS across sexes (P<0.05). Independent of household wealth, higher education was positively correlated with MetS among men (odds ratio (95% confidence interval): MetS: 1.4 (0.99, 2.0)) and negatively correlated with MetS among women (MetS: 0.54 (0.29, 0.99)). Similar sex-specific associations were observed for the co-occurrence of anemia with overweight and MetS.

CONCLUSIONS

Women in this region of India may be particularly vulnerable to co-occurring anemia and cardiometabolic risk, and associated adverse health outcomes as the nutrition transition advances in India.

Expression of Lipoprotein associated phospholipase A2 enzyme in medical undergraduate students with metabolic syndrome

AIMS

Metabolic syndrome (MS) and atherosclerosis are chronic inflammatory conditions. Lipoprotein-associated phospholipase A2 (LpPLA2) is a circulatory marker of systemic inflammation and a risk predictor for cardiovascular diseases. This study aims to evaluate the expression of this enzyme in an effort to understand the underlying mechanism of atherosclerosis in MS.

METHODS

This study included twenty patients of MS and same number of healthy controls. Anthropometry and clinical examination were carried out in both groups. Real time PCR was performed for LpPLA2 mRNA and relative expression was calculated using ΔΔCT method keeping β2 microglobin and β-actin as internal controls.

RESULTS

LpPLA2 mRNA expression was higher in patients of MS. Fold change was 5.7 when β2 microglobin was used as normaliser and 4.97 when β-actin was used. mRNA levels of LpPLA2 correlated significantly with waist circumference (r=0.462, p=0.003) and systolic blood pressure (r=0.392, p=0.015) as well as high density lipoprotein cholesterol (r=-0.453, p=0.003).

CONCLUSIONS

High expression of LpPLA2 mRNA indicates that systemic inflammation has role in pathogenesis of atherosclerosis in patients of MS. This is evident from its direct correlation with blood pressure. The study also suggests that expression of LpPLA2 may be associated with obesity. Therefore, LpPLA2 mRNA expression levels may develop as an important risk predictor for vascular complications in MS.

Prevalence of metabolic syndrome in pre- and post-menopausal women: A prospective study from apex institute of North India

Background:

The metabolic syndrome (MS) (syndrome X, insulin resistance syndrome) is a constellation of metabolic abnormalities and a complex predisease state that predicts future development of type 2 diabetes mellitus and cardiovascular disease. Menopausal transition and postmenopausal state are considered as a vulnerable period for developing MS, and this increased risk has been attributed to decreasing estrogen levels with an increasing risk of insulin resistance following menopause.

Aims and Objectives:

This study aimed to determine the prevalence of MS and its components in pre- and post-menopausal women from North India.

Methodology:

This is a cross-sectional study of 350 women in the age group of 45–55 years attending gynecology clinic in a tertiary center of North India. Details of sociodemographic data, menopausal history, reproductive, and medical profile were obtained. Then, waist circumference, body mass index (BMI), and blood pressure were recorded. A venous blood sample was collected for fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. MS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria.

Results:

The mean age was 49.09 ± 2.2 years in premenopausal and 49.54 ± 2.8 years in postmenopausal women. The prevalence of MS in the study group was 62.6%. Occurrence of MS was higher in older and obese women. Abnormal waist circumference was the most prevalent component (87%) of MS and in terms of odd ratio, correlation was highest for BMI followed by total cholesterol and waist-hip ratio.

Conclusion:

We should target obesity and deranged lipid profile by bringing out changes in lifestyle and dietary habits to decrease the higher prevalence of MS and the risk of cardiovascular diseases.

Metabolic syndrome in antipsychotic naïve patients with schizophrenia: pooled analysis of data from three Indian studies

AIM

This study aimed to assess the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naïve patients with schizophrenia by pooling the data from three different centres in India.

METHODS

One hundred thirty-seven antipsychotic naïve patients with schizophrenia were evaluated for MS using common criteria for clinical diagnosis.

RESULTS

Twenty-six patients (19%) met consensus criteria. Additionally, 56 patients (40.9%) fulfilled one criterion and 32 patients (23.3%) fulfilled two criteria of MS out of five criteria.

CONCLUSION

One-fifth of antipsychotic naïve patients with schizophrenia had MS and another two-third had at least one metabolic abnormality. Awareness of such a high risk is vitally important for rational selection of antipsychotic medications as well as effective implementation of preventive measures.

Troxerutin reverses fibrotic changes in the myocardium of high-fat high-fructose diet-fed mice

A previous study from our laboratory showed that troxerutin (TX) provides cardioprotection by mitigating lipid abnormalities in a high-fat high-fructose diet (HFFD)-fed mice model of metabolic syndrome (MS). The present study aims to investigate the reversal effect of TX on the fibrogenic changes in the myocardium of HFFD-fed mice. Adult male Mus musculus mice were grouped into four and fed either control diet or HFFD for 60 days. Each group was divided into two, and the mice were either treated or untreated with TX (150 mg/kg bw, p.o) from the 16th day. HFFD-fed mice showed marked changes in the electrocardiographic data. Increased levels of myocardial superoxide, p22phox subunit of NADPH oxidase, transforming growth factor (TGF), smooth muscle actin (α-SMA), and matrix metalloproteinases (MMPs)-9 and -2, and decreased levels of tissue inhibitors of MMPs-1 and -2 were observed. Furthermore, degradation products of troponin I and myosin light chain-1 were observed in the myocardium by immunoblotting. Rise in collagen was observed by hydroxyproline assay, while fibrotic changes were noticed by histology and Western blotting. Hypertrophy of cardiomyocytes and myocardial calcium accumulation were also observed in HFFD-fed mice. TX treatment exerted cardioprotective and anti-fibrotic effects in HFFD-fed mice by improving cardiac contractile function, reducing superoxide production and by favorably modifying the fibrosis markers. These findings suggest that TX could be cardioprotective through its antioxidant and antifibrogenic actions. This new finding could pave way for translation studies to human MS.

Effect and Mechanism of Virechana Karma (Therapeutic Purgation) Over Fructose-Induced Metabolic Syndrome: An Experimental Study

BACKGROUND

Panchakarma (biopurification methods) is one of the modes of ayurveda to treat disorders of the body. Virechana karma (therapeutic purgation), one among the Panchakarma, is a purification process that is commonly used to treat metabolic disorders like obesity and diabetes mellitus. Hence this study was planned to provide evidence through animal experiments.

METHODS

Albino rats were subject to Virechana karma (therapeutic purgation) to evaluate the influence of therapy and its mechanism over fructose-induced metabolic syndrome.

RESULTS

Results show that Virechana is effective in the management of the metabolic syndrome with decrease in the fecal fat content, fasting blood glucose, serum triglyceride, and reduced fatty changes in liver, heart, and kidney in comparison with the positive control group.

CONCLUSION

Experimental evaluation showed decrease in fatty acid in the storage like liver, kidney, heart, and muscle adipose tissue can indirectly increase the insulin sensitivity in insulin receptor present at skeletal muscles.

Insulin resistance, metabolic syndrome and chronic low grade inflammation in Sheehan's syndrome on standard replacement therapy: a case control study

BACKGROUND

Increased clustering of metabolic risk factors has been demonstrated in patients with hypopituitarism on standard replacement therapy. This usually has been attributed to persistent growth hormone deficiency, though contribution from underlying etiology of hypopituitarism cannot be underestimated. We, therefore, studied conventional metabolic risk factors and pro inflammatory markers in a cohort of hypopituitary patients in whom the etiology was Sheehan's syndrome.

MATERIAL & METHODS

We studied 30 GH naive patients with Sheehan's syndrome (SS) on standard replacement therapy and compared with healthy age, BMI and parity matched controls. All subjects were normotensive, non-diabetic, non-smokers and none had history of any acute or chronic illness. We recorded height, weight, BMI, waist circumference and waist hip ratio, besides measuring biochemical parameters like lipid profile, fasting plasma glucose and insulin, sVCAM-1, ICAM-1 and hsCRP.

RESULTS

Metabolic syndrome and impaired glucose tolerance were more common with SS patients. Similarly total cholesterol (mean ± SD, 5.21 ± 0.98 vs 4.57 ± 0.88, P = 0.00), LDL-cholesterol (3.15 ± 0.90 vs 2.67 ± 0.75, P = 0.02), triglycerides (2.14 ± 1.00 vs 1.43 ± 0.45, P = 0.00) and pro-inflammatory markers i.e. hsCRP (3.95 ± 2.58 vs 1.45 ± 2.77, P = 0.00) were significantly higher in patients with SS. hsCRP positively correlated with fasting insulin (r = 0.40, P = 0.02), HOMA-IR (r = 0.38, P = 0.03) and negatively with HDL (r = - 0.33, P = 0.05).

CONCLUSIONS

GH naïve SS patients on standard replacement therapy have increased clustering of metabolic and pro-inflammatory risk factors.

Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies

Obesity is reaching epidemic proportions with recent worldwide figures estimated at 1.4 billion and rising year-on-year. Obesity affects all socioeconomic backgrounds and ethnicities and is a pre-requisite for metabolic syndrome. Metabolic syndrome is a clustering of risk factors, such as central obesity, insulin resistance, dyslipidaemia and hypertension that together culminate in the increased risk of type 2 diabetes mellitus and cardiovascular disease. As these conditions are among the leading causes of deaths worldwide and metabolic syndrome increases the risk of type 2 diabetes mellitus fivefold and cardiovascular disease threefold, it is of critical importance that a precise definition is agreed upon by all interested parties. Also of particular interest is the relationship between metabolic syndrome and cancer. Metabolic syndrome has been associated with a plethora of cancers including breast, pancreatic, colon and liver cancer. Furthermore, each individual risk factor for metabolic syndrome has also an association with cancer. Our review collates internationally generated information on metabolic syndrome, its many definitions and its associations with life-threatening conditions including type 2 diabetes mellitus, cardiovascular disease and cancer, providing a foundation for future advancements on this topic.

Interleukin 6(-174G/C) variant and its circulating levels in coronary artery disease patients and their first degree relatives

Interleukin-6 (IL-6) a pleiotropic cytokine is a central mediator of inflammation in the pathogenesis of coronary artery disease (CAD). Our aim is to evaluate the serum levels of IL-6 and C-reactive protein (CRP) and to analyze the IL-6 polymorphism in CAD patients and to identify the first-degree relatives (FDRs) at risk of the disease in comparison with healthy controls. Estimation of IL-6 levels by enzyme-linked immunosorbent assay (ELISA) and CRP by latex reagent kit method, and genotyping of IL6 gene variants -174 (G>C) was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 600 subjects. IL-6 and CRP levels were significantly high in patients followed by FDRs compared to controls. The frequency of the IL-6 genotype was significantly different between cases, FDRs and controls and association of serum IL-6 levels with genotype found to be significant in CC genotype compared to GC and GG at p < 0.01 in CAD patients and FDRs, while there is no significant difference observed in controls. The study shows the importance of inflammation in the pathogenesis of CAD and predicts the risk of future coronary events in healthy asymptomatic FDRs.

High serum level of matrix metalloproteinase 9 and promoter polymorphism - 1562 C:T as a new risk factor for metabolic syndrome

The altered matrix metalloproteinases (MMPs) have been suggested in the pathophysiology of metabolic syndrome (MetS). Genetic variants in the promoter region of MMP1 and MMP9 genes may modulate an individual's susceptibility to MetS. The aim of this study was to determine the frequency of MMP1 -519 A:G and MMP9 -1562 C:T polymorphisms and the correlation with serum levels of MMP1 and MMP9 in MetS susceptibility. On the basis of anthropometric profile and laboratory investigations, 180 confirmed MetS patients and 190 unrelated healthy controls of similar ethnicity were genotyped for MMP1 -519 A:G and MMP9-1562 C:T polymorphisms by using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. In addition, serum levels of MMP1 and MMP9 were quantified by ELISA. We found that the serum level of MMP9 was significantly higher in MetS patients. Variant genotype TT of MMP9 -1562 demonstrated increased risk (odds ratio [OR]=3.70, p=0.015) of MetS. Similarly, variant allele T (OR=1.77, p=0.002) and combined genotype CT+TT (OR=1.81, p=0.057) also showed a significantly higher risk. The CT and TT genotypes of MMP9 -1562 polymorphism contributed to high serum levels of MMP9 in MetS patients. However, no such association was observed with the MMP1 serum level and -519 A:G polymorphism. Our results suggest that a higher serum level of MMP9 in the presence of MMP9 polymorphism -1562 C:T might be a risk factor for the development of MetS. The MMP9 enzyme activity might be a significant indicator in the screening of MetS patients.

Study of metabolic syndrome and its risk components in patients attending tertiary care center of uttarakhand

Metabolic syndrome is a complex of metabolic factors which includes central obesity, insulin-resistance, dyslipidemia and hypertension. Metabolic syndrome is associated with increased risk of cardiovascular disease. This study aimed to know the rate of metabolic syndrome in outpatients presenting to medicine department of our hospital and their profile. The metabolic syndrome was diagnosed using International Diabetes Federation criteria. The parameters analyzed included age, sex, blood pressure, BMI, fasting plasma glucose, HDL and triglycerides. The rate of metabolic syndrome was 21.1 % in our study. The younger population was most susceptible to metabolic derangements. Further, females were found to be affected more than males. The extremely significant parameters were deranged fasting plasma glucose, HDL, triglycerides while hypertension was found to be insignificant. Being overweight maybe a strong predictor for presence of metabolic syndrome in our region of study, and all overweight persons should be assessed and appropriately treated to prevent future cardiovascular events.