Obesity, Metabolic Syndrome and the Risk of Microvascular Complications in Patients with Diabetes mellitus

BACKGROUND

Obesity frequently co-exists with type 2 diabetes mellitus (T2DM), leading to the socalled "diabesity epidemic". The metabolic syndrome (MetS), a cluster of central obesity, hypertension, dysglycemia, insulin resistance and/or atherogenic dyslipidemia, as well as non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of MetS, has been associated with increased cardiovascular disease (CVD), T2DM and chronic kidney disease (CKD) incidence. However, the association between obesity, MetS (including NAFLD) and diabetic microvascular complications is less evident.

METHODS

The present narrative review discusses the associations of obesity, MetS and NAFLD with diabetic kidney disease (DKD), diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN) as well as cardiac autonomic neuropathy (CAN). The available data on the effects of lifestyle measures and bariatric surgery on these diabetic complications are also briefly discussed.

RESULTS

Overall, both obesity and MetS have been related to DKD, DR and DPN, although conflicting results exist. Links between NAFLD and diabetic microvascular complications have also been reported but data are still limited. Lifestyle intervention and bariatric surgery may prevent the development and/or progression of these microvascular complications but more evidence is needed.

CONCLUSION

Clinicians should be aware of the frequent co-existence of MetS and/or NAFLD in T2DM patients to prevent or treat these metabolic disorders, thus potentially minimizing the risk for both CVD and diabetic microvascular complications.

COSMIC project: consensus on the objectives of the metabolic syndrome in clinic

Metabolic syndrome (MetS), a disorder with a high and growing prevalence, is a recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes. It is a constellation of clinical and metabolic risk factors that include abdominal obesity, dyslipidemia, glucose intolerance, and hypertension. Unfortunately, MetS is typically underrecognized, and there is great heterogeneity in its management, which can hamper clinical decision-making and be a barrier to achieving the therapeutic goals of CVD and diabetes prevention. Although no single treatment for MetS as a whole currently exists, management should be targeted at treating the conditions contributing to it and possibly reversing the risk factors. All this justifies the need to develop recommendations that adapt existing knowledge to clinical practice in our healthcare system. In this regard, professionals from different scientific societies who are involved in the management of the different MetS components reviewed the available scientific evidence focused basically on therapeutic aspects of MetS and developed a consensus document to establish recommendations on therapeutic goals that facilitate their homogenization in clinical decision-making.

Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation

The importance of metabolic syndrome (MetS) lies in its associated risk of cardiovascular disease and type 2 diabetes, as well as other harmful conditions such as nonalcoholic fatty liver disease. In this report, the available scientific evidence on the associations between lifestyle changes and MetS and its components is reviewed to derive recommendations for MetS prevention and management. Weight loss through an energy-restricted diet together with increased energy expenditure through physical activity contribute to the prevention and treatment of MetS. A Mediterranean-type diet, with or without energy restriction, is an effective treatment component. This dietary pattern should be built upon an increased intake of unsaturated fat, primarily from olive oil, and emphasize the consumption of legumes, cereals (whole grains), fruits, vegetables, nuts, fish, and low-fat dairy products, as well as moderate consumption of alcohol. Other dietary patterns (Dietary Approaches to Stop Hypertension, new Nordic, and vegetarian diets) have also been proposed as alternatives for preventing MetS. Quitting smoking and reducing intake of sugar-sweetened beverages and meat and meat products are mandatory. Nevertheless, there are inconsistencies and gaps in the evidence, and additional research is needed to define the most appropriate therapies for MetS. In conclusion, a healthy lifestyle is critical to prevent or delay the onset of MetS in susceptible individuals and to prevent cardiovascular disease and type 2 diabetes in those with existing MetS. The recommendations provided in this article should help patients and clinicians understand and implement the most effective approaches for lifestyle change to prevent MetS and improve cardiometabolic health.

Prevalence of metabolic syndrome and association with burden of atherosclerotic disease in patients with stable coronary artery disease

BACKGROUND

We aimed to estimate the prevalence of metabolic syndrome (Met.S.) and to explore the association of Met.S. with the number of diseased vessels in patients with stable coronary artery disease (C.A.D.).

METHODS

This cross-sectional study enrolled stable C.A.D. patients who attended the outpatient cardiology departments of four hospitals between 2006 and 2008. Met.S. was defined according to the National Cholesterol Education Program Adult Treatment Panel III (N.C.E.P./A.T.P. III).

RESULTS

In the study 742 patients (mean age: 62 ± 9 years, male: n = 631, 85.0%) with stable C.A.D. were recruited. The prevalence of Met.S. was 47.3% (95% C.I. = 43.6-50.9%). Among women, a high percentage of the patients had Met.S. (n = 68, 61.3%), whereas in male patients the prevalence of Met.S. was 44.8% (n = 283). Multivariable analysis showed that C.A.D. patients with Met.S. had 84% higher odds of double or triple vessel disease, whereas those with four or five Met.S. components had two times higher odds of double or triple vessel disease after adjustment for potential confounders (O.R. = 1.84 with 95% C.I. = 1.26-2.68, p = 0.001 and O.R. = 2.08 with 95% C.I. = 1.17-3.69, p = 0.012, respectively). Met.S. as well as the accumulation of four or five Met.S. components had a positive association with the likelihood of double or triple vessel disease and this was independent of the presence of diabetes.

CONCLUSIONS

Almost one out of two patients with stable C.A.D. was found to fulfill the criteria of Met.S. Met.S. as well as four or five Met.S. components increased the odds of double or triple vessel disease in patients with stable C.A.D. The study suggests that cardiologists and health care practitioners should be aware that Met.S. is highly prevalent when established C.A.D. is present and that Met.S. and accumulation of four or five Met.S. components seem to be associated more often with double or triple vessel C.A.D.

Metabolic syndrome among hypertensive patients at University of Gondar Hospital, North West Ethiopia: a cross sectional study

Background

Data is sparse concerning the magnitude of metabolic syndrome (MetS) in developing countries like Ethiopia whose major health problem had long been under-nutrition and infectious diseases rather than non-communicable diseases (NCDs) including hypertension, obesity and MetS. However, it is obvious that the NCDs are recently taking over and becoming the major health care concerns in the developing countries. This pattern could be partly explained by the nation’s sustained economical growth in the last few decades in addition to the increasing globalization related adoption of western lifestyle. The aim of this study was to assess the prevalence of metabolic syndrome and associated factors among hypertensive patients in North West Ethiopia.

Method

A cross sectional study was conducted on 300 hypertensive individuals who get follow-up care at University of Gondar Hospital after diagnosed as hypertensive. The WHO STEP-wise approach to surveillance of NCD was used. Fasting blood glucose level, triglyceride and high density lipoprotein cholesterol were determined using standardized laboratory procedures.

Result

The prevalence of metabolic syndrome was 40.7% and 39.3% according to the modified NCEP-ATP III and IDF criteria respectively. Low HDL-c was found to be the most frequently encountered (81.3%) component of MetS other than the hypertension. Being female was significantly associated with MetS (AOR = 4.34; 95% CI: 2.09, 8.99) using IDF and (AOR = 3.30; 95% CI: 1.66, 6.58) using NCEP-ATP III criteria. Abnormal BMI which included both high and low BMI was found to have significant association with MetS (AOR = 3.10; 95% CI: 1.73, 5.58) using IDF and (AOR = 1.84; 95% CI: 1.05, 3.22) as diagnosed using the NCEP-ATP III criteria.

Conclusion

We recommend a comprehensive medical care approach to hypertensive patients to adequately assess and address the additional components of MetS which are known to potentiate the risks of cardiovascular diseases among hypertensive patients.

Correlation of carotid artery disease severity and vasomotor response of cerebral blood vessels

We assessed reactivity of cerebral vessels on hypercapnia in patients with carotid occlusive disease. The effects of vascular risk factors on carotid atherosclerosis and vasomotor reactivity (VMR) of cerebral arterioles were also examined. Patients (n = 50) with carotid stenosis (≥30% in 1 or both sides) were included; 30 patients acted as controls. Hypertension, hyperlipidemia, diabetes, cardiac diseases, inflammation, and smoking were recorded. Vasomotor reactivity was assessed with the apnea test by transcranial Doppler ultrasonography and estimated by flow velocity changes in the middle cerebral artery before and after hypercapnia induction. Vasomotor reactivity was defined by the breath holding index, and values under 0.69 were considered critical for VMR impairment. Vasomotor reactivity reduction was significant (P = .004) in patients with severe carotid stenosis (>70%) and with symptomatic carotid disease (P < .05). The risk factors did not significantly influence VMR reduction. Severe carotid stenosis impairs VMR and may increase the risk of stroke, especially in symptomatic patients.

Comparison Study of Metabolic Syndrome's Differences and Diagnostic Criteria's Applicability among Xingjiang Uighur, Kazak and Han Population

Our paper is a study about metabolism syndrome (MS) incidence situations of different nationalities, including Uighur, Kazak and Han nationality in Xinjiang by means of a cross-sectional survey and compare differences and adaptabilities of applications of the diagnostic criteria for MS recommended by Adult Treatment Protocol III of National Cholesterol Education Program of America (ATP III), International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) in three groups of populations. Conclusion tell us, for Uighur population and Kazak population, IDF criterion and ATPIII criterion had a better consistence, and CDS criterion was worst. For Han population, CDS criterion and IDF criterion had a better consistence, and ATPIII criterion was worst. For the screening of MS incidence rate of Uighur and Kazak adult populations in Xinjiang region, ATPIII criterion was optimal, while CDS criterion was optimal for Han population. However, as for screening of clustering of multiple risk factors of MS, IDF criterion was better than other criteria for the three nationalities.

Metabolic syndrome in the Mediterranean region: Current status

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including abdominal obesity, impaired fasting glucose, hypertension and dyslipidemia. It seems to affect about one-fourth to one-fifth of the Mediterranean population, and its prevalence increases with age, being similar for both sexes and depending on the region and the definition used, with the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATPIII) definition being the most effective in the identification of glucose intolerance and cardiovascular risk. Except for these, MetS is associated with fatty liver disease, some forms of cancer, hypogonadism, and vascular dementia. The Mediterranean diet seems to be an ideal diet in patients with MetS, being rich in fibre, monounsaturated and polyunsaturated fats, and low in animal protein; and decreases the prevalence of MetS and cardiovascular disease risk. Except for weight loss, multifactorial intervention including insulin resistance reduction and normoglycemia, management of dyslipidemia, optimizing blood pressure and administration of low-dose aspirin for patients at high or moderately high cardiovascular disease (CVD) risk are additional targets. The present review provides current understanding about MetS in the Mediterranean region, focusing on its prevalence, clinical significance, and therapeutic strategy.