Weight change and incident metabolic syndrome in Iranian men and women; a 3 year follow-up study

The dynamics of metabolic syndrome development from its isolated components among Iranian adults: findings from 17 years of the Tehran lipid and glucose study (TLGS)

Background

Evaluating the process of changes in the Metabolic Syndrome (MetS) components over time is one of the ways to study of the MetS natural history. This study aimed to determine the trend of changes in the progression of MetS from its isolated components.

Methods

This longitudinal study was performed on four follow-up periods of the Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 3905 adults over the age of 18 years. MetS was diagnosed based on the Joint Interim Statement (JIS). The considered components were abdominal obesity, hypertension, hyperglycemia, and dyslipidemia.

Results

The highest incidence of MetS from its components was related to hypertension in the short term (3.6-year intervals). In the long run, however, the highest increase in the MetS incidence occurred due to abdominal obesity. Overall, the incidence of MetS increased due to obesity and dyslipidemia, but decreased due to the other factors. Nonetheless, the trend of MetS incidence from all components increased in total. The most common components were dyslipidemia with a decreasing trend and obesity with an increasing trend during the study.

Conclusion

The results indicated that obesity and hypertension components played a more important role in the further development of MetS compared to other components in the Iranian adult population. This necessitates careful and serious attention in preventive and control planning.

Soluble P-selectin, procalcitonin, transforming growth factor (TGF)-β and apo-proteins in association with the components of metabolic syndrome in obese individuals

BACKGROUND & AIMS

Metabolic syndrome (MetS) is a clinical disorder with widespread prevalence. In the current study, we aimed to investigate the association between serum soluble P-selectin, procalcitonin, transforming growth factor (TGF)-β and apo-proteins with the components of metabolic syndrome in obese individuals.

MATERIAL AND METHODS

Sixty two obese patients with MetS and sixty five obese apparently healthy controls were participated in the current case-control study. The participants' anthropometric assessments and systolic and diastolic blood pressure (SBP and DBP) were measured. Serum lipids and the concentrations of ox-LDL, P-selectin, procalcitonin, TGF-β and apo-proteins were measured with commercial ELIZA kits.

RESULTS

Serum TG and TC were significantly higher in obese subjects with MetS; while TGF-β, procalcitonin, apoprotein B and insulin concentrations were higher in obese non- MetS group. In obese subjects with MetS, procalcitonin was in positive association with ox-LDL and apoprotein-B was in positive association with HDL. In obese subjects without MetS, apoprotein -B was in positive association with WC and HDL and WC.

CONCLUSION

The current study found several associations between serum lipids and PCT and serum apo-proteins in obese individuals either with or without MetS. Further studies with large sample size are warranted to better elucidate the observed relationships and underlying mechanism.

TRIAL REGISTRATION

Not Applicable.

The Prevalence and Trend of Metabolic Syndrome in the South-East of Iran

Metabolic syndrome (Mets) is a set of metabolic disorders including abdominal obesity, insulin resistance or disorders of glucose absorption and metabolism, lipid disorders, and hypertension, which increases the risk of chronic diseases including type 2 diabetes, cardiovascular diseases, cancer, and mortality. Therefore, the present study aimed to determine the trend of Mets and its components in Zahedan, a city located in South-East of Iran, from 2009 to 2017. A total of 761 individuals aged >20 years were followed from 2009 to 2017. The frequency of metabolic syndrome was measured at two-time points based on four criteria: International Diabetes Federation (IDF), National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATP III), Third Adult Treatment Panel (ATP III), and American Heart Association and the National Heart Lung and Blood Institute (AHA/NHLBI). The prevalence of Mets ranged from 16.6 (95% CI: 13.9 - 19.2) (ATP III) to 23.70% (95% CI: 20.6 - 26.6) (AHA/NHLBI) in 2009. Accordingly, it increased from 5.2% to 7.3% during the study period using different criteria such that the frequency of Mets varied from 21.8 (95% CI: 18.8 - 24.7) (ATP III) to 31.0% (95% CI: 27.7 - 34.3) (AHA/NHLBI) in 2017. The increasing trend was prominent among females, persons aged <40 years, and those with the lowest educational level. Two components of Mets (abdominal obesity and diabetes) increased in prevalence, whereas elevated blood pressure, hypertriglyceridemia, and low HDL declined. The study revealed an annual increase rate of about 1% in the prevalence of metabolic syndrome. Therefore, the increasing trend of some components of Mets highlights the urgency of addressing these components as health priorities.

Prevalence and Incidence of Metabolic Syndrome in Iran: A Systematic Review and Meta-Analysis

Metabolic syndrome (MetS) is a predictor of several diseases such as cardiovascular diseases, diabetes, dyslipidemia, stroke, osteoarthritis, certain cancers, and death leading to public health concern in most societies. We aimed to estimate the pooled prevalence and incidence of MetS in Iranian population through a meta-analysis study. We included cross-sectional and cohort studies to estimate the overall prevalence and incidence rates of MetS in Iran National databases including MagIran, Science Information Database, IranMedex, and international databases including Medline, Web of Sciences, and Scopus were searched up to October 2017. Finally, 125 studies were included. The total sample size was 472,401 with a mean age of 38 ± 7.8 years. The overall pooled prevalence and incidence rate among the general population of Iran was 0.26 (95% CI: 0.26, 0.29) and 97.96 (95% CI: 75.98, 131.48), respectively. The pooled prevalence of MetS was higher in females and in urban areas. The highest and lowest prevalence of MetS was obtained by the Iranian definition criteria (0.43) and the NHANES III (0.12). The highest and lowest incidence rates of MetS were obtained by IDF (144.07 per 1000) and the JIS (89.73 per 1000). The prevalence of MetS was higher in women and those living in urban areas. Furthermore, the prevalence of MetS increased with increasing age in both genders.

The most appropriate cut-off point of anthropometric indices in predicting the incidence of metabolic syndrome and its components

INTRODUCTION

The association of individuals' anthropometric indices with their development of metabolic syndrome (MetS) has been investigated in several studies. Taking into account the ethnic differences, this study aimed to determine the most appropriate cut-off points of anthropometric indices in predicting the incidence of MetS and its components in Ahvaz.

METHODS

This study is part of a cohort study conducted at the Diabetes Research Center of Ahvaz Jundishapur University of Medical Sciences on a population of over 20 in Ahvaz during 2009-2014. Of the 592 patients, 505 patients who were not diagnosed with MetS in 2009, were entered into this study. The data analyzed involved demographic information including age and sex, anthropometric information including height, weight, waist circumference (WC), hip circumference (HC) and the ratios between them, laboratory data including blood levels of Triglyceride (TG), Fasting plasma glucose (FPG) and High-density lipoprotein cholesterol (HDL-C), and clinical data including systolic(S) and diastolic(D)blood pressure(BP). After 5 years, the subjects were re-evaluated for MetS based on the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATP III) criteria and the most appropriate cut-off points of anthropometric indices for the prediction of the incidence of MetS using the Receiver Operative Characteristic (ROC) curves were obtained.

RESULTS

Waist-to-Height Ratio (WHtR) index with a cut-off point of 0.53 followed by WC with a cut-off point of 87.5 cm had the highest power to predict the incidence of MetS. The cut-off points of WC and Body mass index (BMI) were respectively 89.5 cm and 26 kg/m2 for men, and 83.5 cm and 27.5 kg/m2 for women. All anthropometric indices were able to predict the components of this syndrome (with the exception of low HDL-C). The cut-off point of WC in predicting High FBS, High TG and High BP was 84.5, 84.8, and 86.5 cm, respectively.

CONCLUSION

Overall, it seems that given its ease of measurement, the WC index is preferred to other indices for predicting the incidence of MetS and its components in clinical screening.

Early weight gain predicts later metabolic syndrome in depressed patients treated with antidepressants: Findings from the METADAP cohort

BACKGROUND

Metabolic syndrome (MetS) is a major public health issue. We assessed whether early weight gain predicts later MetS in depressed patients treated with antidepressants.

METHODS

In the 6-month prospective METADAP cohort, 260 non-overweight patients with a Major Depressive Disorder (MDD) and a current Major Depressive Episode (MDE) were assessed for early weight gain (>5%) after one month of treatment, and for the later incidence of MetS after three and six months of treatment. Outcome variables were MetS, the number of MetS criteria, and each MetS criterion (high Waist Circumference (WC), high Blood Pressure (BP), high triglyceridemia (TG), low HDL-Cholesterolemia, and high Fasting Plasma Glucose (FPG). Multivariate models were adjusted for age, sex, previous MDD duration, severity of current MDE, and antidepressants.

RESULTS

24.6% of patients had early weight gain. Compared to those without weight gain, patients with early weight gain had higher MetS incidence: 16.7% vs. 6.9% after 3 months (p = 0.07), and 23.8% vs. 7.1% after 6 months (p = 0.02). Among completers (n = 120), early weight gain was significantly associated with later MetS incidence (OR: 5.5) and a higher number of MetS criteria (IRR: 1.7). This effect was driven by the WC, TG, and HDL-C criteria.

CONCLUSION

Compared to Non-early weight gainers, patients with early weight gain in the first month of antidepressant treatment have a significant higher risk of developing MetS during the 6 months of treatment. Early weight monitoring is recommended in order to set preventive measures to avoid new metabolic syndromes in depressed patients treated with antidepressants.

Metabolic Syndrome: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

In recent decades, investigations have been focused on the definition, incidence and predictors of metabolic syndrome (MetS) in Iranians. This study aimed to review systematically investigations on MetS, conducted among the Tehran lipid and glucose study (TLGS) participants.

EVIDENCE ACQUISITION

Literature on MetS documented by TLGS studies published from 2000 to 2017 were searched using Pubmed and Scopus database in English language with a combination of following keywords: Metabolic syndrome, TLGS.

RESULTS

The harmonized definition of MetS was confirmed, based on the estimated cut point of waist circumference (WC) ≥ 95 cm for both genders in Iran. The incidence rate was 550.9/10000 person/years, lower among women (433.5/10000) than men (749.2/10000). The prevalence of abdominal obesity, high triglycerides (TG), low high density lipoprotein cholesterol (HDL-C), high blood pressure (BP), and high fasting blood glucose (FBG) was 30, 46, 69, 34, and 12%, respectively. The prevalence of MetS in adolescents was 10.1% with no significant difference between boys and girls (10.3% in boys and 9.9% in girls). A strong association of WC (OR: 2.32, CI: 2.06 - 2.59) and TGs (OR: 1.95, CI: 1.65 - 2.11) with development of MetS was found. In adolescent boys, WC had the highest OR for MetS risk. WHO-defined MetS was a significant predictor of total and cardiovascular mortality both in men (HR: 1.66, CI: 1.23 - 2.24; HR:1.93, CI: 1.26 - 2.94) and women (HR: 2.01, CI: 1.39 - 2.88; HR:2.71, CI: 1.44 - 5.09).

CONCLUSIONS

Our results indicate high incidence of MetS in Tehranian adults and adolescents; high WC also appears to be a strong predictor of MetS. All definitions of MetS predicted cardiovascular disease.

Prevalence of Metabolic Syndrome and Associations with Lipid Profiles in Iranian Men: A Population-Based Screening Program

Purpose

Metabolic syndrome (MS) is characterized by a collection of interdependent disorders, including abdominal obesity, dyslipidemia, hyperglycemia, hypertension, and diabetes. The current study aimed to estimate the prevalence of MS in Qom, Iran.

Materials and Methods

A population-based screening program was conducted in the city of Qom, in 845 urban adult men over 25 years old in 2014. Abdominal obesity, fasting blood glucose (FBG), blood pressure, and the serum lipid profile were measured in subjects after fasting for at least 8 hours. MS was defined according to the Adult Treatment Panel III criteria. Data were analyzed using the chi-square test, t-test, and multiple logistic regression.

Results

The overall prevalence of MS was 23.0%, and the most common prevalent metabolic abnormalities associated with MS were low high-density lipoprotein cholesterol (<40 mg/dL) in 34.3% of subjects, a waist circumference >102 cm in 33.9%, blood pressure ≥130/85 mmHg in 27.6%, fasting triglycerides (TG) ≥150 mg/dL in 25%, and FBG ≥110 mg/dL in 20.6%. A FBG level ≥110 mg/dL (odds ratio [OR]=4.85; 95% confidence interval [CI], 2.14~8.24), dyslipidemia (OR=3.51; 95% CI, 2.10~5.89), and a fasting TG ≥150 mg/dL were the most important factors contributing to MS.

Conclusions

The prevalence of MS in men in Qom was higher than has been reported in other countries, but it was lower than the mean values that have been reported elsewhere in Iran. FBG was the most important factor contributing to MS, and all elements of the lipid profile showed important associations with MS.

Mediterranean dietary pattern and VEGF +405 G/C gene polymorphisms in patients with metabolic syndrome: An aspect of gene-nutrient interaction

Aims

To evaluate the relationship between Mediterranean dietary pattern, anthropometric and metabolic biomarkers and vascular endothelial growth factor (VEGF) +405 G/C gene polymorphism in patient with metabolic syndrome (Mets).

Materials and methods

In this study 150 patients with Mets and 50 healthy subjects were enrolled. Dietary intakes were evaluated with a semi-quantitative food-frequency questionnaire (FFQ) and Mediterranean dietary quality index (Med-DQI) was assessed. Anthropometric assessments and blood pressure measurement were performed. Biochemical assays including fasting serum glucose (FSG), matrix metalloproteinase-3 (MMP-3), liver enzymes and lipid profiles were also assessed. Polymorphism of +405 G/C VEGF gene was determined utilizing polymerase chain reaction-restriction fragments length polymorphism (PCR-RFLP) method.

Results

Serum high density lipoprotein-cholesterol (HDL-C) was significantly lower and low density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol (TC) concentrations and FSG were significantly higher in metabolic syndrome patients compared with control group (P < 0.05). Metabolic syndrome group with high consumption of “cholesterol” had significantly upper serum TG; also high consumption of “fish” and “vegetables-fruits” was associated with a significantly lower serum LDL concentrations. In metabolic syndrome patients with CC genotype, mean score of “saturated fatty acid” subgroup was significantly higher compared with other genotypes; whereas, in healthy individuals, mean score of “fruit-vegetable” subgroup in individuals of CC and GG genotype was significantly higher (P<0.05).

Conclusion

Our findings indicated a significant relationship between Mediterranean dietary quality index and both anthropometric and metabolic risk factors. We also indicated a higher “saturated fatty acid” intake in CC genotype among metabolic syndrome patients.

The Prevalence of Metabolic Syndrome and Different Obesity Phenotype in Iranian Male Military Personnel

Obesity, especially when concentrated in the abdominal area, is often associated with the presence of metabolic syndrome. Stress, particularly occupational stress, is one of the most important factors contributing to the increased prevalence of metabolic syndrome components among different populations. This study aimed to investigate the prevalence of overweight and obesity as well as the criteria for metabolic syndrome and its risk factors and different obesity phenotype in a population of military personnel aged 20 to 65 years. This study is a retrospective cross-sectional study in which data are extracted from the database of a military hospital (2,200 participants). The records of participants contained information such as age, marital status, educational level, weight, height, body mass index, blood pressure, waist circumference, history of drug use and smoking, as well as the results of tests including lipid profile and fasting blood glucose. The Adult Treatment Panel III criteria as well as two national criteria were used to identify metabolic syndrome among participants. Data analysis was p1erformed using SPSS version 16. The average age of participants was 33.37 (7.75) years. The prevalence of metabolic syndrome according to Iranian cutoff was 26.6% for the waist circumference >90 cm (585 persons) and 19.6% for the waist circumference >95 cm (432 persons). The rate of metabolic syndrome was identified as 11.1% (432 cases) according to Adult Treatment Panel III criteria. Results of the current study identified that the prevalence of metabolic syndrome among military individuals is less than other populations, but the prevalence of the syndrome is higher than other military personnel in other countries.

The impact of body weight gain on nonalcoholic fatty liver disease and metabolic syndrome during earlier and later adulthood

AIM

Body weight gain adds risk for metabolic disorders and there are different metabolic changes in earlier and later adulthood. However, its impact on non-alcoholic fatty liver disease (NAFLD) was indeterminate. The aim of current study was to evaluate the impact of body weight gain on NAFLD and metabolic syndrome (MetS) during overall, earlier (25-40y) and later (over 40y) adulthood.

METHODS

1119 subjects were selected to calculate changes in body weight (ΔBW), body mass index (BMI) (ΔBMI) and bodyweight per year (ΔBW/y) to analysis their impact on NAFLD and MetS in multi-variable regression models, and explored the potential mediators that associated ΔBMI with NAFLD by mediation analysis.

RESULTS

ΔBMI, ΔBW and ΔBW/y in whole adulthood were all positively associated with NAFLD and MetS. Body weight gain during earlier adulthood was more strongly associated with NAFLD than those during later adulthood. In NAFLD, the ORs of ΔBMI (third trisection), ΔBW and ΔBW/y were 3.86 (2.25, 6.57), 1.05 (1.02, 1.09) and 2.05 (1.29, 3.24) during earlier adulthood, and 1.47 (1.09, 2.02), 1.02 (1.00, 1.06), and 1.04 (.99, 1.13) over 40y. Insulin and HOMA-IR were important intermediates that associated ΔBMI with NAFLD. ΔBMI in earlier adulthood increased higher insulin and insulin resistance (IR) than later adulthood.

CONCLUSIONS

Body weight gain in adulthood was positively associated with NAFLD and MetS, and the association was stronger in earlier than later adulthood. Insulin and IR were important mediators that contributed to the association.

A Longitudinal Study of Adherence to the Mediterranean Dietary Pattern and Metabolic Syndrome in a Non-Mediterranean Population

BACKGROUND

Adherence to the Mediterranean diet (MedDiet) has been proposed to reduce the risk of metabolic syndrome (MetS), but the association of the diet on MetS in non-Mediterranean populations remains unclear.

OBJECTIVES

The aim of this study was to investigate whether adherence to the MedDiet is related to the incident MetS and its components during a 3-year follow-up among Iranian adults.

PATIENTS AND METHODS

Longitudinal associations between the MedDiet and MetS components were investigated on 2241 adults, aged 18 - 74 years, without type 2 diabetes selected from participants of the Tehran lipid and glucose study (TLGS). The association between the MedDiet and MetS incidence was also examined in 1661 participants, free of Mets at baseline. Adherence to the MedDiet was assessed using the traditional Mediterranean diet score (MDS) and a recently posteriori adaptation of the MDS of Sofi et al. (Sofi-MDS). MetS was defined according to the recent interim consensus.

RESULTS

After adjusting for potential confounders, neither higher MDS nor higher Sofi-MDS were significantly associated with the mean values of MetS components and the risk of metabolic abnormalities incidence after 3 years follow-up. During the 3 years of follow-up, 246 developed MetS were identified. In multivariable model, the adjusted odds ratio (OR) of developing MetS did not differ significantly in participants with the highest tertile of the MDS (OR (95% CI): 0.88 (0.62 - 1.23)) or sofi-MDS (OR (95% CI):1.12 (0.77 - 1.62)) compared to those in the lowest tertiles.

CONCLUSIONS

Adherence to the MedDiet, according to MDS and Sofi-MDS, may not predict MetS components and MetS incidence after 3 years of follow-up in Iranian adult populations.

Metabolic syndrome and inflammatory biomarkers in adults: a population-based survey in Western region of iran

BACKGROUND

There is evidence that inflammation may be involved in pathogenesis of MetS. Inflammatory biomarkers are moving to the forefront as the potent predictors of MetS.

OBJECTIVES

The present study aimed to evaluate the association between MetS and some inflammatory biomarkers.

PATIENTS AND METHODS

This community-based cross-sectional study was conducted on 800 subjects aged above 35 years selected through random sampling in Borujerd (west of Iran) from 2011 to 2013. MetS was defined based on ATP III criteria and the subjects were divided into two groups (MetS and non-MetS groups). Waist circumference and Body Mass Index (BMI) were calculated. In addition, blood samples were taken and C-Reactive Protein (CRP), lipid profile, Fasting Blood Sugar (FBS), and Bleeding Time (BT) were measured. Then, the correlations between MetS and the above-mentioned variables were estimated. After all, the data were entered into the SPSS statistical software (v. 17) and analyzed using T-test, chi-square, median test, and spearman's rank correlation.

RESULTS

In this study, 344 subjects (43%) met the ATP III criteria. The results showed a significant difference between MetS and non-MetS groups regarding BMI, white blood cell, total cholesterol, LDL, platelet, and high-sensitivity CPR (hs-CRP) (P < 0.0001, P = 0.040, P < 0.0001, P < 0.0001, and P = 0.045, respectively). Besides, waist circumference, Triglyceride (TG), FBS, and systolic and diastolic blood pressure were significantly higher, while HDL was significantly lower in the MetS group (P < 0.0001).

CONCLUSIONS

The incidence rate of MetS in our survey was higher compared to the previous reports. In addition, this incidence rate was higher in females in comparison to males. The results also showed a significant correlation between inflammatory biomarkers and MetS and that the higher levels of hs-CRP were associated with higher rate of MetS.

The effects of 6 isocaloric meals pattern on blood lipid profile, glucose, hemoglobin a1c, insulin and malondialdehyde in type 2 diabetic patients: a randomized clinical trial

BACKGROUND

The present clinical trial study aims at investigating the effect of daily energy intake in 6 isocaloric meals in comparison with the current meal pattern (3 meals and 2 small snacks per day) on type 2 diabetes risk markers in diabetes during 3-month period.

METHODS

Eighty four type 2 diabetes patients were randomly divided into 6 isocaloric meal diet or a balanced diet (3 meals and 2 snacks previous meal pattern). The planned reduced calorie diets for both groups were identical except for the meal pattern. Blood samples were analyzed before and after the investigation for fasting blood sugar (FBS), two-hour post-prandial glucose (2hPP), insulin, hemoglobin A1c (HbA1c), total cholesterol, triglyceride, HDL-C, LDL-C, and molondialdehyde (MDA) concentrations.

RESULTS

HbA1c (P=0.00) and body mass index (BMI) (P=0.04) values decreased significantly in the 6 isocaloric meal pattern compared with the controls. There were no significant differences in fasting serum glucose (P=0.09), insulin (P=0.65), total cholesterol (P=0.32), LDL-C (P=0.43), HDL-C (P=0.40) cholesterol, triglyceride (P=0.40), MDA (P=0.13) and 2hPP serum glucose (P=0.30) concentrations between the 6 isocaloric meal and tradition meal pattern.

CONCLUSION

Six isocaloric meal pattern in comparison with the current meal pattern led to weight loss and improved glycemic control. Serum lipid profile and MDA did not change significantly.

TRIAL REGISTRATION NUMBER

IRCT201205179780N1.

'Red Ruby': an interactive web-based intervention for lifestyle modification on metabolic syndrome: a study protocol for a randomized controlled trial

BACKGROUND

Although effectiveness of web-based interventions on lifestyle changes are recognized, the potential of such programs on metabolic syndrome has not been explored. We describe the protocol of a randomized controlled trial that aims to determine the feasibility, acceptability, usability, and effectiveness of interactive technology on lifestyle intervention in a population with metabolic syndrome.

METHODS/DESIGN

This is a two-arm randomized controlled trial. The study includes 160 participants (n = 80 per arm) who will be recruited via online registration on the study website. The inclusion criteria are that they should have metabolic syndrome and have access to the Internet. All participants will receive information on dietary intake and physical activity through the study website. The intervention group will receive additional resources via the study website including interactive Healthy Heart Profile and calorie restricted diet tailored to the participants. The primary outcomes are feasibility, acceptability, usability, and the change in metabolic syndrome components. The secondary outcomes are comparing quality of life, physical activity and food intake among the study arms. The participants will be followed up to 6 months with data collection scheduled at baseline, 3 and 6 months.

DISCUSSION

There is a need for developing and evaluating web-based interventions that target people with high risk for cardiovascular diseases. This study will therefore make an important contribution to this novel field of research and practice.

TRIAL REGISTRATION

IRCT201111198132N1.

Incidence of metabolic syndrome over 9 years follow-up; the importance of sex differences in the role of insulin resistance and other risk factors

To determine, the predictors of incident metabolic syndrome (MetS) in a community-based cohort of West Asians, during a mean follow-up of 9.3 years, a sample of 2858 non-MetS Iranian adults aged ≥ 20 years were examined at baseline and followed at three year intervals during three consecutive phases. The MetS was defined using the joint interim statement. Cox proportional hazard regression was used to determine the independent variables associated with incident MetS. Overall, 1117 new cases MetS were identified resulting in an incidence rate of 550.9/10000 person years (95% CI: 519.5-584.2). The corresponding incidence rates among women and men were 433.5/10000 person years (95% CI: 398.8-471.2) and 749.2/10000 person years (95% CI: 689.9-813.5), respectively. Baseline-adjusted predictors of developing MetS included all of the MetS components, being overweight or obese in both gender, and family history of diabetes and age only in women. There were significant effect modifications of gender on age (P<0.001), high blood pressure (0.026), high waist circumference (P<0001) and obesity categories (all P ≤ 0.01) in multivariate analysis. After considering HOMA–IR in the model, among women, all of the MetS predictors as well as those with HOMA-IR ≥ 2.23 showed a significant risk for incident MetS [HR: 1.63 (1.16-2.28)]; however, among men all the MetS components (WC was marginally significant) as well as the fourth quartile of HOMA-IR [HR: 1.50 (1.03-2.17)] and being overweight showed a significant risk. Finally, in the pooled analysis, we showed that female gender had lower risk for incident MetS than male [HR: 0.58 (0.47-0.70)]. In the Iranian population, high incidence of MetS, especially among men, was shown. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident MetS.

Relationship between Changes in Components Associated with Metabolic Syndrome and Disappearance, or Remission, of Metabolic Syndrome during 1 Year

OBJECTIVES:

Prior research has focused on the relationship between weight change and incidence of metabolic syndrome. Change in body mass index (BMI), components of metabolic syndrome and metabolic syndrome status were investigated over 1 year of follow-up.

Methods:

Subjects with metabolic syndrome from a community health screening project were recruited. Logistic regression was used to analyse the disappearance or remission of metabolic syndrome during 1 year according to changes in BMI, waist circumference, triglycerides, blood pressure, high-density lipoprotein-cholesterol (HDL-C) and fasting plasma glucose (FPG).

Results:

The study included 490 subjects with metabolic syndrome. After 1 year, metabolic syndrome had disappeared in 30.0% (147/490) of subjects. Decreased triglycerides, blood pressure and HDL-C were significantly associated with the 1-year disappearance of metabolic syndrome, whereas BMI, waist circumference and FPG levels were not.

Conclusions:

Short-term weight reduction has no impact on the status of metabolic syndrome. The disappearance of metabolic syndrome was common during a 1-year follow-up. This finding might impact on the treatment and management of people with metabolic syndrome.

Impact of weight gain on cardiovascular risk factors in Japanese male workers

OBJECTIVE

To evaluate the impact of weight gain on cardiovascular risk factors among younger (25 to 44 years) and older (45 to 64 years) Japanese male workers in terms of population attributable risk percentage (PAR%).

METHODS

Using the 2008 and 2009 health examination data, 49,587 eligible male workers aged 25 to 64 years were examined for their 1-year changes in body weight and cardiovascular risk factors.

RESULTS

Mean weight change was significantly greater than zero in the younger group (+0.27 kg) but not in the older group (-0.08 kg). The PAR% due to weight gain for the development and maintenance of cardiovascular risk factors was estimated at 21.8% and 5.4%, respectively, in the younger and older groups.

CONCLUSIONS

The age-stratified PAR% estimates suggest that weight gain prevention programs will make greater contributions to cardiovascular health in younger than in older male workers.

The weight change impact on metabolic syndrome: a 17-year follow-up study

Introduction: Data on long-term patterns of weight change in relation to the development of metabolic syndrome (MetS) are scarce. The aim of the study was to evaluate the impact of weight change on the risk of MetS in men. Material and Methods: Prospective longitudinal observation (17.9 ± 8.1 years) of apparently healthy 324 men aged 18–64 years. Metabolic risk was assessed in weight gain (⩾ 2.5 kg), stable weight (> −2.5 kg and < 2.5 kg) and weight loss (⩽ −2.5 kg) groups. Adjusted relative risk (RR) of MetS was analyzed using multivariate logistic regression. Results: The prevalence of MetS over follow-up was 22.5%. There was a strong relationship between weight gain and worsening of MetS components among baseline overweight men. Long-term increase in weight was most strongly related with the risk of abdominal obesity (RR=7.26; 95% CI 2.98–18.98), regardless of baseline body mass index (BMI). Weight loss was protective against most metabolic disorders. Leisure-time physical activity (LTPA) with energy expenditure > 2000 metabolic equivalent/min/week was associated with a significantly lower risk of MetS. Conclusions: Reducing weight among overweight and maintaining stable weight among normal-weight men lower the risk of MetS. High LTPA level may additionally decrease the metabolic risk regardless of BMI.

Triglycerides and triglycerides to high-density lipoprotein cholesterol ratio are strong predictors of incident hypertension in Middle Eastern women

Dyslipidemia has been reported as a risk factor for incident hypertension in a few prospective studies, however, no study has specifically assessed different lipid measures including the lipid ratios, that is, total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs)/HDL-C as predictors of hypertension among Middle Eastern women with high prevalences of dyslipidemia and hypertension. The study population consisted of 2831 non-hypertensive women, aged ≥ 20 years. We measured lipoproteins, and calculated non-HDL-C and the lipid ratios. The risk-factor-adjusted odds ratios for incident hypertension were calculated for every 1 standard deviation (s.d.) change in TC, log-transformed TG, HDL-C, non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using multivariate logistic regression analysis. Over a mean follow-up of 6.4 years, 397 women developed hypertension. An increase of 1 s.d. in TG, TC/HDL-C and TG/HDL-C increased the risk of incident hypertension by 16, 19 and 18%, respectively, and 1 s.d. increase in HDL-C decreased the risk of hypertension by 14% in the multivariable model (all P ≤ 0.05). In models excluding women with diabetes and central or general obesity, TG, TG/HDL-C and TC/HDL-C remained as independent predictors of incident hypertension. In conclusion, dyslipidemia, using serum TG and TG/HDL-C, in particular, may be useful in identification of women at risk of hypertension, even in those without diabetes and central or general obesity.

Dietary fructose and risk of metabolic syndrome in adults: Tehran Lipid and Glucose study

Background

Studies have shown that the excessive fructose intake may induce adverse metabolic effects. There is no direct evidence from epidemiological studies to clarify the association between usual amounts of fructose intake and the metabolic syndrome.

Objective

The aim this study was to determine the association of fructose intake and prevalence of metabolic syndrome (MetS) and its components in Tehranian adults.

Methods

This cross-sectional population based study was conducted on 2537 subjects (45% men) aged 19-70 y, participants of the Tehran Lipid and Glucose Study (2006-2008). Dietary data were collected using a validated 168 item semi-quantitative food frequency questionnaire. Dietary fructose intake was calculated by sum of natural fructose (NF) in fruits and vegetables and added fructose (AF) in commercial foods. MetS was defined according to the modified NCEP ATP III for Iranian adults.

Results

The mean ages of men and women were 40.5 ± 13.6 and 38.6 ± 12.8 years, respectively. Mean total dietary fructose intakes were 46.5 ± 24.5 (NF: 19.6 ± 10.7 and AF: 26.9 ± 13.9) and 37.3 ± 24.2 g/d (NF: 18.6 ± 10.5 and AF: 18.7 ± 13.6) in men and women, respectively. Compared with those in the lowest quartile of fructose intakes, men and women in the highest quartile, respectively, had 33% (95% CI, 1.15-1.47) and 20% (95% CI, 1.09-1.27) higher risk of the metabolic syndrome; 39% (CI, 1.16-1.63) and 20% (CI, 1.07-1.27) higher risk of abdominal obesity; 11% (CI, 1.02-1.17) and 9% (CI, 1.02-1.14) higher risk of hypertension; and 9% (CI, 1-1.15) and 9% (1.04-1.12) higher risk of impaired fasting glucose.

Conclusion

Higher consumption of dietary fructose may have adverse metabolic effects.

Excessive 5-year weight gain predicts metabolic syndrome development in healthy middle-aged adults

AIM: To quantitatively examine the impacts of an easy-to-measure parameter - weight gain - on metabolic syndrome development among middle-aged adults.

METHODS: We conducted a five-year interval observational study. A total of 1384 middle-aged adults not meeting metabolic syndrome (MetS) criteria at the initial screening were included in our analysis. Baseline data such as MetS-components and lifestyle factors were collected in 2002. Body weight and MetS-components were measured in both 2002 and 2007. Participants were classified according to proximal quartiles of weight gain (WG) in percentages (%WG ≤ 1%, 1% < %WG ≤ 5%, 5% < %WG ≤ 10% and %WG > 10%, defined as: control, mild-WG, moderate-WG and severe-WG groups, respectively) at the end of the follow-up. Multivariate models were used to assess the association between MetS outcome and excessive WG in the total population, as well as in both genders.

RESULTS: In total, 175 (12.6%) participants fulfilled MetS criteria within five years. In comparison to the control group, mild-WG adults had an insignificant risk for MetS development while adults having moderate-WG had a 3.0-fold increased risk for progression to MetS [95% confidence interval (CI), 1.8-5.1], and this risk was increased 5.4-fold (95% CI, 3.0-9.7) in subjects having severe-WG. For females having moderate- and severe-WG, the risk for developing MetS was 3.6 (95% CI, 1.03-12.4) and 5.5 (95% CI, 1.4-21.4), respectively. For males having moderate- and severe-WG, the odds ratio for MetS outcome was respectively 3.0 (95% CI, 1.6-5.5) and 5.2 (95% CI, 2.6-10.2).

CONCLUSION: For early-middle-aged healthy adults with a five-year weight gain over 5%, the severity of weight gain is related to the risk for developing metabolic syndrome.

Cardiovascular disease in Middle Eastern women

Morbidity and mortality from cardiovascular disease (CVD) are rising among Middle Eastern women. Despite this threat, awareness and understanding of CVD are low and surveillance data are nonexistent for many populations in this region. In this review, the data available on CVD in Middle Eastern women will be generalized. Population-based studies in the Middle East have been sporadic and most have been cross-sectional with small samples. Many Middle Eastern countries lack reliable surveillance data regarding the prevalence and incidence of CVD and its risk factors in women. This information is crucial for monitoring the scope of the problem and for guiding intervention strategies. Because of the ethnic heterogeneity of this region and the rapidly changing lifestyles, well-designed, longitudinal, large-scale population-based studies that focus on CVD and its risk factors are needed in multiple areas of the Middle East.

Long-term weight gain and metabolic syndrome, adiponectin and C-reactive protein in women aged 50-60 years

PURPOSE

The aim of this study was to determine the impact of the weight change during 30-40 year follow-up on the prevalence of metabolic syndrome (MS) components, C-reactive protein (CRP) and adiponectin.

MATERIAL AND METHODS

The study included 153 women. Blood pressure, anthropometric and laboratory measures were done at the age of 50-60 years. All women declared normal body weight at age 20. The MS was defined according to the International Diabetes Federation (IDF 2005). Women were divided into four groups according to weight gain: < 10 kg, 10-19 kg, 20-29 kg, > 30 kg.

RESULTS

The highest values of waist circumference, BMI, WHR, CRP, glucose, HOMA index, insulin, triglycerides, blood pressure and the lowest concentrations of adiponectin and HDL-cholesterol were observed in the group with the highest weight gain (above 30 kg). Odds ratio for MS was tenfold higher in group with weight gain 10-19 kg and 20-29 kg and twenty fold higher in group with weight gain above 30 kg. In multiple regression analysis CRP was most significantly correlated with weight gain.

CONCLUSIONS

Among biochemical parameters of metabolic syndrome CRP seems to be the most significantly related to weight gain. The risk of metabolic syndrome is significantly increased even when the weight gain is 10 kg in middle-aged women characterized by a normal BMI at the age of 20.