Dynamic development of metabolic syndrome and its risk prediction in Chinese population: a longitudinal study using Markov model

High-intensity combination exercise has the highest effect on increasing serum irisin and interleukin 6 levels in women with obesity

OBJECTIVES

Lifestyle, overnutrition, socioeconomic status, environmental conditions, and genetics are factors that cause obesity. Lifestyle modification with a nonpharmacological approach based on physical exercise is the starting point in overcoming obesity. However, physical exercise with the appropriate and effective intensity for obese subjects is still debated. Therefore, this study aims to prove the effect of intensity differences with aerobic-resistance combination exercise on increasing irisin and IL-6 levels in obese women.

METHODS

A total of 32 obese women were selected as subjects and administered the interventions of low-intensity combination exercise (Q2), moderate-intensity combination exercise (Q3), and high-intensity combination exercise (Q4). ELISA was used to measure irisin and IL-6 levels in all samples. Statistical analysis used one-way ANOVA and Turkey's-Honest Significant Difference (HSD) post hoc test.

RESULTS

The mean Δ IL-6 levels in the control groups (Q1), Q2, Q3, and Q4 were 0.27 ± 2.54, 2.07 ± 2.55, 5.99 ± 6.25, and 7.98 ± 2.82 pg/mL with (p=0.015). The mean Δ irisin levels were 0.06 ± 0.81 ng/mL in Q1, 0.59 ± 0.67 ng/mL in Q2, 1.99 ± 1.65 ng/mL in Q3, 4.63 ± 3.57 ng/mL in Q4 with (p=0.001).

CONCLUSIONS

This study proved that all three types of combined exercise intensity increased myokine levels, such as irisin and IL-6. However, high-intensity combination exercise provided the most optimal improvement in myokine levels in obese women. Future studies are needed to design long-term exercise programs specifically for obese adolescent women using the findings from this study.

Obesity and Dyslipidemia in Chinese Adults: A Cross-Sectional Study in Shanghai, China

This study examined the association of obesity and dyslipidemia according to body measurements among Chinese adults in Shanghai, a place in the process of rapid urbanization. Using the baseline data of the Shanghai Suburban Adult Cohort and Biobank study (SSACB), the subjects completed questionnaires and physical examinations, and fasting blood was collected for biochemical assays. We estimated the odds ratios (OR) and 95% confidence interval (CI) by multivariable logistic regression. The prevalence was 12.9% and 28.8% in both general and central obesity, respectively. Compared with the non-obese, the general or central obesity participants had a higher level of TC, TG, LDL-C and lower level of HDL-C. The OR (95%CI) for dyslipidemia was 1.79 (1.69–1.91) and 1.91 (1.83–2.00) in general or central obesity, respectively. Positive associations were also observed between obesity and high TC, high LDL-C, low HDL-C and high TG, with the adjusted OR ranging from 1.11 to 2.00. Significant modifying effect of gender, age, hypertension, and diabetes were found in the association of obesity and different forms of dyslipidemia. The findings of our study indicated that participants with obesity, including general or central obesity, have a higher prevalence of dyslipidemia and gender, age, hypertension, and diabetes might be potential modifiers of the association. More effective attention and interventions should be directed to managing body weight to reduce the prevalence of dyslipidemia.

Prevalence of metabolic syndrome and its related factors among Vietnamese people: A systematic review and meta-analysis

BACKGROUND AND AIMS

Metabolic risk factors are the leading causes of mortality and morbidity in recent decades, yet the burden of metabolic syndrome (MetS) has not been carefully assessed in Vietnam. This review thus aims to examine the prevalence of MetS and its related factors in Vietnam.

METHODS

A systematic review was conducted using literature retrieved from PubMed/Medline, Web of Science, Embase, Scopus, and Google Scholar up until July 2021. We selected descriptive and analytical studies which reported the prevalence of MetS and related factors among healthy people aged less than 65 years old rather than morbid people in Vietnam. A meta-analysis with a random-effects model was applied to estimate the pooled prevalence from the included studies.

RESULTS

Eighteen studies with 35421 participants were included in the final analysis. The pooled MetS prevalence among the adult population in Vietnam was 16.1% (95% Confidence Interval (CI): 14.1%-18.1%). Higher prevalence was seen among females (17.3%, 95% CI: 13.8%-20.8%). Low level of High Density Lipoprotein-Cholesterol (HDL-C) was the most prevalent component (34.1%), followed by high triglycerides (33.3%). Being female, living in urban areas, having obesity, and having a higher body mass index or body fat percentage were associated with an increased likelihood of having MetS.

CONCLUSIONS

MetS was common in the Vietnamese population. Low HDL-C should be considered as an early detectable indicator for MetS screening programs at the population level. Appropriate interventions should be conducted for high-risk groups such as females, those living in urban areas, and obesity.

The exercise-instrumental music program and irisin levels in younger non-professional athletes

A passive lifestyle and lack of exercise are triggering factors in increasing metabolic syndrome, whereas metabolic syndrome is associated with increased morbidity and mortality. This study aimed to analyse an exercise-based non-pharmacological approach combined with instrumental music to the plasma levels of irisin. The study employed a randomised pretest-posttest-only group design recruiting 30 male participants. The individuals aged between 19-21 years, body mass index (BMI) 18.5-24.9 kg/m2, normal blood pressure, normal resting heart rate (RHR), VO2max 40-50 ml/kg bodyweight/min, normal haemoglobin (Hb). The subjects were randomly divided into three groups, MIE (n=10, moderate-intensity exercise), MIEM (n=10, moderate-intensity exercise + instrumental music), and HIE (n=10, high-intensity exercise). Blood sampling was collected from pre- and 5 min post-exercise treatment. ELISA method was used to measure the circulating irisin levels. The non-parametric Kruskal-Wallis test, Mann Whitney test and Spearman correlation were chosen to analyse the data. The results showed that there is no significant difference in pre-exercise irisin levels (ng/ml) in MIE (1.58±0.89), MIEM (1.77±3.12), and HIE (1.65±0.88) with a P-value of 0.098. Importantly, the alteration of irisin levels post-exercise program revealed that the level of this peptide (ng/ml) is higher in HIE (7.28±5.11) compared to MIE (1.95±1.85) and MIEM (4.16±3.40) with a P-value of 0.019. The plasma levels of irisin significantly correlate to energy expenditure (r=0.353, P≤0.01), plasma peroxisome proliferator-activated receptor gamma coactivator-1α (r=0.597, P≤0.001), and high-density lipoprotein (r=0.513, P≤0.01). In summary, increased irisin secretion may directly contribute to the gradual alteration of energy expenditure and correlate to physical exercise intensity-related musical treatment.

Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model

AIM

Metabolic syndrome (MetS) coexists with the occurrence and even death of cardiovascular disease and diabetes mellitus. It is essential to study the factors in the dynamic progression of MetS in the interest of prevention and control.

PURPOSE

The aim of this study was to analyze the dynamic progression of Mets and explore the potential factors influencing the progression or reversal of MetS.

PATIENTS AND METHODS

This study involved 5581 individuals from two waves of the China Health and Retirement Longitudinal Study: 2011 and 2015. A multistate Markov model containing 4 states (free of metabolic disorder (FMD), mild metabolic disorder (MMD), severe metabolic disorder (SMD) and MetS) was adopted to study the dynamic progression of MetS and its influencing factors.

RESULTS

After follow-up, a total of 2862 cases (50.28% of the total number) had disease state transition. The intensity of transition from MetS to SMD is the same as that from SMD to MMD, and is greater than that from MMD to Mets (0.06 vs 0.05). For the MetS state, a mean of 1/0.08=12.5 years was spent in the MetS state before recovery. The exercise, smoke, drink, BMI level, hyperuricemia had statistically significant effects on progression of MetS status (P<0.05). The obesity or overweight, little exercise, smoke, drink and hyperuricemia increased the risk of forward progression of MetS disease status. There were significant nonmodifiable (age, gender) and modifiable factors (exercise, drink, BMI level, or high HbA1c) associated with reversion of MetS state.

CONCLUSION

The likelihood of progression from MMD to MetS is less likely than that of reversion from MetS to SMD and SMD to MMD. Old females were more resistant to recover from worse states than males. Prevention and intervention measures should be adopted early when MMD or SMD onset occurs.

Predicting the natural history of metabolic syndrome with a Markov-system dynamic model: a novel approach

BACKGROUND

Markov system dynamic (MSD) model has rarely been used in medical studies. The aim of this study was to evaluate the performance of MSD model in prediction of metabolic syndrome (MetS) natural history.

METHODS

Data gathered by Tehran Lipid & Glucose Study (TLGS) over a 16-year period from a cohort of 12,882 people was used to conduct the analyses. First, transition probabilities (TPs) between 12 components of MetS by Markov as well as control and failure rates of relevant interventions were calculated. Then, the risk of developing each component by 2036 was predicted once by a Markov model and then by a MSD model. Finally, the two models were validated and compared to assess their performance and advantages by using mean differences, mean SE of matrices, fit of the graphs, and Kolmogorov-Smirnov two-sample test as well as R2 index as model fitting index.

RESULTS

Both Markov and MSD models were shown to be adequate for prediction of MetS trends. But the MSD model predictions were closer to the real trends when comparing the output graphs. The MSD model was also, comparatively speaking, more successful in the assessment of mean differences (less overestimation) and SE of the general matrix. Moreover, the Kolmogorov-Smirnov two-sample showed that the MSD model produced equal distributions of real and predicted samples (p = 0.808 for MSD model and p = 0.023 for Markov model). Finally, R2 for the MSD model was higher than Markov model (73% for the Markov model and 85% for the MSD model).

CONCLUSION

The MSD model showed a more realistic natural history than the Markov model which highlights the importance of paying attention to this method in therapeutic and preventive procedures.

Dynamic behavior of metabolic syndrome progression: a comprehensive systematic review on recent discoveries

BACKGROUND

The assessment of the natural history of metabolic syndrome (MetS) has an important role in clarifying the pathways of this disorder.

OBJECTIVE

This study purposed to provide a rational statistical view of MetS progression pathway.

METHODS

We performed a systematic review in accordance with the PRISMA Statement until September 2019 in the Medline/PubMed, Scopus, Embase, Web of Science and Google Scholar databases. From the 68 found studies, 12 studies were eligible for review finally.

RESULTS

The selected studies were divided in 2 groups with Markovian and non-Markovian approach. With the Markov approach, the most important trigger for the MetS chain was dyslipidemia with overweight/obesity in the under-50 and with hypertension in the over-50 age group, where overweight/obesity was more important in women and hypertension in men. In non-Markov approach, the most common trigger was hypertension. Transition probability (TP) from no component to MetS were higher in all Markovian studies in men than in women. In the Markovians the combination of dyslipidemia with overweight/obesity and in non-Markovians, hyperglycemia with overweight/obesity were the most common combinations. Finally, the most important components, which predict the MetS, were 2-component states and hyperglycemia in Markovian approach and overweight/obesity in non-Markovians.

CONCLUSIONS

Among the components of the MetS, dyslipidemia and hypertension seems to be the main developer components in natural history of the MetS. Also, in this chain, the most likely combination over time that determines the future status of people seems to be the combination of dyslipidemia with obesity or hyperglycemia. However, more research is needed.

Dynamics of detailed components of metabolic syndrome associated with the risk of cardiovascular disease and death

Few studies quantify a cascade of dynamic transitions on the detailed components of metabolic syndrome (MetS) and subsequent progressions to cardiovascular disease (CVD) and its death. A total of 47,495 subjects repeatedly attending a community-based integrated screening program in Taiwan were recruited. The refined MetS-related classification (RMRC) in relation to five criteria of MetS was defined as free of metabolic disorder (FMD, none of any criteria), mild metabolic disorder (MMD, 1–2 criteria) and MetS. A multistate Markov model was used for modelling such a multistate process. The estimated progression rate from FMD to MMD was 44.82% (95% CI 42.95–46.70%) whereas the regression rate was estimated as 29.11% (95% CI 27.77–30.45%). The progression rate from MMD to MetS was estimated as 6.15% (95% CI 5.89–6.42%). The estimated annual incidence rates of CVD increased with the severity of RMRC, being 1.62% (95% CI 1.46–1.79%) for FMD, 4.74% (95% CI 4.52–4.96%) for MMD, to 20.22% (95% CI 19.52–20.92%) for MetS. The estimated hazard rate of CVD death was 6.1 (95% CI 4.6–7.7) per thousand. Elucidating the dynamics of MetS-related transition and quantifying the incidence and prognosis of CVD provide a new insight into the design and the evaluation of intervention programs for CVD.

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.

The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components.

METHODS

This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia.

RESULTS

In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively.

CONCLUSION

It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.