Weight gain and lifestyle risk factors for developing metabolic syndrome

Associations of Recreational and Nonrecreational Physical Activity and Body Weight Change on Cardiovascular Disease Mortality During the Obesogenic Transition in the United States: National Health and Nutrition Examination Survey Follow-up Study

BACKGROUND

To investigate cardiovascular disease mortality associated with longitudinal changes in body weight, and recreational and nonrecreational physical activity during the obesogenic transition in the United States since the 1970s.

METHODS

Data were analyzed from 4921 individuals aged 25-74 years who participated in the National Health and Nutrition Examination Survey between 1971 and 1979 and follow-up studies to 1992. Mortality was confirmed by searching the National Death Index or proxy interview; clinical data were collected in person. Changes in self-reported recreational and nonrecreational physical activity categories over time were coded as stable, increase, or decrease. Competing risks regression was used to determine hazard ratios adjusted for covariates. A logit model in a generalization method was used to explore mediation effects of change in body weight.

RESULTS

Compared with the "moderate-vigorous stable" group (reference), individuals who remained inactive ("inactive stable") or reduced their participation in physical activity ("active to inactive") experienced the highest mortality, with a 50% to 176% and 22% to 222% relative increased hazard ratios for nonrecreational and recreational physical activity, respectively, across all models adjusted for covariates. This corresponded to significant loss of life (up to 3 y; all P < .05). Individuals who became active ("inactive to active") were not at increased risk. We found weak (but nonstatistically significant) evidence of mediation effects of body weight change on mortality.

CONCLUSIONS

Longitudinal changes in moderate-vigorous recreational and nonrecreational physical activity were important predictors of cardiovascular disease mortality during the obesogenic transition period in the United States and were mostly unexplained by changes in body weight.

Association between weight change and risk of metabolic abnormalities in non-overweight/obese and overweight/obese population: A retrospective cohort study among Chinese adults

OBJECTIVES

To explore the effects of weight change on the risk of metabolic abnormalities in the Chinese population.

METHODS

A total of 1895 metabolically healthy adults aged 21-78 years completed anthropometric and biological measurements at baseline (2012) and at an eight year follow-up (2020). Based on absolute weight change and relative weight change, the participants were split into five classes. A Cox proportional hazards regression model was used to estimate the relative risk (RR) and 95% confidence intervals (95% CI) for the risk of metabolic abnormalities using stable weight as the reference group. Stratified analysis was used to explore this relationship in participants with different baseline body mass index (BMI) levels.

RESULTS

During the follow-up period, 35.41% of the participants retained a stable weight, and 10.71% had metabolic abnormalities. After covariate adjustment, for every kilogram gained over eight years, the risk of developing metabolic abnormalities increased by 22% (RR: 1.094; 95% CI: 1.063-1.127). Compared with stable weight participants, weight gain of 2-4 Kg and weight gain ≥ 4 Kg exhibited significantly higher risks of metabolic abnormalities, with RR of 1.700 (95% CI 1.150-2.513) and 1.981 (95% CI 1.372-2.859), respectively. A weight gain of ≥ 4 Kg had an opposite effect on the overweight/obesity and non-overweight/obesity groups, with an increased risk of metabolic abnormalities only in the non-overweight/obesity group (RR, 2.291; 95% CI, 1.331-3.942). Moreover, weight loss ≥ 4 Kg significantly reduced the risk of metabolic abnormalities only among overweight/obese adults (RR 0.373; 95% CI 0.154-0.906). Similar results were observed in relative body weight change analyses.

CONCLUSIONS

Long-term excessive body weight gain is positively associated with an increased risk of metabolic abnormalities among adults with non-overweight/obesity, whereas long-term body weight loss is a protective factor for metabolic health among adults with overweight/obesity.

Does the association between patterns of fruit and vegetables and metabolic syndrome incidence vary according to lifestyle factors and socioeconomic status?

BACKGROUND AND AIMS

The aim of this study is to investigate the association between the identified patterns of fruits and vegetables and metabolic syndrome (MetS) incidence, and to investigate whether lifestyle factors and socioeconomic status modify the effect of the patterns on MetS risk.

METHODS AND RESULTS

We prospectively studied 1915 participants of the Tehran Lipid and Glucose Study, who were aged 19-74 years and followed up for dietary assessment using a validated, semi-quantitative food frequency questionnaire. After adjustment for confounding factors, total vegetable intake was inversely related to the risk of MetS. Total fruit and total fruit and vegetable were not associated with MetS risk. We identified four major patterns of fruits and vegetables by factor analysis: "fresh fruit pattern", "vegetable pattern", "dried fruit and cruciferous vegetable pattern", and "potatoes and fruit juice pattern". "Vegetable pattern" was negatively associated with MetS risk, and "potatoes and fruit juice pattern" increased the risk of MetS. Among participants with weight gain <7% during follow-up, all four identified patterns reduced MetS risk. When stratified by smoking, "vegetable pattern" and "dried Fruit and cruciferous vegetable pattern" lowered MetS risk among non-smokers. Stratification based on education resulted in MetS risk reduction across tertiles of "fresh fruit pattern" and "vegetable pattern". First and second tertiles of "dried fruit and cruciferous vegetable pattern" lowered MetS risk among educated participants, compared to the reference.

CONCLUSIONS

The reduction in MetS risk caused by fruits and vegetables intake depends on the modifying effect of lifestyle and socioeconomic factors.

Routine Screening and Consultation Facilitate Improvement of Metabolic Syndrome

This randomized controlled trial study aimed to investigate the effects of a lifestyle intervention on metabolic syndrome (MetS) among middle-aged Koreans. A total of 243 middle-aged Koreans with MetS were randomly assigned to either of 2 types of lifestyle intervention for MetS and followed for 12 months. Health examinations and interventions were implemented at 16 regional branch facilities of a Korean medical institution from 2010, following the NCEP-ATP III criteria and recommendations. Lifestyle intervention (LI) group (n = 137) participated in a 12-week multi-component intervention including individual counseling, group sessions, and self-help materials. Basic usual intervention (BI) group (n = 106) was provided with one-page health information sheet on MetS and MetS management at baseline. Prevalence of MetS and each of MetS components, except for low HDL-cholesterol, in both groups were significantly reduced and maintained after the intervention. Notably, prevalence of hypertension and abdominal obesity continued to improve during the follow-up period. Between-group differences in results were not found. Both interventions were effective when they were accompanied with repeated check-ups and notification of MetS status. It is recommended to design clear guidelines for the notification of MetS after MetS screening and to encourage checking MetS status periodically for effective MetS management (KCT 0000446).

Risk factors for weight gain and metabolic syndrome in adolescents with psychiatric disorders: a historical prospective study

OBJECTIVE

Adolescents with mental disorders are at increased risk for being overweight or obese, and subsequently developing metabolic syndrome. However, data regarding risk factors for weight gain during psychiatric hospitalization of adolescents are limited and inconsistent. The aim of this study was to investigate the sociodemographic, clinical, and pharmacological risk factors for weight gain during psychiatric treatment, in order to improve prevention of subsequent metabolic syndrome.

METHODS

We conducted a historical prospective study of 146 adolescent patients (mean age 15.2±1.9 years, 52.7% males), consecutively admitted for day treatment in an adolescent day unit (length of stay 141±76 days). Anthropometric measurements and laboratory analyses of fasting glucose and lipid levels were conducted as part of the routine medical care at admission and discharge. Psychiatric diagnoses, medication histories, and sociodemographic data were obtained from the electronic medical records system.

RESULTS

A significant increase in age- and gender adjusted body mass index (BMI) (i.e., z score) was observed (0.5±1.2 vs. 0.7±1.1 at admission and discharge, respectively, p<0.001). Male subjects were more prone to weight gain than females (odds ratio [OR]=3.5, 95% CI=1.2-10.3) and BMI z score at admission was inversely associated with weight gain (R (2)=0.2, p<0.0001). Surprisingly, age at admission, psychiatric diagnoses, length of stay, and number of medications were not associated with weight gain. Despite weight gain, fasting blood glucose and lipid profile did not change significantly during the study period.

CONCLUSIONS

Hospitalization of adolescents in a psychiatric day unit may be associated with a significant weight gain, especially in male subjects and those with normal weight at admission. Efforts should be aimed to reduce weight gain among youth with psychiatric disorders during treatment, to avoid a subsequent metabolic syndrome.

Association between adolescents' physical activity and sedentary behaviors with change in BMI and risk of type 2 diabetes

This study aims at identifying the association between physical activity (PA) and sedentary behavior (SB) patterns during adolescents on the future increase in BMI and risk of diabetes during young adulthood. A total of 3,717 participants aged 11 to 21 at baseline who completed Waves I (1994–1995), II (1996), III (2001–2002), and IV (2008) surveys of the National Longitudinal Study of Adolescent Health (Add Health) were analyzed. Physical activity and sedentary behavior patterns were assessed using an interviewer-administered questionnaire at Waves I, II, and III. A participant was classified as having diabetes at Wave IV according to WHO guidelines. The k-means cluster analysis was used to identify the number of PA and SB patterns assessed using interviewer-administered questionnaire. The k-means cluster analysis identified three clusters; 575 (15.5%), 2,140 (57.6%), and 1,002 (27.0%) participants belonged to the low PA high SB (LPAHSB), the LPALSB, and the HPALSB cluster respectively. Relative to the LPALSB cluster, the HPALSB cluster had lower increase in BMI from Wave III to Wave IV (P = 0.03), whereas the difference between LPAHSB cluster and LPALSB cluster was not significant (P = 0.09). The odds of developing diabetes at Wave IV was significant for the LPAHSB cluster (OR = 1.69, 95% CI = 1.04, 2.75) but not significant for the HPALSB cluster (OR = 0.87, 95% CI = 0.52, 1.47) relative to the LPALSB cluster. To conclude, PA but not SB during adolescence predicted change in BMI during young adulthood. SB but not PA during adolescence predicted type 2 diabetes during young adulthood.