Prevalence and determinants of metabolic syndrome among women in Chinese rural areas

Prevalence, awareness, treatment, and control of dyslipidemia in Chinese adults: a systematic review and meta-analysis

Background

Researchers have conducted a considerable number of epidemiological studies on dyslipidemia in China over recent years. Nevertheless, a representative study to comprehensively appraise for the epidemiological status of dyslipidemia is still lacked. This meta-analysis is intended to explore the pooled prevalence, rates of awareness, treatment, and control of dyslipidemia among adults in Chinese Mainland.

Materials and methods

A systematic review was performed on relevant cross-sectional studies published since January 2012 by searching six authoritative literature databases. Meta-analyses were conducted in included studies based on a random-effect model to summarize the epidemiological status of dyslipidemia in China. A potential source of heterogeneity was detected by subgroup analysis and meta-regression. Publication bias was assessed by Egger's test and funnel plots. A sensitivity analysis was conducted to examine the study quality's influence on the pooled estimate of prevalence and rates of awareness, treatment, and control.

Results

Forty-one original researches with a total of 1,310,402 Chinese participants were finally included in the meta-analysis. The prevalence, rates of awareness, treatment, and control of dyslipidemia were 42.1%, 18.2%, 11.6%, and 5.4%, respectively. With a pooled prevalence estimate at 24.5%, low HDL-C was the most prevalent among various dyslipidemia types, followed by hypertriglyceridemia (TG) (15.4%), hypercholesterolemia (TC) (8.3%), and high LDL-C (7.1%). The pooled prevalence of elevated serum lipoprotein(a) [Lp(a)] was 19.4%. By gender, the prevalence of dyslipidemia was 47.3% in males and 38.8% in females. Subgroup analyses revealed that the prevalence in southern and urban areas were higher than their counterparts. Females and population in urban areas tended to possess higher rates of awareness, treatment, and control. Meta-regression analyses suggested that the year of screening influenced prevalence estimates for dyslipidemia. The impact of the study's quality on the pooled estimates is insignificant.

Conclusion

Our study suggested a severe epidemic situation of dyslipidemia among adults in Chinese Mainland. More importantly, the awareness, treatment, and control rates were extremely low, revealing that dyslipidemia is a grave health issue. Consequently, we should attach more importance to the management of dyslipidemia, especially in economically underdeveloped areas.

Systematic review registration

PROSPERO [CRD42022366456].

Gender discrepancies in predictors for newly onset cardiovascular events and metabolic syndrome in elderly patients from rural China

Objective

The study aimed to estimate the possible predictors of cardiovascular events (CVEs) in elderly patients with metabolic syndrome (MetS) from rural China. Moreover, we also attempted to find the potential risk factors for newly diagnosed MetS.

Methods

The Northeast China Rural Cardiovascular Health Study (NCRCHS) is a community-based prospective cohort study carried out in rural areas of northeast China. Approximately 1,059 elderly patients with MetS but no cardiovascular diseases and 1,565 elderly patients without MetS at baseline were enrolled in this study. They underwent a physical examination, completed a questionnaire in 2012-2013, and were followed up during 2015-2017. Cox proportional hazard analysis was conducted to assess the possible predictors of newly developed CVEs, and multivariate analysis was used to estimate the risk factors of newly diagnosed MetS.

Results

The common predictors of newly developed CVEs in both men and women were family history of stroke (HR [hazard ratios] _female: 1.696; HR _male: 2.504) and soybean consumption (HR _female: 0.253; HR _male: 0.130). Moreover, minority race (HR: 0.109), systolic blood pressure (SBP) (HR: 1.021), current drinking habits (HR: 2.551), family history of hypertension (HR: 2.297), LDL-C (HR: 1.669), 5,000-20,000 CNY/year annual income (HR: 0.290), and strenuous physical activity (HR: 0.397) were predictors of CVEs only in male elderly patients. For newly diagnosed MetS, body mass index (OR _female: 1.212; OR _male: 1.207) and fasting blood glucose (OR _female: 1.305; OR _male: 1.217) were common risk factors in both genders, whereas age (OR:0.958) was a protective factor in men and > 9-h/day sleep duration (OR:0.212) was a protective factor in women. In addition, SBP (OR:1.014) ≥4 times/day, bean consumption (OR:1.955), and uric acid (OR:1.005) increased the risk of MetS in men but not in women.

Conclusion

Our study identified many effective predictors of CVEs in rural elderly patients with MetS and confirmed the presence of a gender-based discrepancy. Moreover, we also identified additional risk factors, along with the traditional ones, for newly diagnosed MetS in rural elderly patients.

Association between life-course cigarette smoking and metabolic syndrome: a discovery-replication strategy

BACKGROUND

The relation between cigarette smoking and metabolic syndrome (MetS) remains unclear, and previous studies focusing on MetS are limited in sample size. We investigated the association between life-course smoking and MetS with independent discovery and replication samples.

METHODS

Preliminary analysis utilized data from an annual cross-sectional survey of 15,222 participants aged ≥ 60 years in Tianjin, China. Suggestive associations were followed-up in 8565 adults from the China Health and Nutrition Survey. MetS was identified according to the criteria of the Chinese Diabetes Society in 2013. Life-course smoking was assessed by a comprehensive smoking index (CSI), based on information on smoking intensity, duration, and time since cessation across life-course, collected through standard questionnaires. Participants were divided into four groups: non-smokers; and the tertiles of CSI in ever smokers. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between life-course smoking and MetS.

RESULTS

In the discovery sample, ORs of MetS were 2.01 (95%CI: 1.64-2.47) and 1.76 (95%CI: 1.44-2.16) for smokers in the highest and second tertile of CSI compared with never smokers. Potential interaction was shown for age, with increased ORs for MetS associated with smoking limited to individuals who aged < 70 years (P_interaction = 0.015). We were able to replicate the association between cigarette smoking and MetS in an independent adult sample (second tertile vs. never: OR = 1.30, 95%CI: 1.04-1.63). The interaction of smoking with age was also replicated.

CONCLUSIONS

Life-course cigarette smoking is associated with an increased odds of MetS, especially among individuals who aged < 70 years.

Serum vitamin E concentration is negatively associated with body mass index change in girls not boys during adolescence

BACKGROUND

Vitamin E is the most abundant lipid-soluble antioxidants present in plasma; however, the relationship between serum vitamin E and change in body mass index (BMI)-for-age Z scores in adolescents has not been well described.

METHODS

This study is a cross-sectional study. Data were analyzed from 4014 adolescents who participated in the National Health and Nutrition Examination Survey. The nutritional status was calculated by BMI Z scores and was classified into normal weight, overweight, and obese. Multivariable-adjusted logistic regression was used to examine the association between serum vitamin E levels with overweight/obesity. Besides, the interaction effects between potential confounders and vitamin E on obesity were further evaluated.

RESULTS

After adjusting potential confounders, serum vitamin E levels were negatively associated with overweight/obesity in girls but not in boys. Per standard deviation increment in vitamin E concentrations was associated with a 92% decreased risk of obesity in females. Besides, lower quartiles of serum vitamin E were associated with a higher risk of overweight/obesity in girls. Moreover, the inverse association between serum vitamin E levels and obesity was also found in most subgroups through subgroup analysis.

CONCLUSIONS

Our study supports the negative association between serum vitamin E levels and overweight/obesity in adolescents. A higher serum vitamin E level may be associated with a reduced probability of obesity in girls, but not in boys.

Associations Between Different Dietary Vitamins and the Risk of Obesity in Children and Adolescents: A Machine Learning Approach

BACKGROUNDS

Simultaneous dietary intake of vitamins is considered as a common and real scenario in daily life. However, limited prospective studies have evaluated the association between multivitamins intake and obesity in children and adolescents.

OBJECTIVES

This study aimed to evaluate the relationship between the intake of different dietary vitamins and the risk of obesity in children (6-11 years) and adolescents (12-19 years).

METHODS

We conducted a cross-sectional study based on data from U.S. National Health and Nutrition Examination Survey, 2013-2016. A total of 3634 children and adolescents were included who had available data on dietary vitamins, obesity and covariates. We analyzed the dietary intake levels of nine vitamins, including vitamin A, vitamin B₁, vitamin B₂, vitamin B₆, vitamin B₁₂, vitamin C, vitamin D, vitamin E, vitamin K. Multivariate logistic regression was used to model the associations between vitamins and obesity. Bayesian kernel machine regression (BKMR) was employed to explore the joint and independent effects of vitamins on obesity among children and adolescents.

RESULTS

In the multivariate logistic regression model, five vitamins (vitamin A, vitamin B₁, vitamin B₂, vitamin B₁₂, and vitamin D) were negatively associated with obesity in children and adolescents. BKMR analysis showed that when the concentration of the nine vitamins was at or above the 55th percentile compared with the median value, the combined intake of these vitamins could significantly reduce the risk of obesity in children and adolescents. Potential interactions between vitamin B₂ and vitamin B₁₂ in increasing the risk of obesity in children and adolescents were observed.

CONCLUSIONS

We determine the combined effects of multivitamins on obesity in children and adolescents, and observe a significant interaction between vitamin B₂ and vitamin B₁₂. Further cohort studies are needed to clarify the health effects of multivitamins intake in a larger population.

Determinant components of newly onset versus improved metabolic syndrome in a population of Iran

This study aimed to determine the risk factors related to regression and progression of metabolic syndrome, in a 4-year cohort study. A total of 540 individuals (≥ 18 years old) participated in both phase of the study. Participants were categorized into 3 categories of regressed, progressed and unchanged metabolic syndrome (MetS). Demographic, anthropometric and biochemical parameters were assessed for each individual in both phase. Variables differences (delta: Δ) between the two phase of study were calculated. Unchanged group was considered as baseline category. Based on IDF, MetS had been regressed and progressed in 42 participants (7.7%) and 112 (20.7%) participants respectively, in the second phase. More than 47% of people, whose MetS regressed, experienced also NAFLD regression. Results of multiple variable analysis revealed that increased age, positive Δ-TG, and Δ-FBS, significantly increased the odds of MetS progression based on IDF and ATP III definitions, while negative Δ-HDL and Δ-neutrophil to lymph ration increased the odds of progression. On the other hand, negative Δ-TG and positive Δ-HDL significantly increased the odds of Mets regression based of both IDF and ATP III. Management of hypertriglyceridemia, hyperglycemia, and HDL is a critical, non-invasive and accessible approach to change the trend of MetS.

The Study of Clustering Effects of Behavior Risk Factors in Patients with Metabolic Syndrome in Southern China: A Cross-Sectional Study

OBJECTIVES

Metabolic syndrome (MetS) is now becoming a serious public health threat. Some behaviors risk factors were considered to be associated with MetS and interacted to adversely affect MetS. However, the clustering effects of behavior risk factors of MetS among Chinese population remain unclear. The aim of this study is to observe the behavior risk factors and their clustering effects of MetS in China.

METHODS

A cross-sectional study design was used. Subjects were recruited in the departments of Cardiology Clinic, Endocrine Clinic, and Health Management from March to December 2019. A demographic sheet was designed to collect the demographic and clinical characteristics of the subjects. International Physical Activity Questionnaire-Short was applied to evaluate the level of PA in this study. Other behavior risk factors were observed by the questionnaire. The stepwise logistic regression analysis was performed to identify the determinants of MetS. The multiple logistic regression analysis was used to analyze the clustering effects of behavior risk factors in MetS.

RESULTS

There are a total of 532 eligible subjects (56.6% females; mean age was 48.4 ± 15.3 years), and approximately 33.3% were diagnosed as MetS. The subjects with a smoking habit (heavy and long-time history) had a 1.833-fold higher risk for MetS than their counterparts (none and light smoking), and the subjects that preferred salty taste had a 1.626-fold higher risk for MetS than the comparison cohort. Smoking and alcohol drinking had the highest clustering effect on MetS among the behavior risk factors.

CONCLUSIONS

The main finding of this study was that smoking and salty taste preference were the independent determinants of MetS. Smoking and alcohol consumption had the highest clustering effect on southern Chinese MetS.

Shift work and metabolic syndrome: A multi-center cross-sectional study on females of reproductive age

Shift work during reproductive age can be a risk factor for metabolic syndrome. The present study evaluated the association between shift work and metabolic syndrome during reproductive age. This multi-center cross-sectional correlational study was performed between September 2017 and May 2018. A total of 419 female shift and day workers were purposively recruited to the study from three central cities in Mazandaran, Iran. To diagnose metabolic syndrome based on the National Cholesterol Education Program Adult Treatment Panel III guidelines, the anthropometric measures, blood pressure, and levels of serum triglyceride, high-density lipoprotein and fasting blood sugar were taken. Data were analyzed using the independent-sample t, Chi-square and the Fisher's exact tests as well as the logistic regression analysis. Among the 419 participants, 28 were excluded during the study. The total prevalence of metabolic syndrome was 16.3%, and its prevalence among shift workers and day workers was 17.3 and 14.9%, respectively. The most prevalent components of metabolic syndrome were low serum level of high-density lipoprotein and abdominal obesity. Following adjustments for the effects of potential cofounders, the logistic regression analysis revealed that the odds of metabolic syndrome among shift workers was ~2 times greater than day workers (odds ratio, 1.83; 95% confidence interval, 0.088-3.79), although this association was statistically insignificant (P=0.10). The results of the current study suggest that shift work is associated with a greater risk of metabolic syndrome for women. The most important components of metabolic syndrome are low serum level of high-density lipoprotein and abdominal obesity, which are attributable to limited physical activity and high occupational stress. The risk of metabolic syndrome among female shift workers of reproductive age may be reduced through strategies, including awareness raising, dietary educations and provision of physical activity facilities in the workplace.

Polyphenols extracted from huangjiu have anti-inflammatory activity in lipopolysaccharide stimulated RAW264.7 cells

HPE with the predominant polyphenol of (+)-catechin exhibits anti-inflammatory activity through the NF-κB pathway and MAPK signaling.

Identification of an obesity index for predicting metabolic syndrome by gender: the rural Chinese cohort study

BACKGROUND

To compare the accuracy of different obesity indexes, including waist circumference (WC), weight-to-height ratio (WHtR), body mass index (BMI), and lipid accumulation product (LAP), in predicting metabolic syndrome (MetS) and to estimate the optimal cutoffs of these indexes in a rural Chinese adult population.

METHODS

This prospective cohort involved 8468 participants who were followed up for 6 years. MetS was defined by the International Diabetes Federation, American Heart Association, and National Heart, Lung, and Blood Institute criteria. The power of the 4 indexes for predicting MetS was estimated by receiver operating characteristic (ROC) curve analysis and optimal cutoffs were determined by the maximum of Youden's index.

RESULTS

As compared with WHtR, BMI, and LAP, WC had the largest area under the ROC curve (AUC) for predicting MetS after adjusting for age, smoking, drinking, physical activity, and education level. The AUCs (95% CIs) for WC, WHtR, BMI, and LAP for men and women were 0.862 (0.851-0.873) and 0.806 (0.794-0.817), 0.832 (0.820-0.843) and 0.789 (0.777-0.801), 0.824 (0.812-0.835) and 0.790 (0.778-0.802), and 0.798 (0.785-0.810) and 0.771 (0.759-0.784), respectively. The optimal cutoffs of WC for men and women were 83.30 and 76.80 cm. Those of WHtR, BMI, and LAP were approximately 0.51 and 0.50, 23.90 and 23.00 kg/m2, and 19.23 and 20.48 cm.mmol/L, respectively.

CONCLUSIONS

WC as a preferred index over WHtR, BMI, and LAP for predicting MetS in rural Chinese adults of both genders; the optimal cutoffs for men and women were 83.30 and 76.80 cm.

Prevalence of metabolic syndrome and its risk factors among rural adults in Nantong, China

The prevalence of metabolic syndrome (MS) varies worldwide due to genetic and environmental factors. A population-based cross-sectional study, with 37,582 participants recruited in Nantong, China in 2007-2008 (stage I) and 2013 (stage II). Socio-demographic, lifestyle factors, disease history and fasting blood sample were collected. The prevalence of MS was much higher in 2013 (42.6%) than that in 2007-2008 (21.6%), which was significantly higher in older people in both stages. Participants with two or more familial history of diseases were associated with a higher MS prevalence compared to those who didn’t have familial history of diseases. Total physical activity (PA) was associated with 24 and 19% decreased risk of MS in men and women. Occupational PA in moderate and vigorous intensity was associated with a 25%-45% decreased risk of MS. Female smokers who smoked more than 10 cigarettes per day or over 25 years were associated with 96 and 74% increased MS risk, respectively. The highest quartile of rice wine consumption was associated with a lower risk of MS with OR of 0.63 in women, compared with female non-drinkers. These findings indicated that PA and rice wine are two protective factors in MS prevention in rural areas of East China.

Association of metabolic syndrome with various anthropometric and atherogenic parameters in the Kazakh population in China

Background

This study aimed to evaluate the association of the metabolic syndrome (MetS) with various anthropometric and atherogenic parameters in adult Kazakh population in China.

Methods

Four thousand ninety-four Kazakhs were recruited since 2007 to 2010. MetS and its components were confirmed according to IDF criteria. Area under the curve (AUC) of each variable was compared. Sensitivity (Sen), specificity (Spe), shortest distance in receiver’s operating characteristic curve (ROC) and cutoff of each variable to diagnose MetS were calculated.

Results

28.6 % of men and 31.0 % of women had MetS in the Kazakh population. In men, WHtR had the highest AUC value 0.821, followed by BMI (0.801), TG/HDL-C (0.792), WHR (0.776) and BAI (0.666). In women, WHtR also had the highest AUC value (0.835), following by BMI (0.789), WHR (0.778), TG/HDL-C (0.778) and BAI (0.751). WHtR had the shortest ROC distance that was 0.37 and the optimal cutoff was 0.55 in men. In women, WHtR also had the shortest ROC distance of 0.35 and the optimal cutoff was 0.54.

Conclusion

WHtR is the best predictor of MetS in both Kazakh men and women according to the IDF criteria.

Leisure-time exercise, physical activity during work and commuting, and risk of metabolic syndrome

Data are limited regarding effect of intensity of leisure-time physical activity on metabolic syndrome. Furthermore, no prospective data are available regarding effect of occupational and commuting physical activity on metabolic syndrome. We compared metabolic syndrome risk by intensity level of leisure-time exercise and by occupational and commuting physical activity in Japanese workers. We followed 22,383 participants, aged 30-64 years, without metabolic syndrome until 2014 March (maximum, 5 years of follow-up). Physical activity was self-reported. Metabolic syndrome was defined by the Joint Statement criteria. We used Cox regression models to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of metabolic syndrome. During a mean follow-up of 4.1 years, 5361 workers developed metabolic syndrome. After adjustment for covariates, compared with engaging in no exercise, the HRs (95 % CIs) for <7.5, 7.5 to <16.5, and ≥16.5 metabolic equivalent hours of exercise per week were 0.99 (0.90, 1.08), 0.99 (0.90, 1.10), and 0.95 (0.83, 1.08), respectively, among individuals engaging in moderate-intensity exercise alone; 0.93 (0.75, 1.14), 0.81 (0.64, 1.02), and 0.84 (0.66, 1.06), among individuals engaging in vigorous-intensity exercise alone; and 0.90 (0.70, 1.17), 0.74 (0.62, 0.89), and 0.81 (0.69, 0.96) among individuals engaging in the two intensities. Higher occupational physical activity was weakly but significantly associated with lower risk of metabolic syndrome. Walking to and from work was not associated with metabolic syndrome. Vigorous-intensity exercise alone or vigorous-intensity combined with moderate-intensity exercise and worksite intervention for physical activity may help prevent metabolic syndrome for Japanese workers.

Prevalence of Metabolic Syndrome and Affecting Factors among Individuals Aged 30 and over in Balçova District of İzmir

BACKGROUND

The studies have shown that metabolic syndrome (MetS) leads to an increase twice as much in cardiovascular diseases (CVD) and four times as much in diabetes mellitus (DM) prevalence since the second half of the 20(th) century.

AIMS

This study aims to determine and discuss the prevalence of the MetS and co- factors among individuals at the age of 30 and over in Balcova district of İzmir province according to the American National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) and InternationalDiabetes Federation (IDF) criteria.

STUDY DESIGN

Cross-sectional study.

METHODS

Data obtained from the Balcova Heart Project in İzmir were used in the study. The dependent variable of the study is MetS existence. The independent variables were socio-demographic characteristics (age, gender, education level, and marital status), self-perceived economic status, physical activity, smoking status, healthy nutrition and body mass index (BMI).

RESULTS

The prevalence of MetS was 36.9% according to the diagnostic criteria of IDF, while it was 27.4% according to ATP III criteria. According to the both criteria, increasing age, low education, poor economic status perception, physical inactivity, and obesity increase the risk of MetS. Apart from the IDF criteria, being female and a current smoker increase the risk of the MetS in the NCEP-ATP III.

CONCLUSION

Compared to educational studies of MetS as of today, which are community and health-oriented studies, it is challenging that the prevalence of MetS was found to be high for both criteria in our study. Therefore, in particular, primary health care doctors must be prompted to protect the public against DM and CVD in particular.

Comparison of Anthropometric and Atherogenic Indices as Screening Tools of Metabolic Syndrome in the Kazakh Adult Population in Xinjiang

Objective: To compare the screening ability of various anthropometric and atherogenic indices for Metabolic syndrome (MetS) using three common criteria and to evaluate the validity of suitable parameters in combination for the screening of MetS among a Kazakh population in Xinjiang. Methods: A total of 3752 individuals were selected using the stratified cluster random sampling method from nomadic Kazakhs (≥18 years old) in Xinyuan county, Xinjiang, China, which is approximately 4407 km away from the capital Beijing. MetS was defined by the International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (ATP III) and Joint Interim Statement (JIS) criteria. The receiver operating characteristic curve (ROC) was used to compare the area under the ROC curve (AUC) of each index. The sensitivity, specificity, Youden’s index and cut-offs of each index for the screening of MetS were calculated. Results: According to the IDF, ATP III and JIS criteria, 18.61%, 10.51%, and 24.83% of males and 23.25%, 14.88%, and 25.33% of females had MetS. According to the IDF criteria, the waist-to-height ratio (WHtR) was the index that most accurately identified individuals with and without MetS both in males (AUC = 0.872) and females (AUC = 0.804), with the optimal cut-offs of 0.53 and 0.52, respectively. According to both the ATP III and JIS criteria, the lipid accumulation product (LAP) was the best index to discriminate between individuals with and without MetS in males (AUC = 0.856 and 0.816, respectively) and females (AUC = 0.832 and 0.788, respectively), with optimal cut-offs of 41.21 and 34.76 in males and 28.16 and 26.49 in females, respectively. On the basis of the IDF standard, Youden’s indices of WHtR and LAP serial tests for the screening of MetS were 0.590 and 0.455 in males and females, respectively, and those of WHtR and LAP parallel tests were 0.608 and 0.479, accordingly. Conclusion: According to the IDF, ATP III and JIS criteria, both the WHtR and LAP were better indices for the screening of MetS. The WHtR and LAP parallel test was the most accurate.

Prevalence of metabolic syndrome in Mainland China: a meta-analysis of published studies

Background

Metabolic syndrome (MS) comprises a set of conditions that are risk factors for cardiovascular diseases and diabetes. Numerous epidemiological studies on MS have been conducted, but there has not been a systematic analysis of the prevalence of MS in the Chinese population. Therefore, the aim of this study was to estimate the pooled prevalence of MS among subjects in Mainland China.

Methods

We performed a systematic review by searching both English and Chinese literature databases. Random or fixed effects models were used to summarize the prevalence of MS according to statistical tests for heterogeneity. Subgroup, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using Egger’s test.

Results

Thirty-five papers were included in the meta-analysis, with a total population of 226,653 Chinese subjects. Among subjects aged 15 years and older, the pooled prevalence was 24.5 % (95 % CI: 22.0–26.9 %). By sex, the prevalences were 19.2 % (95 % CI: 16.9–21.6 %) in males and 27.0 % (95 % CI: 23.5–30.5 %) in females. The pooled prevalence of MS increased with age (15–39 years: 13.9 %; 40–59 years: 26.4 %; and ≥60 years: 32.4 %). Individuals living in urban areas (24.9 %, 95 % CI: 18.5–31.3 %) were more likely to suffer from MS than those living in rural areas (19.2 %, 95 % CI: 14.8–23.7 %). Hypertension was the most prevalent component of MS in males (52.8 %), while the most prevalent component of MS for females was central obesity (46.1 %).

Conclusions

Our systematic review suggested a high prevalence of MS among subjects in Mainland China, indicating that MS is a serious public health problem. Therefore, more attention should be paid to the prevention and control of MS.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2870-y) contains supplementary material, which is available to authorized users.

Association of physical activity with risk of metabolic syndrome: findings from a cross-sectional study conducted in rural area, Nantong, China

The prevalence of metabolic syndrome increases rapidly worldwide, and its association with physical activity (PA) varies with race and lifestyles. Little is known about the association in rural China. The Nantong Metabolic Syndrome Study recruited 13,505 female and 6997 male participants in 2007 and 2008. Socio-demographic characteristics, and physiological and behavioural data were collected. Logistic regression model was applied to estimate associations of metabolic syndrome and its components with different PAs. The overall metabolic syndrome prevalence was 21.6% in current study. Increasing total PA or moderate-to-vigorous-intensity occupational PA was associated with decreasing 5%-60% risk of having metabolic syndrome and abnormal metabolic syndrome components in both genders. An association between leisure-time PA and blood pressure was found in men, but no associations between leisure-time PA and metabolic syndrome components were found in women. Commuting PA, such as walking and taking bus, by bicycle and walking only, was associated with decrease of 20%-45% risk of several abnormal metabolic syndrome components in women. This study provides information for future investigation into the nature of these associations so that recommendations can be developed to reduce the prevalence of metabolic syndrome and its components among rural population in China.

Physical Activity and Sedentary Behavior Associated with Components of Metabolic Syndrome among People in Rural China

Background

Metabolic syndrome is prevalent worldwide and its prevalence is related to physical activity, race, and lifestyle. Little data is available for people living in rural areas of China. In this study we examined associations of physical activity and sedentary behaviors with metabolic syndrome components among people in rural China.

Methods

The Nantong Metabolic Syndrome Study recruited 13,505 female and 6,997 male participants between 2007 and 2008. Data of socio-demographic characteristics and lifestyle were collected. The associations of physical activity and sedentary behaviors with metabolic syndrome components were analyzed.

Results

Prevalence of metabolic syndrome was 21.6%. It was significantly lower in men than in women. Low risks of metabolic syndrome were observed in those who did less sitting and engaged in more vigorous physical activity. The highest tertile of vigorous physical activity was associated with 15–40% decreased odds of metabolic syndrome and all of its components, except for low high-density lipoprotein cholesterol in men. Women with the highest tertile of moderate physical activity had 15–30% lower odds of central obesity, high glucose, and high triglycerides compared with those in the lowest tertile. Sitting time >42 hours per week had a 4%-12% attributable risk of metabolic syndrome, central obesity, and high triglycerides in both genders, and abnormal glucose and diastolic blood pressure in women. Sleeping for more than 8 hours per day was associated with risk of high serum glucose and lipids.

Conclusions

Our data suggested that physical activity has a preventive effect against metabolic syndrome and all its abnormal components, and that longer sitting time and sleep duration are associated with an increased risk of metabolic syndrome components, including central obesity and high triglycerides, glucose, and diastolic blood pressure. This study could provide information for future investigation into these associations. Also, recommendations are developed to reduce prevalence of metabolic syndrome and its components in rural Chinese populations.

Prevalence and Determinants of Metabolic Syndrome-identified by Three Criteria among Men in Rural China: A Population-based Cross-sectional Study Conducted during 2007-2008

OBJECTIVE

The aim of this study was to estimate MS prevalence according to three criteria and its risk factors among men in rural China.

DESIGN

Cross-sectional study.

SETTING

The Nantong Metabolic Syndrome Study (NMSS) was conducted during 2007-2008 in Nantong, China.

PARTICIPANTS

6997 male participants aged 18-74 years.

MEASUREMENTS

In person interviews, blood glucose and lipid measurements were accomplished.

RESULTS

The prevalence of MS was 12.86%, 8.55% and 15.28% according to IDF, ATPIII and ATPIII-modified criteria, respectively. The IDF and ATP III-modified criteria agreed only moderately with ATP III criteria (κ= 0.56 and 0.68), whereas ATP III-modified and the IDF criteria agreed perfectly (κ= 0.90). Vigorous occupational physical activity was associated with a low prevalence of MS with Odds ratio (OR) of 0.58 (95% confidence interval (CI): 0.45-0.74). Beer drinkers (alcohol ≤ 6.2 g/day) and rice wine drinkers (alcohol ≤ 9.0 g/day) had about 34% and 33% low risks of developing MS respectively, compared with non-drinkers. OR of MS was 1.95 (95% CI: 1.39-2.73) in men who had familial history of at least two diseases, including hypertension and diabetes, compared with men without familial history of those diseases.

CONCLUSIONS

Our data suggested that MS is highly prevalent among men in rural China. Family history of diabetes and hypertension is a risk factor in MS development. Physical activity, rice wine and beer consumption are associated with a significantly lower risk.

Significance of normal range urinary albumin to creatinine ratio in Chinese subjects with metabolic syndrome

This study was aimed to investigate clinical features of Chinese metabolic syndrome (MS) subjects with normal urinary albumin to creatinine ratio (UACR) and to estimate independent correlation factor for UACR. Data were drawn from a cross-sectional survey in participants having MS. The patients with different grade of albuminuria were divided into 4 groups according to the value of UACR (<10, 10-20, 21-30, >30 mg/g). All underwent biochemical tests. Bioelectrical impedance body fat content, islet β-cell function and insulin sensitivity were measured. Multivariable linear regression models were applied to further determine association between UACR and clinical factors with adjustment. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), TG, fat mass, fat content and homeostasis model assessment for insulin resistance (HOMA-IR) were significantly higher in the group with UACR at 10-20 mg/g than those in the group with UACA lower than 10 mg/g (P<0.05). Multivariable linear regression showed that TG, HbA1c, waist-hip ratio (WHR) and SBP were independently associated with UACR. The patients with normal UACR had abnormal levels of MS components. The factors independently associated with UACR were TG, HbA1c, WHR and SBP.

Prevalence and Predictors of Metabolic Syndrome in Young Asymptomatic Gujarati Population

Background. Metabolic syndrome is a cluster of risk factors leading to the development of atherosclerotic cardiovascular diseases. We aimed to evaluate the prevalence of metabolic syndrome (MS) and its predictors in young and apparently healthy Gujarati individuals. Methods. This population based cross-sectional study involved a total of 1500 healthy adults of 20-40 years of age. Demographic details and clinical data such as body mass index (BMI), waist circumference (WC), and blood pressure were measured along with the estimations of lipoprotein (a), total cholesterol (TC), triglyceride (TG), total lipid, LDL/HDL ratio, TC/HDL ratio, and fasting blood glucose (FBS). Results. Overall in young Gujarati population (20-40 years) prevalence rates of MS were 16.0% (male: 21.5%; female: 10.8%) where the metabolic abnormalities increased with advanced age as 9.56% of the young population (20-30 years) had MS, in contrast to the 24.57% in the old (31-40 years). Odds ratio analysis had indicated BMI (1.120; 95% CI: 1.077-1.163; P < 0.0001) as the strongest risk factor for MS closely followed by advancing age (1.100; 95% CI: 1.061-1.139; P < 0.0001) levels. Conclusion. Prevalence of metabolic syndrome in young Gujarati population reinforces the need for early life style intervention and awareness programs in this ethnic group.

Associations between Dietary Antioxidant Intake and Metabolic Syndrome

Background

The objective of this study was to evaluate the association between dietary antioxidant intake (carotenoid, vitamin C, E and selenium) intake and metabolic syndrome (MS).

Method

This cross-sectional study included 2069 subjects undergoing a regular health checkup. Biochemical test results and data on dietary intakes were collected for analysis. Adjustment for energy intake and multi-variable logistic regression were performed to determine adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95%CI) for the relationship between dietary antioxidants intake and MS. The lowest quartile of antioxidant intake was regarded as the reference category.

Result

Dietary vitamin C intake (P values for trend were 0.02 in energy adjusted analysis and 0.08 in multivariable adjusted analysis) had a negative association with MS, as did selenium intake in the second quartile (energy adjusted OR: 0.60, 95%CI: 0.43 to 0.85; multivariable adjusted OR: 0.60, 95%CI: 0.43 to 0.86). However, there was no significant relationship between dietary carotenoid and vitamin E intake and MS.

Conclusion

Subjects with low intake of vitamin C might be predisposed to development of MS, while dietary selenium intake had a moderate negative association with MS. Dietary carotenoid and vitamin E intake was not associated with MS.

Metabolic syndrome in fixed-shift workers

OBJECTIVE

To analyze if metabolic syndrome and its altered components are associated with demographic, socioeconomic and behavioral factors in fixed-shift workers.

METHODS

A cross-sectional study was conducted on a sample of 902 shift workers of both sexes in a poultry processing plant in Southern Brazil in 2010. The diagnosis of metabolic syndrome was determined according to the recommendations from Harmonizing the Metabolic Syndrome. Its frequency was evaluated according to the demographic (sex, skin color, age and marital status), socioeconomic (educational level, income and work shift), and behavioral characteristics (smoking, alcohol intake, leisure time physical activity, number of meals and sleep duration) of the sample. The multivariate analysis followed a theoretical framework for identifying metabolic syndrome in fixed-shift workers.

RESULTS

The prevalence of metabolic syndrome in the sample was 9.3% (95%CI 7.4;11.2). The most frequently altered component was waist circumference (PR 48.4%; 95%CI 45.5;51.2), followed by high-density lipoprotein. Work shift was not associated with metabolic syndrome and its altered components. After adjustment, the prevalence of metabolic syndrome was positively associated with women (PR 2.16; 95%CI 1.28;3.64), workers aged over 40 years (PR 3.90; 95%CI 1.78;8.93) and those who reported sleeping five hours or less per day (PR 1.70; 95%CI 1.09;2.24). On the other hand, metabolic syndrome was inversely associated with educational level and having more than three meals per day (PR 0.43; 95%CI 0.26;0.73).

CONCLUSIONS

Being female, older and deprived of sleep are probable risk factors for metabolic syndrome, whereas higher educational level and higher number of meals per day are protective factors for metabolic syndrome in fixed-shift workers.

Waist-to-Height Ratio and Triglycerides/High-Density Lipoprotein Cholesterol Were the Optimal Predictors of Metabolic Syndrome in Uighur Men and Women in Xinjiang, China

OBJECTIVE

This study aimed to identify the best single predictor of metabolic syndrome by comparing the predictive ability of various anthropometric and atherogenic parameters among a Uighur population in Xinjiang, northwest China.

METHODS

A total of 4767 Uighur participants were selected from the Cardiovascular Risk Survey (CRS), which was carried out from October, 2007, to March, 2010. Anthropometric data, blood pressure, serum concentration of serum total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and fasting glucose were documented. Prevalence of metabolic syndrome and its individual components were confirmed according to International Diabetes Federation (IDF) criteria. Area under the receiver operating characteristic curve (AUC) of each variable for the presence of metabolic syndrome was compared. The sensitivity (Sen), specificity (Spe), distance in the receiver operating characteristic (ROC) curve, and cutoffs of each variable for the presence of metabolic syndrome were calculated.

RESULTS

In all, 23.7% of men had the metabolic syndrome, whereas 40.1% of women had the metabolic syndrome in a Uighur population in Xinjiang; the prevalence of metabolic syndrome in women was significantly higher than that in men (P<0.001). In men, the waist-to-height ratio (WHtR) had the highest AUC value (AUC=0.838); it was followed by TGs/HDL-C (AUC=0.826), body mass index (BMI) (AUC=0.812), waist-to-hip ratio (WHR) (AUC=0.781), and body adiposity index (BAI) (AUC=0.709). In women, the TGs/HDL-C had the highest AUC value (AUC=0.815); it was followed by WHtR (AUC=0.780), WHR (AUC=0.730), BMI (AUC=0.719), and BAI (AUC=0.699). Similarly, among all five anthropometric and atherogenic parameters, the WHtR had the shortest ROC distance of 0.32 (Sen=85.40%, Spe=71.6%), and the optimal cutoff for WHtR was 0.55 in men. In women, TGs/HDL-C had the shortest ROC distance of 0.35 (Sen=75.29%, Spe=75.18%), and the optimal cutoff of TGs/HDL-C was 1.22.

CONCLUSION

WHtR was the best predictor of metabolic syndrome in Uighur men, whereas TGs/HDL-C was the best predictor of metabolic syndrome in Uighur women in Xinjiang.

Association of alcohol consumption and components of metabolic syndrome among people in rural China

Background

Accumulative evidence in the literature suggests alcohol consumption is a protective factor of the metabolic syndrome (MS). However, few studies investigated the relationship between alcohol consumption and components of MS. We examined association of several types of alcoholic beverage with components of MS among people in rural China.

Methods

In the Nantong Metabolic Syndrome Study (NMSS), a cross-sectional study, a total of 20,502 participants, including 13,505 women and 6,997 men aged 18–74 years, were recruited between 2007 and 2008 in Nantong, China. Socio-economic status, dietary intake, physical exercise, alcoholic beverage consumption, and smoking status information were obtained, and triglycerides (TG), high-density lipoprtein cholesterol (HDL-c), blood pressure (BP) and blood glucose level were examined for all participants. Logistic regression model and the restricted cubic spline approach were used to analyze the associations between alcoholic beverage consumption and MS components.

Results

The MS prevalence was 21.1% in the whole population, which was significantly low among drinkers (20.6%), compared with non-drinkers (23.6%) in women, and was comparable in men (16.4% versus 17.1%). High HDL-c level was observed among drinkers, compared with non-drinkers in both men and women. Low TG level and Systolic BP (SBP) were found only among rice wine drinkers in women, and high waist circumference, high TG and BP were found among beer and liquor drinkers in men. Furthermore, we found that the highest quartile of rice wine drink in women may decrease 24% risk of high TG, 30% risk of low HDL-c and 43% risk of high glucose among MS components cases respectively, compared with non-drinkers (p for trend <0.01 for those three components). While compared non-drinkers among men, the highest quartile of liquor drink may increase 32% risk of high SBP, 55% risk of high Diastolic BP (DBP) and 34% risk of abdominal obesity among MS components cases respectively, but decrease 45% risk of low HDL-c (p for trend <0.05 for those four components).

Conclusion

Our data suggested that all alcoholic beverages increased HDL-c level. Rice wine decreased both TG level and blood glucose in women only and it could be one of healthy alcoholic beverages in MS prevention in Chinese women. While excessive liquor consumption increased BP and waist circumference level and it may lead to hypertension and central obesity in Chinese men.

A Descriptive Study of the Progression of the Metabolic Syndrome in Middle-Aged Chinese Population

This longitudinal study investigated the prevalence of the Metabolic Syndrome (MetS) in middle-aged (44–56 years) men and women in China. The presence of the components of the MetS was determined in a cohort of 643 persons born in 1956, 1960–1961, and 1964 in Shanxi Province China in 2008 and 2012. The rate of MetS in 2008 was 51.63% (95% CI [44.73, 58.48]) and 37.15% (95% CI [32.56, 41.92]) and in 2012 was 50.23% (95% CI [43.35, 57.10]) and 46.26% (95% CI [41.46, 51.11]) for men and women, respectively. Increased blood glucose and triglycerides and decreased high-density lipoprotein for women, and blood glucose and triglycerides for men were the components responsible for the development of MetS from 2008 to 2012. MetS develops differently between men and women. From age 44 to 56, the rate is unchanged among men and increasing among women.

An update on the prevalence of metabolic syndrome and its associated factors in rural northeast China

Background

The last study reported the prevalence of Metabolic Syndrome (MetS) in rural Northeast China was conducted approximately ten years ago. We aimed to update the data on the prevalence and epidemiological features of MetS in rural Northeast China.

Methods

This survey was conducted from July 2012 to August 2013. In this study, a total of 11,496 residents from the rural Northeast China were randomly selected and examined. MetS was defined according to the ATPIII-modified criteria. Data regarding the demographic and lifestyle characteristics and the blood biochemical indexes of these participants were collected by well-trained personnel.

Results

The prevalence of MetS was 39.0% and was more prevalent in women than in men (45.6% vs. 31.4%, P < 0.001). Elevated blood pressure was the most common metabolic disorder in both genders (71.7% in males and 63.3% in females). Only 11.2% and 9.6% of males and females, respectively, in this study had no metabolic disorders. Multivariate logistic regression, after adjusting for possible confounders, revealed the following factors that increased the risk of MetS: being female, older age, having more than one child, a family income of >20,000 CNY per year, longer sleep duration (>9 h/d), chronic disease status, frequent consumption of beans or bean products and frequent tea drinking. Completion of education through middle school, moderate physical activity and smoking were correlated with lower rates of MetS.

Conclusion

The prevalence of MetS was high in the rural areas of China, especially among females. In addition to some of the more conventional risk factors associated with MetS, including age, sex, annual income and educational status, we also found that having more than one child and frequent consumption of tea and beans were risk factors for MetS, while smoking was a common factor among those that did not have MetS in rural Northeast China.

Associations of cigarette smoking and alcohol consumption with metabolic syndrome in a male Chinese population: a cross-sectional study

Background

Whether cigarette smoking and alcohol consumption are associated with the risk of metabolic syndrome (MetS) remains controversial. This study investigated the associations of cigarette smoking and alcohol consumption with MetS in a male population in China.

Methods

We conducted a cross-sectional study. A questionnaire was used to collect data on cigarette smoking, alcohol consumption, MetS status, and other related information from 8169 men aged 19–97 years. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between smoking and alcohol consumption and the risk of MetS.

Results

The prevalence of MetS was 15.2% in the study population. Proportions of current smokers and drinkers were 48.2% and 46.5%, respectively. Adjusted OR of MetS was 1.34 (95% CI, 1.01–1.79) among smokers who smoked ≥40 cigarettes/day compared with nonsmokers and 1.22 (95% CI 1.03–1.46) for those who consumed 0.1–99 grams of alcohol/day compared with nondrinkers. Adjusted OR was 2.32 (95% CI 1.45–3.73) among ex-drinkers who never smoked, 1.98 (95% CI 1.35–2.91) among ex-drinkers who were current smokers, and 1.34 (95% CI 1.08–1.68) among current drinkers who never smoked compared with those who neither smoked nor drank. There was a significant interaction between smoking and drinking alcohol on MetS (P for interaction is 0.001).

Conclusions

Our study indicated that smoking and drinking is associated with higher prevalence of MetS. Interactions between smoking and drinking on the risk of MetS in men in China may also exist. Our findings need to be confirmed in future case-control or cohort studies.

Prevalence and determinants of metabolic syndrome among adults in a rural area of Northwest China

OBJECTIVES

To evaluate the prevalence and determinants of metabolic syndrome (MetS) among adults in a rural area of Northwest China.

METHODS

A population-based cross-sectional study was conducted in 2010 among adults aged 18 to 80 years in rural areas of Hanzhong, in Northwest China. Interview, physical and clinical examinations, and fasting blood glucose and lipid measurements were completed for 2990 adults. The definitions of MetS proposed by the Third Report of the National Cholesterol Education Program Expert Panel (Adults Treatment Panel III, ATP III) and the International Diabetes Federation (IDF), and the modified ATP III definition for Asian population were used and compared. Proportions were adjusted for age and sex.

RESULTS

The prevalence of MetS was 7.9%, 10.8% and 15.1% according to ATP III, IDF and modified ATP III criteria, respectively. Agreement between ATP III and IDF criteria and that between ATP III and modified ATP III criteria were moderate (Kappa = 0.52 and 0.64, respectively), whereas agreement between IDF and modified ATP III criteria was good (Kappa = 0.83). The prevalence of MetS increased with age, and was higher in women than in men (10.4% versus 5.4%, 13.6% versus 8.1% and 17.4% versus 12.8%, according to ATP III, IDF and modified ATP III criteria, respectively). The most common MetS component was high blood pressure. Having family history of hypertension, lack of physical activity, high economical level, overweight and obesity were positively associated with MetS.

CONCLUSIONS

MetS is prevalent among rural adults in Northwest China and high blood pressure is the most common MetS component. Prevention and treatment of hypertension and MetS should be a public health priority to reduce cardiovascular diseases in rural areas of Northwest China. More attention should be given to the elderly, women, people with family history of hypertension and obese people who are at high risk of MetS.

The complex P2X7 receptor/inflammasome in perivascular fat tissue of heavy smokers

OBJECTIVE

Smoking is a recognized cardiovascular risk factor. Perivascular visceral adipose tissue (PVAT) is a source of inflammatory molecules, thus contributing to atherosclerosis progression. The P2X7 receptor (P2X7 R)-inflammasome complex, crucial in determining IL-1β and IL-18 release, participates in this scenario. We evaluated whether smoking might affect the PVAT inflammatory phenotype and explored the putative role of the axis P2X7 R-inflammasome in this picture.

SUBJECTS AND METHODS

TNFα, IL-6, RBP4, MCP-1, as well as P2X7 R and inflammasome components NLRP3, ASC, caspase-1 and IL-1β and IL-18 expression was determined in adipocytes isolated by PVAT of healthy smokers (Smok) and nonsmokers (No-Smok) subjects. Plasma and culture medium levels of these cytokines were also determined.

RESULTS

Perivascular adipose tissue of Smok had a higher expression of P2X7 R and inflammasome components; via P2X7 R activation, it released more IL-1β and IL-18, whose serum levels were also higher in Smok than in No-Smok. Linear correlations of NLRP3 with P2X7 R and IL-18 expression and release emerged. Smok also had a higher PVAT expression of the chemotactic factor MCP-1. However, no difference was observed in the PVAT expression of genes more strictly related to insulin resistance, like TNFα, RBP4, IL-6; this was coupled with similar plasma levels of TNFα and RBP4 in the two groups.

CONCLUSION

Smoking contributes to the pro-inflammatory status of the PVAT by enhancing expression and activity of the P2X7 R-inflammasome complex; the effect on adipocytokines more related to insulin resistance and metabolic abnormalities appears trivial.

Prevalence of metabolic syndrome and its influencing factors among the Chinese adults: the China Health and Nutrition Survey in 2009

OBJECTIVE

We aimed to estimate the up-to-date prevalence of metabolic syndrome (MS) and its influencing factors among the Chinese adults.

METHODS

Data were obtained from the China Health and Nutrition Survey conducted in 2009, which was a cross-sectional and partially nationally representative study including a total of 7488 Chinese adults (age ≥18 years).

RESULTS

The overall age-standardized prevalence estimates of the MS were 21.3% (95%confidence interval (CI): 20.4%-22.2%), 18.2% (95%CI: 17.3%-19.1%) and 10.5% (95%CI: 9.8%-11.2%) based on definitions of revised NCEP ATPIII, IDF and CDS criteria, respectively. Individuals who were women (compared to men: odds ratio [OR]=1.37, 95% CI=1.16-1.61), 40 years or older (compared to less than 40 years old: OR=2.82, 95%CI=2.37-3.34 for 40-59 years; OR=4.41, 95%CI=3.68-5.29 for 60 years or older), overweight/obese (compared to normal weight: OR=4.32, 95%CI=3.77-4.95 for overweight; OR=11.24, 95%CI=9.53-13.26 for obese), and living in urban area (compared to living in rural area: OR=1.27, 95%CI=1.12-1.43) were more likely to have a higher prevalence estimate of MS. In addition, frequency of alcohol consumption and cigarette intake were also found to be significantly associated with probability of MS.

CONCLUSIONS

Our results suggest an urgent need to develop national strategies for the prevention, detection, treatment and control of obesity and MS in China.

The metabolic syndrome among postmenopausal women in rural Canton: prevalence, associated factors, and the optimal obesity and atherogenic indices

Objectives

This research aimed to (i) determine the prevalence of metabolic syndrome (MetS) and its components; (ii) assess factors associated with MetS, and (iii) define optimal ethnic-specific cutoffs of obesity- and atherogenic-based markers to predict MetS among postmenopausal women in rural Canton.

Methodology/Principal Findings

The Rural Canton Diabetes and Metabolic Disorders Study, a population based cross-sectional study, was conducted during 2011–2012 in Canton. In person interviews, blood glucose and lipid measurements were completed for 4,706 postmenopausal women who did not receive hormone replacement therapy. MetS was diagnosed using criteria of the Joint-Interim-Statement (JIS), the International-Diabetes-Federation (IDF) and the Modified-Third-Adult-Treatment-Panel (M-ATPIII). Age-standardized prevalence of MetS was 38.4%, 28.8%, and 37.1% according to JIS, IDF, and M-ATPIII criteria, respectively. Excellent agreement was observed between three definitions (κ≥0.79), in particular between JIS and ATPIII (κ = 0.98, 95%CI: 0.97–0.98). Factors positively associated with MetS were living in Southern Canton, personal income, current smoking, higher BMI, and family history of cardiovascular disease. However, regular leisure-time physical activity can have protective effects. The optimal cutoff values for waist-circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio(WHtR), BMI, HDL-cholesterol to total cholesterol ratio (HDL/TC), HDL-cholesterol to LDL-cholesterol ratio (HDL/LDL), and triglyceride to HDL-cholesterol ratio (TG/HDL) that predicted the presence of MetS were 79.5 cm, 0.86, 0.53, 22.47 kg/m², 0.33, 0.68, and 0.88, respectively.

Conclusions

This study highlights the importance of MetS among postmenopausal women in rural Canton. Our findings contribute to help selecting Cantonese-specific markers to predict MetS and support the need to establish educational program for promoting healthy-lifestyles among this population.

Effects of Pro12Ala polymorphism in peroxisome proliferator-activated receptor-γ2 gene on metabolic syndrome risk: a meta-analysis

BACKGROUND

Associations between peroxisome proliferator-activated receptor γ2 (PPARγ2) gene polymorphism and metabolic syndrome risk remained controversial and ambiguous. Thus, we performed a meta-analysis to assess the association between Pro12Ala polymorphism in PPARγ2 gene and metabolic syndrome susceptibility.

METHODS

An electronic literature search was conducted on Medline, OVID, Cochrane Library database, and the China National Knowledge Internet up to March 2013. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate the strength of association in the fixed or random effects model.

RESULTS

Ten studies involving a total of 4456 cases and 10343 controls were included in this meta-analysis. No statistical evidence of association was found between Pro12Ala polymorphism and metabolic syndrome risk in all genetic models (homozygote model: OR=0.83, 95% CI=0.62-1.12; heterozygote model: OR=1.04, 95% CI=0.94-1.14; dominant model: OR=1.02, 95% CI=0.93-1.12; recessive model: OR=0.83, 95% CI=0.62-1.11). No statistical evidence of significant association was observed when stratified by ethnicity, definition of metabolic syndrome, source of control groups and quality score of the selected articles. All in all, the results did not support a major role of the Pro12Ala variant of the PPARγ2 gene in metabolic syndrome risk.

CONCLUSIONS

This meta-analysis suggested that the effect of Pro12Ala polymorphism in PPARγ2 gene may not be related to metabolic syndrome as an entity. However, Pro12Ala may affect the single component of metabolic syndrome. A large, well designed study is required to more adequately assess the role for Pro12Ala polymorphism on metabolic syndrome.

Dietary nutrient intake and metabolic syndrome risk in Chinese adults: a case-control study

Background

Because human diets are composed of a wide variety of nutrients that may work synergistically to prevent or promote disease, assessing dietary nutrient intake status may be informative. The purpose of this study was to assess the dietary nutrient intake status of Chinese adults with metabolic syndrome (MetS) and to evaluate its possible role in MetS.

Methods

This case–control study was conducted from March 2010 to January 2011. A total of 123 patients with MetS and 135 controls participated in this study at the Health Examination Center of Heping District in Tianjin, China. Dietary intake was estimated by 24-h dietary recalls. We used principal component factor analysis to derive nutrient groups from 17 major nutrients. We examined the odds ratios and 95% confidence intervals using logistic regression models to test the relationship between tertiles of dietary nutrient pattern and MetS.

Results

There were 4 major dietary nutrient patterns in this study: “vitamin B group”, “protein and lipids”, “vitamin E and minerals”, and “antioxidant vitamins”. After adjustment for potential confounders, the highest tertile of the nutrient pattern factor score for the “vitamin B group” (odds ratio: 0.16; 95% confidence interval: 0.05–0.47) was negatively associated with MetS compared with the lowest tertiles. No relationships were found between other dietary nutrient patterns and MetS.

Conclusions

The “vitamin B group” pattern was inversely associated with MetS in Chinese adults. This finding supports the hypothesis that the “vitamin B group” pattern may have a potentially beneficial effect on the prevention of MetS.

Associations of cardiorespiratory fitness, physical activity, and obesity with metabolic syndrome in Hong Kong Chinese midlife women

BACKGROUND

Several studies have simultaneously examined physical activity (PA) and cardiorespiratory fitness (CRF) with metabolic syndrome (MS). However, the independent roles of both PA and CRF with MS are less firmly established. The combined contributions of PA and CRF with MS are less studied, particularly among Chinese women. There is uncertainty over the extent to which metabolically healthy but overweight/obese individuals have a higher CRF level.

METHODS

The sample included 184 Chinese women aged 55 to 69 years with available metabolic data and lifestyle factors. PA was assessed by self-reported questionnaire; CRF was assessed by maximal oxygen consumption (VO2max) during a symptom-limited maximal exercise test on a cycle ergometer. Metabolically healthy/abnormal was defined on the basis of absence or presence of MS. Overweight was defined as a body mass index (BMI) of ≥ 23 kg/m2 and obese was defined as a BMI of ≥ 25 kg/m2.

RESULTS

The prevalence of MS was 21.7%. PA was inversely associated with the prevalence of MS after adjustment for age, BMI, and dietary total calories intake, but the association was eliminated after further adjustment for CRF. CRF was inversely associated with the prevalence of MS independent of age, BMI, and dietary total calories intake, and the association remained significant after further adjustment for PA. In the PA and CRF combined analysis, compared with those in the lowest tertile of PA (inactive) and lowest tertile of CRF (unfit), the OR (95%CI) of having MS was 0.31 (0.09-1.06) for subjects in the higher tertiles (2nd-3rd) of PA (active) but were unfit, 0.23 (0.06-0.88) for subjects who were inactive but in the higher tertiles (2nd-3rd) of CRF (fit), and 0.14 (0.04-0.45) for subjects who were active and fit. Metabolically healthy but overweight/obese subjects had a higher CRF level than their metabolically abnormal and overweight/obese peers. However, the difference did not reach statistically significance.

CONCLUSIONS

CRF has greater association with the prevalence of MS compared with PA in Chinese midlife women. The interrelationships between CRF, obesity, and MS needs further study.

Increasing Prevalence of Metabolic Syndrome in a Chinese Elderly Population: 2001-2010

Objective

The information on the changes of prevalence of MetS in China is limited. Our objective was to assess a 10-year’s change of the prevalence of MetS in a Chinese elderly population between 2001 and 2010.

Methods

We conducted two cross-sectional surveys in a representative sample of elderly population aged 60 to 95 years in Beijing in 2001 and 2010 respectively. MetS was defined according to the 2009 harmonizing definition.

Results

A total of 2,334 participants (943 male, 1,391 female) in 2001 and 2,102 participants (848 male, 1,254 female) in 2010 completed the survey. The prevalence of MetS was 50.4% (95%CI: 48.4%–52.4%) in 2001 and 58.1% (95%CI: 56.0%–60.2%) in 2010. The absolute change of prevalence of MetS was 7.7% over the 10-year’s period (p<0.001). The syndrome was more common in female than male in both survey years. Among the five components, hypertriglyceridemia and low HDL-C had increased most, with an increase of 14.8% (from 29.4% to 44.2%) and 9.9% (from 28.3% to 38.2%) respectively. The adjusted ORs of MetS for CHD, stroke and CVD were 1.67(95%CI: 1.39–1.99), 1.50(95%CI: 1.19–1.88) and 1.70(95%CI: 1.43–2.01) respectively in 2001, and were 1.74(95%CI: 1.40–2.17), 1.25(95%CI: 0.95–1.63) and 1.52(95%CI: 1.25–1.86) respectively in 2010.

Conclusion

The prevalence of MetS is high and increasing rapidly in this Chinese elderly population. Participants with Mets and its individual components are at significantly elevated ORs for CVD. Urgent public health actions are needed to control MetS and its components, especially for dislipidemia.

Relationship between SSRIs and Metabolic Syndrome Abnormalities in Patients with Generalized Anxiety Disorder: A Prospective Study

OBJECTIVE

SSRIs are some of the most widely prescribed medications in the world. In addition to their effectiveness, SSRIs were reported to be associated with the side effects of weight gain, sexual dysfunction, drug interactions, extrapyramidal symptoms and discontinuation symptoms. However, the effects of SSRIs on metabolic parameters are poorly understood.

METHODS

This study aims to describe the effects of SSRIs on the metabolic parameters of drug-naive first episode patients with generalized anxiety disorder. Ninety-seven female patients aged 20-41 years without any metabolic or psychiatric comorbidity were included in the study. Fluoxetine, sertraline, paroxetine, citalopram and escitalopram were randomly given to the patients. Metabolic parameters, including BMI, waist circumference and the levels of fasting glucose, total cholesterol, triglyceride, HDL, LDL and blood pressure, were measured before and after 16 weeks of treatment.

RESULTS

In the paroxetine group, there was a significant increase in the parameters of weight, BMI, waist circumference, fasting glucose, total cholesterol, LDL and triglyceride after 16 weeks of treatment. There were significant increases in the levels of triglyceride in the citalopram and escitalopram groups. In the sertraline group, the total cholesterol level increased after treatment. In the fluoxetine group, there were significant reductions in the parameters of weight, total cholesterol and triglyceride.

CONCLUSION

To our knowledge, this study is the first to prospectively describe metabolic syndrome abnormalities in patients with first episode generalized anxiety disorder. Although the effectiveness of the different SSRIs is similar, clinicians should be more careful when prescribing SSRIs to patients who have cardiac risk factors. Larger and lengthier controlled clinical trials are needed to explore the associations between SSRI use and metabolic syndrome.

Metabolic syndrome as a predictor of type 2 diabetes, and its clinical interpretations and usefulness

Metabolic syndrome is defined as a cluster of glucose intolerance, hypertension, dyslipidemia and central obesity with insulin resistance as the source of pathogenesis. Although several different combinations of criteria have been used to define metabolic syndrome, a recently published consensus recommends the use of ethnic-specific criteria, including waist circumference as an indicator of central obesity, triglyceride and high-density lipoprotein (HDL) cholesterol as indicators of dyslipidemia, and blood pressure greater than 130/85 mmHg. The definition of dysglycemia, and whether central obesity and insulin resistance are essential components remain controversial. Regardless of the definition, the prevalence of metabolic syndrome is increasing in Western and Asian countries, particularly in developing areas undergoing rapid socioenvironmental changes. Numerous clinical trials have shown that metabolic syndrome is an important risk factor for cardiovascular disease (CVD), type 2 diabetes mellitus and all-cause mortality. Therefore, metabolic syndrome might be useful as a practical tool to predict these two major metabolic disorders. Comprehensive management of risk factors is very important to the improvement of personal and public health. However, recent studies have focused on the role metabolic syndrome plays as a risk factor for CVD; its importance in the prediction of incident diabetes is frequently overlooked. In the present review, we summarize the known evidence supporting metabolic syndrome as a predictor for type 2 diabetes mellitus and CVD. Additionally, we suggest how metabolic syndrome might be useful in clinical practice, especially for the prediction of diabetes.

Polymorphisms of PTPN11 gene could influence serum lipid levels in a sex-specific pattern

Background

Previous studies have reported that different genotypes of PTPN11 gene (protein tyrosine phosphatase, non-receptor 11) were associated with different levels of serum lipids. The aim of this study was to explore the relationship between single nucleotide polymorphisms (SNPs) of PTPN11 and serum lipids in Northeast Chinese.

Methods

A total of 1003 subjects, 584 males and 419 females, were included in the study and their serum lipids were determined. Five htSNPs (rs2301756, rs12423190, rs12229892, rs7958372 and rs4767860) of PTPN11 gene were genotyped using TaqMan assay method.

Results

All of the five SNPs were in Hardy-Weinberg equilibrium. The male subjects had higher triglyceride (TG), higher low-density lipoprotein cholesterol (LDL-C) and lower high-density lipoprotein cholesterol (HDL-C) level than females. In males, rs4767860 was found to be associated with serum TG and total cholesterol (TC) levels and rs12229892 was associated with TC level. However, these significant associations could not be observed in females. In females, rs2301756 was found to be associated with TG and rs7958372 was associated with LDL-C level. Haplotype analysis showed that the GCGTG haplotype was associated with slightly higher TG level and ATGCG with higher TC level.

Conclusions

SNPs of PTPN11 may play a role in serum lipids in a sex-specific pattern. However, more studies are needed to confirm the conclusion and explore the underlying mechanism.

Lower physical activity is a risk factor for a clustering of metabolic risk factors in non-obese and obese Japanese subjects: the Takahata study

In several countries including Japan, people without obesity but with a clustering of metabolic risk factors (MetRFs) were not considered to have the metabolic syndrome (MetS). Here, we examined whether lifestyle characteristics differed between non-obese and obese subjects with or without a clustering of MetRFs. From a population-based cross-sectional study of Japanese subjects aged ≥ 40 years, 1,601 subjects (age: 61.9 ± 10.3 years; 710/891 men/women) were recruited. Physical activity status and daily nutritional intake were estimated using questionnaires. A clustering of MetRFs was defined based on the presence of at least two non-essential risk factors for the diagnosis of the MetS in Japan. Energy intake was not higher in subjects with a clustering of MetRFs compared with those without. Among men, energy expenditure at work was significantly lower in non-obese (9.0 ± 8.2 vs. 11.3 ± 9.3 metabolic equivalents (METs), P = 0.025) and obese (9.0 ± 7.9 vs. 11.6 ± 9.4 METs, P = 0.017) subjects with a clustering of MetRFs than in those without. Multiple logistic regression analysis showed that energy expenditure at work was significantly associated with a clustering of MetRFs after adjusting for possible confounding factors including total energy intake. The ORs (per 1 METs) were 0.970 (95% CI, 0.944-0.997; P = 0.032) in non-obese men and 0.962 (0.926- 0.999; P = 0.043) in obese men. Similar associations were not observed in women. In Japanese males, lower physical activity, but not excessive energy intake, is a risk factor for a clustering of MetRFs independent of their obesity status.