Ethnic differences in the prevalence of metabolic syndrome: results from a multi-ethnic population-based survey in Malaysia. PLoS One. 2012;7:e46365. [PMID: 23029497 PMCID: PMC3460855 DOI: 10.1371/journal.pone.0046365]

Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis

This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.

Combined Effect of Dietary Acid Load and Cardiometabolic Syndrome on Bone Resorption Marker among Post-Menopausal Women in Malaysia

Background

This study aimed to investigate factors associated with bone resorption status and determine the independent and interactive effects of dietary acid load (DAL) and cardiometabolic syndrome (CMS) on bone resorption in post-menopausal women.

Methods

Overall, 211 community-dwelling post-menopausal women were recruited from the National Council of Senior Citizens Organization, Malaysia. DAL was estimated using the potential renal acid load from the food frequency questionnaire. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and smoking behaviour was assessed using the Global Adult Tobacco Survey 2011. Serum 25(OH) vitamin D levels were determined using the ADVIA Centaur vitamin D assay and serum C-terminal telopeptides of type I collagen (CTX1) were used as surrogate markers to assess bone resorption. CMS was determined based on the harmonised criteria.

Results

Age (β = -0.145, t = -2.002, P < 0.05) was negatively associated while DAL (β = 0.142, t = 2.096, P < 0.05) and sleep quality (β = 0.147, t = 2.162, P < 0.05) were positively associated with CTX1. Height was positively correlated with CTX1 (r = 0.136, P <0.05). Conversely, other variables (CMS traits, CMS, serum 25(OH) vitamin D level, years of menopause, years of education and physical activity) were not significantly associated with CTX1 levels. There was no significant interaction between DAL and CMS on bone resorption.

Conclusion

Our findings propose that high DAL, but not CMS, is a potential risk factor for bone resorption. The analysis did not demonstrate the combined effects of DAL and CMS on bone resorption.

Development and validation of a lifestyle risk index to screen for metabolic syndrome and its components in two multi-ethnic cohorts

BACKGROUND

Metabolic syndrome (MetS) is a precursor to cardiovascular diseases and type 2 diabetes. Existing MetS prediction models relied heavily on biochemical measures and those based on non-invasive predictors such as lifestyle behaviours were limited. We aim to (1) develop a weighted lifestyle risk index for MetS and (2) externally validate this index using two Asian-based cohorts in Singapore.

METHODS

Using data from the Multi-Ethnic Cohort (MEC) 1 (n = 2873, 41% male), multiple logistic regression was used to identify predictors associated with MetS. A weighted lifestyle risk index was generated using coefficients of the selected predictors in the development cohort (MEC1). Subsequently, the performance of the lifestyle risk index in predicting the occurrence of MetS within 10 years was assessed by discrimination and calibration in an external validation cohort (MEC2) (n = 6070, 43% male).

RESULTS

A lifestyle risk index for MetS with nine predictors was developed (age, sex, ethnicity, having a family history of diabetes, BMI, diet, physical activity, smoking status, and screen time). This index demonstrated acceptable discrimination in the development cohort [AUC (95% CI) = 0.74 (0.71, 0.76)] and the validation cohort [AUC (95% CI) = 0.79 (0.77, 0.81)].

CONCLUSION

This lifestyle risk index exhibits potential for risk stratification in population-based screening programmes. Future research could apply a similar methodology to develop disease-specific lifestyle risk indices using nationwide registry-based data.

Hormonal assessment and body composition in young males with metabolic syndrome

OBJECTIVE

Aim: To determine the relationship between body composition and hormonal levels in young men with metabolic syndrome.

PATIENTS AND METHODS

Materials and Methods: 123 males with a mean age of 24.1 ± 4.3 years (33 with metabolic syndrome (MS group) and 90 healthy physically active men (control group) were recruited at the study of body composition and hormone status. The total testosterone, cortisol, and insulin in blood serum by ELISA, the body weight (kg), lean body mass (kg) and fat mass (kg, %) by bioimpedance analysis method were investigated.

RESULTS

Results: It was establish the significand difference the mean value of body composition (body weight, lean body weight, fat body mass (kg, %), testosterone, cortisol insulin, and glucose concentration between MS group and control group.

CONCLUSION

Conclusions: A present study established the significant correlation of testosterone, insulin, and glucose concentration with fat body mass in all participants (MS and control groups). The negativee effect of overweight (BMI > 25; FBM > 18 %) and obesity (BMI > 30; FBM > 25 %) for testosterone concentration was determined due to an increase of FBM > 20 % and insulin increasing > 9,0 μlU/l.

Body mass index and waist circumference trajectories across the life course and birth cohorts, 1996-2015 Malaysia: sex and ethnicity matter

OBJECTIVE

The global obesity epidemic remains a significant threat to public health and the economy. Age-period-cohort (APC) analysis is one method to model the trajectory of obesity. However, there is scarce published evidence of such analyses among the South East Asian population. This study aims to explore the sex and ethnic variations of BMI and waist circumference trajectories over time among non-institutionalized Malaysian adults aged 18 to 80 years.

METHODS

Data from four population-based National Health and Morbidity Surveys conducted in 1996, 2006, 2010, and 2015 were pooled. Hierarchical Age-Period-Cohort (HAPC) analysis explored the trajectories of BMI and waist circumference across the life course and birth cohorts by sex and ethnicity. These models assumed no period effect.

RESULTS

Generally, BMI and waist circumference trajectories increased across age and birth cohorts. These trajectories varied by sex and ethnicity. Females have more profound increasing BMI and waist circumference trajectories than their male counterparts as they age and as cohort recency increases. Chinese have less profound BMI and waist circumference increases across the life course and birth cohorts than other ethnic groups.

CONCLUSIONS

The profound increasing cohort trajectories of obesity, regardless of sex and ethnicity, are alarming. Future studies should focus on identifying factors associated with the less profound cohort effect among the Chinese to reduce the magnitude of trajectories in obesity, particularly among future generations.

Depressive symptoms mediate the longitudinal association between diabetes and subjective cognitive decline. Findings from a semirural multi-ethnic older population in Malaysia

The potential role of psychological distress as the pathway linking diabetes and subjective cognitive decline (SCD) is still unclear. This study aims to investigate whether depressive symptoms mediate the relationship between diabetes and SCD in older adults. Baseline data from 3428 adults (55-94 years) of the South East Asia Community Observatory (SEACO), Malaysia were utilized. Subjective cognitive complaints (SCC) were recorded at baseline and five years later. Mediation analyses with non-parametric bootstrapping methods were employed. A proportion of 20% of participants without SCC at baseline reported a decline in SCC after 5 years of follow-up. Known diabetes (β = -0.13, SE = 0.05, p = 0.02) and depressive symptoms (ß = -0.18, SE = 0.05, p = 0.001) were independently associated with SCD. Previously diagnosed diabetes was associated with depressive symptoms at baseline (ß = 0.04, SE = 0.02, p = 0.01), and greater SCD at follow-up (β = -0.19, SE = 0.06, p = 0.001). Mediation analyses revealed that 9% of the association between diabetes and SCD was attributable to an indirect effect through depressive symptoms (ß = -0.01, 95% CI 0.02-0.001, p < 0.0001). This study provides further evidence of the detrimental effects of diabetes and depression on subjective cognitive decline. Our findings also suggest that depression is an important pathway linking previously diagnosed diabetes with subjective cognitive decline in older adulthood.

Comparison between obese and non-obese nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver conditions that are characterized by excess accumulation of fat in the liver, and is diagnosed after exclusion of significant alcohol intake and other causes of chronic liver disease. In the majority of cases, NAFLD is associated with overnutrition and obesity, although it may be also found in lean or non-obese individuals. It has been estimated that 19.2% of NAFLD patients are lean and 40.8% are non-obese. The proportion of patients with more severe liver disease and the incidence of all-cause mortality, liver-related mortality, and cardiovascular mortality among non-obese and obese NAFLD patients varies across studies and may be confounded by selection bias, underestimation of alcohol intake, and unaccounted weight changes over time. Genetic factors may have a greater effect towards the development of NAFLD in lean or non-obese individuals, but the effect may be less pronounced in the presence of strong environmental factors, such as poor dietary choices and a sedentary lifestyle, as body mass index increases in the obese state. Overall, non-invasive tests, such as the Fibrosis-4 index, NAFLD fibrosis score, and liver stiffness measurement, perform better in lean or non-obese patients compared to obese patients. Lifestyle intervention works in non-obese patients, and less amount of weight loss may be required to achieve similar results compared to obese patients. Pharmacological therapy in non-obese NAFLD patients may require special consideration and a different approach compared to obese patients.

Implementation of Nutrigenetics and Nutrigenomics Research and Training Activities for Developing Precision Nutrition Strategies in Malaysia

Nutritional epidemiological studies show a triple burden of malnutrition with disparate prevalence across the coexisting ethnicities in Malaysia. To tackle malnutrition and related conditions in Malaysia, research in the new and evolving field of nutrigenetics and nutrigenomics is essential. As part of the Gene-Nutrient Interactions (GeNuIne) Collaboration, the Nutrigenetics and Nutrigenomics Research and Training Unit (N2RTU) aims to solve the malnutrition paradox. This review discusses and presents a conceptual framework that shows the pathway to implementing and strengthening precision nutrition strategies in Malaysia. The framework is divided into: (1) Research and (2) Training and Resource Development. The first arm collects data from genetics, genomics, transcriptomics, metabolomics, gut microbiome, and phenotypic and lifestyle factors to conduct nutrigenetic, nutrigenomic, and nutri-epigenetic studies. The second arm is focused on training and resource development to improve the capacity of the stakeholders (academia, healthcare professionals, policymakers, and the food industry) to utilise the findings generated by research in their respective fields. Finally, the N2RTU framework foresees its applications in artificial intelligence and the implementation of precision nutrition through the action of stakeholders.

Prevalence and predictors of metabolically healthy obesity in severely obese Asian children

BACKGROUND

Obese individuals who have little or no metabolic syndrome components are proposed to be "metabolically healthy obese (MHO)". This study aim to evaluate the prevalence of MHO and examine the predictors associated with MHO in a multi-ethnic Asian cohort of severely obese children.

METHODS

This study included a cross-sectional cohort of 406 Chinese, Malay and Indian children aged 5-20 years old with BMI for age ≥ 97th percentile. Metabolic syndrome (MS) and metabolic health (MH) definitions based on the presence or absence of metabolic abnormalities (High triglycerides, low HDL cholesterol, elevated blood pressure and high glucose) were used to define MHO in the cohort.

RESULTS

The prevalence of MHO is 63.5% by MS definition and 22.4% by MH definition. Maternal healthy metabolic status (OR: 2.47), age (OR: 0.83, 0.80), paternal obesity (OR: 0.48, 0.53), Malay (OR: 1.97) and Indian ethnicity (OR: 6.38, 3.21) (compared to Chinese ethnicity) are independent predictors for MHO phenotype based on different MHO definitions.

CONCLUSIONS

Adiposity measures are not associated with MHO phenotype, but instead younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype in a multi-ethnic Asian cohort of severely obese children.

IMPACT

The prevalence of metabolically healthy obese (MHO) in our multi-ethnic Asian cohort of severely obese children is 63.5% and 22.4%, respectively, based on different MHO definitions. Adiposity measures are not associated with the MHO phenotype. There are other factors that contribute to the metabolic phenotype in obese individuals. Younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype. Parental influence is important in predicting metabolic health in obese individuals.

Comprehending Nutrition and Lifestyle Behaviors of People with Metabolic Syndrome: A Focus Group Study

Demographically and socio-culturally appropriate care is critical for empowering people with metabolic syndrome (MetS) to self-manage their condition. This focus group study aimed to explore the understanding of nutrition and lifestyle behaviors (NLBs) of Malaysians with MetS. Adults with MetS (N = 21) participated in four focus groups at a university's research clinic in Malaysia. A thematic framework analysis approach was applied to the focus group data using an initial coding framework developed from the Health Belief Model. Six main themes were identified on perceived motivations, barriers, and threats toward healthy NLBs. Motivations to adopt healthy NLBs were body image, personal experience of adverse complications, and family and social support. The perception that healthcare is a business model, the idea that changes in NLBs are difficult and expensive, and cultural influence on food intake were identified as barriers to healthy NLBs. Inadequate knowledge of MetS was identified as a subtheme in this study. Health education and health promotion activities that aim to modify the NLBs of people with MetS should consider the community's perception of motivation and barriers to change. Addressing these aspects in the development of programs can potentially increase program adoption and adherence, ensuring the success of community-based lifestyle interventions.

Prevalence of metabolic syndrome in Brazilian adults in the last 10 years: a systematic review and meta-analysis

Background

A cluster of interconnected cardiometabolic risk factors characterizes metabolic Syndrome (MS). The prevalence of MS is increasing worldwide, but there is not a meta-analysis of this prevalence in the Brazilian population. We aimed to determine the prevalence of metabolic syndrome among adult general population in Brazil through a meta‑analysis study.

Methods

Original research studies were searched at PubMed, Scopus, Web of Science, and SciELO databases, from 2011 to 2021. We used the Joanna Briggs Institute tool to assess the quality of included studies. The random effect model was used to estimate the pooled prevalence of MS. Subgroup and meta-regression analysis were conducted for explored heterogeneity and used the Funnel Plot and Egger’s test to assess publication bias. The study was performed based on the criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Results

The search in electronic databases identified 1598 records. From this total, 26 studies were eligible to be included in the final analysis. The overall pooled prevalence among the general population of Brazil was 33% with high heterogeneity observed. By gender, the prevalences were 26% in males and 38% in females. By criteria that was used to define MS, the prevalence were 31% in NCEP ATP III, 25% in JIS, 37% in IDF/NHLBI/AHA/WHF/IAS/IASO and 33% in IDF criteria. The prevalence in different habitat was 34% in urban, 15% in rural, 28% in quilombola and 37% in indigenous. In different regions was 37% in the South, 30% in Southeast, 38% in North, 31% in Northeast and 39% in Midwest. The pooled prevalence of MS with age was < 45 years: 43% and ≥ 45 years: 42% and the prevalence based on year of study implementation was 31% in 2015–2019, 35% in 2010–2014 and 28% in 2005–2009. There were no statistically significant differences between subgroups. Most of the studies showed high quality assessment criteria’s except adequate sample size criteria and many studies participants were not sampled in an appropriate way.

Conclusions

Our review indicates a high prevalence of MS in the healthy Brazilian adult population, when compared to others countries and with a world estimate.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12753-5.

High atherogenic risk concomitant with elevated HbA1c among persons with type 2 diabetes mellitus in North Ethiopia

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic disease associated with worse clinical presentation. However, the current investigation practices in Ethiopia have limitations to demonstrate the scope of the clinical burden. Hence, this study was aimed at assessing the glycemic status and coronary heart disease (CHD) risk of persons with T2DM using HbA1c and atherogenic index of plasma (AIP).

METHOD

This institution-based cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Demographic, socioeconomic, and lifestyle data were collected through a face-to-face interview. Clinical information was retrieved from medical records whereas anthropometric and biochemical measurements were performed using the WHO protocols. Glycemic status was determined using HbA1c and CHD risk assessed using an atherogenic index of plasma (AIP). Gaussian variables were expressed using mean and standard deviation (SD), Log-normal variables using geometric mean and 95% CI and non- Gaussian variables using median and interquartile ranges. Categorical variables were summarized using absolute frequencies and percentages. Multivariable logistic regression was used to identify factors associated with glycemic control with a statistical significance set at 5%.

RESULT

A total of 195 male and 226 female subjects were involved in this study. The results demonstrated that 77% (324) had HbA1c value ≥7% and 87.2% (367) had high atherogenic risk for CHD. Besides, 57% and 67.9% of persons with T2DM had metabolic syndrome according to International Diabetes Federation (IDF) and the National Cholesterol Education Program-Adult treatment panel III (NCEP-ATP III) criteria, respectively. About 36.8% had one or more comorbidities. Having healthy eating behavior [AOR 1.95; CI 1.11-3.43] and taking metformin [AOR 4.88; CI 1.91-12.44] were associated with better glycemic outcomes.

CONCLUSION

High AIP level concomitant with poor glycemic control indicates increased risk for coronary heart disease among persons with T2DM in Northern Ethiopia.

Correlation between parity and metabolic syndrome in Chinese women aged 40 years and older: the Reaction study

AIMS

The purpose of the present study was to investigate the correlation between the number of live-birth pregnancies and metabolic syndrome (MetS) in Chinese women according to menstruation history.

METHODS

Registry data for all pregnancies in a cohort of 6157 Chinese women aged 40 years or older were obtained and the number of live-birth pregnancies were enumerated. We defined MetS using five criteria: impaired insulin metabolism and glucose tolerance, obesity in the abdominal area, dyslipidemia, and hypertension. Multivariate logistic regression analysis was conducted to assess potential risk factors for MetS. Postmenopausal women with three or more of live-birth pregnancies had the highest prevalence of MetS (P < 0.05).

RESULTS

Among the 6157 females aged 40 years or older in Luzhou city, 2143 (34.8%) participants had incident MetS. The number of live-birth pregnancies was significantly correlated with age and fasting blood glucose (FBG) level (P < 0.05). The prevalence of MetS increased with the number of live-birth pregnancies (P < 0.01), and the frequency in postmenopausal women was significantly higher than that in premenopausal women (P < 0.001). In the binary logistic regression model, menopausal status [OR = 0.343 (0.153-0.769), P < 0.001] were significantly associated with an increased risk of MetS.

CONCLUSIONS

The number of live-birth pregnancies is correlated with an increased risk of MetS in Chinese women aged 40 years and over, especially in postmenopausal women. Greater attention should be paid to postmenopausal women who have had multiple live-birth pregnancies with a view to intervening early to prevent related diseases.

Metabolic syndrome and its effect on the outcomes of rheumatoid arthritis in a multi-ethnic cohort in Singapore

INTRODUCTION

Over-expression of common inflammatory mediators in the metabolic syndrome (MetS) and in rheumatoid arthritis (RA) may lead to mutually adverse outcomes.

AIM

We investigate the prevalence of MetS in a multi-ethnic population of RA patients and its effect on clinical and patient-reported outcomes.

METHOD

Six hundred sixty RA (561 women) patients from a public-sector specialist clinic in a hospital in Singapore were assessed for MetS according to the 2009 Joint Consensus (JC) and the 2004 National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definitions. Univariable and multivariable regression modelling were used to investigate the associations between patients' demographics with MetS and MetS with RA outcomes.

RESULTS

The prevalence of MetS in our RA cohort was 49.4% and 44.9% according to the JC and NCEP ATP III definitions, respectively. The diagnosis of MetS was largely due to hypertriglyceridemia, hypertension, and obesity. MetS was associated with older age (OR 1.06 [95% CI 1.04-1.08]), Malay ethnicity (OR 1.78 [95% CI 1.02-3.09]), or Indian ethnicity (OR 3.07 [95% CI 1.68-5.59]). No significant associations between MetS and RA outcomes were observed. RA patients with MetS are more likely to suffer from stroke and ischemic heart disease.

CONCLUSION

The prevalence of MetS in RA patients in Singapore was almost double that in the general population. MetS does not adversely affect RA outcomes but raises the risks of stroke and heart disease. RA patients, especially those older and of Indian and Malay ethnicities, should be routinely screened for MetS. Any MetS-defining condition should be actively controlled. Key Points • Approximately half of the RA sample from the Singapore RA population can be diagnosed with MetS. • Older patients, and patients of Malay and Indian ethnicities have higher odds of MetS. • MetS does not adversely affect RA outcomes but raises the risks of stroke and heart disease.

Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living donor liver transplantation: A single-centre experience

OBJECTIVES

Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme.

METHODS

This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019.

RESULTS

Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 ± 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 ± 4.0 kg/m²; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan®, we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD.

CONCLUSION

NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia.

Dietary Acid Load and Its Interaction with IGF1 (rs35767 and rs7136446) and IL6 (rs1800796) Polymorphisms on Metabolic Traits among Postmenopausal Women

The objective of this study was to explore the effects of dietary acid load (DAL) and IGF1 and IL6 gene polymorphisms and their potential diet–gene interactions on metabolic traits. A total of 211 community-dwelling postmenopausal women were recruited. DAL was estimated using potential renal acid load (PRAL). Blood was drawn for biochemical parameters and DNA was extracted and Agena^® MassARRAY was used for genotyping analysis to identify the signalling of IGF1 (rs35767 and rs7136446) and IL6 (rs1800796) polymorphisms. Interactions between diet and genetic polymorphisms were assessed using regression analysis. The result showed that DAL was positively associated with fasting blood glucose (FBG) (β = 0.147, p < 0.05) and there was significant interaction effect between DAL and IL6 with systolic blood pressure (SBP) (β = 0.19, p = 0.041). In conclusion, these findings did not support the interaction effects between DAL and IGF1 and IL6 single nucleotide polymorphisms (rs35767, rs7136446, and rs1800796) on metabolic traits, except for SBP. Besides, higher DAL was associated with higher FBG, allowing us to postulate that high DAL is a potential risk factor for diabetes.

Comparing and determining factors associated with hypertension self-care profiles of patients in two multi-ethnic Asian countries: cross-sectional studies between two study populations

OBJECTIVES

To compare the sociodemography, disease characteristics and hypertension self-care profiles and to determine the factors influencing Hypertension Self-Care Profiles (HTN-SCP) in two populations in primary care settings from Singapore and Malaysia.

DESIGN

Cross-sectional, cross national.

SETTING

Multi-centre, primary care clinics Malaysia and Singapore.

PARTICIPANTS

1123 adults with hypertension enrolled and analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Comparison between sociodemography, disease characteristics and the mean scores of HTN-SCP domains (behaviour, motivation and self-efficacy) and the factors influencing hypertension self-care.

RESULTS

1123 adults with hypertension attending primary care clinics in Malaysia and Singapore were involved. The participants' mean age was 63.6 years (SD 9.7) in Singapore and 60.4 (SD 9.1) in Malaysia. Most of the participants in Singapore had tertiary education (22.3%) compared with Malaysia (13.0%), p<0.001. A higher proportion of participants from Singapore had controlled blood pressure (74.6%) compared with Malaysia (33.8%), p<0.001. The mean total score of HTN-SCP was significantly higher among Singapore participants compared with Malaysia participants 190 (SD 28) versus 184 (SD 23) (p<0.001). Similarly, the mean score for motivation domain 67 (SD 10) versus 65 (SD 9), followed by self-efficacy score 65 (SD 11) versus 62 (SD 9) and behaviour score (58 SD 9 vs 56 SD 9) were higher among Singapore participants. In both countries, the factors which influenced higher HTN-SCP mean scores across all domains were being Indian and had tertiary education.

CONCLUSIONS

The study population in Singapore had a higher HTN-SCP mean score compared with Malaysia. The common factors influencing higher HTN-SCP mean scores at both study sites were ethnicity and level of education. Future intervention to improve self-care among people with hypertension may need to be tailored to their behaviour, motivation and self-efficacy levels.

Alopecia areata is not a risk factor for heart diseases: A 10-year retrospective cohort study

Alopecia areata (AA) is an autoimmune skin disease caused by chronic inflammation of hair follicles. Chronic inflammatory skin diseases such as psoriasis and lupus erythematosus can increase the risk of cardiovascular diseases. However, the relationship between AA and heart diseases (HDs) remains unclear. Therefore, we conducted this retrospective cohort study to evaluate the risk of subsequent HDs in patients with AA. We reviewed 3770 cases of AA and from 18,850 age, sex, and income level-matched controls from the National Health Insurance Service-National Sample Cohort. In the subgroup analysis, patients who suffered from alopecia totalis, alopecia universalis, and ophiasis were designated as patients with severe AA and patients having the disease for over a year were designated as patients with long-standing AA. As a result, we found that AA was not associated with a higher risk of heart failure, angina pectoris, or myocardial infarction. There was no significant increase in the risk of overall HD associated with AA (adjusted hazard ratio: 1.17; 95% confidence interval: 0.93-1.48; p = 0.177). Neither the severity nor the duration of AA was related to an increased risk of HDs. During the study period, AA patients did not show a significantly higher cumulative incidence of HDs than controls (log-rank p = 0.157). In conclusion, AA does not increase the risk of HD.

Nonalcoholic Fatty Liver Disease in Lean Subjects: Associations With Metabolic Dysregulation and Cardiovascular Risk-A Single-Center Cross-Sectional Study

INTRODUCTION

Although a milder metabolic phenotype of nonalcoholic fatty liver disease (NAFLD) in lean patients (body mass index [BMI] <25 kg/m2) compared to overweight/obese patients with NAFLD is assumed, the relevance of NAFLD among lean subjects remains a matter of debate. We aimed to characterize the metabolic/cardiovascular phenotype of lean patients with NAFLD.

METHODS

In total, 3,043 subjects (cohort I) and 1,048 subjects (cohort II) undergoing screening colonoscopy between 2010 and 2020 without chronic liver disease other than NAFLD were assigned to one of the following groups: lean patients without NAFLD, lean NAFLD, overweight NAFLD (BMI 25-30 kg/m2), and obese NAFLD (BMI >30 kg/m2). Diagnosis of NAFLD was established using ultrasound (cohort I) and controlled attenuation parameter (cohort II).

RESULTS

The prevalence of lean patients with NAFLD was 6.7%/16.1% in the overall cohort I/II and 19.7%/40.0% in lean subjects of cohort I/II. Compared with lean subjects without NAFLD, lean patients with NAFLD had a higher prevalence of dyslipidemia, dysglycemia, and the metabolic syndrome, together with a higher median Framingham risk score in both cohorts (all P < 0.001). On multivariable analyses, NAFLD in lean subjects was associated with higher odds of metabolic syndrome (adjusted odds ratio cohort I: 4.27 [95% confidence interval (CI): 2.80-6.51], P < 0.001; cohort II: 2.97 [95% CI: 1.40-6.33], P < 0.001), and higher Framingham risk score (regression coefficient B cohort I: 1.93 [95% CI: 0.95-2.92], P < 0.003; cohort II: 1.09 [95% CI: 0.81-2.10], P = 0.034), among others. Only 69.8% of lean patients with NALFD in cohort I and 52.1% in cohort II fulfilled the novel criteria for metabolic associated fatty liver disease.

DISCUSSION

NAFLD in lean patients is associated with the metabolic syndrome and increased cardiovascular risk. Novel metabolic associated fatty liver disease criteria leave a considerable proportion of patients unclassified.

Relationship between anthropometric and biochemical changes of metabolic syndrome with retinal nerve fiber layer and macular thickness

Objective

To evaluate the retinal nerve fiber layer (RNFL) and macular thicknesses and identify systemic risk factors for thinning of these layers in patients with metabolic syndrome (MetS).

Methodology

A cross-sectional observational study was performed on patients diagnosed with MetS and compared to normal controls. All patients underwent ophthalmic and anthropometric examination, serological and biochemical blood investigations; and ocular imaging using spectral-domain optical coherence tomography. Patients with ocular pathology were excluded. Unpaired t-test was used to compare mean thickness between the two groups. One-way ANOVA with Bonferroni correction for multiple comparisons was used to compare mean thickness between different tertiles of MetS parameters, and a generalized estimating equation was used to correct for inter-eye correlation and to assess association between mean thickness and covariates.

Results

Two hundred and forty-eight eyes from 124 participants (1:1 ratio of MetS patients to controls) were included. Age ranged between 30 to 50 years old, and mean age was 40 ± 6.6 years. RNFL thickness was lower globally (93.6 ± 9.9 μm vs 99.0 ± 9.3, p<0.001) and in the inferior (124.5 ± 17.5 μm vs 131.0 ± 16.4 μm, p = 0.002), superior (117.2 ± 16.0 μm vs 126.3 ± 14.4 μm, p<0.001) and temporal (65.5 ± 10.2 μm vs 69.5 ± 9.8, p = 0.002) sectors in MetS patients compared to controls. Only the central (237.0 ± 14.0 μm vs 243.6 ± 18.0 μm, p = 0.002) and inferior parafoveal (307.8 ± 20.9 vs 314.6 ± 14.6, p = 0.004) area of the macula was significantly thinner. The inferior RNFL sector had the most difference (mean difference = 9.1 μm). The Generalized Estimating Equation found that, after adjusting for age, diastolic blood pressure, BMI, HDL and obesity; the number of MetS components and elevated triglyceride levels were independent risk factors for reduced thickness in global RNFL (β = -4.4, 95% CI = -7.29 to -1.5, p = 0.003) and inferior parafovea (β = -6.85, 95% CI = -11.58 to -2.13, p = 0.004) thickness respectively.

Conclusion

RNFL thinning was seen more than macula thinning in MetS patients, suggesting RNFL susceptibility to neurodegeneration than the macula. A higher number of metabolic components and elevated triglyceride levels were independent risk factors for retinal thinning in this group of patients.

Rate of achievement of therapeutic outcomes and factors associated with control of non-communicable diseases in rural east Malaysia: implications for policy and practice

Non-communicable diseases (NCDs) are an increasing problem worldwide, including in Malaysia. National surveys have been performed by the government but had poor coverage in east Malaysia, particularly in rural regions. This study aimed to describe the achievement of target therapeutic outcomes in the control of diabetes mellitus (DM), hypertension (HPT), and dyslipidemia (DLP) among diabetic patients in rural east Malaysia. A cross-sectional study was conducted among DM patients who visited the NCDs clinic in Lundu Hospital, Sarawak, Malaysia, from Jan to March 2016. In total, 214 patients (male, 37.9%; female, 62.1%) were recruited using a systemic sampling method. Multiple logistic regression models were applied to estimate the adjusted odds ratio (AOR) and confidence interval (CI) for the target therapeutic achievement in the control of DM, HPT, and DLP. Compared to the national average, therapeutic target achievement in Lundu was higher for DM (43.0% vs. 23.8%), equal for DLP (35.8% vs. 37.8%) but lower for HPT (30.9% vs. 47.9%). DM patients who had at least yearly HbA1c monitoring (AOR 2.30, 95% CI 1.04–5.06, P = 0.039), and those 58.7 years or older (AOR 2.50, 95% CI 1.32–4.74, P = 0.005) were more likely to achieve the therapeutic target for DM. Health promotion and public education regarding HPT needs to be emphasized in rural Malaysia. HbA1c monitoring at least once a year was one of the important factors associated with achieving DM control in rural east Malaysia. Accessibility to HbA1c tests and monitoring should be ensured for diabetic patients.

Prevalence of metabolic syndrome among breast cancer survivors in East Coast of Peninsular Malaysia

Background

To date, limited data are available on metabolic syndrome prevalence among breast cancer survivors in Malaysia. Therefore, this study was conducted to determine the prevalence of metabolic syndrome and abnormal metabolic syndrome components among breast cancer survivors in East Coast of Peninsular Malaysia.

Methods

This cross-sectional study included 95 breast cancer survivors (age 53.7 ± 7.6 years) who have completed main cancer treatments for ≥6 months. Cancer survivors were recruited from two main government hospitals in Kelantan and Terengganu using a purposive sampling method.

Results

According to the Harmonized criteria, the metabolic syndrome prevalence was 50.5%. Among those with metabolic syndrome, the most prevalent abnormal metabolic components were triglycerides (91.2%), fasting blood glucose (79.6%) and HDL-c level (78.4%). Except for total cholesterol and LDL-c, all other metabolic syndrome components were significantly different (p < 0.05) between those with and without metabolic syndrome. Significant differences between metabolic syndrome and non-metabolic syndrome groups were found for weight, BMI, waist circumference, body fat percentage and cancer stages (p < 0.05). However, no significant relationship was reported between sociodemographic, clinical parameters and metabolic syndrome among breast cancer survivors in this study.

Conclusions

Metabolic syndrome was highly prevalent among breast cancer survivors. It is recommended for health care professionals to closely monitor and improve the triglycerides, blood glucose and HDL-c level of the breast cancer survivors under their care to control the detrimental effect of metabolic syndrome.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10288-9.

Food Security Status is not Associated with Increased Risk of Metabolic Syndrome in Korean Adults

Background: It is still uncertain whether food insecurity increases the risk of metabolic syndrome. Recent reports from the United States and developing countries have shown conflicting results on this issue. This study aimed to investigate the association between food security status and metabolic syndrome in Korean adults. Methods: We performed a nationwide population study using data for 18,782 adults obtained from the 2012 to 2015 Korean National Health and Nutrition Examination Surveys. The 18-item Food Security Survey Module was utilized to assess household food security status. We used multiple logistic regression models to determine the association between food security status and metabolic syndrome. Results: The overall prevalence of food insecurity was 8.2% and that of metabolic syndrome was 27.3%. The prevalences of metabolic syndrome were 26.2%, 32.3%, 30.2%, and 28.8% in the high, marginal, low, and very low food security groups, respectively. Food-insecure participants (participants in the low food security and very low food security groups) were significantly more likely to be female, divorced/widowed/separated, and current smokers compared to food-secure participants. Food-insecure participants also had lower incomes, lower education attainments, and lower physical activities (P < 0.05). Compared with the high food security group, the marginal (odds ratio [OR]: 1.34, 95% confidence interval [95% CI]: 1.19-1.50, P < 0.001) and low food security groups (OR: 1.22, 95% CI: 1.04-1.42, P = 0.01) had increased odds of metabolic syndrome in the unadjusted models. However, after controlling for covariates, including age, sex, marital status, education attainment, household income, smoking, alcohol intake, and physical activity, neither marginal food security (adjusted odds ratio [aOR]: 1.02, 95% CI: 0.87-1.19, P = 0.86) nor low food security (aOR: 0.88, 95% CI: 0.71-1.08, P = 0.22) was significantly associated with an increased risk of metabolic syndrome. Conclusions: Contrary to a prior report from the United States, food security status was not significantly associated with the risk of metabolic syndrome in Korean adults.

Falls, frailty, and metabolic syndrome in urban dwellers aged 55 years and over in the Malaysian elders longitudinal research (MELoR) study - a cross-sectional Study

OBJECTIVES

While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults.

METHODS

Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers.

RESULTS

Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss.

CONCLUSION

Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.

Racial/ethnic differences in the prevalence and incidence of metabolic syndrome in high-income countries: a protocol for a systematic review

BACKGROUND

Metabolic syndrome is a constellation of various cardiovascular and type 2 diabetes risk factors, such as abdominal obesity, atherogenic dyslipidemia, high blood pressure, and high blood glucose, but its prevalence varies widely by geographical region, sex, and race/ethnicity. The objective of this study is to examine the prevalence and incidence of metabolic syndrome among adults of different racial/ethnic origins in high-income countries.

METHODS

We designed and registered a study protocol for a systematic review of descriptive epidemiological data. Observational studies (e.g., cross sectional and cohort studies) reporting morbidity data of metabolic syndrome and conducted in a wide range of adult people (e.g., different racial/ethnic origins, including migrants) will be included. The primary outcome will be the prevalence and incidence of metabolic syndrome. Secondary outcomes will be the prevalence and incidence of individual components of metabolic syndrome (e.g., abdominal obesity, dyslipidemia, high blood pressure, and high blood glucose). Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE, Web of Science Core Collection (Science Citation Index and Social Science Citation Index), CINAHL, and Cochrane Library. Two investigators will independently screen all reference titles, abstracts, and full-text articles. The methodological quality (or potential bias) of selected studies will be appraised using an appropriate tool. Our results will be described narratively. Random-effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be conducted to explore the potential sources of heterogeneity.

CONCLUSION

This systematic review will identify, evaluate, and integrate prevalence and incidence data of metabolic syndrome, with focus on racial/ethnic differences in high-income countries. We anticipate our findings may guide policy formulation and identify knowledge gaps in the literature that future research should address.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42020157189.

Chronic disease profiles of subjective memory complaints: a latent class analysis of older people in a rural Malaysian community

Background: Subjective memory complaints (SMC) are common in the elderly and have been suggested as the first subtle sign of decline which can predict dementia. Cognitive decline is thought to be related to inflammatory processes similarly found in other chronic diseases and conditions such as stroke, heart disease and arthritis. This study aimed to examine the association of SMC with chronic diseases and the profile of these health conditions reported by a group of older adults.Methods: Data from a cross-sectional survey conducted from August 2013 and March 2014 was drawn from 6179 individuals aged 56 years and above. Multivariable logistic regression analyses were used to examine SMC's relationship with individual chronic diseases (asthma, kidney disease, heart disease, stroke, arthritis, hypertension and diabetes) and multimorbidity. Latent class analysis (LCA) was used to identify the profile of health conditions. The effect of SMC was estimated in a multinomial logistic regression as part of the latent class model.Results: SMC was statistically significant in its association with asthma, stroke, heart disease, arthritis and multimorbidity in the fully controlled multivariable logistic regression models. Three health profiles were identified: low comorbidity (n = 4136, low rates in all health conditions), arthritis group (n = 860) and diabetes and hypertension group (n = 1183). SMC was associated with arthritis group (OR = 2.04, 95% CI = 1.51-2.75) and diabetes and hypertension group (OR = 1.22, 95% CI = 1.03-1.46).Conclusion: Adapting a combination of analytical approaches allows a better understanding in the assessment of SMC's relationship with chronic diseases and the patterns of distribution of these health conditions.

The Effects of Wet Cupping Therapy on Fasting Blood Sugar, Renal Function Parameters, and Endothelial Function: A Single-arm Intervention Study

Objectives

Despite being recognized worldwide as an alternative therapy in treating various chronic diseases and pain, the mechanism of wet cupping is still not well understood. The purpose of this study was to evaluate fasting blood sugar (FBS), renal function parameters, and endothelial function changes following wet cupping in healthy individuals.

Methods

We conducted a single-arm intervention study at the Clinical Lab of Community Medicine, Universiti Sains Malaysia, and included 31 healthy individuals aged between 30 and 60 years old. Wet cupping therapy was performed at five treatment points at the beginning of the study and repeated after three months. Health outcomes at baseline, one, three, and four months were assessed for FBS, renal function parameters (urea, creatinine, and uric acid), systolic blood pressure (SBP), and von Willebrand factor (vWF).

Results

Forty-five percent of participants were female, and the mean age of study participants was 44.9±6.4 years. Wet cupping therapy significantly reduced FBS, serum urea, and serum creatinine at one, three, and four months compared with baseline values. Serum uric acid and SBP showed a significant reduction at one and four months compared with baseline. The vWF (a measure of endothelial function) had a 4.0% reduction at four months compared to baseline, with a mean difference of 5.3 (95% confidence interval (CI): 2.20 = 8.55; p = 0.002).

Conclusions

This study provides preliminary support that repeated wet cupping therapy enhances body health status; thus, it could be an effective complementary medicine in disease prevention.

Relationship of sociodemographic and lifestyle factors and diet habits with metabolic syndrome (MetS) among three ethnic groups of the Malaysian population

Objectives

Literature shows a high prevalence of MetS among Malaysians, varying across the major ethnicities. Since sociodemographic characteristics, lifestyle factors and diet habits of such communities have been reported to be diverse, the objective of this study was to investigate the association of various sociodemographic characteristics, lifestyle factors and diet habits with MetS overall, as well as with the three major ethnic communities in Malaysia, specifically.

Materials and methods

We conducted a cross-sectional study among 481 Malaysians of ages 18 years and above living in the state of Johor, Malaysia. Information on demographics, lifestyle and diet habits were collected using a structured questionnaire. Harmonized criteria were used to assess the status of MetS. Multiple logistic regression was employed to determine any associations between sociodemographic and lifestyle factors and dietary behaviours with MetS.

Results

MetS was found among 32.2% of the respondents and was more prevalent among the Indians (51.9%), followed by the Malays (36.7%) and the Chinese (20.2%). Overall, increasing age (AOR = 2.44[95%CI = 1.27–4.70] at 40–49 years vs. AOR = 4.14[95%CI = 1.97–8.69] at 60 years and above) and Indian ethnicity (AOR = 1.95[95%CI = 1.12–3.38)] increased the odds of MetS, while higher education (AOR = 0.44[95%CI = 0.20–0.94] decreased the odds of MetS in this population. Quick finishing of meals (AOR = 2.17[95%CI = 1.02–4.60]) and low physical activity (AOR = 4.76[95%CI = 1.49–15.26]) were associated with increased odds of MetS among the Malays and the Chinese, respectively.

Conclusion

The population of Johor depicts a diverse lifestyle and diet behaviour, and some of these factors are associated with MetS in certain ethnic groups. In the light of such differences, ethnic specific measures would be needed to reduce the prevalence of MetS among those in this population.

Prevalence and associated factors of metabolic syndrome in adults: a population-based epidemiological survey in Jiangxi province, China

Background

Metabolic syndrome (MS) has abruptly increased in China in the past two decades, gradually representing an important public health threat over the years. Here, we firstly reported the prevalence and associated factors of metabolic syndrome in Jiangxi province, China.

Methods

A population-based cross-sectional survey was performed in Jiangxi province, China, from April to August 2015. MS was diagnosed by International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) criteria, respectively. Factors associated with MS were investigated by multivariate logistic regression.

Results

A total of 2665 residents aged over 18 years were enrolled, and 2580 effectively participated. According to IDF and CDS criteria, age-standardized prevalence of MS were 21.1 and 15.2% in all participants, respectively; prevalence were 19.6% or 17.1% in men, and 22.7% or 13.0% in women, based on these respective criteria. Rural participants had a significantly higher prevalence than urban individuals, so did rural females. Prevalence in males did not differ between rural and urban participants. Factors independently associated with MS were low education level and menopausal state.

Conclusions

To the best of our knowledge, this was the latest study on MS prevalence in Jiangxi province. In conclusion, MS prevalence is high in Jiangxi province. Considering the unhealthy lifestyle, education is urgently needed to prevent the rapid increase of MS prevalence.

Positive association between metabolic syndrome and bone mineral density among Malaysians

Objectives: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that elevates the individual risk of cardiovascular diseases. These abnormalities are also known to alter bone remodelling. Therefore, MetS may be associated with osteoporosis. This study aims to determine the association between MetS and its components and bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA) among Malaysians. Methods: 400 Malaysians aged ≥ 40 years (52.5% women) residing in Klang Valley, Malaysia, were recruited. Subjects' demographic and lifestyle details were collected using a questionnaire, and blood pressure and body anthropometry were measured. Subjects' lumbar spine and total hip BMD were measured by DXA. Their fasting blood was collected for blood glucose level and lipid profile analysis. Regression analysis was used to analyze the relationship between MetS or its components and BMD. Results: Subjects with MetS had higher BMD compared to subjects without MetS in models unadjusted for BMI (spine p=0.008; hip p<0.001). This difference was attenuated with BMI adjustment (spine p=0.625; hip p=0.478). Waist circumference was associated positively with BMD in models unadjusted for BMI (spine p=0.012; hip p<0.001), but the association became negative with BMI adjustment (spine p=0.044; hip p=0.021). Systolic blood pressure was associated positively with total hip BMD (p=0.019) but BMI adjustment attenuated the relationship (p=0.080). Triglyceride level was associated with osteoporosis in a fully adjusted model (p=0.001). Overall, MetS was associated with osteoporosis (p=0.019) but lifestyle (p=0.188) and BMI adjustment attenuated the relationship (p=0.904). Conclusion: MetS is positively associated with BMD, and this relationship is predominantly mediated by BMI. Although MetS is not a significant risk factor for osteoporosis, the inverse relationship between waist circumference, a marker of central obesity, and BMD highlights the need to prevent adiposity to improve metabolic and skeletal health.

A Cross-Sectional Study on the Dietary Pattern Impact on Cardiovascular Disease Biomarkers in Malaysia

We conducted this cross-sectional population study with a healthy multi-ethnic urban population (n = 577) in Malaysia, combining nutritional assessments with cardiometabolic biomarkers defined by lipid, atherogenic lipoproteins, inflammation and insulin resistance. We found diametrically opposing associations of carbohydrate (246·6 ± 57·7 g, 54·3 ± 6·5%-TEI) and fat (total = 64·5 ± 19·8 g, 31·6 ± 5·5%-TEI; saturated fat = 14·1 ± 2·7%-TEI) intakes as regards waist circumference, HDL-C, blood pressure, glucose, insulin and HOMA2-IR as well as the large-LDL and large-HDL lipoprotein particles. Diets were then differentiated into either low fat (LF, <30% TEI or <50 g) or high fat (HF, >35% TEI or >70 g) and low carbohydrate (LC, <210 g) or high carbohydrate (HC, >285 g) which yielded LFLC, LFHC, HFLC and HFHC groupings. Cardiometabolic biomarkers were not significantly different (P > 0.05) between LFLC and HFLC groups. LFLC had significantly higher large-LDL particle concentrations compared to HFHC. HOMA-IR2 was significantly higher with HFHC (1·91 ± 1·85, P < 0·001) versus other fat-carbohydrate combinations (LFLC = 1·34 ± 1·07, HFLC = 1·41 ± 1·07; LFHC = 1·31 ± 0·93). After co-variate adjustment, odds of having HOMA2-IR >1.7 in the HFHC group was 2.43 (95% CI: 1·03, 5·72) times more compared to LFLC while odds of having large-LDL <450 nmol/L in the HFHC group was 1.91 (95% CI: 1·06, 3·44) more compared to latter group. Our data suggests that a HFHC dietary combination in Malaysian adults is associated with significant impact on lipoprotein particles and insulin resistance.

Non-communicable diseases among low income adults in rural coastal communities in Eastern Sabah, Malaysia

Background

Rural coastal communities in Sabah are still overly represented in the hardcore poor economic status. The aim of this study was to determine the prevalence of hypertension, diabetes mellitus and hypercholesterolemia among adults, in relation to economic status.

Methods

A cross-sectional study using stratified random sampling was conducted in seven coastal villages in Semporna, Sabah: Kabogan Laut, Salimbangun, Pekalangan, Pokas, Tampi-Tampi Timbayan, Sum Sum and Selinggit. Socio-demographic data were obtained via interviewer administered questionnaires in Sabah Malay creole. Anthropometric measurements, blood pressure, fasting blood glucose and blood lipids were obtained.

Results

A total of 330 adults (133 males, 197 females) completed the study. Mean age was 43.7 ± 15.8 years. Most participants (87%) were living below the Poverty Line Income. Median per capita household income was RM83.33/month (≈ USD20/month). The number of newly diagnosed cases of hypercholesterolemia was 40.6%, diabetes mellitus was 5.8%, and hypertension was 24.5%. Adults from the hardcore poor economic status (household income ≤RM760/month (≈USD183/month) were the most represented in those who did not have a blood pressure, blood sugar and blood lipids check in the 12 months preceding the study (Χ², p < 0.01). Adults from hardcore poor economic status were also the most represented in undiagnosed hypertension and uncontrolled blood pressure among those diagnosed (Χ², p = 0.013). Among diabetics from the hardcore poor group, the undiagnosed fasting blood glucose was 11.2 ± 4.5 compared to 5.1 ± 0.6 mmol/L for diagnosed diabetics (p < 0.001). Among hypercholesterolemics from the hardcore poor group, total cholesterol and LDL cholesterol values were significantly higher in the undiagnosed group compared to the diagnosed group (p < 0.001).

Conclusion

Many people in this rural coastal community were unaware that they had high cholesterol level (40.6%) and elevated blood pressure (24.5%). Routine health check is not common among low income adults in rural coastal communities in Semporna. The findings suggest public health initiatives should emphasize access to and the necessity of routine health checks for those aged 40 years.

Accuracy of ultrasonography in the assessment of liver fat compared with MRI

AIM

To investigate the accuracy of ultrasonography in the assessment of hepatic steatosis using magnetic resonance imaging (MRI) as standard of reference and to explore the influence of additional hepatic iron overload.

MATERIAL AND METHODS

A total of 2,783 volunteers (1,442 women, 1,341 men; mean age, 52.3±13.8 years) underwent confounder-corrected chemical-shift-encoded MRI of the liver at 1.5 T. Proton-density fat fraction (PDFF) and transverse relaxation rate (R2*) were calculated to estimate hepatic steatosis and liver iron overload, respectively. In addition, the presence of hepatic steatosis was assessed by B-mode ultrasonography. The sensitivity, specificity, and accuracy of hepatic ultrasonography were determined for different degrees of hepatic steatosis and different amounts of liver iron.

RESULTS

MRI revealed hepatic steatosis in 40% of participants (n=1,112), which was mild in 68.9% (n=766), moderate in 26.7% (n=297), and severe in 4.4% (n=49) of patients. Ultrasonography detected hepatic steatosis in 37.8% (n=1,052), corresponding to 74.5% sensitivity and 86.6% specificity. The sensitivity of ultrasound increased with the amount of hepatic fat present and was 65.1%, 95%, and 96% for low, moderate, and high fat content; whereas the specificity was constantly high at 86.6%. The diagnostic accuracy of ultrasound for detection of hepatic steatosis did not vary significantly with the amount of liver iron present.

CONCLUSION

Ultrasonography is an excellent tool to assess hepatic steatosis in the clinical setting with some limitations in patients with a low liver fat content. The detection of hepatic steatosis by ultrasonography is not influenced by liver iron.

Elevated blood pressure and its predictors among secondary school students in Sarawak: a cross-sectional study

OBJECTIVES

Hypertension is a health issue affecting adolescents. Accumulating evidence affirms that elevated blood pressure begins in childhood and tracks into adulthood. This cross-sectional study was conducted to determine the prevalence of elevated blood pressure and its predictors among secondary school students in Sarawak, Malaysia.

METHODS

A total of 2,461 secondary school students aged 12-17 years from 19 schools in Sarawak participated in the study. Questionnaire was used to obtain socio-demographic data, parental history of hypertension, and self-reported physical activity. Anthropometric and blood pressure measurements were taken. Data was entered and analysed using SPSS version 23.0.

RESULTS

The prevalence of adolescents with elevated blood pressure, overweight, central obesity, and overfat were 30.1%, 24.3%, 13.5%, and 6.7%, respectively. Multivariate logistic regression demonstrated the predictors significantly associated with elevated blood pressure among respondents: overweight (adjusted odds ratio=3.144), being male (adjusted odds ratio=3.073), being Chinese (adjusted odds ratio=2.321) or Iban (adjusted odds ratio=1.578), central obesity (adjusted odds ratio=2.145), being overfat (adjusted odds ratio=1.885), and being an older adolescent (adjusted odds ratio=1.109). Parental history of hypertension, locality, and physical activity showed no significant associations.

CONCLUSION

The obesity epidemic must be tackled at community and school levels by health education and regulation of school canteen foods.

Metabolic syndrome and cardiometabolic risk factors among indigenous Malaysians

OBJECTIVES

This study was undertaken to investigate the occurrence of metabolic syndrome (MetS) and cardiovascular disease (CVD) risk in Orang Asli (OA), the indigenous people of Peninsular Malaysia. OA consist of Negrito, Proto-Malay, and Senoi groups who collectively comprise only 0.76% of the population of Peninsular Malaysia. Owing to the challenges in accessing their remote villages, these groups are often excluded in larger government health surveys. Although tropical diseases were scourges in the past, with rapid national development, many OA communities have been gradually urbanized. We believe an epidemiological transition is occurring and non-communicable diseases are on the rise.

STUDY DESIGN

A retrospective cross-sectional study.

METHODS

Indigenous Malaysians (n = 629) from three major groups (Negrito, Proto-Malay, and Senoi) were recruited, after ethics approval and informed consent. Body mass index (BMI), body weight, height, waist circumference, and systolic and diastolic blood pressure were measured, and participants were examined for acanthosis nigricans. Venous blood samples were used for measurements of fasting blood sugar, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Insulin resistance was estimated using a surrogate measurement TG/HDL-C. The ratios of TC to HDL-C, and of LDL-C to HDL-C were determined. MetS was accessed according to the Joint Interim Statement of the IDF Tsak Force on Epidemiology and Prevention.

RESULTS

MetS affected 29.57% of the OA population investigated and was significantly more prevalent (P < 0.05) in women than in men (35.25% vs 21.95%, P < 0.001). MetS prevalence was the highest among the Proto-Malays (39.56%), followed by Negritos (26.35%) and Senois (11.26%). The most prevalent risk factor among the Negritos with MetS was low HDL-C (95.35%), whereas central obesity was the most common risk factor among the Proto-Malays (82.91%). In contrast, hypertension was the commonest risk factor among the Senois with MetS (94.44%). Elevated TG/HDL-C ratios resulted in the highest risk for MetS among the OA population (relative risk [RR] = 7.01, 95% confidence interval [CI] = 3.58-13.72). The risk was almost four-fold among those with high TG (RR = 3.89, 95% CI = 3.08-4.91) and three-fold among those with BMI obesity (RR = 3.37, 95% CI = 2.61-4.36) and central obesity (RR = 2.99, 95% CI = 2.48-3.61).

CONCLUSIONS

This may well be the first comprehensive report about MetS in OA indigenous communities in Malaysia. We have shown that rapidly urbanized OA communities had significant prevalence of MetS and associated cardiometabolic risk factors. Major contributory factors may include changes from previous hunter-gatherer lifestyles and subsistence diets to more urbanized lifestyles and easier access to high calorie foods.

Prevalence of Metabolic Syndrome and Its Associated Factors among Vegetarians in Malaysia

The prevalence and factors associated with metabolic syndrome (MetS) remain unknown in Malaysian vegetarians. This cross-sectional study aimed to determine the prevalence of MetS among vegetarians in Kuala Lumpur and Selangor and its associated factors. The data on socio-demographic characteristics, vegetarianism practises, lifestyle behaviours, body weight, height, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), and blood lipid profiles were collected from 273 vegetarians. A majority of the respondents were lacto-ovo vegetarians (44.0%), females (64.8%) and Chinese (54.9%). The prevalence of MetS was 24.2%. High BP (48.7%) and high WC (43.6%) were the most common MetS components. Females had lower WC, SBP, DBP, FBG, TG and higher HDL-c (p < 0.05) as compared to males. Multiple logistic regression analysis showed that being overweight and obese (Odds Ratio (OR) = 7.74, 95% Confidence Interval (CI): 4.04–14.82) was the main risk factor of MetS after being adjusted for sex and age. This study found that one in four vegetarians had MetS. An intervention programme should be developed to reduce Body Mass Index (BMI) among vegetarians, especially among those who are found to be overweight and obese.

Prevalence of Hypercholesterolemia, High LDL, and Low HDL in Iran: A Systematic Review and Meta-Analysis

BACKGROUND

Chronic and abnormal increase of different types of dyslipidemia leads to some important diseases, such as constriction and abstraction of vessels in various parts of the body, especially in the heart. High lipid profile, such as increased total cholesterol and LDL as well as decreased HDL are recognized as cardiovascular disease risk factors. The present study aimed to estimate the prevalence of different types of dyslipidemia in Iran by a meta-analysis method.

METHODS

A literature search for studies published during 1998-2015 was carried out using both Persian and English databases (SID, Magiran, IranMedex, MedLib, PubMed, and Scopus). Keywords such as lipid, dyslipidemia, CVD, cardiovascular risk factors, hypercholesterolemia, high LDL-C, low HDL-C, and prevalence were used in the search. Random-effects model was used for the analysis using STATA (version 11.2).

RESULTS

In total, 163 articles were identified of which 49 articles fulfilled the inclusion criteria. The estimated prevalence (95% confidence interval) of eligible articles for high cholesterol ≥200 mg/dl and ≥240 mg/dl was 42% (95% CI: 38-45) and 17% (95% CI: 14-20), respectively. Moreover, the prevalence (95% confidence interval) for high LDL-C ≥130 mg/dl and ≥160 mg/dl was 40% (95% CI: 32-48) and 19% (95% CI: 16-23), respectively. The pooled prevalence estimate for low HDL-C (<40 among males, <50 among females) was 43% (95% CI: 33-53) in both sexes of the Iranian people. All types of lipid component abnormalities (hypercholesterolemia, high LDL-C, and low HDL-C) were more prevalent in women.

CONCLUSION

The results indicate that the prevalence of different types of dyslipidemia in Iran is substantial. Given the risk of complications (e.g. cardiovascular disease and control of different types of dyslipidemia) in Iranian people, it is important to reduce the burden of cardiovascular diseases.

A case-control study of the association between metabolic syndrome and colorectal cancer: a comparison of International Diabetes Federation, National Cholesterol Education Program Adults Treatment Panel III, and World Health Organization definitions

Background

Metabolic syndrome was linked with various chronic diseases, including cancer. The study on the effect of metabolic syndrome on colorectal cancer (CRC) was not conducted in Malaysia. Therefore, this study aims to determine the association between metabolic syndromes and its components with CRC, based on the three established definitions.

Methods

A multi-centred matched case control study was conducted in five local hospitals. A total of 140 histologically confirmed CRC cases were matched with 280 cancer free controls. Mean value and prevalence of the components of metabolic syndrome between cases and controls were measured based on the three definitions. A multiple variable analysis using Cox regression was conducted to measure the strength of the association between the definitions of MetS, components of MetS and risk of CRC.

Results

Multiple variable analyses showed that metabolic syndrome significantly and independently increased the risk of CRC, with an odds ratio ranging from 1.79 to 2.61. This study identified that the definition of metabolic syndrome by the International Diabetes Federation is the most sensitive in predicting the risk of CRC, compared to metabolic syndrome as defined by the World Health Organization and National Cholesterol Education Program Adults Treatment Panel III. Abdominal obesity, low HDL-cholesterol, and hypertension were identified as the three core risk factors, which promote inflammatory signals that contribute to metabolic syndrome and an increased risk of CRC.

Conclusions

These data hypothesized that simple measurement of abdominal obesity, abnormal BP and HDL-cholesterol especially using International Diabetes Federation (IDF) definition of MetS for South Asians for to detect individuals at CRC risk may have higher clinical utility than applying other universal complex MetS definitions.

Metabolic syndrome among type 2 diabetic patients in Ethiopia: a cross-sectional study

Background

Metabolic syndrome (MetS) increases risk of cardiovascular diseases (CVD), premature death as well as cost related to health care.This study was aimed at investigating the prevalence of MetS and its determinant factors among type2 diabetes mellitus (T2DM) patients attending a specialized hospital.

Methods

A cross-sectional study was conducted on a total of 256 T2DM patients from the first march to 30th May 2017 at university of gondar comprehensive specialized hospital (UGCSH). Data was collected based on STROBE (strengthening the reporting of observational studies in epidemiology) statement. Bivariable and multivariable logistic regression analysis were run to identify predictors of MetS from the independent variables and significance test was set at P <  0.05.

Results

The prevalence of MetS in this study was 70.3, 57 & 45.3% and it is more common in females (66.1, 83.3 & 70.7%) by using national cholesterol education program adult treatment panel III (NCEP-ATP III), International diabetic federation (IDF) and world health organization (WHO) criteria respectively. The most prevalent components of MetS were low level of high density lipoprotein (HDL) and triglyceride(TG). By usingIDF criteria, female gender was significantly associated with MetS (AOR = 0.2 at 95%CI: 0.1, 0.6 P = 0.00). Where as by NCEP-ATP IIIcriteria, age between 51 and 64 years old (AOR = 2.4 95% CI: 1.0,5.8, P = 0.04), self employment (AOR = 2.7 95% CI:1.1, 6.5, P = 0.03), and completetion of secondary school and above (AOR = 3.2, 95% CI:1.6,6.7, P = 0.001) were predictors for the development of MetS. In the WHO criteria, being single in marital status was significantly associated with MetS (AOR = 17 at 95%CI: 1.8, 166, P = 0.000).

Conclusions

This study demonstrates that Metabolic syndrome is a major health concern for diabetic patients in Ethiopia and they are at increased risk of developing complications such as cardiovascular diseases and premature mortality. The predictors female gender, age between 51 and 64 years old, urban area residence, and being single are modifiable.Thus,health authorities shall provide targeted interventions such as life style modifications to these most at risk sub-populations of diabetic patients.

Predicting Type 2 Diabetes Mellitus Occurrence Using Three-Dimensional Anthropometric Body Surface Scanning Measurements: A Prospective Cohort Study

BACKGROUND

An accurate and comprehensive anthropometric measure for predicting type 2 diabetes mellitus (T2DM) has not yet been depicted.

METHODS

A total of 8450 nondiabetic participants were recruited during 2000-2010 in Taiwan. The cohort was followed up to the end of 2013, over an average of 8.87 years. At recruitment, participants completed a questionnaire related to basic demographics, lifestyle variables, personal disease history, and family disease history. 3D body surface scanning was used to obtain 35 anatomical measurements. A Cox proportional hazard model was used to conduct multivariable analyses.

RESULTS

A total of 2068 T2DM cases at an incidence rate of 27.59 × 10-3 (year-1) were identified during the follow-up period. Multivariable-adjusted hazard ratios (HRs) demonstrated that neck circumference (NC) (HR = 1.048; 95% CI = 1.033-1.064), waist width (WW) (HR = 1.061; 95% CI = 1.040-1.081), and left thigh circumference (TC) (HR = 0.984; 95% CI = 0.972-0.995) were significant predictors of the occurrence of T2DM. While dividing body measurement into median high/low groups, an increased risk of T2DM was observed among participants with a larger NC and smaller TC (HR = 1.375; 95% CI = 1.180-1.601) and a larger WW and smaller TC (HR = 1.278; 95% CI = 1.085-1.505) relative to other participants.

CONCLUSIONS

This study suggests that as well as using traditional waist and TC measurements, NC can be used as an indicator to provide an early prediction of developing T2DM, while providing clues for future mechanistic investigations of T2DM.

Physical Activity and Health-Related Quality of Life Among Low-Income Adults in Metropolitan Kuala Lumpur

BACKGROUND

The aim of this research is to assess the level of physical activity (PA) in relation to different socio-economic factors and to examine the effect of the recommended level of PA on the domains of quality of life (QoL) among residents of low-income housing in the metropolitan area of Kuala Lumpur, Malaysia.

METHODS

This was a cross-sectional study that included 680 respondents from community housing projects. Reported PA was assessed using the Global Physical Activity Questionnaire (GPAQ) short form version 2. The SF-12v2 was administered to assess the health-related QoL (HRQoL) among the study population. Respondents were grouped into "active" and "insufficient" groups according to reported weekly PA level. One-way analysis of variance, analysis of co-variance, and multiple linear regression were used in the analysis.

RESULTS

Overall, 17.6% (95% CI, 14.3-20.9) of the respondents did not achieve the recommended levels of PA (≥600 metabolic equivalent [MET]-minutes week^-1). Level of achieving recommended PA was higher among younger participants, females, members belonging to nuclear families, and in self-employed participants. The group that fulfilled recommended PA levels (active) has higher levels of QoL in all domains except physical functioning.

CONCLUSIONS

Almost one out of five low-income urban residents were physically inactive. In addition, individuals who attained recommended PA levels had better scores on some domains of HRQOL than those who did not. Our findings call for tailor-made public health interventions to improve PA levels among the general population and particularly for low-income residents.

Increased waist circumference is the main driver for the development of the metabolic syndrome in South African Asian Indians

There is no current evidence available on the prevalence of metabolic syndrome (MetS) in South African Asian Indians, who are at high risk for cardiovascular disease. The aim of our study was to determine the prevalence of the MetS in this group, between males and females, as well as in the different age-groups, using the harmonised criteria and determined the main components driving the development of MetS.

DESIGN AND METHODS

This cross-sectional study recruited randomly selected community participants between the ages of 15 and 65 years, in the community of Phoenix, in KwaZulu-Natal. All subjects had anthropometric variables and blood pressure measured, as well as blood drawn for blood glucose and lipids after overnight fasting. The MetS was determined using the harmonised criteria.

RESULTS

There were 1378 subjects sampled, mean age 45.5±13years and 1001 (72.6%) women. The age standardised prevalence for MetS was 39.9% and significantly higher (p<0.001) in women (49.9% versus 35.0% in men). The MetS was identified in 6.9% of young adults (15-24 years), with a four-fold increase in the 25-34year olds, and 60.1% in the 55-64year old group. Clustering of MetS components was present in all age-groups, but increased with advancing age. The independent contributors to the MetS were increased waist circumference, raised triglycerides and obesity. This study highlights the high prevalence of MetS in this ethnic group and the emergence of MetS in our younger subjects. Urgent population-based awareness campaigns, focussing on correcting unhealthy lifestyle behaviours should begin in childhood.

Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: Findings from an online survey

Objective

We examined willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia.

Methods

An online survey of 990 MSM was conducted between March and April 2016. Eligibility criteria included being biological male, Malaysian citizen, 18 years of age or above, identifying as MSM, and being HIV negative or unknown status. Participants’ demographics, sexual and drug use behaviors, attitudes towards PrEP, and preferences regarding future access to PrEP were collected. Bivariate analysis and logistic regression were performed to determine factors associated with willingness to use PrEP.

Results

Fewer than half of participants (44%) knew about PrEP before completing the survey. Overall, 39% of the sample were willing to take PrEP. Multivariate logistic regression indicated that Malay men (AOR: 1.73, 95% CI:1.12, 2.70), having 2 or more male anal sex partners in the past 6 months (AOR: 1.98, 95% CI: 1.29, 3.05), previous knowledge of PrEP (AOR: 1.40, 95%CI: 1.06, 1.86), lack of confidence in practising safer sex (AOR: 1.36, 95% CI: 1.02, 1.81), and having ever paid for sex with a male partner (AOR: 1.39, 95% CI: 1.01, 1.91) were independently associated with greater willingness to use PrEP, while men who identified as heterosexual were less willing to use PrEP (AOR, 0.36, 95% CI: 0.13, 0.97). Majority of participants preferred to access PrEP at affordable cost below 100 Malaysian Ringgit (USD25) per month from community based organisations followed by private or government hospitals.

Conclusions

Overall, MSM in Malaysia reported a relatively low level of willingness to use PrEP, although willingness was higher among those previously aware of PrEP. There is a need to provide PrEP at affordable cost, increase demand and awareness of PrEP, and to provide access to this preventative medication via diverse, integrated and tailored sexual health services.

Risk factors for low high-density lipoprotein among Asian Indians in the United States

AIM

To examine the differences in metabolic risk factors (RFs) by gender in the Asian Indian (AI) population in the United States.

METHODS

Using cross-sectional data from 1038 randomly selected Asian Indians, we investigated the relationship between metabolic syndrome (MetS) RFs, cardiovascular disease, and diabetes.

RESULTS

A greater percent of women in this group had increased waist circumference and low high density lipoprotein (HDL) levels than men, but AI males had increased blood glucose, increased blood pressure, and increased triglycerides compared to females. Those individuals who met the MetS criteria had increased cardiovascular disease. One of the biggest single RFs for cardiovascular disease and diabetes reported in the literature for AIs is low HDL.

CONCLUSION

Our results show that lack of knowledge about diabetes, low physical activity, increased body mass index, and age were the factors most significantly correlated with low HDL in this population. Future studies and prospective trials are needed to further elucidate causes of the MetS and diabetes in AIs.

Clinical utility of metabolic syndrome severity scores: considerations for practitioners

The metabolic syndrome (MetS) is marked by abnormalities in central obesity, high blood pressure, high triglycerides, low high-density lipoprotein-cholesterol, and high fasting glucose and appears to be produced by underlying processes of inflammation, oxidative stress, and adipocyte dysfunction. MetS has traditionally been classified based on dichotomous criteria that deny that MetS-related risk likely exists as a spectrum. Continuous MetS scores provide a way to track MetS-related risk over time. We generated MetS severity scores that are sex- and race/ethnicity-specific, acknowledging that the way MetS is manifested may be different by sex and racial/ethnic subgroup. These scores are correlated with long-term risk for type 2 diabetes mellitus and cardiovascular disease. Clinical use of scores like these provide a potential opportunity to identify patients at highest risk, motivate patients toward lifestyle change, and follow treatment progress over time.