Prevalence of metabolic syndrome among adult population in India: A systematic review and meta-analysis

Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease: Mapping Across Different Indian Populations (MAP Study)

INTRODUCTION

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern. MASLD is strongly linked to obesity, sedentary lifestyles, and metabolic syndrome. In India, the prevalence of MASLD exhibits regional variations because of genetic, dietary, and socioeconomic factors. Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) are standardized non-invasive tools for assessing fibrosis and steatosis in MASLD. This study aimed to determine the prevalence and severity of MASLD across different Indian regions and examine regional disparities in MASLD burden.

METHODS

This retrospective, multicenter, cross-sectional study analyzed the data of 13,750 adults from 105 diabetes and endocrine clinics across six geographic zones in India between May 2023 and February 2024. Participants underwent LSM and CAP assessment using FibroScan™. Based on LSM, liver fibrosis was categorized as F0-F1 (2-7 kPa), F2 (7-10 kPa), F3 (10-14 kPa), and F4 (≥ 14 kPa). Based on CAP, MASLD was classified as mild (238-260 dB/m), moderate (261-292 dB/m), and severe (≥ 293 dB/m).

RESULTS

The prevalence of MASLD was 68.2% (CAP ≥ 238 dB/m), and the prevalence of fibrosis was 33.7% (LSM ≥ 7 kPa). The highest MASLD burden was observed in North India (73.3%), particularly in Uttarakhand (80.0%). Severe fibrosis (F4) was highly prevalent in Kerala (20.0%), whereas severe steatosis (S3) was highly prevalent in Jammu and Kashmir (50.3%). The prevalence of MASLD was significantly associated with regional variations (P < 0.001) but not with age.

CONCLUSION

This study highlights significant regional disparities in MASLD burden. The high burden in North India calls for region-specific public health interventions, standardized screening, and preventive strategies.

Sex differences in prevalence of metabolic syndrome components and contributing factors among psychiatric patients in Saudi Arabia

Background/objectives

The purpose of this study was to detect sex differences in metabolic syndrome (MS) features and risk variables among Saudi participants.

Methods

For this study, 144 patients (52.08% males, 47.92% females) aged 19 to 59 signed a written consent form based on the Declaration of Helsinki, either as a patient or a family member. A cross-sectional survey was used to collect data on family disease history, health, and eating habits. MS components included waist circumstance (WC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TGs), fasting glucose (FG), and blood pressure. A chi-square test was used to compare categorical data within and across sexes.

Results

The associations between variables were found using Spearman correlation coefficients and simple regression analysis. Anthropometric indices were significantly (p ≤ 0.01) varied between sexes as well as family history, health behaviors, and eating behaviors. Sex variations in MS components that contributed to an MS diagnosis were discovered and were significantly varied between sexes. The most common components in males were low HDL-C (90.67%), high WC (85.33), and elevated TG levels (76.0%). In females, the most typically recognized components were high WC (86.96%), followed by high FG (69.57%) and high blood pressure and TG (63.77%). Sex differences in other risk variables for MS, such as family history, health, dietary habits, sedentary lifestyle, and smoking, were found to be associated with high anthropometric indices.

Conclusion

Sex-specific public health policies and management techniques for preventing MS in the older adult population should be created for Saudis who are aging physiologically.

Developmental Trends of Metabolic Syndrome in the Past Two Decades: A Narrative Review

Background/Objectives: Metabolic syndrome (MetS) is a complex disorder characterized by insulin resistance (IR), central obesity, atherogenic dyslipidemia, and higher glucose levels. It increases the risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), imposing an economic burden on the healthcare system. However, the historical origins of MetS as well as the development and evolution of its definitions have not been conclusively documented in the literature. This study seeks to enhance the understanding of the developmental trends of MetS during the preceding two decades, placing particular emphasis on the definition, diagnosis and prevalence. Methods: An extensive search was performed from 1920 to 2023 across prominent scientific research engines, including Scopus, PubMed, MDPI, and others. Results: Despite advancements, many aspects of MetS remain inadequately understood. As the understanding of the nature and pathophysiology of MetS progresses, the development and refinement of its diagnostic criteria, and assessment and treatment guidelines will continue. Additionally, there exists significant variation in the global prevalence of metabolic syndrome, ranging from 14 to 39%. This prevalence is projected to increase due to the adoption of less healthy dietary patterns and sedentary lifestyles. The observed disparities in metabolic syndrome prevalence can be attributed to multiple factors, including demographic characteristics. Furthermore, the lack of a standardized definition across studies also contributes to the variation in reported prevalence rates. Conclusions: Further studies focusing on the standardization of the MetS definition across different research are crucial. The establishment of consistent criteria would enhance the reliability and validity of research findings, enabling more meaningful comparisons and interpretations.

Association between Mediterranean diet and metabolic syndrome: analysis of NHANES 2007-2020

Changing poor dietary habits is effective for treating metabolic syndrome (MetS). Despite the global reputation of the Mediterranean diet (MD) for health, research on its link to MetS is limited, especially in non-Mediterranean regions. This study aimed to investigate the relationship between the MD and MetS. Data from the 2007 to 2020 NHANES were analysed using multiple logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis. Among 20,991 participants, a negative association between Mediterranean diet score (MDS) and MetS prevalence was observed. RCS regression indicated a linear relationship. Subgroup analysis revealed a significant negative association in most groups, except those with high school education, other Hispanics, and non-Hispanic blacks. In the American population, greater adherence to the Mediterranean diet is associated with a reduced risk of metabolic syndrome, emphasising its protective effects and relevance in public health strategies. Future research should focus on promoting its adoption and investigating causal mechanisms and the impact of specific dietary components through longitudinal studies.

Metabolic syndrome burden, determinants and treatment status in an urban slum resettlement colony in Delhi, India

BACKGROUND

Metabolic syndrome (MetS) in low-resource settings contributes to accentuated risk of cardiovascular disease, including stroke. The study objective was to estimate the prevalence, determinants and treatment status of MetS in an urban slum resettlement population in Delhi, India.

METHODS

This study was conducted from February to May 2023. Multiphase sampling was conducted with 1910 individuals screened for abdominal obesity (AO), with 996 detected as having AO, of which, 400 were selected by simple random sampling and further evaluated for triglycerides (TGs), high-density lipoprotein (HDL) and fasting glucose levels.

RESULTS

Among the 400 participants detected as having AO, 211 had evidence of MetS (52.75% [95% confidence interval 47.83 to 57.62]). The most prevalent combination of MetS clustering was for all five components (AO, diabetes mellitus [DM], hypertension [HTN], low HDL and high TGs; 14.69%), followed by AO, DM and HTN (12.32%). On adjusted analysis, the odds of having MetS was found to be independently associated with increasing age (≥40 y) but not sex.

CONCLUSIONS

A high burden of MetS and suboptimal treatment status is prevalent in urban slum populations. Screening of individuals with AO, especially in those >40 y of age, can be an effective programmatic strategy for early diagnosis and management of MetS and its underlying components.

Determinants and prevalence of metabolic syndrome among the adult population in Hargeisa, Somaliland: A community-based cross-sectional study

BACKGROUND

Metabolic syndrome (met-s) is a medical condition that includes abdominal obesity, hyperlipidemia, high blood glucose, and high blood pressure. It is associated with a high risk of developing cardiovascular diseases and type 2 diabetes mellitus. The condition was believed to be a challenge mostly faced by developed nations. A few studies conducted showed that met-s is increasing and becoming more common in Africa, where it was considered rare. The study aimed to assess the determinants and prevalence of met-s among the adult population in Hargeisa town, Somaliland, in 2023.

METHODS

A community-based cross-sectional study among 498 adults living in all eight districts of Hargeisa, was carried out from August to September 2023. The sample size was divided proportionally by the number of households in selected sub-districts. Systematic random sampling was employed to select the households in the sub-districts. One adult from each household was selected and assessed. Data were collected using the STEPwise approach of the World Health Organization. The data were analysed using International Diabetic Federation (IDF) criteria for metabolic syndrome with SPSS version 25. Bivariate and multivariate analyses using logistic regression were performed.

RESULT

In total, 498 adults participated in the study. The prevalence of met-s was 26.7% in IDF (males 11% vs. females 38.9%). Being of an advanced age of 45-54 years (AOR = 3.6, CI 1.17-11.27), 55-64 years (AOR = 6.1, CI 1.88-19.83), >64 (AOR = 9.1 CI 2.41-34.92), being a woman (AOR = 10.8, CI 5.3-21.8), being overweight or obese (AOR = 4.5, CI 2.5-8), sedentary behavior (AOR = 3.5, CI 1.6-7.5), and lack of physical exercise (AOR = 0.39, CI 0.17-0.88) were significantly associated with met-s.

CONCLUSION

The met-s was predominant in our findings. Community-based prevention strategies and actions are necessary if the met-s and its potential consequences are needed to be mitigated.

Metabolic syndrome patterns by gender in major depressive disorder

Major depressive disorder (MDD) and metabolic syndrome (MetS) are significant health challenges, with distinct gender-specific manifestations. This suggests that the clinical presentation of MetS within the MDD cohort may also vary by gender. The objective of this study is to explore these gender-specific clinical patterns in the co-occurrence of MetS among hospitalized MDD patients, thereby offering insights and guidance for targeted interventions aimed at managing MetS in this demographic. The study included 1,281 first hospitalization MDD patients. Data were collected on socio-demographic characteristics and general clinical profiles. Metabolic parameters, routine biochemical markers, and psychological symptoms were measured and analyzed. The prevalence of MetS was 8.21% in male patients and 10.34% in female patients, with no significant difference between genders. Gender-specific risk factors were identified: in males, age and anxiety symptoms were significant predictors of MetS, while in females, age at onset and married were linked to the development of MetS. Additionally, MetS severity was influenced by age at onset in males and by both age at onset and married in females. This study found no gender-specific prevalence of MetS in hospitalized MDD patients. However, gender-specific factors influencing MetS development and severity highlight the need for focused management in older, married females and older males with high anxiety symptoms.

Prevalence of metabolic syndrome and its components according to altitude levels: a systematic review and meta-analysis

Metabolic syndrome has a multifactorial origin; however, epidemiological data correspond to populations located at sea level. It has been reported that the altitude can affected the prevalence due to physiological changes. The aim of this study is to show the global prevalence of metabolic syndrome at altitude and its components. We use four databases, all studies published up to November 2023. The prevalences from studies were meta-analyzed using a random-effects model. To assess sources of heterogeneity, subgroup analyses were performed. We included 28 studies. The number of participants was 29 195. The prevalence of metabolic syndrome was 30.3% (95% CI 22.8-38.4%). According to the altitude level, at 1500-2500 was 36.5%, 2500-3500 (21.8%), and > 3500 (30.9%), also it was higher in women (35.5%) that men (26.8%). It was observed that there is an inverse relationship between higher altitude and the prevalence of metabolic syndrome. Among its components, abdominal obesity and low HDL were present in more than 40.0%, while high blood pressure, high triglycerides and impaired glucose were present in less than 30.0%. We recommend that our results be considered for future research in populations living at altitude since they have different characteristics from populations at sea level.

Metabolic syndrome

The metabolic syndrome (MetS) is a multiplex modifiable risk factor for cardiovascular disease, type 2 diabetes mellitus and other health outcomes, and is a major challenge to clinical practice and public health. The rising global prevalence of MetS, driven by urbanization, sedentary lifestyles and dietary changes, underlines the urgency of addressing this syndrome. We explore the complex underlying mechanisms, including genetic predisposition, insulin resistance, accumulation of dysfunctional adipose tissue and ectopic lipids in abdominal obesity, systemic inflammation and dyslipidaemia, and how they contribute to the clinical manifestations of MetS. Diagnostic approaches vary but commonly focus on abdominal obesity (assessed using waist circumference), hyperglycaemia, dyslipidaemia and hypertension, highlighting the need for population-specific and phenotype-specific diagnostic strategies. Management of MetS prioritizes lifestyle modifications, such as healthy dietary patterns, physical activity and management of excess visceral and ectopic adiposity, as foundational interventions. We also discuss emerging therapies, including new pharmacological treatments and surgical options, providing a forward-looking perspective on MetS research and care. This Primer aims to inform clinicians, researchers and policymakers about MetS complexities, advocating for a cohesive, patient-centred management and prevention strategy. Emphasizing the multifactorial nature of MetS, this Primer calls for integrated public health efforts, personalized care and innovative research to address this escalating health issue.

Clinical and Biochemical Parameters in Relation to Serum Fetuin-A Levels in Overweight and Obese with and without Metabolic Syndrome in the North-eastern States of Indian Population

Introduction

: In India the prevalence of metabolic syndrome has dramatically increased. Hepatokines have gained considerable interest, and the role of fetuin-A in overweight and obesity incompletely understood. Therefore, this study aimed to investigate the role of serum fetuin-A in overweight and obese adults with and without metabolic syndrome in the northeastern Indian population.

Methods

This comparative study included 200 subjects (50 control, 50 overweight, 50 obese without metabolic syndrome and 50 obese with metabolic syndrome) aged 20-70 years. Lipid profile and fasting blood glucose, were measured using a fully automated analyzer. ELISA was employed to measure serum fetuin-A levels. Statistical analyses were conducted using SPSS versions 23.0. Furthermore, t-test was used to analyze the numerical investigational data of the present study. Chi squared test for the categorical data, and Pearson's correlation for the correlation analysis.

Results

Overweight and obese adults with and without metabolic syndrome had higher fetuin-A levels were than the controls. The results of this study indicated a positive correlation between fetuin-A and lipid profile, anthropometric parameters, 12 h fasting blood glucose and blood pressure. Contrarily, HDL-C exhibited a negative correlation with fetuin-A.

Conclusions

Fetuin-A is the first hepatokine associated with metabolic diseases. It controls the entire energy homeostasis of the body probably by regulating glucose and lipid metabolism. The current data belief is that fetuin-A may be a promising biomarker for predicting metabolic syndrome and its associated disorders particularly in overweight and obese adults.

Impact of high-sensitivity C-reactive protein on metabolic syndrome in an elderly population: Findings from a hospital-based cross-sectional study in J&K, India

Background

Due to affluent lifestyles, primary care physicians are concerned about metabolic syndrome (MetS). Inflammation and insulin resistance are caused by extra adipose tissue. Our study seeks to evaluate, taking into account numerous variables, the relationship between high-sensitivity C-reactive protein (hsCRP) levels and MetS in adults aged 50+ in Northern Kashmir, India.

Materials and Methods

In Northern Kashmir, India, a hospital-based cross-sectional study looked into the relationship between hsCRP and MetS in people over 50. The recruitment process included people looking for basic healthcare services. Utilising modified NCEP-ATP III criteria, MetS was established. The association between MetS and hsCRP levels was evaluated statistically while taking into account various variables.

Results

The waist circumference, body mass index, systolic and diastolic blood pressure, as well as the prevalence of hypertension, diabetes mellitus (DM), and dyslipidemia were all greater in those with MetS. While demonstrating decreased levels of high-density lipoprotein cholesterol (HDL-C), they also showed higher levels of high-sensitive C-reactive protein (hsCRP) and fasting plasma glucose. A study of correlations revealed a substantial inverse relationship between hsCRP and HDL-C. Elevated hsCRP levels were found to be substantially linked with MetS by the use of logistic regression, along with obesity, uric acid levels, hypertension, DM, and dyslipidemia. These results underline how crucial it is to keep an eye on these variables in order to recognize and treat MetS as soon as possible.

Conclusion

Among this investigation, we found strong evidence that high- hsCRP, an independent risk factor for MetS, was present among middle-aged and elderly residents of the northern Kashmir region of India.

Relationship between Metabolic Syndrome and Mental Health Status among Geriatric Females: A Cross-sectional Study

Introduction

Postmenopausal status is a known risk factors for developing metabolic syndrome (MetS). Studies focusing on establishing the relationship between Mets and mental health state are limited.

Aims and Objective

To identify the frequency of MetS along with its components in geriatric females and assess its relationship with three negative emotional states (depression/anxiety/stress).

Materials and Methods

Women aged ≥60 years from October 2020 to March 2022 were included in study. We used the Consensus Definition IDF and AHA/NHLBI (2009) criteria to classify subjects as having metabolic syndrome. Mental health status were assessed using Depression Anxiety and Stress Scale (DASS 21) questionnaire.

Results

The frequency of metabolic syndrome in this sample was 36.58% (30 out of 82 patients). The Depression, anxiety, stress scale and total scores in women with MetS were 14 ± 5.3, 8.5 ± 3.92, 12.13 ± 5.58 and 34.66 ± 9.60 as compared to 6.6 ± 3.7, 5.3 ± 2.49, 7.1 ± 3.12 and 19.2 ± 6.51 in those without MetS; difference being statistically significant.

Conclusion

MetS results in poor mental health state in geriatric women but large-scale studies are needed to clarify this association.

The onset and the development of cardiometabolic aging: an insight into the underlying mechanisms

Metabolic compromise is crucial in aggravating age-associated chronic inflammation, oxidative stress, mitochondrial damage, increased LDL and triglycerides, and elevated blood pressure. Excessive adiposity, hyperglycemia, and insulin resistance due to aging are associated with elevated levels of damaging free radicals, inducing a proinflammatory state and hampering immune cell activity, leading to a malfunctioning cardiometabolic condition. The age-associated oxidative load and redox imbalance are contributing factors for cardiometabolic morbidities via vascular remodelling and endothelial damage. Recent evidence has claimed the importance of gut microbiota in maintaining regular metabolic activity, which declines with chronological aging and cardiometabolic comorbidities. Genetic mutations, polymorphic changes, and environmental factors strongly correlate with increased vulnerability to aberrant cardiometabolic changes by affecting key physiological pathways. Numerous studies have reported a robust link between biological aging and cardiometabolic dysfunction. This review outlines the scientific evidence exploring potential mechanisms behind the onset and development of cardiovascular and metabolic issues, particularly exacerbated with aging.

Stress Attenuation Effect of Combined Approach of Yoga and Diet Intervention Among Metabolic Syndrome Patients

Background

Persistent exposure to psychosocial stress is linked to an increased risk of metabolic disease, including obesity, cardiovascular disease (CVD), and Type-2 diabetes mellitus (T2DM). Metabolic syndrome is driven by an unhealthy lifestyle encompassing a sedentary lifestyle and unhealthy diet as well as psychological distress, which potentially triggers these metabolic derailments. Various mind-body practices, such as postures, breathing, meditation, and relaxation, are included in yoga. Studies suggest that even one yoga session can improve cognitive function, oxygen saturation, baroreflex sensitivity, sympathovagal balance, and the body's ability to recover from stressful stimuli. Therefore, this study aimed to explore the stress attenuation effect of a combined approach of yoga and diet intervention among metabolic syndrome patients.

Methodology

In this study we randomized 200 subjects diagnosed with metabolic syndrome as per the Joint interim statement 2009 into control and combined (yoga+diet) groups according to their intervention which was given for 6 months. Anthropometric, physiological, perceived stress score and biochemical parameters were collected at baseline, 3 months and 6 months.

Results

The study's findings show that, at three and six months from baseline, the combined yoga with diet approach significantly reduced metabolic risk factors (waist circumference, SBP, DBP, fasting blood glucose, and triglycerides) and improved HDL. At three and six months following the combined (yoga+diet) intervention, the perceived stress score also showed a substantial reduction.

Conclusion

Combined (yoga+diet) interventions are effective in lowering the risk of metabolic syndrome and perceived stress.

The Prevalence of Metabolic Syndrome and Its Association With Waist Circumference in Middle-Aged Individuals From Urban Mumbai

Background Metabolic syndrome (MetS) represents a critical public health challenge globally, characterized by a cluster of metabolic abnormalities that heighten the risk of cardiovascular diseases and type 2 diabetes. In India, the prevalence of MetS, particularly in urban areas, is rising rapidly. This study investigates the prevalence of MetS and its association with waist circumference in middle-aged individuals from urban Mumbai. Methods A cross-sectional study was conducted among 1,851 participants (814 men and 1,037 women, with a mean age of 56.8 years) in a public health camp in urban Mumbai. Data were collected on anthropometric measures, blood pressure, and blood markers, including fasting glucose and lipid profiles. MetS was diagnosed based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. This included the presence of three or more of the following five criteria: waist circumference of ≥102 cm for men and ≥88 cm for women, fasting triglycerides of ≥150 mg/dL, fasting high-density lipoprotein (HDL) cholesterol of <40 mg/dL for men and <50 mg/dL for women, blood pressure of ≥130/85 mm Hg, and fasting glucose of ≥100 mg/dL. Data were analyzed using SPSS Statistics version 23 (IBM SPSS Statistics, Armonk, NY). Statistical analyses were performed using the chi-square test, with statistical significance set at p<0.05. Results The overall prevalence of metabolic syndrome (MetS) in the cohort was 32.6% (605 out of 1,851 participants), with women exhibiting a significantly higher prevalence at 38% (394 out of 1,037 women) compared to men at 26% (211 out of 814 men) (p<0.001). High waist circumference (≥102 cm for men and ≥88 cm for women) was strongly correlated with MetS, as 73.8% of individuals (314 out of 425 participants) in the high waist circumference group met the criteria for MetS, compared to 20.4% of individuals (291 out of 1,426 participants) in the non-high waist circumference group (<102 cm for men and <88 cm for women) (p<0.001). Furthermore, elevated blood pressure, elevated fasting glucose, and elevated fasting triglycerides were significantly more common in the high waist circumference group, than in the non-high waist circumference group (p<0.001). Conclusion The study highlights the significant association between central obesity and MetS in an urban Indian population, with notably higher prevalence in women. Waist circumference is a critical determinant of MetS and should routinely be measured, with significant application especially in resource-limited settings for early detection and intervention.

Association between APOE genotypes and metabolic syndrome in a middle aged and elderly Urban South Indian population

Background

This study examines the association between apolipoprotein E (APOE) genotypes and metabolic syndrome (MetS) in an older urban population in South India, as part of the Tata Longitudinal Study on Aging.

Methods

A total of 618 participants aged 45 and above were analyzed cross-sectionally for the association between APOE carrier status and MetS (based on both NCEP ATP III and Consensus criteria).

Results

Despite the high prevalence of MetS observed in this cohort (51.62 % by NCEP-ATP III and 61.33 % by Consensus criteria), multivariable logistic regression revealed no significant association between APOE genotypes and MetS under both criteria. However, specific associations were noted in age and sex-stratified analyses; notably, E2 carriers under 60 showed 0.42-fold decreased odds (95%CI:0.20,0.89, p-value-0.023) for an increased waist circumference, and E4 carriers above 60 were at 1.85 times increased odds (95 % CI:1.04,3.28, p-value<0.05) for decreased HDL.

Conclusion

These findings suggest that while APOE genotypes influence certain metabolic parameters, their impact on MetS may be limited in this urban setting, possibly overshadowed by environmental factors and lifestyle influences, which was highlighted by the differences seen in its sister rural cohort.

Prevalence and influencing factors of metabolic syndrome among rural adult population in a district of South India

Background

Metabolic syndrome has increased globally due to sedentary lifestyles, unhealthy diets and obesity, which is posing a substantial burden on healthcare systems. Understanding the determinants of metabolic syndrome like lifestyle factors, socioeconomic status and the environment are vital for devising effective prevention and management. Research into these determinants helps to identify high-risk populations and develop interventions to reduce its occurrence.

Objectives

i. To estimate the prevalence of metabolic syndrome among the adult population. ii. To determine the factors associated with metabolic syndrome among the adult population.

Methodology

A cross-sectional study was carried out among 410 adults (≥18 years). A semi-structured questionnaire was used to collect data and National Cholesterol Education Program's Adult Treatment Panel III criteria was used to diagnose metabolic syndrome. Continuous and categorical data were represented as mean and proportion, respectively. The strength of the association was determined using the prevalence ratio and adjusted prevalence ratio.

Results

The mean age of the participants was 44.97 ± 14.7, about 58.3% of them were females. Metabolic syndrome prevalence was 39.8%. Multivariate regression analysis demonstrated that being over 40 years old, marital status, higher socioeconomic status, skilled workers, physical inactivity and obesity were independently linked to metabolic syndrome.

Conclusions

The burden can be reduced by identifying the risk factors at the early stage through screening and by adopting a healthy lifestyle.

The burden and care cascade in young and middle-aged patients with diabetes hypertension comorbidity with abdominal obesity in India: A nationally representative cross-sectional survey

We ascertained the burden, determinants, and care cascade in the young and middle-aged patients having co-existing hypertension (HTN), Diabetes Mellitus (DM), and abdominal obesity in India from a secondary data analysis of nationally representative data. The study examined cross-sectional data from the National Family Health Survey (NFHS-5) conducted in India from 2019 to 2021 in 788974 individuals aged 15-49 years including 695707 women and 93267 men. The weighted prevalence of DM-HTN comorbidity with high waist circumference in the sample was 0.75% (95% CI: 0.71 to 0.79) including 46.33% (95% CI: 44.06 to 48.62) newly diagnosed cases detected for HTN and high blood sugars. The weighted prevalence of Metabolic syndrome as per NCEP ATPIII criteria was found to be 1.13% (95% CI: 1.08 to 1.17). Only 46.16% existing cases were treated with both anti-diabetes and antihypertensive medication (full treatment), while 34.71% cases were untreated. On adjusted analysis, increasing age, females, higher wealth index, high fat diet, obesity and comorbidities were significantly associated with having DM-HTN comorbidity along with high-waist circumference. More than half of young and middle aged-population in India with DM-HTN-abdominal obesity triad are not initiated on treatment for DM and HTN comorbidities, while a majority of the previously diagnosed cases have uncontrolled blood pressure and poor glycemic control. The poor cascade of care for DM and HTN in these high-risk group of patients may substantially increase their risk for early progression and severity of microvascular and macrovascular complications especially cardiovascular disease.

Regional and socio-demographic variation in laboratory-based predictions of 10-year cardiovascular disease risk among adults in north and south India

OBJECTIVE

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in India. There is no laboratory-based CVD risk data among Indians from different regions and backgrounds. This study estimated laboratory-based 10-year CVD risk across different population sub-groups.

METHODS

Data from UDAY derived from cross-sectional surveys of rural and urban populations of northern (Haryana) and southern (Andhra Pradesh) India were analysed. World Health Organization/International Society of Hypertension laboratory-based equations calculated 10-year CVD risk among participants without CVD history. Wilcoxon rank sum test analyzed average CVD risk across subgroups. Chi-square test compared population proportions in different CVD risk categories. Regression analysis assessed the association between CVD risk and participant characteristics.

RESULTS

The mean (SD) age of the participants (n = 8448) was 53.2 (9.2) years. Males in Haryana had increased CVD risk compared to those in Andhra Pradesh (p < 0.01). In both states, female gender was shown to have a protective effect on CVD risk (p < 0.01). Age correlated with increased risk (p < 0.01). Education level did not affect CVD risk however employment status may have. Hypertension, diabetes, hyperlipidemia, smoking, and insufficient exercise were associated with increased CVD risk (p < 0.01). Residence (urban versus rural) and wealth index did not largely affect CVD risk.

CONCLUSION

Minor differences exist in the distribution of laboratory-based CVD risk across Indian population cohorts. CVD risk was similar in urban wealthy participants and rural poor and working-class communities in northern and southern India. Public health efforts need to target all major segments of the Indian population to curb the CVD epidemic.

Prevalence of Metabolic Syndrome and its Related Factors in Bangladeshi Adults: A Cross-Sectional Study

OBJECTIVES

Metabolic syndrome (MetS) is a group of medical conditions that elevate the chances of developing cardiovascular disease, stroke and Type 2 diabetes. This study aimed to determine the frequency and contributing risk factors of MetS in adults from Bangladesh.

METHODS

In this cross-sectional study, 653 individuals (470 males and 183 females) were randomly selected to participate. Fasting blood samples were collected and analysed using standard methods to measure biochemical parameters. MetS was defined on the basis of NCEP-ATP III guidelines, and multivariate logistic regression analyses were conducted to identify factors associated with MetS.

RESULTS

The prevalence of MetS was 19.7% in the healthy control group, 70.2% in the hypertensive group and 46.8% in the diabetic group. Overall, there was no significant difference in the prevalence of MetS between males (45%) and females (45.9%). The participants who had both hypertension and diabetes had the highest prevalence of MetS at 77.3%. Both males and females showed an increased trend in the prevalence of MetS and its components as they aged, except for WC in males (p < 0.01 for all cases). The 46-55 age group in males had a higher prevalence of MetS (68%), whereas the >55 age group in females had a prevalence of 73.9%. The most common component of MetS was low levels of HDL-C, which affected over 80% of the studied sample. According to the logistic regression analyses, age, BMI, hypertension and diabetes were significantly associated with MetS in both genders.

CONCLUSION

This study found a high prevalence of MetS in Bangladeshi adults. Several factors are significantly associated with the risk of MetS. It is crucial to consider the varying prevalence rates of MetS by age and gender as well as its different components while providing health guidance and support.

Sex-specific differences in the association between APOE genotype and metabolic syndrome among middle-aged and older rural Indians

Background

Metabolic syndrome (MetS), characterized by elevated blood pressure, high blood glucose, excess abdominal fat, and abnormal cholesterol or triglyceride levels, significantly increases the risk of various non-communicable diseases. This study focuses on understanding the sex-specific association between Apolipoprotein E (APOE) polymorphism and MetS among middle-aged and older adults in rural southern India.

Methods

This cross-sectional study utilized data from the Centre for Brain Research-Srinivaspura Aging, Neuro Senescence, and COGnition (CBR-SANSCOG) study. Participants (n = 3741) underwent comprehensive clinical assessments and blood investigations, including APOE genotyping. MetS was defined using the National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) and the Consensus criteria. Statistical analyses, including chi-square tests, ANCOVA, and logistic regression, were conducted to explore the association of APOE genotype with MetS and its components, stratified by sex.

Results

Females carrying the APOE E4 allele had 1.31-fold increased odds of MetS (95 % CI: 1.02,1.69, p = 0.035) according to the NCEP ATP III criteria but not when the Consensus criteria were applied. The study also noted sex-specific differences in the association of APOE with various MetS components, including lipid levels and waist circumference.

Discussion

Our findings reveal a sex-specific association between the APOE E4 allele and MetS, with only females having an increased risk. This study contributes to the understanding of the genetic underpinnings of MetS and highlights the importance of considering sex-specific differences in MetS research and its prevention strategies. This study underscores the complexity of MetS etiology and emphasizes the need for further research to elucidate the role of genetic, environmental, and lifestyle factors in its progression, particularly in sex-specific contexts.

The connection between hypertension and diabetes and their role in heart and kidney disease development

Hypertension and diabetes are two common metabolic disorders that often coexist in the same individual. Their concurrence increases the risk of cardiovascular disease, renal dysfunction, and other complications. Cardiovascular disease is the primary cause of morbidity and mortality in individuals with diabetes, and hypertension further aggravates this condition. Interestingly, hypertension and diabetes share several common pathophysiological mechanisms including insulin resistance, vascular inflammation, endothelial dysfunction, obesity, and oxidative stress suggesting a cross-talk between these two conditions that could potentially contribute to the development of other human diseases. Effective management of diabetes should include a multifaceted approach that addresses not only glycemic control but also blood pressure (BP) and lipid control. Treatment plans should be individualized to each patient's needs and should involve a combination of lifestyle modifications and medications to achieve optimal control. With the availability of newer antidiabetic medications such as SGLT inhibitors and GLP1 receptor agonists, it is crucial to consider their potential to reduce BP, enhance kidney function, and lower the risk of cardiovascular diseases when initiating treatment for glycemic control. A more profound comprehension of the shared underlying mechanisms between these conditions could pave the way for the development of innovative therapeutic approaches to tackle them. Our review offers an in-depth analysis of the literature, providing a holistic view of the mechanisms underlying diabetes-hypertension comorbidity and its implications on heart and kidney diseases. The present article concludes by discussing current approaches for managing hypertensive diabetic patients to create a set of comprehensive individualized recommendations.

Body mass index as a dominant risk factor for metabolic syndrome among indonesian adults: a 6-year prospective cohort study of non-communicable diseases

BACKGROUND

Non-communicable diseases (NCDs), notably cardiovascular disease and type 2 diabetes mellitus, are largely driven by metabolic syndrome (MetS), a cluster of critical risk factors. Despite extensive research, the progression of MetS, especially in Indonesia, has received limited attention. This research tracks adult MetS risk dynamics in a populous Bogor District cohort, providing crucial insights into its evolving nature.

METHODS

This prospective open cohort study analysed secondary data from the Special Research - Cohort Study of Non-Communicable Diseases by the Ministry of Health, Republic of Indonesia from 2011 to 2018. The final sample was 1,376 Indonesian adult participants, all residents of Bogor District. MetS outcome, dietary assessment, physical activity, and biomarkers were analysed every two consecutive years.

RESULTS

The risk of overweight and obese participants developing MetS was 2.4 and 4.4 times higher, respectively (95% CI: 1.176-3.320 and 3.345-5.740) than those with body mass index (BMI) in the normal range. Participants who reported less intentional physical exercise had a MetS risk 1.5 times higher (95% CI: 1.034-2.109) than those with more intentional physical exercise. The role of diet is also significant, evidenced by a 30% reduction in MetS risk for people with fat intakes in the 2nd quartile compared to the 1st quartile (95% CI: 0.505-0.972). Meanwhile, a carbohydrate intake in the 2nd quartile increased the risk of MetS 1.5 times (95% CI: 1.063-2.241) in comparison with the 1st quartile.

CONCLUSIONS

Notably, participants with underweight BMI exhibited the highest cumulative survival of MetS, while those with obese BMI recorded the lowest cumulative survival. There is an urgent need for strategic interventions to enhance the existing early detection and NCD monitoring program. This involves a targeted focus on promoting a community-based healthy lifestyle in the Bogor District. The study emphasizes the importance of tailored public health measures to address specific risk factors identified in the local context, aiming to mitigate the prevalence and impact of MetS in the population.

Metabolic Syndrome and Risk of Peripheral Arterial Disease: A Systematic Review and Meta-Analysis

This systematic review aimed to evaluate metabolic syndrome as a risk factor for the development of peripheral arterial disease (PAD). We searched in four databases: (1) PubMed, (2) Web of Science, (3) Scopus, and (4) Embase until March 2021. We included cohort studies that evaluated the risk of PAD in patients with and without metabolic syndrome. Study selection, data extraction, and risk of bias analysis were performed independently by 2 authors. We used a random-effects model to conduct a meta-analysis of effect measures [hazard ratio (HR), risk ratio (RR), and odds ratio (OR)]. Individual analyses were performed according to the diagnostic criterion used for metabolic syndrome. We included 7 cohort studies with a total of 43 824 participants. Most of the studies were performed in the general adult population. The metabolic syndrome and PAD diagnostic criteria used in the individual studies were heterogeneous. Almost all studies using RR found an association between metabolic syndrome and the development of PAD (RR: 1.31; confidence interval 95%: 1.03-1.59; I 2 : 15.6%). On the other hand, almost all the studies that used HR found no association between the two variables. All studies had a low risk of bias. In conclusion, available evidence on the association between metabolic syndrome and the risk of developing PAD is inconsistent. However, given the high prevalence of risk factors that patients with metabolic syndrome have, testing to rule out PAD could be recommended. Future studies should analyze each component of the metabolic syndrome separately and according to the severity of PAD.

Etiological Spectrum of Cirrhosis in India: A Systematic Review and Meta-analysis

BACKGROUND

Cirrhosis is a significant cause of morbidity and mortality globally and in India. This systematic review and meta-analysis aimed to ascertain the etiological spectrum and changing trends of cirrhosis in India.

METHODS

We searched electronic databases, including Pubmed/Medline, Scopus, and Embase. We included original studies that reported the etiology of cirrhosis in the Indian population.

RESULTS

We included 158 studies (adults: 147, children: 11). The overall pooled estimate of alcohol as a cause of cirrhosis in adults was 43.2% (95% confidence interval (CI) 39.8-46.6%; I2 = 97.8%), followed by nonalcoholic fatty liver disease (NAFLD)/cryptogenic in 14.4%, 95% CI (11.7-17.3%; I2 = 98.4%), hepatitis B virus (HBV) in 11.5%, 95% CI (9.8-13.3%; I2 = 96.6%), and hepatitis C virus (HCV) in 6.2%, 95% CI (4.8-7.8%; I2 = 97.2%) of the included patients. The most common cause of cirrhosis in all zones was alcohol-related. Comparison of etiologies over time revealed a reduction in the viral hepatitis-related and an increase in the proportion of alcohol-related and NAFLD/cryptogenic-related cirrhosis. The overall pooled estimates of various etiologies in children were: HBV in 10.7%, 95% CI (4.6-18.7%; I2 = 91.0%), NAFLD/Cryptogenic in 22.3%, 95% CI (9.0-39.2%; I2 = 96.7%), and HCV in 2.0%, 95% CI (0.0-8.5%; I2 = 94.6%).

CONCLUSIONS

Alcohol is the most common etiology of cirrhosis in adults in India. The proportions of alcohol and NAFLD-related cirrhosis are increasing, and those of viral hepatitis-related cirrhosis are reducing. The results of our meta-analysis will help formulate health policies and the allocation of resources.

Prevalence of undiagnosed metabolic syndrome using three different definitions and identifying associated risk factors among apparently healthy adults in Karachi, Pakistan: a cross-sectional survey in the year 2022

OBJECTIVE

To determine the prevalence and associated risk factors of undiagnosed metabolic syndrome (MetS) using three different definitions among apparently healthy adults of Karachi, Pakistan.

METHODS

This community-based cross-sectional survey was conducted in Karachi, Pakistan, from January 2022 to August 2022. A total of 1065 healthy individuals aged 25-80 years of any gender were consecutively included. MetS was assessed using the National Cholesterol Education Program for Adult Treatment Panel (NCEP-ATP) III guidelines, International Diabetes Federation (IDF), and modified NCEP-ATP III.

RESULTS

The prevalence of MetS was highest with the modified NCEP-ATP III definition at 33.9% (95% CI: 31-36), followed by the IDF definition at 32.2% (95% CI: 29-35). In contrast, the prevalence was lower at 22.4% (95% CI: 19-25) when using the NCEP ATP III definition. The risk of MetS significantly increases with higher BMI, as defined by the IDF criteria (adjusted OR [ORadj] 1.13, 95% CI 1.09-2.43), NCEP-ATP III criteria (ORadj 1.15, 95% CI 1.11-1.19), and modified NCEP-ATP III criteria (ORadj 1.16, 95% CI 1.12-1.20). Current smokers had significantly higher odds of MetS according to the IDF (ORadj 2.72, 95% CI 1.84-4.03), NCEP-ATP III (ORadj 3.93, 95% CI 2.55-6.06), and modified NCEP-ATP III (ORadj 0.62, 95% CI 0.43-0.88). Areca nut use was associated with higher odds of MetS according to both IDF (ORadj 1.71, 95% CI 1.19-2.47) and modified NCEP-ATP III criteria (ORadj 1.58, 95% CI 1.10-2.72). Furthermore, low physical activity had significantly higher odds of MetS according to the NCEP-ATP III (ORadj 1.36, 95% CI 1.01-1.84) and modified NCEP-ATP III criteria (ORadj 1.56, 95% CI 1.08-2.26).

CONCLUSION

One-third of the healthy individuals were diagnosed with MetS based on IDF, NCEP-ATP III, and modified NCEP-ATP III criteria. A higher BMI, current smoking, areca nut use, and low physical activity were significant factors.

Exploring the Prevalence and Components of Metabolic Syndrome in Sub-Saharan African Type 2 Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis

Background

Type 2 diabetes mellitus and metabolic syndrome represent two closely intertwined public health challenges that have reached alarming epidemic proportions in low- and middle-income countries, particularly in sub-Saharan Africa. Therefore, the current study aimed to determine the weighted pooled prevalence of metabolic syndrome and its components among individuals with type 2 diabetes mellitus in sub-Saharan Africa as defined by the 2004 National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III 2004) and/or the International Diabetes Federation (IDF) criteria.

Methods

A systematic search was conducted to retrieve studies published in the English language on the prevalence of metabolic syndrome among type 2 diabetic individuals in sub-Saharan Africa. Searches were carried out in PubMed, Embase, Scopus, Google Scholar, African Index Medicus, and African Journal Online from their inception until July 31, 2023. A random-effects model was employed to estimate the weighted pooled prevalence of metabolic syndrome in sub-Saharan Africa. Evidence of between-study variance attributed to heterogeneity was assessed using Cochran's Q statistic and the I2 statistic. The Joanna Briggs Institute quality appraisal criteria were used to evaluate the methodological quality of the included studies. The summary estimates were presented with forest plots and tables. Publication bias was checked with the funnel plot and Egger's regression test.

Results

Overall, 1421 articles were identified and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and 30 studies that met the inclusion criteria were included in the final analysis. The weighted pooled prevalence of metabolic syndrome among individuals with type 2 diabetes mellitus in sub-Saharan Africa was 63.1% (95% CI: 57.9-68.1) when using the NCEP-ATP III 2004 criteria and 60.8% (95% CI: 50.7-70.0) when using the IDF criteria. Subgroup analysis, using NCEP-ATP III 2004 and IDF criteria, revealed higher weighted pooled prevalence among females: 73.5% (95% CI: 67.4-79.5), 71.6% (95% CI: 60.2-82.9), compared to males: 50.5% (95% CI: 43.8-57.2), 44.5% (95% CI: 34.2-54.8), respectively. Central obesity was the most prevalent component of metabolic syndrome, with a pooled prevalence of 55.9% and 61.6% using NCEP-ATP III 2004 and IDF criteria, respectively. There was no statistical evidence of publication bias in both the NCEP-ATP III 2004 and IDF pooled estimates.

Conclusions

The findings underscore the alarming prevalence of metabolic syndrome among individuals with type 2 diabetes mellitus in sub-Saharan Africa. Therefore, it is essential to promote lifestyle modifications, such as regular exercise and balanced diets, prioritize routine obesity screenings, and implement early interventions and robust public health measures to mitigate the risks associated with central obesity.

Correlation between acne and insulin resistance; experience from central India

Introduction

Acne is a common dermatological condition primarily seen in teenage and adolescent patients and is a major concern for cosmological issues. Along with environmental factors, the proliferation of basal keratinocytes in the sebaceous-pilosebaceous unit, abnormal desquamation of follicular corneocytes, and metabolic abnormalities play a significant role in the pathogenesis of acne development.

Aim

To study the causal relation between acne vulgaris and insulin resistance by calculating Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and identify the relation between insulin resistance and the severity of acne.

Materials and Methods

This was a retrospective study, where the data of patients with persistent Acne Vulgaris who were referred to the Endocrine department for evaluation of the hormonal and metabolic causes for acne vulgaris were analysed. The patient's clinical records were evaluated in whom there was no significant hormonal or metabolic abnormality identified known to cause persistent acne were included after proper consent and HOMA-IR was calculated.

Results

Of several patients with persistent acne, 150 patients were included in our study with the male-to-female ratio was 23:27. The mean age of patients was 33.2 years. The mean HOMA-IR in our acne patients was 1.62 ranging from 0.9-3.7. Sixty four (42.67%) patients had HOMA-IR more than 2.0, thereby suggesting insulin resistance.

Conclusion

Our study suggests the prevalence of insulin resistance in 42.67% of patients with acne, thereby providing the possibility of use of insulin modifiers as an adjunct acne treatment and stratifying the possible risk of metabolic syndrome in patients with acne. Also recommended is the control of dietary factors and lifestyle modification for the management of acne with insulin resistance.

Prevalence of metabolic disorders among women in reproductive age group in hilly rural area of North India

Background

Metabolic syndrome consists of cardiometabolic risk factors that promote the development of atherosclerotic cardiovascular disease, type 2 'DM' and obesity. These are associated with increased cardiovascular mortality and morbidity. Metabolic disorders (MD) are becoming more prevalent both in developing countries and developed countries and are now considered as lifestyle diseases. In women of reproductive age group, especially pregnancy, the blood glucose level is increasing which adversely affects the health of mother and child. Similarly, high blood pressure also precipitates the problems. This study was carried out to find the prevalence of hypertension, diabetes mellitus, obesity and 'MD' among the women living in remote rural set-up.

Materials and Methods

This cross-sectional study was done among women of reproductive age group in 15 villages from 5 panchayats of field practice area of Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan. They were screened for 'MD' through investigative procedures (weight, height, BMR, abdominal girth, blood pressure through sphygmomanometer, blood glucose through the glucometer method), serum HDL and triglycerides. Respondents from the family were asked about the common/general information of house. The tool used for collecting general and relevant information from the respondent was a questionnaire, which was pretested for validity before being used in the field.

Results

Four-hundred and sixty-seven women of reproductive age group participated in the study. Half of the participants were with qualification of matriculate and 9.2% participants were illiterate. Three-fourths of the participants were married women and 89% were vegetarian. Sixty-four per cent of participants were housewives. Half of the participants had a normal BMI, whereas 28.9% were overweight and 10% were obese. The prevalence of hypertension and diabetes among the participants were 12.5% and 9.8%, respectively. Forty-seven per cent participants had a waist circumference above 80 cm.

Conclusion

The level of non-communicable diseases is related with the MD which has the adverse effect on the various systems and organs of the subjects. The MD can be controlled with the certain changes in the life style pattern. The GOI is also concerned with such scenarios in the country. It is recommended that women of reproductive age group undergo regular blood pressure and blood sugar screenings to detect hypertension and diabetes early and take appropriate measures to manage them.

Association between urbanization and metabolic syndrome in low- and middle-income countries: A systematic review and meta-analysis

AIMS

The prevalence of metabolic syndrome (MetS) is on the rise in an increasingly urbanized world. The study aimed to review the association between urbanization and MetS in low- and middle-income countries (LMICs).

DATA SYNTHESIS

A comprehensive search of five databases (MEDLINE, Web of Science, Scopus, EMBASE, and CENTRAL) was performed in January 2022 and updated in October 2022. Peer-reviewed studies that met the eligibility selection criteria were included. Search terms were used for the main concepts which are MetS, dietary patterns, and urbanization in LMICs. Study selection was done in two stages and in duplicate. Random effects models were used to calculate the overall pooled prevalence and main study-level characteristics. Out of 9,773 identified studies, nineteen were included in the systematic review and meta-analysis. The studies were done on 313,644 participants (149,616 urban and 164,028 rural). The pooled risk ratio (RR, 95% confidence interval) of MetS between urban and rural dwellers was RR = 1.24; 95%CI [1.15, 1.34] (I2 = 96.0%, P < 0.0001). A relatively higher prevalence of MetS among urban than rural residents has been observed, especially with the International Diabetes Federation criteria (RR = 1.54; 95%CI [1.21, 1.96]; I2 = 65.0%), and in the population in India (RR = 2.19; 95%CI = 1.24, 3.88, I2 = 85%). Overall, the role of dietary patterns in the development of MetS was inconsistent, and few studies showed a lower risk of MetS with adherence to recommended healthy dietary patterns.

CONCLUSIONS

There was an association between urbanization and the high prevalence of MetS. Interventions and policies to reduce the risk of MetS are needed.

Moringa oleifera Lam. as a potential plant for alleviation of the metabolic syndrome-A narrative review based on in vivo and clinical studies

The metabolic syndrome (MetS) refers to the co-occurrence of risk factors, including hyperglycaemia, increased body weight, hypertension and dyslipidemia, which eventually lead to diabetes and cardiovascular disease, a common health problem worldwide. Recently, there has been an increasing interest in the use of plant-based products for the management of MetS, because of their less detrimental and more beneficial effects. Moringa oleifera (Moringaceae), commonly known as drumstick, is cultivated worldwide for its nutritional and medicinal properties. This review focuses on the in vivo and human studies concerning the potential of M. oleifera in the alleviation of MetS and its comorbidities. The search for relevant articles was carried out in PubMed and Google Scholar databases. Randomised controlled and clinical trials from the PubMed database were included in this review. The results suggested that the administration of M. oleifera, in vivo, shows clear signs of improvement in MetS indices. Despite fewer human studies, the existing data documented convincing results that uphold the potential of M. oleifera against MetS. Therefore, future research discussing the probable mechanism of action is much needed which could further assure the usage of M. oleifera in the treatment regimen of MetS.

Effect of Vortioxetine in Comparison to Fluoxetine on Metabolic Parameters in Patients With Depressive Disorder: A Randomized Controlled Trial

Background Major depressive disorder (MDD) is a debilitating mood disorder that increases the risk of metabolic syndrome (MS), emphasizing the need for mental and physical health treatments. Although many studies have linked atypical antipsychotics to metabolic disturbances, there is limited evidence linking selective serotonin reuptake inhibitor use to MS. This study aimed to assess the risk of MS among patients with MDD who were administered vortioxetine and fluoxetine. Methodology This was a prospective, open-label, randomized controlled trial conducted in the psychiatry department. Using computer-generated random numbers, the physician assigned fluoxetine 20 mg or vortioxetine 10 mg and recorded MS parameters at baseline and each visit (4, 8, 12, 16, 20, and 24 weeks). This study was registered with CTRI (CTRI/2021/07/034892). Results A total of 122 participants were allocated randomly to the following two groups: group A (n = 60) and group B (n = 62). An independent-sample t-test showed a significant improvement in fasting plasma glucose (FPG) at week eight (p = 0.005), triglycerides (TGs) at week 16 (p = 0.005), high-density lipoprotein (HDL) at week 20 (p = 0.005), and waist circumference at week 24 (p = 0.005) in group A compared to group B. However, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were not significantly associated with either group (p = 0.126 and p = 0.793, respectively). Overall depression remission (Hamilton Depression Rating Scale (HAM-D)) and medication adherence rating scale scores were similar between groups (p = 0.337 and 0.325, respectively). Furthermore, most adverse drug reactions were possibly associated with the study drugs. Conclusions In comparison to group B, group A showed significant improvements in FPG, HDL, and waist circumference more effectively; however, both groups led to higher TG levels, with non-significant numerical improvements observed in SBP and DBP in both groups. In addition, both treatment groups reduced the HAM-D score and had a similar MDD remission rate.

Prevalence of Metabolic Syndrome and Specific Cardiovascular Risk Factors among Older Persons in the Philippines: Results from the 8th Philippine National Nutrition Survey

Background

Cardiovascular diseases are the leading causes of deaths among adults in the Philippines, and this is true also among older persons aged 60 years and above. Identification of risk factors and diseases that lead to cardiovascular mortality among the elderly is important to have an impact on longevity.

Objective

This study aimed to determine the prevalence of metabolic syndrome and specific cardiovascular risk factors among older persons in the Philippines.

Methods

A cross sectional design was used, with data taken from the results of the 8th Philippine National Nutrition Survey (NNS) Clinical and Health Survey done in 2013. Although there is a more recent survey, only the 2013 data is complete and available for secondary analyses.

Results

There were 1,835 older persons who were participants in the 8th Philippine NNS who had complete clinical data. The prevalence of Metabolic Syndrome was 52.6% in this population with the distribution of the components as follows: 33.5% have elevated waist circumference; 59.25 had elevated BP >130/85 mm Hg; 30.1% had fasting blood glucose ≥100 mg/dL (includes prediabetes and diabetes); 63% have low HDL, and 39% have elevated triglycerides ≥150 mg/dL.The results for other cardiovascular diseases and risk factors are as follows: 44% had hypertension using the criterion of the JNC VII report (BP ≥140/90 mm Hg); 85% had LDL cholesterol ≥100 mg/dL; 31% are current alcohol drinkers; 22% are current smokers; 53.7% have low physical activity; and 82% have an unhealthy diet.

Conclusion

Fifty-two percent (52%) of older Filipinos have metabolic syndrome and have a high prevalence of cardio-vascular risk factors, foremost of which are elevated LDL-cholesterol at 85%, hypertension at 44% based on JNC VII, approximately 10% with diabetes mellitus, but with a double burden of overweight/obesity and undernutrition. This data can help plan for public health approaches to improve quality of life and increase longevity of Filipinos.

Trajectory of metabolic syndrome and its association with knee pain in middle-aged adults

OBJECTIVE

Metabolic syndrome (MetS) is characterised by the clustering of central obesity with metabolic abnormalities. We aimed to describe the association of MetS and trajectories of MetS over 10-13 years with knee symptoms in general population-based middle-aged adults.

METHODS

Fasting blood biochemistry, waist circumference and blood pressure measures were collected during Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-6; n = 2447; mean age:31.48 ± 2.60) and after 10-13 year at CDAH-3 (year:2014-2019; n = 1549; mean age:44 ± 2.90). Participants were defined as having MetS as per International Diabetes Federation (IDF) definition. Knee symptoms were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale at CDAH-3 (mid-adulthood).

RESULTS

The prevalence of MetS increased from 8 % at young adulthood (female:52.06 %) to 13 % in mid-adulthood (female:53.78 %) over 10-13 years. Presence of MetS at mid-adulthood was associated with knee symptoms at mid-adulthood [ratio of means (RoM): 1.33; 95%CI:1.27,1.39]. Four MetS trajectories were identified-'No MetS' (85.01 %); 'Improved MetS' (2.14 %), 'Incident MetS' (8.81 %), and 'Persistent MetS, (4.04 %). Compared to 'No MetS', 'Persistent MetS' [RoM:1.15; 95%CI:1.06,1.25], 'Incident MetS' [RoM:1.56; 95%CI:1.48,1.65], and 'Improved MetS' [RoM:1.22; 95%CI:1.05,1.41] was associated with higher knee symptoms. Notably, 'Incident MetS' was strongly associated with knee symptoms [RoM: 1.56; 95%CI:1.48,1.65] and pain [RoM:1.52; 95%CI:1.37,1.70] at mid-adulthood.

CONCLUSION

In this sample of middle-aged adults, there was a significant positive association between MetS and knee symptoms. Relative to those without MetS at either life stage, the elevation in mean knee pain scores was more pronounced for those who developed MetS after young adulthood than for those who had MetS in young adulthood.

Burden, determinants and treatment status of metabolic syndrome among older adults in India: a nationally representative, community-based cross-sectional survey

Introduction

Metabolic syndrome is a significance driver of mortality and morbidity in India, but nationally representative data regarding disease burden and treatment status are lacking. Here, a cross-sectional study was undertaken to establish national and regional estimates of disease burden and explore reasons for lack of treatment of component conditions of metabolic syndrome in Indian older adults (45 years and older).

Methods

A cross-sectional study was undertaken using data from the first wave of the Longitudinal Ageing Study in India (2017-2018). Data for 66 606 individuals aged 45 years and above were analysed. The primary outcome was metabolic syndrome prevalence, defined by the National Cholesterol Education Programme ATP III criteria as an individual having any three of four component conditions: diabetes mellitus (DM), hypertension, abdominal obesity and hypercholesterolaemia. The secondary outcome of this study was treatment status of patients with component conditions.

Results

Metabolic syndrome was found to have an overall weighted prevalence of 4.83% (n=3630, 95% CI 4.24 to 5.51). Females, urban residents, obese individuals and physically inactive people exhibited greater prevalence. The most prevalent component of metabolic syndrome was hypertension followed by abdominal obesity, DM and hypercholesterolaemia. 8.85% metabolic syndrome patient reported no treatment for component conditions, while 17.58% reported only partial treatment. Elderly individuals between 60 and 69 (crude relative risk ratios, cRRR 2.20, 95% CI 1.20 to 4.01) and 80 years and above (cRRR 7.48, 95% CI 1.99 to 28.16), urban residents (cRRR 2.45, 95% CI 1.48 to 4.05), those from richer monthly per capita consumption expenditure quintiles (cRRR 2.55, 95% CI 1.00 to 6.47) and those with additional comorbidities (cRRR 2.17, 95% CI 1.28 to 3.70) were more likely to report comprehensive treatment.

Conclusions

This study highlights a substantial prevalence of metabolic syndrome in older adults in India and reveals remarkable disparities in provision of treatment. Better prevention, earlier detection and improved provision of treatment are urgently required to combat the rising prevalence of metabolic syndrome and reduce the burden of cardiovascular disease in India.

Prevalence of Metabolic Syndrome and its Risk Factors among Adults in a Rural Area of Dakshina Kannada District

Background

Metabolic syndrome (MS) consists of interconnected factors responsible for increased risk of cardiovascular diseases and development of type 2 diabetes mellitus. Early identification and treatment of components of MS leads to improved cardiovascular outcomes.

Aims

To determine the prevalence of metabolic syndrome among adults >18 years of age and to study the various socio-demographic and behavioral factors associated with MS.

Methods and Material

This was a cross-sectional study conducted among 280 adults of >18 years in a rural area of Dakshina Kannada district. Probability proportional to size and random sampling was used to select the study participants. Data was collected by interviews, anthropometry, blood investigations.

Results

Prevalence of MS was 33.9% and majority were females (71.8%). The mean age was 49.35 (±15.22) years. The prevalence (raised levels/on treatment) of hypertension, hyperlipidemia and hyperglycemia were 56.79% (systolic), 38.93% (diastolic), 38.57% (raised triglycerides), and 45% respectively. Majority of the subjects were obese (52.9%). Participants of 18-49 years age group had 2.30 times higher odds of having MS than ≥50 years age group (P value < 0.001). Female gender and low socio-economic status had 1.49- and 1.31-times higher odds of having MS respectively. Family history of diabetes and presence of co-morbidities had 1.20- and 1.02-times higher odds of developing MS.

Conclusion

There is a high prevalence of MS in rural areas. Intervention based on lifestyle modifications needs to be developed.

Role of gender in explaining metabolic syndrome risk factors in an Iranian rural population using structural equation modelling

Many factors can lead to an increase in the prevalence of metabolic syndrome (MetS) in different populations. Using an advanced structural equation model (SEM), this study is aimed to determine the most important risk factors of MetS, as a continuous latent variable, using a large number of males and females. We also aimed to evaluate the interrelations among the associated factors involved in the development of MetS. This study used data derived from the Fasa PERSIAN cohort study, a branch of the PERSIAN cohort study, for participants aged 35 to 70 years with 10,138 males and females. SEM was used to evaluate the direct and indirect effects, as well as gender effects of influencing factors. Results from the SEM showed that in females most changes in MetS are described by waist circumference (WC), followed by hypertension (HP) and triglyceride (TG), while in males most changes in MetS are described by WC, followed by TG then fasting blood glucose (FBG). Results from the SEM confirmed the gender effects of social status on MetS, mediated by sleep and controlled by age, BMI, ethnicity and physical activity. This study also shows that the integration of TG and WC within genders could be useful as a screening criterion for MetS in our study population.

Detection of Diabetes through Microarray Genes with Enhancement of Classifiers Performance

Diabetes is a life-threatening, non-communicable disease. Diabetes mellitus is a prevalent chronic disease with a significant global impact. The timely detection of diabetes in patients is necessary for an effective treatment. The primary objective of this study is to propose a novel approach for identifying type II diabetes mellitus using microarray gene data. Specifically, our research focuses on the performance enhancement of methods for detecting diabetes. Four different Dimensionality Reduction techniques, Detrend Fluctuation Analysis (DFA), the Chi-square probability density function (Chi2pdf), the Firefly algorithm, and Cuckoo Search, are used to reduce high dimensional data. Metaheuristic algorithms like Particle Swarm Optimization (PSO) and Harmonic Search (HS) are used for feature selection. Seven classifiers, Non-Linear Regression (NLR), Linear Regression (LR), Logistics Regression (LoR), Gaussian Mixture Model (GMM), Bayesian Linear Discriminant Classifier (BLDC), Softmax Discriminant Classifier (SDC), and Support Vector Machine-Radial Basis Function (SVM-RBF), are utilized to classify the diabetic and non-diabetic classes. The classifiers' performances are analyzed through parameters such as accuracy, recall, precision, F1 score, error rate, Matthews Correlation Coefficient (MCC), Jaccard metric, and kappa. The SVM (RBF) classifier with the Chi2pdf Dimensionality Reduction technique with a PSO feature selection method attained a high accuracy of 91% with a Kappa of 0.7961, outperforming all of the other classifiers.

Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India

Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.

The heterogeneity of metabolic syndrome presentation and challenges this causes in its pharmacological management: a narrative review focusing on principal risk modifiers

INTRODUCTION

Metabolic syndrome (MetS), i.e. the cluster of cardiometabolic risk factors comprising visceral obesity, impaired glucose metabolism, arterial hypertension and atherogenic dyslipidemia, is prevalent globally and exacts a heavy toll on health care expenditures.

AREAS COVERED

The pathophenotypes of individual traits of the MetS in adults are discussed first, with strong emphasis on nonalcoholic fatty liver disease (NAFLD) and sex differences. Next, I discuss recent studies on phenotypic and outcome heterogeneity of the MetS, highlighting the role of NAFLD, sex, reproductive status, and depressive disorders. In the second half of the article, the therapeutic implications of the variable MetS types and features are analyzed, focusing on the most recent developments, and guidelines.

EXPERT OPINION

I have identified physiological, pathological, social and medical sources of phenotypical heterogeneity in the MetS and its constitutive traits. Improved understanding of these variables may be utilized in the setting of future precision medicine approaches in the field of metabolic disorders and target organ damage.

Assessment of Corrected QT Interval and QT Dispersion in Patients with Uncomplicated Metabolic Syndrome

Aim

Metabolic syndrome (MS) itself has become a new entity being a constellation of physiological, biochemical, metabolic, and clinical factors that have been related to an increased risk of cardiovascular diseases, type 2 diabetes mellitus (T2DM), and morbidity and mortality. The burden of MS is increasing all over the world with the current prevalence being 30%. The QT interval and QT dispersion (QTd) have been long associated with ventricular arrhythmia and sudden cardiac deaths. The association between QT and diabetes and healthy subjects has been clearly studied, but the association between QT and uncomplicated MS has not been very well defined.

Methods

A total of 400 patients visiting the medicine clinics were assessed for blood pressure, anthropometric measurements, fasting serum lipid profile, FBS, and electrocardiogram (ECG). The patients diagnosed with uncomplicated MS as per the International Diabetic Federation (IDF) criteria were included in the study. QT interval in the ECG was recorded, and the relationship between various parameters of an uncomplicated MetS and the QT interval was recorded.

Results

Our study revealed more females with uncomplicated MS as compared to males and increasing burden as age progressed. Body mass index (BMI), waist circumference (WC), hip circumference (HC), WHP, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Fasting blood sugar (FBS), serum cholesterol, triglyceride (TG), and low-density lipoprotein (LDL) levels were positively correlated with QT values.

Conclusion

QT interval, a strong predictor of malignant ventricular arrhythmias and sudden cardiac deaths, is associated with uncomplicated MS.

Gender differences in prevalence and associated factors of metabolic syndrome in first-treatment and drug-naïve schizophrenia patients

BACKGROUND

Metabolic syndromes (MetS) are clinical syndromes involving multiple pathological states with distinct gender-specific clinical patterns. As a serious disorder associated with psychiatric conditions, the prevalence of MetS is significantly higher in the population with schizophrenia (Sch). The aim of this paper is to report gender differences in the prevalence, associated factors and severity-related factors of MetS in first-treatment and drug-naïve (FTDN) patients with Sch.

METHODS

A total of 668 patients with FTDN Sch were included in this study. We collected socio-demographic and general clinical information on the target population, measured and evaluated common metabolic parameters and routine biochemical indicators, and assessed the severity of psychiatric symptoms using Positive and Negative Symptom Scale (PANSS).

RESULTS

In the target group, the prevalence of MetS was significantly higher in women (13.44%, 57/424) than in men (6.56%, 16/244). In the males, waist circumference (WC), fasting blood glucose (FBG), diastolic blood pressure (DBP), and triglycerides (TG) were risk factors for MetS, while systolic blood pressure (SBP), TG, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and platelet (PLT) were risk factors for the females. More importantly, for the females, we found that age, LDL-C, PANSS scores and blood creatinine (CRE) were risk factors for higher MetS scores, while onset age and hemoglobin (HGB) were protective factors.

CONCLUSION

There are significant gender differences in the prevalence of MetS and its factors among patients with FTDN Sch. The prevalence of MetS is higher and the factors that influence MetS are more numerous and extensive in females. The mechanisms of this difference need further research and clinical intervention strategies should be formulated with gender differences.

Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study

BACKGROUND AND AIMS

Metabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up.

METHODS

Longitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years.

RESULTS

We included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18-34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003-0.118]), body weight (aOR 1.05 [95% CI, 1.007-1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01-1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02-1.16]). On follow-up (n = 100), 13 (13%) had MS.

CONCLUSIONS

One in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.

Association of Vitamin D Status With Metabolic Syndrome and Its Individual Risk Factors: A Cross-Sectional Study

Background Vitamin D deficiency has been associated with metabolic syndrome and its related outcomes, including type 2 diabetes mellitus, cardiovascular disease, myocardial infarction, and stroke. However, studies in Indian populations have provided conflicting results. Methods This single-center cross-sectional study was conducted in a tertiary care hospital in north India to determine the prevalence of vitamin D deficiency in patients with metabolic syndrome and to study the correlations of individual components of metabolic syndrome with 25 hydroxy vitamin D levels. The study included 235 patients aged between 30 to 70 years who met the criteria for metabolic syndrome. Patients with diabetes, hypothyroidism, Cushing's, and other disorders affecting vitamin D status, on supplements of vitamin D or anti-dyslipidaemic drugs were excluded. Information regarding socio-demographic characteristics, medical history, and anthropometric measurements were collected. Blood samples were collected to assess vitamin D levels. Results The prevalence of vitamin D deficiency (<20 ng/ml) was 76% among the study population. There was a significant negative correlation between vitamin D levels and diastolic blood pressure (Spearman's rho: -0.134, 95% CI: -0.82,-0.260, p=0.040), fasting blood glucose (Spearman's rho: -0.142, 95% CI: -0.101,-0.269, p=0.029), A weak correlation was also found between vitamin D3 levels and total cholesterol (Spearman's rho: -0.246, 95% CI: -0.119,-0.367, p<0.001), triglyceride levels (Spearman's rho: -0.246, 95% CI: -0.118,-0.370, p<0.001) and low-density lipoprotein (LDL) levels (Spearman's rho: -0.229, 95% CI: -0.102,-0.351, p<0.001). Conclusion The study findings suggest that vitamin D deficiency is prevalent among patients with metabolic syndrome in north India. There is a significant negative correlation between vitamin D levels and some components of metabolic syndrome. This highlights the need for further research to understand the underlying mechanisms and potential benefits of vitamin D supplementation in this population. Identification of high-risk individuals for hypovitaminosis D can aid in streamlining treatment guidelines and preventing unnecessary prescription of investigations in developing countries.

Prevalence of Metabolic Syndrome among Apparently Healthy Adult Population in Pakistan: A Systematic Review and Meta-Analysis

BACKGROUND

Metabolic syndrome (MetS) is considerably higher worldwide. It varies greatly in different populations geographically and based on criteria used to diagnose the disease. This review was conducted to determine the prevalence of MetS among apparently healthy adults of Pakistan. A systematic review was performed on Medline/PubMed, SCOPUS, ScienceDirect, Google Scholar, and Web of Science databases until July 2022. Articles published on Pakistani healthy adult population reporting MetS were included. Pooled prevalence was reported with 95% confidence interval (CI). Of 440 articles, 20 articles met the eligibility.

RESULTS

The pooled prevalence of MetS was 28.8% (95% CI: 17.8-39.7). The maximum prevalence was from a sub-urban village of Punjab (68%, 95% CI: 66.6-69.3) and Sindh province (63.7%, 95% CI: 61.1-66.3). International Diabetes Federation guidelines had shown 33.2% (95% CI: 18.5-48.0) whereas National Cholesterol Education Program guidelines showed 23.9% (95% CI: 8.0-39.8) prevalence of MetS. Furthermore, individuals with low high-density lipoprotein (HDL) 48.2% (95% CI: 30.8-65.6), central obesity 37.1% (95% CI: 23.7-50.5), and high triglyceride 35.8% (95% CI: 24.3-47.3) showed higher prevalence.

CONCLUSION

A considerably higher prevalence of MetS was observed among apparently healthy individuals in Pakistan. High triglyceride, low HDL, and central obesity were found as significant risk factors. (Registration # CRD42022335528).

Multimorbidity combinations and their association with functional disabilities among Indian older adults: evidence from Longitudinal Ageing Study in India (LASI)

OBJECTIVE

This study aims to identify the unique multimorbidity combinations (MMCs) and their associations with the functional disability of Indian older adults. Moreover, the population attributable fractions (PAFs) were calculated to assess the potential impact of additional diseases in the nested groups on disability.

DESIGN

A cross-sectional data were analysed in this study.

SETTING AND PARTICIPANTS

The present study uses data from the first wave of the Longitudinal Ageing Study in India (2017-2018). The sample for the study consists of 27 753 aged 60 years and over.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was functional disability, measured by the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index.

RESULTS

Out of 197 uniquely identified MMCs, the combination of hypertension and high depressive symptoms (HDS) was the most prevalent (10.3%). Overall, all MMCs were associated with increased functional limitation. Specifically, the combination of hypertension, arthritis and HDS was associated with greater ADL-IADL disability than any other MMC. The addition of HDS in group 3 (hypertension and arthritis) (incidence rate ratios (IRR)=1.44; 95% CI 1.26 to 1.64) and the addition of arthritis in group 1 (hypertension, HDS) (IRR=1.48; 95% CI 1.28 to 1.71) and group 2 (hypertension, diabetes) (IRR=1.49; 95% CI 1.22 to 1.82) significantly increases the rates of ADL-IADL disability. The estimated PAFs of the group 1 (hypertension and HDS), group 3 (hypertension and arthritis) and group 4 (arthritis and HDS) for ADL-IADL disability were 22.5% (19.2-25.5), 21.6% (18.7-24.4) and 23.5% (20.6-26.3), respectively.

CONCLUSION

The findings from this study underscore the importance of addressing the morbidity combinations which are more disabling than the others in older adults. Understanding the somatic and psychological relevance of the morbidities in functional health is necessary and can help reduce disabilities among older adults.

δ-Tocotrienol in Combination with Resveratrol Improves the Cardiometabolic Risk Factors and Biomarkers in Patients with Metabolic Syndrome: A Randomized Controlled Trial

Background: Metabolic syndrome (MetS) is a cluster of central obesity, hypertension, hyperglycemia, and dyslipidemia. It is a global health issue with an increased risk of cardiovascular disease. Recently, a few natural products have been reported with promising anti-inflammatory and antioxidative effects. We aimed to evaluate the impact of δ-tocotrienol and resveratrol mixture (TRM) supplementation on cardiometabolic risk factors and biomarkers in patients with MetS. Methods: A randomized controlled trial was conducted at the hospitals of National University of Medical Sciences Rawalpindi, Pakistan. A total of 82 patients with MetS aged 18-60 years were enrolled based on International Diabetes Federation-2005 diagnostic criteria and randomly grouped into TRM (n = 41) and placebo (n = 41). Patients in the TRM group were given a 400 mg capsule (δ-tocotrienol 250 mg; resveratrol 150 mg), and a placebo (cellulose 400 mg) twice daily for 24 weeks. The biochemical tests were analyzed on ADVIA 1800 Chemistry^® analyzer and inflammatory biomarkers by ELISA methods. Results: In the TRM group, a significant reduction in waist circumference, blood pressure, mean (95% confidence interval) of fasting plasma glucose -0.15 mmol/L (-0.22 to -0.08), serum triglyceride -0.32 mmol/L (-0.47 to -0.17), and increment in high-density lipoprotein cholesterol were observed as compared with placebo. TRM supplementation also improved biomarkers: high-sensitive C-reactive protein -0.61 mg/L (-0.89 to -0.33), interleukin-6-1.99 pg/mL (-2.50 to -1.48), tumor necrosis factor-α -2.19 pg/mL (-2.55 to -1.83), malondialdehyde -0.48 μmol/L (-0.65 to -0.30), and total antioxidant capacity 1.71 U/mL (1.29 to 2.13). Conclusion: TRM supplementations improved cardiometabolic risk factors and biomarkers of inflammation and oxidative stress without any significant side effects in the patients with MetS. Clinical Trials Registry: The clinical trial was registered in Sri Lanka Clinical Trials Registry (https://slctr.lk/trials/slctr-2019-021).

Comparison of Novel Biomarkers of Insulin Resistance With Homeostasis Model Assessment of Insulin Resistance, Its Correlation to Metabolic Syndrome in South Indian Population and Proposition of Population Specific Cutoffs for These Indices

Background The clustering of risk factors of cardiovascular disease (CVD) in individuals has been defined as Metabolic Syndrome (MetS). The major forerunner of all the components of MetS is Insulin Resistance (IR) which is measured by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and requires the measurement of fasting plasma insulin levels. We attempted to study the performance of lipid-based biochemical markers of IR for the diagnosis of MetS and postulate a population-specific cutoff for these indices in the South Indian population. In this study, we analyzed three lipid-based indices, Triglyceride Glucose index (TyG index), triglyceride: high-Density Lipoprotein (TG:HDL) ratio, and lipid accumulation product (LAP).  Methods This was a cross-sectional study and included apparently healthy individuals presenting to our hospital for routine Master Health Checkup assessment and apparently healthy population residing in Kallindhiri, a village near Madurai. Based on the anthropometric measurements and blood investigations, Body Mass Index (BMI), Waist hip ratio, Waist height ratio, HOMA-IR, TyG index, TG:HDL ratio, and LAP were calculated. The diagnostic efficacy of these indices was compared against the presence of MetS based on the NCEP ATP III criteria. The receiver operating characteristic (ROC) Curve was performed to discriminate decision levels (cutoffs) of serum markers in early diagnosis of metabolic syndrome. The results were considered significant with a p-value less than 0.05. Results We included a total of 192 patients in our study, consisting of 36% (n=70) males and 63% (n=122) females. All the baseline characteristics except height, weight, and HDL cholesterol were comparable between the male and female groups. The values of HOMA-IR, TyG index, TG:HDL ratio, and LAP showed an increasing trend with the BMI. The mean values of HOMA-IR, TyG index, TG:HDL ratio and LAP was significantly higher in patients with MetS than in patients without MetS. Based on the ROC curve plotted for the data, a population-specific cutoff for these indices was computed. Our proposed cutoff for the South Indian population for HOMA-IR is 1.23, for TyG index is 4.65, for TG:HDL ratio is 3.44 in males and 2.6 in females and for LAP is 43.81 Conclusion The cutoffs for the novel indices of insulin resistance which have been previously studied in Caucasian populations cannot be applied to Indian populations due to distinct ethnic characteristics. The diagnostic accuracy of these novel lipid-based biomarkers of Insulin Resistance is better than the biochemical gold standard of HOMA-IR based on the ROC curve. We propose the usage of these population-specific cutoffs in routine clinical practice for early diagnosis of metabolic syndrome.