Prevalence of metabolic syndrome in the Canadian adult population

Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions

Several hallmarks of metabolic syndrome, such as dysregulation in the glucose and lipid metabolism, endothelial dysfunction, insulin resistance, low-to-medium systemic inflammation, and intestinal microbiota dysbiosis, represent a pathological bridge between metabolic syndrome and diabesity, cardiovascular, and neurodegenerative disorders. This review aims to highlight some therapeutic strategies against metabolic syndrome involving integrative approaches to improve lifestyle and daily diet. The beneficial effects of foods containing antioxidant polyphenols, intestinal microbiota control, and physical activity were also considered. We comprehensively examined a large body of published articles involving basic, animal, and human studie, as well as recent guidelines. As a result, dietary polyphenols from natural plant-based antioxidants and adherence to the Mediterranean diet, along with physical exercise, are promising complementary therapies to delay or prevent the onset of metabolic syndrome and counteract diabesity and cardiovascular diseases, as well as to protect against neurodegenerative disorders and cognitive decline. Modulation of the intestinal microbiota reduces the risks associated with MS, improves diabetes and cardiovascular diseases (CVD), and exerts neuroprotective action. Despite several studies, the estimation of dietary polyphenol intake is inconclusive and requires further evidence. Lifestyle interventions involving physical activity and reduced calorie intake can improve metabolic outcomes.

Adiposity Phenotypes and Associated Cardiometabolic Risk Profile in the Inuit Population of Nunavik

The Inuit population of Nunavik is faced with a significant rise in the prevalence of obesity [body mass index (BMI) ≥ 30 kg/m2], but the impact on cardiometabolic health is unclear. The aim of this study was to characterize adiposity phenotypes and explore their associations with cardiometabolic risk factors among Nunavimmiut men and women. We used data obtained from 1296 Inuit who participated in the Qanuilirpitaa? 2017 Nunavik Inuit Health survey. Collected information included demographics, anthropometric measurements including visceral fat level (VFL) measured using electrical bioimpedance, biomarkers, hemodynamics, medical history and medication list. Adjusted population-weighted linear regressions were conducted to assess associations between body fat distribution and cardiometabolic risk factors. The accuracy and cut-off points of anthropometric indices to detect cardiometabolic abnormalities was evaluated by area under the receiver operator characteristic curve (AUROC) and a maximum Youden index analysis. Among Nunavimmiut (mean age 38.8 years [95%CI: 38.4 to 39.3]), obesity was observed in 42.8% of women and 25.6% of men. Compared to men, women presented a higher prevalence of abdominal obesity (78.8% vs. 46.4% in men, p < 0.05) and elevated VFL (54.4% vs. 20.1% with an InBody level ≥ 13, p < 0.05). Indices of global fat distribution and abdominal adiposity including VFL provided poor to moderate ability to detect cardiometabolic abnormalities (AUROC between 0.64 and 0.79). This analysis revealed that despite a high prevalence of abdominal obesity, particularly among women, anthropometric measurements of adiposity are inconsistently associated cardio-metabolic risk factors in Inuit adults of Nunavik.

Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study

INTRODUCTION

The burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate.  Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex.

METHOD

Data from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex,  age and gender-related factors were also tested.

RESULTS

Among 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated a decreased risk of MetS compared to males. Conversely smoking and unemployment were significant risk factors for MetS development among male adults.

CONCLUSIONS

Gender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people.

Increased Prevalence of Adverse Health Outcomes Across the Lifespan in Those Affected by Polycystic Ovary Syndrome: A Canadian Population Cohort

Background

Polycystic ovary syndrome (PCOS) is the most common metabolic-endocrine disorder impacting the health and quality of life of women over the lifespan. Evidence-based data on the scope of adverse health outcomes in those affected by PCOS is critical to improve healthcare and quality of life in this population. The aim of this study was to determine the prevalence of adverse health outcomes in those with PCOS compared to age-matched controls.

Methods

We conducted a retrospective observational case-control study in those diagnosed with PCOS and age-matched controls using the Alberta Health Services Health Analytics database and the International Classification of Diseases, for the period from 2002-2018 in Alberta, Canada.

Results

The cohort consisted of n = 16,531 exposed PCOS cases and n = 49,335 age-matched un-exposed controls. The prevalences of hypertension, renal disease, gastrointestinal disease, eating disorders, mental illness, depression-anxiety, rheumatoid arthritis, respiratory infections, and all malignancies were 20%-40% (P < 0.0001) higher in those with PCOS, compared to controls. The prevalence of obesity, dyslipidemia, nonalcoholic fatty liver disease, and type 2 diabetes was 2-3 fold higher in those with PCOS (P < 0.001). Cardiovascular, cerebrovascular, and peripheral vascular disease were 30%-50% higher, and they occurred 3-4 years earlier in those with PCOS (P < 0.0001); a 2-fold higher prevalence of dementia occurred in those with PCOS, compared to controls.

Conclusion

These findings provide evidence that PCOS is associated with a higher prevalence of morbidities over the lifespan, and the potential scope of the healthcare burden in women affected by PCOS.

Impact of Sex and Gender on Metabolic Syndrome in Adults: A Retrospective Cohort Study From the Canadian Primary Care Sentinel Surveillance Network

OBJECTIVE

Metabolic syndrome (MetS), a cluster of 5 interconnected factors, is the main contributor to cardiovascular disease. Although sex- and gender-related elements have been linked to MetS and its components, this association has not been explored among Canadians with or without MetS. In this study, we aimed to identify sex and gender differences in characteristics of MetS in the Canadian population.

METHODS

This retrospective cohort study used data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database. The CPCSSN contains de-identified electronic health records of >1.5 million Canadians (2010-2019). Individuals 35 to 75 years of age who had a primary care encounter formed the study sample (N=37,813). Multiple logistic regression models were used to estimate adjusted odds ratios for sex and gender differences among Canadians with and without MetS, which was the primary outcome variable.

RESULTS

The estimated prevalence of MetS was 41.9%. The risk of developing MetS was significantly lower among females compared with males (odds ratio 0.73, 95% confidence interval 0.70 to 0.76). However, the risk was higher in females who used antidepressants (odds ratio 1.53, 95% confidence interval 1.42 to 1.65). An equal distribution of deprivation indexes was observed between males and females with MetS, with risk slightly higher for those with material deprivation. Females were found to be the most socially deprived.

CONCLUSIONS

This study provides important sex- and gender-specific differences in MetS among Canadians. Targeting sex- and gender-specific risk factors could assist in reversing the trend of adverse cardiovascular outcomes associated with MetS.

Encapsulation of conjugated linoleic acid and ruminant trans fatty acids to study the prevention of metabolic syndrome-a review

Studies have reported the potential benefits of consuming conjugated linoleic acid (CLA) and ruminant trans fatty acids (R-TFAs) in reducing the risk factors of metabolic syndrome (MetS). In addition, encapsulation of CLA and R-TFAs may improve their oral delivery and further decrease the risk factors of MetS. The objectives of this review were (1) to discuss the advantages of encapsulation; (2) to compare the materials and techniques used for encapsulating CLA and R-TFAs; and (3) to review the effects of encapsulated vs non-encapsulated CLA and R-TFAs on MetS risk factors. Examination of papers citing micro- and nano-encapsulation methods used in food sciences, as well as the effects of encapsulated vs non-encapsulated CLA and R-TFAs, was conducted using the PubMed database. A total of 84 papers were examined; of these, 18 studies were selected that contained information on the effects of encapsulated CLA and R-TFAs. The 18 studies that described encapsulation of CLA or R-TFAs indicated that micro- or nano-encapsulation processes stabilized CLA and prevented oxidation. CLA was mainly encapsulated using carbohydrates or proteins. So far, oil-in-water emulsification followed by spray-drying were the frequently used techniques for encapsulation of CLA. Further, 4 studies investigated the effects of encapsulated CLA on MetS risk factors compared with non-encapsulated CLA. A limited number of studies investigated the encapsulation of R-TFAs. The effects of encapsulated CLA or R-TFAs on the risk factors for MetS remain understudied; thus, additional studies comparing the effects of encapsulated and non-encapsulated CLA or R-TFAs are needed.

Metabolic Syndrome: A Narrative Review from the Oxidative Stress to the Management of Related Diseases

Metabolic syndrome (MS) is a growing disorder affecting thousands of people worldwide, especially in industrialised countries, increasing mortality. Oxidative stress, hyperglycaemia, insulin resistance, inflammation, dysbiosis, abdominal obesity, atherogenic dyslipidaemia and hypertension are important factors linked to MS clusters of different pathologies, such as diabesity, cardiovascular diseases and neurological disorders. All biochemical changes observed in MS, such as dysregulation in the glucose and lipid metabolism, immune response, endothelial cell function and intestinal microbiota, promote pathological bridges between metabolic syndrome, diabesity and cardiovascular and neurodegenerative disorders. This review aims to summarise metabolic syndrome's involvement in diabesity and highlight the link between MS and cardiovascular and neurological diseases. A better understanding of MS could promote a novel strategic approach to reduce MS comorbidities.

Effects of Daily Intake of Rosehip Extract on Low-Density Lipoprotein Cholesterol and Blood Glucose Levels: A Systematic Review

This systematic review evaluates the effects of the daily intake of rosehip extract on low-density lipoprotein cholesterol (LDL-C) and blood glucose levels. It synthesizes findings from randomized clinical trials focusing on cardiovascular and metabolic health outcomes. The review includes studies employing various forms of rosehip supplementation, assessing primary outcomes such as LDL-C, HDL-C, total cholesterol, triglycerides, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c). Secondary outcomes, such as body weight, BMI, and blood pressure, are also considered. The paper discusses the potential mechanisms of rosehip's action, including modulation of peroxisome proliferator-activated receptors and effects on various metabolic pathways. The results indicate mixed effects on lipid profiles and blood glucose levels, with some studies showing significant benefits. This review underscores the need for further research to confirm optimal dosages, treatment durations, and rosehip's efficacy in diverse populations, considering its favorable safety profile. The findings suggest the potential of rosehip extract as a complementary agent in managing cardiometabolic risk factors.

Comparison of different definitions of metabolic syndrome and their associations with non-alcoholic fatty liver disease: a retrospective study

Background

Metabolic syndrome (MetS) is considered an important risk factor for non-alcoholic fatty liver disease (NAFLD). The aim of this study was to measure the prevalence of MetS based on six different MetS definitions and compare the performance of various definitions for identifying diabetes, hypertension, and dyslipidemia among NAFLD patients.

Methods

The definitions compared were those developed by the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), American Association of Clinical Endocrinologists (AACE), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI), and Interim Joint Statement "harmonized" criteria. Receiver operator characteristic (ROC) curves were plotted for the six MetS definitions with NAFLD diagnosis. The diagnosis for NAFLD was established based on liver imaging or biopsy compatible with fatty liver disease.

Results

A total of 500 NAFLD patients were analyzed. The mean age was 61.2 (SD 13.2) years, and BMI was 32.7 (SD 8.0) kg/m2. The most prevalent MetS component was dyslipidemia (83%), followed by hypertension (60%), obesity (61%), and diabetes (57%). The prevalence of MetS according to the WHO, NCEP/ATP-III, IDF, AACE, AHA/NHLBI, and harmonized criteria was 69%, 59%, 54%, 64%, 78%, and 79%, respectively. The highest area under the ROC curve for diabetes and hypertension was with the WHO definition (0.7405) and (0.8120), respectively.

Conclusions

The prevalence of MetS in NAFLD patients varies according to the definitions of MetS employed. The modified WHO definition appeared to be most useful for the screening of MetS in NAFLD patients.

Prevalence of metabolic syndrome and its association with oral health: First results from the Kurdish cohort study

Aims

Investigate the association between oral and dental health (ODH) and metabolic syndrome (MetS) in adults aged 35-70 years.

Methods

The study utilized data from the enrollment phase of Dehgolan prospective cohort study in the west of Iran. A cross-sectional assessment was conducted on a total of 3996 participants, involving a comprehensive oral examination and the assessment of their oral hygiene behavior (ODH). MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III. Logistic regression used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics.

Results

MetS was more prevalent among those who not daily brushing and flossing. Participants with missing teeth (MT) show higher prevalent of MetS. Being female, lower age, illiteracy, family history of diabetes, low physical activity, and salt at table were independently associated with increase odds of MetS (p < 0.05). Odds of MetS were significantly decreased with use flossing (OR = 0.75; CI = 0.60-0.93), decayed (OR = 0.83; CI = 0.72-0.97), filled (OR = 0.84; CI = 0.71-0.99), and increased with MT (OR = 1.45; CI = 1.16-1.81) as long as adjusted for ODH factors. When other potential confounder such as sociodemographic, personal and nutritional habits were adjusted, daily flossing was the only factor that still statistically decreased (OR = 0.79; CI = 0.62-0.99) the odds of MetS.

Conclusion

Daily flossing was the only factor that independently associated with MetS. Relationship of other ODH factors with Mets were confounded by sociodemographic characteristics of the participants.

Metabolic syndrome criteria and severity and carbon dioxide (CO2) emissions in an adult population

BACKGROUND

Metabolic syndrome (MetS) has become a growing risk factor of some non-communicable diseases. Increase of greenhouse gas emissions affects the planet.

AIMS

To assess the association between MetS severity and amount of carbon dioxide (CO₂) emitted in an adult population.

DESIGN

Cross-sectional study (n = 6646; 55-76-year-old-men; 60-75-year-old-women with MetS).

METHODS

Dietary habits were assessed using a pre-validated semi quantitative 143-item food frequency questionnaire. The amount of CO₂ emitted due to the production of food consumed by person and day was calculated using a European database, and the severity of the MetS was calculated with the MetS Severity Score.

RESULTS

Higher glycaemia levels were found in people with higher CO₂ emissions. The risk of having high severe MetS was related to high CO₂ emissions.

CONCLUSIONS

Low CO₂ emissions diet would help to reduce MetS severity. Advantages for both health and the environment were found following a more sustainable diet.

TRIAL REGISTRATION

ISRCTN, ISRCTN89898870 . Registered 05 September 2013.

Elevated Chinese visceral adiposity index increases the risk of stroke in Chinese patients with metabolic syndrome

Introduction

Patients with Metabolic Syndrome (MetS) are considered at high-risk for incident stroke. An indicator of visceral adiposity dysfunction, the Chinese Visceral Adiposity Index (CVAI) is used to evaluate the dysfunction of visceral fat. Given the impact of visceral adiposity dysfunction on elevating cardiovascular hazards, this study aimed to examine the association between CVAI and stroke risk in MetS patients.

Method

Between November 2017 and December 2018, a total of 18,974 individuals aged ≥40 underwent standardized in-person clinical interviews in Hunan Province, with 6,732 meeting the criteria for MetS. After the baseline survey was completed, subsequent surveys were conducted biennially. The study was split into two stages performed at baseline and after two years. During the former, receiver-operating characteristic curves were used to assess the accuracy of using baseline CVAI in diagnosing MetS. After two years, we examined the association between CVAI and incident stroke in MetS patients using logistic regression, subgroup analysis, and restricted cubic spline (RCS) analysis.

Result

As evidenced by a higher AUC (AUC:0.741), CVAI demonstrated superior diagnostic performance relative to body mass index (AUC:0.631) and waist circumference (AUC:0.627) in diagnosing MetS. After a 2-year follow-up, 72 MetS patients had a stroke event. There was a robust positive correlation between incident stroke and CVAI in patients with MetS. Each 1 SD increase in CVAI was associated with a 1.52-fold higher risk of stroke after adjustment for confounding factors (aOR=1.52, 95%CI: 1.18-1.95). The RCS demonstrated a reduced risk of stroke for MetS patients when the CVAI was below 110.91. However, no significant correlation was detected between CVAI and stroke in non-MetS patients.

Conclusion

Our findings recommend CVAI as a superior screening tool for detecting MetS and suggest that reducing CVAI can mitigate the risk of stroke in patients with MetS.

Geniposide alleviates pressure overload in cardiac fibrosis with suppressed TGF-β1 pathway

BACKGROUND

Cardiac fibrosis is one of the main contributors to the pathogenesis of heart failure. Geniposide (GE), a major iridoid in gardenia fruit extract, has recently been reported to improve skeletal muscle fibrosis through the modulation of inflammation response. This investigation aimed to illuminate the cardio-protective effect and the potential mechanism of GE in cardiac fibrosis.

MATERIAL AND METHODS

A transverse aortic contraction (TAC) induction mice model was established and GE (0 mg/kg; 10 mg/kg; 20 mg/kg; 40 mg/kg) was administered by oral gavage daily for 4 weeks. Hemodynamic parameters, Masson's trichrome stain, and hematoxylin-eosin (HE) staining were estimated and cardiomyocyte fibrosis, interstitial collagen levels, and hypertrophic markers were analyzed using qPCR and western blot. In vitro, H9C2 cells were exposed to the Ang II (1 μM) pretreated with GE (0.1 μM, 1 μM, and 10 μM). Cardiomyocyte apoptosis was detected. Moreover, the transforming growth factor β1 (TGF-β1)/Smad2 pathway was assessed in vivo and in vitro.

RESULTS

GE significantly ameliorated TAC-induced cardiac hypertrophy, ventricular remodeling, myocardial fibrosis, and improved cardiac function in vivo, and it inhibited Ang II-induced cardiomyocyte apoptosis in vitro. We further observed that the inflammatory channel TGF-β1/Smad2 pathway was suppressed by GE both in vivo and in vitro.

CONCLUSION

These results indicate that GE inhibited myocardial fibrosis and improved hypertrophic cardiomyocytes with attenuated the TGF-β1/Smad2 pathway and proposed to be an important therapeutic of cardiac fibrosis reduced by TAC.

Metabolic syndrome predicts cardiovascular risk and mortality in familial hypercholesterolemia

BACKGROUND

The association between familial hypercholesterolemia (FH) and premature atherosclerotic cardiovascular disease (ASCVD) is well established. Several risk factors other than the cumulative low-density lipoprotein cholesterol (LDL-C) have been shown to modulate the severity of the phenotype in these patients. However, the effect of the metabolic syndrome (MetS) on ASCVD risk in FH remains to be determined.

OBJECTIVES

The objective was to study the association between the presence of MetS and the incidence of different ASCVD endpoints and all-cause mortality.

METHODS

This prospective follow up study used data from 5 independent FH cohorts from Europe and North America. We analysed data of 2401 adult heterozygous FH without history of a prior ASCVD event (21,139 person-years of follow-up). Multivariate Cox proportional hazards regression was used to estimate the association between MetS and the incidence of the different endpoints.

RESULTS

The prevalence of MetS was 14% in the study population. The presence of MetS was a significant predictor of incident 10-year ASCVD after adjustment for traditional cardiovascular risk factors (HR 2.07, 95% CI 1.34-3.19), as well as of 10-year major adverse cardiovascular event (MACE) (HR 4.59, 95% CI 2.27-9.30), 10-year myocardial infarction (MI) (HR 4.29, 95% CI 1.91-9.63), and 30-year all-cause mortality (HR 4.87, 95% CI 1.99-11.89).

CONCLUSION

Our findings suggests that FH patients with MetS, have an increased cardiovascular risk that is independent from LDL-C and other traditional risk factors. Future studies are required to determine the most appropriate strategy to reduce the cardiovascular burden associated with MetS in this population.

The effect of Tabata-style functional high-intensity interval training on cardiometabolic health and physical activity in female university students

Introduction: The increasing prevalence of metabolic syndrome and physical inactivity enhances exposure to cardiometabolic risk factors in university students. High-intensity interval training (HIIT) improved cardiometabolic health in clinical adults but the evidence in the university setting is limited. Furthermore, few studies examined the effect of low-volume HIIT on habitual physical activity (PA). Therefore, the primary aim of this study was to evaluate the efficacy of 12-week Tabata-style functional HIIT for improving multiple cardiometabolic health outcomes and habitual PA. We also investigated whether changes in habitual PA over the intervention period had an impact on exercise-induced health outcomes. Methods: 122 female freshmen were randomized into the Tabata group (n = 60) and the control (n = 62). The Tabata training protocol involved 8 × 20 s maximal repeated functional exercises followed by 10 s rest with a frequency of 3 times per week for 12 weeks. Body composition, maximal oxygen uptake (VO_2max), blood pressure (BP), blood lipids, fasting glucose and insulin, C-reactive protein and PA were objectively measured using standardized methods. Dietary intake was measured using a valid food frequency questionnaire. All variables were measured pre- and post-intervention. Results: Mixed linear modelling results showed that there were large intervention effects on VO_2max (p < 0.001, d = 2.53, 95% CI: 2.03 to 3.00 for relative VO_2max; p < 0.001, d = 2.24, 95% CI: 1.76 to 2.68 for absolute VO_2max), resting heart rate (p < 0.001, d = -1.82, 95% CI: -2.23 to -1.37), systolic BP (p < 0.001, d = -1.24, 95% CI: -1.63 to -0.84), moderate-to-vigorous intensity physical activity (MVPA) (p < 0.001, d = 2.31, 95% CI: 1.83 to 2.77), total PA (p < 0.001, d = 1.98, 95% CI: 1.53 to 2.41); moderate effects on %BF (p < 0.001, d = -1.15, 95% CI: -1.53 to -0.75), FM (p < 0.001, d = -1.08, 95% CI: -1.46 to -0.69), high-density lipoprotein (HDL) (p < 0.001, d = 1.04, 95% CI: 0.65 to 1.42), total cholesterol (p = 0.001, d = -0.64, 95% CI: -1.00 to -0.26); small effects on BMI (p = 0.011, d = -0.48, 95% CI: -0.84 to 0.11), WC (p = 0.043, d = -0.37, 95% CI: -0.74 to -0.01), low-density lipoprotein (p = 0.003, d = -0.57, 95% CI: -0.93 to -0.19), HOMA-IR (p = 0.026, d = -0.42, 95% CI: -0.78 to -0.05) and fasting insulin (p = 0.035, d = -0.40, 95% CI: -0.76 to -0.03). Regression analysis showed that only the percentage change of HDL was associated with the change of MVPA (b = 0.326, p = 0.015) and TPA (b = 0.480, p = 0.001). Conclusion: From the findings of the study we can conclude that 12-week low-volume Tabata-style functional HIIT was highly effective for university female students to improve cardiorespiratory fitness, body fat, some cardiometabolic health outcomes and habitual PA.

Association between liver enzymes and metabolic syndrome in Canadian adults: results from the Canadian health measures survey - cycles 3 &4

Background

The relationship between liver enzymes and Metabolic Syndrome (MetS) in different populations, including Canadians, is not consistent and well understood. We used the Canadian Health Measures Survey data (Cycles 3 and 4) to examine the cross-sectional relationships between select liver biomarkers and MetS in the adult Canadian population. The biomarkers selected were gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alkaline phosphatase (ALKP).

Methods

Fasting blood samples (FBS) were collected from adults above the age of 20 years for Cycle 3 and Cycle 4 (n = 3003). MetS was diagnosed if the subjects had three or more risk determinants according to the Joint Interim Statement criteria. Primary risk factors included quartile cut-offs for each of the biomarkers ALKP, AST, GGT for males and females separately. A multivariable logistic regression technique based on a maximum likelihood approach was used to evaluate the association between quartiles of ALKP, AST, and GGT, other individual and contextual factors, and the prevalence of MetS.

Results

MetS was prevalent in 32.3% of subjects. BMI was an effect modifier in the relationship between GGT and MetS prevalence, while sex was an effect modifier in the relationship between ALKP and MetS prevalence; and age was an effect modifier in the relationship between AST and MetS prevalence.

Conclusions

Since the mechanisms to underpin the associations between the liver enzymes activity and MetS are unknown, further epidemiologic investigations using longitudinal designs are necessary to understand these associations.

Sleeping duration, physical activity, alcohol drinking and other risk factors as potential attributes of metabolic syndrome in adults in Ethiopia: A hospital-based cross-sectional study

Background

Available evidence showed that metabolic syndrome in the adult population is persistently elevated due to nutrition transition, genetic predisposition, individual-related lifestyle factors, and other environmental risks. However, in developing nations, the burden and scientific evidence on the pattern, and risk exposures for the development of the metabolic syndrome were not adequately investigated. Thus, the study aimed to measure the prevalence of metabolic syndrome and to identify specific risk factors among adult populations who visited Dessie Comprehensive Specialized Hospital, Ethiopia.

Methods

A hospital-based cross-sectional study was conducted among randomly selected 419 adults attending Dessie Comprehensive Specialized Hospital from January 25 to February 29, 2020. We used the WHO STEP-wise approach for non-communicable disease surveillance to assess participants’ disease condition. Metabolic syndrome was measured using the harmonized criteria recommended by the International Diabetes Federation Task Force in 2009. Data were explored for missing values, outliers and multicollinearity before presenting the summary statistics and regression results. Multivariable logistic regression was used to disentangle statistically significant predictors of metabolic syndrome expressed using an odds ratio with a 95% of uncertainty interval. All statistical tests were managed using SPSS version 26. A non-linear dose-response analysis was performed to show the relationships between metabolic syndromes with potential risk factors.

Results

The overall prevalence of metabolic syndrome among adults was 35.0% (95% CI, (30.5, 39.8)). Women were more affected than men (i.e. 40.3% vs 29.4%). After adjusting for other variables, being female [OR = 1.85; 95% CI (1.01, 3.38)], urban residence [OR = 1.94; 95% CI (1.08, 3.24)], increased age [OR = 18.23; 95% CI (6.66, 49.84)], shorter sleeping durations [OR = 4.62; 95% CI (1.02, 20.98)], sedentary behaviour [OR = 4.05; 95% CI (1.80, 9.11)], obesity [OR = 3.14; 95% CI (1.20, 8.18)] and alcohol drinking [OR = 2.85; 95% CI (1.27,6.39)] were positively associated with the adult metabolic syndrome. Whilst have no formal education [OR = 0.30; 95% CI (0.12, 0.74)] was negatively associated with metabolic syndrome.

Conclusions

The prevalence of adult metabolic syndrome is found to be high. Metabolic syndrome has linear relationships with BMI, physical activity, sleep duration, and level of education. The demographic and behavioural factors are strongly related with the risk of metabolic syndrome. Since most of the factors are modifiable, there should be urgent large-scale community intervention programs focusing on increased physical activity, healthy sleep, weight management, minimize behavioural risk factors, and healthier food interventions targeting a lifecycle approach. The existing policy should be evaluated whether due attention has given to prevention strategies of NCDs.

Development and Validation of a Simple Risk Model for Predicting Metabolic Syndrome (MetS) in Midlife: A Cohort Study

Purpose

To develop and validate a simple risk model for predicting metabolic syndrome in midlife using a prospective cohort data.

Design

Prospective cohort study.

Participants

A total of 7626 members of the 1958 British birth cohort (individuals born in the first week of March 1958) participated in the biomedical survey at age 45 and have completed information on metabolic syndrome.

Methods

Variables utilised were obtained prospectively at birth, 7, 16, 23 and 45 years. Multivariable logistic regression was used to develop a total of ten (10) MetS risk prediction models taking the life course approach. Measures of discrimination and calibration were used to evaluate the performance of the models. A pragmatic criteria developed was used to select one model with the most potential to be useful. The internal validity (overfitting) of the selected model was assessed using bootstrap technique of Stata.

Main Outcome Measure

Metabolic syndrome was defined based on the NCEP-ATP III clinical criteria.

Results

There is high prevalence of MetS among the cohort members (19.6%), with males having higher risk as compared to females (22.8% vs 16.4%, P < 0.001). Individuals with MetS are more likely to have higher levels of HbA1c and low HDL-cholesterol. Similarly, regarding the individual components of MetS, male cohort members are more likely to have higher levels of glycaemia (HbA1c), BP and serum triglycerides. In contrast, female cohort members have lower levels of HDL-cholesterol and higher levels of waist circumference. Furthermore, a total of ten (10) MetS risk prediction models were developed taking the life course approach. Of these, one model with the most potential to be applied in practical setting was selected. The model has good accuracy (AUROC 0.91 (0.90, 0.92)), is well calibrated (Hosmer-Lemeshow 6.47 (0.595)) and has good internal validity.

Conclusion

Early life factors could be included in a risk model to predict MetS in midlife. The developed model has been shown to be accurate and has good internal validity. Therefore, interventions targeting socioeconomic inequality could help in the wider prevention of MetS. However, the validity of the developed model needs to be further established in an external population.

Mindfulness-Based Stress Reduction in Older Adults at Risk for Coronary Artery Disease: A Pilot Randomized Trial

OBJECTIVES

Stress influences metabolic activity and increases risk for cardiovascular disease (CVD). We sought to a) examine feasibility and acceptability of mindfulness-based stress reduction (MBSR) in older adults at risk for CVD, and b) obtain preliminary data on its metabolic impact.

METHODS

A pilot RCT was conducted using a pre-post, 2-month follow-up design. Eighty-one individuals with metabolic syndrome and non-normative responses to stress in a previous investigation were invited. Participants were randomized (by sex and stress response) to a 9-week MBSR or a wait-list control group. Feasibility and acceptability were assessed and blood assayed. Between-subjects (MBSR vs waitlist control) ANOVAs on metabolic parameter change scores, and one-way repeated measures ANOVAs (pre-, post-, follow-up) were performed.

RESULTS

Thirty-three individuals (41%) responded to invitations, 26 were interested, of whom 19 were randomized (M_age = 67 years, SD = 7.70). Completion rate of MBSR was 72% and overall attendance was 96%. Reported benefits included increased relaxation, greater interpersonal connection, and increased body awareness. MBSR led to a decrease of 15% in LDL cholesterol and 10% in total cholesterol versus 4.5% and 1%, respectively, in the waitlist. Within group analyses showed notable decreases in LDL, triglycerides, and waist circumference post-MBSR and 2 months later.

CONCLUSIONS

A RCT was largely feasible and MBSR acceptable to participants. MBSR may lead to sustained decreases in cholesterol levels, warranting development of large-scale research on this topic.

CLINICAL IMPLICATIONS

Given the role of stress in CVD, addition of stress management interventions may serve as a useful complement to risk management among older individuals.

Obesity and metabolic comorbidity in bipolar disorder: do patients on lithium comprise a subgroup? A naturalistic study

BACKGROUND

Bipolar disorders (BD) are associated with increased prevalence of obesity and metabolic syndrome (MetS). Nevertheless, there is a wide range in prevalence estimates, with little known about the contributions of pharmacotherapy. It has been suggested that lithium might have a more favorable metabolic profile. We hypothesized that lithium use is associated with less increased body mass index (BMI), MetS, and type II diabetes, when compared with non-lithium users (those on anticonvulsants, second-generation antipsychotics).

METHODS

Cross-sectional study of 129 patients aged 18-85 with bipolar disorder, followed at tertiary care clinics in Montreal. Patients using lithium were compared with those not on lithium, for body mass index and metabolic syndrome.

RESULTS

The prevalence of obesity and metabolic syndrome in the sample of lithium-using patients with BD was 42.4 and 35.7% respectively, with an average BMI of 29.10 (+/- 6.70). Lithium and non-lithium groups did not differ in BMI or prevalence of MetS. However, compared to the non-lithium group, lithium users had lower hemoglobin A1C (5.24 +/- 0.53 versus 6.01 +/- 1.83, U = 753.5, p = 0.006) and lower triglycerides (1.46 +/- 0.88 versus 2.01 +/- 1.25, U = 947, p = 0.020).

CONCLUSIONS

There is a high prevalence of obesity and metabolic syndrome among patients with bipolar disorder. However, this did not appear to be associated with lithium use, when compared to those not on lithium. The lithium subgroup was also associated with lower prevalence of type II diabetes. Future prospective and intervention studies with larger sample sizes are necessary to further explore the association between lithium and insulin resistance, as well as its underlying mechanisms.

Fast-Food Dietary Pattern Is Linked to Higher Prevalence of Metabolic Syndrome in Older Canadian Adults

Background

Metabolic syndrome (MetS) is known to increase the risk of cardiovascular diseases and diabetes. Diet is a key factor in prevention and development of MetS. This study aimed to determine the association between dietary patterns and MetS among Canadians 12–79 years old using the Canadian Health Measures Survey (CHMS) combined Cycles 1 and 2 data from 2007–11. We hypothesized that MetS varies among different sociodemographic and lifestyle factors and that Canadians who have less healthy dietary patterns are more likely to have MetS.

Methods

In the CHMS, MetS was determined using objective health measures. The principal component analysis method was used to determine the dietary patterns. Using logistic regression, the association between MetS and dietary patterns, controlling for potential covariates, was investigated for age groups of 12–19, 20–49, and 50–79 years. Survey data were weighted and bootstrapped to be representative at the national level.

Results

The prevalence of MetS was 16.9% for ages 12–79 y (n = 4,272, males = 49.6%), representing 26,038,108 Canadians aged 12–79 years. MetS was significantly different across sociodemographic variables; Canadians with less education, income, and activity had higher MetS prevalence than their counterparts. In older adults (50–79 years of age), the “fast-food” dietary pattern was associated with 26% (odds ratio = 1.26; 95% CI: 1.04 to 1.54; p=0.0195) higher likelihood of having MetS.

Conclusions

Among older Canadians, MetS is associated with a “fast-food” dietary pattern after adjustment for socioeconomic/lifestyle factors. Findings suggest the importance of diet quality/composition in the development of MetS among older Canadians and the need for further longitudinal studies on MetS and diet across the lifespan.

Chronic Liver Disease and Metabolic Comorbidities in Healthy Young Males Followed for 65 Years: The Manitoba Follow-up Study

BACKGROUND & AIMS

The prevalence of chronic liver disease (CLD) is largely derived from cross-sectional epidemiologic surveys. The goal of this long-term, prospective study was to document the lifetime risk of developing chronic liver disease and determine the impact of common metabolic conditions associated with metabolic syndrome (MetS) on the development and outcomes of CLD.

METHODS

3,983 air force men were enrolled in the Manitoba Follow-up Study in 1948. The comprehensive database on results of routine physicals and health encounters was examined for evidence of CLD and MetS. The joint relationship between CLD and components of MetS on mortality was examined using Cox proportional hazard model.

RESULTS

In 65 follow-up years, 5.2% of men developed CLD and 6.4% MetS. Hypertension was the strongest predictor of CLD (HR 2.958, 95% CI - 2.065 to 4.236, p < .0001), followed by insulin resistance /diabetes mellitus (IR/DM) (2.008, 95% CI - 1.332 to 3.027, p = .0009) and obesity (1.958, 95% CI - 1.419 to 2.703, p < .0001). Relative to men without MetS comorbidities, an increasing gradient of risk for CLD was apparent with increasing numbers of MetS components; the HR of 3.67, 5.97 and 14.3 for IR/DM, IR/DM + one component, and IR/DM + two or more components respectively. The relative risk of mortality in men with vs. without CLD was 3.33 (95% CI - 2.83 to 3.91, p < .0001) and 1.505 (95% CI - 1.31 to 1.73, p < .0001) in men with vs. without MetS.

CONCLUSIONS

CLD and MetS independently increase the relative risk of mortality; the magnitude of the effect is greater in CLD.

The Relationship between Metabolic Syndrome and Smoking and Alcohol Experiences in Adolescents from Low-Income Households

Metabolic syndrome (MetS) in children and adolescents is increasing globally and the age of onset is gradually decreasing. MetS is associated with serious health problems and presents an early risk for adult morbidity and mortality. From 2014-2019, we investigated the relationship between MetS and health behaviors such as smoking, alcohol consumption, and nutrition education in Korean adolescents (boys: 1235, girls: 1087, age: 13-18 years) based on household income; the relationship with hand grip strength was also evaluated. The prevalence of MetS was 8.8% in boys and 5.1% in girls; in the lowest income households, the risk increased ~1.5-fold for boys and ~4-fold for girls, whereas risks of smoking and alcohol use increased 1.81 vs. 2.34 times, and 2.34 vs. 2.37 times for boys and girls, respectively. In adolescents with the weakest grip strength, the risk of MetS increased 9.62 and 7.79 times in boys and girls, respectively. Girls lacking nutrition education exhibited a 1.67-fold increased risk of MetS, but this was not significant in boys. Low household income increased the risk of unhealthy behaviors such as smoking and alcohol consumption in both sexes, and together with low hand grip strength, was an important predictor for developing MetS.

In Utero Exposure to Δ9-Tetrahydrocannabinol Leads to Postnatal Catch-Up Growth and Dysmetabolism in the Adult Rat Liver

The rates of gestational cannabis use have increased despite limited evidence for its safety in fetal life. Recent animal studies demonstrate that prenatal exposure to Δ9-tetrahydrocannabinol (Δ9-THC, the psychoactive component of cannabis) promotes intrauterine growth restriction (IUGR), culminating in postnatal metabolic deficits. Given IUGR is associated with impaired hepatic function, we hypothesized that Δ9-THC offspring would exhibit hepatic dyslipidemia. Pregnant Wistar rat dams received daily injections of vehicular control or 3 mg/kg Δ9-THC i.p. from embryonic day (E) 6.5 through E22. Exposure to Δ9-THC decreased the liver to body weight ratio at birth, followed by catch-up growth by three weeks of age. At six months, Δ9-THC-exposed male offspring exhibited increased visceral adiposity and higher hepatic triglycerides. This was instigated by augmented expression of enzymes involved in triglyceride synthesis (ACCα, SCD, FABP1, and DGAT2) at three weeks. Furthermore, the expression of hepatic DGAT1/DGAT2 was sustained at six months, concomitant with mitochondrial dysfunction (i.e., elevated p66shc) and oxidative stress. Interestingly, decreases in miR-203a-3p and miR-29a/b/c, both implicated in dyslipidemia, were also observed in these Δ9-THC-exposed offspring. Collectively, these findings indicate that prenatal Δ9-THC exposure results in long-term dyslipidemia associated with enhanced hepatic lipogenesis. This is attributed by mitochondrial dysfunction and epigenetic mechanisms.

The Effect of Peer Support on Knowledge and Self-Efficacy in Weight Management: A Prospective Clinical Trial in a Mental Health Setting

Metabolic disturbances commonly occur with serious mental illness (SMI). Strategies for weight management include group education, peer support, and follow up. This study evaluated the effects of group peer support on body weight, Confidence and Conviction (C&C), diet quality and health-related quality of life in a mental health setting. Fourteen participants [aged 51.7 + /- 12.2 years; four male ten female] who were unable to achieve and maintain 5% weight loss were recruited from a metabolic clinic at a mental health care facility. Weight, C&C, Dietary Screener Questionnaire (DSQ), and 36-item Short Form Survey Instrument (SF-36) were collected at baseline, 3, 6, and 12 months. SF-36 showed significant improvement in Vitality/Energy (-3.823, p = 0.003) and General Health Perception (-2.919, p = 0.014) at 3 months, significant decrease in Physical Functioning (-2.391, p = 0.048) and significant improvement in Pain (-2.885, p = 0.023) from baseline to 12 months. DSQ showed an inverse association between C&C and sugar intake.

Cardiovascular Risk Screening and Pregnancy Complications: A Comparison of Two Canadian Maternal Health Clinic Populations

OBJECTIVE

This study compared pregnancy-related cardiovascular disease risk indicators between women who attended 2 different postpartum screening and education clinics: 1 at an urban tertiary care centre and 1 at a northern, rural community hospital. Risk differences associated with ethnicity were also examined.

METHODS

We conducted a retrospective record review that compared data from an urban clinic in Kingston, Ontario (n = 675) with those from a rural clinic in Prince Rupert, British Columbia (n = 65). Patients who had a hypertensive disorder of pregnancy, gestational diabetes, intrauterine growth restriction, idiopathic preterm birth, or placental abruption attended the clinics at 6 months postpartum. Demographic information, personal and family history, physical examination findings, and laboratory results were collected and used to generate cardiovascular risk estimates using validated scoring systems. These estimates were compared between clinic populations and between ethnic subsets.

RESULTS

Fifty-five percent of the Prince Rupert cohort were Indigenous, while 87% of the Kingston cohort were White (P < 0.001). A greater proportion of the Kingston cohort had experienced hypertensive disorders of pregnancy (P = 0.002), while a greater proportion of the Prince Rupert cohort had developed gestational diabetes (P=0.010). The Prince Rupert population had higher lifetime and 30-year cardiovascular disease risk scores (P = 0.008 and P = 0.005, respectively). Indigenous patients had more major cardiovascular risk factors as well as higher lifetime and 30-year cardiovascular risk scores (P = 0.001 and P = 0.008, respectively) than White and Asian patients.

CONCLUSION

The increased cardiovascular disease risk in both rural and Indigenous women supports the need for better postpartum care, long-term follow-up, and early promotion of cardiovascular health in these populations.

An 8-week freeze-dried blueberry supplement impacts immune-related pathways: a randomized, double-blind placebo-controlled trial

Background

Blueberries contain high levels of polyphenolic compounds with high in vitro antioxidant capacities. Their consumption has been associated with improved vascular and metabolic health.

Purpose

The objective was to examine the effects of blueberry supplement consumption on metabolic syndrome (MetS) parameters and potential underlying mechanisms of action.

Methods

A randomized double-blind placebo-controlled intervention trial was conducted in adults at risk of developing MetS. Participants consumed 50 g daily of either a freeze-dried highbush blueberry powder (BBP) or a placebo powder for 8 weeks (n = 49). MetS phenotypes were assessed at weeks 0, 4 and 8. Fasting blood gene expression profiles and plasma metabolomic profiles were examined at baseline and week 8 to assess metabolic changes occurring in response to the BBP. A per-protocol analysis was used.

Results

A significant treatment effect was observed for plasma triglyceride levels that was no longer significant after further adjustments for age, sex, BMI and baseline values. In addition, the treatment*time interactions were non-significant therefore suggesting that compared with the placebo, BBP had no statistically significant effect on body weight, blood pressure, fasting plasma lipid, insulin and glucose levels, insulin resistance (or sensitivity) or glycated hemoglobin concentrations. There were significant changes in the expression of 49 genes and in the abundance of 35 metabolites following BBP consumption. Differentially regulated genes were clustered in immune-related pathways.

Conclusion

An 8-week BBP intervention did not significantly improve traditional markers of cardiometabolic health in adults at risk of developing MetS. However, changes in gene expression and metabolite abundance suggest that clinically significant cardiometabolic changes could take longer than 8 weeks to present and/or could result from whole blueberry consumption or a higher dosage. BBP may also have an effect on factors such as immunity even within a shorter 8-week timeframe.

Clinical trial registration

clinicaltrials.gov, NCT03266055, 2017

Supplementary Information

The online version contains supplementary material available at 10.1186/s12263-021-00688-2.

Metabolic dysfunction in pregnancy: Fingerprinting the maternal metabolome using proton nuclear magnetic resonance spectroscopy

Aims

Maternal metabolic disorders place the mother at risk for negative pregnancy outcomes with potentially long-term health impacts for the child. Metabolic syndrome, a cluster of features associated with increased risk of metabolic disorders, such as cardiovascular disease, diabetes and stroke, affects roughly one in five Canadians. Metabolomics is a relatively new technique that may be a useful tool to identify women at risk of metabolic disorders. This study set out to characterize urinary metabolic biomarkers of pregnant women with obesity and of pregnant women who later developed gestational diabetes mellitus (pre-GDM), compared to controls.

Methods and Materials

Second trimester urine samples were collected through the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort and examined with 1H nuclear magnetic resonance (NMR) spectroscopy. Multivariate analysis was used to examine group differences, and machine learning feature selection tools identified the metabolites contributing to separation.

Results

Obesity and pre-GDM metabolomes were distinct from controls and from each other. In each comparison, the glycine, serine and threonine pathways were the most impacted. Pantothenate, formic acid and glycine were downregulated by obesity, while formic acid, dimethylamine and galactose were downregulated in pre-GDM. The three most impacted metabolites for the comparison of obesity versus pre-GDM groups were upregulated creatine/caffeine, downregulated sarcosine/dimethylamine and upregulated maltose/sucrose in individuals who later developed GDM.

Conclusion

These findings suggest a role for urinary metabolomics in the prediction of GDM and metabolic marker identification for potential diagnostics and prognostics in women at risk.

Physical activity energy expenditure and fat-free mass: relationship with metabolic syndrome in overweight or obese postmenopausal women

Menopause transition is associated with detrimental changes in physical activity, body composition, and metabolic profile. Although physical activity energy expenditure (PAEE) is inversely associated with metabolic syndrome (MetS) in individuals at higher risk of cardiovascular disease, the association is unknown in low-risk individuals. The aim of the study was to investigate the association between PAEE and MetS (prevalence and severity) in inactive overweight or obese postmenopausal women with a low Framingham Risk Score (<10%). Cross-sectional data of 126 participants were divided into quartiles based on PAEE (Quartile (Q)1 = lowest PAEE) while fat-free mass (FFM) and fat mass were measured by dual-energy X-ray absorptiometry. MetS prevalence was significantly different between Q1 and Q4 (37.9% vs 13.3%, p = 0.03). After controlling for potential confounders, MetS severity was negatively associated with PAEE (B = -0.057, p < 0.01) and positively with FFM (B = 0.038, p < 0.001). Moderation analyses indicated that a greater FFM exacerbated the association between PAEE and MetS severity in Q1 and Q2 (PAEE × FFM; B = -0.004; p = 0.1). Our results suggest that displaying a low FRS and lower PAEE increase MetS prevalence and severity. In addition, greater FFM interacts with lower PAEE to worsens MetS severity, while higher PAEE lessened this effect. Novelty: Inactive individuals displaying higher daily PAEE also have a lower MetS prevalence. Greater FFM is associated with a worse MetS severity where a higher PAEE mitigated this deleterious effect in our cohort.

Feasibility of identifying and describing the burden of early-onset metabolic syndrome in primary care electronic medical record data: a cross-sectional analysis

BACKGROUND

The prevalence of metabolic syndrome is growing worldwide, yet remains underinvestigated in Canadian young adults. We sought to explore the use of a harmonized case definition specific to early-onset metabolic syndrome and determine its feasibility in assessing the prevalence of metabolic syndrome among electronic medical record (EMR) data of young adults in Northern Alberta.

METHODS

We conducted a cross-sectional study using a sample of EMR data from young adult patients aged 18-40 years and residing in Northern Alberta, who had an encounter with a participating primary care clinic between June 29, 2015, and June 29, 2018. Physical examination, laboratory investigation and disease diagnosis data were collected. A case definition and algorithm were developed to assess the feasibility of identifying metabolic syndrome, including measures for body mass index (BMI), blood pressure (BP), dysglycemia, hypertriglyceridemia, high-density lipoprotein cholesterol, diabetes and hypertension.

RESULTS

Among 15 766 young adults, the case definition suggested the prevalence of metabolic syndrome was 4.4%, 95% confidence interval (CI) 4.1%-4.7%. The most frequent 3-factor combination (41.6%, 95% CI 37.9%-45.3%) of metabolic syndrome criteria consisted of being overweight or obese, having elevated BP and hypertriglyceridemia. Half of metabolic syndrome cases (51.3%, 95% CI 47.6%-55.0%) were missing measures for fasting blood glucose, and one-fifth were missing a hemoglobin A_1c (HbA_1c) level. Notably, most young adults with a BMI of 25 or greater were missing HbA_1c (68.7%, 95% CI 67.6%-69.8%), fasting blood glucose (84.0%, 95% CI 83.2%-84.8%) and triglyceride testing (79.0%, 95% CI 78.1%-79.9%).

INTERPRETATION

We have shown that our case definition is feasible in identifying early-onset metabolic syndrome using EMR data; however, the degree of missing data limits the feasibility in assessing prevalence. Further investigation is required to validate this case definition for metabolic syndrome in the EMR data, which may involve comparing this definition to other validated metabolic syndrome case definitions.

Whole-Body Cryotherapy Is an Effective Method of Reducing Abdominal Obesity in Menopausal Women with Metabolic Syndrome

Abdominal obesity predominates in menopausal women (MW) and contributes to the development of metabolic syndrome (MetS). It is associated with increased mortality related to cardiovascular disease, diabetes and fatty liver disease. The effects of whole-body cryotherapy (WBC) on body composition and the blood concentration of irisin, interleukin-6 (IL-6) and C-reactive proteins (CRP) in MW with MetS and in healthy women (HW), were assessed. The study included 19 women with MetS (61.53 ± 3.99 y, BMI 30.09 ± 4.98 kg/m²) and 18 HW (60.28 ± 3.63 y, BMI 25.50 ± 2.37 kg/m²) who were subjected to 20 WBC treatments at −130 °C for 3 min daily. In both groups, body mass (BM), BMI, abdominal circumference, triceps skinfold, total fat mass and percentage of leg fat significantly decreased after 20 WBC sessions. Additionally, the percentage of total, trunk and android fat in the MetS group were significantly decreased after 20 WBC applications. Waist circumference (WC) and waist-to-height ratio (WHtR) significantly decreased in both groups, and in the HW group, hip circumference and abdominal skinfold also significantly decreased after 10 WBC and 20 WBC treatments. In both groups, the concentration of plasma irisin significantly increased after 1 WBC and 10 WBC exposures, while the concentration of IL-6 significantly increased only in MetS group after 10 WBC and 20 WBC, and were significantly higher than in HW. CRP concentrations were significantly higher in the MetS group than in HW before 1 WBC, after 1 WBC and 10 WBC sessions, but not after 20. In the MetS group, there were significant negative correlations between the change in irisin level and the changes in WC and BM, and between the level of irisin and the change in percentage of total fat, and significant negative correlations between the change in IL-6 level and changes in WC, waist-to-hip ratio and WHtR. Whole-body cryotherapy, assuming the application of 20 treatments in the series, reduces abdominal obesity in menopausal women indirectly through the secretion of irisin and IL-6, and can be used as adjunctive therapy in the treatment of metabolic syndrome. Our conclusion is limited to menopausal women with low–moderate physical activity for whom its level as well as diet were not changed during the treatment.

Parasympathetic Response Patterns are Associated with Metabolic Syndrome Among Older Women but Not Men

Background

Little is known about the role of physiological stress responses in metabolic syndrome (MetS).

Purpose

To examine whether patterns of autonomic response to psychological stress are associated with MetS and whether this association is moderated by sex

Methods

1121 men and women (M_age = 65.3 ± 6.77 years) with and without coronary artery disease (CAD) underwent an anger recall stressor task. Heart rate and heart-rate variability (HRV; HF, LF/HF) were assessed. Clusters of participants showing similar patterns of response across baseline, stress, and recovery periods were created using ACECLUS and FASTCLUS in SAS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. ANCOVAs were conducted in secondary analyses utilizing a continuous composite representation of MetS.

Results

Men and women showing greater tonic and phasic HR elevations were more likely to meet MetS criteria (OR = 1.45, [95% CI = 1.02–2.07], p = .037). HF-HRV cluster interacted significantly with sex (p < .001) to predict MetS. In women, those with significant parasympathetic withdrawal to stress and poor recovery were more likely to have MetS than women with a more moderate response (OR = 2.56, [95% CI = 1.23–5.41], p = .013). Women who displayed stress-related parasympathetic activation were also at greater risk of MetS (OR = 2.30, [95% CI = 1.30–4.07], p = .004). Results using a continuous measure of MetS were generally consistent with these findings.

Conclusion

Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women. Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk.

Regional variability in Canadian routine care of type 2 diabetes, hypercholesterolemia, and hypertension: Results from the The Cardio-Vascular and metabolic treatments in Canada: Assessment of REal-life therapeutic value (CV-CARE) registry

BACKGROUND

Regional differences in the profile and treatment strategies of patients with cardiometabolic diseases have been studied in several different countries. The Cardio-Vascular and metabolic treatments in Canada: Assessment of REal-life therapeutic value (CV-CARE) registry was designed to evaluate patient profiles and medical management of cardiometabolic diseases in routine clinical care settings across Canada. Primary objectives were to (1) evaluate regional variability of patient profiles with cardiometabolic disease(s) and (2) assess treatment differences of patients treated for type 2 diabetes (T2D), hypercholesterolemia (HCh), and hypertension (HTN) across Canada.

METHODS

CV-CARE is a multi-center, observational, prospective registry that enrolled Canadian patients treated with metformin-extended release (MetER) for T2D, colesevelam (C) for HCh, azilsartan (AZI) for mild-to-moderate essential HTN and azilsartan/chlorthalidone (AZI/CHL) for severe, essential HTN. Patient characteristics and treatments were assessed at baseline.

RESULTS

The registry enrolled 6960 patients, with a total of 4194 patients making up the primary analysis population [MetER (n=995); C (n=1639); AZI (n=1364); AZI/CHL (n=498)]. First-line use of MetER was more common in British Columbia (BC; 45.5%) compared to Ontario (ON; 29.8%), and Quebec (QC; 12.9%). C treatment for HCh was used as monotherapy most readily in BC (68.7%) compared with QC (59.7%) and ON (35.8%). Dual action of low-density lipoprotein cholesterol and hemoglobin A1c reduction was the predominant reason for C add-on therapy (46.8%), with highest usage seen in ON (62.9%). AZI treatment for HTN was most frequently used in BC (43.8%), and AZI/CHL was most commonly used in ON (12.0%). First-line use of AZI was more common in QC (50%) vs. ON (34.9%) and BC (24.1%). The primary reason for switching to AZI and AZI/CHL from prior treatment was lack of efficacy across provinces.

CONCLUSION

This is the first regional description of the CV-CARE cohort. Significant variations in both baseline profile and treatments were observed which could have an impact on long-term outcomes.

Prediction modelling of 1-year outcomes to a personalized lifestyle intervention for Canadians with metabolic syndrome

Metabolic syndrome (MetS) comprises a cluster of risk factors that includes central obesity, hypertension, dyslipidemia, and impaired glucose homeostasis. Although lifestyle interventions reduce MetS risk, not everyone responds to the same extent. The primary objective of this study was to identify variables that could predict 1-year changes in MetS risk in individuals participating in the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program. Participants were allocated into training (n = 157) and test (n = 29) datasets by availability of genetic data. A linear mixed-effect model revealed that age, medication, fasting glucose, triglycerides, high-density lipoprotein cholesterol, waist circumference, systolic blood pressure, and fibre intake were associated with continuous MetS (cMetS) score across all time points. Multiple linear regressions were then used to build 2 prediction models using 1-year cMetS score as the outcome variable. Model 1 included only baseline variables and was 38% accurate for predicting cMetS score. Model 2 included both baseline variables and the 3-month change in cMetS score and was 86% accurate. As a secondary objective, we also examined if we could build a model to predict a person's categorical response bin (i.e., positive responder, nonresponder, or adverse responder) at 1 year using the same variables. We found 72% concordance between predicted and observed outcomes. These various prediction models need to be further tested in independent cohorts but provide a potentially promising new tool to project patient outcomes during lifestyle interventions for MetS. Novelty Short-term changes in cMetS score improve prediction model performance compared with only baseline variables. Predictive models could potentially facilitate clinical decision-making for personalized treatment plans.

Exposure to parabens and prevalence of obesity and metabolic syndrome: An analysis of the Canadian Health Measures Survey

BACKGROUND

Parabens are group of widely used preservative agents in the cosmetic, food, and pharmaceutical industries. They are estrogenic and anti-androgenic, and thus have the potential to alter the hormonal regulation of energy metabolism, and in turn affect obesity and metabolic health. Compared to obesity alone, having metabolic syndrome (a cluster of cardiometabolic risk factors) further increases the risk of cardiovascular disease, diabetes, and certain cancers. We examined whether exposure to parabens was associated with obesity, metabolic syndrome or its components among Canadians.

METHODS

Methyl, ethyl, propyl, and butyl paraben concentrations were measured in the urine of 2,564 individuals participating in Cycle 4 (2014-2015) of the Canadian Health Measures Survey, a national biomonitoring survey. We assessed associations between specific gravity-corrected log10-transformed paraben concentrations and obesity, metabolic syndrome and its components (waist circumference, HDL cholesterol, triglycerides, fasting blood glucose and blood pressure) via Poisson regression with robust variance estimators for binary outcomes and via linear regression for outcomes expressed continuously. We stratified analyses by age (children aged 3 to 17 years vs. adults aged 18 years and older) and investigated the presence of effect modification by sex.

RESULTS

A 10-fold increase in propyl paraben concentration was associated with a 40% (95% CI: 3, 90) higher prevalence of metabolic syndrome among men, while ethyl paraben was associated with a 63% (95% CI: 2, 86) lower prevalence among women. Among women, methyl paraben was inversely associated with obesity, and methyl, propyl and ethyl parabens were associated with higher high density lipoprotein (HDL) cholesterol. No associations were observed among children.

CONCLUSIONS

This is the first study to report a positive association between parabens and metabolic syndrome in men. Protective associations among women previously reported for obesity were also observed for metabolic syndrome and HDL cholesterol. These results should be confirmed in longitudinal studies.

Management of Iron Overload in Resource Poor Nations: A Systematic Review of Phlebotomy and Natural Chelators

Iron is an essential element and the most abundant trace metal in the body involved in oxygen transport and oxygen sensing, electron transfer, energy metabolism, and DNA synthesis. Excess labile and unchelated iron can catalyze the formation of tissue-damaging radicals and induce oxidative stress. English abstracts were identified in PubMed and Google Scholar using multiple and various search terms based on defined inclusion and exclusion criteria. Full-length articles were selected for systematic review, and secondary and tertiary references were developed. Although bloodletting or phlebotomy remains the gold standard in the management of iron overload, this systematic review is an updated account of the pitfalls of phlebotomy and classical synthetic chelators with scientific justification for the use of natural iron chelators of dietary origin in resource-poor nations.

Retrospective Analysis of Cardiovascular Disease Risk Parameters in Participants of a Preventive Health and Wellness Program

Lifestyle, dietary, and nutritional choices are important influencing parameters of cardiovascular disease (CVD) risk, the number one cause of morbidity and mortality globally. Our aims were to i) characterize CVD risk parameters using data from 7939 participants enrolled in a preventive health and wellness program between March 2010 and January 2017; and ii) evaluate intervention effects in 3,020 participants who returned for follow-up. Blood measurements (nutrient markers), CVD risk parameters (abdominal obesity, hypertension, hyperglycemia, hypertriglyceridemia, low high-density lipoprotein (HDL), insulin resistance, and inflammation), glycemic status (HbA1c), and insulin resistance (HOMA-IR) were assessed. Framingham and Reynold's risk scores were also calculated. After approximately one year of treatment (n = 3 020), mean arachidonic acid:eicosapentaenoic acid (AA:EPA) ratio, homocysteine, and HbA_lc concentrations were significantly reduced; other risk parameters did not improve but mean values remained within reference ranges. Excluding participants taking related medications, 38.8%, 37.2%, 38.0%, 42.5%, and 59.7% of those with hyperglycemia, hypertriglyceridemia, low HDL, insulin resistance, or prediabetes, respectively, at baseline no longer had the condition at follow-up. In contrast, of individuals within the reference range at baseline, new cases at follow-up were found for 10.1%, 12.2%, 6.3%, 8.2%, and 7.6% (as above, respectively). Regression models revealed a significant association between serum 25-hydroxyvitamin D concentrations ≥100 nmol/L and reductions in many CVD risk parameters after adjustment for confounding variables. These findings suggest that a preventive approach to health and wellness focused on nutrients, optimal serum 25-hydroxyvitamin D concentrations, and lifestyle changes has the potential to reduce the risk of CVD.

Adiponectin: An Indicator for Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, consider as a manifestation of obesity. However, a proportion of obese patients do not develop MetS. The aim of our study was to determine whether concentration of plasma adiponectin and leptin differ between metabolic unhealthy obese (MUO) patients and comparable age- and sex-matched control groups.

METHODS

In this case-control study, we assigned 51 obese patients with MetS (MUO) in cases group and 102 metabolic healthy obese (MHO) and normal weight metabolic healthy subjects matched for age and gender to cases in control groups. The study was conducted between December 2014 and February 2016 in the Endocrinology Research Center of Tehran University of Medical Sciences, Tehran, Iran. We measured serum adiponectin, leptin, their ratio, and body composition in all subjects.

RESULTS

No significant differences were observed between MHO and MUO in term of total fat mass and trunk fat (P>0.05). Compared to MHO and normal weight metabolic healthy subjects, MUO subjects had lower levels of plasma adiponectin (P<0.001) and lower plasma adiponectin to leptin ratio (P<0.001) and a higher level of plasma leptin (P<0.002). A Receiver Operator Characteristic curve was used to identify the ability of adiponectin and leptin level to predict the MetS. The area under the Receiver Operator Characteristic curve was 0.66 (P<0.01), 0.73 (P<0.001) and 0.75 (P<0.001) for leptin, adiponectin, and adiponectin/leptin ratio levels respectively.

CONCLUSION

Our study introduced adiponectin and leptin as indicator of MetS and obesity respectively.

Socio-economics status and metabolic syndrome: A meta-analysis

OBJECTIVE

The metabolic syndrome (MetS) is responsible for an increased risk of type 2 diabetes, cardiovascular diseases and is associated with all-cause and cardiovascular mortality. Economic and social vulnerability is not an easy concept to grasp, but some studies investigate the association between MetS and socioeconomic and demographic factors, deprivation (more often correlations rather than causal one due to data). This work aims to assess the association between MetS and socio-economic gradient (SEG) in the literature by performing a meta-analysis.

DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews were followed.

SETTING

The raw list of studies extracted from PubMed as regard to the inclusion/exclusion criteria was imported in Word. Studies were filed with regard to our three definitions of SEG and their title.

PARTICIPANTS

Subgroup analysis were performed considering several definitions of Mets: NCEP-ATPIII and IDF2006.

RESULTS

The overall multivariable-adjusted OR showed that the risk of MetS was significantly increased in association with SEG The results of the subgroup analysis showed an increased risk of MetS in association with SEG when IDF definition was considered.

CONCLUSIONS

Targeted interventions must be implemented in a specific way as prevention campaigns aimed at the general population are generally not adapted to this particular vulnerable population.

Patient experiences of a lifestyle program for metabolic syndrome offered in family medicine clinics: a mixed methods study

BACKGROUND

Patient perspectives on new programs to manage metabolic syndrome (MetS) are critical to evaluate for possible implementation in the primary healthcare system. Participants' perspectives were sought for the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) study, which enrolled 293 participants, and demonstrated 19% reversal of MetS after 1 year. The main purpose of this study was to examine participants' perceptions of their experiences with the CHANGE program, enablers and barriers to change.

METHODS

A convergent parallel mixed methods design combined patients' perspectives collected by questionnaires (n = 164), with insights from focus groups (n = 41) from three sites across Canada. Qualitative data were thematically analyzed using interpretative description. Insights were organized within a socio-ecologic framework.

RESULTS

Key aspects identified by participants included intra-individual factors (personal agency, increased time availability), inter-individual factors (trust, social aspects) and organizational factors (increased mental health support, tailored programs).

CONCLUSION

Results revealed participants' overall support for the CHANGE program, especially the importance of an extended program under the guidance of a family physician along with a skilled and supportive team. Team delivery of a lifestyle program in primary care or family medicine clinics is a complex intervention and use of a mixed methods design was helpful for exploring patient experiences and key issues on enablers and barriers to health behavior change.

Irisin Serum Levels in Metabolic Syndrome Patients Treated with Three Different Diets: A Post-Hoc Analysis from a Randomized Controlled Clinical Trial

BACKGROUND

Irisin, a hormone-like myokine, regulates energy homeostasis and mediates the benefits of physical activity on health.

METHODS

To estimate the effect of different diets on irisin concentrations in subjects with the Metabolic Syndrome (MetS).

METHODS

Subjects with MetS were derived from a population survey; 163 subjects were enrolled and randomized to a: Low Glycaemic Index (LGID), Mediterranean (MD) or Low Glycaemic Index Mediterranean (LGIMD) Diet, and the groups were compared, also with 80 controls without MetS. Sociodemographic, medical and nutritional data were collected and fasting blood samples drawn. Subjects underwent LUS and bioimpedentiometry. Generalized Estimating Equations were performed.

RESULTS

At baseline, lower irisin concentrations were observed in MetS subjects. Mean irisin levels increased in all diet groups but only the LGID group reached statistical significance, as well as showing an interaction between LGID and time at the sixth month examination (4.57, 95% CI −1.27, 7.87). There was a positive effect of Vegetable Proteins (0.03, 95% CI −0.01,0.06) and Saturated Fatty Acids (0.04, 95% CI 0.01, 0.07) on irisin concentrations. In the LGIMD, a positive effect on Fat-Free Mass (0.38, 95% CI 0.19, 0.57) and a negative effect on the Body Mass Index (−0.75, 95% CI −1.30, −0.19) were observed.

CONCLUSIONS

There seems to be a link between diet and muscle physiology. We showed that patients following a LGID had higher levels of irisin, a promising biomarker of muscle activity.

Metabolic syndrome prevalence in the Iranian adult's general population and its trend: A systematic review and meta-analysis of observational studies

AIMS

Metabolic syndrome (MetS) is one of the most important predictors of CVD. Determining the trend of MetS, represents the trend of its components and consequently could forecast the incidence of related diseases particularly CVD. The main object of this study is describing the trend of MetS prevalence in both male and female.

MATERIALS AND METHODS

Original research studies from March 21, 2005 to March 20, 2015 that were published in English database and Persian databases were included in the systematic review. The random effect model was used to estimate the pooled prevalence of MetS. Subgroup analyses, to portray the trend of MetS, conducted based on implementation year.

RESULTS

The total sample sizes for males using the criteria of ATP III and IDF were 30012 and 35064, and for female were 14572 and 16292. The pooled estimation of MetS prevalence in total, male, and female population according to ATP III was 28%, 23%, and 33%; for IDF definitions was 28%, 22%, and 33%. Moreover, according to meta-regression for ATP III the most important source of heterogeneity was mean age.

CONCLUSION

The findings revealed the trend of MetS prevalence is declining although steady in the last 10 years.

Age and gender-specific distribution of metabolic syndrome components in East China: role of hypertriglyceridemia in the SPECT-China study

BACKGROUND

Chinese population are experiencing remarkably changes of economic and cultural environments. The present study was to examine the prevalence of metabolic syndrome (MetS) by age between genders and to investigate the current characteristics of MetS and its components in China.

METHODS

SPECT-China is a population-based cross-sectional survey on Chinese adults aged ≥18 years in East China. A total of 10,441 Chinese residents participated in anthropometric and laboratory measurements. Of these, 9969 subjects (females, 5868) were eligible for the data analysis reported here. Estimates of the prevalence of MetS and its components were calculated. Presence of MetS was defined based on the IDF/AHA harmonized criteria. MetS z-score was calculated to evaluate the degree of total metabolic disorder.

RESULTS

The age-standardized prevalence of the metabolic syndrome was 22.0% (21.9% in men and 22.0% in women). Unlike the continuous MetS rise with age in females, the MetS prevalence in males remained stable among 46-55, 56-65 and > 65 yrs. age groups (31.2%, 31.4%, 32.5%, p = 0.538). In the five components of MetS, contrary to the elevated BP and BG disorders, the frequency of TG disorders decreased with age in males (46.6%(46-55 yrs), 37.2% (56-65 yrs), 27.7%(> 65 yrs), p < 0.001). Multivariable logistic regression showed that in males, more TG disorders were associated with higher BMI, higher educational level and current nonsmoker. In the MetS subjects, the 3-factor combinations which included TG disorders decreased with age in both genders. The whole metabolic profile became better in older male MetS subjects, which was opposite to the female.

CONCLUSION

Our results showed a distinct age-related prevalence of MetS between genders in dramatically changed China, in which the TG disorders played an important role. More targeted measures need to be taken to meet the serious challenges of metabolic diseases.

TRIAL REGISTRATION

ChiCTR-ECS- 14005052 , Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China).

Effects of a 6-month caloric restriction induced-weight loss program in obese postmenopausal women with and without the metabolic syndrome: a MONET study

OBJECTIVE

To compare the effects of a caloric restriction (CR) on body composition, lipid profile, and glucose homeostasis in obese postmenopausal women with and without metabolic syndrome (MetS).

METHODS

Secondary analyses were performed on 73 inactive obese postmenopausal women (age 57.7 ± 4.8 years; body mass index 32.4 ± 4.6 kg/m) who participated in the 6-month CR arm of a study of the Montreal-Ottawa New Emerging Team. The harmonized MetS definition was used to categorize participants with MetS (n = 20, 27.39%) and without MetS (n = 53, 72.61%). Variables of interest were: body composition (dual-energy X-ray absorptiometry), body fat distribution (computed tomography scan), glucose homeostasis at fasting state and during a euglycemic/hyperinsulinemic clamp, fasting lipids, and resting blood pressure.

RESULTS

By design, the MetS group had a worse cardiometabolic profile, whereas both groups were comparable for age. Fifty-five participants out of 73 displayed no change in MetS status after the intervention. Twelve participants out of 20 (or 60.0%) in the MetS group had no more MetS after weight loss (P = NS), whereas 6 participants out of 53 (or 11.3%) in the other group developed the MetS after the intervention (P = NS). Overall, indices of body composition and body fat distribution improved significantly and similarly in both groups (P between 0.03 and 0.0001). Furthermore, with the exception of triglyceride levels and triglycerides/high-density lipoprotein cholesterol ratio, which decrease significantly more in the MetS group (P ≤ 0.05), no difference was observed between groups for the other variables of the cardiometabolic profile.

CONCLUSIONS

Despite no overall significant effects on MetS, heteregeneous results were obtained in response to weight loss in the present study, with some improving the MetS, whereas other displaying deteriorations. Further studies are needed to identify factors and phenotypes associated with positive and negative cardiometabolic responses to CR intervention.

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

BACKGROUND

With the increasing prevalence of metabolic syndrome (MS), there is a need to track and predict the development of MS. In this study, we established a Markov model to explore the natural history and predict the risk of MS.

METHODS

A total of 21,777 Chinese individuals who had at least two consecutive health check-ups between 2010 and 2015 were studied. MS was defined using the Chinese Diabetes Society criteria. Twelve metabolic abnormal states (the no component state, four isolated component states, six 2-component states, and the MS state) were contained in each Markov chain. The transition probability was the mean of five probabilities for the transition between any two states in 2 consecutive years.

RESULTS

The dyslipidemia or overweight/obesity components were most likely to initiate the progress of MS in individuals aged 18-49. However, for individuals over 50 years old, the most likely initiating component of MS was dyslipidemia or hypertension. People who initially had dyslipidemia were most likely to develop the combined state of dyslipidemia with overweight/obesity before the age of 50, but after 50 years of age, the state of dyslipidemia merged with hypertension was the most common. Subjects (with the exception of males over 50 years of age who initially had an isolated state of hyperglycemia) who initially had an isolated state of overweight/obesity, hypertension, or hyperglycemia were most likely to develop a combination of one of these initial states with dyslipidemia. Males who initially had isolated hyperglycemia tended to develop hypertension after age 50. There was a greater chance for subjects who initially had an isolated hyperglycemia state or 2-component state that contained hyperglycemia to develop MS within 10 years compared to those who initially had other abnormal metabolic states.

CONCLUSIONS

The occurrence of MS primarily began with overweight/obesity or dyslipidemia in people aged 18-49. However, for those over 50 years old, MS primarily initiated under the conditions of dyslipidemia or hypertension. When MS started under the conditions of overweight/obesity, hypertension or hyperglycemia, dyslipidemia tended to occur next. People who initially had isolated hyperglycemia or a 2-component state that contained hyperglycemia had a higher risk of developing MS than those with other initiating states.