Metabolic Syndrome for Cardiovascular Disease Morbidity and Mortality Among General Japanese People: A Mini Review

Hepatic steatosis, metabolic dysfunction and risk of mortality: findings from a multinational prospective cohort study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) are implicated in the aetiology of non-communicable diseases. Our study aimed to evaluate associations between NAFLD and MetS with overall and cause-specific mortality.

METHODS

We used dietary, lifestyle, anthropometric and metabolic biomarker data from a random subsample of 15,784 EPIC cohort participants. NAFLD was assessed using the fatty liver index (FLI) and MetS using the revised definition. Indices for metabolic dysfunction-associated fatty liver disease (MAFLD) were calculated. The individual associations of these indices with overall and cause-specific mortality were assessed using multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs). As a subobjective, risk associations with adaptations of new classifications of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic and alcohol-related liver disease (MetALD) were also assessed.

RESULTS

Among the 15,784 sub-cohort participants, a total of 1997 deaths occurred (835 due to cancer, 520 to CVD, 642 to other causes) over a median 15.6 (IQR, 12.3-17.1) years of follow-up. Compared to an FLI < 30, FLI ≥ 60 was associated with increased risks of overall mortality (HR = 1.44, 95%CI = 1.27-1.63), and deaths from cancer (HR = 1.32, 95%CI = 1.09-1.60), CVD (HR = 2.06, 95% CI = 1.61-2.63) or other causes (HR = 1.21, 95%CI = 0.97-1.51). Mortality risk associations were also elevated for individuals with MAFLD compared to those without. Individuals with MetS were at increased risk of all mortality endpoints, except cancer-specific mortality. MASLD and MetALD were associated with higher risk of overall mortality.

CONCLUSIONS

Our findings based on a prospective cohort suggest that individuals with hepatic steatosis or metabolic dysfunction have a higher overall and cause-specific mortality risk.

Comparison of atherogenic indices for predicting the risk of metabolic syndrome in Southwest Iran: results from the Hoveyzeh Cohort Study (HCS)

BACKGROUND

Metabolic syndrome (MetS) is a cluster of risk factors related to diabetes and cardiovascular disease (CVD). Given that early identification of MetS might decrease CVD risk, it is imperative to establish a simple and cost-effective method to identify individuals at risk of MetS. The purpose of this study was to explore the relationships between several atherogenic indices (including AIP, TyG index, non-HDL-C, LDL-c/HDL-c, and TC/HDL-c) and MetS, and to assess the ability of these indices to predict MetS.

METHODS

The present cross-sectional study was conducted using baseline data from 9809 participants of the Hoveyzeh Cohort Study (HCS). MetS was defined based on the International Diabetes Federation (IDF). To examine the discriminatory abilities of each atherogenic indices in the identification of MetS, a receiver-operating characteristic curve was conducted. Logistic regression analysis was also performed to evaluate the relationship between atherogenic indices and MetS.

RESULTS

All of the atherogenic indices including the TyG index, AIP, non-HDL-C, TC/HDL-c, and LDL-c/HDL-c were significantly higher in participants with MetS than in those without MetS. According to the ROC curve analysis, the TyG index revealed the highest area under the curve (0.79 and 0.85 in men and women, respectively), followed by the AIP (0.76 and 0.83 in men and women, respectively). The best cutoff values for the TyG index and AIP were 8.96 and 0.16 for men and 8.84 and 0.05 for women, respectively. The TyG index and AIP were also strongly associated with MetS.

CONCLUSION

Among the 5 atherogenic indices evaluated, the TyG index and AIP were strongly related to MetS. The TyG index also demonstrated superior discriminative ability compared to other atherogenic indices in predicting MetS.

Usefulness of New Criteria for Metabolic Syndrome Optimized for Prediction of Cardiovascular Diseases in Japanese

AIMS

We attempted to clarify whether the multiple criteria for metabolic syndrome (MetS) can sufficiently predict cardiovascular disease, whether waist circumference (WC) should be required, and whether sex-specific thresholds for each component are necessary. Only a few large-scale studies among East Asians have addressed the ability of MetS to predict cardiovascular disease.

METHODS

We analyzed the data of 330,051 men and 235,028 women aged 18-74 years with no history of coronary artery disease (CAD) or cerebrovascular disease (CVD) from a nationwide Japanese claims database accumulated during 2008-2016. The association of each MetS component with CAD or CVD (CAD/CVD), MetS associated with CAD/CVD according to various criteria, and utility of modified criteria with more specific optimal values for each component were examined using multivariate Cox regression and receiver operating characteristic (ROC) analysis.

RESULTS

During the study, 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD. For each current MetS criteria, there was a 1.3- to 2.9-fold increased risk of CAD/CVD. Optimal thresholds for predicting CAD/CVD were WCs of 83 and 77 cm, triglycerides levels of 130 and 90 mg/dl, high-density lipoprotein cholesterol levels of 50 and 65 mg/dl, blood pressures of 130/80 and 120/80 mmHg, and fasting plasma glucose levels of 100 and 90 mg/dl for men and women, respectively. The existing MetS criteria and modified criteria were not significantly different in predicting CAD/CVD, but using the modified criteria markedly increased the prevalence of MetS and percentage of people with MetS developing CAD/CVD.

CONCLUSIONS

Although various criteria for MetS similarly predicted CAD/CVD, the new criteria greatly reduced the number of high-risk individuals, especially women, overlooked by the current criteria.

Metabolic Abnormalities Following Tirzepatide Monotherapy in Japanese Patients with Type 2 Diabetes: A Phase 3 SURPASS J-mono Post Hoc Analysis

INTRODUCTION

The presence of metabolic abnormalities in patients with type 2 diabetes (T2D) increases the risk of cardiovascular disease and other comorbidities. This analysis compared the effects of tirzepatide (5, 10, and 15 mg) and dulaglutide 0.75 mg on the prevalence of metabolic abnormalities in Japanese patients with T2D.

METHODS

This was a post hoc analysis of SURPASS J-mono, a multicenter, randomized, double-blind, active-controlled, parallel-group, phase 3 trial that compared the efficacy and safety of tirzepatide monotherapy (5, 10, and 15 mg) to dulaglutide 0.75 mg in Japanese patients with T2D. Thresholds for abnormalities were based on the Japanese criteria for metabolic syndrome. Proportions of participants meeting a composite endpoint (visceral fat accumulation measured by waist circumference plus two or more of dyslipidemia, hypertension, or hyperglycemia) or individual component thresholds were calculated at baseline and week 52 for the overall population and for baseline body mass index (BMI) subgroups (< 25, 25 to < 30, and ≥ 30 kg/m2).

RESULTS

Of 636 randomized participants, 431 (67.8%) met the composite endpoint at baseline, with similar findings observed across treatment arms. At week 52, the proportion of participants on treatment that met the composite endpoint was 31.7%, 23.0%, and 14.2% in the tirzepatide 5-, 10-, and 15-mg arms, respectively, and 56.5% in the dulaglutide arm (p < 0.001). A higher proportion met the composite endpoint at baseline in the BMI 25 to < 30 and ≥ 30 kg/m2 subgroups (73.2-79.3%) compared with the < 25 kg/m2 subgroup (45.3%), with reductions observed across all BMI subgroups treated with tirzepatide. The proportion of participants with individual metabolic abnormalities showed similar trends to those observed for the composite endpoint. Tirzepatide was consistently superior to dulaglutide across all assessments.

CONCLUSIONS

Tirzepatide reduced the prevalence of multiple metabolic abnormalities, indicating tirzepatide may have metabolic benefit in Japanese patients with T2D.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03861052.

The association between continuous metabolic syndrome score and its components with electrocardiographic abnormalities in community-dwelling older adults: the Bushehr elderly health (BEH) program

BACKGROUND

Metabolic syndrome (MetS) known as a risk factor for cardiovascular diseases (CVDs) has developed into a major source of health issue, especially for the elderly. In the present study, we investigated the association between continuous MetS (cMetS) score and its components with electrocardiographic (ECG) abnormalities in the community-dwelling older adults.

METHODS

This cross-sectional study is derived from the second phase of BEH cohort study which is conducted on individuals aged over 60 years old. Standard 12-lead ECGs were recorded and coded by qualified physicians and continuous values of metabolic syndrome risk scores (cMetS) were measured. Data regarding socio-demographic, medical history, and lifestyle variables were collected by trained interviewers. The multinomial regression analysis was used to investigate the relationship between cMetS and its components with ECG abnormalities in the included participants.

RESULTS

2426 individuals (mean age ± standard deviation: 69.30 ± 6.33 years) were included in the final analysis. Overall, 22.5% of the participants showed ECG abnormalities. Among these, 8.0% (n = 139) of participants had minor and 14.6% (n = 354) had major ECG abnormalities. In the final models, cMetS (OR = 1.04), mean arterial pressure (MAP((OR = 1.01), and higher fasting blood glucose (FBG) (OR = 1.01) increased the risk of ECG abnormalities (p < 0.05). Also, cMetS (OR = 1.05) and MAP (OR = 1.02) were associated with an increased risk of major ECG abnormalities (p < 0.05).

CONCLUSION

MetS and MAP were significantly associated with ECG abnormalities. The results of the present study suggest that ECG screening in the older population with MetS could potentially help to detect those at the higher risk of CVDs.

Prevalence of Metabolic Syndrome in Patients with Type 2 Diabetes in Japan: A Retrospective Cross-Sectional Study

INTRODUCTION

Recent data on the prevalence of metabolic syndrome in Japanese patients with type 2 diabetes (T2D) are limited.

METHODS

This retrospective, cross-sectional, observational study investigated the prevalence of metabolic syndrome in patients with T2D using a Japanese administrative claims database. Patients with a T2D diagnosis, prescription of a hypoglycemic agent, and one or more annual health checkups in 2020 were included. Trends in the prevalence of metabolic syndrome by sex and body mass index (BMI) subgroup were assessed.

RESULTS

The study cohort consisted of 155,653 patients (men, 81.6%; mean age 54.6 ± 8.5 years). Patients with metabolic syndrome had a higher mean BMI (29.1 ± 4.5 kg/m2 versus 25.2 ± 4.5 kg/m2) and mean waist circumference (98.3 ± 10.0 cm versus 87.9 ± 11.2 cm) compared to those without metabolic syndrome. Overall, the prevalence of metabolic syndrome was 43.0% in patients with T2D, with prevalence higher in men (46.6%) than women (27.0%). The prevalence increased across BMI subgroups from 17.3% in the < 25 kg/m2 subgroup, to 54.6% and 66.1% in the 25 to < 30 and ≥ 30 kg/m2 subgroups, respectively. A greater proportion of patients with metabolic syndrome had cardiovascular or renal comorbidities (BMI < 25, 0.3-2.0%; BMI 25 to < 30, 0.7-6.2%; BMI ≥ 30 kg/m2, 0.7-6.8%) and cardiovascular drug usage (BMI < 25, 1.3-9.0%; BMI 25 to < 30, 3.8-31.1%; BMI ≥ 30 kg/m2, 3.5-37.0%) in the higher BMI subgroups compared to the BMI < 25 kg/m2 subgroup.

CONCLUSION

The prevalence of metabolic syndrome in Japanese patients with T2D was 43.0% and increased with higher BMI. In patients with T2D and metabolic syndrome, cardiovascular drug usage and comorbidities increased in patients with a higher BMI. These data highlight the importance of managing metabolic parameters in addition to glycemic control in Japanese patients with T2D, particularly in patients with metabolic syndrome and BMI ≥ 25 kg/m2.

Associations between e-cigarette use or dual use of e-cigarette and combustible cigarette and metabolic syndrome: results from the National Health and Nutrition Examination Survey (NHANES)

PURPOSE

Examine associations between e-cigarette use or dual use of e-cigarette and combustible cigarette and metabolic syndrome (MetS).

METHODS

Cross-sectional data of 5121 U.S. adults from the National Health and Nutrition Examination Survey were analyzed. Weighted multivariable Poisson regression models were used to examine associations between e-cigarette use or dual use and MetS and its components. Prevalence ratios (PRs) with 95% confidence intervals (95% CI) were estimated.

RESULTS

Current and former e-cigarette users were 30% (95% CI: 1.13, 1.50) and 15% (95% CI: 1.03, 1.28) more likely to have MetS than never e-cigarette users. Current or former e-cigarette use was also associated with elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, and elevated blood pressure (AOR ranged from 1.15 to 1.42, all P < 0.05). The prevalence of MetS for dual users was 1.35-fold (95% CI: 1.15, 1.58) higher than that for never smokers and 1.21-fold (95% CI: 1.00, 1.46) higher than that for combustible cigarette-only users. Dual users were also more likely to report elevated triglycerides and reduced HDL cholesterol than never smokers or combustible cigarette-only users (all P < 0.05).

CONCLUSIONS

E-cigarette use or dual use is associated with MetS. Our findings may inform tobacco control policies regarding regulations of e-cigarette use.

Common clinical laboratory features among women with polycystic ovary syndrome and metabolic syndrome

Women with polycystic ovary syndrome (PCOS) have a high prevalence of metabolic syndrome (MS), with rates up to 33%. This is associated with long-term consequences such as cardiovascular diseases, type 2 diabetes mellitus (T2DM), cancer, sleep apnea, and psychological issues. The prevalence of MS worldwide is often associated with obesity and T2DM, yet regional variations are reported. In this study, 122 women consulting general practice and family medicine physicians were evaluated, revealing a BMI exceeding 30 kg/m2. Among MS criteria, the most common diagnoses were T2DM in 29 patients, insulin resistance (IR) in 36, arterial hypertension (AH) in 51, reduced HDL levels in 53, and elevated triglycerides in 39. Further analysis revealed 16 unique combinations of MS components in these patients, with 75% of PCOS cases exhibiting three MS components and 25% having four. Additionally, research indicated that most women with PCOS face persistent, treatment-resistant obesity, with a notably higher BMI (ρ=0.87; r=0.76). These findings highlight the multifactorial nature of PCOS and MS etiology.

Metabolic syndrome and the risk of severe cancer events: a longitudinal study in Japanese workers

BACKGROUND

Metabolic syndrome (MetS) is associated with cancer risk; however, little is known regarding its relationship with the risk of cancer-related premature death and long-term sick leave (LTSL), which can lead to a substantial loss in working years. The present study aimed to quantify the all-site and site-specific associations between MetS and the risk of severe cancer events (a composite outcome of LTSL and mortality due to cancer) in a large working population in Japan.

METHODS

We recruited 70,875 workers (59,950 men and 10,925 women), aged 20-59 years, who attended health check-ups in 2011 (10 companies) and 2014 (2 companies). All workers underwent follow up for severe cancer events until March 31, 2020. MetS was defined in accordance with the Joint Interim Statement. Cox regression models were used to quantify the association between baseline MetS and severe cancer events.

RESULTS

During 427,379 person-years of follow-up, 523 participants experienced the outcome consisting of 493 LTSLs of which 124 eventually resulted in death, and 30 deaths without taking LTSL. The adjusted hazard ratios (HR) (95% confidence intervals [CI]) for composite severe events due to all-site, obesity-related, and non-obesity-related cancer among those with vs. without MetS were 1.26 (1.03, 1.55), 1.37 (1.04, 1.82), and 1.15 (0.84, 1.56), respectively. In cancer site-specific analyses, MetS was associated with an increased risk of severe events due to pancreatic cancer (HR, 2.06; 95% CI, 0.99-4.26). When mortality was treated solely as the endpoint, the association was significant for all-site (HR, 1.58; 95% CI, 1.10-2.26), and obesity-related (HR, 1.59; 95% CI, 1.00-2.54) cancer. Additionally, a greater number of MetS components was associated with a greater risk of both severe cancer events and cancer-related mortality (P trend < 0.05).

CONCLUSION

Among Japanese workers, MetS was associated with an increased risk of severe cancer events, especially those due to obesity-linked cancer.

Association of Serum Cystatin C Level With Carotid Arterial Wall Elastic Resistance as a Potential Marker for Detection of Early Stage Atherosclerosis

BACKGROUND

Early diagnosis of atherosclerosis is exigent in patients with known cardiovascular disease (CVD) risk factors. During the initial phases of atherosclerosis, appearance of plaques can be detected by the ultrasonic phased tracking method which measures the arterial wall elasticity. However, reliable and easily available biochemical markers are not evaluated in the diagnosis of early-stage atherosclerosis. So the current study was carried out to assess the serum cystatin C level as an atherosclerotic marker, by evaluating its association with carotid arterial elastic modulus using the phased tracking method.

MATERIALS AND METHODS

A cross-sectional study was conducted on 115 patients having risk factors for atherosclerosis but not meeting carotid intima-media thickness (IMT) criteria. The early-stage atherosclerosis was detected by using the ultrasonic phased tracking method and the patients were divided based on low and high carotid elastic modulus. Serum levels of cystatin-C were measured in association with IMT, and elastic modulus was calculated using a novel method. This study also put forth the evaluation of the sensitivity and specificity of cystatin C for early diagnosis of atherosclerosis.

RESULTS

Cystatin C was strongly related to carotid elasticity (r=0.650). Based on multi-linear regression analysis, cystatin C showed significant association with carotid elasticity (β=0.509; p<0.001). It also displayed significant positive association with high carotid elastic modulus (β=0.511; p=0.02). Cystatin C showed a sensitivity of 85% in the prediction of high carotid elastic modulus.

CONCLUSION

For patients who are at risk to evolve atherosclerosis but are not evident with arterial plaques, cystatin C exhibits a significant association with carotid wall elastic modulus, which eases the detection of atherosclerosis. Thus, cystatin C is a potential biochemical marker for early diagnosis of atherosclerosis.

Caesarean section and childhood obesity at age 3 years derived from the Japan Environment and Children's Study

Caesarean section (CS) birth is widely reported to be a risk factor for childhood obesity. Although susceptibility to childhood obesity is influenced by race and ethnicity, it is unclear whether this risk of childhood obesity with CS birth also applies in the Japanese population. We investigated the impact of CS birth on obesity at 3 years of age in Japanese children. We obtained data from 60,769 mother-toddler pairs in the Japan Environment and Children's Study, a large-scale birth cohort study. Obesity was determined by body mass index measured at 3 years of age. Analysis revealed that 11,241 toddlers (18.5%) had a CS birth and that 4912 toddlers (8.1%) were obese. The adjusted risk ratio for obesity at 3 years of age when born by CS compared with vaginal delivery, estimated using inverse probability of treatment weighting, was 1.16 (95% confidence interval 1.08-1.25). These results suggest that CS birth modestly increases the risk of obesity at 3 years of age in Japanese children.

Obesity and Voiding Parameters in a Community-Based Population of Okinawa, Japan: Kumejima Digital Health Project (KDHP)

(1) Background: Evidence has accumulated regarding the etiology of lower urinary tract symptoms associated with obesity and metabolic syndrome. Therefore, the present study aimed to identify which subjectively and objectively measured voiding parameters were associated with obesity in a community-based population. (2) Methods: Voiding parameters on a self-administered questionnaire and a digital self-health monitoring system for urine excretion (s-HMSU) were compared between participants with and without obesity, defined as a body mass index ≥ 25 kg/m2 (n = 30 and 29, respectively), from a community in Okinawa, Japan. Logistic regression analysis was employed to calculate the odds ratios of abnormalities in voiding parameters for the obese group, with the non-obese group serving as a reference. (3) Results: The obese group had odds ratios of 5.17 (95% confidence interval: 1.33−20.0) for shortened hours of undisturbed sleep (<302 min) by s-HMSU and 7.65 (1.88−31.1) for nighttime urinary frequency by a questionnaire after adjusting for age and sex. In addition, the obese group had an adjusted odds ratio of 2.27 (0.76−6.78) for decreased maximum bladder capacity (<212 mL) by s-HMSU. (4) Conclusion: the results of the present study suggest that nocturia and shortened hours of undisturbed sleep are signs of obesity.

Independent and joint effects of body mass index and metabolic health in mid- and late-life on all-cause mortality: a cohort study from the Swedish Twin Registry with a mean follow-up of 13 Years

BACKGROUND

There is robust evidence that in midlife, higher body mass index (BMI) and metabolic syndrome (MetS), which often co-exist, are associated with increased mortality risk. However, late-life findings are inconclusive, and few studies have examined how metabolic health status (MHS) affects the BMI-mortality association in different age categories. We, therefore, aimed to investigate how mid- and late-life BMI and MHS interact to affect the risk of mortality.

METHODS

This cohort study included 12,467 participants from the Swedish Twin Registry, with height, weight, and MHS measures from 1958-2008 and mortality data linked through 2020. We applied Cox proportional hazard regression with age as a timescale to examine how BMI categories (normal weight, overweight, obesity) and MHS (identification of MetS determined by presence/absence of hypertension, hyperglycemia, low HDL, hypertriglyceridemia), independently and in interaction, are associated with the risk of all-cause mortality. Models were adjusted for sex, education, smoking, and cardiovascular disease.

RESULTS

The midlife group included 6,252 participants with a mean age of 59.6 years (range = 44.9-65.0) and 44.1% women. The late-life group included 6,215 participants with mean age 73.1 years (65.1-95.3) and 46.6% women. In independent effect models, metabolically unhealthy status in midlife increased mortality risks by 31% [hazard ratio 1.31; 95% confidence interval 1.12-1.53] and in late-life, by 18% (1.18;1.10-1.26) relative to metabolically healthy individuals. Midlife obesity increased the mortality risks by 30% (1.30;1.06-1.60) and late-life obesity by 15% (1.15; 1.04-1.27) relative to normal weight. In joint models, the BMI estimates were attenuated while those of MHS were less affected. Models including BMI-MHS categories revealed that, compared to metabolically healthy normal weight, the metabolically unhealthy obesity group had increased mortality risks by 53% (1.53;1.19-1.96) in midlife, and across all BMI categories in late-life (normal weight 1.12; 1.01-1.25, overweight 1.10;1.01-1.21, obesity 1.31;1.15-1.49). Mortality risk was decreased by 9% (0.91; 0.83-0.99) among those with metabolically healthy overweight in late-life.

CONCLUSIONS

MHS strongly influenced the BMI-mortality association, such that individuals who were metabolically healthy with overweight or obesity in mid- or late-life did not carry excess risks of mortality. Being metabolically unhealthy had a higher risk of mortality independent of their BMI.

Associations between metabolic syndrome and female stress urinary incontinence: a meta-analysis

INTRODUCTION AND HYPOTHESIS

The objective was to identify the associations between metabolic syndrome (MS) and stress urinary incontinence (SUI) in women and to provide an evidence base for clinical practice.

METHODS

A meta-analysis of cohort, case-control, and cross-sectional studies about the association between MS and SUI was performed using databases including PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), Wanfang Database (WanFang Data), and VIP database (VIP). The time limit was from the commencement of each database to 1 November 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias. RevMan 5.3 software was used for statistical analysis. The dichotomous variables were presented as the risk ratio (odds ratio, OR) and 95% CI as the effect indicators.

RESULTS

Six studies were included in the meta-analysis, with a total sample size of 3,678 cases. The results showed that the risk for SUI in women with MS was three times those without MS (OR = 3.41, 95% CI 2.01, 5.77, p <0.00001), and the difference was statistically significant. The results of subgroup analysis showed that MS was significantly associated with SUI in the subgroups of pre- and postmenopausal women (OR = 2.46, 95% CI 1.63, 3.73, p < 0.00001), and in the subgroups of other types of women (OR = 3.41, 95% CI 2.01, 5.77, p = 0.0003), and the differences were statistically significant.

CONCLUSIONS

Metabolic syndrome is associated with SUI in women and increases its risk.

Air pollution and metabolic syndrome risk: Evidence from nine observational studies

BACKGROUND AND AIMS

Globally, the number of metabolic syndrome (MetS) cases has increased substantially over time. However, the association between air pollution (AP) and MetS risk has been contradictory in observational studies. This is the first reported meta-analysis quantitatively exploring the aforementioned association.

METHODS

We searched PubMed, Embase, and Web of Science database entries up to September 14, 2020, and searches were updated up to December 6, 2020 to identify eligible articles on the AP-MetS risk association. No language restriction was imposed. Random-effects models were applied to estimate summary and subgroup effect sizes with 95% confidence intervals (CIs). PROSPERO registration number: CRD42020210431.

RESULTS

Eight articles (nine studies) were eligible for the meta-analysis. Increased MetS prevalence was not found to be associated with particulate matter less than 1 μm (PM₁), 2.5 μm (PM_2.5), and 10 μm (PM₁₀) in diameter or nitrogen dioxide (NO₂), and the summary effect sizes were 1.33 (95% CI: 0.95-1.85), 1.34 (95% CI: 0.96-1.89), 1.18 (95% CI: 0.98-1.19), and 1.28 (95% CI: 0.89-1.82), respectively, based on cross-sectional studies. The summary results indicated no association between each 10 μg/m³ increase in PM_2.5 and MetS incidence (effect size 2.78 [95% CI: 0.70-11.02]), based on cohort studies. Subgroup analysis demonstrated that MetS incidence in older men increased dramatically by 992% with each 10 μg/m³ increase in PM_2.5.

CONCLUSIONS

The evidence presented here suggests that although exposure to PM₁, PM_2.5, PM₁₀, or NO₂ was not found to have a significant association with the occurrence of MetS, the statistical significance of the relationship between exposure to PM₁, PM_2.5, or PM₁₀ and MetS prevalence was approximately borderline. More studies on AP-MetS risk association in low-/middle-income countries, as well as on the association between other air pollutants and MetS risk, are warranted. A sufficient number of high-quality studies is required to perform a meaningful meta-analysis of the relationship between air pollutants and MetS.

Metabolic Syndrome and Autophagy: Focus on HMGB1 Protein

Metabolic syndrome (MetS) affects the population worldwide and results from several factors such as genetic background, environment and lifestyle. In recent years, an interplay among autophagy, metabolism, and metabolic disorders has become apparent. Defects in the autophagy machinery are associated with the dysfunction of many tissues/organs regulating metabolism. Metabolic hormones and nutrients regulate, in turn, the autophagy mechanism. Autophagy is a housekeeping stress-induced degradation process that ensures cellular homeostasis. High mobility group box 1 (HMGB1) is a highly conserved nuclear protein with a nuclear and extracellular role that functions as an extracellular signaling molecule under specific conditions. Several studies have shown that HMGB1 is a critical regulator of autophagy. This mini-review focuses on the involvement of HMGB1 protein in the interplay between autophagy and MetS, emphasizing its potential role as a promising biomarker candidate for the early stage of MetS or disease's therapeutic target.

The beneficial effects of cinnamon among patients with metabolic diseases: A systematic review and dose-response meta-analysis of randomized-controlled trials

This systematic review and meta-analysis aims to summarize and conclude the clinical evidence regarding the use of cinnamon among patients with metabolic diseases. A comprehensive literature search without any limitation on language was conducted using the following bibliographical databases: ISI Web of Science, Embase, Scopus, PubMed, and Google Scholar. Search was conducted up to 23 January 2020. A total of 35 clinical trials were included for final analysis. Pooling of results showed a significant reducing effect of cinnamon on total cholesterol (TC) (weighted mean difference (WMD) = -11.67 mg/dL; P = 0.010), triglyceride (TG) (WMD = -16.27 mg/dL; P < 0.001), low density lipoprotein-cholesterol (LDL-C) (WMD = -6.36 mg/dL; P < 0.001), serum glucose (WMD = -11.39 mg/dL; P < 0.001), serum insulin (WMD = -1.27 μIU/mL; P = 0.028), and waist circumstance (WC) (WMD = -1.68 cm; P = 0.016). These lowering effects on TG, TC, LDL-C, and serum glucose levels were robust in studies that used cinnamon supplementation dose ≤1.5 g. Also, our findings of the present meta-analysis showed that cinnamon supplementation could have favorable effects on high density lipoprotein-cholesterol (HDL-C, WMD = 1.35; P = 0.038) as well as systolic (WMD = -3.95 mmHg; P = 0.018) and diastolic (WMD = -3.36; P = 0.001) blood pressure among patients with metabolic diseases. The present meta-analysis suggests that cinnamon might exert beneficial effects on various cardiometabolic risk factors among patients with metabolic diseases.

The potential of Artemisia species for use as broad-spectrum agents in the management of metabolic syndrome: a review

Although the prevalence of metabolic syndrome (MetS), a cluster of cardiometabolic risk factors that predispose to the development of type 2 diabetes mellitus and cardiovascular diseases, is increasing globally, there is no broad-spectrum agent for its holistic treatment. Natural plant-derived products with a wide spectrum of biological activities are currently being explored as alternatives in the management of diseases. Artemisia species are a heterozygous group of plants of the Compositae family that possess several health benefits. Here we highlight their antidiabetic, anti-obesity, anti-hyperlipidaemic, hepatoprotective and cardioprotective properties among others. These activities have been linked to the presence of phytochemicals that act on several molecular targets to exert their effects and the species of Artemisia are considered to be relatively safe. Artemisia species offer significant anti-MetS activity and thus are strong therapeutic candidates for the effective management of MetS.

The effect of paleolithic diet on glucose metabolism and lipid profile among patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Several randomized clinical trials (RCTs) have investigated the effects of the Paleolithic diet (PD) in adult patients suffering from metabolic disorders. However, the results of these RCTs are conflicting. Therefore, we conducted a systematic review and meta-analysis to assess the effects of the PD in patients with metabolic disorders.

METHODS

We searched the PubMed/Medline, Scopus, Cochrane Databases, Google Scholar, Web of Science, and Embase databases up to June, 2020. The data were pooled using a random-effects model. From the eligible publications, 10 articles were selected for inclusion in this systematic review and meta-analysis. The meta-analysis was performed using a random-effects model. The heterogeneity was determined using the I² statistics and the Cochrane Q test.

RESULTS

The pooled results from the random-effects model showed a significant reduction of the homeostatic model assessment of insulin resistance (HOMA-IR) (weighted mean difference, WMD: -0.39, 95% CI: -0.70, -0.08), fasting insulin (WMD: -12.17 μU/mL, 95% CI: -24.26, -0.08), total cholesterol (WMD: -0.32 mmol/l, 95% CI: -0.49, -0.15), triglycerides (WMD: -0.29 mmol/L, 95% CI: -0.42, -0.16), low-density lipoprotein cholesterol (WMD: -0.35 mmol/L, 95% CI: -0.67, -0.03), blood pressure (BP)(WMD - 5.89 mmHg; 95% CI - 9.973 to - 1.86 for the systolic BP and WMD - 4.01 mmHg; 95% CI - 6.21 to - 1.80 for the diastolic BP values) and C-reactive protein (CRP) levels (WMD: -0.84, mg/L, 95% CI: -1.62, -0.06) in the PD group versus control group.

CONCLUSIONS

Our findings provide better insights into the effect of the PD on the modulation of the glucose and lipid metabolism factors in patients with metabolic disorders, providing comprehensive information for the development of future RCTs with a high quality design.

A Predictive Model of Metabolic Syndrome by Medical Examination: Evidence from an 8-Year Chinese Cohort

PURPOSE

To develop a predictive model for the risk of metabolic syndrome (MetS).

PATIENTS AND METHODS

Totally, 1556 residents without MetS were finally included in 2006 and they were observed for 8 years to check who developed MetS. Univariate and multivariate logistic regression analyses was adopted to explore the risk factors of MetS and develop the predictive model that used the medical examination information of MetS risk after 8 years. The receiver operating characteristic (ROC) curve was drawn to assess the predictive capacity of the model.

RESULTS

The risk of MetS in overweight, prehypertension, hypertension subjects were 4.610 [95% confidence interval (CI): 2.415 to 8.800], 2.759 (95% CI: 1.519 to 5.011) and 3.589 (95% CI: 1.672 to 7.706) times higher than that in controls, respectively. The risk of MetS in people with high-density lipoprotein (HDL) <1.10 mmol/L was 3.716-fold in comparison with HDL ≥1.55 mmol/L [odds risk (OR) = 3.716, 95% CI: 1.483 to 9.313]. Individuals with fatty liver had a higher risk of MetS (OR = 2.577, 95% CI: 1.472 to 4.512). The AUC of the predictive model was 0.831 (95% CI: 0.798 to 0.865), with the sensitivity of 0.898 (95% CI: 0.831 to 0.941) and the specificity of 0.676 (95% CI: 0.651 to 0.700).

CONCLUSION

The model performed well predictive power for the risk of MetS, which may provide a reference for clinicians to identify high-risk groups early.

The Incidence of Metabolic Syndrome and the Valid Blood Pressure Cutoff Value for Predicting Metabolic Syndrome Within the Normal Blood Pressure Range in the Population Over 40 Years Old in Guiyang, China

PURPOSE

The study was conducted to investigate metabolic syndrome (MS) incidence within the normal blood pressure (BP) range in a population over 40 years old in an urban area of Guiyang, Guizhou Province, China, and to identify a valid BP cutoff value for predicting MS.

MATERIALS AND METHODS

Data from this study are based on the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. In total, 2935 subjects in the normal BP range and without MS (795 males, 2140 females) aged 40-80 years were included in this study. Follow-up subjects were classified by baseline BP and grouped by age. After the 3-year follow-up, the MS incidence and valid BP cutoff value for predicting MS were calculated for subjects within the normal BP range.

RESULTS

After the 3-year follow-up study, the crude and standardized MS incidences in the cohort were 19.83% and 16.89% for follow-up subjects, respectively, with incidences of 10.94% and 10.50% for males and 23.13% and 20.66% for females. The incidence of MS in normotensive subjects (15.53%) was lower than that in subjects with high-normal BP (29.08%). After adjusting for age, sex, BMI, smoking, and drinking, the risk of having MS in the high-normal BP group was 1.823-fold [HR 1.823 95% CI (1.538-2.162)] higher than that in the normotensive group. The ROC curve showed that the BP cutoff values were more than 117/74 mmHg in males and 112/74 mmHg in females.

CONCLUSION

When BP was within the normal range, the incidence of MS in participants was very high. The MS incidence was higher among high-normal BP subjects than among normotensive subjects, as was the risk of having MS. The valid BP cutoff value for predicting MS in the population was 117/74 mmHg in males and 112/74 mmHg in females. Currently, epidemiological investigations are needed to determine whether a lower BP cutoff value is needed in diagnosing MS.

The Impact of Low Advanced Glycation End Products Diet on Metabolic Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Several randomized clinical trials have investigated the effect of dietary advanced glycation end products (AGEs) on metabolic syndrome risk factors in adults. However, the results of these studies were conflicting. Therefore, our aim was to assess the effect of dietary AGEs on metabolic syndrome risk factors. We searched the PubMed-MEDLINE, Scopus, Cochrane Databases, Google Scholar, Web of Science, and Embase databases for papers published up to October 2019 that investigated the effect of dietary AGEs on metabolic syndrome risk factors. From the eligible trials, 13 articles were selected for inclusion in this systematic review and meta-analysis. The meta-analysis was performed using a random-effects model. Heterogeneity was determined by I2 statistics and Cochrane Q test. Pooled results from the random-effects model showed a significant reduction for insulin resistance [weighted mean difference (WMD): -1.204; 95% CI: -2.057, -0.358; P = 0.006], fasting insulin (WMD: -5.472 μU/mL; 95% CI: -9.718, -1.234 μU/mL; P = 0.011), total cholesterol (WMD: -5.486 mg/dL; 95% CI: -10.222, -0.747 mg/dL; P = 0.023), and LDL (WMD: -6.263 mg/dL; 95% CI: -11.659, -0.866 mg/dL; P = 0.023) in the low-AGEs groups compared with the high-AGEs groups. There were no changes in the other components of the metabolic syndrome. The results of this review suggest that a diet with a low AGEs content has beneficial effects on insulin resistance, fasting insulin, total cholesterol, and LDL. Moreover, following a diet low in AGEs may be a helpful strategy to decrease the burden of metabolic syndrome risk factors in adults and particularly in patients with diabetes.

Impact of Metabolic Syndrome Components in High-Risk Cardiovascular Disease Development in Older Adults

OBJECTIVE

Analyze the influence between the components of metabolic syndrome and the independent risk for cardiovascular disease (CVD) in the elderly.

METHODS

A descriptive cross-sectional study was carried out with 205 older adults from a primary healthcare unit of the Federal District, Brazil. The cardiovascular risk was determined by the Framingham Risk Score (FRS). The National Cholesterol Evaluation Program for Adult Treatment Panel III 2001 (NCEP-ATP III) criteria were considered to analyze metabolic syndrome (MS) diagnoses.

RESULTS

There was a strong association between MS and high cardiovascular risk (OR = 8.86). The univariate analysis main findings revealed that male gender, diabetes, smoking habit, systolic blood pressure, HDL level, high blood glucose, glycated hemoglobin, and LDL level were associated with high cardiovascular risk. FRS increases significantly with the presence of four or more MS components (by 30%, if 4 components are present, and by 40%, if 5 components) when compared with the presence of three or fewer components (P <0.001). A logistic regression analysis of high-risk predictors was described to reduce the effects of confounding and bias factors.

CONCLUSION

The identification of MS associated with high FRS values represents a cascading of adverse effects on the population's aging process.