Selected dietary nutrients and the prevalence of metabolic syndrome in adult males and females in Saudi Arabia: a pilot study

Sleep Quality, Nutrient Intake, and Social Development Index Predict Metabolic Syndrome in the Tlalpan 2020 Cohort: A Machine Learning and Synthetic Data Study

This study investigated the relationship between Metabolic Syndrome (MetS), sleep disorders, the consumption of some nutrients, and social development factors, focusing on gender differences in an unbalanced dataset from a Mexico City cohort. We used data balancing techniques like SMOTE and ADASYN after employing machine learning models like random forest and RPART to predict MetS. Random forest excelled, achieving significant, balanced accuracy, indicating its robustness in predicting MetS and achieving a balanced accuracy of approximately 87%. Key predictors for men included body mass index and family history of gout, while waist circumference and glucose levels were most significant for women. In relation to diet, sleep quality, and social development, metabolic syndrome in men was associated with high lactose and carbohydrate intake, educational lag, living with a partner without marrying, and lack of durable goods, whereas in women, best predictors in these dimensions include protein, fructose, and cholesterol intake, copper metabolites, snoring, sobbing, drowsiness, sanitary adequacy, and anxiety. These findings underscore the need for personalized approaches in managing MetS and point to a promising direction for future research into the interplay between social factors, sleep disorders, and metabolic health, which mainly depend on nutrient consumption by region.

Protein supplement intake by non-athlete gym attendees in Jazan region: misconceptions and gender differences

BACKGROUND

Protein supplements (PSs) have gained widespread popularity among non-athlete gym attendees, who often perceive them as essential tools for muscle growth and recovery. However, misinformation surrounding PSs may lead to inappropriate use and negative health consequences. This study aimed to assess whether non-athlete gym attendees using PSs have greater misconceptions than non-users while also examining the prevalence of PS consumption and gender differences.

METHODS

A cross-sectional study of 387 participants in the Jazan region was conducted. Customers of 10 fitness centers were screened with a questionnaire comprising questions to measure PS misconceptions. Participants were divided into PS users and non-users. Data were analyzed using descriptive statistics and the Chi-square test to assess the associations between variables. An independent t-test was used to compare the PS Misconception Index Score between the two groups.

RESULTS

A total of 82.4% of non-athlete gym attendees consumed at least one PS. Our findings revealed a significant association between gender and PS utilization (P<0.001), with a higher proportion of females (90.8%) consuming PS than males (77.6%). PS users had a significantly lower PS Misconception Index Score than non-users (26.8 vs. 28.3; P=0.006), indicating that PS users had a higher number of misconceptions. The internet (41.37%) and coaches (gym instructors/trainers) (34.48%) were the most common sources of information about PSs, with muscle gain being the primary reason for consumption (82.75%).

CONCLUSIONS

PS consumption is highly prevalent among non-athlete gym attendees in the Jazan region, with many individuals having misconceptions about their benefits and potential risks. Targeted educational interventions are needed to promote evidence-based knowledge about PSs for gym attendees, as well as for coaches, given that they were among the primary sources of information on supplements.

The association between plant-based diet indices and metabolic syndrome: a systematic review and dose-response meta-analysis

Aim/introduction

The prevalence of metabolic syndrome (MetS) and its components have markedly increased worldwide. Among lifestyle factors introduced to lower the risk of MetS, healthy dietary patterns have gained considerable attention. This study aimed to assess the association between adherence to plant-based diet indices including O-PDI (overall plant-based diet index), H-PDI (healthy plant-based diet index), U-PDI (unhealthy plant-based diet index), and risk of MetS development.

Methods

To find related observational studies which assessed the association between Plant-based Diet indices and risk of MetS development, PubMed/Medline, Scopus, and Web of Science databases were searched from January 2016 to November 2023. A random effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (95% CI). To assess the heterogeneity of included studies, the I2 index was used.

Results

Nine studies including 34,953 participants from the initial 288 studies were recognized to include in this meta-analysis study. According to pooled analysis, there was a significant relationship between the adherence to H-PDI and the lower risk of MetS (ES: 0.81; 95% CI: 0.67, 0.97; I2 = 77.2%, p < 0.001), while greater adherence to U-PDI was associated with 27% increases in the risk of MetS (ES: 1.27; 95% CI: 1.05, 1.54; I2 = 76.8%, p < 0.001). According to our analysis of the association between adherence to PDIs and the risk of MetS components, greater adherence to O-PDI and H-PDI was significantly associated with a higher risk of elevated FBS and obesity, respectively. As well, greater adherence to U-PDI was significantly associated with a higher risk of obesity, hypertriglyceridemia, low HDL-C, and elevated FBS.

Conclusion

Our results highlighted the importance of food choices in the context of a plant-based dietary pattern, indicating that adherence to unhealthy plant-based dietary patterns rich in less healthful carbohydrates may induce the risk of MetS development.

Systematic review registration

PROSPERO CRD42023428981.

Assessment of dietary magnesium intake in the Eastern Province of Saudi Arabia

Magnesium is an essential element and the most abundant intracellular cation after potassium. This cross-sectional study assessed the average dietary magnesium intake among residents of the Eastern Province of Saudi Arabia. Data was collected using a self-reported validated electronic questionnaire between April 2022 and July 2023. The first part of the survey included demographic data, and the second section comprised 33 items, including a semi-quantitative tool specifically designed to evaluate magnesium intake over the last three months. We included 1065 participants, out of whom 61.1% were women. The predominant age group was 19 - 26 years (56.9%), and most participants (83.3%) reported no comorbidities. The majority (48.5%) had normal weight, 246 (23%) were overweight, and 193 (18.1%) were obese. Most participants had low dietary magnesium intake, ranging from one to five times monthly. There was a positive correlation between age and dietary magnesium consumption. The study highlights a concerning trend of low magnesium intake, representing a risk for various chronic diseases. This trend could be linked to increased consumption of typical diets low in magnesium, such as those high in refined sugars, flour, and processed foods, prevalent among the younger Saudi population.

A causal relationship between antioxidants, minerals and vitamins and metabolic syndrome traits: a Mendelian randomization study

BACKGROUND

The available evidence regarding the association of antioxidants, minerals, and vitamins with the risk of metabolic syndrome (MetS) traits is currently limited and inconsistent. Therefore, the purpose of this Mendelian randomization (MR) study was to investigate the potential causal relationship between genetically predicted antioxidants, minerals, and vitamins, and MetS.

METHODS

In this study, we utilized genetic variation as instrumental variable (IV) to capture exposure data related to commonly consumed dietary nutrients, including antioxidants (β-carotene, lycopene, and uric acid), minerals (copper, calcium, iron, magnesium, phosphorus, zinc, and selenium), and vitamins (folate, vitamin A, B6, B12, C, D, E, and K1). The outcomes of interest, namely MetS (n = 291,107), waist circumference (n = 462,166), hypertension (n = 463,010), fasting blood glucose (FBG) (n = 281,416), triglycerides (n = 441,016), and high-density lipoprotein cholesterol (HDL-C) (n = 403,943), were assessed using pooled data obtained from the most comprehensive genome-wide association study (GWAS) available. Finally, we applied the inverse variance weighting method as the result and conducted a sensitivity analysis for further validation.

RESULTS

Genetically predicted higher iron (OR = 1.070, 95% CI 1.037-1.105, P = 2.91E-05) and magnesium levels (OR = 1.130, 95% CI 1.058-1.208, P = 2.80E-04) were positively associated with increased risk of MetS. For each component of MetS, higher level of genetically predicted selenium (OR = 0.971, 95% CI 0.957-0.986, P = 1.09E-04) was negatively correlated with HDL-C levels, while vitamin K1 (OR = 1.023, 95% CI 1.012-1.033, P = 2.90E-05) was positively correlated with HDL-C levels. Moreover, genetically predicted vitamin D (OR = 0.985, 95% CI 0.978-0.992, P = 5.51E-5) had a protective effect on FBG levels. Genetically predicted iron level (OR = 1.043, 95% CI 1.022-1.064, P = 4.33E-05) had a risk effect on TG level.

CONCLUSIONS

Our study provides evidence that genetically predicted some specific, but not all, antioxidants, minerals, and vitamins may be causally related to the development of MetS traits.

Association of bone mineralization markers with dietary nutrient intake in adolescents with and without biochemical osteomalacia

Background

Dietary intake is widely known to play a crucial role in achieving peak bone mass among children and adolescents. Unfortunately, this information is lacking among Arab adolescents, an understudied demographic that has recently been observed to have a high prevalence of abnormal mineralization markers [low serum 25(OH)D, high serum alkaline phosphatase (ALP), low calcium (Ca) and/or inorganic phosphate (Pi)] suggestive of biochemical osteomalacia (OM, defined as any 2 of the 4 parameters). In order to fill this gap, we aimed to evaluate the associations of serum markers of biochemical OM with dietary intake of macronutrients, vitamins and trace minerals.

Methods

Saudi adolescents (N = 2,938, 57.8% girls), aged 12-17 years from 60 different schools in Riyadh, Saudi Arabia were included. Dietary intake of nutrients was calculated following a semi-quantitative 24 h dietary recall over 3 weekdays and 1 weekend-day using a validated food frequency questionnaire. Compliance to reference daily intake (RDI) of macronutrients, vitamins and trace minerals were calculated. Fasting blood samples were collected and circulating levels of 25(OH)D, ALP, Ca, and Pi were analyzed.

Results

A total of 1819 (1,083 girls and 736 boys) adolescents provided the dietary recall data. Biochemical OM was identified in 175 (9.6%) participants (13.5% in girls, 3.9% in boys, p < 0.01) while the rest served as controls (N = 1,644). All participants had serum 25(OH)D levels <50 nmoL/L. Most participants had very low dietary intakes of Ca (median ~ 290 mg) and vitamin D (median ~ 4 μg) which are far below the RDI of 1,300 mg/day and 20 μg/day, respectively. In contrast, excess dietary intakes of Pi, Na, K, and Fe were observed in all participants. In the biochemical OM group, thiamine and protein intake were significant predictors of serum 25(OH)D, explaining 4.3% of the variance perceived (r = 0.23, adjusted r² = 4.3%, p = 0.01). Among controls, dietary vitamin C and vitamin D explained 0.6% of the total variation in serum 25(OH)D (r = 0.09, adjusted r² = 0.6%, p = 0.004).

Conclusion

Arab adolescents do not meet the RDI for dietary Ca and vitamin D, and none have sufficient vitamin D status (25(OH)D levels >50 nmol/L) but they exceed the RDI for dietary Pi. Interpreting these data in the light of the increased prevalence of rickets in Arab countries, food fortification to optimise vitamin D and Ca intake in Saudi adolescents should be considered.

Metabolic Syndrome Is Associated with Low Diet Quality Assessed by the Healthy Eating Index-2015 (HEI-2015) and Low Concentrations of High-Density Lipoprotein Cholesterol

Presenting diet quality of patients with metabolic syndrome (MetS), using a holistic approach is more useful than investigating dietary individual components, but there is still a small amount of research in this area. The aim of this study assessed the diet quality, as measured by the HEI-2015, of MetS patients compared to healthy individuals. The study and control group consisted of 215 patients with MetS and 320 people without MetS, respectively. A nutritional analysis using a semi-quantitative food frequency questionnaire was used to evaluate the nutritional habits in the study and control group. Total HEI-2015 scores were significantly lower in MetS subjects than in those in the control group (65.04 ± 9.71 vs. 66.75 ± 8.88) and the quality of women’s diets was better than the quality of men’s diet (66.83 ± 8.99 vs. 64.75 ± 9.57). We also observed that low HDL-c concentration increased the risk of MetS in the general population the most. Across the population, there was a weak positive correlation between HDL-c concentrations and total HEI-2015 scores and a weak negative correlation between mean waist circumference values and total HEI-2015 scores. HDL-c concentrations may be a key factor in the prevention of MetS and appropriate therapeutic management to increase HDL-c levels may be of key importance in patients diagnosed with MetS.

Dietary Patterns Derived from Reduced Rank Regression Are Associated with the 5-Year Occurrence of Metabolic Syndrome: Aichi Workers' Cohort Study

The aim of the present study was to derive dietary patterns to explain variation in a set of nutrient intakes or in the measurements of waist circumference (WC) and fasting blood glucose (FBG) using reduced rank regression (RRR) and to prospectively investigate these patterns in relation to the risk of developing metabolic syndrome (MetS) and its components during the follow-up. The study participants were comprised of 2944 government employees aged 30−59 years without MetS. RRR was applied with 38 food groups as predictors and with two sets of response variables. The first set included intake of putatively beneficial nutrients, and the first factor retained was named the Healthy Dietary Pattern (HDP). The second one included baseline WC and FBG, and the first factor was named the Unhealthy Dietary Pattern (UHDP). Multivariable Cox proportional hazard model was used to estimate hazard ratio and 95% confidence intervals with adjustments for age, sex, total energy consumption and other potential confounders. During the 5-year median follow-up, we ascertained 374 cases of MetS. The HDP score was inversely associated with the incidence of MetS (p-trend = 0.009) and hypertension (p-trend = 0.002) and marginally significantly associated with elevated triglyceride and decreased high-density lipoprotein cholesterol (p-trend = 0.08). The UHDP score was linearly positively associated with the incidence of MetS and all its components (all p-trend < 0.05). Both the HDP and UHDP predicted the development of MetS and its components.

Cheese Intake Exhibits an Alteration of Glycolipid Profile and Impacts on Non-Alcoholic Fatty Liver in Bahraini Older Adults

Background: Metabolic syndrome (MetS) is a multifactorial condition characterized by a complex interrelation between genetic and environmental factors that heighten the risk of cardiovascular diseases and all-cause mortality. It is hypothesized that diet may play an important role in the regulation of metabolic syndrome factors and influence the process. Therefore, the main objective of this study was to investigate the specific dietary patterns associated with metabolic syndrome markers and quantify the possible effects of dietary patterns among Bahrain older adults. Methods: This is a cross-sectional study that included 151 Bahraini patients diagnosed with MetS, 89 (58.7%) were females and 62 (41.3%) males. Results: The prevalence of Non-Alcoholic Fatty Liver was 89%. Statistically significant correlations were found between dairy products with low fat and SBP (r = 0.182, p < 0.001) body mass index (BMI) (r = −0.195; p < −0.01). Higher chicken consumption was associated with reduction of BMI (r = −0.273; p < −0.01). A higher consumption of ricotta and cheddar cheese (high in fat) was associated with higher levels of triglycerides (p < 0.01). Higher frequent consumption of rice (basmati) was associated with lower glucose levels (r = −0.200; p < −0.01). Fatty liver has been associated with high consumption of cream cheese (p < 0.01). Conclusion: In older Bahraini adults with metabolic syndrome, higher frequency of food consumption of full-fat cheese was linked with a derangement of lipid profile and Non-Alcoholic Fatty Liver. Positive effects on BMI have been recorded with higher-frequency consumption of basmati rice and chicken.

Relationship between Dietary Magnesium Intake and Metabolic Syndrome

Metabolic syndrome (MetS) is increasingly prevalent, and the relationship between dietary magnesium and MetS remains controversial. Therefore, we aimed to explore the association and dose-response relationship between dietary magnesium intake and MetS and its single component. The sample was adults aged 18 years and above who participated in at least two follow-up surveys in 2009, 2015 and 2018. Food consumption data were collected from three consecutive 24-h dietary recalls. The multivariate Cox proportional risk regression model and restricted cubic spline (RCS) model were used to analyze the association and dose-response relationship between dietary magnesium intake and MetS and its components. In our study, 6104 subjects were included, with a total follow-up of 37,173.36 person-years, and the incidence was 33.16%. Cox regression analysis showed that the multivariable-adjusted Hazard Ratio (HR) for MetS comparing the highest to the lowest quintile of dietary magnesium intake was 0.84 (95% confidence intervals [CI] = 0.71-0.99). Central obesity, elevated TG, elevated blood pressure and elevated blood glucose were reduced by 18%, 41%, 20% and 42%, respectively. The risk of decreased HDL-C was reduced by 23% in the third quintile of dietary magnesium intake, with a slightly increased risk in the highest group. RCS analysis showed that the overall and non-linear associations between dietary magnesium and MetS and its components were statistically significant, the risk of them decreased significantly when magnesium intake was lower than 280 mg/day, and then the curve leveled off or slightly increased.

Knowledge, Attitudes, and Use of Protein Supplements among Saudi Adults: Gender Differences

Saudi Arabia has witnessed recent reforms and positive socio-political changes that have led to increased opportunities for women to participate in fitness centers. This study investigated protein supplement consumption among Saudi females compared with that among males and examined the knowledge and attitudes of the participants toward protein supplement use. A cross-sectional study was conducted in Riyadh using a previously validated, self-administered online survey. The questionnaire included items related to the prevalence, knowledge, attitudes, and practice of protein supplementation. The participants were 354 adults (58.2% were females). The results showed that over 47% of the participants attended fitness centers with more male (80.3%) than female (41%) attendees. Nearly 50% of the participants consumed protein supplements, with males (68.7%) using significantly (p < 0.001) more protein supplements than females (35.6%). The powdered form was most commonly consumed. The percentage of gym attendees (67.8%) who used protein supplements was higher than that among non-gym attendees (32.2%). Gaining muscles (56.1%) followed by compensating for protein deficiency (28.6%) were the reasons for taking protein supplements, with a significant gender difference (p < 0.001). Coaches provided the most information on protein supplements. The participants appeared to be knowledgeable about protein supplements. Although over 68% of protein supplement users suffered from various symptoms, only 20% of the participants thought that there was no risk in taking protein supplements, with significant gender differences. It was concluded that Saudi male participants are twice more likely to attend the gym and consume protein supplements compared with females. Of both genders, those attending the gym consumed more protein supplements than non-gym attendees.

Association Between Dietary Zinc Intake and Metabolic Syndrome. A Meta-Analysis of Observational Studies

Background

Epidemiological studies have investigated the association between dietary zinc intake and metabolic syndrome (MetS). However, their results are conflicting. This meta-analysis was therefore employed to investigate the associations further.

Methods

A comprehensive literature search was employed by using the electronic database of PubMed, Web of Science, and Embase up to November 2021. The pooled relative risk (RR) of MetS for the highest vs. lowest dietary zinc intake category, and the weighted mean difference (WMD) of dietary zinc intake for MetS vs. control subjects as well as their corresponding 95% confidence interval (CI) were calculated.

Results

A total of 13 observational studies (18,073 participants) were identified in this meta-analysis. The overall multi-variable adjusted RR demonstrated that the dietary zinc intake was inversely associated with MetS (RR = 0.75, 95%CI: 0.61 to 0.93; P = 0.009). The subgroup analysis confirmed such findings in cross-sectional (RR = 0.70, 95%CI: 0.55 to 0.87; P = 0.002), NCEP-ATP III (RR = 0.64, 95%CI: 0.48 to 0.84; P = 0.002), adult (RR = 0.77, 95%CI: 0.62 to 0.96; P = 0.02), dietary recall method (RR = 0.70, 95%CI: 0.55 to 0.87; P = 0.002), and >500 sample-sized study (RR = 0.79, 95%CI: 0.64 to 0.99; P = 0.002), respectively. On the other hand, the overall combined WMD showed that the dietary zinc intake in MetS was also lower than that in control subjects (WMD = −0.21, 95%CI: −0.42 to 0.00; P = 0.05).

Conclusions

Our results suggest that the dietary zinc intake is negatively associated with MetS. However, due to the limitation of available evidence. More well-designed prospective cohort studies are still needed.

Awareness, Knowledge and Attitude towards 'Superfood' Kale and Its Health Benefits among Arab Adults

This cross-sectional online survey aimed to determine the awareness of Arab adults on the benefits of consuming nutrient-dense foods, such as kale. A total of 1200 respondents completed the survey. The questionnaire included questions related to socio-economic information, e.g., whether the participants have consumed kale, if they observed any health effects, and 13 other questions to test their knowledge on this superfood. Only 276 (23%) of the participants had previously consumed kale, with 64.5% reporting favorable health outcomes, the most common of which was weight reduction, and only 17.8% reporting side effects, such as constipation and gastrointestinal irritation. From the 13 kale knowledge questions, the average total knowledge score, scaled from 0 to 10, was 3.5 and 3.7 for males and females, respectively. The regression analysis revealed that age, income, and educational status were significant contributors for predicting better knowledge scores, as older individuals with a higher income and higher education scored higher (odds ratio of 2.96, 2.00 and 4.58, respectively). To summarize, there is a dearth of awareness about kale and its health benefits in Saudi Arabia. Kale should be promoted as a super food in all segments, particularly among the younger, lower-income, and less-educated sections of the population.

Associations of Dietary and Circulating Vitamin E Level With Metabolic Syndrome. A Meta-Analysis of Observational Studies

Objective: The associations of dietary and circulating vitamin E level with metabolic syndrome (MetS) remains conflicting. This meta-analysis of observational study was therefore employed to investigate the issue above.

Methods: The PubMed, Web of Science and Embase database were searched up to April 2021. The observational studies on the associations of dietary and circulating vitamin E level with MetS were specified. The pooled relative risk (RR) of MetS for the highest vs. lowest dietary and circulating vitamin E level, and the standard mean difference (SMD) of dietary and circulating vitamin E level for MetS vs. control subjects, were calculated.

Results: A total of 25 observational studies with 51,276 participants, were included in this meta-analysis. The overall multi-variable adjusted RR demonstrated that the dietary vitamin E level was inversely associated with MetS (RR = 0.92, 95%CI: 0.85–1.00; P = 0.044). In addition, the dietary vitamin E level in MetS was also lower than that in control subjects according to the overall combined SMD (SMD = −0.08, 95%CI: −0.14 to −0.02; P = 0.024). On the other hand, the overall multi-variable adjusted RR showed no significant relationship between the circulating vitamin E level and MetS (RR = 1.46, 95%CI: 0.85–2.48; P = 0.17). However, the circulating vitamin E level in MetS was lower than that in control subjects according to the overall combined SMD (SMD = −0.58, 95%CI: −1.04 to −0.13; P = 0.013).

Conclusions: The results of this meta-analysis suggest that the dietary vitamin E level is inversely associated with MetS. On the other hand, current evidence is still insufficient to conclude a relationship between the circulating vitamin E level and MetS. More well-designed prospective cohort studies are needed to address the issues further.

Vitamin C and Metabolic Syndrome: A Meta-Analysis of Observational Studies

Background: The association between vitamin C and metabolic syndrome (MetS) has been evaluated in several epidemiological studies with conflicting results. This meta-analysis was therefore employed to further investigate the above issue. Methods: The observational studies on the associations of dietary and circulating (serum and plasma) vitamin C levels with MetS were searched in the PubMed, Web of Science, and Embase database up to April 2021. The pooled relative risk (RR) of MetS for the highest vs. lowest dietary and circulating vitamin C levels and the standard mean difference (SMD) of dietary and circulating vitamin C levels for MetS vs. control subjects were calculated, respectively. Results: A total of 28 observational studies were identified in this meta-analysis. Specifically, 23 studies were related to the dietary vitamin C level. The overall multivariable-adjusted RR demonstrated that the dietary vitamin C level was inversely associated with MetS (RR = 0.93, 95% CI: 0.88-0.97; P = 0.003). Moreover, the overall combined SMD showed that the dietary vitamin C level in MetS was lower than that in control subjects (SMD = -0.04, 95% CI: -0.08 to -0.01; P = 0.024). With regard to the circulating vitamin C level, 11 studies were included. The overall multivariable-adjusted RR demonstrated that the circulating vitamin C level was inversely associated with MetS (RR = 0.60, 95% CI: 0.49-0.74; P < 0.001). In addition, the overall combined SMD showed that the circulating vitamin C level in MetS was lower than that in control subjects (SMD=-0.82, 95%CI: -1.24 to -0.40; P < 0.001). Conclusions: Current evidence suggests that both dietary and circulating vitamin C level is inversely associated with MetS. However, due to the limitation of the available evidence, more well-designed prospective studies are still needed.

Associations Between Serum Multiple Metals Exposures and Metabolic Syndrome: a Longitudinal Cohort Study

Although many studies have confirmed metabolic syndrome (MetS) is correlated with metal exposures, few studies have elucidated the associations of multiple metals with MetS risk. We aim to explore the relationship between serum 22 metals and MetS. We determined serum 22 metals using ICP-MS and used LASSO regression to select metals independently related with MetS to construct multiple-metals model. We further explored the dose-response relationship between positive metals and MetS by the restricted cubic spline regression. After screening by LASSO regression, serum 11 metals were selected to construct multiple-metals model in cross-sectional analysis, while 5 metals in longitudinal analysis. In the 11-metal model, only tin and zinc were associated with MetS in cross-sectional analysis (OR_tin = 2.22, 95% CI:1.43, 3.45; OR_zinc = 2.17, 95% CI: 1.42, 3.32; both P_trend < 0.05). Besides, the same results were found in the 5-metal model in longitudinal analysis (HR_tin = 1.66, 95% CI: 0.87, 3.17; HR_zinc = 1.83, 95% CI: 1.07, 3.14; both P_trend < 0.05). Moreover, there were positive linear relationships between serum tin and zinc concentrations and the increasing risk of MetS (both P_overall < 0.05, P_{non-linearity} > 0.05). Furthermore, the interaction between high tin and high zinc was also associated with increasing MetS risk (P_interaction < 0.05). We found that serum tin and zinc were independently and interactively associated with MetS in the southern Chinese men. Our results suggested that high tin and zinc may be the risk factors of MetS.

Association between serum Vitamin E concentrations and the presence of Metabolic Syndrome: A population-based cohort study

BACKGROUND

Metabolic syndrome (MetS) is a cluster of clinical and metabolic features that include central obesity, dyslipidemia, hypertension and impaired glucose tolerance. These features are accompanied by increased oxidative stress and impaired antioxidant defenses. Vitamin E is a major factor in the non-enzymatic antioxidant defenses. The aim of present study was to investigate the association between serum levels of vitamin E and the presence of MetS and its components in a sample population of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study.

METHODS

This cross-sectional study was carried out in 128 subjects with MetS and 235 subjects without MetS. MetS was defined according to the International-Diabetes-Federation criteria. Serum levels of vitamin E were measured using the HPLC method. Anthropometric and biochemical parameters were measured using standard protocols.  Results. MetS patients had significantly lower serum levels of vitamin E (Vit E), Vit E/Total cholesterol (TC), and Vit E/ (TC+triglyceride(TG)) compared to the control group (P < 0.05).  Vit E/ (TG+TC) was also significantly lower in diabetics or those with elevated levels of high sensitive C-reactive protein (hs-CRP). Additionally, there was a significant association between Vit E/ (TG + Total Cho) and the number of components of the metabolic syndrome (p= 0.02) Conclusions. There is a significant inverse association between indices of Vit E status and the presence of MetS. Moreover, a significantly lower Vit E/ (TC+TG) was observed along with individuals with increasing numbers of components of the MetS.

The Study of Relationship between Nutritional Behaviors and Metabolic Indices: A Systematic Review

Metabolic indices are the wide range of characteristic factors, which can be changed during several medical conditions such as metabolic syndrome. Nutrition and related behaviors are one of the main aspects of human lifestyle which recent investigations have recognized their roles in the development of metabolic disorders. According to the spread of risky nutritional habits/behaviors due to the changes in lifestyle, and its importance in the prevalence of metabolic disorders, the authors attempted to summarize these evidences in a systematic review. The present study is a systematic review that encompasses those studies investigating the association between metabolic indices and nutritional/dietary behaviors published in two international databases in recent 11 years. Twenty-nine related articles were considered and their data were extracted. The relation between food choices and metabolic indices is more frequent in studies. While, inhibition and abstinent and eating together were two behavioral sets with the smallest share of research. Anthropometric indices have the highest rate in the evaluations. Finding the links between nutritional behavior and metabolic indices will be the key point in selecting the different types of interventions. These results will guide therapists to the accurate recognition of metabolic effects in targeting behavior for their intervention.

Difference on the prevalence, patterns and awareness of soft drink consumption among male and female Arab students

BACKGROUND

The increase in soft drink (SD) consumption is emerging as a serious health issue. Our aim is to explore the prevalence and awareness regarding SD consumption among Saudi students.

METHODS

This cross-sectional study included 1000 apparently healthy Saudi students (527 males, 473 females) aged 16-23 years. A designed questionnaire including various sections was used to obtain the required information.

RESULTS

The BMI and frequency of SD consumption were significantly higher in males (P < 0.001) than females, whereas, females exhibited higher awareness and knowledge regarding SD consumption than males. The SD consumption in females was due to society, taste, availability and markets, whereas in males it was due to cheap price. Females support the implementation of new policies to prevent consumption of SD.

CONCLUSIONS

Arab students exhibited a high prevalence of SD consumption especially in males. Although females showed more awareness and knowledge about SD, various misconceptions were notable in both sexes. New policies, health promotion campaigns must be organized to raise awareness among children and parents. Parents and health educators should motivate and encourage the children to consume more water in the context of a healthy balanced diet.

"Playing with Little Behaviors"; Physical Activity Promotion by Gamified Education in Young Boys

Background:

Physical activity is affecting every aspect of our life. A sedentary lifestyle can be the risk factor for noncommunicable diseases (NCD) or premature death all over the world. Several studies demonstrate that school-based physical activity promotion is an important solution to make healthy behaviors, especially in children and adolescents. In this vein, the current research evaluates a model for physical activity, which is promoted through a game among high school students.

Methods:

In this study, 47 high school's 10^th-grade boys from Tehran were requited. The game scenario included the suggestion of some behaviors which can increase daily physical activity by each student, like or dislike each behavior by other students, counting likes, selecting the most-liked behaviors, and rewarding their proposers. After a week, the behavioral recall was assessed and compared with a control group who had been heard these behaviors in the class without gamification.

Results:

The participants in the game could recall physical activity behaviors significantly more than peers in the control group.

Conclusions:

The findings show gamification could significantly improve the effectiveness of education for normal behaviors in physical activity.

Association between unhealthy plant-based diets and the metabolic syndrome in adult men and women: a population-based study in South Korea

No studies have investigated the associations between established plant-based diet indices and the metabolic syndrome (MetS). We evaluated the associations between an overall plant-based diet index (PDI), healthy PDI (hPDI), unhealthy PDI (uPDI) and the MetS in a nationally representative sample using data from 14 450 Korean adults (≥19 years) in the Korea National Health and Nutrition Examination Survey 2012-2016. Dietary intakes were assessed by a semi-quantitative FFQ. In the PDI, all plant foods received positive scores. In the hPDI, only healthy plant foods received positive scores. In the uPDI, only unhealthy plant foods received positive scores. All indices reverse scored animal food intake. Multivariable logistic regression models were used to examine the associations between three PDI and the MetS by sex, adjusting for potential risk factors. A total of 23·3 % of Korean adults had the MetS. In the overall study population, individuals in the highest quintile of uPDI had greater odds (OR 1·54, 95 % CI 1·28, 1·86, Ptrend < 0·001) of the MetS than those in the lowest quintile. Higher uPDI score was associated with higher odds of hypertriacylglycerolaemia in men and abdominal obesity, high fasting glucose and hypertriacylglycerolaemia in women. No significant associations were observed between PDI, hPDI and the MetS. Greater adherence to unhealthy plant-based diets was associated with greater odds of the MetS and its components suggesting the importance of the quality of plant-based diet in South Korean adults. Sex differences may be considered when recommending plant-based diets for the prevention and management of metabolic diseases.

Awareness and Knowledge Regarding the Consumption of Dietary Fiber and Its Relation to Self-Reported Health Status in an Adult Arab Population: A Cross-Sectional Study

The objective of this study was to examine the awareness, knowledge, and habits regarding dietary fiber intake and to analyze its relationship with self-reported health status among Saudi adults. A survey-based study using face-to-face interview was designed, and 1363 apparently healthy adult Saudi males and females participated. Most participants were females (81.2%), aged 25 and above (87.2%), and were educated at least up to the secondary level of education (80.8%). The majority of the participants were aware of the role of fiber-rich foods in health conditions such as obesity (70.5%), cardiovascular diseases (68.9%), and regulation of blood sugar (68.9%), with females significantly having higher nutrition knowledge than males. A disconnect in translating this nutrition knowledge was observed particularly in food choices when eating out, where preferences for white bread (84.4%), fried potatoes (69.9%) and peeled fruits (60.6%) were significantly higher than preferences for cooked vegetables (29.6%) and brown bread (18.1%). The most common reason for this disconnect was due to perception that foods rich in dietary fibers were expensive (72.1%), have less health benefits (56.5%), were not readily available (51.6%), and participants’ disliking of the taste (52.8%). Participants in the highest quartile (Q4) for dietary fiber consumption reported a lower prevalence of constipation (odds ratio, 95% confidence interval of 0.40, 0.28–0.57, p < 0.01), high cholesterol (0.43, 0.27–0.68, p < 0.01) and obesity (0.67, 0.44–0.98, p = 0.03) than participants in the lowest quartile (Q1). Dietary fiber intake appears to be protective against constipation, high cholesterol and obesity in Saudi adults. However, a disparity observed between knowledge and attitude towards intake of dietary fibers could limit its health benefits. Further studies including adolescents should be conducted to impart knowledge on the emotional, cognitive and sensory factors related to food choices in order to minimize the gap between nutrition knowledge and the consumption of healthy high-fiber diets.

Prevalence of metabolic syndrome in the Gulf Cooperation Council countries: meta-analysis of cross-sectional studies

Metabolic syndrome is a collection of health-related conditions that lead to serious health condition. An individual with metabolic syndrome may acquire greater risk for adult-onset complications such as cardiovascular or neurological disorders. The aim of this study was to review and provide the prevalence of metabolic syndrome in Gulf Cooperation Council countries (GCC). Literature searches were performed on PubMed, Google scholar, and Web of Science Core Collection for English-language articles along with national studies. The following search terms were used during search: “prevalence of metabolic syndrome in GCC,” “prevalence of metabolic syndrome in middle east,” “prevalence of metabolic syndrome in Arab,” and “prevalence of metabolic syndrome name of country.” Thirty-seven studies were selected for final review out of 132 studies. The weighted pooled prevalence of metabolic syndrome was 27.3% with high heterogeneity (I²=98.94%; Cochran Q-test P<0.01). The results showed comparatively high and rising rate of metabolic syndrome in the GCC area. Preventative strategy should be considered to reduce the risk of morbidity or mortality related to metabolic syndrome.

Vitamin C: A Review on its Role in the Management of Metabolic Syndrome

Oxidative stress and inflammation are two interlinked events that exist simultaneously in metabolic syndrome (MetS) and its related complications. These pathophysiological processes can be easily triggered by each other. This review summarizes the current evidence from animal and human studies on the effects of vitamin C in managing MetS. In vivo studies showed promising effects of vitamin C, but most of the interventions used were in combination with other compounds. The direct effects of vitamin C remain to be elucidated. In humans, the current state of evidence revealed that lower vitamin C intake and circulating concentration were found in MetS subjects. A negative relationship was observed between vitamin C intake / concentration and the risk of MetS. Oral supplementation of vitamin C also improved MetS conditions. It has been postulated that the positive outcomes of vitamin C may be in part mediated through its anti-oxidative and anti-inflammatory properties. These observations suggest the importance of MetS patients to have an adequate intake of vitamin C through food, beverages or supplements in order to maintain its concentration in the systemic circulation and potentially reverse MetS.

Dietary Calcium Intake and the Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

Growing evidence has suggested a possible relationship between dietary calcium intake and metabolic syndrome (MetS) risk. However, the findings of these observational studies are inconclusive, and the dose-response association between calcium intake and risk of MetS remains to be determined. Here, we identified relevant studies by searching PubMed and Web of Science databases up to December 2018, and selected observational studies reporting relative risk (RR) with 95% confidence interval (CI) for MetS based on calcium intake and estimated the summary RRs using random-effects models. Eight cross-sectional and two prospective cohort studies totaling 63,017 participants with 14,906 MetS cases were identified. A significantly reduced risk of MetS was associated with the highest levels of dietary calcium intake (RR: 0.89; 95% CI: 0.80–0.99; I² = 75.3%), with stronger association and less heterogeneity among women (RR: 0.74, 95% CI: 0.66–0.83; I² = 0.0%) than among men (RR: 1.06, 95% CI: 0.82–1.37; I² = 72.6%). Our dose-response analysis revealed that for each 300 mg/day increase in calcium intake, the risk of MetS decreased by 7% (RR: 0.93; 95% CI: 0.87–0.99; I² = 77.7%). In conclusion, our findings suggest that dietary calcium intake may be inversely associated with the risk of MetS. These findings may have important public health implications with respect to preventing the disease. Further studies, in particular longitudinal cohort studies and randomized clinical trials, will be necessary to determine whether calcium supplementation is effective to prevent MetS.

Improvements in Glycemic, Micronutrient, and Mineral Indices in Arab Adults with Pre-Diabetes Post-Lifestyle Modification Program

The present study aimed to investigate the changes in dietary patterns of adult Saudis with prediabetes who underwent a six-month lifestyle modification program. A total of 160 Saudis with prediabetes (baseline fasting glucose 5.6–6.9 mmol/L), aged 20–60 years, were enrolled in one of the two arms: A one-time general advice about lifestyle modification (GA group) at orientation or a well-structured and monitored nutrition and lifestyle counseling for six months (guidance group). Fasting blood samples and a dietary recall for daily intakes of macro/micronutrients using a validated computerized food database “ESHA—the Food Processor Nutrition Analysis program” were collected pre- and post-intervention. Compliance to reference daily intake (RDI) was also calculated at both time points. At baseline, overall, severe deficiencies in the majority of micronutrient intakes were observed. Post intervention, clinically significant improvements in the glycemic indices (fasting glucose and insulin resistance) were seen over time in the guidance group. Also, significant improvements in dietary habits and physical activity levels were more apparent in the guidance group than the GA group, particularly in the daily intakes of total carbohydrate (46.9% compliance post vs. 20.3% at baseline); dietary fiber (21.9% vs. 3.1%); and some micronutrients like vitamin B6 (21.3% vs. 6.7%), vitamin B12 (45.3% vs. 28%), vitamin C (21.9% vs. 7.8%), riboflavin (40% vs. 10.7%), niacin (41.3% vs. 14.7%), magnesium (18.8% vs. 4.7%), iron (54.7% vs. 34.4%), and copper (37.3% vs. 13.3%). The study highlights the effects of a six-month lifestyle modification program in improving dietary micronutrient intakes of Saudis with prediabetes. Since micronutrient intake was observed to be low, fortification of these micronutrients in the Saudi diet is recommended.

Prospective associations between total, animal, and vegetable calcium intake and metabolic syndrome in adults aged 40 years and older

BACKGROUND & AIMS

Calcium (Ca) consumption may contribute to a decreased risk of developing metabolic syndrome (MetS). However, epidemiologic evidence on the association between Ca intake and MetS is limited. This study aimed to evaluate the association between dietary Ca intake (animal-based Ca and vegetable-based Ca separately, as well as total Ca intake) and the incidence risk of MetS and its components in the Korean Multi-Rural Communities Cohort (MRCohort).

METHODS

A total of 5509 participants who did not have MetS were enrolled. Dietary Ca intake was calculated using a food frequency questionnaire composed of 106 items.

RESULTS

After 18,880 person-years of follow-up, 876 participants had developed de novo MetS. A significant inverse association between dietary total Ca intake and MetS were observed (incidence rate ratio (IRR) = 0.62, 95% confidence interval (CI) = 0.48-0.81, P for trend = 0.002 for the highest quartile of total Ca intake compared with the lowest quartile). Trends for animal Ca (IRR = 0.77, 95% CI = 0.62-0.97, P for trend = 0.039) and vegetable Ca (IRR = 0.54, 95% CI = 0.40-0.73, P for trend <0.001) were similar. The individual components of overall MetS were also inversely related to total, animal, and vegetable Ca. The tendency for an inverse association was more evident in the group with two of any of the metabolic abnormalities of MetS at baseline than in the group with no more than one MetS component.

CONCLUSIONS

Our findings indicate that a relatively high dietary intake of Ca is associated with lower risk of MetS.

Dietary Fat Intake and Metabolic Syndrome in Older Adults

BACKGROUND

Metabolic Syndrome (MetS) is associated with higher rates of cardiovascular disease (CVD), type 2 diabetes mellitus, and cancer worldwide.

OBJECTIVE

To assess fat intake in older adults with or without MetS.

DESIGN

Cross-sectional nutritional survey in older adults living in the Balearic Islands (n = 477, 48% women, 55-80 years old) with no previous CVD.

METHODS

Assessment of fat (total fat, MUFA, PUFA, SFA, TFA, linoleic acid, α-linolenic acid, marine and non-marine ω-3 FA, animal fat and vegetable fat, cholesterol) and macronutrient intake using a validated food frequency questionnaire, and its comparison with recommendations of the US Institute of Medicine (IOM) and the Spanish Society of Community Nutrition (SENC).

RESULTS

Participants with MetS showed higher BMI, lower physical activity, higher total fat and MUFA intake, and lower intake of energy, carbohydrates, and fiber than participants without MetS. Men and women with MetS were below the Acceptable Macronutrient Distribution Range (AMDR) proposed by IOM for carbohydrates and above the AMDR for total fat and MUFAs, and women were below the AMDR proposed for α-linolenic acid (ALA) compared with participants without MetS.

CONCLUSIONS

Subjects with MetS were less likely to meet IOM and SENC recommendations for fat and macronutrient intakes as compared to non-MetS subjects.

Vitamins in diet of patients with metabolic syndrome

Aim - analysis of data on the role of vitamin and carotenoid deficiency in the development of metabolic syndrome (MS), the consumption of individual vitamins and vitamin supplements, as well as estimation of the effectiveness of the use of vitamins in patients with MS. A review of the existing literature has been carried out in the databases of RINC, CyberLeninka, Google Scholar, Pubmed. The lack of vitamins is a risk factor for MS and its components. The diet of people with MS is characterized by excessive caloric content and at the same time contains an inadequate amount of most vitamins. The most frequent in patients with MS is the deficiency (blood level) of vitamin D, E, B vitamins, carotenoids. Among patients with MS, individuals with a reduced concentration of vitamins in the blood plasma are often found. In turn, among those with a deficiency of vitamins, MS is more often found. Low concentrations of 25(OH)D in the serum are associated with an increased risk of MS. An inverse association between the concentration of the hormonal form of vitamin 1.25(OH)2D3 in the serum and the development of MC has been found. In patients with MS, the α-tocopherol concentration associated with lipids is lower than in healthy individuals, and γ-tocopherol, on the contrary, is higher. Taking high doses of one of the vitamin E homologues shifts the balance between tocopherols in the blood plasma. Sufficient supply of the body with all vitamins involved in the formation of metabolically active forms of vitamins (D, B6, PP) is a necessary condition for the exercise of these biological functions by these vitamins. The lack of vitamins is a risk factor for MS and its components. Enrichment of the diet of patients with MS should be considered as a necessary favorable background for its treatment. Since the body has functional connections between vitamins, it is advisable to use not individual vitamins, but their complexes.

Zinc Intake and Status and Risk of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Zinc could have a protective role against type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis aimed to evaluate the association between dietary, supplementary, and total zinc intake, as well as serum/plasma and whole blood zinc concentration, and risk of T2DM. Observational studies, conducted on cases of incident diabetes or T2DM patients and healthy subjects that reported a measure of association between zinc exposure and T2DM, were selected. Random effects meta-analyses were applied to obtain combined results. Stratified meta-analyses and meta-regressions were executed to assess sources of heterogeneity, as well as the impact of covariates on the findings. From 12,136 publications, 16 studies were selected. The odds ratio (OR) for T2DM comparing the highest versus lowest zinc intake from diet was 0.87 (95% CI: 0.78–0.98). Nevertheless, no association between supplementary or total zinc intake from both diet and supplementation, and T2DM was observed. A direct relationship was found between serum/plasma zinc levels and T2DM (OR = 1.64, 95% CI: 1.25–2.14). A moderately high dietary zinc intake, in relation to the Dietary Reference Intake, could reduce by 13% the risk of T2DM, and up to 41% in rural areas. Conversely, elevated serum/plasma zinc concentration was associated with an increased risk of T2DM by 64%, suggesting disturbances in zinc homeostasis.

Dietary calcium intake and the risk of metabolic syndrome: evidence from observational studies

OBJECTIVE

Epidemiological investigations evaluating the association of dietary Ca intake with metabolic syndrome (MetS) risk have yielded controversial results. Therefore, a meta-analysis was conducted to quantitatively summarize the association between dietary Ca intake and the risk of MetS.

DESIGN

PubMed, Embase and Web of Science were searched for relevant articles published up to October 2018. The pooled OR and 95 % CI were calculated with a random-effects model.

SETTING

Meta-analysis.ParticipantsNine cross-sectional studies.

RESULTS

A total of nine articles with fifteen studies for dietary Ca intake were finally included in the meta-analysis. The combined OR with 95 % CI of MetS for the highest v. lowest category of dietary Ca intake was 0·80 (95 % CI 0·70, 0·91). For dose-response analysis, a non-linear relationship was found between dietary intake of Ca and risk of MetS (P non-linearity&lt;0·001). The threshold for dietary Ca intake was 280 mg/d (OR=0·87; 95 % CI 0·82, 0·93), reducing the risk of MetS by 13 %.

CONCLUSIONS

The present meta-analysis suggests that dietary Ca intake might reduce the risk of MetS, which needs to be further confirmed by larger prospective cohort studies.

Association of serum copper, zinc and selenium levels with risk of metabolic syndrome: A nested case-control study of middle-aged and older Chinese adults

Trace elements, such as copper, zinc and selenium, have been linked to the development of metabolic syndrome. However, previous studies concerning these trace elements in association with metabolic syndrome have presented conflicting results in different countries. The aim of this study was to analyse the association between serum copper, zinc and selenium concentrations and the risk of metabolic syndrome among middle-aged and older Chinese adults. We performed a nested case-control study that included 349 individuals who developed metabolic syndrome (125 males and 224 females) during a 3-year follow-up and 349 controls matched by baseline age (±1 years), sex and area. Serum trace element concentrations were measured using atomic absorption spectrometry. The median serum selenium levels in males and females in the metabolic syndrome group were 82.2 (13.4) μg/L and 82.6 (11.1) μg/L, respectively, which were significantly higher than the serum selenium levels in the control group (p = 0.001 and p < 0.001). After adjusting for potential confounders, the odds ratios of risk for metabolic syndrome in the highest tertile of serum selenium levels were 2.72 [95% confidence interval (CI) 1.43-5.20; p for trend 0.002] for males and 5.30 (95% CI 3.31-8.74; p for trend <0.001) for females, respectively, compared with the lowest tertile. In addition, serum selenium levels were positively correlated with postprandial plasma glucose in both genders (for males: odds ratio 2.42; 95% CI 1.27-4.61; for females: odds ratio 2.11; 95% CI 1.32-3.37) and negatively associated with high-density lipoprotein in only females (odds ratio 3.21; 95% CI 1.75-5.91). These results suggest that higher levels of serum selenium might be an independent risk factor for metabolic syndrome, especially in relation to elevated postprandial plasma glucose and reduced high-density lipoprotein levels. However, we failed to demonstrate an association between copper or zinc status and metabolic syndrome or its components.

Nutritional Effects of Zinc on Metabolic Syndrome and Type 2 Diabetes: Mechanisms and Main Findings in Human Studies

Zinc (Zn) plays crucial roles in mammalian metabolism. There is increasing interest about the potential beneficial effects of Zn on the prevention or treatment of non-communicable diseases. This review critically analyzes the information related to the role of Zn on the metabolic syndrome (MetS) as well as type 2 diabetes (T2D), and summarizes the biological basis of these potential effects of Zn. There are several mechanisms by which Zn may help to prevent the development or progression of MetS and T2D, respectively. Zn is involved in both insulin secretion and action in peripheral tissues. Specifically, Zn has insulin-mimetic properties that increase the activity of the insulin signaling pathway. Zn modulates long-chain polyunsaturated fatty acids levels through its action on the absorption of essential fatty acids in the intestine and its subsequent desaturation. Zn is also involved in both the assembly of chylomicrons and lipoproteins as well as their clearance, and thus, plays a role in lipolysis regulation. Finally, Zn has been found to play a role in redox metabolism, and in turn, on blood pressure. The evidence related to the association between Zn status and occurrence of MetS is inconsistent. Although there are several studies reporting an inverse relationship between Zn status or dietary Zn intake and MetS prevalence, others found a direct relationship between Zn status and MetS prevalence. Intervention studies also provide confusing information about this issue, making it hard to reach firm conclusions. Zn as part of the treatment for patients with T2D has been shown to have positive responses in terms of glucose control outcomes, but only among those with Zn deficiency.

Effects of food items and related nutrients on metabolic syndrome using Bayesian multilevel modelling using the Tehran Lipid and Glucose Study (TLGS): a cohort study

OBJECTIVES

Diet and nutrition might play an important role in the aetiology of metabolic syndrome (MetS). Most studies that examine the effects of food intake on MetS have used conventional statistical analyses which usually investigate only a limited number of food items and are subject to sparse data bias. This study was undertaken with the goal of investigating the concurrent effect of numerous food items and related nutrients on the incidence of MetS using Bayesian multilevel modelling which can control for sparse data bias.

DESIGN

Prospective cohort study.

SETTING

This prospective study was a subcohort of the Tehran Lipid and Glucose Study. We analysed dietary intake as well as pertinent covariates for cohort members in the fourth (2008-2011) and fifth (2011-2014) follow-up examinations. We fitted Bayesian multilevel model and compared the results with two logistic regression models: (1) full model which included all variables and (2) reduced model through backward selection of dietary variables.

PARTICIPANTS

3616 healthy Iranian adults, aged ≥20 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Incident cases of MetS.

RESULTS

Bayesian multilevel approach produced results that were more precise and biologically plausible compared with conventional logistic regression models. The OR and 95% confidence limits for the effects of the four foods comparing the Bayesian multilevel with the full conventional model were as follows: (1) noodle soup (1.20 (0.67 to 2.14) vs 1.91 (0.65 to 5.64)), (2) beans (0.96 (0.5 to 1.85) vs 0.55 (0.03 to 11.41)), (3) turnip (1.23 (0.68 to 2.23) vs 2.48 (0.82 to 7.52)) and (4) eggplant (1.01 (0.51 to 2.00) vs 1 09 396 (0.152×10-6 to 768×1012)). For most food items, the Bayesian multilevel analysis gave narrower confidence limits than both logistic regression models, and hence provided the highest precision.

CONCLUSIONS

This study demonstrates that conventional regression methods do not perform well and might even be biased when assessing highly correlated exposures such as food items in dietary epidemiological studies. Despite the complexity of the Bayesian multilevel models and their inherent assumptions, this approach performs superior to conventional statistical models in studies that examine multiple nutritional exposures that are highly correlated.

The Association Between Metabolic Syndrome and Serum Concentrations of Micronutrients, Inflammation, and Oxidative Stress Outside of the Clinical Reference Ranges: A Cross-Sectional Study

BACKGROUND

Clinical reference ranges are often used to assess nutritional status, but whether having lower or higher than the current clinical reference range for micronutrients, inflammation, and oxidative stress is related to metabolic syndrome (MetS) is not known. Our objectives are to estimate the odds of having MetS outside of established clinical references, and to identify any effect modifications by sex have for these relationships.

METHODS

Data from the 2005 to 2006 National Health and Nutrition Examination Survey were used (≥20 years; N = 2049) with MetS defined utilizing the harmonized criteria from the Joint Interim Statement. The odds of having MetS in individuals with lower or higher than the clinical reference range for the serum concentrations of micronutrient antioxidants, inflammation, and oxidative stress were estimated following adjustments for age, sex, ethnicity, education, income, smoking, alcohol intake, recreational physical activity, and BMI.

RESULTS

Having lower than the clinical reference range for carotenoids and vitamin C [odds ratios (95% confidence interval): 1.37 (1.05-1.78) and 1.39 (1.01-1.90), respectively] was associated with significantly greater odds of MetS. By contrast, having higher than the clinical reference range for vitamins A and E, uric acid, and γ-glutamyl transferase (GGT) [2.10 (1.50-2.92), 2.36 (1.78-3.13), 2.65 (1.54-4.57), and 2.08 (1.61-2.69), respectively] was associated with higher odds of MetS, whereas higher levels of vitamins B12 were protective [0.64 (0.42-0.98]. Sex moderated these relationships for carotenoids, vitamin A, C, E, uric acid, C-reactive protein, and GGT.

CONCLUSIONS

Lower carotenoids and vitamin C and higher vitamins A and E, uric acid, and oxidative stress were associated with a greater likelihood of MetS, whereas higher vitamin B12 was protective. Further research is necessary to replicate these findings in a prospective setting to confirm the importance of the overall and sex-specific findings.

Relationship Between Serum Zinc Level and Metabolic Syndrome: A Meta-Analysis of Observational Studies

Objective: This research sought to summarize the evidence regarding the relationship between serum zinc level and metabolic syndrome (MetS).Methods: The electronic databases of PubMed, Web of Science, and Embase were searched up to October 2017 for observational studies on the association between serum zinc level and MetS. The standard mean difference (SMD) and its corresponding 95% confidence interval (CI) of the serum zinc level for MetS versus control participants were calculated. In addition, the pooled odds ratio (OR) and relative risk (RR) of MetS for the highest versus lowest category of serum zinc level, as well as their corresponding 95% CI, were also calculated.Results: A total of 11 observational studies (8 cross-sectional, 1 case-control, and 2 cohort studies) were included in this meta-analysis. The combined SMD demonstrated that the serum zinc level in MetS was higher than that in control participants (SMD = 0.11; 95% CI, 0.03-0.19; p = 0.009). Moreover, the overall multivariable-adjusted RR showed that the increased serum zinc level was associated with a higher risk of MetS (RR = 1.82; 95% CI, 1.33-2.50; p < 0.001). On the contrary, the overall multivariable-adjusted OR showed that there was no significant relationship between serum zinc level and MetS (OR = 1.00; 95% CI, 0.99-1.01; p = 0.841).Conclusions: Although the serum zinc level in participants with MetS was significantly higher than that in control ones, the existing evidence was still insufficient to conclude a definite relationship between serum zinc level and MetS. More well-designed prospective cohort studies are needed to elaborate the concerned issues further.

Comparative analysis of IDF, ATPIII and CDS in the diagnosis of metabolic syndrome among adult inhabitants in Jiangxi Province, China

Background

Currently, the prevalence of metabolic syndrome (MS) has attracted widespread public attention. However, there is a war regarding the applicability of the diagnosis in different populations regarding the distinct criteria for the diagnosis of MS. Data about the prevalence rate of MS and its components in Jiangxi Province are limited. Thus, our goals were to compare the consistency rates and applicability of three criteria, i.e., those of the International Diabetes Federation (IDF), the National Cholesterol Education Program Adult Treatment PanelⅢ (ATPⅢ), and the Chinese Diabetes Society (CDS).

Methods

From September 2013 to March 2014, 5959 residents (age≥18 years) from Jiangxi Province were selected by multistage stratified cluster random sampling methods. The prevalence rate of MS and its components were calculated according to the IDF, ATPⅢ and CDS criteria, and the protocols of the different criteria were measured in terms of consistency with the kappa statistic and Youden’s index. Receiver operator characteristic (ROC) curve analysis was used to explore the optimal cut-off points of body mass index (BMI) and waist circumference (WC).

Results

The mean age of the participants was 50.52±13.92 years among the total of 5959 individuals (2451 male and 3508 female). The standardized prevalence rate of MS was 19.85%, 24.77% and 9.95% according to the IDF, ATPⅢ and CDS criteria, respectively. The order of the prevalence rates of the different components of MS according to the IDF or ATPⅢ criteria from high to low were as follows: elevated blood pressure, central obesity, reduced high density lipoprotein cholesterol (HDL-C), hyperglycemia, and hypertriglyceridemia. The most prevalent component of MS, according to the CDS criterion, was being overweight or obese, followed by elevated blood pressure, dyslipidemia and hyperglycemia. The Youden’s index in IDF criterion was higher than which in CDS criterion (0.79 for IDF vs. 0.38 for CDS) referring to the ATPⅢ criterion. The agreement between the IDF and ATPⅢ criteria was good (kappa = 0.85), whereas the agreement of the CDS with the IDF and ATPⅢ criteria was moderate (kappa = 0.46 and 0.46, respectively). The ability to predict MS risk factors clusters was superior when the BMI cut-off point was 24/24kg/m² (male/female), and the WC cut-off point was 87/80cm (male/female). Among the 18~59 years old male group, BMI was superior to WC in predicting clusters of risk factors for MS; while in the 60 years and above male group and all-age female group, WC was superior to BMI.

Conclusion

Our results revealed that the prevalence rate of metabolic syndrome among adults was high in Jiangxi Province. BMI and WC had different ability to predict clusters of risk factors for MS in different age groups and gender. Among the three criteria for MS, there was bigger difference in applicability for the adults of Jiangxi Province. The choice of the appropriate criteria should be based on the actual conditions of the site.

Nutrient-Derived Dietary Patterns and Their Association With Metabolic Syndrome in a Japanese Population

Background

Nutrients have been proposed to be related to metabolic syndrome (MetS). The aims of this study were to identify dietary patterns that correlated with several nutrients using reduced rank regression (RRR) and to examine the association between extracted dietary patterns and prevalence of MetS in a Japanese population.

Methods

The study population comprised 1,092 Japanese men and women (35–69 years old) who had participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort Study in Tokushima Prefecture. Dietary patterns were derived with RRR using 46 food items as predictors and six established nutrients (potassium, calcium, vitamin D, vitamin C, insoluble dietary fiber, and carotene) as response variables. Associations between extracted dietary patterns and MetS were then examined with logistic regression models.

Results

Among the six dietary patterns, dietary pattern 1 (DP1) explained the largest proportion (60.1%) of variance in the six nutrients. Therefore, only DP1 was selected for further analysis. DP1 was characterized by high intake frequency of vegetables, fruits, fish and small fish, natto (fermented soybeans), and deep-fried tofu. After adjustment for potential confounders, significant inverse associations were found between DP1 score and MetS (odds ratio [OR] for each quartile: 1.00, 0.58, 0.60, 0.52; P_trend = 0.02); DP1 and high blood pressure (P_trend = 0.0002); and DP1 and high blood glucose (P_trend = 0.02).

Conclusion

A dietary pattern characterized by high intake of vegetables, fruits, fish and small fish, natto, and deep-fried tofu was associated with reduced prevalence of MetS in a Japanese population.

Biomarkers of the metabolic syndrome: Influence of minerals, oligo- and trace elements

Influences of minerals, oligo- and trace elements on the concentration of biomarkers of the metabolic syndrome (MetS) are reviewed. Since food is a complex mixture of caloric compounds and essential non-caloric food components with multiple interactions and varying bioavailability, it is hard to separate or identify the effect of one single component in a total meal or diet. Moreover the diet contains various non-nutritive biologically active components, which may add some beneficial characteristics. Therefore, conclusions on the effect of components on various biomarkers of MetS are sometimes quite contradictory. Reasons therefore are mentioned. Literature data should be studied in detail to conclude whether a component is related to a reduction of MetS-related symptoms or whether its influence is merely affecting a biomarker.

Zinc Status Biomarkers and Cardiometabolic Risk Factors in Metabolic Syndrome: A Case Control Study

Metabolic syndrome (MS) involves pathophysiological alterations that might compromise zinc status. The aim of this study was to evaluate zinc status biomarkers and their associations with cardiometabolic factors in patients with MS. Our case control study included 88 patients with MS and 37 controls. We performed clinical and anthropometric assessments and obtained lipid, glycemic, and inflammatory profiles. We also evaluated zinc intake, plasma zinc, erythrocyte zinc, and 24-h urinary zinc excretion. The average zinc intake was significantly lower in the MS group (p < 0.001). Regression models indicated no significant differences in plasma zinc concentration (all p > 0.05) between the two groups. We found significantly higher erythrocyte zinc concentration in the MS group (p < 0.001) independent from co-variable adjustments. Twenty-four hour urinary zinc excretion was significantly higher in the MS group (p = 0.008), and adjustments for age and sex explained 21% of the difference (R² = 0.21, p < 0.001). There were significant associations between zincuria and fasting blood glucose concentration (r = 0.479), waist circumference (r = 0.253), triglyceride concentration (r = 0.360), glycated hemoglobin concentration (r = 0.250), homeostatic model assessment-insulin resistance (r = 0.223), and high-sensitivity C-reactive protein concentration (r = 0.427) (all p < 0.05) in the MS group. Patients with MS had alterations in zinc metabolism mainly characterized by an increase in erythrocyte zinc and higher zincuria.

Women in Saudi Arabia and the Prevalence of Cardiovascular Risk Factors: A Systematic Review

Background. Cardiovascular disease (CVD) is one of the leading causes of death in Saudi Arabia. Saudi women in particular are more susceptible as there are sociocultural restrictions on female physical activities that may lead to high prevalence of CVD risks, especially obesity, and physical inactivity. This study aims to systematically review the published articles related to the prevalence of CVD risk among women in Saudi Arabia. The search strategy covers all published articles that assess the risk factor of CVD in Saudi Arabia from January 2000 to December 2015, using the following sources: Medline, Embase, and PsycINFO. A total of 61 studies were included. Results. Prevalence among Saudi women of smoking ranged from 1.1% to 9.1%, hypertension was 21.8%, diabetes ranged from 9.6% to 27.6%, overweight was 27%, and obesity was 40.23%, and physical inactivity ranged from 53.2% to 98.1%. Hypercholesterolemia prevalence on Saudi women on average was 24.5%, while metabolic syndrome ranged from 13.6% to 40.3%. Conclusion. The prevalence of CVD risk factors is high among women in Saudi Arabia especially in obesity and physical inactivity. Public health authorities must implement solutions from a gender specific aspect to reverse the trend and decrease the prevalence of CVDs among Saudi women.

Should antioxidant vitamin supplementation be applied in patients with metabolic syndrome? A case-control study

INTRODUCTION

All cells in the human body are exposed to reactive oxygen species (ROS), which disturb the metabolic reactions in the organism. The antioxidant system in the human body consists of enzymatic and non-enzymatic mechanisms, among which vitamins A, C, and E play a major role.

THE AIM OF THE STUDY

The aim of the study was to evaluate the supply of vitamins A, C, and E from daily food rations (DFR) in postmenopausal women with metabolic syndrome (MS) in relation to current nutrition standards.

MATERIAL AND METHODS

The study involved 184 women with MS, aged 45-68 years (mean 57.38 ±8.17 years). The control group comprised 90 women, aged 41-65 years (mean 57.48 ±5.79 years) without MS. The food intake was assessed using 24-hour dietary recalls.

RESULTS

The evaluation of intake of vitamins measured with daily food rations (DFR) demonstrated that the optimal level of 90-110% according to standards was achieved only in 3.62% of women with metabolic syndrome for vitamin A, in 8.88% for vitamin C, and in 11.41% for vitamin E, which was significantly less often found than in the control group (p < 0.001).

CONCLUSIONS

Women with MS are characterised by diversified intake of vitamins A, C and E, and a subgroup of this patients present low level of antioxidant vitamins intake. Supplementation with antioxidant vitamins should be prescribed individually to postmenopausal women with MS.

Gender-specific associations of serum sex hormone-binding globulin with features of metabolic syndrome in children

BACKGROUND

Sex hormone-binding globulin (SHBG) has been proposed as a biomarker of MetS in children and adults. We aim to determine the associations of SHBG with components of MetS in children from the Middle-East where the prevalence of MetS are on the rise.

METHODS

In this cross-sectional study, a total of 509 randomly selected school children (226 boys and 283 girls) aged 12-16 years were recruited. Fasting blood glucose and lipid profile were determined using routine laboratory procedures. Serum SHBG is measured with Cobas e411 using an electrochemiluminescence immunoassay. The modified definition of ATP-III (NHANES III) was used for the diagnosis of MetS.

RESULTS

Among 509 children, 23.4 % had metabolic syndrome. Boys had a significantly higher waist circumference and systolic blood pressure (p < 0.032, 0.024, respectively) than girls, while levels of glucose (p < 0.029), and SHBG (p < 0.003) were significantly higher in girls than in boys. In overall population, a significant inverse correlation of SHBG level with age, BMI, systolic blood pressure and triglycerides and a significant direct correlation between SHBG level and HDL-c was exhibited. Children with the lowest tertile of serum SHBG had significantly higher prevalence of MetS (p < 0.05). ROC curve shows SHBG level as more sensitive marker of MetS in boys (AUC = 0.70, p < 0.001).

CONCLUSIONS

Serum SHBG is significantly more sensitive in identifying MetS in boys, not girls, indicating gender dimorphism.

Individualized medicine enabled by genomics in Saudi Arabia

The biomedical research sector in Saudi Arabia has recently received special attention from the government, which is currently supporting research aimed at improving the understanding and treatment of common diseases afflicting Saudi Arabian society. To build capacity for research and training, a number of centres of excellence were established in different areas of the country. Among these, is the Centre of Excellence in Genomic Medicine Research (CEGMR) at King Abdulaziz University, Jeddah, with its internationally ranked and highly productive team performing translational research in the area of individualized medicine. Here, we present a panorama of the recent trends in different areas of biomedical research in Saudi Arabia drawing from our vision of where genomics will have maximal impact in the Kingdom of Saudi Arabia. We describe advances in a number of research areas including; congenital malformations, infertility, consanguinity and pre-implantation genetic diagnosis, cancer and genomic classifications in Saudi Arabia, epigenetic explanations of idiopathic disease, and pharmacogenomics and personalized medicine. We conclude that CEGMR will continue to play a pivotal role in advances in the field of genomics and research in this area is facing a number of challenges including generating high quality control data from Saudi population and policies for using these data need to comply with the international set up.

Dietary magnesium intake and metabolic syndrome in the adult population: dose-response meta-analysis and meta-regression

ncreasing evidence has suggested an association between dietary magnesium intake and metabolic syndrome. However, previous research examining dietary magnesium intake and metabolic syndrome has produced mixed results. Our objective was to determine the relationship between dietary magnesium intake and metabolic syndrome in the adult population using a dose-response meta-analysis. We searched the PubMed, Embase and the Cochrane Library databases from August, 1965, to May, 2014. Observational studies reporting risk ratios with 95% confidence intervals (CIs) for metabolic syndrome in ≥ 3 categories of dietary magnesium intake levels were selected. The data extraction was performed independently by two authors, and the quality of the studies was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS). Based on eight cross-sectional studies and two prospective cohort studies, the pooled relative risks of metabolic syndrome per 150 mg/day increment in magnesium intake was 0.88 (95% CI, 0.84-0.93; I(2) = 36.3%). The meta-regression model showed a generally linear, inverse relationship between magnesium intake (mg/day) and metabolic syndrome. This dose-response meta-analysis indicates that dietary magnesium intake is significantly and inversely associated with the risk of metabolic syndrome. However, randomized clinical trials will be necessary to address the issue of causality and to determine whether magnesium supplementation is effective for the prevention of metabolic syndrome.

Prevalence of metabolic syndrome: association with risk factors and cardiovascular complications in an urban population

Introduction

Metabolic syndrome (MS) is a set of cardiovascular risk factors and type 2 diabetes, responsible for a 2.5-fold increased cardiovascular mortality and a 5-fold higher risk of developing diabetes.

Objectives

1-to evaluate the prevalence of MS in individuals over 18 years associated with age, gender, socioeconomic status, educational levels, body mass index (BMI), HOMA index and physical activity; moreover, to compare it to other studies; 2-to compare the prevalence of elevated blood pressure (BP), high triglycerides and plasma glucose levels, low HDL cholesterol and high waist circumference among individuals with MS also according to gender; 3-to determine the number of risk factors in subjects with MS and prevalence of complications in individuals with and without MS aged over 40 years.

Methods

A cross-sectional study of 1369 Individuals, 667 males (48.7%) and 702 females (51.3%) was considered to evaluate the prevalence of MS and associated factors in the population.

Results

The study showed that 22.7% (95% CI: 19.4% to 26.0%) of the population has MS, which increases with age, higher BMI and sedentary lifestyle. There was no significant difference between genders until age ≥70 years and social classes. Higher prevalence of MS was observed in lower educational levels and higher prevalence of HOMA positive among individuals with MS. The most prevalent risk factors were elevated blood pressure (85%), low HDL cholesterol (83.1%) and increased waist circumference (82.5%). The prevalence of elevated BP, low HDL cholesterol and plasma glucose levels did not show significant difference between genders. Individuals with MS had higher risk of cardiovascular complications over 40 years.

Conclusion

The prevalence of MS found is similar to that in developed countries, being influenced by age, body mass index, educational levels, physical activity, and leading to a higher prevalence of cardiovascular complications after the 4th decade of life.

Association between the serum concentration of triiodothyronine with components of metabolic syndrome, cardiovascular risk, and diet in euthyroid post-menopausal women without and with metabolic syndrome

PURPOSE

To determine the association between the serum concentration of triiodothyronine (T3) with components of metabolic syndrome (MetS), cardiovascular risk (CVR), and diet in euthyroid post-menopausal women without and with MetS.

METHODS

A cross-sectional study was performed in 120 voluntary women of an indigenous population from Tlaxcala-México. Euthyroid status was assessed measuring the serum concentration of thyrotropin (TSH) and thyroid hormones, while that of estradiol was measured to confirm the postmenopausal condition. MetS was diagnosed using the American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (AHA/NHLBI) criterion. Estimation of CVR was calculated based on the Framingham scale. Diet components were evaluated based on survey applications. Correlations, logistic regression analyses, ANOVA or Kruskall-Wallis, and chi-square tests were used to determine significant differences (P ≤ 0.05) between women without MetS and women with MetS having different serum concentrations of T3.

RESULTS

Triiodothyronine was positively correlated with insulin but negatively correlated with glucose, high-density lipoprotein cholesterol (HDL-C), and CVR. Compared to women without MetS, women with MetS and low-normal T3 concentration showed a high risk for hyperglycemia and moderate/high risk for CVR. In contrast, a high-normal T3 concentration increased the risk to have a big waist circumference, a high concentration of HDL-C, and insulin resistance. Diet analysis showed a high grade of malnutrition in women from all groups. The intake of calories was positively affected by the T3 concentration, albeit it did not affect the extent of malnutrition.

CONCLUSIONS

In contrast to concentrations of TSH, total thyroxin (T4), and free T4, the concentration of serum T3 was strongly correlated with cardio-metabolic variables in euthyroid postmenopausal women. In comparison to women without MetS, a high-normal serum concentration of T3 in women with MetS is positively associated with reduced glycaemia and CVR but negatively related to body mass index (BMI), insulin, insulin resistance, and HDL-C. Although the analyzed population had a nutritional deficiency, both calories and iron intake were positively affected by the T3 concentration. Our results suggest the necessity of health programs monitoring T3 in old people in order to treat hyperglycemia, cardio-metabolic components, and the ageing anorexia.