[Effects of Dietary and Physical Activity Interventions on Metabolic Syndrome: A Meta-analysis]

Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Development and effectiveness of a mobile-based autonomy support program for the prevention of metabolic syndrome in middle-aged women

Objective

Utilizing self-directed strategies for maintaining and managing healthy lifestyle habits is efficient, and it is essential to consider individual motivation, as it is a factor that directly influences the adoption and maintenance of healthy behaviors. The study aimed to assess the effects of a mobile-based autonomy support program on basic psychological needs, autonomous motivation, health behavior, and metabolic syndrome indicators in middle-aged women.

Methods

This study was a non-randomized controlled trial with a pre-test and post-test design, focused on validating a mobile-based autonomy-supportive program to prevent metabolic syndrome in middle-aged women. The experimental group participated in a 12-week mobile-based autonomy support program, which included components such as education, physical activity guidance, dietary management, and real-time data monitoring. In contrast, the control group was provided with comparable educational resources. Assessments of basic psychological needs, autonomous motivation, health behavior, and metabolic syndrome indicators were conducted at baseline and again at the 12-week mark.

Results

After a 12-week period, the experimental group demonstrated significant enhancements in autonomy (p = 0.004) and competence (p < 0.001), two key dimensions of basic psychological needs. Autonomous motivation (p < 0.001) and health behavior scores (p < 0.001) were also significantly higher in the experimental group, while waist circumference (p = 0.048) and systolic blood pressure (p = 0.011) were significantly reduced. Other variables such as relatedness, high-density cholesterol, fasting blood sugar, diastolic blood pressure, and neutral fat scores were also improved in the experimental group, but these changes were not statistically significant.

Conclusion

The autonomy support program offers a cost-effective and community-accessible health care strategy for middle-aged women and may be integrated into various nursing practices.

Metabolic syndrome and erectile dysfunction: a systematic review and meta-analysis study

PURPOSE

The clinical significance of metabolic syndrome (MetS) versus its single components in erectile dysfunction (ED) is conflicting. Thus, the purpose is to analyze the available evidence on the relationship between MetS-along with its components-and ED.

METHODS

All prospective and retrospective observational studies reporting information on ED and MetS were included. In addition, we here reanalyzed preclinical and clinical data obtained from a previously published animal model of MetS and from a consecutive series of more than 2697 men (mean age: 52.7 ± 12), respectively.

RESULTS

Data derived from this meta-analysis showed that MetS was associated with an up to fourfold increased risk of ED when either unadjusted or adjusted data were considered. Meta-regression analysis, performed using unadjusted statistics, showed that the MetS-related risk of ED was closely associated with all the MetS components. These associations were confirmed when unadjusted analyses from clinical models were considered. However, fully adjusted data showed that MetS-associated ED was more often due to morbidities included (or not) in the algorithm than to the MetS diagnostic category itself. MetS is also associated with low testosterone, but its contribution to MetS-associated ED-as derived from preclinical and clinical models-although independent, is marginal.

CONCLUSIONS

The results of our analysis suggest that MetS is a useless diagnostic category for studying ED. However, treating the individual MetS components is important, because they play a pivotal role in determining ED.

Psychosocial Determinants of Recommended Lifestyle Behaviors among Hypertensive Patients: An Integrative Literature Review

Healthy lifestyle levels are low among adults with hypertension (HTN). Unfortunately, psychosocial factors contributing to patients' inability to meet healthy lifestyle recommendations are not well-understood. This integrative review examined the relationships of three psychosocial factors (self-efficacy, outcome expectancy, and social support) with dietary adherence (DA) and physical activity (PA) among adults with HTN. In total, 24 peer-reviewed studies were assessed. Results showed self-efficacy had small-to-large relationships with PA (r = 0.02-0.46) and DA (r = 0.06-0.79), with the strength of the associations varying by the assessed domain and country of origin. However, few studies reported a small relationship between the remaining factors (outcome expectancy and social support) and PA and DA. Thus, more efforts are needed to delineate the contributions of social support and outcome expectancies on DA or PA. When designing an intervention that focuses on improving PA or DA among adults with HTN, these psychosocial factors should be targeted.

Peripheral and cognitive benefits of physical exercise in a mouse model of midlife metabolic syndrome

Despite national and international efforts for the prevention of metabolic syndrome and its underlying diseases/disorders, its prevalence is still rising, especially in the middle-aged population. In this study, we explore the effect of high fat diet on the development of metabolic syndrome in middle-aged mice and to evaluate the potential benefits of voluntary physical exercise on the periphery as well as brain cognitive function, and to explore the potential mechanisms. We found that metabolic syndrome developed at middle age significantly impairs cognitive function and the impairment is associated with gene dysregulation in metabolic pathways that are largely affecting astrocytes in the brain. Eight-week voluntary wheel running at a frequency of three times a week, not only improves peripheral glucose control but also significantly improves learning and memory. The improvement of cognitive function is associated with restoration of gene expression involved in energy metabolism in the brain. Our study suggests that voluntary physical exercise is beneficial for metabolic syndrome-induced peripheral as well as cognitive dysfunction and can be recommended as therapeutic intervention for metabolic syndrome and associated diseases.

Impact of motivational interviewing as a follow-up to an exercise intervention among women with or at risk for metabolic syndrome: A randomized controlled trial

OBJECTIVES

Women have a higher prevalence of metabolic syndrome than their male counterparts, and interventions should target women with or at risk for metabolic syndrome. The objective of this study was to compare two intervention strategies on long-term outcomes following the completion of an exercise intervention.

METHODS

Twenty-six women (M age = 43.35 ± 9.03) with at least one risk factor for metabolic syndrome were randomized into either a motivational interviewing group (n = 10) or self-regulation-based mobile messaging control group (n = 16) as a 12-week follow-up to a 10-week, 30-session exercise intervention. Outcomes of interest were body fat percentage, bone mineral density, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density cholesterol, and fasting blood glucose.

RESULTS

Mixed ANOVAs revealed a significant effect for group × time for body fat percentage F(1, 24) = 8.30, p = 0.01,η p 2  = 0.26, bone mineral density F(1, 24) = 6.68, p = 0.02,η p 2  = 0.22, waist circumference F(1, 24) = 10.35, p = 0.01,η p 2  = 0.30, triglycerides F(1, 24) = 5.06, p = 0.03,η p 2  = 0.17, and systolic blood pressure F(1, 24) = 5.39, p = 0.03,η p 2  = 0.18 all in favor of the motivational interviewing group after 12 weeks when compared to the self-regulation-based mobile messaging group. No significant effect for group × time was noted for diastolic blood pressure p = 0.36,η p 2  = 0.04, high-density cholesterol p = 0.08,η p 2  = 0.12, or fasting blood glucose p = 0.85,η p 2  = 0.01 when comparing the motivational interviewing and self-regulation-based mobile messaging groups.

CONCLUSIONS

Motivational interviewing may be a more impactful solution to extend the effects of exercise intervention studies compared to a self-regulation-based mobile messaging control group. Future interventions should focus on increasing sample size, utilizing more objective measures of body composition, utilizing booster sessions, and increasing the length of follow-up periods.

Metabolic Syndrome and Functional Fitness Abilities

BACKGROUND

It has been pointed out that moderate to vigorous exercise improves metabolic syndrome (MetS) criteria; however, studies on functional fitness in subjects with MetS are scarce.

AIM

This study aimed to assess functional fitness abilities in MetS and non-MetS subjects.

METHODS

Cross-sectional study. Participants living in the Balearic Islands (n = 477, 52% men, 55-80 years old) with MetS (n = 333) and without MetS (n = 144). Anthropometric, socioeconomic and lifestyle characteristics were measured, and blood samples were collected. Functional fitness tests included: one leg balance, standing and sitting handgrip, 30-s chair stand, arm curl, chair sit-and-reach, back scratch, 8-foot time up-and-go, 30-m walk, and 6-min walk tests. A Functional Fitness Score was created from tests that measured agility and dynamic balance, static balance, lower-and-upper body strength, lower-and-upper body flexibility, aerobic endurance, and speed.

RESULTS

All functional fitness tests were lower in MetS subjects, except for back scratch and standing handgrip test. After adjusting for possible confounders (sex, age, civil status, education level, leisure-time physical activity) MetS subjects were more likely to be below average for a sex and age specific cut-off value of one leg balance (Odds Ratio, OR: 2.37; 95% Confidence Interval, CI: 1.25-4.48), chair stand (OR: 2.30; 95% CI: 1.26-3.20), arm curl (OR: 3.43; 95% CI:1.90-6.26), back scratch (OR: 3.49; 95% CI: 2.31-5.91), 8-foot up-&-go (OR: 13.03; 95% CI: 6.66-25.55), 30-m walk (OR: 8.10; 95% CI: 4.33-15.57) and 6-min walk test (OR: 3.28; 95% CI: 1.76-6.52), whereas they were more likely to be above average for sitting handgrip test (OR:1.69; 95% CI:1.21-2.95). Functional Fitness Score was lower in MetS subjects (5.44 ± 2.40 vs. 7.04 ± 1.72, p < 0.001), independently of sex and age.

CONCLUSION

MetS participants showed lower functional fitness abilities and lower Functional Fitness Score than non-MetS peers, independently of sex, age, body mass index and waist circumference, showing lower ability to perform everyday activities safely and independently.

[Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research]

PURPOSE

This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR).

METHODS

A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test.

RESULTS

The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem.

CONCLUSION

The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

Gender Differences of Health Behaviors in the Risk of Metabolic Syndrome for Middle-Aged Adults: A National Cross-Sectional Study in South Korea

This study examined gender differences in health behaviors for the risk of metabolic syndrome (MetS) among middle-aged adults using nationally representative data from the Seventh Korea National Health and Nutrition Examination Survey (2016–2018). The sample included data from 8677 middle-aged adults. The Health Practice Index measured health behaviors, including smoking, alcohol use, physical activity, sleeping, eating breakfast, working hours, nutritionally balanced diet, and mental stress. Complex sample multiple logistic regression analyses were conducted to determine the association between the Health Practice Index (HPI) and MetS. Men and women with poor or moderate HPI scores had significantly higher risks of having MetS than those with good HPI scores. Controlling for covariates, high-risk alcohol use (p < 0.001) and physical activity (p = 0.008) were associated with the risk of MetS in men and women, respectively. Men reporting alcohol use and women lacking a healthy diet were, respectively, 2.056 times (adjusted odds ratio (OR) = 2.056, 95% CI: 1.681–2.514) and 1.306 times (adjusted OR = 1.306, 95% CI: 1.075–1.587) more likely to have increased risks of MetS. Given these gender differences in health behaviors, developing tailored interventions could be beneficial in preventing MetS among middle-aged men and women.

A Technology-Mediated Interventional Approach to the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND

Technology-mediated interventions help overcome barriers to program delivery and spread metabolic syndrome prevention programs on a large scale. A meta-analysis was performed to evaluate the impact of these technology-mediated interventions on metabolic syndrome prevention.

METHODS

In this meta-analysis, from 30 January 2018, three databases were searched to evaluate interventions using techniques to propagate diet and exercise lifestyle programs for adult patients with metabolic syndrome or metabolic risk.

RESULTS

Search results found 535 citations. Of these, 18 studies met the inclusion criteria analyzed in this article. The median duration of intervention was 4 months and the follow-up period ranged from 1.5 to 30 months. The standardized mean difference (SMD) between the two groups was waist circumference -0.35 (95% CI -0.54, -0.15), triglyceride -0.14 (95% CI -0.26, -0.03), fasting blood glucose -0.31 (95% CI -0.42, -0.19), body weight -1.34 (95% CI -2.04, -0.64), and body mass index -1.36 (95% CI -2.21, -0.51). There was no publication bias in this study.

CONCLUSION

Technology-mediated intervention improved clinically important metabolic syndrome related indicators such as excess body fat around the waist, fasting glucose, and body mass index. These interventions will play an important role in the dissemination of metabolic syndrome prevention programs.

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.

Flavonoids and Insulin-Resistance: From Molecular Evidences to Clinical Trials

Insulin-resistance is one of the main factors responsible for the onset and progression of Metabolic Syndrome (MetS). Among all polyphenols, the effects of flavonoids and their main food sources on insulin sensitivity have been widely evaluated in molecular and clinical studies. The aim of this review is to analyse the data observed in vitro, in vivo and in clinical trials concerning the effects of flavonoids on insulin resistance and to determine the molecular mechanisms with which flavonoids interact with insulin signaling.

Metabolic fitness in relation to genetic variation and leukocyte DNA methylation

Metabolic syndrome (MetS) is a highly prevalent condition causing increased risk of several life-threatening diseases. MetS has a pronounced hereditary basis but is also influenced by environmental factors, partly through epigenetic mechanisms. In this study, the five phenotypes underlying MetS were incorporated into a continuous score for metabolic fitness (MF), and associations with both genotypic variation and leukocyte DNA methylation were investigated. Baseline MF phenotypes (waist circumference, blood pressure, blood glucose, serum triglycerides, and high-density lipoproteins) of 710 healthy Flemish adults were measured. After a 10 yr period, follow-up measures were derived from 618 of these subjects. Genotyping was performed for 65 preselected MF-related genetic variants. Next, full genetic predisposition scores (GPSs) were calculated, combining genotype scores of multiple genetic variants. Additionally, stepwise GPSs were constructed, including only the most predictive genetic variants for the different MF phenotypes. For a subset of 68 middle-aged men, global and gene-specific DNA methylation was investigated, and a biological pathway analysis was performed. The full GPSs were predictive for some baseline MF phenotypes, but not for changes over time. Only a limited number of genetic variants were significantly predictive individually. On the contrary, global and gene-specific DNA methylation was associated with changes in the MF phenotypes rather than with the baseline measures, indicating that effects of DNA methylation on MF are somewhat delayed. Furthermore, several biological pathways were associated with the MF phenotypes through gene promoter methylation. For CETP, G6PC2, MC4R, and TFAP2B both a genetic and epigenetic relationship was found with MF.

Obesity, An Enemy of Male Fertility: A Mini Review

Obesity is a highly prevalent non-communicable disease worldwide and is commonly associated with male infertility. Several etiopathological theories have been mentioned in the literature by which obesity affects spermatogenesis, thus affecting the male fertility potential. Mechanisms for explaining the effect of obesity on male infertility include endocrinopathy, increased aromatization activity, associated erectile dysfunction, psychological and thermal effects, obstructive sleep apnea, increased leptin and oxygen free radicals, and associated inflammatory and obstructive elements of epididymitis. Treatment of such a complex problem includes weight reduction (by lifestyle modification and increased physical activity), optimization of altered testosterone-to-estradiol ratio using aromatase inhibitors and/or gonadotropins, treatment of associated comorbidities by phosphodiesterase inhibitors for erectile dysfunction, and insulin-sensitizing agents for the management of diabetes. The aim of this mini-review is to highlight the pathological basis of this problem and to focus on obesity as an etiology of male infertility.

Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort

Background

There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the association between physical activity and colon cancer.

Methods

We conducted a nested case-control study in a cohort of 519 978 men and women aged 25 to 70 years followed from 1992 to 2003. A total of 713 incident colon cancer cases were matched, using risk-set sampling, to 713 controls on age, sex, study centre, fasting status and hormonal therapy use. The amount of total physical activity during the past year was expressed in metabolic equivalent of task [MET]-h/week. Anthropometric measurements and blood samples were collected at study baseline.

Results

High physical activity was associated with a lower risk of colon cancer: relative risk ≥91 MET-h/week vs <91 MET-h/week = 0.75 [95% confidence interval (CI): 0.57 to 0.96]. In mediation analyses, this association was accounted for by waist circumference: proportion explained effect (PEE) = 17%; CI: 4% to 52%; and the biomarkers soluble leptin receptor (sOB-R): PEE = 15%; 95% CI: 1% to 50% and 5-hydroxyvitamin D (25[OH]D): PEE = 30%; 95% CI: 12% to 88%. In combination, these factors explained 45% (95% CI: 20% to 125%) of the association. Beyond waist circumference, sOB-R and 25[OH]D additionally explained 10% (95% CI: 1%; 56%) and 23% (95% CI: 6%; 111%) of the association, respectively.

Conclusions

Promoting physical activity, particularly outdoors, and maintaining metabolic health and adequate vitamin D levels could represent a promising strategy for colon cancer prevention.

Association between Siesta (Daytime Sleep), Dietary Patterns and the Presence of Metabolic Syndrome in Elderly Living in Mediterranean Area (Medis Study): The Moderating Effect of Gender

OBJECTIVES

Several lifestyle parameters including diet, physical activity and sleep were associated in isolation with the presence of Metabolic Syndrome (MetS) in adults, to date there is a paucity of studies which evaluated their combined role aging populations and especially with respect to gender. Therefore, the aim of the present study was to provide a global consideration of the lifestyle factors associated with MetS among elderly individuals.

DESIGN

Cross-sectional observational study.

SETTING

21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece.

PARTICIPANTS

during 2005-2015, 2749 older (aged 65-100 years) from were voluntarily enrolled in the study.

MEASUREMENTS

Dietary habits, energy intake, physical activity status, socio-demographic characteristics, lifestyle parameters (sleeping and smoking habits) and clinical profile aspects were derived through standard procedures. The presence of MetS was defined using the definition provided by NCEP ATP III (revised) and cluster analysis was used to identify overall dietary habit patterns.

RESULTS

The overall prevalence of MetS in the study sample was 36.2%, but occurred more frequently in females (40.0% vs. 31.8%, respectively, p=0.03). Individuals with MetS were more likely to sleep during the day (89.4% vs. 76.8% respectively, p=0.039) and frequent 'siesta' was positively linked to the odds of MetS presence in females (Odds Ratio (OR) =3.43, 95% Confidence Intervals (CI): 1.08-10.9), but not for men (p=0.999). The lower carbohydrate (i.e., 45.2% of total daily energy, 120±16gr/day) dietary cluster was inversely associated with the odds for MetS presence, but only for men (OR=0.094, 95%CI: 0.010-0.883).

CONCLUSIONS

Lifestyle parameters including sleep and diet quality are strongly associated with the presence of MetS in elderly cohort, but different their level of influence appears to be different, depending on gender. Further research is needed to better consider the role of lifestyle characteristics in the management of MetS in clinical practice.

Prevalence of Central Obesity among Adults with Normal BMI and Its Association with Metabolic Diseases in Northeast China

OBJECTIVES

The present study aimed to investigate the prevalence of central obesity among adults with normal BMI and its association with metabolic diseases in Jilin Province, China.

METHODS

A population-based cross-sectional study was conducted in 2012 in Jilin Province of China. Information was collected by face to face interview. Descriptive data analysis and 95% confidence intervals (CI) of prevalence/frequency were conducted. Log-binomial regression analyses were used to find the independent factors associated with central obesity and to explore the adjusted association between central obesity and metabolic diseases among adults with normal BMI.

RESULTS

Among the adult residents with normal BMI in Jilin Province, 55.6% of participants with central obesity self-assessed as normal weight and 27.0% thought their body weight were above normal. 12.7% of central obesity people took methods to lose weight, while 85.3% didn't. Female, older people and non-manual worker had higher risk to be central obesity among adults with normal BMI. Hypertension, diabetes and hyperlipidemia were significantly associated with central obesity among adults with normal BMI, the PRs were 1.337 (1.224-1.461), 1.323 (1.193-1.456) and 1.261 (1.152-1.381) separately when adjusted for gender, age and BMI.

CONCLUSIONS

Hypertension, diabetes and hyperlipidemia were significantly associated with central obesity among adults with normal BMI in Jilin Province, China. The low rates of awareness and control of central obesity among adults with normal BMI should be improved by government and health department.