Lifestyle Modification in the Management of Metabolic Syndrome: Statement From Korean Society of CardioMetabolic Syndrome (KSCMS)

Metabolic diseases in the East Asian populations

East Asian populations, which account for approximately 20% of the global population, have become central to the worldwide rise of metabolic diseases over the past few decades. The prevalence of metabolic disorders, including type 2 diabetes mellitus, hypertension and metabolic dysfunction-associated steatotic liver disease, has escalated sharply, contributing to a substantial burden of complications such as cardiovascular disease, chronic kidney disease, cancer and increased mortality. This concerning trend is primarily driven by a combination of genetic predisposition, unique fat distribution patterns and rapidly changing lifestyle factors, including urbanization and the adoption of Westernized dietary habits. Current advances in genomics, proteomics, metabolomics and microbiome research have provided new insights into the biological mechanisms that might contribute to the heightened susceptibility of East Asian populations to metabolic diseases. This Review synthesizes epidemiological data, risk factors and biomarkers to provide an overview of how metabolic diseases are reshaping public health in East Asia and offers insights into biological and societal drivers to guide effective, region-specific strategies.

Glucagon-Like Peptide-1 Receptor Agonists Combined With Personalized Digital Health Care for the Treatment of Metabolic Syndrome in Adults With Obesity: Retrospective Observational Study

Background

Metabolic syndrome (MetS) represents a complex and multifaceted health condition characterized by a clustering of interconnected metabolic abnormalities, including central obesity, insulin resistance, dyslipidemia, and hypertension. Effective management of MetS is crucial for reducing the risk of cardiovascular diseases and type 2 diabetes.

Objective

This study aimed to assess the effectiveness of combining glucagon-like peptide-1 (GLP-1) and dual gastric inhibitory polypeptide (GIP)/GLP-1 agonists with a continuous, digitally delivered behavioral change model by an integrated care team, in treating MetS among individuals with obesity.

Methods

The 6-month Zone.Health (meta[bolic]) weight loss program involved 51 participants (mean age 45, SD 10 years; mean BMI 35, SD 5 kg/m²), categorized by gender, and treated with either tirzepatide or semaglutide. Participants received continuous support via a digital health platform, which facilitated real time monitoring and personalized feedback from an integrated care team. Engagement levels with the digital platform, measured by the frequency of inbound interactions, were tracked and analyzed in relation to health outcomes.

Results

Tirzepatide reduced waist circumference (WC) by -18.08 cm, compared with -13.04 cm with semaglutide (P<.001). Triglycerides decreased significantly with both drugs, with tirzepatide showing a reduction of -64.42 mg/dL and semaglutide -70.70 mg/dL (P<.001). Tirzepatide generally showed more pronounced improvements in fasting glucose, blood pressure (BP), low-density lipoprotein, and total cholesterol compared with semaglutide. Higher engagement with the digital health platform showed significant difference among the 3 groups; the group with the highest level of app-based interactions (≥25 interactions) had the greatest WC reduction (mean -19.04, SD 7.40 cm) compared with those with ≤15 interactions (mean -9.60, SD 5.10 cm; P=.002). Similarly, triglycerides showed the greatest reduction in the group with ≥25 interactions (mean -108.56, SD 77.06 mg/dL) compared with those with ≤15 interactions (mean -44.49, SD 50.85 mg/dL; P=.02). This group also exhibited the largest reduction in diastolic BP (mean -10.33, SD 7.40 mm Hg) compared with those with ≤15 interactions (mean -0.83, SD 7.83 mm Hg; P=.004), and the most substantial decrease in fasting glucose levels (mean -18.60, SD 10.82 mg/dL) compared with those with ≤15 interactions (mean -2.49, SD 27.54 mg/dL; P=.02). Participants in the highest quartile of digital engagement had a 60% greater likelihood of MetS reversal compared with those in the lowest quartile.

Conclusions

This study shows that combining GLP-1 and dual GIP/GLP-1 agonists with a digital behavioral change model significantly improves MetS markers in individuals with obesity. Tirzepatide proved more effective than semaglutide, leading to greater reductions in WC and triglyceride levels, along with better improvements in fasting glucose, BP, and lipid profiles. Higher app-based engagement was linked to better health outcomes, with participants in the highest engagement group having a 60% greater likelihood of treating MetS compared with those with the lowest engagement.

Effects of nanocurcumin supplementation on metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Metabolic syndrome (MetS) encompasses metabolic risk factors like elevated blood glucose, abnormal lipid levels, and hypertension. Nanocurcumin, a nanoscale formulation of curcumin, may offer therapeutic benefits for MetS management. This systematic review and meta-analysis evaluates the impact of nanocurcumin supplementation on key MetS parameters.

METHODS

A systematic literature search identified 20 randomized controlled trials (RCTs) with 1394 participants. Data were pooled using a random-effects model, and standardized mean differences (SMDs) were calculated for key outcomes.

RESULTS

Nanocurcumin supplementation significantly improved waist circumference (WC) (standardized mean difference (SMD): -0.30 cm), fasting blood sugar (FBS) (SMD: -0.34 mg/dL), HbA1c (SMD: -0.33 %), and quantitative insulin sensitivity check index (QUICKI) score (SMD: 0.73). Lipid profile parameters, including total cholesterol (SMD: -0.18 mg/dL), LDL-C (SMD: -0.16 mg/dL), and HDL-C (SMD: 0.32 mg/dL), also reduced significantly. Improvement in diastolic blood pressure (DBP) (SMD: -0.32 mmHg), total antioxidant capacity (TAC) (SMD: 0.44 mmol/L), malondialdehyde (MDA) (SMD: -0.37 mmol/L), tumor necrosis factor-α (TNF-α) (SMD: -2.30 ng/L), interleukin-6 (IL-6) (SMD: -1.07 ng/L), and high-sensitivity C-reactive protein (hs-CRP) (SMD: -0.34 mg/L) were observed.

CONCLUSION

Nanocurcumin supplementation significantly improves multiple MetS-related parameters, including anthropometric measures, glycemic control, lipid profile, blood pressure, oxidative stress markers, and inflammatory biomarkers. These findings highlight nanocurcumin's potential as an effective adjunctive therapy for managing MetS. However, the variability in study participant ages, treatment durations, and sample sizes suggests the need for further well-designed RCTs to establish optimal usage guidelines.

Association between healthy beverage index and healthy beverage score with metabolic syndrome: a cross-sectional study

Metabolic syndrome (MetS) is a widespread and complex health disorder. Dietary habits and consumption of simple sugars have been shown to play an important role in the prevention and treatment of MetS. This cross-sectional study was conducted in a population of 3380 adults from the Shiraz University of Medical Sciences (SUMS) employees' health cohort. The healthy beverage index (HBI) and healthy beverage score (HBS) were calculated. Risk for MetS and its components, including blood pressure, fasting blood glucose, waist circumference, triglyceride levels, and high-density lipoprotein cholesterol, were measured using standardised protocols. Results showed a significant inverse association between higher adherence to HBI (OR = 0.60, 95% CI: 0.48-0.74, P < 0.001) and HBS (OR = 0.80, 95% CI: 0.65-0.97, P = 0.030) with lower risk of MetS. Also, we observed a significant association between higher level of HBI and HBS with decreased risk of hypertension, as a critical component of MetS. These findings support the notion that healthier beverage consumption, as indicated by higher HBI and HBS levels, may play a critical role in reducing the risk of MetS.

Healthy lifestyle reduces cardiovascular risk in women with genetic predisposition to hypertensive disorders of pregnancy

The genetic risk for hypertensive disorders of pregnancy is linked with the development of atherosclerotic cardiovascular disease. However, the effects of lifestyle and metabolic syndrome on atherosclerotic cardiovascular disease have not been evaluated. Here, we assess the long-term association between these factors and atherosclerotic cardiovascular disease in women with genetic risk for hypertensive disorders of pregnancy. We evaluate the genetic risk for hypertensive disorders of pregnancy using a genome-wide polygenic risk score derived from a large-scale GWAS. The incidence of atherosclerotic cardiovascular disease is evaluated according to genetic risk, lifestyle, and metabolic syndrome. Individuals with a very high genetic risk for hypertensive disorders of pregnancy have a 53.0% higher chance of developing atherosclerotic cardiovascular disease than those with a low genetic risk. However, the risk of developing atherosclerotic cardiovascular disease is reduced by up to 64.6% through the maintenance of an ideal metabolic syndrome status and a healthy lifestyle in the high genetic risk group (top 20%), and by up to 65.4% in the low genetic risk group (bottom 20%). These findings emphasize that maintaining a healthy lifestyle in women is equally effective at reducing the risk of atherosclerotic cardiovascular disease independent of genetic risk for hypertensive disorders of pregnancy.

The Role of Omega-3 Polyunsaturated Fatty Acids in Patients with Metabolic Syndrome and Endothelial Dysfunction

Background and Objectives: Metabolic syndrome (MS) represents several diseases encompassing a heterogeneous group of biochemical and physiological abnormalities characterized by structural and functional alterations in the myocardium, including the endothelium of the coronary arteries. MS also affects a substantial portion of the global population. Understanding the risk factors, the development and treatment associated with MS are of paramount importance for early identification, treatment and prevention. This study was designed to evaluate the role of the supplementation of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on endothelial function in patients with MS. Materials and Methods: A total of 80 patients with MS were enrolled in two groups. The study evaluated endothelial function (EF) in subjects before and after a three-month treatment with n-3 PUFAs in a dose of 2.4 g daily (800 mg, three times a day) vs. placebo, using an Endo-PAT2000 device (Itamar Medical Ltd., Caesarea, Israel) measuring the reactive hyperemia index (a parameter of EF) and augmentation index (a parameter of arterial stiffness). Plasmatic levels of glutathione peroxidase, homocysteine, apolipoprotein B and lipoprotein were also evaluated for comparison. Results: The results showed that the average value of reactive hyperemia index before the treatment with n-3 PUFAs was 1.62 ± 0.42, compared to 1.96 ± 0.62 at the end of the study (p < 0.005). The augmentation index changed from 14.66 ± 19.55 to 9.21 ± 15.64 after the treatment (p = 0.003) with n-3 PUFA. The results also revealed a statistically significant decrease in apolipoprotein B (0.94 ± 0.36 vs. 1.13 ± 0.35, p = 0.001) and homocysteine (19.31 ± 5.29 vs. 13.78 ± 3.05, p = 0.001) and an increase in glutathione peroxidase plasma levels (41.65 ± 8.90 vs. 45.20 ± 8.01), p = 0.001. Conclusions: The results of this prospective study showed a significant improvement in EF in subjects with MS treated with n-3 PUFAs in a dose of 2.4 g daily.

The interplay of factors in metabolic syndrome: understanding its roots and complexity

Metabolic syndrome (MetS) is an indicator and diverse endocrine syndrome that combines different metabolic defects with clinical, physiological, biochemical, and metabolic factors. Obesity, visceral adiposity and abdominal obesity, dyslipidemia, insulin resistance (IR), elevated blood pressure, endothelial dysfunction, and acute or chronic inflammation are the risk factors associated with MetS. Abdominal obesity, a hallmark of MetS, highlights dysfunctional fat tissue and increased risk for cardiovascular disease and diabetes. Insulin, a vital peptide hormone, regulates glucose metabolism throughout the body. When cells become resistant to insulin's effects, it disrupts various molecular pathways, leading to IR. This condition is linked to a range of disorders, including obesity, diabetes, fatty liver disease, cardiovascular disease, and polycystic ovary syndrome. Atherogenic dyslipidemia is characterized by three key factors: high levels of small, low-dense lipoprotein (LDL) particles and triglycerides, alongside low levels of high-density lipoprotein (HDL), the "good" cholesterol. Such a combination is a major player in MetS, where IR is a driving force. Atherogenic dyslipidemia contributes significantly to the development of atherosclerosis, which can lead to cardiovascular disease. On top of that, genetic alteration and lifestyle factors such as diet and exercise influence the complexity and progression of MetS. To enhance our understanding and consciousness, it is essential to understand the fundamental pathogenesis of MetS. This review highlights current advancements in MetS research including the involvement of gut microbiome, epigenetic regulation, and metabolomic profiling for early detection of Mets. In addition, this review emphasized the epidemiology and fundamental pathogenesis of MetS, various risk factors, and their preventive measures. The goal of this effort is to deepen understanding of MetS and encourage further research to develop effective strategies for preventing and managing complex metabolic diseases.

Higher Animal-Based Protein Intake Levels Show a Greater Likelihood of Having Metabolic Syndrome in Single-Person Households Among Korean Adults

BACKGROUND/OBJECTIVES

Despite the increasing intake of animal-based protein and the growing number of single-person households (SPHs) in Korean populations, no studies have analyzed the relationship of protein intake by source with metabolic syndrome (MetS) according to household type. This study examined the association between protein intake (plant- and animal-based sources) and MetS risk factors in SPH and multi-person households (MPHs) among Korean adults.

METHOD

A total of 12,022 participants aged 30-64 years (SPH: 982; MPH: 11,040) were selected from the 2016-2021 Korea National Health and Nutrition Examination Survey. Protein intake level was defined as the percentage contribution of food source to daily intake, assessed using 24 h recall dietary data.

RESULTS

The animal-based protein intake level was slightly higher in SPHs (51.2%) compared to MPHs (49.5%), whereas the contributions of plant sources from vegetables, fruits, and whole grains were higher in MPHs (p < 0.01). The prevalence of MetS and abdominal obesity increased with higher animal-based protein intake levels across all household types. Only in SPHs, each 1% rise in the proportion of animal-based protein was positively associated with increased blood pressure (OR = 1.013, 95% CI: 1.004-1.022). Moreover, the interaction between animal-based protein intake levels and household type was significantly associated with a higher prevalence of elevated triglycerides (TGs) (MPH[Q1] vs. SPH[Q4] OR = 1.51; p for interaction = 0.0335). However, these two risk factors did not show significant association in MPHs.

CONCLUSIONS

The results suggest that reducing dietary animal protein could help manage MetS risk factors, particularly increased blood pressure, and elevated TGs in SPHs of Korean adults. In conclusion, dietary guidelines that promote a higher intake of plant-based protein over animal-based protein for the health of the SPH population would be valuable from a public health perspective.

Protein source associated with risk of metabolic syndrome in adults with low and adequate protein intake: A prospective cohort study of middle-aged and older adults

OBJECTIVES

Metabolic syndrome is associated with an increased risk of diabetes, cardiovascular disease, and all-cause mortality. Some evidence suggests that the cardiometabolic health benefits of protein intake may vary by the source (animal or plant); however, the evidence is inconsistent. This study aimed to assess the risk of developing metabolic syndrome according to the protein source.

PARTICIPANTS

Among a total of 3,310 participants aged 40 years or older in the Ansan and Ansung population based prospective cohort, 1,543 incident cases of metabolic syndrome were identified between 2007 and 2018.

MEASUREMENTS

Dietary intake was assessed using a validated food frequency questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) by quintile (Q), adjusting for demographics and health-related lifestyle factors.

RESULTS

Higher intake of animal protein (HRquintile5 (Q5) vs quintile1 (Q1) [95% CIs]: 0.76 [0.59-0.96], P-trend ≤ 0.0307) and a higher relative intake of animal protein (HRQ5 vs.Q1: 0.78 [0.64-0.95], P-trend ≤ 0.0017) were associated with a significantly decreased risk of developing metabolic syndrome. In subgroup analyses, associations between the risk of metabolic syndrome and the relative intake of animal and plant protein differed according to whether the total protein intake was within the recommended nutrient intake (RNI). Specifically, significant associations were observed only among those with a total protein consumption below the RNI (HRQ5vs Q1 [95% CIs]: 0.72 [0.56-0.93] for the relative intake of animal protein), but not among those consuming above the RNI. This association was more significant in women than in men.

CONCLUSION

A higher absolute and relative intake of animal protein were associated with a significantly decreased risk of metabolic syndrome, particularly among those who consumed less than the RNI of protein.

Associations Between Delayed Sleep Phase Syndrome and Daytime Napping with the Metabolic Syndrome Among Adults: Results from the Ravansar Non-Communicable Disease (RaNCD) Cohort Study

Objective

Adverse sleep and wake patterns are associated with physical health complaints, including metabolic disorders. The aim of this study was to evaluate the relationship between delayed sleep phase syndrome (DSPS) and napping during the day with metabolic syndrome (MetS).

Methods

This study was conducted on 10 065 participants aged 35-65 years using baseline data from the Ravansar Non-Communicable Disease (RaNCD) cohort study. Delayed sleep phase syndrome was evaluated through a clinical interview to rule out the possibility that the sleep complaints were a result of psychiatric disorders. Logistic and linear regression models were used to determine associations.

Results

The severity of MetS was found to be higher in men, older age groups, married people, subjects with a lower education level, urban residents, smokers, people with low physical activity, and DSPS. In the fully adjusted model, the odds of having MetS were 26% (95% Confidence interval (CI): 1.08, 1.48) higher in those with DSPS compared to those without DSPS. Additionally, the odds of MetS were 18% higher in people who napped less than 1 hour per day, 26% higher in those who napped 1-2 hours per day, and 21% higher in those who napped over 2 hours per day, compared to non-nappers. All of these associations were statistically significant. The odds of having the severity of MetS were significantly 6% (95% CI: 0.01, 0.12) higher in those with DSPS compared to those without DSPS.

Conclusion

The findings of this study indicate that DSPS and daytime napping are associated with an increased risk of MetS. Interventions aimed at improving sleep quality are recommended as potential strategies to help reduce the risk of developing MetS.

Study protocol for a single-arm pilot trial investigating the feasibility of a multimodal digital technology for managing metabolic syndrome in patients with chronic obstructive pulmonary disease

Individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are exposed to an increased risk of metabolic syndrome (MetS), which negatively affects their health outcomes and quality of life. Lifestyle interventions have shown promise in managing MetS. This study outlines the protocol for a web-based multimodal self-care program, Digital Metabolic Rehabilitation, for managing MetS in patients with COPD. The Digital Metabolic Rehabilitation is a single-arm pilot trial that integrates the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) Program and a web-based wellness platform. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which integrates a holistic, multicomponent approach to promote wellness. The intervention will primarily focus on lifestyle changes for patients with COPD. Over 6 months, participants will use the web-based wellness platform and engage in weekly online support group sessions. Fifty patients diagnosed with stage I-II COPD and MetS will participate. Blood tests, anthropometrics, body composition, physical function, muscle strength, physical activity, energy metabolism, quality of life and mental health will be assessed at baseline, 3, and 6 months. The Digital Metabolic Rehabilitation program aims to explore whether a multimodal integrative intervention delivered through a web-based wellness platform can be implemented by patients with COPD with MetS. By combining the expertise of the CHANGE Program with the digital delivery format, the intervention seeks to enhance self-monitoring and foster better self-management practices. The protocol outlines a novel and potentially impactful intervention for managing MetS in patients with COPD.

Role of melatonin in mitigation of insulin resistance and ensuing diabetic cardiomyopathy

Addressing insulin resistance or hyperinsulinemia might offer a viable treatment approach to stop the onset of diabetic cardiomyopathy, as these conditions independently predispose to the development of the disease, which is initially characterized by diastolic abnormalities. The development of diabetic cardiomyopathy appears to be driven mainly by insulin resistance or impaired insulin signalling and/or hyperinsulinemia. Oxidative stress, hypertrophy, fibrosis, cardiac diastolic dysfunction, and, ultimately, systolic heart failure are the outcomes of these pathophysiological alterations. Melatonin is a ubiquitous indoleamine, a widely distributed compound secreted mainly by the pineal gland, and serves a variety of purposes in almost every living creature. Melatonin is found to play a leading role by improving myocardial cell metabolism, decreasing vascular endothelial cell death, reversing micro-circulation disorders, reducing myocardial fibrosis, decreasing oxidative and endoplasmic reticulum stress, regulating cell autophagy and apoptosis, and enhancing mitochondrial function. This review highlights a relationship between insulin resistance and associated cardiomyopathy. It explores the potential therapeutic strategies offered by the neurohormone melatonin, an important antioxidant that plays a leading role in maintaining glucose homeostasis by influencing the glucose transporters independently and through its receptors. The vast distribution of melatonin receptors in the body, including beta cells of pancreatic islets, asserts the role of this indole molecule in maintaining glucose homeostasis. Melatonin controls the production of GLUT4 and/or the phosphorylation process of the receptor for insulin and its intracellular substrates, activating the insulin-signalling pathway through its G-protein-coupled membrane receptors.

Association between the Korean Healthy Diet Score and Metabolic Syndrome: Effectiveness and Optimal Cutoff of the Korean Healthy Diet Score

OBJECTIVES

Although the prevalence of metabolic syndrome has increased among Koreans, the specific health benefits of the Korean Healthy Diet score remain unexplored. This study aimed to evaluate the association between the Korean Healthy Diet score and metabolic syndrome and to identify the optimal cutoff of the Korean Healthy Diet score for reducing metabolic syndrome prevalence.

METHODS

This cross-sectional study used data from 11,403 participants of the seventh and eighth Korea National Health and Nutrition Examination Survey. The Korean Healthy Diet score was calculated based on adherence to 13 dietary components. A logistic regression analysis was used to determine the association between the Korean Healthy Diet score and metabolic syndrome, as well as to identify the optimal cutoff values for the Korean Healthy Diet score.

RESULTS

The average Korean Healthy Diet score was significantly lower in participants with metabolic syndrome than in those without metabolic syndrome (5.03 vs. 5.14, p = 0.016). A one-point increase in the Korean Healthy Diet score was associated with a reduction in metabolic syndrome prevalence (odds ratio: 0.95, 95% confidence interval: 0.91-0.98). The optimal cutoff for the Korean Healthy Diet score was identified as >7 points, particularly showing significantly decreased prevalence of hypertriglyceridemia and low high-density lipoprotein cholesterol.

CONCLUSIONS

The Korean Healthy Diet score was inversely associated with metabolic syndrome prevalence, and the identified optimal cutoff values can serve as a practical tool for public health interventions aimed at reducing the risk of metabolic syndrome.

Health-Promoting Lifestyle and Its Predictors in Renal Transplant Recipients in Hunan, China: A Cross-Sectional Study

Background

Kidney transplantation is a critical treatment for end-stage renal disease (ESRD), with health-promoting lifestyle (HPL) significantly impacting patient outcomes. HPL involves behaviors like regular exercise, balanced nutrition, stress management, and habit modification. However, few studies have analyzed the HPL of renal transplant recipients, addressing a significant gap in current research.

Objective

This study aimed to determine the predictors of HPL in renal transplant recipients using the Chinese Health Promoting Lifestyle Profile (HPLP).

Methods

This cross-sectional study enrolled renal transplant recipients completing the revised Chinese HPLP at organ transplant center in a tertiary hospital in Hunan Province of China between May 2022 and July 2022.

Results

A total of 450 patients were included, comprising 256 males (56.9%), with a mean age of 44.85 ± 10.57 years. The mean score of self-actualization, health responsibility, interpersonal support, physical activity, stress management, nutrition, and overall HPLP were 15.27 ± 5.03 (possible range: 0-24), 11.41 ± 4.18 (possible range: 0-24), 11.61 ± 3.13 (possible range: 0-18), 7.53 ± 3.79 (possible range: 0-18), 12.68 ± 3.61 (possible range: 0-21), 11.17 ± 2.41 (possible range: 0-15), and 69.66 ± 16.98 (possible range: 0-120), respectively. Multivariate logistic regression analysis showed that urban residence (OR = 2.061, 95% CI: 1.350-3.148, P = 0.001), non-smoking after transplantation (OR = 2.010, 95% CI: 1.123-3.600, P = 0.019) and two post-transplant complications (OR=0.387, 95% CI: 0.218-0.689, P = 0.001).

Conclusion

Although renal transplant recipients exhibit a moderate level of HPL, targeted interventions are essential to improve these behaviors. These interventions should focus especially on individuals from rural households, post-transplant smokers, and those experiencing post-transplant complications, to enhance their quality of life and clinical outcomes.

Jaboticaba peel improves postprandial glucose and inflammation: A randomized controlled trial in adults with metabolic syndrome

The modulation of glucose metabolism through dietary sources has been recognized as 1 of the most sustainable approaches for preventing of cardiometabolic diseases. Although fibers and phenolic compounds derived from jaboticaba (Plinia jaboticaba) peel have demonstrated improvements in metabolic pathways in preclinical models, their beneficial effects in clinical trials remain to be fully determined. This study aimed to assess the impact of jaboticaba peel (JP) powder supplementation on glucose metabolism compared with a placebo in individuals with metabolic syndrome (MetS). A single-blind, parallel, randomized, placebo-controlled trial involving 49 individuals with MetS was conducted. Participants were assigned to receive either a JP supplement (15 g/day) or a matched placebo. Anthropometry measurements, body composition, blood pressure, metabolic and inflammatory parameters, and a mixed-meal tolerance test were assessed at weeks 0 and 5. Daily intake of JP improved the area under the curve of glucose (P = .025) and the interleukin-6 (IL-6) (P = .045). No significant time × treatment effects were observed for blood pressure, body weight, body composition, lipid metabolism, glucagon-like peptide-1, inflammatory cytokines (tumor necrosis factor-α, IL-1β), C-reactive protein, and insulin sensitivity and resistance indexes. JP supplementation may be a promising approach for managing MetS disorders, potentially by reducing the area under the curve for glucose and the proinflammatory cytokine IL-6. This research is registered at the Brazilian Registry of Clinical Trials (RBR-8wwq9t).

Gestational diabetes mellitus as a risk factor for future Type-2 diabetes mellitus: An experience from a tertiary care diabetes hospital, Karachi - Pakistan

Objective

To evaluate the history of gestational diabetes mellitus and other risk factors in women presenting with Type-2 diabetes mellitus at a tertiary care hospital.

Methods

This cross-sectional study was carried out at Baqai Institute of Diabetology & Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from July 2019 to May 2022. Women with Type-2 diabetes mellitus (T2DM) visiting outpatient department of BIDE with a previous history of GDM were recruited. Details were obtained on pre-designed questionnaire after taking informed written consent.

Results

A total of 378 women who had a prior history of GDM were included. Mean age (years) was 43.53±10.17. Mostly women were obese (BMI = 30.53±6.08) and have sedentary lifestyle. Mean HbA1c (%) was 9.08±2.24. This study found family history of T2DM and hypertension were common risk factors in women with GDM history. Mostly, women were diagnosed as GDM during 2nd trimester 153(42%) and was mainly seen in multiparous women (occur in 4th and above pregnancy). We found hypertension as common complication during pregnancy. Around 46% women developed T2DM within one year of GDM diagnosis, and 29.6% between one to five years.

Conclusion

Majority of women with GDM developed T2DM within five years of diagnosis. The potential associated risk factors were age, family history of diabetes, insulin use during pregnancy, trimester of GDM diagnosis, and hypertension during pregnancy. Awareness and life style modifications along with regular post-partum follow up with screening for T2DM should be part of GDM management to prevent or delay the occurrence of this serious complication.

Differences in Risk Factors for Coronary Atherosclerosis According to Sex

Interest in sex differences related to coronary artery disease (CAD) has steadily increased, and the risk factors for CAD show distinct sex differences. For women, cardiovascular risk increases significantly after menopause due to a decrease in estrogen levels. In older individuals, increased arterial stiffness results in a higher pulse pressure, leading to a more common occurrence of isolated systolic hypertension; these changes are more noticeable in women. While the incidence of diabetes is similar in both sexes, women with diabetes face a 50% higher relative risk of fatal coronary heart disease compared to men. Smoking significantly increases the risk of ischemic heart disease in women, particularly those who are younger. The decrease in estrogen in women leads to a redistribution of fat, resulting in increased abdominal obesity and, consequently, an elevated cardiovascular risk. Pregnancy and reproductive factors also have a significant impact on CAD risks in women. Additionally, disparities exist in medical practice. Women are less likely to be prescribed cardioprotective drugs, referred for interventional or surgical treatments, or included in clinical research than men. By increasing awareness of these sex differences and addressing the disparities, we can progress toward more personalized treatment strategies, ultimately improving patient outcomes.

Causal association study of the dynamic development of the metabolic syndrome based on longitudinal data

The dynamic progression of metabolic syndrome (MetS) includes developmental deterioration and reverse recovery; however, the key factors in this bidirectional progression have not been identified. Our study aimed to use the data obtained from the China Health and Retirement Longitudinal Study (CHARLS) and construct a Bayesian network to explore the causal relationship between influential factor and the development and recovery of MetS. Followed up at 4 years, forward progression of MetS occurred in 1543 and reverse recovery of MetS occurred in 1319 of 5581 subjects. Bayesian Networks showed that hyperuricemia and body mass index (BMI) levels directly influenced progression of MetS, and gender, exercise and age play an indirect role through hyperuricemia and BMI levels; high hemoglobin A1c (HbA1c) and BMI levels directly influenced recovery of MetS, and gender and exercise play an indirect role through BMI levels. Bayesian Network inference found that the rate of progression of MetS in subjects with hyperuricemia increases from 36 to 60%, the rate of progression of MetS in subjects with overweight or obese increases from 36 to 41% and the rate of reverse recovery rate of MetS in subjects with high HbA1c decreased from 33 to 20%. Therefore, attention to individuals at high risk of hyperuricemia, high HbA1c levels, and overweight/obesity should be enhanced, with early detection and following healthy behavioral interventions to prevent, control and delay the progression of MetS and its components.

Targeting Metabolic Diseases: The Role of Nutraceuticals in Modulating Oxidative Stress and Inflammation

The escalating prevalence of metabolic and cardiometabolic disorders, often characterized by oxidative stress and chronic inflammation, poses significant health challenges globally. As the traditional therapeutic approaches may sometimes fall short in managing these health conditions, attention is growing toward nutraceuticals worldwide; with compounds being obtained from natural sources with potential therapeutic beneficial effects being shown to potentially support and, in some cases, replace pharmacological treatments, especially for individuals who do not qualify for conventional pharmacological treatments. This review delves into the burgeoning field of nutraceutical-based pharmacological modulation as a promising strategy for attenuating oxidative stress and inflammation in metabolic and cardiometabolic disorders. Drawing from an extensive body of research, the review showcases various nutraceutical agents, such as polyphenols, omega-3 fatty acids, and antioxidants, which exhibit antioxidative and anti-inflammatory properties. All these can be classified as novel nutraceutical-based drugs that are capable of regulating pathways to mitigate oxidative-stress- and inflammation-associated metabolic diseases. By exploring the mechanisms through which nutraceuticals interact with oxidative stress pathways and immune responses, this review highlights their potential to restore redox balance and temper chronic inflammation. Additionally, the challenges and prospects of nutraceutical-based interventions are discussed, encompassing bioavailability enhancement, personalized treatment approaches, and clinical translation. Through a comprehensive analysis of the latest scientific reports, this article underscores the potential of nutraceutical-based pharmacological treatment modulation as a novel avenue to fight oxidative stress and inflammation in the complex landscape of metabolic disorders, particularly accentuating their impact on cardiovascular health.

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.

Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review

The correlation between obesity, type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) is an escalating and widely acknowledged epidemic in industrialized nations. Recently, this complex web of interrelated health conditions has been collectively defined as the Cardiovascular-Kidney-Metabolic (CKM) syndrome by the American Heart Association (AHA). The molecular mechanisms underlying CKM disease contain a spectrum of interconnected factors, including hyperglycemia, insulin resistance, heightened activity of the renin-angiotensin-aldosterone system (RAAS), the generation of advanced glycation end-products, oxidative stress, lipotoxicity, endoplasmic reticulum stress, abnormalities in calcium handling, malfunctioning of mitochondria and impaired energy production, as well as persistent chronic inflammation. Addressing their prevention, management, and treatment is of paramount importance to promote better patient health outcomes. The objective of this review is to provide a comprehensive and critical examination of the current state-of-the-art regarding the recently defined CKM syndrome. This includes an exploration of epidemiological evidence establishing connections between cardio-renal-metabolic diseases, an examination of the underlying pathophysiological mechanisms, and a comprehensive overview of existing treatment modalities.

Comparing the association of two metabolic syndrome definitions, NCEP ATP III and IDF, with the risk of developing atherosclerotic cardiovascular disease: An analytical cross-sectional study

INTRODUCTION

Atherosclerotic cardiovascular diseases (ASCVD) are significant sources of mortality and morbidity with substantial economic implications and preventive measures play key roles in this regard. Metabolic syndrome (MetS) is a common condition, and its association with ASCVD and mortality has made it clinically important. However, controversies persist regarding the best definition for MetS. Here in, we investigated the ability of the International Diabetes Federation (IDF) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) in the prediction of ASCVD incidence.

METHODS

We conducted an investigation on individuals diagnosed with MetS as part of the "Kerman Coronary Artery Diseases Risk Factor Study" (KERCADRS). This study was a cohort study conducted on a population aged 15-75 years residing in Kerman, Iran to assess the risk of ASCVD. We employed ACC/AHA ASCVD Risk Estimator for predicting ASCVD occurrence in the future and then compared the results with different definitions of MetS including IDF and NCEP ATP III.

RESULTS

Patients with MetS consistent with NCEP ATP III had higher ASCVD risk scores than those with IDF (10.63 ± 10.989 vs. 9.50 ± 9.357). NCEP ATP III had better overall performance in terms of specificity, accuracy, sensitivity and positive and negative predictive values especially in higher ASCVD risk score categories. The agreement between IDF and NCEP ATP III was none to slight (Cohen's Kappa <0.2) except for IDF in the group of ASCVD >30%, which revealed no agreement (Cohen's Kappa = 0).

CONCLUSION

NCEP ATP III has better overall performance compared to IDF. The ability of NCEP ATP III increases as the ASCVD risk score goes higher. IDF may be useful in primary screening and patients with lower ASCVD risk scores.

Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE)

Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.

Limosilactobacillus reuteri consumption significantly reduces the total cholesterol concentration without affecting other cardiovascular disease risk factors in adults: A systematic review and meta-analysis

As one of the most significant probiotics, Limosilactobacillus reuteri (L. reuteri) has been exploited as a nutritional supplement. We hypothesized that L. reuteri consumption might improve the significant risk factors of cardiovascular disease, including blood pressure, blood lipid, and blood glucose. However, previous clinical studies have shown controversial results. This study aims to explore the effect of L. reuteri consumption on these risk factors. PubMed, Embase, Scopus, the Cochrane Library, and Web of Science were searched for eligible randomized controlled trials published before May 2022. A total of 6 studies with 4 different L. reuteri strains and including 512 participants were included. The results showed that L. reuteri consumption significantly reduced total cholesterol (TC) by -0.26 mmol/L compared with the control group. In contrast, it did not affect systolic blood pressure, diastolic blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), or triglycerides. Subgroup analysis showed a significant reduction in TC when participants were <55 years old, had a body mass index between 25 and 30, or had hypercholesterolemia. In addition, TC decreased significantly when L. reuteri supplementation was >5 × 109 colony-forming unit or the length of the intervention was <12 weeks. Strain subgroup analysis showed that L. reuteri NCIMB 30242 significantly reduced TC and LDL-C. In conclusion, L. reuteri consumption has a significant TC-lowering effect, which can effectively reduce the risks of cardiovascular disease associated with hypercholesterolemia. However, the results do not support the effectiveness of L. reuteri consumption on other metabolic outcomes. Further examination of larger sample sizes is needed to confirm these findings.

Trends in Serum Total Cholesterol and High Total Cholesterol Prevalence Among Royal Thai Army Personnel in Thailand, 2017-2022

INTRODUCTION

High total cholesterol (TC) is a robust-documented risk factor for atherosclerosis cardiovascular diseases. Approximately one-fourth (23.5%) of Thai civilians had high TC. However, the information on high TC among the Royal Thai Army (RTA) personnel is limited.

AIM

The study aimed to identify the trends in serum TC and high TC prevalence among RTA personnel from 2017 to 2022.

METHODS

A serial cross-sectional study from 2017 to 2022 was conducted. A total of 318,353 active-duty RTA personnel aged 35-60 years were included in the study. High TC was defined as fasting TC ≥ 240 mg/dL. A multivariable log-binomial regression analysis was performed to investigate factors associated with high TC.

RESULTS

The overall age- and sex-adjusted high TC prevalence was 26.3% in 2017 and dropped to 22.9% in 2020; then, it increased to 26.4% in 2022 (p for quadratic trend < 0.001). Younger-aged RTA personnel have significantly rising trends in sex-adjusted high TC prevalence over 6 years. In the south, the age- and sex-adjusted high TC prevalence was 24.4% in 2017 and substantially rose to 33.6% in 2022 (p for quadratic trend < 0.001). Meanwhile, in the northeast, it rose by 3.6% over 6 years. High body mass index, high blood pressure, and hyperglycemia were associated with high TC prevalence among this population.

CONCLUSION

High TC was a common essential health issue among RTA personnel. Rising trends in mean serum TC and high TC prevalence from 2017 to 2022 were discovered, especially in younger participants and those residing in the south and northeast.

Obesity-related hypertension and chronic kidney disease: from evaluation to management

With the recent obesity pandemic, obesity-related hypertension and its complications (e.g., heart failure, coronary disease, and chronic kidney disease [CKD]) are gaining attention in clinical and research fields. Obesity-related hypertension frequently precedes the onset of CKD and aggravates its progression. In this review, we discuss the role of visceral fat in the pathophysiology of obesity-related hypertension and the potential therapeutic strategies for its prevention and management. Various factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system, and inflammatory pathways, are intricately involved in the pathogenesis of obesity-related hypertension. These factors individually and jointly contribute to the development of hypertension (usually sodium-sensitive or resistant hypertension) and, ultimately, to the progression of CKD. From a clinical standpoint, a decline in renal function in advanced CKD further makes blood pressure control challenging since only a few options are available for blood pressure-lowering medications. Proactive lifestyle modification, pharmacological treatment for obesity, and bariatric surgery can be considered for obesity control and management. Furthermore, intensive blood pressure control is required to prevent and halt the development and progression of CKD.

Influence of metabolic syndrome on survival of patients with localized renal clear cell carcinoma: A retrospective cohort study in China

OBJECTIVE

To assess the effects of metabolic syndrome (MetS) and its components on the survival and prognosis of patients with localized clear cell renal cell carcinoma (ccRCC).

DESIGN AND METHODS

This retrospective cohort study in Chongqing, China, identified patients with localized ccRCC from two medical centers of Chongqing Medical University between January 1, 2011, and December 31, 2020. The Chinese Medical Association Diabetes Society criteria of 2004 were used to diagnose MetS. Univariate and multivariate Cox proportional hazards regression analyses were conducted to identify independent risk factors for ccRCC. The outcomes were overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS).

RESULTS

In our cohort, 378 eligible patients with localized ccRCC were included (median age, 56; range, 30-85; 255 men [67.5%]), and 87 patients (23.0%) were diagnosed with MetS. The median follow-up time was 66 months (1-126 months). Kaplan-Meier and log-rank analyses showed shorter PFS (P = 0.043) and CSS (P = 0.009) in patients with MetS. Univariate and multivariate Cox regression analyses found that MetS and dyslipidemia were independent risk factors for CSS in patients with localized ccRCC (P = 0.047; P = 0.035). When we analyzed MetS separately, the 4 components of MetS (hypertension, hyperglycemia, overweight/obesity, and dyslipidemia) did not show significant differences in OS, PFS, and CSS.

CONCLUSION

MetS and dyslipidemia are independent adverse prognostic factors for CSS in patients with localized ccRCC. It is suggested to assign comprehensive therapy and follow-up to this patient population.

The methanol extract of Ceiba pentandra reverses monosodium glutamate-induced cardiometabolic syndrome in rats via the regulation of dyslipidemia, inflammation, oxidative stress, and insulin sensitization

The antidiabetic effects of the methanol extract of the stem bark of Ceiba pentandra (Cp) have been demonstrated in various experimental models. Besides, this extract is rich in 8-formyl-7-hydroxy-5-isopropyl-2-methoxy-3-methyl-1,4-naphthaquinone, 2,4,6-Trimethoxyphenol and vavain. However, it remains unknown whether Cp can mitigate cardiometabolic syndrome (CMS). The present study assessed the curative properties of Cp against Monosodium Glutamate (MSG)-induced CMS in rats. Male neonate Wistar rats were intraperitoneally administered with MSG (4 mg/g/day) during the first 5 days of life (postnatal days 2-6). They were kept under standard breeding conditions up to 5 months of age for the development of CMS. Diseased animals were then orally treated with atorvastatin (80 mg/kg/d) or Cp (75 and 150 mg/kg/day) for 28 days during which food intake, body mass, blood pressure, heart rate, glucose, and insulin tolerance were monitored. Plasma and tissues were collected on day 29th to assess the lipid profile, oxidative stress, and inflammatory parameters. The histomorphology of the adipose tissue was also evaluated. Cp significantly (p < 0.001) reduced the obesogenic and lipid profiles, adipocyte size, blood pressure, and oxidative and inflammatory status in MSG-treated rats. Cp also ameliorated glucose (p < 0.05) and insulin sensitivities (p < 0.001) hence, reducing animals' cardiometabolic risk score (p < 0.001). The curative effect of Cp on cardiometabolic syndrome is related to its capacity to reduce oxidative stress, inflammation, dyslipidemia, and increase insulin sensitivity. These results demonstrate the potential of Cp as a good candidate for alternative treatment of CMS.

Acupuncture for metabolic syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Metabolic syndrome (MS) is showing an epidemic trend worldwide, and its annual incidence is increasing. Conventional treatment options have limitations and it is necessary to develop new management strategies for MS.

METHODS

Eligible randomized controlled clinical trials (RCTs) were screened by searching multiple Chinese and English databases. References to the included literature, gray literature in OpenGrey, and other relevant literature, such as clinical studies registered in ClinicalTrials.gov, were also manually searched. Relevant data were extracted, and meta-analysis was performed using Reviewer Manager 5.4.

RESULTS

This study provides a high-quality review of the efficacy and safety of acupuncture in the treatment of MS, and provides a basis for the clinical application of acupuncture in the treatment of MS.

CONCLUSION

This study provides evidence of the effectiveness and safety of acupuncture in the treatment of MS.

The effect of dietary fiber supplement on prevention of gestational diabetes mellitus in women with pre-pregnancy overweight/obesity: A randomized controlled trial

Objective: To investigate the effect of dietary fiber intake during pregnancy on the prevention of gestational diabetes mellitus (GDM) in women who are overweight/obese prior to pregnancy.

Methods: This randomized controlled trial was conducted in Shanghai General Hospital from June 2021 to March 2022. A total of 98 women who reported BMI≥24 kg/m² prior to pregnancy were recruited before their 20th gestational week, and randomly (simple random allocation) assigned to the fiber supplement group (12 g of dietary fiber power twice daily) and the control group (standard prenatal care) from 20 to 24⁺⁶ gestational weeks. Both groups received nutrition education and dietary advice during the study. GDM diagnosis was performed by an oral glucose tolerance test (OGTT) at 25–28 weeks’ gestation. Data are presented as means with SD, as medians with IQR, or as counts with percentages as appropriate. Comparisons were conducted using a t-test, Mann-Whitney U test, and χ² test, respectively.

Results: The incidence of GDM was significantly reduced in the fiber supplement group compared with the control group: 8.3 vs. 24.0% (χ² = 4.40, p = 0.036). At OGTT, the mean fasting plasma glucose in the fiber supplement group was significantly lower than before the intervention (4.57 ± 0.38 mmol/L vs. 4.41 ± 0.29 mmol/L, p < 0.01) but not in the control group (4.48 ± 0.42 mmol/L vs. 4.37 ± 0.58 mmol/L, p = 0.150). Compared with the control group, the TG and TG/HDL-C ratio levels in the intervention group were significantly higher than those in the control group (2.19 ± 0.54 mmol/L vs. 2.70 ± 0.82 mmol/L and 1.19 ± 0.49 vs.1.63 ± 0.63, respectively, all P＜0.05). The body weight gain was significantly lower in the fiber supplement group than the control group (1.99 ± 1.09 kg vs. 2.53 ± 1.20kg, p = 0.022). None of the women randomized to the fiber supplement group experienced preterm birth (<37 weeks gestation) compared with 12.0% in the control group (p = 0.040). Excessive weight gain (total weight gain >11.5 kg for overweight, and >9.0 kg for obesity) occurred in 46.7% of women in the fiber supplement group compared with 68.0% in the control group (p = 0.035). There were no differences in other maternal and neonatal outcomes.

Conclusion: Increased dietary fiber intake in pregnant women who were overweight/obese prior to pregnancy may reduce the risk of GDM, excessive weight gain, and preterm birth, but it did not improve blood lipids.

Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model

AIM

Metabolic syndrome (MetS) coexists with the occurrence and even death of cardiovascular disease and diabetes mellitus. It is essential to study the factors in the dynamic progression of MetS in the interest of prevention and control.

PURPOSE

The aim of this study was to analyze the dynamic progression of Mets and explore the potential factors influencing the progression or reversal of MetS.

PATIENTS AND METHODS

This study involved 5581 individuals from two waves of the China Health and Retirement Longitudinal Study: 2011 and 2015. A multistate Markov model containing 4 states (free of metabolic disorder (FMD), mild metabolic disorder (MMD), severe metabolic disorder (SMD) and MetS) was adopted to study the dynamic progression of MetS and its influencing factors.

RESULTS

After follow-up, a total of 2862 cases (50.28% of the total number) had disease state transition. The intensity of transition from MetS to SMD is the same as that from SMD to MMD, and is greater than that from MMD to Mets (0.06 vs 0.05). For the MetS state, a mean of 1/0.08=12.5 years was spent in the MetS state before recovery. The exercise, smoke, drink, BMI level, hyperuricemia had statistically significant effects on progression of MetS status (P<0.05). The obesity or overweight, little exercise, smoke, drink and hyperuricemia increased the risk of forward progression of MetS disease status. There were significant nonmodifiable (age, gender) and modifiable factors (exercise, drink, BMI level, or high HbA1c) associated with reversion of MetS state.

CONCLUSION

The likelihood of progression from MMD to MetS is less likely than that of reversion from MetS to SMD and SMD to MMD. Old females were more resistant to recover from worse states than males. Prevention and intervention measures should be adopted early when MMD or SMD onset occurs.