A Comparative Assessment of Metabolic Syndrome and its Association with Vitamin D and Other Risk Factors in Type 2 Diabetes Mellitus Patients

OBJECTIVES

To determine the overall prevalence of metabolic syndrome using the World Health Organization (WHO); National Cholesterol Education Program (NCEP), and the International Diabetes Federation (IDF) guidelines and to study its association with vitamin D and other biochemical parameters in patients with type 2 Diabetes mellitus, as well as to identify the set of biochemical parameters that jointly influence the metabolic syndrome using different diagnostic criteria.

METHODS

A cross-sectional study was carried out at a private health care center in -a total of 291 diabetic patients. Socio-demographic, clinical, and laboratory data were obtained from the medical records of patients. Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS, version 23).

RESULTS

A total number of 291 patients with T2DM were included in this study. The overall prevalence of metabolic syndrome among the study subjects was 48.1%, 87.3%, 64.9% using the WHO, IDF, and NCEP-ATPIII criteria, respectively. The highest prevalence was reported following IDF diagnostic criteria. Sex, triglyceride, and fasting blood sugar were associated factors of metabolic syndrome by all the three diagnostic criteria of metabolic syndrome.

CONCLUSION

The study revealed a high prevalence rate of metabolic syndrome among type 2 diabetic patients, which was highest at 87.3% according to IDF and lowest was observed according to the WHO criteria i.e, 48.1%. A significant variance in the prevalence of metabolic syndrome was reported between WHO, IDF, and NCEP criteria.

Effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program Step 2 diet on low-density lipoprotein in children and adolescents with dyslipidemia: A double-blind crossover trial

OBJECTIVE

To evaluate the effect of phytosterol capsule supplementation associated with the National Cholesterol Education Program (NCEP) Step 2 diet on LDL-C levels in children and adolescents with dyslipidemia.

METHODS

This is a randomized, double-blind, crossover trial conducted with children and adolescents (n = 31; mean ± SD, age 9.0 ± 2.22 years, BMI zscore 1.65 ± 1.47 kg/m²) with dyslipidemia. After a run-in period, the participants were randomly allocated to control or intervention groups. The intervention group received capsules containing 1.5 g/day of phytosterols, and the control group received capsules containing 2 g/day of sunflower oil for 8 weeks. Patients in both groups were instructed to follow the NCEP Step 2 diet during the study. The primary outcome was LDL-C and secondary outcomes were total cholesterol (TC), HDL-C, triglyceride, insulin, blood pressure, and anthropometric measures. Intention-to-treat analyses were performed using the proc mixed procedure in SAS.

RESULTS

The rate of change for LDL-C was not different between intervention and control groups (p=0.30). No significant reduction was also observed for TC (p=0.47), HDL-C (p=0.97), insulin (p=0.27), triglycerides (p=0.38), systolic blood pressure (p=0.11), and diastolic blood pressure (p=0.57) compared to control group. Although we observed a high adherence to the capsule intake (95.7% in phytosterol and 93.8% in the control group), the low adherence to the diet may have contributed to explaining the results.

CONCLUSION

Daily phytosterol capsules supplementation associated with the NCEP Step 2 diet did not reduce LDL-cholesterol concentrations in children and adolescents with dyslipidemia.

Genome-wide association studies of obesity and metabolic syndrome

Until just a few years ago, the genetic determinants of obesity and metabolic syndrome were largely unknown, with the exception of a few forms of monogenic extreme obesity. Since genome-wide association studies (GWAS) became available, large advances have been made. The first single nucleotide polymorphism robustly associated with increased body mass index (BMI) was in 2007 mapped to a gene with for the time unknown function. This gene, now known as fat mass and obesity associated (FTO) has been repeatedly replicated in several ethnicities and is affecting obesity by regulating appetite. Since the first report from a GWAS of obesity, an increasing number of markers have been shown to be associated with BMI, other measures of obesity or fat distribution and metabolic syndrome. This systematic review of obesity GWAS will summarize genome-wide significant findings for obesity and metabolic syndrome and briefly give a few suggestions of what is to be expected in the next few years.

Determination of most suitable cut off point of waist circumference for diagnosis of metabolic syndrome in Kerman

OBJECTIVES

Metabolic syndrome is a determining indicator of cardiovascular diseases and diabetes. Abdominal obesity, determined by measuring waist circumference, is one of the most important criteria for diagnosing this syndrome. This criterion varies between men and women and among different races. The present study aims at the assessment of the sensitivity and specificity of the commonly used cut off point of waist circumference, and the estimation of the most suitable cut off point of waist circumference for the diagnosis of metabolic syndrome in the urban society of Kerman.

METHODS

5332 subjects consisting of 2966 women and 2366 men, 20 years old and above were studied in a population based, cross sectional study. Waist circumference, blood pressure, blood sugar, and blood lipids were measured. People with at least two of the NCEP ATP III criteria - high blood pressure (BP>130/80), high triglycerides (TG>150), high glucose (FBG>100) and low HDL (HDL<40 in men and <50 in women) - were taken as population at risk. ROC analysis was used for determining the most suitable cut off point of waist circumference. The prevalence of metabolic syndrome was then assessed based on IDF, NCEP criteria and the proposed criterion, and agreement among the three methods in diagnosing people suffering from metabolic syndrome was examined.

RESULTS

The average±standard deviation of waist circumference in women and in men was 83.90±12.55 and 87.99±11.94 cm respectively. The most suitable cut off point of waist circumference for metabolic syndrome diagnosis was 86 in women and 89 in men. These circumferences had the highest specificity and sensitivity. The prevalence of metabolic syndrome in IDF, NCPE, and the proposed criterion was 30.4%, 27.7%, and 35.2% respectively. The new criterion and the NCEP criterion achieved the highest agreement (kappa factor=83%).

CONCLUSION

The cuts off point of waist circumference in men and women are close. It is possible, then, to determine a common cut off point of waist circumference for both in Iran. Therefore, the cut point of 90-cm of waist circumference proposed by the National Obesity Committee seems to be appropriate for the Iranian society. These clinical findings should nevertheless be verified by simulation.

Serum 25-hydroxyvitamin D levels, obesity and the metabolic syndrome among Korean children

BACKGROUND AND AIM

Evidence of the relationship between serum vitamin D levels and cardiovascular risk factors in children is limited. We investigated the associations between serum vitamin D levels (25-hydroxyvitamin D [25(OH)D]) and obesity and metabolic syndrome and its components in Korean children.

METHODS AND RESULTS

We recruited 1660, nine-year-old, Korean children (904 boys and 756 girls) who voluntarily participated in this study while being examined during school-based health examinations. We measured anthropometric variables (height and weight), metabolic parameters (blood pressure, fasting plasma glucose, triglyceride, and HDL cholesterol levels) and serum vitamin D levels. We analyzed the data using multivariate logistic regression models. Mean 25(OH)D levels were lower in children defined as obese or abdominally obese (P <0.001). When serum levels of 25(OH)D were divided into quartiles, BMI, waist circumference, and triglyceride levels were lower, and HDL cholesterol levels were higher, as vitamin D levels increased. Using children from the highest quartile of 25(OH)D levels as a referent, the adjusted ORs (95% CI) for obesity in those in the third, second, and lowest quartiles of 25(OH)D levels were 1.55 (1.01-2.40), 1.87 (1.22-2.85), and 2.59 (1.71-3.90), respectively (P for trend <0.001). For abdominal obesity the ORs (CI) were 2.08 (1.20-3.60), 2.32 (1.36-3.95), and 2.96 (1.75-5.00) (P for trend<0.001), and for metabolic syndrome they were 2.60 (1.08-6.30), 4.00 (1.73-9.26), and 4.25 (1.84-9.85), respectively (P for trend <0.05).

CONCLUSIONS

We found low vitamin D levels in Korean children to be associated with obesity and metabolic syndrome. Insufficient serum vitamin D levels in children may be a risk factor of obesity and metabolic syndrome.

Coronary risk factors and metabolic disorders in first-degree relatives of normocholesterolaemic patients with premature atherosclerosis

AIMS

Despite agreement on the need for screening for the presence of cardiovascular risk factors in first-degree family members of patients with premature coronary artery disease (CAD), this is not routinely carried out in relatives of normocholesterolaemic patients. We evaluated cardiovascular risk factors in family members of normocholesterolaemic patients with premature CAD.

METHODS

Eligible index subjects were patients with premature CAD (<55 years in men and <65 years in women), who had undergone percutaneous transluminal coronary angioplasty. Patients with fasting total cholesterol levels >6.5 mmol/l were excluded. Sixteen index subjects were included with a mean age of 49±8 years and total cholesterol levels of 5.5±0.8 mmol/l. Sixty-four first-degree relatives from these 16 pedigrees were screened, namely 18 children, 42 siblings and four parents. National Cholesterol Education Program III guidelines were used to identify candidates for lipid-lowering treatment. Furthermore, the presence of four additional metabolic disorders was investigated: the metabolic syndrome, increased levels of lipoprotein(a) (Lp(a)), hyperhomocysteinaemia and postprandial hyperlipidaemia.

RESULTS

Of 64 relatives free of CAD, 34 subjects (53%) fulfilled the criteria to receive therapeutic advice, 20 of whom (31% of the relatives) were candidates for drug therapy. Sixty-one relatives were available for a full assessment of metabolic disorders and in 37 relatives (61%) at least one metabolic abnormality was present. Twelve subjects had hyper-Lp(a), seven subjects had postprandial hyperlipidaemia and two had the metabolic syndrome. Furthermore, 16 subjects had a combination of at least two out of four metabolic disorders.

CONCLUSION

Careful evaluation of coronary risk factors and metabolic variables in first-degree relatives of normocholesterolaemic CAD patients identifies a significant number of subjects at increased coronary risk in whom primary prevention measures should be initiated.