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The National Cholesterol Education Program–Adult Treatment Panel III, International Diabetes Federation, and World Health Organization Definitions of the Metabolic Syndrome as Predictors of Incident Cardiovascular Disease and Diabetes
Abstract
The clinical value of metabolic syndrome is uncertain. Thus, we examined cardiovascular disease (CVD) and diabetes risk prediction by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII), International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome.
We analyzed the risks associated with metabolic syndrome, the NCEP multiple risk factor categories, and 2-h glucose values in the San Antonio Heart Study (n = 2,559; age range 25-64 years; 7.4 years of follow-up).
Both ATPIII metabolic syndrome plus age > or = 45 years (odds ratio 9.25 [95% CI 4.85-17.7]) and multiple (two or more) risk factors plus a 10-year coronary heart disease (CHD) risk of 10-20% (11.9 [6.00-23.6]) had similar CVD risk in men without CHD, as well as CHD risk equivalents. In women counterparts, multiple (two or more) risk factors plus a 10-year CHD risk of 10-20% was infrequent (10 of 1,254). However, either a 10-year CHD risk of 5-20% (7.72 [3.42-17.4]) or ATPIII metabolic syndrome plus age > or = 55 years (4.98 [2.08-12.0]) predicted CVD. ATPIII metabolic syndrome increased the area under the receiver operating characteristic curve of a model containing age, sex, ethnic origin, family history of diabetes, and 2-h and fasting glucose values (0.857 vs. 0.842, P = 0.013). All three metabolic syndrome definitions imparted similar CVD and diabetes risks.
Metabolic syndrome is associated with a significant CVD risk, particularly in men aged > or = 45 years and women aged > or = 55 years. The metabolic syndrome predicts diabetes beyond glucose intolerance alone.
... A hypertension diagnosis was considered as systolic blood pressure > 140 mmHg or diastolic blood pressure > 90. Arterial blood pressure measurements were done according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Hypertension [17]. ...
... Currently there are a limited number of studies about risk factors and clinical characteristics of vsOSA. In Argentine, one study recruited 10 patients with AHI > 100 for 1.5 years in 2019, while in South America 19 patients were recorded with AHI >100 in 6 years, and in Mongolia we found the same AHI category in 9 patients over a period of 2 years [17][18][19][20]. ...
Objectives: To determine risk factors and clinical characteristics of obstructive sleep apnea patients (OSA) according to the severity of the value of AHI ≥ 60 (Apnea-Hypopnea Index). Methods: A hospital-based, case-control study, December 2018 - 2020. Patients were grouped by severity of AHI as moderate, severe, and very severe. Results: Of 103 male cases, 52 were very severe obstructive sleep apnea (vsOSA). The control group consisted of 16 moderate OSA (mOSA) and 35 severe OSA (sOSA) patients. The case group consisted of 52 vsOSA patients. The average age was 48.7 ± 12.6. There was statistically significant increased body mass index (p < 0.003), systolic blood pressure, and abdominal circumference (p < 0.006) in the vsOSA group. Moreover, on polysomnography there was less deep sleep (p < 0.004), a greater arousal index (p < 0.000), higher apnea-hypopnea index (p < 0.000), and higher night systole pressure (p < 0.010). According to a bivariate analysis, abdominal circumferences were the variable with the closest association to the vsOSA group (crude OR: 9.14, p > 0.004), followed by decreased maximum saturation of O2 (crude OR: 6.6, p > 0.451). Conclusion: Of male OSA patients, 50.1% have vsOSA (AHI > 60) and most of them were obese and suffered from high blood pressure. Lower levels of O2 saturation and increased abdominal and neck circumferences were significant risk factors for the very severe obstructive sleep apnea group.
... 75 The predominant definition of metabolic health is characterized by the lack of insulin resistance, the absence of subclinical inflammation as designated by hs-CRP and the presence of just one of the criteria for the metabolic syndrome as defined by the Adult Treatment Panel III criteria. 76,77 The likelihood of developing steatohepatitis and severe fibrosis escalates in a dose-dependent manner as the number of metabolic risk factors increases. 78 A study of over 1000 patients with biopsy-confirmed MAFLD has consistently shown that metabolic health has a more substantial influence on the likelihood of developing metabolic steatohepatitis and advanced fibrosis, regardless of BMI. ...
The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is significant, impacting almost one-third of the global population. MAFLD constitutes a primary cause of end-stage liver disease, liver cancer and the need for liver transplantation. Moreover, it has a strong association with increased mortality rates due to various extrahepatic complications, notably cardiometabolic diseases. While MAFLD is typically correlated with obesity, not all individuals with obesity develop the disease and a significant percentage of MAFLD occurs in patients without obesity, termed lean MAFLD. The clinical features, progression and underlying physiological mechanisms of patients with lean MAFLD remain inadequately characterized. The present review aims to provide a comprehensive summary of current knowledge on lean MAFLD and offer a perspective on defining MAFLD in individuals with normal weight. Key to this process is the concept of metabolic health and flexibility, which links states of dysmetabolism to the development of lean MAFLD. This perspective offers a more nuanced understanding of MAFLD and its underlying mechanisms and highlights the importance of considering the broader metabolic context in which the disease occurs. It also bridges the knowledge gap and offers insights that can inform clinical practice.
... Metabolic syndrome (MetS) is highly prevalent and considered a serious global health problem [1]. It comprises endocrine disturbances such as obesity, altered fasting glucose levels, dyslipidemia, and hypertension [2][3][4]. MetS is associated with an increased risk for atherosclerosis, cardiovascular diseases, and type 2 diabetes mellitus (T2D) [5]. All these disturbances have serious impacts on individuals' quality of life. ...
Resveratrol is a natural polyphenol with important anti-inflammatory and antioxidant properties for treating cardiometabolic disorders. Therefore, the present meta-analysis aimed to review and investigate the oral resveratrol supplementation effects on metabolic syndrome (MetS) components. The bibliographic search was carried out in 2023 in the following databases: PubMed, Web of Science, and Scopus. Studies that investigated the oral resveratrol effects on the MetS parameters were included. Statistical analyses were performed using RevMan Software V.5.3. The main findings showed that resveratrol significantly decreased systolic and diastolic blood pressure while having no significant effects on waist circumference and high-density lipoprotein levels. In addition, glucose level was significantly decreased in the subgroup of studies reporting change from baseline means, although the overall effect was not statistically significant (p = 0.81), while triglyceride levels were increased after the treatment period. In conclusion, the present meta-analysis evidenced the potential therapeutic effect of resveratrol on improving some MetS features, especially regarding systolic blood pressure, diastolic blood pressure, and glucose reduction; however, the results are still borderline and sometimes controversial, which might be justified by the methodological and statistical heterogeneity of the studies, with the latter varying from 17 to 57%.
... Numerous population studies have documented that the incidence of fatty liver illnesses rises with age and that these individuals are also more vulnerable to morbidity and death [5]. People who have fatty liver disease are more likely to develop type 2 diabetes, heart disorders, cirrhosis, and several types of cancer [6]. Six characteristics of fatty liver that increase the risk of cardiovascular disease (CVD) have been identified. ...
... Але, як бачимо в усіх класифікаціях ключовим є інсулінорезистентність (ІР), як стан, при якому клітини організму втрачають здатність ефективно реагувати на інсулін, що виробляється підшлунковою залозою. І саме ІР є ключовим фактором в розвитку МС і власне вона запускає всі інші процеси в організмі [6,7]. Необхідно розуміти, що це є прихований стан, який спочатку визначається лише лабораторними методами. ...
Article is devoted to the problem of metabolic syndrome, covering its history, main causes, and pathogenetic mechanisms of development, as well as current classifications and their practical significance. The role of insulin resistance in the development of metabolic syndrome is highlighted, and modern methods of its investigation are explained. The article also describes the role of metabolic syndrome in the development of cardiovascular events and other diseases.
... Although these variables are not depicted in Fig. 12.1, they should provide an ample source of hypotheses for future work exploring how stress gets "under the skin" for various constellations of people. Although men are diagnosed with CVD at higher rates than women earlier in life, women are diagnosed at much higher rates of CVD following menopause (Lorenzo et al., 2007). Conversely, women are diagnosed with higher rates of depressive disorders than men throughout the entire lifespan (Albert, 2015). ...
... MetS is defined as the presence of chronic non-communicable diseases, such as hypertension, hyperglycaemia, abdominal obesity and dyslipidemia with an atherogenic profile (high concentration of low-density (LDL) or very low-density lipoproteins, triglycerides or cholesterol, and low concentration of high-density lipoproteins (HDL)) [2,3]. MetS is diagnosed when at least 3 of these conditions are present [4], and a strong correlation has been reported between MetS and the development of cardiovascular diseases (coronary artery disease, myocardial infarction and stroke) [5][6][7], supraventricular arrhythmias and sudden cardiac death [8,9], and diabetes mellitus [10], the risk being higher the more components of the syndrome are present [11]. Currently, MetS is one of the main public health challenges worldwide. ...
Metabolic syndrome (MetS) has been linked to a higher prevalence of cardiac arrhythmias, the most frequent being atrial fibrillation, but the mechanisms are not well understood. One possible underlying mechanism may be an abnormal modulation of autonomic nervous system activity, which can be quantified by analysing heart rate variability (HRV). Our aim was to investigate the modifications of long-term HRV in an experimental model of diet-induced MetS to identify the early changes in HRV and the link between autonomic dysregulation and MetS components. NZW rabbits were randomly assigned to control (n = 10) or MetS (n = 10) groups, fed 28 weeks with high-fat, high-sucrose diet. 24-hour recordings were used to analyse HRV at week 28 using time-domain, frequency-domain and nonlinear analyses. Time-domain analysis showed a decrease in RR interval and triangular index (Ti). In the frequency domain, we found a decrease in the low frequency band. Nonlinear analyses showed a decrease in DFA-α1 and DFA-α2 (detrended fluctuations analysis) and maximum multiscale entropy. The strongest association between HRV parameters and markers of MetS was found between Ti and mean arterial pressure, and Ti and left atrial diameter, which could point towards the initial changes induced by the autonomic imbalance in MetS.
... In the fully adjusted model (model 4), the p-value of the proportional hazards assumption of the global test in normoglycemic and prediabetic subjects at baseline is equal to 0. 18 trajectory pattern, even after excluding those who were prediabetic, as per the fully adjusted model. Many epidemiological studies have indicated the association between the different sets of the traditional MetS criteria and new-onset T2DM; however, most evidence casts substantial doubt on its clinical predictive value beyond its individual components [3,13,14]. There still has been much controversy concerning the certainty of the definition and its value in identifying those at high risk of diabetes [3,15]. ...
Background
The available evidence indicates that the severity of metabolic syndrome tends to worsen progressively over time. We assessed the trajectory of age and sex-specific continuous MetS severity score (cMetS-S) and its association with the development of diabetes during an 18-year follow-up.
Methods
In a prospective population-based Tehran Lipid and Glucose Study, 3931 eligible participants free of diabetes, aged 20–60 years, were followed at three-year intervals. We examined the trajectories of cMetS-S over nine years using latent growth mixture modeling (LGMM) and subsequent risks of incident diabetes eight years later. The prospective association of identified trajectories with diabetes was examined using the Cox proportional hazard model adjusting for age, sex, education, and family history of diabetes, physical activity, obesity (BMI ≥ 30 kg/m ² ), antihypertensive and lipid-lowering medication, and baseline fasting plasma glucose in a stepwise manner.
Results
Among 3931 participants, three cMetS-S trajectory groups of low (24.1%), medium (46.8%), and high (29.1%) were identified during the exposure period. Participants in the medium and high cMetS-S trajectory classes had HRs of 2.44 (95% CI: 1.56–3.81) and 6.81 (95% CI: 4.07–10.01) for future diabetes in fully adjusted models, respectively. Normoglycemic individuals within the high cMetS-S class had an over seven-fold increased risk of diabetes (HR: 7.12; 95% CI: 6.05–12.52).
Conclusion
Although most adults exhibit an unhealthy metabolic score, its severity usually remains stable throughout adulthood over ten years of follow-up. The severity score of metabolic syndrome has the potential to be utilized as a comprehensive and easily measurable indicator of cardiometabolic dysfunction. It can be employed in clinical settings to detect and track individuals at a heightened risk of developing T2DM, even if their glucose levels are normal .
... In particular, those with poor iCVH status face a significantly greater cardiovascular disease risk of up to 100%. In previous prospective studies, the inclusion of metabolic syndrome did not add to the traditional risk factors in predicting cardiovascular disease in both US and MENA populations [23][24][25] . Contrary to these studies, use of MetS/IR an improvement in the risk prediction of cardiovascular disease was observed among individuals with coronary artery diseases 26 and type 2 diabetes 27,28 . ...
Aims/Introduction
The aim was to examine the joint effect of metabolic syndrome (MetS) and insulin resistance (IR) with ideal cardiovascular health (iCVH) status on incident cardiovascular diseases (CVDs).
Materials and Methods
The study included 6,240 Iranian adults ≥30 years, free of prior cardiovascular disease. Ideal cardiovascular health was determined based on American Heart Association's Life Simple 7. Metabolic syndrome was defined according to the Joint Interim Statement Criteria, and insulin resistance was defined as HOMA‐IR ≥1.85 in women and ≥2.17 in men. Multivariable Cox proportional hazard ratios (HRs) were applied to examine the impact of metabolic syndrome, and insulin resistance at various levels of iCVH status.
Results
During the median follow‐up of 14.0 years, 909 cases of cardiovascular disease occurred. Metabolic syndrome and insulin resistance were significantly associated with incident cardiovascular disease events. In the poor and intermediate status, metabolic syndrome increased cardiovascular disease events with HRs of 1.83 and 1.57, respectively; the corresponding values for insulin resistance in the mentioned categories were 1.91 and 1.25, respectively ( P values < 0.05). In the intermediate and poor iCVH status, hypertriglyceridemia was linked to a 40% and 35% higher risk of cardiovascular disease, the corresponding values for low HDL‐C was 20% and 60%, respectively ( P values < 0.05). Although adding metabolic syndrome, its dyslipidemia and insulin resistance to iCVH status in both poor and intermediate status significantly improve the prediction of cardiovascular disease using net reclassification improvement ( P values < 0.05), the value of C‐index did not change.
Conclusions
Metabolic syndrome and the dyslipidemia component had a negligible but significant improvement in the prediction of cardiovascular disease among individuals with non‐optimal iCVH status.
... MetS components, defined by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) 16 were measured as follows: (1) Waist circumference (WC) was measured in the standing position at the middle between the lower rib and the iliac crest without any pressure to the body surface; (2) Blood pressure (BP) was measured twice after at least 5 min of rest by using right arm in a sitting position. The average of the two measurements was recorded for both systolic and diastolic BP; (3) Fasting blood glucose (FBG); (4) highdensity lipoproteins (HDL)-cholesterol (KIMIA Kit, code 890,303, Iran) and triglycerides (TG) were measured by standard method in a central, certified laboratory using Pars Azmoon kits (Pars Azmoon Co., Tehran, Iran). ...
Many factors can lead to an increase in the prevalence of metabolic syndrome (MetS) in different populations. Using an advanced structural equation model (SEM), this study is aimed to determine the most important risk factors of MetS, as a continuous latent variable, using a large number of males and females. We also aimed to evaluate the interrelations among the associated factors involved in the development of MetS. This study used data derived from the Fasa PERSIAN cohort study, a branch of the PERSIAN cohort study, for participants aged 35 to 70 years with 10,138 males and females. SEM was used to evaluate the direct and indirect effects, as well as gender effects of influencing factors. Results from the SEM showed that in females most changes in MetS are described by waist circumference (WC), followed by hypertension (HP) and triglyceride (TG), while in males most changes in MetS are described by WC, followed by TG then fasting blood glucose (FBG). Results from the SEM confirmed the gender effects of social status on MetS, mediated by sleep and controlled by age, BMI, ethnicity and physical activity. This study also shows that the integration of TG and WC within genders could be useful as a screening criterion for MetS in our study population.
... Metabolic syndrome (MS) is identified by central obesity, hypertension, hyperlipidemia, and insulin resistance. The National Cholesterol Education Program (NECP) defines MS as any three or more of the following: (1) fasting blood glucose greater than 100 mg/dL or drug treatment for elevated blood glucose; (2) HDL cholesterol < 40 mg/dL in men and 50 mg/dL in women or drug treatment for low HDL cholesterol; (3) serum triglycerides > 150 mg/dL or drug treatment of elevated triglycerides; (4) waist circumference > 102 cm in men or 88 cm in women; and (5) blood pressure > 130/85 mm Hg or drug treatment for hypertension [1]. There are differences in the definitions between Caucasian [2] and Asian populations [3], reflecting differences in body anthropomorphy. ...
Metabolic-associated fatty liver disease (MAFLD) is now the predominant liver disease worldwide consequent to the epidemic of obesity. The intestinal microbiome (IM), consisting of the bacteria, fungi, archaea, and viruses residing in the gastrointestinal tract, plays an important role in human metabolism and preserving the epithelial barrier function. Disturbances in the IM have been shown to influence the development and progression of MAFLD and play a role in the development of metabolic syndrome (MS). The main treatment for MAFLD involves lifestyle changes, which also influence the IM. Manipulation of the IM by fecal microbial transplantation (FMT) has been approved for the treatment of recurrent Closteroides difficile infection. This may be administered by endoscopic administration from the lower or upper GI tract. Other methods of administration include nasogastric tube, enema, and oral capsules of stool from healthy donors. In this narrative review, we elaborate on the role of the IM in developing MS and MAFLD and on the current experience with IM modulation by FMT on MAFLD.
... MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria [16], but with a modified definition of abdominal obesity as per the Korean Society for the Study of Obesity [17]. To be categorized as having MetS, individuals had to meet at least 3 of the following 5 criteria at baseline: (1) a WC ≥ 90 cm for men and ≥ 85 cm for women; (2) elevated BP, specifically SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg, or the use of antihypertensive medication; (3) an el-evated FBG level of ≥ 100 mg/dL or the use of medication for diabetes mellitus; (4) an elevated TG level, defined as ≥ 150 mg/dL; and (5) a reduced HDL-C level, defined as < 40 mg/dL for men and < 50 mg/dL for women. ...
Objectives:
Limited and inconsistent prospective evidence exists regarding the relationship of dietary total antioxidant capacity (dTAC) and antioxidant intake with metabolic syndrome (MetS) risk. We evaluated the associations of the cumulative averages of dTAC and antioxidant intake (in 5 classes: retinol, vitamin C, vitamin E, carotenoids, and flavonoids, as well as 7 flavonoid subclasses) with the risk of MetS.
Methods:
This study included 11,379 participants without MetS, drawn from the Korean Genome and Epidemiology Study_CArdioVascular disease Association Study (KoGES_CAVAS). The cumulative average consumption was calculated using repeated food frequency questionnaires. Incidence rate ratios were estimated using a modified Poisson regression model with a robust error estimator.
Results:
The median follow-up period was 5.16 years, and 2,416 cases of MetS were recorded over 58,750 person-years. In men, significant inverse associations were observed in all 5 antioxidant classes, except for the highest quartile of dTAC. In women, dTAC and total flavonoids were not significantly associated with MetS; however, significant L-shaped associations were found for the remaining 4 antioxidant classes. Of the 7 flavonoid subclasses, only flavones in the highest quartile for men and flavan-3-ols in women lacked significant associations with MetS. The inverse associations were not sex-specific, but they were particularly pronounced among participants with a body mass index (BMI) of 23 kg/m2 or higher.
Conclusion:
The findings suggest that most antioxidant classes and flavonoid subclasses, unlike dTAC, exhibit a clear beneficial association with MetS in an L-shaped pattern in both men and women, particularly those with a high BMI.
... Africa has always been known for its public health problems caused by infectious diseases and nutritional deficiencies; however, as a result of the nutritional transition and changes in lifestyle brought about by industrialization, chronic non-communicable diseases and over-nutrition have increased exponentially on the continent [1]. Aside from abdominal fat accumulation, hypertension, hypertriglyceridemia, hyperglycemia, insulin resistance, and low HDL-C levels are the leading causes of death worldwide [2]. The presence of three or more of these disorders in the same person gave rise to the concept of metabolic syndrome (MS) [3]. ...
Background:
The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations.
Methods:
A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study.
Results:
In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6).
Conclusion:
This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
... With 2 out of 24 parameters, this is close to what one might expect as accidental significance. Accidental difference is also indicated by the lack of differences in parameters that are associated with HDL-C as part of metabolic syndrome, such as weight, BMI, waist circumference, WHtR, blood pressure, plasma glucose and HOMA-IR [52,53]. Likewise, parameters associated with ALT, such as body weight, waist circumference, liver steatosis grade, AST and GGT [54], as well as CRP [55], did not differ. ...
L. fermentum strains K7-Lb1, K8-Lb1 and K11-Lb3 were found to suppress Th1 and Th2 response and to enhance defensin release by enterocytes, respectively. Based on these anti-inflammatory actions, we investigated the effect of these strains on traits of metabolic syndrome, which is driven by low-grade inflammation. In a double-blind, randomised, placebo-controlled clinical trial with three parallel arms, 180 individuals with abdominal overweight were administered for 3 months with (1) placebo; (2) probiotic, comprising L. fermentum strains; or (3) synbiotic, comprising the strains + acacia gum (10 g daily). The effects were evaluated using Kruskal-Wallis one-way analysis of variance on ranks and post hoc tests (Holm-Sidak and Dunn's tests). The alteration (∆) in body fat mass (kg) (primary parameter) during intervention was significantly (p = 0.039) more pronounced in the Probiotic group (-0.61 ± 1.94; mean ± SD) compared with the Placebo group (+0.13 ± 1.64). Accordingly, differences were found in ∆ body weight (p = 0.012), BMI (p = 0.011), waist circumference (p = 0.03), waist-to-height ratio (p = 0.033), visceral adipose tissue (SAD) (p < 0.001) and liver steatosis grade (LSG) (p < 0.001), as assessed using sonography. In the Synbiotic group, ∆SAD (p = 0.002), ∆LSG (p < 0.001) and ∆constipation score (p = 0.009) were improved compared with Placebo. The probiotic mixture and the synbiotic improved the parameters associated with overweight.
... The interrelationships of these risk factors are being studied, and the contribution of the genetic component in the pathogenesis of these diseases is important. Lorenzo C. et al. conducted studies where they applied the MS criteria of four programmes: The National Cholesterol Education Program (NCEP), Adult Treatment Panel III (ATPIII), International Diabetes Federation (IDF) and WHO (4). They argue that although these programmers have different sensitivity in detecting MS, they can predict CVDs and diabetes. ...
Background:
Insulin resistance (IR) is a consequence of chronic adipose tissue inflammation and underlies the pathogenesis of several diseases, such as type 2 diabetes mellitus, cardiovascular diseases and metabolic syndrome. In this study, we examined the association between dyslipidaemia and IR; directly comparing conventional lipid ratios and apoB/apoA1 ratios for strength and independence as risk factors for IR in a Kazakh population.
Methods:
The design of this study was a case-control study. There were 507 participants in the study. We examined each participant's plasma total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, apolipoprotein B, and apolipoprotein A1. IR was determined using an IR homeostasis model assessment (HOMA-IR). To assess the risk of an atherogenic blood lipid profile, atherogenicity coefficients were calculated: Bad cholesterol to good cholesterol ratio ((TC-HDL)/HDL); TG to HDL ratio (TRG/HDL); apoB to apoA1 ratio (apoB/apoA1).
Results:
In this study, high waist circumference and BMI were more common in men. The group with IR had significantly higher waist circumference (cm) (p = 0.0001) and BMI (kg/m2) (p = 0.04) than the group without IR. The risk of IR was significantly associated with the apoB/apoA1 ratio (p = 0.03). Analysis of the association between HOMA-IR and apoB/apoA1 ratio increased the risk of IR at apoB/apoA1 ratios of 0.71 to 0.85 and above 0.86 by a factor of 1.93 and 1.84, respectively. HOMA-IR levels were weakly significantly correlated with TG levels (rS = 0.3; p = 0.0001) and very weakly positively correlated with apoB levels (rS = 0.1; p = 0.002) and apoB/apoA1 (rS = 0.1; p = 0.001), there was a weak negative correlation with apoA1 levels (rS = -0.1; p = 0.02). Logistic regression analysis showed that the risk of developing IR was significantly lower in men than in women, adjusted OR (95% CI) = 0.75 (0.49-1.0) p = 0.02.
Conclusion:
In our study, IR was more common in Kazakh women than in Kazakh men. IR was also associated with apoB and TG levels. Thus, we suggest that analysis of TG, apoB and apoB/apoA1 ratio may be recommended as early predictors of IR risk in the Kazakh population (Tab. 3, Ref. 22). Text in PDF www.elis.sk Keywords: insulin resistance, dyslipidaemia, apolipoproteins, triglycerides, lipids.
... MetS has been regarded as one of the most serious non-communicable chronic diseases and is a risk factor for type 2 diabetes and cardiovascular disease (CVD) [6,7]. Several studies have found that the prevalence of diabetes and CVD in the population with MetS was five-fold and doubled-fold higher than that without MetS, respectively [8,9]. The rapid increase in MetS prevalence may be attributed to changes in population behavior patterns in modern society [10,11]. ...
Metabolic syndrome (MetS) is recognized as one of the most severe non-communicable chronic diseases. Diet plays an essential role in the development and exacerbation of MetS. Thus, this study aimed to investigate the relationship between dietary patterns and MetS in a suburban population in Shanghai, China. Data were collected on the Zhongshan community from the Shanghai Suburban Adult Cohort and Biobank (SSACB) study between May and September 2017. A total of 5426 participants who completed the questionnaire investigation, physical measurements, and biological sample collection were effectively enrolled in this study. Both posteriori and priori methods were utilized to generate different dietary patterns, including the dietary approaches to stop hypertension (DASH) and Mediterranean diet (MD). The prevalence of MetS in this study was 22.47%. Compared to the reference, dietary patterns with a higher intake of “dairy and fruits” and “coarse cereals and soy products” had protective effects on MetS (p < 0.05). However, no significant correlation with MetS was observed for DASH and MD. Our study recommends higher consumption of fruits, coarse cereals, and soy products, which was associated with a lower prevalence of MetS in the suburban population of Shanghai. The correlation of DASH and MD with MetS in the Chinese population requires further exploration.
... A recent study showed that cumulative exposure to IFG was associated with a higher risk of type 2 diabetes [36]. Some studies have reported that metabolic syndrome is a more potent risk factor for developing diabetes than elevated FPG levels [37]. Another study reported conflicting results that metabolic syndrome was not superior to the measurement of blood glucose alone in predicting diabetes [38]. ...
Background
Metabolic syndrome is associated with type 2 diabetes and its prevalence is increasing worldwide in young adults. We aimed to determine whether cumulative exposure to metabolic syndrome is associated with type 2 diabetes risk in young adults.
Methods
Data of 1,376,540 participants aged 20–39 years without a history of type 2 diabetes and who underwent four annual health check-ups were collected. In this large-scale prospective cohort study, we evaluated the incidence rates and hazard ratios (HRs) of diabetes according to cumulative frequencies of metabolic syndrome over 4 years of consecutive annual health check-ups (burden score 0–4). Subgroup analyses were performed by sex and age.
Results
During 5.18 years of follow-up, 18,155 young adults developed type 2 diabetes. The incidence of type 2 diabetes increased with burden score (P < 0.0001). The multivariable-adjusted HRs for type 2 diabetes were 4.757, 10.511, 18.288, and 31.749 in participants with a burden score of 1 to 4, respectively, compared to those with 0. In subgroup analyses, the risk of incident diabetes was greater in women than men and in the 20–29 years age group than the 30–39 years age group. The HRs were 47.473 in women and 27.852 in men with four burden scores.
Conclusion
The risk of type 2 diabetes significantly increased with an increase in the cumulative burden of metabolic syndrome in young adults. Additionally, the association between cumulative burden and diabetes risk was stronger in women and the 20s age group.
... *Về lâm sàng: Đánh giá tuổi (chia 2 nhóm: <60 tuổi và ≥60 tuổi), giới tính, một số yếu tố nguy cơ hay gặp, bao gồm: tăng huyết áp (THA), đái tháo đường (ĐTĐ), rối loạn lipid máu, rung nhĩ, hút thuốc lá, uống rượu, tiền sử đột quỵ não cũ. Chẩn đoán THA theo hội Tim mạch Mỹ (AHA) khi huyết áp tâm thu ≥ 140mmHg và/hoặc huyết áp tâm trương ≥ 90mmHg, chẩn đoán ĐTĐ theo hướng dẫn 2017 của Hiệp Hội Đái tháo đường Mỹ (ADA), rối loạn chuyển hóa lipid: được xác định dựa vào Triglycerid ≥ 2,2 mmol/l và/ hoặc Cholesterol ≥ 5,2mmol/l [4], rung nhĩ được xác định trong tiền sử hoặc được ghi nhận bởi kiểm tra sức khoẻ trước đó [5], hút thuốc lá được xác định khi có hút ít nhất 1 gói năm và có hút bất kỳ điếu thuốc nào trong tháng qua tính đến thời điểm nhập viện [6]. Đánh giá thời gian từ khi khởi phát đến khi nhập viện, các triệu chứng lâm sàng khi vào viện (liệt nửa người, liệt mặt, rối loạn ngôn ngữ, rối loạn ý thức….), ...
Mục tiêu: 1) Đánh giá một số đặc điểm lâm sàng theo giới ở bệnh nhân nhồi máu não (NMN) cấp. 2) Đánh giá mức độ tuần hoàn bàng hệ trên CTA 3 pha theo giới. Đối tượng và phương pháp: Tiến hành ở 118 bệnh nhân NMN (67 nam và 51 nữ) được chụp CTA 3 pha trong 7 ngày đầu từ khi khởi phát triệu chứng, điều trị nội trú tại Khoa Đột quỵ, Bệnh viện Quân y 103 từ tháng 11 năm 2021 đến tháng 7 năm 2022. Đánh giá một số đặc điểm lâm sàng vào viện và ra viện; đánh giá mức độ THBH trên phim chụp CTA 3 pha, 64 dãy theo thang điểm Calgary; xác định mối liên quan giữa đặc điểm lâm sàng và mức độ THBH với giới tính. Kết quả: tỷ lệ nam/nữ=1,31; nữ giới có tuổi bị bệnh cao hơn nam giới (p>0,05), hay gặp rung nhĩ (p<0,05), ĐTĐ (p>0,05), rối loạn lipid máu (p>0,05), ít gặp THA (p>0,05) và hút thuốc lá (p<0,05); rối loạn ý thức hay gặp hơn ở nữ; điểm NIHSS trung bình vào viện ở nữ cao hơn nam 2,97 điểm (p<0,05), tỷ lệ THBH tốt ở nữ thấp hơn (p<0,05) và mức độ tàn phế nặng khi ra viện (mRS 5-6) cao hơn (p>0,05). Kết luận: Nhóm nữ giới có tỷ lệ rung nhĩ, THBH kém cao hơn nam giới. NMN ở nữ giới hay gặp triệu chứng rối loạn ý thức hơn và điểm NIHSS trung bình vào viện cao hơn ở nam giới.
... Đánh giá các yếu tố nguy cơ hay gặp ở bệnh nhân NMN, bao gồm: tăng huyết áp, đái tháo đường, rối loạn lipid máu, rung nhĩ, hút thuốc lá, uống rượu, tiền sử đột quỵ não cũ. Chẩn đoán THA khi huyết áp tâm thu ≥ 140mmHg và/hoặc huyết áp tâm trương ≥ 90mmHg, chẩn đoán ĐTĐ theo hướng dẫn 2017 của Hiệp Hội Đái tháo đường Mỹ (American Diabetes Association -ADA), rối loạn chuyển hóa lipid: được xác định dựa vào Triglycerid ≥ 2,2 mmol/l và/hoặc Cholesterol ≥ 5,2mmol/l [7], rung nhĩ được xác định trong tiền sử hoặc được ghi nhận bởi kiểm tra sức khoẻ trước đó [8], hút thuốc lá được xác định khi có hút ít nhất 1 gói năm và có hút bất kỳ điếu thuốc nào trong tháng qua tính đến thời điểm nhập viện [10]. ...
Mục tiêu: Đánh giá các bất thường của đa giác Willis và mối liên quan với tuần hoàn bàng hệ (THBH) ở bệnh nhân nhồi máu não (NMN) cấp. Đối tượng và phương pháp: Tiến hành ở 136 bệnh nhân NMN tại Khoa Đột quỵ, Bệnh viện Quân y 103 từ tháng 11/2021 đến tháng 7/2022. Bệnh nhân được chụp cắt lớp vi tính mạch máu não (CTA) 3 pha trong vòng 7 ngày đầu từ khi khởi phát đột quỵ. Đánh giá mức độ THBH trên phim chụp CTA 3 pha theo thang điểm Calgary và các bất thường của đa giác Willis; xác định mối liên quan giữa mức độ THBH với bất thường của đa giác Willis. Kết quả: Các bất thường của đa giác Willis gặp ở 57,4% bệnh nhân. Trong đó hay gặp nhất là thiểu sản động mạch thông sau (Pcom) 2 bên với 16,2%, tiếp đến là thiểu sản động mạch thông sau 1 bên với 13,2%. Tỷ lệ THBH tốt cao nhất ở nhóm không có bất thường đa giác Willis và giảm dần theo các nhóm thiểu sản động mạch thông sau 1 bên, thiểu sản động mạch thông sau 2 bên, bất sản động mạch thông sau 1 bên và bất sản động mạch thông sau 2 bên (94,8%, 83,3%, 68,2%, 58,8% và 50%). Kết luận: Các bất thường của đa giác Willis gặp ở 57,4% bệnh nhân. Tỷ lệ THBH tốt cao nhất ở nhóm không có bất thường đa giác Willis và giảm ở các nhóm có thiểu sản, bất sản động mạch.
... Most metabolic disorders, such as high blood pressure, imbalanced blood sugar metabolism, insulin resistance, general and abdominal obesity, hyperuricemia, dyslipidemia, and hyperglycemia, have increased significantly over the past few decades. These conditions are risk factors for several serious illnesses, including coronary heart disease, obesity, type 2 Diabetes Mellitus, stroke and Polycystic Ovarian diseases [11][12][13][14] . Body mass index (BMI) and blood pressure are anthropometric and physiological measurements that must indicate not only innate genetic and physiological dependencies but also, essentially, metabolic putdowns resulting from the interaction between people and their surroundings as mediated by stress, nutrition, activity, and a variety of other variables that might also change between the genders 15,16 . ...
In the present era, Metabolic disorder is a challenge to the medical community because of its increasing prevalence and unsatisfactory management. There is no permanent remedy, and the patient has to continue the medicine for a longer life. According to Ayurveda, all metabolic diseases are caused due to Jathragnimandya(improper digestion & metabolism). Hence the correction of Agni is the principle to treat it. Various herbs act as agnivardhak (increase digestive fire or Rasayan (Rejuvenator). Haridra (Curcuma longa) and Amalaki (Emblica Officinalis) are the herbal drugs recommended in Ayurveda literature. Ayurveda practitioners are using these medicines for various metabolic disorders. Hence this review was carried out to discover their utility in metabolic disorders. The aim and objective of this review are to study the role of common herbs available worldwide, which are Haridra (Curcuma longa) and Amalaki (Emblicaofficinalis), in metabolic disorders. The related data were collected from classical texts of Ayurveda, google scholar, and PubMed. A total of 10 articles were considered for review. Out of these, four were animal studies, and six were analytical studies in which the assessment parameters were fasting. From this review, few studies have been conducted on only Haridra as compared to Amalaki on the post-meal blood sugar levels, glycolatedhaemoglobin (HbA1c) levels, oral glucose tolerance test, and complete blood count metabolic disorders. The maximum studies are on Nisha-Amalaki(a combination of Haridra&Amalakialongwith bhavna[trituration process] of Amalakiswarasa[Juice form of Emblicaofficinalis]to Haridra[Curcuma longa]) which is found to be effective in Diabetes mellitus and dyslipidemia, which can be considered as the cavity of previous reviews. Therefore, there is a need to conduct studies on Nisha-amalaki to explore its effect on other common metabolic disorders like PCOD, Hypothyroidism.
... A fasting plasma glucose concentration of ≥200 mg/dl (11.1 mmol/L) or an FPG of ≥126 mg/dl (7 mmol/L) during an OGTT or with anti-diabetic medicines is diagnostic of diabetes. LDL cholesterol is over 100 mg/dl, total cholesterol is above >200 mg/dl, HDL cholesterol is below <40 mg/dl, and triglycerides are above >150 mg/dl; this is according to ATP-III standards [10]. For family early history of IHD, which has previously been associated with the development of angina, MI, and sudden cardiac death (SCD), at least one direct blood relative (parents, siblings, children) who were <55 years old when they experienced any of the following were examined: angina, MI, and SCD without obvious cause [11]. ...
Background: AMI happens earlier and more often in South Asians compared to Western populations. In Bangladesh, very little information is known about the connections between avoidable risk factors and outcomes of AMI in young people. This research aims to discover risk variables and the in-hospital results of AMI among those under the age of 40 in Bangladesh. Methods: A cohort study of individuals with an acute case of Acute ST-Segment Elevation MI (STEMI) was done, which examined all patients aged under 40 and over 40 years of age in successive groups of 50. The clinical findings, biochemistry data, nutrition, and echocardiography result of the participants were compared against each other, including an examination and hospitalization outcomes. Regression analysis was done to determine the risk factors related to a patient's hospital-based treatment, controlling for other confounding variables previously discovered. Results: Young and older patients were about 36.5 and 57 years old, respectively. The most striking factors contributing to the greater incidence of AMI in the younger group were their age (OR 3.4, 95% CI 1.2–9.75), smoking (OR 2.4, 95% CI 1.04–5.62), family history of myocardial infarction (OR 2.4, 95% CI 1.11–5.54), homocysteine (OR 1.2, 95% CI 1.08–1.36), and frequent consumption of rice (OR 3.5, 95% CI 1.15–10.6). Lastly, beef consumption (OR 4.5, 95% CI 1.83–11.3) also contributed to a greater AMI risk. Older patients were considerably more likely to experience heart failure (a 70% higher probability), reinfarction (a 50% higher chance), arrhythmia (a 70% higher chance), and cardiogenic shock (a 6-fold larger risk) in multivariate analysis. Conclusion: Young AMI patients tend to have better outcomes in the hospital than their older counterparts since they have a distinct risk profile. To help Bangladesh youth avoid life-shortening diseases, Bangladesh should reduce avoidable risk factors, such as smoking, bad food, obesity, and poor ......
... (2) At least any 3 of following features are used regarding pediatric definition of MtS modified from the Third National Cholesterol Education Program [21] that reflect the 2007 American Diabetes Association definition of comprising: ...
Background
The second-generation antipsychotics (SGAs) are a group of antipsychotic drugs, used to treat psychiatric conditions. SGAs have been shown to precipitate rapid weight gain and dyslipidemia, as well as to promote insulin resistance, leading to the emergence of type 2 diabetes and metabolic syndrome. Prescriptions of SGAs in children have increased 6- to 10-fold during the last decade. This research work designed to find correlation between duration of second-generation antipsychotics (SGA) use, in children and adolescent, and the increase in metabolic syndrome disturbance components including weight gain, hypertension, hyperlipidemia and diabetes mellitus. This is cross-sectional analytic study was carried out in Suez Canal University Hospital, Psychiatry Outpatient Clinic on Children and adolescent aged 4–17 years. It included 151 children and adolescents diagnosed by Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). They were divided into two groups, 72 patients who regular on (SGA) as treated group and 79 patients who did not receive pharmacological medication as control group.
Results
The overall prevalence of metabolic syndrome in the current study was high 27.81% in SGA-treated children compared to 0.60% in control group. In the SGA-treated group, 22.22% had type 2 diabetes, compared with 2.53% in the control group. SGA-treated patients showed a highly significant increase in their weight, body mass index and waist circumference compared to their control group patients. The correlation of different metabolic syndrome indices and SGAs duration showed positive correlation with body mass index, fasting blood sugar, and blood lipids (low density lipoproteins and cholesterol) but negative correlation with high density lipoproteins. Blood pressure did not correlate with SGA-duration in the studied patients. Indices which showed correlation could be predictors of the metabolic syndrome developments. Although the correlation and regression model showed moderate degree of association, this is considered important issue for the young patients.
Conclusion
SGA treatment in children and adolescence confers a significantly increased risk for metabolic syndrome and SGA-treatment duration is important for MtS development.
... The cut-off for high HbA1c was according to the WHO definition of ≥6.5%. 19 The prevalence of high total triglycerides was defined as ≥180 mg/ dL, 20 high serum cholesterol was defined as a low-density lipoprotein cholesterol of ≥100 mg/dL. 20 Anaemia was defined as haemoglobin ≤13 g/dL for males and ≤12 g/dL for females. ...
Background:
People with severe mental illness (SMI) die earlier than the general population, primarily because of physical disorders.
Aims:
We estimated the prevalence of physical health conditions, health risk behaviours, access to healthcare and health risk modification advice in people with SMI in Bangladesh, India and Pakistan, and compared results with the general population.
Method:
We conducted a cross-sectional survey in adults with SMI attending mental hospitals in Bangladesh, India and Pakistan. Data were collected on non-communicable diseases, their risk factors, health risk behaviours, treatments, health risk modification advice, common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis and compared our findings with the general population in the World Health Organization (WHO) 'STEPwise Approach to Surveillance of NCDs' reports.
Results:
We recruited 3989 participants with SMI, of which 11% had diabetes, 23.3% had hypertension or high blood pressure and 46.3% had overweight or obesity. We found that 70.8% of participants with diabetes, high blood pressure and hypercholesterolemia were previously undiagnosed; of those diagnosed, only around half were receiving treatment. A total of 47% of men and 14% of women used tobacco; 45.6% and 89.1% of participants did not meet WHO recommendations for physical activity and fruit and vegetable intake, respectively. Compared with the general population, people with SMI were more likely to have diabetes, hypercholesterolemia and overweight or obesity, and less likely to receive tobacco cessation and weight management advice.
Conclusions:
We found significant gaps in detection, prevention and treatment of non-communicable diseases and their risk factors in people with SMI.
... Dyslipidemia was defined as either hypo-HDL or hypertriglyceridemia, applying cut-offs from the Adult Treatment Panel III criteria for the metabolic syndrome. 16 In order to prevent distortion of those without dyslipidemia who are unlikely to benefit from statin use, we identified three subgroups based on statin use and dyslipidemia: statin use, non-treated dyslipidemia and no dyslipidemia. These groups were used to quantify the association of statin use with NAFLD by logistic regression. ...
Background
Statin use could benefit patients with non-alcoholic fatty liver disease (NAFLD), but the evidence is segmented and inconclusive. This multidimensional study comprehensively investigated the potential benefits and mechanism-of-action of statins in NAFLD.
Methods
A cross-sectional investigation was performed within the Rotterdam Study (general population; n = 4.576) and the PERSONS cohort (biopsy-proven NAFLD patients; n = 569). Exclusion criteria were secondary causes for steatosis and insufficient data on alcohol, dyslipidemia or statin use. Associations of statin use with NAFLD (among entire general population), fibrosis and NASH (among NAFLD individuals and patients) were quantified. These results were pooled with available literature in meta-analysis. Last, we assessed statins’ anti-lipid and anti-inflammatory effects in 3D cultured human liver organoids and THP-1 macrophages, respectively.
Findings
Statin use was inversely associated with NAFLD in the Rotterdam study compared to participants with untreated dyslipidemia. In the PERSONS cohort, statin use was inversely associated with NASH, but not with fibrosis. The meta-analysis included 7 studies and indicated a not significant inverse association for statin use with NAFLD (pooled-Odds Ratio: 0.69, 95% Confidence Interval: 0.46–1.01) and significant inverse associations with NASH (pooled-OR: 0.59, 95% CI: 0.44–0.79) and fibrosis (pooled-OR: 0.48, 95% CI: 0.33–0.70). In vitro, statins significantly reduced lipid droplet accumulation in human liver organoids and downregulated expression of pro-inflammatory cytokines in macrophages.
Interpretation
Pooled results demonstrated that statin use was associated with a lower prevalence of NASH and fibrosis and might prevent NAFLD. This may be partially attributed to the anti-lipid and anti-inflammatory characteristics of statins. Given their under-prescription, adequate prescription of statins may limit the disease burden of NAFLD.
Funding
ZonMw, KWF, NWO, SLO, DGXII, RIDE, National and regional government, Erasmus MC and Erasmus University.
... According to the WHO global report on diabetes 2016 "the percentage of undiagnosed type 2 diabetes differs widely -a recent data review from many countries revealed that between 24% to 62% of people who have diabetes were undiagnosed and untreated" this high proportion even involves high-income countries where the percentage of undiagnosed DM may be as high 30-50% (11) . This delay in diagnosis carries high risks, because these patients remain untreated for unknown period of time and are under the risk of developing the complications of diabetes (12,13) with possibility to prevent these complications by early diagnosis and intervention (14) , so it is reasonable to say that screening programs is important to help in early diagnosis (15) . The American Diabetes Association (ADA) has recommended screening population for diabetes, this includes any adult with risk factors, all adults aged 45 years or older even if they don't have risk factors, and also these criteria include testing for prediabetes (Table 1) (14) . ...
... The most significant behavioral risk factors for CD and stroke include age, sex, poor eating, sedentary lifestyle, cigarette smoking, and problematic alcohol use [5]. As a result of behavioral risk factors, people may have increased blood pressure, blood glucose, or blood lipids [4]. Chronic diabetic syndrome affects 64 out of 1.32 billion people in the United States over the age of 20. ...
Cardiovascular illnesses have surpassed disease as the leading cause of death in industrialized, emerging, and underprivileged countries in recent decades. The mortality rate can be lowered through early detection and effective care of cardiac diseases. However, reliable detection of heart disorders in all conditions and serving doctors with 24-hour medical consultations are not possible since they require more intelligence, time, and talent to train the computer for a specific duty. Artificial intelligence and machine learning algorithms may have a substantial impact on the lives of those who are afflicted with chronic diseases. In this work, we used artificial intelligence to create a hybrid model for the prediction of cardiac disease and flags for prevention. The goal of this research was to develop a prediction model that can identify and characterize a patient's illness. We used data of 68975 patients from the University of California, Irvine's repository and trained several algorithms for CVD illness prediction. In our simulation maximum classifiers have achieved the greatest accuracy, which is a huge accomplishment for our research team. Our proposed hybrid ML algorithm framework improved CVD prediction performance when compared to previously offered prediction models. The proposed methods are decision tree and random forest models, which have a 99.98% accuracy for training, followed by support vector machine, which has a 99.30% accuracy followed by other classifiers which yield higher results in comparison. Pre-existing CVD history was considered the most important factor determining the prediction model's accuracy. Our findings reveal that our CVD prediction model based on machine learning techniques developed for health screening datasets is simple to apply and more accurate. Our proposed classifiers have the best accuracy rate.
... Estes fatores de risco são independentes para o desenvolvimento de doença cardiovascular aterosclerótica (SCUTERI et al., 2004;DEKKER et al., 2005;GIRMAN et al., 2005;POLLEX et al., 2006;ATHYROS et al., 2007;EMPANA et al., 2007;LORENZO et al., 2007) ...
Este estudo teve por objetivo determinar a frequência de fatores de risco para síndrome metabólica (SM) em pacientes atendidos pela equipe de residência multiprofissional do Hospital Universitário Cassiano Antônio Moraes, e evidenciar a importância da equipe multiprofissional na assistência destes pacientes. Foram analisados 85 prontuários dos pacientes atendidos entre abril de 2010 a junho de 2011. A presença da SM seguiu os critérios do NCEP-ATPIII. Entre os pacientes estudados, 32,9%, 27,1% e 10,6% apresentaram três, quatro e cinco fatores da SM respectivamente, havendo associação significativa entre faixa etária, IMC e a presença de SM. Enfermeiros, nutricionistas, farmacêuticos, assistentes sociais e odontólogos, da equipe multiprofissional acompanharam 85,71%; 98,82%; 80,00%; 63,53%; 55,29%, respectivamente. Os pacientes com sobrepeso e obesidade estão mais expostos a fatores de risco cardiovasculares envolvidos na SM e, consequentemente, a maior risco de morbidade e mortalidade. Para redução dos riscos e das doenças cardiovasculares, ressalta-se a integração da equipe multiprofissional de saúde.
... The diagnosis of metabolic syndrome was determined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel (NCE/ATPIII) when the presence of three of the five listed criteria is confirmed [25]. Blood samples collected from the cubital vein (by BD Vacutainer sampling tubes) were centrifuged, and isolated blood serum was stored at −70 • C until analysis. ...
Psoriasis and metabolic syndrome (MetS), a common comorbidity of psoriasis, are associated with mild chronic systemic inflammation that increases oxidative stress and causes cell and tissue damage. At the cellular level, chromosomal and DNA damage has been documented, thus confirming their genotoxic effect. The main objective of our study was to show the genotoxic potential of chronic inflammation and determine whether the presence of both pathologies increases chromosomal damage compared to psoriasis alone and to evaluate whether there are correlations between selected parameters and chromosomal aberrations in patients with psoriasis and MetS psoriasis. Clinical examination (PASI score and MetS diagnostics according to National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults; NCE/ATPIII criteria), biochemical analysis of blood samples (fasting glucose, total cholesterol, low density and high density lipoproteins; LDL, HDL, non-HDL, and triglycerides;TAG), DNA/RNA oxidative damage, and chromosomal aberration test were performed in 41 participants (20 patients with psoriasis without MetS and 21 with MetS and psoriasis). Our results showed that patients with psoriasis without metabolic syndrome (nonMetS) and psoriasis and MetS had a higher rate of chromosomal aberrations than the healthy population for which the limit of spontaneous, natural aberration was
... Dyslipidemia was defined as either hypo-HDL or hypertriglyceridemia, applying cut-offs from the Adult Treatment Panel III criteria for the metabolic syndrome. 16 In order to prevent distortion of those without dyslipidemia who are unlikely to benefit from statin use, we identified three subgroups based on statin use and dyslipidemia: statin use, non-treated dyslipidemia and no dyslipidemia. These groups were used to quantify the association of statin use with NAFLD by logistic regression. ...
... The risk of diabetes is 5-7 fold higher in patients with IFG or IGT as compared to normoglycemic patients and for the patients with metabolic syndrome, the risk of developing diabetes is 5 fold more as compared to the patients who are not having metabolic syndrome. [7,8] However, when pre-diabetes combines with metabolic syndrome, the risk is increased even more. ...
Patients with prediabetes are not only at increased risk of progression to type 2 diabetes, but they are also at high risk of developing cardiovascular (CV) risk compared to normoglycemic people. Further, prediabetes is also often associated with abnormal lipid levels (dyslipidemia). We therefore aimed to evaluate the effect of saroglitazar in patients with prediabetes and dyslipidemia. This was a prospective, single centre, single arm study involving patients with pre-diabetes and dyslipidemia. Subjects with baseline HbA1c 5.7-6.4% and dyslipidemia were enrolled in this study. Subjects with on-going medications affecting blood glucose or lipids were excluded from the study. Saroglitazar 4mg once daily was administered for a period of 24 weeks. The primary outcome was change in serum triglycerides and secondary outcome parameters included changes in other lipid parameters and HbA1c levels at 24 weeks follow-up. Forty patients with prediabetes and dyslipidemia were enrolled in the study. At 24 weeks follow-up, serum triglycerides was significantly reduced from 348 mg/dl to 216 mg/dl (P <0.0001). HbA1c was significantly reduced from 6.3% to 5.5% after 24 weeks of Saroglitazar therapy (P<0.0001).
... Diagnostic criteria for determining the presence of MetS were the criteria defined in uniform international standards based on the National Cholesterol Education Program/Adult Treatment Panel III [20]. It has been reported that Mets defined in this criteria are related to cardiovascular disease onset by the follow-up survey of the Suita study for 13 years [21]. ...
We examined whether the number of teeth could be a surrogate marker for metabolic syndrome (MetS) risk in cross-section. A total of 3771 individuals from the general urban Japanese population (1690 men, 2081 women; mean age 67.1 ± 11.0 years) participated in this study. Participants were diagnosed with MetS with three or more components hypertension, hyperglycemia, lipid metabolism abnormality, and abnormal abdominal girth. Questionnaires were administered to determine the number of teeth, smoking status, drinking status, and past illnesses. To clarify the relationships between the number of teeth and the presence of MetS components, we divided subjects into two groups: those with less than 20 residual teeth and those with 20 or more, then statistical analyses (Mantel-Haenszel tests and logistic regression analysis) were performed. MetS were higher for those with ≤19 teeth than those with ≥20 teeth when examining all participants and women-only groups. Hyperglycemia, low HDL cholesterol, high triglycerides, and diagnosis with MetS were all significantly higher in the ≤19 teeth group for both sexes combined and for women. These results suggest that less than 20 teeth may be a surrogate marker for MetS risk, but further studies on gender differences and pathological background are needed.
The simplistic approach frequently used in biological sciences is no longer sufficient if we want to research complicated multi-factorial illnesses like Metabolic Syndrome (MetS) by utilizing cutting-edge ‘omics’ techniques. A thorough understanding of the system is required to comprehend the adaptive changes in molecular mechanisms at various phases of pathogenicity since activating various pathways may still result in the same functionality but at multiple metabolic costs. Systems biology is an interdisciplinary branch of research that employs a much more thorough overview to tackle biomedical and biologic research. It focuses on complex interactions within and across biological systems. Whereas the significance of the systems biology approach has long being understood, experimental and simulation methods have progressed to the point where thorough molecular characterization of biological systems is now attainable. The term metabolic syndrome describes a collection of illnesses that include dyslipidaemia, fatty liver, diabetes, obesity, resistance to insulin and other cardiovascular issues. Metabolic syndrome is significant due to its frequency, possible severity and expense. The control of the metabolic pathways that control the overall balance of the body’s systems depends heavily on the liver. An intricate web of hormones, transcription factors, and signalling pathways regulates how much glucose and lipids are produced in the liver. A prevalent understanding nowadays is that the metabolic syndrome’s hepatic manifestation is fatty liver that is associated with dysfunctional lipoprotein, fatty acid and glucose metabolism. In order to replicate the recognized metabolic activities in a cell, metabolic systems biology provides significant abstracted techniques, which results in a picture which is near to the observed phenotype. This will enable identifying the patient’s illness pattern and giving accurate medical solutions, leading to prophylactic medicine, less treatment and in silico clinical studies when combined with cutting-edge machine learning techniques.
Background
The metabolically healthy obese (MHO) phenotype is associated with an increased risk of coronary heart disease (CHD) in the general population. However, association of metabolic health and obesity phenotypes with CHD risk in adult cancer survivors remains unclear. We aimed to investigate the associations between different metabolic health and obesity phenotypes with incident CHD in adult cancer survivors.
Methods
We used National Health Insurance Service (NHIS) to identify a cohort of 173,951 adult cancer survivors aged more than 20 years free of cardiovascular complications. Metabolically healthy nonobese (MHN), MHO, metabolically unhealthy nonobese (MUN), metabolically unhealthy obese (MUO) phenotypes were created using as at least three out of five metabolic health criteria along with obesity (body mass index ≥ 25.0 kg/m ² ). We used Cox proportional hazards model to assess CHD risk in each metabolic health and obesity phenotypes.
Results
During 1,376,050 person‐years of follow‐up, adult cancer survivors with MHO phenotype had a significantly higher risk of CHD (hazard ratio [HR] = 1.52; 95% confidence intervals [CI]: 1.41 to 1.65) as compared to those without obesity and metabolic abnormalities. MUN (HR = 1.81; 95% CI: 1.59 to 2.06) and MUO (HR = 1.92; 95% CI: 1.72 to 2.15) phenotypes were also associated with an increased risk of CHD among adult cancer survivors.
Conclusions
Adult cancer survivors with MHO phenotype had a higher risk of CHD than those who are MHN. Metabolic health status and obesity were jointly associated with CHD risk in adult cancer survivors.
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.
Introduction: The metabolic syndrome (MS) constitutes of a series of metabolic disorders that together are considered a risk factor to develop diabetes and cardiovascular disease. Objective. To determine the prevalence of MS and its components in students of the National University of Asunción - San Lorenzo Campus in the 2015-2016 period. Materials and Methods. Observational descriptive cross-sectional study with a cluster sampling. A total of 163 students from selected faculties or institutes was included. A questionnaire was applied for sociodemographic data and physical activity and waist circumference (WC), weight and height were measured, as well as fasting serum levels of Glucose, HDLc cholesterol and triglycerides, together with blood pressure to determine the presence of MS according to the Panel III criteria (NCEP-ATP-III). All data were kept strictly confidential. Results. 50,92% of participants were male, with a mean age of 21,6± 2,4 years. 49.7% were considered sedentary, 25,16% presented overweight, and 8,59% obesity, 16,56% hypertension. 6,75% presented an elevated abdominal circumference, 2,45% elevated basal glycemia, 4,9% elevated Triglycerides, 37,42% low HDLc. The prevalence of MS was 4,91% and 52,15% presented at least one NCEP-ATP-III factor for MS. Conclusion. Around half of the participants presented at least one risk factor for MS, the most frequent components were low HDLc concentration and arterial hypertension. It is recommended preventive actions in the youth population based on physical activity and healthy eating.
Objective: In this study, we aimed to compare psoriasis patients with healthy controls in terms of impaired eating attitudes and to investigate the relationship of eating attitudes with cardiometabolic and clinical parameters, anxiety, depression, and quality of life. Methods: 45 psoriasis patients and 45 healthy controls were included in the study. Personal and clinical information form, eating attitude test (EAT-40), body mass index (BMI) and MetS criteria were used for all participants. Psoriasis patients were evaluated with clinical information form, hospital anxiety and depression scale (HADS), dermatological quality of life index (DQLI), psoriasis area and severity index (PASI). Results: The data of the patient and control groups differed in terms of doing sports, impaired EAT, BMI groups, and metabolic syndrome (MetS). Abnormal eating attitudes such as negative body image, inability to control oneself in eating, overeating, and some restrictive attitudes were significantly higher in the psoriasis group. Overeating, overeating or stress-induced emotional eating, presence of MetS, weight dissatisfaction, frequent dieting to lose weight, some compensatory behaviours, and loss of self-control were significantly higher in patients with BMI>25. EAT points; showed a positive moderate correlation with BMI and HAD-Anxiety. DQLI results; showed a moderate positive correlation with HADAnxiety and PASI scores. Conclusion: Our study is the first to reveal what kind of disordered eating attitudes are at risk for cardiometabolic diseases in psoriasis patients. In psoriasis patients, the rate of not being able to control their eating behaviour is high. Our results primarily highlight the relationship that can be explained by autonomic reactivity between anxiety and difficulty resisting food cravings. Professional support including psychoeducational, cognitive behavioural therapy, and acceptance-based therapies should be provided to reduce maladaptive reactions and anxiety by improving self-regulation skills.
Cite this article as: Güneş E, Güneş M, Çurgunlu A. Non dipping pattern frequency and metabolic syndrome relationship according to two different metabolic syndrome diagnostic methods in newly diagnosed hypertensive individuals. ABSTRACT Aim: The literature presents conflicting data regarding whether the non dipping pattern (NDP) in patients with metabolic syndrome (MS) compared to those without. In our study, we aimed to investigate the MS effect of the NDP in individuals with hypertension. Methods: This prospective study included 117 newly diagnosed hypertensive patients (79 women and 38 men) who were not receiving any anti-hypertensive treatment. MS was evaluated according to the currently used the US National Cholesterol Education Programme Adult Treatment Panel-III definition criteria (MS-ATP-III) and a new diagnostic scoring method (MS-Score). NDP defined, nocturnal blood pressure (BP) fell by <10% from daytime BP Results: The mean age of the patients who met the MS-ATP-III criteria was 53.9+8.1 years. The prevalence of the MS-ATP-III among the study population was 60.6%. The NDP frequency was similar in patients with and without MS-ATP-III, high MS-Score and low MS-Score group (respectively; 44.8%, 47.5%, p=0.79, 44.7%, 46.9%, p= 0.9). The reverse dipping pattern (RDP) frequency was higher in patients with MS-ATP-III compared to those without MS (13.8% and 2.5%, p=0.021), RDP was 10.8% in the high MS-Score group and 8.2% in the low MS-Score group (p=0.66). The LDL (mg/dL) values were higher in those with NDP compared to those without (142.6+32.2, 125.5+28.9, p=0.008). Conclusion: Despite the high prevalence of MS among newly diagnosed hypertensive patients, the prevalence of NDP does not show a different distribution in patients with MS in both the MS-ATP-III and MS-Score method.
Background:
The impact of integrated lifestyles on health has attracted a lot of attention. It remains unclear whether adherence to low-risk healthy lifestyle factors is protective in individuals with metabolic syndrome and metabolic syndrome-like characteristics. We aimed to explore whether and to what extent overall lifestyle scores mitigate the risk of all-cause mortality in individuals with metabolic syndrome and metabolic syndrome-like characteristics.
Methods:
In total, 6934 participants from the 2007 to 2014 National Health and Nutrition Examination Survey (NHANES) were included. The weighted healthy lifestyle score was constructed based on smoking, alcohol consumption, physical activity, diet, sleep duration, and sedentary behavior information. Generalized linear regression models and restricted cubic splines were used to analyze the association between healthy lifestyle scores and all-cause mortality. RESULTS: Compared to participants with relatively low healthy lifestyle scores, the risk ratio (RR) in the middle healthy lifestyle score group was 0.51 (RR = 0.51, 95% CI 0.30-0.88), and the high score group was 0.26 (RR = 0.26, 95% CI 0.15-0.48) in the population with metabolic syndrome. The difference in gender persists. In females, the RRs of the middle and high score groups were 0.47 (RR = 0.47, 95% CI 0.23-0.96) and 0.21 (RR = 0.21, 95% CI 0.09-0.46), respectively. In males, by contrast, the protective effect of a healthy lifestyle was more pronounced in the high score group (RR = 0.33, 95% CI 0.13-0.83) and in females, the protective effects were found to be more likely. The protective effect of a healthy lifestyle on mortality was more pronounced in those aged < 65 years. Higher lifestyle scores were associated with more prominent protective effects, regardless of the presence of one metabolic syndrome factor or a combination of several factors in 15 groups. What's more, the protective effect of an emerging healthy lifestyle was more pronounced than that of a conventional lifestyle.
Conclusions:
Adherence to an emerging healthy lifestyle can reduce the risk of all-cause mortality in people with metabolic syndrome and metabolic syndrome-like characteristics; the higher the score, the more obvious the protective effect. Our study highlights lifestyle modification as a highly effective nonpharmacological approach that deserves further generalization.
Metabolic syndrome (MeS) is a common multifaceted disorder. Plants contain antioxidant bioactive compounds, which are beneficial to improve the health condition of patients with MeS. Propolis is a hive natural product that is composed of various constituent. We aimed to assess the effects of Iranian propolis as a natural and safe agent on indicators of MeS, quality of life and mood status in individuals with MeS. In total, 66 interested eligible patients recruited to the present study. Participants were randomly assigned to consume a tablet at dose of 250 mg of propolis extract, twice daily for 12 weeks or placebo. Propolis supplementation could lead to a significant reduction in waist circumference (WC), increase in physical functioning, general health and the overall score of SF-36 compared with placebo group (P-value < 0.05). However, no significant differences were observed regarding other anthropometric indices and biochemical parameters between two groups (P-value > 0.05). The current study indicated that propolis can be effective in decreasing WC and improving physical health and quality of life, while had no significant effects on other components of MeS among subjects with this syndrome.
Clinical trials registration Iran Registry of Clinical Trials.ir IRCT20121216011763N49, registration date 23/12/2020.
A growing body of evidence from multiple areas proposes that periodontal disease, accompanied by oral inflammation and pathological changes in the microbiome, induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). A subgroup of NAFLD patients have a severely progressive form, namely nonalcoholic steatohepatitis (NASH), which is characterized by histological findings that include inflammatory cell infiltration and fibrosis. NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma. The oral microbiota may serve as an endogenous reservoir for gut microbiota, and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis. Gut dysbiosis increases the production of potential hepatotoxins, including lipopolysaccharide, ethanol, and other volatile organic compounds such as acetone, phenol and cyclopentane. Moreover, gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall, leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation. In particular, many animal studies support that oral administration of Porphyromonas gingivalis, a typical periodontopathic bacterium, induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis. NAFLD, also known as the hepatic phenotype of metabolic syndrome, is strongly associated with metabolic complications, such as obesity and diabetes. Periodontal disease also has a bidirectional relationship with metabolic syndrome, and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively. In this review, we will describe the link between periodontal disease and NAFLD with a focus on basic, epidemiological, and clinical studies, and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome. In conclusion, it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease, gut microbiota, and metabolic syndrome. Thus, the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics, prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.
Obesity is a complex disease that contributes to increased risk for many serious health conditions. Primary care nurse practitioners play an integral role in the management and treatment of obesity, including endocrine conditions often associated with this chronic disease. This article provides information to increase the knowledge and confidence of nurse practitioners managing obesity and associated comorbidities in the primary care setting. An illustrative case study is presented, followed by a discussion of endocrine-related comorbidities including metabolic syndrome, hypothyroidism, polycystic ovary syndrome, and nonalcoholic fatty liver disease.
Metabolic syndrome (MS) comprises a vast range of metabolic dysfunctions, which can be associated to cardiovascular disease risk factors. MS is reaching pandemic levels worldwide and it currently affects around 25% in the adult population of developed countries. The definition states for the diagnosis of MS may be clear, but it is also relevant to interpret the patient data and realize whether similar criteria were used by different clinicians. The different criteria explain, at least in part, the controversies on the theme. Several studies are presently focusing on the microbiota changes according to the components of MS. It is widely accepted that the gut microbiota is a regulator of metabolic homeostasis, being the gut microbiome in MS described as dysbiotic and certain taxonomic groups associated to metabolic changes. Probiotics, and more recently synbiotics, arise as promising therapeutic alternatives that can mitigate some metabolic disturbances, namely by correcting the microbiome and bringing homeostasis to the gut. The most recent studies were revised and the promising results and perspectives revealed in this review.
We examined whether resilience modified associations between allostatic load (AL), a physiological indicator of coping with repeated stressors, and cardiovascular disease (CVD) among 2758 African Americans in the Jackson Heart Study. Baseline AL was quantified using biological measures of metabolic, cardiovascular, and immune markers. We constructed a multidimensional resilience measure using validated questionnaires for social support, social networks, religious experiences, and optimism. Participants were followed until 2016 for stroke, coronary heart disease (CHD), and heart failure (HF). We used multivariable-adjusted, sex-stratified Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between dichotomous AL and CVD. High AL was associated with CHD among women (HR = 1.73, 95% CI = 1.00, 2.99) and HF among women (HR = 1.52, 95% CI = 0.98, 2.37) and men (HR = 2.17, 95% CI = 1.28, 3.68). Among women, resilience did not modify the AL-CVD relationship. Among men, we observed higher stroke risk among men with low resilience (HR = 2.21, 95% CI = 0.94, 5.22) and no association among those with high resilience. Counterintuitively, high AL was associated with greater HF (HR = 5.80, 95% CI = 2.32, 14.47) in the subgroup of men with high resilience. Future studies addressing different facets of resilience are needed to elucidate underlying mechanisms for CVD prevention among African Americans.
Background & Aims
Dietary pattern is a comprehensive assessment of diet that may reflect the interrelationships between foods. Analysis on actual dietary pattern and metabolic syndrome (MetS) risk are insufficient. This study examined the prospective association between empirically identified dietary patterns and MetS risk in adults aged 40 years or older.
Methods
A total of 11,305 participants (58,318 person-years) without MetS were followed. Predefined 37 food/food groups from the 106-item food frequency questionnaire were used in factor analysis to identify dietary patterns. Subsequently, we conducted a hierarchical clustering analysis of group participants based on their dietary pattern scores. Incidence rate ratios and 95% confidence intervals were estimated using a modified Poisson regression model with a robust error estimator.
Results
We identified three similar, but not identical, dietary patterns in men and women separately. The “vegetables/seaweeds” and “meat/poultry/seafood” patterns and MetS risk were associated differently between men and women; in men, the association with MetS risk was inverse for "vegetables/seaweeds" but U-shaped in the "meat/poultry/seafood" pattern, whereas it was positive and inverse in women, respectively. The “non-traditional/non-staple foods” pattern was inversely associated in both men and women. Three and four clusters of the three dietary patterns were observed in men and women, respectively. A cluster in women with a high “vegetables/seaweeds” score (cluster 2) showed higher incidence rate ratios of MetS compared with all other clusters.
Conclusions
In the present study, the “non-traditional/non-staple foods” dietary pattern is possibly beneficial in the development of MetS in both men and women, while the “vegetables/seaweeds” pattern, if their sodium amount is not controlled, may be harmful in the development of MetS among women.
Purpose:
This study investigated the prevalence and characteristics of prediabetes (PreDM) and metabolic syndrome (MetS) in seemingly healthy persons attending a health check-up clinic at a tertiary care hospital.
Patients and methods:
This was a cross-sectional study that enrolled 1213 subjects (339 male, 874 female) who underwent an annual health check-up at Siriraj Hospital, Bangkok, Thailand from 2009 to 2019. Factors that independently related to PreDM were analyzed using unconditional logistic regression analysis with adjustments for age, BMI, and gender.
Results:
The prevalence of PreDM and MetS was 54.3% and 19.7% respectively. Participants with impaired fasting glucose (IFG) and glycated hemoglobin (HbA1c) 38.8-46.4 mmol/mol had significantly higher waist circumference (WC) and blood pressure (BP) compared to those with IFG or HbA1c 38.8-46.4 mmol/mol alone (P < 0.05). Among three PreDM subgroups, the average age was lowest in the HbA1c 38.8-46.4 mmol/mol subgroup (P < 0.001). PreDM participants with MetS were older (p = 0.03), had higher WC, BP, fasting plasma glucose and serum triglyceride level (all P < 0.001) but had lower serum high-density lipoprotein (HDL) cholesterol level (P < 0.001). Multivariate analysis revealed high MetS score, obesity, and low serum HDL cholesterol level to be independently associated with PreDM with odds ratios of 9.02 (95% confidence interval [CI]: 4.03-20.18), 1.8 (95% CI: 1.07-3.04), and 1.42 (95% CI: 1.02-1.96), respectively.
Conclusion:
The prevalence of PreDM and MetS was relatively high in seemingly healthy persons. Distinct PreDM subgroups with or without MetS exhibited diverse clinical and biochemical features suggesting dissimilar pathogenesis.
The metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, mild dyslipidemia, and hypertension, is associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (CVD). Despite its high prevalence, little is known of the prospective association of the metabolic syndrome with cardiovascular and overall mortality.
To assess the association of the metabolic syndrome with cardiovascular and overall mortality using recently proposed definitions and factor analysis.
The Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based, prospective cohort study of 1209 Finnish men aged 42 to 60 years at baseline (1984-1989) who were initially without CVD, cancer, or diabetes. Follow-up continued through December 1998.
Death due to coronary heart disease (CHD), CVD, and any cause among men with vs without the metabolic syndrome, using 4 definitions based on the National Cholesterol Education Program (NCEP) and the World Health Organization (WHO).
The prevalence of the metabolic syndrome ranged from 8.8% to 14.3%, depending on the definition. There were 109 deaths during the approximately 11.4-year follow-up, of which 46 and 27 were due to CVD and CHD, respectively. Men with the metabolic syndrome as defined by the NCEP were 2.9 (95% confidence interval [CI], 1.2-7.2) to 4.2 (95% CI, 1.6-10.8) times more likely and, as defined by the WHO, 2.9 (95% CI, 1.2-6.8) to 3.3 (95% CI, 1.4-7.7) times more likely to die of CHD after adjustment for conventional cardiovascular risk factors. The metabolic syndrome as defined by the WHO was associated with 2.6 (95% CI, 1.4-5.1) to 3.0 (95% CI, 1.5-5.7) times higher CVD mortality and 1.9 (95% CI, 1.2-3.0) to 2.1 (95% CI, 1.3-3.3) times higher all-cause mortality. The NCEP definition less consistently predicted CVD and all-cause mortality. Factor analysis using 13 variables associated with metabolic or cardiovascular risk yielded a metabolic syndrome factor that explained 18% of total variance. Men with loadings on the metabolic factor in the highest quarter were 3.6 (95% CI, 1.7-7.9), 3.2 (95% CI, 1.7-5.8), and 2.3 (95% CI, 1.5-3.4) times more likely to die of CHD, CVD, and any cause, respectively.
Cardiovascular disease and all-cause mortality are increased in men with the metabolic syndrome, even in the absence of baseline CVD and diabetes. Early identification, treatment, and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle.
A marker strongly associated with outcome (or disease) is often assumed to be effective for classifying persons according to their current or future outcome. However, for this assumption to be true, the associated odds ratio must be of a magnitude rarely seen in epidemiologic studies. In this paper, an illustration of the relation between odds ratios and receiver operating characteristic curves shows, for example, that a marker with an odds ratio of as high as 3 is in fact a very poor classification tool. If a marker identifies 10% of controls as positive (false positives) and has an odds ratio of 3, then it will correctly identify only 25% of cases as positive (true positives). The authors illustrate that a single measure of association such as an odds ratio does not meaningfully describe a marker's ability to classify subjects. Appropriate statistical methods for assessing and reporting the classification power of a marker are described. In addition, the serious pitfalls of using more traditional methods based on parameters in logistic regression models are illustrated.
The prevalence of the metabolic syndrome is high among U.S. adults. Our purpose was to determine whether the prevalence of this syndrome has changed since 1988-1994.
A total of 6,436 men and women aged > or = 20 years from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and 1,677 participants from NHANES 1999-2000 were included in the analyses. We used the definition of the metabolic syndrome developed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
The unadjusted prevalence of the metabolic syndrome was 23.1% in NHANES III and 26.7% in NHANES 1999-2000 (P = 0.043), and the age-adjusted prevalences were 24.1 and 27.0% (P = 0.088), respectively. The age-adjusted prevalence increased by 23.5% among women (P = 0.021) and 2.2% among men (P = 0.831). Increases in high blood pressure, waist circumference, and hypertriglyceridemia accounted for much of the increase in the prevalence of the metabolic syndrome, particularly among women.
The increased prevalence of the metabolic syndrome is likely to lead to future increases in diabetes and cardiovascular disease.
To assess the magnitude of the association between the National Cholesterol Education Program's Third Adult Treatment Panel Report (ATP III) definition of the metabolic syndrome and cardiovascular disease (CVD).
Cox regression was used to estimate the relative risk of incident coronary heart disease (CHD) and stroke among 12,089 black and white middle-aged individuals in the Atherosclerosis Risk in Communities (ARIC) study.
The metabolic syndrome was present in approximately 23% of individuals without diabetes or prevalent CVD at baseline. Over an average of 11 years of follow-up, 879 incident CHD and 216 ischemic stroke events occurred. Among the components of the metabolic syndrome, elevated blood pressure and low levels of HDL cholesterol exhibited the strongest associations with CHD. Men and women with the metabolic syndrome were approximately 1.5 and 2 times more likely to develop CHD than control subjects after adjustment for age, smoking, LDL cholesterol, and race/ARIC center (sex interaction P < 0.03). Similar associations were found between the metabolic syndrome and incident ischemic stroke. Comparison of receiver operating characteristic curves indicated that the metabolic syndrome did not materially improve CHD risk prediction beyond the level achieved by the Framingham Risk Score (FRS).
Individuals without diabetes or CVD, but with the metabolic syndrome, were at increased risk for long-term cardiovascular outcomes, although statistical models suggested that most of that risk was accounted for by the FRS. Nevertheless, identification of individuals with the metabolic syndrome may provide opportunities to intervene earlier in the development of shared disease pathways that predispose individuals to both CVD and diabetes.
Different definitions of the metabolic syndrome have been proposed. Their value in a clinical setting to assess cardiovascular disease (CVD) risk is still unclear. We compared the definitions proposed by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), World Health Organization (WHO), European Group for the Study of Insulin Resistance (EGIR), and American College of Endocrinology (ACE) with respect to the prevalence of the metabolic syndrome and the association with 10-year risk of fatal and nonfatal CVD.
The Hoorn Study is a population-based cohort study. The present study population comprised 615 men and 749 women aged 50 to 75 years and without diabetes or a history of CVD at baseline in 1989 to 1990. The prevalence of the metabolic syndrome at baseline ranged from 17% to 32%. The NCEP definition was associated with about a 2-fold increase in age-adjusted risk of fatal CVD in men and nonfatal CVD in women. For the WHO, EGIR, and ACE definitions, these hazard ratios were slightly lower. Risk increased with the number of risk factors. Elevated insulin levels were more prevalent in subjects with multiple risk factors, but metabolic syndrome definitions including elevated insulin level were not more strongly associated with risk.
The metabolic syndrome, however defined, is associated with an approximate 2-fold increased risk of incident cardiovascular morbidity and mortality in a European population. In clinical practice, a more informative assessment can be obtained by taking into account the number of individual risk factors.
Background:
The term 'metabolic syndrome' refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is thought to be related to insulin resistance.
Methods:
Since the term is widely used in research and clinical practice, we undertook an extensive review of the literature in relation to the syndrome's definition, underlying pathogenesis, association with cardiovascular disease and to the goals and impact of treatment.
Discussion:
While there is no question that certain CVD risk factors are prone to cluster, we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a 'syndrome'.
Conclusion:
Until much-needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the 'metabolic syndrome'.
We sought to compare metabolic syndrome (MetS) with the Framingham Risk Score (FRS) as predictors of coronary heart disease (CHD), stroke, and type 2 diabetes mellitus (DM2) in middle-aged men.
A prospective study of 5128 men aged 40 to 59 years with no history of cardiovascular disease (CVD) (CHD or stroke) or DM2 drawn from general practices in 24 British towns and observed for 20 years. Metabolic syndrome was defined as the presence of 3 or more metabolic abnormalities based on modified National Cholesterol Education Program criteria.
Men with MetS at baseline (26%) showed significantly higher relative risk (RR) than men without MetS of developing CHD (RR, 1.64; 95% confidence interval [CI], 1.41-1.90), stroke (RR, 1.61 95% CI, 1.26-2.06), and DM2 (RR, 3.57; 95% CI, 2.83-4.50). The probability of developing CVD or DM2 over 20 years increased from 11.9% in those with no abnormalities to 31.2% in those with 3 abnormalities to 40.8% in those with 4 or 5 abnormalities. The FRS was a better predictor of CHD and stroke than MetS but was less predictive of DM2. Areas under the receiver-operating characteristic curves for FRS vs the number of metabolic abnormalities were 0.68 vs 0.59 for CHD, 0.60 vs 0.70 for DM2, and 0.66 vs 0.55 for stroke (P< .001 for all).
Presence of MetS is a significant predictor of CVD and DM2 but is a stronger predictor of DM2 than of CHD. Although MetS does not predict CHD as well as the FRS, it serves well as a simple clinical tool for identifying high-risk subjects predisposed to CVD or DM2.
The purpose of this study was to compare the predictive ability of the National Cholesterol Education Panel (NCEP), revised NCEP (NCEP-R), and International Diabetes Federation (IDF) metabolic syndrome criteria for mortality risk, and to examine the effects of waist circumference on mortality within the context of these criteria.
The sample included 20,789 white, non-Hispanic men 20-83 years of age from the Aerobics Center Longitudinal Study. The main outcome measures were all-cause and cardiovascular disease (CVD) mortality over 11.4 years of follow-up.
The proportions of men with the metabolic syndrome were 19.7, 27, and 30% at baseline, respectively, according to NCEP, NCEP-R, and IDF criteria. A total of 632 deaths (213 CVD) occurred. The relative risks (RRs) and 95% CIs of all-cause mortality were 1.36 (1.14-1.62), 1.31 (1.11-1.54), and 1.26 (1.07-1.49) for the NCEP, NCEP-R, and IDF definitions, respectively. The corresponding RRs for CVD mortality were 1.79 (1.35-2.37), 1.67 (1.27-2.19), and 1.67 (1.27-2.20). Additionally, there was a significant trend for a higher risk of CVD mortality across waist circumference categories (<94, 94-102, and >102 cm) among men with at least two additional metabolic syndrome risk factors (P = 0.01).
The prediction of mortality with IDF and NCEP metabolic syndrome criteria was comparable in men. Waist circumference is a valuable component of metabolic syndrome; however, the IDF requirement of an elevated waist circumference warrants caution given that a large proportion of men with normal waist circumference have multiple risk factors and an increased risk of mortality.
To find out if the presence of the metabolic syndrome increases the risk of subsequent total and cardiovascular mortality, taking into account established risk factors for cardiovascular disease.
Prospective cohort study.
General population.
A community based sample of 2322 men followed since 1970 for a maximum of 32.7 years, investigated at ages 50 and 70.
The relations of the metabolic syndrome defined by the national cholesterol education programme (NCEP) of the US National Heart, Lung, and Blood Institute or criteria of the World Health Organization (WHO) to subsequent total and cardiovascular mortality.
When adding the metabolic syndrome to models with established risk factors for cardiovascular disease (smoking, diabetes, hypertension, and serum cholesterol) at age 50, presence of the metabolic syndrome as defined in the NCEP significantly predicted total and cardiovascular mortality (Cox proportional hazard ratios 1.36, 95% confidence interval 1.17 to 1.58; and 1.59, 1.29 to 1.95, respectively). The metabolic syndrome added prognostic information to that of the established risk factors for cardiovascular disease (likelihood ratio tests, P < 0.0001 for both outcomes). Similar results were obtained in a subsample without diabetes or manifest cardiovascular disease.
In a large, community based sample of middle aged men, the presence of the metabolic syndrome according to the definition of the NCEP gave long term prognostic information regarding total and cardiovascular mortality if the status of established risk factors for cardiovascular disease was known. If confirmed this may indicate clinical value in diagnosing the metabolic syndrome.
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The oral glucose tolerance test identifies high-risk subjects for diabetes, but it is costly and inconvenient. To find better predictors of type 2 diabetes, we evaluated two different definitions of the metabolic syndrome because insulin resistance, which is commonly associated with this clustering of metabolic factors, frequently precedes the onset of type 2 diabetes.
We compared the ability of the National Cholesterol Education Program (NCEP) definition, a modified version of the 1999 World Health Organization (WHO) definition that excludes the 2-h glucose requirement, and impaired glucose tolerance (IGT) to predict incident type 2 diabetes. In the San Antonio Heart Study, 1734 participants completed a 7- to 8-year follow-up examination.
IGT and the NCEP definition had higher sensitivity than the modified WHO definition (51.9, 52.8, and 42.8%, respectively). IGT had a higher positive predictive value than the NCEP and modified WHO definitions (43.0, 30.8, and 30.4%, respectively). The combination of the IGT and NCEP definitions increased the sensitivity to 70.8% with an acceptable positive predictive value of 29.7%. Risk for incidence of type 2 diabetes using the NCEP definition was independent of other risk factors, including IGT and fasting insulin (odds ratio 3.30, 95% CI 2.27-4.80). The NCEP definition performed better with fasting glucose >or=5.4 mmol/l (sensitivity 62.0% and positive predictive value 30.9%).
The metabolic syndrome predicts diabetes independently of other factors. However, the NCEP definition performs better than the modified 1999 WHO definition. Lowering the fasting glucose cutoff to 5.4 mmol/l improves the prediction of diabetes by the metabolic syndrome.
To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization
A total of 4,483 subjects aged 35-70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798) or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years.
In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002).
The WHO definition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from diferent studies.
LR: 20061115; JID: 7501160; 0 (Antilipemic Agents); 0 (Cholesterol, HDL); 0 (Cholesterol, LDL); 57-88-5 (Cholesterol); CIN: JAMA. 2001 Nov 21;286(19):2401; author reply 2401-2. PMID: 11712930; CIN: JAMA. 2001 Nov 21;286(19):2400-1; author reply 2401-2. PMID: 11712929; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712928; CIN: JAMA. 2001 Nov 21;286(19):2400; author reply 2401-2. PMID: 11712927; CIN: JAMA. 2001 May 16;285(19):2508-9. PMID: 11368705; CIN: JAMA. 2003 Apr 16;289(15):1928; author reply 1929. PMID: 12697793; CIN: JAMA. 2001 Aug 1;286(5):533-5. PMID: 11476650; CIN: JAMA. 2001 Nov 21;286(19):2401-2. PMID: 11712931; ppublish
Methods of evaluating and comparing the performance of diagnostic tests are of increasing importance as new tests are developed and marketed. When a test is based on an observed variable that lies on a continuous or graded scale, an assessment of the overall value of the test can be made through the use of a receiver operating characteristic (ROC) curve. The curve is constructed by varying the cutpoint used to determine which values of the observed variable will be considered abnormal and then plotting the resulting sensitivities against the corresponding false positive rates. When two or more empirical curves are constructed based on tests performed on the same individuals, statistical analysis on differences between curves must take into account the correlated nature of the data. This paper presents a nonparametric approach to the analysis of areas under correlated ROC curves, by using the theory on generalized U-statistics to generate an estimated covariance matrix.
The classification of diabetes mellitus and the tests used for its diagnosis were brought into order by the National Diabetes Data Group of the USA and the second World Health Organization Expert Committee on Diabetes Mellitus in 1979 and 1980. Apart from minor modifications by WHO in 1985, little has been changed since that time. There is however considerable new knowledge regarding the aetiology of different forms of diabetes as well as more information on the predictive value of different blood glucose values for the complications of diabetes. A WHO Consultation has therefore taken place in parallel with a report by an American Diabetes Association Expert Committee to re-examine diagnostic criteria and classification. The present document includes the conclusions of the former and is intended for wide distribution and discussion before final proposals are submitted to WHO for approval. The main changes proposed are as follows. The diagnostic fasting plasma (blood) glucose value has been lowered to > or =7.0 mmol l(-1) (6.1 mmol l(-1)). Impaired Glucose Tolerance (IGT) is changed to allow for the new fasting level. A new category of Impaired Fasting Glycaemia (IFG) is proposed to encompass values which are above normal but below the diagnostic cut-off for diabetes (plasma > or =6.1 to <7.0 mmol l(-1); whole blood > or =5.6 to <6.1 mmol l(-1)). Gestational Diabetes Mellitus (GDM) now includes gestational impaired glucose tolerance as well as the previous GDM. The classification defines both process and stage of the disease. The processes include Type 1, autoimmune and non-autoimmune, with beta-cell destruction; Type 2 with varying degrees of insulin resistance and insulin hyposecretion; Gestational Diabetes Mellitus; and Other Types where the cause is known (e.g. MODY, endocrinopathies). It is anticipated that this group will expand as causes of Type 2 become known. Stages range from normoglycaemia to insulin required for survival. It is hoped that the new classification will allow better classification of individuals and lead to fewer therapeutic misjudgements.
The prevalence of type 2 diabetes has increased in the early part of the 20th century, particularly in developing countries. There is now evidence that the prevalence also continues to increase in developed countries, including the United States. However, it is unknown whether this increase is due to a rise in the incidence of diabetes or to decreasing diabetic mortality or both.
Participants in the San Antonio Heart Study, who were nondiabetic at baseline and who returned for a 7- to 8-year follow-up examination, were examined for secular trends in the incidence of type 2 diabetes. Risk factors for diabetes, such as obesity, were also examined. Patients were enrolled in the San Antonio Heart Study from 1979 to 1988 and 7- to 8-year incidence of diabetes was determined from 1987 to 1996.
A significant secular trend in the 7- to 8-year incidence of type 2 diabetes was observed in Mexican Americans (5.7% for participants enrolled in 1979 to 15.7% for participants enrolled in 1988). In non-Hispanic whites, the incidence increased from 2.6% for participants enrolled in 1980 to 9.4% for participants enrolled in 1988 (P = .07) . After adjusting for age and sex, the secular trend remained significant in Mexican Americans and borderline significant in non-Hispanic whites. This indicates that between 1987 and 1996 the 7- to 8-year incidence of type 2 diabetes approximately tripled in both ethnic groups. The overall secular trend also remained significant after adjusting for additional risk factors for diabetes, such as obesity. A rising secular trend in obesity was also observed.
There has been a significant increasing secular trend in the incidence of type 2 diabetes in Mexican Americans and a borderline significant trend in non-Hispanic whites participating in the San Antonio Heart Study. Unlike other cardiovascular risk factors such as lipid levels, cigarette smoking, and blood pressure, which are either declining or under progressively better medical management and control, and unlike cardiovascular mortality, which is also declining, obesity and type 2 diabetes are exhibiting increasing trends. Thus, obesity and diabetes could easily become the preeminent US public health problem.
Our objective was to compare the performance of oral glucose tolerance tests (OGTTs) and multivariate models incorporating commonly available clinical variables in their ability to predict future cardiovascular disease (CVD).
We randomly selected 2,662 Mexican-Americans and 1,595 non-Hispanic whites, 25-64 years of age, who were free of both CVD and known diabetes at baseline from several San Antonio census tracts. Medical history, cigarette smoking history, BMI, blood pressure, fasting and 2-h plasma glucose and serum insulin levels, triglyceride level, and fasting serum total, LDL, and HDL cholesterol levels were obtained at baseline. CVD developed in 88 Mexican-Americans and 71 non-Hispanic whites after 7-8 years of follow-up. Stepwise multiple logistic regression models were developed to predict incident CVD. The areas under receiver operator characteristic (ROC) curves were used to assess the predictive power of these models.
The area under the 2-h glucose ROC curve was modestly but not significantly greater than under the fasting glucose curve, but both were relatively weak predictors of CVD. The areas under the ROC curves for the multivariate models incorporating readily available clinical variables other than 2-h glucose were substantially and significantly greater than under the glucose ROC curves. Addition of 2-h glucose to these models did not improve their predicting power.
Better identification of individuals at high risk for CVD can be achieved with simple predicting models than with OGTTs, and the addition of the latter adds little if anything to the predictive power of the model.
To evaluate the cardiovascular risk associated with the presence of the Metabolic Syndrome in Type 2 diabetic subjects.
Subjects with the Metabolic Syndrome, defined by WHO criteria, were identified in a large sample of non-insulin-treated Type 2 diabetic patients examined within the Verona Diabetes Complications Study (n = 946). At baseline and after a mean of 4.5 years follow-up, cardiovascular disease (CVD) was assessed by medical history, physical examination, electrocardiogram (ECG) and echo-duplex of carotid and lower limb arteries. Death certificates and medical records of subjects who died during the follow-up were scrutinized in order to identify CVD deaths. In statistical analyses, CVD was considered as an aggregate end-point, including fatal and non-fatal coronary, cerebrovascular and peripheral vascular disease as well as ischaemic ECG abnormalities and vascular lesions at the echo-duplex.
The proportion of subjects with the Metabolic Syndrome was very high (92.3%). At the baseline, 31.7% of subjects were coded positive for CVD, which was more prevalent in subjects with the Metabolic Syndrome (32.9 vs. 17.8%, P = 0.005). Among subjects free of CVD at the baseline (n = 559), CVD events during the follow-up were significantly increased in patients with the Metabolic Syndrome as compared with those without it (19.9% vs. 3.9%, P < 0.001). Multiple logistic regression analysis showed that, along with sex, age, smoking and HbA1c, the presence of the Metabolic Syndrome independently predicted prevalent (OR 2.01, P = 0.045) and incident CVD (OR 4.89, P = 0.031).
In Type 2 diabetes, the presence of the Metabolic Syndrome is associated with an almost 5-fold increase in CVD risk.
The metabolic syndrome, which is a set of lipid and nonlipid risk factors of metabolic origin linked with insulin resistance, is believed to be associated with an elevated risk for cardiovascular disease, but few have studied this association in prospective long-term cardiovascular outcomes trials. Placebo data from the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) were used post hoc to estimate the long-term relative risk of major coronary events (MCEs) associated with the metabolic syndrome, after excluding diabetes mellitus. In 4S and AFCAPS/TexCAPS, respectively, placebo-treated patients with the metabolic syndrome were 1.5 (95% confidence interval 1.2 to 1.8) and 1.4 (95% confidence interval 1.04 to 1.9) times more likely to have MCEs than those without it. Of the components of the metabolic syndrome, low high-density lipoprotein levels were associated with elevated risk of MCEs in both studies, whereas high triglycerides in 4S and elevated blood pressure and obesity in AFCAPS/TexCAPS were associated with significantly increased relative risk. Patients with the metabolic syndrome showed increased risk of MCEs irrespective of their Framingham-calculated 10-year risk score category (>20% vs </=20%). These data demonstrate that the metabolic syndrome is associated with increased risk of MCEs in both hypercholesterolemic patients with coronary heart disease in 4S and in those with low high-density lipoprotein cholesterol but without coronary heart disease in AFCAPS/TexCAPS. It appears that the metabolic syndrome is associated with risk that is not entirely accounted for by traditional risk scoring paradigms.
Incidence rates and risk factors for type 2 diabetes in low-risk populations are not well documented. We investigated these in white individuals who were aged 40-79 years and from the population of Bruneck, Italy. Of an age- and sex-stratified random sample of 1,000 individuals who were identified in 1990, 919 underwent an oral glucose tolerance test (OGTT) and an assessment of physiological risk factors for diabetes, including insulin resistance (homeostasis model assessment, HOMA-IR), and postchallenge insulin response (Sluiter's Index). Diabetes at baseline by fasting or 2-h OGTT plasma glucose (World Health Organization criteria, n = 82) was excluded, leaving 837 individuals who were followed for 10 years. Incident cases of diabetes were ascertained by confirmed diabetes treatment or a fasting glucose >or=7.0 mmol/l. At follow-up, 64 individuals had developed diabetes, corresponding to a population-standardized incidence rate of 7.6 per 1,000 person-years. Sex- and age-adjusted incidence rates were elevated 11-fold in individuals with impaired fasting glucose at baseline, 4-fold in those with impaired glucose tolerance, 3-fold in overweight individuals, 10-fold in obese individuals, and approximately 2-fold in individuals with dyslipidemia or hypertension. Incidence rates increased with increasing HOMA-IR and decreasing Sluiter's Index. As compared with normal insulin sensitivity and normal insulin response, individuals with low insulin sensitivity and low insulin response had a sevenfold higher risk of diabetes. Baseline impaired fasting glucose, BMI, HOMA-IR, and Sluiter's Index were the only independent predictors of incident diabetes in multivariate analyses. We conclude that approximately 1% of European white individuals aged 40-79 years develop type 2 diabetes annually and that "subdiabetic" hyperglycemia, obesity, insulin resistance, and impaired insulin response to glucose are independent predictors of diabetes.
The metabolic syndrome as currently defined by the Adult Treatment Panel III includes multiple components. This article describes the background for these components' inclusion in the syndrome,measurement of these factors, and the appropriate interventions. The factors are highly interrelated and the true utility of this diagnostic entity is under critical evaluation as new and existing data are evaluated concerning the role of the syndrome in the development of vascular disease and other clinical outcomes.
To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988.
Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13-3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13-1.92) for NCEP-MetS and 1.27 (95% CI, 0.97-1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35-9.21) and 1.82 (95% CI, 1.14-2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55-5.17) and 1.15 (95% CI, 0.72-1.86).
In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.
The aim of this study was to assess in an 11-year survival follow-up of a population-based cohort of type 2 diabetes the predictive role of World Health Organization-defined metabolic syndrome, independent of conventional cardiovascular risk factors.
During the follow-up (1991-2001), 1,565 patients were regularly examined with centralized measurements of HbA(1c). The independent role of the metabolic syndrome as a predictor of all-cause and cardiovascular mortality was assessed with multivariate Cox proportional hazards modeling.
At baseline, the prevalence of the metabolic syndrome was 75.6% (95% CI 73.6-77.9). Results are based on 685 deaths (520 with the metabolic syndrome and 165 without it) in 10,890.2 person-years of observations. With respect to subjects without the metabolic syndrome, those with the metabolic syndrome had a similar hazard ratio (HR) of cardiovascular mortality after adjustment for age, sex, smoking, total cholesterol level, and coronary heart disease. In contrast, relative to subjects with diabetes only, the HR of subjects with only one component of the syndrome was 2.92 (1.16-7.33), independent of other risk factors.
We found that 1) the prevalence of the metabolic syndrome in a population-based cohort of type 2 diabetes is high (75.6%); 2) the metabolic syndrome is not a predictor of 11-year all-cause and cardiovascular mortality; and 3) more than twofold higher cardiovascular risk, independent of conventional risk factors, is evident in diabetic subjects with only one component of the syndrome compared with those with diabetes only. Categorizing type 2 diabetic subjects as having or not having the metabolic syndrome does not provide further prediction compared with the knowledge of its single components.
In recent years, several major organizations have endorsed the concept of the metabolic syndrome and developed working definitions for it. How well these definitions predict the risk for adverse events in people with the metabolic syndrome is only now being learned. The purpose of this study was to summarize the estimates of relative risk for all-cause mortality, cardiovascular disease, and diabetes reported from prospective studies in samples from the general population using definitions of the metabolic syndrome developed by the National Cholesterol Education Program (NCEP) and World Health Organization (WHO).
The author reviewed prospective studies from July 1998 through August 2004.
For studies that used the exact NCEP definition of the metabolic syndrome, random-effects estimates of combined relative risk were 1.27 (95% CI 0.90-1.78) for all-cause mortality, 1.65 (1.38-1.99) for cardiovascular disease, and 2.99 (1.96-4.57) for diabetes. For studies that used the most exact WHO definition of the metabolic syndrome, the fixed-effects estimates of relative risk were 1.37 (1.09-1.74) for all-cause mortality and 1.93 (1.39-2.67) for cardiovascular disease; the fixed-effects estimate was 2.60 (1.55-4.38) for coronary heart disease.
These estimates suggest that the population-attributable fraction for the metabolic syndrome, as it is currently conceived, is approximately 6-7% for all-cause mortality, 12-17% for cardiovascular disease, and 30-52% for diabetes. Further research is needed to establish the use of the metabolic syndrome in predicting risk for death, cardiovascular disease, and diabetes in various population subgroups.
The incidence of cardiovascular disease (CVD), coronary heart disease (CHD), and type 2 diabetes mellitus (T2DM) has not been well defined in persons with the metabolic syndrome (at least 3 of the following: abdominal adiposity, low HDL cholesterol, high triglycerides, hypertension, and impaired fasting glucose). The objective was to investigate risk for CVD, CHD, and T2DM according to metabolic syndrome traits.
The study followed a cohort of 3323 middle-aged adults for the development of new CVD, CHD, and T2DM over an 8-year period. In persons without CVD or T2DM at baseline, the prevalence of the metabolic syndrome (> or =3 of 5 traits) was 26.8% in men and 16.6% in women. There were 174 incident cases of CVD, 107 of CHD, and 178 of T2DM. In men, the metabolic syndrome age-adjusted relative risk (RR) and 95% CIs were RR=2.88 (95% CI 1.99 to 4.16) for CVD, RR=2.54 (95% CI 1.62 to 3.98) for CHD, and RR=6.92 (95% CI 4.47 to 10.81) for T2DM. Event rates and RRs were lower in women for CVD (RR=2.25, 95% CI 1.31 to 3.88) and CHD (RR=1.54, 95% CI 0.68 to 3.53), but they were similar for T2DM (RR=6.90, 95% CI 4.34 to 10.94). Population-attributable risk estimates associated with metabolic syndrome for CVD, CHD, and T2DM were 34%, 29%, and 62% in men and 16%, 8%, 47% in women.
Metabolic syndrome is common and is associated with an increased risk for CVD and T2DM in both sexes. The metabolic syndrome accounts for up to one third of CVD in men and approximately half of new T2DM over 8 years of follow-up.
Many studies have recommended use of metabolic syndrome as an 'alternative' means to assess vascular disease risk, but few have been rigorous, leading to confusion amongst physicians regarding risk screening. This review critically appraises this evidence and also evaluates the data linking metabolic syndrome to type 2 diabetes.
Although presence of metabolic syndrome predicts vascular events, such prediction is inferior and does not enhance simpler Framingham-based risk scores which can be determined using nonfasting blood samples. The dichotomous nature of metabolic syndrome criteria and lack of age, low-density lipoprotein cholesterol, and smoking in part account for their inferior predictive ability. Metabolic syndrome criteria better predict type 2 diabetes but diabetes screening, if adopted, will likely require a two-stage process, with the first stage not dependent on blood sampling. Nevertheless, recent interest in metabolic syndrome has contributed to greater interaction between diabetologists and cardiologists and highlighted more strongly the relevance of obesity to vascular risk.
Best evidence suggests that current metabolic syndrome criteria should not be used as an alternative to established charts for risk prediction for vascular disease. Clinical focus should remain on established risk factors to determine and reduce risk of vascular events.
The metabolic syndrome, which is characterized by a constellation of fasting hyperglycemia, hypertriglyceridemia, low HDL cholesterol, hypertension, and/or abdominal obesity, is a risk factor for the development of coronary artery disease (CAD) and cardiovascular events. The interrelationship between metabolic status and CAD on cardiovascular risk in women is not known.
We evaluated interrelationships between angiographic CAD, the metabolic syndrome, and incident cardiovascular events among 755 women from the Women's Ischemia Syndrome Evaluation (WISE) study who were referred for coronary angiography to evaluate suspected myocardial ischemia; 25% of the cohort had the metabolic syndrome at study entry. Compared with women with normal metabolic status, women with the metabolic syndrome had a significantly lower 4-year survival rate (94.3% versus 97.8%, P=0.03) and event-free survival from major adverse cardiovascular events (death, nonfatal myocardial infarction, stroke, or congestive heart failure; 87.8% versus 93.5%, P=0.003). When the subjects were stratified by the presence or absence of angiographically significant CAD at study entry, in women with angiographically significant CAD, the metabolic syndrome resulted in significantly higher risk of cardiovascular events than in women with normal metabolic status (hazard ratio 4.93, 95% CI 1.02 to 23.76; P=0.05), whereas it did not result in increased 4-year cardiovascular risk in women without angiographically significant CAD (hazard ratio 1.41, 95% CI 0.32 to 6.32; P=0.65).
These data suggest that in women with suspected myocardial ischemia, the metabolic syndrome modifies the cardiovascular risk associated with angiographic CAD. Specifically, the metabolic syndrome was found to be a predictor of 4-year cardiovascular risk only when associated with significant angiographic CAD.
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Table 2) In subjects who were free of CHD and/or CHD risk equivalents, ATPIII, IDF, and WHO definitions had similar ORs, but the IDF definition had a higher sensitivity and FPR than the other two
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