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Metab Syndr Relat Disord [journal]
- High Prevalence of Abdominal Obesity Increases the Risk of the Metabolic Syndrome in Nigerian Type 2 Diabetes Patients: Using the International Diabetes Federation Worldwide Definition. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Mar 6.
Abstract Background: Some Nigerian studies have reported cases of the metabolic syndrome in the population. This study aims to assess the prevalence of the components of the metabolic syndrome in type 2 diabetes mellitus (T2DM) patients using the International Diabetes Federation (IDF) worldwide definition. Methods: Eighty-nine T2DM patients were studied after an overnight fast. The patients' blood pressure, anthropometric indices, and biochemical parameters were measured. The components of the metabolic syndrome-raised blood pressure, waist circumference, triglycerides (TGs), and reduced high-density lipoprotein cholesterol (HDL-C)-were calculated using the IDF definition for the European ethnic group. Results: About 25% of the patients had raised blood pressure (>130/85 mmHg), with the male patients having higher prevalence of raised systolic blood pressure (SBP>130 mmHg) than the female patients (73.3 vs. 52.3%, P<0.05). Although the prevalence of raised TGs did not differ in gender, more females than males had reduced HDL-C (77.3 vs. 46.7%, P<0.001). Although generalized obesity is similar in both gender (17.8% vs. 31.8%, P>0.05), abdominal obesity predominates significantly in female patients (97.7 vs. 68.9%, P<0.001). Overall, total obesity (P<0.05), raised blood pressure (P<0.05), raised TGs, and reduced HDL-C are significantly clustered in abdominally obese patients. Conclusion: It is concluded that the abdominally obese T2DM patients had a higher cluster of the components of the metabolic syndrome and are consequently at greater risk of cardiovascular disease (CVD). We recommend that diabetes education emphasizing the risk of CVD in patients with increased abdominal fat should be intensified in the developing countries.
- Do Insulin Resistance Conditions Further Impair the Lipid and Inflammatory Profile in End-Stage Renal Disease Patients on Hemodialysis? [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Mar 6.
Abstract Background: Type 2 diabetes (T2DM) and chronic renal disease constitute important risk factors of atherosclerotic cardiovascular disease, associated with lipid abnormalities, and proinflammatory states. Advances in renal replacement therapy such as hemodialysis (HD) have not reduced morbi-mortality. It has not been elucidated if the concomitant presence of T2DM or metabolic syndrome with end-stage renal disease further impairs the atherogenic profiles. Methods: We studied 122 HD patients, among which 44 presented with T2DM (HD-T2DM) and 30 with metabolic syndrome (HD-MS); 48 had neither T2DM nor metabolic syndrome (HD-C). Lipoprotein profile, including atherogenic remnant lipoproteins (RLP), and inflammation markers-high sensitivity C-reactive protein (hsCRP), adiponectin, and interleukin-6 (IL-6)-were measured. Results: In all HD patients, triglycerides, free fatty acids, and RLP showed no differences between HD groups, whereas high-density lipoprotein cholesterol (HDL-C) was decreased, particularly in HD-T2DM and HD-MS, with respect to HD-C (P<0.01). Regarding inflammatory parameters, both IL-6 and hsCRP were found to be similar between HD groups. Adiponectin paradoxically shows higher values in relation to those expected for insulin resistance situations showing no differences between HD groups. Conclusions: The presence of T2DM or metabolic syndrome did not worsen atherogenic lipoprotein levels, but did reduce HDL-C. Neither was the proinflammatory profile further altered in HD patients in the presence of insulin resistance conditions.
- Relationship Between Retinol-Binding Protein-4/Adiponectin and Leptin/Adiponectin Ratios with Insulin Resistance and Inflammation. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Mar 4.
Abstract Background: There is much data supporting a role for adipokines in both obesity and metabolic syndrome. Insulin resistance and low-grade inflammation are crucial in the genesis of both disorders. Although data suggest that the ratio of leptin/adiponectin correlates with insulin resistance and predicts cardiovascular disease (CVD), there is scanty data on the relationship between the retinol-binding protein-4 (RBP4)/adiponectin ratio with insulin resistance and inflammation. We tested the relationship of both these ratios with measures of insulin resistance and inflammation. Methods: In 72 individuals, including controls and patients with metabolic syndrome, we calculated the homeostasis model assessment of insulin resistance (HOMA-IR) and assayed high-sensitivity C-reactive protein (hsCRP) and the adipokines, adiponectin, leptin, and RBP4. Results: Whereas both the leptin/adiponectin and RBP4/adiponectin ratios did not correlate with HOMA-IR, both correlated significantly with the prototypic biomarker of inflammation, hsCRP. Also in patients with metabolic syndrome following adjustment for adiposity, only the RBP4/adiponectin ratio was significantly increased. Conclusions: Hence it appears that whereas both the leptin/adiponectin and RBP4/adiponectin ratios correlate with inflammation, only the RBP4/adiponectin ratio was significantly increased in metabolic syndrome and would be more useful to predict CVD, especially in metabolic syndrome.
- Metabolic Syndrome and Subclinical Carotid Atherosclerosis Among Chinese Elderly People Living in a Rural Community. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Mar 3.
Abstract Background: The relationship between the metabolic syndrome and subclinical atherosclerosis among elderly people remains controversial. We seek to investigate the associations of metabolic syndrome and its components with subclinical carotid atherosclerosis in older people living in rural China. Methods: This cross-sectional study included 911 participants (age ≥60 years, 59.4% women) of the community-based Confucius Hometown Aging Project in Shandong, China, who were free of clinical cardiovascular disease. In 2010-2011, data were collected through interviews, clinical examinations, and laboratory tests. Carotid intima media thickness (cIMT) and carotid artery plaque were assessed using ultrasonography. Metabolic syndrome was defined by four sets of criteria. Data were analyzed with multiple general linear and logistic regression models. Results: Carotid plaque was detected in 514 (56.4%) persons. Depending on the defining criteria, prevalence of metabolic syndrome ranged from 30.6% to 56.9%. Hypertension, elevated blood pressure (≥130/85 mmHg), diabetes/prediabetes, and high fasting plasma glucose (≥5.6 mmol/L) were significantly associated with an increased likelihood of carotid plaque, whereas an increased cIMT was associated with elevated blood pressure and hypertension (P<0.05). Obesity, high triglycerides, and dyslipidemia were not associated with carotid artery plaque or cIMT. The significant association of metabolic syndrome with an increased likelihood of carotid plaque disappeared when elevated blood pressure and high plasma glucose were added to the models. Metabolic syndrome was not associated with cIMT. Conclusions: Metabolic syndrome is associated with subclinical carotid plaque among Chinese elderly people, driven primarily by elevated blood pressure and hyperglycemia. Older adults with metabolic syndrome, especially those with high blood pressure and hyperglycemia, may benefit from evaluation for subclinical atherosclerosis.
- Neck Circumference Is a Predictor of Metabolic Syndrome and Obstructive Sleep Apnea in Short-Sleeping Obese Men and Women. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Feb 26.
Abstract Background: The constellation of metabolic syndrome, although controversial with regard to its clinical usefulness, is epidemiologically related to increased diabetes risk and cardiovascular mortality. Our goal was to investigate the associations among neck circumference (NC), obstructive sleep apnea syndromes (OSAS), and metabolic syndrome in obese men and women sleeping less than 6.5 hr per night. Methods: This was a cross-sectional study of obese men and premenopausal obese women sleeping less than 6.5 hr per night. We enrolled 120 individuals (92 women), age 40.5±6.9 years and body mass index (BMI) 38.6±6.5 kg/m(2). Metabolic syndrome severity was assessed by a score and OSAS was defined as a respiratory disturbance index (RDI) ≥5. Metabolic end endocrine parameters were measured, and sleep duration was determined by actigraphy and validated questionnaires. Results: Metabolic syndrome was found in 41% and OSAS in 58% (28% had both). Subjects with metabolic syndrome were 3 years older and more often Caucasian; they had higher RDI scores, larger NC, more visceral fat, lower serum adiponectin, higher 24-hr urinary norepinephrine (NE) excretion, and lower growth hormone concentrations. A NC of ≥38 cm had a sensitivity of 54% and 58% and a specificity of 70% and 79% in predicting the presence of metabolic syndrome and OSAS, respectively. RDI, adiponectin, and NC accounted for approximately 30% of the variability in the metabolic syndrome score, as estimated by an age-, gender-, and race-corrected multivariate model (R(2)=0.376, P<0.001). Conclusion: Greater NC is associated with OSAS and metabolic syndrome in short-sleeping obese men and premenopausal obese women. Addition of NC to the definition of metabolic syndrome should be considered and needs to be validated in future studies.
- Variations in the Prevalence of Metabolic Syndrome in Adolescents According to Different Criteria Used for Diagnosis: Which Definition Should Be Chosen for This Age Group? [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Feb 24.
Abstract Background: Despite the increasing prevalence of metabolic syndrome in adolescents, there is no consensus for its diagnosis. Methods: A cross-sectional study was conducted to compare the prevalence of metabolic syndrome in adolescents by different definitions, evaluate their concordance, and suggest which definition to apply in this population. A total of 851 adolescents between 10 and 18 years of age were evaluated. Anthropometric (weight, height, waist circumference), biochemical (glucose, lipid profile), and blood pressure data were taken. The prevalence of metabolic syndrome was determined by the definitions of the International Diabetes Federation (IDF) and four published studies by Cook et al., de Ferranti et al., Agudelo et al., and Ford et al. Concordance was determined according to the kappa index. Results: The prevalence of metabolic syndrome was 0.9%, 3.8%, 4.1%, 10.5%, and 11.4%, according to the IDF, Cook et al., Ford et al., Agudelo et al., and de Ferranti et al. definitions, respectively. The most prevalent components were hypertriglyceridemia and low high-density lipoprotein cholesterol, whereas the least prevalent components were abdominal obesity and hyperglycemia. The highest concordance was found between the definitions by Cook et al. and Ford et al. (kappa=0.92), whereas the greatest discordance was between the de Ferranti et al. and IDF definitions (kappa=0.14). Conclusions: Metabolic syndrome and its components were conditions present in the adolescents of this study. In this population, with a high prevalence of dyslipidemia and a lower prevalence of abdominal obesity and hyperglycemia, the recommendation to diagnose metabolic syndrome would be that used by Ford et al.
- No Benefit of Saxagliptin on Cardiovascular Outcomes in Type 2 Diabetes Mellitus: Potential Explanations. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Feb 12.
- Comparative Effects of the Renin-Angiotensin System Blockers on Nonalcoholic Fatty Liver Disease and Insulin Resistance in C57Bl/6 Mice. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Feb 11.
Abstract Background: The activation of the renin-angiotensin system (RAS) has been related to various aspects of metabolic syndrome. The current study evaluated the effects of RAS blockers in a model of diet-induced insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD). Methods: Male C57BL/6 mice were fed a standard chow (SC; 10% lipids, n=15) diet or a high-fat (HF; 50% lipids, n=60) diet for 8 weeks and then treated with aliskiren (HF-A; 50 mg/kg per day, n=15), enalapril (HF-E; 30 mg/kg per day, n=15), or losartan (HF-L; 10 mg/kg per day, n=15) for an additional 6 weeks. We assessed glucose and lipid metabolism, hepatic histopathology, the expression profile of genes and proteins affecting hepatic gluconeogenesis, RAS and insulin signaling, and lipid beta-oxidation and accumulation. The differences between the groups were tested via analysis of variance (ANOVA) and the post hoc Holm-Sidak test. Results: All treatments restored the up-regulation of hepatic RAS. The enalapril treatment, but not aliskiren or losartan, was effective in improving leptin, glucose intolerance, IR, hepatic steatosis, and triglycerides and in preventing increased hepatic protein levels of phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6Pase), and glucose transporter-2 (GLUT-2). Furthermore, enalapril improved the response to the deleterious effects of the HF diet by upregulating signal transduction through the insulin receptor substrate (IRS) 1/protein kinase B (Akt) pathway, as well as downregulating the protein levels and mRNA expression of peroxisome proliferator-activated receptor-γ (PPARγ), sterol regulatory element-binding protein-1c (SREBP-1c), and fatty acid synthase (FAS). Conclusions: Enalapril was the most successful treatment in protecting against hepatic IR and NAFLD by enhancing hepatic insulin action, leptin, and gluconeogenesis and by reducing the lipogenic pathway and lipid accumulation in the liver.
- Use of HbA1c for Diagnoses of Diabetes and Prediabetes: Comparison with Diagnoses Based on Fasting and 2-Hr Glucose Values and Effects of Gender, Race, and Age. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Feb 10.
Abstract Background: Glycated hemoglobin (HbA1c) has been advocated for the diagnosis of diabetes and prediabetes. Its performance has been commonly assessed in corroboration with elevated fasting plasma glucose (FPG), but not the combination of FPG and 2-hr glucose values. This study assesses receiver operating characteristics (ROC) curves of HbA1c pertaining to the diagnoses of prediabetes and diabetes by FPG and/or 2-hr glucose, and the effects of age, gender, and race. Methods: We assessed the utility of HbA1c for diagnosing diabetes and prediabetes among 5395 adults without known diabetes from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Results: Current cutoffs of HbA1c for diabetes (6.5%) or prediabetes (5.7%) exhibited low sensitivity (0.249 and 0.354, respectively) and high specificity in identifying patients diagnosed using both FPG and 2-hr glucose, resulting in large false-negative rates (75.1% and 64.9%). Misdiagnosis rates increased with age and in non-Hispanic whites and Mexican Americans. When HbA1c was combined with FPG for diagnoses, the false-negative rate remained high for diabetes (45.7%), but was reduced for prediabetes (9.2%). Conclusions: When assessed against diagnoses using both FPG and 2-hr glucose, HbA1c had low sensitivity and high specificity for identifying diabetes and prediabetes, which varied as a function of age and race. Regarding recently released American Diabetes Association (ADA) and joint European guidelines, it is important to consider that HbA1c values below 6.5% and 5.7% do not reliably exclude the presence of diabetes and prediabetes, respectively. Overall, the data argue for greater use of oral glucose tolerance tests (OGTTs) and both FPG and 2-hr glucose values for diagnosis of diabetes and prediabetes.
- Vitamin D Intake and Cardiometabolic Risk Factors in Adolescents. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2014 Feb 4.
Abstracrt Background: A growing body of research suggests that vitamin D might play an important role in overall health. No data exist on vitamin D intake for the Azorean adolescent population. The purpose of this study was to assess vitamin D intake and investigate a possible association between vitamin D intake and cardiometabolic risk factors in Azorean adolescents. Methods: A cross-sectional school-based study was conducted on 496 adolescents (288 girls) aged 15-18 years from the Azorean Islands, Portugal. Anthropometric measurements (waist circumference and height), blood pressure (systolic), and plasma biomarkers [fasting glucose, insulin, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs)] were measured to assess metabolic risk. Homeostasis model assessment (HOMA), TC-to-HDL-C ratio, and waist-to-height ratio were calculated. For each of these variables, a Z-score was computed by age and sex. A metabolic risk score was constructed by summing the Z-scores of all individual risk factors. High risk was considered when the individual had ≥1 standard deviation (SD) of this score. Vitamin D intake was assessed with a semiquantitative food frequency questionnaire. Participants were classified into quartiles of vitamin D intake. Logistic regression was used to determine odds ratios for high cardiometabolic risk scores after adjusting for total energy intake, pubertal stage, fat mass percentage, and cardiorespiratory fitness. Results: Mean (SD) vitamin D intake was 5.8 (6.5) μg/day, and 9.1% of Azorean adolescents achieved the estimated average requirement of vitamin D (10 μg/day or 400 IU). Logistic regression showed that the odds ratio for a high cardiometabolic risk score was 3.35 [95% confidence interval (CI) 1.28-8.75] for adolescents in the lowest vitamin D intake quartile in comparison with those in the highest vitamin D intake quartile, even after adjustment for confounders. Conclusion: A lower level of vitamin D intake was associated with worse metabolic profile among Azorean adolescents.