Metab Syndr Relat Disord [journal]
- Glucagon-Like Peptide-1 Receptor Agonists and Diabetic Cardiovascular Disease: Implications of the LEADER Study. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 23.
- Subclinical Hypothyroidism and Metabolic Syndrome: A Common Association by Chance or a Cardiovascular Risk Driver? [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 23.
The metabolic syndrome (MS) and subclinical hypothyroidism (SCH) are highly prevalent in the general population. Cross-sectional epidemiological data suggest that a mutual association exists between the two, although the cause-effect relationship remains poorly elucidated. As SCH raises cholesterol, blood pressure, and visceral fat, it is easy to understand why it associates with MS. Rather, the reasons whereby MS patients are at higher risk for SCH are less apparent. Some studies have reported that SCH is itself characterized by high cardiovascular risk. Therefore, the coexistence of SCH and MS may identify subjects at a particularly high risk for future cardiovascular events. Recent data published in Metabolic Syndrome and Related Disorders indicate that carotid intima-media thickness, a marker of initial atherosclerosis and a possible predictor of future events, is higher in patients with both SCH and MS than in the presence of each condition alone. In this Editorial, we discuss the clinical implications of SCH and MS association and the interpretation of such recent findings.
- Relationship Between Metabolic Syndrome and Cognitive Abilities in U.S. Adolescents. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 16.
Metabolic syndrome is increasingly common in U.S. adolescents and has been linked to cognitive dysfunction. Purpose of this study is to explore associations between metabolic syndrome and cognitive impairment in U.S. adolescents using population-based data.Participants included adolescents aged 12-16 years who participated in the National Health and Nutrition Examination Survey (NHANES) III. The main outcome measures included assessments of cognitive function using Wide Range Achievement Test-Revised (WRAT-R) and Wechsler Intelligence Scale for Children-Revised (WISC-R) tools. The WRAT-R consisted of mathematics and reading tests. The WISC-R consisted of block design test, which measures spatial visualization and motor skills, and digit span test, which measures working memory and attention. Linear regression models were used to examine associations between metabolic syndrome and cognitive function. We used education levels of the family reference person, while controlling for education levels because of missing data.Presence or absence of metabolic syndrome was tested in 1170 of 2216 NHANES III participants aged 12-16 years. Regression models showed that participants with metabolic syndrome scored an average 1.25 [95% confidence interval (CI) = -2.14 to -0.36] points lower in reading examination and an average 0.89 (95% CI = -1.65 to -0.13) points lower in digit span examination, compared to those without metabolic syndrome. In addition, components of metabolic syndrome-elevated systolic blood pressure and increased waist circumference (WC)-were associated with impaired working memory/attention, and higher fasting glucose and increased WC were associated with poorer reading test scores.Metabolic syndrome was associated with impaired reading, working memory, and attention among adolescents.
- Characteristics of Metabolic Syndrome in Morbidly Obese Subjects. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 11.
Metabolic syndrome (MetSyn) magnifies risks of cardiovascular disease (CVD) and type 2 diabetes, but its expression varies within the obese population. We examined body mass index (BMI), metabolic traits, and fat distribution in morbidly obese individuals.Lipids and inflammatory, oxidative stress and hepatic biomarkers in 346 women and 203 men (BMI ≥35 kg/m(2) and co-morbidity or ≥40 kg/m(2)) were stratified by MetSyn components (1-5, excluding diabetes). Age- and smoking-adjusted partial correlations were calculated. Dual-energy X-ray absorptiometry was measured in 206 participants.Apolipoprotein B, ferritin, uric acid, and alanine aminotransferase (ALT) concentrations worsened with increasing MetSyn components (P ≤ 0.0001), while BMI and LDL-cholesterol showed no association. BMI correlated inversely with triglycerides (r = -0.16, P = 0.03) and positively with HDL-cholesterol in men (r = 0.16, P = 0.02), but not in women. BMI correlated with C-reactive protein (CRP) (r = 0.32, P < 0.0001; r = 0.24, P < 0.0001 in men and women, respectively) and white blood cell count (r = 0.24, P = 0.001 in men; r = 0.15, P = 0.008 in women). Truncal fat percentage correlated to CRP (r = 0.31, P = 0.03; r = 0.20, P = 0.02 in men and women, respectively). In women, number of MetSyn components was inversely related to truncal and peripheral fat (r = -0.20, P = 0.02; r = -0.42, P < 0.0001, respectively) as was ALT (r = -0.21, P = 0.009; r = -0.38, P < 0.0001, respectively) and triglycerides with peripheral fat (r = -0.38, P < 0.0001), while HDL cholesterol was positively associated with truncal and peripheral fat (r = 0.26; P = 0.001).BMI and fat distribution showed expected associations to inflammation biomarkers, but paradoxical relations between fat indices, and MetSyn components and biomarkers were seen. This suggests a need for better markers of CVD risk in morbid obesity.
- Associations of Circulating PYY3-36 Concentrations with Metabolic Syndrome in Extremely Obese Subjects. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 11.
The gut hormone peptide YY3-36 (PYY3-36) plays major roles in regulation of appetite and energy metabolism, mediates beneficial effects of bariatric surgery, and may be a potential weight-reducing and glucose-modulating therapy. Obesity may influence the metabolic expression of circulating PYY3-36 and metabolic markers. We studied the relationship of PYY3-36 concentrations with metabolic syndrome (MetSyn) components, lipids, insulin resistance, and inflammatory biomarkers in subjects with extreme obesity.We measured MetSyn components and PYY3-36, lipids, hormones, homeostasis model assessment (HOMA) index, and inflammatory biomarkers in consecutively referred patients (180 women and 111 men) aged 18-78 years with body mass index (BMI) ≥40 kg/m(2). Associations of PYY3-36 to components, insulin resistance, and biomarkers were examined with partial correlations and linear regression.PYY3-36 concentrations were not related to MetSyn components, HOMA index, or to inflammatory biomarker or leptin concentrations. PYY3-36 concentrations correlated with systolic blood pressure (r = 0.21; P < 0.0001) after adjustment for age and gender. In linear regression analysis, PYY3-36 concentrations were associated with systolic blood pressure after adjustment for age, gender, and central obesity in the entire sample (Beta 0.21; 95% CI 0.09-0.34) as well as in subjects not taking blood pressure-lowering medication (Beta 0.19; 95% CI 0.04-0.36). These associations were not statistically significant in the small subset of participants (22%) with type 2 diabetes.In extremely obese patients, fasting PYY3-36 concentrations were linked to systolic blood pressure, but not to other components of MetSyn, suggesting divergence between pathways of blood pressure and glucose/body weight regulation. However, this finding will need to be further investigated.
- Metabolic Syndrome and Associated Factors in a Population-Based Sample of Schoolchildren in Colombia: The FUPRECOL Study. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 10.
In contrast to the definition of metabolic syndrome (MetS) in adults, there is no standard definition of MetS in pediatric populations. We aimed at assessing the differences in the prevalence of MetS in children and adolescents aged 9-17 years using four different operational definitions for these age groups and at examining the associated variables.A total of 675 children and 1247 adolescents attending public schools in Bogota (54.4% girls; age range 9-17.9 years) were included. The prevalence of MetS was determined by the definitions provided by the International Diabetes Federation (IDF) and three published studies by Cook et al., de Ferranti et al., and Ford et al. In addition, we further examined the associations between each definition of MetS in the total sample and individual risk factors using binary logistic regression models adjusted for gender, age, pubertal stage, weight status, and inflammation in all participants.The prevalence of MetS was 0.3%, 6.3%, 7.8%, and 11.0% according to the definitions by IDF, Cook et al., Ford et al., and de Ferranti et al., respectively. The most prevalent components were low high-density lipoprotein cholesterol and high triglyceride levels, whereas the least prevalent components were higher waist circumference and hyperglycemia. Overall, the prevalence of MetS was higher in obese than in non-obese schoolchildren.MetS diagnoses in schoolchildren strongly depend on the definition chosen. These findings may be relevant to health promotion efforts for Colombian youth to develop prospective studies and to define which cut-offs are the best indicators of future morbidity.
- The Presence and Duration of Overweight Are Associated with Low-Grade Inflammation in Prepubertal Chilean Children. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Aug 1.
Overweight is associated with low-grade inflammation, but it is under debate whether the effect of fat mass accumulation is acute or chronic. We aimed to study the association of overweight duration with low-grade inflammation in children in whom overweight initiation can be established.Observational longitudinal study, including a subsample of 250 Chilean children from the Growth and Obesity Cohort Study followed-up yearly since preschool age (n = 1195). At 4 years, 324 children provided blood. From those, 272 participants were evaluated at 7 years. The current analysis includes 250 children with a blood sample at 4 and 7 years of age and C-reactive protein (CRP) <5 mg/L. Anthropometric data (0-4 years) were obtained from health records and measured thereafter; sex- and age-specific body mass index Z-scores (BAZ) were computed. Among overweight (BAZ ≥ 1) participants at 7 years, the duration of overweight (time since diagnosis) was computed and categorized according to tertiles: <36, 36-<72, or ≥72 months. The independent association between overweight (diagnosis and duration) and low-grade inflammation (CRP ≥ 1 mg/L) was studied (logistic regression models).Overweight was associated with CRP ≥ 1 mg/L at 7 years [odds ratio (OR) = 2.93 confidence interval (95% CI = 1.60-5.38)], but not at 4 years [OR = 1.26 (95% CI = 0.71-2.26)]. An overweight duration <36 m was independently associated with CRP ≥ 1 mg/L [OR = 3.53 (95% CI = 1.21-10.28)] (reference = normal weight), whereas longer overweight durations (36-<72 or ≥72 m) were not associated with CRP ≥ 1 mg/L [OR = 1.35 (95% CI = 0.41-4.40) and OR = 1.21 (95% CI = 0.35-4.18), respectively].Overweight at 7 years of age was associated with low-grade inflammation only in the case of recent onset. Inflammatory disturbances may be associated with the early phases of excess weight.
- Predicting Glucose Effectiveness in Chinese Participants Using Routine Measurements. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Jul 26.
Glucose effectiveness (GE) is the capacity of glucose to increase its own uptake and to maintain endogenous hepatic glucose output under basal insulin levels. In addition to decreased insulin sensitivity (IS) and impaired insulin secretion, GE plays a critical role in glucose balance in patients with type 2 diabetes (T2DM). In the study, we developed an equation for predicting GE.We enrolled 227 participants with glucose tolerances ranging from normal glucose tolerance to diabetes. Of the participants, 75% (171) participants were randomly assigned to the study group, whose data were used to construct the equation for estimating GE. The remaining 56 participants comprised the validation group. All participants underwent a frequently sampled intravenous glucose tolerance test; IS, GE, and the acute insulin response after the glucose load were determined.Age, triglyceride (TG), and fasting plasma glucose (FPG) were independently correlated with GE and selected for inclusion in multiple linear regression analysis. We constructed the following equation: GE = (29.196 - 0.103 × age - 2.722 × TG - 0.592 × FPG) × 10(-3). Using this same equation, we also calculated the GE of the validation group. The calculated GE was significantly correlated with the measured GE (r = 0.430, P = 0.001).Using the equation based on routine measurements enabled the GE to be predicted with acceptable accuracy (r = 0.430). This method of predicting GE may aid clinicians in further understanding the underlying pathological mechanisms of T2DM.
- Increased Pre- and Post-Meal Free Fatty Acid Levels in Black, Obese Adolescents. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Jul 15.
Black adolescents are at increased risk of cardiometabolic disease but have lower fasting triglyceride, which is usually associated with decreased risk. No one has studied racial differences in triglycerides or free fatty acids (FFAs) after a high-fat meal.Oral glucose tolerance testing was used to assess insulin secretion, sensitivity, and disposition index (DI). Endothelial function, triglycerides, FFA, c-reactive protein, interleukin 6 (IL6), and adiponectin were measured both pre- and 3 hr postprandially (McDonald's Big Breakfast(®) and 12 ounce Sprite(®)) in obese adolescents (10-13 years, 9 black and 7 white). Endothelial function was assessed using reactive hyperemic changes in forearm vascular resistance (FVR).Oral glucose tolerance test (OGTT) showed no difference in insulin sensitivity, but blacks tended to have (P = 0.08) higher insulin secretion and had increased DI (P = 0.003). After a high-fat meal, triglycerides increased in both groups (P < 0.001), tended to be lower in blacks compared with whites preprandially (64 ± 33 mg/dL vs 110 ± 80, P = 0.064), and was lower postprandially (112 ± 63 vs 188 ± 112, P = 0.039). Pre- and postprandial FFA (Black: 0.58 ± 0.15 and 0.39 ± 0.18 vs. white: 0.44 ± 0.14 and 0.26 ± 0.06, P = 0.020) and adiponectin (P = 0.002) were increased in blacks. FFA decreased in both groups postprandially (P = 0.002). IL6 increased after the meal (P = 0.022). Endothelial function decreased postprandially (P < 0.02), but this was due to a decrease in preocclusion FVR.These results indicate that differences in fat metabolism are present in both black and white obese adolescents. How these differences explain higher rates of cardiometabolic disease in blacks is unclear.
- The Burden of Obesity, Elevated Blood Pressure, and Diabetes in Uninsured and Underinsured Adolescents. [JOURNAL ARTICLE]
- Metab Syndr Relat Disord 2016 Jul 11.
Obesity, elevated blood pressure (BP), and diabetes mellitus are rising among the general U.S. adolescent population, but prevalence estimates are not available for uninsured or Medicaid populations.This retrospective epidemiological study extracted 155,139 electronic medical records collected between 1998 and 2012 on patients aged 10-19 years, from a clinical population predominantly uninsured or insured by Medicaid. Age, sex, race, height, weight, BP, and insurance type were captured at first clinic visit. Classifications included obesity (≥95th body mass index percentile), elevated BP (≥90th percentile), and diabetes mellitus (ICD-9-250.xx).Among the 26,696 patients with complete data at first clinic visit, 24.4% were classified as obese and 39.5% had elevated BP. In logistic regression analyses, odds of obesity were significantly higher among uninsured versus commercially insured patients (odds ratio [OR]: 1.1 [95% confidence interval: 1.0-1.2]) and girls (OR: 1.3 [1.2-1.4]), but lower among older adolescents (for 15-17 years, OR: 0.7 [0.6-0.7]; for 18-19 years, OR: 0.7 [0.7-0.8]). Odds of elevated BP were significantly higher among Medicaid (OR: 1.1 [1.0-1.2]) and uninsured (OR: 1.2 [1.1-1.4]) versus commercially insured patients, but lower among African American versus White youth (OR: 0.9 [0.8-0.9]). Prevalence of type 1 diabetes was 1.46 per 1000 and prevalence of type 2 diabetes was 1.68 per 1000, with both occurring more often in girls versus boys and in Whites versus African Americans.In this low-income clinical population, prevalence of obesity and elevated BP were higher than national estimates. The provision of preventive healthcare to all Medicaid and uninsured youth should remain a priority.