Metabolic syndrome and urinary cGMP excretion in general population

To examine the relationship between metabolic syndrome and endothelial dysfunction, we investigated cross-sectionally the correlation between metabolic risk factors and urinary excretion of cyclic guanosine 3′,5′-monophosphate (cGMP), a second messenger of nitric oxide (NO), in 1541 Japanese men and women aged 40–79 years. The 24-h urinary excretion of cGMP was measured using a ¹²⁵I-labeled cGMP radioimmunoassay and was adjusted for urinary creatinine excretion (nmol/mmol creatinine). The components of metabolic syndrome were defined based on the following criteria: body mass index (BMI) ≥ 25.0 kg/m², fasting plasma glucose ≥ 6.11 mmol/l or non-fasting plasma glucose level ≥ 11.1 mmol/l, systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 85 mm Hg, high-density lipoprotein (HDL)-cholesterol < 1.03 mmol/l for men and <1.29 mmol/l for women, and triglyceride ≥ 1.69 mmol/l. The number of components of metabolic syndrome correlated inversely with urinary cGMP excretion; means of cGMP excretion for the whole group adjusted for age, sex, and cardiovascular risk factors were 53.6, 48.6, 47.9, 44.4 and 42.3 nmol/mmol for 0, 1, 2, 3, and 4–5 components of metabolic syndrome, respectively (p = 0.002). Our data suggest that a reduction of NO bioactivity concur with clustered features of the metabolic syndrome.     

Prevalence of obesity and metabolic syndrome in Indigenous Australian youths

We conducted a cross-sectional study of Indigenous youths residing in the Torres Strait region of Australia to assess the prevalence of obesity and the metabolic syndrome. Data on body mass index (BMI), waist circumference, blood pressure, presence of acanthosis nigricans and blood glucose were collected. Fasting glucose, insulin, C-Peptide, HbA1c and lipids were measured, and an oral glucose tolerance test was performed in those with a BMI greater than 25 (childhood-equivalent cut-points) or fasting glucometer reading >5.5 mmol/L. Of 158 youths, 31% were overweight and 15% were obese, 38% had enlarged waist circumference consistent with central obesity, 43% had acanthosis nigricans and 27% were hypertensive. More females than males had enlarged waist circumferences (59% vs. 13%, P  < 0.001). Among overweight or obese youth, 56% had significantly elevated insulin ( P  = 0.021); they also had higher HOMA-IR ( P  = 0.002). The metabolic syndrome was present in 17% of all youths (mostly females) and in 33% of the overweight or obese subgroup. Type 2 diabetes was diagnosed in two youths. These very high proportions of overweight or obese Torres Strait youth with metabolic risk factors have major public health implications.     

Cardiovascular risk factor levels and their relationships with overweight and fat distribution in children: the Fleurbaix Laventie Ville Santé II study

This study aimed to document for the first time in a general population of French children the prevalence and levels of cardiovascular risk factors and to assess separately in boys and girls whether these risk factors were associated with fat mass distribution independently of subcutaneous overall adiposity. A cross-sectional analysis of baseline data from 452 children (235 boys and 217 girls) aged 8 to 17 years included in a 1999 population-based epidemiologic study (the Fleurbaix Laventie Ville Santé II study) was made. Overweight was defined according to the International Obesity Task Force references and the 90th percentiles of the French body mass index curves. The thresholds of parameters defining cardiovascular and metabolic risks were the 95th percentile of the Task Force Report on High Blood Pressure in Children and Adolescents for blood pressure and those of the American Academy of Pediatrics for lipids. Anthropometric and biological parameters were described by sex and according to overweight status. Partial correlations between cardiovascular risk factors and anthropometric measures of adiposity (body mass index, sum of 4 skinfold thicknesses, waist circumference, waist-to-height ratio) were calculated. Then, these correlations were additionally adjusted for the sum of 4 skinfold thicknesses. High plasma triglycerides, high insulin concentration, and low plasma high-density lipoprotein cholesterol (HDL-C) concentration were associated with all measures of adiposity (|r| > or = 0.20, P < .002). When obese children were excluded, overweight children already had high triglycerides and low HDL-C levels, respectively, 2 and 20 times more frequently than normal-weight children did. Among overweight children, 7.7% had at least 2 risk factors among high blood pressure, high plasma triglycerides or glucose, and low HDL-C concentration vs 0.25% among normal-weight children (P = .002). After adjusting for the sum of skinfolds, an independent association between the risk factors and waist circumference was found in girls. In conclusion, (a) modest excess weight is associated with increased levels of cardiovascular risk factors. (b) In girls, abdominal fat distribution is associated with cardiovascular risk factors, independently of overall adiposity. (c) International definition of abdominal obesity in children is required to standardize studies and to progress in the evaluation of childhood obesity and its consequences.     

上海某社区中老年人群超重与肥胖的现况调查

目的:了解上海社区中老年人超重和肥胖的患病情况以及肥胖相关疾病的患病风险。方法:在上海市嘉定区40岁及以上居民中进行问卷调查、体格检查及生化检测,对其中数据完整的10 375名居民进行统计分析。根据体质量指数(BMI),按照WHO标准界定肥胖和超重者。采用线性回归法分析BMI与一些危险因素的相关性,并采用Logistic回归法分析超重以及肥胖状态对于各种代谢相关性疾病患病风险的影响。结果:本研究人群的BMI均值为25.1±3.3,超重和肥胖的患病率分别为42.92%和7.27%;多元线性回归分析显示:校正多种混杂因素后,随着BMI水平的上升,腰围、收缩压、舒张压、空腹血糖、餐后2 h血糖、总胆固醇、低密度脂蛋白胆固醇、三酰甘油随之增加(均P<0.01),高密度脂蛋白胆固醇随之下降(P     

Prevalence of obesity and its association with cardiovascular disease risk factors in adolescent girls from a college in central Taiwan

Although obesity is associated with important hemodynamic disturbances, little data exists on population-wide cardiovascular risk factors in obese adolescent girls in Taiwan. This study measured the prevalence of overweight/obesity and related cardiovascular disease risk factors in adolescent females. This was a school-based survey of a representative sample of 291 females aged 15 and 18 years in a public college in Central Taiwan. The main measures were height, body weight, systolic (SBP) and diastolic blood pressure (DBP), uric acid, cholesterol, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C). Obese (body mass index [BMI] > or = 25.3) and overweight (22.7 < or = BMI < or = 25.2) individuals were combined and labeled as overweight (BMI > or = 22.7) to make communication of results clearer. Data gleaned from freshmens health examinations were analyzed. The prevalence of obesity (BMI > or = 25.3) was 9.28% and of overweight (BMI > or = 22.7) was 21.31%. Being overweight was associated with higher SBP, DBP, uric acid and TG, and lower levels of HDL-C, but was not associated with cholesterol. The 15-year-old group showed higher mean levels of uric acid, total cholesterol, TG and HDL-C than the 18-year-old group (p < 0.05). All told, 3.1%, 15.12% and 2.1% of the girls showed abnormally elevated levels of uric acid, cholesterol and TG, respectively. In addition, 5.84% had abnormally lower HDL-C levels, indicating that interventions should focus on reducing obesity and encouraging proper dietary habits and sufficient exercise, especially in subjects with lower HDL-C levels and higher levels of cholesterol, TG and uric acid.     

血管内皮功能与血糖、胰岛素水平及心血管危险因素的相关性

目的 研究超重肥胖者血管内皮功能与血糖、胰岛素水平及心血管病危险因素的关系。方法 367例超重肥胖者被分成2型糖尿病组、糖耐量减低组、空腹血糖受损组、正常糖耐量组及单纯超重肥胖组，并与66例正常体重者对照。测定血管内皮依赖性舒张功能(血流介导)和内皮非依赖性舒张功能(硝酸甘油介导)，并测定体脂、血压、血糖、血脂和胰岛素抵抗指数(HOMA-IR)。结果 超重肥胖者的内皮依赖性舒张功能显著降低，合并代谢异常者降低更显著。血管内皮依赖性舒张功能与腰臀比、收缩压、HOMA-IR呈显著负相关。结论 超重肥胖者血管内皮功能受损，腰臀比、收缩压及HOMA—IR是影响内皮功能的主要因素。     

Hypoglycemia in Type 2 diabetic patients randomized to and maintained on monotherapy with diet, sulfonylurea, metformin, or insulin for 6 years from diagnosis: UKPDS73

The UK Prospective Diabetes Study (UKPDS) showed that a more intensive glucose control policy reduced risk of diabetic complications. As hypoglycemia is a barrier to achieving glycemic targets, we examined its occurrence and contributing factors in UKPDS patients randomized to and remaining for 6 years on diet, sulfonylurea, metformin (overweight subjects only), or insulin monotherapy from diagnosis of Type 2 diabetes. Self-reported hypoglycemic episodes were categorized as (1) transient, (2) temporarily incapacitated, (3) requiring third-party assistance, and (4) requiring medical attention, recording the most severe episode each quarter. Proportions of patients reporting at least one episode per year were calculated in relation to therapy, HbA_1c, and clinical characteristics. In 5063 patients aged 25–65 years, only 2.5% per year reported substantive hypoglycemia (Grades 2–4) and 0.55% major hypoglycemia (Grade 3 or 4). Hypoglycemia was more frequent in younger (4.0% <45 years vs. 2.2% ≥45 years), female (3.0% vs. 2.2% male), normal weight (3.6% body mass index <25 kg/m² vs. 1.9% ≥25 kg/m²), less hyperglycemic (5.2% HbA_1c <7% vs. 2.3% ≥7%), or islet autoantibody-positive patients (4.3% vs. 2.1% negative) (all P<.0001). More on basal insulin reported hypoglycemia (3.8% per year) than diet (0.1%), sulfonylurea (1.2%), or metformin (0.3%) therapy, but less than on basal and prandial insulin (5.3%) (all P<.0001). Low hypoglycemia rates seen during the first 6 years of intensive glucose lowering therapy in Type 2 diabetes are unlikely to have a major impact on attempts to achieve guideline glycemic targets when sulfonylurea, metformin, or insulin are used as monotherapy.     

Insulin resistance in Brazilian adolescent girls: association with overweight and metabolic disorders

We assessed the association between insulin resistance, overweight and metabolic disorders in a probabilistic sample of 388, 12-19-year-old girls from public schools in Niterói, Rio de Janeiro State, Brazil. Insulin resistance was determined using Homeostatic Model Assessment-Insulin Resistance (HOMA-IR). Overweight and obesity were defined by the sex- and age-specific body mass index cut-offs recommended by the International Obesity Task Force. Metabolic syndrome (MS) was identified by the presence of at least three of the following factors: fasting glucose >or=100mg/dL, triglycerides >130 mg/dL, LDL-C >or=110 mg/dL, HDL-C <35 mg/dL and overweight. The combined prevalence of obesity (2.9%) and overweight was 14.2%. The average HOMA-IR level was 2.24 (95% confidence interval=1.40-3.10) in the overweight group and 1.91 (95% CI=1.32-2.50) in the non-overweight one, and MS prevalence was 20 times higher in the first group (21.4 and 0.1%). MS prevalence in the overweight group was 6.3 times higher in adolescents above the 66th percentile of HOMA-IR (55.9%) than those under the 33rd percentile (8.9%). Brazilian overweight girls with higher insulin resistance had high risk of developing MS. Therefore, prevention should occur at an early age to impair the evolution of this process.     

Metabolic syndrome in Turkish children and adolescents

The aim of this study was to determine the prevalence and phenotype of metabolic syndrome in Turkish children and adolescents. We adapted the National Cholesterol Education Program Adult Treatment Panel III criteria of metabolic syndrome to children and adolescents. Using the international cutoff points and percentiles, we determined 10- to 17-year-old Turkish children and adolescents with high blood pressure, high triglyceride (TG), low high-density lipoprotein cholesterol (HDL-C), fasting glucose of 100 mg/dL or greater, and elevated body mass index corresponding to overweight or obesity. We examined 1385 apparently healthy students between the ages of 10 to 17 years from Ankara, Turkey: 4.9% of the subjects were overweight or obese; 29.2% had either low HDL-C and/or high TG levels; and 15.7% had either systolic or diastolic blood pressure above the 95th age-, sex-, and height-specific percentile. Thirty students (2.2%) had metabolic syndrome by having 3 or more risk variables. Metabolic syndrome was nearly 10 times more common among overweight and obese students (21%), compared with lean students. Components of metabolic syndrome such as high blood pressure and high TG, and low HDL-C levels were common among Turkish children and adolescents. Strategies should focus on early detection and treatment of these risk variables in Turkish children.     

Clustering of cardiovascular risk factors with diabetes in Chinese patients: the effects of sex and hyperinsulinaemia

SUMMARY
Objective   This study was designed to investigate factors which affect the clustering of cardiovascular risk factors with diabetes in Chinese patients.
Research Design and Methods: Six hundred and fifty-four patients with diabetes were assessed comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and after a meal tolerance test. Results were analysed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes.
Results   Cardiovascular risk factors were common in Chinese diabetic patients. The clustering of three or more of these factors with diabetes occurred more often than by chance alone and was associated with postprandial hyperinsulinaemia. Patients with a high number of risk factors were more prone to macrovascular events but did not have higher albuminuria. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more women with multiple risk factors. However, this disappeared if the same criteria were used for men and women. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients.
Conclusions   The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is associated with hyperinsulinaemia and possibly the female sex. This study emphasises the importance of public health measures to control cardiovascular risk factors in patients with diabetes.     

The role of obesity in the association of cardiovascular risk factors and glucose intolerance in small Japanese and North American communities

To investigate whether the influence of obesity on cardiovascular risk factors and glucose intolerance differs between Japan and the US, we conducted cross-sectional surveys in those with elevated plasma glucose in Tanushimaru, Japan, and a stratified random population sample, in Wadena, MN. Subjects numbered 204 in Tanushimaru and 334 in Wadena. Body mass index (BMI), blood pressure, blood lipids, fasting plasma levels of glucose, glycosylated hemoglobin A(1c,) insulin, and free fatty acids were assessed. Overweight was defined as BMI of 27.5-29.9 kg/m(2) and obesity as BMI> or =30 kg/m(2). Gradual increases in risk factors were seen as BMI increased in both studies. Most risk factors were associated with glucose intolerance, except for BMI in Tanushimaru. In Wadena, glucose intolerance increased sharply among the obese. Adjustment for BMI attenuated the associations of cardiovascular risk factors with glucose intolerance in Wadena, but not in Tanushimaru. Obesity has an exaggerated influence on risk factors, compared with being overweight. The associations of glucose intolerance with cardiovascular risk factors are more affected by adjustment for BMI in Wadena than in Tanushimaru, not because of a different influence of body weight on risk factors between the two cities, but because obesity is rare in Japan.     

Dietary weight loss in insulin-resistant non-obese humans: Metabolic benefits and relationship to adipose cell size

Background and Aims

Overweight and obesity increase risk for diabetes and cardiovascular disease, largely through development of insulin resistance. Benefits of dietary weight loss are documented for obese individuals with insulin resistance. Similar benefits have not been shown in overweight individuals. We sought to quantify whether dietary weight loss improves metabolic risk profile in overweight insulin-resistant individuals, and evaluated potential mediators between weight loss and metabolic response.

超重和肥胖者血管内皮功能障碍的相关因素分析

目的探讨超重和肥胖者血管内皮功能障碍的相关因素.方法367例单纯超重和肥胖者,其中血管内皮功能正常组122例,血管内皮功能异常组245例.通过反应性充血时肱动脉内径变化,评估血管内皮功能,并对体脂含量和分布、血压、血糖、胰岛素、血脂、肌酐、尿酸和胰岛素抵抗指数(HOMA-IR)等指标进行测定,应用相关分析和多元线性回归方程分析血管内皮功能与上述指标的相关性.结果血管内皮功能异常组的腰围、腰臀比、餐后血糖、空腹胰岛素、餐后胰岛素和HOMA-IR均显著高于血管内皮功能正常组(P＜0.05～0.01).进一步分析表明内皮依赖性血管舒张功能与体重指数、腰围、腰臀比、空腹胰岛素及HOMA-IR呈负相关,其中腰臀比和空腹胰岛素是内皮依赖性血管舒张功能损伤的重要相关因素.结论单纯超重或肥胖人群中,向心性肥胖及空腹胰岛素水平升高是影响血管内皮功能的重要因素.     

Erosive esophagitis associated with metabolic syndrome,impaired liver function,and dyslipidemia

AIM:To investigate whether erosive esophagitis is correlated with metabolic syndrome and its components,abnormal liver function,and lipoprotein profiles.METHODS:We conducted a cross-sectional,case control study of subjects who underwent upper endoscopy during a health examination at the Health Management and Evaluation Center of a tertiary medical care facility located in Southern Taiwan.Metabolic syndrome components,body mass index(BMI),liver function,dyslipidemia,and cardiovascular risk factors,as defined by the ratio of total cholesterol to high-density lipoprotein cholesterol(HDL-C),and the ratio of low-density lipoprotein cholesterol to HDL-C were compared betweenindividuals with and without erosive esophagitis.Risk factors for erosive esophagitis were evaluated by multivariate logistic regression.RESULTS:Erosive esophagitis was diagnosed in 507of 5015 subjects who were individually age and sex matched to 507 esophagitis-free control subjects.In patients with erosive esophagitis,BMI,waist circumference,blood pressure,fasting plasma glucose,triglyceride levels,aspartate aminotransferase,alanine aminotransferase,the ratio of total cholesterol to HDL-C,and the ratio of low-density lipoprotein cholesterol to HDL-C were significantly higher and HDL-C was significantly lower compared to patients without erosive esophagitis(all P<0.05).In a multivariate analysis,central obesity(OR=1.38;95%CI:1.0-1.86),hypertension(OR=1.35;95%CI:1.04-1.76),hypertriglyceridemia(OR=1.34;95%CI:1.02-1.76),cardiovascular risk factors as defined by a ratio of total cholesterol to HDL-C>5(OR=1.45;95%CI:1.06-1.97),and aspartate aminotransferase(OR=1.59;95%CI:1.08-2.34)were significantly associated with erosive esophagitis.CONCLUSION:Metabolic syndrome,impaired liver function,and a higher ratio of total cholesterol to HDL-C were associated with erosive esophagitis.     

老年人群代谢异常与认知功能的相关性研究

目的对老年人群进行认知功能评定,探讨代谢异常因素对认知功能的影响,为老年痴呆的早防、早治提供依据。方法选择老年人群2315例,根据简易智能状态检查量表(MMSE),分为MMSE正常组(2283例)和MMSE异常组(32例),进行流行病学调查,检测身高、体重、腰臀围、血压、血脂、血糖等指标,并进行统计学分析。结果 MMSE异常组年龄、腰围、腰臀比、HDL-C、收缩压、空腹血糖明显高于MMSE正常组,差异有统计学意义(P<0.05)。中心性肥胖、超重或肥胖、HDL-C异常、高血压、空腹血糖升高人群MMSE评分明显低于对应正常人群,差异有统计学意义(P<0.05,P<0.01)。Pearson相关分析显示,体重指数、腰围、腰臀比、收缩压、空腹血糖与MMSE评分呈负相关,HDL-C与MMSE评分呈正相关。线性多元回归分析显示,MMSE评分与受教育程度、经济收入、吸烟、饮酒、年龄、腰围、收缩压、空腹血糖和HDL-C密切相关。结论老年人群的认知功能与年龄、受教育程度、吸烟及饮酒等密切相关,同时中心性肥胖、高血压、血脂异常及高血糖等代谢异常与认知功能障碍的受损程度亦密切相关。     

Serum insulin and inflammatory markers in overweight individuals with and without dyslipidemia

CONTEXT: The worldwide epidemic of overweight and obesity is setting the scene for a new wave of premature cardiovascular disease. OBJECTIVE: The objective of this study was to define relationships between dyslipidemia and other metabolic abnormalities in overweight subjects. DESIGN: This study included comparison of overweight subjects with and without dyslipidemia. SETTING: The setting was an institutional practice. PATIENTS: Dyslipidemic subjects (n = 715) had plasma triglyceride greater than or equal to the 75th percentile in combination with high-density lipoprotein cholesterol (HDL-C) less than or equal to the 25th percentile. Unrelated, normolipidemic controls (n = 1073) had HDL-C higher than the median and triglyceride lower than the median. It was a requirement for the control subjects to have a body mass index (BMI) greater than 25 kg/m(2). MAIN OUTCOME MEASURES: The main outcome measures included BMI, inflammatory markers, adipokines, blood pressure, and fasting plasma glucose and insulin. RESULTS: The mean BMI in the subjects and controls was 28.7 and 28.2 kg/m(2), respectively. Subjects had higher levels of plasma high-sensitivity C-reactive protein (3.0 vs. 2.0 mg/liter; P < 0.001), lower levels of adiponectin (4.7 vs. 6.6 mg/liter; P < 0.001), and, after adjustment for age, BMI, gender, smoking, statin, and beta-blocker use, higher systolic (P = 0.001) and diastolic (P = 0.05) blood pressures. Fasting plasma glucose, insulin, and homeostasis model of assessment-insulin resistance were all significantly higher in subjects than controls (P < 0.0001). CONCLUSIONS: Identification of people solely on the basis of an elevated plasma triglyceride and a low HDL-C uncovers an overweight group of people who have a generalized metabolic disorder. In contrast, overweight people with normal plasma lipids have normal glucose and insulin metabolism, low levels of inflammatory markers, and normal blood pressure. Such people may thus be at relatively low risk of developing diabetes and cardiovascular disease despite being overweight.     

Prevalence of cardiovascular risk factors in schoolchildren in a rural Georgia community

BACKGROUND: In the context of a national childhood obesity epidemic, this study sought to document the cardiovascular risk status of children in a rural Georgia community. METHODS: Anthropometrics and blood pressure were measured in 211 children, and fasting glucose and lipid profile in 160, recruited from schools in 2002 (grades 2 to 11, ages 7 to 18 years). RESULTS: Nearly half the schoolchildren (48%) were overweight or at risk of overweight; 15% had metabolic syndrome. Overweight children were at higher risk for metabolic syndrome and had more risk factors. Blood pressure: 19% had elevated systolic blood pressure; 4% had elevated diastolic blood pressure. Glycemia: 14% had impaired fasting glucose levels; no diabetes cases were detected. Lipid profile: 26% had high total cholesterol (>170 mg/dL), 20% had high low-density lipoprotein (>110 mg/dL), 13% had high triglycerides (>150 mg/dL), 43% had low high-density lipoprotein (females, <50 mg/dL; males, <40 mg/dL). Ethnicity, gender, and grade level were not predictive of risk except that fewer black children had low high-density lipoprotein, and blood pressure and body mass index increased with grade, as expected. CONCLUSIONS: Results from this study indicate a significant problem with overweight and cardiovascular risk in rural schoolchildren. Notably, younger children were just as likely to have risk factors as adolescents, suggesting that screening and intervention ought to begin by school age. Ethnic and gender differences in prevalence were not found, suggesting that contextual factors in a rural setting may outweigh demographic influences on risk.     

Clustering of silent cardiovascular risk factors in apparently healthy Hispanics

Ischaemic heart disease is one of the leading causes of cardiovascular morbidity and mortality. Because most factors leading to cardiovascular disease have a silent course, early screening is needed for prevention and for halting disease progression. In our centre, a programme was implemented in apparently healthy subjects for the early diagnosis and treatment of factors known to increment the risk of developing cardiovascular and metabolic disease. We present data from the first 153 individuals evaluated. The incidence of modifiable risk factors in our healthy population was as follows: overweight 33% (BMI: 25-30 kg/m(2)), obesity 45% (BMI >30 kg/m(2)), sedentarism 84%, arterial hypertension 15% (>140/90 mm Hg), hyperinsulinaemia 50%, glucose intolerance 14% (>160 mg/dl 120 min after 75 g glucose load), type 2 diabetes mellitus 5%, hypercholesterolaemia 50%, hypertriglyceridaemia 28%, and salt sensitivity 25%. Clustering of three or more cardiovascular risk factors was observed in 59% of the apparently healthy subjects. Obesity was associated with greater clustering of risk factors. The cardiovascular dysmetabolic syndrome was present in 72% of the obese individuals. These findings revealed a very high prevalence of cardiovascular risk factors in apparently healthy Hispanics. Even though these individuals were clinically asymptomatic, they are at increased risk for developing cardiovascular disease and type 2 diabetes mellitus. Mechanisms for the early detection and correction of modifiable risk factors in the healthy population must be implemented. Only through prevention will a reduction in the incidence of cardiovascular atherosclerotic disease and of type 2 diabetes mellitus be achieved.     

Differential impact of serum glucose, triglycerides, and high-density lipoprotein cholesterol on cardiovascular risk factor burden in nondiabetic, obese African American women: implications for the prevalence of metabolic syndrome

Metabolic syndrome (MetS) as defined by the Adult Treatment Panel (ATP) III criteria includes 3 metabolic parameters: serum glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C) measurements. However, the impact of each of the 3 metabolic parameters on cardiovascular disease (CVD) risk in African American women (AAW) is unknown. Therefore, we investigated CVD risk clusters associated with each of the 3 metabolic components of MetS in adult nondiabetic, overweight/obese AAW. We studied the clinical and metabolic CVD risk factors of 258 AAW (mean age, 42.4 ± 8.4 years; mean body mass index, 33.4 ± 8.0 (kg/m²). Fasting serum insulin, glucose, and C-peptide levels were obtained in each subject. Waist circumference and systolic and diastolic blood pressure were measured. Insulin sensitivity (Bergman minimal model method) and insulin resistance (homeostasis model assessment) were calculated. We examined the prevalence of MetS and its components associated with each of the 3 metabolic components (ie, serum glucose, HDL-C, and triglycerides) of the MetS as defined by ATP III. Worsening of any of the 3 metabolic parameters was associated with increasing waist circumference but not with age and body mass index nor with insulin, C-peptide, homeostasis model assessment of insulin resistance, and insulin sensitivity. As a group, the prevalence of MetS was 35.5% in our AAW. The prevalence of MetS increased 3-fold from first to third tertiles of serum glucose (14.1% and 42.3%, respectively). Worsening of serum HDL-C from tertiles 3 to 1 was associated with significant increases in the prevalence of MetS (1.2% vs 42.3%, respectively). Comparing first with third tertile of triglycerides, there was no significant increase in MetS in our AAW (7% vs 17%). Contrasting the 3 metabolic components, the prevalence of MetS was higher in the third tertile of glucose (43.2%) and first tertile of HDL-C (42.3%) and least with the third tertile of triglycerides (17%). In summary, each of the metabolic components of MetS was associated with different degrees of the clustering of CVD risk factors in AAW. We found that alterations in serum glucose and HDL-C were more predictive of MetS, each yielding approximately 40% of the prevalence of MetS in our nondiabetic, obese AAW. We found that triglycerides had the least impact on MetS in our AAW. We propose (1) that the 3 metabolic parameters for MetS defined by ATP III should be weighted differently with respect to their potential for CVD risks and perhaps outcomes and (2) that nondiabetic AAW in our third tertile of serum glucose (>100 mg/dL) and/or first tertile of HDL-C (<40 mg/dL) should be targeted for screening for MetS.     

Clinical diagnosis of metabolic and cardiovascular risks in overweight children: early development of chronic diseases in the obese child

Childhood overweight (body mass index (BMI)>90th centile) poses a major public health problem in so far as adult diseases manifest themselves already during childhood. In this review, after examining the prevalence of metabolic and cardiovascular diseases, the issue of whether BMI or other clinical parameters are valid tools to predict co-morbidities in children is discussed. Data of 2001-2008 are reviewed, including several studies conducted on more than 260,000 overweight and obese children in Germany and Switzerland. Apart from non-metabolic co-morbidities, namely musculoskeletal complications and attention deficit/hyperactivity disorders in up to 74% and up to 58% of overweight children, respectively, at least one cardiovascular and metabolic risk factor was seen in 52% of the overweight children, mostly high blood pressure (35%) with increased left ventricular mass or arterial stiffness. Signs of fatty liver disease or dyslipidemia were found in up to 29 and 32% of the children, respectively. Type 2 diabetes was found in less than 0.7% of the children, and an elevated fasting glucose or glucose intolerance in 3%. Irrespective of BMI, the quality of fat and protein intake predicted hypertension or insulin resistance, and fructose predicted lower (and more atherogenic) particle size of low-density lipoprotein-cholesterol. Out of the adiposity markers, waist circumference was closely correlated with insulin resistance and the components of the metabolic syndrome. In conclusion, risk factors are found in more than half of the overweight children, most frequently high blood pressure or dyslipidemia, and were mainly related to waist circumference, but also to BMI and fat mass. Even in the presence of normal BMI, screening for cardiovascular risk factors is advocated in each child with elevated waist circumference, but its cut-off points still remain to be validated. The increased occurrence of orthopedic and psychiatric complaints may detrimentally influence health-related lifestyle and obesity therapy.