Association of glucocorticoid receptor polymorphisms with clinical and metabolic profiles in polycystic ovary syndrome

OBJECTIVES:

We aimed to investigate whether glucocorticoid receptor gene polymorphisms are associated with clinical and metabolic profiles in patients with polycystic ovary syndrome. Polycystic ovary syndrome is a complex endocrine disease that affects 5-8% of women and may be associated with metabolic syndrome, which is a risk factor for cardiovascular disease. Cortisol action and dysregulation account for metabolic syndrome development in the general population. As glucocorticoid receptor gene (NR3C1) polymorphisms regulate cortisol sensitivity, we hypothesized that variants of this gene may be involved in the adverse metabolic profiles of patients with polycystic ovary syndrome.

METHOD:

Clinical, metabolic and hormonal profiles were evaluated in 97 patients with polycystic ovary syndrome who were diagnosed according to the Rotterdam criteria. The alleles of the glucocorticoid gene were genotyped. Association analyses were performed using the appropriate statistical tests.

RESULTS:

Obesity and metabolic syndrome were observed in 42.3% and 26.8% of patients, respectively. Body mass index was positively correlated with blood pressure, triglyceride, LDL-c, total cholesterol, glucose and insulin levels as well as HOMA-IR values and inversely correlated with HDL-c and SHBG levels. The BclI and A3669G variants were found in 24.7% and 13.4% of alleles, respectively. BclI carriers presented a lower frequency of insulin resistance compared with wild-type subjects.

CONCLUSION:

The BclI variant is associated with a lower frequency of insulin resistance in women with polycystic ovary syndrome. Glucocorticoid gene polymorphism screening during treatment of the syndrome may be useful for identifying subgroups of at-risk patients who would benefit the most from personalized treatment.     

385 C/A polymorphism of the fatty acid amide hydrolase gene is associated with metabolic syndrome in the Chinese Han population

Introduction

The endocannabinoid system participates in food intake, energy balance and lipid and glucose metabolism. The biological effects of cannabinoids are limited by the activation of the endocannabinoid degrading enzyme fatty acid amide hydrolase (FAAH). This study aims to analyse whether 385 C/A polymorphism of FAAH is associated with metabolic syndrome (MetS) in the Chinese Han population.

Material and methods

A total of 112 subjects at risk for MetS and 80 healthy controls from Fuzhou, China were genotyped for 385 C/A polymorphism of FAAH using TaqMan assay. Anthropometric measurements and biochemical assessments such as BMI, waist circumference, blood pressure, serum triglycerides (TG), serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, fasting plasma glucose, and plasma insulin levels were performed.

Results

CA and AA genotypes of FAAH had higher incidence in MetS subjects than in control subjects. CA and AA genotypes of FAAH in subjects with MetS had relatively elevated levels of waist circumference, body mass index, homeostasis model assessment of insulin resistance (HOMA-IR) and serum triglycerides, and lowered level of high-density lipoprotein cholesterol (HDL-c) compared with CC genotype in MetS subjects.

Conclusions

Results suggest that 385 C/A polymorphism of the FAAH gene may confer an increased risk of MetS in the Chinese Han population.     

Relationship between N-terminal pro-B-type natriuretic peptide levels and metabolic syndrome

Introduction

Previous studies have shown that obese individuals have reduced natriuretic peptide levels. But conflicting data exist on the relation of natriuretic peptide levels to other metabolic risk factors.

Material and methods

We investigated the relationship between plasma N-terminal pro-B-type natriuretic peptide levels (NT-proBNP) and metabolic syndrome (MetS) and metabolic risk factors in 469 patients free of heart failure. Two hundred thirty diagnosed MetS cases and 239 non-MetS cases were included in this study. Echocardiography examinations were performed and left ventricular mass index was calculated according to the Devereux correction formula. NT-proBNP was measured by electrochemiluminescence. The log-transformed NT-proBNP levels were used for abnormal distribution. Multiple linear regression analysis was performed to assess the association between levels of NT-proBNP and metabolic factors. Covariance analysis was used for group comparisons.

Results

Log NT-proBNP levels were independently related to age, gender, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, left ventricular mass index and left ventricular ejection fraction in multiple linear regression analysis (p < 0.05). Adjusted log NT-proBNP levels were lower in persons with MetS compared with those without MetS (p < 0.05). Individuals with hyperlipidaemia, elevated body mass index, diastolic blood pressure and fasting plasma glucose had lower levels of log NT-proBNP than those without MetS (p < 0.05).

Conclusions

There is a relationship between metabolic components and lower plasma NT-proBNP concentration. These findings raise the possibility that reduced plasma NT-proBNP levels are a manifestation of MetS, which might possess significant clinical and pathophysiological implications.     

Prevalence of metabolic syndrome and related factors in Taiwanese high-tech industry workers

OBJECTIVES:

In light of the increasing number of high-tech industry workers and the differences in their working conditions compared to those of the general population, the health status of these workers merits serious attention. This study aimed to explore the prevalence of metabolic syndrome and its correlates among Taiwanese high-tech industry workers.

METHODS:

This cross-sectional study included 4,666 workers who participated in labor health examinations at a hospital in southern Taiwan in 2008. Participants with metabolic syndrome were defined using the criteria proposed by the Taiwan National Department of Health in 2007. Factors associated with metabolic syndrome were determined using multiple logistic regression analysis.

RESULTS:

The overall prevalence of metabolic syndrome was 8.2%, and the prevalence was higher in men than in women (14.0% vs. 2.3%, p<0.01). Male gender, advanced age, elevated white blood count, and elevated levels of blood biochemistry markers, such as alanine aminotransferase and uric acid, can independently predict metabolic syndrome.

CONCLUSIONS:

The prevalence of metabolic syndrome among high-tech industry workers is lower than in the general population. Our study''s findings may facilitate early health assessments and the provision of proper workplace health promotion programs to reduce the risks faced by high-risk workers.     

Inter-arm blood pressure difference in type 2 diabetes: a barrier to effective management?

Background

Previous studies have identified a substantial prevalence of a blood pressure difference between arms in various populations, but not patients with type 2 diabetes. Recognition of such a difference would be important as a potential cause of underestimation of blood pressure.

Aim

To measure prevalence of an inter-arm blood pressure difference in patients with type 2 diabetes, and to estimate how frequently blood pressure measurements could be erroneously underestimated if an inter-arm difference is unrecognised.

Design of study

Cross-sectional study.

Setting

Five surgeries covered by three general practices, Devon, England.

Method

Patients with type 2 diabetes underwent bilateral simultaneous blood pressure measurements using a validated protocol. Mean blood pressures were calculated for each arm to derive mean systolic and diastolic differences, and to estimate point prevalence of predefined magnitudes of difference.

Results

A total of 101 participants were recruited. Mean age was 66 years (standard deviation [SD] = 13.9 years); 59% were male, and mean blood pressure was 138/79 mmHg (SD = 15/10 mmHg). Ten participants (10%; 95% confidence interval [CI] = 4 to 16) had a systolic inter-arm difference ≥10 mmHg; 29 (29%; 95% CI = 20 to 38) had a diastolic difference ≥5 mmHg; and three (3%; 95% CI = 0 to 6) a diastolic difference ≥10 mmHg. No confounding variable was observed to account for the magnitude of an inter-arm difference.

Conclusion

A systolic inter-arm difference ≥10 mmHg was observed in 10% of patients with diabetes. Failure to recognise this would misclassify half of these as normotensive rather than hypertensive using the lower-reading arm. New patients with type 2 diabetes should be screened for an inter-arm blood pressure difference.     

Exercise training prevents diastolic dysfunction induced by metabolic syndrome in rats

OBJECTIVE:

High fructose consumption contributes to the incidence of metabolic syndrome and, consequently, to cardiovascular outcomes. We investigated whether exercise training prevents high fructose diet-induced metabolic and cardiac morphofunctional alterations.

METHODS:

Wistar rats receiving fructose overload (F) in drinking water (100 g/l) were concomitantly trained on a treadmill (FT) for 10 weeks or kept sedentary. These rats were compared with a control group (C). Obesity was evaluated by the Lee index, and glycemia and insulin tolerance tests constituted the metabolic evaluation. Blood pressure was measured directly (Windaq, 2 kHz), and echocardiography was performed to determine left ventricular morphology and function. Statistical significance was determined by one-way ANOVA, with significance set at p<0.05.

RESULTS:

Fructose overload induced a metabolic syndrome state, as confirmed by insulin resistance (F: 3.6±0.2 vs. C: 4.5±0.2 mg/dl/min), hypertension (mean blood pressure, F: 118±3 vs. C: 104±4 mmHg) and obesity (F: 0.31±0.001 vs. C: 0.29±0.001 g/mm). Interestingly, fructose overload rats also exhibited diastolic dysfunction. Exercise training performed during the period of high fructose intake eliminated all of these derangements. The improvements in metabolic parameters were correlated with the maintenance of diastolic function.

CONCLUSION:

The role of exercise training in the prevention of metabolic and hemodynamic parameter alterations is of great importance in decreasing the cardiac morbidity and mortality related to metabolic syndrome.     

Physical and Mental Factors Associated with Obesity in Individuals with Mental Disorders Attending Psychiatric Day-Care Facilities

Background

Individuals with mental disorders have increased rates of obesity and metabolic syndrome. Here we evaluated factors influencing obesity in individuals with mental disorders who were attending psychiatric day-care facilities on an outpatient basis.

Methods

The subjects (n = 108) were outpatients attending hospital-based rehabilitation programs. We assessed body fat, weight, height, waist circumference, body mass index (BMI), blood pressure, Geriatric Depression Scale-15 (GDS) scores, frequency of day-care visits, satisfaction with body shape, physical comorbidity and lifestyle habits. Lifestyle habits were evaluated using Breslow''s health index based on health-related choices.

Results

The subjects were divided into 2 groups: obese group (BMI ≥ 25 kg/m²) and non-obese group (BMI < 25 kg/m²). The physical parameters and attributes of both groups were compared, and factors related to BMI were statistically analyzed. The prevalence of obesity was 47.2% in all patients, 42.4% in males and 54.8% in females. Weight, waist circumference, body fat and systolic and diastolic blood pressure were significantly higher in the obese group than in the non-obese group. Body fat, waist circumference, systolic blood pressure and diastolic blood pressure exhibited significant positive correlations with BMI, whereas the frequency of day-care visits, satisfaction with body shape, GDS score and Breslow''s health index exhibited significant negative correlations with BMI.

Conclusion

The present results showed that the prevalence of obesity was high in outpatients with mental disorders. Improvement in lifestyle choices is necessary to prevent obesity and the onset of metabolic syndrome in such patients.     

Aerobic exercise training induces metabolic benefits in rats with metabolic syndrome independent of dietary changes

OBJECTIVES:

We evaluated the effects of aerobic exercise training without dietary changes on cardiovascular and metabolic variables and on the expression of glucose transporter Type 4 in rats with metabolic syndrome.

METHODS:

Twenty male spontaneously hypertensive rats received monosodium glutamate during the neonatal period. The animals were allocated to the following groups: MS (sedentary metabolic syndrome), MS-T (trained on a treadmill for 1 hour/day, 5 days/week for 10 weeks), H (sedentary spontaneously hypertensive rats) and H-T (trained spontaneously hypertensive rats). The Lee index, blood pressure (tail-cuff system), insulin sensitivity (insulin tolerance test) and functional capacity were evaluated before and after 10 weeks of training. Glucose transporter Type 4 expression was analyzed using Western blotting. The data were compared using analysis of variance (ANOVA) (p<0.05).

RESULTS:

At baseline, the MS rats exhibited lower insulin sensitivity and increased Lee index compared with the H rats. Training decreased the body weight and Lee index of the MS rats (MS-T vs. MS), but not of the H rats (H-T vs. H). There were no differences in food intake between the groups. At the end of the experiments, the systolic blood pressure was lower in the two trained groups than in their sedentary controls. Whole-body insulin sensitivity increased in the trained groups. Glucose transporter Type 4 content increased in the heart, white adipose tissue and gastrocnemius muscle of the trained groups relative to their respective untrained groups.

CONCLUSION:

In conclusion, the present study shows that an isolated aerobic exercise training intervention is an efficient means of improving several components of metabolic syndrome, that is, training reduces obesity and hypertension and increases insulin sensitivity.     

Effect of vitamin E in nonalcoholic fatty liver disease with metabolic syndrome: A propensity score-matched cohort study

Background/Aims

Vitamin E improves the biochemical profiles and liver histology in nonalcoholic steatohepatitis, but the role of vitamin E is not clearly defined in the management of nonalcoholic fatty liver disease (NAFLD) which includes both simple steatosis and steatohepatitis. Co-morbid metabolic syndrome increases the probability of steatohepatitis in NAFLD. In this study, we aimed to determine the short-term effects of vitamin E and off-treatment durability of response in a propensity-score matched cohort of NAFLD patients with metabolic syndrome.

Methods

A retrospective cohort was constructed by retrieving 526 consecutive NAFLD patients from the electronic medical record data warehouse of a tertiary referral hospital in South Korea. Among them, 335 patients (63.7%) had metabolic syndrome and were eligible for vitamin E therapy. In order to assess the effect of vitamin E, propensity score matching was used by matching covariates between control patients (n=250) and patients who received vitamin E (n=85).

Results

The PS-matched vitamin E group (n=58) and control group (n=58) exhibited similar baseline metabolic profiles. After 6 months of vitamin E therapy, the mean ALT levels decreased significantly compared to PS-matched control (P<0.01). The changes in metabolic profiles (body weight, lipid and glucose levels) did not differ between control and vitamin E groups during the study period.

Conclusions

Short-term vitamin E treatment significantly reduces ALT levels in NAFLD patients with metabolic syndrome, but metabolic profiles are not affected by vitamin E.     

Metabolic syndrome in Tunisian bipolar I patients

Background

The metabolic syndrome is a growing global public health problem which is frequently associated with psychiatric illness.

Objectives

To evaluate the prevalence of metabolic syndrome and to study its profile in Tunisian bipolar I patients.

Methods

Our study included 130 patients with bipolar I disorder diagnosed according to the DSM-IV and assessed for metabolic syndrome according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria. The mean age was 37.9 ±12.1 years, 45 were women (mean age 37.5±13.4 years) and 85 were men (mean age 38.1 ± 11.4 years).

Results

The prevalence of metabolic syndrome was 26.1%.The highest prevalence of this syndrome was obtained by association between obesity, low c-HDL and hypertriglyceridemia (44.1%). In the total sample, 59.2% met the criteria for low c-HDL, 53.1% for hypertriglyceridemia, 33.8% for obesity, 16.1% for high fasting glucose and 5.4% for hypertension. Gender, age, illness episode and treatment were not significantly associated with metabolic syndrome, while patients under lithium had higher prevalence of metabolic syndrome than those under valproic acid, carbamazepine or antipsychotics. Patients with metabolic syndrome had significant higher levels of HOMA-IR and uric acid than metabolic syndrome free patients (p< 0.001).

Conclusions

Bipolar patients have high prevalence of metabolic syndrome which is associated with insulin resistance and an increase of uric acid values that raise the risk of cardiovascular disease.     

Association of visceral fat and risk factors for metabolic syndrome in children and adolescents

Purpose

Visceral fat (VF) is closely associated with many metabolic risk factors and is also known to be a strong predictive factor for severe metabolic complications in adults. But there are only a few studies concerning the association of VF and risk factors for metabolic syndrome (MS) in children and adolescents. In our study, we emphasized the association of VF [measured by VF computed tomography (VFCT)] and risk factors for metabolic syndrome in children and adolescents.

Materials and Methods

The subjects were outpatients aged 6 to 18 years who underwent VFCT in the family medicine of The Catholic University of Korea from January 2005 to August 2009. There were 82 patients in total (42 children, 40 adolescents). Height, weight, blood pressure (BP), blood tests, body composition analysis and VF were measured. The three groups were also classified by metabolic score.

Results

In children, only high density lipoprotein cholesterol (HDL-C) showed a statistically significant difference, while in adolescents, triglyceride, HDL-C, BP, body mass index (BMI), waist circumference (WC) and VFA showed statistically significant differences. In terms of VFA, fasting glucose, BP, BMI, basal metabolic rate (BMR) and WC showed statistically significant differences. BMI showed a statistically significant difference in terms of BP, BMR, WC, VFA and HDL-C.

Conclusion

There is a need to acknowledge the statistically significant associations of VF and risk factors for MS in children and adolescents. Screening tests for BP, cholesterol, fasting glucose and WC should be given in clinics for children and adolescents so that MS can be detected and its risk factors treated early.     

Day/Night Rhythm of Hemostatic Factors in Obstructive Sleep Apnea

Study Objectives:

To investigate the hypothesis that day/night patterns of prothrombotic activity differ between patients with obstructive sleep apnea (OSA) and individuals with no OSA.

Design:

Prothrombotic markers'' day/night rhythms recorded over one 24-h period.

Setting:

General clinical research center.

Patients:

38 untreated OSA patients as verified by polysomnography (apnea-hypopnea index ≥10/h sleep) and 22 non-OSA controls.

Measurements and Results:

Blood samples were collected every 2 h to measure plasma levels of fibrinolysis-inhibiting plasminogen activator inhibitor (PAI)-1 and the primary fibrin degradation product D-dimer. Day/night variation in hemostasis factors was examined using a cosinor analysis. Mesor (mean) PAI-1 over the 24-h period was higher (P = 0.015), and mesor of D-dimer was lower (P = 0.001) in patients with OSA than in the non-OSA controls. These group differences stayed significant when controlling for age and gender. After further adjustment for body mass index, mean arterial pressure, and smoking, the relationship between OSA and PAI-1 became non-significant, but the relationship between OSA and D-dimer continued to be significant (P = 0.006). In the fully adjusted analysis, the amplitude (peak) for D-dimer was lower in OSA patients than in non-OSA controls (P = 0.048). The acrophase (time of the peak) for PAI-1 and D-dimer did not significantly differ between groups.

Conclusions:

The relatively higher average level of PAI-1 and lower average level of D-dimer across the 24-h in OSA patients might reflect decreased fibrinolytic capacity and fibrin degradation, respectively. The findings provide some evidence for a prothrombotic state in OSA, but were only partially independent of metabolic variables.

Citation:

von Käanel R; Natarajan L; Ancoli-Israel S; Mills PJ; Loredo JS; Dimsdale JE. Day/night rhythm of hemostatic factors in obstructive sleep apnea. SLEEP 2010;33(3):371-377.     

Body Mass Index-Independent Metabolic Alterations in Narcolepsy with Cataplexy

Study Objectives:

To contribute to the anthropometric and metabolic phenotyping of orexin-A–deficient narcoleptic patients, and to explore a possible risk of their developing a metabolic syndrome.

Design:

We performed a cross-sectional study comparing metabolic alterations in patients with narcolepsy with cataplexy (NC) and patients with idiopathic hypersomnia without long sleep time.

Setting:

University hospital.

Patients:

Fourteen patients with narcolepsy with cataplexy and 14 sex and age-matched patients with idiopathic hypersomnia without long sleep time.

Interventions:

N/A.

Measurements and results:

Metabolic parameters were evaluated by measuring body mass index (BMI), waist circumference (also with abdominal computed tomography), blood pressure, and daily calorie intake (3-day diary). Chronotypes were assessed through the morningness-eveningness questionnaire. Lumbar puncture for cerebrospinal fluid orexin-A determination and HLA typing were performed. Patients with narcolepsy with cataplexy (all HLA DQB1*0602 positive and with cerebrospinal fluid orexin-A levels < 110 pg/mL) had a higher BMI and BMI-independent metabolic alterations, namely waist circumference, high-density lipoprotein cholesterol, and glucose/insulin ratio (an insulin resistance index), with respect to patients with idiopathic hypersomnia without long sleep time (cerebrospinal fluid orexin-A levels > 300 pg/mL). Despite lower daily food intake, patients with narcolepsy with cataplexy displayed significant alterations in metabolic parameters resulting in a diagnosis of metabolic syndrome in more than half the cases.

Conclusions:

BMI-independent metabolic alterations and the relative hypophagia of patients with narcolepsy with cataplexy, as compared with patients with idiopathic hypersomnia without long sleep time, suggest that orexin-A influences the etiology of this phenotype. Moreover, considering that these dysmetabolic alterations are present from a young age, a careful metabolic follow-up of patients diagnosed with narcolepsy with cataplexy is mandatory.

Citation:

Poli F; Plazzi G; Dalmazi GD; Ribichini D; Vicennati V; Pizza F; Mignot E; Montagna P; Pasquali R; Pagotto U. Body mass index-independent metabolic alterations in narcolepsy with cataplexy. SLEEP 2009;32(11):1491-1497.     

Sleep symptoms predict the development of the metabolic syndrome

Background:

Sleep complaints are highly prevalent and associated with cardiovascular disease (CVD) morbidity and mortality. This is the first prospective study to report the association between commonly reported sleep symptoms and the development of the metabolic syndrome, a key CVD risk factor.

Methods:

Participants were from the community-based Heart Strategies Concentrating on Risk Evaluation study. The sample was comprised of 812 participants (36% African American; 67% female) who were free of metabolic syndrome at baseline, had completed a baseline sleep questionnaire, and had metabolic syndrome evaluated 3 years after baseline. Apnea-hypopnea index (AHI) was measured cross-sectionally using a portable monitor in a subset of 290 participants. Logistic regression examined the risk of developing metabolic syndrome and its components according to individual sleep symptoms and insomnia syndrome.

Results:

Specific symptoms of insomnia (difficulty falling asleep [DFA] and “unrefreshing” sleep), but not a syndromal definition of insomnia, were significant predictors of the development of metabolic syndrome. Loud snoring more than doubled the risk of developing the metabolic syndrome and also predicted specific metabolic abnormalities (hyperglycemia and low high-density lipoprotein cholesterol). With further adjustment for AHI or the number of metabolic abnormalities at baseline, loud snoring remained a significant predictor of metabolic syndrome, whereas DFA and unrefreshing sleep were reduced to marginal significance.

Conclusion:

Difficulty falling asleep, unrefreshing sleep, and, particularly, loud snoring, predicted the development of metabolic syndrome in community adults. Evaluating sleep symptoms can help identify individuals at risk for developing metabolic syndrome.

Citation:

Troxel WM; Buysse DJ; Matthews KA; Kip KE; Strollo PJ; Hall M; Drumheller O; Reis SE. Sleep symptoms predict the development of the metabolic syndrome. SLEEP 2010;33(12):1633-1640.     

ApoE polymorphism may determine low-density lipoprotein cholesterol level in association with obesity and metabolic syndrome in postmenopausal Korean women

Purpose

We investigated how serum low-density lipoprotein (LDL) level is related to various isoforms of apolipoprotein (ApoE) polymorphism in association with obesity and metabolic syndrome.

Materials and Methods

We gathered total 332 sample of postmenopausal Korean women and analyzed ApoE isoforms, serum lipid level including LDL, blood pressure, fasting glucose, and anthropometry. The relationship between ApoE isoforms and serum lipid level, metabolic syndrome, and obesity was investigated.

Results

Six ApoE isoforms were found, ApoE2 [E2/2 (n=1), E2/3 (n=54), E2/4 (n=14)], ApoE3 (E3/3, n=200), ApoE4 [E3/4 (n=55), and E4/4 (n=8)]. The prevalence of metabolic syndrome and obesity showed higher ApoE3 isoform than that of other isoforms. In additon, ApoE3 isoform was related to higher serum LDL and total cholesterol level than to ApoE2 isoform. The odds ratio of having the highest LDL cholesterol quartile in ApoE3 with obesity, compared to ApoE2 without obesity, was 3.46 [95% confidence interval (CI); 1.07-11.14, p=0.037], and odds ratio of ApoE3 with metabolic syndrome compared to ApoE2 without metabolic syndrome was 5.06 (95% CI; 1.14-22.29, p=0.037). Serum LDL cholesterol was positively associated with obesity or metabolic syndrome in ApoE3 isoform.

Conclusion

This study suggests that obesity or metabolic syndrome risk should be effectively managed in ApoE3 isomform groups to reduce serum LDL in postmenopausal Korean women.     

Identification of Cardiometabolic Risk Among Collegiate Football Players

Context:

Excessive fat mass clearly has adverse effects on metabolic processes that can ultimately lead to the development of chronic disease. Early identification of high-risk status may facilitate referral for definitive diagnostic tests and implementation of interventions to reduce cardiometabolic risk.

Objective:

To document the prevalence of metabolic syndrome among collegiate football players and to develop a clinical prediction rule that does not require blood analysis to identify players who may possess a high level of cardiometabolic risk.

Design:

Cross-sectional cohort study.

Setting:

University athletic training research laboratory.

Patients or Other Participants:

Sixty-two National Collegiate Athletic Association Division I Football Championship Subdivision football players (age  =  19.9 ± 1.2 years, height  =  182.6 ± 6.1 cm, mass  =  97.4 ± 18.3 kg).

Main Outcome Measure(s):

Anthropometric characteristics associated with body fat, isokinetic quadriceps strength, and biometric indicators associated with metabolic syndrome were measured. Participants were classified as high risk or low risk for future development of type 2 diabetes and cardiovascular disease.

Results:

The prevalence of metabolic syndrome in the cohort was 19% (12 of 62), and 79% (49 of 62) of the players exceeded the threshold for 1 or more of its 5 components. A 4-factor clinical prediction rule that classified individuals on the basis of waist circumference, blood pressure, quadriceps strength, and ethnic category had 92% sensitivity (95% confidence interval  =  65%, 99%) and 76% specificity (95% confidence interval  =  63%, 86%) for discrimination of high-risk or low-risk status.

Conclusions:

The risk for developing type 2 diabetes and cardiovascular disease appears to be exceptionally high among collegiate football players. A lack of race-specific criteria for the diagnosis of metabolic syndrome almost certainly contributes to an underestimation of the true level of cardiometabolic risk for African American collegiate football players.     

Application of alternative anthropometric measurements to predict metabolic syndrome

OBJECTIVE:

The association between rarely used anthropometric measurements (e.g., mid-upper arm, forearm, and calf circumference) and metabolic syndrome has not been proven. The aim of this study was to assess whether mid-upper arm, forearm, calf, and waist circumferences, as well as waist/height ratio and waist-to-hip ratio, were associated with metabolic syndrome.

METHODS:

We enrolled 387 subjects (340 women, 47 men) who were admitted to the obesity outpatient department of Istanbul Medeniyet University Goztepe Training and Research Hospital between September 2010 and December 2010. The following measurements were recorded: waist circumference, hip circumference, waist/height ratio, waist-to-hip ratio, mid-upper arm circumference, forearm circumference, calf circumference, and body composition. Fasting blood samples were collected to measure plasma glucose, lipids, uric acid, insulin, and HbA1c.

RESULTS:

The odds ratios for visceral fat (measured via bioelectric impedance), hip circumference, forearm circumference, and waist circumference/hip circumference were 2.19 (95% CI, 1.30-3.71), 1.89 (95% CI, 1.07-3.35), 2.47 (95% CI, 1.24-4.95), and 2.11(95% CI, 1.26-3.53), respectively. The bioelectric impedance-measured body fat percentage correlated with waist circumference only in subjects without metabolic syndrome; the body fat percentage was negatively correlated with waist circumference/hip circumference in the metabolic syndrome group. All measurements except for forearm circumference were equally well correlated with the bioelectric impedance-measured body fat percentages in both groups. Hip circumference was moderately correlated with bioelectric impedance-measured visceral fat in subjects without metabolic syndrome. Muscle mass (measured via bioelectric impedance) was weakly correlated with waist and forearm circumference in subjects with metabolic syndrome and with calf circumference in subjects without metabolic syndrome.

CONCLUSION:

Waist circumference was not linked to metabolic syndrome in obese and overweight subjects; however, forearm circumference, an unconventional but simple and appropriate anthropometric index, was associated with metabolic syndrome and bioelectric impedance-measured visceral fat, hip circumference, and waist-to-hip ratio.     

Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review

Background

Patients with high blood pressure (hypertension) in the community frequently fail to meet treatment goals: a condition labelled as ‘uncontrolled’ hypertension. The optimal way to organise and deliver care to hypertensive patients has not been clearly identified.

Aim

To determine the effectiveness of interventions to improve control of blood pressure in patients with hypertension.

Design of study

Systematic review of randomised controlled trials.

Setting

Primary and ambulatory care.

Method

Interventions were categorised as following: self-monitoring; educational interventions directed to the patient; educational interventions directed to the health professional; health professional- (nurse or pharmacist) led care; organisational interventions that aimed to improve the delivery of care; and appointment reminder systems. Outcomes assessed were mean systolic and diastolic blood pressure, control of blood pressure and proportion of patients followed up at clinic.

Results

Seventy-two RCTs met the inclusion criteria. The trials showed a wide variety of methodological quality. Self-monitoring was associated with net reductions in systolic blood pressure (weighted mean difference [WMD] −2.5mmHg, 95%CI = −3.7 to −1.3 mmHg) and diastolic blood pressure (WMD −1.8mmHg, 95%CI = −2.4 to −1.2 mmHg). An organised system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure and all-cause mortality in a single large randomised controlled trial.

Conclusion

Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. Self-monitoring is a useful adjunct to care while reminder systems and nurse/pharmacist -led care require further evaluation.     

A comparison of predictability of cardiovascular events between each metabolic component in patients with metabolic syndrome based on the revised National Cholesterol Education Program criteria

Purpose

The prevalence of metabolic syndrome (MetS) generally varies depending on its diagnostic definition, and many different definitions inevitably lead to substantial confusion and lack of comparability between studies. Despite extensive research, there is still no gold standard for the definition of MetS, which continues to be a matter of debate. In this study, we investigate whether and to what extent its individual components are related to the risk of cardiovascular disease (CVD) in Korean population.

Materials and Methods

We used data from the 2005 Korea National Health and Nutrition Examination Survey, which is a nationally representative survey of the noninstitutionalized civilian population. The study sample consisted of 1,406 Korean adults (587 men, 819 women) who were diagnosed with MetS based on the revised National Cholesterol Education Program (NCEP) criteria. Central obesity is defined as a waist circumference cutoff point reported in Asia-Pacific criteria for obesity based on waist circumference by the World Health Organization. CVD was defined as presence of stroke, myocardial infarction, or angina pectoris on a medical history questionnaire.

Results

The CVD prevalence among the subjects was 6.8% for men and 8.6% for women. Besides age, the components of MetS showing a significant difference in the number of CVD events were high fasting glucose (FG) in men and high blood pressure (BP) and high FG in women. After adjusting for gender and age, high FG was shown to yield a significant difference (odds ratio: unadjusted 2.08, adjusted 1.81), alone among all MetS components. However, after adjusting for only age, no significant difference was found.

Conclusion

Fasting glucose level is the highest predicting factor for CVD in Korean patients with MetS based on the revised NECP definition.