Dieta mediterránea hipocalórica y factores de riesgo cardiovascular: análisis transversal de PREDIMED-Plus

Introduction and objectivesThe cardiovascular benefits of the Mediterranean diet have usually been assessed under assumptions of ad libitum total energy intake (ie, no energy restriction). In the recently launched PREDIMED-Plus, we conducted exploratory analyses to study the baseline associations between adherence to an energy-restricted Mediterranean diet (MedDiet) and the prevalence of cardiovascular risk factors (CVRF).MethodsCross-sectional assessment of all PREDIMED-Plus participants (6874 older adults with overweight/obesity and metabolic syndrome) at baseline. The participants were assessed by their usual primary care physicians to ascertain the prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidemia). A 17-point PREDIMED-Plus score was used to measure adherence to the MedDiet. Multivariable models were fitted to estimate differences in means and prevalence ratios for individual and clustered CVRF.ResultsBetter adherence to a MedDiet pattern was significantly associated with lower average triglyceride levels, body mass index, and waist circumference. Compared with low adherence (≤ 7 points in the 17-point score), better adherence to the MedDiet (11-17 points) showed inverse associations with hypertension (prevalence ratio = 0.97; 95%CI, 0.94-1.00) and obesity (prevalence ratio = 0.96; 95%CI, 0.92-1.00), but positive associations with diabetes (prevalence ratio = 1.19; 95%CI, 1.07-1.32). Compared with the lowest third of adherence, women in the upper third showed a significantly lower prevalence of the clustering of 3 or more CVRF (prevalence ratio = 0.91; 95%CI, 0.83-0.98).ConclusionsAmong participants at high cardiovascular risk, better adherence to a MedDiet showed significant inverse associations with CVRF among women, and improved lipid profiles and adiposity measures.This trial was registered in 2014 at the International Standard Randomized Controlled Trial Registry (ISRCTN89898870).     

Systemic and vascular markers of inflammation in relation to metabolic syndrome and insulin resistance in adults with elevated atherosclerosis risk

ObjectiveIn recent years high sensitive C-reactive protein (hsCRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular cell adhesion molecule-1 (sICAM-1), fibrinogen, and plasminogen activator inhibitor-1 (PAI-1) were recognized as risk factors for cardiovascular disease (CVD). The aim of the present study was to investigate the relationship between these vascular and systemic markers of low-grade inflammation and traditional risk factors, the metabolic syndrome (MetS) or insulin resistance (IR).Methods and resultsIn 137 adults (41–78 years) with at least 2 risk factors for atherosclerosis the following parameters were determined: hsCRP, sVCAM-1, sICAM-1, PAI-1, fibrinogen, waist circumference (WC), blood pressure, Body Mass Index (BMI), fasting serum glucose (FSG), insulin, triglycerides (TG), total cholesterol (TC), LDL, and HDL. The presence or absence of MetS according to the AHA/NHLBI Scientific Statement criteria was assessed. IR was defined using the homeostasis model (HOMA-IR). Subjects with MetS had significantly higher values of hsCRP, sICAM-1, sVCAM-1, PAI-1, fibrinogen (each P < 0.05) and lower HDL-levels (P < 0.05) compared with subjects without MetS. Similar results were found using HOMA-IR-quartiles. Subjects in the bottom quartile (HOMA-IR ≤ 1.32) had significantly lower levels of hsCRP, sVCAM-1, sICAM-1, and PAI-1 (each P < 0.05) than subjects in the top quartile (HOMA-IR ≥ 5.03). HDL was significantly higher (P < 0.05) in subjects in the lowest quartile versus those in the highest quartile. Incidentally we found no significant differences in total and LDL cholesterol among MetS, HOMA, and traditional CVD risk factor groups, respectively.ConclusionSystemic and vascular markers of inflammation showed significant associations with IR and the MetS and may be incorporated into traditional CVD risk prediction models. Such models should be established and validated in forthcoming large scale prospective studies on CVD risk.     

Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk

Background and aimIt has been suggested that overall dietary patterns and not single nutrients should be studied, since food items might have a synergistic and antagonistic effect on health. The Mediterranean diet has long been associated with lower incidence of cardiovascular disease and cancer. Therefore, we developed a diet score that incorporates the inherent characteristics of this dietary pattern.Methods and resultsWe used 11 main components of the Mediterranean diet (non-refined cereals, fruits, vegetables, potatoes, legumes, olive oil, fish, red meat, poultry, full fat dairy products and alcohol). For the consumption of items presumed to be close to this pattern we assigned scores 0, 1, 2, 3, 4 and 5 when a participant reported no consumption, rare, frequent, very frequent, weekly and daily, respectively. For the consumption of foods presumed to be away from this pattern we assigned the scores on a reverse scale. Especially for alcohol, we assigned score 5 for consumption of less than 300 ml/day, score 0 for consumption of more than 700 ml/day or none and scores 1–4 for consumption of 300–400, 400–500, 500–600, and 600–700 ml/day (100 ml = 12 g ethanol), respectively. Then a total score ranging from 0 to 55 was calculated. After having applied this diet score in the participants of the ATTICA study we observed a significant positive association with monounsaturated fat and monounsaturated-to-saturated fat intake. We also observed, an inverse association with serum lipids, blood pressures, inflammation and coagulation markers related to cardiovascular disease. The application of that score in a case–control study (CARDIO2000) suggested that the score was inversely associated with the odds of having acute coronary syndromes.ConclusionThe Mediterranean diet score proposed above may be useful in assessing the nutritional status of an individual and investigating the relationship of the Mediterranean diet with various health outcomes.     

Effect of the Mediterranean diet on plasma adipokine concentrations in men with metabolic syndrome

ObjectiveWhile a Mediterranean dietary pattern (MedDiet) has been associated with favorable changes in several features of metabolic syndrome (MetS), its impact on plasma adipokine concentrations remains largely unknown. The objective of this study was to determine the impact of the MedDiet consumed under controlled feeding conditions, without (? WL) and with weight loss (+ WL), on plasma adipokine concentrations in adult men with MetS (NCEP-ATP III).Materials/MethodsThe diet of 26 men with MetS (age 24 to 62 yrs) was first standardized to a North American control diet for 5 weeks. Participants then consumed a pre-determined MedDiet for 5 weeks. Both diets were consumed under weight-maintaining isoenergetic feeding conditions. Participants then underwent a 20-week free-living caloric restriction period, after which they consumed the MedDiet again in weight stabilizing, isoenergetic feeding conditions.ResultsBody weight was reduced by 10.2% ± 2.9% and waist circumference by 8.6 ± 3.3 cm after the weight loss period and stabilization on MedDiet (P < 0.001). MedDiet ? WL had no impact on plasma concentrations of leptin, plasminogen activator inhibitor-1, resistin, visfatin, acylation stimulating protein and adiponectin. MedDiet + WL reduced plasma leptin concentrations (P < 0.01) and increased plasma adiponectin concentrations (P < 0.05) compared with the control diet and MedDiet ? WL.ConclusionData from this nutritionally controlled study suggest that short-term consumption of MedDiet has little effect on the concentrations of many adipokines in the absence of weight loss.     

Hematological parameters and metabolic syndrome: Findings from an occupational cohort in Ethiopia

AimsTo examine associations between hematological parameters (i.e., hemoglobin, hematocrit, platelet counts, red blood cell (RBC), and white blood cell (WBC) counts) and components of metabolic syndrome (MetS) among working adults in Addis Ababa, Ethiopia.Materials and MethodsParticipants were 1868 (1131 men and 737 women) working Ethiopian adults. MetS was classified according to the International Diabetes Federation criterion. Odds ratios (ORs) and 95% confidence intervals (95% CIs) of MetS were calculated using logistic regression procedures.ResultsHematologic parameters (hemoglobin, hematocrit, and RBC) were positively associated with MetS components (P_trend < 0.05). In both men and women, white blood cell (WBC) counts were positively associated with BMI and waist circumference (P < 0.05). RBC counts were associated with diastolic blood pressure in men (P < 0.05) and women (P < 0.001). Men in the third quartile of hemoglobin concentrations had 2-fold increased odds (OR = 1.99; 95% CI) of MetS compared with the lowest reference quartile (P_trend = 0.031) while women in the fourth hemoglobin quartile had 2.37-fold increased odds of having MetS compared with the reference group (P_trend = 0.003). Both men and women in the fourth quartiles of RBC counts had 2.26-fold and 3.44-fold increased odds of MetS (P = 0.002 in men, P < 0.001 in women). Among women, those in the fourth quartiles of hematocrit and platelet counts had 2.53-fold and 2.01-fold increased odds of MetS as compared with those in the reference group (P_trend = 0.004 and 0.065 respectively).ConclusionOur study findings provide evidence in support of using hematological markers for early detection of individuals at risk for cardiovascular disease.     

Serum bilirubin as a predictor of incident metabolic syndrome: A 4-year retrospective longitudinal study of 6205 initially healthy Korean men

AimSerum bilirubin is an endogenous antioxidant with anti-inflammatory properties. Several cross-sectional studies have reported that bilirubin was negatively associated with oxidative stress-mediated diseases, including the metabolic syndrome (MetS). However, the clinical relevance of bilirubin as a risk factor for incident MetS remains controversial. For this reason, the longitudinal effects of baseline serum bilirubin concentrations on incident MetS were evaluated in Korean men.MethodsThis 4-year retrospective longitudinal observational study involved 6205 Korean men without MetS. Subjects underwent routine health examinations in 2007 and returned for a follow-up examination in 2011. Baseline serum bilirubin concentrations were determined using the vanadate oxidation method.ResultsDuring the 4-year period, 936 cases of incident MetS (15.1%) were identified. Its incidence decreased across baseline bilirubin quartile categories (P < 0.001), with an odds ratio (OR) for developing MetS being significantly lower in the highest quartile group (≥ 1.40 mg/dL) compared with the lowest (≤ 0.90 mg/dL) after adjusting for all confounding variables [OR = 0.70, 95% confidence interval (CI) 0.54–0.90; P for trend = 0.019]. Among individual components of MetS, bilirubin was found to be negatively associated with only the risk of incident hypertriglyceridaemia. The OR (95% CI) for incident hypertriglyceridaemia in the highest vs lowest quartile was 0.75 (0.61–0.91; P for trend = 0.002).ConclusionSerum total bilirubin level was negatively associated with incidence of MetS in healthy Korean men over a 4-year period.     

Adherence to Mediterranean diet and anthropometric and metabolic parameters in an observational study in the 'Alto Molise' region: the MOLI-SAL project

Background and aimsThe Mediterranean diet is reportedly a healthy eating pattern with protective effects on chronic diseases. The aim of this study was to assess the relationship between adherence to the Mediterranean diet and anthropometric and metabolic variables in a rural setting in southern Italy, in the context of a health screening initiative.Methods and resultsFive hundred and twenty-two healthy participants from the “Alto Molise” region in southern Italy were studied. Blood pressure, glucose, and total cholesterol were measured using automatic devices. Food intake was evaluated with a semi-quantitative food-frequency questionnaire, and the Mediterranean adequacy index (MAI) was calculated. The median value of MAI in the population studied was 3.0 (1.5–5.4) in men and 2.4 (1.2–5.1) in women.In women, the stronger contributors to MAI were dairy products (42.5%), sweets (29.3%) and meat (19.4%), while in men they were cereals (39.1%), meat (18.6%), dairy products (16.9%) and sweets (16.1%). In multiple linear regression analysis MAI was positively associated with age in both sexes (P = 0.0044 in men and P = 0.0054 in women) and with systolic blood pressure in women (P = 0.012). After stratification of women by age, systolic blood pressure was significantly associated with MAI only in older persons (P = 0.040) but not at younger ages (interaction effect P < 0.0001).ConclusionsAdherence to the Mediterranean diet depends on age, possibly because in younger people the traditional Mediterranean style diet is decreasing, even in rural areas of southern Italy. Age also influences the association between MAI and metabolic variables such as systolic blood pressure in women.     

The role of serum adipocyte fatty acid-binding protein on the development of metabolic syndrome is independent of pro-inflammatory cytokines

Background and aimAdipocyte fatty acid-binding protein (FABP4) is abundantly expressed in adipocytes and plays a role in glucose homeostasis. We analysed the relationship between serum FABP4 levels and the progression of metabolic syndrome in healthy adults.Methodsand resultsA total of 465 subjects were selected from participants in a medical check-up programme at a Health Promotion Center. Baseline serum FABP4 levels were measured, and the subjects were evaluated for the presence of metabolic syndrome (MetS) according to the recommendations of the American Heart Association/National Heart, Lung, and Blood Institute. The subjects were re-evaluated 4 years later.Baseline FABP4 concentrations were significantly higher in subjects with MetS than in those without MetS (P < 0.001). At the 4-year follow-up, subjects in the highest FABP4 tertile at baseline exhibited higher values for body mass index, fat mass and percent body fat, as well as blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, insulin, homeostasis model assessment of insulin resistance, monocyte chemoattractant protein-1 and tumor necrosis factor-α levels (all P < 0.05). The subjects with higher FABP4 levels had lower HDL-cholesterol concentrations (P < 0.05). After adjustment for age, sex, change in percent body fat and baseline values for other metabolic and inflammatory parameters, FABP4 levels at baseline were shown to be strongly associated with the development of MetS by year 4 (odds ratio (OR), 5.75; 95% confidence interval (CI), 2.71–12.23 for highest tertile vs. lowest tertile, P < 0.001)ConclusionBaseline serum FABP4 levels appear to be a significant predictor for the future development of MetS, independent of pro-inflammatory cytokines.     

Low sensitivity for the metabolic syndrome to detect uric acid elevations in females and non-Hispanic-black male adolescents: an analysis of NHANES 1999-2006

BackgroundUric acid is tightly linked to the metabolic syndrome (MetS) and among adults higher uric acid levels are associated with future risk for diabetes, cardiovascular disease, hypertension and renal disease.ObjectiveEvaluate the sensitivity of MetS to identify adolescents with elevated uric acid levels on a race/ethnicity and gender-specific basis.MethodsWe evaluated 3296 male and female adolescents 12–19 y participating in the National Health and Nutrition Evaluation Survey 1999–06, comprised of 67.6% non-Hispanic whites, 15.1% non-Hispanic blacks, and 17.3% Hispanics. We used a definition of MetS modified for use in adolescents and evaluated the sensitivity of a diagnosis of MetS to identify individuals with uric acid elevations (approximately the 95th percentile of uric acid by gender among normal-weight adolescents).ResultsWhen used as a screening test to identify individuals with uric acid elevations MetS performed more poorly among females (18.0%) than among males (37.0%) (p < 0.001). Among males, MetS exhibited a lower sensitivity among non-Hispanic blacks (17.8%) compared to Hispanics (45.9%) (p < 0.01) and non-Hispanic whites (37.4%) (p < 0.05). There were no race/ethnicity differences in detecting elevated uric acid levels among females (non-Hispanic-white 15.5%, non-Hispanic-black 19.4%, Hispanic 26.5%, p > 0.05).ConclusionCurrent criteria to diagnose MetS exhibit racial/ethnic and gender differences in the ability to identify adolescents with elevated uric acid levels, performing poorly among non-Hispanic-black males and among females. Given emerging data regarding the ability of uric acid elevations for predicting future disease, these data may have implications regarding the use of MetS as a marker of risk among all gender and racial/ethnic groups.     

Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study

BackgroundOnly a few previous studies have investigated endothelium-dependent vasodilation in the metabolic syndrome (MetS). In the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study, different techniques to assess vasodilation in conduit and resistance arteries were evaluated in relation to the MetS and insulin resistance.MethodsIn this population-based study, 1016 subjects aged 70 were evaluated by the invasive forearm technique with acetylcholine (EDV), brachial artery ultrasound to assess flow-mediated vasodilation (FMD) and pulse wave analysis with a beta-2 receptor agonist challenge, terbutaline.ResultsEDV was lower in subjects with the MetS (NECP/ATP III-criteria, prevalence 23%) compared to those without (p < 0.0001), and declined with increasing number of MetS criteria (p < 0.0001), after adjustment for coronary heart disease, stroke and cardiovascular medication. Also a reduced pulse wave response (p = 0.015), but not FMD (p = 0.64), was seen in those with the MetS. EDV and the pulse wave response, but not FMD, were inversely related to insulin resistance evaluated by the HOMA index. Also endothelium-independent vasodilation (EIDV) induced by intra-brachial infusion of sodium nitroprusside was impaired in subjects with MetS and in insulin resistance.ConclusionsVasodilation evaluated with the invasive forearm technique and pulse wave analysis with a beta-2 agonist, but not FMD, was reduced in elderly subjects with the MetS and was related to insulin resistance. Also EIDV showed the same pattern, suggesting a general deterioration in vasoreactivity mainly in resistance arteries in elderly subjects with the MetS.     

The Mediterranean and CHO diets decrease VCAM-1 and E-selectin expression induced by modified low-density lipoprotein in HUVECs

Background and AimThe oxidative modifications of low-density lipoprotein (LDL) are crucial for the atherosclerosis process. The aim of this study was to determine if the minimally modified LDL, obtained after the ingestion of three different diets, produce differential effects on the vascular cell adhesion molecule-1 (VCAM-1) and E-selectin expression in human umbilical endothelial cells (HUVECs).Methods and ResultsTwenty healthy young males were exposed to three dietary periods. Each period lasted four weeks. During the first period, all subjects consumed a saturated fat (SFA) enriched diet (38% fat, 20% SFA). The second and third dietary periods were administered following a randomized crossover design: a low fat high carbohydrates diet (CHO diet) and a Mediterranean diet. LDL particles, isolated during each dietary period, were oxidized by exposure to UV light and incubated for 48 h with HUVEC. Thereafter, 100 U/mL of TNF-α was added and incubation continued for 6 h. Cellular ELISA determined adhesion molecules expression. Lag time, propagation rate and total amounts of formed conjugated dienes were calculated in LDL incubated with 10 μmol/L Cu²⁺. When compared to the SFA diet, LDL isolated from the Mediterranean and CHO diets induced a lower expression of VCAM-1 and E-selectin in HUVECS (P < 0.007). There were no differences between both lipid lowering diets. However, lag time of LDL from the Mediterranean diet was higher than with the CHO diet (P < 0.042). This parameter was inversely correlated with E-selectin expression (r = − 0.497; P < 0.04).ConclusionOur results suggest that both the Mediterranean and CHO diets may decrease the pro-inflammatory environment induced by modified LDL in endothelial cells.     

Metabolic syndrome and left ventricular hypertrophy in the prediction of cardiovascular events: the Strong Heart Study

Background and aimsMetabolic syndrome (MetS) is associated with increased prevalence of echocardiographic LV hypertrophy (LVH), a potent predictor of cardiovascular (CV) outcome. Whether MetS increases risk of CV events independently of presence of LVH has never been investigated. It is also unclear whether LVH predicts CV risk both in the presence and absence of MetS.Methods and resultsParticipants in the 2nd Strong Heart Study examination without prevalent coronary heart disease, congestive heart failure or renal insufficiency (plasma creatinine >2.5 mg/dL) were studied (n = 2758; 1746 women). MetS was defined by WHO criteria. Echocardiographic LV hypertrophy was defined using population-specific cut-point value for LV mass index (>47.3 g/m^2.7). After controlling for age, sex, LDL-cholesterol, smoking, plasma creatinine, diabetes, hypertension and obesity, participants with MetS had greater probability of LVH than those without MetS (OR = 1.55 [1.18–2.04], p < 0.002). Adjusted hazard of composite fatal and non-fatal CV events was greater when LVH was present, in participants without (HR = 2.03 [1.33–3.08]) or with MetS (HR = 1.64 [1.31–2.04], both p < 0.0001), with similar adjusted population attributable risk (12% and 14%). After adjustment for LVH, risk of incident CV events remained 1.47-fold greater in MetS (p < 0.003), an effect, however, that was not confirmed when diabetic participants were excluded.ConclusionLVH is a strong predictor of composite 8-year fatal and non-fatal CV events either in the presence or in the absence of MetS and accounts for a substantial portion of the high CV risk associated with MetS.     

Slow heart rate recovery after exercise is associated with carotid atherosclerosis

ObjectiveSlow heart rate recovery (HRR) after exercise is an estimate of impaired parasympathetic tone and predictor of all-cause and cardiovascular mortality. Carotid atherosclerosis is associated with high risk of developing coronary heart disease (CHD) and stroke. We tested the hypothesis that slow HRR is associated with carotid atherosclerosis in a cross-sectional study of 12,712 middle-aged men (age 49.1 ± 8.9 years).MethodsCarotid atherosclerosis was measured using B-mode ultrasonography and defined as stenosis >25% and/or intima–media thickness >1.2 mm. HRR was calculated as the difference between peak heart rate during a graded exercise treadmill test and heart rate 2 min after cessation of exercise.ResultsThe prevalence of carotid atherosclerosis was 8.4%. The prevalence of atherosclerosis was significantly higher among subjects in the lowest (<44 bpm) versus the highest (>61 bpm) quartile of HRR (14.4% versus 4.1%, p < 0.001). In multivariable logistic regression models adjusted for established CHD risk factors, inflammatory markers, and exercise capacity, subjects in the lowest quartile of HRR (<44 bpm) were 1.50 times (95% CI: 1.13–2.00) more likely to have carotid atherosclerosis than subjects in the highest quartile (HRR >61 bpm).ConclusionsSlow heart rate recovery after exercise, an index of decreased parasympathetic activity, is associated with carotid atherosclerosis independent of established risk factors in middle-age men.     

Adiponectin is associated with increased mortality and heart failure in patients with stable ischemic heart disease: data from the Heart and Soul Study

ObjectiveSerum adiponectin protects against incident ischemic heart disease (IHD). However, in patients with existing IHD, higher adiponectin levels are paradoxically associated with worse outcomes. We investigated this paradox by evaluating the relationship between adiponectin and cardiovascular events in patients with existing IHD.MethodsWe measured total serum adiponectin and cardiac disease severity by stress echocardiography in 981 outpatients with stable IHD who were recruited for the Heart and Soul Study between September 2000 and December 2002. Subsequent heart failure hospitalizations, myocardial infarction, and death were recorded.ResultsDuring an average of 7.1 years of follow-up, patients with adiponectin levels in the highest quartile were more likely than those in the lowest quartile to be hospitalized for heart failure (23% vs. 13%; demographics-adjusted hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.04–2.56, p = 0.03) or die (49% vs. 31%; HR 1.67, 95% CI 1.24–2.26, p < 0.008), but not more likely to have a myocardial infarction (12% vs. 17%; HR 0.64, 95% CI 0.38–1.06, p = 0.08). The combined outcome of myocardial infarction, heart failure, or death occurred in 56% (136/245) of participants in the highest quartile of adiponectin vs. 38% (94/246) of participants in the lowest quartile (HR 1.54, 95% CI 1.31–2.21, p < 0.002). Adjustment for left ventricular ejection fraction, diastolic dysfunction, inducible ischemia, C-reactive protein, and NT-proBNP attenuated the association between higher adiponectin and increased risk of subsequent events (HR 1.43, 95% CI 0.98–2.09, p = 0.06).ConclusionsHigher concentrations of adiponectin were associated with heart failure and mortality among patients with existing IHD.     

White blood cell count is associated with carotid and femoral atherosclerosis

ObjectiveRelationship of high sensitivity C-reactive protein (hsCRP) with Metabolic Syndrome (MetS) is well documented in many populations, but comprehensive data is lacking in Indian population. Thus, we set out to investigate the association of hsCRP levels with MetS and its features and the effect of obesity and insulin resistance on this association in urban Indians.MethodsThis is a cross-sectional study that included 9517 subjects comprising 4066 subjects with MetS. MetS was defined according to the modified National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) criteria for Asians.ResultsMedian levels of hsCRP were considerably higher in individuals with MetS with higher levels in women compared to men. Among the features of MetS, waist circumference was most strongly correlated with hsCRP levels (r = 0.28) and contributed maximally (β = 0.025 mg/l ln hsCRP, P = 7.4 × 10^?147). Subjects with high risk hsCRP levels (>3 mg/l) were at high risk of MetS (OR (95% CI) = 1.65(1.41–1.92), P = 1.7 × 10^?10). Risk of MetS increased in a dose dependent manner from low risk to high risk hsCRP category with increase in BMI and HOMA-IR.ConclusionsOur findings suggest that hsCRP predicts the risk of MetS, independent of obesity and insulin resistance, and therefore, can be a valuable tool to aid the identification of individuals at risk of MetS. The study provides a lead for future investigation for effects of hsCRP, obesity, and insulin resistance on MetS in this population.     

Associations between alcohol consumption and selected cytokines in a Swiss population-based sample (CoLaus study)

ObjectiveTo assess the associations between alcohol consumption and cytokine levels (interleukin-1beta – IL-1β; interleukin-6 – IL-6 and tumor necrosis factor-α – TNF-α) in a Caucasian population.MethodsPopulation sample of 2884 men and 3201 women aged 35–75. Alcohol consumption was categorized as nondrinkers, low (1–6 drinks/week), moderate (7–13/week) and high (14+/week).ResultsNo difference in IL-1β levels was found between alcohol consumption categories. Low and moderate alcohol consumption led to lower IL-6 levels: median (interquartile range) 1.47 (0.70–3.51), 1.41 (0.70–3.32), 1.42 (0.66–3.19) and 1.70 (0.83–4.39) pg/ml for nondrinkers, low, moderate and high drinkers, respectively, p < 0.01, but this association was no longer significant after multivariate adjustment. Compared to nondrinkers, moderate drinkers had the lowest odds (Odds ratio = 0.86 (0.71–1.03)) of being in the highest quartile of IL-6, with a significant (p < 0.05) quadratic trend. Low and moderate alcohol consumption led to lower TNF-α levels: 2.92 (1.79–4.63), 2.83 (1.84–4.48), 2.82 (1.76–4.34) and 3.15 (1.91–4.73) pg/ml for nondrinkers, low, moderate and high drinkers, respectively, p < 0.02, and this difference remained borderline significant (p = 0.06) after multivariate adjustment. Moderate drinkers had a lower odds (0.81 [0.68–0.98]) of being in the highest quartile of TNF-α. No specific alcoholic beverage (wine, beer or spirits) effect was found.ConclusionsModerate alcohol consumption is associated with lower levels of IL-6 and (to a lesser degree) of TNF-α, irrespective of the type of alcohol consumed. No association was found between IL-1β levels and alcohol consumption.     

Dietary patterns,inflammation and the metabolic syndrome

AimThe study of dietary patterns offers a comprehensive, real-life approach towards examining the complex diet and disease relationship. The simultaneous association of dietary patterns with inflammation and the metabolic syndrome (MetS) has not been extensively reviewed. This report reviews the association of dietary patterns with inflammation in the context of the MetS.MethodsOriginal English-language research studies with humans were identified via MEDLINE, using inflammation, MetS, whole diets and dietary patterns as keywords. The findings were carefully examined and synthesized along consistent axes.ResultsMany observational and a few prospective studies, as well as some randomized controlled trials (RCTs), support an inverse association between a Mediterranean dietary pattern and markers of inflammation. The link is generally independent of traditional cardiovascular disease (CVD) risk factors and weight loss. The few studies that have examined the association between following a healthy dietary pattern, evaluated using various diet quality scores, and inflammation report an inverse association; however, this association was attenuated upon adjusting for CVD risk factors. A Mediterranean dietary pattern has also been associated with a reduced risk of the MetS in several cross-sectional studies and a few prospective studies conducted with healthy people. Few RCTs (lasting 1–2 years) have confirmed the benefits of following a Mediterranean diet on MetS risk in obese individuals, in those with the MetS or in those at CVD risk. The evidence, albeit limited, for a link between healthy diets based on other diet quality scores and the MetS supports a similar inverse association for the primary and secondary prevention of the MetS.ConclusionAdhering to healthy diets such as the Mediterranean diet and/or national dietary guidelines can reduce inflammation and the MetS.     

Dietary fat, abdominal obesity and smoking modulate the relationship between plasma complement component 3 concentrations and metabolic syndrome risk

ObjectiveChronic inflammation plays a role in the pathogenesis of metabolic syndrome (MetS) and cardiovascular disease (CVD). Complement component 3 (C3) is a novel cardiometabolic risk factor. Whether dietary fat intake modulates MetS risk conferred by elevated C3 concentrations is unknown. Our objective is to investigate the relationship between C3 concentrations and risk of the MetS and its phenotypes, and to further examine whether dietary fat intake modulates these relationships.MethodsBiochemical, dietary and lifestyle measurements were determined in the LIPGENE-SU.VI.MAX study of MetS cases and matched controls (n = 1754).ResultsElevated C3 concentrations (>median) were associated with increased risk of impaired insulin sensitivity [OR 1.78, CI 1.34–2.36, P < 0.0001], insulin resistance [OR 1.73, CI 1.31–2.89, P = 0.0001], abdominal obesity [OR 2.15, CI 1.43–3.24, P = 0.0002] and low HDL cholesterol [OR 1.40, CI 1.05–1.86, P = 0.02] compared to low C3 concentrations. Increased MetS risk conferred by elevated C3 concentrations [OR 3.11, 95% CI 2.52–3.82, P < 0.0001] was further accentuated among high dietary fat consumers [OR 4.80, 95% CI 2.77–8.33, P < 0.0001] (particularly of saturated [OR 4.05, 95% CI 2.33–7.05, P < 0.0001] and monounsaturated fat [OR 4.48, 95% CI 2.62–7.56, P < 0.0001]), and smokers [OR 3.83, 95% CI 2.12–6.94, P < 0.0001], however this effect was abolished in abdominally lean individuals [OR 1.46, 95% CI 0.69–3.14, P = 0.33].ConclusionsDietary fat (intake and composition), abdominal obesity and smoking modulate the relationship between elevated plasma C3 concentrations and MetS risk.     

The differences of metabolic syndrome in elderly subgroups: A special focus on young-old,old-old and oldest old

BackgroundMetabolic syndrome (MetS) is known to be correlated to future diabetes and cardiovascular disease. Due to the aging society, the increasing prevalence of MetS in the elderly is an important health issue. However, there were few studies focusing in this field. We investigated the changes of MetS components in the subgroups of the elderly.MethodsSubjects aged above 65 years old who underwent routine health checkups in Taiwan (N = 18916) were divided into three groups (young-old: ≧65 and <75, old-old: ≧75 and <85 and oldest-old ≧85). By using multiple logistic regressions, the odds ratio (OR) of subjects with abnormal MetS components to have MetS were evaluated.ResultsFor men, the systolic blood pressure (SBP) and high-density lipoprotein cholesterol increased as the age got older. On the contrary, the diastolic blood pressure and triglycerides (TG) decreased. In women, the waist circumference and SBP increased significantly from the young-old to the oldest-old groups. The highest percentage having MetS was 35% in old-old men and 62% in oldest-old women. Finally, subjects with high TG had the highest and BP had the lowest ORs for having MetS in both genders except oldest-old women.ConclusionsIn the elderly, the MetS and its components have different patterns not only in young-, old- and oldest-old groups but also in men and women. Moreover, among the five components, hypertension was always the most prevalent one. Finally, subjects had high TG had the highest ORs to have MetS compared to other components.     

Telomerase, telomere length, and coronary artery calcium in black and white men in the CARDIA study

ObjectiveTo evaluate whether telomerase activity, measured in circulating blood leukocytes, might be associated with prevalent atherosclerosis, or predict future coronary artery disease risk.Methods and resultsWe examined associations of telomerase activity levels measured at year 15 in the Coronary Artery Risk Development in Young Adults (CARDIA) Study with prevalent coronary artery calcium (CAC), progressive CAC at year 20, and incident CAC between years 15 and 20, in 440 black and white men aged 33–45 years. Telomere length was also measured in a subset of participants (N = 129).In multivariate-adjusted analysis, higher quartiles of telomerase were cross-sectionally associated with greater odds of prevalent CAC at year 15 (quartile 2: OR = 1.32, 95% CI: 0.54–3.23; quartile 3: OR = 1.40, 95% CI: 0.60–3.30; quartile 4: OR = 3.27, 95% CI: 1.39–7.71 compared with quartile 1, p-continuous = 0.012) and progressive CAC at year 20, but telomerase was not significantly associated with incidence of newly detectable CAC. Higher telomerase activity levels predicted greater CAC progression at year 20 among persons with short telomere length; low telomerase and short TL predicted less CAC progression.ConclusionTelomerase activity in leukocytes was associated with calcified atherosclerotic plaque, and was also a predictor of advancing plaque among persons with short telomeres.