Metabolic syndrome and insulin resistance in migraine

Metabolic syndrome is associated with migraine but there is no study comparing the characteristics of migraine with and without metabolic syndrome from Southeast Asia. This study was therefore undertaken to compare the clinical characteristics of migraine in patients with and without metabolic syndrome and insulin resistance. 135 consecutive patients with migraine diagnosed on the basis of International Headache Society criteria were subjected to clinical evaluation as per fixed protocol. Headache severity, frequency and functional disability were recorded. Metabolic syndrome was diagnosed as per National Cholesterol Education Programme: Adult Treatment Panel III and International Diabetic Federation criteria. Insulin resistance was calculated by homeostases model assessment. Their age ranged between 14 and 61 years and 108 were females. Metabolic syndrome was present in 31.9% patients and only 13 were obese. Insulin resistance was present in 11.1%. Metabolic syndrome was correlated with age, gender, number of triggers, years of headache and duration of migraine attacks. Insulin resistance correlated with duration of migraine attacks. From this study, it can be concluded that metabolic syndrome was present in 31.9% of the migraineurs which was mainly in elderly who had longer duration of headache and multiple triggers.     

Lipid Accumulation Product Index to Predict Metabolic Syndrome in People Living with HIV

Background:Dyslipidemia and central obesity are the main components of metabolic syndrome, which represent important risk factors for cardiovascular diseases in people living with human immunodeficiency virus (HIV). The lipid accumulation product (LAP) index has been shown in studies as an efficient marker of metabolic syndrome in general adult population and its applicability in HIV-infected population is not discussed. We aimed to assess the accuracy of the LAP index to identify metabolic syndrome in people living with HIV.Methods:It is a cross-sectional study with 141 HIV-infected patients on antiretroviral therapy, conducted in a reference centre of infectious diseases in southeast Brazil. Evaluations included LAP index, anthropometric measurements and clinical and laboratorial variables. Metabolic syndrome was defined by International Diabetes Federation (IDF) criteria.Results:The prevalence of metabolic syndrome in our sample was 10.6%. A positive and significant correlation was found between the metabolic syndrome and LAP (r=0.401; P<0.01), metabolic syndrome and body mass index (r=0.361; P<0.01) and metabolic syndrome and waist circumference (r=0.427; P<0.01) in our sample. The analysis of the receiver-operating characteristic (ROC) curve revealed that the best cut-off value for LAP index to define metabolic syndrome was 59.4 (sensitivity 80%, specificity 79% and area under the curve (AUC) of 0.875. In female and male, analysis of the ROC curve revealed that the best cut-off value for LAP index to define metabolic syndrome was 56.3 (sensitivity 100%, specificity 82% and AUC of 0.929) and 52.0 (sensitivity 78%, specificity 74% and AUC of 0.838), respectively.Conclusion:Despite the low prevalence of metabolic syndrome in our sample, the ROC curves analyzes demonstrated a good diagnostic accuracy as an additional screening tool of metabolic syndrome according to the IDF.     

Metabolic syndrome and chronic kidney disease in a rural Chinese population

BackgroundMetabolic syndrome is a common risk factor for cardiovascular disease. Chronic kidney disease (CKD) is a worldwide public health problem. We investigated the association between metabolic syndrome and CKD in a rural Chinese population.MethodsThis was a cross-sectional study using data from the Handan Eye Study.Results4944 of participants aged ≥ 30 y were included in this analysis. Participants with metabolic syndrome had a higher prevalence of CKD (20.9% vs.15.8%, P < 0.001) than those without. As the number of metabolic syndrome components increased, so did the prevalence of CKD (P < 0.001). The multivariate-adjusted odds ratio (OR) of chronic kidney disease in participants with metabolic syndrome was 1.293 (95% CI 1.093–1.529) compared with those without. In multivariate logistic regression analysis, high blood pressure (OR 1.348; 95% CI 1.122–1.619) and high fasting glucose (OR 1.501; 95% CI 1.235–1.794) were independently associated with the risk for CKD. Compared with participants without any component, multivariate adjusted OR for CKD was 1.316 (95%CI 1.004–1.723), 1.397(95%CI 1.038–1.882), 1.672 (95%CI 1.183–2.363) for those with 2, 3, 4 or 5 components, respectively.ConclusionIn this rural Chinese population aged ≥ 30 y, metabolic syndrome was associated with CKD.     

Impact of a nurse practitioner role on metabolic monitoring completion and referrals for consumers admitted to the intensive care area of an acute inpatient psychiatric unit

Mental illness increases a person's risk of physical health issues, including cardiovascular disease, leading to premature morbidity and mortality. Screening for cardiovascular disease through metabolic monitoring is recommended to aid in early detection. The aim of the present study was to ascertain whether consumers admitted to an inpatient mental health unit receive routine metabolic monitoring, and to explore the contribution of a nurse practitioner to metabolic monitoring and the actioning of abnormal results. The present study used a retrospective mirror image cohort method to look at clinical consumer files for two separate 6‐month periods before and after a nurse practitioner role commenced. Metabolic monitoring variables were computed as completion frequencies and percentages. Univariate analyses were computed to describe differences among metabolic monitoring variables. A total of 497 consumers were admitted to the mental health inpatient unit's intensive care area across the two 6‐month data‐collection periods. Prior to the nurse practitioner role, only 2% of consumers had their body mass index (BMI) risk calculated; less than 1% had their waist circumference measured, and no abnormal results were referred to a general practitioner (GP). After the nurse practitioner role commenced, BMI risk was calculated for 67% of consumers, waist circumference recorded for 68%, and referrals for abnormal results were forwarded to 37 consumers’ GPs. A nurse practitioner on the inpatient mental health unit has allowed for a considerable increase in the metabolic screening of admitted consumers resulting in a number of referrals being forwarded to consumers’ GPs to be acted upon.     

The epidemic of violence in America

Abstract

Background: Osteoarthritis (OA) and cardiovascular disease (CVD) share age and obesity as risk factors, but may also be linked by pathogenic mechanisms involving metabolic abnormalities and systemic inflammation. This study compared the prevalence of OA and metabolic syndrome (MetS) in subjects with OA versus the general population without OA to determine whether having OA predicts increased cardiovascular risk. Methods: National Health and Nutrition Examination Survey III data were used as a representative sample of the general US population. Subjects included adults aged ≥ 18 years with records of history, physical, radiographic, and laboratory data adequate to assess for diagnoses of MetS and OA. Logistic regression was used to examine the association between MetS and population-weighted variables. Results: The general population sample included 7714 subjects (weighted value representing 174.9 million population), of whom 975 subjects had OA (weighted value 17.5 million) and 6739 did not (weighted value 157.4 million). Metabolic syndrome was prevalent in 59% of the OA population and 23% of the population without OA. Each of the 5 cardiovascular risk factors that comprise MetS was more prevalent in the OA population versus the population without OA: hypertension (75% vs 38%), abdominal obesity (63% vs 38%), hyperglycemia (30% vs 13%), elevated triglycerides (47% vs 32%), and low high-density lipoprotein cholesterol (44% vs 38%). Metabolic syndrome was more prevalent in subjects with OA regardless of sex or race. The association between OA and MetS was greater in younger subjects and diminished with increasing age. Having OA at age 43.8 years (mean age of the general population) was associated with a 5.26-fold (SE = 1.58, P < 0.001) increased risk of MetS. This association remained strong when obesity was controlled for in additional regression models. Conclusions: Osteoarthritis is associated with an increased prevalence of MetS, particularly in younger individuals. Global cardiovascular risk should be assessed in individuals aged ≤ 65 years with OA, and should be considered when prescribing analgesics for OA patients.     

Who is responsible for metabolic screening for mental health clients taking antipsychotic medications?

Metabolic syndrome is common in mental health consumer populations, and is linked to cardiovascular disease, stroke and diabetes. Metabolic screening is a way of recognising consumers who are at risk of developing metabolic syndrome but internationally screening rates remain low. A retrospective audit was completed at one Australian public mental health service on the case files of 100 randomly selected consumers to determine nurses level of compliance with metabolic screening policies over a 12 month period. Consumers included in the review were prescribed antipsychotic medications for at least 12 months and had their care in the community coordinated by mental health nurses. Data were entered into an Excel spreadsheet for analysis. Low levels of metabolic screening were identified and these levels decreased over the 12 months under review. No consumers had metabolic screening that recorded all parameters at three monthly intervals over the 12 month period. Only one consumer had every metabolic parameter recorded on the physical health screen tool at baseline assessment. The findings demonstrated that while there is increased awareness of co‐morbid physical health issues in this consumer population, the translation of guidelines and policy directives to clinical practice to address this disparity remains low. Improving physical health outcomes is the responsibility of all health professionals, particularly doctors who prescribe and nurses who administer antipsychotic medications regularly to mental health consumers. Moreover, nurses are well placed to demonstrate leadership in reducing the rate of metabolic syndrome through the delivery of holistic care that includes effective screening programs.     

Prevalence and Influencing Factors of Metabolic Syndrome Among Persons with Physical Disabilities

Purpose

Metabolic syndrome is an important cluster of coronary heart disease risk factors. However, it remains unclear to what extent metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors among Korean persons with physical disabilities. This study aimed to determine the prevalence and influencing factors of metabolic syndrome among persons with physical disabilities using the Korean National Health Insurance Service–National Sample Cohort.

Gender differences in metabolic syndrome risk factors among patients with serious mental illness

The prevalence of metabolic syndrome and its components continue to increase among patients with serious mental illness. This cross‐sectional study investigated whether metabolic syndrome prevalence and risk factors differ between male and female patients with serious mental illness. In total, 260 eligible patients were recruited from two hospitals. The data on demographic characteristics, lifestyle behaviour factors, biochemistry, and anthropometry were collected. Analyses were performed using multivariate logistic regression. Metabolic syndrome prevalence was 40.8% (35.1% in men and 46.8% in women). Among patients aged 40–49 years, metabolic syndrome prevalence was higher in men; however, the trend was reversed among patients aged 50 years or older. Notably, gender‐specific metabolic syndrome risk factors were observed. In men, they included low education level, high body mass index (BMI), prolonged illness, comorbid physical illness, and diagnosis of bipolar disorder, whereas they included being married, old age, and high BMI in women. Our findings suggest that mental health professionals should consider the gender‐ and age‐based metabolic syndrome prevalence trend in patients with serious mental illness when designing interventions for the study population to minimize metabolic syndrome prevalence.     

Metabolic syndrome and diabetes are associated with an increased likelihood of inducible myocardial ischemia among patients with subclinical atherosclerosis

OBJECTIVE: Coronary artery calcification (CAC) is associated with cardiac events and the likelihood of inducible myocardial ischemia. Because metabolic syndrome contributes to atherosclerosis, we assessed whether it also influences the relationship between CAC levels and myocardial ischemia. RESEARCH DESIGN AND METHODS: We evaluated 1,043 patients without known coronary artery disease (CAD) who underwent stress myocardial perfusion scintigraphy (MPS) and computed tomography. Metabolic syndrome was defined by modified National Cholesterol Education Program criteria. Metabolic abnormalities were present in 313 patients (30%), including 140 with diabetes (with or without metabolic syndrome) and 173 who had metabolic syndrome without diabetes. RESULTS: Although CAC scores <100 identified a low likelihood ( approximately 2%) of ischemia, the presence (versus absence) of metabolic abnormalities (metabolic syndrome or diabetes) was a predictor of more frequent ischemia among patients with CAC scores of 100-399 (13.0 vs. 3.6%, P < 0.02) and CAC scores >/=400 (23.4 vs. 13.6%, P = 0.03). Similar trends were observed when patients with metabolic syndrome and diabetes were considered separately. Multiple logistic regression revealed the odds of MPS ischemia to be 4.3-fold greater per SD of log CAC (P < 0.001) and 2.0-fold greater in the presence of metabolic abnormalities (P < 0.01). CONCLUSIONS: Among patients with CAC scores >/=100, metabolic abnormalities, and even metabolic syndrome in the absence of diabetes predicted a higher likelihood of inducible ischemia. These findings suggest the need for assessment of metabolic status when interpreting the results of CAC imaging among patients undergoing such testing because of suspected CAD.     

Metabolic Syndrome: prevalence and prediction of mortality in elderly individuals

OBJECTIVE: Little is known about the prevalence of the metabolic syndrome among elderly people in Italy, its association with all-cause mortality, and whether measurement of serum C-reactive protein (CRP) and interleukin (IL)-6 affects this association. RESEARCH DESIGN AND METHODS: The baseline prevalence of metabolic syndrome, diagnosed according to the National Cholesterol Education Program (NCEP) criteria, and all-cause mortality at 4 years were recorded in an Italian population-based cohort (981 subjects, 55% women, aged 65-97 years). A Cox model adjusted for sociodemographic, lifestyle, and medical variables was used to investigate 1) whether metabolic syndrome was a predictor of mortality and 2) how the association was affected by baseline high CRP (>3 mg/l) and IL-6 (>1.33 pg/ml). RESULTS: Overall, metabolic syndrome prevalence was 27.2% [95% CI 24.0-30.5] and higher in women (33.3% [28.7-38.0]) than in men (19.6% [15.5-24.2]). During follow-up, 137 deaths occurred. Using the no metabolic syndrome/no high IL-6 group as the reference, mortality was not associated with the metabolic syndrome alone (multivariable-adjusted hazard ratio 1.24 [0.60-2.59]), only weakly associated with high IL-6 alone (1.66 [1.04-2.63]), but strongly associated with the concurrent presence of metabolic syndrome and high IL-6 (3.26 [2.00-5.33]). High CRP was not a mortality predictor (0.83 [0.58-1.20]) nor did it affect the association of the other variables with mortality. CONCLUSIONS: Metabolic syndrome by NCEP criteria is highly prevalent in the Italian elderly population. It is not itself associated with mortality but may improve the usefulness of IL-6 as a mortality predictor in older age.     

Adverse drug reactions: managing the risk

Aim  This study aims to assess the need to formalize medication monitoring strategies in electronic records in two crisis resolution home treatment (CRHT) teams in one UK NHS Trust.
Background  The management and monitoring of prescribed medications has long been a cause for concern. As a result of the potential adverse drug reactions associated with commonly prescribed medication, clients of mental health teams are vulnerable to iatrogenic risk linked to physical health problems.
Method  Electronic records for all clients receiving care in two CHRT teams in one UK mental health Trust in November 2007 were examined for evidence of monitoring for potential adverse drug reactions. Findings were compared with the sample of paper records submitted to a national audit.
Results  Electronic records omitted important aspects of medication monitoring, for example: 14 out of 57 clients had blood pressure recorded; 15 out of 57 had heart rate recorded; 13 out of 57 had weight recorded. However, the teams' paper records were significantly better than both the electronic records and a national audit sample at recording blood pressure and obesity. We found few differences between our two teams.
Conclusions  The format of our electronic records requires modification to ensure that systems are in place to document adverse drug reactions and the physical health of those with mental illness.
Implications for nursing management  The transition to electronic records needs to be carefully managed to ensure that information on adverse drug reactions is included. The West Wales Adverse Drug Reaction profile, version II, is one strategy to achieve this in mental health.     

The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town

ObjectiveThis study examines whether implementation of electronic reminders is associated with a change in the amount and content of diagnostic data recorded in primary health care emergency departments (ED).DesignA register-based 12-year follow-up study with a before-and-after design.SettingThis study was performed in a primary health care ED in Finland. An electronic reminder was installed in the health record system to remind physicians to include the diagnosis code of the visit to the health record.Subjects and main outcome measuresThe report generator of the electronic health record-system provided monthly figures for the number of different recorded diagnoses by using the International Classification of Diagnoses (ICD-10th edition) and the total number of ED physician visits, thus allowing the calculation of the recording rate of diagnoses on a monthly basis and the comparison of diagnoses before and after implementing electronic reminders.ResultsThe most commonly recorded diagnoses in the ED were acute upper respiratory infections of various and unspecified sites (5.8%), abdominal and pelvic pain (4.8%), suppurative and unspecified otitis media (4.5%) and dorsalgia (4.0%). The diagnosis recording rate in the ED doubled from 41.2 to 86.3% (p < 0.001) after the application of electronic reminders. The intervention especially enhanced the recording rate of symptomatic diagnoses (ICD-10 group-R) and alcohol abuse-related diagnoses (ICD-10 code F10). Mental and behavioural disorders (group F) and injuries (groups S-Y) were also better recorded after this intervention.ConclusionElectronic reminders may alter the documentation habits of physicians and recording of clinical data, such as diagnoses, in the EDs. This may be of use when planning resource managing in EDs and planning their actions.

KEY POINTS

• Electronic reminders enhance recording of diagnoses in primary care but what happens in emergency departments (EDs) is not known.
• Electronic reminders enhance recording of diagnoses in primary care ED.
• Especially recording of symptomatic diagnoses and alcohol abuse-related diagnoses increased.

     

Metabolic syndrome and its components are underdiagnosed in cardiology clinics

Background Although metabolic syndrome (MetS) is an important clinical condition, evidence is scarce on how often doctors successfully diagnose this syndrome. Aims To assess the extent of doctors' diagnosis of MetS and its components in cardiology outpatient setting and whether such diagnosis affects the way patients are counselled on lifestyle modification. Methods This is a multicentre cross‐sectional study on randomly selected clinical notes at ambulatory cardiology clinics in three academic centres in the USA. We abstracted data on cardiovascular risk factors, and examined whether doctors documented a diagnosis of MetS and its components. Results Of 511 participants who satisfied our inclusion criteria, the MetS was present in 246 participants (48%). The proportions with which a doctor correctly documented diagnoses were: MetS 9.3% (23/246), obesity 60% (119/197), elevated blood pressure 74% (305/412), elevated fasting glucose 17% (49/291), reduced high density lipoprotein cholesterol 10% (18/190) and elevated triglycerides 20% (32/164). This pattern of diagnoses, less frequent with dyslipidaemia and elevated fasting glucose compared with the rest, was persistently observed regardless of sex, age, and presence or absence of MetS. Those diagnosed were more likely to receive a recommendation of weight loss or increase in physical activity than those undiagnosed: 91% (21/23) versus 37% (82/223) for weight loss, and 83% (19/23) versus 26% (58/223) for increase in physical activity (P < 0.001 for both). Conclusions Our data indicate that MetS and its components are commonly underdiagnosed in cardiology outpatient setting. Better diagnosis may lead to better counselling on lifestyle changes and improvement in the quality of care.     

Metabolic syndrome and mild hypertension

The clinical definition of Metabolic Syndrome in Japan was issued in April, 2005 by a committee which is consisted of related 8 Japanese societies. The Japanese definition indicates that both abdominal obesity(AO male > or = 85 cm, female > or = 90cm) as a required component, and two out of three following factors, high blood pressure(BP > or = 130/ > or = 85mmHg), dyslipidemia(high triglyceride: TG > or = 150 mg/dL and/or low HDL-cholesterol : HDL-C < 40 mg/dL), and high fasting plasma glucose (FPG > or = 110 mg/dL) are necessary for the diagnosis. This concept is mostly the same with IDF. The blood pressure criteria of Japanese definition is over 130/85 mmHg. Frequency of high normal blood pressure and mild hypertension were 21.5% and 30.0% in male and 18.4% and 24.2% in female over 40 years old, respectively. High blood pressure was most frequent risk factor among metabolic syndrome components. The control of high normal or mild hypertension is very important to prevent the cardiovascular risk in metabolic syndrome.     

Do Limited English Proficiency and Language Moderate the Relationship Between Mental Health and Pain?

AimTo explore whether the relationship between mental health diagnosis (i.e., mood or neurotic, stress-related, or somatoform disorder) and pain is moderated by language in patients with limited English proficiency (LEP). Southeast Asian languages (i.e., Hmong, Lao, Khmer) and Spanish were compared with English.MethodA retrospective data mining study was conducted (n = 79,109 visits). Pain scores, language, mental health diagnoses, age, sex, race, ethnicity, and pain diagnosis were obtained from electronic medical records. Cragg two-equation hurdle regression explored: (1) the effect of patient language and mental health diagnosis on pain and (2) the interaction between language and mental health diagnosis on pain.ResultsVisits were primarily for female (62.45%), White (80.10%), not Hispanic/Latino (96.06%), and English-speaking (97.85%) patients. Spanish or Southeast Asian language increased chances of reporting any pain (i.e., pain score of 0 versus ≥1) and pain severity in visits with pain scores ≥1, whereas mental health diagnosis decreased chances of reporting any pain and pain severity. The combination of Southeast Asian language and mood disorder contributed to higher chances of reporting any pain (odds ratio [OR] = 1.78, p<.001) but no difference in severity. A similar trend was observed for Southeast Asian language and neurotic disorder (OR = 1.29, p=.143). In contrast, the combination of Spanish language and mood (p = .066) or neurotic (p = .289) disorder contributed to lower pain severity but did not change the chances of reporting any pain.ConclusionsLEP and patient language should be considered during pain assessment within the context of mental health.     

Age and Sex Differences in the Clustering of Metabolic Syndrome Factors: Association with mortality risk

OBJECTIVE

The metabolic syndrome is a general term given to a clustering of cardiometabolic risk factors that may consist of different phenotype combinations. The purpose of this study was to determine the prevalence of the different combinations of factors that make up the metabolic syndrome as defined by the National Cholesterol Education Program and to examine their association with all-cause mortality in younger and older men and women.

RESEARCH DESIGN AND METHODS

A total of 2,784 men and 3,240 women from the Third National Health and Nutrition Examination Survey with public-access mortality data linkage (follow-up = 14.2 ± 0.2 years) were studied.

RESULTS

Metabolic syndrome was present in 26% of younger (aged ≤65 years) and 55.0% of older (aged >65 years) participants. The most prevalent metabolic syndrome combination was the clustering of high triglycerides, low HDL cholesterol, and elevated blood pressure in younger men (4.8%) and triglycerides, HDL cholesterol, and elevated waist circumference in younger women (4.2%). The presence of all five metabolic syndrome factors was the most common metabolic syndrome combination in both older men (8.0%) and women (9.2%). Variation existed in how metabolic syndrome combinations were associated with mortality. In younger adults, having all five metabolic syndrome factors was most strongly associated with mortality risk, whereas in older men, none of metabolic syndrome combinations were associated with mortality. In older women, having elevated glucose or low HDL as one of the metabolic syndrome components was most strongly associated with mortality risk.

CONCLUSIONS

Metabolic syndrome is a heterogeneous entity with age and sex variation in component clusters that may have important implications for interpreting the association between metabolic syndrome and mortality risk. Thus, metabolic syndrome used as a whole may mask important differences in assessing health and mortality risk.Since the introduction of the metabolic syndrome operational criteria by the National Cholesterol Education Program (NCEP) in 2001 (1), the surveillance of metabolic syndrome has garnered considerable research interest. Metabolic syndrome has been shown to be associated with increased all-cause and cardiovascular disease (CVD) mortality risk (2,3), but, of late, the clinical utility of metabolic syndrome has also been criticized (4,5). One of the criticisms is that because metabolic syndrome is operationalized as three or more of the five components, the 16 possible combinations that result may present with different pathophysiology, consequences, and treatment options, depending on which factors are present. Indeed, studies that have compared metabolic syndrome clusters for their ability to predict mortality have demonstrated variations in mortality risk among the different metabolic syndrome operational definitions (6,7) and the different metabolic syndrome clusters or components (6,8).However, it has also been reported that the prevalence of each metabolic syndrome risk factor differs with sex (9,10), and, thus, it follows that men and women may be characterized by different metabolic syndrome combinations. To date, it is unclear whether these sex differences are consistent across the life span and whether the different combinations of metabolic syndrome are similarly related with mortality risk in younger and older men and women. Thus, the purpose of this study was to provide U.S. estimates of the prevalence of the different metabolic syndrome combinations and quantify the risk of all-cause mortality for these unique metabolic syndrome phenotypes in younger and older men and women.     

Prevalence of metabolic syndrome in HIV-infected patients receiving highly active antiretroviral therapy using International Diabetes Foundation and Adult Treatment Panel III criteria: associations with insulin resistance, disturbed body fat compartmentalization, elevated C-reactive protein, and [corrected] hypoadiponectinemia

OBJECTIVE: Metabolic syndrome is a cluster of risk factors for cardiovascular disease and type 2 diabetes. Definitions exist to identify those "at risk." Treatment of HIV infection with highly active antiretroviral therapy can induce severe metabolic complications including lipodystrophy, dyslipidemia, and insulin resistance. The purpose of this study was to report the prevalence of metabolic syndrome in HIV-infected patients and compare insulin resistance and total body, limb, and visceral fat and adipokines in those with and without metabolic syndrome. RESEARCH DESIGN AND METHODS: This was an international cross-sectional study of a well-characterized cohort of 788 HIV-infected adults recruited at 32 centers. Metabolic syndrome prevalence was examined using International Diabetes Federation (IDF) and U.S. National Cholesterol Education Program Adult Treatment Panel III (ATPIII) criteria, relative to body composition (whole-body dual-energy X-ray absorptiometry and abdominal computed tomography), lipids, glycemic parameters, insulin resistance, leptin, adiponectin, and C-reactive protein (CRP). RESULTS: The prevalence of metabolic syndrome was 14% (n = 114; 83 men) by IDF criteria and 18% (n = 139; 118 men) by ATPIII criteria; the concordance was significant but only moderate (kappa = 0.46, P < 0.0001). Many patients (49%) had at least two features of metabolic syndrome but were not classified as having metabolic syndrome as their waist circumferences or waist-to-hip ratios were in the non-metabolic syndrome range. Metabolic syndrome was more common in those currently receiving protease inhibitors (P = 0.04). Type 2 diabetes prevalence was five- to ninefold higher in those with metabolic syndrome. With IDF criteria, subjects with metabolic syndrome showed disturbances in inflammation and adipokines: they had higher CRP (5.5 +/- 7.0 vs. 3.9 +/- 6.0 mg/l, P < 0.003) and leptin (9 +/- 9 vs. 4 +/- 6 ng/ml, P < 0.0001) and lower adiponectin (12 +/- 8 vs. 15 +/- 10 microg/ml, P < 0.0001) levels. By ATPIII criteria, those with metabolic syndrome had higher leptin (6 +/- 8 ng/ml, P = 0.006) and lower adiponectin (15 +/- 10 vs. 18 +/- 8 microg/ml, P < 0.0001) levels. CONCLUSIONS: Metabolic syndrome prevalence in HIV-positive adults was lower than that reported for the general population. Metabolic syndrome was associated with a substantially increased prevalence of type 2 diabetes in this specific cohort. Many subjects without metabolic syndrome had at least two metabolic syndrome components (particularly elevated lipid levels) but did not meet waist circumference or waist-to-hip ratio cutoff metabolic syndrome criteria in this group with high rates of body fat partitioning disturbances.