The metabolic syndrome and incidence of cardiovascular disease in non-diabetic subjects--a population-based study comparing three different definitions.

Aims Between 1998 and 2005, a number of definitions of the metabolic syndrome (MetS) have been proposed. The aim of this population‐based cohort study was to compare prevalence rates and the prediction of cardiovascular disease (CVD) using different definitions of MetS. Methods A total of 5047 non‐diabetic subjects (66% women), from the city of Malmö, Sweden, were followed. The incidence of fatal and non‐fatal CVD (cardiac events, n = 176, and stroke, n = 171) was monitored over 11 years of follow‐up. MetS was defined in three different ways [by International Diabetes Federation (IDF), National Cholesterol Education Program—Adult Treatment Panel III (NCEP‐ATPIII), or European Group for the study of Insulin Resistance (EGIR) criteria] based on data on waist circumference, blood pressure, serum triglycerides, High‐density lipoprotein cholesterol and fasting blood glucose. The IDF definition identified 21.9% of the subjects having the MetS. Corresponding figures for the NCEP‐ATPIII and EGIR definitions were 20.7 and 18.8%, respectively. Results After taking age, gender, low‐density lipoprotein cholesterol and lifestyle factors into account, the hazard ratio (HR) for CVD event according to the IDF, NCEP‐ATPIII and EGIR definitions were HR 1.11 (95% CI: 0.86–1.44), 1.59 (1.25–2.03) and 1.35 (1.05–1.74), respectively. The results were largely similar for cardiac and stroke events. Conclusions The prevalence of Mets according to the IDF definition was higher in comparison with NCEP‐ATPIII and EGIR definitions, but the IDF definition was not superior to these definitions for prediction of CVD events. This was true for both genders and questions the usefulness of the current IDF criteria of MetS in a North‐European, Caucasian population. In addition, single risk factors such as smoking had an equal prediction as the metabolic syndrome.     

The most appropriate cut-off point of anthropometric indices in predicting the incidence of metabolic syndrome and its components

IntroductionThe association of individuals’ anthropometric indices with their development of metabolic syndrome (MetS) has been investigated in several studies. Taking into account the ethnic differences, this study aimed to determine the most appropriate cut-off points of anthropometric indices in predicting the incidence of MetS and its components in Ahvaz.MethodsThis study is part of a cohort study conducted at the Diabetes Research Center of Ahvaz Jundishapur University of Medical Sciences on a population of over 20 in Ahvaz during 2009–2014. Of the 592 patients, 505 patients who were not diagnosed with MetS in 2009, were entered into this study. The data analyzed involved demographic information including age and sex, anthropometric information including height, weight, waist circumference (WC), hip circumference (HC) and the ratios between them, laboratory data including blood levels of Triglyceride (TG), Fasting plasma glucose (FPG) and High-density lipoprotein cholesterol (HDL-C), and clinical data including systolic(S) and diastolic(D)blood pressure(BP). After 5 years, the subjects were re-evaluated for MetS based on the National Cholesterol Education Program – Adult Treatment Panel III (NCEP-ATP III) criteria and the most appropriate cut-off points of anthropometric indices for the prediction of the incidence of MetS using the Receiver Operative Characteristic (ROC) curves were obtained.ResultsWaist-to-Height Ratio (WHtR) index with a cut-off point of 0.53 followed by WC with a cut-off point of 87.5 cm had the highest power to predict the incidence of MetS. The cut-off points of WC and Body mass index (BMI) were respectively 89.5 cm and 26 kg/m2 for men, and 83.5 cm and 27.5 kg/m2 for women. All anthropometric indices were able to predict the components of this syndrome (with the exception of low HDL-C). The cut-off point of WC in predicting High FBS, High TG and High BP was 84.5, 84.8, and 86.5 cm, respectively.ConclusionOverall, it seems that given its ease of measurement, the WC index is preferred to other indices for predicting the incidence of MetS and its components in clinical screening.     

All-cause mortality risk predictors in a preventive cardiology clinic cohort-examining diabetes and individual metabolic syndrome criteria: a PRECIS database study

Aim:  It is unclear if metabolic syndrome (MS) is equal to type 2 diabetes mellitus (DM) in predicting cardiovascular disease (CVD) risk and mortality, and its prognostic value compared to Framingham risk model is controversial. We assessed mortality, CVD risk and prevalence in patients with DM and those without DM who met National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) MS criteria compared to patients without DM or MS. We analysed which component(s) of NCEP MS criteria had greatest predictive value for mortality.
Methods:  Retrospective cohort analysis of 1189 DM, 1241 MS (fasting glucose < 126 mg/dl and ≥3 components NCEP-ATP III criteria) and 3023 non-DM/non-MS patients presented for baseline visit to Preventive Cardiology clinic between 1995 and 2006, whose subsequent vital status was determined for a median of 5.2 years. The association with mortality was determined by Cox proportional hazards models. The incremental predictive value of MS components was performed by concordance indexes.
Results and conclusion:  DM group had highest mortality and CVD prevalence vs. MS and non-DM/non-MS groups respectively (all p ≤ 0.001). Patients with MS criteria had increased CVD prevalence and 1.5-fold increased mortality vs. non-DM/non-MS group (all p < 0.02). In NCEP MS criteria, only fasting glucose significantly predicted mortality in MS group (p = 0.05). MS criteria predicted CVD prevalence in a parallel manner to Framingham risk score assessment. In a cohort of patients at high risk for CVD whose risk factors are being treated, presence of diabetes in addition to plasma glucose within NCEP MS criteria strongly predicts all-cause mortality.     

不同代谢综合征定义在广州地区中老年人群中应用的比较

目的比较国际糖尿病联盟(IDF)与中华糖尿病学会(CDS)关于代谢综合征(MS)的定义在广州地区中老年人群中诊断的符合率及差异。方法于2004年对年龄≥35岁的广州造船厂(广船)1270名工人及广州番禺大石(大石)4个自然村农民2082人进行调查,调查内容包括问卷及病史调查,身高、体重、腰围、血压测量,血液生化指标检测等。除掉资料不完整者,用于分析的分别为广船1266人,大石1658人。按照IDF对MS的定义及CDS对MS的定义分别计算不同人群MS患病率。结果 (1)共有40.5%的个体满足两种诊断标准,仅符合IDF定义的为34.6%,仅符合CDS定义的为24.9%,两者对MS诊断符合率达到87%(城市87.3%,农村87.1%),Kapple值为0.501(P0.001)。(2)不论用IDF定义或CDS定义,城市或农村MS患病率水平大致相同,分别为城市15.5%(IDF定义)和14.6%(CDS定义),农村16.6%(IDF定义)和13.8%(CDS定义)。但是在IDF定义中,因为腰围未达标,尽管有其他3项指标达到标准也未诊断为MS的人数城市105人,农村160人。(3)男性MS患病率CDS定义(16.1%)高于IDF定义(12.3%);女性则IDF定义比CDS定义高(分别为20.1%和12.0%)。(4)按年龄不同分为40岁、40～49岁、50～59岁、60～69岁和≥70岁共5个年龄组,两种定义MS患病率均随年龄增长而增高,但70岁以后MS患病率则是下降趋势,最高患病率出现在60～69岁年龄组。结论用现有的诊断标准,IDF和CDS对MS患病率的检出基本一致,只是男性对CDS定义较敏感,而女性对IDF定义更敏感;老年人是MS的重点防治对象。     

Melatonin–insulin interactions in patients with metabolic syndrome

Abstract:  Metabolic syndrome (MS) as a group of risk factors is strongly associated with diabetes type 2 and cardiovascular disease. Insulin resistance plays a key role in the pathogenesis of MS. Recent studies have shown that melatonin may influence insulin secretion and glucose homeostasis. Therefore, the present study analyzed the relationships between the melatonin and the insulin in patients with MS and controls. The melatonin rhythm, insulin and lipid levels were studied in 40 subjects (21 patients and 19 controls) in reproductive age. The night melatonin–insulin ratio was correlated negatively with low-density lipoprotein cholesterol ( r  = −0.370, p  = 0.024) and total cholesterol ( r  = −0.348, p  = 0.030), and positively with high-density lipoprotein cholesterol levels ( r  = +0.414, p  = 0.010). Night-time melatonin levels were related to night-time insulin concentrations ( r  = +0.313, p  = 0.049). The correlation was pronounced in patients with MS ( r  = +0.640, p  = 0.002), but did not reach statistical significance in controls ( P  > 0.05). In the patients with MS unlike the controls the night–day melatonin difference (%) correlated negatively with the fasting glucose ( r  = −0.494, p  = 0.023) and positively to daily insulin ( r  = +0.536, p  = 0.012). Our results show that melatonin–insulin interactions may exist in patients with MS, as well as relationships between melatonin–insulin ratio and the lipid profile. Pineal disturbances could influence the pathogenesis and the phenotype variations of the MS. Larger studies are needed to confirm or reject this hypothesis and to clarify the role of the melatonin in the metabolic disturbances.     

IDF and ATP-III definitions of metabolic syndrome in the prediction of all-cause mortality in type 2 diabetic patients

AIM: The metabolic syndrome (MS) is associated with increased cardiovascular morbidity and mortality. Recently, the International Diabetes Federation (IDF) proposed to lower diagnostic thresholds for fasting glucose and waist circumference and to limit the diagnosis of MS only to subjects with abdominal adiposity. The aim of the present study was to assess the prognostic value of IDF criteria in diabetic patients, in comparison with previous ATP-III criteria. METHODS: An observational cohort study was performed on a consecutive series of 882 Caucasian type 2 diabetic outpatients, aged 65.3 +/- 10.9 years, with a duration of diabetes of 13.1 +/- 10.6 years. Information on 3-year all-cause mortality was obtained by the City of Florence Registry Office. RESULTS: The prevalence of MS was 68.4 and 73.7% using ATP-III and IDF criteria, respectively. Over the follow-up period, 115 (13.6%) deaths were recorded. Patients with ATP-III-defined MS showed a significantly higher mortality rate when compared with the rest of the sample (16.1% vs. 8.2%; p = 0.002), whereas a non-significant trend was observed using IDF classification (14.9% vs. 10.0%, p = 0.064). At Cox regression analysis, after adjustment for sex, age, and its individual components, diagnosis of MS with ATP-III criteria, but not with IDF criteria [OR (95% CI) 1.65 (0.99-2.72), p = 0.053], was significantly associated with higher mortality [OR (95%,CI) 2.38 [1.18-4.76]). CONCLUSION: In conclusion, in Caucasian type 2 diabetic patients the application of IDF criteria determines an increase of estimated prevalence of MS, without improving its prognostic value. Further studies are needed before the newer IDF criteria for MS are adopted on a larger scale.     

The association between anthropometric parameters,the metabolic syndrome and microalbuminuria in black Africans: the SABPA study

Summary

We aimed to determine which surface anthropometric and metabolic syndrome (MS) markers could be associated with the development of microalbuminuria (MA), and assessed 200 urban Africans (25–60 years) stratified into low (≤ 0.90 and ≤ 0.85) and high (> 0.90 and > 0.85) waist-to-hip ratio (WHR) groups from the North-West province. Anthropometric and fasting MS markers, such as systolic and diastolic blood pressure (BP), and glucose, triglyceride (TG) and high-density lipoprotein (HDL) levels, as well as MA markers were measured.Males revealed higher lifestyle risk factors (body mass index, smoking, alcohol consumption, low physical activity), anthropometric and MS markers compared to the females. The same overall trend was seen for high-WHR males but not for high-WHR females compared to their low-WHR counterparts. Both high-WHR groups revealed increased glucose values (males, 6.34 mmol/l; females, 6.13 mmol/l). Multiple linear regression analysis, independent of confounders, showed positive associations between diastolic blood pressure (DBP) (high WHR and all males), TG, waist circumference (WC) and development of MA in all males. In high-WHR females, positive associations existed only between WC and the development of MA, while neck circumference (NC) was associated with MA development in all females. To conclude, vascular BP, TG and WC were associated with risk of renal impairment in males, while in females, NC and WC circumferences were associated with this risk.     

Cardiovascular metabolic syndrome - an interplay of, obesity, inflammation, diabetes and coronary heart disease

Cardiovascular disease is currently one of the biggest causes of morbidity and mortality facing humanity. Such a paradigm shift of disease pattern over the last century has only worsened due to the alarming global prevalence of obesity and type 2 diabetes. In recent years there is increasing focus on inflammation as one of the key players in the patho-physiology of these disorders. In addition to these overt risk factors new research is unraveling the significance of a constellation of early metabolic abnormalities that include weight gain, insulin resistance, prehypertension and a specific pattern of dyslipidaemia. There exists a complex interrelationship of these various metabolic disorders and their effect on cardiovascular system. Simplified explanation can be that inflammation increases insulin resistance, which in turn leads to obesity while perpetuating diabetes, high blood pressure, prothrombotic state and dyslipidaemia. While inflammation and insulin resistance have direct adverse effects on cardiac muscle, these metabolic abnormalities as a whole cause causes cardiovascular complications; warranting a multi pronged therapeutic and preventive approach for the 'Cardiovascular Metabolic Syndrome' as an entity.     

National Cholesterol Education Program and International Diabetes Federation definitions of metabolic syndrome in the prediction of diabetes. Results from the FIrenze-Bagno A Ripoli study

Background:  The International Diabetes Federation (IDF) proposed to modify the diagnostic criteria for metabolic syndrome (MS) previously issued by the National Cholesterol Education Program (NCEP). Aim of the present investigation is to compare the predictive value for diabetes of NCEP and IDF definitions of MS in a large sample of predominantly Caucasian subjects.
Methods:  A prospective observational study was performed on a cohort study (n = 3096) enrolled in a diabetes-screening programme, the FIrenze-Bagno A Ripoli study. All subjects with fasting glucose >126 mg/dl and/or post-load glucose ≥200 mg/dl (5.7%) were excluded from the present analysis. Follow-up of each subject was continued until diagnosis of diabetes, death or until 31 December 2005. Mean follow-up was 27.7 ± 11.3 months.
Results:  Among subjects enrolled, 13.7 and 25.2% were affected by MS using NCEP and IDF criteria respectively. During follow-up, 38 new cases of diabetes were diagnosed, with a yearly incidence rate of 0.5%. The relative risk for diabetes in subjects with MS was 10.10 [5.13; 20.00] and 7.87 [3.70; 16.7] using NCEP and IDF definitions respectively. After adjustment for age, sex, fasting glucose and waist circumference, NCEP-defined MS, but not IDF-, was significantly associated with incident diabetes (hazard ratio, 95% CI: 2.41 [1.01; 5.95] and 2.05 [0.80; 5.29] respectively).
Conclusions:  Although the reasons for the proposed changes in diagnostic criteria for MS are easily understandable, the newer IDF definition, while increasing estimates of prevalence of the syndrome, reduces the effectiveness of MS in identifying subjects at risk for diabetes. Further research is needed before the previous NCEP criteria are abandoned.     

The remission phase in type 1 diabetes: Changing epidemiology,definitions, and emerging immuno‐metabolic mechanisms

Type 1 diabetes mellitus (T1DM) is characterized by irreversible islet β cell destruction. During the progression of this disease, some patients with T1DM experience a phase of remission known as honeymoon or partial remission (PR) that is mainly characterized by satisfactory glycemic control and the transient recovery of islet β cell function. This special phase is a good model for studying the mechanism of β cell protection, might serve as a proper intervention period for immunotherapy, and may be related to disease prognosis. This special stage is highly valuable for studies aiming to identify possible targets that may be used to cure T1DM. An in‐depth understanding of the diagnosis, epidemiology, and possible mechanisms of the PR phase is highly needed. In general, patients enter the PR phase approximately 3 months after starting insulin therapy, and this phase could be sustained for 6 to 9 months. Current research increasingly focuses on the metabolic and immunological aspects to constantly update our understanding of this phase. This review concentrates on the PR phase of T1DM to provide a comprehensive outlook of its epidemiology, diagnostic criteria, and underlying immune metabolic mechanisms.     

Inflammatory mediators involved in the progression of the metabolic syndrome

The metabolic syndrome is often associated with type 2 diabetes mellitus, dyslipidemia, atherosclerosis, hypertension, steatosis of the liver and other organs, as well as hypertension, type 2 diabetes mellitus, and atherosclerosis. Recent studies have implicated a number of inflammatory mediators including cytokines, adipokines and eicosanoids in the inflammatory responses that accompany the metabolic syndrome. Measurements of the circulating levels of the inflammatory molecules that accompany this syndrome might provide leads to therapeutic approaches to modulate the inflammatory responses and thereby alter disease progression. In this review, we summarize recent studies on classical and newer inflammatory mediators in the pathogenesis of the metabolic syndrome in humans and experimental models.     

The metabolic syndrome in critically ill patients

Metabolic support in intensive care is a rapidly evolving field with new information being gathered almost on a daily basis. In endocrine practice, over the last 20 years, researchers have focussed on a new entity, termed the "metabolic syndrome". This describes the constellation of abnormalities which include central adiposity, insulin resistance and inflammation. All of these predispose the individual to a greater risk of cardiovascular events. Of interest is the observation that some of the metabolic abnormalities in sepsis and multiple organ dysfunction syndrome of critical illness share several common features with that of the metabolic syndrome. In this chapter we describe the features of the metabolic syndrome as is understood in endocrine parlance, the metabolic abnormalities of critical illness and explore the common threads underlying the pathophysiology and the treatment of the two syndromes. The role of adiponectin in the metabolic abnormalities in both the metabolic syndrome and in sepsis are reviewed. The potential role of the pleiotropic effects of statins in the therapy of sepsis is also discussed.     

New anthropometric indices in the definition of metabolic syndrome in pediatrics

Pediatrics metabolic syndrome (MetS) may be associated with the risk of development of chronic diseases in adulthood; however, the definition of pediatric MetS is unclear, and may vary with ethnicity. The primary goal of this study was to determine the best anthropometric predictors for pediatric MetS. For this purpose, 988 high school girls were recruited. Anthropometric indices and biochemical parameters were measured using standard procedures. The adapted MetS for pediatrics, including the IDF, NCEP, and two modified-NCEPs (Cook's and DeFerranti's) were used to establish a diagnosis of MetS. Statistical analysis was performed using SPSS and MedCalc softwares. Except for body frame size (r), the values for anthropometric indices were significantly lower in an individual without MetS. Waist to height (WHtR), BMI and hip circumference (HiC) showed the strongest association with the different MetS definitions. For the IDF definition, the highest sensitivity and specificity were observed for HiC (100.0, 85.2) and WHtR (100.0, 84.7); while for the NCEP definition, the r index showed the highest sensitivity (85.0); but low specificity made it inapplicable. For the Cook's definition of MetS, wrist circumference (WrC), HiC, WHtR, BMI and SR had similar sensitivity values with WC (92.9%), and HiC (85.3%) have the highest specificity. WHtR (86.05, 80.5), SR (86.05, 82.7) and HiC (76.7, 87.0) sensitivity and specificity were the best indexes for DeFerranti's criteria. Based on this date, we concluded that HiC and WHtR might be helpful as auxiliary indexes for pediatric MetS definition; however, further studies are required in both genders.     

Prevalence of metabolic syndrome and its association with obesity indices in a Chinese population

Background: To investigate the prevalence of metabolic syndrome in an urbanizing community in Qingpu, a suburb of Shanghai, and to determine which obesity indices, including body mass index, waist circumference (WC), and waist:hip (WHpR), and waist:height (WHtR) ratios, are most closely associated with metabolic syndrome. Methods: We conducted a cross‐sectional health survey of 1634 individuals (age 15–87 years) in the Jinhulu community located in Qingpu. The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP ATP III) criteria were used to define metabolic syndrome, with central obesity defined according to Asia–Pacific (APC) region criteria. Results: The age‐standardized prevalence of metabolic syndrome was 3.6% in men and 7.2% in women. Using the criterion of central obesity in the APC, the age‐standardized prevalence of metabolic syndrome increased to 8.3% in men and 10.9% in women. Regardless of age, WHtR consistently showed a higher odd ratios (OR) after adjustment for confounding factors of 2.17 (95% confidence interval [CI] 1.12–4.20; P = 0.022) in subjects<52 years of age and 1.92 (95% CI 1.18–3.11; P = 0.008) in those ≥52 years of age. In men, the WHtR was the only significant predictor (OR 2.42; 95% CI 1.15–5.08; P = 0.02) of metabolic syndrome after adjustment, whereas in women WHtR (OR 1.87; 95% CI 1.37–2.85; P =0.0088) was slightly inferior to WHpR and WC. Conclusion: Metabolic syndrome is prevalent in an urbanizing rural area in Qingpu. Of the anthropometric parameters commonly used to identify metabolic syndrome, WHtR may be the best.     

The metabolic syndrome as a predictor of incident diabetes mellitus in Mauritius

Aims To assess the utility of the metabolic syndrome (MetS) and a Diabetes Predicting Model as predictors of incident diabetes. Methods A longitudinal survey was conducted in Mauritius in 1987 (n = 4972; response 80%) and 1992 (n = 3685; follow‐up 74.2%). Diabetes status was retrospectively determined using 1999 World Health Organization (WHO) criteria. MetS was determined according to four definitions and sensitivity, positive predictive value (PPV), specificity and the association with incident diabetes before and after adjustment for MetS components calculated. Results Of the 3198 at risk, 297 (9.2%) developed diabetes between 1987 and 1992. The WHO MetS definition had the highest prevalence (20.3%), sensitivity (42.1%) and PPV (26.8%) for prediction of incident diabetes, the strongest association with incident diabetes after adjustment for age and sex [odds ratio 4.6 (3.5–6.0)] and was the only definition to show a significant association after adjustment for its component parts (in men only). The low prevalence and sensitivity of the International Diabetes Federation (IDF) and ATPIII MetS definitions resulted from waist circumference cut‐points that were high for this population, particularly in men, and both were not superior to a diabetes predicting model on receiver operating characteristic analysis. Conclusions Of the MetS definitions tested, the WHO definition best identifies those who go on to develop diabetes, but is not often used in clinical practice. If cut‐points or measures of obesity appropriate for this population were used, the IDF and ATPIII MetS definitions could be recommended as useful tools for prediction of diabetes, given their relative simplicity.     

Small, dense low-density-lipoproteins and the metabolic syndrome

Small, dense low-density-lipoproteins (LDL) are associated with increased risk for cardiovascular diseases and diabetes mellitus and a reduction in LDL size has been reported in patients with coronary and non-coronary forms of atherosclerosis. LDL size has been accepted as an important predictor of cardiovascular events and progression of coronary artery disease as well as an emerging cardiovascular risk factor by the National Cholesterol Education Program Adult Treatment Panel III. Small, dense LDL, with elevated triglyceride levels and low HDL-cholesterol concentrations, constitute the 'atherogenic lipoprotein phenotype (ALP)', a form of atherogenic dyslipidemia that is a feature of type 2 diabetes and the metabolic syndrome. LDL size and subclasses show specific alterations in patients with the metabolic syndrome that probably significantly increase their cardiovascular risk; however, so far it has not been recommended to incorporate LDL size measurements in treatment plans, when hypolipidemic therapies are installed. Patients with type 2 diabetes are at high cardiovascular risk and it is still on debate if the treatment goals may be identical or whether there are distinct groups with different cardiovascular risks and hence with different treatment goals. Measurements beyond traditional lipids, such as measurements on the presence of small, dense LDL in patients with the metabolic syndrome, may help to identify cardiovascular risk subgroups. In addition, it might be possible in the future to individualize hypolipidemic treatments if more than the traditional lipids are taken into account. LDL size measurement may potentially help to assess cardiovascular risk within the metabolic syndrome and adapt the treatment goals thereafter.