An epidemiological approach to the metabolic syndrome

OBJECTIVE: To investigate four risk factors for the metabolic syndrome. METHODS: Using the health examination database of a Japanese company, 8,194 middle-aged male workers were assessed for the metabolic syndrome with reference to: (1) obesity (body mass index > or = 25 kg/m2); (2) hypertension (> or = 140/90 mmHg or taking antihypertensive drugs); (3) diabetes (fasting blood glucose > or = 110 mg/dl); and (4) hyperlipidemia (total cholesterol > or = 220 mg/dl or triglyceride > or = 150 mg/dl). (1) Those who had developed the metabolic syndrome (n = 148) were retrospectively followed for 5 years. Persistence rates for the four risk factors were calculated. (2) Those who had three risk factors (n = 1,100) were followed for 5 years to observe the development of metabolic syndrome. The incidence rates from Kaplan-Mayer analysis were compared among four different patterns for three risk factors. Adjusted hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using the Cox's proportional hazard RESULTS: (1) The highest persistence rate was found for obesity, followed by hyperlipidemia, hypertension, and diabetes. (2) After adjusting for age, smoking, drinking, and exercise, significantly higher HRs (95%CIs) were found for those with obesity, hypertension, and diabetes (4.4; 2.9 to approximately 6.9), those with obesity, diabetes, and hyperlipidemia (3.2; 2.1 to approximately 4.9), and those with obesity, hypertension, and hyperlipidemia (2.1; 1.4 to approximately 3.0), compared with those with hypertension, diabetes, and hyperlipidemia. CONCLUSIONS: Obesity may be the key to developing the metabolic syndrome in those who demonstrate three risk factors.     

Vitamin D deficiency is associated with the metabolic syndrome in morbid obesity

BACKGROUND & AIMS: Vitamin D deficiency has been recently associated with the metabolic syndrome. However, it is not known whether this possible association of vitamin D deficiency with the metabolic syndrome is still present at very high degrees of obesity, as in morbidly obese patients. METHODS: Transversal, observational study that included 73 consecutive morbidly obese patients (body mass index 40 kg/m(2)). In every patient, anthropometric variables were recorded, fasting blood was assayed for 25-hydroxyvitamin D concentrations, lipid profiles, glucose and insulin levels, and insulin resistance was estimated by homeostasis model assessment. RESULTS: Vitamin D deficiency was present in 37 of the 73 patients (50.7%). As defined by revised Adult Treatment Panel III criteria, 46 of the 73 obese patients (63%) had the metabolic syndrome. Vitamin D deficiency was more prevalent in morbidly obese patients presenting with the metabolic syndrome, compared with those who did not achieve the criteria for this syndrome (60.9% vs. 33.3% respectively, P = 0.023). When serum concentrations of 25-hydroxyvitamin D were categorized in tertiles, there was an association of the prevalence of the metabolic syndrome with the former (P = 0.038). Serum high-density lipoprotein cholesterol concentrations were lower (37.0+/-7.8 mg/dl vs. 44.9+/-8.7 mg/dl, P = 0.003), and triglycerides levels were higher (163.3+/-81.5 mg/dl vs. 95.1+/-24.2 mg/dl, P = 0.001) in the vitamin D-deficient group. CONCLUSION: Vitamin D deficiency is associated with the metabolic syndrome in morbidly obese patients.     

Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio

BACKGROUNDS: Obesity is one of the criteria for defining metabolic syndrome. However, overt obesity in Asians is relatively low despite high prevalence of metabolic risks. METHODS: We investigated the effectiveness of various anthropometric indices {body mass index (BMI), waist circumference, waist-to-height ratio (W/Ht)} for the evaluation of coronary risk factors (hypertension, hyperglycemia, hypertriglyceridemia, and low HDL cholesterol) and as one of the criteria for metabolic syndrome (clustering of three or more from one obesity and four coronary risk factors) in Japanese on 6141 men and 2137 women. RESULTS: (1) The areas under the receiver operating characteristic curves for the different anthropometric indices to identify any one and two or more coronary risk factors were highest for W/Ht. (2) The sensitivities for the identification of any one and two or more coronary risk factors were greater for W/Ht > or =0.5 than BMI > or =25, > or =23, and indices of waist circumference (Adult Treatment Panel III and Japan Society for the Study of Obesity). (3) The prevalence of metabolic syndrome varied greatly by different anthropometric indices, and the percentages of obesity risk factors in metabolic syndrome were highest for W/Ht > or =0.5 in both genders (approximate 95%). CONCLUSIONS: W/Ht >/=0.5 may be the most effective anthropometric index for screening Japanese people for metabolic syndrome.     

Metabolic syndrome, insulin resistance and the inflammation markers C-reactive protein and ferritin

BACKGROUND: Patients with metabolic syndrome (MS) have above-average risk of developing atherosclerosis and cardiovascular disease. Inflammation plays a key role in the development of atherosclerosis. High levels of the acute phase reactants C-reactive protein (CRP) and ferritin have been reported to correlate with various components of MS. PATIENTS AND METHODS: The serum CRP, ferritin, glucose, insulin, triglycerides, HDL-cholesterol and total cholesterol concentrations of 598 obese or overweight patients were determined, together with relevant anthropometric parameters. Insulin resistance was evaluated by the HOMA method. MS was diagnosed using the ATP III criteria. RESULTS: CRP levels were higher among patients with central obesity than in those without (5.8 vs 3.9 mg/l; P=0.003), and higher among those with fasting plasma glucose concentrations >or=110 mg/dl than in those with lower concentrations (7.4 vs 4.1 mg/l; P=0.01). Serum ferritin levels were higher among patients with triglyceride concentrations >or=150 mg/dl than in those with lower levels (76.8 vs 40.1 ng/ml; P<0.001), and higher among those with fasting plasma glucose concentrations >or=110 mg/dl than in those with lower concentrations (75.7 vs 41.7 ng/ml; P=0.005). The number of MS criteria that were satisfied increased with CRP and ferritin levels. Patients with insulin resistance also had higher CRP and ferritin levels than those without, 7.3 vs 4.3 mg/l for CRP (P=0.032) and 124.5 vs 80.1 ng/ml for ferritin (P<0.001). CONCLUSIONS: MS and insulin resistance are associated with elevated serum CRP and ferritin. Evaluation of subclinical chronic inflammation in patients with MS and/or insulin resistance by determination of these markers might aid in their evaluation as candidates for aggressive intervention against cardiovascular risk factors.     

Peer Reviewed: Identifying Adolescent Metabolic Syndrome Using Body Mass Index and Waist Circumference

Introduction

Metabolic syndrome is increasing among adolescents. We examined the utility of body mass index (BMI) and waist circumference to identify metabolic syndrome in adolescent girls.

Methods

We conducted a cross-sectional analysis of 185 predominantly African American girls who were a median age of 14 years. Participants were designated as having metabolic syndrome if they met criteria for 3 of 5 variables: 1) high blood pressure, 2) low high-density lipoprotein cholesterol level, 3) high fasting blood glucose level, 4) high waist circumference, and 5) high triglyceride level. We predicted the likelihood of the presence of metabolic syndrome by using previously established cutpoints of BMI and waist circumference. We used stepwise regression analysis to determine whether anthropometric measurements significantly predicted metabolic syndrome.

Results

Of total participants, 18% met the criteria for metabolic syndrome. BMI for 118 (64%) participants was above the cutpoint. Of these participants, 25% met the criteria for metabolic syndrome, whereas only 4% of participants with a BMI below the cutpoint met the criteria for metabolic syndrome (P <.001). Girls with a BMI above the cutpoint were more likely than girls with a BMI below the cutpoint to have metabolic syndrome (P = .002). The waist circumference for 104 (56%) participants was above the cutpoint. Of these participants, 28% met the criteria for metabolic syndrome, whereas only 1% of participants with a waist circumference below the cutpoint met the criteria for metabolic syndrome (P <.001). Girls with a waist circumference above the cutpoint were more likely than girls with a waist circumference below the cutpoint to have metabolic syndrome (P = .002). Stepwise regression showed that only waist circumference significantly predicted metabolic syndrome.

Conclusion

Both anthropometric measures were useful screening tools to identify metabolic syndrome. Waist circumference was a better predictor of metabolic syndrome than was BMI in our study sample of predominantly African American female adolescents living in an urban area.     

Metabolic Syndrome Based on IDF Criteria in a Sample of Normal Weight and Obese School Children

Metabolic syndrome was once reported only in adults but is now occurring more frequently in children. This study compared the incidence of metabolic syndrome and its components among normal and obese children using the 2007 International Diabetes Federation (IDF) pediatric definition for metabolic syndrome. Subjects comprised 78 school children aged 8-10 years, with 34 obese and 44 normal weight children. Body weight, height, and waist circumference (WC) were measured and body mass index was calculated. Clinical profiles measured included fasting blood glucose, triglyceride, HDL cholesterol, LDL cholesterol, total cholesterol, and blood pressure. Metabolic syndrome (MS) was defined using the 2007 IDF pediatric criteria. Obese subjects had a significantly (p< 0.001) higher mean BMI (26.0 ± 3.6 kg/m2) compared to normal weight subjects (15.1 ± 0.8 kg/m2). Only one obese subject (1.3% of subjects) had metabolic syndrome based on the IDF definition, but all obese subjects had at least one component of metabolic syndrome. In comparison, no normal weight subjects had metabolic syndrome and only 9.1% of normal weight subjects had at least one component of metabolic syndrome. The most common component was central obesity, observed in 43.6% of subjects having WC equal to or greater than the 90th percentile. In concurrence with central obesity as the core feature of the IDF criteria, WC showed the strongest correlation with indicators of obesity such as BMI (r=0.938, p< 0.001), fat mass (r=0.912, p< 0.001) and fat-free mass (r=0.863, p< 0.001). We conclude that the problem of metabolic syndrome is more prominent among obese children, although the incidence of MS as defined by the 2007 pediatric IDF criteria, is low in this population (1.3%).     

超重、肥胖和腹型肥胖与心血管代谢性疾病的关联研究

目的 了解超重、肥胖和腹型肥胖对心血管代谢性疾病的影响。方法 采用整群抽样方法,选取河南省开封市通许县673名15岁以上居民为调查对象进行横断面调查,并对研究对象进行问卷调查和体格检查,留取空腹和餐后2h静脉血进行血糖检测。结果 开封地区居民标化超重患病率为35.52%;标化肥胖患病率为14.18%;标化腹型肥胖患病率为42.62%。单因素logistic回归分析显示,超重、肥胖和腹型肥胖是高血压、2型糖尿病、高血脂的危险因素;腹型肥胖是冠心病和脑卒中的危险因素(P<0.05)。腹型肥胖的人群归因危险度(PAR)在高血压、2型糖尿病、高血脂和心脑血管疾病中均高于70%。结论 在对高危人群进行筛查时,腰围比体质指数更为重要。减少腹型肥胖人群比例对预防心血管代谢性疾病的意义更为重大。     

Metabolic syndrome – a risk factor for all-cause disability pension: a prospective study based on the Swedish WOLF cohort

ObjectiveThe aim was to study the impact of metabolic syndrome on the risk for disability pension among Swedish employees.MethodsA working population-based prospective cohort [Work, Lipids and Fibrinogen (WOLF) cohort, N=10 803], was linked to national registry records of all-cause disability pension for the period 1992–2013. Occupational health service data included 1992–2009 anthropometric measurements, blood samples, and questionnaires. Metabolic syndrome was defined according to International Diabetes Federation criteria, and risk for any all-cause disability pension was analyzed using Cox proportional hazard regression as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex and other covariates.ResultsOf the employees, 17.9% (men 21.5%, women 9.7%) met the criteria for metabolic syndrome. The prevalence of all-cause disability pension was 15.2% in men with metabolic syndrome and 7.5% in men without metabolic syndrome; for women, the corresponding results were 23.2% and 12.7%. After adjustment for socio-demographic factors, health behaviors, work-related factors, diabetes, and obesity, the risk for all-cause disability pension among subjects with metabolic syndrome displayed an HR of 1.37 (95% CI 1.18–1.60). Results were similar for men and women. In a subgroup, further adjustment for chronic diseases resulted in an HR of 1.32 (95% CI 1.04–1.68).ConclusionThis study demonstrates an increased risk for all-cause disability pension, even after adjustment for other risk factors, among Swedish employees with metabolic syndrome compared to those without at baseline.     

Assessment of risk factors of metabolic syndrome in girls and boys from south-west area of Poland

The research was aimed at evaluating risk factors: level of physical activity, BMI, using of unhealthy substances, appearing of illness in the family, age and sex in according to increase frequency of the metabolic syndrome (MS) in teenagers from Wroc?aw. Height and the body weight were measured to assess BMI according to Cole's index in group of 409 girls and 369 boys. Metabolic syndrome was characterized when three of risk factors was noticed like: high level of triglycerids (> or = 110 mg/dl), glucose (> or = 110 mg/dl), waist circumference (> or = 90 percentyl) or low level of HDL - cholesterol (< or = 40 mg/dl). Logistic regression and odds ratio were used to identify number of group with MS (7.7% boys, 6.4% girls), generally 7.1%. One components of ZM was noticed in 36.8% of group, two - 14.9%. Metabolic syndrome was not stated in 41.3% of teenagers. A significant influence of the excess weight and the obesity, the age of pupils, smoking cigarettes to the height of the risk of the metabolic syndrome and his components was stated. In the MS prevention they are essential alterable elements: a proper physical effort, the standardization of parameters of the body and not-taking substances.     

Ten-year change in serum uric acid and its relation to changes in other metabolic risk factors in young black and white adults: the CARDIA study

Elevated serum uric acid is commonly seen in association with obesity, glucose intolerance, hypertension and dyslipidemia. There is currently no satisfactory explanation for the relation of uric acid and the metabolic syndrome (MetSyn). This study aimed to evaluate the relations of change in serum uric acid with changes in components of the MetSyn in young adults. We studied 1,249 male and 1,362 female black and white subjects aged 17–35 years (baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, which attended a 10-year follow-up. Metabolic factors assessed at both time periods included BMI, waist circumference, blood pressure, fasting glucose, insulin, and lipids. Confounders examined (baseline and change variables) were serum creatinine, alcohol, smoking, physical activity, and oral contraceptives. Mean uric acid increased the most in black males (+0.5 mg/dl), followed by white males (+0.3 mg/dl) and black females (+0.2 mg/dl) (all P < 0.01), with the least change among white females (+0.1 mg/dl) (ns). Although change in all of the metabolic factors was associated with change in uric acid in the anticipated directions, in multivariable analyses only BMI and triglycerides had a significant independent association with uric acid in all race-sex-groups. Among confounders, only change in serum creatinine showed a strong independent association with uric acid. In conclusion, besides weight gain and renal excretion, increasing uric acid concentrations in young adults are strongly related to corresponding changes in triglycerides. The correlation of uric acid and triglycerides was found within the normal range and could not be explained by obesity.     

Prevalence of metabolic syndrome among Filipino adults aged 20 years and over

This study sought to determine the prevalence of metabolic syndrome, using data collected from 4,541 adults aged 20 years and over covered in the Fifth National Nutrition Survey conducted in 1998. The metabolic variables analyzed were: total cholesterol, LDL-c, HDL-c, triglycerides and fasting blood glucose. In addition, measurements of obesity such as body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC) as well as blood pressure were taken. Comparing the mean metabolic characteristics of the non-obese, total obese and the android obese, results showed significant differences in almost all the variables except for the HDL-c. By gender, non-significant differences were observed between males and females in the non-obese group in terms of the BMI and glucose levels and in the android group, in terms of total cholesterol. In all three groups, the biggest difference was observed in the mean triglycerides, where males had significantly higher mean than the females. Comparing adults with >125 mg/dl fasting blood sugar (FBS) there were higher rates of hypertension, high waist-to-hip ratio (WHR), high cholesterol, high triglycerides, high LDL-c, low HDL-c, among the overweight and obese than among those with normal BMI. In general, the proportion of subjects with co-morbid factors increased with higher levels of FBS, except for high cholesterol wherein no pattern was established. The highest prevalence of high FBS was found in both males (35.8%) and females (14.5%) with the following combined characteristics: high BMI, high WHR and high WC. Males with co-existing high BMI, high WHR, and high WC were observed to have the highest prevalence rate of hypertension (66.5%). Among females, the highest prevalence rate of hypertension (37.9%) was seen among those with high fasting blood sugar. The proportion of subjects with hypertension generally increased with age irrespective of the BMI status. One of the significant correlates of high FBS is waist-hip ratio. Males with WHR of equal or greater than 1 have almost six times the risk of having high FBS, while females with WHR of equal or greater than 0.85 have five times the risk of having high FBS compared to those with normal WHR. Among females with triglyceride levels of equal or greater than 200 mg/dL, the risk of having high FBS is five times compared to those with triglyceride levels below 200 mg/dL. Univariate analysis to see the effect of the type of obesity to dyslipidaemia and hypertension revealed that females with high waist circumference generally provided greater risk compared to those who were overweight and obese as well as those with android obesity. For males, high waist circumference had greater risk of developing high triglyceride and high LDL-c. Android obese males had greater risk to high FBS. The results showed that the prevalence rate of metabolic syndrome is 0.28%, based on the number of individuals with the following characteristics: high FBS, hypertensive, android obese, with body mass index (BMI) of > or =25.0 and high WC. Females had a higher rate than males - almost twice. Considering that metabolic syndrome, with its co-morbidity factors is prevalent among some Filipino adults aged 20 years and over, it is recommended that health programs geared towards minimizing the morbid risk factors be properly developed, promoted and fully implemented.     

Relation of serum total antioxidant status with metabolic risk factors in Korean adults

The purpose of the present study was to examine the relation of total antioxidant status (TAS) to metabolic risk factors in Korean adults. Anthropometric measures, blood pressure, serum lipids and fasting glucose were determined in 406 men and women. TAS was measured by using commercially available Randox kit. Serum TAS was significantly positively correlated with body weight (p=0.004), body mass index (BMI) (p=0.033), waist circumference (p=0.017), total cholesterol (p=0.038) and triglyceride (TG) (p<0.001). The mean TAS of hypertriglyceridemic subjects (TG ≥150 mg/dl) was significantly higher than that of subjects whose TG was lower than 150 mg/dl (p=0.001). When central obesity, TG, high density lipoprotein cholesterol, fasting glucose and blood pressure were considered as metabolic risk factors, TAS was shown to be elevated with increased number of metabolic risk factors (p=0.004). The positive association between TAS and a number of metabolic risk factors suggests that increased TAS may not always indicate one''s healthier condition. In order to help understand TAS as a marker of total antioxidant capacity in humans with various metabolic conditions, it is needed to clarify the factors affecting TAS in relation to changes in metabolic risk factors.     

Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults

BACKGROUND: Although dietary guidelines recommend increased intake of grain products to prevent chronic diseases, epidemiologic data regarding whole-grain intake association with metabolic syndrome are sparse. OBJECTIVE: To evaluate the relationship between whole-grain intakes, metabolic syndrome and metabolic risk factors in Tehranian adults. DESIGN: Population-based cross-sectional study. SETTING: Tehran, the capital of Iran. SUBJECTS: A representative sample of 827 subjects (357 men and 470 women) aged 18-74 y. METHODS: Usual dietary intake was assessed using a food frequency questionnaire. The procedure developed by Jacobs et al was used to classify grain products into whole and refined grains. Weight and height were measured according to standard protocols and body mass index was calculated. Fasting blood samples were taken for biochemical measurements and blood pressure was assessed according to standard methods. Hypertriglyceridemia, hypercholestrolemia, high LDL, low HDL and metabolic syndrome were defined according to ATP III guidelines and hypertension based on JNC VI. Diabetes was defined as fasting plasma glucose level of > or = 126 mg/dl or 2-h postchallenge blood glucose level of > or = 200 mg/dl. Subjects were categorized based on quartile cut-points of whole- and refined-grain intake. RESULTS: Mean (+/-s.d.) consumptions of whole and refined grains were 93+/-29 and 201+/-57 g/day, respectively. Both men and women reported higher intakes of refined grain than of whole grains. Compared with subjects in the lower quartile category, those in the upper category of whole-grain intake had lower prevalence of metabolic risk factors. Conversely, those in the higher category of refined-grain intake had higher prevalence of metabolic risk factors, except for diabetes. After controlling for confounders, a significantly decreasing trend was observed for the risk of having hypertriglyceridemia (odds ratios among quartiles: 1.00, 0.89, 0.74, 0.61, respectively), hypertension (1.00, 0.99, 0.93, 0.84) and metabolic syndrome (1.00, 0.84, 0.76, 0.68). Higher consumption of refined grains was associated with higher odds of having hypercholestrolemia (1.00, 1.07, 1.19, 1.23), hypertriglyceridemia (1.00, 1.17, 1.49, 2.01), hypertension (1.00, 1.22, 1.48, 1.69) and metabolic syndrome (1.00, 1.68, 1.92, 2.25). CONCLUSION: Whole-grain intake is inversely and refined-grain intake is positively associated with the risk of having metabolic syndrome. Recommendations to increase whole-grain intake may reduce this risk.     

The whey fermentation product malleable protein matrix decreases TAG concentrations in patients with the metabolic syndrome: a randomised placebo-controlled trial

Animal and human studies suggest that a malleable protein matrix (MPM) from whey decreases plasma lipid concentrations and may positively influence other components of the metabolic syndrome such as glucose metabolism and blood pressure (BP). The primary objective of this double-blind, multi-centre trial was to investigate the effects of a low-fat yoghurt supplemented with whey MPM on fasting TAG concentrations in patients with the metabolic syndrome. A total of 197 patients were randomised to receive MPM or a matching placebo yoghurt identical in protein content (15 g/d). Patients were treated during 3 months with two daily servings of 150 g yoghurt each to compare changes from baseline in efficacy variables. MPM treatment resulted in a significantly larger reduction of TAG concentrations in comparison to placebo (relative change -16%, P=0·004). The difference was even more pronounced in subjects with elevated fasting TAG (≥200 mg/dl) at baseline (-18%, P=0·005). The relative treatment difference in fasting plasma glucose was -7·1 mg/dl (P=0·089). This effect was also more pronounced in subjects with impaired fasting glucose at baseline (-11 mg/dl, P=0·03). In patients with hypertension, the relative treatment difference in systolic BP reached -5·9 mmHg (P=0·054). The relative treatment difference in body weight was -1·7 kg (P=0·015). The most common adverse events were gastrointestinal in nature. Conclusions from the present study are that consumption of a low-fat yoghurt supplemented with whey MPM twice a day over 3 months significantly reduces fasting TAG concentrations in patients with the metabolic syndrome and improves multiple other cardiovascular risk factors.     

Presence of the Metabolic Syndrome in Obese Adolescents Predicts Impaired Glucose Tolerance and Nonalcoholic Fatty Liver Disease

PURPOSE: To evaluate whether the presence of metabolic syndrome (MS) in obese adolescents is associated with other comorbidities of obesity METHODS: A total of 85 obese teens (70% female and 30% male) with fasting insulin >25 microU/ml and family history of type 2 diabetes mellitus and/or acanthosis nigricans were studied. Mean age was 15.8 +/- 1.7 years and body mass index (BMI) was 39.3 +/- 6.6 kg/m(2). Of the subjects, 54% were Hispanic and 35% black, 5% white, 5% American Indian, and 1% Asian. Laboratory analysis included fasting lipids, glucose, gamma-glutamyl transpeptidase (GGT), and oral glucose tolerance testing. Additional liver transaminase levels were determined and liver ultrasound (US) was performed to evaluate the presence and severity of fatty liver. RESULTS: All subjects met MS criteria for children for waist circumference, 49% for blood pressure, 54% for high-density lipoprotein, 54% for triglycerides, and 20% for impaired fasting glucose (IFG) or impaired glucose tolerance [IGT]). In all, 47 subjects had three or more MS criteria. BMI was no different between groups with and without MS. Subjects with three or more MS criteria were more likely to have IGT (p = .004), elevated alanine aminotransferase (p = .039), elevated GGT (p = .036), fatty liver on US (p < .001), and more severe fatty liver (p = .001). CONCLUSIONS: Abnormal glucose regulation and evidence of nonalcoholic fatty liver disease (NAFLD) were more common in subjects meeting three criteria for MS than in those meeting fewer criteria. The identification of MS provides value to the primary care provider. Those patients meeting criteria for MS should be evaluated for glucose intolerance and NAFLD.     

Prevalence and Correlates of Metabolic Syndrome in the Adolescents of Rural Wardha

Background and Objective:

Metabolic syndrome is a major concern as a precursor of cardiometabolic diseases. The present study was designed to study the magnitude and correlates of metabolic syndrome among the adolescents of rural Wardha.

Materials and Methods:

A cross-sectional study was carried out among the adolescents (10-19 years) of Anji PHC. A sample of 405 was selected by random sampling from the sampling frame available with department of Community Medicine. We collected data about their sociodemographic variables and other cardiometabolic risk factors. Fasting blood sample was collected to measure lipid profile and blood glucose. Blood pressure and anthropometric measurements (height, weight, and waist circumference) were also taken.

Results:

Prevalence of metabolic syndrome using ATP-III criteria modified for adolescents was found to be 9.9% (95% CI: 7.3-13.1) in the study population and lower level of high-density lipoprotein (HDL) cholesterol was found with a prevalence of 58.3% (95% CI: 53.4-63.0). The prevalence of metabolic syndrome was found to be significantly (P < 0.05) associated with the presence of obesity and hypertension among family members.

Interpretation:

There was a moderately high prevalence of metabolic syndrome among rural adolescents.

Conclusion:

The early identification of cardiometabolic risk factors such as hypertension and obesity can help prevent metabolic syndrome, diabetes, and cardiovascular disease.     

Weight excess and abdominal fat in the metabolic syndrome among Japanese-Brazilians

OBJECTIVE: Obesity, especially abdominal, has been associated with cardiovascular risk factors such as dyslipidemia, hypertension and diabetes mellitus (DM). The importance of these risk factors among Japanese-Brazilians was previously shown, although obesity is not a typical characteristic of Japanese migrants. In this study the prevalence of weight excess and central adiposity (CA) among Japanese-Brazilians and their association with metabolic disorders was evaluated. METHODS: A sample of 530 1st and 2nd generation Japanese-Brazilians (aged 40 - 79 years) went through anthropometric and blood pressure measurements, lipid profile and oral glucose tolerance tests. The prevalence rate (point and confidence interval) of overweight was calculated using a cut-off value of >26.4 kg/m2. CA diagnosis was based on waist-to-hip circumference ratio (WHR): greater-than-or-equal 0.85 and 0.95 in women and men, respectively. RESULTS: The prevalence of weight excess was 22.4% (CI 95% 20.6 - 28.1), and CA was 67.0% (95% CI 63.1 - 70.9). In addition to higher prevalence of DM, hypertension and dyslipidemia, stratifying by BMI and WHR, people with weight excess and CA revealed a poorer metabolic profile: blood pressure levels were significantly higher among those with weight excess with or without CA; CA individuals had higher glucose, triglycerides, total and LDL cholesterol, and lower HDL than those without weight excess or CA; fasting insulinemia was significantly higher among subjects with weight excess (with or without CA) than among those without weight excess or CA. CONCLUSION: Comparing subgroups with and without CA supports the hypothesis that abdominal fat accumulation represents a risk factor for insulin resistance-related diseases, even among Japanese descendants. The increased prevalence of metabolic syndrome among Japanese migrants could be attributed to visceral fat deposition, which has been implicated in the genesis of insulin resistance.     

瘦素与代谢综合征组成成分的聚集特性分析

目的　探讨瘦素水平与代谢综合征 (MS)组成成分的关系 ,分析MS危险因素聚集的特征和规律。方法　观测 795名非糖尿病成人的空腹血清真胰岛素 (FTI)、瘦素、血脂、血糖水平以及血压、体重指数、腰臀围比值和定量胰岛素敏感检测指数 (QUICKI)等指标 ,采用因子分析等方法探讨瘦素水平与上述变量的关系。结果　血清瘦素浓度随代谢异常组合个数的增多而上升。瘦素水平处于上三分位人群检出肥胖、高血压、血脂紊乱以及MS的比例比处在下三分位的人群明显升高。因子分析结果显示 ,男性与女性组包括瘦素等 11个变量的变化各受 3个因子支配 ,累计方差贡献率分别为6 2 0 %和 6 6 7% ,分别由瘦素与体重指数、腰臀围比值、FTI、QUICKI和高甘油三酯和低的高密度脂蛋白胆固醇等变量构成的核心因子 ,由血糖、FTI、QUICKI和高甘油三酯 (女 )构成的糖耐量因子以及由血压和体重指数 (男 )构成的高血压因子 ,其中高胰岛素和胰岛素抵抗 (IR)同时连接前两个因子。结论　该人群的瘦素水平与MS的多个关键组成成分密切相关 ,高瘦素血症可能是MS的 1个新成分。MS危险因素的聚集受多个因子支配 ,IR虽起重要作用 ,但不能单独解释其成因。     

Analysis of obesity and hyperinsulinemia in the development of metabolic syndrome: San Antonio Heart Study

OBJECTIVE: To use standardized cut-offs of body mass index (BMI), waist circumference, waist-to-hip ratio, and fasting insulin levels to predict the development of metabolic disorders and metabolic syndrome. RESEARCH METHODS AND PROCEDURES: We performed an 8-year follow-up study of 628 non-Hispanic whites and 1340 Mexican Americans, ages 25 to 64 years, from the second cohort of the San Antonio Heart Study. We defined metabolic disorders as dyslipidemia (triglycerides > or =2.26 mM or high-density lipoprotein <0.91 mM in men and <1.17 mM in women), hypertension (blood pressure > or =140 or >=90 mm Hg, or receiving antihypertensive medications), and type 2 diabetes (fasting glucose > or =7.0 mM, 2-hour test glucose > or =11.1 mM, or receiving anti-diabetic medications). People with at least two metabolic disorders were defined as having metabolic syndrome. RESULTS: High waist-to-hip ratio and fasting insulin levels were significant predictors of developing metabolic syndrome. High anthropometric indices remained significant predictors of metabolic syndrome after adjusting for fasting insulin. Waist circumference, BMI, and insulin had similar areas under the receiver operating characteristic curves (0.74 to 0.76). Further multivariate analyses combining these indices showed minimal increase in prediction. Of subjects who had a combination of high BMI (> or =30 kg/m(2)) and high waist circumference (above "Action Level 2"), 32% developed metabolic syndrome, compared with 10% of subjects with both low BMI and low waist circumference. DISCUSSION: These findings support the National Institutes of Health recommendations for reducing the risk of metabolic syndrome. Adjustment for baseline fasting insulin levels had only a small effect on the ability of anthropometric indices to predict the metabolic syndrome.     

上海市社区40岁～居民代谢综合征现患调查

目的调查上海市部分社区中老年人群中代谢综合征(MS)及其各危险因子的现患情况。方法于2007-2008年随机抽取社区40岁~常住居民619人进行调查,以中华医学会糖尿学分会的建议为诊断标准,对社区中老年居民的MS患病率进行分析。结果人群中超重/肥胖、高血压、糖尿病、血脂异常及MS的患病率分别为57.7%,43.5%,16.6%,53.3%及12.0%;其中老年组的患病率高于中年组和高龄组,而中年组高血压患病率高于老年组;体质指数(MBI)、收缩压(SBP)、舒张压(DBP)、血清总胆固醇(TC)、血清甘油三酯(TG)、血清高密度脂蛋白-胆固醇(HDL-C)及空腹血糖(FBG)水平随代谢异常组合数目的增加而升高;BMI值与SBP、DBP、TG及HDL-C水平呈明显相关性。结论BMI异常人群是MS高危人群,应加强对体重及肥胖的控制及心脑血管疾病防治。