Central obesity and its association with metabolic syndrome in adolescent students of Aceh Sport High School: A cross-sectional study

Visceral Adipose Tissue Attacks Beyond the Liver: Esophagogastric Junction as a New Target

Waist Circumference, Visceral Obesity, and Cardiovascular Risk

Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome

The association of type 2 diabetes mellitus and hypertension is so high that it cannot be explained on the basis of diabetic nephropathy. This phenomenon has been attributed to a condition known as metabolic syndrome. Depression may be another aspect of metabolic syndrome. We conducted a cross-control study with 110 patients with type 2 diabetes mellitus (DM) and 110 control subjects of comparable age and sex. We determined the time since diagnosis of diabetes, the presence of hypertension (HT), coronary heart disease, cerebrovascular insufficiency, and depression, and took several anthropometric measurements, including height, weight, body mass index (BMI) waist circumference (WC), waist-to-hip circumference ratio (WHR), triceps skin fold thickness (TSFT), mid-upper arm circumference (MUAC), and mid-upper arm muscle area (MAMA). We also investigated depression in metabolic syndrome by comparing patients with type 2 diabetes alone and with type 2 diabetes and hypertension who attended a diabetes clinic. The prevalence of depression in hypertensive diabetics was 57% whereas in diabetics alone it was 40% (X2=4.3, P is less than 0.05). Likewise, combined hypertension and depression was more common among diabetics than controls (66% vs 25% respectively P is less than 0.01). The presence of combined hypertension and type 2 diabetes should alert the clinician to look for other features of the metabolic syndrome and for associated depression, which should be treated in most cases by pharmacotherapy.

Hypertension has long been known to be more prevalent among obese subjects or in patients with diabetes, ie, in states of insulin resistance.1 After the demonstration that essential hypertension is an insulin-resistant state in its own right,2 it was logical to include hypertension in the insulin resistance syndrome,3 later transmuted into the metabolic syndrome.4 A large number of studies, both epidemiological and physiological, have explored this association and, more in general, the interrelationships between blood pressure and insulin action. Summarizing the available evidence—and critically analyzing its merits and pitfalls—is beyond the scope of this brief commentary. It may be nevertheless useful to recall a few general points. First, the association between insulin resistance and hypertension extends into the normal state as an association between insulin action on glucose metabolism and blood pressure levels5; this clearly speaks for the existence of multiple cross-talk between the 2 homeostatic systems. Second, longitudinal studies have confirmed that insulin resistance (as measured by its surrogate, fasting hyperinsulinemia) may precede the development of frank hypertension.6 The reverse temporal sequence, ie, hypertension antedating insulin resistance, has not been documented. Third, associations, even if fairly consistent, do …

Abdominal obesity, insulin resistance, and metabolic syndrome in a southern European population

Case Presentation: E.C. is a 53-year-old postmenopausal female, referred for treatment of hypertension, with a family history of type 2 diabetes, hypertension, and coronary heart disease (CHD). Until learning that her blood pressure was “too high” during a routine physical examination, she felt well, and her postmenopausal symptoms had responded to hormone replacement therapy. She was not overweight (her body mass index [BMI] was 23.7 kg/m2), and the only abnormality on physical examination was a blood pressure of 145/95 RAR. Laboratory results revealed a normal blood count and urinalysis, with the following fasting plasma concentrations of relevant metabolic variables (in mg/dL): glucose 102, triglycerides (TG) 238, low-density lipoprotein cholesterol (LDL-C) 147, and high-density lipoprotein cholesterol (HDL-C) 52. E.C. is hypertensive and hypertriglyceridemic and at increased risk for CHD. Less obvious is that these metabolic abnormalities are highly likely to be the manifestations of a more fundamental defect—resistance to insulin-mediated glucose disposal and compensatory hyperinsulinemia, changes that greatly increase CHD risk.1,2⇓ The importance of insulin resistance as a CHD risk factor was first explicated in 1998, and the cluster of abnormalities likely to appear as manifestations of the defect in insulin action designated as syndrome X.1 Support for this notion has grown almost as fast as the names used to describe the phenomenon. The Adult Treatment Panel III (ATP III) has recently3 recognized the importance as CHD risk factors of a “constellation of lipid and nonlipid risk factors of metabolic origin,” designated this cluster of abnormalities as “the metabolic syndrome,” and indicated that “this syndrome is closely linked to insulin resistance.” Table 1 lists the criteria the ATP III stipulated be used to diagnose the metabolic syndrome, and a recent report4 has applied these criteria to the database of the Third National Health and Nutrition …

The metabolic syndrome (MS) is a complex of interrelated risk factors for cardiovascular disease and diabetes. These factors include hyperglycemia, hypertension, high triacylglycerol levels, low HDL-cholesterol (HDL-c) levels, and abdominal obesity. Evidence suggests that iron influences glucose metabolism, even in the absence of significant iron overload. Iron stores, expressed as serum ferritin concentration, have been proposed to be a component of the insulin-resistance syndrome. In 1997, Moirand et al. first reported the presence of histologically proven liver iron overload in overweight subjects with abnormal glucose metabolism and dyslipidemia. The aim of this study was to evaluate the correlation between serum levels of hepcidin and ferritin in patients with metabolic syndrome in R.Macedonia. The study included 240 subjects - 60 males are with MS and 60 males as control group. 60 females are with MS and 60 females as control group. Individuals aged 18 years or older were eligible to participate in the study. In this analysis we included subjects with available complete data allowing their classification according to established criteria for MetS. In detail, the following features were considered: 1) abdominal obesity, defined as the presence of waist circumference ≥102 cm in men or ≥88 cm in women; 2) fasting plasma glucose ≥ 6.1 mmol/l or drug treatment for elevated blood glucose; 3) serum triglycerides ≥ 1.69 mmol/l or drug treatment for elevated triglycerides; 4) serum HDL cholesterol in men< 1.03 mmol/l and <1.29 mmol/l in women or drug treatment for low HDL-C; 5) blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure. Statistical analysis showed that males and females with MS had statistically higher ferritin levels than control group. Statistical analysis showed that males and females with MS had statistically higher hepcidin levels than control group. Serum ferritin levels significantly correlate with hepcidine in all participants with MS excluded females control group.Body mass, BMI, waist circumference, hip circumference, and WHR are statistically significant higher in subjects with MS compared to control groups. Concentrations of lipid parameters for all examinated groups. The concentrations of HDL- cholesterol, triglycerides and apo A are significantly increased in subjects with MS compared to control groups. It has been demonstrated that the prevalence of MS is increasing worldwide, largely the result of greater obesity and sedentary lifestyles. The concentration of serum hepcidin is associated with gender. Males hepcidine levels are higher than females levels. We found a statistically higher hepcidin levels in both groups with MS, compared to control groups, and males hepcidine levels are almost twice higher then females hepcidine levels in bout groups (control group and group with MS). The authors found a strong positive relationship between increased iron stores measured by the concentration of plasma ferritin and risk of type 2 diabetes, impaired glucose tolerance and metabolic syndrome in middle age and older people. The average concentration of ferritin in men is almost twice higher than in postmenopausal women, and three times higher than in premenopausal women with metabolic syndrome.

The classic role of aldosterone is to regulate water and electrolyte balance and, therefore, blood pressure homeostasis.1 Apart from that, experimental studies have demonstrated that aldosterone induces structural and functional alterations in the heart, kidneys, and vessels with effects such as myocardial fibrosis, nephrosclerosis, vascular inflammation and remodeling, and disturbed fibrinolysis.2,3 This damage seems to be aldosterone mediated, and aldosterone blockade with mineralocorticoid receptor (MR) antagonists, such as spironolactone, may prevent the onset of these effects.4,5 On the other hand, it cannot completely be ruled out that potassium and high blood pressure also play additional key roles in this damage.6,7 This evidence has impressively been supported by clinical studies, such as the Randomized Aldactone Evaluation Study and the Eplerenone Post-Acute Myocardial Infarction Survival and Efficacy Study.8,9 For example, increased mortality in patients with chronic heart failure has been associated with elevated aldosterone plasma levels,10 and high circulating plasma aldosterone levels predict the clinical outcome in patients after myocardial infarction.11 Furthermore, primary aldosteronism (PA) has been demonstrated to enhance the risk of cardiovascular events12 and kidney disease.13 In summary, aldosterone is considered a cardiovascular risk factor, promoting disease processes such as cardiac fibrosis, nephrosclerosis, and arteriosclerosis,2,3,14 all of which are increased in patients with obesity and the metabolic syndrome.15,16 The term “metabolic syndrome” (MSyn) has evolved various definitions in recent times; most of the studies introduced here use slight modifications. Nevertheless, all of the definitions used have a common denominator, which is reflected in a definition by the American Heart Association/National Heart, Lung, and Blood Institute.17 According to this definition, the MSyn is considered as a constellation of interrelated risk factors of metabolic origin, including arterial hypertension, dyslipidemias, alterations in glucose homeostasis with type 2 diabetes mellitus, and abdominal …

Objective To assess the relationship between central obesity and metabolic syndrome (MS) in community population. Methods One thousand and fifty-three individuals aged ≥18 (mean, 45.6), including 542 men and 511 women, were recruited for questionnaire survey and medical examination from 4 communities of Hangzhou during March and November 2007.Their blood pressure, waist circumference, serum glucose, lipid profile, and other biochemical markers were measured.All data were used for variance analysis. Results The prevalence of MS, central obesity, hypertension, and diabetes mellitus (DM) was 11.2%, 23.6%, 30.5%, and 8.5%, respectively.The prevalence of MS, DM, and hypertension was increased with waist circumference (P<0.05). Waist circumference was positively correlated to body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DSP), fasting blood sugar, total cholesterol, and triglyceride (r=0.812, 0.649, 0.712, 0.657, 0.598, and 0.676, respectively), although negatively with high-density lipoprotein cholesterol (r=-0.578). Waist circumference also showed positive relationship with the number of lipid metabolism abnormity (r=0.658, P<0.01). Conclusion For Hangzhou community population, central obesity might be one of the risk factors of MS. Key words: Obesity; Metabolic syndrome X; Community healthcare services

Case presentation: A 36-year-old nonsmoking, normotensive South Asian man presented to the emergency department of a community hospital with retrosternal chest pain of &60 minutes’ duration. His 12-lead ECG demonstrated 10 mm of ST-segment elevation in leads V2 through V6, and he received fibrinolytic therapy within 90 minutes of symptom onset. His pain resolved, but his ST segments only partially normalized; he had a peak creatine kinase of 4564 IU/L, and he showed signs of early heart failure. LDL cholesterol was 135 mg/dL, HDL 32 mg/dL, triglycerides 20 mg/dL, and total cholesterol 206 mg/dL; his body mass index (BMI) was 24 kg/m2. Cardiac catheterization demonstrated severe and diffuse triple-vessel disease, including occlusion of the proximal left anterior descending artery, as well as moderate left ventricular dysfunction. While in the hospital, he was diagnosed with new-onset type 2 diabetes mellitus and subsequently underwent uncomplicated coronary bypass surgery. South Asians are individuals whose ethnic roots originate from the Indian subcontinent, a large geographic area that includes India, Pakistan, Sri Lanka, Nepal, and Bangladesh. Collectively, South Asians represent one fifth of the global population. In North America, more than 2 million South Asians reside in the United States and almost 1 million in Canada. It is important to recognize that the term “South Asian” refers to a heterogeneous population, with important differences in diet, culture, and lifestyle among different South Asian populations and religions. Multiple studies of migrant South Asian populations have, however, confirmed a 3- to 5-fold increase in the risk for myocardial infarction and cardiovascular death as compared with other ethnic groups.1–3 In an analysis of age-standardized coronary heart disease (CHD) mortality in Canada over a 15-year period, South Asians had the highest CHD mortality compared with individuals of Chinese and European descent.4 In …

An Evidence-Based Review of Exercise and Metabolic Syndrome

Backgrounds: The study aimed to determine the prevalence and covariates of metabolic syndrome among the elderly residents in nursing homes in Semnan Province, Iran. Methods: This cross-sectional study was conducted among aged participants institutionalized in nursing home in 2018. The study participants’ characteristics were assessed using a demographic assessment form. Moreover, the Mini Nutritional Assessment (MNA) questionnaire, Mentally Assessing Nutritional Assessment (MANA), Katz's Index of Independence in Activity of Daily Living, Mini-Mental State Examination (MMSE) and well-being were applied to assess the participants’ physical and mental status. In addition, Para-clinical and biochemical tests for diagnosis of metabolic syndrome used based on the Adult Treatment Panel (ATPIII). Results: In this study, of 129 eligible participants, 27.7% were suffering from metabolic syndrome. The prevalence of MS in male and female subjects were 26.6% and 28%, respectively. The results of the study indicated a significant relationship between metabolic syndrome and nutritional statues (Pvalue=0.004), mental status (Pvalue=0.001) and ADL (Pvalue=0.003). Moreover, the results showed no significant relationship between well-being and metabolic syndrome. Of all variables of the study, significant relationship between smoking habit, lack of daily activity, abdominal obesity, high systolic and blood pressure, high density lipoprotein cholesterol (HDL-C) HDL-cholesterol, Waist Circumference (WC), systole blood pressure (SBP) were found to be statistically significant. Conclusions: The findings of the study indicated the prevalence of metabolic syndrome among institutionalized elderlies is high. It is recommended to implement preventive and therapeutic measures in this vulnerable group of elderly people. Key words: Metabolic Syndrome, Elderly People, Nursing Homes, Prevalence

Overweight and obesity have become increasingly common; worldwide, at least 1.1 billion adults are overweight and 312 million are obese, when overweight and obesity are defined conventionally as having a body mass index (BMI) of >25 kg/m2 and >30 kg/m2, respectively.1,2 In the general population, overweight and obesity are associated with increased risk of developing cardiovascular disease,3,4 and thus it is not surprising that in cohorts of patients with prevalent ischemic heart disease or acute coronary events, well over 50% are overweight or obese.5,6 Despite the association between obesity and cardiovascular risk in the general population, a multitude of studies have described an inverse correlation between BMI and mortality in patients with coronary artery disease (CAD), including post-coronary revascularization patients and those with acute myocardial infarction (MI); the association between elevated BMI and improved survival has been termed the obesity paradox .7,8 Article p 482 In this issue of Circulation , Zeller et al9 further investigate the obesity paradox in a cohort of 2229 consecutive patients presenting with acute MI in the Cote d’Or region of France. In assessing the impact of obesity on mortality after MI, the group uses both BMI, a traditional index of obesity, as well as waist circumference, an alternate anthropometric index that is more specific for abdominal obesity. Approximately one-half of the subjects in the study were overweight (BMI 25 to 29.9 kg/m2), one-quarter were obese (BMI >30 kg/m2) and one-half had increased waist circumference, which was defined as >102 cm in men and >88 cm in women. Left ventricular ejection fraction, type of MI, and acute treatment strategy did not generally differ by BMI or waist circumference values. Of note, BMI was inversely correlated with age and plasma N-terminal pro B-type natriuretic peptide, whereas …

FABP4 plasma levels are increased in familial combined hyperlipidemia