Metabolic Syndrome Abnormalities Research Articles

Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Korea Children and Adolescents and Nutrient intakes: Using 2008 the Korea National Health and Nutrition Examination Survey

Objectives: The purpose of this study was to estimate the prevalence of metabolic syndrome (MS), metabolic abnormalities, and nutrient intakes in Korea children and adolescents using the Korea National Health and Nutrition Examination Survey from 2008. Methods: A sample of 838 children and adolescent males (n = 442) and females (n = 396) aged 10-18 was used from the 2008 Korea National Health and Nutrition Examination survey. The diagnosis of the metabolic syndrome subjects was adapted from modified National Cholesterol Education Program-Adult Treatment Panel III by Ford. To compare nutrient intakes, we used a judgment sampling. The first group was composed of all children and adolescents (n = 46) with MS. The second one along with the first group had children and adolescents with the same age, sex, and body mass index (BMI) but without MS (n = 46). The control group like the first two had children and adolescents with same sex and same age but with normal BMI and without MS (n = 46). Results: In this randomized controlled controlled trial, the prevalence of the metabolic syndrome was 5.8%. The risk factors was associated with the MS were abdominal obesity 9.4%, hypertriglyceridemia 25.0%, low HDL-cholesterol 10.3%, hypertension 23.4%, and hyperglycemia 7.1%. Among metabolic abnormalities, blood pressure was significantly affected by sex, age and obesity. On the other hand, HDL-cholesterol, triglycerides, and waist circumference were directly linked to obesity. There were no significant differences in nutrient intakes among the three groups.

Metabolic syndrome and prostate abnormalities in male subjects of infertile couples.

No previous study has evaluated systematically the relationship between metabolic syndrome (MetS) and prostate-related symptoms and signs in young infertile men. We studied 171 (36.5 ± 8.3-years-old) males of infertile couples. MetS was defined based on the National Cholesterol Education Program Third Adult Treatment Panel. All men underwent hormonal (including total testosterone (TT) and insulin), seminal (including interleukin-8 (IL-8), seminal plasma IL-8 (sIL-8)), scrotal and transrectal ultrasound evaluations. Because we have previously assessed correlations between MetS and scrotal parameters in a larger cohort of infertile men, here, we focused on transrectal features. Prostate-related symptoms were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostate Symptom Score (IPSS). Twenty-two subjects fulfilled MetS criteria. In an age-adjusted logistic ordinal model, insulin levels increased as a function of MetS components (Wald = 29.5, P < 0.0001) and showed an inverse correlation with TT (adjusted r = -0.359, P< 0.0001). No association between MetS and NIH-CPSI or IPSS scores was observed. In an age-, TT-, insulin-adjusted logistic ordinal model, an increase in number of MetS components correlated negatively with normal sperm morphology (Wald = 5.59, P< 0.02) and positively with sIL-8 levels (Wald = 4.32, P < 0.05), which is a marker of prostate inflammation, with prostate total and transitional zone volume assessed using ultrasound (Wald = 17.6 and 12.5, both P < 0.0001), with arterial peak systolic velocity (Wald = 9.57, P = 0.002), with texture nonhomogeneity (hazard ratio (HR) = 1.87 (1.05–3.33), P < 0.05), with calcification size (Wald = 3.11, P < 0.05), but not with parameters of seminal vesicle size or function. In conclusion, in males of infertile couples, MetS is positively associated with prostate enlargement, biochemical (sIL8) and ultrasound-derived signs of prostate inflammation but not with prostate-related symptoms, which suggests that MetS is a trigger for a subclinical, early-onset form of benign prostatic hyperplasia.

Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables

Individuals with depression have an elevated risk of cardiovascular disease (CVD) and metabolic syndrome (MetS) is an important risk factor for CVD. We aimed to clarify the prevalence and correlates of MetS in persons with robustly defined major depressive disorder (MDD). We searched Medline, PsycINFO, EMBASE and CINAHL up until June 2013 for studies reporting MetS prevalences in individuals with MDD. Medical subject headings 'metabolic' OR 'diabetes' or 'cardiovascular' or 'blood pressure' or 'glucose' or 'lipid' AND 'depression' OR 'depressive' were used in the title, abstract or index term fields. Manual searches were conducted using reference lists from identified articles. The initial electronic database search resulted in 91 valid hits. From candidate publications following exclusions, our search generated 18 studies with interview-defined depression (n = 5531, 38.9% male, mean age = 45.5 years). The overall proportion with MetS was 30.5% [95% confidence interval (CI) 26.3-35.1] using any standardized MetS criteria. Compared with age- and gender-matched control groups, individuals with MDD had a higher MetS prevalence [odds ratio (OR) 1.54, 95% CI 1.21-1.97, p = 0.001]. They also had a higher risk for hyperglycemia (OR 1.33, 95% CI 1.03-1.73, p = 0.03) and hypertriglyceridemia (OR 1.17, 95% CI 1.04-1.30, p = 0.008). Antipsychotic use (p < 0.05) significantly explained higher MetS prevalence estimates in MDD. Differences in MetS prevalences were not moderated by age, gender, geographical area, smoking, antidepressant use, presence of psychiatric co-morbidity, and median year of data collection. The present findings strongly indicate that persons with MDD are a high-risk group for MetS and related cardiovascular morbidity and mortality. MetS risk may be highest in those prescribed antipsychotics.

Abstract B52: Profiling of genes associated with sustained high calcium adaptation of invasive breast cancer cells

Abstract Younger African American and Hispanic patients are frequently diagnosed with highly invasive and metastatic breast cancers with poorer prognosis. The molecular mechanisms underlying the aggressiveness and in particular, race-related differences in progression of these cancers, remain poorly understood. Patients with advanced and metastatic breast cancer inevitably become hypercalcemic, but about 30% of most solid tumor cases develop this abnormal metabolic syndrome early in the course of the disease. The cancer-induced hypercalcemia (CIH) is primarily due to increased bone resorption that is provoked by tumor cell-derived osteolytic factors. In the CIH susceptible patients, it is expected that tumor progression may be accompanied by progressive severity of CIH. Here we examined the effects of sustained high (5 mM) Ca2+ on the growth of breast epithelial and breast cancer cells and attempted to identify the genes mediating high calcium adaptation of invasive breast cancer cells. We show that normal breast epithelial cells (184A1) and luminal breast cancer cells (MCF-7) grow poorly at high Ca2+ while triple negative breast cancer (TNBC) cells (MDA-MB-231, BT-549, HCC-1806) are to a greater extent high Ca2+ tolerant cell lines. To gain a better understanding of the mechanisms of sustained high calcium adaptation by TNBC cell lines, we examined the gene expression profiles of MDA-MB-231 cells maintained at high (5 mM) Ca2+ for 48 h. Cells maintained in complete medium containing 1 mM Ca2+ were used as controls. Analysis of the cDNA microarrays revealed that at least 111 genes were up regulated and 69 genes were down regulated at +/- 1.5 fold and p &amp;lt; 0.05. Some of the most up- and down-regulated genes were validated by quantitative RT-PCR in MDA-MB-231, BT-549, HCC-1806 and MCF-7 cell lines. Among the up-regulated genes, we identified and validated the early response genes FOS and EGR1 as well as MAGEC2 (CT10), SERPINB2, NCF2, SCG5, IL11, IL24 and IL6. Among the consistently down-regulated genes were DNM1 and ITGB4. Interestingly, MCF-7 cells that express relatively low levels of the calcium sensing receptor (CaSR) and are sensitive to high Ca2+, did not show significant up regulation of FOS, EGR1 and MAGEC2. MAGEC2 is strongly expressed by HCC1806 and is remarkable induced by high Ca2+ in BT-549 cells. These data suggests that high Ca2+ adaptation of invasive breast cancer cells is mediated via the CaSR and initiated by the up regulation of early response genes and presumably sustained by the up regulation of tumor promoters and/or down regulation of tumor suppressors. Further studies are ongoing to determine how some of these genes mediate the high calcium response and their potential implication in breast cancer progression and outcomes. Citation Format: Amos M. Sakwe. Profiling of genes associated with sustained high calcium adaptation of invasive breast cancer cells. [abstract]. In: Proceedings of the Third AACR International Conference on Frontiers in Basic Cancer Research; Sep 18-22, 2013; National Harbor, MD. Philadelphia (PA): AACR; Cancer Res 2013;73(19 Suppl):Abstract nr B52.

Response to Bartoli et al.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessResponse to Bartoli et al.Davy Vancampfort, Ph.D., Alex J. Mitchell, M.D., Christoph U. Correll, M.D., Pascal Sienaert, M.D., Ph.D., and Marc De Hert, M.D., Ph.D.Davy VancampfortSearch for more papers by this author, Ph.D., Alex J. MitchellSearch for more papers by this author, M.D., Christoph U. CorrellSearch for more papers by this author, M.D., Pascal SienaertSearch for more papers by this author, M.D., Ph.D., and Marc De HertSearch for more papers by this author, M.D., Ph.D.Published Online:1 Aug 2013https://doi.org/10.1176/appi.ajp.2013.13040447rAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We would like to thank Bartoli et al. (1) for their supplementary analysis to our recently published article (2) comparing metabolic syndrome in patients with bipolar disorder and schizophrenia assessed within the same study. Meta-analytic data comparing major diagnostic subgroups with each other are indeed currently lacking. We agree with Bartoli et al. that such pooled comparisons are relevant, as they allow investigation of the frequency of metabolic syndrome in patients with different disorders who were assessed with the same methodology. Moreover, such analyses could assist with dissecting risk factors associated with mental disorders from those independent of the underlying illness, at least inasmuch as such data were actually collected and uniformly reported. Comparison and pooling of data across major diagnostic categories also allows investigation into the effects of specific treatments, particularly mood stabilizers and antipsychotics, in psychotic and nonpsychotic conditions. If risk stratification is observed, this information could help guide clinicians in monitoring and treatments decisions.However, although the complementary findings of Bartoli et al. (1) are relevant, we believe they should still be interpreted with caution. Mitchell et al. (3) found disease stage and medication history to be influential, and these factors are not controlled for in these comparisons. Moreover, both Mitchell et al. (4) in schizophrenia patients and Vancampfort et al. (2) in bipolar patients found that age was also a significant moderating variable for the prevalence of metabolic syndrome in severely mentally ill patients. As in the general population, older age is associated with higher metabolic syndrome prevalence rates. However, in the majority (8/11) of the studies included in the Bartoli et al. analysis (1), patients with bipolar disorder and schizophrenia were not matched for age. Therefore, we suggest that more research with age-matched, medication-equivalent clinical populations that have similar durations of illness is needed before we can conclusively state that patients with bipolar disorder and schizophrenia have comparable risks for metabolic syndrome.Finally, we agree with Bartoli et al. (1) that further research should assess the relative contribution to metabolic syndrome of not only different psychiatric diagnoses, but also other components such as genetics, medication use, and health behaviors. To allow such analyses, these highly relevant moderating and mediating variables should be assessed more uniformly in studies reporting on metabolic syndrome frequencies in patients with specific mental disorders.From the University Psychiatric Centre KU Leuven, Campus Kortenberg, Kortenberg, Belgium; the Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Heverlee, Belgium; the Zucker Hillside Hospital, Glen Oaks, N.Y.; the Hofstra North Shore–LIJ School of Medicine, Hempstead, N.Y.; the Department of Psycho-oncology, Leicestershire Partnership Trust, Leicester, U.K.; and the Department of Cancer and Molecular Medicine, University of Leicester, U.K.The authors’ disclosures accompany the original article.References1 Bartoli F, Carrà G, Crocamo C, Carretta D, Clerici M: Bipolar disorder, schizophrenia, and metabolic syndrome (letter). Am J Psychiatry 2013; 170:927–928Link, Google Scholar2 Vancampfort D, Vansteelandt K, Correll CU, Mitchell AJ, De Herdt A, Sienaert P, Probst M, De Hert M: Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators. Am J Psychiatry 2013; 170:265–274Link, Google Scholar3 Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M: Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders: a systematic review and meta-analysis. Schizophr Bull 2013; 39:306–318Crossref, Medline, Google Scholar4 Mitchell AJ, Vancampfort D, De Herdt A, Yu W, De Hert M: Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? a comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull 2013; 39:295–305Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByBipolar disorders, obesity, and metabolic disturbances: Mechanisms and implicationsWorld Psychiatry, Vol. 14, No. 3 Volume 170Issue 8 August 2013Pages 928-929 Metrics PDF download History Accepted 1 May 2013 Published online 1 August 2013 Published in print 1 August 2013

Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile

Depression is the most common psychiatric disorder worldwide. The burden of disease for depression goes beyond functioning and quality of life and extends to somatic health. Depression has been shown to subsequently increase the risk of, for example, cardiovascular, stroke, diabetes and obesity morbidity. These somatic consequences could partly be due to metabolic, immuno-inflammatory, autonomic and hypothalamic-pituitary-adrenal (HPA)-axis dysregulations which have been suggested to be more often present among depressed patients. Evidence linking depression to metabolic syndrome abnormalities indicates that depression is especially associated with its obesity-related components (for example, abdominal obesity and dyslipidemia). In addition, systemic inflammation and hyperactivity of the HPA-axis have been consistently observed among depressed patients. Slightly less consistent observations are for autonomic dysregulation among depressed patients. The heterogeneity of the depression concept seems to play a differentiating role: metabolic syndrome and inflammation up-regulations appear more specific to the atypical depression subtype, whereas hypercortisolemia appears more specific for melancholic depression. This review finishes with potential treatment implications for the downward spiral in which different depressive symptom profiles and biological dysregulations may impact on each other and interact with somatic health decline.

Metabolic Syndrome and Metabolic Abnormalities in Bipolar Disorder: A Meta-Analysis of Prevalence Rates and Moderators

Patients with bipolar disorder have high levels of cardiovascular disease risk factors. The presence of metabolic syndrome significantly influences future cardiovascular disease morbidity and mortality. The authors sought to clarify the prevalence and moderators of metabolic syndrome in bipolar patients, accounting for subgroup differences. The authors searched MEDLINE, PsycINFO, EMBASE, and CINAHL through April 2012 for research reporting metabolic syndrome prevalence rates in bipolar patients. Medical subject headings "metabolic syndrome" and "bipolar" were used in the title, abstract, or index term fields. Manual searches were conducted using the reference lists from identified articles. The search yielded 81 articles in 37 publications (N=6,983). The overall metabolic syndrome rate was 37.3% (95% confidence interval [CI]=36.1-39.0) using any standardized metabolic syndrome criteria. Compared with general population groups, bipolar patients had higher metabolic syndrome rates (odds ratio=1.98; 95% CI=1.74-2.25). In bipolar patients, older age had a modest effect on the metabolic syndrome rate. The strongest moderator was the region in which the study took place, with the highest rates observed in New Zealand and Australia (64.2% [95% CI=38.3-83.9]) and North America (49.3% [95% CI=29.7-69.3]). Metabolic syndrome was significantly more prevalent in patients currently treated with antipsychotics (45.3% [95% CI=39.6-50.9] than in patients who were antipsychotic free (32.4% [95% CI=27.5-37.4]; odds ratio=1.72 [95% CI=1.24-2.38]). These findings strongly support the claim that patients with bipolar disorder are at high risk for metabolic syndrome and related cardiovascular morbidity and mortality and require regular monitoring and adequate preventive efforts and treatment for cardio-metabolic risk factors. These findings further suggest that the risk of metabolic syndrome is greater in bipolar patients taking prescribed antipsychotic medication.

Cell cycle abnormality in metabolic syndrome and nuclear receptors as an emerging therapeutic target.

In recent years, many researchers have emphasized the importance of metabolic syndrome based on its increasing prevalence and its adverse prognosis due to associated chronic vascular complications. Upstream of a cluster of metabolic and vascular disorders is the accumulation of visceral adipose tissue, which plays a central role in the pathophysiology. In the accumulation of adipose tissues, cell cycle regulation is tightly linked to cellular processes such as proliferation, hypertrophy and apoptosis. In addition, various cell cycle abnormalities have also been observed in other tissues, such as kidneys and the cardiovascular system, and they are critically involved in the progression of disease. Here, we discuss cell cycle abnormalities in metabolic syndrome in various tissues. Furthermore, we describe the role of nuclear receptors in cell growth and survival, and glucose and lipid metabolism in the whole body. Therapeutic strategies for modulating various cell cycles in metabolic disorders by targeting nuclear receptors may overcome obesity and its chronic vascular complications in the future.

Relationship between SSRIs and Metabolic Syndrome Abnormalities in Patients with Generalized Anxiety Disorder: A Prospective Study

ObjectiveSSRIs are some of the most widely prescribed medications in the world. In addition to their effectiveness, SSRIs were reported to be associated with the side effects of weight gain, sexual dysfunction, drug interactions, extrapyramidal symptoms and discontinuation symptoms. However, the effects of SSRIs on metabolic parameters are poorly understood.MethodsThis study aims to describe the effects of SSRIs on the metabolic parameters of drug-naive first episode patients with generalized anxiety disorder. Ninety-seven female patients aged 20-41 years without any metabolic or psychiatric comorbidity were included in the study. Fluoxetine, sertraline, paroxetine, citalopram and escitalopram were randomly given to the patients. Metabolic parameters, including BMI, waist circumference and the levels of fasting glucose, total cholesterol, triglyceride, HDL, LDL and blood pressure, were measured before and after 16 weeks of treatment.ResultsIn the paroxetine group, there was a significant increase in the parameters of weight, BMI, waist circumference, fasting glucose, total cholesterol, LDL and triglyceride after 16 weeks of treatment. There were significant increases in the levels of triglyceride in the citalopram and escitalopram groups. In the sertraline group, the total cholesterol level increased after treatment. In the fluoxetine group, there were significant reductions in the parameters of weight, total cholesterol and triglyceride.ConclusionTo our knowledge, this study is the first to prospectively describe metabolic syndrome abnormalities in patients with first episode generalized anxiety disorder. Although the effectiveness of the different SSRIs is similar, clinicians should be more careful when prescribing SSRIs to patients who have cardiac risk factors. Larger and lengthier controlled clinical trials are needed to explore the associations between SSRI use and metabolic syndrome.

Fiber Treating Metabolic Syndrome

The number of individuals diagnosed with metabolic syndrome has risen dramatically in recent years. Although not a disease itself, metabolic syndrome significantly raises the risk of developing cardiovascular disease and type 2 diabetes mellitus, both considered to be epidemics. Therefore, it is critical to promote aggressive therapies that effectively combat conditions associated with the metabolic syndrome. However, treating metabolic syndrome is complicated due to the complex nature of its pathophysiology coinciding with the many health abnormalities metabolic syndrome is often associated with, including but not limited to, insulin resistance, central obesity, hypertension, and atherogenic dyslipidemia. One promising compound that has been demonstrated to alleviate metabolic syndrome is fiber. The various types of fiber work through multiple mechanisms of action in the human body and can potentially result in weight loss in addition to blood glucose control and the lowering of cholesterol. Therefore, increasing intake of dietary fiber might prevent or even reverse some of the negative health anomalies associated with metabolic syndrome. The purpose of this review is to provide a cursory overview of the core components of metabolic syndrome and address how fiber intake may combat these conditions.

Combinative analysis of factors influence serum alanine aminotransferase activity in adult male population from southern China

ObjectivesAbnormal alanine aminotransferase (ALT) activity is indicative of liver disease even a burden of overall health. We assessed the factors associated with ALT activity and their internal relationships in a male population from southern China. Design and methodsData of physical examinations, laboratory tests, hepatic ultrasounds and standardized questionnaire were collected from 2119 males participating in a population-based survey from September 2009 to December 2009. ResultsNonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) were associated with the elevation of ALT levels (P<0.05). Prevalence of NAFLD was correlated to MetS (r=0.991, P=0.009). The levels of abnormal metabolic syndrome components increased in proportion with the ALT elevation (P<0.01). Obesity and hyperlipidemia were associated with the ALT levels in multivariate regression analysis (P<0.01). There was no synergic effect of hepatitis B virus surface antigen (HBsAg) and MetS on the ALT levels (synergy index [SI]=0.74, 95% confidence interval [CI]: 0.71–0.80). ConclusionNAFLD and MetS were associated with ALT levels in a male population from southern China. Obesity and hyperlipidemia were independent MetS components contributing to elevated ALT (e-ALT). This finding might suggest necessity on justification of these confounding factors when detecting ALT levels among this population.

Is the Prevalence of Metabolic Syndrome and Metabolic Abnormalities Increased in Early Schizophrenia? A Comparative Meta-Analysis of First Episode, Untreated and Treated Patients

We aimed to discover whether metabolic complications of schizophrenia (SZ) are present in first episode (FE) and unmedicated (UM) patients, in comparison with patients established on antipsychotic medication (AP). A systematic search, critical appraisal, and meta-analysis were conducted of studies to December 2011 using Medline, PsycINFO, Embase and experts. Twenty-six studies examined FE SZ patients (n = 2548) and 19 included UM SZ patients (n = 1325). For comparison we identified 78 publications involving 24 892 medicated patients who had chronic SZ already established on AP. In UM, the overall rate of metabolic syndrome (MetS) was 9.8% using any standardized criteria. Diabetes was found in only 2.1% and hyperglycaemia (>100 mg/dl) in 6.4%. In FE, the overall MetS rate was 9.9%, diabetes was found in only 1.2%, and hyperglycaemia in 8.7%. In UM and FE, the rates of overweight were 26.6%, 22%; hypertriglyceridemia 16.9%, 19.6%; low HDL 20.4%, 21.9%; high blood pressure 24.3%, 30.4%; smoking 40.2%, 46.8%, respectively. In both groups all metabolic components and risk factors were significantly less common in early SZ than in those already established on AP. Waist size, blood pressure and smoking were significantly lower in UM compared with FE. There is a significantly lower cardiovascular risk in early SZ than in chronic SZ. Both diabetes and pre-diabetes appear uncommon in the early stages, especially in UM. However, smoking does appear to be elevated early after diagnosis. Clinicians should focus on preventing initial cardiometabolic risk because subsequent reduction in this risk is more difficult to achieve, either through behavioral or pharmacologic interventions.

Visceral Adiposity Index Is Associated with Insulin Sensitivity and Adipocytokine Levels in Newly Diagnosed Acromegalic Patients

The visceral adiposity index (VAI) has proved to be a marker of visceral adipose dysfunction, strongly associated with insulin sensitivity in both the general and specific populations of patients at metabolic risk. The objective of the study was to test VAI as a useful tool to assess early metabolic risk in acromegaly. Twenty-four newly diagnosed acromegalic patients (11 women and 13 men, aged 54.9 ± 13.6 yr) were grouped into those with normal (group A, n = 13, 54.2%) and those with high VAI (group B, n = 11, 45.8%). Glucose, hemoglobin A1c, nadir and area under the curve (AUC) of GH (AUC(GH)) during the oral glucose tolerance test, AUC(Cpeptide) during a mixed-meal tolerance test, M value during euglycemic-hyperinsulinemic clamp, oral dispositional index (DIo), each component of the metabolic syndrome, leptin, adiponectin, TNF-α, and IL-6. The VAI value was positively correlated with the age of patients (ρ = 0.408; P = 0.048), tumor volume (ρ = 0.638; P = 0.001), basal GH (ρ = 0.622; P = 0.001), nadir GH (ρ = 0.534; P = 0.007), AUC(GH) (ρ = 0.603; P = 0.002), IGF-I (ρ = 0.618; P = 0.001), TNF-α (ρ = 0.512; P = 0.010), and AUC(Cpeptide) (ρ = 0.715; p<0.001) and negatively with adiponectin (ρ = -0.766; P < 0.001), M value (ρ = -0.818; P < 0.001), and DIo (ρ = -0.512; P = 0.011). Patients with high VAI showed significantly higher basal GH levels (P = 0.018), AUC(GH) (P = 0.047), IGF-I (P = 0.047), AUC(Cpeptide) (P = 0.018), lower M value (P < 0.001), DIo (P = 0.006), and adiponectin levels (P < 0.001), despite the absence of a significantly higher prevalence in the overt metabolic syndrome and glucose tolerance abnormalities. AUC(GH) proved to be the main independent factor influencing VAI. In acromegaly, VAI appears to be associated with disease activity, adiponectin levels, and insulin sensitivity and secretion and is influenced independently by GH levels. VAI could therefore be used as an easy and useful new tool in daily clinical practice for the assessment of early metabolic risk associated with active acromegaly.

High carbohydrate intake was inversely associated with high-density lipoprotein cholesterol among Korean adults

The traditional Asian diet, which is characterized as being high in carbohydrate with an abundance of vegetables, may be beneficial for preventing metabolic syndrome abnormalities within the Asian population. However, the prevalence of metabolic syndrome is increasing in Asian countries. This study explored the association between dietary carbohydrates and low high-density lipoprotein cholesterol (HDL-C) prevalence, one of the abnormalities of metabolic syndrome in Korean adults. We used the data from the Fourth Korea National Health and Nutrition Examination Survey and evaluated a total of 9947 Korean adults older 20 years. To measure carbohydrate quality and quantity, total carbohydrate intake (g/d), percentage of energy from carbohydrate, glycemic index, and glycemic load were divided into quintiles. Mean levels of HDL-C significantly decreased across the quintiles for all types of dietary carbohydrate intake except glycemic index after adjusting for potential variables in both men and women. Odds ratios for having low HDL-C in the highest quintile were 1.66 (95% confidence interval, 1.24-2.22) for total carbohydrate, 1.34 (1.02-1.75) for percentage of energy from carbohydrate, and 1.54 (1.17-2.03) for glycemic load in men as compared with the second quintile as a reference. Odds ratio for low HDL-C was 1.38 (1.12-1.71) for percentage of energy from carbohydrate in women. In conclusion, our study indicates that low HDL-C is associated with high carbohydrate intake without regard to energy or fat intake. Further studies would be necessary to optimize carbohydrate intake quantitatively on dyslipidemia for Asian population.

Low Vital Capacity and Electrocardiographic ST-T Abnormalities in Asymptomatic Adults.

Studies have shown that low forced vital capacity (LFVC) is associated with atherosclerosis. However, it is unclear whether LFVC is associated with resting electrocardiographic ST-T abnormalities, a common finding that is prognostic for cardiovascular events. Therefore, pulmonary functions, ST-T abnormalities defined with Minnesota Code, and cardiometabolic risk factors were examined in a cross-sectional study of 1,653 asymptomatic adults without past history of coronary heart diseases. The prevalence of diabetes, metabolic syndrome, and ST-T abnormalities significantly increased with decreasing percent of predicted forced vital capacity (%PFVC). ST-T abnormalities were observed in 73 subjects (4.4% in total). Multiple logistic regression analysis showed that, compared with the highest quartile of %PFVC (≥99.7%), the lowest quartile of %PFVC (≤84.2%) was persistently associated with ST-T abnormalities even after further adjustment for diabetes or metabolic syndrome (odds ratio (95%CI): 2.44 (1.16–5.14) and 2.42 (1.15–5.10), resp.). Similar trends were observed when subjects were divided into quartiles according to percent of predicted forced expiratory volume in 1 second (FEV1), but not the ratio of FEV1/FVC. In conclusion, LFVC may be associated with ST-T abnormalities independent of metabolic abnormalities in asymptomatic adults, suggesting a plausible link between impaired pulmonary defects and cardiovascular diseases.

Mannose-Binding Lectin in Obesity with Different Degrees of Metabolic Syndrome Abnormalities: Association with Atherogenic and Metabolic Traits

In subjects with metabolic syndrome (MetS) endothelial dysfunction is a very consistent finding. Processes leading to endothelial dysfunction and atherosclerosis involve the altered control of subclinical inflammation by innate immune defenses that possibly include mannose-binding lectin (MBL). We investigated the associations of MBL with traits of MetS and early atherosclerosis in obese subjects before and after marked weight reduction. In a prospective longitudinal study, MBL concentrations of 96 severely obese subjects with and without MetS (Ø BMI with MetS 41.0±7.9 kg/m(2), Ø BMI without MetS 39.4±7.7 kg/m(2) were examined in association with markers of insulin resistance, dyslipidemia, adipokines, and subclinical atherosclerosis before and after marked weight loss (Ø weight loss 20±8 kg after 3 months of participation in a standardized weight reduction program), in addition to the study of 25 seemingly healthy lean subjects (BMI 20-25 kg/m(2). MBL concentrations did not differ between healthy lean and severely obese subjects independently of the presence of metabolic abnormalities. In severely obese subjects there was no significant difference concerning the cardiovascular risk profile, apolipoproteins, inflammatory and metabolic parameters, and markers of endothelial dysfunction and atherosclerosis between subjects with functional MBL deficienct (MBL<778 ng/mL) and MBL sufficient (MBL≥778 ng/mL) obesity. Marked weight loss did not influence MBL levels. Our findings suggest that plasma levels of MBL did not differ between healthy lean and severely obese subjects. MBL did not affect cardiovascular risk factors, or markers of endothelial dysfunction and early atherosclerosis in severely obese patients before and after marked weight loss.

Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders—A Systematic Review and Meta-Analysis

Individuals with schizophrenia have high levels of medical comorbidity and cardiovascular risk factors. The presence of 3 or more specific factors is indicative of metabolic syndrome, which is a significant influence upon future morbidity and mortality. We aimed to clarify the prevalence and predictors of metabolic syndrome (MetS) in adults with schizophrenia and related disorders, accounting for subgroup differences. A PRISMA systematic search, appraisal, and meta-analysis were conducted of 126 analyses in 77 publications (n = 25,692). The overall rate of MetS was 32.5% (95% CI = 30.1%-35.0%), and there were only minor differences according to the different definitions of MetS, treatment setting (inpatient vs outpatient), by country of origin and no appreciable difference between males and females. Older age had a modest influence on the rate of MetS (adjusted R(2) = .20; P < .0001), but the strongest influence was of illness duration (adjusted R(2) = .35; P < .0001). At a study level, waist size was most useful in predicting high rate of MetS with a sensitivity of 79.4% and a specificity of 78.8%. Sensitivity and specificity of high blood pressure, high triglycerides, high glucose and low high-density lipoprotein, and age (>38 y) are shown in supplementary appendix 2 online. Regarding prescribed antipsychotic medication, highest rates were seen in those prescribed clozapine (51.9%) and lowest rates of MetS in those who were unmedicated (20.2%). Present findings strongly support the notion that patients with schizophrenia should be considered a high-risk group. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.

Liver markers, prevalence of the metabolic syndrome abnormalities and effect of Roux-en-Y gastric bypass in morbidly obese subjects.

To evaluate the relations between liver markers (GGT, ALT and AST) and the metabolic syndrome (and its components) in morbidly obese subjects, and to determine the response of these metabolic factors and hepatic enzymes after weight loss induced by Roux-en-Y gastric bypass. This study was carried out at a university hospital, in Santo André (SP), Brazil. We evaluated 140 morbidly obese subjects aged from 18 to 60 years submitted to a Roux-en-Y gastric bypass, who were followed for a mean period of 8 months. Patients with a history of heavy drinking, type 1 diabetes, and/or liver disease were excluded. Liver markers, most notably GGT, were strongly associated with metabolic abnormalities, mainly hyperglycemia. The prevalence of type 2 diabetes significantly increased with increasing levels of GGT (highest versus lowest quartile GGT: odds ratio 3.89 [95%CI: 1.07-14.17]). Liver markers significantly decreased 8 months after the Roux-en-Y gastric bypass and the reduction of GGT levels were associated with the reduction of glucose levels (Pearson r = 0.286; p = 0.001). Elevated levels of liver markers, principally GGT, in morbidly obese subjects are associated with metabolic abnormalities. In addition to the well-known benefits of bariatric surgery, Roux-en-Y gastric bypass, reduced the levels of liver markers to the normal range.

Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. The EURIKA study

ObjectiveTo examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. MethodsCross-sectional study conducted in 2009–2010 in 12 European countries among outpatients aged ≥50years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥2 additional major cardiovascular risk factors). ResultsAmong 1431 highest-risk patients, 64.6% (between-country range [BCR] 40–84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5–28.6%) had LDL-cholesterol<70mg/dl, non-HDL-cholesterol<100mg/dl, and apolipoprotein B<80mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5–55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5–57.6%) had LDL-cholesterol<100mg/dl, non-HDL-cholesterol<130mg/dl, and apolipoprotein B<90mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals. ConclusionThere is a substantial gap between clinical guidelines and medical practice since only one in 5–7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.

Electrocardiographic Abnormalities Associated with the Metabolic Syndrome and Its Components: The Multi-Ethnic Study of Atherosclerosis

The association between metabolic syndrome and electrocardiographic (ECG) abnormalities is not well established. ECG tracings of 6,765 men and women aged 45-84 years, free of clinical cardiovascular disease, from the Multi-Ethnic Study of Atherosclerosis were obtained (2000-2002) and classified as normal or having major or minor abnormalities. We evaluated the associations of metabolic syndrome and its components with ECG abnormalities, adjusting for age, ethnicity, and gender and testing for effect modification by ethnicity and gender. The associations of metabolic syndrome, hypertension, and high triglycerides with ECG abnormalities varied significantly by gender. In males, metabolic syndrome and hypertension were significantly associated with major ECG abnormality [1.69 (1.33-2.13), and 2.22 (1.72-2.86), respectively] after adjusting for ethnicity and gender. Hypertension was also associated significantly with minor ECG abnormality in males after adjusting for age and ethnicity. In females, metabolic syndrome and hypertension were significantly associated with major [1.84 (1.44-2.37), and 1.68 (1.27-2.22), respectively] and minor [1.38 (1.19-1.59), and 1.53 (1.32-1.79), respectively] ECG abnormalities after adjusting for age and ethnicity. High triglycerides were only significantly associated with major ECG abnormality in females after adjusting for age and ethnicity. After adjusting for age, ethnicity, and gender, central obesity and high fasting blood glucose were significantly associated with major and minor ECG abnormalities, whereas low high-density lipoprotein cholesterol was significantly associated with major ECG abnormality only. Metabolic syndrome and its components are associated with major and/or minor ECG abnormalities. The relationship of metabolic syndrome, hypertension, and high triglycerides with ECG abnormalities varied according to gender.