Additional Component Of Metabolic Syndrome Research Articles

Insulin-like growth factor-IAS an additional component of metabolic syndrome in females of reproductive age

Insulin-like growth factor-IAS an additional component of metabolic syndrome in females of reproductive age

Связь полиморфных вариантов генов-кандидатов АСЕ, AGT, AGTR1, MTHFR и NOS3 с артериальной гипертензией в рамках метаболического синдрома в коренной малочисленной популяции шорцев

Background: The problem of high blood pressure in the framework of metabolic syndrome (MS) is one of the most important for modern medicine in connection with the predicted increase in the incidence in the future and an increase in the mortality rate from cardiovascular disease. Aims : the aim of the study is to examine the frequency of arterial hypertension (AH) as part of the MS among the members of the indigenous population of the Mountain Shoria and to state the degree of the interconnection between the expression level of the candidate genes ACE, AGT, AGTR1, MTHFR and NOS3 and certain health problem. Materials and methods : The sample included 901 members of the indigenous population living in the settlements of the Mountain Shoria region. All experimental subjects had their blood pressure measured, anthropometry (measurements of height, body weight, waist circumference) taken according to standard procedures, fasting blood taken to determine the lipid spectrum and glucose level, morning urine dose taken and albumin level detected. All the patients with hypertension underwent duplex scanning of the brachycephalic arteries and examination of the structural and functional state of the myocardium was performed using echocardiography. Gene polymorphisms ACE (I/D, rs4340), AGT (c.803T>C, rs699), AGTR1 (A1166C, rs5186), MTHFR (c.677C>T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested using polymerase chain reaction. Results: Among the indigenous population of the Mountain Shoria, the frequency of hypertension combined with abdominal obesity and any other additional component of MS was 28.2%. In the group of the patients with, organ changes in the form of left ventricular myocardial hypertrophy and an increase in the thickness of the intima-media complex were more common than in the group of patients with AH alone: 58.0% versus 45.1%, p = 0.029 and 81.9% versus 67 , 0%, p = 0.007, respectively. The high risk of hypertension within the framework of MS was determined by the D allel of the ACE gene [OR = 2.45; 95% CI (1.05-5.72)]. Conclusions: The high frequency of the spread of high blood pressure within MS confirms that hypertension is less frequently manifested as an isolated disease, more often combined with other components of MS — abdominal obesity or disorders of carbohydrate and lipid metabolism. Stated genetic predisposition to hypertension within the MS in a specific small cohort of the Shors will undoubtedly help in the development and implementation of the health programs.

Polymorphic variants of ACE, AGT, AGTR1, MTHFR and NOS3 candidate genes connected with arterial hypertension as part of the metabolic syndrome among the shor people

Background: The problem of high blood pressure in the framework of metabolic syndrome (MS) is one of the most important for modern medicine in connection with the predicted increase in the incidence in the future and an increase in the mortality rate from cardiovascular disease.Aims: the aim of the study is to examine the frequency of arterial hypertension (AH) as part of the MS among the members of the indigenous population of the Mountain Shoria and to state the degree of the interconnection between the expression level of the candidate genes ACE, AGT, AGTR1, MTHFR and NOS3 and certain health problem.Materials and methods: The sample included 901 members of the indigenous population living in the settlements of the Mountain Shoria region. All experimental subjects had their blood pressure measured, anthropometry (measurements of height, body weight, waist circumference) taken according to standard procedures, fasting blood taken to determine the lipid spectrum and glucose level, morning urine dose taken and albumin level detected. All the patients with hypertension underwent duplex scanning of the brachycephalic arteries and examination of the structural and functional state of the myocardium was performed using echocardiography. Gene polymorphisms ACE (I/D, rs4340), AGT (c.803T>C, rs699), AGTR1 (A1166C, rs5186), MTHFR (c.677C>T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested using polymerase chain reaction.Results: Among the indigenous population of the Mountain Shoria, the frequency of hypertension combined with abdominal obesity and any other additional component of MS was 28.2%. In the group of the patients with, organ changes in the form of left ventricular myocardial hypertrophy and an increase in the thickness of the intima-media complex were more common than in the group of patients with AH alone: 58.0% versus 45.1%, p = 0.029 and 81.9% versus 67 , 0%, p = 0.007, respectively. The high risk of hypertension within the framework of MS was determined by the D allel of the ACE gene [OR = 2.45; 95% CI (1.05-5.72)].Conclusions: The high frequency of the spread of high blood pressure within MS confirms that hypertension is less frequently manifested as an isolated disease, more often combined with other components of MS — abdominal obesity or disorders of carbohydrate and lipid metabolism. Stated genetic predisposition to hypertension within the MS in a specific small cohort of the Shors will undoubtedly help in the development and implementation of the health programs.

Metabolic syndrome and its components as criteria for evaluating the efficiency of hypertension disease treatment

Purpose of the studywas to evaluate the effectiveness of complex treatment of essential hypertension based on the definition of risk of development, frequency and severity of metabolic syndrome (MS) and its components before and after treatment in male patients of the therapeutic clinic.Materials and methods.The study included 123 patients hospitalized with a main diagnosis of hypertension. In addition to the main examination, anthropometric, instrumental and hormonal-biochemical examination was additionally carried out. A point assessment of deviation degree and additional components of MS from reference was defined. In accordance with the received sum of points each patient was assigned a specific stratification category in relation to MS: lack of risk of development, existence of low, moderate or high risk of development and also light, medium or heavy severity of MS. Repeated examination was carried out in 14 days from initiation of treatment. The effectiveness of treatment was estimated as significant improvement, improvement, without change, deterioration, or significant deterioration depending on change of sum of points.Results.Before the start of treatment, 22.8% of the examined patients had a moderate or high risk of developing MS, and 77.2% had MS of varying degrees of severity. After 14 days the number of patients with MS decreased by 14.6%, and the number of patients with risk of its development increased to 37.4%. In 14 days the number of patients with MS decreased by 14.6%, and the number of patients with risk of his development increased to 37.4%. Among all components of the MS, the greatest number of cases of improvement was noted for hypertension. Significant improvement from the carried-out therapy was revealed in 17.9%, improvement in 39.0%, lack of changes in 37.4% and deterioration in 5.7% of patients.Conclusion.The employment of the method of Point assessment of degree of risk development and severity of MS, as a cluster of risk factors for the development of cardiovascular diseases, in patients with essential hypertension allowed the estimation of efficiency of the carried-out therapy and the individualization of a treatment regimen.

Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial

Background & aimsLong-term adherence to conventional weight-loss diets is limited while intermittent fasting has risen in popularity. We compared the effects of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk factors in adults with abdominal obesity and ≥1 additional component of metabolic syndrome. Methods & resultsIn total 112 participants (men [50%] and women [50%]) aged 21–70 years with BMI 30–45 kg/m2 (mean 35.2 [SD 3.7]) were randomized to intermittent or continuous energy restriction. A 6-month weight-loss phase including 10 visits with dieticians was followed by a 6-month maintenance phase without additional face-to-face counselling. The intermittent energy restriction group was advised to consume 400/600 kcal (female/male) on two non-consecutive days. Based on dietary records both groups reduced energy intake by ∼26–28%. Weight loss was similar among participants in the intermittent and continuous energy restriction groups (8.0 kg [SD 6.5] versus 9.0 kg [SD 7.1]; p = 0.6). There were favorable improvements in waist circumference, blood pressure, triglycerides and HDL-cholesterol with no difference between groups. Weight regain was minimal and similar between the intermittent and continuous energy restriction groups (1.1 kg [SD 3.8] versus 0.4 kg [SD 4.0]; p = 0.6). Intermittent restriction participants reported higher hunger scores than continuous restriction participants on a subjective numeric rating scale (4.7 [SD 2.2] vs 3.6 [SD 2.2]; p = 0.002). ConclusionsBoth intermittent and continuous energy restriction resulted in similar weight loss, maintenance and improvements in cardiovascular risk factors after one year. However, feelings of hunger may be more pronounced during intermittent energy restriction. Trial registrationwww.clinicaltrials.govNCT02480504.

Stratification of the risk and severity of metabolic syndrome
 in patients in need of therapeutic treatment

The purpose of the present study was to estimate the risk and severity of metabolic syndrome (MS) in 108 therapeutic profile patients of different age and gender. The method based on the numerical score of deviation of the main and additional components of MS from the standard values was used. It included the detection of insulin resistance and the waist to the hip circumference ratio as a criterion of abdominal obesity. The metabolic syndrome was diagnosed in 57.4% of patients, with its mild, moderately severe and very severe forms being documented in 35.5%, 29.0% and 35.5% of the cases respectively. Mild MS was occurred much more often in women than in men in whom moderately severe and very severe forms predominated. MS manifestations were totally absent only in 3 women. In the remaining patients, the low, moderate and high risk of development of MS was estimated at 25.6%, 32.5% and 41.9% respectively. In groups with different risk and severity of MS, the average age of men was lower than in women, the difference amounting to 10 years and more in the groups including patients with mild and moderately severe MS. The proposed method of the stratification allows the personalized approach to diagnosis and correction of metabolic disorders, determination of the necessary volume of medical aid, and taking decisions about the treatment of individual patients.

PREDICTORS OF SUBCLINICAL ISOLATED AND COMBINED ATHEROSCLEROTIC LESIONS IN MIDDLE-AGED MEN AND ITS CORRELATION WITH METABOLIC SYNDROME

Objective. To determine clinical, laboratory and instrumental predictors of subclinical isolated and combined atherosclerotic lesions in middle-aged men and its association with metabolic syndrome. design and methods. We examined 194 middle-aged men (44–60 years, WHO, 2009) with subclinical atherosclerotic arterial lesions: coronary artery (CA), extracranial artery (ECA) and peripheral artery (PA). The 1st subgroup included 40 men with isolated lesion in one arterial region (mean age — 53,6 ± 4,7 years): 17 subjects had CA lesion, 9 had ECA involvement, and 14 patients had PA lesion. The 2nd subgroup included 154 patients with combined lesions of 2 or more vascular pools (mean age — 52,1 ± 4,1 years). Both groups were comparable by age. Past acute myocardial infarction and stroke were exclusion criteria. All subjects underwent general clinical examination (medical history, physical examination, blood pressure (BP) and body mass index assessment), blood tests (lipids, coagulogram, inflammatory markers), ultrasonography (duplex scanning, power and color Doppler and spectral analysis of blood flow), stress-testing (stress-echocardiography, treadmill-test) and angiographic methods. The following parameters were analyzed in a logistic regression model as predictors of subclinical atherosclerosis: systolic and diastolic BP, total cholesterol, high-density lipoprotein cholesterol, triglycerides, basal and postprandial glucose level, homocysteine, fibrinogen, C-reactive protein (CRP), smoking and cardiovascular (CV) heredity factors, intima-media (IMT) thickness, total duration of exercise test and oxygen intake (MET) at stressechocardiography, and change of the ankle-brachial index (ABI) at treadmill-test. Results . The most significant predictors of isolated CA atherosclerosis are the following: cardiovascular disease in close relatives, increased CRP and IMT, decreased exercise tolerance and increment of ejection fraction during stress-echocardiography, ECA — family CV history, increased CRP and IMT, for PA — hyperglycemia and reduction in ABI increase at the peak exercise. Combined subclinical atherosclerotic lesions were associated with family CV history, hyperhomocysteinemia, increased CRP, decrease of the total duration of stress-test, oxygen intake and increment of ejection fraction during stress-echocardiography, as well as decreased ABI elevation at the treadmill test. Combined subclinical atherosclerosis is also associated with traditional and additional components of metabolic syndrome (hyperhomocysteinemia and increased CRP). Conclusions. Besides to the known association with arterial hypertension, dyslipidemia, vascular wall thickening, the following predictors of isolated arterial lesions were found: for CA — with family CV history, increased CRP, decreased exercise tolerance, and increment of ejection fraction at stress-echocardiography, for ECA — family CV history, increased CRP, for PA — hyperglycemia and decreased ABI elevation at the peak exercise. Subclinical multifocal atherosclerosis is closely associated with hyperhomocysteinemia, increased CRP and reduced exercise tolerance at stress-tests.

Metabolic syndrome: prevalence and association with electrocardiographic abnormalities in Nigerian hypertensive patients.

Hypertension is an important component of metabolic syndrome, and a third of hypertensive patients have metabolic syndrome, with the common mechanistic pathway believed to be insulin resistance. It is probable that hypertensive patients with metabolic syndrome will have more severe cardiac abnormalities than those without. Similarly, electrocardiogram (ECG) abnormalities have serious implications for cardiovascular disease outcome. Data on association between metabolic syndrome and ECG abnormalities are scarce in Nigeria. This study aimed to assess the prevalence of metabolic syndrome and its components in hypertensive patients and possible association of metabolic syndrome with ECG abnormalities in them. One hundred and thirty-five new adult hypertensive patients were studied in a hospital-based cross-sectional study. Metabolic syndrome prevalence was estimated by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. ECG abnormalities were divided into minor and major abnormalities based on Novacode. SPSS IBM 20 was used to analyze data. Mean age was 59.19 ± 13.33 (30-75 years). Metabolic syndrome prevalence was 40.74% (28.85% in males; 48.19% in females). Abnormal waist circumference (58.51%) was the commonest additional component of metabolic syndrome in these patients. ECG abnormalities were in 77.78% of the population, with 49.63% and 28.15% being minor and major abnormalities, respectively. There was no significant association between metabolic syndrome and ECG abnormalities in these patients. Prevalence of metabolic syndrome in hypertensive patients was high, central obesity being the commonest component of the syndrome. The high prevalence of ECG abnormalities may be more a reflection of the presence of hypertension than any other component of the syndrome.

Nonalcoholic fatty liver and metabolic syndrome in Italy: results from a multicentric study of the Italian Arteriosclerosis society

Nonalcoholic fatty liver disease (NAFLD) is associated with all the components of metabolic syndrome (MS) and might to be considered an additional component of MS itself. The Italian Society for the Study of Atherosclerosis (SISA) in 2005 started a research project aimed to study the NAFLD, using ultrasound (US), in nondiabetic MS subjects matching at least one of the ATP III criteria for HDL-C or triglycerides [TG]. Prevalence of US-NAFLD and its associated risk factors and prevalence of hypertransaminasemia and its possible determinants were evaluated. NAFLD prevalence was 0.78. Men with steatosis compared to men without steatosis were younger (P<0.05) with higher TG (P<0.03), homeostasis model assessment insulin resistance (HOMA-R) (P<0.003), and visceral fat thickness (VFT) (P<0.0001). Women with steatosis showed higher TG (P<0.05), HOMA-R (P<0.04), VFT (P<0.0001), and lower age (P<0.05). At multivariate analyses, VFT (P<0.0001), HOMA-R (P<0.02), and TG/HDL (P<0.05) were associated with severity of NAFLD. Age (P<0.05), LogTG (P<0.005), and VFT (P<0.01) were associated with higher ALT. The US prevalence of steatosis in this study (0.78) is the highest reported in patients with MS. Considering the exclusion of severe obese and diabetic patients and the recruitment criteria, this finding highlights the prominent role played by the alterations of lipid metabolism in the pathogenesis of NAFLD.

RELATION BETWEEN PLASMA LEPTIN LEVEL AND LEFT VENTRICULAR FUNCTION IN OBESE FEMALES WITH INSULIN RESISTANCE

An association between obesity and cardiac mass has been recognized for almost two decades, whereas the precise nature of the association remains elusive Theoretical consideration have long suggested that it may be mediated at least in part by insulin resistance (Mc, Nutly ,2003).Several studies have found an association between insulin resistance and left ventricular hypertrophy.(Lacobellis et al,2003) In human, production of leptin( an adipocyte – derived peptide), has been linked to obesity, insulin and insulin sensitivity (Leyva et al, 1998) .It was considered that alteration in plasma concentration could constitute an additional component of metabolic syndrome of cardio-vascular risk(Leyva et al, 1998). Aim of the work: The aim of this work was to evaluate the relationship between obesity, insulin resistance, leptin and left ventricular mass and function in young obese females with insulin resistance. Subjects and methods: Sixty five premenopausal females aged 25-45 years with no history of diabetes or hypertension was participated in this study. Twenty were non obese and forty five were obese .Fasting serum glucose, insulin and leptin were assessed and homeostatic model assessment HOMA-IR score was calculated. According to HOMA-IR obese premenopausal females were divided into 2 subgroups: - Subgroups 1: (Insulin sensitive group or IS group) included 20 obese females with HOMA-IR Subgroup 2: (insulin resistance group or IR group) included 25 obese females with HOMA-IR≥3.8.Echocardiography was done for all females participated in the study to evaluate L.V mass and function. Results: Waist circumference (WC), serum insulin, serum leptin and HOMA-IR were significantly higher in obese group compared to non obese group (p<0.05, <0.05, 2.7 (LVM/h2.7 )were significantly higher in obese group compared to non obese group (p<0.05) and between IR and IS subgroups (p2.7 and serum insulin (p<0.05)and serum leptin (p<0.05) in IS subgroup while the correlation was highly significant between both and fasting leptin (p<0.001) in IR subgroup Conclusion: Obesity is a clinical syndrome associated with hyperinsulinemia, hyperleptinemia and insulin resistance Abnormalities of LV diastolic function and mass occur frequently in obese patients. Hyperleptinemia can be an early sign for left ventricular dysfunction in obese females.

Serum carcinoembryonic antigen is associated with metabolic syndrome in female Korean non-smokers

Background Carcinoembryonic antigen (CEA), a serological marker of malignant tumors, demonstrates a modest increase under nonmalignant conditions and the pro-inflammatory features of CEA suggest that CEA may be related to insulin resistance and metabolic syndrome. Methods A total of 7075 female Korean non-smokers who underwent health check-ups were analyzed in the present study. The interquartile cutoff values for serum CEA concentrations were 0.39, 0.84, and 1.40 ng/ml. Results The prevalence of metabolic syndrome increased significantly with the increasing CEA quartiles, and the age-adjusted mean CEA concentration increased consistently with each additional component of metabolic syndrome. Logistic regression analysis adjusted for age, alcohol intake, exercise, body mass index, total cholesterol, WBC count, and hsCRP showed that the third and fourth CEA quartiles were associated with metabolic syndrome with odds ratios of 1.29 (95% CI 1.07 to 1.63 P < 0.001) and 1.39 (95% CI 1.10 to 1.66, P < 0.001), respectively. Conclusion In female Korean non-smokers, serum CEA was independently associated with metabolic syndrome. The pathophysiologic and clinical significance of these findings requires further investigation.

Is uric acid a surrogate and additional component of incident metabolic syndrome, insulin resistance among inactive Central Africans?

Objective To assess the patterns underlying the co-occurrence of components of metabolic syndrome defined by IDF criteria and metabolic syndrome insulin resistance by using Factor Analysis. Methods A 5-year patient clinic-based prospective and randomized study active versus inactive was conducted among black Africans aged over 40 years at LOMO MEDICAL Center, Kinshasa, DRC. Results Among 282 patients, 1.7%, 12.7%, 2.8%, 15.9%, 10.9%, and 15.9% of patients were defined by incidence of type 2 diabetes, acute stroke, acute myocardial infarction, metabolic syndrome insulin resistance, metabolic syndrome + insulin resistance and hyperuricemia. Male gender, physical inactivity, high Hs-CRP and abdominal obesity were the independent predictors of hyperuricemia. Obesity factor (hip circumference, BMI, WC), insulin resistance (HOMA index and insulin), dysglycemia/dyslipidemia (glucose, LDL, HDL, total cholesterol, triglycerides) and inflammation (Hs-CRP) were identified and explained a total variance of 79% on Factor analysis in patients with metabolic syndrome + insulin resistance. In patients with isolated metabolic syndrome, fat distribution, metabolic disorders (WC, BMI, triglycerides, glucose and uric acid, HDL) and blood pressure were the two factors explaining 55% of total variance in the model. Conclusion Uric acid may be considered as an additional component of the metabolic syndrome without insulin resistance.

Metabolic syndrome and its association with white blood cell count in children and adolescents in Korea: The 2005 Korean National Health and Nutrition Examination Survey

Background and aims To estimate the prevalence of metabolic syndrome (MS) and determine its association with white blood cell (WBC) count as a marker of low-grade systemic inflammation in children and adolescents in Korea. Methods and results We investigated the prevalence of MS and its association with WBC count in 928 children and adolescents. MS was defined as having 3 or more conditions based on the modified criteria of the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III). The odds ratios (ORs) for MS were also calculated using multivariate logistic regression analysis across WBC count quartiles (Q1, <5200; Q2, 5200–6100; Q3, 6200–7200; and Q4, ≥7300 cells/μL for boys; Q1, <5200; Q2, 5200–6000; Q3, 6100–7000; and Q4, ≥7100 cells/μL for girls). The prevalence of MS in children and adolescents in Korea was 6.7% (8.5% in boys, 4.5% in girls, P < 0.001). MS was more prevalent in overweight and obese children and adolescents in both boys and girls. The mean WBC counts continuously increased with each additional component of MS in both boys and girls. The ORs (95% CIs) for MS in each WBC quartile were 1.00, 1.56 (0.43–5.67), 4.47 (1.42–14.07), and 5.25 (1.71–16.07) in boys and 1.00, 1.05 (0.15–7.61), 2.89 (0.55–15.17), and 7.47 (1.61–36.67) in girls after adjusting for age, household income, and residential area. Conclusion In summary, this study shows that a substantial number of children and adolescents in Korea have MS, and elevated WBC count may be a surrogate marker for MS.

Use of confirmatory factor analysis for the identification of new components of the metabolic syndrome: The role of plasminogen activator inhibitor-1 and Haemoglobin A1c

Background and aim This study was aimed to identify additional components of metabolic syndrome from a set of cardiovascular risk markers. Methods and results The homeostasis model assessment of insulin resistance (HOMA-IR), C-reactive protein, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor, homocysteine, Haemoglobin A1c (HbA1c), and lipoprotein(a) were assessed in a population-based sample of 902 nondiabetic adult subjects. Those biomarkers that were associated with metabolic syndrome were evaluated by multiple regression analysis, along with other traditional cardiovascular risk factors. Confirmatory factor analysis (CFA) was used to test the hypothesis that both the established components of metabolic syndrome and the novel variables identified by the regression analysis were associated with a single underlying factor. HOMA-IR, PAI-1 and HbA1c were the only biomarkers independently related to metabolic syndrome. CFA validated a one-factor model that included these variables. Moreover, the indices of goodness of fit were better for this expanded model than those obtained for a previously validated one-factor model that was restricted to the conventional elements of the syndrome. Conclusions These findings show that PAI-1 and HbA1c are singularly linked to metabolic syndrome. Their elevation is presumably another manifestation of the same pathophysiological mechanism that underlies the recognized traits of the syndrome.

HYPOGONADISM AND METABOLIC SYNDROME: IMPLICATIONS FOR TESTOSTERONE THERAPY

Metabolic syndrome, characterized by central obesity, insulin resistance, dyslipidemia and hypertension, is highly prevalent in the United States. When left untreated, it significantly increases the risk of diabetes mellitus and cardiovascular disease. It has been suggested that hypogonadism may be an additional component of metabolic syndrome. This has potential implications for the treatment of metabolic syndrome with testosterone. We reviewed the available literature on metabolic syndrome and hypogonadism with a particular focus on testosterone therapy. A comprehensive MEDLINE review of the world literature from 1988 to 2004 on hypogonadism, testosterone and metabolic syndrome was performed. Observational data suggest that metabolic syndrome is strongly associated with hypogonadism in men. Multiple interventional studies have shown that exogenous testosterone has a favorable impact on body mass, insulin secretion and sensitivity, lipid profile and blood pressure, which are the parameters most often disturbed in metabolic syndrome. Hypogonadism is likely a fundamental component of metabolic syndrome. Testosterone therapy may not only treat hypogonadism, but may also have tremendous potential to slow or halt the progression from metabolic syndrome to overt diabetes or cardiovascular disease via beneficial effects on insulin regulation, lipid profile and blood pressure. Furthermore, the use of testosterone to treat metabolic syndrome may also lead to the prevention of urological complications commonly associated with these chronic disease states, such as neurogenic bladder and erectile dysfunction. Physicians must be mindful to evaluate hypogonadism in all men diagnosed with metabolic syndrome as well as metabolic syndrome in all men diagnosed with hypogonadism. Future research in the form of randomized clinical trials should focus on further defining the role of testosterone for metabolic syndrome.