Adult Treatment Panel-III Criteria Research Articles

Metabolic Syndrome in Behçets Disease Patients: Keep an Eye on the Eye.

Metabolic syndrome (MetS) is characterized by insulin resistance, high blood pressure/ sugar, dyslipidemia, and obesity. Whether MetS and its components affect the development of Behçet's Disease (BD) remains unclear. The aim was to determine the frequency of MetS among BD patients and to study its relationship with disease characteristics. The study included 1028 adult BD patients recruited from 18 specialized rheumatology centers. 51 healthy matched control were considered. Behçet Disease Current Activity Form (BDCAF) and the BD damage index (BDI) were estimated. Adult Treatment Panel-III criteria were used to define MetS. The mean age of patients was 36.8 ± 10.1 years, M:F 2.7:1 and disease duration 7.01 ± 5.2 years. Their mean BDCAF was 5.1 ± 4.6 and BDI 5.5 ± 2.8. MetS was present in 22.8% of patients and in 5.9% of control (3.9 fold higher-risk). Patients with MetS had a significantly increased age at onset (31.8 ± 9.2 vs. 29 ± 8.5 years) and higher frequency of genital ulcers (96.2% vs. 79.7%), skin involvement (73.1% vs. 50.4%), arthritis (48.3% vs. 29.1%) (p<0.0001) and CNS manifestations (18.8% vs. 13%) (p=0.042) compared to those without it. Eye involvement was significantly increased in those with MetS (82.1% vs. 74.2%) (p=0.003) with increased frequency of posterior uveitis (67.1% vs. 43.5%), retinal vessel occlusion (35.9% vs. 21.3%), retinal vasculitis (41.9% vs. 26.4%) (p<0.0001) and vitritis (37.2% vs. 24%) (p=0.001). BDCAF was significantly lower (3.9 ± 4.3 vs. 5.6 ± 4.6) and BDI higher (7.4 ± 2.7vs5 ± 2.6) (p<0.0001). BD patients with MetS are predisposed to mucocutaneous, musculoskeletal, neuropsychiatric and ocular manifestations with consequently increased damage. The involvement of the deeper structures of the eye should alarm rheumatologists to keep in mind that all patients should have an eye examination, especially those with MetS.

Prevalence of the metabolic syndrome and associated factors among inpatients with severe mental illness in Botswana: a cross-sectional study

IntroductionThe metabolic syndrome, a cluster of inter-related risk factors for cardiovascular diseases is highly prevalent among individuals with obesity and sedentary lifestyle. Chronic psychiatric disorders such as severe mental illness are associated with increased risk for cardiovascular diseases. We aimed to assess the prevalence and correlates of metabolic syndrome among inpatients with severe mental illness in a resource limited setting with high HIV prevalence.MethodsThis was a cross-sectional study among adult inpatients at a referral psychiatric hospital in Botswana. We used convenience sampling to enrol participants available at the time of the study. The National Cholesterol Education Program Adult Treatment Panel-III (NCEP-ATP III) criteria was used to define the metabolic syndrome. Data were analysed using descriptive statistics as well as multiple logistic regression modelling.ResultsA total of 137 participants were enrolled. Of these, 119 (87%) had complete data for the main analysis. The overall prevalence of metabolic syndrome was 22.6% (95% CI 15.9, 30.6) and did not differ significantly by gender or HIV status. Age was significantly associated with the risk of having the metabolic syndrome while gender, body mass index, HIV status, and days of moderate physical activity were not.ConclusionThere was a moderately high prevalence of metabolic syndrome. Thus, the management of individuals with severe mental illness in resource limited settings should include assessment of cardiovascular risk and target modifiable risk factors in this population. Consideration for the patient’s age should be made when rationalizing the limited resources available for assessing metabolic syndrome among patients with severe mental illness.

Associations of Body Mass Index-Metabolic Phenotypes with Cognitive Decline in Parkinson’s Disease

Background: Growing evidence suggests important effects of body mass index (BMI) and metabolic status on neurodegenerative diseases. However, the roles of BMI and metabolic status on cognitive outcomes in Parkinson’s disease (PD) may vary and are yet to be determined. Methods: In total, 139 PD patients from the whole PD cohort in Parkinson’s Progression Markers Initiative database underwent complete laboratory measurements, demographic and anthropometric parameters at baseline, and were enrolled in this study. Further, they were categorized into 4 different BMI-metabolic status phenotypes using Adult Treatment Panel-III criteria. Motor and cognition scales at baseline and longitudinal changes after a 48-month follow-up were compared among the 4 groups. Repeated-measure linear mixed models were performed to compare PD-related biomarkers among BMI-metabolic status phenotypes across time. Results: We found that PD patients in the metabolically unhealthy normal weight group showed more cognitive decline in global cognition and visuospatial perception after a 48-month follow-up than those in the other 3 groups (p < 0.05). No difference was found in motor scales among different BMI-metabolic status phenotypes. Finally, compared to the metabolically healthy normal weight group, the metabolically healthy obesity group had lower CSF Aβ42 and serum neurofilament levels in repeated-measure linear mixed models adjusting for age, gender, APOE e4 carrier status, and years of education (p = 0.031 and 0.046, respectively). Conclusion: The MUNW phenotype was associated with a rapid cognitive decline in PD.

The evaluation of metabolic syndrome in patients diagnosed with non-alcoholic fatty liver disease (NAFLD): a cross-sectional study of Iranian population

Introduction:Our study is assessing the epidemiological aspects of nonalcoholic fatty liver disease (NAFLD) in Iranian population and evaluates the relationship between NAFLD and metabolic syndrome.Methods and Materials:We conducted this cross-sectional study on 145 subjects who were diagnosed with NAFLD and referred to the Gastroenterology clinics of Ghaem Hospital, Mashhad, Iran in the year of 2013. Using ultrasonography method, we diagnosed NAFLD as a fatty liver manifestation in the absence of other liver complications. We used National Cholesterol Education Program Adult Treatment Panel III criteria (ATPIII) as a guideline to establish metabolic syndrome diagnosis.Results:Metabolic syndrome had an overall prevalence of 49.7% among our subjects. The results showed no difference in mean AST and ALT levels between the groups of patients with and without metabolic syndrome. Our results were unable to maintain an association between our targeted liver enzymes (AST and ALT) and different features of metabolic syndrome. In multivariate linear regression models, the presence of metabolic syndrome was unable to predict AST (p=0.631, r2=0.002) or ALT (p=0.122, r2=0.017) abnormalities.Conclusion:The present study has shown a high prevalence of metabolic syndrome in Iranian patients who diagnosed with NAFLD. Contrary to previous reports, despite the high prevalence of metabolic syndrome conditions in NAFLD patients, we found that the presence of metabolic syndrome had not increased the risk of NAFLD in the population undergone our study.

Correlates of metabolic syndrome in patients with depression: A study from north-western India

Background and AimsMetabolic syndrome (MS) is found to be prevalent in patients with mental illness including depression. Data is sparse on the role of lifestyle factors on MS in depression. MethodsThis study was aimed to assess correlates of MS in patients with depression. Methodology: Three hundred eighty-two patients with depressive disorders were assessed for the prevalence of MS by using modified National Cholesterol Education Program- Adult Treatment Panel-III criteria (NCEP ATP-III). Their illness severity, functionality, physical activity and nutritional habits were also assessed. ConclusionsMajority of patients with depression (82.2%) were drug naive. One-fourth of the patients had metabolic syndrome (27.7%). Additionally, other 59% of patients had one or two metabolic abnormalities and one-third of patients were obese. Lower high density lipoprotein cholesterol level was the most common abnormality (65%), while abnormal blood pressure was the least common abnormality (18%). Significant correlates of MS were greater age, and age at onset of depression, greater illness duration, lesser physical activity and lower nutritional score. ConclusionNearly one-fourth of patients with depression had MS; another three-fifth of patients had one or two metabolic abnormalities. MS was more commonly seen with sedentary lifestyle and poor nutritional habits. It calls for comprehensive assessment and timely management of cardiovascular risk factors as well as lifestyle factors in depression.

Association of HIV serostatus and metabolic syndrome with neurobehavioral disturbances.

Metabolic syndrome (MetS), a constellation of related metabolic risk factors, is a common comorbidity associated with cognitive difficulty in people living with HIV (PLWH). Neurobehavioral disturbances (e.g., behavioral manifestations of frontal-subcortical dysfunction) are also prevalent in HIV, yet the role MetS might play in HIV-associated neurobehavioral disturbances is unknown. Thus, we examined the link between MetS and neurobehavioral disturbances in PLWH. Participants included 215 adults (117 PLWH, 98 HIV-uninfected), aged 36 to 65years, from a cohort study at the University of California San Diego. Using the Frontal Systems Behavior Scale, we captured neurobehavioral disturbances (apathy, disinhibition, and executive dysfunction). MetS was defined by the National Cholesterol Education Program's Adult Treatment Panel-III criteria. Covariates examined included demographic, neurocognitive impairment, and psychiatric characteristics. When controlling for relevant covariates, both HIV serostatus and MetS were independently associated with greater apathy and executive dysfunction. HIV, but not MetS, was associated with greater disinhibition. The present findings suggest an additive effect of HIV and MetS on specific neurobehavioral disturbances (apathy and executive dysfunction), underscoring the importance of identifying and treating both HIV and MetS to lessen central nervous system burden among PLWH.

Metabolically healthy obesity reduces the risk of Alzheimer's disease in elders: a longitudinal study.

A subgroup of overweight/obese individuals, who had favorable metabolic profiles, was termed as metabolically healthy overweight/obese (MHO). Several studies suggested that MHO individuals were not at increased risk of cardiovascular disease and all-course mortality. However, whether MHO is associated with excess risk of Alzheimer’s disease (AD) in elders remains unclear. To explore the risk of AD among MHO phenotype and investigate whether MHO associates with neurodegenerative biomarkers of AD, we assessed body mass index-metabolic status phenotypes of 1199 longitudinal elders from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort using the Adult Treatment Panel-III (ATP- III) criteria. MHO subjects were at a significantly decreased risk for AD (adjusted HR=0.73, 95% CI: 0.54-0.97) compared with metabolically healthy normal weight (MHNW) subjects. In multivariable linear regression models, the cross-sectional associations of MHO with cerebrospinal fluid (CSF) biomarkers, brain Aβ load, and cortical structure were explored. MHO was positively correlated with CSF-Aβ (β=0.746, P=0.015), hippocampal volume (β=0.181, P=0.011), and whole brain volume (β=0.133, P=0.004). The MHO phenotype of the elder conferred a decreased risk of AD and its role may be driven by Aβ.

2111-P: Effect Modification of Vitamin D Intervention by Obesity-Related Metabolites

Background: Effects of vitamin D on biomarkers of cardiometabolic disorders among obese individuals are highly variable between studies. Comparing the effects of vitamin D supplementation in metabolically healthy (MHO) vs. metabolically unhealthy (MUHO) obesity using metabolomics may yield mechanistic insights into the observed heterogeneity. Objective: To quantify small molecular changes shortly after vitamin D intervention in MHO and MUHO individuals with sub-optimal levels of vitamin D (&amp;lt;75 nmol/L) using a targeted metabolomics approach. Methods: In two randomized double-blind clinical trials, 110 MHO and 105 MUHO individuals were separately and randomly assigned to receive a daily dose of vitamin D supplement (4000 IU) or placebo. These MHO/MUHO phenotypes were defined using the Adult Treatment Panel-III criteria. Obesity-related metabolites (n=104) were measured at baseline and after four months of supplementation, using liquid chromatography coupled to a triple quadrupole mass spectrometry. Multiple linear regression models were fit to assess changes in metabolite levels, adjusting for appropriate covariates as well as controlling for multiple testing. Results: In the MUHO group (n=78), we identified ten metabolites (citrulline, acyl-lysophosphatidylcholines C16:0, C16:1, C18:0 and C18:1, diacyl-phosphatidylcholines C32:0, C34:1, C38:3 and C38:4 and sphingomyelin C40:4) that were significantly altered (P=4.9×10-4 to P=0.007) in response to vitamin D therapy. In the MHO group (n=82), no significant metabolite changes were observed after the intervention. Conclusion: Findings from our study contribute to the understanding of biological variation in Vitamin D metabolism across different obesity phenotypes. Upon successful validation, these insights can increase precision of clinical approaches to metabolic derangements in obesity. This study was registered at www.irct.ir as IRCT2015061522762N1. Disclosure M. Bagheri: None. S. Aslibekyan: Employee; Self; 23andMe. A. Djazayery: None. F. Farzadfar: None. Funding Tehran University of Medical Sciences

Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death.

AIMTo describe the prevalence of posttransplant metabolic syndrome (PTMS) after donation after cardiac death (DCD) liver transplantation (LT) and the pre- and postoperative risk factors.METHODSOne hundred and forty-seven subjects who underwent DCD LT from January 2012 to February 2016 were enrolled in this study. The demographics and the clinical characteristics of pre- and post-transplantation were collected for both recipients and donors. PTMS was defined according to the 2004 Adult Treatment Panel-III criteria. All subjects were followed monthly for the initial 6 mo after discharge, and then, every 3 mo for 2 years. The subjects were followed every 6 mo or as required after 2 years post-LT.RESULTSThe prevalence of PTMS after DCD donor orthotopic LT was 20/147 (13.6%). Recipient’s body mass index (P = 0.024), warm ischemia time (WIT) (P = 0.045), and posttransplant hyperuricemia (P = 0.001) were significantly associated with PTMS. The change in serum uric acid levels in PTMS patients was significantly higher than that in non-PTMS patients (P < 0.001). After the 1st mo, the level of serum uric acid of PTMS patients rose continually over a period, while it was unaltered in non-PTMS patients. After transplantation, the level of serum uric acid in PTMS patients was not associated with renal function.CONCLUSIONPTMS could occur at early stage after DCD LT with growing morbidity with the passage of time. WIT and post-LT hyperuricemia are associated with the prevalence of PTMS. An increased serum uric acid level is highly associated with PTMS and could act as a serum marker in this disease.

Effectiveness of vitamin D therapy in improving metabolomic biomarkers in obesity phenotypes: Two randomized clinical trials.

Uncertainty remains about the effect of vitamin D therapy on biomarkers of health status in obesity. The molecular basis underlying this controversy is largely unknown. To address the existing gap, our study sought to compare changes in metabolomic profiles of obesity phenotypes (metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO)) patients with sub-optimal levels of vitamin D following vitamin D supplementation. We conducted two randomized double-blind clinical trials on participants with either of the two obesity phenotypes from Tehran province. These phenotypes were determined by the Adult Treatment Panel-III criteria. Patients in each of the MHO (n = 110) and MUHO (n = 105) groups were separately assigned to receive either vitamin D (4000 IU/d) or placebo for 4 months. Pre- and post-supplementation plasma metabolomic profiling were performed using Liquid chromatography coupled to a triple quadrupole mass spectrometry. Multivariable linear regression was used to explore the association of change in each metabolite with the trial assignment (vitamin D/placebo) across obesity phenotypes. Metabolites (n = 104) were profiled in 82 MHO and 78 MUHO patients. After correction for multiple comparisons, acyl-lysophosphatidylcholines C16:0, C18:0, and C18:1, diacyl-phosphatidylcholines C32:0, C34:1, C38:3, and C38:4, and sphingomyelin C40:4 changed significantly in response to vitamin D supplementation only in MUHO phenotype. The interaction analysis revealed that vitamin D therapy was different between the two obesity phenotypes based on acyl-lysophosphatidylcholines C16:0 and C16:1 and citrulline which were altered significantly after supplementation. Changes in metabolites were associated with changes in cardiometabolic biomarkers after the intervention. Vitamin D treatment influenced the obesity-related plasma metabolites only in adults with obesity and metabolically unhealthy phenotype. Therefore, not all patients with obesity may benefit from an identical strategy for vitamin D therapy. These findings provide mechanistic basis highlighting the potential of precision medicine to mitigate diseases in health-care settings.

Abstract 030: Natural History of Obesity Subphenotypes: Dynamic Changes Over Two Decades and Prognosis in the Framingham Heart Study

Introduction: The natural history of obesity (body mass index [BMI]≥30 kg/m 2 ) sub-phenotypes is not fully understood. We investigated longitudinal changes in obesity sub-phenotypes, and their associations with health outcomes. Hypothesis: We hypothesized that metabolically heathy obesity (MHO) is associated with elevated risk of cardiovascular disease [CVD], metabolic disease and cancer, compared to healthy non-obesity. Methods: We evaluated 4,291 Framingham Offspring Study participants attending at least two examinations between cycles 2 [1979-1983] through 7 [1998-2001] (26,508 participant-observations). Obesity subphenotypes were defined using metabolic health (&lt;2 of Adult Treatment Panel-III criteria) and BMI (metabolically healthy non-obese [MHNO], MHO, metabolically unhealthy non-obese [MUNO], metabolically unhealthy obese [MUO]). We assessed changes in subphenotypes over time, and their relations to coronary artery calcification (CAC), subclinical CVD (presence of one or more of the following: left ventricular [LV] systolic dysfunction, LV hypertrophy, increased carotid intima-media thickness, reduced ankle-brachial index or microalbuminuria) and incident diabetes, hypertension, chronic kidney disease, CVD and mortality. Results: At baseline, 4% and 31% of participants exhibited the MHO and MUNO subphenotypes, respectively. Between two consecutive exams, &gt;40% of MHO participants became MUO. Transition probabilities were highest for MHO to MUO changes (43-46%). Compared to MHNO, MHO participants had 1.28-fold and 1.9-fold higher odds of subclinical CVD and CAC, respectively; corresponding values for MUNO were 1.95 and 1.92 ( P &lt;0.05). Compared to MHNO, MHO increased the risks of diabetes and hypertension ( Table ); while MUNO increased the risks of diabetes, hypertension, CVD and death. Conclusion: Over two decades, most MHO participants developed metabolic abnormalities, subclinical and clinical disease, suggesting that this subphenotype is a harbinger of future disease risk.

Metabolically Healthy Obesity and Risk of Kidney Function Decline.

ObjectiveTo examine the association between body mass index (BMI) categories, stratified by metabolic health status, and risk of kidney function declineMethodsWe classified 42,128 adult patients with stable BMI over a 3-year baseline window by BMI and metabolic health status (assessed by Adult Treatment Panel-III criteria). Kidney function decline (KFD) was defined as eGFR decline ≥ 30%, eGFR<15 ml/min/1.73m2, or receipt of dialysis/transplant.ResultsOver a median of 5.1 years (IQR 2.1–8.9), 6,533 (15.5%) individuals developed KFD. Compared to the normal weight, metabolically healthy category, metabolically healthy obesity (MHO) was associated with higher risk of KFD [adjusted hazard ratio (aHR) 1.52, 95% CI: 1.22– 1.89]. Adjusted HRs for KFD were 1.17 (95% CI: 0.89 –1.53), 2.21 (95% CI: 1.59 – 3.08), and 2.20 (95% CI: 1.55–3.11) for MHO with BMI 30–34.9, BMI 35–39.9, and BMI ≥ 40 kg/m2. These associations were consistent among men and women, patients with eGFR ≥ or < 90 ml/min/1.73m2, and age ≥ or < 55 y. Risk of KFD was highest among metabolically unhealthy individuals with BMI ≥ 40 (aHR 4.02, 95% CI: 3.40–4.75 vs. metabolically healthy, normal weight individuals).ConclusionsObesity, whether in the presence or absence of metabolic health, is a risk factor for KFD.

Association among metabolic syndrome, inflammation, and survival in prostate cancer

BackgroundMetabolic syndrome (MS) and inflammation (INF) alterations are among the factors involved in cancer progression. The study aimed to assess the relationship between MS and INF and its effect on progression-free/overall survival (PFS/OS) in metastatic castration-resistant prostate cancer (mCRPC) treaed with abiraterone or enzalutamide. MethodsWe, retrospectively, evaluated patients with mCRPC in 7 Italian Institutes between March 2011 and October 2016. MS was defined by modified adult treatment panel-III criteria. INF was characterized by at least one of these criteria: neutrophil to lymphocyte ratio ≥ 3, elevated erythrocyte sedimentation rate or C-reactive protein. ResultsEighty-three of 551 (15.1%) patients met MS criteria at baseline and 34 (6.2%) during treatment. MS patients (MS+) presented a greater INF profile compared to MS− (P<0.0001). Median PFS was 3.7 for MS+ vs. 8.7 months for MS− (hazard ratio [HR] = 2.77; 95% CI: 2.12–3.61; P<0.0001). Median OS was 6.9 and 19 months in MS+ and MS−, respectively (HR = 3.43; 95% CI: 2.56–4.58; P<0.0001). We also demonstrated INF led to shorter PFS and OS (4.5 vs. 8.5 months, HR = 1.48, 95% CI: 1.15–1.90, P = 0.002, and 11.2 vs. 18.8 months, HR =1.66, 95% CI: 1.26–2.18, P = 0.0003, respectively). The combination of MS with INF provided the identification of high-risk prognostic group (MS+/INF+ vs. MS−/INF−) with worse PFS (3.7 vs. 9 months, HR = 2.7, 95% CI: 1.88–3.89, P<0.0001) and OS (6.3 vs. 20.4 months, HR = 4.04, 95% CI: 2.75–5.93, P<0.0001). Multivariable analysis confirmed that MS was independently associated with PFS (HR = 2.07; 95% CI: 1.03–4.18; P = 0.041) and OS (HR = 4.87; 95% CI: 2.36–10.03; P<0.0001). The absence of INF as an independent predictor of survival underlined the correlation between MS/INF. ConclusionsPretreatment identification of MS and INF alterations might represent an available and easy tool for better prognostication of patients with mCRPC. A prospective evaluation is warranted.

Is obstructive sleep apnea the missing link between metabolic syndrome and second-generation antipsychotics: Preliminary study.

Background:Metabolic syndrome in individuals taking second-generation antipsychotics is thought to be mediated by antipsychotic-induced weight gain. However, recent literature challenges this notion, and theoretically, it may also be mediated through obstructive sleep apnea (OSA). This study explores the contribution of OSA in antipsychotic-induced metabolic syndrome.Materials and Methods:Forty-three participants suffering from schizophrenia spectrum disorder and major depressive disorder, taking second-generation antipsychotics were included in this study. Treatment history was taken in detail, and lifetime exposure to antipsychotics was converted to olanzapine-equivalent doses. Physical characteristics were noted. OSA was screened through the Hindi version of Berlin Questionnaire. Plasma glucose, serum total cholesterol, serum high-density lipoprotein, and serum triglyceride were measured after 12-h fasting. Adult treatment Panel-III criteria were used to diagnose metabolic syndrome.Results:Gender distribution was comparable in the study sample. About 27% had continuous illness, 25.6% of participants had metabolic syndrome, and 20.9% were at high risk for sleep apnea. Participants with and without metabolic syndrome were comparable with regard to demographic variables, duration of illness, and lifetime exposure to antipsychotics. Logistic regression depicted that OSA (odds ratio [OR] = 15.09), waist circumference (OR = 1.15), and fasting plasma glucose (OR = 1.21) increased the risk of metabolic syndrome.Conclusion:Results of the present study suggest that metabolic syndrome in participants taking second-generation antipsychotics is mediated through OSA.

Comparison of the prevalence of metabolic syndrome in patients with schizophrenia and bipolar disorder: a cross-sectional study from Black Sea region

Objective: Previous research has suggested that metabolic syndrome is more prevalent among patients with schizophrenia and bipolar disorder. Given the scarcity of comparative research on these disorders, this study aims to compare the prevalence of metabolic syndrome in two diagnostic groups and to identify sociodemographic or clinical factors related to metabolic syndrome. Methods: A total of 235 patients diagnosed with schizophrenia (n=160) and bipolar disorder (n=75) and were being followed up by a metabolic monitoring program in a specialized outpatient clinic and using antipsychotic therapy for at least eight weeks have participated in this cross-sectional study. Patients were diagnosed with metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP-III) criteria. Sociodemographic and clinical data including metabolic records were collected retrospectively by reviewing the patients’ medical records. Results: The overall prevalence of meta-bolic syndrome was 32.3% and waist circumference was the most frequent individual component with a prevalence of 60%. There were no differences in the prevalence of metabolic syndrome between schizophrenia and bipolar patients. Age, body mass index (BMI), and use of certain types of atypical antipsychotics were found related to metabolic syndrome. Conclusion: The prevalence of metabolic syndrome and its components among patients with severe mental illness is alarming irrespective of their diagnoses. Thus, metabolic screening is crucial especially for high-risk groups.

Regional arterial stiffness in central and peripheral arteries is differentially related to endothelial dysfunction assessed by brachial flow-mediated dilation in metabolic syndrome.

The interrelationship between endothelial function and arterial stiffness may be different for central and peripheral arteries due to their structural and functional differences. The study aims to assess the interrelationship between central and peripheral vascular function and haemodynamics in metabolic syndrome. Thirty-seven patients [63.0 (57.5-66.0) years, 68.4% males] of metabolic syndrome (National Cholesterol Education Program - Adult Treatment Panel-III criteria) were studied. Carotid-femoral, carotid-radial pulse wave velocity and augmentation index (AIx@75) were assessed using applanation tonometry. Endothelial function was evaluated by brachial flow-mediated dilation using B-mode ultrasonography. Central and peripheral pressures were measured by radial tonometry and sphygmomanometer, respectively. Carotid-radial pulse wave velocity correlated significantly with peripheral diastolic blood pressure ( r = 0.33, p = 0.04) and inversely with flow-mediated dilation ( r = -0.61, p = 0.0001). AIx@75 correlated significantly with carotid-femoral pulse wave velocity ( r = 0.35, p = 0.03) and with aortic pulse pressure ( r = 0.43, p = 0.01). In principal component analysis, an inverse relationship was observed between flow-mediated dilation and carotid-radial pulse wave velocity but not with carotid-femoral pulse wave velocity. Regional arterial stiffness assessed by pulse wave velocity in central-elastic and peripheral-muscular arteries differentially relates to endothelial dysfunction. The central arteries might be predominantly influenced by endothelial dysfunction-induced structural changes, while the peripheral arteries are majorly affected by functional alterations.

Fatty liver disease determines the progression of coronary artery calcification in a metabolically healthy obese population.

ObjectivesMetabolically healthy obese (MHO) phenotype describes an obese state with a favorable metabolic profile. However, the prognosis of this subpopulation remains controversial. We aimed to examine whether MHO phenotype is associated with progression of atherosclerotic activity, reflected as the changes in coronary artery calcification (CAC) over time. If so, we sought to determine the role of fatty liver disease (FLD), the hallmark of hepatic steatosis, in this progression.MethodsWe enrolled 1,240 asymptomatic subjects who underwent repeated CAC score measurement during routine health examinations. CAC score progression was defined as either incident CAC in a population free of CAC at baseline, or an increase by ≥2.5 units between the baseline and final square root of CAC scores in participants with detectable CAC at baseline. Subjects were stratified by body mass index (cut-off, 25.0 kg/m2) and metabolic health state using Adult Treatment Panel-III criteria. FLD was assessed via ultrasonography.ResultsOver 2.9 years of follow-up, 25.2% of total subjects exhibited CAC score progression. The MHO phenotype was not significantly associated with CAC score progression (multivariate adjusted-odds ratio [OR], 1.45; 95% confidence interval [CI], 0.93–2.25), as compared to the metabolically healthy non-obese (MHNO) phenotype. However, subgroup analysis indicated that the MHO/FLD phenotype was significantly associated with CAC score progression (multivariate adjusted-OR, 2.37; 95% CI, 1.34–4.16), as compared to the MHNO/no FLD phenotype, whereas the MHO/no FLD phenotype was not (multivariate adjusted OR, 1.25; 95% CI, 0.71–2.24).ConclusionsObese individuals with FLD have an increased risk of atherosclerosis progression, despite their healthy metabolic profile. Preventive interventions targeting cardiometabolic risk factors should be considered in such individuals, regardless of the weight status.

Are all metabolically healthy individuals with obesity at the same risk of diabetes onset?

To examine the risk of diabetes and the development of an unhealthy status according to metabolic health. To assess the effect of changes in metabolic health among participants with metabolically healthy obesity (MHO) on the risk of diabetes. A total of 4,340 subjects were included. Unhealthy metabolic status was defined as having three or more risk factors of the Adult Treatment Panel-III criteria. A Cox proportional-hazard analysis was conducted to estimate the hazard ratio (HR) of developing diabetes across the change in the metabolic status of subjects with MHO. After 40,622 person-years of follow-up, the risk of becoming unhealthy was 1.53 times higher for participants with MHO, compared with lean or overweight healthy subjects. A greater risk of diabetes was found in MHO, but it was attributable to those who progressed to an unhealthier status over time: HR of 4.78 (95% CI: 3.38-6.78). The combination of being metabolically unhealthy and obesity heightened the risk of diabetes: HR of 10.09 (95% CI: 4.82-21.55). The increased risk of diabetes in MHO is attributed to the progression to an unhealthier state. "Healthy obesity" is not a permanent situation but a transitory state.

Metabolic Syndrome After Liver Transplantation: Five-Year Prevalence and Risk Factors

Survival after orthotopic liver transplantation (OLT) has increased over the last decades, focusing on the metabolic complications that contribute to patient morbidity and mortality. The aim of our study was to describe the prevalence of metabolic syndrome (MS), its components, and its associated factors in patients who underwent OLT in a hospital in Spain. From November 2001 to January 2014, we performed 415 transplantations in 386 patients. We analyzed 204 patients with a minimum follow-up of 1 year (77.6% were male and the mean age was 54.2+/−9.5 years). The most frequent etiology was alcohol (41%), followed by hepatitis C virus (29.1%). The indication was decompensated cirrhosis in 51.8% and hepatocellular carcinoma in 34%. According to modified National Cholesterol Education Program–Adult Treatment Panel-III (NCEP-ATP III) criteria, 5 years post-transplantation MS was diagnosed in 38.2% of patients. Significant independent predictors of post-transplantation MS on logistic regression analysis were as follows: pretransplantation obesity (odds ratio [OR], 3.09; P = .056), 1-year post-transplantation obesity (OR, 3.95; P = .009), pretransplantation diabetes (OR, 4.63; P = .001), 1-year post-transplantation diabetes (OR, 3.01; P = .015), 1-year post-transplantation hypertension (OR, 1.85; P = .176), and hypertriglyceridemia at the first year after transplantation (OR, 2.32; P = .063). In our center the prevalence of MS at 5 years after OLT is slightly lower than published. The most important risk factors were obesity and diabetes (both pretransplantation and the first year post-transplantation).

Risk of incident ischemic stroke according to the metabolic health and obesity states in the Vascular-Metabolic CUN cohort

Background Whether obesity is a major risk factor for cardiovascular disease in the absence of metabolic comorbidities remains under debate. Indeed, some obese individuals may be at low risk of metabolic-related complications, while normal-weight individuals may not be "healthy." Aims To assess the incidence of ischemic stroke according to the metabolic health and obesity states of 5171 participants from the Vascular-Metabolic CUN cohort. Methods A Cox proportional-hazard analysis was conducted to estimate the hazard ratio and their 95% confidence interval of stroke according to the metabolic health and obesity states based on TyG index and Adult Treatment Panel-III criteria, during 9.1 years of follow-up. Results After 50,056.2 person-years of follow-up, 162 subjects developed an ischemic stroke (incidence rate 3.23 per 1000 person-years). Metabolically healthy obese subjects did not show greater risk of stroke, while metabolically unhealthy participants, obese and non-obese, had an increased risk of stroke, compared with healthy non-obese. The hazard ratios for the multivariable adjusted model were 1.55 (95% CI: 1.36-1.77) and 1.86 (95% CI: 1.57-2.21), respectively. Conclusions Metabolically unhealthy individuals exhibited a greater risk of ischemic stroke than metabolically healthy obese individuals.