Changes In MetS Research Articles

Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance.

To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence. We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2 years. In an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk. MetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.

Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome.

Metabolic syndrome (MetS) is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to examine comprehensively the LV and arterial responses to exercise in individuals with MetS without diabetes and/or overt cardiovascular disease in comparison to a healthy control population. Cardiovascular function was characterized using Doppler echocardiography and gas exchange in individuals with MetS (n = 27) versus healthy control subjects (n = 20) at rest and during peak exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.

The Challenging Chase for Nutrigenetic Predictors of Metabolic Responses to Dietary Interventions

Development of the metabolic syndrome (MetS) is influenced by genetic and environmental factors. It is of interest to identify genetic factors associated with changes in MetS in response to dietary interventions to maximize the individual benefits gained from preventive or therapeutic measures (i.e., personalized nutrition). In this issue of Diabetes Care , Qi et al. (1) examined the contributions of two genetic variants (rs1522813 and rs2943641) near the insulin receptor substrate 1 ( IRS1 ) gene and their interactions with dietary fat intake on the reversion of the MetS using the data of the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) study. The POUNDS LOST study was a 2-year population-based trial in which 811 overweight and obese adults (64% females) were randomly assigned to one of four diets (2). The percentage of calories derived from the macronutrients varied 20–40% for dietary fat, 15–25% for protein, and 35–65% for carbohydrates. A total of 645 subjects were defined as completers and they lost 4 kg on average with no significant differences among the four dietary groups. MetS was present in 32% of the participants at baseline and this prevalence was reduced to ∼20% at 2 years with no differences between diet groups. Participants changed their diets in the direction of the specified macronutrient goals, but these goals were not fully achieved. For instance, the reported fat intake at 2 years differed from the targets by almost 7 percentage points, with the differences being ∼7% higher for the 20% dietary fat diet group and ∼7% lower for the 40% fat diet group (2). For reasons not specified in the article, Qi et al. used 738 subjects for the current study, a number that apparently includes almost 100 noncompleters as defined in the …

Aldosterone, C-reactive protein, and plasma B-type natriuretic peptide are associated with the development of metabolic syndrome and longitudinal changes in metabolic syndrome components: findings from the Jackson Heart Study.

OBJECTIVESeveral pathomechanisms are implicated in the pathogenesis of metabolic syndrome (MetS), most of which have not been investigated in African Americans (AAs). We examined the contribution of a selected panel of biomarkers to the development of MetS in Jackson Heart Study (JHS) participants in this investigation.RESEARCH DESIGN AND METHODSWe evaluated 3,019 JHS participants (mean age, 54 years; 64% women) with measurements for seven biomarkers representing inflammation (high-sensitivity C-reactive protein [CRP]), adiposity (leptin), natriuretic pathway (B-natriuretic peptide [BNP]), adrenal pathway (cortisol and aldosterone), and endothelial function (endothelin and homocysteine). We related the biomarker panel to the development of MetS on follow-up and to longitudinal changes in MetS components.RESULTSThere were 278 (22.9%) of 1,215 participants without MetS at baseline who had development of new-onset MetS at follow-up. The incidence of MetS was significantly associated with serum aldosterone (P = 0.004), CRP (P = 0.03), and BNP (P for trend = 0.005). The multivariable-adjusted odds ratios (95% CI) per SD increment of log biomarker were as follows: 1.25 (1.07–1.45) for aldosterone, 1.20 (1.02–1.43) for CRP, and 1.54 (1.07–2.23) and 1.91 (1.31–2.80) for low and high BNP quartiles, respectively. Aldosterone was positively associated with change in all MetS risk components, except low HDL cholesterol and waist circumference. CRP concentration was significantly and directly associated with change in systolic blood pressure (SBP) and waist circumference but inversely associated with HDL cholesterol. For BNP, we observed a U-shape relation with SBP and triglycerides.CONCLUSIONSOur analysis confirms that, in AAs, higher circulating aldosterone and CRP concentrations predict incident MetS. The nonlinear U-shape relation of BNP with MetS and its components has not been reported before and thus warrants replication.

Metabolic syndrome and mortality in the elderly: A time-dependent association

AimsTo evaluate the association between metabolic syndrome (MetS) components and mortality over time. Methods3086 residents aged ≥49 years were followed in the Blue Mountains Eye Study, Australia. MetS components as defined by the International Diabetes Federation criteria were measured at baseline (1992–1994), 5-year (1997–1999) and 10-year (2002–2004). Using Cox proportional hazards and competing risks models with MetS as a time-dependent covariate, we estimated the effects of MetS on all-cause and cause-specific mortality. Time-dependent receiver-operating-characteristic curve, integrated-discrimination-improvement and net-reclassification-improvement tests assessed predicting abilities of individual and combined MetS components. ResultsEffect of MetS on mortality increased with time: all cause: 2-year: adjusted hazard ratio 0.96 [95% confidence interval 0.69–1.34]; 5-year: 1.06 [0.84–1.32]; 10-year: 1.23 [1.01–1.51]; and CHD: 2-year: 0.46 [0.20–1.03]; 5-year: 0.70 [0.41–1.21]; 10-year: 1.62 [1.02–2.59]. Conversely, MetS was associated with an increased risk of cancer death at 2-year only: 1.62 [1.01–2.62]; but not 5-year: 1.30 [0.94–1.81] or 10-year: 0.90 [0.57–1.44]. The discrimination analyses showed that different MetS components were associated with different causes of death. ConclusionsThe long-term effect of MetS on all-cause and CHD mortality in an older population was detected using time-dependent models while simulating the real scenarios of MetS changes over time.

Measurement Site and the Association Between Visceral and Abdominal Subcutaneous Adipose Tissue With Metabolic Risk in Women

The associations between visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (ASAT) and metabolic risk may be influenced by measurement site. The aim of this study was to compare the strength of the associations between VAT and ASAT, as assessed by a cross-sectional image (area) or total volume, and prevalent metabolic syndrome (MetS). We also examined the association between changes in abdominal AT area and volume with concomitant changes in metabolic risk. Abdominal AT volume and areas were derived using ~35 continuous computed tomography (CT) images from T10-T11 to L5-S1 in overweight or obese postmenopausal women before (n = 67) and after (n = 39) a 6-month exercise intervention. At baseline, measurement site did not influence the inter-relationship between ASAT area and total volume, and between ASAT and MetS. Conversely, VAT areas at L1-L2 and L2-L3 were stronger correlates of VAT volume at baseline (L1-L2 (r = 0.94), L2-L3 (r = 0.95), L4-L5 (r = 0.89)) and changes therein (L1-L2 (r = 0.77), L2-L3 (r = 0.75), L4-L5 (r = 0.55)) as compared to L4-L5, but were not significantly better predictors of MetS as compared to L4-L5 or the total volume (L2-L3: odds ratio (OR) = 2.68 (1.6-4.4), L1-L2: OR = 1.88 (1.2-3.0), L4-L5: OR = 2.56 (1.6-4.1), volume: OR = 2.07 (1.1-3.8)). Changes in VAT and ASAT were not associated with changes in MetS (P > 0.10). Although measurement site has an impact on the prediction of VAT volume, this does not translate into an improved prediction for the MetS. Thus, there is not enough evidence to support changing the current research practice of assessing VAT volume or at L4-L5 for the prediction of metabolic risk.

Age- and sex-specific prevalence and ten-year risk for cardiovascular disease of all 16 risk factor combinations of the metabolic syndrome - A cross-sectional study

BackgroundBased on the AHA/NHLBI-definition three out of five cardiometabolic traits must be present for the diagnosis of the metabolic syndrome (MetS), resulting in 16 different combination types. The associated cardiovascular risk may however be different and specific combination may be indicative of an increased risk, furthermore little is known to which extent these 16 combinations contribute to the overall prevalence of MetS. Here we assessed the prevalence of all 16 combination types of MetS, analyzed the impact of age and gender on prevalence rates, and estimated the 10-year risk of fatal and non-fatal myocardial infarction (MI) of each MetS combination type.MethodsWe used data of the German Metabolic and Cardiovascular Risk Project (GEMCAS), a cross-sectional study, performed during October 2005, including 35,869 participants (aged 18-99 years, 61% women). Age-standardized prevalence and 10-year PROCAM and ESC risk scores for MI were calculated.ResultsIn both men and women the combination with elevated waist-circumference, blood pressure and glucose (WC-BP-GL) was the most frequent combination (28%), however a distinct unequal distribution was observed regarding age and sex. Any combination with GL was common in the elderly, whereas any combination with dyslipidemia and without GL was frequent in the younger. Men without MetS had an estimated mean 10-year risk of 4.7% (95%-CI: 4.5%-4.8%) for MI (PROCAM), whereas the mean 10-year risk of men with MetS was clearly higher (age-standardized 7.9%; 7.8-8.0%). In women without MetS the mean 10-year risk for MI was 1.1%, in those with MetS 2.3%. The highest impact on an estimated 10-year risk for MI (PROCAM) was observed with TG-HDL-GL-BP in both sexes (men 14.7%, women 3.9%). However, we could identify combinations with equal risks of non-fatal and fatal MI compared to participants without MetS.ConclusionsWe observed large variations in the prevalence of all 16 combination types and their association to cardiovascular risk. The importance of different combinations of MetS changes with age and between genders putting emphasis on a tailored approach towards very young or very old subjects. This knowledge may guide clinicians to effectively screen individuals and prioritize diagnostic procedures depending on age and gender.

Effect of postmenopausal hormone replacement therapy on cardiovascular performance

Summary: Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atherosclerotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance. Methods: Thirty-six postmenopausal women (mean age: 51±4 years, 39–60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined. Results: HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI ( P>0.05). However, at the sixth month of HRT, these changes became significant (68±12 vs. 75±13 cm/s, P<0.01; 171±24 vs. 184±14 ms, P<0.01; 1.01±0.23 vs. 1.11±0.27, P<0.01, and 44±9 vs. 39±8%, P<0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of HRT (423±104 vs. 482±104 s, P<0.001; 8.2±1.7 vs. 9.1±2 METS, P<0.001). These improvements also continued at the sixth month of HRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance.