Development Of Metabolic Risk Factors Research Articles

Elevated risk of liver steatosis in first-episode psychosis patients: Results from a 3-year prospective study

BackgroundCardiometabolic disorders are largely responsible for excess mortality in schizophrenia. Non-alcoholic fatty liver disease (NAFLD) is increasingly relevant in the development of metabolic risk factors that have been associated with antipsychotic treatment.We aimed to assess the incidence of NAFLD and metabolic disturbances during the first 3 years of antipsychotic treatment in patients with first episode of psychosis (FEP), and compare it with the incidence in a control group. MethodsData were obtained from patients with psychosis (n = 160) and healthy controls (n = 66) included in the Cantabria's clinical and research program on FEP (PAFIP) from 2012 to 2018. Fatty Liver Index (FLI) was used to estimate the amount of fat in the liver. FLI has been validated for the diagnosis of NAFLD against different standards such as liver ultrasound and biopsy. FLI and metabolic parameters were registered at baseline, 3 months and then yearly for 3 years. ResultsAt the end of the follow-up (3-years), 21.9 % of patients with psychosis developed a FLI ≥ 60, suggestive of liver steatosis, compared to only a 3 % of subjects within the control group (X2 = 12.120; p < 0.001). In the FEP patients group, developing a FLI ≥ 60 was statistically associated with significant increments in metabolic parameters, and with Metabolic Syndrome (MetS) (X2 = 16.151; p < 0.001) and high blood pressure (X2 = 10.654; p = 0.001). ConclusionsHaving a first episode of non-affective psychosis was significantly associated with developing liver steatosis (FLI ≥ 60) in the first three years after initiating antipsychotic treatment. The results highlight the importance of early screening the emergence of NAFLD in schizophrenia patients.

Untreated adult GH deficiency is not associated with the development of metabolic risk factors: a long-term observational study.

Uncertainties exist about the predictors of the severity of the clinical picture of GH deficiency (GHD) syndrome. Aim of the study was to evaluate, in adult patients with GHD, the predictors of the development of hypercholesterolemia, hypertension, diabetes mellitus, and osteoporosis. We retrospectively studied 327 adult patients (age 47.1 ± 17.1years) with untreated severe GHD (mean follow-up 110.9 ± 56.8months). GHD was defined by GHRH + arginine test using BMI cut-offs. The possible development of hypercholesterolemia, hypertension, diabetes mellitus, and osteoporosis was investigated by Kaplan-Meier survival analysis. For each clinical outcome, either a univariate or multivariate analysis according to the Cox proportional-hazards model was performed to identify those factors that were associated with the development of the event. GH secretion parameters were not associated with the outcomes. Hypercholesterolemia was positively and negatively predicted by a BMI ≥ 30kg/m2 (HR 2.50, p 0.00) and the dose of l-thyroxine possibly in place (HR 0.98, p 0.02), respectively. Hypertension was positively predicted by a BMI ≥ 30kg/m2 (HR 2.64, p 0.00) and IGF-I SDS values (HR 2.26, p 0.00). Diabetes mellitus was positively predicted by hypertension (HR 11.76, p 0.01). Osteoporosis was positively and negatively predicted by hypercholesterolemia (HR 3.25, p 0.01) and hypertension (HR 0.21, p 0.00), respectively. The severity of the impairment of GH secretion does not predict the development of the clinical picture of GHD syndrome: untreated adult GHD does not increase the development of metabolic risk factors in hypopituitaric patients.

The effect of exercise in the treatment of obesity

The world continues in the midst of a significant public health problem related to obesity and inactivity. This epidemic has far-ranging consequences on the workforce of the world and on our children, and shows no signs of slowing down in the near future. A significant amount of research has been performed on the effects of exercise for the reduction of body weight. A literature review was performed to address the effects of aerobic exercise, strength training, and high intensity interval training (HIIT) on obesity and weight loss. Most studies indicate that exercise alone has a small effect on body weight reduction independent of caloric restriction. When combined with dietary restriction, exercise has a synergistic effect and enhances weight loss beyond the effect of diet alone. Exercise also has been shown to have significant beneficial effects on cardiovascular and metabolic risk factors independent of actual weight loss, and losing just a small amount of weight can have a significant beneficial effect. Genetic factors related to obesity have been found to be positively modified when individuals incorporate physical activity into their lifestyle. Sitting time also appears to be an independent risk factor for the development of metabolic risk factors; individuals who spend more time sitting and watching television have worse metabolic profiles, even if they achieve the recommended amount of physical activity per week. High intensity interval training has been shown to be a safe, effective, and well-tolerated mode of exercise in the obese population, and compliance may be better than continuous moderate duration exercise. Continuous moderate intensity aerobic exercise has a synergistic effect with diet to enhance weight loss. Resistance training has significant cardiovascular and metabolic effects independent of weight loss. High intensity interval training is effective, time efficient, and well-tolerated in the obese population.

Long-term metabolic risk for the metabolically healthy overweight/obese phenotype

Background/ObjectivesThe clinical relevance of the metabolically healthy overweight/obese (MHO) phenotype is controversial and the relationships between weight change and the development of cardiometabolic risk factors is unknown. Therefore, we aim to: 1) Assess the long-term risk of developing one or more components of the metabolic syndrome in MHO adults compared with metabolically healthy normal weight (MHNW); 2) Evaluate risk of a composite of death, CVD, and risk of developing type 2 diabetes between adults defined according to baseline BMI and metabolic health.Subjects/MethodsRetrospective cohort study of adults 18–65 years of age seen at our institution between 1998 and 2000 who lived in Olmsted County. Metabolically healthy was defined as the absence of all components of the metabolic syndrome (except for waist circumference). Main outcome was the development of metabolic risk factors. The secondary outcome was a composite of mortality, CVD and heart failure.ResultsOf the 18071 individuals with complete data at baseline, 1805 (10%) were MHO (mean age 38 ± 11 years) and 3048 were MHNW (mean age 35 ± 11 years). After a median follow up of 15 years, IQR 10–17, 80% of MHO vs. 68% of MHNW developed at least one cardiometabolic risk factor (p < 0.001). In multivariate analysis, MHO individuals who gained ≥ 10% of their body weight were more likely to have developed metabolic complications compared to MHO individuals that did not gain weight (p=0.001 for 10–15%, p< 0.001 for > 15% weight gain). The risk for the secondary composite endpoint was similar between MHO and MHNW, number of events 218/1805 vs. 217/3048 for MHO and MHNW, respectively, (HR: 1.16, 95% CI 0.96–1.40).ConclusionsMHO are more likely to develop metabolic complications than MHNW, especially if they gain weight.

Metabolic Effects of Berries with Structurally Diverse Anthocyanins.

Overconsumption of energy dense foods and sedentary lifestyle are considered as major causes of obesity-associated insulin resistance and abnormal glucose metabolism. Results from both cohort studies and randomized trials suggested that anthocyanins from berries may lower metabolic risks, however these reports are equivocal. The present study was designed to examine effects of six berries with structurally diverse anthocyanin profiles (normalized to 400 µg/g total anthocyanin content) on development of metabolic risk factors in the C57BL/6 mouse model of polygenic obesity. Diets supplemented with blackberry (mono-glycosylated cyanidins), black raspberry (acylated mono-glycosylated cyanidins), blackcurrant (mono- and di-glycosylated cyanidins and delphinidins), maqui berry (di-glycosylated delphinidins), Concord grape (acylated mono-glycosylated delphinidins and petunidins), and blueberry (mono-glycosylated delphinidins, malvidins, and petunidins) showed a prominent discrepancy between biological activities of delphinidin/malvidin-versus cyanidin-type anthocyanins that could be explained by differences in their structure and metabolism in the gut. Consumption of berries also resulted in a strong shift in the gastrointestinal bacterial communities towards obligate anaerobes that correlated with decrease in the gastrointestinal luminal oxygen and oxidative stress. Further work is needed to understand mechanisms that lead to nearly anoxic conditions in the gut lumens, including the relative contributions of host, diet and/or microbial oxidative activity, and their implication to human health.

Physical activity, BMI and metabolic risk in Portuguese adolescents

DOI: http://dx.doi.org/10.5007/1980-0037.2016v18n1p103 It has been reported, in the last decades, a significant decrease in physical activity (PA) levels, with a consequent increase in obesity and metabolic risk factors among youth. The aims of this study were to describe PA levels, the prevalence of overweight/obesity and metabolic risk factors, and to examine the association between PA and body mass index (BMI) with metabolic risk among Portuguese youth. The sample comprises 212 Portuguese adolescents (12-16 years old). Height and weight were measured. PA was estimated with the Bouchard questionnaire (3 days recall), as well as with the use of a pedometer (used for 5 consecutive days). Metabolic risk factors comprised fasting glucose, triglycerides, HDL-cholesterol, systolic blood pressure and waist circumference. Subjects were classified as normal weight, overweight or obese according to BMI; the maturational status was indirectly estimated with the maturity offset procedure. A continuous metabolic risk score was computed (zMR) and PA values were divided into tertiles. Qui-square test, t-test and ANOVA were used in statistical analyses. SPSS 18.0 and WinPepi softwares were used and p&lt;0.05. A moderate to high prevalence of overweight/obesity and HDL-cholesterol was found, as well as a high prevalence of high blood pressure and low to moderate PA levels among Portuguese youth. The relationship between BMI and zMR showed that obese adolescents have higher zMR when compared to normal weight or overweight adolescents. This finding suggests that increased levels of PA and reduction in the prevalence of overweight/obesity may have a positive role against the development of metabolic risk factors.

The development of metabolic risk factors after the initiation of the second line anti- retroviral therapy.

A Highly Active Anti-Retroviral Therapy (HAART) is accompanied with several metabolic effects like adipose redistribution and insulin resistance. In this study, we evaluated the association between a HAART and lipodystrophy. A cross sectional study, whose subjects were Human Immunodeficiency Virus (HIV) infected patients, was conducted at a tertiary care hospital in south India. Among these, 27 were on protease inhibitors for at-least 6 months and 13 were drug naive patients. The assessments of lipodystrophy, fasting blood sugar and the fasting lipid profile were done and these parameters were compared in the two groups. The analysis of the data which was collected, showed an elevation in the total cholesterol levels in the individuals who were on the protease inhibitors versus the drug naive patients. There was a significant elevation in the Low Density Lipoprotein (LDL) cholesterol levels and a decrease in High Density Lipoprotein (HDL) cholesterol levels in the individuals who were on protease inhibitors. It was also observed that the HDL cholesterol levels decreased with an increase in the duration of the therapy. The LDL cholesterol levels increased with the duration of the therapy. The human immunodeficiency virus infection is itself related to the metabolic complications which are aggravated on the use of second line anti retroviral therapy. Therefore, after initiating the treatment with protease inhibitors, a periodic evaluation of the serum lipid levels and the blood sugar profile should be done as a standard care.

The Role of Exercise in the Treatment of Obesity

The United States is in the midst of a significant public health problem that relates to obesity and inactivity. This epidemic has far-ranging consequences for our workforce and our children and shows no signs of slowing in the near future. Significant research has been performed on the effects of exercise for the reduction of body weight; results of most studies indicate that exercise alone has a small effect on body-weight reduction independent of caloric restriction. However, when combined with dietary restriction, exercise has a synergistic effect and enhances weight loss beyond the effect of diet alone. In addition, exercise has been shown to have significant beneficial effects on cardiovascular and metabolic risk factors independent of actual weight loss, and losing just a small amount of weight can have a significant beneficial effect on these parameters. Genetic factors related to obesity have been found to be positively modified when persons incorporate physical activity into their lifestyle. Sitting time appears to be an independent risk factor for the development of metabolic risk factors; persons who spend more time sitting and watching television have worse metabolic profiles, even if they achieve the recommended amount of physical activity per week, than do those who move about throughout the day. Exercise also is essential for the prevention of weight gain over a life span, although the amount required to prevent weight gain may be closer to twice the amount of exercise recommended by the current Physical Activity Guidelines for Americans (www.health.gov/paguidelines). In many ways, the physiatrist is the most well prepared of all the specialists to address the complex, multidimensional problems of obesity and inactivity.

Can Adoption of Regular Exercise Later in Life Prevent Metabolic Risk for Cardiovascular Disease?

To determine the impact of chronic exercise training initiated later in life upon development of metabolic markers of cardiovascular disease risk. Two inception cohorts of previously sedentary healthy adults aged 55-75 years at baseline (1989), one initiating regular supervised physical exercise training and the other a geographical similar sedentary control, were assessed for anthropometric, biochemical, and clinical markers of the metabolic syndrome and comorbidity over 10 years. At baseline, active individuals aged 68 years compared with sedentary individuals aged 67 years had similar fitness levels (5.7 vs. 5.8 metabolic equivalents). At follow-up, complete data were obtained for 161 active and 136 sedentary subjects. Drop out occurred primarily because of failure to adhere to the exercise regimen and poor physical health for active and sedentary individuals, respectively. More metabolic abnormalities were seen in the sedentary group than in the active group for one or two (64 vs. 36%, P < 0.001) and three or more (35 vs. 22%, P < 0.003) abnormalities, respectively. In those assessed at follow-up, the sedentary group compared with the active group had lower fitness levels (5.0 [13.8% decrease] vs. 5.9 [3.5% increase] metabolic equivalents), had a greater likelihood of a positive exercise electrocardiogram or symptom (32 vs. 10%, P < 0.001), and had more comorbid conditions (Charlson Comorbidity Index score 0.9 vs. 0.4, P < 0.01). Higher fitness achieved over 10 years of regular exercise training in older adults was associated with reduced development of metabolic risk factors for cardiovascular disease, fewer exercise-induced cardiac abnormalities, and reduced comorbidity.

Can Adoption of Regular Exercise in Later Life Prevent Metabolic Syndrome?

0088 Clustering of early metabolic markers of cardiovascular disease risk may be modifiable through lifestyle interventions including regular exercise. It is not known whether regular physical exercise adopted later in life can alter the development of these markers and associated morbidity. Purpose: To determine the effect of regular exercise training initiated in later life, and development of metabolic risk factors. Methods: Two inception cohorts of previously sedentary healthy adults aged 55–85 years at baseline (1986–89); one initiating regular supervised physical exercise training (ACTIVE) and the other an age-matched sedentary control (CONTROL) were assessed for anthropometric, biochemical and clinical markers of the metabolic syndrome. Those free of metabolic syndrome were followed for 10 years. Four hundred and fiftysix subjects completed baseline assessment and 36 were excluded with presence of metabolic risk factors. ACTIVE (n = 193) initiated regular exercise training according to published guidelines. Training prescription was updated yearly. SEDENTARY (n = 178) was a randomly selected, geographically similar group of communitydwelling residents obtained using census data who received maximal exercise treadmill testing at baseline and after 10 years but who did not receive formal regular exercise programming during that interval. Markers of metabolic syndrome included elevated systolic blood pressure; LDL-C; serum triglycerides; fasting blood glucose; BMI and waist circumference as per published guidelines. Clinical outcomes included exercise METS, presence of ST-segment depression or angina during exercise, reported cardiac events and co-morbidities using the Charlson co-morbidity index score. Results: At baseline, no differences between groups were observed. At follow up, more metabolic abnormalities were observed in the SEDENTARY compared to ACTIVE for 1 or 2 (64 vs 36%, p<0.001) and 3 or more (35 vs 22%, p<0.003) respectively. SEDENTARY compared to ACTIVE group had more cardiac events (41 vs 33%, p<0.005), comorbid conditions (Charlson score 0.9 vs 0.4, p<0.01), achieved a lower workload (5.0 [9.1% decrease] vs 5.9 [3.5% increase] METS, p<0.01) and had a greater likelihood of a positive exercise test composite (32 vs 10%, p<0.001). Conclusions: Higher fitness achieved over 10 years of regular exercise training in older adults was associated with reduced development of metabolic risk factors. Even when fitness improved among sedentary controls, there was not a similar improvement in risk factors compared to engaging in a regular exercise program.

Can Adoption of Regular Exercise in Later Life Prevent Metabolic Syndrome?

0088 Clustering of early metabolic markers of cardiovascular disease risk may be modifiable through lifestyle interventions including regular exercise. It is not known whether regular physical exercise adopted later in life can alter the development of these markers and associated morbidity. Purpose: To determine the effect of regular exercise training initiated in later life, and development of metabolic risk factors. Methods: Two inception cohorts of previously sedentary healthy adults aged 55–85 years at baseline (1986–89); one initiating regular supervised physical exercise training (ACTIVE) and the other an age-matched sedentary control (CONTROL) were assessed for anthropometric, biochemical and clinical markers of the metabolic syndrome. Those free of metabolic syndrome were followed for 10 years. Four hundred and fiftysix subjects completed baseline assessment and 36 were excluded with presence of metabolic risk factors. ACTIVE (n = 193) initiated regular exercise training according to published guidelines. Training prescription was updated yearly. SEDENTARY (n = 178) was a randomly selected, geographically similar group of communitydwelling residents obtained using census data who received maximal exercise treadmill testing at baseline and after 10 years but who did not receive formal regular exercise programming during that interval. Markers of metabolic syndrome included elevated systolic blood pressure; LDL-C; serum triglycerides; fasting blood glucose; BMI and waist circumference as per published guidelines. Clinical outcomes included exercise METS, presence of ST-segment depression or angina during exercise, reported cardiac events and co-morbidities using the Charlson co-morbidity index score. Results: At baseline, no differences between groups were observed. At follow up, more metabolic abnormalities were observed in the SEDENTARY compared to ACTIVE for 1 or 2 (64 vs 36%, p<0.001) and 3 or more (35 vs 22%, p<0.003) respectively. SEDENTARY compared to ACTIVE group had more cardiac events (41 vs 33%, p<0.005), comorbid conditions (Charlson score 0.9 vs 0.4, p<0.01), achieved a lower workload (5.0 [9.1% decrease] vs 5.9 [3.5% increase] METS, p<0.01) and had a greater likelihood of a positive exercise test composite (32 vs 10%, p<0.001). Conclusions: Higher fitness achieved over 10 years of regular exercise training in older adults was associated with reduced development of metabolic risk factors. Even when fitness improved among sedentary controls, there was not a similar improvement in risk factors compared to engaging in a regular exercise program.

Prevention Conference VI: Diabetes and Cardiovascular Disease: executive summary: conference proceeding for healthcare professionals from a special writing group of the American Heart Association.

The American Heart Association (AHA) sponsored a scientific conference entitled “Prevention VI: Diabetes and Cardiovascular Disease” on January 18 to 20, 2001, in Orlando, Fla. The purpose of this conference was to create a report that would assist the AHA in the development of an agenda to reduce cardiovascular diseases (CVDs) that are associated with diabetes. The report has been developed by working group sections. The topics to be covered by each working group were introduced by a series of presentations, and this was followed by an extensive discussion of a team of working group members. The primary objectives of this meeting were as follows: The key findings of each working group are presented in this Executive Summary of the conference. The full conference report with references is available online at http://www.circulationaha.org in the May 7, 2002, issue of Circulation . The prevalence of diabetes in the United States is increasing rapidly, and individuals with diabetes are at high risk for cardiovascular disorders that affect the heart, brain, and peripheral vessels. Although CVD accompanying diabetes is on the rise, many unanswered questions remain concerning the temporal relations between diabetes and CVD, the contributions of conventional risk factors, and the role of diabetes-specific risk factors. Almost 35 million Americans—20% …

LDL size distribution in relation to insulin sensitivity and lipoprotein pattern in young and healthy subjects.

Smaller LDL particles are associated with an increased risk for coronary artery disease and have been found predominantly in subjects with the insulin resistance syndrome. Although insulin resistance has been suggested to be a basic defect, little is known about the relation between this predisposing factor (and associated metabolic disturbances) and LDL size distribution in young and metabolically healthy subjects. In the present study, we investigated the relation between insulin sensitivity, lipoprotein distribution, and LDL patterns in young adults to increase the understanding of the development of metabolic risk factors in an early phase of the life span. Young, clinically healthy subjects (n = 50; age 21.1-30.6 years) were enrolled in the study. Glucose metabolism was characterized by peripheral insulin sensitivity assessed by a hyperinsulinemic-euglycemic clamp and by levels of fasting insulin, C-peptide, and glucose. Lipoproteins were measured, and LDL fractions were additionally characterized by the diameter of the major LDL peak, estimated by 2-16% polyacrylamide gradient gel electrophoresis. Cholesterol ester transfer was estimated with a fluorescent spectroscopic method that measures the transfer of fluorescent cholesteryl linoleate between exogenous donor and acceptor particles. In this assay system, cholesterylester transfer protein (CETP) activity was only influenced by the plasma CETP concentration therefore reflecting more likely the CETP mass. In the entire study group, 47 subjects had LDL phenotype A (LDL diameter > 25.75 nm) and 3 subjects had an intermediate phenotype (25.50-25.75 nm). An interrelation between LDL size and LDL triglyceride (LDL-TG) per apolipoprotein (apo) B (Spearman's rank correlation analysis; r = -0.78; P < 0.001) or LDL cholesterol ester (CE) per apoB (r = 0.58, P < 0.001) was found, and 39% of the plasma samples studied were characterized by a monodispersed LDL pattern. Furthermore, LDL diameters correlated negatively with total TGs (men: r = -0.52, P < 0.001; women: r = -0.61, P < 0.001) and positively with insulin sensitivity (total population: r = 0.54, P < 0.001). In addition, LDL size was inversely related to the [VLDL + LDL cholesterol (CH)]/HDL-CH ratio and positively to the HDL-CE/TG ratio, which were both related vice versa to CETP activity levels. A direct relation between CETP activity levels and LDL size or composition was not observed. In a linear regression analysis including parameters of lipoprotein metabolism (TG, HDL cholesterol, CETP activity level), glucose metabolism (insulin sensitivity, fasting insulin), and sex, only TGs predicted significantly for 62% of LDL size variability. If the total study population was evaluated according to quintiles of insulin sensitivity, increasing TGs (analysis of variance, Scheffé test; P < 0.05) and CETP activity levels (P < 0.05) were combined with decreasing LDL particle diameters (P < 0.05) and with a preponderance of a monodispersed LDL pattern (60%) in the most insulin-resistant group. Among parameters of the lipoprotein and glucose metabolism, total TG is the single most important factor affecting LDL size variability, even in young adults. If the study population is evaluated according to insulin sensitivity, lipoprotein pattern is altered in a more atherogenic manner in the most insulin-resistant subjects. In this group, increasing TG and CETP activity levels are associated with decreasing LDL particle diameters and preponderance of a monodispersed LDL pattern. Although increasing CETP levels are combined with this particular lipoprotein profile, a direct relation to LDL size and composition is not found.

Metabolic risk factors for atherosclerosis in heart transplant recipients

Development of coronary artery disease (CAD) in the cardiac allograft limits long-term survival after heart transplantation. Previous studies, focusing on lipoprotein metabolism, have paid little attention to changes in glucose and insulin metabolism that increase the risk of CAD in these patients. To address this issue, plasma glucose and insulin responses to an oral glucose load and lipid and lipoprotein concentrations were measured in male normal volunteers ( n = 40) and cardiac transplant recipients with pretransplant diagnoses of either idiopathic cardiomyopathy ( n = 24) or ischemic heart disease ( n = 28), matched for age and body mass index. Patients with a pretransplant diagnosis of ischemic heart disease had higher plasma glucose and insulin concentrations in response to oral glucose as well as higher fasting plasma triglyceride, cholesterol, and low-density lipoprotein cholesterol concentrations than did the control group ( p < 0.005 to p < 0.001). In addition, high-density lipoprotein cholesterol concentrations were lower and the ratio of cholesterol to high-density lipoprotein cholesterol higher than control values in those with a pretransplant diagnosis of ischemic heart disease ( p < 0.001). Values for almost all variables were intermediate in patients with a pretransplant diagnosis of idiopathic cardiomyopathy and in most instances were significantly different from both. Thus, male cardiac transplant recipients are dyslipidemic, relatively glucose intolerant, and hyperinsulinemic compared to normal volunteers. These changes, observed in patients with a pretransplant diagnosis of either ischemic heart disease or idiopathic cardiomyopathy, emphasize the important role of immunosuppression in the development of metabolic risk factors for CAD in these individuals.