Joint Interim Statement Research Articles

Comparisons of different metabolic syndrome definitions and associations with coronary heart disease, stroke, and peripheral arterial disease in a rural Chinese population.

ObjectivesWe estimated the prevalence of metabolic syndrome (MetS) and compared associations of different MetS definitions with coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) in a rural Chinese population.MethodsAmong 4,748 residents (2,145 men and 2,603 women) aged 30+ years in rural China from 2006 to 2007, the prevalence of MetS was estimated by using five different definitions: modified World Health Organization (WHO), Chinese Diabetes Society (CDS), the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) for Asian-Americans, International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Multivariable logistic regression analyses were implemented to estimate the association between MetS and the prevalence of CHD, stroke and PAD, respectively.ResultsPrevalence of MetS in men was 11.5% (WHO), 14.8% (CDS), 32.4% (NCEP-ATP III), 27.5% (IDF) and 39.7% (JIS) and in women was 15.7% (WHO), 20.7% (CDS), 54.2% (NCEP-ATP III), 51.5% (IDF) and 54.2% (JIS), respectively. Respective ORs (95% CI) for associating MetS with CHD in men were 1.79 (1.02-3.17), 1.25 (0.69-2.26), 1.61 (1.01-2.58), 1.84 (1.14-2.96), and 1.53 (0.96-2.43). Corresponding ORs (95% CI) for stroke in men were 2.18 (95% CI 1.20 to 3.97), 2.20 (95% CI 1.25 to 3.89), 1.71 (95% CI 1.02 to 2.84), 1.30 (95% CI 0.77 to 2.23), and 1.61 (95% CI 0.97 to 2.68), respectively. In women, CHD and stroke were significantly associated with MetS using all five definitions of MetS. In addition, PAD was associated with all five MetS definitions in men, but not in women. Only hyperglycemia and BMI were significantly associated with PAD in women.ConclusionsIn this rural Chinese population, the JIS, IDF and CDS criteria may not be more suitable than WHO and updated NCEP-ATPIII definitions for screening high-risk individuals and estimating the risk of CHD and stroke from MetS, especially in men.

Predictors of Obstructive Sleep Apnea Risk among Blacks with Metabolic Syndrome

Identification of risk factors for obstructive sleep apnea (OSA) is important to enable comprehensive intervention to reduce OSA-related cardiovascular disease (CVD). The metabolic syndrome outcome study (MetSO) provides a unique opportunity to address these factors. This study investigated risk of OSA among blacks with metabolic syndrome. The present study utilized data from MetSO, an NIH-funded cohort study of blacks with metabolic syndrome. A total of 1,035 patients provided data for the analysis. These included sociodemographic factors, health risks, and medical history. Physician-diagnosed conditions were obtained using an electronic medical record system (Allscripts, Sunrise Enterprise). Patients were diagnosed with metabolic syndrome using criteria articulated in the joint interim statement for harmonizing the metabolic syndrome. Patients with a score ≥6 on the Apnea Risk Evaluation System (ARES) questionnaire were considered at risk for OSA. Obesity is defined by body mass index (BMI ≥ 30 kg/m2). Of the 1,035 patients screened in the MetSO cohort, 48.9% were at high risk for OSA. Using multivariate-adjusted logistic regression analysis, we observed that obesity was the strongest predictor of OSA risk (OR=1.59, 95%CI=1.24-2.04, p<0.0001). This finding remained significant even after adjustment for known covariates including blood pressure, low-density lipoprotein, high-density lipoprotein, and glucose levels (OR=1.44, 95%CI=1.11-1.86, p<0.001). Blacks in the MetSO cohort are at greater OSA risk, relative to the adult population in developed countries. Consistent with previous observations, obesity proved the strongest independent predictor of OSA risk among blacks with metabolic syndrome.

Association of ferritin elevation and metabolic syndrome in males. Results from the Aragon Workers' Health Study (AWHS).

Ferritin concentration is associated with metabolic syndrome, but the possibility of a nonlinear association has never been explored. This study aimed to examine the relationship between serum ferritin levels and the metabolic syndrome in Spanish adult males. This was a cross-sectional analysis of baseline data from the Aragon Workers' Health Study. Healthy workers from a factory were studied during their annual checkup. Spanish male adults (n = 3386) between the ages of 19 and 65 years participated. We excluded participants with ferritin > 500 μg/L, ferritin < 12 μg/L, or C-reactive protein > 10 mg/L. Metabolic syndrome was defined according to the 2009 consensus definition from the Joint Interim Statement of several international societies. Metabolic syndrome prevalence was 27.1%. We found a positive association between elevated iron stores, measured as serum ferritin concentration, and metabolic syndrome and its criteria. Participants within the highest serum ferritin quintile had a higher risk than those in the lowest quintile for central obesity (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.46-2.42), hypertriglyceridemia (OR, 2.15; 95% CI, 1.69-2.74), and metabolic syndrome (OR, 1.92; 95% CI, 1.48-2.49). The association was nonlinear and occurred at serum ferritin concentrations > 100 μg/L (∼ 33th percentile). Ferritin was also associated with insulin resistance, measured by homeostatic model assessment-insulin resistance (HOMA-IR) (P trend < .001). Our findings suggest that serum ferritin is significantly associated with metabolic syndrome and its criteria (especially central obesity and hypertriglyceridemia), suggesting that ferritin could be an early marker of metabolic damage in the development of metabolic syndrome.

Hemoglobin concentration and incident metabolic syndrome: a population-based large-scale cohort study.

Previous cross-sectional studies revealed an association between hemoglobin concentration and a prevalence of metabolic syndrome (MetS). However, the association between hemoglobin concentration and incident MetS remains to be elucidated. Thus, the aim of this study was to investigate the association between hemoglobin concentration and incident MetS. We enrolled 2695 subjects (1454 men and 1241 women) and performed 8-year follow-up cohort study. MetS was diagnosed, according to the joint interim statement, when a subject had three or more of the following components: hypertension; hyperglycemia; hypertriglyceridemia; low high-density lipoprotein cholesterol; and abdominal obesity. Logistic regression analyses were performed to assess the impact of hemoglobin concentration on incident MetS by adjusting for age, body mass index, lifestyle factors, including smoking status, habit of alcohol and habit of exercise, systolic blood pressure, fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, creatinine, and uric acid. The highest (≥157 g/L) and third (151-156 g/L) hemoglobin concentration quartiles were associated with the increased risk of incident MetS compared to the lowest (<145 g/L) hemoglobin concentration quartile after adjusting for covariates in men (multivariate odds ratio (OR) 2.24, 95% CI 1.34-3.85, P = 0.0021 and multivariate OR 2.03, 95% CI 1.21-3.45, P = 0.0070). On the other hand, there was no association between hemoglobin concentration and incident MetS in women. Hemoglobin concentration was a novel risk marker for incident MetS in men.

Donation intensity and metabolic syndrome in active whole‐blood donors

Increased iron and metabolic syndrome (MetS) go hand in hand. Frequent blood donation depletes iron stores. This study investigates whether high-intensity blood donation is associated with lower MetS prevalence compared with low-intensity blood donation, and whether iron acts as an intermediary factor. A random sample of 422 male and 211 female active whole-blood donors ≥45 years of age was included in a cross-sectional study. Lipids, glucose and iron parameters were measured after overnight fasting. MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Three groups of donation intensity were created by sex-specific tertiles of donation frequency per year and duration of donor career. MetS was present in 22·9% of donors. Prevalence of MetS was 1·46 (95% confidence interval [CI]: 0·93-2·30) times higher in men with high donation intensity, whereas in women MetS prevalence was 2·14 (95% CI: 0·94-4·86) times higher in donors with high donation intensity compared with those with low donation intensity. In men, increased prevalence of MetS was mainly associated with higher ferritin, whereas high hepcidin predominantly affected MetS prevalence in women. High-intensity blood donation is not associated with a decreased prevalence of MetS. In men and women, different iron parameters are associated with MetS prevalence. The temporal relationship between blood donation, iron and MetS, and gender differences herein need to be explored in future research.

The association between cardiovascular risk factors and anthropometric obesity indicators in university students in São Luís in the State of Maranhão, Brazil.

The article aims to evaluate the relation between cardiovascular risk factors (CVRF) and anthropometric indicators in a sample of university students from São Luís-MA, Brazil. It is a cross-sectional study conducted with 968 university students, with median age of 22. Glycemia, triglycerides, HDL-c, smoking, alcohol consumption, physical inactivity, metabolic syndrome (Joint Interim Statement criteria) and insulin resistance (IR), were associated and correlated with anthropometric indicators such as BMI, WC, WHR and WHtR. Associations were found between TGL, SH, SM and higher values of all anthropometric variables. The RI was associated with higher BMI values and WHtR in men and women. The low HDL-c was associated with higher values of all anthropometric variables in women. Consumption of alcohol was associated with higher values of BMI and WC in women and WHR in men and WHtR. Smoking was associated with higher values of WHtR in both sexes. Physical inactivity was associated with higher values of WHR in men only. The highest correlations were established for women between TGL and BMI CC, WHR and WHtR. The indicators most associated with CVRF were BMI, WC and WHtR in females and WHR and WHtR in men.

Clinical associations between metabolic syndrome and the development of microalbuminuria in Korean men

AimsThere have been several studies on the association between metabolic syndrome (MetS) and microalbuminuria. However, none has examined whether MetS is associated with the prospective development of microalbuminuria. Accordingly, we performed a prospective study to evaluate the longitudinal effects of baseline number of MetS traits on the development of microalbuminuria in Korean men. Methods1649 Korean men without microalbuminuria in 2005 were included and followed prospectively until 2010 with the endpoint being the development of microalbuminuria. MetS was defined according to the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Microalbuminuria was evaluated by urine albumin creatinine ratio (UACR). Risk estimations for development of microalbuminuria were analyzed according to the number of MetS traits using multivariate adjusted Cox proportional hazards model. ResultsDuring 5611.8 person-years of follow-up (median 3.40±1.46 years), microalbuminuria developed in 91 (5.5%) participants between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence interval) for development of microalbuminuria comparing 1, 2 and 3–5 MetS traits vs 0 were 2.57 (0.97–6.82), 2.94 (1.09–7.98) and 3.85 (1.37–10.86), respectively. ConclusionsThe number of MetS traits independently associated with the future development of microalbuminuria during the 5-year follow-up period, and MetS per se was an independent risk factor for microalbuminuria.

Prevalence of Metabolic Syndrome According to Three Defining Criteria in Hypertensive Population in a Rural Hospital Setting

Aim: To determine the prevalence of metabolic syndrome using National Cholesterol Education Program-Adult treatment Panel III, American Heart Association-National Heart, Lung and Blood Institute and the Joint Interim Statement criteria and determine the prevalence of each of the cardiovascular risk factors in hypertensives attending a rural cardiology clinic in North central Nigeria Methods: This cross-sectional study used the National Cholesterol Education Program-Adult treatment Panel III (NCEP-ATP III), American Heart Association-National Heart Lung and Blood institute (AHA-NHLBI) and the Joint Interim Statement (JIS) criteria to assess metabolic syndrome in 204 patients with arterial hypertension attending cardiology clinic of Federal medical centre, Bida, North central Nigeria from February 2010 to April 2013. The demographic and clinical history of the patients was taken. Results: There were 97 men (47.5%) and 107 (52.5%) women. The mean age was 53.44 ± 11.71 years and range from 21-84years. Using the NCEP-ATP III, eighty three (40.7%) hypertensives had metabolic syndrome (33 males: 16.2%, 50 females: 24.5%) while the application of AHA-NHLBI criteria, resulted in metabolic syndrome in 96 (47.1%) of hypertensives (42 males: 20.6%, 54 females: 26.5% females) and with the JIS, 108 (52.9%) hypertensives (46 males: 22.5%, 62 females: 33.9% females). The prevalence of metabolic syndrome increases with age. In both male and female hypertensives with metabolic syndrome, low high density lipoprotein cholesterol (HDL-C) and abdominal obesity were the most common cardiovascular risk factor. Conclusion: The prevalence of metabolic syndrome in hypertensives in rural Nigeria is high and varies considerably depending on the definition used. The need for public health promotion, screening and management of hypertension and other components of metabolic syndrome is hereby recommended

Determination of the Optimal Waist Circumference Cut-Off Points in Benin Adults

Obesity is an independent risk factor for chronic diseases such as diabetes, cardiovascular diseases and certain cancers. Early detection of abdominal obesity followed by appropriate interventions will prevent associated diseases. The objective was to determine optimal waist circumference (WC) cut-off points predictive of at least one other component of metabolic syndrome in Benin adults. This longitudinal and observational study included at the baseline 541 apparently healthy subjects aged 25 - 60 years randomly selected in the largest city of Cotonou (n = 200), the smaller-size city of Ouidah (n = 171) and rural surroundings of Ouidah (n = 170) in Benin. Components of the metabolic syndrome considered along with abdominal obesity were high blood pressure, high fasting glycaemia, low HDL-cholesterol and high triglycerides as defined by the Joint Interim Statement. After the baseline survey, the subjects were followed-up for four years. Complete data at baseline and four years later were available in 416 subjects. The receiver operating characteristic (ROC) curve for waist circumference to predict at least one other component of the metabolic syndrome was plotted and the Youden index was used to define the optimal cut-offs of WC. At the baseline of the study, the optimal WC cut-off point to predict the presence of at least one other component of the metabolic syndrome was 80 cm for men (sensitivity = 0.62, specificity = 0.65); the area under the ROC curve was 0.67 (IC 95%: 0.61-0.74). In women, the optimal WC cut-off point was 90 cm (sensitivity = 0.54, specificity = 0.80), and the area under the ROC curve was 0.68 (IC 95%: 0.62-0.75). These optimal cut-offs were similar four years later. Optimum WC cut-off points for both men and women in Benin differ from those currently recommended for sub-Saharan Africans. Therefore, waist circumference cut-off points for abdominal obesity need to be reconsidered for these populations.

Metabolic syndrome: An independent risk factor for erectile dysfunction.

Objective:The objective was to determine the role of various components of metabolic syndrome (MetS) as independent risk factor for erectile dysfunction (ED).Materials and Methods:A total of 113 subjects of MetS, as recommended by recent IDF and AHA/NHLBI joint interim statement were selected for study who presented for ED. After doing Anthropometric examination, fasting laboratory assay for fasting plasma glucose (FPG), fasting insulin, hemoglobin A1c, triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and 2 h oral glucose tolerance test (OGTT) was done. Erectile function was assessed by completing questions one through five of the International Index of Erectile Function (IIEF-5). A multiple linear regression analysis was carried out on 66 subjects with IIEF-5 score as dependent variable and components of MetS FPG, 2 h OGTT, TG, HDL, and waist circumference as independent variables.Results:Using a multiple linear regression analysis, we observed that presence of the various components of MetS was associated with ED and a decrease IIEF-5 score and this effect was greater than the effect associated with any of the individual components. Of the individual components of the MetS, HDL (B = 0.136; P = 0.004) and FPG (B = −0.069; P = 0.007) conferred the strongest effect on IIEF-5 score. However, overall age had most significant effect on IIEF-5 score.Conclusion:It is crucial to formulate strategies and implement them to prevent or control the epidemic of the MetS and its consequences. The early identification and treatment of risk factors might be helpful to prevent ED and secondary cardiovascular disease, including diet and lifestyle interventions.

Inflammation, Oxidative Stress, and Antioxidants Contribute to Selected Sleep Quality and Cardiometabolic Health Relationships: A Cross-Sectional Study.

Sleep is vital for cardiometabolic health, but a societal shift toward poor sleep is a prominent feature of many modern cultures. Concurrently, factors such as diet and lifestyle have also changed and may mediate the relationship between sleep quality and cardiometabolic health. Objectives were to explore (1) the interrelationship and (2) mediating effect of inflammation, oxidative stress, and antioxidants on sleep quality and cardiometabolic health. Cross-sectional data from the US National Health and Nutritional Examination Survey 2005-06 (≥20 y; N = 2,072) was used. Cardiometabolic health was defined as per the Joint Interim Statement; overall sleep quality was determined from six sleep habits and categorized as good, fair, poor, and very poor. Fair quality sleepers had optimal inflammation, oxidative stress, and antioxidant levels. Inflammation was above the current clinical reference range across all sleep quality categories, while oxidative stress was only within the clinical reference range for fair sleep quality. Selected sleep quality-cardiometabolic health relationships were mediated by inflammation, oxidative stress, and antioxidants and were moderated by sex. Our results provide initial evidence of a potential role for inflammation, oxidative stress, and antioxidants in the pathway between poor sleep quality-cardiometabolic decline. Further prospective research is needed to confirm our results.

Association between Metabolic Syndrome and Microalbuminuria in Korean Adults.

BackgroundWe conducted a population-based cross-sectional study of Korean adults to evaluate the association between metabolic syndrome and microalbuminuria as a marker for early-stage chronic kidney disease.MethodsA total of 8,497 adults (3,625 men and 4,872 women) who participated in the Korea National Health and Nutrition Examination Survey between 2011 and 2012 were included. Metabolic syndrome was defined according to recommendation from a joint interim statement of international organizations published in 2009. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio of 30 to 300 mg/g. The association between metabolic syndrome and microalbuminuria was evaluated using logistic regression analysis with adjustment for covariates while considering sampling weights and the complex survey design.ResultsThe prevalence of microalbuminuriain subjects with metabolic syndrome was 11% for men and 14.4% for women, whereas the prevalence in subjects without metabolic syndrome was 3.1% for men and 6.7% for women. Metabolic syndrome was significantly associated with an increased risk of microalbuminuriain both women (odds ratio, 2.79; 95% confidence interval, 2.01 to 3.88) and men (odds ratio, 3.00; 95% confidence interval, 2.11 to 4.27). All components of the metabolic syndrome were associated with a significantly increased risk of microalbuminuria with the strongest association for high blood pressure. The risk of microalbuminuria increased in a dose-dependent manner (P-value for trend < 0.001) with the number of metabolic syndrome components observed for both sexes.ConclusionThese findings suggest that metabolic syndrome is a risk factor for chronic kidney disease from an early stage.

Optimal waist circumference cutoff points for the determination of abdominal obesity and detection of cardiovascular risk factors among adult Egyptian population.

Objective:To determine the best anthropometric measurement of obesity, and its optimal cutoff, that best predicts the presence of cardiovascular risk factors among adult Egyptian population.Methods:This is a cross-sectional study including a representative randomly chosen sample of the adult Egyptian population from all Alexandria Districts (the second largest governorate in Egypt) based on the multistage random technique. It included 3209 subjects (1567 men, 1642 women) aged 18–80 years from urban and rural areas. The response rate was 80.2%. History, blood pressure, and anthropometric measurements were taken. Laboratory investigations included fasting lipid profile, fasting plasma glucose, and serum uric acid. Different criteria of metabolic syndrome were used and compared. Receiver operator characteristic curve and Youden index were used to determine predictability and cutoffs.Results:Waist circumference (WC) is the best to predict at least two other components of the metabolic syndrome as defined by the International Diabetes Federation (IDF). The optimal WC cutoffs were 100.5 and 96.25 cm for Egyptian men and women, respectively. The Joint Interim Statement definition (JIS) of metabolic syndrome was the best to predict cardiovascular disease in both genders and diabetes mellitus in women. The prevalence of metabolic syndrome and abdominal obesity was 42.5%, 61%, respectively (ATPIII definition); 43.8%, 61% (American Heart Association definition); 44.3%, 76.4% (IDF definition); 33.8%, 51.7% (IDF definition with Egyptian cutoffs); and 41.5%, 51.7% (JIS with Egyptian cutoffs).Conclusion:WC cutoffs in Egyptians differ from those currently recommended. Prevalence of metabolic syndrome and abdominal obesity is high in Egypt, despite being lower on using the Egyptian cutoffs.

Gender Disparity in the Prevalence of Metabolic Syndrome in Korea: Results from the Korea National Health and Nutrition Examination Survey, 2012

Objectives: To evaluate gender specific characteristics in the prevalence of metabolic syndrome (MetS) and abnormalities in Korean population using the 2009 Joint Interim Statement of the International Diabetes Federation. Methods: We performed a secondary analysis of data based on the 2012 Korea National Health and Nutrition Examination Survey (KNHANES). MetS prevalence was calculated for 5,935 Korean adults (≥ 20 years of age) by sex and age group. Incidence rates of five MetS risk factors were also assessed. Results: The prevalence of MetS among Koreans was 21.7% (22.9% for men, 20.6% for women). Elderly women after menopause had the highest prevalence of MetS and all five risk factors. Young and middle-aged men had higher prevalence and risk factors of MetS than similarly-aged women, but the rate of MetS in women surged significantly from age 50 and surpassed that of men thereafter. Women had a higher prevalence of low HDL cholesterol than men in all age groups. Of the five MetS risk factors, the prevalence of hypertension was highest (36.0%). About one-third of Korean have hypertension as a main risk factor. Conclusion: We observed a mounting gender disparity with age due to an increase in the prevalence of metabolic abnormalities in female. Preventive strategies including lifestyle interventions and health education about MetS need to be implemented pre-menopausal women and middle-aged men. Therapeutic strategies including drug intervention should be employed for elderly women. In 2012, more than one-fifth of Korean have MetS. These results indicate that MetS is an imperative public health issue that needs to be managed at the national level. Reducing the rates of hypertension and dyslipidemia will be critical to controlling MetS. This study provides not only the latest information but also target population and high risk factors for controlling MetS.

Dairy consumption is associated with a lower prevalence of metabolic syndrome among young adults from Ribeirão Preto, Brazil

ObjectiveIt has been suggested that a greater dairy consumption is a contributing factor to a lower prevalence of metabolic syndrome (MetS) as a result of the possible actions of some milk nutrients. However, results remain controversial. The aim of this study was to examine the association between dairy consumption and MetS and its components. MethodsDairy consumption and biochemical and anthropometric parameters were determined in 2031 young adults ages 23 to 25 y. Food consumption was assessed using a food frequency questionnaire. The estimated habitual portion of dairy products consumed daily was divided into quintiles. The criteria of the International Diabetes Federation (IDF) and of the Joint Interim Statement (JIS) were used for the classification of MetS. Nonadjusted and adjusted odds ratios (ORs) were estimated by logistic regression. ResultsThe prevalence of MetS was 11.9% by the IDF criteria and 9% by the JIS criteria. A greater dairy consumption was associated with a lower prevalence of MetS according to both IDF (OR, 0.61; 95% confidence interval [CI], 0.38–0.97) and JIS (OR, 0.62; 95% CI, 0.39–0.98) criteria when the last quintile was compared with the first. The association persisted in the model adjusted for demographic, socioeconomic, dietary, and lifestyle variables according to the IDF (OR, 0.53; 95% CI, 0.30–0.93) and was borderline according to the JIS (OR, 0.59; 95% CI, 0.34–1.00), but lost significance when data were adjusted for calcium in both models. ConclusionsA greater dairy consumption is associated with a lower prevalence of MetS, with calcium probably being the nutrient responsible for this association.

Abdominal obesity phenotypes and risk of cardiovascular disease in a decade of follow-up: The Tehran Lipid and Glucose Study

Objective: Obesity is a heterogeneous condition and risk of related health outcomes in different obesity phenotypes is a controversial subject. In this study, we aimed to evaluate the risk of cardiovascular disease (CVD) in different abdominal obesity phenotypes during a decade-long follow-up. Methods: In this large population-based cohort, 7122 participants (42.7% men), aged ≥30 years, from the Tehran Lipid and Glucose Study (TLGS) were enrolled. Abdominal obesity was defined using national waist circumference cut-off points of ≥89 cm for men and ≥91 cm for women. Metabolic health was defined as ≤1 components of metabolic syndrome (excluding waist circumference), using the Joint Interim Statement (JIS) definition. Results: At baseline, 3745 individuals (52.7%) were abdominal obese and 23.5% (n = 881) of these were categorized as “metabolically healthy abdominal obese” (MHAO). A total of 638 CVD events occurred during a median follow-up of 10 years (1999–2011). “Metabolically healthy non-abdominal obese” was considered as the reference group. After adjustment for various variables, MHAO individuals were at increased risk for CVD events compared with the reference group (HR: 1.64, CI: 1.09–2.47). Both the metabolically unhealthy phenotypes (with and without abdominal obesity) were also at increased risk. We also observed the same pattern using insulin resistance data for categorizing abdominal obesity phenotypes. Conclusion: Abdominal obesity and presence of metabolic derangements are both important risk factors for future CVD. MHAO may not be a benign condition regarding future CVD events, which highlights the importance of prevention and treatment of abdominal obesity, even in the absence of metabolic derangements.

Serum uric acid level and the incidence of metabolic syndrome in middle-aged Korean men: a 5-year follow-up study.

Objectives:Elevated serum uric acid (UA) has been known to be associated with the prevalence of metabolic syndrome (MetS). However, no prospective studies have examined whether serum UA levels are actually associated with the development of MetS. We performed a prospective study to evaluate the longitudinal effects of baseline serum UA levels on the development of MetS.Methods:A MetS-free cohort of 14 906 healthy Korean men, who participated in a medical check-up program in 2005, was followed until 2010. MetS was defined according to the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Cox proportional hazards models were performed.Results:During 52 466.1 person-years of follow-up, 2428 incident cases of MetS developed between 2006 and 2010. After adjusting for multiple covariates, the hazard ratios (95% confidence intervals) for incident MetS for the second, the third, and the fourth quartile to the first quartile of serum UA levels were 1.09 (0.92-1.29), 1.22 (1.04-1.44), and 1.48 (1.26-1.73), respectively (p for trend <0.001). These associations were also significant in the clinically relevant subgroup analyses.Conclusions:Elevated serum UA levels were independently associated with future development of MetS in Korean men during the 5-year follow-up period.

Best Anthropometric and Atherogenic Predictors of Metabolic Syndrome in the Chinese Han Population in Xinjiang: The Cardiovascular Risk Survey

Objective: This study aimed to identify the best predictor of metabolic syndrome (MetS) by comparing the predicting ability of various anthropometric and atherogenic parameters in the Chinese Han population in Xinjiang. Methods: A representative, cross-sectional sample of 5,757 Chinese Han adults were selected from the Cardiovascular Risk Survey conducted from October 2007 to March 2010. MetS prevalence, area under the curve (AUC), distance on the receiver operating characteristic curve and the cut-offs of each variable were compared for the presence of MetS. Results: According to the criteria of the International Diabetes Federation (IDF), the Joint Interim Statement (JIS) and the Third Adult Treatment Panel (ATPIII), 32.1, 48.5, 39.3% of men and 38.0, 45.1, 44.9% of women had MetS in Xinjiang. According to the IDF criteria, the waist-to-height ratio (WHtR) had the highest AUC value in men (0.836) and women (0.837), with the optimal cut-off of 0.54 in men and 0.53 in women. According to both the JIS and ATPIII criteria, triglycerides/high-density lipoprotein cholesterol TG/HDL-C had the highest AUC value in men (0.830 and 0.833, respectively) and women (0.832 and 0.827, respectively), with the optimal cut-offs being 1.6 and 1.2 in men and 1.1 and 1.1 in women, respectively. Conclusion: WHtR was the best predictor of MetS according to the IDF criteria while TG/HDL-C was the best predictor of MetS according to the JIS and ATPIII criteria.

Natural course of metabolically healthy abdominal obese adults after 10 years of follow-up: the Tehran Lipid and Glucose Study.

This study aims to assess the natural course of metabolically healthy abdominal obese (MHAO) phenotype and determine the predictors of change in the metabolic status in this population over 10 years of follow-up. A total of 916 MHAO subjects from the Tehran Lipid and Glucose Study were followed for changes in their metabolic health status. Anthropometric and metabolic indices were measured at baseline and were compared between subjects with healthy and unhealthy metabolic conditions at the end of follow-up. Predictors of change in metabolic health were assessed in logistic regression models. National waist circumference cutoffs were used for definition of abdominal obesity. Metabolic health was defined as ⩽1 metabolic components of metabolic syndrome according to the Joint Interim Statement criteria. At the end of the follow-up, nearly half of the MHAO subjects lost their metabolic health and 42.1% developed metabolic syndrome by definition. Low high-density lipoprotein cholesterol, hypertriglyceridemia and homeostasis model assessment-insulin resistance at baseline were significant predictors of change in metabolic health condition. MHAO is a relatively unstable condition and a considerable percentage of these individuals will lose their metabolic health as time passes. Baseline metabolic characteristics may be useful predictors of this change and should be considered in the care of these individuals.

Serum free thyroxine concentration is associated with metabolic syndrome in euthyroid subjects.

The association between thyroid hormones within the euthyroid range and metabolic syndrome is not clear. This study evaluated the relationship between thyroid hormones and metabolic syndrome and its components in euthyroid subjects. This is a cross-sectional population based study conducted within the framework of the cohort of the Tehran Thyroid Study. Out of 5786 subjects aged ≥ 20 years, 3755 euthyroid subjects without a history of thyroid disorders, diabetes, or use of steroids or lipid-lowering agents were investigated. Body weight, waist circumference (WC), and blood pressure (BP) were measured. Serum concentrations of lipids and lipoproteins, fasting blood glucose (FBG), insulin, free T4 (FT4), and thyrotropin (TSH) were assayed. Metabolic syndrome was determined by definition of the Joint Interim Statement adjusted for the Iranian population. After adjustment for age, sex, and smoking, serum FT4 was significantly associated with high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), WC, systolic BP, and diastolic BP; the associations that remained significant after further adjustment for body mass index (BMI) and the homeostasis model assessment index for insulin resistance (HOMA-IR) except for HDL-C. Serum TSH was associated only with TGs after adjustments for age, sex, smoking, and BMI, an association that disappeared after further adjustment for HOMA-IR. Serum FT4 was negatively associated (β=-0.02, 95% confidence interval [CI: -0.03, -0.01]) and TSH was positively associated (β = 0.03 [CI: 0.01, 0.04) with insulin resistance. The prevalence of metabolic syndrome decreased from 30.1% in the lowest FT4 tertile to 22.4% in the highest FT4 tertile (p<0.001). The prevalence of other metabolic syndrome components decreased significantly from higher to lower FT4 tertiles. Higher FT4 values were associated with lower odds of metabolic syndrome (OR = 0.96 [95% CI: 0.92, 0.99]; p=0.01). In euthyroid subjects, FT4, rather than TSH, is associated with risk of metabolic syndrome and its components.