Joint Interim Statement Research Articles

Metabolic Syndrome Over 4 Years Before the Onset of Cardiovascular Disease - Nested Case-Control Study.

We investigated the risk of cardiovascular disease (CVD) with duration of metabolic syndrome (MetS) for the past 4 years before the CVD event.Methods and Results:We performed a nested case-control study within the Japan Epidemiology Collaboration on Occupational Health Study. A total of 139 registered cases of CVD and 561 self-reported cases of CVD were identified and matched individually on age, sex, and worksite with 695 and 2,803 controls, respectively. MetS was defined by the Joint Interim Statement definition. The odds ratio (95% confidence interval) for registered CVD was 4.7 (2.9, 7.5) for people with persistent MetS (positive for MetS for ≥3 assessments) and 1.9 (1.1, 3.3) for those with intermittent MetS (positive for MetS for 1-2 assessments), compared with people without MetS during the past 4 years before the event/index date (P for trend <0.001). The corresponding odds ratio for self-reported CVD was 2.7 (2.2, 3.5) and 1.8 (1.4, 2.3) (P for trend <0.001). The association with MetS duration was stronger for myocardial infarction than for other CVD subtypes. Similar results were obtained when using the Japanese MetS criteria. The risk of CVD increases with increasing MetS duration. These findings contribute to risk stratification and encourage lifestyle modification for people with MetS to minimize their health risk.

The Number of Teeth Is Inversely Associated With Metabolic Syndrome: A Korean Nationwide Population-Based Study.

Objectives of this research are to determine the relationship between number of natural teeth and metabolic syndrome (MetS) in a representative sample of the Korean population. From the Korean National Health and Nutrition Examination Survey, a cross-sectional study was conducted on 13,066 participants aged >19 years. The number of teeth was assessed by clinical oral examination. MetS was defined based on the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. Multivariable logistic regression analyses were used to evaluate the association between number of teeth and MetS adjusted for the following criteria: 1) age; 2) sex; 3) income; 4) education; 5) toothbrushing frequency; 6) periodontitis; 7) smoking; 8) drinking; 9) physical activity; and 10) diabetes mellitus. The number of existing permanent teeth was inversely associated with MetS after controlling for all confounders (adjusted odds ratio [AOR] = 1.19, 95% confidence interval [CI] = 1.04 to 1.36 for 20 to 27 teeth; AOR = 1.37, 95% CI = 1.12 to 1.67 for 0 to 19 teeth). Association between fewer teeth and MetS increased for individuals aged ≥40 years and for women. The number of teeth found is inversely proportional to occurrence of MetS.

Recommendations for revision of Chinese diagnostic criteria for metabolic syndrome: A nationwide study.

Diagnostic criteria for metabolic syndrome (MS) proposed by the Chinese Diabetes Society (CDS) may have limitations because an additional 2-h postprandial plasma glucose (2-h PPG) test is required to diagnose hyperglycemia. The aim of this study was to revise the CDS-MS criteria by removing the 2-h PPG test and determining the optimal fasting plasma glucose (FPG) cut-off for a diagnosis of hyperglycemia in the Chinese population. The study population was from the 2007-08 China Diabetes and Metabolic Disorders Study. The optimal FPG diagnostic cut-off value was determined using receiver operating characteristic curves. Hyperglycemia defined using CDS-MS criteria was the end-point. Agreement between different diagnostic methods was assessed using κ values. The study enrolled 46 239 participants (mean age 44.95 years). The optimal diagnostic cut-off for FPG was found to be 5.62 mmol/L, which showed a sensitivity of 66.92%, a specificity of 89.09%, and an area under the curve of 0.848. Using this diagnostic criterion, the standardized prevalence of MS was similar to that using the CDS-MS criteria (18.26% vs 17.89%, respectively), with both values being lower than those obtained using conventional international criteria (20.64-26.67%). Compared with the CDS-MS criteria, the recommended FPG cut-off showed better agreement (κ) with international criteria: 0.695, 0.774, and 0.730 with the International Diabetes Federation (IDF), revised Adult Treatment Panel III, and Joint Interim Statement of the IDF criteria, respectively. We recommend eliminating the 2-h PPG blood test and lowering the FPG diagnostic cut-off value to 5.6 mmol/L in the CDS-MS diagnostic criteria.

Variations in Serum Free Thyroxine Concentration Within the Reference Range Predicts the Incidence of Metabolic Syndrome in Non-Obese Adults: A Cohort Study.

The association of changes in thyroid hormone values over time with the incidence of metabolic syndrome (MetS) has not yet been evaluated. For the first time, this study assessed the effect of thyroid hormone variations in the subclinical and euthyroid range on the incidence of MetS and its components over a 10-year follow-up in an adult population. Data were analyzed from the prospective population-based Tehran Thyroid Study. Of 5786 randomly selected subjects aged ≥20 years, after excluding subjects with MetS (n = 1403), those with serum thyrotropin (TSH) >10 or <0.1 mIU/L (n = 104), those taking thyroid drugs (n = 85) or corticosteroids (n = 97), those with a body mass index (BMI) <18.5 kg/m2, those with a glomerular filtration rate <30, and those with a history of cancer (12), data for 2393 subjects were analyzed. Body weight, waist circumference, and blood pressure were measured, and serum concentrations of lipids and lipoproteins, fasting blood glucose, insulin, free thyroxine (fT4), and TSH were assayed at baseline and during three follow-up studies at three-year intervals. MetS was determined using definition of the Joint Interim Statement, adjusted for the Iranian population. An increase in fT4 values overtime was associated with lower odds of abdominal obesity (odds ratio [OR] = 0.49 [confidence interval (CI) 0.35-0.69]) and hypertriglyceridemia (OR = 0.57 [CI 0.41-0.78]), and with higher odds of hypertension (OR = 1.35 [CI 1.05-1.74]), adjusted for age, sex, smoking, BMI, and Homeostasis Model Assessment Index for Insulin Resistance. fT4 was associated with lower odds of MetS in the crude model, and after adjustment for age, sex, and smoking (OR = 0.59 [CI 0.39-0.9]). This association lost its significance after further adjusting for BMI. In a subgroup analysis of obese (i.e. BMI ≥30 kg/m2) and non-obese (i.e., BMI <30 kg/m2) subjects, fT4 was a significant predictor of MetS only in non-obese subjects after adjusting for age, sex, and smoking (β = 0.49 [CI 0.29-0.83], p = 0.007) and also after further adjustment for Homeostasis Model Assessment Index for Insulin Resistance (β = 0.57 [CI 0.34-0.96], p = 0.03). Serum TSH variations over time were not associated with any of the MetS components or with odds of MetS. A decrease in serum fT4 values is associated with an increased risk for MetS, especially in non-obese adults.

The prevalence of the metabolic syndrome in Portugal: the PORMETS study

BackgroundThe PORMETS study was designed to estimate the prevalence of metabolic syndrome and its determinants in the overall and administrative regions of the Portuguese mainland.MethodsA cross-sectional study of a representative sample of non-institutionalized Portuguese adults selected from primary health care centres lists including 1695 men and 2309 women was conducted from February 2007 to July 2009. A structured questionnaire was administered, collecting information on personal medical history and socio-demographic and behavioural characteristics. Anthropometrics, blood pressure, and venous blood samples were obtained. Metabolic syndrome was defined according to three operational definitions. The prevalence ratios and their respective 95% confidence intervals were calculated using binomial generalized linear regression, with the log link function.ResultsThe prevalence rates of metabolic syndrome in this sample of Portuguese adults were 36.5%, 49.6%, and 43.1%, using the Adult Treatment Panel III, International Diabetes Federation and Joint Interim Statement definitions, respectively. The most prevalent feature of metabolic syndrome in this sample was high blood pressure (64.3%) and the lowest was high fasting glucose (24.9%). After adjustment for age and gender, significant differences were observed for the 18 districts of the Portugal mainland. Additionally, metabolic syndrome was significantly more frequent in non-urban areas than in urban ones (p = 0.001). The prevalence of metabolic syndrome was significantly higher in women (p˂0.001) and older participants (p˂0.001), as well as in those who reported being housewives (p = 0.010), retired (p = 0.046) or unemployed (p = 0.024).ConclusionsThis study showed that metabolic syndrome is highly prevalent in the Portuguese adult population. Regional differences in the prevalence of this syndrome were observed, and this condition was more common in non-urban areas and less favoured socio-economic categories.

Metabolic syndrome components and diabetes incidence according to the presence or absence of impaired fasting glucose: The Japan Epidemiology Collaboration on Occupational Health Study.

BackgroundWe prospectively examined the association of diabetes risk with the number of metabolic abnormalities, as well as their combinations, according to the presence or absence of impaired fasting glucose (IFG) in a large-scale Japanese working population.MethodsParticipants included 55,271 workers at 11 companies who received periodic health check-ups between 2008 and 2013. The metabolic syndrome (MetS) components were defined using the 2009 Joint Interim Statement. IFG was defined as fasting plasma glucose 5.6–6.9 mmol/L. Diabetes newly diagnosed after the baseline examination was defined according to the American Diabetes Association criteria. We calculated the hazard ratios (HRs) for diabetes incidence using the Cox proportional hazards model.ResultsDuring the follow-up period (median 4.95 years), 3183 subjects developed diabetes. In individuals with normal fasting glucose levels, the risk of diabetes increased steadily with the increasing number of MetS components; the multivariable-adjusted HRs for incident diabetes for the number of MetS components were 2.0, 4.3, 7.0, and 10.0 for one, two, three, or four MetS components, respectively, compared with the absence of components. A similar association was observed among individuals with IFG; the corresponding HRs were 17.6, 23.8, 33.9, and 40.7. The combinations that included central obesity appeared to be more strongly associated with diabetes risk than other combinations with the same number of MetS components within the same glucose status.ConclusionsOur findings indicate that risk stratification of individuals by the presence or absence of IFG and the number of MetS components can detect individuals with a high risk of diabetes.

Metabolic syndrome in antipsychotic naive African patients with severe mental illness in usual care.

To determine the prevalence and incidence of metabolic syndrome in individuals with a first episode of severe mental illness from South Africa. Antipsychotic naïve study subjects with a first episode of severe mental illness and control subjects were recruited at baseline for a prospective study. Individuals without metabolic syndrome at baseline were followed up for 12 months after antipsychotic medication was initiated. Metabolic syndrome was determined at baseline and at the 12-month follow-up using the Joint Interim Statement criteria. At baseline, the 67 study (M:F; 48:19) and 67 control subjects (M:F; 48:19) had a mean age of 22.8 (±3.7) and 23.3 (±2.6) years (P = .4), respectively. The majority were of black African ethnicity (97%) and 82% were diagnosed with schizophrenia. There was no difference in the prevalence of metabolic syndrome (4.5%) or any of the individual components between the study and control group prior to the initiation of antipsychotics. Of the 64 study subjects without metabolic syndrome at baseline, only 36 (M:F; 25:11) completed the 12-month follow-up (response rate 56.3%) and 2 subjects developed metabolic syndrome .The incidence of metabolic syndrome was 5.5% with a significant increase in the elevated waist circumference criterion after 1 year of antipsychotic treatment (P = .02). There was a low prevalence and incidence of metabolic syndrome in this group of patients with a first episode of severe mental illness.

High risk of metabolic syndrome among black South African women with severe mental illness.

BackgroundThere is an increased prevalence of metabolic syndrome (MetS) in individuals with severe mental illness (SMI) globally. The prevalence of MetS is higher in black women compared to black men from South Africa.AimTo compare the prevalence of MetS between black South African men and women with SMI taking antipsychotic medication. Further, this prevalence was compared to the prevalence in a matched control group of black South African men and women without SMI.SettingA general hospital psychiatric unit.MethodsA cross-sectional study was undertaken to compare the prevalence of MetS in a group of multi-ethnic participants with SMI treated with antipsychotic medication and a matched control group without SMI, applying the 2009 Joint Interim Statement (JIS) criteria. Here, we included only the black African participants to compare MetS prevalence between men and women.ResultsThere were 232 participants in the group with SMI (male 155 and female 77) and without SMI (male 156 and female 76). The prevalence of MetS was more than three times higher in women with SMI compared to men with SMI (37.7% vs. 10.3%, p < 0.001). There was no significant difference in the prevalence of MetS in men or women between the groups with and without SMI. In multivariate logistic regression analysis, female gender (odds ratio [OR] 7.66), advancing age (OR 1.08) and longer duration of illness (OR = 1.15) were significant risk factors for MetS in SMI.ConclusionIn black South Africans with SMI on antipsychotic medication, there is a higher prevalence and risk for MetS in women compared to men.

Predictors of incident obesity phenotype in nonobese healthy adults.

Despite their different cardiovascular consequences, little is known about predictors of metabolically healthy (MHO) and metabolically unhealthy obesity (MUHO). This cohort study was designed to address this question in participants of the Tehran Lipid and Glucose Study. Employing the Joint Interim Statement (JIS) metabolic syndrome criteria to define MHO/MUHO phenotypes, nonobese, otherwise healthy individuals, aged >20years (n=3489) were recruited and followed up for a median of 13·4years. At the follow-up, MHO incidence rate in obese individuals was 36·6%. Comparing MHO vs. MUHO, female gender [odds ratio (OR)=3·28, 95% confidence interval (CI) 1·27, 8·46)], increased body mass index (BMI; OR=1·32, 95% CI: 1·12, 1·60) and elevated high-density lipoprotein cholesterol (HDL-C) levels (OR=1·04, 95% CI: 1·02, 1·07) were related to higher odds of incident MHO, while older age (OR=0·95, 95% CI: 0·92, 0·98), increased waist circumference (WC; OR=0·86, 95% CI: 0·81, 0·91), higher WC gain (OR=0·91, 95% CI: 0·87, 0·95) and increased diastolic blood pressure (DBP; OR=0·94, 95% CI: 0·91, 0·98) prevented progression towards MHO. While baseline BMI and WC were detrimental for developing MHO vs. MUHO, gender was the strongest predictor of incident obesity phenotype in healthy nonobese individuals.

Diagnostic concordance between seven definitions of metabolic syndrome in overweight and obese adults

The aim of this study was to determine the level of diagnostic concordance between seven definitions of metabolic syndrome (MS) in a group of overweight and obese adults. 350 subjects aged from 19 to 70 years were recruited for study from a clinic for overweight and obese subjects. The definitions of MS used were those given by the WHO (World Health Organization), EGIR (European Group for the Study of Insulin Resistance), NCEP- ATPIII (Adult Treatment Panel), AHA/NHLBI (American Heart Association), IDF (International Diabetes Federation), and JIS (Joint Interim Statement) as well as the Szabo criteria. Concordance between the definitions was calculated with the Kappa coefficient. Insulin resistance (IR) was assessed using the HOMA-IR index. According to the Szabo, WHO, EGIR, NCEP-ATPIII, AHA/NHLBI, IDF, and JIS criteria, MS frequency was 74.3%, 42.0%, 46.8%, 56.0%, 52.9%, 58.6%, and 58.6%, respectively. The concordance between the Szabo and AHA/NHLBI criteria was 0.559, while the Kappa coefficient between the Szabo criteria and the rest of the guides (NCEP-ATPIII, IDF, and JIS) was from 0.612 to 0.657, respectively. The concordance of the WHO with the EGIR was 0.602, but it was between 0.358 and 0.422 with the other guidelines. IR was distributed similarly in all guidelines. There is a considerable concordance between the NCEP-ATPIII, IDF, and JIS guidelines and the Szabo criteria. The Szabo criteria could be an option for the active surveillance of MS in populations.

Comorbidities according to airflow limitation severity: data from comprehensive health examination in Japan

ObjectivesThe present study aimed to investigate the relationship between airflow limitation (AL) severity and comorbidities in comprehensive health examination.MethodsThis cross-sectional study included 6661 men and 6044 women aged 40–89 who underwent a lung function test during medical checkups. AL was defined as forced expiratory volume in 1 s/forced vital capacity of < 0.7. Logistic regression analysis was used to assess the association between AL severity and the presence of comorbidities.ResultsWhen compared with the normal lung function group, subjects with AL had a higher prevalence of lung cancer (odd ratio (OR) 9.88, 95% confidence interval (CI) 3.88–25.14) in men, hypertension (OR 1.63, 95% CI 1.26–2.10) in women, diabetes and hyperglycemia (OR 1.23, 95% CI 1.02–1.49 in men, OR 1.61, 95% CI 1.18–2.20 in women) in men and women after adjusting for potential confounders. In men, lung cancer and MetS (the Joint Interim Statement: JIS) were significantly associated with moderate-to-very severe AL after adjustment. In women, hypertension, diabetes and hyperglycemia, MetS (JIS), and MetS (the Japanese Committee of the Criteria for MetS: JCCMS) were significantly associated with mild AL after adjustment. Hypertension was significantly associated with moderate-to-very severe AL after adjustment in women.ConclusionsSignificant relationships were found between AL severity and the presence of comorbid lung cancer in men, hypertension in women, diabetes and hyperglycemia, and MetS in men and women. Knowledge of comorbidities associated with AL should be widely publicized to raise the awareness of chronic obstructive pulmonary disease (COPD).

Cardiovascular risk in different obesity phenotypes over a decade follow-up: Tehran Lipid and Glucose Study

Background and aimsConsidering the inconsistent data available on cardiovascular (CV) risk of different obesity phenotypes, the aim of this study was to investigate the development of cardiovascular disease (CVD) in different obesity phenotypes over a median follow-up of 12 years. MethodsIn this large population-based cohort, 7842 participants (44.8% men), aged ≥ 30 years, were enrolled. Participants were divided into six phenotypes based on body mass index and metabolic status. Metabolic health was defined based on two definitions: 1) having ≤1 component of metabolic syndrome using the Joint Interim Statement (JIS) criteria and 2) homeostasis model assessment-insulin resistance (HOMA-IR) < 2.6 mole × μU/L2. Multivariate adjusted hazard ratios (HRs) were calculated for cardiovascular events. ResultsA total of 712 new CVD events occurred. CV risk increased in all metabolically unhealthy phenotypes. Multivariable adjusted HRs for CVD events in metabolically healthy overweight (MHOW) and metabolically healthy obese (MHO) participants were 1.22 (0.73–2.04) and 1.74 (0.68–4.44), respectively. CV risk increased in all obesity phenotypes based on insulin resistance except the insulin resistance-normal weight group. However, this increased risk disappeared after further adjustment for metabolic risk factors. ConclusionsOur findings showed that CV risk did not increase in MHOW and MHO phenotypes over a 12-year follow-up. However, all metabolically unhealthy phenotypes were associated with increased incident CVD. Further studies with longer follow-up are needed to confirm the benign nature of MHOW/MHO phenotypes.

Metabolic Syndrome in People Living with Human Immunodeficiency Virus: An Assessment of the Prevalence and the Agreement between Diagnostic Criteria.

Objectives. We determined metabolic syndrome (MetS) prevalence and assessed the agreement between different diagnostic criteria in HIV-infected South Africans. Method. A random sample included 748 HIV-infected adult patients (79% women) across 17 HIV healthcare facilities in the Western Cape Province. MetS was defined using the Joint Interim Statement (JIS 2009), International Diabetes Federation (IDF 2005), and Adult Treatment Panel III (ATPIII 2005) criteria. Results. Median values were 38 years (age), 5 years (diagnosed HIV duration), and 392 cells/mm3 (CD4 count), and 93% of the participants were on antiretroviral therapy (ART). MetS prevalence was 28.2% (95%CI: 25–31.4), 26.5% (23.3–29.6), and 24.1% (21–27.1) by the JIS, IDF, and ATPIII 2005 criteria, respectively. Prevalence was always higher in women than in men (all p < 0.001), in participants with longer duration of diagnosed HIV (all p ≤ 0.003), and in ART users not receiving 1st-line regimens (all p ≤ 0.039). The agreement among the three criteria was very good overall and in most subgroups (all kappa ≥ 0.81). Conclusions. The three most popular diagnostic criteria yielded similarly high MetS prevalence in this relatively young population receiving care for HIV infection. Very good levels of agreement between criteria are unaffected by some HIV-specific features highlighting the likely comparable diagnostic utility of those criteria in routine HIV care settings.

Impact of fatty liver disease and metabolic syndrome on incident type 2 diabetes; a population based cohort study.

Fatty liver disease and metabolic syndrome (MetS) are both shown to increase the risk of type 2 diabetes. The aim of this study was to investigate the combined effect of fatty liver and MetS on incident diabetes. In this cohort study of 17,810 participants, fatty liver was diagnosed by abdominal ultrasonography and MetS was defined by a joint interim statement. We divided the participants into four groups according to the presence of fatty liver and/or MetS. Type 2 diabetes was defined as HbA1c ≥6.5%, fasting plasma glucose ≥7.0 mmol/L or treatment for diabetes. During the follow up examination (median 5.1 years), 804 participants developed diabetes. Compared with non-MetS without fatty liver, hazard ratios (HR) for incident diabetes after adjusting for age, body mass index, smoking status, exercise habit, alcohol consumption, family history of diabetes logarithm of alanine aminotransferase and fasting plasma glucose, were as follow: 2.35 (95 % CI 1.91-2.89, p<0.001) in non-MetS with fatty liver, 1.70 (95% CI 1.30-2.20, p<0.001) in MetS without fatty liver, and 2.33 (95% CI 1.85-2.94, p<0.001) in MetS with fatty liver. In addition, adjusted HRs for incident diabetes compared with MetS without fatty liver were 1.39 (95% CI 1.07-1.80, p=0.012) in non-MetS with fatty liver and 1.38 (95% CI 1.07-1.79, p=0.013) in MetS with fatty liver. Fatty liver affects more on the risk of incident diabetes than MetS. To prevent the further risk of diabetes, we should pay more attention to fatty liver.

Lack of Association between FTO Gene Variations and Metabolic Healthy Obese (MHO) Phenotype: Tehran Cardio-Metabolic Genetic Study (TCGS)

Background: Obesity is currently an international epidemic and metabolic derangements pose these individuals at greater risk for future morbidity and mortality. Genetics and environmental factors have undeniable effects and among genetic risk factors, FTO/CETP genes are important. The current study examines the interaction between obesity phenotypes and FTO/CETP SNPs and their effects on lipid profile changes. Material and methods: We selected 954 adult subjects from TCGS (47.9% male). Participants were stratified according to their BMI and presence of metabolic syndrome according to the Joint Interim Statement (JIS) definition. Nine selected polymorphisms from FTO/CETP genes were genotyped using Tetra ARMS-PCR method. After age and sex adjustment the interaction of 9 markers with lipid profiles among phenotypes were tested by PASW. Results: In three main groups, HDL-C level had a strong significant association with CETP markers: (rs3764261, β(95%CI) -0.48(-0.61-0.35), P=1.0 × 10-11), (rs1800775, β(95%CI) 0.5(0.36;0.65), P=1.0 × 10-6) and (rs1864163, β(95%CI) 0.3(0.16;0.43), P=9.1 × 10-5). This association was also seen in rs7202116 within the total population. In only unhealthy metabolic obese (MUHO) subgroups four new FTO markers (rs1421085, rs1121980, rs1558902 and rs8050136) (P-value<0.01) demonstrated significant association, even after lipid profile adjustment. Conclusion: In the present study, we investigated the association between obesity phenotypes and some variations in FTO/CETP genes for the first time. Our study showed that four markers in the first intron of the FTO gene should be the risk marker in MUHO participants.

Associations of vitamin D with metabolic syndrome components in Indian urban middle-aged women

Background: The prevalence of metabolic syndrome is increasing in developing countries and the prevalence is reported to be higher in Indian urban women and vitamin D deficiency is documented as a common health problem. However, little is known regarding whether vitamin D deficiency plays an important role in the heightened prevalence of metabolic syndrome. Aims and Objectives: This study was planned to assess the levels of vitamin D and their association with components of metabolic syndrome in middle-aged women. Materials and Methods: A total of 300 women volunteers who were in the age group of 35-64 years were included in the study. We used the criteria of metabolic syndrome defined by A joint interim statement of the International Diabetes Federation task force. Plasma levels of 25-hydroxyvitamin D [25(OH)D] was assessed by chemiluminescence method. Pearson’s correlation was used for associations. Results: Vitamin D levels are significantly lower in women with metabolic syndrome. Waist circumference (WC), systolic blood pressure (BP), and triglyceride concentrations were inversely associated with vitamin D concentrations. 84% are with deficient levels of vitamin D. Conclusion: Vitamin D deficiency was found to be common in Indian women. Elevated WC, BP, and triglycerides were found to inversely associate with low serum levels of 25(OH)D. Improving vitamin D status would be useful in improving the health in middle-aged urban women.

Metabolic Syndrome and Associated Factors in Adults of the Amazon Region.

Metabolic syndrome (MS) plays a key role in the origin of cardiovascular diseases. Studies on the MS in Brazil are recent, and its epidemiology in more isolated regions such as the Amazon is still unknown. The study aimed to estimate the prevalence of MS and associated factors in adults of the Brazilian Amazon. This study was conducted in 2012–2013. It is a cross-sectional population-based study, involving 787 adults randomly selected from the urban area of four cities in the state of Pará, in the Brazilian Eastern Amazon. The participants underwent anthropometric measurements, laboratory examination, and were questioned about their lifestyle. MS was defined by the Joint Interim Statement criteria, using the multiple logistic regression to investigate the potential association of risk factors with the presence of MS. The overall prevalence of MS was 34.1% (95% CI = 30.8–37.4), increasing linearly with the increasing body mass index and age. From 40–49 years of age, MS was observed in about half of the women (46.0%), while men only experienced a high prevalence in the fifth decade of life (43.3%). The low HDL-c (64.4%) and abdominal obesity (58.9%) were higher in women (p < 0.001), while for men, high blood pressure was significantly higher (p < 0.001). Individuals aged 40–59 years old (odds ratio [OR] = 3.35 [95% CI = 2.30–4.90]), ≥ 60 years old (OR = 5.80 [3.63–9.27]), overweight (OR = 4.17 [2.77–6.29]), and obese (OR = 8.82 [5.56–13.98]) were more likely to have MS. The study population experienced high cardiometabolic risk, requiring government efforts to control MS and related risk factors, especially obesity.

Physical Activity Contributes to Several Sleep-Cardiometabolic Health Relationships.

To estimate the contribution of accelerometer-derived physical activity to the relationship between sleep and cardiometabolic health. Data from the 2005 to 2006 US National Health and Nutritional Examination Survey were used (N = 1226; 20 years+). Metabolic syndrome (MetS) was defined by the Joint Interim Statement, and sleep quality and quantity by the Sleep Disorders Questionnaire. Physical activity intensities were defined by activity thresholds (counts per minute) as sedentary activity (0-99), light intensity (100-759), lifestyle activity (760-2019), moderate intensity (2020-5996), and vigorous intensity (≥5999). Outcomes were MetS, number of MetS components, waist circumference (WC), systolic and diastolic blood pressure (BP), triglycerides, HDL-cholesterol, fasting plasma glucose, and fasting insulin concentration. The bootstrap method was used to estimate the amount of mediation or contribution of activity intensities (ab) to the sleep-cardiometabolic health relationships, which were quantified as large (≥0.25) or moderate (≥0.09). Lifestyle activity level contributes to several sleep duration and cardiometabolic health relationships, most notably for WC (ab: 0.28), systolic BP (0.39), and fasting insulin concentration (0.85). While moderate intensity and lifestyle activity intensities were large contributors to the sleep quality-fasting insulin concentration relationship (0.47 and 0.48, respectively), light intensity activity only moderately contributed to the relationship between sleep duration and quality with abdominal obesity (0.15). Lifestyle and moderate intensity physical activity have a large effect on the relationship between sleep and cardiometabolic health, including WC, BP, and fasting insulin concentration. Appropriate sleep hygiene, in combination with regular physical activity should be considered mutually beneficial targets for cardiometabolic health.

Risk of all-cause mortality in abdominal obesity phenotypes: Tehran Lipid and Glucose Study

Background and AimLong-term health risks in the so-called “healthy obesity” phenotypes remain controversial. Also it is unknown if “metabolically healthy abdominal obese” (MHAO) phenotype is at increased risk of all-cause mortality compared to their non-abdominally obese counterparts. In this study we assessed the risk of all-cause mortality in different abdominal obesity phenotypes. Methods and ResultsIn this large population-based cohort, 8804 participants (aged ≥ 30 years), from the Tehran Lipid and Glucose Study (TLGS) were enrolled and followed for a median of 12.0 (8.7–12.5) years. Abdominal obesity was defined using national waist circumference (WC) cut-off points of ≥89 cm for men and ≥91 cm for women. Metabolic health was defined as ≤1 components of metabolic syndrome (excluding WC), using the Joint Interim Statement (JIS) definition. Baseline prevalence of MHAO phenotype was 12.8% in the whole population and 23.4% in those with abdominal obesity. A total of 540 all-cause death occurred during the follow-up. After multivariate adjustment, all-cause mortality risk in MHAO phenotype was not significantly increased compared to “metabolically healthy non abdominal obese” (MHNAO) as the reference group (HR: 1.35, CI: 0.89–2.03). ConclusionOur results indicate that MHAO individuals were not at higher risk for all-cause mortality over a median of 12 years follow-up. However, considering inadequate power of our analysis for fully adjusted model, larger studies with more follow-ups are needed.

Ethnic disparities in the prevalence of metabolic syndrome and its risk factors in the Suriname Health Study: a cross-sectional population study

BackgroundThe metabolic syndrome (MetS) indicates increased risk for cardiovascular disease and type 2 diabetes. We estimated the overall and ethnic-specific prevalence of MetS and explored the associations of risk factors...