Criteria For Metabolic Syndrome Research Articles

THE RELATIONSHIP BETWEEN METABOLIC SYNDROME AND GASTROESOPHAGEAL REFLUX DISEASE

ABSTRACT Aim: Metabolic syndrome, characterized by a cluster of conditions including central obesity, dyslipidemia, hypertension, and insulin resistance. Gastroesophageal reflux disease is a chronic condition in which stomach contents regurgitate into the esophagus. The association between metabolic syndrome and gastroesophageal reflux disease has garnered considerable attention. Methods: Our study's case group consists of patients diagnosed with gastroesophageal reflux disease who have not used proton pump inhibitors. The control group, on the other hand, comprises patients who visited the gastroenterology outpatient clinic. Metabolic syndrome criteria were investigated in the participants. This study is retrospective in nature. For comparisons, the simple t-test was employed. Categorical data were analyzed using the Chi-square test. Continuous variables that did not conform to a normal distribution were analyzed using One-Way ANOVA and the Kruskal-Wallis tests. Results: When comparing the BMI, waist circumference, and laboratory parameters of both groups, it was determined that the BMI and waist circumference values were significantly higher in the gastroesophageal reflux disease group compared to the control group (p=0.04 and p<0.01, respectively). Conversely, the levels of total cholesterol and triglycerides were significantly higher in the control group (both with p=0.01). Conclusion: In conclusion, our study substantiates the significant association between metabolic syndrome, and gastroesophageal reflux disease highlighting the need for heightened awareness and integrated management strategies in affected individuals.

METABOLICALLY ASSOCIATED FATTY LIVER DISEASE IN PATIENTS WITH VERY HIGH CARDIOVASCULAR RISK: PREVALENCE, CLINICAL SIGNIFICANCE, GENDER DIFFERENCES

Introduction. Recently, metabolically associated fatty liver disease (MAFLD) had been proposed as a new term. Due to increasing prevalence, significant morbidity and hepatic and cardiovascular mortality, the association of MAFLD with cardiovascular diseases is gaining considerable relevance and needs further study. The aim of our study was to determine the proportion of MAFLD among patients with a very high cardiovascular risk, and to elucidate clinical features and gender differences in this cohort. Materials and methods. All patients underwent a comprehensive examination to assess both cardiovascular risk and MAFLD. Hepatic steatosis was diagnosed after liver ultrasonography. Participants who met MAFLD criteria were included into the group 1 (n=77; 32 women, 45 men), other patients were assigned to the group 2 (n=39; 19 women, 20 men). Results. Among patients with very high cardiovascular risk, proportion of MAFLD was 66.7 %. Although mild alanine aminotransferase elevation was much more common among patients with MAFLD (16 women (50.0 %) vs. 2 women (10.5 %) in group 2, P = 0.006; 21 men (46.7 %) vs. 2 men in group 2 (10.0 %), P = 0.005), none of the participants met the criteria for steatohepatitis. Despite, the presence of metabolic disorders in the vast majority of participants, proportion of obesity, metabolic dyslipidaemia, prediabetes and type 2 diabetes were significantly higher in patients with MAFLD. Besides, patients with MAFLD usually met 4 or 5 metabolic syndrome criteria, had higher median values of lipid accumulation product (LAP) and HOMA-IR index, but lower median values of Matsuda index. Significant direct correlations were found between MAFLD and LAP, logarithmic index (TG/HDL-C), and HOMA-IR; negative correlations were observed between MAFLD and insulin sensitivity indices. Women with MAFLD had significantly higher median values of glycated haemoglobin, post-load glucose, fasting insulin levels; there was direct correlation between MAFLD and non-HDL-C. Among women with MAFLD, a history of menopause before 45 years of age had 15 persons (46.9 %) vs. one person (5.3 %) in group 2 (P < 0.002); the median age when ASCVD was diagnosed was 58.5 [53.0; 64.0] years vs. 68.0 [63.0; 69.0] years in group 2 (P = 0.002); cardiac valve calcinosis was detected in 31 women (96.6 %) vs. 9 women (47.4 %) in group 2 (P = 0.0001); the left ventricular myocardial mass (LVM) index was 77.5 [62.1; 86.9] g/m2.7 vs. 64.0 [50.6; 74.0] g/m2.7 in women without MAFLD, 67.0 [55.1; 74.0] g/m2.7 in men with MAFLD, and 63.9 [50.0; 73.5] g/m2.7 in men without MAFLD (Kruskal–Wallis ANOVA P <0.0001; median test P=0.002). The prevalence of smoking and alcohol intake was significantly more common among men (gender differences P <0.0001 and P=0.0001 in group 1; P = 0.0004 and P=0.0023 in group 2 for smoking and alcohol intake, respectively). Men with MAFLD had significantly higher median values of fasting plasma glucose, fasting and post-load insulin levels than men without MAFLD; there was a significant direct correlation between MAFLD and serum TG level. In addition, 11 men with MAFLD (24.4 %) had hypertriglyceridemia >2.3 mmol/l that was not observed among men without MAFLD (P=0.013). The proportion of men with fasting and post-load hyperinsulinemia was much higher in group 1 than in group 2 (28 persons (62.2%) vs. 3 persons (15.0 %), P=0.0005 and 26 persons (57.8%) vs. 2 persons (10.0 %), P = 0.0003, respectively). Conclusions: among patients with a very high cardiovascular risk, the prevalence of MAFLD was significantly higher than in the general population. Concomitant MAFLD was associated with more severe metabolic disorders (i.e., obesity, metabolic dyslipidaemia, hyperglycaemia, insulin resistance), which usually combined. The LAP index is a simple available tool that may be used in routine clinical practice to determine the need for MAFLD screening. Women with MAFLD frequently had early menopause, cardiac valve calcification, and much higher median value of LVM index; direct correlation was observed between MAFLD and non-HDL-C. Men with MAFLD more often had fasting and/or post-load hyperinsulinemia and moderate hypertriglyceridemia.

Effects of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals living in a refugee camp in Greece: A randomized controlled trial

BackgroundThe metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components. MethodsWe conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling. ResultsIn total, 62.7 % of participants presented with low cardiorespiratory fitness levels (<40th percentile), and 24.6 % met the criteria for metabolic syndrome. In the intervention group, 73.5 % attended the exercise and sport sessions at least once a week. There was evidence for a direct intervention effect on cardiorespiratory fitness, ßdirect = 0.12, p = 0.022, but not for any of the metabolic syndrome components (p ≥ 0.192). Cardiorespiratory fitness significantly facilitated the intervention's indirect effect on abdominal obesity, ßindirect = −0.03, p = 0.012, high diastolic blood pressure, ßindirect = −0.04, p = 0.011, and elevated triglycerides, ßindirect = −0.03, p = 0.025. ConclusionImplementing exercise and sport activities in a refugee camp in Greece effectively reaches a wider target population and improves cardiorespiratory fitness among forcibly displaced individuals. The intervention contributes to a decrease in abdominal obesity, high diastolic blood pressure and elevated triglycerides indirectly via improved cardiorespiratory fitness.

Exploring metabolically healthy obesity: prevalence, characteristics, and cardiovascular risk in the Iranian population based on the STEPS 2021.

Regarding the rapidly increasing prevalence of obesity throughout the globe, it remains a serious public health concern. A subgroup of obesity that does not meet metabolic syndrome criteria is called metabolically healthy obesity (MHO). However, whether the MHO phenotype increases cardiovascular disease (CVD) risk is controversial. This study aimed to evaluate the prevalence of MHO and its 10-year CVD risk in Iranian populations. Based on the STEPS 2021 project in Iran, we collected data on 18119 Iranians 25 years and older from all 31 provinces after applying many statistical factors. Using the Framingham score, we evaluated the 10-year cardiovascular risk associated with the various MHO definition criteria for Iranian populations. The prevalence of MHO was 6.42% (5.93-6.91) at the national level according to the AHA-NHLBI definition, and 23.29% of obese women and 24.55% of obese men were classified as MHOs. Moreover, the MHO group was younger than the metabolically unhealthy obesity (MUO) group based on all definitions (p < 0.001). The odds ratio of MUO individuals being classified as high-risk individuals by the Framingham criteria for CVD was significantly higher than that of MHO individuals by all definitions, with a crude odds ratio of 3.55:1 based on AHA-NHLBI definition. This study reveals a significant prevalence of MHO in the Iranian population, with approximately 25% of obese individuals classified as MHO. While MHO is associated with a lower risk of cardiovascular disease compared to MUO, MHO carries the potential for transitioning to an unhealthy state. The online version contains supplementary material available at 10.1007/s40200-023-01364-5.

Prediction and Validation of Metabolic Dysfunction-Associated Fatty Liver Disease Using Fatty Liver-Related Indices in a Japanese Population.

Background: Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed. It is uncertain how indices that predict fatty liver are associated with MAFLD in Japanese. Methods: Among subjects who underwent a health examination at our hospital, 1257 (men: 787, women: 474) subjects participated in fatty liver evaluation of the fatty liver index (FLI) and fatty liver predicting index (FLPI) were included in this cross-sectional study. The discriminatory ability of each index for MAFLD was tested using receiver operating characteristic curve analysis. The association between FLI, FLPI, and MAFLD was investigated using multiple logistic regression analysis. Results: FLI and FLPI had good discriminatory ability for identifying MAFLD in both men and women, with specific cutoff values. Both FLI and FLPI were significantly higher in subjects with MAFLD, and the odds of MAFLD were higher among those in the highest tertile relative to the lowest tertile in both men and women. FLI and FLPI were higher in subjects who met the criteria for both MAFLD and metabolic syndrome (MetS) compared to those who had MAFLD or MetS alone, and most of the examined parameters in subjects with both conditions indicated a high metabolic risk profile. Conclusions: The study suggests that FLI and FLPI are valuable tools for predicting MAFLD and are similarly correlated with the disease. Furthermore, the highest values of these indices were observed in subjects who met the criteria for both MAFLD and MetS, emphasizing the importance of considering both conditions when assessing metabolic risk.

Evaluating metabolic syndrome criteria in gabonese type 2 diabetes patients

Background : Metabolic syndrome (MS) is the association of several cardiovascular risk factors. It aggravates cardiovascular complications, in diabetic subjects. Its prevalence depends on the definition used to describe it. This study aimed to compare four definitions of metabolic syndrome in type 2 diabetic subjects in Gabon.&#x0D; Materials And Methods : It was a prospective, observational study of type 2 diabetic subjects, followed at the University Hospital of Libreville. The MS was defined according to the criteria of the WHO, the National Education Program on NCEP ATP III Cholesterol, those of the International Diabetes Federation FID and the harmonized definition. Cohen's Kappa test was used to assess the two-to-two concordance between definitions and differences were significant for a p value&lt; 0.05.&#x0D; Results : The panel was composed of 100 diabetics. The 4 definitions, showed the respective SM values of 41%, 71%, 64% and 78%. All methods showed that women were more affected and that abdominal obesity was the most common metabolic abnormality. The best concordance was found between the NCEP definition and the harmonized one (k= 0.82 p=0.000).&#x0D; Conclusion : The prevalence of metabolic syndrome showed female predominance according to the 4 definitions. The NCEP ATP III and harmonized definitions gave the most consistent results within this population.

Effect of Blood Flow-Restricted Strength Training on Body Composition: a Randomized Controlled Study of Patients with Metabolic Syndrome

INTRODUCTION. Low-intensity resistance training with blood flow restriction is an effective strategy for increasing muscle mass and strength, as well as reducing excess subcutaneous and visceral fat deposition. In recent years, this method has been used in various populations. The purpose of this study was to evaluate the effect of low-intensity resistance training with blood flow restriction on anthropometric parameters and body composition in men with metabolic syndrome.&#x0D; AIM. To evaluate the effect of low-intensity strength training with blood flow restriction on anthropometric indices and body composition in men with metabolic syndrome.&#x0D; MATERIALS AND METHODS. The study involved 60 untrained men (mean age 38.7 ± 5.6 years) who meet the criteria for metabolic syndrome due to health reasons. Participants were divided into three groups according to resistance training regimens: low-intensity resistance with blood flow restriction; high-intensity training; low-intensity training without blood flow restriction. Before and after 12 weeks of training, the groups were assessed for body mass index, fat mass, visceral fat area, musculoskeletal mass, waist circumference.&#x0D; RESULTS. There was a statistically significant decrease in fat mass, visceral fat area, waist circumference and an increase in musculoskeletal mass (p 0.05) in the groups of low-intensity strength training with blood flow restriction and high-intensity strength training. In the parameters of men belonging to the group of low-intensity strength training without blood flow restriction, no statistically significant changes were found (p 0.05).&#x0D; CONCLUSION. In summary, the study found that low-intensity resistance training with blood flow restriction effectively altered the body composition of men with metabolic syndrome.

Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6–18 years

BackgroundWaist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide.MethodsWe used ten population-based cross-sectional data on 24,605 children and adolescents aged 6–18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6–18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors.ResultsBased on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA).ConclusionsThe proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

How close are children with obesity to becoming an adult with chronic illnesses?

Childhood obesity has become a global threat due to its serious negative consequences. We aimed to determine the patterns of metabolic syndrome and cardio-metabolic risk factors in Turkish children with obesity. We examined 169 schoolchildren with obesity in April and May 2019 in Samsun, Turkey. After clinical evaluation and anthropometric measurements, fasting blood samples were collected to measure total cholesterol, low and high-density lipoprotein, fasting blood glucose, triglycerides, and insulin levels. The proportion of those who met the metabolic syndrome criteria in boys was 14.3%, but it was twice as high in girls (28.2%). The most prevalent component of cardio-metabolic risk factor was increased waist circumference (96.4%) followed by a high homeostasis model assessment insulin resistance index (74.6%) and high blood pressure (29.0%). While the average high-density lipoprotein was higher in boys than in girls, on the contrary, insulin, HbA1c, and homeostasis model assessment insulin resistance concentrations were higher in girls. The prevalence of dyslipidemia was also higher in girls (67.1%) than in boys (47.6%), as were all impaired metabolic syndrome components. One in five children with obesity was at risk of metabolic syndrome. For early intervention and prevention, children with obesity should be monitored in terms of cardio-metabolic risk factors, but obese girls are more prioritized.

Serum monoterpene levels, glucose homeostasis, lipid profiles, and metabolic syndrome in adults: NHANES, 2013–2014

Monoterpenes are organic compounds which have been studied for their medicinal benefits. However, the association between monoterpene exposure and metabolic parameters in humans is unknown. We investigated the connection between three specific monoterpenes (α-pinene, β-pinene, and limonene), glucose homeostasis biomarkers, lipid profiles, and metabolic syndrome (MS) in 1627 adults from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. We found serum levels of α-pinene and β-pinene were positively associated with fasting glucose, total cholesterol, triglyceride, and apolipoprotein B. In addition, increased levels of limonene and Σmonoterpene (sum of three monoterpene chemicals) were linked to higher insulin, β-cell function, total cholesterol, low density lipoprotein cholesterol (LDL-C), triglycerides, and apolipoprotein B. Participants with all three monoterpenes above the 50th percentile had notably higher values for total cholesterol and triglycerides compared to those with all three monoterpenes below the 50th percentile (P for trend <0.001). Regarding MS, higher serum concentrations of α-pinene were linked to an increased risk of high-density lipoprotein cholesterol (HDL-C) insufficiency and hypertriglyceridemia. Elevated concentrations of β-pinene were associated with a higher prevalence of hypertriglyceridemia. Moreover, increased levels of limonene and Σmonoterpene were connected to a higher risk of MS, larger waist circumference, low HDL-C, hypertriglyceridemia, and higher blood pressure according to MS criteria. In conclusion, serum monoterpenes levels were linked to glucose regulation, lipid profiles, and indicators of MS. Further studies are necessary to clarify the potential causal relationships.

Body Composition and Cardiovascular Risk: A Study of Polish Military Flying Personnel.

(1) Background: Military personnel worldwide exhibit high rates of obesity. Obesity, and especially visceral obesity, contribute to various health issues, including type 2 diabetes and cardiovascular diseases (CVD). While BMI is commonly used to diagnose obesity, it has limitations and does not consider factors like fat distribution or muscle mass. This study aims to assess the relationship between BMI, percent body fat, waist circumference (WC), waist-to-height ratio (WHtR), and cardiovascular risk factors in Polish military flying personnel. Methods: This study involved 200 men from the Polish Air Force aged 38.8 ± 8.5 years. Anthropometric tests, body composition tests, and tests of biochemical markers of CVD were conducted. (2) Results: The prevalence of overweight and obesity varied based on the evaluation criterion; they were present in 63.5% of soldiers by BMI and in 52.5% by percent body fat; abdominal obesity was present in almost half (47%) of the surveyed soldiers according to WC and in 62.5% according to WHtR. All markers of obesity correlated positively with various biochemical markers of CVD, and 8.5% of subjects met the criteria for metabolic syndrome. (3) Conclusions: The prevalence of obesity in Polish military flying personnel, regardless of the evaluation criterion, is associated with significant metabolic complications in the form of lipid disorders and insulin resistance.

Correlation analysis of obesity phenotypes with leptin and adiponectin

Obesity can be categorized as metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). However, individuals with MHO are characterized by the absence of metabolic syndrome (MS) and appear to have lower inflammation levels compared to MUO. This study aimed to investigate the association of obesity phenotypes with leptin (LEP) and adiponectin (ADP). According to the inclusion and exclusion criteria, we selected 178 subjects from the previous cross-sectional survey. Based on the body mass index (BMI) and diagnostic criteria of MS, we divided the individuals into three groups, including healthy control group (HC group), metabolically healthy obesity group (MHO group) and metabolically unhealthy obesity group (MUO group). The concentrations of LEP and ADP in serum were measured, and the association of these two cytokines with different obesity phenotypes were subsequently analyzed. Compared to both the HC and MHO groups, the MUO group showed significantly higher BMI, waist circumference (WC), waist-hip ratio (WHR), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), homeostasis model assessment of insulin resistance (Homa-IR) and blood pressure (P < 0.05). In contrast, serum high-density lipoprotein cholesterol (HDL-C) was notably lower in the MUO group (P < 0.05). ADP was found to have a positive correlation with systolic blood pressure (SBP) and a negative correlation with FPG in the MHO group. In the MUO group, LEP demonstrated a positive correlation with fasting insulin (FINS) and Homa-IR, while ADP showed a positive correlation with TC and SBP. Linear regression analysis further indicated that SBP (β = 0.234, P = 0.043), TG (β = − 0.292, P = 0.001) and LDL-C (β = 0.626, P = 0.000) were independently correlated with ADP, and BMI (β = 0.398, P = 0.002) was independently correlated with LEP in obese individuals. In conclusion, ADP and LEP were closely related with glucose and lipid metabolism in obese individuals, these two cytokines might play critical roles in obesity-associated metabolic disorders.

Impact of components of metabolic syndrome on the risk of adverse renal outcomes in patients with atrial fibrillation: a nationwide cohort study.

The renal effect of metabolic syndrome components is unclear in patients with atrial fibrillation. This study aimed to investigate the association between metabolic syndrome components and incident end-stage renal disease among patients with atrial fibrillation. A total of 202,434 atrial fibrillation patients without prevalent end-stage renal disease were identified from the National Health Insurance Service database between 2009 and 2016. We defined the metabolic score range from 0 to 5 points such that a patient received every 1 point if the patient met each component listed in the diagnostic criteria of metabolic syndrome. The population was divided into 6 groups: MS0-MS5 for a metabolic score of 0-5, respectively. Multivariate Cox regression analysis was used to estimate the risks of end-stage renal disease. There were 12,747, 31,059, 40,361, 48,068, 46,630, and 23,569 patients for MS0-MS5, respectively. Compared with MS0, MS5 had a higher CHA2DS2-VASc score (3.8 vs. 1.0) (P < .001). During a median follow-up of 3.5 years, compared with MS0, MS1-MS5 were associated with a gradually increasing incidence of end-stage renal disease, in relation to an increase in the metabolic score, (log-rank P < .001). After multivariate adjustment, a higher metabolic score was associated with a greater risk of incident end-stage renal disease: adjusted hazard ratio [95% confidence interval] = 1.60 [0.78-3.48], 2.08 [1.01-4.31], 2.94 [1.43-6.06], 3.71 [1.80-7.66], and 4.82 [2.29-10.15], for MS1-MS5, respectively. Metabolic syndrome components additively impacts the risk of incident end-stage renal disease among patients with atrial fibrillation.

Metabolically healthy obese individuals are still at high risk for diabetes: Application of the marginal structural model.

To assess the effect of obesity phenotype on the incidence of diabetes, considering phenotype as a time-varying exposure. We used community-based cohort data from the Korean Genome and Epidemiology Study, with a 16-year follow-up period. Obesity phenotype was determined using body mass index and metabolic syndrome criteria. The influence of obesity phenotype on the occurrence of diabetes was evaluated using a Cox proportional hazard model and a marginal structural model (MSM). Obesity phenotypes were defined in 6265 individuals, with diabetes identified in 903 (14.4%) during the follow-up period. Individuals with metabolically healthy obesity (MHO) exhibited a higher risk of diabetes compared to those with metabolically healthy normal weight (MHNW), with a hazard ratio (HR) of 1.48 (95% confidence interval [CI] 1.15-1.90). This association remained significant after applying the MSM (HR 1.49, 95% CI 1.01-2.20). Moreover, various sensitivity analyses consistently demonstrated a higher risk of diabetes in individuals with MHO compared to those with MHNW. Even when obesity phenotype was treated as a time-varying exposure, individuals with MHO were still at higher risk for developing diabetes than those with MHNW. Consequently, such individuals should aim to avoid transitioning to a metabolically unfavourable state and strive to reduce their body weight to a normal range.

FRI033 Metabolically Healthy Obesity In A Young Population Assisted By The Family Health Strategy

Abstract Disclosure: R.B. Boghossian: None. G.F. Maselli: None. C.C. Lopes: None. C.A. Vasconcellos: None. C.A. Parente: None. D.D. Ferreira: None. J.C. Garcia: None. L.M. Guimarães: None. E.S. Muxfeldt: None. C.P. Damião: None. Background: Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease. Objective: To evaluate the prevalence and cardiovascular (CV) risk factors associated with metabolically healthy obesity (MHO) in a young population assisted by a Family Health Care unit in a large urban center. Design and Methods: A cross-sectional population study for CV risk assessment in adults aged 20-50 years old from a Family Health Care unit. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (BP) measurements, laboratory evaluation (lipid and glycidic profile), Home Blood Pressure Monitoring (HBPM), and bioimpedance. Obesity was defined as a body mass index (BMI) &amp;gt; 30 kg/m2 and MHO are those who have less than 3 of the following criteria for metabolic syndrome: office BP higher or equal to 130 x 85 mmHg, hypertension, fasting blood sugar higher or equal to 100 mg/dL, HDL &amp;lt; 40 mg/dL (men) and 50 mg/dL (women), triglycerides &amp;gt;150 mg/dL and waist circumference &amp;gt; 102 cm (men) and &amp;gt; 88 cm (women). Results: A total of 726 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 24.9%, of which 73.4% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 42%, p=0.03), hypertension (44% vs 19%, p&amp;lt;0.001), and diabetes (10% vs 2%, p=0.001) with higher office and home blood pressure. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower waist circumference (102 vs 110 cm, p=0.03), with lower office and home BP. There is no significant difference in relation to corporal composition. Conclusion: MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention Presentation: Friday, June 16, 2023

Insulin resistance and central obesity determine hepatic steatosis and explain cardiovascular risk in steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been proposed to replace non-alcoholic fatty liver disease and focus on patients with progressive disease due to the presence of metabolic dysfunction. However, it is unclear whether the new definition actually identifies patients with hepatic steatosis at increased cardiovascular risk. A total of 4,286 asymptomatic subjects from the SAKKOPI study aged 45-80 years undergoing screening colonoscopy were analyzed. Steatosis was diagnosed by abdominal ultrasound. MASLD was diagnosed according to the recent expert consensus. Insulin resistance was assessed by homeostasis model assessment-insulin resistance score (HOMA-IR) (cutoff: ≥2.5), subclinical inflammation was estimated by ferritin/CRP/uric acid, and cardiovascular risk was assessed using SCORE2/ASCVD. Mean age was 59.4 ± 8.5 years, 51.6% were male; mean BMI was 27.0 ± 4.5 kg/m², 9.2% had type 2 diabetes mellitus. In total, 1,903 (44.4%) were diagnosed with hepatic steatosis and were characterized by more severe metabolic dysfunction including insulin resistance (47.1% vs. 12.2%, p < 0.001) and central obesity (waist circumference ≥102/88 cm, 71.8% vs. 37.1%, p < 0.001). This translated into higher (subclinical) inflammation (ferritin 153 vs. 95 mg/dL, p < 0.001, uric acid 6.3 mg/dL vs. 5.2 mg/dL, p < 0.001) and 10-year cardiovascular risk (SCORE2 7.8 points vs. 5.1 points, p < 0.001, ASCVD 17.9 points vs. 10.8 points, p < 0.001). 99.0% of subjects with steatosis met the MASLD definition, 95.4% met the MAFLD definition, and 53.6% met the definition of metabolic syndrome, while 95.4% of subjects without steatosis also met the MASLD criteria for metabolic dysfunction compared to 69.0% and 17.4% who met the MAFLD and metabolic syndrome criteria, respectively. Forward stepwise regression indicated that waist circumference, HOMA-IR, and triglycerides were most relevant in explaining the presence of hepatic steatosis across all subgroups of increasing metabolic dysfunction. At the same time, hepatic steatosis was not associated with cardiovascular risk in the overall cohort (SCORE2: B = 0.060, 95% CI: -0.193-0.314, and p = 0.642) and in patients with metabolic dysfunction after adjusting for age, sex, and these three metabolic dysfunction components. Although hepatic steatosis is associated with increased central obesity and insulin resistance, metabolic dysfunction per se rather than hepatic steatosis explains cardiovascular risk in these patients.

Age-related determinants of the metabolic syndrome in women of reproductive age of the main ethnic groups of the Baikal Region

The aim of the study. To determine the age limit of the initial manifestations of the metabolic syndrome in women of reproductive age of the Caucasian and Asian ethnic groups. Materials and methods. The study included women of reproductive age of the Russian and Buryat ethnic groups (n = 1231). We carried out general clinical examination, studied glycemia levels and lipid metabolism indicators. The analysis of the components of the metabolic syndrome was performed taking into account age characteristics and ethnicity. Threshold values for the age of metabolic disorders manifestation were determined. Results. It was found that the main components of the metabolic syndrome in women of reproductive age of the Russian and Buryat ethnic groups were a decrease in high-density lipoprotein (HDL), an increase in waist circumference, and an increase in blood pressure. The age-related determinants of the metabolic syndrome in the population of women of reproductive age in the Baikal region were determined. It was shown that the age-related determinants of the metabolic syndrome in Caucasian and Asian women do not differ significantly and amount to 33.5 years (95% confidence interval (95% CI): 32.5; 38.5) and 36.5 years (95% CI: 27.5; 52.5), respectively. A universal critical age value was determined as 34.5 years (95% CI: 32.5; 38.5), which is associated with a significant increase in the prevalence of the metabolic syndrome in accordance with the ATP III criteria. The ranking of metabolic syndrome criteria in the studied groups revealed the following order of their occurrence: the decrease in HDL index prevailed, followed by the increase in waist circumference, blood pressure, glucose and triglycerides; no dependence on the ethnicity was found. Conclusion. When assessing the age-related determinants of the metabolic syndrome in the mixed Caucasoid-Asian group, it is advisable to use universal approaches, taking into account the cut-off point of age, which is 34.5 years. The determination of age criteria for the correct classification of patients with respect to the manifestations of the metabolic syndrome is necessary to analyze the contribution of the age factor to the implementation of various metabolic syndrome predictors, to develop prognostic models, and to use effective age-determined markers of metabolic disorders.

Intermittent fasting and changes in clinical risk scores: Secondary analysis of a randomized controlled trial

BackgroundIntermittent fasting may increase longevity and lower cardiometabolic risk. This study evaluated whether fasting modifies clinical risk scores for mortality [i.e., Intermountain Mortality Risk Score (IMRS)] or chronic diseases [e.g., Pooled Cohort Risk Equations (PCRE), Intermountain Chronic Disease score (ICHRON)]. Methods and resultsSubjects (N = 71) completing the WONDERFUL trial were aged 21–70 years, had ≥1 metabolic syndrome criteria, elevated cholesterol, and no anti-diabetes medications, statins, or chronic diseases. The intermittent fasting arm underwent 24-h water-only fasting twice-per-week for 4 weeks and once-per-week for 22 weeks (26 weeks total). Analyses examined the IMRS change score at 26 weeks vs. baseline between intermittent fasting (n = 38) and ad libitum controls (n = 33), and change scores for PCRE, ICHRON, HOMA-IR, and a metabolic syndrome score (MSS). Age averaged 49 years; 65% were female. Intermittent fasting increased IMRS (0.78 ± 2.14 vs. controls: −0.61 ± 2.56; p = 0.010) but interacted with baseline IMRS (p-interaction = 0.010) to reduce HOMA-IR (but not MSS) more in subjects with higher baseline IMRS (median HOMA-IR change: fasters, −0.95; controls, +0.05) vs. lower baseline IMRS (−0.29 vs. −0.32, respectively). Intermittent fasting reduced ICHRON (−0.92 ± 2.96 vs. 0.58 ± 3.07; p = 0.035) and tended to reduce PCRE (−0.20 ± 0.22 vs. −0.14 ± 0.21; p = 0.054). ConclusionsIntermittent fasting increased 1-year IMRS mortality risk, but decreased 10-year chronic disease risk (PCRE and ICHRON). It also reduced HOMA-IR more in subjects with higher baseline IMRS. Increased IMRS suggests fasting may elevate short-term mortality risk as a central trigger for myriad physiological responses that elicit long-term health improvements. Increased IMRS may also reveal short-term fasting-induced safety concerns.

Independent association between age- and sex-specific metabolic syndrome severity score and cardiovascular disease and mortality

Traditional metabolic syndrome (MetS) criteria have several limitations, which hinder its use in clinical practice. To overcome the limitations, we investigated the association between age- and sex-specific continuous MetS severity score (cMetS-S) and cardiovascular disease (CVD) and mortality beyond MetS components in the framework of the Tehran Lipid and Glucose Study. Participants aged 20–60 years at baseline were included in the study. We excluded participants with CVD, cancer, use of corticosteroids, estimated glomerular filtration rate < 30 ml/min/1.73 m2, and those who were pregnant. We evaluated the association between cMetS-S with CVD and mortality over 18 years of follow-up among 8500 participants with continuous and quantile approaches using the Cox proportional hazard regression model. In addition, the model performance of cMetS-S for predicting CVD events was compared to the conventional MetS criteria. Participants with higher cMetS-S had a significantly increased risk for CVD, coronary (CHD) and non-coronary heart disease (non-CHD), and all-cause, cardiovascular, and sudden cardiac death. Independent of the confounders and MetS components, the cMetS-S had the HRs of 1.67 (95% CI 1.47–1.89), 1.60 (95% CI 1.37–1.86), and 1.88 (95% CI 1.50, 2.35) for CVD, CHD, and non-CHD events upon 1-SD increment, respectively. The risk of mortality was increased for 1-SD of cMetS-S (all-cause mortality, HR 1.24; 95% CI 1.09–1.41; CVD mortality, HR 1.72; 95% CI 1.20–2.45; sudden cardiac death, HR 1.60; 95% CI 1.03–2.49). The model fitness of cMetS-S was superior to the conventional MetS criteria in predicting CVD and mortality. The cMetS-S provided an additional risk for CVD and mortality beyond the individual MetS components. Standardized cMetS-S could be a potential universal measure to define MetS severity while considering the weighted contribution of MetS components and their variations by age, sex, and ethnicity.

Effect of adipose tissue quantity and dysfunction on the risk of cancer in individuals with and without type 2 diabetes.

To determine the role of waist circumference and metabolic dysfunction in the risk of cancer in individuals with type 2 diabetes (T2D) and to compare this to individuals without T2D. Individuals with (n=1925) and without T2D (n=10,204) were included from the UCC-SMART cohort. Incident cancer diagnoses were obtained by linkage with the Netherlands Cancer Registry. Metabolic dysfunction was defined as ≥3 adapted NCEP ATP-III metabolic syndrome criteria. The effects of waist circumference and metabolic dysfunction on cancer were assessed using Cox proportional hazards models, adjusted for confounders. During a median follow-up of 8.3 years (IQR 4.2-13.1), 1740 individuals were diagnosed with cancer. Incidence rates of total cancer were 19.3 and 15.5/1000 person-years for individuals with and without T2D, respectively. In individuals without T2D, a higher waist circumference was associated with an increased risk of colorectal (per standard deviation: HR 1.23; 95%CI 1.03-1.46), urinary tract (HR 1.28; 95%CI 1.05-1.56) and total cancer (HR 1.06; 95%CI 1.02-1.13). Metabolic dysfunction was related to an increased risk of colorectal (HR 1.35; 95%CI 1.01-1.82), lung (HR 1.37; 95%CI 1.07-1.75) and total cancer (HR 1.13; 95%CI 1.01-1.25) in individuals without T2D. In individuals with T2D, no significant associations were found. Incidence rates of cancer are higher among individuals with T2D. However, higher waist circumference and metabolic dysfunction are only associated with an increased cancer risk in patients without T2D. These findings provide novel insights into the role of metabolic dysfunction in the occurrence of cancer.