Definition Of MetS Research Articles

LBODP027 Detection Of Metabolic Syndrome In Adolescent With Explainable Artificial Intelligence: Which Place For Mean Blood Pressure?

Abstract Metabolic syndrome (MetS) definition in adolescents is complicated by the physiologic evolution with age and sexual maturation of the components of this syndrome. While screening for MetS in youth should be useful to assess current complications and prevent future ones, it is not simple in clinical practice due to the number of different definitions of MetS in adolescents, which are generally based for most of them on percentiles. The aim of this study was to check the validity of artificial intelligence (AI)-based scores in screening for MetS in adolescents, using new parameters identified with AI techniques and without using percentiles. This study included 1,086 adolescents (559 girls and 527 boys) aged 12 to 18 with BMI 21.2±3.9 kg/m2. All had anthropometric measurements taken and had blood tests. Mean blood pressure (MBP), and triglyceride glucose index (TyG) were calculated. AI techniques are characterized by their black-box nature. Explainable AI methods are used to extract the learned function. "Gini importance" techniques were tested and used to build new scores for the detection of MetS among children and adolescents. We used 2007 IDF and Cook definitions of MetS to test the validity of these scores. MetS prevalence was 0.9% and 2.2% according to IDF and Cook definitions, respectively. The most accurate AI scores (S-IDF, S-Cook) for the detection of MetS according to these definitions include age, waist circumference, MBP and TyG index: S-IDF= - 0.52×age + 0.48×WC - 0.51×TyG + 0.27×MBP; S-Cook= - 0.52×age + 0.48×WC - 0.51×TyG + 0.29×MBP. With cut-off levels of 51.35/51. 06, these AI scores offer AUC 0.91/0.93, specificity 81%/75%, and sensitivity 90%/100% for MetS detection. Furthermore, with a cut-off point of 92 mmHg, MBP alone offers a better specificity 85%/83% and sensitivity 80%/88%, AUC 0.89, than TyG index alone (100%/46% for specificity, 30%/88% for sensitivity) to detect MetS based on IDF and Cook definitions, and slightly lower performance than AI-scores. MBP was associated with the occurrence of type 2 diabetes (T2D) and cardiovascular disease among the general population; cardiovascular disease and cardiovascular mortality among patients with T2D; and a discriminatory ability as strong as for SBP and DBP in predicting T2D. However, we did not find in the literature similar studies in the pediatric population. TyG index has been assessed mainly in adults and in a few studies in adolescents, and recently proposed as an alternative marker of insulin resistance and a marker of high risk for diabetes and cardiovascular complications or events in both adult and pediatric populations. In this study, AI techniques have proven their ability to extract knowledge from data and come up with new scores based on simplified criteria in adolescents. It allowed us to reveal the MBP as a simple alternative marker for MetS screening in adolescents. Presentation: No date and time listed

Metabolic Syndrome in Children and Adolescents

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that include hypertension, altered glucose metabolism, dyslipidemia, and abdominal obesity and is strongly associated with an increased risk for diabetes and cardiovascular disease onset in obese adults and children. A progressively greater number of children and adolescents are being affected by this syndrome due to the constant increase in the prevalence of obesity. Like obesity, childhood MetS highly tracks to adulthood. The pathogenesis of MetS includes the interaction between obesity, insulin resistance, and inflammation. Early diagnosis and intervention are important in order to conduct lifestyle modification. In this article, we review the definition and pathophysiology of MetS, the importance of screening, and prevention and treatment options for MetS in childhood.

Association of Metabolic Syndrome with Adverse Outcomes in Patients with Stable Coronary Artery Disease: A Meta-Analysis.

A consensus has not been reached on the association of metabolic syndrome (MetS) with adverse outcomes in patients with stable coronary artery disease (CAD). The purpose of this systematic review and meta-analysis was to summarize the prognostic implication of MetS in patients with stable CAD. We comprehensively searched articles indexing in PubMed and Embase databases until August 14, 2022. Original studies investigating the association of MetS with adverse outcomes in patients with stable CAD were included. Seven studies including 32 736 patients with stable CAD were identified. Depending on the definition of MetS, the reported prevalence of MetS ranged from 23.4% to 63%. Meta-analysis showed that patients with MetS conferred an increased risk of all-cause mortality [risk ratio (RR) 1.22; 95% confidence intervals (CI) 1.15-1.19], cardiovascular mortality (RR 1.49; 95% CI 1.16-1.92), and MACEs defined by death, myocardial infarction, revascularization, cardiac arrest, or angina admission (RR 1.47; 95% CI 1.20-1.79), respectively. Leave-one-out sensitivity analysis indicated the robustness of the value of MetS in prediction of all-cause mortality. MetS may be an independently predictor of adverse outcomes in patients with stable CAD. However, future studies are required to consolidate the current evidence due to the small number of studies included.

The prevalence and characteristics of metabolic syndrome according to different definitions in China: a nationwide cross-sectional study, 2012–2015

BackgroundMetabolic syndrome (MetS) is characterized by a cluster of signs of metabolic disturbance and has caused a huge burden on the health system. The study aims to explore the prevalence and characteristics of MetS defined by different criteria in the Chinese population.MethodsUsing the data of the China Hypertension Survey (CHS), a nationally representative cross-sectional study from October 2012 to December 2015, a total of 28,717 participants aged 35 years and above were included in the analysis. The MetS definitions of the International Diabetes Federation (IDF), the updated US National Cholesterol Education Program Adult Treatment Panel III (the revised ATP III), and the Joint Committee for Developing Chinese Guidelines (JCDCG) on Prevention and Treatment of Dyslipidemia in Adults were used. Multivariable logistic regression was used to identify factors associated with MetS.ResultsThe prevalence of MetS diagnosed according to the definitions of IDF, the revised ATP III, and JCCDS was 26.4%, 32.3%, and 21.5%, respectively. The MetS prevalence in men was lower than in women by IDF definition (22.2% vs. 30.3%) and by the revised ATP III definition (29.2% vs. 35.4%), but the opposite was true by JCDCG (24.4%vs 18.5%) definition. The consistency between the three definitions for men and the revised ATP III definition and IDF definition for women was relatively good, with kappa values ranging from 0.77 to 0.89, but the consistency between the JCDCG definition and IDF definition (kappa = 0.58) and revised ATP III definition (kappa = 0.58) was poor. Multivariable logistic regression showed that although the impact and correlation intensity varied with gender and definition, area, age, education, smoking, alcohol use, and family history of cardiovascular disease were factors related to MetS.ConclusionsThe prevalence and characteristics of the MetS vary with the definition used in the Chinese population. The three MetS definitions are more consistent in men but relatively poor in women. On the other hand, even if estimated according to the definition of the lowest prevalence, MetS is common in China.

Is non-high-density lipoprotein associated with metabolic syndrome? A systematic review and meta-analysis.

IntroductionNovel atherogenic lipid indices, including non-high-density lipoprotein cholesterol (non-HDL-C) which is calculated by subtracting the HDL-C value from the total cholesterol level, atherogenic index (ratio between triglycerides (TG) and HDL-C concentrations (TG/HDL-C)), and Diff-C (calculated by subtracting low-density lipoprotein (LDL-C) from non-HDL-C), have been known as valuable predictors of dyslipidemia and subsequent cardiovascular diseases. Previous studies have reported the potential association of novel atherogenic lipid indices with metabolic syndrome (MetS). This meta-analysis aimed to assess the pooled association of novel atherogenic lipid indices with MetS or its components.MethodsA systematic search was conducted through PubMed, Scopus, and Web of Science (WoS) databases from January 2000 until March 2021 to evaluate the association of novel atherogenic lipid indices, including non-HDL-C, atherogenic index, and the difference between non-HDL-C and LDL-C (Diff-C) with MetS. Observational studies were included without any language restriction. As exclusive studies evaluating the association of non-HDL-C with metabolic syndrome (MetS) were eligible to be included in quantitative analyses, a random-effect meta-analysis was performed to pool the odds ratios (ORs). A stratified meta-analysis was performed based on the definition of MetS [Adult Treatment Panel (ATP) and International Diabetes Federation (IDF)] and the studied population.ResultsOverall, 318 studies were retrieved from an initial systematic search. After screening, 18 and five studies were included in the qualitative and quantitative syntheses, respectively. Qualitative synthesis revealed an association between non-HDL-C, Diff-C, and atherogenic index with MetS and its components. Stratified meta-analysis showed that an increased non-HDL-C level was associated with an increased odds of MetS based on ATP criteria (OR: 3.77, 95% CI: 2.14-5.39) and IDF criteria (OR: 2.71, 95% CI: 1.98-3.44) in adults (OR: 3.53, 95% CI: 2.29-4.78) and in children (OR: 2.27, 95% CI: 1.65-2.90).ConclusionNovel atherogenic lipid indices, including atherogenic index, Diff-c, and non-HDL-C, are strongly associated with increased odds of MetS and its components. The indices could be considered as potential predictors of MetS and its components in clinical practice.

Prevalence Trends of Metabolic Syndrome among Korean Children and Adolescents from a Population-Based Cross-Sectional Survey.

The prevalence of metabolic syndrome (MetS) is increasing worldwide. This study aimed to investigate the prevalence trend of metabolic syndrome among Korean adolescents and to examine the effect of changes in dietary components on metabolic syndrome components. It has used the data of children and adolescents (8718 subjects aged 10–18) from the National Health and Nutrition Survey IV-VII (KNHANES 2007–2018) to estimate the recent prevalence of MetS and identify related nutritional factors. The definition of MetS used modified NCEP-ATP III and IDF criteria. The prevalence of MetS among Korean adolescents in 2007–2018 was 4.6% using the modified NCEP-ATP III criteria, and the trend of MetS increased significantly (p trend = 0.02). In the overweight and obese groups, the risk of MetS increased 7.08 (95% CI, 5.19–9.79) and 27.13 (95% CI, 20.90–35.24) compared to the normal-weight group. During KNHANES IV-VII, overall caloric intake increased, carbohydrate and sodium intake decreased, but fat intake increased (KNHANE-IV; 21.3% to VII; 24.0%, p < 0.001). These fat intakes were significantly correlated with an increase in systolic blood pressure, fasting blood glucose, and waist circumference. The prevalence of MetS is also increasing in Korean adolescents, and changes in dietary habits are related. In the future, it is also necessary to study the relationship of MetS to lifestyle.

Mortality associated with metabolic syndrome in people with COPD managed in primary care.

ObjectiveThe prevalence of metabolic syndrome (MetS) has been reported to be higher in selected populations of people with COPD. The impact of MetS on mortality in COPD is unknown. We used routinely collected healthcare data to estimate the prevalence of MetS in people with COPD managed in primary care and determine its impact on 5-year mortality.MethodsRecords from 103 955 patients with COPD from the Clinical Practice Research Datalink (CPRD-GOLD) between 2009 to 2017 were scrutinised. MetS was defined as the presence of three or more of: obesity, hypertension, lowered high-density lipoprotein cholesterol, elevated triglycerides or type 2 diabetes mellitus (T2DM). Univariate and multivariable Cox regression models were constructed to determine the prognostic impact of MetS on 5-year mortality. Similar univariate models were constructed for individual components of the definition of MetS.ResultsThe prevalence of MetS in the COPD cohort was 10.1%. Univariate analyses showed the presence of MetS increased mortality (hazard ratio (HR) 1.19, 95% CI: 1.12–1.27, p<0.001), but this risk was substantially attenuated in the multivariable analysis (HR 1.06, 95% CI: 0.99–1.13, p=0.085). The presence of hypertension (HR 1.70, 95% CI: 1.63–1.77, p<0.001) and T2DM (HR 1.41, 95% CI: 1.34–1.48, p<0.001) increased and obesity (HR 0.74, 95% CI: 0.71–0.78, p<0.001) reduced mortality risk.ConclusionMetS in patients with COPD is associated with higher 5-year mortality, but this impact was minimal when adjusted for indices of COPD disease severity and other comorbidities. Individual components of the MetS definition exerted differential impacts on mortality suggesting limitation to the use of MetS as a multicomponent condition in predicting outcome in COPD.

Metabolic syndrome screening in adolescents: New scores AI_METS based on artificial intelligence techniques

Background and aimsMetabolic syndrome (MetS) definitions in adolescents based on the percentiles of its components are rather complicated to use in clinical practice. The aim of this study was to test the validity of artificial intelligence (AI)-based scores (AI_METS) that do not use these percentiles for MetS screening for adolescents. Methods and resultsThis study included 1086 adolescents aged 12 to 18. The cohort underwent anthropometric measurements and blood tests. Mean blood pressure (MBP), and triglyceride glucose index (TyG) were calculated. Explainable AI methods are used to extract the learned function. Gini importance techniques were tested and used to build new scores for the screening of MetS. IDF, Cook, De Ferranti, Viner, and Weiss definitions of MetS were used to test the validity of these scores.MetS prevalence was 0.4%–4.7% according to these definitions. AI_METS used age, waist circumference, MBP, and TyG index. They offer area under the curves (AUCs) 0.91, 0.93, 0.89, 0.93, and 0.98; specificity 81%, 75%, 72%, 80%, and 97%; and sensitivity 90%, 100%, 90%, 100%, and 100%, respectively, for the detection of MetS according to these definitions. Considering only MBP offers a better specificity and sensitivity to detect MetS than considering only TyG index. MBP offers slightly lower performance than AI_METS. ConclusionAI techniques have proven their ability to extract knowledge from data. They allowed us to generate new scores for MetS detection in adolescents without using specific percentiles for each component. Although these scores are less intuitive than the percentile-based definition, their accuracy is rather effective for the detection of MetS.

Prevalence of metabolic syndrome and related factors in a large sample of antipsychotic naïve patients with first-episode psychosis: Baseline results from the PAFIP cohort

BackgroundFew investigations have been carried out on metabolic syndrome in antipsychotic- naïve patients with schizophrenia. MethodsOur primary objective was to compare the prevalence of Metabolic Syndrome (MetS), as defined by the National Cholesterol Education Program, Adult Treatment Panel III in 2001 (NCEP-ATP III), between a Spanish cohort of 303 drug-naïve patients with a first episode of psychosis (FEP) without any previous cardiovascular condition, and 153 healthy individuals. ResultsParticipants included 303 patients with FEP (M:F 53:46) and 153 control subjects (M:F 56:43). The mean and standard deviation ages were 31(9.38) and 29 (7.57) years in the study and control groups respectively (F = 4.09; p = 0.93). We found that the prevalence of MetS in drug-naïve patients with FEP (5.6 %) was similar to the prevalence of MetS in age-sex matched controls (5.12 %). However, 60.7 % of patients with FEP met at least one of the five MetS components, while among the control subjects only 36.5 % met at least one component. Additionally, we found that other factors not included among the operational definition of MetS, but still important in cardiovascular risk, were also altered. ConclusionFEP patients have a greater risk of presenting at least one altered MetS component than healthy controls which could indicate the need of development of screening methods detecting cardiovascular risk. Likewise, gender differences in metabolic components such as waist circumference, which is a predictor of cardiovascular events have been found. Similarly, research should focus on metabolic risk predictors that include not only MetS, but also specific parameters for the early psychosis population.

Prevalence of Metabolic Syndrome Among Mexican Adults.

Background: Metabolic syndrome (MetS) has increased worldwide, and since 2012, prevalence of obesity, hypertension, diabetes, and dyslipidemia has increased in Mexico. Objective: To assess the prevalence of MetS, and its relationship with sociodemographic and lifestyle factors among Mexican adults. Methods: Analytical cross-sectional study nationally representative, carried out on Mexican adults (≥20-year-old adults of both sexes; n = 4595). Socioeconomic factors, geographic area, health care coverage and previous medical diagnoses of diabetes and hypertension, and smoking were assessed. Anthropometrics, and triglyceride, total cholesterol, high-density lipoprotein cholesterol (HDL-chol), creatinine, and glucose plasma levels were measured. The ATP III MetS definition was applied. Results: A MetS prevalence of 44.2% was observed, which was higher in males than females, and increased with age, lower school level, and overweight. Hyperglycemia, hypertriglyceridemia, low HDL-chol, abdominal obesity, and hypertension were higher in people with MetS, and were associated with obesity. Conclusions: The prevalence of MetS in the Mexican adult observed in the ENSADER 2007 was high, and mainly in men than women. Specific associations of MetS with age, scholar level, and body mass index have been found. Obesity and MetS were associated.

Prevalence of Metabolic Syndrome and Association with Physical Activity and Frailty Status in Spanish Older Adults with Decreased Functional Capacity: A Cross-Sectional Study.

Metabolic syndrome (MetS) is a cluster of medical conditions associated with several health disorders. MetS and frailty can be related to prolonged physical deconditioning. There is a need to know whether there is concordance between the different ways of diagnosing it and to know their prevalence in Spanish older adults. Thus, the aims of this study were to describe the prevalence of MetS; to analyse the concordance between different definitions to diagnose MetS; and to study the associations between MetS, frailty status, and physical activity (PA) in older adults with decreased functional capacity. This report is a cross-sectional study involving 110 Spanish older adults of ages ≥65 years with decreased functional capacity. Clinical criteria to diagnose MetS was defined by different expert groups. Anthropometric measurements, blood biochemical analysis, frailty status, functional capacity, and PA were assessed. The Kappa statistic was used to determine the agreement between the five MetS definitions used. Student’s t-test and the Pearson chi-square test were used to examine differences between sex, frailty, and PA groups. The sex-adjusted prevalence of MetS assessed by the National Cholesterol Education Program—Third Adult Treatment Panel was 39.4% in men and 32.5% in women. The International Diabetes Federation and the Harmonized definitions had the best agreement (k = 1.000). The highest odds ratios (ORs) of cardiometabolic risk factors to develop MetS were elevated triglycerides (37.5) and reduced high-density lipoprotein cholesterol (27.3). Central obesity and hypertension prevalence were significantly higher in the non-active group (70.7% and 26.8%, respectively), compared to the active group (50.0% and 7.7%, respectively). Moreover, the active group (OR = 0.85, 95% CI = 0.35, 2.04) and active women group (OR = 0.77, 95% CI = 0.27, 2.20) appeared to show a lower risk of developing this syndrome. MetS is highly prevalent in this sample and changes according to the definition used. It seems that sex and frailty do not influence the development of MetS. However, PA appears to decrease central obesity, hypertension, and the risk of developing MetS.

The association of depressive and anxiety symptoms with the metabolic syndrome and its components among Russian, Somali, and Kurdish origin adults in Finland: A population-based study

ObjectivePositive association of depressive and anxiety symptoms with the metabolic syndrome (MetS) have been reported, however there is little information on these among migrant origin populations. The aim of this study was to examine these associations among diverse migrant origin populations in Finland. MethodsData of 318 Russian, 212 Somali, and 321 Kurdish origin participants in the cross-sectional Finnish Migrant Health and Wellbeing Study (Maamu) aged 30–64 years was used. The general population reference group constituted of 786 Health 2011 Survey participants. Depressive and anxiety symptoms were measured with HSCL-25 subscales. Harmonized definition of MetS was used. ResultsDepressive symptoms were associated with elevated blood pressure in Kurdish origin (30.1%, 95% CI 22.7–38.8 vs. 19.9%, 95%CI 15.4–25.4 for those with and without symptoms respectively); and elevated waist circumference (72.1%, 95%CI 56.9–83.5 vs. 55.0%, 95%CI 50.6–59.4) and triglycerides (30.8%, 95%CI 16.0–51.0 vs. 11.9%, 95%CI 9.3–15.0) in general population. Anxiety symptoms were associated with MetS (47.0%, 95%CI 37.6–56.7 vs. 31.9%, 95%CI 26.7–37.6) and elevated blood pressure (37.2%, 95%CI 28.3–46.9 vs. 18.8%, 95%CI 14.7–23.6), and with elevated triglycerides in Somali origin (33.0%, 95%CI 14.5–59.0 vs. 5.7%, 95%CI 3.3–9.6) and general population (30.2%, 95%CI 16.4–48.8, 12.8%, 95%CI 9.9–16.2). No associations between low HDL-cholesterol and depressive or anxiety symptoms were observed. ConclusionCardiometabolic health should be taken into account in mental health services. Future studies should explore the underlying pathways to the observed differences in strengths of associations of depressive and anxiety symptoms with MetS and its components across diverse migrant origin populations.

Distinct racial and ethnic metabolic syndrome characteristics: A comparative assessment in low-income children 7-10 years of age.

Pediatric MetS prevalence varies due to lack of consensus on evaluative criteria and associated thresholds, with most not recommending a diagnosis <10 years. However, MetS risk components are becoming evident earlier in life and affect races and ethnicities disproportionately. To compare the prevalence of MetS based on existing definitions and elucidate racial- and ethnic-specific characteristics associated with MetS prevalence. The baseline and follow-up samples included 900 and 557 children 7-10 years, respectively. Waist circumference, BMI percentile, blood pressure, fasting plasma glucose (FPG), insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C) were measured. Agreement between MetS definitions was quantified via kappa statistics. MetS and risk factor prevalence and the predictability of metabolic parameters on MetS eight months later was evaluated via logistic regression. McFadden pseudo-R2 was reported as a measure of predictive ability, and the Akaike information criterion evaluated fit of each model. The baseline sample was 55.0% male and 71.6% Hispanic, followed by non-Hispanic White (NHW) (17.3%) and non-Hispanic Black (NHB) (11.1%), with an average age of 9.2 years. MetS prevalence ranged from 7.6% to 21.4%, highest in Hispanic (9.0%-24.0%) and lowest in NHB children (4.0%-14.0%). Highest agreement was between Ford et al. and Cook et al. definitions (K= 0.88) and lowest agreements were consistently with the International Diabetes Federation criteria (K≤ 0.57). Compared to NHW children, Hispanic children had higher odds for MetS (OR: 1.7; p= 0.03) and waist circumference, HDL-C, and FPG risk factors (p< 0.05), while NHB children had higher odds for the FPG risk factor (p≤ 0.007) and lower odds for the plasma triglycerides risk factor (p= 0.002), across multiple MetS definitions. In longitudinal analyses, HDL-C was the strongest independent predictor of MetS in Hispanic and NHW children (p< 0.001 and p< 0.01, respectively), while plasma triglycerides was the strongest independent predictor of MetS in NHB children (p< 0.05). MetS prevalence was high in children ≤10 years, and proposed criteria are susceptible to racial and ethnic bias, diagnosing some populations more than other populations with high cardiovascular risk. Earlier preventative measures should be imposed in clinical settings, accounting for racial and ethnic differences, to mitigate disease onset.

Scoring systems of metabolic syndrome and prediction of cardiovascular events: A population based cohort study.

Background and AimsContinuous scoring systems were developed versus traditional dichotomous approaches to define metabolic syndrome. The current study was carried out to evaluate the ability of scoring systems to predict fatal and nonfatal cardiovascular events.Materials and MethodsThe data of 5147 individuals aged 18 years or more obtained from a population‐based cohort study were analyzed. The occurrence of atherosclerotic cardiovascular disease (ASCVD) in the period of 7 years follow‐up was considered as the associated outcome. Joint Interim Statement (JIS) definition, as a traditional definition of metabolic syndrome (MetS), and two versions of MetS scoring systems, based on standardized regression weights from structural equation modeling (SEM) and simple method for quantifying metabolic syndrome (siMS) were considered as potential predictors.ResultsThe scoring systems, particularly, based on SEM, were observed to have a significant association with composite cardiovascular events (HR = 1.388 [95% CI = 1.153–1.670], p = .001 in men and HR = 1.307 [0.95% CI = 1.120–1.526] in women) in multiple Cox proportional hazard regression analyses, whereas the traditional definition of MetS did not show any significant association. While both two scoring systems showed acceptable predictive abilities for cardiovascular events in women (MetS score based on SEM: area of under curve [AUC] = 0.7438 [95% CI = 0.6195–0.7903] and siMS: AUC = 0.7207 [95% CI = 0.6676–0.7738]), the two systems were not acceptable for identifying risk in men.ConclusionUnlike the dichotomous definition of MetS, the scoring systems showed an independent association with cardiovascular events. Scoring systems, particularly those based on SEM, may be useful for the prediction of cardiovascular events in women.

Impact of excluding hyperglycemia from international diabetes federation metabolic syndrome diagnostic criteria on prevalence of the syndrome and its association with microvascular complications, in adult patients with type 1 diabetes.

We aimed to determine, in patients with type 1 diabetes (T1DM), the impact of excluding hyperglycemia as a criterion from the International Diabetes Federation (IDF) definition of the metabolic syndrome (MetS), both on its prevalence and on its association with micro and macrovascular complications and markers of subclinical inflammation. A cross-sectional design, including 280 patients with T1DM. We defined MetS by three different models: (i) the standard IDF criteria, (ii) a modification consisting of excluding of hyperglycemia as a criterion (modified IDF criteria) and (iii) a modification consisting in changing the hyperglycemia by insulin resistance (MetS + IR model) defined by the estimated glucose disposal rate. Microvascular complications and cardioautonomic neuropathy were assessed. We measured an inflammatory panel including high sensitivity C reactive protein, erythrocyte sedimentation rate, homocysteine, and fibrinogen concentrations. After excluding hyperglycemia, the prevalence of MetS was 6.4% (95%CI: 4.1 to 9.9) compared with 20.7% (95%CI: 16.3 to 25.8) using standard IDF criteria. After adjusting for duration of diabetes, all three MetS definitions increased the odds for having microvascular complications [OR: 6.012 (2.208-16.307) for modified definition; OR: 5.176 (2.555-10.486) for standard definition and [OR: 3.374 (1.649-8.456) for MetS+IR model]. However, the both modified IDF models for MetS showed better predictive performance than standard criteria for suffering from neuropathy, nephropathy, cardiovascular disease and were associated with markers of subclinical inflammation. The prevalence of MetS significantly varies as a function whether or not hyperglycemia is included as a diagnostic criterion. The subset of patients fulfilling the modified MetS definitions may reflect better the concept of metabolic syndrome in T1DM. These modified definitions were accompanied by a poorer metabolic control and lipid profile, showing the worse inflammatory biomarker profiles and higher odds for micro- and macrovascular complications. In patients with T1DM, the inclusion of insulin resistance instead of hyperglycemia as a criterion of MetS may be of interest in routine clinical practice.

Adiposity measures in screening for metabolic syndrome among Chinese children and adolescents.

Existing various and complicated metabolic syndrome (MetS) definitions have contributed to the difficulty in assessing MetS in children and adolescents, and therefore it is urgently needed to develop a convenient and effective screening tool for pediatric MetS. This study aimed to identify the optimal adiposity measure to screen for pediatric MetS. The cross-sectional data was collected from 8,150 children and adolescents aged 7-17y living in southern China. Anthropometric indices, blood lipids, and serum glucose were determined. Results of two commonly used MetS definitions were compared: International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel Ⅲ (NCEP-ATP) modified by Cook. Receiver operating characteristic curve analyses were performed and areas under the curve (AUCs) were calculated to determine the optimal index for MetS screening. MetS prevalence assessed by NCEP-ATP was significantly higher than that by IDF (6.2% vs. 1.5%, p<0.001). Waist-to-height ratio (WHtR) showed the highest screening power for MetS defined by both IDF and NCEP-ATP (AUC 0.932 and 0.900, respectively), and its optimal cut-off point was 0.48 by both IDF and NCEP-ATP definition (sensitivity 0.944 and 0.847, specificity 0.800 and 0.830, respectively), regardless of age or sex. When taking sex diversity into account, the optimal WHtR cut-off point was 0.49 (IDF) or 0.50 (NCEP-ATP) in boys, and 0.46 (both definitions) in girls. Among children and adolescents aged 7-17y in southern China, a WHtR greater than 0.48 can be a simple but effective screening tool for MetS.

Community-based lifestyle intervention improves metabolic syndrome and related markers among Kenyan adults.

Metabolic syndrome (MetS) is a major risk factor for cardiovascular diseases and type-2 diabetes. The study aimed to establish the efficacy of a community-based lifestyle intervention on MetS in Kenyan adults using randomized control trial involving a 15-months follow up. A randomized controlled trial involving 352 (18-64years old) adults with MetS spanning 15-months duration. Participants were recruited from a Nairobi based Mission-led outpatient clinic, randomly assigned equally into intervention and control groups. The intervention group was exposed to a community-based health education on lifestyle modification, while control group was subjected to hospital-led routine care involving treatment and general lifestyle advice. The study was structured into baseline, intervention and evaluation phases with inbuilt data collection in each phase. Physiologic, anthropometric, and clinical parameters as well lifestyle characteristics were measured at baseline, midline and end-line. The parameters were compared across the groups and between the time points during analyses using chi-square test, binary logistic, independent t-test and paired t-test. Proportion of participants with MetS declined significantly (p < 0.001) with marked (p < 0.05) improvement in markers of MetS (elevated BP, raised sugars, cholesterols, central obesity) in intervention compared to control group. The rates of consumption of fruits, vegetables, legumes, nuts and uptake of physical activity significantly (p < 0.05) improved in the intervention group. However, the intake of processed/fast foods, salt, sugar, and alcohol significantly (p < 0.05) declined in the intervention compared to controls by the end-line. One in three adults under the community-based lifestyle intervention had improvement in physiologic, anthropometrics and clinical markers relevant to definition of MetS. Additionally, an improved adherence to the recommended dietary intake and increased uptake of physical activity in adults with MetS was observed. These findings underscore the feasibility, effectiveness and proof of concept for community-based lifestyle approach as a viable strategic intervention for addressing premorbid risk factors for cardiovascular CVDs and diabetes before evolving into full blown conditions in low-income settings.

Structural Equation Modelling for Predicting the Relative Contribution of Each Component in the Metabolic Syndrome Status Change.

Understanding the factor weighting in the development of metabolic syndrome (MetS) may help to predict the progression for cardiovascular and metabolic diseases. Thus, the aim of this study was to develop a confirmatory model to describe and explain the direct and indirect effect of each component in MetS status change. A total of 3581 individuals diagnosed with MetS, aged 18–102 years, were selected between January 2019 and December 2020 from a community-representative sample of Portuguese adults in a north-eastern Portuguese region to test the model’s goodness of fit. A structural equation modelling (SEM) approach and a two-way ANOVA (age × body composition) were performed to compare the relative contribution of each MetS component using joint interim statement (JIS). Waist circumference (β = 0.189–0.373, p < 0.001), fasting glucose (β = 0.168–0.199, p < 0.001) and systolic blood pressure (β = 0.140–0.162, p < 0.001) had the highest direct effect on the change in MetS status in the overall population and concerning both sexes. Moreover, diastolic blood pressure (DBP), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) had a low or non-significant effect. Additionally, an indirect effect was reported for age and body composition involving the change in MetS status. The findings may suggest that other components with higher specificity and sensitivity should be considered to empirically validate the harmonised definition of MetS. Current research provides the first multivariate model for predicting the relative contribution of each component in the MetS status change, specifically in Portuguese adults.

TG: HDL-C Ratio as Insulin Resistance Marker for Metabolic Syndrome in Children With Obesity.

Insulin resistance (IR) is an important variable in the diagnosis of metabolic syndrome (MetS). Currently, IR is not part of the existing pediatric definition of MetS, instead elevated fasting blood glucose (FBG) is measured as an indicator of hyperglycemia. Arguably, many obese children with severe IR are still able to regulate their FBG well. Hence, this study aimed to assess the utility of triglyceride-to-high-density lipoprotein cholesterol (TG : HDL-C) ratio as an IR marker in the modeling of pediatric MetS among children with obesity using structural equation modeling (SEM). A total of 524 blood samples from children with obesity (age 10–16 years old) were analyzed for FBG, lipids, insulin, leptin, and adiponectin. Both exploratory (EFA) and confirmatory factor analysis (CFA) were used to examine TG : HDL-C ratio as an IR marker in pediatric MetS. EFA shows that TG: HDL-C ratio (standardized factor loading = 0.904) groups together with homeostasis model assessment-estimated insulin resistance (HOMA-IR) (standardized factor loading = 0.664), indicating a strong correlation to the IR factor. Replacing FBG with TG: HDL-C ratio improved the modeling of MetS structure in children with obesity. Our MetS model of TG: HDL-C ratio as IR component shows comparable model fitness indices (goodness of fit, Akaike’s information criterion, and Bayesian information criterion) with leptin:adiponectin ratio (platinum standard for adiposity:IR marker) model. The least model fit was seen when using FBG as an IR surrogate. TG : HDL-C ratio performed better as IR surrogate in MetS structures (standardized factor loading = 0.39) compared to FBG (standardized factor loading = 0.27). TG: HDL-C ratio may be considered as an IR component in pediatric MetS.

Which Clusters of Metabolic Syndrome Are the Most Associated with Serum Uric Acid?

Background and Objectives: Metabolic syndrome is defined as three or more of five components; therefore, there are 16 possible different clusters of metabolic risk factors that are under one diagnosis of metabolic syndrome. In this study, we evaluated the different clusters of metabolic syndrome (MetS) across serum uric acid (SUA) quartiles and analyzed the association of these clusters with SUA levels, respectively, in both men and women. Materials and Methods: A total of 606 subjects were recruited to a cross-sectional study from the ongoing Lithuanian High Cardiovascular Risk primary prevention program (LitHiR). All of the study subjects were diagnosed with MetS (according to the 2005 National Cholesterol Education Program Adult Treatment Panel III MetS definition). Results: In the middle-aged population of patients with MetS living in Lithuania, a high proportion of hyperuricaemia was detected—35.5% (95% Cl 31.7% to 39.4%). For women possessing all five MetS components, the chances of having hyperuricaemia are 2.807 higher than for women with three risk factors (p < 0.001). However, men do not have a statistically significantly higher chance of having hyperuricaemia, depending on the number of MetS components in our population. Using multivariable models, the statistically significant chance of having hyperuricaemia was observed only in women possessing all five MetS components (OR = 2.386, p < 0.0001), compared to any other of 15 MetS clusters. After adjustment for age and sex, the chance of having hyperuricaemia for individuals with the cluster of all five MetS components, compared to any other of 15 MetS clusters, remained (OR = 1.982, p = 0.001). Also, a lower probability (OR = 0.653, p = 0.039) of having hyperuricaemia was observed for individuals having the combination of abnormal plasma glucose, blood pressure, and waist circumference. Conclusions: Patients with the clustering of all five metabolic syndrome components are at higher risk for having hyperuricaemia than patients with any other combination of MetS clusters. This risk is even higher for women. It could be beneficial for patients presented with all five MetS components to be screened for SUA concentration in the primary CVD prevention program.