National Cholesterol Education Program Adult Research Articles

Metabolic syndrome in type 1 diabetes: higher time above range and glycemic variability revealed by continuous glucose monitoring (CGM)

AimsTo investigate the glucose profile of Chinese individuals with type 1 diabetes (T1D) who also have metabolic syndrome.Materials and methodsType 1 diabetes participants from Peking University People’s Hospital were recruited from Jan 2017 to Jan 2024. The diagnosis of metabolic syndrome was developed based on the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Demographic data, anthropometric measurements, clinical information and continuous glucose monitoring (CGM) data were collected and compared between participants with metabolic syndrome and those without.ResultsThe median age of the participants was 50.0 years (IQR 35.0-63.3), and the median duration was 10.0 years (IQR 2.0–17.0). Compared to those without metabolic syndrome, participants with metabolic syndrome were older (63.0 years, IQR 41.0–69.0 vs. 48.5 years, IQR 35.0–60.0; P < 0.001) and had a longer duration (13.0 years, IQR 5.0–22.0 vs. 9.0 years, IQR 2.0–15.0; P = 0.011). The comparison of CGM metrics suggested significantly higher time above range (TAR, 48.9%, IQR 35.3–59.5 vs. 32.8%, IQR 16.1–47.6; P < 0.001), standard deviation (SD, 3.6 ± 0.9 mmol/L vs. 3.2 ± 1.0 mmol/L; P = 0.022) and interquartile range (IQR, 4.2 mmol/L, IQR 3.2–4.8 vs. 3.7 mmol/L, IQR 3.0-4.5; P = 0.046) in those with metabolic syndrome. And the Logistic regression analysis showed that TAR (OR 1.53, 95% CI 1.02–2.23, per 20% increase), SD ( OR 1.75, 95% CI 1.07–2.84, P = 0.025) and IQR (OR 1.50, 95% CI 1.03–2.19, P = 0.036) were positively associated with metabolic syndrome after adjusting for age, sex, diabetes duration, BMI and complication status.ConclusionsOur findings suggested that in T1D participants, metabolic syndrome was associated with higher glucose level and glycemic variability. Personalized diabetes education including optimal meal planning and sufficient physical activity should be emphasized to improve glycemic control in T1D with metabolic syndrome.

Influence of waist circumference measurement site on the cardiometabolic risk factors in Korean adults.

Waist circumference (WC) has been recognized as a simple anthropometric measure of abdominal obesity and associated health risk. We compared WC values at five measurement sites, and examined whether measurement sites influence the relationships between WC and cardiometabolic risk in Korean adults. In this cross-sectional study, participants included 180 men and 176 women (age: 30-60 years, BMI: 18.5-30.0 kg/m2) who underwent a regular health examination between 2021 and 2022. WC was measured at the following sites; lowest rib, superior border of the iliac crest, midpoint between the lowest rib and the iliac crest, umbilicus, and narrowest waist. Fasting glucose and lipids, and resting blood pressure were measured after a 10-hour overnight fast. Cardiometabolic risk factors were defined using the modified National Cholesterol Education Program Adult Treatment Panel-III. All WC measures at five sites were highly correlated (P < 0.01) with each other in men (r = 0.933-0.995) and women (r = 0.893-0.990). Differences in absolute mean WC values existed in both men and women. The prevalence of abdominal obesity (men: 17.2 %-34.4 %, women: 5.7 %-40.9 %) and metabolic syndrome (men: 30.6 %-38.9 % women: 13.6 %-22.2 %) varied depending on the measurement site. All five WC sites were similarly associated (P < 0.05) with an increased odd ratio for elevated glucose, elevated triglycerides, low HDL cholesterol and cardiometabolic risk clustering in men, and elevated blood pressure and cardiometabolic risk clustering in women. Although the differences in absolute WC values existed, the associations between WC at each site and cardiometabolic risk were similar in Korean adults.

Prevalence of metabolic syndrome among pregnant women: a systematic review and meta-analysis.

Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of cardiometabolic diseases. The prevalence of MetS and individual components across pregnancy has not been reviewed in the literature. This research was conducted to identify the prevalence of MetS and its components among pregnant women. The PubMed, EMBASE, CINAHL, Web of Science and Scopus databases were searched. The review protocol is registered in PROSPERO (CRD42023460729). Quality assessment was performed using the JBI critical appraisal checklist. The study selection, data extraction and data analyses were performed in accordance with the MOOSE guidelines. The prevalence of MetS among pregnant women was 16.3%, (n = 3946). The prevalences for individual MetS components were: low HDL, 12.3% (n = 1108); high fasting glucose, 16.2% (n = 2333); high triglycerides, 48.5% (n = 2880); obesity, 42.7% (n = 5162) and high blood pressure 37.7% (n = 828). According to the definitions used to diagnose MetS, the prevalences were 18.2% according to the World Health Organization, 15.0% according to the International Diabetes Federation and 17.2% according to the National Cholesterol Education Program Adult Treatment Panel III. When stratified by gestational age at assessment, the prevalence of MetS was 9.9% before 16 weeks' and 24.1% after 20 weeks' of gestation. This review demonstrates that MetS is detected in approximately one-fifth of pregnant women. Screening for MetS and its components during pregnancy may help identify young women at risk for future cardiovascular disease.

Metabolic Syndrome in Patients with Depressive Disorder: A Cross-sectional Study.

Depression not only fosters the development of metabolic syndrome through behavioral, physiological, genetic, and treatment-related factors, but it also doubles the risk of experiencing metabolic syndrome. The objectives were to assess the sociodemographic and clinical profile of patients with depressive disorder, to assess the various metabolic parameters of metabolic syndrome in patients with depressive disorder, and to study the association between the severity of depression and metabolic syndrome. A cross-sectional study was conducted among patients diagnosed with depression (n = 160) attending the Psychiatry outpatient department of a tertiary healthcare facility in Puducherry. The Hamilton Depression Rating Scale (HAM-D) and modified National Cholesterol Education Program-Adult Treatment Panel-III (NCEP ATP-III) criteria were used to assess the severity of depression and diagnose metabolic syndrome, respectively. The mean age at onset of depression was 31.4 years (+11.3); the duration of depression was 41.2 months (+32.5); and the severity of depression as assessed using the HAM-D was 17.9 (+6.3). The results showed that 27.5% of patients had metabolic syndrome. Factors associated with higher rates of metabolic syndrome included increasing age, female gender (79.5%), being single (25.0%), belonging to upper socioeconomic class (65.9%), non-Hindu religion (20.5%), and urban residence (72.7%) (P < .05). Patients with metabolic syndrome had later onset (36.4 years) and longer duration (51.6 months) of depression, more severe symptoms (18.2), and were more likely to have recurrent depressive disorder or dysthymia (88.6%) (P < .05). Furthermore, the current use of psychotropic medications (59.1%) and obesity (93.2%) were significantly associated with metabolic syndrome (P < .05). This study reveals a high prevalence of metabolic syndrome among patients with depressive disorders linked to factors such as age, gender, marital status, socioeconomic status, religion, and urban residence. Integrated care approaches, including comprehensive screening and targeted interventions, are crucial for improving both mental and metabolic health outcomes.

Prevalence of dyslipidemia and influencing factors in HIV-infected people before starting antiretroviral therapy in China, 2018-2023

Objective: To investigate the prevalence of baseline dyslipidemia in HIV-infected people before starting antiviral therapy (ART) in China. Methods: The data were collected from HIV/AIDS ART database of Chinese Disease Prevention and Control Information System. A national sample of HIV- infected people who initiated ART from 2018 to 2023 was used to collect baseline information, including sociodemographic characteristics and laboratory test results. According to the Chinese Lipid Management Guidelines (2023) and the National Cholesterol Education Program Adult Treatment Panel Ⅲ guidelines, triglyceride (TG) ≥1.7 mmol/L or total cholesterol (TC) ≥5.2 mmol/L were identified as dyslipidemia. Statistical analysis was performed with software SAS 9.4. An unconditional logistic regression model was used to analyze the factors influencing TG and TC abnormalities in HIV-infected patients before ART. Results: A total of 359 952 adults infected with HIV were included in this study, the prevalence rate of dyslipidemia was 38.41% (138 263/359 952). The abnormal rates of TG and TC were 31.40% (113 041/359 952) and 13.75% (49 494/359 952), respectively. In all age groups except for the 25-44 age groups, the abnormal rates of TG and TC were higher in HIV-infected women than in HIV-infected men. In HIV-infected patients, women, those aged 45-64 years, those lived in northeast region, those had heterosexual transmission, and those with BMI ≥28.0 kg/m2, CD4+T lymphocytes counts ≥500 cells/µl had higher rates of baseline dyslipidemia (all P<0.05). Conclusions: The abnormal rate of TG in HIV-infected people before ART was higher in China from 2018 to 2023, especially in HIV-infected women, and the abnormal rate of TG and TC increased with age. Attention should be paid to the clinical diagnosis and ART selection in the treatment of HIV infection.

Evaluation of some biochemical changes and associated metabolic syndrome among pregnant women in Enugu Southeast of Nigeria

Objective: Metabolic syndrome is a global health problem which involves a cluster of conditions that increases the risk of heart disease, stroke and diabetes. Pregnancy induces significant physiological, hormonal and metabolic changes in a woman. The complex of metabolic and hormonal disorders is a risk factor for clinical manifestations of cardiovascular diseases, nephropathy and retinopathy. This study assessed some biochemical changes and associated metabolic syndrome among pregnant women in Enugu, Nigeria. Methods: A total of one hundred and thirty apparently healthy women consisting of seventy pregnant women as test group and sixty non-pregnant women as control group were recruited for this cross sectional study. Anthropometric parameters waist circumference (WC), height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) were measured and body mass index (BMI) calculated. Five milliliters of fasting blood samples were collected and used for the determination of fasting plasma glucose (FPG) and lipid profile (TC, TG, HDL-C, LDL-C, VLDL-C) using enzymatic colorimetric methods. Metabolic Syndrome (MetS) prevalence was estimated using the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria. Data was analysed using the Statistical Package for the Social Sciences (SPSS) version 26. Results: The results showed a significant (P&lt; 0.05) increase in BMI, WC, SBP, DBP, TG, VLDL-C and a decrease in HDL-C of pregnant women compared to non-pregnant women. Using the NCEP-ATP III criteria, it was found that about twenty-eight (40%) pregnant women had metabolic syndrome and only two (3.33%) non-pregnant woman had metabolic syndrome while the IDF criteria, presented about thirty (42.9%) pregnant women and ten (16.7%) non-pregnant women with metabolic syndrome. Conclusion: This study concludes that pregnancy predisposes women to higher risk of developing metabolic syndrome.

Metabolic syndrome prevalence in Mexican individuals exposed to polycyclic aromatic hydrocarbons and their association with an increased risk of cardiovascular events

Polycyclic aromatic hydrocarbons (PAHs) are an organic chemical family produced during incomplete combustion of organic materials. Besides, PAHs are associated with different detrimental health effects. Therefore, this research was aimed to assess the association between PAHs exposure, metabolic syndrome (MetS) prevalence, and cardiovascular risk in a Mexican population. Urinary 1-hydroxypyrene (1-OHP) was the exposure biomarker quantified. MetS prevalence was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the International Diabetes Federation (IDF) criteria. Also, we used the atherogenic index of plasma (AIP) as a cardiovascular risk biomarker. The mean urinary 1-OHP level quantified was 2.50 ± 1.25 µmol/mol creatinine. The MetS prevalence found was 35% (n = 222) and 31% (n = 197) using NCEP ATP III and IDF criteria, respectively. The mean AIP value was 0.32 ± 0.15. Furthermore, the data analysis showed robust associations between PAH exposure (urinary 1-OHP concentrations), MetS prevalence, and cardiovascular risk (AIP). The real significance of the findings in this study needs to be clarified completely, as MetS and cardiovascular diseases represent a critical challenge in contaminated zones of developing countries such as Mexico.

Associations of Combined Physical Activity and Body Mass Index with Metabolic Syndrome in American Adults: From the National Health and Nutrition Examination Survey, 2017-2020.

The purpose of this study is to examine the combined associations of physical activity and body mass index with the prevalence of metabolic syndrome in a population-based sample of American adults. Cross-sectional study. Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). A total of 2945 American adults who participated in the NHANES 2017-2020. Participants' physical activity levels were categorized based on the Physical Activity Guidelines for Americans. Metabolic syndrome was determined using the National Cholesterol Education Program Adult Treatment Panel III guidelines. The prevalence of metabolic syndrome among the various groups was analyzed using binary logistic regression to observe differences in the associated risks of developing metabolic syndrome. An increase in body mass index and a decrease in physical activity are both risk factors for metabolic syndrome. Statistical results show that the prevalence of metabolic syndrome in the obese and sedentary group is 22.31 times higher than that in the normal weight and active group (P = 0.000). A combination of at least 600 MET-minutes of physical activity per week and a lower body mass index is significantly associated with the lowest prevalence of metabolic syndrome.

STUDY OF SERUM URIC ACID LEVELS IN PATIENTS DIAGNOSED WITH METABOLIC SYNDROME IN A HOSPITAL-BASED STUDY IN WEST BENGAL

Objective: The occurrence of hyperuricemia is growing even in developing countries. It has been known to be associated with metabolic syndrome (MetS). MetS is a bunch of numerous metabolic disorders including reduced high-density lipoprotein cholesterol (HDL-C), hypertension, hyperglycemia, abdominal obesity, and raised triglyceride level in serum. Methods: The present work was done in the Department of Biochemistry in combination with Medicine Department, SRIMS and Sanaka Hospital, Durgapur, WB, India. A total of 50 diagnosed MetS patients were selected for further studies and same number (50) of healthy volunteers controls without MetS were selected. Diagnosis of MetS was done according to the National Cholesterol Education Program Adult Treatment Panel-III. Results: In our study, the level of serum uric acid (SUA) is high in MetS patients (7.8 mg/dL) compared to control group (4.6 mg/dL). The compared between two groups was statistically significant (p&lt;0.000). Conclusion: Our study showed that the components of MetS are increased with rise in the concentrations of SUA.

Metabolic Syndrome, Adipokines, and Response to Advanced Therapies in Rheumatoid Arthritis.

We determined if metabolic syndrome, its components, and adipokines (adiponectin, leptin, and fibroblast growth factor-21) were associated with response to advanced therapies among patients with rheumatoid arthritis (RA). This study included participants with RA initiating either tumor necrosis factor inhibitor (TNFi) or non-TNFi biologic therapies from the Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory Conditions (CERTAIN) cohort within the CorEvitas registry. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III definition. Adipokines were assessed on stored samples from a subsample of responders and nonresponders (n = 200). The primary outcome was the achievement of a change as large as the minimal clinically important difference (MCID) for the Clinical Disease Activity Index (CDAI) at 6 months. Among 2,368 participants, 687 (29%) had metabolic syndrome. Metabolic syndrome was associated with lower odds of achieving CDAI MCID (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.56-0.86, P = 0.001) with a dose-dependent decrease in response rate according to the number of components present. Model fit was superior for metabolic syndrome compared with body mass index. Associations between metabolic syndrome and MCID achievement were similar between patients receiving TNFi (OR 0.65, 95% CI 0.49-0.87, P = 0.003) versus non-TNF therapies (OR 0.76, 95% CI 0.55-1.04, P = 0.08 [P for interaction = 0.49]). Adipokines were not associated with MCID achievement. Metabolic syndrome is associated with lower response rates with the initiation of an advanced therapy in RA, with similar effects for both TNFi and non-TNFi agents. Adipokines were strongly associated with metabolic syndrome but were not associated with clinical response.

The Independent Association Between Changes in Physical Activity Participation Time and Dyslipidemia Risk

Background and AimThis study aimed to examine the independent association between changes in participation time across different types of physical activities and dyslipidemia. Methods and ResultsThe study utilized data from a large-scale cohort survey of Koreans, comprising a total of 2,543 participants recruited during 2011-2012 and 2013-2014. Physical activity participation times by type were assessed using validated questionnaires, and changes in these participation times over two years were categorized into four groups(Consistently Inactive, Formerly Active, Newly Active, and Consistently Active). Dyslipidemia was classified according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Multiple logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to assess the association between changes in physical activity participation times and dyslipidemia. The analysis revealed that, when adjusting for sex and age, the Consistently Active group had a 40% lower odds ratio (OR=0.60, 95% CI=0.45, 0.81) of dyslipidemia compared to the Consistently Inactive group. Similar results were observed after adjusting for various confounding factors. Also, being newly active(OR=0.75, 95% CI=0.58, 0.97) or consistently active(OR=0.63, 95% CI=0.41, 0.97) in moderate-intensity physical activity, as well as being consistently active(OR=0.76, 95% CI=0.61, 0.95), in walking, independently reduced the risk of dyslipidemia after adjusting for various confounding variables. ConclusionsMaintaining a high level of physical activity was associated with a reduced risk of dyslipidemia. Therefore, national recommendations should focus on sustaining and increasing physical activity levels to manage dyslipidemia effectively.

Periodontal Disease and Metabolic Syndrome in Women at Prior High Risk for Gestational Diabetes.

This study aimed to assess the association between periodontal disease and metabolic syndrome (MetS) among women at prior high risk for gestational diabetes with the hypothesis that women with MetS show more signs of periodontal disease than women without MetS. A total of 112 women from an original study cohort of 348 women at high risk of gestational diabetes were examined 4-6 years postpartum. Diagnosis of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. Insulin resistance was approximated by the homeostatic model assessment for insulin resistance. Full-mouth examinations and panoramic radiographs provided the total dental index, number of teeth, and decayed, missing, and filled teeth index. Clinical examination assessed bleeding on probing, probing depth, visible plaque index, signs of infection, and clinical attachment levels. The periodontal inflammatory burden index (PIBI) was also calculated. Information on oral health habits, symptoms, and individual opinions on oral health was collected through questionnaires. Five years after delivery, 21% of the women had MetS, and they had more gingivitis compared to those without MetS (bleeding on probing: 52% and 44%, p = 0.011). Women with MetS tended to have more periodontitis than those without (39% and 25%, p = 0.13). A high PIBI correlated with insulin resistance (partial correlation of PIBI and homeostatic model assessment for insulin resistance: 0.25 p < 0.05). Periodontal disease was associated with insulin resistance and MetS in women at prior high risk of developing gestational diabetes.

Associations between Metabolic Syndrome, Grip Strength, and Depressive Symptom among Community-Dwelling Older Adult: A Cross-Sectional Study

PURPOSE: This study aimed to investigate the influence of muscle strength on the association between metabolic syndrome and depressive symptoms in community-dwelling older adults.METHODS: A cross-sectional survey was conducted on 630 randomly selected community-dwelling older adults aged 65 years and older living in Suwon City. After excluding those younger than 65 years and those with mobility limitations or musculoskeletal disorders, 619 participants were included in the final analysis. The 15-item Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Metabolic syndrome (MetS) was defined based on the National Cholesterol Education Program Adults Treatment Panel III criteria, which included triglyceride (TG), reduced blood high-density lipoprotein (HDL), high blood pressure (BP), elevated fasting plasma glucose, and waist circumference (WC). A digital dynamometer was used to assess grip strength, and the maximum value was determined.RESULTS: Depressive symptoms were significantly associated with relative hand grip strength (RHGS). Specifically, when comparing groups based on the presence of MetS and RHGS levels, grip strength (RHGS) was confirmed to have an important mediating effect on depressive disorders. The following odds ratios (OR) were observed: normal RHGS with metabolic syndrome (OR: 1.859, 95% CI: 0.867-3.985, &lt;i&gt;p&lt;/i&gt;=.111), low RHGS without metabolic syndrome (OR: 3.613, 95% CI: 1.735-6.522, &lt;i&gt;p&lt;/i&gt;&lt;.001), and low RHGS with MetS (OR: 4.145, 95% CI: 1.687-10.188, &lt;i&gt;p&lt;/i&gt;=.002).CONCLUSIONS: Depression appears to have a strong correlation with MetS in adults aged 65 and older. Among the various factors associated with MetS, muscle strength has the closest and most significant association with depressive symptoms. Therefore, implementing strategies to improve muscle strength may be crucial in reducing the likelihood of depression in the elderly population.

The Occurrence of Metabolic Syndrome In Patients With Psoriasis

Objective: To determine occurrence of metabolic syndrome in patients of Psoriasis and to highlight any gender-based differences. Study Design: Cross-sectional study design. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi. Our research was conducted from July to December 2020 (6 months). Patients and Methods: A total of 80 patients diagnosed with psoriasis were selected using non-probability consecutive sampling. Informed written consent was obtained from each patient and a questionnaire was filled. Variables such as blood pressure, waist circumference, body surface area covered by psoriasis, and Psoriasis Area Severity Index were recorded on initial visit. Fasting blood sugar, serum triglyceride and HDL cholesterol levels were advised. Patients were diagnosed to have metabolic syndrome if 3 or more of the 5 criteria for the modified version of the National Cholesterol Education Program Adult Panel III were met. Results: There were 62 male &amp; 18 female patients. A total of 39 patients (48.8%) met the criteria for metabolic syndrome. Amongst these, 26/62(41.9%) males &amp; 13/18(72.2%) females fulfilled the criteria. The mean BMI of males was 26.0 and those of females was 28.3 &amp; their comparison demonstrated a noteworthy difference (p=0.04). A statistically significant (p=0.038) positive correlation (r) of 0.233 was observed between body surface area and BMI. Conclusion: Metabolic syndrome is seen frequently in patients of Psoriasis. Female patients have a significant frequency of metabolic syndrome and tend to have a higher BMI than males.

Metabolic syndrome among patients with type 2 diabetes in Jordan: A cross-sectional study.

Metabolic syndrome is a major public health problem worldwide and an independent predictor of cardiovascular disease in patients with type 2 diabetes (T2DM). This study aimed to determine the prevalence of metabolic syndrome and its individual components among Jordanian patients with T2DM. A cross-sectional design was conducted among T2DM patients at the National Center for Diabetes, Endocrinology and Genetics in Jordan. Data were collected using a structured questionnaire and clinical data extracted from medical records. The National Cholesterol Education Program-Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) diagnostic criteria were used to define metabolic syndrome. Among 1017 participants aged between 22 and 90 years, the overall prevalence of IDF defined metabolic syndrome was 84.2% (72.5% and 96.2% among males and females, respectively). Using ATP III criteria, overall prevalence was 79.1% (77.4% and 80.8% among males and females, respectively). Advancing age, female gender, nonadherence to a diet regimen, sedentary lifestyle or insufficient physical activity, and duration of diabetes ≥10 years were significantly associated with increased odds of metabolic syndrome, regardless of the definition used. Current smoking status and family history of cardiovascular diseases were significantly associated with increased likelihood of ATP III defined metabolic syndrome. The prevalence of metabolic syndrome among Jordanian patients with T2DM is extremely high. The main modifiable risk factors of metabolic syndrome among these patients include nonadherence to a diet regimen, insufficient physical activity, being overweight/obese and smoking. It is recommended that healthcare providers counsel patients on the importance of maintaining physical activity, smoking cessation, and adherence to a diet regimen.

Metabolic Phenotype and Risk of Obesity-Related Cancers in the Women's Health Initiative.

Body mass index (BMI) may misclassify obesity-related cancer (ORC) risk, as metabolic dysfunction can occur across BMI levels. We hypothesized that metabolic dysfunction at any BMI increases ORC risk compared with normal BMI without metabolic dysfunction. Postmenopausal women (n = 20,593) in the Women's Health Initiative with baseline metabolic dysfunction biomarkers [blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, fasting glucose, homeostatic model assessment for insulin resistance (HOMA-IR), and high-sensitive C-reactive protein (hs-CRP)] were included. Metabolic phenotype (metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese) was classified using four definitions of metabolic dysfunction: (i) Wildman criteria, (ii) National Cholesterol Education Program Adult Treatment Panel III, (iii) HOMA-IR, and (iv) hs-CRP. Multivariable Cox proportional hazards regression, with death as a competing risk, was used to assess the association between metabolic phenotype and ORC risk. After a median (IQR) follow-up duration of 21 (IQR, 15-22) years, 2,367 women developed an ORC. The risk of any ORC was elevated among metabolically unhealthy normal weight (HR = 1.12, 95% CI, 0.90-1.39), metabolically healthy overweight/obese (HR = 1.15, 95% CI, 1.00-1.32), and metabolically unhealthy overweight/obese (HR = 1.35, 95% CI, 1.18-1.54) individuals compared with metabolically healthy normal weight individuals using Wildman criteria. The results were similar using Adult Treatment Panel III criteria, hs-CRP alone, or HOMA-IR alone to define metabolic phenotype. Individuals with overweight or obesity with or without metabolic dysfunction were at higher risk of ORCs compared with metabolically healthy normal weight individuals. The magnitude of risk was greater among those with metabolic dysfunction, although the CIs of each category overlapped. Prevention Relevance: Recognizing metabolic dysfunction as a significant risk factor for ORCs underscores the importance of preventive measures targeting metabolic health improvement across all BMI categories.

Systemic immune-inflammation mediates the association between Klotho protein and metabolic syndrome: findings from a large-scale population-based study.

This study utilized large-scale population data from the National Health and Nutrition Examination Survey (NHANES) to elucidate the relationship between the Klotho protein and metabolic syndrome along with its components. We further investigated the possible mediating effect of inflammation on these relationships. Our objective was to identify biomarkers for risk stratification and potential therapeutic targets for metabolic syndrome. This study enrolled 13,119 participants aged 40-79 years, spanning five NHANES cycles from 2007 to 2016, with complete information on metabolic syndrome and the Klotho protein. The definition of metabolic syndrome followed the criteria of the National Cholesterol Education Program-Adult Treatment Panel III. Survey-weighted logistic regression and subgroup analysis were used to explore the associations between serum Klotho protein levels and metabolic syndrome, along with its components. Mediation analysis was performed to investigate the mediating effects of inflammation-related markers, including white blood cells, neutrophils, lymphocytes, monocytes, the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the systemic immune-inflammation index (SII) and the monocyte-to-HDL ratio (MHR), with the aim of elucidating how the Klotho protein influences the onset and progression of metabolic syndrome. The study participants had an average age of 56.06 years (95% CI: 55.76-56.37), with a Klotho protein concentration of 798.10 pg/ml (95% CI: 656.50-980.50) and a 43.77% prevalence of metabolic syndrome (n = 5742). In the crude model, Klotho was negatively correlated with metabolic syndrome and its components, including central obesity, hypertension, and hypertriglyceridemia. After adjusting for all confounding factors, Klotho was demonstrated to be negatively associated only with metabolic syndrome (OR: 0.82, 95% CI: 0.70-0.97), hypertension (OR: 0.83, 95% CI: 0.70-0.98), and hypertriglyceridemia (OR: 0.78, 95% CI: 0.67-0.91). Subgroup and interaction analyses revealed significant interactions between age, sex, race/ethnicity, body mass index, and Klotho. Additionally, mediation analysis demonstrated that leukocytes, neutrophils and monocytes accounted for 34.78%, 31.91% and 7.13%, respectively, of the associations between Klotho and metabolic syndrome. The serum concentration of Klotho protein was negatively associated with metabolic syndrome, with the relationship being partly mediated by systemic immune inflammation. The findings of this research revealed that the Klotho protein may be a valuable biomarker for risk stratification and a potential therapeutic target for metabolic syndrome.

Red cell distribution width/albumin ratio as a marker for metabolic syndrome: findings from a cross-sectional study

BackgroundMetabolic syndrome (MetS) imposes a significant health burden on patients globally. Chronic low-grade inflammation is pivotal in the onset and progression of this condition. However, the role of the novel inflammatory marker, red cell distribution width to albumin ratio (RAR), in the development of MetS remains unclear.MethodsThis population-based cross-sectional study utilized data from the 2011–2020 National Health and Nutrition Examination Survey (NHANES). Participants included individuals over 18 years old with complete data on serum albumin concentration, red cell distribution, and MetS and its components. MetS was defined using the criteria established by the National Cholesterol Education Program Adult Treatment Panel III. The calculation formula for RAR is: RAR = Red cell distribution width (%)/serum albumin (g/dL). Study participants were stratified into four quartiles based on RAR levels. Logistic regression analysis and subgroup analysis were employed to explore the independent interaction between RAR and MetS, as well as investigate the relationship between RAR levels and the specific components of MetS. Finally, the receiver operating characteristic (ROC) curve was used to assess the predictive efficacy of RAR for MetS.ResultsA total of 4899 participants were included in this study, comprising 2450 males and 2449 females; 1715 individuals (35.01%) were diagnosed with MetS. As the quartile of RAR increased, the proportion of individuals with MetS also increased. Spearman correlation analysis indicated a positive correlation between RAR and the insulin resistance index HOMA-IR. Logistic regression analysis, adjusting for multiple confounding factors, showed that each standard deviation increase in RAR was associated with a significant 1.665-fold increase (95% CI, 1.404–1.975; P < 0.001) in the odds of MetS prevalence. In logistic regression analysis stratified by quartiles of RAR, the risks of MetS in Q1-Q4 were 1.372 (95% CI, 1.105–1.704; P = 0.004), 1.783 (95% CI, 1.434–2.216; P < 0.001), and 2.173 (95% CI, 1.729–2.732; P < 0.001), respectively. Subgroup analyses and interaction tests demonstrated that gender, age, race, education, smoking status, and physical activity modified the positive association between RAR and MetS (p for interaction < 0.05). Additionally, analysis of the area under the receiver operating characteristic (ROC) curve showed that the optimal cutoff value for predicting MetS using RAR was 3.1348 (sensitivity: 59.9%; specificity: 60.6%; and AUC: 0.628).ConclusionsIncreasing RAR levels are associated with a higher risk of MetS. Therefore, greater attention should be given to patients with high RAR levels for improved prevention and treatment of MetS.

Associations of sarcopenia, obesity, and metabolic health with the risk of urinary incontinence in U.S. adult women: a population-based cross-sectional study.

Urinary incontinence (UI) significantly impairs women's quality of life. Identifying its risk factors is essential for developing effective interventions. Sarcopenia, characterized by the accelerated loss of muscle mass and function, is an emerging concern often linked to obesity and abnormal metabolic status, exacerbating various adverse health outcomes. This population-based study aimed to explore the independent and joint associations of sarcopenia, obesity, and metabolic health with UI risk, as well as to evaluate the mediating role of metabolic indicators in these associations. A total of 3,557 women aged ≥20 years from the National Health and Nutrition Examination Survey were included. Sarcopenia was assessed using the appendicular lean mass index (ALMI), and obesity was defined by body mass index and waist circumference. Metabolic health was evaluated using revised criteria from the National Cholesterol Education Program-Adult Treatment Panel III. UI was identified through responses to the "Kidney Conditions-Urology" questionnaire and classified into stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Multivariable logistic regression and restricted cubic spline models were used to evaluate the associations and visualize the relationship between ALMI and UI. Mediation models were constructed to assess the mediating role of metabolic indicators. We found that sarcopenia was significantly associated with an increased risk of MUI in the general population. Age-specific analysis revealed that sarcopenia is an independent risk factor for SUI in women aged ≥60, and for MUI in women aged 40-59 years. Sarcopenic obesity, particularly under central obesity criteria, further elevated the risk of UI. Notably, women with the metabolically unhealthy obese phenotype with sarcopenia were at the highest risk for both SUI and MUI. Metabolically unhealthy status, glycohemoglobin, vitamin D, and serum albumin levels were partial mediators of these associations. Our findings elucidated the complex interactions between sarcopenia, obesity, and metabolic health, underscoring the critical need for integrated therapeutic strategies that address both metabolic health and targeted nutritional interventions, aiming to enhance muscular health and effectively manage and prevent UI.

Associations of metabolic heterogeneity of obesity with the risk of dementia in middle-aged adults: three prospective studies

BackgroundThe associations of different obesity and metabolic phenotypes during midlife with the risk of incident dementia remain unclear. This study aimed to investigate the associations between metabolic heterogeneity of obesity and long-term risk of dementia.MethodsWe conducted prospective analyses from three cohorts, including the UK Biobank (UKB), Atherosclerosis Risk in Communities (ARIC) study, and Framingham Offspring Study (FOS). Eligible participants were those aged 45–65 years with valid assessments of body mass index (BMI) and metabolic status at the study baseline. Obesity was defined as a BMI of ≥ 30.0 kg/m2, while metabolic abnormality was defined as meeting ≥ 2 of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Metabolic heterogeneity of obesity was evaluated based on obesity and metabolic phenotypes and grouped as metabolically normal non-obesity (MNNO), metabolically abnormal non-obesity (MANO), metabolically normal obesity (MNO), and metabolically abnormal obesity (MAO).ResultsIncluded in this study were 295,823 participants aged 56.3 ± 5.9 years from the UKB, 12,547 participants aged 54.0 ± 5.7 years from the ARIC, and 2,004 participants aged 53.9 ± 5.9 years from the FOS. Over 4,348,208 person-years, a total of 6,190 participants (3,601 in the UKB, 2,405 in the ARIC, and 184 in the FOS) developed incident dementia. In the pooled analysis of three cohorts, metabolic abnormality was associated with a hazard ratio (HR) of 1.41 (95% confidence interval [CI]: 1.10–1.80) for dementia, while obesity was associated with an HR of 1.20 (1.03–1.41). Compared with MNNO, individuals with MANO and MAO had increased risks of dementia (pooled HR: 1.33, 95% CI: 1.04–1.71 for MANO and 1.48, 1.16–1.89 for MAO). However, there was no significant difference in the risk of dementia among MNO (pooled HR: 1.10, 95% CI: 0.98–1.24). In addition, participants who recovered from MANO to MNNO had a lower risk of dementia (pooled HR: 0.79, 95% CI: 0.64–0.97), as compared with stable MANO.ConclusionsMetabolic abnormality has a stronger association with dementia than obesity. Metabolically abnormal non-obesity and obesity, but not metabolically normal obesity, are associated with higher risks of incident dementia as compared with metabolically normal non-obesity. Recovering from an abnormal metabolic status to normal reduces the risk of dementia in populations without obesity. Our findings highlight the important role of metabolic status in the development of dementia and recommend the stratified management of obesity based on metabolic status.