Persistent Metabolic Syndrome Research Articles

IBC-Oxford University2023_BJSPoster_5In The Era of “Sleeve Revision”, What is The Perfect Algorithm?: Suggested Algorithm with Review of the literature

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is the mainstream treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, however it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome. Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Methods A systematic literature search was performed in PubMed, Embase and Cochrane library. Data were collected and analysed. Results Revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass (MGB), single anastomosis duodeno-ileal bypass (SADI) and transit bipartition. The overall revision rate was 10.4%, but for patients with ≥ 10-year follow-up, the rate was 22.6%. European studies had a higher revision rate (14.4%) than other studies. The most common reason for revision was failure in weight loss, and the most frequent revisional procedure was gastric bypass. Conclusion Reaching a clear algorithm for revisional bariatric surgery is still debated. However, we assume that it depends mainly on pre-revisional BMI and presence of GERD symptoms as follows: patients with BMI> 40 kg/m2 should receive Standard R-Y gastric bypass, those with BMI < 40 kg/m2 with GERD should have R-Y gastric bypass with long biliopancreatic limb or MGB with RY configuration. Patients with BMI < 40 kg/m2 without GERD may benefit from MGB or SADI

Abstract 6459: Developed and persistent dyslipidemia is associated with increased risk of gastric cancer in a prospective study

Abstract Background: Increasing evidence suggests that metabolic disorders are a risk factor for gastric cancer. However, there is a lack of evidence on whether changes and persistence of metabolic disorders affect the subsequent gastric cancer occurrence. Therefore, this study aimed to evaluate the effects of changes or persistence in metabolic syndrome and its components' status on the incidence of gastric cancer among Korean population. Methods: This study comprised 59,671 individuals from the Health Examinees Study who had baseline surveys from 2004 to 2012 and repeated measurements from 2012 to 2016; and were followed up until 2018. Metabolic syndrome and its components were defined according to the National Cholesterol Education Program Adult Treatment Panel III and modified based on Korean population criteria. Participants were categorized into free, developed, recovered, and persistent metabolic syndrome and its components. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for gastric cancer incidence using multivariable cox proportional hazard models with age as a time scale. Results: During the mean follow-up of 9.4 years, 312 subjects were newly diagnosed with gastric cancer. Compared with the metabolic syndrome-free group, the persistent group had a higher incidence of gastric cancer (HR 1.37, 95% CI 1.02-1.84). Among individual components, the developed-high triglycerides group had the highest gastric cancer incidence (HR 1.52, 95% CI 1.12-2.05), followed by the persistent group (HR 1.40, 95% CI 1.04-1.90) compared to the free group. The low HDL-cholesterol persistent group (HR 1.45, 95% CI 1.08-1.93) showed a higher incidence than in the free group. In the subgroup analysis, we found association between high triglycerides developed and gastric cancer in men, while for women, the associations were significant between high triglycerides and low HDL-cholesterol persistent groups and gastric cancer incidence. Conclusions: In this prospective cohort study, we found that developed or persistent dyslipidemia, assessed as abnormal triglycerides and low HDL-cholesterol, were associated with an increased incidence of gastric cancer. These findings suggest that effective management of dyslipidemia may reduce gastric cancer risk. Keywords: Gastric cancer, Dyslipidemia, Metabolic syndrome, Prospective cohort Citation Format: Dan Huang, Woo-Kyoung Shin, Katherine De la Torre, Sukhong Min, Aesun Shin, Jong-Koo Lee, Hyung-Ho Kim, Daehee Kang. Developed and persistent dyslipidemia is associated with increased risk of gastric cancer in a prospective study. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6459.

Persistent status of metabolic syndrome and risk of cholangiocarcinoma: A Korean nationwide population-based cohort study

ObjectiveIt is unknown whether persistent metabolic syndrome (MetS) is associated with an increased risk of cholangiocarcinoma (CCA). Therefore, we investigated the risk of CCA according to changes in MetS status. Research design and methodsThis nationwide cohort study included 8,581,407 adults who underwent anthropometric measurements and laboratory tests in two consecutive national health screenings during 2009–2012 and observed the subjects until 2017. Individuals with cancer, or follow-up duration <1 year were excluded (n = 377,915). Subjects were classified into the MetS-free, MetS-developed, MetS-improved, and MetS-persistent groups. The outcome was the incidence of CCA, identified using the claims database. Multivariable Cox proportional hazards regression models were used. ResultsAmong the 8,203,492 subjects (mean age 48.9 ± 12.8 years; 56.7% male), 7506 CCA patients were newly identified during a median follow-up of 5.1 years. The probability of CCA was consistently higher in the MetS-persistent group than in the MetS-free group (P < 0.001). MetS-persistent status was significantly associated with an increased risk of CCA compared with the MetS-free status (unadjusted hazard ratio [HR] 2.8, 95% confidence interval [CI] 2.66–2.95), even after adjusting for multiple covariates (adjusted HR 1.07, 95% CI 1.01–1.13). Improved or newly developed MetS was not associated with CCA risk in the fully adjusted model (aHR 1.02, 95% CI 0.94–1.10 and aHR 0.99, 95% CI 0.92–1.06, respectively). ConclusionsMetS was associated with an increased risk of CCA if it persisted for ≥2 years. Our finding suggests that MetS may be a potentially modifiable risk factor for CCA.

Cardiometabolic efficacy of multidisciplinary weight loss interventions is not altered in adolescents with obesity initially diagnosed or with a persistent metabolic syndrome

The efficacy of weight loss interventions might be affected by the metabolic profile of adolescents with obesity. In this study, we hypothesized that the initial diagnosis of the MS, or its persistence after an intervention, will not reduce the efficacy of a 16-week multidisciplinary weight loss program. Ninety two adolescents (12-15 years; 62 girls) with obesity completed baseline anthropometric and body composition evaluation (DXA). Lipid profile, insulinemia, glycaemia and blood pressure were measured and metabolic syndrome (MS) diagnosed. The adolescents then followed a 4-month inpatient multidisciplinary weight-management program. All measurements were performed before (T0) and after 4 months of intervention (T1). Body weight, body mass index (BMI) and percentage of fat mass (%FM) decreased significantly between T0 and T1 (P< .001), with no difference in fat-free mass (kg). All metabolic variables (except blood pressure) were improved. 47.6% of the whole sample presented with MS at baseline against 35.7% at T1. Body weight (P = 0.006), BMI (P = 0.0261), %FM (P = 0.0211), hip circumference (= 0.0131), BMI percentile (P = 0.0319), and diastolic blood pressure (P = 0.0365) showed a time x group interaction and their deltas (variations between T0 and T1) were significantly different between adolescents with and without MS at baseline. There was no significant difference between adolescents with persistent and nonpersistent MS except for ΔBMI percentile that deceased significantly more in the nonpersistent group (P = 0.0115). According to our results, the efficacy of weight loss interventions is not reduced in adolescents initially diagnosed with MS or different between those who present a persistent or nonpersistent MS after the intervention.

Glucose–insulin stabilization in type-1 diabetic patient: A uniform exact differentiator–based robust integral sliding mode control approach

Diabetes mellitus is a persistent metabolic syndrome caused by impaired capability of the body’s production and usage of insulin. This impaired capability results in chronic hyperglycaemia, the elevated glucose concentration in the bloodstream, which may lead to many incurable complications. To escape this dire situation, a proper model-based exogenous infusion of insulin bolus is required, which is usually established via different feedback control strategies. In this article, the authors present a mathematical model–based robust integral sliding mode control approach for stabilization of internal glucose–insulin regulatory system in type-1 diabetic patient. Since the state variables of the system are not directly available to the controller, a uniform exact differentiator observer is employed to accomplish the aforementioned task. In the proposed control law, the incorporation of integral term in the switching manifold eliminates the reaching phase, which causes the sliding mode to establish from the very initial point, thus enhances the robustness property of the proposed control scheme. Moreover, the chattering problem is also substantially suppressed to a considerable extent along a defined manifold. To verify the theoretical analysis, the proposed control law is verified via computer simulations which demonstrate the effectiveness of the proposed control law against the external perturbations, that is, unannounced meal intake and physical exercise.

Metabolic Syndrome After Preeclamptic Pregnancy: A Longitudinal Cohort Study.

History of preeclampsia increases the risk of cardiovascular disease in women. Most formerly, preeclamptic women have generally one or even more traditional cardiovascular and/or cardiometabolic risk factors consistent with metabolic syndrome in the first year after delivery. The objective of this study was to analyze the prevalence and persistence of risk factors contributing to metabolic syndrome for the course of years after preeclamptic pregnancy. In a longitudinally cohort study, 107 formerly preeclamptic women were assessed for traditional risk factors (insulin resistance, obesity, dyslipidemia, hypertension, and microalbuminuria) of metabolic syndrome (World Health Organization criteria) at two time points: at 3-30 months postpartum (visit 1) and 24-65 months later (visit 2). At visit 1, 10 of 107 (9%) formerly preeclamptic women had metabolic syndrome, and at visit 2, 14 of 107 (13%) (p = 0.21) had metabolic syndrome. Most formerly, preeclamptic women (90%) did not change their metabolic syndrome status over the years, as 7 of 107 (7%) women had persistent metabolic syndrome and 90 of 107 (84%) women did not meet the criteria for metabolic syndrome on either visit. In 3 of 107 (3%) formerly preeclamptic women, metabolic syndrome disappeared over time, whereas 7 of 107 (7%) preeclamptic women developed it. The presence or absence of metabolic syndrome remains unchanged in 90% of formerly preeclamptic women for the first years after preeclampsia. Only in 10% of women, metabolic syndrome developed or recovered, indicating that early screening within the first year postpartum in these women effectively detects those with metabolic syndrome who are known to be at increased risk for cardiovascular disease later in life.

Persistent metabolic syndrome and risk of cardiovascular disease in children and adolescents.

to verify persistence of metabolic syndrome (MetS) and components in overweight children and adolescents, as well as its relation to socioeconomic and demographic characteristics and to the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score. a two-point longitudinal study: at enrollment and after a 24-month interval, with 133 individuals ages from two to 18 years. The demographic anthropomorphic and blood variables were evaluated. Analysis was carried out by simple and paired association tests, as well as multiple logistic regression. persistent MetS was observed in 38.3% of the sample, associated cardiovascular risk (ACR) in 79.7%, reduction in arterial pressure and do HDL-c. After adjusting for age and sex, excess weight (ExpB: 0.182; CI: 0.059-0.561), low HDL-c (ExpB: 9.247; CI: 1.157-73.930) and high LDL-c (ExpB:1.915; CI: 0.921-3.979) were associated with persistent MetS. persistent MetS was associated with obesity, HDL-c and LDL-c, but not with the PDAY score.

Persistence of metabolic syndrome in children and adolescents are overweight according to two diagnostic criteria: a longitudinal study

Objective: To investigate the persistence of the metabolic syndrome (MS) in children and adolescents are overweight according to the diagnostic criteria of the World Health Organization (WHO) and National Cholesterol Education Panel Adult Treatment Program- III (NCEP / ATP III). Methods: A longitudinal study was conducted at the Center for Childhood Obesity between April/2009 and April/2012, involving 133 children and adolescents are overweight. The evaluation was made at first and after 24 months of follow up, anthropometry being performed, then the nutritional classification and diagnosis of MS which was subsequently divided into three groups: negative, intermittent and and persistent MS. Descriptive and agreement between the two criteria and also between groups analysis was performed using the Kappa index, using SPSS version 17.0 (95% CI). Results: Among those evaluated, the majority were female (60.9%), and adolescent with severe obesity. Among the components of metabolic syndrome, fasting glucose, blood pressure levels and insulin resistance were reduced in the period. There was no significant correlation between the diagnostic criteria, although it has seen significant coincidence in the group with persistent metabolic syndrome (p = 0.002). Conclusion: A significant similarity between the criteria of WHO and NCEP/ATPIII only in the group with persistent SM, demonstrating sensitivity of the tests, but the use of more specific markers for this age group it is necessary to identify the early SM.

Adiponectin Levels and Longitudinal Changes in Metabolic Syndrome: The Healthy Twin Study.

We investigated the association of plasma adiponectin levels with longitudinal changes in metabolic syndrome and the metabolic syndrome-related traits [insulin and homeostasis model assessment of insulin resistance (HOMA-IR)], as well as their genetic and environmental correlations. A total of 1030 Koreans (380 men and 650 women; 44.0 ± 12.7 years old) without diabetes of the Healthy Twin Study visited at baseline (2005-2010) and returned for a follow-up examination 3.7 ± 1.2 years later. Baseline plasma adiponectin, metabolic syndrome components [waist circumference (WC), glucose, blood pressure, high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs)] and metabolic syndrome-related traits were measured at baseline and follow-up. After adjusting for age, sex, smoking, alcohol consumption, physical activity, caloric intake, education level, body mass index (BMI), family history of diabetes, and changes in BMI, 1 standard deviation increment in baseline adiponectin levels was associated with 38-63% lower odds of incident and persistent metabolic syndrome. After additionally adjusting for the baseline levels of each trait, baseline adiponectin levels were inversely associated with WC, blood pressure, insulin, HOMA-IR, and TGs values at follow-up. After adjusting for age, sex, and baseline values of each trait or sum of metabolic syndrome components, baseline adiponectin levels exhibited significantly inverse genetic and environmental correlations with insulin, HOMA-IR, and HDL-C values and the sum of metabolic syndrome components at follow-up. High adiponectin levels reduce the risk of developing metabolic syndrome and having persistent metabolic syndrome and increase of metabolic syndrome-related traits over time. These associations may be explained by pleiotropic genetic mechanisms.

Metabolic Syndrome Over 10 Years and Cognitive Functioning in Late Midlife

OBJECTIVEEvidence that the metabolic syndrome is a risk factor for poor cognition is mixed and is focused mainly on the elderly population; rarely is an adjustment made for socioeconomic factors. We examined this association in late midlife, with particular focus on cumulative effects and the role of socioeconomic circumstances.RESEARCH DESIGN AND METHODSAnalyses were performed for 4,150 white participants from the Whitehall II study. Metabolic syndrome, using the National Cholesterol Education Program Adult Treatment Panel III criteria, was assessed three times over the 10-year follow-up (1991–2001). Cognitive function was assessed using a battery of six tests at the end of the follow-up.RESULTSAfter adjustment for demographic variables, health behaviors, and health status, participants with persistent metabolic syndrome (at least two of the three screenings) over the 10-year follow-up had lower cognitive performance than participants who never had metabolic syndrome. No significant differences in cognitive function were observed between participants with nonpersistent metabolic syndrome (one of the three screenings) and those who never had metabolic syndrome during the follow-up. Adjustment for adult occupational position attenuated this association by between 41 and 86%, depending on the measure of cognitive function. Adjustment for education had little effect.CONCLUSIONSOnly persistent metabolic syndrome was associated with lower cognitive performance in late midlife. Adult occupational position but not education had a substantial impact on this association; these results highlight the importance of adult socioeconomic circumstances in identifying and targeting risk factors for cognitive aging.

Persistence of the Metabolic Syndrome Over 3 Annual Visits in Overweight Hispanic Children: Association with Progressive Risk for Type 2 Diabetes

To examine an association between persistent metabolic syndrome (MetS) and the risk for type 2 diabetes in overweight Hispanic children. A total of 73 subjects (mean age, 11.0 +/- 1.7 years) from a longitudinal study were classified as Never (negative for MetS at all 3 annual visits), Intermittent (positive for MetS at 1 or 2 visits), or Persistent (positive for MetS at all 3 visits). Measures included dual-energy x-ray absorptiometry, magnetic resonance imaging, the 2-hour oral glucose tolerance test, and the frequently sampled intravenous glucose tolerance test. The Persistent group had a faster rate of fat mass gain than the Never group (20% vs 15% gain of baseline value; P < .05 for time *group interaction [time = visit]). Independent of body composition, the Persistent group increased by 70% in insulin incremental area under the curve, whereas the other groups decreased (P < .05 for time *group interaction). Despite no time *group interactions for insulin sensitivity, acute insulin response, or disposition index, the Persistent group maintained 43% lower insulin sensitivity (P < .01) and by visit 2 had a 25% lower disposition index (P < .05) compared with the Never group. Patients with persistent MetS had accelerated fat gain, increased insulin response to oral glucose, and decreased sensitivity and beta cell function, indicators of progressively greater risk for type 2 diabetes.

The Effects of Changes in the Metabolic Syndrome Detection Status on Arterial Stiffening: A Prospective Study

We conducted a prospective study to examine the effects of alterations of the metabolic syndrome detection status on the rate of progression of arterial stiffness, which is recognized as a marker of arterial damage and an indicator of cardiovascular risk. Brachial-ankle pulse wave velocity as an index of arterial stiffening was recorded twice over a 3-year period in 2080 Japanese men (age, 42 +/- 9 years). At the start of the prospective study, pulse wave velocity was higher in the subjects with metabolic syndrome (n=125) than in those without metabolic syndrome (n=1,955) even after adjusting for mean blood pressure. The annual rate of increase of the pulse wave velocity was higher in the group with persistent metabolic syndrome (27 +/- 51 cm/s/year, n=71) than in the group with regression of metabolic syndrome (6 +/- 39 cm/s/year, n=54) or the group in which metabolic syndrome was absent (13 +/- 37 cm/s/year, n=1843; p < 0.05) after adjustment for changes in blood pressure. In conclusion, the changes in the metabolic syndrome detection status of the subjects during the study period affected the annual rate of progression of arterial stiffening, and persistent metabolic syndrome during the study period was associated with acceleration of arterial stiffening in middle-aged Japanese men. On the other hand, resolution of metabolic syndrome may be associated with attenuation of the progression of arterial damage. Therefore, the increased cardiovascular risk associated with the presence of metabolic syndrome may be at least partly mediated by acceleration of the progression of arterial stiffening.

From Molecular Footprints of Disease to New Therapeutic Interventions in Diabetic Nephropathy

Proteins are particularly attractive targets for product analysis, which is used to understand pathology. Protein modifications, such as advanced glycation end products (AGEs), serve as footprints of biochemical processes and also help in the search for novel agents that efficiently inhibit protein damage. Interestingly, several medical agents that are used clinically interfere with oxidative protein damage through different mechanisms characteristic of their chemical structures. We recently found that angiotensin II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) lower the in vitro formation of the AGEs pentosidine and carboxymethyllysine. Their inhibition for AGE formation is more striking than aminoguanidine. Unlike aminoguanidine, ARBs and ACEIs do not trap reactive carbonyl precursors of AGEs. Rather, they inhibit AGE formation, possibly as a result of their potent ability to scavenge hydroxyl radicals and to chelate the transition metals necessary for the Fenton reaction. We tested their AGE-lowering ability in vivo in a unique type-2 diabetic model with nephropathic SHR/NDmcr-cp rats, which exhibits the metabolic syndrome (obesity, hyperglycemia, hyperlipidemia, hyperinsulinemia) in addition to hypertension. Obesity and associated metabolic derangements, in addition to hypertension, markedly accelerate renal injury. Expectedly, correction of hyperglycemia and hyperinsulinemia partially but significantly improves renal injury. A low-calorie diet greatly improves renal injury despite persistent hypertension. Among antihypertensive agents, ARBs, unlike nifedipine and atenolol, are renoprotective despite persistent metabolic syndrome, but their action is independent of blood pressure lowering and is observed in a dose-dependent manner despite the complete blockade of angiotensin II receptor. Interestingly, the improvement of renal injury by ARBs as well as a low-calorie diet is associated with a significant reduction in local oxidative stress and AGE formation in the kidney. During the characterization of the AGE-lowering profile of our chemical compound libraries ( approximately 2000), we identified several inhibitors of oxidative stress and advanced glycation. They are indeed renoprotective, independently of correction of hypertension and metabolic syndrome, in experimental diabetic nephropathy and other nephritis models. Altogether, our data are in good agreement with the recent therapeutic concept for diabetic nephropathy that multiple risk factor interventions are critical in the treatment of diabetic renal injury, and further implicate a therapeutic potential of inhibition of oxidative stress and advanced glycation.