Updated National Cholesterol Education Program Research Articles

RISK OF MAJOR ADVERSE CARDIAC EVENTS IN HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND METABOLIC SYNDROME: RESULTS OF A LONGITUDINAL COHORT STUDY

Objective: Obstructive sleep apnea (OSA) and metabolic syndrome (MS) may act synergistically and possibly accelerate the initiation and progression of cardiovascular events disease. We examined the joint effect of OSA and MS on the risk of major adverse cardiovascular events (MACE) in hypertensives in a Longitudinal cohort study. Design and method: We conducted a retrospective cohort study enrolling 3134 participants, no history of myocardial infarction (MI), coronary revascularization, unstable angina, and hospitalization for heart failure at baseline, from the Urumqi Research on Sleep Apnea and Hypertension study. An apnoea-hypopnoea index (AHI) of greater than or equal to 5 events per hour recorded by PSG was defined as the diagnostic criterion for OSA. MS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria (ATP III). The outcome was the composite of MACE, which included cardiac death, MI, coronary revascularization, unstable angina and hospitalization for heart failure. We divided participants into four groups for the primary exposure according to the presence/absence of OSA or MS. The Kaplan-Meier method helped to calculate the cumulative incidence of MACE in different groups. Cox proportional hazards regression models were used to evaluate the association of OSA and/or MS with the risk of MACE. Results: During a median follow-up period of 7.06 years (interquartile range: 6.18-8.08 years), 190 incident MACE were identified. Overall, after adjusting for confounding variables, participants with OSA and MS were associated with a 2.51-fold and 1.60-fold increased risk of MACE with corresponding HRs (95% CI) of 2.51 (1.01, 6.21) and 1.60 (1.10, 2.31), compared with participants without OSA and MS, and participants with OSA or MS, respectively. Similar results were obtained in various subgroup and sensitivity analyses. The combination of OSA and MS was associated with the highest risk of MACE among participants who in younger age, and have shorter duration of hypertension. Sensitivity analyses further validated our primary findings. Conclusions: Combination of OSA and MS in hypertension could significantly increase the risk of MACE, suggesting that recognition and treatment of OSA and MS may decrease the cardiovascular risk in hypertensives.

Prevalence of metabolic syndrome and its association with oral health: First results from the Kurdish cohort study.

Investigate the association between oral and dental health (ODH) and metabolic syndrome (MetS) in adults aged 35-70 years. The study utilized data from the enrollment phase of Dehgolan prospective cohort study in the west of Iran. A cross-sectional assessment was conducted on a total of 3996 participants, involving a comprehensive oral examination and the assessment of their oral hygiene behavior (ODH). MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III. Logistic regression used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics. MetS was more prevalent among those who not daily brushing and flossing. Participants with missing teeth (MT) show higher prevalent of MetS. Being female, lower age, illiteracy, family history of diabetes, low physical activity, and salt at table were independently associated with increase odds of MetS (p < 0.05). Odds of MetS were significantly decreased with use flossing (OR = 0.75; CI = 0.60-0.93), decayed (OR = 0.83; CI = 0.72-0.97), filled (OR = 0.84; CI = 0.71-0.99), and increased with MT (OR = 1.45; CI = 1.16-1.81) as long as adjusted for ODH factors. When other potential confounder such as sociodemographic, personal and nutritional habits were adjusted, daily flossing was the only factor that still statistically decreased (OR = 0.79; CI = 0.62-0.99) the odds of MetS. Daily flossing was the only factor that independently associated with MetS. Relationship of other ODH factors with Mets were confounded by sociodemographic characteristics of the participants.

1158-P: The Effect of Surgical Weight Loss on Diabetic Complications in the Severely Obese

The aim of this study was to determine the effect of surgical weight loss on chronic kidney disease (CKD) , retinopathy, and cardiovascular autonomic neuropathy (CAN) in people with severe obesity. We completed a prospective cohort study of participants with severe obesity who underwent bariatric surgery. At baseline and at 2 years following bariatric surgery, participants had outcome measurements and underwent metabolic phenotyping. The updated National Cholesterol Education Program (NCEP) criteria were used to define the metabolic syndrome (MetS) and its individual components. The primary outcome for CKD was the estimated Glomerular Filtration Rate (eGFR) , retinopathy was mean deviation on frequency doubling technology testing, and CAN was the expiration/inspiration (E/I) ratio. Among 138 baseline participants, 80 (mean (standard deviation) age: 45.6 (11.2) years, 72.5% female) completed 2 years of follow-up. Participants lost 31.9 (17.5) kg. All metabolic syndrome components improved with the exception of blood pressure. CKD worsened (eGFR: baseline: 85.6 (19.7) , 2-year: 82.6 (23.1) , p=0.04) , retinopathy was stable (mean deviation: baseline: −1.2 (4.3) , 2-year: −1.6 (4.2) , p=0.53) , and CAN was stable (E/I ratio: baseline: 1.18 (0.12) , 2-year: 1.18 (0.11) , p=0.95) following bariatric surgery. Greater reduction in fasting glucose was associated with significant improvements to primary CKD (eGFR: point estimate (PE) : -0.22, 95% Confidence Interval (CI) : −0.38, −0.06) and retinopathy (mean deviation: PE: -0.04, 95%CI: −0.08, −0.004) , after adjusting for age, sex, and baseline BMI. Surgical weight loss was associated with improvements in all metabolic parameters except blood pressure. Despite the improvement to metabolic risk factors, CKD significantly worsened during follow-up, whereas retinopathy and CAN outcomes remained stable. This stability may be an improvement compared to the natural progression of these conditions, however controlled trials are needed to confirm. Disclosure E.L.Reynolds: None. M.Watanabe: None. M.Elafros: None. E.L.Feldman: None. B.C.Callaghan: None. Funding The project described was supported by Grant Number P30DK020572 (MDRC) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) . Dr. Callaghan is currently funded by a NIH NIDDK R-award (DK115687) . Dr. Reynolds was supported by NIH T32 (NS0007222) . Dr. Feldman was supported by an NIH NIDDK DP3 award (DK094292) and is currently funded by NIH NIDDK (R24082841 and R21 NS102924) and the Novo Nordisk Foundation Center for Basic Metabolic Research (NNF14°C0011633) . Dr. Reynolds, Dr. Callaghan, and Dr. Feldman receive support from the NeuroNetwork for Emerging Therapies and the A. Alfred Taubman Research Institute at the University of Michigan.

Clinical investigation of lipopolysaccharide in the persistence of metabolic syndrome (MS) through the activation of GRP78-IRE1α-ASK1 signaling pathway.

Endoplasmic reticulum stress (ERS) might play a pivotal role in the persistence of metabolic syndrome (MS). Lipopolysaccharide (LPS) derived from various gram-negative bacteria could result in the ERS. Therefore, we aimed to investigate the association between LPS and ERS in MS. We enrolled 86 patients with MS and 42 healthy people aged 35-65years. Body weight, waist circumference, blood pressure were measured. LPS, LBP and inflammation factors, fasting plasma glucose (FPG), insulin, total cholesterol (TC), triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), free fatty acid (FFA) were analyzed in blood plasma of patient's cohort. Body mass index (BMI) and HOMA-IR were calculated. The mRNA and protein expression of ERS GRP78, IRE1α, ASK1 and IKKβ, JNK1 were measured in blood plasma of patient's cohort by RT-PCR and Elisa. MS was defined by the updated National Cholesterol Education Program Adult Treatment Panel III criterion for Asian Americans. BMI, waist circumference, blood pressure, FPG, insulin, HOMA-IR, TC, triglyceride, HDL-C, LDL-C, FFA and LPS, LBP, TNF-α, CRP, IL-1, IL-6, MCP-1 were significantly higher in patients with MS than healthy people (P < 0.001). The correlation analysis suggested that LPS were associated with TNF-α, IL-1, IL-6, MCP-1, LBP, FFA, HOMA-IR potently (P < 0.05). The marker gene and protein expressions of ERS (GRP78, IRE1α, ASK1, IKKβ and JNK) were significantly overexpressed in patients with MS and were positive correlation with LPS (P < 0.05). LPS may play an important role in mediating chronic low-grade inflammation by activating the ERS GRP78-IRE1α-ASK1 signaling pathway, contributing to the persistence of MS.

Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus.

BackgroundBoth type 1 diabetes mellitus (T1DM) and metabolic syndrome (MetS) are associated with an elevated risk of morbidity and mortality yet with increasing heterogeneity. This study primarily aimed to evaluate the prevalence of MetS among adult patients with T1DM in China and investigate its associated risk factors, and relationship with microvascular complications.MethodsWe included adult patients who had been enrolled in the Guangdong T1DM Translational Medicine Study conducted from June 2010 to June 2015. MetS was defined according to the updated National Cholesterol Education Program criterion. Logistic regression models were used to estimate the odds ratio (OR) for the association between MetS and the risk of diabetic kidney disease (DKD) and diabetic retinopathy (DR).ResultsAmong the 569 eligible patients enrolled, the prevalence of MetS was 15.1%. While female gender, longer diabetes duration, higher body mass index, and glycosylated hemoglobin A1c (HbA1c) were risk factors associated with MetS (OR, 2.86, 1.04, 1.14, and 1.23, respectively), received nutrition therapy education was a protective factor (OR, 0.46). After adjustment for gender, age, diabetes duration, HbA1c, socioeconomic and lifestyle variables, MetS status was associated with an increased risk of DKD and DR (OR, 2.14 and 3.72, respectively; both P<0.05).ConclusionAlthough the prevalence of MetS in adult patients with T1DM in China was relatively low, patients with MetS were more likely to have DKD and DR. A comprehensive management including lifestyle modification might reduce their risk of microvascular complications in adults with T1DM.

Plasma glycerophospholipid profile, erythrocyte n–3 PUFAs, and metabolic syndrome incidence: a prospective study in Chinese men and women

Animal studies have highlighted critical roles of glycerophospholipid (GP) metabolism in various metabolic syndrome (MetS)-related features such as dyslipidemia, obesity, and insulin resistance. However, human prospective studies of associations between circulating GPs and risks of MetS are scarce. We aimed to investigate whether GPs are associated with incidence of MetS in a well-established cohort. A total of 1243 community-dwelling Chinese aged 50-70 y without MetS at baseline and followed up for 6 y were included in current analyses. A total of 145 plasma GPs were quantified by high-throughput targeted lipidomics. MetS was defined using the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. After 6 y, 429 participants developed MetS. Eleven GPs, especially those with long-chain polyunsaturated fatty acids (LCPUFAs) or very-long-chain polyunsaturated fatty acids (VLCPUFAs) at the sn-2 position, including 1 phosphatidylcholine (PC) [PC(18:0/22:6)], 9 phosphatidylethanolamines (PEs) [PE(16:0/22:6), PE(18:0/14:0), PE(18:0/18:1), PE(18:0/18:2), PE(18:0/20:3), PE(18:0/22:5), PE(18:0/22:6), PE(18:1/22:6), and PE(18:2/22:6)], and 1 phosphatidylserine (PS) [PS(18:0/18:0)], were positively associated with incident MetS (RRs: 1.16-1.30 per SD change; Bonferroni-corrected P<0.05). In network analysis, the strongest positive association for MetS incidence was evidenced in a module mainly composed of PEs containing C22:6 and PSs [RR: 1.21; 95% CI: 1.12, 1.31 per SD change; Bonferroni-corrected P<0.05]. This association was more pronounced in participants with lower erythrocyte total n-3 PUFA concentrations [Bonferroni-corrected Pinter(P value for the interaction)<0.05]. Elevated plasma concentrations of GPs, especially PEs with LCPUFAs or VLCPUFAs at the sn-2 position, are associated with higher risk of incident MetS. Future studies are merited to confirm our findings.

The determinants of complication trajectories in American Indians with type 2 diabetes.

BACKGROUNDWe aimed to determine whether metabolic syndrome (MetS) affects longitudinal trajectories of diabetic complications, including neuropathy, cardiovascular autonomic neuropathy (CAN), and kidney disease in American Indians with type 2 diabetes.METHODSWe performed a prospective study where participants underwent annual metabolic phenotyping and outcome measurements. The updated National Cholesterol Education Program criteria were used to define MetS and its individual components, using BMI instead of waist circumference. Neuropathy was defined using the Michigan Neuropathy Screening Instrument index, CAN with the expiration/inspiration ratio, and kidney disease with glomerular filtration rate. Mixed-effects models were used to evaluate associations between MetS and these outcomes.RESULTSWe enrolled 141 participants: 73.1% female, a mean (±SD) age of 49.8 (12.3), and a diabetes duration of 19.6 years (9.7 years) who were followed for a mean of 3.1 years (1.7 years). MetS components were stable during follow-up except for declining obesity and cholesterol. Neuropathy (point estimate [PE]: 0.30, 95% CI: 0.24, 0.35) and kidney disease (PE: –14.2, 95% CI: –16.8, –11.4) worsened over time, but CAN did not (PE: –0.002, 95% CI: –0.006, 0.002). We found a significant interaction between the number of MetS components and time for neuropathy (PE: 0.05, 95% CI: 0.01–0.10) but not CAN (PE: –0.003, 95% CI: –0.007, 0.001) or kidney disease (PE: –0.69, 95% CI: –3.16, 1.76). Systolic blood pressure (SBP, unit = 10 mmHg) was associated with each complication: neuropathy (PE: 0.23, 95% CI: 0.07, 0.39), CAN (PE: –0.02, 95% CI: –0.03, –0.02), and kidney disease (PE: –10.2, 95% CI: –15.4, –5.1).CONCLUSIONIn participants with longstanding diabetes, neuropathy and kidney disease worsened during follow-up, despite stable to improving MetS components, suggesting that early metabolic intervention is necessary to prevent complications in such patients. Additionally, the number of MetS components was associated with an increased rate of neuropathy progression, and SBP was associated with each complication.FUNDINGThe following are funding sources: NIH T32NS0007222, NIH R24DK082841, NIH R21NS102924, NIH R01DK115687, the Intramural Program of the NIDDK, the NeuroNetwork for Emerging Therapies, the Robert and Katherine Jacobs Environmental Health Initiative, the Robert E. Nederlander Sr. Program for Alzheimer’s Research, and the Sinai Medical Staff Foundation.TRIAL REGISTRATIONClinicalTrials.gov, NCT00340678.

Incidence of the Metabolic Syndrome among Patients with Epilepsy Attending a Neuropsychiatric Hospital in Kigali, Rwanda

Background &amp; Aims: Metabolic syndrome (MetS), a combination of diverse metabolic disorders (hypertension, diabetes mellitus, high triglycerides, increased waist circumference, and low high density cholesterol, HDLc), is a well known public health problem worldwide, and its prevalence is increasing dramatically. MetS is a confirmed great risk factor for cardiovascular diseases. Presently, limited information exists about incidence and the risk factors associated with metabolic syndrome (MetS) in patients with epilepsy. We prospectively estimated the incidence of MetS in patients with epilepsy. Methods: We recruited 322 participants, 161 patients with epilepsy and 161 healthy volunteers all of them free of any MetS criteria at the baseline and followed-up them for one year. New onset cases of MetS were defined according to the updated National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) criteria. Results: Over a 1-year follow-up, we observed 8 incident cases of MetS (7 individuals in patients group and 1 individual in control group) resulting in an annual cumulative incidence rate of 2.5%. We observed 9 cases losses to follow up. Patients with epilepsy presented a higher risk of developing MetS (RR=7.00, 95% CI: 0.891 – 1.67, p=0.032) than in control group. Sedentariness was associated with higher risk for MetS (hazard ratio, HR=6.537, 95%; confidence interval, C.I=1.269-33.685, p value =0.025. Conclusion: Anti-epileptic therapy combined with sedentariness increases the risk of developing MetS among patients with epilepsy. Holistic clinical management of patients with epilepsy will significantly contribute to MetS prevention.

The metabolic drivers of neuropathy in India

AimsTo determine the association between the metabolic syndrome (MetS) and neuropathy in Chennai, India. MethodsWe recruited participants attending the M.V. Hospital for Diabetes. Neuropathy was defined using the Michigan Neuropathy Screening Instrument combined index and MetS was defined using the updated National Cholesterol Education Program criteria. Multivariable logistic regression models were used to assess the associations between individual metabolic components and neuropathy. ResultsOf the 652 participants (42% female and mean (SD) age of 45.5 (9.7)) included in the study, the prevalence of neuropathy was 9.8%. Neuropathy prevalence increased with worsening glycemic status (p < 0.01), but not as the number of MetS components increased (p = 0.12). Among normoglycemic participants, an increasing neuropathy trend was observed as the number of MetS components increased (p = 0.04). Multivariable logistic regression found that diabetes (OR:3.41,1.28–9.11) was associated with neuropathy, but waist circumference was not (OR:1.002,0.88–1.14). ConclusionsSimilar to previous studies, diabetes was the most important metabolic risk factor for neuropathy in a population from Chennai, India. In contrast to other population-based studies, waist circumference was not associated with neuropathy. Whether the distribution of obesity affects nerves differently in Indian populations requires future studies with more precise anthropometric measures.

Erythrocyte Membrane Polyunsaturated Fatty Acids Are Associated with Incidence of Metabolic Syndrome in Middle-Aged and Elderly People–An 8.8-Year Prospective Study

Background:The total and specific types of polyunsaturated fatty acids (PUFAs) related to metabolic syndrome (MetS) remain inconsistent. Objective:We assessed the association of erythrocyte n–3 and n–6 PUFAs with MetS and the components of MetS in a cohort population. Methods:This prospective analysis included 2754 participants (aged 40–75 y) from the Guangzhou Nutrition and Health Study (2008–2019) in China. Erythrocyte PUFAs at baseline were measured using gas chromatography. MetS was assessed every 3 y according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariable Cox proportional hazard models were used to evaluate HRs and 95% CIs. Results:We identified 716 incident cases of MetS. The primary analyses showed that the HRs (95% CIs) of MetS (tertile 3 versus 1) were 0.67 (0.56, 0.80) for n–3 PUFAs and 0.70 (0.58, 0.85) for n–6 PUFAs (all Ps trend <0.001). The secondary outcomes showed that, higher erythrocyte very-long-chain (VLC) PUFAs [20:3n–3, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), arachidonic acid (ARA), and 22:4n–6], but lower α-linolenic acid (ALA) and α-linolenic acid (GLA), tended to be associated with lower incidences of MetS and its components; among individual MetS components, the associations of PUFAs were more pronounced for hypertriglyceridemia (HTG) and hypertension, followed by low high-density lipoproten (HDL) cholesterol. Significantly higher concentrations of n–3 PUFAs (total, DPA, and DHA) and n–6 PUFAs (total, ARA, and 22:4) were observed in participants with improved (versus progressed) status of MetS (all Ps trend ≤0.003). Conclusion:This study reveals that higher erythrocyte VLC n–3 and n–6 PUFAs, but lower 18-carbon PUFAs (ALA and GLA), are associated with lower risks of MetS components (HTG, hypertension, and low HDL cholesterol) and thereby lower MetS incidence in Chinese adults.

532-P: The Longitudinal Determinants of Diabetic Complications in the Pima Indians of Arizona

The 5 components of the metabolic syndrome (MetS) increase the likelihood of developing diabetes, heart disease, and stroke, but their association with neuropathy and diabetic kidney disease (DKD) is less understood. We examined the longitudinal association between the components of the updated National Cholesterol Education Program criteria for MetS, neuropathy and DKD in Pima Indians with type 2 diabetes, after substituting BMI for waist circumference. The primary outcome for neuropathy was the Michigan Neuropathy Screening Instrument index, for cardiovascular autonomic neuropathy (CAN) was the expiration/inspiration ratio, and for DKD was the Glomerular Filtration Rate. At baseline and during annual follow-up exams, participants underwent metabolic phenotyping and outcome measurements. Linear mixed effects models with a random patient effect were used to evaluate the associations between the number of MetS components and neuropathy, CAN, and DKD outcomes. We also examined mixed models for each outcome with individual MetS components. Between 11/1/2013 and 7/1/2019, we studied 141 Pima Indian subjects, who were followed an average of 3.2 years. The mixed effects models revealed a significant interaction between the number of MetS components and follow-up time for neuropathy (point estimate (PE): 0.07, CI: 0.02-0.11), indicating that the rate of neuropathy increases as the number of MetS components increases. Additionally, we found that neuropathy (year PE: 0.30, CI: 0.24,0.35) and DKD (PE: -14.2, CI: -16.8,-11.4), worsened over time, but CAN did not. The mixed models with individual MetS components revealed SBP was associated with each complication: neuropathy (PE: 0.23, CI: 0.07,0.39), CAN (PE: -0.02, CI: -0.03,-0.02) and DKD (PE: -10.2, CI: -15.4,-5.1). Neuropathy progression was the complication most affected by the number of MetS components. Neuropathy and DKD worsened during follow-up, emphasizing how quickly these complications can change within this population. Disclosure E.L. Reynolds: None. R.G. Nelson: None. G. Akinci: Advisory Panel; Spouse/Partner; Aegerion Pharmaceuticals, Regeneron Pharmaceuticals. Speaker’s Bureau; Spouse/Partner; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Servier. R. Henn: None. A. Patterson: None. E.L. Feldman: Consultant; Self; Novartis Pharmaceuticals Corporation. B.C. Callaghan: None. Funding National Institutes of Health (R24DK082841, T32NS0007222, R01DK115687); Program for Neurology Research &amp; Discovery; Robert and Katherine Jacobs Environmental Health Initiative; Robert E. Nederlander, Sr. Program for Alzheimer’s Research; Sinai Medical Staff Foundation

Small dense LDL cholesterol is associated with metabolic syndrome traits independently of obesity and inflammation

BackgroundSmall dense LDL cholesterol (sdLDL-c) has been established to be highly associated with metabolic disorder. However, the relationship between circulating sdLDL-c and the presence of metabolic syndrome (MetS) has not been fully established.MethodsA total of 1065 Chinese males (45.07 ± 11.08 years old) without diabetes and general obesity was recruited into a population-based, cross-sectional study. The MetS was defined based on the updated National Cholesterol Education Program/ Adult Treatment Panel III criteria for Asian Americans. Serum sdLDL-c concentration was measured by a homogeneous assay method and its relationship with MetS and its traits was investigated.ResultsSerum sdLDL-c concentrations increased gradually with increasing numbers of MetS components (p < 0.001) and the proportion of patients with MetS increased gradually with increasing sdLDL-c levels (p for trend< 0.001). For the second, third, and fourth sdLDL-c quartiles versus the first, the OR (95% CI) for MetS were 4.47(2.41,8.28), 5.47(2.97,10.07) and 8.39(4.58,15.38) (p < 0.001 for trend) after multivariate adjustment. The stratified analysis conducted according to LDL-c levels showed that the OR between serum sdLDL-c levels and MetS was greater in those LDL-c levels lower than 3.3 mmol/L (OR = 22.97; 95% CI, 7.64–69.09) than in those LDL-c levels higher than 3.3 mmol/L (OR = 17.49; 95% CI, 4.43–68.98). Mediation analysis showed sdLDL-c mediated 38.6% of the association of waist circumference with triglycerides, while the association between sdLDL-c and MetS components did not mediate by hsCRP.ConclusionsThis study found that high sdLDL-c concentrations were associated with the presence of MetS independently of central obesity and inflammation.

Equation‐derived body fat percentage indicates metabolic abnormalities among normal‐weight adults in a rural Chinese population

Obesity classification using body mass index (BMI) may miss subjects with elevated body fat percentage (BF%) and related metabolic risk factors. We aimed to evaluate whether BF% calculated by equations could provide more information about metabolic risks, in addition to BMI classification, in a cross-sectional rural Chinese population. A total of 2,990 men and women aged 18-80 years were included in this study. BF% was calculated using previously validated Chinese-specific equations. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Panel III criteria for Asian Americans. In total, 33.6% men and 32.9% women were overweight/obese according to BMI classification. Among those within the normal BMI range, 25.4% men and 54.7% women were indicated as overweight or obese given their elevated BF% (men: BF% ≥ 20%; women: BF% ≥ 30%). In both men and women, compared with those with normal BMI and BF% (NBB), subjects with normal BMI but elevated BF% (NBOB) were more likely to carry abnormal serum lipid profile and to have higher risks of metabolic syndrome. The multivariable adjusted odds ratios (95% confidence intervals) for metabolic syndrome were 5.45 (2.37-9.53, P < 0.001) and 5.65 (3.36-9.52, P < 0.001) for men and women, respectively. Moreover, the women with NBOB also showed higher blood pressure and serum uric acid than women with NBB. Our study suggested that high BF% based on equations may indicate adverse metabolic profiles among rural Chinese adults with a normal BMI.

Metabolic syndrome and osteoporotic fracture: a population-based study in China.

BackgroundAssociations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether metabolic syndrome associates with osteoporotic fracture.MethodsThis was a cross-sectional study of 9930 Chinese adults aged 40 year or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 years prior to the study.ResultsAmong women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, P =0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P =0.737). The presence of Mets was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12–1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men.ConclusionsThe presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0106-x) contains supplementary material, which is available to authorized users.

Comparisons of different metabolic syndrome definitions and associations with coronary heart disease, stroke, and peripheral arterial disease in a rural Chinese population.

ObjectivesWe estimated the prevalence of metabolic syndrome (MetS) and compared associations of different MetS definitions with coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) in a rural Chinese population.MethodsAmong 4,748 residents (2,145 men and 2,603 women) aged 30+ years in rural China from 2006 to 2007, the prevalence of MetS was estimated by using five different definitions: modified World Health Organization (WHO), Chinese Diabetes Society (CDS), the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) for Asian-Americans, International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Multivariable logistic regression analyses were implemented to estimate the association between MetS and the prevalence of CHD, stroke and PAD, respectively.ResultsPrevalence of MetS in men was 11.5% (WHO), 14.8% (CDS), 32.4% (NCEP-ATP III), 27.5% (IDF) and 39.7% (JIS) and in women was 15.7% (WHO), 20.7% (CDS), 54.2% (NCEP-ATP III), 51.5% (IDF) and 54.2% (JIS), respectively. Respective ORs (95% CI) for associating MetS with CHD in men were 1.79 (1.02-3.17), 1.25 (0.69-2.26), 1.61 (1.01-2.58), 1.84 (1.14-2.96), and 1.53 (0.96-2.43). Corresponding ORs (95% CI) for stroke in men were 2.18 (95% CI 1.20 to 3.97), 2.20 (95% CI 1.25 to 3.89), 1.71 (95% CI 1.02 to 2.84), 1.30 (95% CI 0.77 to 2.23), and 1.61 (95% CI 0.97 to 2.68), respectively. In women, CHD and stroke were significantly associated with MetS using all five definitions of MetS. In addition, PAD was associated with all five MetS definitions in men, but not in women. Only hyperglycemia and BMI were significantly associated with PAD in women.ConclusionsIn this rural Chinese population, the JIS, IDF and CDS criteria may not be more suitable than WHO and updated NCEP-ATPIII definitions for screening high-risk individuals and estimating the risk of CHD and stroke from MetS, especially in men.

Lipid-lowering therapy in older persons.

Numerous randomized, double-blind, placebo-controlled studies and observational studies have shown that statins reduce mortality and major cardiovascular events in older high-risk persons with hypercholesterolemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk persons regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education Program III guidelines state that in very high-risk persons, a serum low-density lipoprotein (LDL) cholesterol level of < 70 mg/dl (1.8 mmol/l) is a reasonable clinical strategy for moderately high-risk persons (2 or more risk factors and a 10-year risk for coronary artery disease of 10% to 20%), and the serum LDL cholesterol should be reduced to < 100 mg/dl (2.6 mmol/l). When LDL cholesterol-lowering drug therapy is used to treat high-risk persons or moderately high-risk persons, the serum LDL cholesterol should be reduced by at least 30% to 40%. The serum LDL cholesterol should be decreased to less than 160 mg/dl in persons at low risk for cardiovascular disease. Addition of other lipid-lowering drugs to statin therapy has not been demonstrated to further reduce cardiovascular events and mortality.

Association between metabolic syndrome and osteoporotic fracture in middle-aged and elderly Chinese peoples.

Associations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether MetS associates with osteoporotic fracture. This was a cross-sectional study of 9,930 Chinese adults aged 40 years or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low trauma in 2 years prior to the study. Among women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, = 0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P = 0.737). The presence of MetS was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12-1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men. The presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women.

Association between hepatitis B virus infection and metabolic syndrome: a retrospective cohort study in Shanghai, China.

BackgroundMetabolic syndrome (MS) and hepatitis B (HBV) infection are two major public health problems in China. There are few studies about their association, and the results of these studies are contradictory. We conducted a retrospective cohort study to assess the association between MS and HBV in a Shanghai community-based cohort.MethodsNine hundred seventy-six Shanghai residents were recruited from the Putuo community. 480 HBV infections were in exposed group and 496 non-infections in unexposed group. All metabolic-related parameters and hepatitis B serology were tested with routine biochemical or immunological methods. “Exposed” was defined by HBV infection represented by hepatitis B surface antigen (HBsAg) and without anti-virus treatment. “Unexposed” were subjects who didn’t infect with HBV (Represented by HBsAg) and no MS when they entered the cohort. MS was defined based on the updated National Cholesterol Education Program Adult Treatment Panel III criteria. The Cox proportional hazards model was used to estimate the hazard ratios (HR) and related 95% confidence intervals (95% CI) for the association between HBV infection and MS over a 20-year follow-up period.ResultsOf 976 subjects recruited, 480 had latent HBV infection (exposed subjects). After adjusting for age, the crude HR was 2.46 (95% CI: 1.77, 3.41). After adjusting for potential risk factors of MS (age, gender, smoking, passive smoking, alcohol consumption, physical activity, and diet), the HR was 2.27 (95% CI: 1.52, 3.38).ConclusionsThis 20-year follow-up retrospective cohort study in Shanghai showed a positive association between HBV infection and MS.

Association between metabolic syndrome and white matter lesions in middle‐aged and elderly patients

Metabolic syndrome (MetS) has been reported to be associated with silent lacunar infarction, which is highly related to white matter lesions (WMLs). However, little is known about the relationship between MetS and the prevalence of WMLs. The association between MetS, its components and WMLs in middle-aged and elderly patients was investigated. Consecutive patients aged 50years and older were prospectively enrolled in this study. All participants underwent magnetic resonance imaging scans to assess the presence and severity of WMLs. The MetS was defined according to the updated National Cholesterol Education Program's Adult Treatment Panel III criteria. Multivariate logistic regression analyses were performed to examine the relationship between MetS, its components and WMLs. A total of 852 patients were enrolled in the study. MetS was present in 38.4%. MetS was associated with an increased risk of periventricular WMLs (PVWMLs) and deep WMLs (DWMLs) after multivariable adjustment (odds ratio 3.21, 95% confidence interval 2.26-4.55 for PVWMLs; odds ratio 2.93, 95% confidence interval 2.09-4.09 for DWMLs). Amongst MetS components, elevated blood pressure, elevated fasting blood glucose and low high density lipoprotein cholesterol were associated with PVWMLs, whilst elevated blood pressure and low high density lipoprotein cholesterol were related to DWMLs. Our findings demonstrate that MetS is associated with the prevalence of PVWMLs and DWMLs independent of other risk factors in middle-aged and elderly patients. The association between MetS as a cluster and WMLs was not driven by MetS components.

Association between serum uric acid levels and cardiovascular disease in middle-aged and elderly Chinese individuals.

BackgroundA link between uric acid (UA) levels and cardiovascular diseases has been previously reported. However, its importance as a risk factor is still controversial. This study sought to determine whether elevated serum uric acid levels are associated with cardiovascular disease (CVD) in middle-aged and elderly Chinese individuals.MethodsWe conducted a population-based cross-sectional study in Shanghai, with a total of 8510 participants aged ≥40 years. The CVD included diagnosed coronary heart disease (CHD) and stroke. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans.ResultsUric acid levels were positively associated with BMI, waist circumference, triglycerides, systolic blood pressure, diastolic blood pressure, glycohemoglobin, fasting plasma glucose, postprandial 2-hour plasma glucose (all P < 0.05), and negatively associated with HDL-cholesterol (P < 0.001). The prevalence of CVD significantly increased with increasing quartiles of UA in those without MetS group (p trend < 0.001), but not necessarily increased in those with MetS. After adjustment for metabolic syndrome and other cardiovascular risk factors, multivariate logistic regression analysis showed that odds ratios (OR) for CHD, stroke, and CVD in those in the fourth quartiles were 2.34 (95% confidence interval [CI] 1.73 to 3.45), 2.18 (95% CI 1.86 to 3.28), and 2.16 (95% CI 1.80 to 3.29), respectively, compared with those in the first quartile of UA.ConclusionsElevated serum uric acid level was associated with CVD, independent of conventional cardiovascular disease risk factors and metabolic syndrome.