Metabolic syndrome

Studies were conducted to determine whether maternal substrate utilization during pregnancy affects fetal growth and predisposes offspring to metabolic disease. Female wild-type (WT) and glucose transporter 4 heterozygous mice (G4+/-, a model of altered peripheral substrate utilization) were fed high-fat diet (HFD, 35.5% fat) or control chow (C, 9.5% fat) for 2 wk before mating, throughout pregnancy and lactation (IU/L). WT HFD females exhibited increased serum nonesterified fatty acid and lactate levels and increased hepatic mRNA expression of peroxisome proliferator-activated receptor gamma coactivator-1-beta and SREBP-1c, consistent with increased lipogenesis. G4+/- HFD females exhibited enhanced lipid clearance, and exposure to HFD did not increase hepatic gene expression. HFD independent of maternal genotype decreased fetal growth and birth weight. WT offspring were weaned onto a low-fat diet (5.6% fat). Male offspring of WT mothers exposed to HFD exhibited "catch-up"...

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

Background and Objectives: Metabolic syndrome (MS) has many risk factors that are important to investigate in populations living at sea level and in high-altitude geographic regions. The aim was to identify the components of MS that cross-sectional studies use to assess in adult populations residing in high-altitude regions. Materials and Methods: A systematic review study was conducted. The Pubmed database was used. The search for original articles (cross-sectional) was performed from January 2013 to December 2020. The procedure was carried out by two researchers. The keywords used were metabolic syndrome, adults, and altitude regions. The search strategy considered the components of the PICOS tool. Results: Ten cross-sectional studies were identified in the Pubmed database from 2014 to 2020. Altitude levels varied between countries and regions, from 2060 to 4900 m above sea level. Three studies were conducted in both China and Peru, two studies in Ecuador, and one in Bolivia and I...

Endocrine dysfunction and parameters of metabolic syndrome were assessed in 91 patients aged 4.3-32.5 years who underwent allogeneic or autologous BMT in childhood. Final short stature, found in five of the 35 patients who attained final height, was associated with the underlying disease (specifically, Fanconi anemia) (P ¼ 0.0013), previous cranial irradiation (P ¼ 0.0007), type of conditioning irradiation (Po0.05) and allogeneic BMT (P ¼ 0.05). Growth hormone deficiency (n ¼ 10) was associated with previous cranial irradiation (Po0.005) and conditioning total body irradiation (Po0.001). Twelve patients had primary hypothyroidism, one had hyperthyroidism and one papillary thyroid carcinoma. Hypothyroidism was associated with neck/mediastinal (Po0.005) and conditioning irradiation (Po0.05). Primary gonadal failure was found in 24 of the mature patients (62.5% females). Hypogonadism was associated with the underlying disease (especially hematological malignancies) (Po0.05), pretransplant treatment (Po0.05), irradiation conditioning (Po0.001), older age (Po0.005) and advanced pubertal stage at BMT (Po0.05). Obesity (body mass index 42 s.d.) was found in 4.4% and type II diabetes and impaired glucose tolerance in 3.3% each. Dyslipidemia was found in 27.9% of the 43 patients tested. These findings emphasize the need for long-term follow-up of endocrine and metabolic parameters in young patients after BMT in order to offer proper treatment and improve quality of life.

The synthesis and SAR of a series of arylsulfonylpiperazine inhibitors of 11b-HSD1 are described. Optimization rapidly led to potent, selective, and orally bioavailable inhibitors demonstrating efficacy in a cynomolgus monkey ex vivo enzyme inhibition model.

Fifty-seven type 2 diabetic patients with metabolic syndrome and on insulin were assessed by a paired analysis before and 6 months after addition of metformin as combination therapy to evaluate the impact of the association on glycemic control, blood pressure, and lipid profile. This was a historical cohort study in which the files of type 2 diabetic patients with metabolic syndrome on insulin were reviewed. The body mass index (BMI), waist circumference, lipid profile, A1C level, fasting blood glucose level, daily dose of NPH insulin, systolic blood pressure, and diastolic blood pressure were assessed in each patient before the start of metformin and 6 months after the initiation of combination therapy. Glycemic control significantly improved (P < 0.001) after the addition of metformin (1404.4 ± 565.5 mg/day), with 14% of the 57 patients reaching A1C levels up to 7%, and 53% reaching values up to 8%. There was a statistically significant reduction (P < 0.05) of total cholesterol (229.0 ± 29.5 to 214.2 ± 25.0 mg/ dL), BMI (30.7 ± 5.4 to 29.0 ± 4.0 kg/m 2), waist circumference (124.6 ± 11.7 to 117.3 ± 9.3 cm), and daily necessity of insulin. The reduction of total cholesterol occurred independently of the reductions of A1C (9.65 ± 1.03 to 8.18 ± 1.01%) and BMI and the reduction of BMI and WC did not interfere with the improvement of A1C. In conclusion, our study showed the efficacy of the administration of metformin and insulin simultaneously without negative effects. No changes were detected in HDL-cholesterol or blood pressure.

Context: Metabolic syndrome (MetS) is defined as clustering of risk factors including obesity, dyslipidemia, hyperglycemia, and hypertension, which is associated with increased risk of cardiovascular disease (CVD) and Type 2 diabetes mellitus (T2DM). Objectives: The present study aimed at reviewing all reported single-nucleotide polymorphisms (SNPs) related to childhood metabolic syndrome (MetS). Data Sources: In this review, an electronic literature search was conducted in PubMed and Huge Navigator database. For the HuGE Navigator search, we used the "metabolic syndrome" search term. For the PubMed search, we used "metabolic syndrome", "child", "adolescents", "pediatrics", "genes", and "polymorphism", without any restriction for time and language. Study Selection: Human studies with cross-sectional or case-control designs, which contained MetS as outcome and recruited participants younger than 21 years, were included. All definitions of pediatrics MetS were acceptable. Data Extraction: This study was designed as systematic review without meta-analysis in accordance with the preferred reporting item for systematic reviews meta-analysis (PRISMA) statement recommendation. After excluding duplicated and irrelevant studies, data extraction and quality control were conducted by 2 researchers using STROBE checklist. Results: In this review, during primary literature search, 219 and 1025 articles were identified through PubMed and HuGE navigator database, respectively. During 2 refining steps and after quality assessment, 38 qualified articles were evaluated at the final step. According to the whole data of systematic review results, the number of total population and points of data were 14 536. Number of studied genes and related SNP were 60 and 125, respectively. SNPs of the following genes were associated with MetS:

Preproghrelin gene polymorphisms (SNPs) are possible predisposing factors to obesity and metabolic syndrome. We analysed SNPs in obese Japanese individuals and studied the correlation with diabetes and metabolic syndrome. We recruited 235 subjects (BMI > 28.3) from individuals undergoing periodic medical check-up at Saku Central Hospital. Their SNPs were genotyped using PCR-RFLP method. Frequencies of 5 SNPs in the preproghrelin gene −1500C>G (rs3755777), −1062G>C (rs26311), −994C>T (rs26312), Leu72Met (+408C>A) (rs696217), and +3056T>C (rs2075356) were compared with healthy individuals (data from HapMap Project or Asian population studies). Associations between these SNPs and clinical parameters were investigated. The phenotypes evidently differed between men and women. In men, higher fasting glucose and HbA1c values were observed in the +3056C/C minor homozygotes without leptin or insulin accumulation. The +408C -+3056C haplotype was more frequent in the diabetic subgroup, in which diagnosis was based on fasting glucose, 75gOGTT, and HbA1c values, than normal subgroup. In contrast, in women, a significant correlation was observed between fat metabolism and obesity. The −1062C/C minor homozygotes had higher values of C-peptide, insulin, total and visceral fat area, waist circumference and BMI. The 72Met/Met minor homozygotes showed reduced leptin, total, HDL and LDL cholesterol concentrations and increased value of visceral fat area. Further, in the other SNPs, the minor homozygotes showed a similar trend, and the heterozygotes had intermediate values. Preproghrelin gene polymorphisms in obese Japanese may be predisposing

Background The enzyme 11-β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) catalyzes intracellular glucocorticoid reactivation by conversion of cortisone to cortisol in different tissues and have been implicated in several metabolic disorders associated with obesity. The aim of this study was to evaluate the 11β-HSD1 expression in liver, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) in morbidly obese patients undergoing bariatric surgery and its correlations with clinical, anthropometric, and biochemical variables. Methods A prospective study was conducted over a 27-month period. Hepatic, VAT, and SAT samples were obtained at the time of surgery. 11β-HSD1 and 18S gene expression was measured using real-time quantitative reverse transcriptase-polymerase chain reaction. Results Forty nine patients met the inclusion criteria [mean age: 42.2 ± 10 years, body mass index (BMI): 42 ± 6 kg/m2, 71% women and 63% with metabolic syndrome (MS)]. 11β-HSD1 mRNA levels were higher in liver than fat tissue (p < 0.001), being higher in SAT than in VAT (p < 0.001) without gender-specific differences. Hepatic expression of 11β-HSD1 correlated positively with SAT and VAT, alanine aminotransferase (ALT), and serum glucose and was inversely associated with BMI. 11β-HSD1 mRNA in VAT correlated positively with insulinemia, ALT, and LDL cholesterol. There were no associations between 11β-HSD1 mRNA in SAT and the variables analyzed. Conclusions 11β-HSD1 expression is higher in liver in comparison to adipose tissue in obese patients. The observed correlations between hepatic and VAT 11β-HSD1 expression with dyslipidemia and insulin resistance suggest that this enzyme might have a pathogenic role in obesity and related metabolic disorders.

GABRIELSSON, BRITT G., JENNY M. JOHANSSON, MALIN LÖ NN, MARGARETA JERNÅS, TORSTEN OLBERS, MARKKU PELTONEN, INGRID LARSSON, LARS LÖ NN, LARS SJÖ STRÖ M, BJÖ RN CARLSSON, AND LENA M.S. CARLSSON. High expression of complement components in omental adipose tissue in obese men. Obes Res. 2003;11:699-708. Objective: Accumulation of visceral fat is recognized as a predictor of obesity-related metabolic disturbances. Factors that are predominantly expressed in this depot could mediate the link between visceral obesity and associated diseases. Research Methods and Procedures: Paired subcutaneous and omental adipose tissue biopsies were obtained from 10 obese men. Gene expression was analyzed by DNA microarrays in triplicate and by real-time polymerase chain reaction. Serum C3 and C4 were analyzed by radial immunodiffusion assays in 91 subjects representing a cross section of the general population. Body composition was measured by computerized tomography. Results: Complement components C2, C3, C4, C7, and Factor B had higher expression in omental compared with subcutaneous adipose tissue (ϳ2-, 4-, 17-, 10-, and 7-fold, respectively). In addition, adipsin, which belongs to the alternative pathway, and the classical pathway components C1QB, C1R, and C1S were expressed in both depots. Analysis of tissue distribution showed high expression of C2, C3, and C4 in omental adipose tissue, and only liver had higher expression of these genes. Serum C3 levels corre-lated with both visceral and subcutaneous adipose tissue in both men (r ϭ 0.65 and p Ͻ 0.001 and r ϭ 0.52 and p Ͻ 0.001, respectively) and women (r ϭ 0.34 and p ϭ 0.023 and r ϭ 0.49 and p Ͻ 0.001, respectively), whereas C4 levels correlated with only visceral fat in men (r ϭ 0.36, p ϭ 0.015) and with both depots in women (visceral: r ϭ 0.58, p Ͻ 0.001; and subcutaneous: r ϭ 0.51, p Ͻ 0.001). Discussion: Recent studies show that the metabolic syndrome is associated with chronically elevated levels of several immune markers, some of which may have metabolic effects. The high expression of complement genes in intra-abdominal adipose tissue might suggest that the complement system is involved in the development of visceral adiposity and/or contributes to the metabolic complications associated with increased visceral fat mass.

As doenças cardiovasculares são as principais causas de morbidade e mortalidade no Brasil e no mundo. Atualmente é possível avaliar o risco cardiovascular individual com base em estudos observacionais. Assim, aliando o elevado risco cardiovascular atual à possibilidade de se prever a ocorrência de eventos, realizou-se neste estudo a avaliação dos fatores de risco e o desenvolvimento de Doença Arterial Coronariana (DAC) em 10 anos em pacientes do município de São Caetano do Sul, com o objetivo de determinar o risco cardiovascular dos mesmos com base no Escore de Framingham e relacionar o risco encontrado com outras variáveis que caracterizam a Síndrome Metabólica (SM). Pôde-se observar uma baixa prevalência de DAC nos 63 pacientes analisados, já que 47,6% encontravam-se em grupos de baixo risco, 36,5% em médio risco e apenas 15,9% em alto risco. Entretanto, esse quadro inicialmente favorável não se confirmou quando relacionado à SM, pois 23,3% dos pacientes com baixo risco para DAC tiveram diagnóstico positivo para SM. Concluiuse que, o baixo risco resultante da avaliação dos pacientes baseada apenas nos critérios de Framingham, não significa que os mesmos estão isentos de risco cardiovascular, pois podem apresentar outros fatores que não estão incluídos neste escore de predição clínica. A abordagem que possui maior respaldo na análise detalhada das evidências disponíveis consiste em estimar o risco cardiovascular total não pela elevação de fatores isolados e sim pela soma de risco decorrente de múltiplos fatores, estimada pelo risco absoluto global em cada indivíduo.

Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed an...

BACKGROUND: Obesity, common condition among patients with COVID-19, contributes to illness severity during hospitalization. To date, knowledge on the prevalence, risk of hospital and intensive care units (ICU) admissions and mortality is limited. Therefore, systematic review and meta-analysis were conducted using a PRISMA guideline. PURPOSE: The study aimed to address the prevalence, risk of hospital and ICU admissions and mortality among patients with COVID-19 and obesity. METHODS: The Newcastle–Ottawa scale was used to assess the quality of a study. Primary outcomes were the prevalence and risk of hospitalization, and secondary outcomes were the risk of ICU admissions and mortality risk. Mantel–Haenszel with random effects was applied, and the effect measure was odds ratio (OR) with 95% confidence interval (CI). RESULTS: Nine studies were included in the systematic review, and only four studies for meta-analysis. Among 29,776 patients with COVID-19, obesity was identified as the s...

Background: Metabolic syndrome contributes to the development of albuminuria and to the decrease of glomerular filtration rate (GFR) in type 2 diabetes patients. The aim of this study was to analyze the effect of MS treatment on the progression of diabetic nephropathy (DN). Methods: This was a retrospective and comparative cohort study. Baseline and follow-up data related to the presence of metabolic syndrome, microalbuminuria (mA), and GFR were obtained in individuals with type 2 diabetes. Subjects were classified in two groups: (1) With correction of metabolic syndrome and (2) without correction of metabolic syndrome at follow-up. Furthermore, they were stratified in four subgroups: (A) Without metabolic syndrome at baseline and at follow-up, (B) with metabolic syndrome and correction of metabolic syndrome, (C) without metabolic syndrome and development of metabolic syndrome, and (D) with metabolic syndrome and persistence of metabolic syndrome. Results: Final GFR and mA were lower and higher, respectively, in group 2 versus 1 [89.8-3 2.3 vs. 98.3-32.0 mL/min, P = 0.010, and 51.0 (13.5-195) vs. 7.9 (4-31) mg/day, P < 0.001, respectively]. Lack of metabolic syndrome correction [hazard ratio (HR) = 2.8, 95% confidence interval (CI) 1.9-4.2, P < 0.001], being in subgroups C (HR = 2.05, 95% CI 1.03-4.1, P = 0.04) and D (HR = 3.3, 95% CI 2.0-5.3, P < 0.001), and the presence of two (HR = 3.4, 95% CI 1.9-6.1, P < 0.001), three (HR = 5.0, 95% CI 2.5-9.9, P < 0.001), and four (HR = 4.2, 95% CI 1.5-12.1, P = 0.006) metabolic syndrome components were independent factors associated with development of mA in Cox regression analysis adjusted for age, gender, baseline mA and GFR, glycosylated hemoglobin (HbA1c), hypertension, and obesity. Conclusions: Metabolic syndrome treatment and control are independently associated with a lesser progression of DN.

Aims/hypothesis There has been much focus on the potential role of mitochondria in the aetiology of type 2 diabetes and the metabolic syndrome, and many case–control mitochondrial association studies have been undertaken for these conditions. We tested for a potential association between common mitochondrial variants and a number of quantitative traits related to type 2 diabetes in a large sample of >2,000 healthy Australian adolescent twins and their siblings, many of whom were measured on more than one occasion. Methods To the best of our knowledge, this is the first mitochondrial association study of quantitative traits undertaken using family data. The maternal inheritance pattern of mitochondria means established association methodologies are unsuitable for analysis of mitochondrial data in families. We present a methodology, implemented in the freely available program Sib-Pair for performing such an analysis. Results Despite our study having the power to detect variants with modest effects on these phenotypes, only one significant association was found after correction for multiple testing in any of four age groups. This was for mt14365 with triacylglycerol levels (unadjusted p = 0.0006). This association was not replicated in other age groups. Conclusions/interpretation We find little evidence in our sample to suggest that common European mitochondrial variants contribute to variation in quantitative phenotypes related to diabetes. Only one variant showed a significant association in our sample, and this association will need to be replicated in a larger cohort. Such replication studies or future meta-analyses may reveal more subtle effects that could not be detected here because of limitations of sample size.

Aim  The aim of the study was to assess the influence of physical activity on the components of metabolic syndrome (MS) in an urban south Indian population in Chennai.Methods  The Chennai Urban Population Study (CUPS) is an epidemiological study involving two residential areas in Chennai in South India. Of the total of 1399 eligible subjects (age ≥ 20 years), 1262 individuals participated in the study. MS was diagnosed based on modified Adult Treatment Panel (ATP) III guidelines. Details about the physical activity were collected using questionnaire, which included job-related and leisure-time activities, and specific questions on exercise. Study individuals were then graded as light, moderate and heavy using a scoring system. We assessed the relationship between the grades of physical activity and the components of MS and coronary artery disease (CAD). Insulin resistance was calculated using the homeostasis assessment model (HOMA-IR).Results  Prevalence of most of the components of MS (diabetes P < 0.001, obesity P = 0.003, abdominal obesity P < 0.001 and hypertension P < 0.001) and MS per se (P < 0.001) increased significantly with decrease in physical activity. Among non-diabetic subjects, HOMA-IR was significantly higher in subjects who did light-grade activity compared with heavy-grade activity (P = 0.041). Logistic regression analysis revealed physical activity to be significantly associated with MS [heavy activity: reference, moderate activity, odds ratio (OR) 1.639, (P = 0.017); light activity: OR 2.289, (P < 0.001)]. Subjects in the light-grade activity group also had higher odds of CAD (OR 2.42, 95% confidence interval 1.40, 4.24, P = 0.011), compared with the heavy-grade activity group.Conclusion  Physical inactivity is associated with the components of MS and CAD in this urban south-Indian population. Lifestyle changes focusing on increasing physical activity could help to prevent the exploding epidemic of MS and CAD in India.

Background: Metabolic syndrome is a recognizable clinical cluster of risks known to be associated in combination and independently with an increased risk for cardiovascular disease (CVD). Identifying and treating metabolic syndrome is one promising strategy to reduce CVD. The intersection of race/ethnicity, gender, and economic status complicates our understanding of who is at risk for metabolic syndrome, but understanding this social patterning is important for the development of targeted interventions. This study examines the relationship between metabolic syndrome (and the underlying contributing risk factors) and race/ethnicity, economic status, and gender.

OBJECTIVE—The ability of the Adult Treatment Panel III (ATP III) criteria of metabolic syndrome to identify insulin-resistant subjects at increased cardiovascular risk is suboptimal, especially in the absence of obesity and diabetes. Nonalcoholic fatty liver disease (NAFLD) is ...

Chronic obstructive pulmonary disease (COPD) is usually associated with a variety of extra-pulmonary manifestations. Metabolic syndrome (MetS) is one such entity that has been scarcely studied in Indian patients. Availability of a good screening marker may help in timely detection of this co morbidity in COPD patients. We conducted a cross sectional study to evaluate the prevalence of MetS among COPD patients and to evaluate the role of Interleukin-6 and insulin resistance (as measured by HOMA-IR) as screening markers for MetS in COPD. A total of 100 stable COPD patients were evaluated for MetS using US National Cholesterol Education Program Adult Treatment Panel III (2005) guidelines. Interleukin-6 and HOMA-IR (for insulin resistance) were measured and compared between COPD patients with and without MetS. ROC analysis was done to find the best cut-off value and sensitivity and specificity of both the molecules in detecting MetS. In the results, the mean age of the study cohort was ...

The pathophysiology of metabolic syndrome involves altered glucose and lipid metabolism, and proinflammatory and prothrombotic states. All of these abnormalities appear to be linked to insulin resistance, which is associated with an increase in the free fatty acid level, usually due to obesity. This condition disturbs cellular glucose management and hepatic synthesis. In addition, lipid metabolism is also impaired by insulin resistance. In these circumstances, hypertriglyceridemia and HDL hypocholesterolemia both develop. Moreover, hypertension is related to altered insulin regulation and impaired autonomic nervous system activity. In addition to the well-demonstrated relationship with atherosclerosis, recently metabolic syndrome has also been associated with steatohepatitis and polycystic ovary syndrome.

Metabolic syndrome (MS) is a group of interrelated components that predispose individual to increased risk for type2 diabetes mellitus (DM) and cardiovascular disease (CVD). The International Diabetes Federation (IDF) has proposed a definition of MS in order to use for clinical practice and epidemiologic studies [1]. Central obesity, determined by waist circumference, is a prerequisite criterion for the diagnosis of the MS. The minimal waist circumference varies from 90 to 102 centimeters (cm) in males and from 80 to 88 cm in females depending on ethnic group [1]. The MS can be diagnosed when central obesity plus any two of the following four factors are present. These include raised triglycerides (TG) level (!150 mg/dL, or specific treatment for this lipid abnormality), reduced high density lipoprotein cholesterol (HDL-C) (<40 mg/dL in males, and <50 mg/dL in females, or specific treatment for this lipid abnormality), or raised blood pressure (BP) (systolic BP ! 130 or diastolic BP ! 85 mmHg, or treatment of previously diagnosed hypertension) and raised fasting plasma glucose (FPG) (!100 mg/dL, or previously diagnosed type2 DM) [1]. In Thailand, the prevalence of MS varies from 15 to 20% among various population groups which is comparable to those in developed countries [2-4]. Many drugs used in the treatment of MS can affect salivation and may induce oral complications such as glossitis, oral candidiasis, dental caries and some drugs have been reported to induce oral lichenoid reactions [5-8]. Moreover, high prevalence of candidiasis, denture stomatitis and periodontitis has been reported in patients with DM, a component of MS [9-13]. Therefore, we aimed to study the prevalence of oral manifestations, xerostomia, hyposalivation and level of oral microflora in a group of Thai patients with MS and to determine if there is any association between MS and these oral health components.

Background: Chronic kidney disease (CKD) is more likely to progress to kidney failure (end-stage renal disease) in African Americans, although the reasons for this are unclear. Metabolic syndrome is a risk factor for the development of diabetes and cardiovascular disease and recently was linked to incident CKD. The purpose of this study is to examine whether metabolic syndrome is associated with kidney disease progression in hypertensive African Americans.

Aims: A number of intervention studies have shown that therapy with angiotensin receptor blockers, such as irbesartan, can improve metabolic parameters and reduce the incidence of diabetes mellitus. It is unknown whether this observation also holds true in routine clinical settings.

The vascular endothelium is an active, dynamic tissue that controls many important functions, including regulation of vascular tone and maintenance of blood circulation, fluidity, coagulation, and inflammatory responses. Cardiovascular risk factors affect many of the normal functions of the endothelium. In particular, oxidized low-density lipoprotein cholesterol initiates a series of events that begin with cell activation, endothelial dysfunction, local inflammation, and a procoagulant vascular surface. These conspire to result in plaque formation and ultimately plaque rupture and cardiovascular events.

Metabolic syndrome poses additional risk for postmenopausal women who are already at risk for osteoporosis. We hypothesized that a nutritional supplement containing anti-inflammatory phytochemicals and essential bone nutrients would produce a favorable bone biomarker profile in postmenopausal women with metabolic syndrome. In this 14-week, randomized trial, 51 women were instructed to consume a modified Mediterranean-style, low-glycemic-load diet and to engage in aerobic exercise. Those in the intervention arm (n = 25) additionally received 200 mg hop rho iso-alpha acids, 100 mg berberine sulfate trihydrate, 500 IU vitamin D 3 , and 500 μg vitamin K 1 twice daily. Forty-five women completed the study. Baseline nutrient intake did not differ between arms. Compared with baseline, the intervention arm exhibited an approximate 25% mean decrease (P b .001) in serum osteocalcin (indicative of bone turnover), whereas the placebo arm exhibited a 21% increase (P = .003). Serum 25-hydroxyvitamin D increased 23% (P = .001) in the intervention arm and decreased 12% (P = .03) in the placebo arm. The between-arm differences for osteocalcin and 25-hydroxyvitamin D were statistically significant. Serum insulin-like growth factor I was statistically increased in both arms, but the between-arm differences were not statistically significant. Subanalysis showed that among those in the highest tertile of baseline insulin-like growth factor I, the intervention arm exhibited a significant increase in amino-terminal propeptide of type I collagen, whereas the placebo arm showed a significant decrease at 14 weeks. Treatment with rho iso-alpha acids, berberine, vitamin D 3 , and vitamin K 1 produced a more favorable bone biomarker profile indicative of healthy bone metabolism in postmenopausal women with metabolic syndrome.

Because of their wide range of actions on glucose homeostasis, lipid metabolism and vascular inflammation, peroxisome proliferator-activated receptors (PPARs) are promising targets for the development of new drugs for the treatment of metabolic disorders such as diabetes, dyslipidemia and atherosclerosis. In clinical practice, PPARα agonists, such as the already available fibrates, improve dyslipidemia, while PPARγ agonists, such as thiazolidinediones, improve

In recent years, advances in epidemiological approaches and laboratory technology, along with the availability of sophisticated imaging methods to evaluate body fat distribution, made it possible to define the close correlation between visceral fat accumulation and the occurrence of metabolic abnormalities, cardiovascular diseases and respiratory disturbances in obese patients. Some 250 y ago, JB Morgagni with the help of only a knife for anatomical dissection, an acute mind, and an observational skillfulness was able to identify the intra-abdominal and mediastinal fat accumulation in android obesity. He clearly described the association between visceral obesity, hypertension, hyperuricemia, atherosclerosis and obstructive sleep apnea syndrome, long before the modern recognition of this syndrome.

The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin).

Background and Objective: Eotaxin is a pre-inflammatory adipokinin secreted from adipose tissue that plays an important role in function regulating of adipose tissue. This study was done to determine the effect of high-intensity interval training on the gene expression of eotaxin in visceral adipose tissue and insulin resistance following metabolic syndrome in rats.
Methods: In this experimental study, 40 male Wistar rats (weight 180±20 gr) were selected and after 12 weeks of high-fat diet and the creation of the metabolic syndrome model were randomly divided into four groups including  control, metabolic syndrome, High-Intensity Interval Training (HIIT) and metabolic syndrome with HIIT. Rats in the high-fat diet were subjected to a special diet (30 to 40% fat) for 12 weeks to develop a model of metabolic syndrome. HIIT consisted of 5 to 10 interval 1-minute intensive running on treadmill at 80 to 95% of maximum speed and in slow alternations at 55% of maximum speed for 8 weeks. Insulin resistance using HOMA-IR mode is considered as a basic factor for determining metabolic syndrome.
Results: The gene expression of eotaxin and insulin resistance in the metabolic syndrome group were significantly higher than the control group (P<0.05). Gene expression of eotaxin and insulin resistance was significantly lower in HIIT and metabolic syndrome with HIIT groups than the metabolic syndrome group (P<0.05). Also, the gene expression of eotaxin and insulin resistance was significantly lower in HIIT group than the metabolic syndrome with HIIT group.
Conclusion: It seems that HIIT may be an important factor in down-regulating eotaxin and insulin resistance in metabolic syndrome.
Keywords: Eotaxin, Metabolic Syndrome, High-Intensity Interval Training, Insulin Resistance, Rat

Background: Diet is central to treatment of type 2 diabetes. This review aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters.

Methods: Cochrane CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO were searched for randomised controlled trials of three months duration or longer, published from 1st January 2008 to 18th June 2019. Relevant data were extracted from studies with additional author information. Random-effects meta-analysis assessed mean changes in HbA1c and other clinical parameters. PROSPERO registration number: CRD42019130528.

Results: Of 2477 records identified, fourteen studies, involving 3338 participants, were eligible for qualitative synthesis and meta-analysis. The mean changes [95% CI] at follow-up in HbA1c, BMI, weight, LDL cholesterol, systolic and diastolic blood pressure were -0·47 [-0·92, -0·02] %, -0·38 [-0·63, -0·13] kg/m2, -1·49 [-2·14, -0·84] kg, -0·15 [-0·33, 0·04] mmol/L, -0·75 [-2·45, 0·96] mm Hg and -1·17 [-4·52, 2·17] mm Hg respectively in favour of the intervention group. The quality of evidence was limited due to heterogeneity, risk of bias, publication bias and indirectness.

Conclusions: Nutrition therapy provided by dietitians was associated with better clinical parameters of type 2 diabetes, including clinically significant improved glycaemic control, across diverse multiethnic patient groups from all six inhabited continents. This conclusion should be reflected in clinical guidelines.

Keywords: Clinical effectiveness; Dietetic counseling; Medical nutrition therapy; Metabolic syndrome; Systematic review; Type 2 diabetes mellitus.

Background: We recently demonstrated leucine to modulate energy partitioning between adipose tissue and muscle. Further, leucine exhibits a synergy with B6, resulting in reduced adipocyte lipid storage coupled with increased muscle fat oxidation.

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Evidence for the association of bisphenol A (BPA) with type II diabetes mellitus (T2DM) has been inconsistent in human studies. In-vitro and animal studies indicate that chlorinated BPA derivatives aggravate BPA health effects via higher estrogenic activity and alteration of membrane-initiating signaling pathways. We evaluated the association between urinary monochlorinated BPA (mono-ClBPA) concentrations and the incidence of T2DM. In our cross-sectional study, we identified 20 adult participants (≥18 yr) who reported having T2DM (doctor-diagnosed) and 131 adults with normal health. First morning void urine samples were analyzed for total BPA and mono-ClBPA. Detection limits of the analytical method were 95 ng L(-1) for BPA and 32 ng L(-1) for mono-ClBPA. Multivariable logistic regression analyses and additive Bayesian network modeling were performed. After adjusting for age, gender, BMI, urinary total BPA and other confounders, the odds of having T2DM was 3.29 times higher (95% confidence interval, CI: 1.10, 11.4; P < 0.05) per unit increase in log-transformed and creatinine-adjusted urinary mono-ClBPA levels (n = 151); this relation did not hold for total BPA. The globally optimum Bayesian model corroborated the results of the logistic regression by expressing mono-ClBPA in the pathway of T2DM, and not for total BPA. An age-matched sensitivity analysis confirmed the increase in OR of T2DM by 3.04 times (95% CI: 1.10, 11.0; P < 0.05) per unit increase in log-transformed and creatinine-adjusted urinary mono-ClBPA concentration (n = 68). The urinary monochlorinated BPA derivative was significantly associated with T2DM, whereas the parent compound (total BPA) was not. Caution should be applied in interpreting these findings, as this is the first study to report this association and the sample size of participants with T2DM is small. Additional research with a larger sample size coupled with relevant toxicological studies is warranted.

demographics in REM sleep behavior disorder [2], and therefore could not be included in the discussion. Their prior findings of high rates of RBD symptoms among psychiatric patients taking serotonergic antidepressants [3] concur with the findings in our case series [2] and other reports [4], and we read with interest their follow-up study with polysomnographic confirmation, which is critical for distinguishing RBD from its multiple mimics. The intriguing finding that, despite a decrease in subjective dream enactment episodes with antidepressant change or discontinuation, there was persistent REM without atonia (RWA) noted objectively on polysomnogram [1], lends further credence to a contributory role of antidepressants in RBD and RWA in susceptible individuals. However, studies with polysomnograms before and after antidepressant initiation, demonstrating RBD occurring as a consequence of antidepressants, are still lacking. We certainly agree that further investigation is necessary in this area, particularly as antidepressant usage becomes increasingly widespread. Additionally, long-term follow-up studies are required to determine any relationship between antidepressant-related RBD and neurodegenerative disease.

Non-alcoholic steatohepatitis (NASH) is one of the most important emerging health issues. Insulin resistance and metabolic syndrome play a central role in the pathogenesis of NASH. Intake of nutrients strongly affects insulin resistance, carbohydrate and lipid metabolism, and hepatic steatosis. However, there are few reports about the intake of various nutrients in nonalcoholic fatty liver disease. In this work, we identified the characteristics of dietary habits and nutrient intake in patients with NASH. Methods: Twenty-eight patients with NASH and 18 with simple steatosis (FL) were diagnosed from histologic findings, and their dietary habits and intake of nutrients were analyzed by detailed questioning by physicians and dieticians. Results: There was an excess intake of carbohydrates/energy in patients with NASH 20-59 y of age compared with patients with FL. Among carbohydrates, intake of simple carbohydrates was higher in those with NASH. There also was a low intake of protein/energy in patients with NASH 40-59 y of age and a low intake of zinc in those 20-59 y of age compared with patients with FL. Ratio of intake of polyunsaturated fatty acid to saturated fatty acid was lower in patients with NASH and those with FL compared with the general Japanese subjects. Conclusion: These results suggest that imbalanced diets play important roles in development and progression of NASH and correction of these diets may be necessary in patients with NASH.

Obesity and dyslipidemias are both signs of metabolic syndrome, usually associated with ventricular arrhythmias. Here, we tried to identify cardiac electrical alteration and biomarkers in nonobese rats with metabolic syndrome (MetS), and these findings might lead to more lethal arrhythmias than obese animals. The MetS model was developed in Wistar rats with high-sucrose diet (20%), and after twenty-eight weeks were obtained two subgroups: obese (OMetS) and nonobese (NOMetS). The electrocardiogram was used to measure the ventricular arrhythmias and changes in the heart rate variability. Also, we measured ventricular hypertrophy and its relationship with electrical activity alterations of both ventricles, using micro-electrode and voltage clamp techniques. Also, we observed alterations in the contraction force of ventricles where a transducer was used to record mechanical and electrical papillary muscle, simultaneously. Despite both subgroups presenting long QT syndrome ( 0.66 ± 0.05 ...

The aim of this study is to investigate the impact of aircraft noise pollution on community and workers' health near Abu Dhabi International Airport. This study was conducted in residential neighborhoods and employment areas living and working within a 25-km radius of the airport with high exposure to aircraft noise and in matched control areas far from the airport (outside the 25-km radius) and are unaffected by aircraft noise. Data was collected by conducting a revealed-preference face-to-face interview surveys among the residents and the workers nea rand far from Abu Dhabi International Airport during the months of September and December 2014. A total of 5,070 residents in both areas (2,579 near the airport and 2,492 far from the airport) and 1,995 workers in both areas (995 near the airport and 1,000 far from the airport) were interviewed and completed the questionnaire. Binomial Logit Regression Model was used to determine the impact of aircraft noise on community and workers' health. After controlling for confounders, the health of the residents adjacent to the airport who have been chronically exposed to high aircraft noise level are found to be worse than the control group. The results show that residents from the noise exposure area have a high level of noise stress, hypertension, headache, general disturbance, loss of sleep/insomnia, and hearing problems than the matched control area. On the other hand, aircraft noise pollution near Abu Dhabi Airport has no negative impact on workers adjacent to the airport. The impact of aircraft noise on community health should not restrain the growth of air travel industry in the city as this growth is essential and beneficial to the whole nation's economy. The reduction of aircraft noise level in the exposed area could be achieved by imposing policies, codes of practices, and action noise plans to assess and evaluate land use management as an effective tool for mitigating aircraft noise. Future research should assess community health based on self-reported physician diagnosed blood pressure; and hearing, stress, headache diagnostic examination.

One of the proposed causes of obesity and metabolic syndrome is the excessive intake of products containing added sugars, in particular, fructose. Although the ability of excessive intake of fructose to induce metabolic syndrome is mounting, to date, no study has addressed whether a diet specifically lowering fructose but not total carbohydrates can reduce features of metabolic syndrome. A total of 131 patients were randomized to compare the short-term effects of 2 energy-restricted diets-a low-fructose diet vs a moderate natural fructose dieton weight loss and metabolic syndrome parameters. Patients were randomized to receive 1500, 1800, or 2000 cal diets according to sex, age, and height. Because natural fructose might be differently absorbed compared with fructose from added sugars, we randomized obese subjects to either a low-fructose diet (<20 g/d) or a moderate-fructose diet with natural fruit supplements (50-70 g/d) and compared the effects of both diets on the primary outcome of weight loss in a 6-week follow-up period. Blood pressure, lipid profile, serum glucose, insulin resistance, uric acid, soluble intercellular adhesion molecule-1, and quality of life scores were included as secondary outcomes. One hundred two (78%) of the 131 participants were women, mean age was 38.8 ± 8.8 years, and the mean body mass index was 32.4 ± 4.5 kg/m 2 .

The prevalence and magnitude of childhood obesity are increasing in the world. There is some studies which indicate that fatty acids can reduce body fat in childrens; however, data are relatively few and have generally been conducted over short time periods with small sample sizes, making it difficult to draw definitive conclusions. Therefore, in this study the effects exerted by the omega-3 fatty acids on the concentration of glucose, triglycerides, total cholesterol and body mass index in obese children were evaluated using two experimental designs; In the first stage, a dietary intake of fish was administered to obese children: In the second stage, a dietary intake of gummies with omega-3 fatty acids was used on obese children. The results showed that dietary intake of gummies with omega-3 fatty acids induces greater changes in the levels of triglycerides, total cholesterol and body mass index compared with the dietary intake of fish. In conclusion, all these data suggest that dietary intakes of omega-3 fatty acids can decrease the degree of obesity in obese children.

Cardiovascular diseases are the main cause of mortality in Brazil and all over the world. Nowadays it is possible to evaluate the individual cardiovascular risk based on observational studies. Therefore, linking the high cardiovascular risk level to the possibility of preventing the occurrence of events related to it, an evaluation of risk factors and development of Coronary Artery Disease (CAD)

We propose that excessive fructose intake (>50 g/d) may be one of the underlying etiologies of metabolic syndrome and type 2 diabetes. The primary sources of fructose are sugar (sucrose) and high fructose corn syrup. First, fructose intake correlates closely with the rate of diabetes worldwide. Second, unlike other sugars, the ingestion of excessive fructose induces features of metabolic syndrome in both laboratory animals and humans. Third, fructose appears to mediate the metabolic syndrome in part by raising uric acid, and there are now extensive experimental and clinical data supporting uric acid in the pathogenesis of metabolic syndrome. Fourth, environmental and genetic considerations provide a potential explanation of why certain groups might be more susceptible to developing diabetes. Finally, we discuss the counterarguments associated with the hypothesis and a potential explanation for these findings. If diabetes might result from excessive intake of fructose, then simple public health measures could have a major impact on improving the overall health of our populace. (Endocrine Reviews 30: 96 -116, 2009)

The relations of dietary habits to insulin sensitivity and postprandial triglyceride metabolism were evaluated in 25 patients with nonalcoholic steatohepatitis (NASH) and 25 age-, body mass index (BMI)-, and gender-matched healthy controls. After a 7-day alimentary record, they underwent a standard oral glucose tolerance test (OGTT), and the insulin sensitivity index (ISI) was calculated from the OGTT; an oral fat load test was also performed in 15 patients and 15 controls. The dietary intake of NASH patients was richer in saturated fat (13.7% ؎ 3.1% vs. 10.0% ؎ 2.1% total kcal, respectively, P ‫؍‬ .0001) and in cholesterol (506 ؎ 108 vs. 405 ؎ 111 mg/d, respectively, P ‫؍‬ .002) and was poorer in polyunsaturated fat (10.0% ؎ 3.5% vs. 14.5% ؎ 4.0% total fat, respectively, P ‫؍‬ .0001), fiber (12.9 ؎ 4.1 vs. 23.2 ؎ 7.8 g/d, respectively, P ‫؍‬ .000), and antioxidant vitamins C (84.3 ؎ 43.1 vs. 144.2 ؎ 63.1 mg/d, respectively, P ‫؍‬ .0001) and E (5.4 ؎ 1.9 vs. 8.7 ؎ 2.9 mg/d, respectively, P ‫؍‬ .0001). The ISI was significantly lower in NASH patients than in controls. Postprandial total and very low density lipoproteins triglyceride at ؉4 hours and ؉6 hours, triglyceride area under the curve, and incremental triglyceride area under the curve were higher in NASH compared with controls. Saturated fat intake correlated with ISI, with the different features of the metabolic syndrome, and with the postprandial rise of triglyceride. Postprandial apolipoprotein (Apo) B48 and ApoB100 responses in NASH were flat and strikingly dissociated from the triglyceride response, suggesting a defect in ApoB secretion. In conclusion, dietary habits may promote steatohepatitis directly by modulating hepatic triglyceride accumulation and antioxidant activity as well as indirectly by affecting insulin sensitivity and postprandial triglyceride metabolism. Our findings provide further rationale for more specific alimentary interventions, particularly in nonobese, nondiabetic normolipidemic NASH patients. (HEPATOLOGY 2003;37:909-916.) Abbreviations: NASH, nonalcoholic steatohepatitis; NAFLD, nonalcoholic fatty liver disease; Tg, triglyceride; BMI, body mass index; OGTT, oral glucose tolerance test; ISI, insulin sensitivity index; VLDL, very low density lipoproteins; Apo, apolipoprotein; ANOVA, analysis of variance; AUC, area under the postprandial curve; IAUC, incremental area under the postprandial curve; SFA, saturated fatty acids; P:S ratio, polyunsaturated to saturated fat ratio. From the