To investigate the association between Metabolic syndrome (MetS) and Health related quality of life (QoL) in Iranian population.
We used data from the post-intervention phase of Isfahan Healthy Heart Program (IHHP), a community trial for cardiovascular disease (CVD) prevention and control. We recruited 9570 healthy adults, aged ≥ 19 years who were randomly selected using multistage random sampling method. World Health Organization QoL questionnaire (WHOQOL-BREF) which contains 26 items was used to assess QoL. It assesses four domains of QoL; Physical health, Psychological health, Social relationship and Environmental issues. MetS was defined based on ATP III criteria.
The mean age of participants was 38.8±15.6 years (mean ± SD) and the prevalence of MetS was 22.5%. From all participant 18.2% were illiterate and 13.2% had university educational level. Two way multivariate analyses of covariance (MANCOVA) test after adjusting age showed significant difference between women with and without Mets in regard to physical health and social relations domains, while none of QoL domains was different in men with Mets in comparison to men without it.
After adjusting the role of socio-demographic factors as components of QoL score, no association was observed between QoL domains and MetS in men, while only social relations and physical health scores were higher in women with Mets compared to those without Mets. Other variety of health-related QoL assessment tools or definitions of MetS may show different relationship in the Iranian socio-cultural context.
Metabolic syndrome; Quality of life; General population
The increasingly high number of immigrants from South-East Asia with The Metabolic Syndrome (MetS) is an important challenge for the public health sector. Impaired glucose is essential in MetS. The blood glucose concentration is not only governed by diet and physical activity, but also by psychological distress which could contribute to the development of MetS. The aim of this study is to describe health-related quality of life, subjective health complaints (SHC), psychological distress, and coping in Pakistani immigrant women, with and without MetS. As a part of an randomized controlled intervention study in Oslo, Norway, female Pakistani immigrants (n = 198) answered questionnaires regarding health related quality of life, SHC, psychological distress, and coping. Blood variables were determined and a standardized oral glucose tolerance test was performed. The participants had a high score on SHC and psychological distress. About 40% of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. Those with MetS also had more SHC, depressive symptoms, higher levels of somatisation, and scored significantly lower on the coping strategy of active problem solving. Pakistani immigrant women seem to have a high prevalence of SHC and psychological distress, especially those with MetS.
Pakistani immigrant women; Immigration; Psychological distress; Coping; Metabolic syndrome
Recent studies have confirmed inflammatory factors and metabolic syndrome (MetS) as important cardiovascular disease (CVD) risk factors. Recently measurement of carotid intima-media thickness (IMT) has been used for evaluation of early atherosclerosis. This study was designed to assess the correlation between IMT with some inflammatory biomarkers, ghrelin and adiponectin in people with and without MetS in a cohort sample in Isfahan province.
Among participants of Isfahan Cohort Study (ICS) by random sampling, 88 participants were selected and divided into case (with MetS) and control (without MetS) groups. A questionnaire including demographic data and CVD risk factors was completed for all of the participants. Physical examination and blood pressure, height, weight and waist circumference measurements were done for all subjects. Vascular echocardiography was done for evaluation of IMT of each carotid artery of both sides. Interlukin-6 (IL-6), interlukin-10 (IL-10), highly sensitive C-reactive protein (hs-CRP), ghrelin and adiponectin levels were measured using ELIZA method. Data were entered in SPSS15 software and analyzed by t-test, chi square, Pearson correlation and linear regression analyze.
The mean waist circumference, BMI, systolic blood pressure, diastolic blood pressure, hs-CRP and IMT of left carotid artery were significantly higher in participants with Mets. There was significant correlation between left carotid IMT and IL-6 level in all patients (P = 0.03). After adjustment for age and sex, significant relationship in groups with MetS was only reported between the left IMT and IL-6 (P = 0.02). There was no relation between IMT and other inflammatory markers in subjects with and without MetS.
Significant correlation between IL-6 and IMT was reported in patients with MetS. While no significant correlation between IL-10, adiponectin and ghrelin with IMT was observed in metabolic syndrome group.
Intima-media thickness (IMT); Carotid artery; hs-CRP; Ghrelin; Adiponectin IL-6; IL-10
Metabolic syndrome (MetS) is increasingly common. Obesity has been suggested to associate with neck pain but prevalence of neck pain in subjects with MetS has not been studied. Aim of this study was to analyse the association between MetS and neck pain.
The study population consisted of 1294 middle-aged subjects in Pieksämäki, Finland. A total of 399 males and 500 females participated (69%). The mean age of both males and females was 46 years. Clinical and biochemical measurements were taken. The participants filled out a standard questionnaire. Psychological distress was assessed with the 12-item General Health Questionnaire (GHQ-12). Neck pain was defined as neck pain perceived daily. MetS was defined using National Cholesterol Education Program (NCEP) criteria. Statistical comparisons between the groups were performed using a bootstrap-type t-test or Chi-Square test. Risk ratios of having neck pain were calculated using generalised linear models with age, smoking, alcohol use, exercise and GHQ-12 score as covariates.
The prevalence of MetS was 33% in males and 29% in females. Neck pain was present in 11% (N = 42) of males and 19% (N = 93) of females (P < 0.001). The prevalence of neck pain was 7.9% (95% CI, 4.9% to 12%) among male subjects without MetS and 16% (95% CI, 10% to 23%) among those with MetS. The respective proportions among females were 16% (95% CI, 12% to 20%) and 25% (95% CI, 18% to 33%). The multivariate analysis showed an increased risk of neck pain in males with MetS (RR 2.1, 95% CI, 1.2 to 3.7, P = 0.010) and in females with MetS (RR 1.5, 95% CI, 1.0 to 2.1, P = 0.040).
MetS was associated with neck pain. This association was stronger in males, but the prevalence of neck pain was higher in females. Prospective studies should explore the potential causal association between neck pain and MetS and the potential common background factors of neck pain and MetS.
To study the association between metabolic syndrome (MetS) and self-perceived depression.
A cross-sectional community-based study.
Semi-rural community of Lapinlahti in eastern Finland in 2005.
A total of 416 subjects in eight adult birth cohorts (55%) with complete Beck Depression Inventory (BDI-21) questionnaire data.
Main outcome measures
The values of the 21 BDI items and the BDI-21 total score with a cut-off point of 14/15 were used to study the association between MetS and depression. National Cholesterol Education Programme (NCEP) 2005 criteria were used for MetS classification.
The total BDI-21 score was significantly higher in the subjects with MetS than in the subjects without MetS (p=0.020). Men with MetS were significantly worse off than men without MetS in the BDI-21 items of irritability (p=0.008), work inhibition (p=0.008), fatigability (p=0.037), weight loss (p=0.045), and loss of libido (p=0.014), while women were only so on the item of loss of libido (p=0.007). In a logistic regression analysis using a BDI-21 cut-off point of 14/15 adjusted for age, marital status, vocational education, and working status, significant association was retained between perceived depression and elevated blood glucose among men (OR=1.697) and large waist circumference among women (OR=1.066).
Elevated plasma glucose in men and central obesity in women are associated with self-perceived depression. This co-occurrence deserves attention in clinical practice.
Adult population; depression; family practice; fasting plasma glucose; metabolic syndrome; waist circumference
Given the increasing prevalence of both metabolic syndrome (MetS) and depressive symptoms during old age, we aimed to examine prospectively the association between MetS and onset of depressive symptoms according to different age-groups in a large general elderly population.
Research Design and Methods
Prospective cohort study of 4446 men and women aged 65 to 91 and free of depression or depressive symptoms at baseline (the Three-City study, France). MetS was defined using the NCEP-ATP III criteria. New onset of depressive symptoms (the Center for Epidemiologic Studies Depression Scale (CES-D) score≥16 and use of antidepressant treatment) was assessed at 2- and 4-year follow-ups.
After adjusting for a large range of potential confounders, we observed MetS to be associated with a 1.73-fold (95% CI: 1.02–2.95) odds for new-onset depressive symptoms in the youngest age group (65 to 70 at baseline), independently of cardiovascular diseases. No such association was seen in older age groups.
Our findings suggest that the link between MetS and depressive symptoms evidenced until now in middle-aged can be extended to older adults but not to the oldest ones. Further research is needed to examine if a better management of MetS prevents depressive symptoms in people aged 65 to 70.
Depressive symptoms; metabolic syndrome; elderly; prospective study
Behavioral alterations, including depression, are frequent in individuals with the metabolic syndrome (MetS). Recent findings suggest that chronic activation of innate immunity may be involved. The objective of this study was to examine the relationship between MetS and depressive symptoms and to elucidate the involvement of inflammation in this relationship.
Participants were 323 male twins, with and without MetS and free of symptomatic cardiovascular disease, drawn from the Vietnam-Era-Twin Registry. Depressive symptoms were measured with the Beck-Depression-Inventory (BDI). Inflammatory status was assessed using C-reactive protein (CRP) and interleukin-6 (IL-6); twins with both CRP and IL-6 levels above the median were classified as having an elevated inflammatory status. Factor analysis was performed on individual BDI items to extract specific symptom dimensions (neurovegetative, mood, affective-cognitive).
Subjects with MetS had more depressive symptoms than those without. Depressive symptoms with neurovegetative features were more common and more robustly associated with MetS. Both the BDI total score and each symptom subscore were associated with inflammatory biomarkers. After adjusting for age, education and smoking status, the MetS was significantly associated with the BDI total score and the neurovegetative score. After further adjusting for inflammation, the coefficient for MetS decreased somewhat, but remained statistically significant for the BDI neurovegetative subscore. When controlling for the MetS, inflammation remained significantly associated with the BDI mood subscore.
The MetS is associated with higher depressive symptomatology characterized primarily by neurovegetative features. Inflammation is one determinant of depressive symptoms in individuals with MetS.
Metabolic Syndrome; Inflammation; Cytokines; Depression; Mood
Given the increasing prevalence of both metabolic syndrome (MetS) and depressive symptoms during old age, we aimed to examine prospectively the association between MetS and the onset of depressive symptoms according to different age-groups in a large, general elderly population.
RESEARCH DESIGN AND METHODS
This was a prospective cohort study of 4,446 men and women aged 65–91 years who were free of depression or depressive symptoms at baseline (the Three-City Study, France). MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. New onset of depressive symptoms (the Center for Epidemiologic Studies Depression Scale score ≥16 and use of antidepressant treatment) was assessed at 2- and 4-year follow-ups.
After adjusting for a large range of potential confounders, we observed MetS to be associated with 1.73-fold (95% CI 1.02–2.95) odds for new-onset depressive symptoms in the youngest age-group (65–70 years at baseline), independently of cardiovascular diseases. No such association was seen in older age-groups.
Our findings suggest that the link between MetS and depressive symptoms evidenced until now in middle-aged people can be extended to older adults but not to the oldest ones. Additional research is needed to examine if a better management of MetS prevents depressive symptoms in people aged 65–70 years.
To investigate the respective associations and clinical usefulness of the metabolic syndrome (MetS) and its individual components to predict the risk of first coronary heart disease (CHD) events in elderly.
The Three-City is a French prospective multisite community-based cohort.
Three large French cities: Bordeaux, Dijon and Montpellier.
7612 subjects aged 65 and over who were free of CHD at baseline.
Main outcome measures
The MetS was defined by the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria.
During a median follow-up of 5.2 years, 275 first CHD events were adjudicated. The MetS was associated with increased risks of total (adjusted HR: 1.78; 95% CI 1.39 to 2.28), fatal (HR: 2.40; 95% CI 1.41 to 4.09) and non-fatal (HR: 1.64; 95% CI 1.24 to 2.17) CHD events. The association with total CHD was significant in women (HR: 2.56; 95% CI 1.75 to 3.75) but not in men (HR: 1.39; 95% CI 0.99 to 1.94; p for interaction=0.012). When in the same multivariable model, hyperglycemia and abdominal adiposity in women, hyperglycemia, lower HDL cholesterol and abdominal adiposity (inverse association) in men were the components significantly associated with CHD. The components of the MetS but not the MetS itself improved risk prediction beyond traditional risk factors (NRI= 9.35%, p<0;001).
The MetS is a risk marker for CHD in community-dwelling elderly subjects but may not be useful for CHD risk prediction purposes compared to its individual components.
Metabolic syndrome; coronary heart disease; elderly; risk stratification; psychology/psychiatry; epidemiology
To investigate the association between components of the metabolic syndrome (MetS) measured during childhood/adolescence, and adult MetS.
This investigation focused on members of the Muscatine Study Longitudinal Adult Cohort. Predictor variables were risk factor measurements obtained between 1970 and 1981 when Cohort members participated in school survey examinations. Risk factor measurements obtained between 1982 and 2008 when Cohort members participated in follow-up examinations as young and middle-aged adults were utilized for MetS classification.
33.0% (29.7% of 474 women; 37.0% of 384 men) of Cohort members were classified as having the MetS. The initial MetS classification occurred at ages ranging from 23 to 52 with a mean age of 37.2 years (SD = 7.4). Cohort members with the MetS had significantly higher body mass index (BMI), systolic blood pressure, and triglycerides (TRIG) at the time they participated in the school survey examinations (p < 0.0001). Estimated probabilities of remaining MetS free at age 35 for those whose school survey BMI and TRIG measurements were both < 50th vs. ≥ 75th percentile were strikingly different (0.94 vs. 0.42).
BMI is the strongest childhood predictor of adult MetS. Early identification of at-risk children may reduce the burden of atherosclerotic cardiovascular disease.
Adiponectin and leptin play critical roles in the development of Metabolic Syndrome (MetS). The study was designed to assess circulating levels of adiponectin and leptin in early diagnosis of Metabolic Syndrome (MetS).
This cross-sectional study was performed on 367 participants randomly selected from a well-characterized cohort of Mexican-Americans living at the US-Mexico border.
Significant differences in circulating levels of adiponectin and leptin were observed between males and females. The adiponectin/leptin ratio significantly correlated with MetS in this population. A receiver-operator characteristic (ROC) analysis demonstrated that adiponectin/leptin ratio is a valuable biomarker for the diagnosis of MetS
Our study supported the central role of adiponectin and leptin in MetS, and demonstrated that adiponectin/leptin ratio can be used as a highly sensitive and specific biomarker for MetS.
adiponectin; computer-aided diagnosis; leptin; MetS; receiver operator characteristic
The metabolic syndrome (MetS) is a precursor of diabetes. Physical activity (PA) improves endothelial dysfunction and may benefit patients with MetS. Aims. To evaluate the effect of a physical activity (PA) program on markers of endothelial dysfunction and oxidative stress in adolescents with (MetS). Methods. We carried out a cohort study of 38 adolescents with and without MetS (18 females and 20 males). All participants completed a 3-month PA program. All variables of the MetS as well as markers of endothelial dysfunction and oxidative stress tests were evaluated. Results. Females with and without MetS showed significant differences for almost all components of the MetS, whereas males were significantly different in half of the components. After the PA program, components of the MetS were not different from baseline values except for HDL-C levels. Some baseline endothelial dysfunction markers were significantly different among adolescents with and without MetS; however, after the PA program, most of these markers significantly improved in subjects with and without MetS. Conclusion. PA improves the markers of endothelial dysfunction in adolescents with MetS although other changes in the components of the MetS were not observed. Perhaps the benefits of PA on all components of MetS would appear after a PA program with a longer duration.
To compare by BMI percentile group the point prevalence of Metabolic Syndrome (MetS) and its components in adolescents using two definitions of MetS, one including a measure of fasting plasma glucose (MetSIFG) and the other an estimate of insulin resistance (MetSHOMA).
Two New York City public high schools, from 2008 through 2011.
Convenience sample of 1,185 high school students participating in The BODY Project, a medical screening and education program.
Main Outcome Measures
Prevalence of individual MetS components: central adiposity, hypertriglyceridemia, low high-density lipoprotein cholesterol, hypertension, impaired fasting glucose, and insulin resistance using the homeostasis model assessment of insulin resistance (HOMA-IR); and rates of MetSIFG and MetSHOMA.
The MetSIFG and MetSHOMA point prevalences were both 0.3% in the healthy weight group and respectively 2.6% and 5.9% (P < 0.05) in the overweight group and 22.9% and 35.1% (P < 0.05) in the obese group. Only 1.0% of participants had impaired fasting glucose (IFG; glucose levels ≥ 100 mg/dl), whereas HOMA-IR ≥ 3.99 was found in 19.5% of participants.
Elevated HOMA-IR is much more sensitive than IFG to identify adolescents with metabolic dysregulation, and as a result, using a HOMA-IR value ≥ 3.99 identifies more youth as having MetS than using IFG. In addition to increasing the sensitivity of detection of MetS, HOMA-IR has a much higher association to the other MetS components than IFG, and may thus better reflect a unified underlying pathological process useful to identify youth at risk for disease.
The clustering of metabolic and cardiovascular risk factors is known as metabolic syndrome (MetS). The risk of having MetS is strongly associated with increased adiposity and can be further modified by smoking behavior. Apolipoproteins (apo) associated with low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) may be altered in MetS. This study aimed to examine the association between smoking and the following parameters: MetS and its components, levels of apolipoproteins and estimated lipoprotein particle size, separately for men and women, and in different body mass index (BMI) classes.
We included 24,389 men and 35,078 women aged between 18 and 80 years who participated in the LifeLines Cohort Study between December 2006 and January 2012; 5,685 men and 6,989 women were current smokers. Participants were categorized into three different body mass index (BMI) classes (BMI <25; BMI 25 to 30; BMI ≥30 kg/m2). MetS was defined according to the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP:ATPIII) criteria. Blood pressure, anthropometric and lipid measurements were rigorously standardized, and the large sample size enabled a powerful estimate of quantitative changes. The association between smoking and the individual MetS components, and apoA1 and apoB, was tested with linear regression. Logistic regression was used to examine the effect of smoking and daily tobacco smoked on risk of having MetS. All models were age adjusted and stratified by sex and BMI class.
Prevalence of MetS increased with higher BMI levels. A total of 64% of obese men and 42% of obese women had MetS. Current smoking was associated with a higher risk of MetS in both sexes and all BMI classes (odds ratio 1.7 to 2.4 for men, 1.8 to 2.3 for women, all P values <0.001). Current smokers had lower levels of HDL cholesterol and apoA1, higher levels of triglycerides and apoB, and higher waist circumference than non-smokers (all P <0.001). Smoking had no consistent association with blood pressure or fasting blood glucose. In all BMI classes, we found a dose-dependent association of daily tobacco consumption with MetS prevalence as well as with lower levels of HDL cholesterol, higher triglyceride levels and lower ratios of HDL cholesterol/apoA1 and, only in those with BMI <30, LDL cholesterol/apoB (all P <0.001).
Smoking is associated with an increased prevalence of MetS, independent of sex and BMI class. This increased risk is mainly related to lower HDL cholesterol, and higher triglycerides and waist circumference. In addition, smoking was associated with unfavorable changes in apoA1 and apoB, and in lipoprotein particle size.
Please see related commentary: http://www.biomedcentral.com/1741-7015/11/196.
Metabolic syndrome; Smoking; HDL; Cholesterol; Apolipoproteins; Triglycerides; Obesity; Cross-sectional; BMI classes
To evaluate the pertinent cutoffs of waist circumference (WC) and the discriminatory performance of other anthropometric indices to detect clustering cardiovascular risk factors for metabolic syndrome (MetS) in Japan, where the current WC cutoffs for MetS (85 cm for men and 90 cm for women) remain controversial.
We analyzed the baseline data from 844 subjects (330 men and 514 women) aged 40–69 years who participated in a cohort study in Saga city, Japan, between November 2005 and December 2007. Receiver operating characteristic (ROC) analyses were performed to find an appropriate cutoff (defined as the point nearest to the upper left corner of the ROC curve) of each anthropometric index for the presence of multiple risk factors among dyslipidemia, hypertension, and hyperglycemia [which was defined as hemoglobin A1c (HbA1c) levels at and above 5.2, 5.5, or 5.8%, values approximately corresponding to fasting plasma glucose levels of 100, 110, and 120 mg/dL, respectively].
The optimal WC cutoff was 88 cm (sensitivity 60%, specificity 70%) for men and 82 cm (sensitivity 78%, specificity 62%) for women; changing the HbA1c cutoff affected the results in women only (~85 cm). For the currently defined WC cutoffs in Japan, specificity was low (53–57%) in men, whereas sensitivity was very low (32–42%) in women. Body mass index, proportion of body fat, waist-to-height ratio, and waist-to-hip ratio showed area under the curve values similar to that of WC.
The current Japanese criteria of WC for MetS may be low for men and too high and insensitive for women in our study population. Other anthropometric indices such as waist-to-height ratio did not confer an improved discriminatory performance compared with WC.
Metabolic syndrome; Waist circumference; Cutoff; Cross-sectional study; ROC analysis
Uncertainties exist about the rates, predictors and outcomes of major depressive disorder (MDD) among people with traumatic brain injury (TBI).
To describe MDD related rates, predictors, outcomes and treatment during the first year after TBI
Cohort from 6/2001–3/2005 followed by structured telephone interviews at months 1–6, 8, 10, and 12 (data collection ending 2/2006).
Harborview Medical Center, a Level I trauma center in Seattle, WA
559 consecutively hospitalized adults with complicated mild to severe TBI
Main Outcome Measures
The Patient Health Questionnaire (PHQ) depression and anxiety modules were administered at each assessment and the European Quality of Life measure (EQ-5D) was given at 12 months.
53% met criteria for MDD at least once in the follow-up period. Point prevalences ranged between 31% at one month and 21% at six months. In a multivariate model, increased risk of MDD after TBI was associated with MDD at the time of injury (risk ratio [RR], 1.62; 95% confidence interval [CI], 1.37–1.91), history of MDD prior to injury (but not at the time of injury) (RR, 1.54; 95% CI, 1.31–1.82), age (RR, 0.61; 95% CI, 0.44–0.83 for 60+ years vs. 18–29 years) and lifetime alcohol dependence (RR, 1.34; 95% CI, 1.14–1.57). Those with MDD were more likely to report co-morbid anxiety disorders after TBI than those without MDD (60% versus 7%; RR, 8.77; 95% CI, 5.56–13.83). Only 44% of those with MDD received antidepressants or counseling. After adjusting for predictors of MDD, persons with MDD reported lower quality of life at one year, compared to the nondepressed group.
Among a cohort of patients hospitalized for TBI, 53% met criteria for MDD during the first year after TBI. MDD was associated with prior history of MDD and was an independent predictor of poorer health-related quality of life.
To examine quality of life (QOL) in nursing home (NH) residents with advanced dementia and identify correlates of QOL near the end of life.
Cross-sectional data derived from NH records, interviews with residents’ surrogate decision-makers, QOL ratings by NH caregivers, and assessment of residents’ cognitive function.
Three NHs in Maryland.
A cohort of NH residents with dementia (n=119), who were either receiving hospice or palliative care or met hospice criteria for dementia, and their surrogates.
QOL based on the proxy-rated Alzheimer Disease Related Quality of Life (ADRQL) scale administered to NH staff and validated against a single-item surrogate-rated measure of QOL, the Severe Impairment Rating Scale to measure cognitive function, and dichotomous indicators of neuropsychiatric symptoms (i.e., behavior problems, mood disorders, psychosis/delusions).
Total ADRQL scores, ranging from 12.4 to 95.1 out of 100, were normally distributed and positively correlated (p<.001) with surrogate-rated QOL. Multiple regression analysis of ADRQL scores showed that residents with higher cognitive function (p<.001, CI = .966 – 1.650) and those receiving pain medication (p=.006, CI = 3.303 – 19.588) had higher QOL, while residents with behavior problems (p=.014, CI = −11.604 – −1.298) had lower QOL.
The ADRQL is a valid indicator of QOL in NH residents with advanced dementia. QOL in this population may be improved near the end of life by appropriate assessment and treatment of pain and more effective management of behavior problems.
quality of life; advanced dementia; end of life; nursing home residents
Although attention to metabolic syndrome (MetS) in children has increased, there is still no universally accepted definition and its pathogenesis remains unclear. Our aim was to compare the current definitions of childhood MetS in a Chinese cohort and to examine the clustering pattern of MetS risk factors, particularly inclusion of leptin and adiponectin as additional components.
3373 schoolchildren aged 6 to 18 years were recruited. Anthropometric and biochemical parameters and adipokines were measured. MetS was identified using both the International Diabetes Federation (IDF) and a modified Adult Treatment Panel III (ATP III) definitions. Exploratory factor analysis was performed to establish grouping of metabolic characteristics.
For children ≥10 years, the prevalence of MetS was 14.3% in the obese group and 3.7% in the overweight group according to the new IDF definition, and 32.3% in the obese group and 8.4% in the overweight group according to the modified ATPIII definition. Frequency of hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), impaired fasting glucose, elevated blood pressure, and central obesity according to the new IDF definition was 16.7%, 20.7%, 15.8%, 25.5% and 75.5% in obese boys and 14.7%, 24.0%, 12.0%, 11.0% and 89.0% in obese girls, respectively. Metabolic abnormalities in children under 10 years of age were also noted. Using factor analysis on eight conventional variables led to the extraction of 3 factors. Waist circumference (WC) provided a connection between two factors in boys and all three factors in girls, suggesting its central role in the clustering of metabolic risk factors. Addition of leptin and adiponectin also led to the extraction of 3 factors, with leptin providing a connection between two factors in girls. When using WC, mean arterial pressure, triglyceride/HDL-C ratio, HOMA-IR and leptin/adiponectin ratio as variables, a single-factor model was extracted. WC had the biggest factor loading, followed by leptin/adiponectin ratio.
MetS was highly prevalent amongst obese children and adolescents in this cohort, regardless of the definition used. Central obesity is the key player in the clustering of metabolic risk factors in children, supporting the new IDF definition. Moreover, our findings suggest that a common factor may underlie MetS. Leptin/adiponectin ratio as a possible component of MetS deserves further consideration.
Metabolic syndrome (MetS) is characterized by central obesity, hypertension, insulin resistance, and hypercholesterolemia. Hypothalamic-pituitary-adrenal (HPA) axis activity is frequently abnormal in MetS, and excessive cortisol exposure may be implicated in metabolic derangements. We investigated the hypothesis that cortisol and adrenocorticotropic hormone (ACTH) responses to a standardized neuroendocrine challenge test would be associated with indices of MetS in a community sample of healthy adults. Healthy adults, 125 men and 170 women, without significant medical problems or chronic medications were recruited from the community. Participants completed the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test, and anthropometric measurements, blood pressure, glycosylated hemoglobin (HbA1c), and cholesterol were measured. Participants reported on their history of early life stress and recent stress, as well as mood and anxiety symptoms. Cortisol and ACTH responses to the Dex/CRH test were negatively associated with measures of central adiposity (p < 0.001) and blood pressure (p < 0.01), and positively associated with HDL cholesterol (p < 0.01). These findings remained significant after controlling for body mass index (BMI). Measures of stress and anxiety and depressive symptoms were negatively correlated with cortisol and ACTH responses in the Dex/CRH test but were not related to MetS indices. That altered HPA axis function is linked to MetS components even in a healthy community sample suggests that these processes may be involved in the pathogenesis of MetS. Identification of premorbid risk processes might allow for detection and intervention prior to the development of disease.
metabolic syndrome; HPA axis; cortisol; ACTH; corticotrophin-releasing hormone
Quality of life (QoL) is consistently decreased in gastroesophageal reflux disease (GERD), but the relationship between QoL and psychological factors in GERD has not yet been clearly defined. The present study investigated the relationship between the psychological factors of two subtypes of GERD and QoL.
A cohort of 769 participants underwent upper endoscopic evaluation in the health-promotion center of St. Paul's Hospital. The severity of GERD symptoms, psychological factors, and QoL were analyzed using the Visual Analogue Scale, the Hospital Anxiety and Depression Scale, and the abbreviated version of the World Health Organization Quality of Life instrument, respectively.
Among the total of 769 participants, 153 participants were included in the exclusion criteria. Erosive reflux disease (ERD) and nonerosive reflux disease (NERD) were present in 106 (14%) and 61 (8%) of the participants, respectively, and 449 (58%) acted as controls. In each GERD group, the QoL had no correlatioion with the symptom severity. The scores for anxiety and depression were highest in the NERD group, and QoL scores were lower in both the ERD and NERD groups than in the control group. Anxiety and depression resulted in QoL scores being lower in both the ERD and NERD groups than in the nonanxiety and nondepressed groups, respectively.
This study provides evidence that the QoL associated with the ERD and NERD subtypes may be more related to psychological factors than to symptom severity.
Gastroesophageal reflux; Quality of life; Anxiety; Depression; Psychology
To assess the effects of leisure-time physical activity (LTPA) and resistance training on metabolic syndrome (MetS) and its components in a post hoc analysis of the Finnish Diabetes Prevention Study, a randomized controlled lifestyle counseling trial.
RESEARCH DESIGN AND METHODS
A cohort of 486 middle-aged overweight men and women with impaired glucose tolerance were followed for an average of 4.1 years. The intervention and control groups were combined in the analyses. LTPA was assessed by questionnaires, dietary intake by food records, and features of the MetS by anthropometric and biochemical measures annually. Resistance training sessions were documented for 137 participants.
Increased moderate-to-vigorous LTPA, even after adjustments for changes in dietary intakes of total and saturated fat, fiber, and energy, and change in BMI was associated with a greater likelihood for resolution (29.7 vs. 19.1%; P = 0.004 in the upper versus lower third of change) and a lesser likelihood for development (23.5 vs. 44.7%; P = 0.041) of the MetS. Of the components of the MetS, the increase in moderate-to-vigorous LTPA was associated most strongly with improvement of glycemia. Among the 137 participants who participated in resistance training, MetS components were favorable in individuals who were in the upper third of participation rate (median 51 times/year) compared with individuals in the lowest third (median 8.5 times/year).
Increased moderate-to-vigorous LTPA was associated with a decreased likelihood of developing the MetS and an increased likelihood of its resolution in individuals at high risk for type 2 diabetes.
Few studies have focused on the association between diet quality scores and the Metabolic Syndrome (MetS), a multi-component condition predictive of cardiovascular diseases (CVD) and death. The present study aims at investigating, in a cross-sectional design, the association between adherence to the French dietary guidelines through an a priori score – the French Nutrition and Health Program-Guideline Score (PNNS-GS) – and cardiovascular risk factors (CVRF) including the MetS and adiposity markers.
7902 French adults participating in the NutriNet-Santé study (an on-going web-based cohort study) attended a clinical and biological examination between January 2011 and November 2012: a fasting blood sample was drawn, blood pressure and body composition (bio-impedance) were measured. Multivariate linear and logistic regression models were used to assess the association between PNNS-GS and CVRF or the MetS.
An increase of PNNS-GS was significantly negatively associated with waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP) and serum triglycerides concentrations. From bottom to top quartile of PNNS-GS, SBP decreased from 129.9 to 128.8 mm Hg, DBP from 76.7 to 75.9 mm Hg, serum triglycerides concentrations from 110.8 to 104.6 mg/dL and WC from 94.8 to 90.1 cm for men and 81.3 to 78.9 cm for women. All adiposity markers (waist and hip circumference, % body fat, % trunk fat, % leg fat) were markedly reduced across quartiles of PNNS-GS and linearly. Individuals with a better PNNS-GS (quartile 4 vs quartile 1) were less likely to have the MetS (OR=0.71, 95% CI: 0.56-0.89).
The negative association between a higher adherence to the French dietary guidelines and a number of CVRF, the MetS prevalence and regional adiposity supports the importance of promoting the PNNS dietary guidelines in the population for the prevention of cardiometabolic abnormalities and hence, cardiovascular diseases.
The objective of this study was to determine whether the progressive increase of metabolic syndrome (MetS) score, the number of components of MetS, is correlated significantly with increasing pulse pressure (PP).
Materials and Methods
4,034 subjects were enrolled from the Cardiovascular Genome Center of Yonsei University (M : F = 2344 : 1690, 55.2 ± 10.5). Most of the study population were recruited from hypertension clinics, controlled with medications according to JNC7 guidelines. The Asian modified criteria of MetS were applied and MetS score was estimated. The HOMA index for insulin resistance, cholesterol profiles, and anthropometric measurements were assessed.
Among 4034 participants, 1690 (41.9%) were classified as MetS. Progressive increase in PP was demonstrated for increasing components of the MetS score. Multiple linear regression analysis with PP as the dependent variable showed that age (β = 0.311, p < 0.001), MetS score (β = 0.226, p < 0.001), male gender (β = -0.093, p < 0.001) and HOMA index IR (β = 0.033, p = 0.03) are significantly associated with PP (R2 = 0.207, p < 0.001).
The present results from this study demonstrate that increasing MetS score is an independent determinant of increasing PP. The results also demonstrate the independent role of MetS in increasing arterial stiffness and PP.
Metabolic syndrome; pulse pressure; arterial stiffness; metabolic syndrome scores
Cardiovascular diseases have the highest death rates in human society. Coronary artery disease is among the most important of these diseases. No treatment of cardiovascular disease has as much impact on the quality of life of the patients as the heart surgery. The recovery from heart surgery is associated with symptoms of pain and psychological distress. In the early recovery period, the patients will face moderate symptoms of anxiety and depression. In this regard, various measures of nursing, as complementary therapy practices have been performed to help the patients for overcoming the physical and psychological needs. One of these methods, in recent years has been the use of complementary and alternative therapies, particularly massage therapy, after heart surgery. Thus, the aim of this study was to determine the effectiveness of massage therapy on the mood of patients after open-heart surgery in Isfahan Chamran Hospital during 2010-11.
Materials and Methods:
In this study 72 patients, who underwent coronary artery bypass surgery, were selected. They were randomly assigned to the two case and control groups. The patients of the case group (n = 36) received Swedish massage for 20 minutes in 4 sessions in 4 consecutive days, 3 to 6 days after the open-heart surgery. The patients in the control group received only the routine care. The mood questionnaire (POMS) which was used in this study has been completed the day before the start of the study and intervention and again after the last day of the intervention. SPSS software version 12 and descriptive and inferential statistical methods were used for data analysis.
The comparison of study results showed that massage decreased the overall rating of the patients’ mood after the surgery.
The use of massage therapy as an effective nursing intervention can improve the patients’ mood after open-heart surgery. Due to the low cost and simplicity of this method, it can perhaps be used as a complement to drug therapy and postoperative interventions used in these patients.
Massage; mood; heart surgery
The metabolic syndrome (MetS) is defined as concomitant disorders of lipid and glucose metabolism, central obesity, and high blood pressure, with an increased risk of type 2 diabetes and cardiovascular disease. This study tests whether common genetic variants with pleiotropic effects account for some of the correlated architecture among five metabolic phenotypes that define MetS.
RESEARCH DESIGN AND METHODS
Seven studies of the STAMPEED consortium, comprising 22,161 participants of European ancestry, underwent genome-wide association analyses of metabolic traits using a panel of ∼2.5 million imputed single nucleotide polymorphisms (SNPs). Phenotypes were defined by the National Cholesterol Education Program (NCEP) criteria for MetS in pairwise combinations. Individuals exceeding the NCEP thresholds for both traits of a pair were considered affected.
Twenty-nine common variants were associated with MetS or a pair of traits. Variants in the genes LPL, CETP, APOA5 (and its cluster), GCKR (and its cluster), LIPC, TRIB1, LOC100128354/MTNR1B, ABCB11, and LOC100129150 were further tested for their association with individual qualitative and quantitative traits. None of the 16 top SNPs (one per gene) associated simultaneously with more than two individual traits. Of them 11 variants showed nominal associations with MetS per se. The effects of 16 top SNPs on the quantitative traits were relatively small, together explaining from ∼9% of the variance in triglycerides, 5.8% of high-density lipoprotein cholesterol, 3.6% of fasting glucose, and 1.4% of systolic blood pressure.
Qualitative and quantitative pleiotropic tests on pairs of traits indicate that a small portion of the covariation in these traits can be explained by the reported common genetic variants.