Metabolic Syndrome Criteria As Predictors of Insulin Resistance, Inflammation and Mortality in Chronic Hemodialysis Patients

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Analysis of criteria for metabolic syndrome in a population-based study of Japanese-Brazilians

Objective: Criteria for metabolic syndrome (MS) differ particularly regarding the definition of central obesity and consequently, there could be differences in the assessment of cardiovascular risk. We estimated the prevalence of metabolic syndrome, compared the agreement of the World Health Organization (WHO) criteria with the standard and a modified National Cholesterol Education Program (NCEP) criterion and investigated whether additional factors were associated with the diagnosis of the syndrome in a Japanese descendant population.Methods: In this cross-sectional, population-based survey, 1166 Japanese-Brazilians (533 men, 633 women) aged 57.4 +/- 12.4 years with mean body mass index (BMI) and waist of 25.2 +/- 4.0 kg/m(2) and 84.5 +/- 10.6 cm, respectively, were included. McNemar and kappa statistics were used to assess the concordance between WHO criteria with the standard and a modified NCEP criteria (waist of 90 and 80 cm, for men and women, respectively). in logistic regression analysis, a number of metabolic variables and albumin-to-creatinine ratio were included to test independent associations with metabolic syndrome defined by the modified NCEP criteria.Results: According to WHO, 55.4% (95% Cl 52.5-58.2%) of the subjects had MS and to NCEP 47.4% (95% Cl 44.6-50.0%). WHO criterion detected 48.3% of central obese subjects while NCEP only 14.0%. Kappa statistics showed a good strength of agreement (k = 0.67, p < 0.01) between WHO and NCEP standard definitions of MS. Using the modified NCEP criterion for Asians, more subjects with metabolic syndrome were identified (58%) and agreement with WHO was improved (k = 0.72, p < 0.001). However, similar Framingham risk scores were attributed to the subsets of subjects classified by any of the three criteria. Areas under the receiver operating characteristic curves, obtained for the modified waist values to diagnose metabolic syndrome according to WHO, were > 0.80 and corresponded, respectively, to sensitivity and specificity of 63 and 83% for men and 77 and 72% for women. In final logistic regression model, age, male sex, BMI and homeostasis model assessment-insulin resistance but not with albumin-to-creatinine ratio (ACR) were independently associated with the syndrome.Conclusions: High prevalence of MS, independent of the criterion considered, was found in this Japanese-Brazilian population. The replacement of waist cutoff by those proposed by WHO for Asians lead to this diagnosis in a higher number of subjects with elevated cardiovascular risk. Our data did not support that ACR should be included in the classical definition of MS in Japanese descendants as previously suggested by WHO.

Evaluation of Toll-Like Receptor 2 and 4 RNA Expression and the Cytokine Profile in Postmenopausal Women with Metabolic Syndrome

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Are metabolic syndrome and its components associated with 5-year mortality in chronic obstructive pupmonary disease patients?

The aim of this study was to evaluate the risk of mortality according to the presence of metabolic syndrome in chronic obstructive pulmonary disease (COPD) patients who were followed for 5 years. We did not establish the influence of metabolic syndrome on mortality rate. However, an increase of 100 mg of triglycerides was associated with a 39% increase in the probability of death in the period of the study (hazard ratio 1.39, 95% confidence interval 1.06-1.83).

Effects of omega-3 on metabolic markers in postmenopausal women with metabolic syndrome

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Red-fleshed sweet orange juice improves the risk factors for metabolic syndrome

Orange juice consumption can promote lower levels of oxidative stress and inflammation due to the antioxidant activity of citrus flavonoids and carotenoids. In addition, red-fleshed sweet orange juice (red orange juice) also contains lycopene. This study investigated the effects of red orange juice consumption on risk factors for metabolic syndrome. Volunteers consumed red orange juice daily for 8 weeks, with clinical and biochemical assessments performed at baseline and on the final day. There was no change in the abdominal obesity, but low-density lipoprotein cholesterol, C-reactive protein decreased, while there was an increase of the antioxidant activity in serum after red orange juice consumption. Insulin resistance and systolic blood pressure were reduced in normal-weight volunteers, while diastolic blood pressure decreased in overweight volunteers after intervention. Red orange juice showed anti-inflammatory, antioxidant, and lipid-lowering properties that may prevent the development of metabolic syndrome.

Changes in malondialdehyde and C-reactive protein concentrations after lifestyle modification are related to different metabolic syndrome-associated pathophysiological processes

Metabolic syndrome (MetS) is often accompanied by pro-oxidative and pro-inflammatory processes. Lifestyle modification (LiSM) may act as primary treatment for these processes. This study aimed to elucidate influencing factors on changes of malondialdehyde (MDA) and C-reactive protein (CRP) concentrations after a LiSM intervention. Sixty subjects (53 yrs, 84% women) clinically approved to attend a 20 weeks LiSM-program were submitted to weekly nutritional counseling and physical activities combining aerobic (3 times/week) and resistance (2 times/week) exercises. Before and after intervention they were assessed for anthropometric, clinical, cardiorespiratory fitness test (CRF) and laboratory markers. Statistical analyses performed were multiple regression analysis and backward stepwise with p<0.05 and R(2) as influence index. LiSM was responsible for elevations in CRF, healthy eating index (HEI), total plasma antioxidant capacity (TAP) and HDL-C along with reductions in waist circumference measures and MetS (47-40%) prevalence. MDA and CRP did not change after LiSM, however, we observed that MDA concentrations were positively influenced (R(2)=0.35) by fasting blood glucose (β=0.64) and HOMA-IR (β=0.58) whereas CRP concentrations were by plasma gamma-glutamyltransferase activity (β=0.54; R(2)=0.29). Pro-oxidant and pro-inflammatory states of MetS can be attenuated after lifestyle modification if glucose metabolism homeostasis were recovered and if liver inflammation were reduced, respectively.

Anthropometric indicators predict metabolic syndrome diagnosis in maintenance hemodialysis patients

Obesity has been considered the key in metabolic syndrome (MetS) development, and fat accumulation may be responsible for the occurrence of metabolic abnormalities in hemodialysis patients. The use of gold-standard methods to evaluate obesity is limited, and anthropometric measures may be the simplest methods. However, no study has investigated the association between anthropometric indexes and MetS in these patients. Therefore, the aim was to determine which anthropometric indexes had the best association and prediction for MetS in patients undergoing hemodialysis. Cross-sectional study that included patients older than 18 years, undergoing hemodialysis for at least 3 months. Patients with liver disease and cancer or those receiving corticosteroids or antiretroviral therapy were excluded. Diagnostic criteria from Harmonizing Metabolic Syndrome were used for the diagnosis of MetS. Anthropometric indexes evaluated were body mass index (BMI); percent standard of triceps skinfold thickness and of middle arm muscle circumference; waist circumference (WC); sagittal abdominal diameter; neck circumference; waist-to-hip, waist-to-thigh, and waist-to-height ratios; sagittal index; conicity index; and body fat percentage. Ninety-eight patients were included, 54.1% male, and mean age was 57.8 ± 12.9 years. The prevalence of MetS was 74.5%. Individuals with MetS had increased accumulation of abdominal fat and general obesity. Waist-to-height ratio was the variable independently associated with MetS diagnosis (odds ratio, 1.21; 95% confidence interval, 1.09-1.34; P < .01) and that better predicts MetS, followed by WC and BMI (area under the curve of 0.840, 0.836, and 0.798, respectively, P < .01). Waist-to-height ratio was the best anthropometric predictor of MetS in maintenance hemodialysis patients.

One-hundred days of monitoring of patients undergoing hematopoietic stem cell transplantation: events of metabolic syndrome

Objective This study assessed early manifestations of metabolic syndrome determinants in patients submitted to hematopoietic stem cell transplantation. Methods Twenty-seven individuals participated in the study (20 with autologous and 7 with allogeneic hematopoietic stem cell transplantation). Anthropometric variables and biochemical indicators of lipid and glucose metabolism were determined before and 100 days after hematopoietic stem cell transplantation.Results The mean total cholesterol (p=0.086), very low density lipoprotein-cholesterol (p=0.069) and triglycerides (p=0.086) of all patients did not change significantly between the two study periods, but when the patients were separated by type of hematopoietic stem cell transplantation, triglycerides and very low density lipoprotein-cholesterol were close to the critical level of significance for individuals with allogeneic hematopoietic stem cell transplantation (p=0.060) and total cholesterol was significant in individuals with autologous hematopoietic stem cell transplantation (p=0.027). Anthropometric variables did not change significantly between before and 100 days after hematopoietic stem cell transplantation. Conclusion Metabolic syndrome risk factors may be associated with lipid metabolism in the early phase of allogeneic and autologous hematopoietic stem cell transplantation.

Indeterminate form of chagas disease and metabolic syndrome: a dangerous combination

Chagas’ disease (CD) has been a major concern in public health in Latin America countries and in Brazil there are about 3 million people suffering from this disease. With the social and economic changes which have been occurring in the last 6 decades in the country, there have been a lot of changes in the population life style with severe metabolic consequences, especially for those with Chagas' disease. The objective of this study was to evaluate the prevalence of metabolic syndrome in individuals with the indeterminate form of CD. A total of 74 individuals, mean age of 55.6 years, participated in the study. Anthropometric and biochemical evaluations were performed. Overweight/obesity was found in 86.5 % of individuals, increased waist circumference in 72.5%, and 67% had more than 30% of fat mass. Hyperglycemia and dyslipidemia were observed in 24.3% and 75.7% of patients, respectively. Metabolic syndrome was diagnosed in 48.2% of patients. The family history revealed high prevalence of cardiovascular diseases (80.3%), systemic arterial hypertension (57.1%) and diabetes mellitus (42.8%). A total of 90% of patients were overweight/obese, and it is well known that increased adipose tissue, specially visceral adipose tissue is highly associated with dyslipidemia and cardiovascular diseases, as well as imbalance in production of proinflammatory and antiinflammatory cytokines produced by that tissue. Adipocytes are also known as a reservoir for Trypanosoma cruzi, favoring an increase in parasite load and a possible reacutization of the disease. Therefore, the study individuals are at high risk of developing cardiovascular diseases as well as further symptomatic form of the Chagas' disease, mainlychagastic cardiopathy.

Association of dietary patterns with metabolic syndrome components in low-income, free-living Brazilian adults

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Omega-3 fatty acids supplementation decreases metabolic syndrome prevalence after lifestyle modification program

The additional effect of omega-3 supplementation in association with lifestyle modification program (LSMP) in free living-adults was evaluated.We studied 39 adults (control group with LSMP (G1, n = 16) and LSMP plus supplementation of 3 g of fish oil per day (360 mg of docosahexaenoic acid and 540 mg of eicosapentaenoic acid) (G2, n = 23)) during 20 weeks. The fish oil group showed a significant decrease in waist circumference (1.3%) followed by metabolic syndrome reduction (29%) mainly due to normalization of blood pressure (33.3%) and triacylglycerol (27.3%). Omega-3 supplementation provided additional benefits to LSMP in the resolution of metabolic syndrome