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, José Luis Llisterri Caro, Antonio Segura Fragoso, , Carlos Escobar Cervantes, , Luis Rodríguez Padial, Vicente Pallarés Carratalá, , Sonia Miravet Jiménez, et al.
Metabolic Syndrome and Related Disorders, Volume 15, pp 431-438; https://doi.org/10.1089/met.2017.0114

Abstract:
Objective: The main objective of this study is to know the prevalence and the clinical and epidemiological characteristics of patients with metabolic syndrome (MetS) and premorbid metabolic syndrome (pre-MetS) included in the Identification of the Spanish Population at Cardiovascular and Renal Risk (IBERICAN) study. Materials and Methods: The IBERICAN study is an epidemiological, multicentric observational study carried out in Primary Healthcare Centers from all over Spain, in which an open cohort of subjects with/without cardiovascular risk factors (CVRF) is constituted. The MetS was defined according to the international criterion based on the presence of at least three of the five criteria of the harmonized definition. Results: A total of 4304 patients were selected; 38.5% patients (95% confidence interval 37.0–40.0) met the MetS criteria. In both groups (MetS and pre-MetS), patients were older (62.3 ± 12.1 vs. 54.4 ± 15.2, P< 0.001). The CVRF analyzed were more frequent in patients with MetS: hypertension (HT) (71.1% vs. 33.0%, P< 0.001), dyslipidemia (65.8% vs. 40.2%, P< 0.001), diabetes mellitus (DM) (38.2% vs. 6.4%, P< 0.001), and obesity (54.8% vs. 21.7%, P< 0.001), and all the cardiovascular diseases (CVDs) analyzed were more prevalent in these patients: stroke (5.1% vs. 3.6%, P = 0.013), heart failure (5.1% vs. 1.6%, P< 0.001), ischemic heart disease (9.8% vs. 5.8%, P< 0.001), and peripheral arterial disease (6.8% vs. 3.7%, P< 0.001). We observed that patients with DM were 6.36 times more likely to present MetS; patients with obesity, 3.81 times; and patients with HT, 2.66 times. Conclusion: Patients with MetS and with pre-MetS presented higher CVRF and increased associated renal and CVD. The prognostic value of these findings must be analyzed in the longitudinal follow-up of the IBERICAN cohort.
, Daisuke Ninomiya, Kensuke Senzaki, Teru Kumagi
Metabolic Syndrome and Related Disorders, Volume 15, pp 407-415; https://doi.org/10.1089/met.2017.0064

Abstract:
Background: Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. Alanine aminotransferase (ALT) at high levels and total bilirubin (T-BiL) at low levels were oxidative potentials, but it was uncertain whether ALT and T-BiL had an additive interaction for the risk of MetS. Methods: From a single community, we recruited 864 women (70 ± 8 years) during their annual health examination. We cross-sectionally investigated whether ALT and T-BiL are associated with MetS and its components based on the modified criteria of the National Cholesterol Education Program's Adult Treatment Panel (NCEP-ATP) III report. Results: Of these subjects, 415 women (48.0%) had MetS. Participants with MetS had a higher ALT and lower T-BiL level than those without MetS. The adjusted-odds ratios (OR) (95% confidence interval [CI]) for MetS across tertiles of ALT and T-BiL were 1.00, 1.19 (0.78–1.81), and 1.86 (1.24–2.80) and 1.00, 0.96 (0.65–1.43), and 0.54 (0.36–0.81), respectively. When ALT and T-BiL were categorized into three binary characteristics by tertiles of ALT and T-BiL, high T-BiL was associated with decreased risk for MetS in a multivariable model (OR: 0.55, 95% CI: 0.37–0.82), especially among those with 1st tertile ALT. Similarly, high ALT was also associated with increased risk for MetS in a multivariate model (OR: 1.81, 95% CI: 1.20–2.71), especially among those with 2nd & 3rd tertiles of T-BiL. In the formal testing of addictive interaction between ALT and T-BiL for MetS, presence of T-BiL <0.72 mg/dL (1st and 2nd tertile) alone was not associated with increased risk of MetS in a multivariate analysis, and presence of ALT ≥16 IU/L (2nd and 3rd tertile) alone was not associated with increased risk of MetS. Conclusions: These results suggested that higher ALT and lower T-BiL levels were synergistically associated with MetS, independent of other confounding factors among Japanese women.
Jae Hyun Kim, Kyoung Im Cho, Young A. Kim, Seun Ja Park
Metabolic Syndrome and Related Disorders, Volume 15, pp 393-399; https://doi.org/10.1089/met.2017.0041

Abstract:
Background: Metabolic syndrome (MetS) is an important cardiovascular risk factor for insulin resistance and has been linked to colorectal adenoma via inflammation. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as an important inflammatory marker. We initiated this investigation to determine the relationship between colorectal adenoma and NLR in patients with MetS. Methods: We examined participants who visited the Health Promotion Center at Kosin University Gospel Hospital, Busan, Korea. Subjects who underwent both colonoscopy and liver ultrasonography were included. Colorectal adenoma was defined as the presence of a colon polyp with a histologically adenomatous component. MetS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III definition for South Asians. Anthropometric measurements and biochemical tests of liver and metabolic function were assessed. Results: A total of 1007 subjects were included in the study sample. Their mean age was 48.3 ± 9.7 years and 262 (26.0%) subjects had MetS, while 439 (43.6%) subjects had pathologically proven colorectal adenoma. Subjects with MetS were older, more likely to be male, and had significantly higher prevalences of colorectal adenoma (49.2% vs. 41.6%, P = 0.032), nonalcoholic fatty liver disease (62.8% vs. 19.5%, P< 0.001), and higher NLR (2.0 ± 0.9 vs. 1.7 ± 0.7, P< 0.001) compared to those without MetS. High NLR (≥2.0) was an independent factor affecting the prevalence of colorectal adenoma [odds ratio (OR) 1.38, confidence interval (95% CI) 1.02–1.88, P = 0.040], especially in subjects with MetS (OR 1.91, 95% CI 1.12–3.28, P = 0.018). Conclusion: High NLR was associated with increased colorectal adenomatous polyps, particularly in subjects with MetS. Screening colonoscopies for the prevention of colorectal adenoma may be warranted for patients with high NLR and MetS.
Simona Ferjan, ,
Metabolic Syndrome and Related Disorders, Volume 15, pp 515-520; https://doi.org/10.1089/met.2017.0095

Abstract:
Background: Weight loss is often nonsustainable after liraglutide cessation. The present study is the first insight into the potential prevention of weight regain in obese subjects who have been withdrawn from liraglutide. We evaluated whether dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin in adjunct to metformin prevents body weight regain more effectively than metformin alone in obese polycystic ovary syndrome (PCOS) previously treated with liraglutide. Methods: A 12-week prospective randomized open-label study was conducted with 24 obese women with PCOS who had been pretreated with liraglutide 3.0 mg due to antiobesity management (aged 34.3 ± 6.8 years, body mass index [BMI] 36.3 ± 5.2 kg/m2, mean ± standard deviation). They were randomized to combined treatment (COMBO) with sitagliptin 100 mg per day (QD) and metformin (MET) 1000 mg twice daily (BID) (n = 12) or MET 1000 mg BID (n = 12). Lifestyle intervention was promoted in both groups. The primary outcome was change in anthropometric measures of obesity. Results: Women treated with MET regain 4.7 ± 2.7 kg (P = 0.002) compared with a 0.9 ± 2.5 kg in COMBO (P = 0.147). BMI increased for 1.7 ± 0.9 kg/m2 in MET (P = 0.002) compared with 0.3 ± 0.8 kg/m2 increase in COMBO (P = 0.136). MET group regain 4.5% ± 2.5% of body weight as opposed to 0.8% ± 2.6% in COMBO. The between-treatment differences were significant for weight change (P< 0.001), percentage of weight change (P< 0.001), and BMI change (P< 0.001). Greater ability to resist emotional eating was demonstrated in COMBO. Conclusion: Sitagliptin in adjunct to metformin prevented weight regain in obese women with PCOS previously treated with liraglutide.
, Alberto de Leiva
Published: 1 December 2017
Metabolic Syndrome and Related Disorders, Volume 15, pp 494-499; https://doi.org/10.1089/met.2017.0103

Abstract:
Background: We undertook a study to assess β-cell function, metabolic and immunological features of patients with latent autoimmune diabetes in adults (LADA) and investigate heterogeneity within LADA based on low and high glutamic acid decarboxylase autoantibodies (GADA) titers. Methods: A total of 139 patients with adult-onset diabetes were examined cross-sectionally in the National capital region of Northern India. Medical history of all subjects was reviewed with the aim of collecting clinical data. Glucose, glycosylated hemoglobin, lipid profile, creatinine, C-peptide, and GADA were measured in 10–12 hrs fasting blood sample. Results: Assessment of metabolic features revealed lower mean systolic blood pressure in subjects with LADA than in those with type 2 diabetes (DM2). Mean triglyceride levels were lower in LADA subjects compared to DM2 subjects. Compared to DM2 subjects, prevalence of metabolic syndrome (MS) was also lower in LADA subjects. Compared to GADA-low, all GADA-high patients were male, had lower waist circumference, fasting C-peptide (FCP), and prevalence of MS. Compared to DM2 patients, GADA-high patients were younger, had lower age at onset, body mass index, waist circumference, systolic blood pressure, triglycerides, FCP, and prevalence of MS. The rate of patients on insulin was higher in GADA-high compared to DM2. There were no significant differences between characteristics of DM2 and GADA-low patients. Conclusions: Our results indicate that LADA patients have distinct metabolic features with lower residual β-cell function than DM2 patients. GADA titer is important parameter in defining the severity of the disease as patients with high GADA titer tend to have significant β-cell impairment.
Tatiana Toro-Ramos, , Youngin Kim, Andreas Michaelides, , , ,
Metabolic Syndrome and Related Disorders, Volume 15, pp 465-473; https://doi.org/10.1089/met.2017.0062

Abstract:
Background: There are inconsistent results for the effectiveness of using smartphone applications (apps) or websites on weight loss. We investigated the efficacy of a smartphone intervention using a designated app that utilizes a lifestyle intervention-focused approach, including a human coaching element, toward weight loss in overweight or obese Korean adults. Methods: One hundred four adults aged 20–60 years with a body mass index ≥23 kg/m2, who signed up for a smartphone program for weight loss (using the Noom app), were recruited. Participants received an in-person orientation about the study and app use, and a baseline blood sample was obtained. The in-app intervention with daily behavior and nutrition education content and coaching lasted 15 weeks. The primary endpoint of the study was a change in weight. The secondary endpoints were changes in metabolic risk factors such as blood pressure, waist circumference, and glucose and lipid profiles. Body composition changes were also assessed, and body weight at 52 weeks was measured to ascertain long-term effects. Results: Participants showed a clinically significant weight loss effect of −7.5% at the end of the 15-week program (P< 0.001), and at a 52-week follow-up, a weight loss effect of −5.2% was maintained. At 15 weeks, percent body fat and visceral fat decreased by −6.0 ± 5.4% and −3.4 ± 2.7 kg, respectively (both P< 0.001). Fasting glucose level also decreased significantly by −5.7 ± 14.6 mg/dL at 15 weeks. Lipid parameters showed significant improvements, except for high-density lipoprotein cholesterol. The frequency of logging meals and exercise was associated with body fat loss. Conclusions: This advanced smartphone app was a useful tool to maintain weight loss in overweight or obese people.
Bai Jin, Liping Liu, Shuxuan Zhang, Xiaohui Cao, Yuhong Xu, Junsong Wang,
Published: 1 November 2017
Metabolic Syndrome and Related Disorders, Volume 15, pp 439-449; https://doi.org/10.1089/met.2017.0065

Abstract:
Aims: This study aimed at detecting the difference of metabolic profile in mild gestational diabetes mellitus (GDM) patients, and at identifying the correlation between the disturbed metabolites and insulin resistance pathway induced by the inflammation factors secreted by the placenta and adipocytes. Materials and Methods: Blood samples were collected from 36 pregnant women diagnosed with mild GDM and 36 normal glucose-tolerant (NGT) pregnant women. Metabolic profiles were acquired by using proton nuclear magnetic resonance (1H-NMR) spectroscopy, and the data were analyzed by multivariate statistical data analysis. The messenger RNA (mRNA) expression of CX3CL1, CD14, and CD86 in placenta and omental adipose tissues was detected by quantitative real-time polymerase chain reaction. Results: (1) Weight and body mass index in GDM group were remarkably higher at both pre-pregnancy and delivery than those in the NGT group. The levels of fasting blood glucose, insulin, and homeostasis model assessment-2 for insulin resistance in GDM group were also significantly higher than those in the NGT group. (2) The expression of mRNA of CD86 was significantly higher in placenta of GDM patients. However, the gene expression of CX3CL1 and CD86 in omental adipose tissues of GDM was markedly lower as compared with the control group. (3) The GDM group exhibited severely perturbed glucose metabolism, fatty acid metabolism, amino acid metabolism, and activated inflammatory response. Conclusions: The 1H-NMR-based metabonomics approach together with biochemical assay and the mRNA expression analysis provided metabolic information about mild GDM, which indicated disturbed glucose metabolism, fatty acid metabolism, amino acid metabolism, and activated inflammatory response in mild GDM patients. This integrated study provides a new idea and methods to understand underlying mechanisms of mild GDM in clinics.
Metabolic Syndrome and Related Disorders, Volume 5, pp 291-296; https://doi.org/10.1089/met.2007.0018

Abstract:
Lifestyle and diet play important roles in the development of cardiovascular disease (CVD), which is the leading cause of death in Western countries. Metabolic syndrome, which is characterized by a group of metabolic risk factors, is associated with the subsequent development of type 2 diabetes and CVD. Epidemiological studies have documented that nutritional factors may affect the prevalence of the metabolic syndrome. Beyond weight control and reduction of total calories, the diet should be low in saturated fats, trans fats, cholesterol, sodium, and simple sugars. In addition, there should be ample intake of fruits, vegetables, whole grains, and monounsaturated fat; fish intake should be encouraged. These features are very reminiscent of the nutritional principles currently used to define the Mediterranean-style diet. This diet's high fiber content, n-3 fatty acids, and antioxidants, as well as phytochemicals from olive oil, legumes, whole grains, fruits, and vegetables, might be responsible for its beneficial effect on the health of metabolic syndrome patients. This may occur through the reduction of systemic vascular inflammation and endothelium dysfunction without having a drastic effect on body weight. The choice of healthy sources of carbohydrates, fat, and proteins, associated with regular physical activity and avoidance of smoking, is critical to fighting the war against chronic disease.
Published: 1 December 2010
Metabolic Syndrome and Related Disorders, Volume 8; https://doi.org/10.1089/met.2010.0087

Abstract:
Type 2 diabetes mellitus (T2DM) and prediabetes (or patients at risk for diabetes) have been increasing in epidemic proportions. Dyslipidemia and hypertension are cardiovascular risk factors frequently associated with diabetes and prediabetes. Bile acid sequestrants (BAS) were initially approved for the treatment of elevated low-density lipoprotein cholesterol (LDL-C), but they were subsequently found to have a glucose-lowering effect as well. Colesevelam hydrochloride (HCl), a BAS, has been approved as an adjunct to diet and exercise to improve glycemic control in adults with T2DM based on several studies that used it as an addition to sulfonylurea-based, metformin-based, and insulin-based therapies. Colesevelam HCl has not been approved for use for glycemic control in type 1 diabetes or for treating diabetic ketoacidosis and has not been studied in T2DM as monotherapy or in combination with dipeptidyl peptidase 4 inhibitors, or extensively with thiazolidinediones. A recent study has examined the combination of colesevelam HCl and metformin as an initial therapy for treatment-naïve patients with T2DM. Another recent study, which looked at colesevelam for the treatment of dyslipidemia of prediabetes, raised the possibility of the use of colesevelam therapy for both dyslipidemia and hyperglycemia of T2DM. This article reviews and summarizes the recent clinical studies regarding colesevelam as therapy for both diabetes and dyslipidemia. This dual mechanism of action is an attractive feature for the treatment of diabetes.
Iyad Syoufi, , Matthew J. Budoff,
Metabolic Syndrome and Related Disorders, Volume 9, pp 77-79; https://doi.org/10.1089/met.2010.0065

Abstract:
Background: Fetuin-A has been associated with insulin resistance and inversely related with vascular calcification. The present study evaluated whether serum fetuin-A explains the ethnic disparity in the subclinical atherosclerosis and risk for diabetes between healthy Hispanic and non-Hispanic white (NHW) subjects. Methods: Fetuin-A was measured in serum of 76 age-matched healthy males (41 NHW, 35 Hispanics). Bodymass index, blood pressure, serum lipoprotein cholesterol and triglyceride levels, coronary artery calcium (CAC), fasting glucose and insulin concentrations, and plasma glucose levels 2 h after a 75-g oral glucose tolerance test were measured in all participants. Insulin resistance was estimated using the homeostasis model assessment (HOMA). Results: Fasting insulin, fasting and 2-h serum glucose, and HOMA values were all significantly higher in Hispanics (p< 0.05 for all), yet CAC trended lower and the prevalence of very high CAC (>400 Agatston score) was lower (P = 0.03). There was no statistically significant difference in serum fetuin-A when comparing Hispanics and NHW (P = 0.12). Furthermore, there was no correlation between fetuin-A levels and CAC (P = 0.9). Conclusions: Serum fetuin-A concentration was not associated with measures of insulin resistance or with preclinical atherosclerosis in Hispanics and NHW. These data indicate that the disparity in prevalence of insulin resistance, type 2 diabetes, and subclinical atherosclerosis between Hispanics and NHW does not appear attributable to differences in fetuin-A concentrations.
, Shabnam Salekzamani, Ali Kalayi, , , , Nastaran Shariatzadeh
Metabolic Syndrome and Related Disorders, Volume 9, pp 41-47; https://doi.org/10.1089/met.2010.0075

Abstract:
Objective: Extra fat mass is usually accompanied by metabolic as well as clinical derangements, including systemic inflammation and high blood pressure. This study aimed to evaluate the associations among anthropometric indicators, blood levels of high-sensitivity C-reactive protein (hsCRP), lipid profile, blood glucose, insulin resistance, and blood pressure and determine the actual predictors of hsCRP and blood pressure in overweight/obese nondiabetic women in Tehran. Subjects and Methods: A total of 200 women with body mass index (BMI) of ≥25 kg/m2 were enrolled in a cross-sectional study. Dietary intake and anthropometric as well as laboratory evaluations, including fasting plasma glucose (FPG), lipid profile, serum insulin, and hsCRP, were performed for all the subjects. Pearson (r) and Spearman (rs) correlation coefficients and multivariate linear regression analysis were used to establish a model to predict hsCRP and systolic blood pressure (SBP) variations. Results: Although serum hsCRP directly correlated with levels of FPG, triglycerides (TG), total cholesterol, BMI, and waist circumference (WC), its strongest association was found with percent of body fat mass (FM) (rs = 0.326, p< 0.001). Also, SBP directly correlated with FPG, TG, and FM, but it was more strongly correlated with BMI (r = 0.343, p< 0.001) and WC (rs = 0.350, p< 0.001). No association was found between blood or anthropometric variables and dietary data. In different regression models, WC and FM were the predictors of hsCRP, but BMI was the significant predictor of SBP. Conclusion: Adiposity in Iranian middle-aged women can affect both inflammatory biomarkers and SBP, thus predisposing for metabolic syndrome and further morbidities. We identified FM and WC as the predictors of serum hsCRP levels and BMI as the predictor of SBP in our population.
P.G. Sundararaman, R. Manomani, G.R. Sridhar, V. Sridhar, A. Sundaravalli, Meena Umachander
Published: 1 December 2003
Metabolic Syndrome and Related Disorders, Volume 1, pp 271-275; https://doi.org/10.1089/1540419031361435

Abstract:
Women with polycystic ovary syndrome (PCOS) often present for cosmetic and or reproductive symptoms; attention is generally not paid to the future risk of atherosclerosis for these women. Given that Asian Indians are insulin resistant and prone to metabolic syndrome at an earlier age, we assessed glucose/insulin ratio and intimal medial thickness (IMT) in young women with PCOS from south India. In this cross-sectional case control study, we assessed insulin resistance and carotid IMT in 40 women presenting with hyperandrogenic features of PCOS. Insulin resistance was assessed by fasting glucose/insulin ratio and IMT by the Doppler system with electrical linear transducer midfrequency of 12 MHz. Women with PCOS had higher fasting insulin levels (36.58 ± 17.81 μU/mL, vs. 16.60 ± 3.22 μU/mL in controls; p < 0.001), higher insulin resistance (glucose/insulin ratio 2.81 ± 1.47 vs. 5.47 ± 1.46 in controls; p < 0.001), and greater IMT (0.53 ± 0.14 mm vs. 0.39 ± 0.06 mm in controls; p < 0.001). Women with PCOS had a higher body mass index (BMI) (26.46 ± 5.24 vs. 23.24 ± 3.05 in controls; p < 0.001), and the differences between PCOS and controls persisted, even among those who had a BMI of less than 25. We concluded that South Indian women with the reproductive abnormalities of PCOS have greater insulin resistance and IMT, and therefore they must be advised about lowering the risk of future vascular disease.
W. Wayne Lautt
Metabolic Syndrome and Related Disorders, Volume 1, pp 261-270; https://doi.org/10.1089/1540419031361417

Abstract:
The perspective presented here is a working hypothesis suggesting a new paradigm for insulin resistance where, analogous to the cause of type 1 diabetes being attributed to lack of insulin, type 2 diabetes is due to lack of action of a hepatic insulin sensitizing substance (HISS). In both cases, the major metabolic dysfunction is with post-meal nutrient processing. In the immediate postprandial state, insulin causes the release of the putative hormone, HISS, from the liver. HISS stimulates glucose uptake in skeletal muscle. The hepatic parasympathetic nerves determine, in a permissive manner, the ability of insulin to cause HISS release maximally in the postprandial state. HISS release in response to insulin is progressively reduced with fasting. The glucose disposal effect of insulin in the fed state is decreased by approximately 55% by blocking HISS release. HISS release is blocked by fasting, surgical parasympathetic denervation of the liver, blockade of hepatic cholinergic muscarinic receptors, blockade of hepatic nitric oxide production, or blockade of hepatic cyclooxygenase, and results in a condition referred to as HISS-dependent insulin resistance (HDIR). HDIR is physiologically and appropriately produced in the fasted state and, pathologically, in chronic liver disease, sucrose fed, fetal alcohol exposed, spontaneously hypertensive, and aging rats. Therapeutic approaches to correct the metabolic imbalance in processing the meal nutrients that occur in type 2 diabetes can be approached through this paradigm.
Paresh Dandona
Metabolic Syndrome and Related Disorders, Volume 1, pp 253-253; https://doi.org/10.1089/1540419031361372

Abstract:
The only peer-reviewed journal focused on the rapidly moving field of 3D printing and related technologies, providing comprehensive coverage of academic research and industrial and commercial developments that have applications in medicine, education, food, and architecture.
Husrev Hatemi, , Nurten Turan, Nurol Arik
Metabolic Syndrome and Related Disorders, Volume 1, pp 285-290; https://doi.org/10.1089/1540419031361363

Abstract:
The objectives of this study were to determine the prevalence of overweight and obesity in Turkey, and to investigate their association with age, gender, and blood pressure. A crosssectional population-based study was performed. A total of 20,119 inhabitants (4975 women and 15,144 men, age > 20 years) from 11 Anatolian cities in four geographic regions were screened for body weight, height, and systolic and diastolic blood pressure between the years 1999 and 2000. The overall prevalence rate of overweight was 25.0% and of obesity was 19.4%. The prevalence of overweight among women was 24.3% and obesity 24.6%; 25.9% of men were overweight, and 14.4% were obese. Mean body mass index (BMI) of the studied population was 27.59 ± 4.61 kg/m2. Mean systolic and diastolic blood pressure for women were 131.0 ± 41.0 and 80.2 ± 16.3 mm Hg, and for men 135.0 ± 27.3 and 83.2 ± 16.0 mm Hg. There was a positive linear correlation between BMI and blood pressure, and between age and blood pressure in men and women. Obesity and overweight are highly prevalant in Turkey, and they constitute independent risk factors for hypertension.
James R. Bailes, Misty T. Strow, Joseph Werthammer, Richard A. McGinnis, Yoram Elitsur
Metabolic Syndrome and Related Disorders, Volume 1, pp 221-225; https://doi.org/10.1089/154041903322716697

Abstract:
Childhood obesity has been recognized as the new epidemic in developed countries. Caloric restriction with physical activity is the main therapeutic treatment available for these children. We compared two different dietary protocols to assess treatment efficacy. Obese children from the Pediatric Endocrinology clinic were prospectively recruited for the study. Children and their parents were allowed to choose one of two dietary protocols: (1) carbohydrate restricted diet (<30 g/day), with unlimited calories, protein, and fat (High protein, Low CHO Diet), and (2) calorie restricted diet (Low Cal Diet). Anthropometric data were measured at baseline and at the 2 month follow up appointment. Thirty-seven children completed the study of whom 27 chose High Protein, Low CHO Diet and 10 chose Low Cal diet. No differences in gender ratio, age, or BMI were observed at baseline. At 2 months, children in the High Protein, Low CHO Diet lost an average of 5.21 +/- 3.44 kg (p < 0.001) and decreased their BMI by 2.42 +/- 1.3 points (p < 0.001), compared to the children in the Low Cal Diet who gained an average of 2.36 +/- 2.54 kg and 1.00 point on the BMI value (p < 0.001). A high protein, low carbohydrate, unlimited calorie diet was superior to a restricted calorie protocol for weight loss in obese school age children; moreover, compliance was better.
Richard D. Feinman,
Metabolic Syndrome and Related Disorders, Volume 1, pp 189-197; https://doi.org/10.1089/154041903322716660

Abstract:
One of Robert Atkins contributions was to define a diet strategy in terms of an underlying metabolic principle ("the science behind Atkins"). The essential feature is that, by reducing insulin fluxes, lipids are funnelled away from storage and oxidized. Ketosis can be used as an indicator of lipolysis. A metabolic advantage is also proposed: controlled carbohydrates leads to greater weight loss per calorie than other diets. Although the Atkins diet and its scientific rationale are intended for a popular audience, the overall features are consistent with current metabolic ideas. We have used the Atkins controlled-carbohydrate diet as a focal point for teaching nutrition and metabolism in the first-year medical school curriculum. By presenting metabolism in the context of the current epidemic of obesity and of metabolic syndrome and related disorders, we provide direct application of the study of metabolic pathways, a subject not traditionally considered by medical students to be highly relevant to medical practice. We present here a summary of the metabolic basis of the Atkins diet as we teach it to medical students. We also discuss a proposed mechanism for metabolic advantage that is consistent with current ideas and that further brings out ideas in metabolism for students. The topics that are developed include the role of insulin and glucagon in lipolysis, control of lipoprotein lipase, the glucose-glycogen-gluconeogenesis interrelations, carbohydrate-protein interactions and ketosis. In essence, the approach is to expand the traditional feed-fast (post-absorptive) cycles to include the effect of low-carbohydrate meals: the disease states studied are generalized from traditional study of diabetes to include obesity and metabolic syndrome. The ideal diet for weight loss and treatment of metabolic syndrome, if it exists, remains to be determined, but presenting metabolism in the context of questions raised by the Atkins regimen prepares future physicians for critical analysis of clinical and basic metabolic information.
Ahmad Aljada, Priya Mohanty,
Published: 1 September 2003
Metabolic Syndrome and Related Disorders, Volume 1, pp 185-188; https://doi.org/10.1089/154041903322716651

Paresh Dandona
Metabolic Syndrome and Related Disorders, Volume 1, pp 179-179; https://doi.org/10.1089/154041903322716624

Abstract:
The only peer-reviewed journal focused on the rapidly moving field of 3D printing and related technologies, providing comprehensive coverage of academic research and industrial and commercial developments that have applications in medicine, education, food, and architecture.
Yeon Woo Lee,
Published: 1 October 2017
Metabolic Syndrome and Related Disorders, Volume 15, pp 387-392; https://doi.org/10.1089/met.2017.0058

Abstract:
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases in the Western world and yet there is little research into its impact on pregnancy. Methods: A literature review was conducted in the database PubMed, with articles published between 1990 and 2017. The selected studies addressed features specifically attributed to NAFLD and associated obstetric and neonatal outcomes. Nine studies met criteria. Our aim was to consolidate the limited literature and identify trends. Results: There was considerable heterogeneity in the diagnostic approach to NAFLD. Data are conflicting as to whether NAFLD increases the risk of gestational diabetes independent of obesity. NAFLD is associated with an elevated risk of extremes of birth weight, both small and large for gestational age. Several studies found a greater impact of NAFLD on maternal morbidity including preeclampsia in women with a body mass index <30kg/m2. Conclusions: NAFLD appears to be associated with increased obstetric morbidity, particularly among non-obese women. More research is needed to clarify the pathophysiology and optimize safe treatment.
Yoon Ji Kim, Seun Deuk Hwang, , , Hak Chul Jang, , , , Soo Lim
Published: 1 October 2017
Metabolic Syndrome and Related Disorders, Volume 15, pp 416-422; https://doi.org/10.1089/met.2017.0053

Abstract:
Background: Chronic kidney disease (CKD) has often been defined based on glomerular filtration rate (GFR) alone. The Kidney Disease: Improving Global Outcomes guideline highlights albuminuria in the CKD definition. Thus, we investigated the association between obesity and CKD, as defined by both GFR and albuminuria, in Korean adults. Methods: We used Korea National Health and Nutrition Examination Survey 2011–2014 data (N = 19,331, ≥19 years old) representing the national Korean population. CKD was classified by (1) estimated GFR (eGFR) < 60 mL/min/1.73 m2 (CKDGFR); (2) albumin-to-creatinine ratio (ACR) ≥30 mg/gram (CKDACR); and (3) eGFR < 60 mL/min/1.73 m2 or ACR ≥30 mg/gram (CKDRisk). Associations between obesity and each CKD category were evaluated using multivariate logistic regression analysis. Results: The prevalence rates of CKDGFR, CKDACR, and CKDRisk were 2.2%, 6.7%, and 8.1%, respectively. Compared with the normal body mass index (BMI; 18.5–22.9 kg/m2) group, men with BMI ≥ 25 kg/m2 had 1.88 times greater risk of CKDGFR in the adjusted model [95% confidence interval (CI), 1.26–2.80; P = 0.002]; BMI was not significantly associated with CKDGFR in women. In contrast, both men and women with BMI ≥ 25 kg/m2 had 1.58 and 1.40 times higher risk of CKDACR (95% CI, 1.21–2.07 and 1.08–1.81, respectively, both P < 0.01). Obese men and women had 1.65 and 1.38 times higher risk of CKDRisk (95% CI, 1.29–2.12 and 1.09–1.75, respectively, both P < 0.01). Conclusions: Obesity was significantly associated with an increased ACR-based CKD risk. Longitudinal studies are needed to investigate the role of overweight and obesity in the development and progression of CKD.
, Maria M. Llabre, Denise C. Vidot, Carmen R. Isasi, Krista Perreira, , Christina M. Parrinello, Linda C. Gallo, Guadalupe X. Ayala, Alan Delamater
Published: 1 October 2017
Metabolic Syndrome and Related Disorders, Volume 15, pp 400-406; https://doi.org/10.1089/met.2017.0054

Abstract:
Background: Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is being diagnosed in youth. Specific diagnostic criteria used to define MetS influence prevalence estimates and populations considered at risk for cardiovascular disease. The National Cholesterol Education Program's Adult Treatment Panel III (ATP), the World Health Organization (WHO), and the International Diabetes Federation (IDF) provide three MetS definitions used in medical research. This study examined concordance among these definitions in 1137 children 10–16 years of age, who participated in the Hispanic Community Children's Health Study/Study of Latino Youth. Methods: Prevalence of MetS and of individual components was estimated using SAS. Mplus was used to test a single-factor model of MetS components (triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, waist circumference, and fasting glucose). Results: The ATP definition identified most MetS cases in 10–15 (N = 19, 4.7%) and 16-year-old girls (N = 3, 7.3%). The IDF definition identified most cases of MetS in 10–15 (N = 16, 3.1%) and 16-year-old boys (N = 2, 2.8%). Fewest cases of MetS were identified with the WHO definition across age and sex groups. Conclusion: Only one participant was classified as having MetS across all three definitions. Confirmatory factor analysis indicated fasting glucose and systolic blood pressure did not reliably cluster with other risk factors that define MetS in Hispanic/Latino adolescents. We conclude that prevalence estimates of MetS in youth are unstable across current criteria, calling into question the accuracy of defining and diagnosing MetS in youth.
Gadadharan Vijayakumar, Ganapathy K. Sreehari, Aswathi Vijayakumar,
Published: 1 November 2017
Metabolic Syndrome and Related Disorders, Volume 15, pp 458-464; https://doi.org/10.1089/met.2017.0047

Abstract:
Background: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and the age of disease onset is falling. Although there is rising prevalence of early onset T2DM in India, little is known about their clinical characteristics and cardiovascular risks profiles. The aim of this study was to address this knowledge gap by comparing the characteristics of early onset T2DM and usual onset T2DM patients from our clinic population in India. Methods: We studied the clinical and biochemical parameters of 98 consecutive early onset T2DM patients of age <45 and 50 years and similar disease duration. Results: There was a strong component of family history of T2DM in early onset T2DM patients; however, no difference was observed in body mass index or waist circumference between the groups. When compared with usual onset group, the early onset T2DM patients were more hypertriglycedemic, with higher total cholesterol, higher total cholesterol/high-density lipoprotein (HDL) ratio, higher low-density lipoprotein levels, and lower HDL cholesterol. Early onset T2DM patients showed significantly worse glycemic control and rapid decline in insulin secretion compared with usual onset T2DM patients. Conclusions: Our results demonstrate that early onset T2DM in Asian Indians appears to be a disease phenotype with adverse risk factors having poor glycemic control and longer disease duration demanding strategies for novel clinical management.
Rhoda H. Cobin
Metabolic Syndrome and Related Disorders, Volume 3, pp 259-269; https://doi.org/10.1089/met.2005.3.259

Abstract:
Polycystic ovarian syndrome (PCOS) is the most frequent endocrine disorder of reproductive age women, affecting an estimated 8–10% of all women in this age group or approximately six million women. Further, women with PCOS continue to manifest the metabolic alterations inherent in the insulin resistance syndrome after menopause, rendering them more susceptible to type 2 diabetes and cardiovascular disease. Aging and obesity further contribute to these risks. Since estrogen-containing therapy is commonly used for menstrual regulation in premenopausal women with PCOS, it is important to evaluate the possible consequences of hormonal therapy on subsequent metabolic and cardiovascular risk. In postmenopausal women, a consensus regarding the appropriate role of estrogen replacement therapy is currently in evolution. By examining the effects of estrogen with or without progesterone on insulin resistance, insight may be gained about the risk/benefit ratio of this therapy in the subset of women with insulin resistance, PCOS, and type 2 diabetes. The goal of this review, then, is to examine the known effects of estrogen on insulin sensitivity and its implications for cardiovascular and metabolic risk.
Pathmaja Paramsothy, Robert H. Knopp
Metabolic Syndrome and Related Disorders, Volume 3, pp 250-258; https://doi.org/10.1089/met.2005.3.250

Abstract:
The obesity pandemic engenders the global threat of metabolic syndrome and its related disorders, including diabetes and coronary artery disease (CAD). The purpose of this review is to discuss the deleterious effects of metabolic syndrome on women of childbearing age, including pregnancy, with a discussion of lipid management. Treatment options will also be presented.
, Elisabeth Mathiesen, , Kresten Rubeck Petersen
Published: 1 September 2005
Metabolic Syndrome and Related Disorders, Volume 3, pp 244-249; https://doi.org/10.1089/met.2005.3.244

Abstract:
Planned pregnancy is mandatory in women with diabetes, and their need for contraception is essential. Basically, the same methods can be used as in women without diabetes, but a number of specific conditions have to be considered when guiding these women, as we discuss in this review. Unfortunately, the field is limited in studies in certain areas, especially considering contraception for women with type 1 diabetes and late diabetic complications and women with type 2 diabetes. Thus, in the real clinical world, the choice of contraceptive often will be a kind of compromise, balancing pro and cons for the different available methods.
Lois Jovanovič
Metabolic Syndrome and Related Disorders, Volume 3, pp 233-243; https://doi.org/10.1089/met.2005.3.233

Abstract:
In this review, the thesis is presented that maternal hyperglycemia produces an overnourished, fat fetus. If the fetus has a predisposition for type 2 diabetes, then the fat deposition in the fetus is predominantly in the fetal visceral cavity. Visceral fat deposition is the origin of insulin resistance. The fat fetus begins life with its pancreatic output of insulin compromised. Thus, the stage is set for developing type 2 diabetes in its lifetime. This review supports the hypothesis that normalization of maternal nutrition and fucose will decrease the risk of type 2 diabetes.
, Yuko Kai, Mayumi Nagano, Buha Zou, Hiroyo Kishimoto, Haruka Sasaki
Published: 1 September 2005
Metabolic Syndrome and Related Disorders, Volume 3, pp 213-220; https://doi.org/10.1089/met.2005.3.213

Abstract:
The objective of this study was to examine the contribution of endurance fitness and visceral fat accumulation on the prevalence of metabolic syndrome in Japanese male patients with either an impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM). The subjects of this cross-sectional study consisted of 135 Japanese male patients with either IGT or type 2 DM who had not taken any medication or intervention. They were classified into three fitness categories (low, moderate, and high) based on the tertiles of their maximal oxygen uptake ( O2max) predicted by the Åstrand nomogram using a cycle ergometer. Metabolic syndrome was defined based on the WHO criteria. The visceral fat area (VFA) was determined using a computed tomography scan. The age- and VFA-adjusted odds ratio was 3.49 (95% CI, 1.13–10.82) for subjects in the low fitness category in comparison to those in the high fitness category. We calculated the odds ratio for the prevalence of metabolic syndrome in the nine categories classified based on the three VFA and three 2max levels. In Moderate- and Low- 2 max categories, the odds ratios increased in line with increases in the VFA level. The highest odds ratios were observed in the low fitness and high visceral fat group. In the High- O2max category, no significant odds ratios were observed in the Moderate- and High-VFA categories. These results indicate that a high degree of cardiorespiratory fitness positively contributed to the low prevalence of metabolic syndrome in Japanese male patients with IGT and type 2 DM.
M.A. Charles, J.L. Selam
Metabolic Syndrome and Related Disorders, Volume 3, pp 203-212; https://doi.org/10.1089/met.2005.3.203

Abstract:
The most common cause of death in diabetes is cardiovascular. Diabetic nephropathy has an important role in cardiovascular disease among susceptible diabetic patients. What is not well appreciated is that independent cardiovascular death risk factors (e.g., hypertension, hyperglycemia, dyslipidemias and microalbuminuria) may each have a cyclic relationship with diabetic nephropathy. Thus, as discussed in this review, each risk factor may aggravate diabetic nephropathy, increasing the likelihood of end-stage renal disease. Diabetic nephropathy in turn may aggravate each of the risk factors, increasing the likelihood of a cardiovascular event. These cardiovascular risk factors, amplified by vicious cycles with diabetic nephropathy, may then lead to accelerated cardiovascular morbidity and mortality.
David M. Kendall
Metabolic Syndrome and Related Disorders, Volume 3, pp 202-202; https://doi.org/10.1089/met.2005.3.202

Metabolic Syndrome and Related Disorders, Volume 7, pp 53-59; https://doi.org/10.1089/met.2008.0043

Abstract:
There is an association between insulin resistance, glucose intolerance, and essential hypertension, but the relation between insulin resistance, glucose intolerance, and hypertension diagnosed during pregnancy is not well understood. Transient hypertension of pregnancy, the new-onset nonproteinuric hypertension of late pregnancy, is associated with a high risk of later essential hypertension and glucose intolerance; thus, these conditions may have a similar pathophysiology. To assess the association between insulin resistance, glucose intolerance, essential hypertension, and subsequent development of proteinuric and nonproteinuric hypertension in pregnancy in women without underlying essential hypertension, we performed a prospective study comparing glucose (fasting, I and 2 hours postglucose load), insulin, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), and triglycerides levels on routine screening for gestational diabetes mellitus. Women who developed hypertension in pregnancy (n = 37) had higher glycemic levels (fasting, 1 and 2 hours postglucose load) on a 100-gram oral glucose loading test, although only the fasting values showed a statistical significance (p < 0.05), and a significantly higher frequency of abnormal glucose loading tests, two hours after glucose load (>= 140 mg/dL) (p < 0.05) than women who remained normotensive (n = 180). Glucose intolerance was common in women who developed both subtypes of hypertension, particularly preeclampsia. Women who developed hypertension had greater prepregnancy body mass index (p < 0.0001), higher frequency and intensity of acanthosis nigricans (p < 0.0001), and higher baseline systolic and diastolic blood pressures (p <= 0.0001 for both), although all subjects were normotensive at baseline by study design; they also presented lower levels of HDL-C (p < 0.05). However, after adjustment for these and other potential confounders, an abnormal glucose loading test remained a significant predictor of development of hypertension (p < 0.05) and, specifically, preeclampsia (p < 0.01). There was a trend toward higher insulin and homeostasis model assessment-insulin resistance (HOMA-IR) levels in women developing any type of hypertension. When comparing women that remained normotensive to term with those with transient hypertension and preeclampsia, the preeclamptic women were born with lower weight (p < 0.05) and shorter length (p < 0.005); at screening they were older (p < 0.005), showed higher frequency and intensity of acanthosis nigricans (p < 0.0001), had higher prepregnancy BMI (p < 0.0005), as well as higher baseline systolic and diastolic blood pressures (p <= 0.0001 for both). They also showed higher HOMA-IR levels that did not show a statistical significance. When glucose tolerance status was taken in account, an association was found between increasing indexes of hypertension (p < 0.05) and of HOMA-IR (p < 0.05) with the worsening of glucose tolerance. These results suggest that insulin resistance and relative glucose intolerance are associated with an increased risk of new-onset hypertension in pregnancy, particularly preeclampsia, and support the hypothesis that insulin resistance may play a role in the pathogenesis of this disorder
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