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• Although many studies have used sleep-related variables, there is no clear evidence on cutoffs of sleep-related variables. • In this study, the cutoff was obtained through the receiver operating characteristic analysis of sleep-related variables. • The optimal cutoff to discriminate cardiovascular disease risk factors was 10:00 PM to 11:00 PM for bedtime. • The optimal cutoff to discriminate cardiovascular disease risk factors was 12:00 AM to 3:00 AM for mid-sleep time. • The optimal cutoff to discriminate cardiovascular disease risk factors was around 6 h for sleep duration. We aimed to establish the optimal cutoffs of sleep timing and duration to assess obesity, hypertension (HTN), diabetes mellitus (DM), dyslipidemia (DL), and metabolic syndrome (MetS) using data from the Korea National Health and Nutrition Examination Surveys. In this cross-sectional study, data from 18,677 participants (8,107 men and 10,570 women) aged 19 or over were used. A receiver operating characteristic (ROC) curve adjusted for potential confounding variables was constructed to calculate the cutoff of sleep-related variables (bedtime, mid-sleep on free days corrected for sleep debt on workdays (MSFsc), and sleep duration) for assessing cardiovascular disease (CVD) risk factors according to sex. Bedtime between 9:00 PM to 0:30 AM for men and 10:00 PM to 11:00 PM for women is appropriate for assessing obesity, HTN, DM, DL, and MetS. The cutoff range was 9:00 PM to 11:00 PM for men ≥65 years and 9:00 PM to 12:00 AM for women ≥65 years, which was slightly earlier than that for participants <65 years. The optimal MSFsc cutoff points were established between 12:00 AM to 3:00 AM and sleep durations around 6 h were associated with the optimal cutoffs for assessing CVD risk factors. Bedtime between 10:00 PM to 11:00 PM, early MSFsc, and short sleep durations were appropriate for assessing CVD risk factors. [ABSTRACT FROM AUTHOR]

Aims: To investigate the risk of postpartum metabolic syndrome in women with GDM compared with those without GDM in a Chinese population.Methods: Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM. Multivariate logistic regression was used to assess risks of postpartum metabolic syndrome between women with and without GDM. Postpartum metabolic syndrome was diagnosed by two commonly used criteria.Results: During a mean 3.53 years of follow up, 256 cases of metabolic syndrome were identified by using the NCEP ATPIII criteria and 244 cases by using the IDF criteria. Multivariable-adjusted odds ratios of metabolic syndrome in women with GDM compared with those without GDM were 3.66 (95% confidence interval [CI] 2.02-6.63) for NCEP ATPIII criteria and 3.90 (95% CI 2.13-7.14) for IDF criteria. Women with GDM had higher multivariable-adjusted odds ratios of central obesity, hypertriglyceridemia, and high blood pressure than women without GDM. The multivariable-adjusted odds ratios of low HDL cholesterol and hyperglycemia were not significant between women with and without GDM, however, the multivariable-adjusted odds ratio of hyperglycemia became significant when we used the modified criteria.Conclusions: The present study indicated that women with prior GDM had significantly higher risks for postpartum metabolic syndrome, as well as its individual components. [ABSTRACT FROM AUTHOR]

Aims: Metabolic syndrome (MetS) is one of the most important issues in elderly people because of its association with ensuing cardiovascular disease (CVD). The components of MetS play a key role in the pathogenesis of arterial thickness and stiffness. Pulse pressure (PP), an easily accessible parameter in a basic health evaluation, has been documented as a marker of arterial stiffness and widespread atherosclerosis. The aim of our study was to assess the association between PP and MetS in Korean elderly people.Methods: A nationwide cross-sectional study was conducted to examine the relationship between PP and MetS among 6187 participants (2687 men and 3500 women) aged 60years older Korean people using the Korean National Health and Nutrition Examination Survey. The odds ratios (ORs) and 95% confidence intervals (CIs) for MetS were calculated across PP quartiles using multiple logistic regression analyses.Results: There was a positive relationship between PP and MetS in a dose-response manner. The prevalence of MetS significantly increased with increasing PP quartile in both men and women (p<0.001). Compared with the lowest PP quartile group, the ORs (95% CIs) for MetS of the highest PP quartile was 2.60 (1.91-3.52) for men and 1.97 (1.48-2.59) for women after adjusting for age, cigarette smoking, alcohol intake, regular exercise and mean arterial blood pressure. These associations remained valid after additionally adjusting for hypertension and diabetes medications.Conclusion: We found a positive relationship between PP and MetS among Korean elderly men and women. [ABSTRACT FROM AUTHOR]

Aims: To compare diabetes-related mortality rates and factors associated with this disease in the Canary Islands compared with other 10 Spanish regions.Methods: In a cross-sectional study of 28,887 participants aged 35-74 years in Spain, data were obtained for diabetes, hypertension, dyslipidemia, obesity, insulin resistance (IR), and metabolic syndrome. Healthcare was measured as awareness, treatment and control of diabetes, dyslipidemia, and hypertension. Standardized mortality rate ratios (SRR) were calculated for the years 1981 to 2011 in the same regions.Results: Diabetes, obesity, and hypertension were more prevalent in people under the age of 64 in the Canary Islands than in Spain. For all ages, metabolic syndrome and insulin resistance (IR) were also more prevalent in those from the Canary Islands. Healthcare parameters were similar in those from the Canary Islands and the rest of Spain. Diabetes-related mortality in the Canary Islands was the highest in Spain since 1981; the maximum SRR was reached in 2011 in men (6.3 versus the region of Madrid; p<0.001) and women (9.5 versus Madrid; p<0.001). Excess mortality was prevalent from the age of 45 years and above.Conclusions: Diabetes-related mortality is higher in the Canary Islands population than in any other Spanish region. The high mortality and prevalence of IR warrants investigation of the genetic background associated with a higher incidence and poor prognosis for diabetes in this population. The rise in SRR calls for a rapid public health policy response. [ABSTRACT FROM AUTHOR]

Aims: Better knowledge of the global metabolic syndrome (MetS) prevalence and its components is a prerequisite to curb the related burden.Methods: We systematically searched PubMed, EMBASE, Web of Knowledge, Africa Journal Online, Global Index Medicus up to May 23, 2021. Prevalence pooling was done with a random-effects meta-analysis.Results: In total, 1,129 prevalence data (28,193,768 participants) were included. The MetS global prevalence varied from 12.5% (95 %CI: 10.2-15.0) to 31.4% (29.8-33.0) according to the definition considered. The prevalence was significantly higher in Eastern Mediterranean Region and Americas and increased with country's level of income. The global prevalence was 45.1% (95 %CI: 42.1-48.2) for ethnic-specific central obesity, 42.6% (40.3-44.9) for systolic blood pressure (BP) ≥ 130 mmHg and/or diastolic BP ≥ 85 mmHg, 40.2% (37.8-42.5) for HDL-cholesterol < 1.03 for men or < 1.29 mmol/L for women, 28.9% (27.4-30.5) for serum triglycerides ≥ 1.7 mmol/L, and 24.5% (22.5-26.6) for fasting plasma glucose ≥ 5.6 mmol/L.Conclusions: This study reveals that MetS and its related cardiometabolic components are highly prevalent worldwide. This study calls for more aggressive and contextualized public health interventions to tackle these conditions. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Pyruvate dehydrogenase kinase 4 (PDK4) plays a crucial role in glucose utilization and lipid metabolism by regulating the pyruvate dehydrogenase complex (PDC) and is an emerging therapeutic target for type 2 diabetes. To date, no study has specifically examined the relationship between PDK4 gene polymorphisms and type 2 diabetes or metabolic syndrome. Methods: The association of common single nucleotide polymorphisms (SNPs) was examined in PDK4 [−208A/G (rs10085637), IVS3+192C/T (rs3779478), IVS6+31A/G (rs2301630), IVS7+514A/G (rs12668651), IVS10+75C/T (rs10247649)] with type 2 diabetes and metabolic syndrome in 651 Korean subjects with type 2 diabetes and 350 nondiabetic Korean subjects. The association of these SNPs with clinical parameters related to metabolic syndromes including obesity, hyperglycemia, hypertension, and dyslipidemia was also examined. Results: No significant association was found between the studied SNPs and type 2 diabetes, metabolic syndrome, or clinical parameters. The PDK4 gene haplotype ACAGC showed a modest association with type 2 diabetes. However, the significance of this association was lost after considering for multiple comparisons. Conclusions: PDK4 polymorphisms may not be associated with type 2 diabetes or metabolic syndrome. Further studies utilizing a larger study population are required to confirm these results. [Copyright &y& Elsevier]

Abstract: Aim: This study sought to assess the association between metabolic syndrome (MS) and health-related quality of life (HRQOL) in the general population. Methods: We analyzed data for 4463 adults, aged 30 years or older, from the Korea National Health and Nutrition Examination Survey 2005. “EuroQol 5D”, which measures two dimensions, the EuroQol 5D index score (EQ-5D) and the EuroQol visual analogue scale (EQ-VAS), was used to evaluate HRQOL. Results: Mean scores for the EQ-5D in both sexes and EQ-VAS in women decreased with increasing number of MS components, and women''s means for both scores were significantly lower than men''s. In individual domains of HRQOL, men with more MS components tended to have higher odds ratios for decreased self-care, and women had decreased mobility, according to the EQ-5D. In men, high blood pressure led to decreased EQ-5D, and in women, abdominal obesity and high blood pressure did so. Additionally, we found that taking medication had an impact on decreased HRQOL, especially in subjects with impaired fasting glucose. Conclusions: HRQOL was negatively associated with the number of MS components and it was decreased by taking hypoglycemic medications. This association differed by gender. [Copyright &y& Elsevier]

Abstract: Aims: The CIDEA gene is involved in energy metabolism and a non-synonymous single nucleotide polymorphism (SNP), V115F (G/T), is a risk factor for obesity in Swedish subjects and metabolic syndrome (MetS) in Japanese subjects. However, the risk allele was a G in Swedish subjects and a T in Japanese subjects. The present study investigated the association between this SNP and MetS in a Chinese population. Methods: Three hundred and fifty-one subjects evaluated at the Cardiac Clinic in Xuanwu Hospital for MetS risks were recruited. Anthropometric measurements, blood pressure, fasting blood glucose, and blood lipid levels were determined in addition to the polymorphism. Results: The proportion of subjects with MetS was significantly higher based on genotype, in the order: GG

Abstract: Aim: To determine the prevalence of and risk factors for metabolic syndrome (MS) among urban Asian Indian adults. Methods: 2225 subjects aged ≥20 years were studied in a population based cross-sectional survey in Chandigarh, a city in north India. Anthropometric measurements, estimation of capillary plasma glucose, HDL cholesterol and triglycerides were done. Metabolic syndrome prevalence was estimated using National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III), modified NCEP ATP III and International Diabetes Federation (IDF) criteria. Multiple logistic regression analysis was done to find out risk factors for metabolic syndrome. Results: The prevalence rates of metabolic syndrome were 35.8% (NCEP ATP III), 45.3% (modified NCEP ATP III) and 39.5% (IDF criteria). As per modified NCEP ATP III criteria, central obesity was the commonest abnormality among females and elevated blood pressure among males. Risk factors for MS were increasing age, female gender, sedentary lifestyle and diabetes in parents. Conclusions: Our study showed a high prevalence of metabolic syndrome and its individual components. Independent risk factors for metabolic syndrome included increasing age, female gender, sedentary lifestyle and diabetes mellitus in parents. [Copyright &y& Elsevier]

Abstract: Attempts to explain the associations among metabolic syndrome (MetS) features using factor analysis to identify unobserved potential causes have resulted in inconsistent findings. We examined whether an unobserved categorical factor explains the associations among MetS features using latent class analysis. A cross-sectional analysis of 499 non-diabetic Japanese-Americans who underwent measurements of fasting blood, waist circumference (WC) and CT-measured intra-abdominal fat (IAF) area was conducted. MetS components were defined by IDF criteria. IAF and fasting serum insulin (FI) were dichotomized at the 75th percentile. Latent two- and three-class models were fit that included hypertension, dyslipidemia, hyperglycemia, and either WC, IAF, or FI for a total of six models. A three-class latent model fit the data well, while a two-class model did not. In the three-class model, one latent class was strongly associated with all MetS components, while another was associated with hyperglycemia and hypertension only. IAF was associated with only one latent class. Latent class analysis supports the presence of an unobserved factor linked to the co-occurrence of MetS features. One class of this factor was associated with hypertension and hyperglycemia but not central adiposity or FI, suggesting another pathway for observed MetS features. [Copyright &y& Elsevier]

Abstract: Aim: To determine mutable risk factors for asymptomatic diastolic dysfunction in ethnic minority patients newly diagnosed with type 2 diabetes. Methods: We recruited consecutive adults with newly diagnosed diabetes who had no signs or symptoms or history of heart disease. All patients received standardized evaluation including interview, physical examination, laboratory tests and echocardiogram with tissue Doppler studies. We used logistic regression models to identify mutable risk factors for diastolic dysfunction. Results: Among 126 study subjects (52% women, age 45±10 years, BMI 33±7, 42% with hypertension, 100% ejection fraction ≥50%), evidence of diastolic dysfunction was present in 64 (51%). After controlling for age, heart rate and blood pressure, independent predictors of diastolic dysfunction included physical inactivity (OR: 2.3; 95% CI: 0.9–6.1; P =0.08) and glucose (OR: 4.9; 95% CI: 1.4–17.8; P =0.02). Physical inactivity was associated with early diastolic dysfunction (impaired relaxation), whereas epicardial fat thickness and glucose levels were associated with late diastolic dysfunction (impaired compliance). The hs-CRP and BNP levels were not associated with diastolic dysfunction. Conclusions: Asymptomatic diastolic dysfunction was prevalent among urban minority patients newly diagnosed with diabetes. Important differences exist among factors that affect early and late diastolic function that may have prognostic and therapeutic implications. [Copyright &y& Elsevier]

Abstract: Aims: To determine the appropriate cutoff value of waist circumference associated with cardiometabolic risk factors in Koreans. Methods: Clinical and laboratory data on 31,076 Korean adults (age 20–89 years, 40% women) were recorded at regular health check-ups. Receiver operating characteristic curves were used to determine the cutoff values of waist circumference with respect to myocardial ischemia, hypertension, diabetes, and multiple risk factors for metabolic syndrome. Results: Age-adjusted odds ratios for myocardial ischemia, diabetes, hypertension, and multiple components of metabolic syndrome for one standard-deviation increase in waist circumference were 1.45, 1.37, 1.55, and 1.89 for men, and 1.28, 2.03, 1.64, and 2.08 for women, respectively. The cutoff value showing the maximum sensitivity plus specificity for detecting myocardial ischemia was 87cm for men and 74cm for women. The cutoff values for discrimination of hypertension, diabetes, and multiple risk factors for metabolic syndrome, were 84, 85, and 83cm, respectively, for men, and 77, 77, and 76cm, respectively, for women. Conclusions: The waist-circumference cutoff values for cardiometabolic disease and its risk factors are lower than those recommended for Asians by the WHO. Waist-circumference cutoff for defining metabolic syndrome should be lowered in the Korean population. [Copyright &y& Elsevier]

Abstract: Aims: To examine the effects of a 24-week lifestyle intervention prescribed by family doctors on carotid artery stiffness in metabolic syndrome (MS) subjects with pre-hypertension and/or pre-diabetes. Methods: Sixty-three middle-aged and older subjects with pre-hypertension and/or pre-diabetes were divided into subjects without MS (MS−) and with MS (MS+). MS components and carotid artery stiffness by ultrasound were determined at baseline, at 8 weeks, and following the 24 weeks of lifestyle intervention. Family doctors prescribed an individually customized lifestyle prescription for aerobic exercise and Mediterranean-style diet. Results: Carotid artery distensibility significantly increased in MS+ following the 24 weeks of intervention compared with baseline (0.191±0.012 vs. 0.143±0.011, 1/mmHg×10−2, p <0.05). Similarly, β stiffness index decreased in MS+ following the 24 weeks of intervention (9.8±1.1 vs. 12.5±1.1 AU, p <0.05). Following the intervention, waist circumference, BP and fasting glucose levels reduced in MS+ (all p <0.05), and 13 MS+ subjects were free from MS. Conclusions: The results show the reduction of carotid artery stiffness and the improvement of some MS components in MS subjects, suggesting a favorable effect of our lifestyle modification strategy on central artery stiffness as well as MS components in MS subjects. [Copyright &y& Elsevier]

Aims: The aim of this study was to compare the effectiveness of teneligliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, and canagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, at reducing a composite outcome of three metabolic risk factors (obesity, hypertension, and dyslipidemia) in Japanese patients with type 2 diabetes mellitus (T2DM) and metabolic risks.Methods: In this prospective, multicenter, open-label, randomized, parallel-group comparison study, 162 patients with T2DM and one or more metabolic risk factors were randomized into a teneligliptin or canagliflozin group and treated for 24 weeks. The primary endpoint was the composite percentage of subjects who experienced an improvement in at least one metabolic risk after 24 weeks of treatment.Results: The primary endpoint was achieved significantly by more patients in the canagliflozin group than in the teneligliptin group (62.2% vs. 31.3%, p = 0.0004). A ≥ 3% body weight loss was also achieved by significantly more participants in the canagliflozin group than in the teneligliptin group (55.9% vs. 10.5%, p < 0.0001).Conclusions: This study showed canagliflozin to be more effective at reducing metabolic risks than teneligliptin. In Japanese patients with T2DM and metabolic risk factors, SGLT2 inhibitors may be superior to DPP-4 inhibitors at controlling multiple metabolic risk. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Hexacosanoic acid (C26:0) is a saturated very long-chain fatty acid and high levels of C26:0 in red blood cells are reported to be closely related with risk factors of atherosclerosis. However, the relationship between absolute levels of C26:0 in whole blood and metabolic syndrome (MS) has not been determined. Materials and method: We divided 218 consecutive apparently healthy male subjects into an MS group (n =78) and a non-MS group (n =140) according to the definition of the International Diabetes Federation. The levels of C26:0 in whole blood were measured by gas liquid chromatography–mass spectrometry. Results: The MS group had significantly higher levels of C26:0 than the non-MS group (2.42±0.31μg/ml vs. 2.25±0.29μg/ml, P =0001). There was a significant association between the levels of C26:0 and the number of factors of MS. The levels of C26:0 positively correlated with age, blood pressure, triglyceride and fasting plasma glucose. Multivariate analysis revealed that the level of C26:0 is still an independent variable for the presence of MS after adjustment for age and each criterion of MS. Conclusion: The absolute levels of C26:0 in whole blood appear to be associated with MS independent of its component parts. [Copyright &y& Elsevier]

Abstract: Aims/hypothesis: Our aim was to determine the predictive values on the all-cause and cardiovascular mortality and the future risks of hypertension and diabetes of the metabolic syndrome defined by the third report of the National Cholesterol Education Program''s Adult Treatment Panel in the absence of established hypertension and diabetes (who may still have elevated blood pressure within 130–139/85–89mmHg and/or elevated fasting blood glucose within 5.5–6.9mmol/L (100–125mg/dL)). Methods: A community-based population of 11,058 Chinese aged 30 years and above in Kinmen island was followed up for 10.6 years. All-cause and cardiovascular mortality and incidence of hypertension and diabetes mellitus were determined. Results: The hazard ratios and 95% confidence intervals for all-cause and cardiovascular mortality in subjects with metabolic syndrome but without hypertension and diabetes versus subjects without metabolic syndrome, hypertension, and diabetes, were 0.81 (0.51–1.30) and 0.89 (0.57–1.37) in men, and 1.14 (0.45–2.92) and 0.73 (0.27–2.68) in women, respectively. In the non-diabetic non-hypertensives at baseline, the odds ratios and 95% confidence intervals for predicting hypertension and diabetes for subjects with versus without the metabolic syndrome were 2.25 (1.80–2.82) and 3.12 (2.30–4.24), respectively. Conclusions/interpretation: In this Chinese population, metabolic syndrome in the absence of hypertension and diabetes was not associated with increased risk of all-cause or cardiovascular mortality. In contrast, the presence of metabolic syndrome predicted future risk of hypertension and diabetes. Therefore, the intervention strategies for subjects with metabolic syndrome may be focused on the prevention of hypertension and diabetes. [Copyright &y& Elsevier]

Abstract: Objective: We investigated the link between a reduction in waist circumference and metabolic syndrome. Methods: 105 obese Japanese men were enrolled in this study with a 1-year follow-up. Anthropometric and body composition parameters, i.e. height, body weight, body fat percentage, waist circumference and hip circumference, blood pressure, triglyceride, HDL cholesterol and blood sugar, were evaluated. Metabolic syndrome was diagnosed using criteria developed in Japan. Results: After a 1-year follow-up, the parameters of metabolic syndrome were significantly improved. The prevalence of metabolic syndrome was significantly reduced in subjects with at least 3cm of waist circumference reduction (Group R). However, in subjects without such reduction (Group C), the prevalence of metabolic syndrome was similar to baseline levels. The prevalence of abdominal obesity, hypertension and dyslipidemia was also significantly reduced in Group R. In addition, there were remarkable differences of delta triglyceride (delta represents positive changes in parameters) and delta HDL cholesterol between Group R and Group C. Conclusion: At least 3cm of waist circumference reduction may be beneficial for improving metabolic syndrome in obese Japanese men. [Copyright &y& Elsevier]

Abstract: Aims:: To examine the association between habitual snoring and components of the metabolic syndrome in Korean adults. Whether these associations are independent of obesity was also explored. Methods:: Four thousand five hundred and six men and 5041 women aged 40–69 years from the Korean Health and Genome Study were examined. Information of snoring frequency was obtained by a questionnaire and components of the metabolic syndrome were measured. Results:: There was a clear dose–response relationship between the increasing frequency of snoring and the higher prevalence of each component of the metabolic syndrome (P <0.001). After adjustment for age, abdominal obesity, and the other metabolic components, hypertension was significantly associated with a 1.2-fold excess of habitual snoring in both men (P <0.05) and women (P <0.05). The association of habitual snoring with hypertension was unaltered by obesity. Regardless of the presence or absence of abdominal obesity, there was an increase in the prevalence of habitual snoring as the number of metabolic abnormalities increased. Conclusions:: Habitual snoring is associated with hypertension independent of obesity. While the relationship between habitual snoring and obesity is well recognized, characterization of the role of the other components of the metabolic syndrome as a cause or result of habitual snoring warrants a further study. [Copyright &y& Elsevier]

Abstract: To assess the prevalence of the metabolic syndrome disease cluster in the Hong Kong Chinese population we applied the US National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) guidelines. This was present if ≥3 of the following conditions were present: Hypertension (≥130/85mmHg); fasting plasma glucose was ≥6.1mmol/L; fasting plasma triglycerides ≥1.69mmol/L; fasting HDL-cholesterol <1.04 or <1.29mmol in males and females, respectively; or subjects were receiving treatment for their condition; waist circumference >88 or 102cm (Asian WHO criteria ≥80 or 90cm) in females and males, respectively. A total of 16.7% (17.1 (95%CI 15.7–18.5)% age and gender-adjusted) of the 2893 subjects had the metabolic syndrome. The prevalence of having at least 2, 3, 4 or 5 components was 34.5, 16.7, 6.4 and 1.4%, respectively. The prevalence increased from 3.1% in those aged 25–29 years to 41.0% in those aged over 70 years. Using the 2001 Census, 880,499 Hong Kong residents would have the metabolic syndrome. If the WHO recommended waist circumference for Asians is used, the age and gender-adjusted prevalence is significantly higher at 21.2% (21.9 (95%CI 20.4–23.4)%). In summary, the high prevalence of the metabolic syndrome in adult Hong Kong Chinese, particularly in the elderly, forewarns a rapidly increasing problem in Mainland China, and other Asian populations, which may have overwhelming public health ramifications. [Copyright &y& Elsevier]

In this study, we have assessed age and gender-related influences on the presence of the metabolic syndrome (MS) and closely related variables in Type 2 diabetic patients attending a diabetes clinic. For this purpose, we have taken retrospective clinical and biochemical data from consecutive Type 2 diabetic patients (n=291) and we have classified them by gender, age (with 55 and 70 years as cut-off levels) and having or not having the MS (using both the WHO and NCEP–ATP III MS definitions). A higher prevalence of adiposity and hypertension was present in the females. Males were characterized by higher uric acid and lower HDL-cholesterol and apoA1 levels (two-way ANOVA considering jointly age and gender as main effects, P<0.05 in every case). Overall the prevalence of NCEP–ATP III-defined MS was less frequent than WHO-defined MS (63.2% versus 81.1%, respectively). This difference was greater for males (42.1% versus 77.6%, respectively) than for females (75.5% versus 83.2% respectively). The κ-coefficient for the concordance between both MS definitions was 0.46 for males and 0.72 for females in the first age band, 0.29 for males and 0.48 for females in the second age band and 0.24 for males and 0.51 for females in the third age band. Thus, this study reveals relevant differences in the application of WHO and NCEP–ATP III MS definitions in a clinic-based Type 2 diabetic population from Southern Spain. In addition, the data suggest that gender confers a specific influence upon some MS-associated features in Type 2 diabetic patients attending a diabetes clinic irrespective of age band. [Copyright &y& Elsevier]

The metabolic or insulin resistance syndrome, characterized by hypertension, dyslipidemia, glucose intolerance and hyperinsulinemia, may have genetic determinants. The insulin gene (INS), insulin receptor gene (INSR) and insulin receptor substrate 1 gene (IRS1) have been proposed as candidate genes. We examined eight polymorphisms in these genes in 163 individuals from Yucatan, Mexico; this population has a high prevalence of obesity, type 2 diabetes mellitus and dyslipidemia. Subjects were evaluated for body mass index (BMI) and blood pressure. Blood samples were collected to determine glucose, insulin, triglycerides and cholesterol levels, as well as for DNA isolation. Restriction fragment length polymorphisms in INS, INSR and IRS1 were identified by polymerase chain reaction and digestion with selected restriction enzymes. Among the eight polymorphisms analyzed, the PstI polymorphism in INS was significantly associated with hypertriglyceridemia and with the presence of at least one abnormality related to the metabolic syndrome (P=0.007 and 0.004, respectively). The MaeIII polymorphism in INS was associated with fasting hyperinsulinemia (P=0.045). In multilocus analyses including both INS polymorphisms, significant associations were seen with hypertriglyceridemia (P=0.006), hypercholesterolemia (P=0.031) and with presence of at least one metabolic abnormality (P=0.009). None of the polymorphisms in INSR or IRS1 was associated with any of these traits. These findings suggest that the insulin gene may be an important determinant of metabolic syndrome, and particularly of dyslipidemia, in this population. [Copyright &y& Elsevier]

The current study assessed whether features of the metabolic syndrome are associated with higher apolipoprotein B100 (apoB100) levels in people with Type 2 diabetes (n=298) not taking lipid-lowering drugs. Body-mass index (BMI), waist:hip ratio (WHR), urinary albumin excretion rate, presence or absence of hypertension, uric acid levels, and apoB100 levels were assessed. Both higher BMI and urinary albumin excretion rate were associated with higher apoB100 levels (1.02±0.25 (±S.D.) g/l in normal weight, 1.07±0.22 g/l in overweight and 1.14±0.25 g/l in obese individuals; P<0.01; 1.09±0.23 g/l in normoalbuminuric patients, 1.06±0.22 g/l if urinary albumin excretion rate 20–50 μg/min and 1.17±0.27 g/l if urinary albumin excretion rate >50 μg/min; P<0.05). An association between the number of features of the metabolic syndrome and higher apoB100 levels was found (1.03±0.22 g/l if no features, 1.08±0.25 g/l if one feature, 1.11±0.20 g/l if two features and 1.15±0.27 g/l if >2 features; P for trend <0.01). Thus apoB100 levels show an association with the metabolic syndrome and, hypothetically, to insulin-insensitivity in Type 2 diabetes. BMI (but not WHR) and urinary albumin excretion rate accounted for most of the power of this relationship. [Copyright &y& Elsevier]

Abstract: Several factors are incriminated in the genesis of diabetic nephropathy (DN). To elucidate their interplays, we utilized a diabetic rat model with nephropathy (SHR/NDmcr-cp). This model is characterized by hypertension, obesity with the metabolic syndrome, diabetes with insulin resistance, and intrarenal AGE accumulation. Various therapeutic approaches were used to achieve renoprotection. Caloric restriction corrects metabolic abnormalities and protects the kidney without correcting hypertension. Anti-hypertensive agents, angiotensin II receptor blocker (ARB) and calcium channel blocker, lower blood pressure to the same extent, but only ARBs protect the kidney without changes in metabolic abnormalities. Glycemic control is better with insulin than with pioglitazone. The plasma insulin level is increased by insulin but decreased by pioglitazone which worsens the obesity. Nevertheless, pioglitazone provides renoprotection unlike insulin, perhaps as a result of the up-regulation of TGF-beta by hyperinsulinemia. Cobalt up-regulates the expression of a hypoxia-inducible factor (HIF) and its downstream genes (erythropoietin, VEGF, HO-1). It protects the kidney without correcting hypertension and metabolic abnormalities. Altogether, renoprotection is not necessarily associated with blood pressure or glycemic control. By contrast, it is almost always associated with a decreased AGE formation. AGE reduction may reflect a decreased oxidative stress as it is concomitant with a marked reduction of oxidative stress markers. [Copyright &y& Elsevier]

Abstract: The metabolic syndrome is a cluster of metabolic abnormalities, including impaired glucose metabolism, hypertension, dyslipidemia and abdominal obesity. It is a precursor to type 2 diabetes and a powerful independent risk factor for cardiovascular disease. Lifestyle changes, such as a diet high in saturated fats and a lack of physical exercise, have contributed to a worldwide increase in the prevalence of the metabolic syndrome and its associated complications. Identification and effective management of patients with the metabolic syndrome is important to reduce their risk of subsequent disease. Lifestyle modifications are an essential first step, and lipid-lowering therapy may also be required to achieve the lipid goals set out in current treatment guidelines. Statins are the most effective class of lipid-lowering drugs. Recent studies in patients with type 2 diabetes or the metabolic syndrome have shown that rosuvastatin was more effective than atorvastatin, simvastatin or pravastatin in reducing low-density lipoprotein cholesterol and enabling patients to reach lipid goals. [Copyright &y& Elsevier]