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Background: Obesity has become a major health problem in contemporary society and it is closely related to many chronic diseases, so it is an important issue for measuring adiposity accurately and predicting its future. Prevention and treatment of overweight and obesity has become one of the key prevention and treatment of metabolic disorders. Objective: In this study, we compared the ability of the four anthropometric indicators (body mass index, waist circumstance, waist--height ratio, waist-to-hip ratio) to identify metabolic disorders (hypertension, hyperlipidaemia, hyperglycemia and hyperuricemia) by receiver operating characteristic (ROC) curve analyses and to provide evidence for clinical practice. Methods: In this large scale cross-sectional study, 13,275 Han adults (including 7595 males and 5680 females) received physical examination between January, 2009 and January, 2010 in Xuanwu Hospital of Capital Medical University were investigated by the means of questionnaire, Meanwhile, the physical examination and serological results were recorded. A package known as Statistical Package for Social Scientist (SPSS) was employed to analyse the responses while t-test, one-way analysis of variance (ANOVA), ROC analysis and chi-square statistical methods were used to test the hypotheses. Results: WC, WHtR, WHR and BMI were all significantly (P < 0.001) correlated with all metabolic risk factors regardless of gender. And the area under the curve (AUC) of WHtR was significantly greater than that of WC, BMI or WHR in the prediction of hypertension, hyperlipidaemia, hyperglycemia and hyperuricemia. [ABSTRACT FROM AUTHOR]

Introduction: Obesity being a preventable risk factor for Non Communicable Diseases (NCD) needs to be measured in college students, as they undergo transition from adolescence to adulthood and are more likely to adopt lifestyles promoting weight gain. Objective: The present study was carried out to find out the burden of overweight/ obesity and associated lifestyle factors among medical undergraduate of Ujjain. Methods: Data was collected by self administered questionnaire enquiring family history of NCD, food habits and physical activity. Body Mass Index (BMI) and Waist circumference (WC) was measured to estimate burden of overweight /obesity. Results: Nearly half (44.9%) of the students were either overweight or obese. As per recommended WC cut off points (≥78cm –men, ≥72cm-women) and action level one for Indians, 68% students had central obesity. All most all (>90%) were frequent fast food eaters, eat between meals and not interested in regular physical activity. Conclusion: Higher prevalence of obesity especially central obesity among college students is alarming. If they continue their unhealthy food habits and physical inactivity they are likely to develop lifestyle diseases at an early age. Timely identification and correction of lifestyle is recommended to prevent obesity among students.

Background Elevated waist circumference (WC) is an important risk factor for cardiovascular disease (CVD). Aboriginals in Australia are at higher risk of CVD compared to non-Aboriginals. We examined the association between waist circumference and CVD, and developed a model for projecting absolute risk of cardiovascular disease using WC and age in one high risk Australian Aboriginal community. Methods We followed up 920 (470 men, 450 women) participants (more than 80% of the eligible population) aged 18 to 76 years, without CVD at baseline, for up to 20 years. Hazard ratios were estimated using Cox proportional hazards models adjusting for potential confounding factors. Absolute risk was estimated using the Weibull regression model. Results Of 920 study participants, 156 males and 177 females developed CVD in the follow-up period. Incidence rates for males and females in the 4th WC quartile (Q4) were 38.3 (95%CI 29.6, 49.7) and 47.2 (95%CI 37.1, 60.3) respectively. Crude hazard ratios of CVD for Q4 WC group using Q1 (quartile 1) as the referent quartile were 2.9 (95%CI 1.8- 4.6) for males and 3.5 (95%CI 2.2- 5.5) for females. Association remained after controlling for age, smoking status and alcohol drinking status (HR = 1.8 for males and HR = 3.1 for females). At 45 years of age with baseline waist circumference of 100 cm, a male had an absolute CVD risk of 32.5%, while a female had a 30.6% risk of the disease. Conclusions Risk of CVD among participants increased with increasing WC, and the relationship was accentuated with increasing age. The prediction model provides a tool for understanding the combined effects of WC with age on CVD events in the Australian Aboriginal community. It is simple and easily understood and will assist in identifying individuals at risk of CVD in relation to waist circumference values. [ABSTRACT FROM AUTHOR]

Highlights: [•] Evaluation the association of genetic polymorphism of MBL2 as a risk factor for cardiovascular disease (CVD) in 311 postmenopausal women. [•] The codon 54 polymorphic allele was found in 25.8% women is associated with the presence of hypertension and insulin resistance. [•] This is a possible mechanism of a decreased ability to activate the complement cascade for subsequent production of MBL binding to pro-inflammatory mediators, thereby decreasing inflammation and reducing the risk of vascular damage and/or insulin resistance. [Copyright &y& Elsevier]

Summary: Background & aims: It is unclear whether sarcopenia contributes to the prediction of metabolic dysregulations in addition to that predicted by waist circumference. Methods: Subjects consisted of 6832 adult participants in the 2009 Korea National Health and Nutrition Examination Survey, grouped into categories of waist circumference (normal vs. high). Sarcopenia was assessed by appendicular skeletal muscle mass divided by weight. Results: In the normal waist circumference category, the risk of metabolic syndrome was nearly 3.5-fold higher in sarcopenic men (OR, 3.39; 95% CI, 1.67–6.90) than in those without sarcopenia. For the high waist circumference category, the risk of metabolic syndrome was 2.5-fold higher in sarcopenic women (OR, 2.37; 95% CI, 1.66–3.40) than in those without sarcopenia. The corresponding risk was also higher in sarcopenic men (OR, 1.81; 95% CI, 1.11–2.94) than in those without sarcopenia. With the exception in men with high waist circumference category, adjustments for other potential confounders did not substantially affect the results. Appendicular skeletal muscle mass divided by weight as a continuous variable was also associated with metabolic syndrome in men (OR, 0.39; 95% CI, 0.35–0.44) and women (OR, 0.53; 95% CI, 0.48–0.60). Conclusions: Sarcopenia is associated with metabolic syndrome in men with normal waist circumference and women with high waist circumference. Our results emphasize that sarcopenia may contribute additionally to the risk of metabolic abnormalities beyond what is predicted by the abdominal obesity category. [Copyright &y& Elsevier]

Abstract: Background: Obesity defined by body mass index (BMI) is associated with higher levels of functional impairment. However, BMI strata misrepresent true adiposity, particularly in those with a normal BMI but elevated body fat (BF%) (normal weight obesity [NWO]) whom are at higher metabolic and mortality risk. Whether this subset of patients is associated with worsening functional outcomes is unclear. Methods: Subjects aged ≥60years with a BMI ≥18.5kg/m2 from NHANES III (1988–1994) were included. We created sex-specific tertiles of BF%. Data on physical limitations (PL), instrumental (IADL) and basic activities of daily living (BADL) were obtained. The analysis focused on the association between NWO and these outcomes. Comparative rates among each tertile using logistic regression (referent=lowest tertile) were assessed, incrementally adding co-variates. Results: Of the 4484 subjects aged ≥60years, 1528 had a normal BMI, and the range of the mean age of tertiles was 69.9–71.2years. Lean mass was lowest in the elevated BF% group than in the middle or low tertiles (42.6 vs 44.9 vs 45.8; p <0.001). Those with NWO had higher PL risk than the referent in females only in our adjusted model (males OR 1.18 [0.63–2.21]; females OR 1.90 [1.04–3.48]) but not after incorporating lean mass (males OR 1.11[0.56–2.20]; females (1.73 [0.92–3.25]). Neither sex with high BF% had higher IADL risk than the corresponding tertiles (males OR 0.67 [0.35–1.33]; females OR 1.20 [0.74–1.93]). NWO was protective in males only (OR 0.28 [0.10–0.83]) but not in females (OR 0.64 [0.40–1.03]). Conclusions: NWO is associated with increased physical impairment in older adults in females only, highlighting the importance of recognizing the association of obesity with disability in elders. [Copyright &y& Elsevier]

Objective: To correlate circulating levels of insulin-like growth factor (IGF)-I, IGF-II, and IGF binding protein (IGFBP)-3 in a population of obese children with biopsy-proven nonalcoholic fatty liver disease (NAFLD) with clinical, biochemical, and histological features. Study design: We conducted a cross-sectional study at the Hepatometabolic Unit of the Bambino Gesù Children's Hospital, Rome, Italy. Obese children (42 girls and 57 boys) underwent liver biopsy, anthropometry, biochemical assessment, and IGF system evaluation. Serum concentrations of IGF-I, IGF-II, and IGFBP-3 were measured. The liver biopsy features of each case were graded according to the NAFLD Activity Scoring system. The degrees of steatosis, inflammation, ballooning, and fibrosis were calculated. Results: Nonalcoholic steatohepatitis was diagnosed in 14/99 obese subjects. Stepwise regression analysis revealed that IGF-I was the major predictor of ballooning (β = −0.463; P < .0001) and NAFLD activity score (β = −0.457; P < .0001), IGF-I/IGFBP-3 ratio was the major predictor of liver inflammation (β = -0.285; P = .005), and IGF-II was the major predictor of liver fibrosis (β = 0.343; P < .005). Conclusion: Circulating levels of IGF-I and IGF-II are associated with the histological stages of NAFLD and may represent novel markers of liver damage progression in obese children. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this work was to meta-analyze prospective studies that have evaluated the effect of a Mediterranean diet on the development of type 2 diabetes. Materials/Methods: PubMed, Embase and the Cochrane Central Register of Controlled Trials databases were searched up to 20 November 2013. English language publications were allocated; 17 original research studies (1 clinical trial, 9 prospective and 7 cross-sectional) were identified. Primary analyses were limited to prospective studies and clinical trials, yielding to a sample of 136,846 participants. A systematic review and a random effects meta-analysis were conducted. Results: Higher adherence to the Mediterranean diet was associated with 23% reduced risk of developing type 2 diabetes (combined relative risk for upper versus lowest available centile: 0.77; 95% CI: 0.66, 0.89). Subgroup analyses based on region, health status of participants and number of confounders controlling for, showed similar results. Limitations include variations in Mediterranean diet adherence assessment tools, confounders’ adjustment, duration of follow up and number of events with diabetes. Conclusions: The presented results are of major public health importance, since no consensus exists concerning the best anti-diabetic diet. Mediterranean diet could, if appropriately adjusted to reflect local food availability and individual’s needs, constitute a beneficial nutritional choice for the primary prevention of diabetes. [Copyright &y& Elsevier]

Objectives: This study sought to determine the capacity of cardiorespiratory fitness (CRF) algorithms without exercise testing to predict the risk for nonfatal cardiovascular disease (CVD) events and disease-specific mortality. Background: Cardiorespiratory fitness (CRF) is not routinely measured, as it requires trained personnel and specialized equipment. Methods: Participants were 43,356 adults (21% women) from the Aerobics Center Longitudinal Study, followed up between 1974 and 2003. Estimated CRF was determined on the basis of sex, age, body mass index, waist circumference, resting heart rate, physical activity level, and smoking status. Actual CRF was measured by a maximal treadmill test. Risk reduction per 1–metabolic equivalent increase, discriminative ability (c statistic), and net reclassification improvement were determined. Results: During a median follow-up of 14.5 years, 1,934 deaths occurred, 627 due to CVD. In a subsample of 18,095 participants, 1,049 cases of nonfatal CVD events were ascertained. After adjustment for potential confounders, both measured and estimated CRF were inversely associated with risks for all-cause mortality, CVD-related mortality and nonfatal CVD events in men, and all-cause mortality and nonfatal CVD events in women. The risk reduction per 1–metabolic equivalent increase ranged from approximately 10% to 20%. Measured CRF had a slightly better discriminative ability (c statistic) than did estimated CRF, and the net reclassification improvement values in measured CRF versus estimated CRF were 12.3% in men (p < 0.05) and 19.8% in women (p < 0.001). Conclusions: These CRF algorithms utilized information routinely collected to obtain an estimate of CRF, which provides a valid indication of health status. In addition to identifying people at risk, this method can provide more appropriate exercise recommendations that reflect initial CRF levels. [Copyright &y& Elsevier]

Abstract: Dysregulation of adipose hormones in obesity has been associated with the hastened development of metabolic syndrome and associated chronic disease sequalae including cardiovascular disease and type 2 diabetes mellitus. This study aims to identify common biochemical and anthropometric markers that impact adipose hormones, including adiponectin and leptin. Based on previous literature, it was hypothesized that these would be adversely impacted by liver function parameters, and adiponectin levels would be positively correlated with phospholipid Ω-3 fatty acids. Forty nondiabetic adult subjects (body mass index, ≥25.0 kg/m2) were recruited. Fasting plasma samples were taken to assess adipokine levels, glucose metabolism, electrolytes, liver enzymes, and blood lipids. Basic anthropometric measurements were also recorded. Adiponectin levels were positively correlated with high-density lipoprotein cholesterol and negatively correlated with anthropometric measures, insulin, liver enzymes, triglycerides, and very low–density lipoprotein cholesterol but not body mass index. Conversely, plasma leptin levels were positively correlated with anthropometric measures, C-reactive protein, high-density lipoprotein cholesterol, and plasma phospholipid proportions of Ω-3 α linoleic acid but inversely correlated with creatinine levels. These results support other data regarding correlations between adiponectin and relative adipose distribution. Correlations with specific liver enzymes may indicate that adiponectin levels are tied to fatty acid deposition in the liver; however, liver/kidney damage though further mechanistic clarification is required. Leptin levels were associated with measures of adiposity but not liver enzymes. Each of these variables, along with blood lipids, may serve as potential future therapeutic targets for the prevention and management of obesity and related comorbidities. [Copyright &y& Elsevier]

Abstract: Objectives: Increased insulin concentration is a surrogate for insulin resistance and early assessment of fasting insulin may help in identifying those who are potentially at high risk of type 2 diabetes, hypertension, and cardiovascular disease. The aim of this study was to determine age- and sex-related reference values for serum insulin and insulin resistance/sensitivity indices in Iranian subjects. Design and methods: Serum insulin levels were measured by electrochemiluminescence immunoassay in 5786 participants of the Tehran Lipid and Glucose Study. After application of exclusion criteria, 309 non-obese healthy subjects (124 men and 185 women), aged 24–83y, were included. The International Federation of Clinical Chemistry guidelines (non-parametric method) and the robust method were used for determining reference values. Results: Overall 95% reference values for fasting insulin were 1.61–11.37, 2.34–11.98, and 2.11–12.49μU/mL in men, women, and total population respectively. Mean fasting insulin concentration showed a decreasing trend with age in both genders (p for trend ≤0.001). Age, waist circumference, and systolic blood pressures were biological determinants of fasting insulin in both genders; in addition, insulin was modulated by triglycerides in men and fasting glucose in women. Reference intervals for HOMA1-IR, HOMA2-IR, and QUICKI were 0.63–2.68, 0.40–1.80, and 0.33–0.42, respectively. Conclusion: This study presents the first set of reference values for fasting serum insulin to be 2–12μU/mL for both genders in a healthy sample of Iranian adults along with the reference values for insulin resistance/sensitivity indices. These values could be used for identifying subjects with insulin resistance in epidemiological and clinical research. [Copyright &y& Elsevier]

Abstract: Objective: This cross-sectional study analyzed the association of serum irisin concentrations with cardiorespiratory fitness levels and common single nucleotide polymorphisms (SNPs) in the FNDC5 gene and examined the relationships between cardiorespiratory fitness levels, common SNPs in FNDC5, and glucose metabolism. Materials/Methods: Cardiorespiratory fitness was assessed by measuring peak oxygen uptake (VO2peak) and serum irisin levels by ELISA in 163 Japanese men (age, 21–79years). Subjects were divided into low- and high-fitness groups within each age group according to the median VO2peak value. Common SNPs (rs3480 and rs16835198) of the FNDC5 gene were genotyped with the TaqMan assay. Glucose metabolism was evaluated by measuring HbA1c, fasting plasma glucose (FPG), insulin levels, and HOMA-IR. Results: Serum irisin levels were negatively correlated with age (p <0.001) and not associated with the VO2peak or HOMA-IR. In the low-fitness group, SNP analysis revealed that subjects with the rs3480 AG and GG genotypes had higher levels of insulin and HOMA-IR than those with the AA genotype (p <0.01; no significant difference was observed in the high-fitness group). The GG genotypes of rs16835198 were associated with increased HbA1c and FPG in the low-fitness group only (p <0.05). SNPs and both fitness groups were not associated with serum irisin levels. Conclusions: In Japanese men, cardiorespiratory fitness levels and common SNPs in FNDC5 are not associated with circulating irisin levels, whereas high cardiorespiratory fitness abolishes the association between the rs3480 and rs16835198 SNPs and glucose metabolism independent of serum irisin levels. [Copyright &y& Elsevier]

Abstract: Objective: The cardiometabolic risk cluster metabolic syndrome (MS) includes ≥3 of elevated fasting glucose, hypertension, elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL-c), and increased waist circumference. Each can be affected by physical activity and diet. Our objective was to determine whether determine whether baseline physical activity and/or diet behavior impact MS in the course of a large pharmaceutical trial. Materials/Methods: This was an observational study from NAVIGATOR, a double-blind, randomized (nateglinide, valsartan, both, or placebo), controlled trial between 2002 and 2004. We studied data from persons (n=9306) with impaired glucose tolerance and cardiovascular disease (CVD) or CVD risk factors; 7118 with pedometer data were included in this analysis. Physical activity was assessed with 7-day pedometer records; diet behavior was self-reported on a 6-item survey. An MS score (MSSc) was calculated using the sum of each MS component, centered around the Adult Treatment Panel III threshold, and standardized according to sample standard deviation. Excepting HDL-c, assessed at baseline and year 3, MS components were assessed yearly. Follow-up averaged 6 years. Results: For every 2000-step increase in average daily steps, there was an associated reduction in average MSSc of 0.29 (95% CI -0.33 to -0.25). For each diet behavior endorsed, there was an associated reduction in average MSSc of 0.05 (95% CI -0.08 to -0.01). Accounting for the effects of pedometer steps and diet behavior together had minimal impact on parameter estimates with no significant interaction. Relations were independent of age, sex, race, region, smoking, family history of diabetes, and use of nateglinide, valsartan, aspirin, antihypertensive, and lipid-lowering agent. Conclusions: Baseline physical activity and diet behavior were associated independently with reductions in MSSc such that increased attention to these lifestyle elements provides cardiometabolic benefits. Thus, given the potential to impact outcomes, assessment of physical activity and diet should be performed in pharmacologic trials targeting cardiometabolic risk. [Copyright &y& Elsevier]

Abstract: Obesity is a major public health problem, and measuring adiposity accurately and predicting its future comorbidities are important issues. Therefore, we hypothesized that 4 adiposity measurements, body mass index (BMI), waist circumference (WC), waist-to-height ratio, and body fat percentage, have different physiological meanings and distinct associations with adverse health consequences. This study aimed to investigate the relationship of these 4 measurements with metabolic syndrome (MetS) components and identify the most associated factor for MetS occurrence in older, non-medicated men. Cross-sectional data from 3004 men, all 65 years of age and older, were analyzed. The correlation and association between adiposity measurements and MetS components were evaluated by Pearson correlation and multiple linear regression. Based on multivariate logistic regression, BMI and WC were significantly associated with MetS and were selected to build a combined model of receiver operating characteristic curves to increase the diagnosis accuracy for MetS. The results show that BMI is independently associated with systolic and diastolic blood pressure; WC and body fat percentage are associated with fasting plasma glucose and log transformation of triglyceride; BMI and WC are negatively associated with high-density lipoprotein cholesterol (HDL-C); and WC is a better discriminate for MetS than BMI, although the combined model (WC + BMI) is not significantly better than WC alone. Based on these results, we conclude that the 4 adiposity measurements have different clinical implications. Thus, in older men, BMI is an important determinant for blood pressure and HDL-C. Waist circumference is associated with the risk of fasting plasma glucose, HDL-C, triglyceride, and MetS occurrence. The combined model did not increase the diagnosis accuracy. [Copyright &y& Elsevier]

Abstract: Objectives: Sedentary behavior (SB) is distinct from physical inactivity. Children's guidelines recommend ≤2h/day screen time and ≥60min/day moderate-to-vigorous physical activity (MVPA). This study describes SB in children at elevated risk of obesity, including the possibility of high SB in otherwise active children. Methods: Participants were 534 children from Quebec, Canada, aged 8–10years with ≥1 obese parent in 2005–2008. SB and MVPA were measured by accelerometer and specific SBs by self-report, and height and weight were directly measured. Results: Overweight/obese children were significantly more sedentary overall and reported higher screen time than normal weight children. About 19% of boys and 46% of girls met screen time but not PA guidelines; 28% of boys and 5% of girls met PA but not screen time guidelines. About 46% of overweight/obese children met neither guideline (32% normal weight); only 5% overweight/obese children met both (21% normal weight). Reported behaviors contributed 60%–80% of total SB time; the most sedentary children had the most unaccounted for SB time. Conclusions: Overweight/obese children are more sedentary overall and report higher screen time than normal weight children. Public health efforts targeting PA and SB in children must consider sex and weight status while being cognizant that being sufficiently active is not exclusive of high levels of SB. [Copyright &y& Elsevier]

Highlights: [•] Broccoli sprouts powder reduced H. pylori bacterial load in diabetic patients. [•] Broccoli sprouts could not compete with standard triple therapy on H. pylori eradication. [•] Broccoli sprouts had no effect on gastric inflammatory parameters. [Copyright &y& Elsevier]

Abstract: Background and aim: Cardiac steatosis has been related to increased risk of heart disease. We investigated the association between cardiac steatosis, electrocardiographic (ECG) abnormalities, and individual components of the metabolic syndrome (MetS). Methods and results: A 12-lead ECG and laboratory data were examined in 31 men with the MetS and in 38 men without the MetS. Myocardial triglyceride (MTG) content was measured with 1.5 T magnetic resonance (MR) spectroscopy and epicardial and pericardial fat by MR imaging. MTG content, epicardial and pericardial fat depots were higher in men with the MetS compared with subjects without the MetS (p < 0.001). The heart rate was increased (p < 0.001), the PR interval was longer (p < 0.044), the frontal plane QRS axis shifted to the left (p < 0.001), and the QRS voltage (p < 0.001) was lower in subjects with the MetS. The frontal plane QRS axis and the QRS voltage were inversely correlated with MTG content, waist circumference (WC), body mass index (BMI), TGs, and fasting blood glucose. High-density lipoprotein cholesterol correlated positively and measures of insulin resistance negatively with the QRS voltage. MTG content and hypertriglyceridemia were determinants of the frontal plane QRS and WC and hyperglycemia were predictors of the QRS voltage. Conclusion: The MetS and cardiac steatosis appear to associate with multiple changes on 12-lead ECG. The frontal plane QRS axis is shifted to the left and the QRS voltage is lower in subjects with the MetS. Standard ECG criteria may underestimate the presence of left ventricular hypertrophy in obese subjects with cardiometabolic risk factors. [Copyright &y& Elsevier]

Background: The metabolic syndrome is the most important risk factor for cardiovascular disease. The heat shock proteins (HSPs) are highly conserved families of proteins expressed by a number of cell types following exposure to stressful environmental conditions include several known risk factors for cardiovascular disease. Recent studies have shown the potential of constituents of saffron in the treatment of atherosclerosis. We aimed on investigating the effect of saffron on antibody titers to HSP in patients with metabolic syndrome. Methods: This was a randomized, placebo-controlled clinical trial. One-hundred and five subjects with metabolic syndrome were randomly allocated to one of the three groups: the case group received 100 mg/day saffron, the placebo control group received a capsule of placebo and a non-placebo control group received no capsule, for 12 weeks. Results: Antibodies against heat shock proteins 27, 60, 65 and 70 were determined in all patients before (week 0) and after (week 6 and 12) intervention. At 12 weeks, saffron produced a significantly decrease in AntiHSP27, 70 levels. Saffron can decrease AntiHSP27, 70 levels in patients with metabolic syndrome. Conclusions: The results of this study indicate the efficacy of saffron in the improvement of some markers of autoimmunity HSPs in patients with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: The metabolic syndrome (MetS) is a clustering of various metabolic abnormalities which is associated with increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus. Due to its increasing prevalence, it has become an important public health concern. Altered fatty acid (FA) composition and desaturase activities have been associated with several metabolic diseases, including MetS. The aim of the present study was to evaluate the relationship of the plasma FA profile and desaturase activities with the MetS in a Mediterranean population at high risk of CVD. Methods: Baseline data from 427 participants aged 55–80 years who took part in the interventional PREDIMED study were obtained. Individual FA was determined in plasma and desaturase activities were estimated from product/precursor ratios. Odds ratios (OR) and partial correlation coefficients were used to examine these relations with MetS and its components, respectively. Results: We found higher levels of C14:0, C16:0, C16:1n-7, estimated Δ9- or stearoyl-CoA desaturase (SCD), and estimated Δ6 desaturase (D6D), and lower levels of C18:2n-6 in people with MetS compared to those without it. After adjustment for several confounders, only higher quartiles of C14:0, C16:0, C16:1n-7, and D6D were found to be associated with an increasing prevalence of MetS, while higher quartiles of C18:2n-6 were inversely associated with MetS. High proportions of C14:0, C16:0, C16:1n-7, C20:3n-6, SCD, and D6D, and decreased proportions of C18:2n-6 and estimated Δ5-desaturase (D5D) were associated with adverse profiles of several metabolic risk factors. Women showed more unhealthy FA pattern and lipid profiles than men, but only among those with MetS. Conclusion: A FA composition and estimated desaturase activities consisting in high levels of SFA, SCD and D6D, and low levels of PUFA and D5D are associated with increased MetS probability and are characteristic of people presenting MetS, especially women. These findings support those observed in non-Mediterranean populations in which an altered FA profile and estimated desaturase activities are associated with MetS. [Copyright &y& Elsevier]

Abstract: Objective: To ascertain the effect of arm cranking exercise on improving plasma levels of inflammatory cytokines and adipokines in untrained adults with chronic spinal cord injury (SCI). Design: Longitudinal study. Setting: Community-based supervised intervention. Participants: Men (N=17) with complete SCI at or below T5 volunteered for this study. Participants were randomly allocated to the intervention (n=9) or control group (n=8) using a concealed method. Intervention: A 12-week arm cranking exercise program of 3 sessions per week consisted of warm-up (10–15min), arm crank (20–30min; increasing 2min and 30s every 3wk) at a moderate work intensity of 50% to 65% of heart rate reserve (starting at 50% and increasing 5% every 3wk), and cool-down (5–10min). Main Outcome Measures: Plasma levels of leptin, adiponectin, plasminogen activator inhibitor-1, tumor necrosis factor-alpha, and interleukin-6 were determined. Furthermore, physical fitness (maximum oxygen consumption [ O2max]) and body composition (anthropometric index, waist circumference, and body mass index) were also assessed. Results: Plasma levels of leptin, tumor necrosis factor-alpha, and interleukin-6 were significantly decreased after the completion of the training program. Similarly, the anthropometric index and waist circumference were diminished too. A moderate correlation was found between leptin and the anthropometric index. Finally, O2max was significantly increased, suggesting an improvement of physical fitness in the intervention group. No changes were found in the control group. Conclusions: Arm cranking exercise improved low-grade systemic inflammation by decreasing plasma levels of inflammatory cytokines. Furthermore, it also reduced plasma leptin levels. Long-term, well-conducted studies are still required to determine whether these changes may improve clinical outcomes of adults with chronic SCI. [Copyright &y& Elsevier]

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Abstract: Objective: The metabolic syndrome (MetS) is typically diagnosed based on abnormalities in specific clustered clinical measures that are associated with increased risk for coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM). However, current MetS criteria result in racial/ethnic discrepancies. Our goals were to use confirmatory factor analysis (CFA) to delineate differential contributions to MetS by sub-group, and if contributions were discovered, develop sex and racial/ethnic-specific equations to calculate MetS severity. Research Design and Methods: Using data on adults from the National Health and Nutrition Examination Survey 1999–2010, we performed a CFA of a single MetS factor that allowed differential loadings across groups, resulting in a sex and race/ethnicity-specific continuous MetS severity score. Results: Loadings to the single MetS factor differed by sub-group for each MetS component (p<0.001), with lower factor loadings among non-Hispanic-blacks for triglycerides and among Hispanics for waist circumference. Systolic blood pressure exhibited low factor loadings among all groups. MetS severity scores were correlated with biomarkers of future disease (high-sensitivity C-reactive-protein, uric acid, insulin resistance). Non-Hispanic-black-males with diabetics had a low prevalence of MetS but high MetS severity scores that were not significantly different from other racial/ethnic groups. Conclusions: This analysis among adults uniquely demonstrated differences between sexes and racial/ethnic groups regarding contributions of traditional MetS components to an assumed single factor. The resulting equations provide a clinically-accessible and interpretable continuous measure of MetS for potential use in identifying adults at higher risk for MetS-related diseases and following changes within individuals over time. These equations hold potential to be a powerful new outcome for use in MetS-focused research and interventions. [Copyright &y& Elsevier]

Abstract: Until just a few years ago, the genetic determinants of obesity and metabolic syndrome were largely unknown, with the exception of a few forms of monogenic extreme obesity. Since genome-wide association studies (GWAS) became available, large advances have been made. The first single nucleotide polymorphism robustly associated with increased body mass index (BMI) was in 2007 mapped to a gene with for the time unknown function. This gene, now known as fat mass and obesity associated (FTO) has been repeatedly replicated in several ethnicities and is affecting obesity by regulating appetite. Since the first report from a GWAS of obesity, an increasing number of markers have been shown to be associated with BMI, other measures of obesity or fat distribution and metabolic syndrome. This systematic review of obesity GWAS will summarize genome-wide significant findings for obesity and metabolic syndrome and briefly give a few suggestions of what is to be expected in the next few years. [Copyright &y& Elsevier]

Abstract: Background: Acute intensive exercise has been shown to induce a decreased subsequent daily energy intake in obese adolescents without altering the subjective appetite feelings. It is however unclear whether or not those nutritional adaptations to acute exercise are affected by the adolescents' weight status. The aim of this study was to compare the energy intake and macronutrient preferences, appetite feeling and energy expenditure response to acute exercise between lean and obese adolescents. Methods: Ten obese and nine normal weight 12–15year old adolescents randomly completed a session with a 30minute cycling exercise at 75% VO2max and a sedentary session. During both sessions energy expenditure was assessed using Armband, ad libitum energy intake measured by weighing at both lunch and dinner time and appetite feelings assessed using visual analog scales. Results: Daily, morning and afternoon energy expenditure were significantly higher in obese than in normal weight adolescents (p<0.001). Total energy expenditure was significantly higher during EX (1086±157kcal) compared to SED (853±154kcal) in lean (p<0.05) but not significantly different in obese (respectively 1865±222 and 1803±232kcal). Afternoon energy expenditure was significantly lower during EX compare to SED in obese (p<0.05) but not in normal weight adolescents. Lunch, dinner and total daily energy intake were significantly reduced after the exercise session in obese (p>0.05) but not in lean adolescents. No group or condition effects were observed on subjective appetite feelings. Discussion: Post exercise spontaneous energy intake and energy expenditure are reduced in obese but not in normal weight adolescents, without appetite feeling changes. Acute exercise may have a greater impact on energy balance through the induced decreased energy intake in the absence of significant change in energy expenditure in obese youth. [Copyright &y& Elsevier]

Abstract: Aims: We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox. Background: The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF). Methods: Prospective study of 4046 men aged 60–79years followed up for a mean period of 11years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF. Results: Overweight (BMI 25–9.9kg/m2) and obesity (BMI≥30kg/m2) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9kg/m2) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p =0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p =0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p =0.60 for trend) but made minor differences to those with HF [p =0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p =0.98 for trend]. Conclusion: The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association. [Copyright &y& Elsevier]

Abstract: Background: Apolipoprotein A5 (APOA5) gene variants are associated with increased plasma triglycerides, a risk factor for metabolic syndrome (MS). The goal of the current study was the investigation of the distribution of T-1131C variant among obese adolescents with MS compared with healthy controls. Subjects and methods: The study included 150 obese adolescents (75 males and 75 females) with MS and 204 age and sex matched normal healthy controls (100 males and 104 females). The mean age of the patients was 15.47±2.54years, ranged from 17 to 20years. They were genotyped by polymerase chain reaction–restriction fragment length polymorphism for the mutation (T-1131C). Results: The blood pressure, triglyceride and HOMA-R levels were significantly higher and HDL-C levels were significantly lower in carrier (TC+CC) compared to non-carrier (TT) MS patients. There was accumulation of −1131C allele frequency in the MS group (31.33% vs. control group 11.76%), p<0.001. The genotypes were in Hardy–Weinberg equilibrium both in the patients with metabolic syndrome and in the control subjects. Results of analysis of multiple regression models showed that the ApoA5 −1131C carriers showed an increased incidence of MS (OR=1.73, 95% CI: 1.41–2.11). Conclusions: The present study suggests that the 1131T>C polymorphism is a risk factor for the development of metabolic syndrome in obese adolescents. [Copyright &y& Elsevier]

Abstract: Objectives: To examine associations of total sitting time, TV-viewing and leisure-time computer use with cardiometabolic risk biomarkers in adults. Design: Population based cross-sectional study. Methods: Waist circumference, BMI, total cholesterol, HDL cholesterol, blood pressure, non-fasting glucose, gamma glutamyltransferase (GGT) and triglycerides were measured in 48,882 adults aged 20 years or older from the Nord-Trøndelag Health Study 2006–2008 (HUNT3). Adjusted multiple regression models were used to test for associations between these biomarkers and self-reported total sitting time, TV-viewing and leisure-time computer use in the whole sample and by cardiometabolic disease status sub-groups. Results: In the whole sample, reporting total sitting time ≥10h/day was associated with poorer BMI, waist circumference, total cholesterol, HDL cholesterol, diastolic blood pressure, systolic blood pressure, non-fasting glucose, GGT and triglyceride levels compared to those reporting total sitting time <4h/day (all p <0.05). TV-viewing ≥4h/day was associated with poorer BMI, waist circumference, total cholesterol, HDL cholesterol, systolic blood pressure, GGT and triglycerides compared to TV-viewing <1h/day (all p <0.05). Leisure-time computer use ≥1h/day was associated with poorer BMI, total cholesterol, diastolic blood pressure, GGT and triglycerides compared with those reporting no leisure-time computing. Sub-group analyses by cardiometabolic disease status showed similar patterns in participants free of cardiometabolic disease, while similar albeit non-significant patterns were observed in those with cardiometabolic disease. Conclusions: Total sitting time, TV-viewing and leisure-time computer use are associated with poorer cardiometabolic risk profiles in adults. Reducing sedentary behaviour throughout the day and limiting TV-viewing and leisure-time computer use may have health benefits. [Copyright &y& Elsevier]

Abstract: Background and aims: Kiwifruit has the potential to improve markers of metabolic dysfunction, but the response may be influenced by inflammatory state. We aimed to investigate whether inflammatory state would modulate the effect of consuming two green kiwifruit daily on plasma lipids and markers of inflammation. Methods and results: Eighty-five hypercholesterolaemic men completed a 4-week healthy diet run-in, before randomisation to a controlled cross-over study of two 4-week interventions of two green kiwifruit/day plus healthy diet (intervention) or healthy diet alone (control). Anthropometric measures and fasting blood samples (plasma lipids, serum apolipoproteins A1 and B, high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6, tumour necrosis factor-alpha (TNF-α) and IL-10) were taken at baseline, 4 and 8 weeks. Subjects were divided into low and medium inflammatory groups, using pre-intervention hs-CRP concentrations (hs-CRP <1 and 1–3 mg/L, respectively). In the medium inflammatory group the kiwifruit intervention resulted in significant improvements in plasma high-density lipoprotein cholesterol (HDL-C) (mean difference 0.08 [95% CI: 0.03, 0.12] mmol/L [P < 0.001]), total cholesterol (TC)/HDL-C ratio (−0.29 [−0.45, −0.14] mmol/L [P = 0.001]), plasma hs-CRP (−22.1 [−33.6, −4.97]% [P = 0.01]) and IL-6 (−43.7 [−63.0, −14.1]% [P = 0.01]) compared to control treatment. No effects were seen in the low inflammatory group. There were significant between inflammation group differences for TC/HDL-C (P = 0.02), triglyceride (TG)/HDL-C (P = 0.05), and plasma IL-6 (P = 0.04). Conclusions: Inflammatory state modulated responses to the kiwifruit intervention by improving inflammatory markers and lipid profiles in subjects with modestly elevated CRP, suggesting this group may particularly benefit from the regular consumption of green kiwifruit. Registered 16th March 2010, Australian New Zealand Clinical Trials Registry (no. ACTRN12610000213044), www.ANZCTR.org.au. [Copyright &y& Elsevier]

Abstract: Background and aims: The increasing prevalence of obesity has been paralleled by a trend of reduced sleep duration. Sleep is considered a modulator of neuroendocrine function. The aim of this study was to determine the relation between sleep duration, overweight, and metabolic syndrome in Korean adolescents. Methods and results: This study was based on data from the Korean National Health and Nutrition Examination Survey (KNHANES) IV. Data from 1187 adolescents aged 12–18 years were included in the analysis. Subjects were classified according to self-reported sleep duration: ≤5 h, 6–7 h, 8–9 h, and ≥10 h. We analysed the association between sleep duration, overweight, and metabolic syndrome after adjustment for potential confounding variables. Body mass index (BMI), waist circumference (WC), and diastolic blood pressure (DBP) were higher in subjects who slept ≤5 h, and triglyceride level was higher in subjects who slept ≥10 h. According to logistic regression analysis, subjects who slept ≤5 h had a higher risk of overweight (odds ratio (OR) 2.04, 95% confidence interval (CI) 1.17–3.57) and elevated blood pressure (BP) (OR 2.11, 95% CI 1.22–3.65). We did not find any association between sleep duration and metabolic syndrome. Subjects who slept ≥10 h had a higher risk of hypertriglyceridemia (OR 2.17, 95% CI 1.14–4.13). Conclusion: Short sleep duration was associated with overweight in adolescents. Although there was no association between sleep duration and metabolic syndrome, short sleep duration was associated with elevated BP and long sleep duration was associated with hypertriglyceridemia. [Copyright &y& Elsevier]

Abstract: Objective: Bilirubin, a natural product of heme catabolism by heme oxygenase, one of key antioxidant enzymes, has been recognized as a substance with potent antioxidant and cytoprotective properties. Several studies have shown a significant negative relationship between serum bilirubin levels and the risk of metabolic disorders, including type 2 diabetes. However, longitudinal studies investigating the association of elevated serum bilirubin levels and type 2 diabetes are lacking. In the present study, we aimed to investigate the longitudinal effects of baseline serum bilirubin concentrations on the development of type 2 diabetes in healthy Korean men. Materials and Methods: This 4year retrospective longitudinal observational study was conducted at the Asan Medical Center, Seoul, Republic of Korea. The study population consisted of 5960 men without type 2 diabetes who underwent routine health examinations in 2007 (baseline) and 2011 (follow-up). Baseline serum bilirubin concentrations were determined by the vanadate oxidation method. Results: During a 4year period, 409 incident cases of diabetes (6.9 %) were identified. Incident type 2 diabetes decreased across the baseline bilirubin quartile categories (P for trend <0.001). In multivariable-adjusted model, the relative risk (RR) for the development of type 2 diabetes was significantly lower in the highest (i.e., 1.30–2.00mg/dl) than in the lowest bilirubin quartile category (i.e., ≤0.90mg/dl), even after adjustment for confounding variables (RR=0.69, 95% confidence interval 0.48–0.99, P for trend=0.041). Conclusions: The results indicate that serum total bilirubin level may provide additional information for predicting future development of type 2 diabetes in healthy subjects. [Copyright &y& Elsevier]

Abstract: Obesity is a growing public health problem in the general population, and significantly increases the risk for the development of new-onset heart failure (HF). However, in the setting of chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal-weight patients. Evidence exists for an “obesity paradox” in HF, with the majority of data measuring obesity by body mass index, but also across various less-frequently used measures of body fat (BF) and body composition including waist circumference, waist–hip ratio, skinfold estimates of percent BF, and bioelectrical impedance analysis of body composition. Other emerging areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context. [Copyright &y& Elsevier]

Abstract: Until recently, cardiorespiratory fitness (CRF) has been overlooked as a potential modifier of the inverse association between obesity and mortality (the so-called obesity paradox), observed in patients with known or suspected cardiovascular (CV) disease. Evidence from five observational cohort studies of 30,104 patients (87% male) with CV disease indicates that CRF significantly alters the obesity paradox. There is general agreement across studies that the obesity paradox persists among patients with low CRF, regardless of whether adiposity is assessed by body mass index, waist circumference, or percentage body fat. However, among patients with high CRF, risk of all-cause mortality is lowest for the overweight category in some, but not all, studies, suggesting that higher levels of fitness may modify the relationship between body fatness and survival in patients manifesting an obesity paradox. Further study is needed to better characterize the joint contribution of CRF and obesity on mortality in diverse populations. [Copyright &y& Elsevier]

Abstract: Individuals with normal body weight by body mass index (BMI) and high body fat percentage show a high degree of metabolic dysregulation. This phenomenon, defined as normal weight obesity, is associated with a significantly higher risk of developing metabolic syndrome, cardiometabolic dysfunction and with higher mortality. Recently, we have also shown that coronary artery disease patients with normal BMI and central obesity have the highest mortality risk as compared to other adiposity patterns. Therefore, it is important to recognize these high-risk groups for better adiposity-based risk stratification. There is a need for an updated definition of obesity based on adiposity, not on body weight. [Copyright &y& Elsevier]

Abstract: Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon. [Copyright &y& Elsevier]

Abstract: The prevalence of obesity has increased worldwide and is a source of concern since the negative consequences of obesity start as early as in childhood. The most commonly used anthropometric tool to assess relative weight and classify obesity is the body mass index (BMI); BMI alone shows a U- or a J-shaped association with clinical outcomes and mortality. Such an inverse relationship fuels a controversy in the literature, named the ‘obesity paradox', which associates better survival and fewer cardiovascular (CV) events in patients with elevated BMI afflicted with chronic diseases compared to non-obese patients. However, BMI cannot make the distinction between an elevated body weight due to high levels of lean vs. fat body mass. Generally, an excess of body fat (BF) is more frequently associated with metabolic abnormalities than a high level of lean body mass. Another explanation for the paradox is the absence of control for major individual differences in regional BF distribution. Adipose tissue is now considered as a key organ regarding the fate of excess dietary lipids, which may determine whether or not body homeostasis will be maintained (metabolically healthy obesity) or a state of inflammation/insulin resistance will be produced, with deleterious CV consequences. Obesity, particularly visceral obesity, also induces a variety of structural adaptations/alterations in CV structure/function. Adipose tissue can now be considered as an endocrine organ orchestrating crucial interactions with vital organs and tissues such as the brain, the liver, the skeletal muscle, the heart and blood vessels themselves. Thus, the evidence reviewed in this paper suggests that adipose tissue quality/function is as important, if not more so, than its amount in determining the overall health and CV risks of overweight/obesity. [Copyright &y& Elsevier]

Abstract: Objective: We aimed to estimate the up-to-date prevalence of metabolic syndrome (MS) and its influencing factors among the Chinese adults. Methods: Data were obtained from the China Health and Nutrition Survey conducted in 2009, which was a cross-sectional and partially nationally representative study including a total of 7488 Chinese adults (age≥18years). Results: The overall age-standardized prevalence estimates of the MS were 21.3% (95%confidence interval (CI): 20.4%–22.2%), 18.2% (95%CI: 17.3%–19.1%) and 10.5% (95%CI: 9.8%–11.2%) based on definitions of revised NCEP ATPIII, IDF and CDS criteria, respectively. Individuals who were women (compared to men: odds ratio [OR]=1.37, 95% CI=1.16–1.61), 40years or older (compared to less than 40years old: OR=2.82, 95%CI=2.37–3.34 for 40–59years; OR=4.41, 95%CI=3.68–5.29 for 60years or older), overweight/obese (compared to normal weight: OR=4.32, 95%CI=3.77–4.95 for overweight; OR=11.24, 95%CI=9.53–13.26 for obese), and living in urban area (compared to living in rural area: OR=1.27, 95%CI=1.12–1.43) were more likely to have a higher prevalence estimate of MS. In addition, frequency of alcohol consumption and cigarette intake were also found to be significantly associated with probability of MS. Conclusions: Our results suggest an urgent need to develop national strategies for the prevention, detection, treatment and control of obesity and MS in China. [Copyright &y& Elsevier]

Background & Aims: Unhealthy food intake, specifically fructose, has been associated with metabolic alterations and with the severity of liver fibrosis in patients with non-alcoholic fatty liver disease. In a cohort of patients with genotype 1 chronic hepatitis C (G1 CHC), we tested the association of fructose intake with the severity of liver histology. Methods: Anthropometric and metabolic factors, including waist circumference (WC), waist-to-hip ratio (WHR), dorso-cervical lipohypertrophy and HOMA were assessed in 147 consecutive biopsy-proven G1 CHC patients. Food intake, namely industrial and fruit fructose, was investigated by a three-day structured interview and a computed database. All biopsies were scored by an experienced pathologist for staging and grading (Scheuer classification), and graded for steatosis, which was considered moderate-severe if ⩾20%. Features of non-alcoholic steatohepatitis (NASH) in CHC were also assessed (Bedossa classification). Results: Mean daily intake of total, industrial and fruit fructose was 18.0±8.7g, 6.0±4.7g, and 11.9±7.2g, respectively. Intake of industrial, not fruit fructose, was independently associated with higher WHR (p =0.02) and hypercaloric diet (p <0.001). CHC patients with severe liver fibrosis (⩾F3) reported a significantly higher intake of total (20.8±10.2 vs. 17.2±8.1g/day; p =0.04) and industrial fructose (7.8±6.0 vs. 5.5±4.2; p =0.01), not fruit fructose (12.9±8.0 vs. 11.6±7.0; p = 0.34). Multivariate logistic regression analysis showed that older age (OR 1.048, 95% CI 1.004–1.094, p =0.03), severe necroinflammatory activity (OR 3.325, 95% CI 1.347–8.209, p = 0.009), moderate-severe steatosis (OR 2.421, 95% CI 1.017–6.415, p = 0.04), and industrial fructose intake (OR 1.147, 95% CI 1.047–1.257, p = 0.003) were independently linked to severe fibrosis. No association was found between fructose intake and liver necroinflammatory activity, steatosis, and the features of NASH. Conclusions: The daily intake of industrial, not fruit fructose is a risk factor for metabolic alterations and the severity of liver fibrosis in patients with G1 CHC. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Waist circumference (WC) is highly associated with metabolic risk factor clusters (RFC) for chronic non-communicable diseases (NCDs). In this study, we evaluated the use of WC measurements to detect hyperglycemia and dyslipidemia in children and adolescents using the WC cutoff points reported in the Bogalusa Heart study and the New Zealand study. Design and methods: Students (n=1011; aged 6 to 14years) were enrolled in a cross-sectional study. Anthropometric indices, fasting glucose, and lipid profiles were measured. The associations between WC measures and serum parameters were investigated by logistic regression models, and the clinical accuracy of the studied parameters was assessed using receiver operating characteristic (ROC) curve analysis. Results: The prevalence of increased WC was 30.2% using the New Zealand cutoff points and 13.7% using the Bogalusa cutoff values. In general, children with increased WC exhibited higher concentrations of total cholesterol, triglycerides, LDL-cholesterol, and non-HDL-cholesterol and lower levels of HDL-cholesterol. The areas under the ROC curves (AUC) of the WC measurements were 0.770 (95% CI: 0.744–0.797) and 0.600 (95% CI: 0.569–0.631) using, respectively, the New Zealand and Bogalusa cutoff points for WC, indicating the prediction of simultaneous hyperglycemia, increased levels of non-HDL-cholesterol, and reduced HDL-cholesterol for students with increased WC. There was a significant difference between AUC values (P =0.001). Furthermore, the sensitivity of using WC for detecting RFC in students was 2.0 to 2.5-fold higher with the New Zealand study cutoff values for WC than with those from the Bogalusa study. Logistic regression analysis revealed that increased WC was associated with simultaneous hyperglycemia and dyslipidemia after controlling for differences in sex and age (P <0.01 for all). Conclusions: Children and adolescents exhibited a high prevalence of increased WC associated with other RFCs for NCDs. Increased WC may be used to screen and identify students with elevated clusters of metabolic risk factors for NCDs. [Copyright &y& Elsevier]

Abstract: Background and aims: Fatty liver index (FLI), a surrogate parameter for nonalcoholic fatty liver disease, is an emerging risk factor for cardiovascular diseases and mortality. We aimed to evaluate whether FLI is associated with all-cause, cardiovascular, and non-cardiovascular mortality as well as fatal cancer in a cohort of subjects routinely referred to coronary angiography. Methods and results: FLI was calculated using BMI (body mass index), waist circumference (WC), triglycerides (TG) and gamma-glutamyl transferase (GGT) in 3270 subjects who were referred to coronary angiography (1997–2000). The main outcome measures were Cox proportional hazard ratios (HRs) for mortality from all causes, cardiovascular causes, non-cardiovascular causes, and fatal cancer. After a median follow-up time of 7.7 years, 740 subjects (22.6%) had died. There were 437 deaths due to cardiovascular disease and 303 deaths due to non-cardiovascular disease. Age-, sex-, and BMI-adjusted HRs (with 95% confidence intervals) for all-cause, cardiovascular, and non-cardiovascular mortality in the highest compared to the lowest FLI quartile were 2.56 (1.90–3.43; p < 0.001), 2.17 (1.47–3.22; p < 0.001), and 3.49 (2.16–5.66; p < 0.001), respectively. In age-, sex-, and BMI-adjusted analyzes, we found no significant association of FLI with fatal cancer. Multivariate adjusted HRs for all-cause, cardiovascular, non-cardiovascular mortality, and fatal cancer in the highest compared to the lowest FLI quartile were 2.17 (1.58–2.99; p < 0.001), 1.64 (1.07–2.51; p = 0.023), 3.72 (2.22–6.24; p < 0.001), and 2.33 (1.01–5.41; p = 0.048) respectively. Conclusion: In subjects referred to coronary angiography, high FLI levels are independently associated with increased all-cause, cardiovascular, and non-cardiovascular mortality as well as fatal cancer. [Copyright &y& Elsevier]

Abstract: Objective: The osteoblast-derived protein osteocalcin (OCN) is known to be involved in glucose metabolism by increasing adiponectin secretion from adipocytes. Recently, OCN was also found to enhance testosterone production in mouse testes, suggesting that OCN effects on energy metabolism may be mediated through testosterone. Our aim was to assess a possible gender difference in the metabolic effect of OCN in humans. Methods: We included 135 women and 155 men exhibiting changes in glucose tolerance in our study. Oral and intravenous glucose tolerance tests (OGTT and IVGTT, respectively) and a hyperinsulinemic normoglycemic clamp were performed. For clamp indices, whole body (M1) and muscle (M2) glucose uptake values were used. Leptin, adiponectin serum lipid, lipoprotein, total serum OCN and testosterone levels, and body composition were determined. Results: Higher OCN values were associated with improving metabolic state in both genders. Adiponectin and OCN correlated significantly only in females (r=+0.254, p=0.0029), while in men, testosterone and OCN values showed a significant positive correlation (r=+0.243, p=0.0023), independent of age, BMI, HbA1c and body composition. In women, adiponectin was confirmed by feature selection analysis as being an independent determinant of OCN, in addition to age and three of the IVGTT glucose values. In men, besides M1, BMI, M2, leptin, body fat percent, and the 90-minute OGTT glucose reading testosterone, but not adiponectin were identified as independent contributors for OCN. Conclusion: We confirmed the ‘classic’ adiponectin-mediated insulin-sensitising effect of OCN only in females. In men, a testosterone-mediated OCN metabolic effect is more likely. [Copyright &y& Elsevier]

Abstract: Background and aims: Prader–Willi syndrome (PWS), the most common genetic cause of obesity, is characterized by elevated morbility and mortality in all ages. In this context, non-obese PWS children showed low frequency of metabolic syndrome (MetS), while a comparable prevalence was observed in obese PWS and obese controls. Aim of this study was to estimate the occurrence of MetS and its components in a large group of PWS adults, according to obesity status. Methods and results: A cross-sectional study was performed in 108 PWS aged 18.0–43.2 years (87 obese and 21 non-obese) and in 85 controls with nonsyndromic obesity matched for age, gender, and BMI with obese PWS. Non-obese PWS showed lower waist circumference, insulin, HOMA-index, triglycerides, diastolic blood pressure, and higher HDL-C than both obese PWS and obese controls (p < 0.017). Obese PWS showed higher glucose and systolic blood pressure than both non-obese PWS and obese controls (p < 0.017). MetS was found in 1/21 (4.8%) non-obese PWS, 36/87 (41.4%) obese PWS and 39/85 (45.9%) obese controls. Non-obese PWS showed lower frequency for each MetS component as compared with obese PWS and obese controls. PWS patients with deletion of the chromosome 15q11–13 showed a lower risk for low HDL-C (p < 0.01) and a trend towards a lower MetS risk (p < 0.06) compared to subjects without deletion. Conclusion: Our findings suggest the main role that obesity status plays on the individual metabolic risk clustering in PWS adults. Early identification of MetS could be helpful to improve morbidity and prevent mortality in such patients. [Copyright &y& Elsevier]

Abstract: MicroRNAs (miRNAs) regulate posttranscriptional gene expression usually by binding to 3′-untranslated regions (3′UTRs) of target message RNAs (mRNAs). Previous studies have demonstrated that SNPs within miRNA target sites could modulate miRNA–mRNA interaction to affect the regulation of target genes and the individual's diseases. So far, little is known about the relationship of miRNA binding site polymorphisms with the risk of metabolic syndrome (MetS) in the general population. Therefore, we conducted a case–control study in Chinese Han population to evaluate the association between SNPs within miRNA binding sites and risk of MetS. 8 SNPs in miRNA binding sites with a minor allele frequency (MAF) of ≥0.05 in the Chinese Han population were selected by bioinformatics software. TaqMan ®assay was performed to test the genotypes in MetS patients (n=1026) and normal controls (n=1032). We found rs5750146 (adjusted odds ratio (OR)=1.24 for GA/AA, P =0.023, compared with GG), rs5999924 (adjusted OR=1.22 for AT/TT, P =0.038, compared with AA) in the APOL6 3′UTR were identified to correlate with MetS in the total sample and females. Rs11724758 (adjusted OR=0.65 for AA, P =0.002, compared with GG) in the FABP2 3′UTR was found to correlate with MetS in the total sample and males. Correlations between FABP2 rs11724758 polymorphisms and components of MetS reveal that high-density lipoprotein cholesterol (HDL-c) levels are significantly higher in FABP2 rs11724758 AA genotype carrier compared with noncarriers, whereas triglycerides (TG) and fasting plasma glucose (FG) were to be significantly lower in the AA genotype carrier. These findings indicate that these three polymorphisms which located at the predicted miRNAs binding sites were identified to contribute to susceptibility to MetS in the Chinese Han population. [Copyright &y& Elsevier]

Although obesity is a key predisposing risk factor in the development of insulin resistance (IR) and type 2 diabetes mellitus, not all obese individuals develop IR. This study aimed to identify key anthropometric and biochemical parameters that predict insulin sensitivity in overweight and obese adults. Based on previous literature, we hypothesized that markers of insulin sensitivity would be negatively correlated with plasma concentrations of free fatty acids and liver enzymes. Forty nondiabetic adult participants (body mass index ≥25.0kg/m2) were recruited. Data collection included anthropometric measurements and fasting plasma samples for the quantification of liver enzymes (alanine transaminase, aspartate transaminase, γ-glutamyl transpeptidase), blood lipid profile, and markers of insulin sensitivity. Questionnaires relating to dietary intake, physical activity, and fatigue were also completed. Insulin and Homeostasis Model of Assessment (HOMA) scores were significantly correlated with indirect measures of central obesity (P < .05). Glycosylated hemoglobin, insulin, and HOMA scores for IR were all positively correlated with selected liver function markers (P < .05). Scores of HOMA-IR were significantly positively correlated with plasma phospholipid levels of n-3 fatty acids (P = .04) and ratio of n-3/n-6 fatty acids (P < .05) and negatively correlated with n-6 fatty acids (P = .03). No significant correlations were found between markers of insulin sensitivity and cholesterol levels, physical activity, or self-reported fatigue. These results have reinforced the integral role of liver function in the development of IR. Despite previous data linking elevations in free fatty acid to the development of IR, we found no relationship between these variables in this study. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of the present study was to examine the effectiveness of a community-based exercise program to lower metabolic syndrome (MetS) risk factors. Methods: MetS components were retrospectively analyzed in 332 adults (190 women, 142 men) before and after a 14-week supervised community exercise program between January 2007 and May 2012 at the University of Wisconsin-Eau Claire. Results: Except for total cholesterol, all health outcome variables, including the 5 MetS components, improved following community exercise. Individuals having MetS decreased from 22.3% before participation to 13.5% at end (p<0.05), while prevalence of participants with no MetS components increased 56% (from 65 to 102; p<0.05). Compared to the lowest quartile of relative energy expenditure, participants with the highest quartile were 6.4 (95% CI 1.8–23.2; p<0.05), 7 (95% CI 2.5–20.0; p<0.05) and 9.3 (95% CI 2.6–34.0; p<0.05) times more likely to eliminate low-HDL cholesterol, impaired fasting glucose, and low cardiorespiratory fitness as MetS risk factors, respectively. Conclusion: A community exercise program is an effective method to reduce cardiovascular risk in adults by substantially decreasing the prevalence of MetS and its components. Greater volumes of exercise may increase the likelihood of MetS risk factor elimination. [Copyright &y& Elsevier]

Abstract: Background: Vitamin D deficiency is a common worldwide problem. Low levels of serum 25-hydroxy vitamin D [25(OH)D], as a marker of vitamin D deficiency, have been linked to a wide field of health problems, including metabolic diseases such as insulin resistance, type 1 and type 2 DM. There is no universal definition for cutoff value of vitamin D deficiency and it seems that it varies in different populations. Objective: Most previous studies have used a start rise of PTH as a criteria to detect threshold of serum 25(OH)D, However, the aim of this study was to determine a cutoff point of serum 25(OH)D for vitamin D deficiency based on HOMA-IR. Materials and methods: Two hundred and ninety seven healthy children (aged 7–11 years) were enrolled. Serum 25(OH)D and PTH were measured and HOMA-IR was calculated. The ROC curve was utilized to obtain a cutoff of vitamin D deficiency based on HOMA-IR. Results: 25(OH)D concentrations were inversely correlated with HOMA-IR levels (Spearman's r =−0.14, p =0.016). Serum 25(OH)D cutoff point was 11.6ng/mL (29nmol/L) in relation with HOMA-IR >2.1. By using this cutoff value, the prevalence of vitamin D deficiency was 43.4% in this study population of healthy children. Conclusion: We found that serum 25(OH)D levels are inversely associated with insulin resistance. These results suggest that in MetS patients it may benefit to determine cutoff value of 25(OH)D levels based on HOMA-IR. [Copyright &y& Elsevier]

Background & Aims: In the West, a substantial proportion of subjects with adenocarcinoma of the gastric cardia and gastroesophageal junction have no history of reflux. We studied the gastroesophageal junction in asymptomatic volunteers with normal and large waist circumferences (WCs) to determine if central obesity is associated with abnormalities that might predispose individuals to adenocarcinoma. Methods: We performed a study of 24 healthy, Helicobacter pylori–negative volunteers with a small WC and 27 with a large WC. Abdominal fat was quantified by magnetic resonance imaging. Jumbo biopsy specimens were taken across the squamocolumnar junction (SCJ). High-resolution pH-metry (12 sensors) and manometry (36 sensors) were performed in upright and supine subjects before and after a meal; the SCJ was visualized fluoroscopically. Results: The cardiac mucosa was significantly longer in the large WC group (2.5 vs 1.75 mm; P = .008); its length correlated with intra-abdominal (R = 0.35; P = .045) and total abdominal (R = 0.37; P = .034) fat. The SCJ was closer to the upper border of the lower esophageal sphincter (LES) in subjects with a large WC (2.77 vs 3.54 cm; P = .02). There was no evidence of excessive reflux 5 cm above the LES in either group. Gastric acidity extended more proximally within the LES in the large WC group, compared with the upper border (2.65 vs 4.1 cm; P = .027) and peak LES pressure (0.1 cm proximal vs 2.1 cm distal; P = .007). The large WC group had shortening of the LES, attributable to loss of the distal component (total LES length, 3 vs 4.5 cm; P = .043). Conclusions: Central obesity is associated with intrasphincteric extension of gastric acid and cardiac mucosal lengthening. The latter might arise through metaplasia of the most distal esophageal squamous epithelium and this process might predispose individuals to adenocarcinoma. [Copyright &y& Elsevier]

Objective: To describe auxologic, physical, and behavioral features in a large cohort of males with 47,XYY (XYY), ages newborn to young adult. Study design: This is a cross-sectional descriptive study of male subjects with XYY who were evaluated at 1 of 2 specialized academic sites. Subjects underwent a history, physical examination, laboratory testing, and cognitive/behavioral evaluation. Results: In 90 males with XYY (mean age 9.6 ± 5.3 years [range 0.5-36.5]), mean height SD was above average (1.0 ± 1.2 SD). Macrocephaly (head circumference >2 SD) was noted in 28/84 (33%), hypotonia in 57/90 (63%), clinodactyly in 47/90 (52%), and hypertelorism in 53/90 (59%). There was testicular enlargement for age (>2 SD) in 41/82 (50%), but no increase in genital anomalies. No physical phenotypic differences were seen in boys diagnosed prenatally vs postnatally. Testosterone, luteinizing hormone, and follicle stimulating hormone levels were in the normal range in most boys. There was an increased incidence of asthma, seizures, tremor, and autistic spectrum disorder (ASD) compared with the general population rates. Prenatally diagnosed boys scored significantly better on cognitive testing and were less likely to be diagnosed with ASD (P < .01). Conclusions: The XYY phenotype commonly includes tall stature, macrocephaly, macroorchidism, hypotonia, hypertelorism, and tremor. Physical phenotypic features were similar in boys diagnosed prenatally vs postnatally. Prenatal diagnosis was associated with higher cognitive function and less likelihood of an ASD diagnosis. [Copyright &y& Elsevier]