ASCO, Author Interviews, Breast Cancer, Cancer Research, Journal Clinical Oncology, Metabolic Syndrome, Race/Ethnic Diversity, Social Issues / 08.06.2021 Interview with: Giampaolo Greco PhD MPH Assistant Professor Department of Population Health Science and Policy Icahn School of Medicine  at Mount Sinai What is the background for this study? Response: The motivation for our study was to understand why mortality rate from breast cancer is much higher in African American women than in White women, despite the fact that these groups have similar incidence rate of breast cancer. Metabolic syndrome, a cluster of metabolic abnormalities that includes abdominal obesity, hypertension, hyperglycemia and dyslipidemia, is more prevalent among African American women and may be a risk factor for breast cancer. Subjective social status (SSS) is the perception of individuals of their own ranking in the social hierarchy and complements other parameters of socioeconomic status, such as income and education, that are considered more objective. Socioeconomic status is associated with cardiovascular and mental health. Although objective measures of social status are associated with worse breast cancer outcomes, the relationship of SSS to breast cancer is uncertain. (more…)
Author Interviews, Heart Disease, JAMA, Lipids, Metabolic Syndrome, UCSF / 12.08.2020 Interview with: Prakash Deedwania, MD, FACC,FAHA,FASH,FHFSA,FESC Professor of Medicine, UCSF School of Medicine, San Francisco What is the background for this study? What are the main findings? Response: This paper describes the findings form the FOURIER study, a very large study evaluating the efficacy of evolocumab, a PCSK9 inhibitor in patients with metabolic syndrome and preexisting atherosclerotic cardiovascular disease (ASCVD) who were already being treated with statins. In this largest study of its kind of 27,000 patients we found that 60% of patients with ASCVD had metabolic syndrome. We also found that the presence of metabolic syndrome identified a higher risk of future cardiac & coronary events in these patients despite them receiving maximum tolerated doses of statin. Furthermore, study treatment with evolocumab was efficacious in reducing the increased risk during the median follow up of nearly 3 years . Unlike treatment with statins there was no risk of new-onset diabetes with evolocumab, which was generally well tolerated. What was interesting thatpatients without metabolic syndrome had much less benefit with PCSK9 inhibition. These findings suggest that the presence of metabolic syndrome can help the clinicians identify the ASCVD patients who are most likely to benefit from treatment with PCSK9 inhibitors. This will be of great help for the cost containment of therapeutic strategy as PCSK9 inhibitors as a class are still quite expensive drugs. (more…)
Author Interviews, JAMA, Metabolic Syndrome, Nutrition, Sugar / 09.07.2020 Interview with: Zhila Semnani-Azad, Ph.D. Candidate  Department of Nutritional Sciences Faculty of Medicine, University of Toronto Toronto, ON, Canada What is the background for this study? Response: Dietary fructose-containing sugars have been suggested to be an important contributing factor to increased metabolic syndrome risk. Several studies have consistently shown a strong association between sugar-sweetened beverages and increased incidence of metabolic syndrome. There is little information, however, on the role of other food sources of fructose-containing sugars in the development of metabolic syndrome. (more…)
Author Interviews, JAMA, Metabolic Syndrome, Race/Ethnic Diversity, Weight Research / 26.06.2020 Interview with: Robert Wong, MD, MS Division of Gastroenterology and Hepatology Veterans Affairs Palo Alto Healthcare System Stanford University School of Medicine What is the background for this study? Response: Prior to this study, we already knew that obesity and metabolic syndrome were major public health issues in the U.S.  A previous analyses by our team which analyzed data through 2012 observed than one in three adults in the U.S. have metabolic syndrome.  The aim of our current study was to evaluate more recent trends in the prevalence of metabolic syndrome and to identify whether certain groups are at higher risk of having metabolic syndrome.  (more…)
Author Interviews, Diabetes, JAMA, Metabolic Syndrome, Stroke / 10.02.2019 Interview with: David Spence M.D., FRCPC, FAHA Professor of Neurology and Clinical Pharmacology Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University London, ON Canada What is the background for this study? What are the main findings?  Response: The motivation for the study was the chair of the committee that advises the Ontario Drug Benefit which medications to pay for said the IRIS results were not relevant to clinical practice. This because the Insulin Resistance Intervention after Stroke (IRIS) trial reported effects of pioglitazone in patients with stroke or TIA and insulin resistance assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score for insulin resistance.1 ( However, few clinicians measure a HOMA-iR score, so the clinical impact of that trial was limited. In this study we analyzed the effect of pioglitazone in stroke/TIA patients with prediabetes, which is commonly assessed by clinicians. Prediabetes was defined by the American Diabetes Association: a glycosylated hemoglobin (A1C) of  5.7% to <6.5% (we did not do glucose tolerance tests).  We analyzed primarily the results for patients with 80% adherence, but also did  an intention-to-treat (ITT) analysis.  The reason for focusing on patients with good adherence was that pioglitazone cannot be taken by about 10-20% of patients, because of fluid retention and weight gain (mainly due  to fluid retention).  (The reasoning was that third party payers would not need to pay for the medication in patients who do not take it.) In stroke/TIA patients with good adherence, the benefits of pioglitazone were greater than in the original IRIS trial. We found a 40% reduction of stroke/MI, a 33% reduction of stroke, and an 80% reduction of new-onset diabetes, over 5 years.  Pioglitazone also improved blood pressure, triglycerides and HDL-cholesterol. As expected, pioglitazone was somewhat less beneficial in the ITT analysis. Fluid retention can usually be managed by reducing the dose of pioglitazone; even small doses still have a beneficial effect . Also, amiloride has been shown to reduce fluid retention with pioglitazone.
  1. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, Guarino PD, Lovejoy AM, Peduzzi PN, Conwit R, Brass LM, Schwartz GG, Adams HP, Jr., Berger L, Carolei A, Clark W, Coull B, Ford GA, Kleindorfer D, O'Leary JR, Parsons MW, Ringleb P, Sen S, Spence JD, Tanne D, Wang D, Winder TR and Investigators IT. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016;374:1321-31. 
Author Interviews, Diabetes, Metabolic Syndrome, Sleep Disorders / 28.01.2019 Interview with: Chiyori Haga, R.N. P.H.N Ph.D Department of Community Nursing Graduate School of Health Science Okayama University in Japan What is the background for this study? What are the main findings? Response: In Japan, we have a health checkup system for middle and elderly people to prevent their non-communicable diseases (NCDs) including the Metabolic Syndrome (MetS) and give them some health guidance based a guideline. The guideline has suggested that short duration between bed time and dinner time will be a risk factor of metabolic syndrome or diabetes mellitus for some duration. However, there may be no association between them, it is the main findings.  (more…)
Alzheimer's - Dementia, Author Interviews, Heart Disease, JAMA, Metabolic Syndrome / 26.07.2018 Interview with: Maude Wagner, PhD Student Biostatistics Team Lifelong Exposures, Health and Aging Team Bordeaux Population Health Research Center Inserm Univ. Bordeaux What is the background for this study? What are the main findings?  Response: Many studies haves shown associations between cardiometabolic health and dementia in midlife, but associations later in life remain inconclusive. This study aimed to model concurrently and to compare the trajectories of major cardiometabolic risk factors in the 14 years before diagnosis among cases of dementia and controls. This study showed that demented persons presented a BMI decline and lower blood pressure (specifically systolic blood pressure) several years before dementia diagnosis that might be a consequence of underlying disease. In contrast, cases presented consistently higher blood glucose levels up to 14 years before dementia suggesting that high glycemia is a strong risk factor for dementia. (more…)
Author Interviews, Diabetes, Heart Disease, Lancet, Metabolic Syndrome, Weight Research / 01.06.2018 Interview with: Nathalie Eckel, MSc German Diabetes Center Düsseldorf, Germany What is the background for this study?  Response: Obesity is associated with metabolic disorders such as diabetes, high blood pressure and hypercholesterolemia, and with a higher risk of cardiovacular disease compared to normal weight. However, there is also the phenomenon of the so-called "metabolically healthy obesity" and "metabolically unhealthy normal-weight". So far it has been unclear how metabolic risk factors change over time in metabolically healthy people depending on body weight and what cardiovascular disease risk results from this. (more…)
Author Interviews, Gender Differences, Heart Disease, JACC, Metabolic Syndrome / 01.03.2017 Interview with: Mark D. DeBoer, MD Associate Professor of Pediatrics Division of Pediatric Endocrinology University of Virginia Charlottesville, VA 22908 What is the background for this study? What are the main findings? Response: Worldwide there remains a need for accurate prediction of cardiovascular disease. One such predictor is the metabolic syndrome, a cluster of individual risk factors including central obesity, high blood pressure, high triglycerides, low HDL cholesterol, and high fasting glucose. Metabolic Syndrome is usually diagnosed using set criteria, where a person is diagnosed if he or she has abnormalities in at least 3 of the individual components. Using these criteria, someone with MetS (compared to without MetS) has a >50% greater chance of developing cardiovascular disease over the ensuing 10 years. The problem is that prior studies showed that having MetS did not increase risk above that seen for having the abnormalities in the individual risk factors themselves. Our study used a continuous MetS severity score that we derived previously and assessed this score as a predictor of future cardiovascular disease in two large cohorts. We found that even when analyzed with abnormalities in the individual Metabolic Syndrome components, higher levels of the MetS severity score conferred higher risk for cardiovascular disease. This suggests the potential for following this score in individuals over time to identify those at higher risk for future cardiovascular disease. (more…)
Author Interviews, Diabetes, Metabolic Syndrome, Weight Research / 21.02.2017 Interview with: Prof. Dr. Michael Roden Director, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Chair/Professor, Endocrinology and Metabolic Diseases Heinrich Heine University Düsseldorf Director, Department of Endocrinology and Diabetology University Hospital Düsseldorf Düsseldorf, Germany What is the background for this study? What are the main findings? Response: The prevalence of obesity, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) continue to increase at an alarming rate. Their occurrence has been associated with intake of saturated fats, for example that of palm oil. This study aimed to shed light on how dietary fat initiates metabolic changes which lead to the aforementioned diseases. To this end we provided 14 young healthy volunteers an oral dose of palm oil or placebo randomly, in a crossover manner, with an 8-week washout period between each intervention. One acute dose of palm oil leads to insulin resistance in the main insulin sensitive tissues of the body: the liver, skeletal muscle and adipose tissue. In the liver, it also results in increased accumulation of triglycerides, increased production of glucose from lipid and amino acid precursors (rather than from glycogen), and increased energy metabolism, as denoted by increased hepatic adenosine triphosphate (ATP) content. Moreover, a similar experiment in mice revealed that one dose of palm oil differentially regulates genes and pathways which are known or suspected regulators of NAFLD, such as lipopolysaccharide (LPS), members of the peroxisome proliferator-activated receptor (PPAR) family and nuclear factor kappa-light-chain-enhancer of activated B-cells. (more…)
Author Interviews, Metabolic Syndrome / 15.02.2017 Interview with: “The Mountains of Spain” by Nan Palmero is licensed under CC BY 2.0Pedro González Muniesa  Director of International Relations of Human Nutrition and Dietetics Universidad de Navarra Nutrition Research Center / Dpt. Nutrition, Food Science and Physiology School of Pharmacy / University of Navarra What is the background for this study? What are the main findings? Response: Several other studies have reported lower incidence rates of conditions linked to MetS such as obesity (Díaz-Gutiérrez et al.,2016; Voss et al., 2013; Woolcott et al., 2014), heart disease (Ezzati et al., 2012; Faeh et al., 2016), hypertension (Norboo et al., 2015) or type 2 diabetes (Woolcott et al., 2014) on subjects living at high altitudes. To our knowledge this is the first study that has found a protective effect on living at a higher altitude against metabolic syndrome, and it is one of the very few that has found this effect at a median altitude of less than 600 meters. (more…)
Author Interviews, Metabolic Syndrome, Psychological Science, University of Pennsylvania, Weight Research / 27.01.2017 Interview with: Rebecca L. Pearl PhD Department of Psychiatry, Center for Weight and Eating Disorders Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania What is the background for this study?  Response: Weight bias is a pervasive form of prejudice that leads to weight-based discrimination, bullying, and the overall stigmatization of obesity. Some individuals with obesity may internalize weight bias by applying negative weight stereotypes to themselves and “self-stigmatizing.” Exposure to weight bias and stigma increases risk for poor obesity-related health (in part by increasing physiological stress), but little is known about the relationship between weight bias internalization and risk for cardiovascular and metabolic diseases. (more…)
Artificial Sweeteners, Author Interviews, Brigham & Women's - Harvard, Metabolic Syndrome, Weight Research / 28.11.2016 Interview with: Richard Hodin, MD Gastrointestinal and Endocrine Surgery Professor of Surgery, Harvard Medical School Chief of Academic Affairs, Department of Surgery, Massachusetts General Hospital Boston, Mass 02114 What is the background for this study? What are the main findings? Response: Sugar substitutes like Aspartame are widely used and supposed to make people lose weight and have less diabetes, heart disease, etc. However, a number of studies indicate that theses substitutes don’t work very well. The reasons for them not working have not been clear. Our study found that the most common sugar substitute (aspartame) blocks an enzyme in our gut called Intestinal Alkaline Phosphatase (IAP). By blocking IAP, Aspartame prevents the beneficial effects of IAP which normally works to prevent obesity, diabetes, and other aspects of the metabolic syndrome. So, we now have an explanation for why Aspartame may make obesity and the metabolic syndrome worse, rather than better. (more…)
Author Interviews, Metabolic Syndrome / 12.07.2016 Interview with: Ilaria Cavallari, MD Department of Cardiovascular Sciences University Campus Bio-Medico Roma, Italy What is the background for this study? Response: Obesity is a well-known risk factor for metabolic and cardiovascular disease (CVD). However, more than the amount of adipose tissue, its function plays important roles in the development of CVD. Distribution of adiposity, evaluated by measuring body circumferences, is related to adipose dysfunction. Wrist circumference has been recently associated with insulin-resistance and diabetes. Therefore, body circumferences, wrist circumference in particular, are candidate easy and fast markers of cardiovascular risk, beyond the classical body mass index (BMI). (more…)
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Metabolic Syndrome, OBGYNE / 28.06.2016 Interview with: Dr. Jian-Min Niu Department of Obstetrics Guangdong Women and Children Hospita Guangzhou , China What is the background for this study? Response: Physiological alteration leads to the question of whether the criteria for the diagnosis of gestational hypertension are suitable because the current criteria (systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg) are derived from the non-pregnant population. The optimal blood pressure levels in pregnant women remain an open question. Recent studies have demonstrated associations between prehypertension before pregnancy and hypertensive disorders during pregnancy and gestational diabetes mellitus. To our knowledge, the association between prehypertension during pregnancy and postpartum cardiovascular risk has not been addressed. (more…)
Author Interviews, Diabetes, Metabolic Syndrome, OBGYNE, Pediatrics, University Texas, Weight Research / 21.04.2016 Interview with: Antonio Saad, MD Fellow in Maternal Fetal Medicine & Critical Care Medicine University of Texas Medical Branch at Galveston What is the background for this study? What are the main findings? Dr. Saad: Recently the WHO announced an alarming news, the prevalence of diabetes has increased four fold in the past quarter-century. The major factors attributed for this increase included excessive weight, and obesity. In the US alone, two thirds of people are either overweight or obese. There are shocking numbers that should alert physicians, patients and government officials for awareness and interventions that we can alter the path away from this drastic epidemic. In light of recent events, our group strongly believes that poor diet during pregnancy predisposes offspring in adult life to develop obesity and diabetes through fetal programming. High fructose introduction into our food chain has coincided with the obesity and diabetes epidemics. Hence, we designed an animal study where we fed pregnant mice with either regular diet or high fructose diet until delivery. Then we looked at the offspring, at 12 months of age. We looked at  their blood pressure, glucose tolerance tests, insulin resistance,  and weights. We also tested for serum marker of metabolic dysfunction and used computed tomography imaging to assess for liver fat infiltration and percent visceral adipose tissue. To our surprise, these offspring (mothers were fed high fructose diet) developed several features of metabolic syndrome.  Female offspring’s cardiovascular and metabolic function at one year of age (adulthood) had increased weight, blood pressure, visceral adiposity, liver fat infiltrates and  insulin resistance with impaired glucose tolerance).  The  male counterparts were limited to high blood pressure  and glucose intolerance. Keeping in mind that the amount of fructose given to these animals were equivalent to daily soda cans consumption in humans. (more…)
Author Interviews, JACC, Metabolic Syndrome, OBGYNE, Race/Ethnic Diversity, Women's Heart Health / 26.02.2016 Interview with: Catherine J. Vladutiu, PhD, MPH Research Assistant Professor, Department of Obstetrics & Gynecology Adjunct Assistant Professor, Department of Epidemiology Chapel Hill, NC Medical Research: What is the background for this study? Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life.  Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women.  Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts. (more…)
Author Interviews, FASEB, Metabolic Syndrome, Nutrition, Weight Research / 13.11.2015 Interview with: Suzan Wopereis, Ph.D. TNO, Microbiology and Systems Biology Group Zeist, The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Wopereis: For the first time we could demonstrate the very subtle start of negative health effects caused by a high calorie snack diet in healthy men. We already knew about the negative consequences of such diets from so called epidemiologic studies. In such studies, scientists compare large populations (thousands of people) to better understand disease development. For example, by comparing  obese populations to a lean population, scientists could define various steps in the disease development related to obesity, like high cholesterol, onset of inflammation, high blood pressure, high glucose, etc. Yet, the early deviations from health  were difficult to study because human metabolism (the way we digest and metabolize our meals from a biochemical viewpoint)  is very flexible and able to efficiently deal with all kinds of daily stressors, such as a meal or intensive exercise. So, at TNO we decided to exploit  this flexibility by giving our healthy volunteers a ‘challenge test’, in the form of a high-fat milkshake. Next, we studied how multiple aspects of their metabolism react to such a challenge test. We showed that a snack diet for 4 weeks reduced many aspects of  flexibility of our healthy men, thus indicating very early changes in health. Both the high-fat challenge test and the integral study of many different outcomes form a novel approach of what “healthy” really means. In the study we used two groups of male volunteers. One group of 10 healthy male volunteers and one group of 9 male volunteers with Metabolic Syndrome, who had a combination of 2 or more risk factors that raises your risk for heart disease and other health problems (unhealthy cholesterol levels, high blood pressure, high blood sugar, high blood lipids, and abdominal fat). In other words, subjects with Metabolic Syndrome have a suboptimal health condition. Both groups received a high-fat milk-shake, and before and up to 8 hours after consumption of this metabolic challenge-test, blood samples were taken. In these blood samples, 61 different biomarkers were measured, such as cholesterol and blood sugar. These 61 biomarkers were used for a thorough health assessment of these 2 groups in response to the challenge test. We noted that biochemical processes related to sugar metabolism, fat metabolism and inflammation function abnormal in subjects with Metabolic Syndrome. The next step was to provide the 10 healthy male volunteers with a snack diet for 4 weeks. On top of their normal diet they had to consume an additional 1300 kcal per day, in the form of sweets and savory products such as candy bars, tarts, peanuts, and crisps. After these 4 weeks the response of the same 61 biomarkers to the challenge test was evaluated. Here, we observed that signaling molecules such as hormones regulating the control of sugar and fat metabolism and inflammation were changed, resembling the very subtle start of negative health effects. Without the use of the challenge test, we would not have been able to observe that even this short period of overfeeding induces changes in the metabolism of healthy people that resemble what happens in people with metabolic syndrome. (more…)
Author Interviews, Metabolic Syndrome, Weight Research / 22.10.2015

Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital A member of Alameda Health System Oakland, CA Interview with: Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital A member of Alameda Health System Oakland, CA 94602 Medical Research: What is the background for this study? What are the main findings? Dr. Wong: The rising prevalence of obesity and diabetes has led to concurrent rise in metabolic syndrome in the U.S.  Identifying metabolic syndrome is important to implement targeted treatment as metabolic syndrome contributes to cardiovascular disease, nonalcoholic fatty liver disease, and overall mortality.  However, while obesity is a major risk factor for metabolic syndrome, out study highlights the importance of considering metabolic syndrome even in individuals who do not meet criteria for obesity.  We demonstrated that nearly 20% of adults who do not meet current definitions of obesity still have metabolic syndrome in the U.S. (more…)
Author Interviews, Heart Disease, JACC, Metabolic Syndrome, Pediatrics / 07.10.2015

Mark Interview with: Mark DeBoer, MD Children's Hospital's Department of Pediatrics University of Virginia  Medical Research: What is the background for this study? What are the main findings? Dr. DeBoer: We have been interested in how the severity of the metabolic syndrome relates to long term risks, both for children and adults.  We formulated a score that takes the different components of the metabolic syndrome (body mass index, blood pressure, fasting blood sugar, triglycerides and high density cholesterol) for an individual and forms a score estimating how severe the metabolic syndrome is in that individual.  When we looked at long-term data from individuals followed for 40 years, we found that children and adults with higher scores were more much likely to develop cardiovascular disease. (more…)
AHA Journals, Author Interviews, Heart Disease, Metabolic Syndrome, Race/Ethnic Diversity, Weight Research / 21.05.2015

Michelle Schmiegelow, MD, PhD-studerende Hjertemedicinsk Forskning Gentofte Universitetshospital Interview with: Michelle Schmiegelow, MD, PhD-student Hjertemedicinsk Forskning Gentofte Universitetshospital Hellerup Medical Research: What is the background for this study? Dr. SchmiegelowObesity has become a worldwide epidemic, but the excess cardiovascular risk observed in obese individuals may primarily be attributable to metabolic mediators, rather than obesity per se. Several studies conducted in primarily non-Hispanic white populations suggest that obese individuals without the metabolic syndrome, defined as metabolically healthy obese, have a cardiovascular risk similar to that of normal weight metabolically healthy individuals. We used prospectively collected data from the Women’s Health Initiative studies to evaluate whether obesity unaccompanied by metabolic abnormalities was associated with increased risk of cardiovascular disease (CVD) across racial/ethnic subgroups in postmenopausal women. Additionally, we examined whether the use of the metabolic syndrome to define the metabolically healthy obese applied to the various racial/ethnic subgroups by quantifying the number and type of metabolic syndrome components. All women were classified by obesity level and metabolic health status at baseline. The women were thus categorized according to body mass index (BMI, kg/m2) into normal weight (BMI 18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) and obese (30.0 kg/m2) women. Metabolic health status was first defined by presence of the metabolic syndrome (yes/no), and second by number of metabolic syndrome components. In accordance with the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute we defined the metabolic syndrome as any two of the following (criteria for women): increased waist circumference ≥80 cm; increased level of triglycerides ≥150 mg/dL (≥1.7 mM); decreased level of HDL-C <50 mg/dL (<1.3 mM); increased blood pressure with either systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, or treatment with antihypertensive drugs; and impaired fasting serum glucose ≥100 mg/dL (6.1 mM). Medical Research: What are the main findings? Dr. Schmiegelow: The study population comprised 14,364 women without diabetes or prior cardiovascular disease. The women had a median age of 64 years (interquartile range 57–69), and 47% were white, 36% were black and 18% were Hispanic. Over a median follow-up of 13 years (interquartile range 12–14 years), 1,101 women (7.7%) had a first cardiovascular event. The main findings of this study were that metabolic abnormalities appeared to confer more cardiovascular risk among black women than among white women. Consistent with other studies, among white women without the metabolic syndrome, obesity was not associated with increased cardiovascular risk compared with normal weight women. Conversely, black overweight and black obese women had increased cardiovascular risk compared with normal weight black women without the metabolic syndrome, even in absence of the metabolic syndrome. According to number of metabolic syndrome components, black overweight or obese women with just two metabolic abnormalities had increased risk of cardiovascular disease, although they would be considered “metabolically healthy” based on the standard definition, particularly since one of these abnormalities were abdominal obesity for 79% of overweight and 98% of obese women, irrespective of race/ethnicity. White obese women with three metabolic abnormalities did not have a statistically significantly increased cardiovascular risk compared with normal weight metabolically healthy women. Thus, cardiovascular disease risk appeared to be elevated in black women by the presence of only two or three metabolic abnormalities to a degree that would require four or more metabolic abnormalities among white women. These findings did not appear to be driven by any particular combination of metabolic abnormalities. (more…)
Aging, Author Interviews, JAMA, Metabolic Syndrome / 20.05.2015

Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Research Highland Hospital   I A member of Alameda Health System Oakland, CA Interview with: Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Research Highland Hospital   I A member of Alameda Health System Oakland, CA 94602 Medical Research: What is the background for this study? What are the main findings? Dr. Wong: The main findings are that despite the stabilizing prevalence of metabolic syndrome, a large proportion of U.S. adults affected with metabolic still raises concern, especially given the significant health consequences associated with this syndrome.  In additional to cardiovascular disease, metabolic syndrome also increases the risk of concurrent nonalcoholic fatty liver disease, often considered the hepatic manifestation of metabolic syndrome.  Many studies, including work that our group has completed suggests that nonalcoholic fatty liver disease will soon become the leading etiology of chronic liver disease in the U.S.  Furthermore, our finding that metabolic syndrome increases with increasing age, reflects the increased risk for metabolic syndrome associated diseases such as hypertension, diabetes, and dyslipidemia with older age.  This is important to recognize given the aging population of the U.S. (more…)
Author Interviews, Endocrinology, JCEM, Metabolic Syndrome, Sleep Disorders / 03.04.2015

CDC- Interview with: Nan Hee Kim M.D., Ph.D., Professor Korea University Ansan Hospital, Gojan1-dong, Danwon-gu, Gyunggi-do, Korea MedicalResearch: What is the background for this study? Dr. Nan Hee Kim: Many individuals in modern society experience a discrepancy between social and biological time. Especially during the work or school week, we are often forced to be awake against our preferred time. In addition, the increase of light, TV, computer and internet make people stay up late at night. However, night owls (evening persons) have been reported to have more health and behavioral problems than morning persons. Evening persons experience eating disorders, negative mood and insufficient sleep compared to morning persons. They initiate sleep later in the night but need to wake up earlier than their biologic morning due to social demands. There is abundant evidence that short sleep duration and insomnia are significant risk factors for obesity and diabetes. Therefore, we feel the necessity to reveal whether evening persons are associated with metabolic abnormalities in the general population. MedicalResearch: What are the main findings? Dr. Nan Hee Kim: In middle-aged adults, people who stayed up late had a 1.7-fold increased risk for type 2 diabetes and metabolic syndrome, and a 3.2-fold increase in risk for sarcopenia as compared with morning persons, independent of sleep duration and lifestyle. Evening persons were associated with reduced muscle mass in men and increased fat mass including visceral fat in women. (more…)
Author Interviews, Endocrinology, Metabolic Syndrome, Nutrition, Pediatrics, UT Southwestern / 06.03.2015

Dr. Roy Kim, MD Depts. Endocrinology and Pediatrics UT Southwestern Medical Interview with: Dr. Roy Kim, MD Depts. Endocrinology and Pediatrics UT Southwestern Medical Center Medical Research: What was the problem you were focused on? Dr. Kim: We were focused on the problem of adolescent metabolic syndrome, a major public health problem. Our objective was to determine whether nut intake is linked with any difference in odds for metabolic syndrome in US adolescents. Medical Research: How is metabolic syndrome defined? Dr. Kim: In general it is diagnosed when there are 3 or more of the following things: increased belly fat, high blood pressure, high fasting glucose, elevated triglycerides, and low HDL cholesterol. Medical Research: How did you do your study? Dr. Kim: We used data from the National Health and Nutrition Examination Survey (NHANES), years 2003-2010, to examine health status and the diet history for 2,322 US adolescents age 12 to 19 years. Dr. Kim: Our first major finding was that adolescents who ate at least 12.9 grams of nuts per day - this is the equivalent of about 1 ounce of nuts 3 times per week – had a dramatically lower odds for metabolic syndrome compared to adolescents who ate less than that amount. The odds for nut-consumers was only about 43% of the odds for non-consumers. This remained true after controlling for age, gender, race, income, and dietary factors including sugar, fruit, and vegetable intake. Our second major finding was that average nut intake is very low among US adolescents – only about 5 grams per day - and more than 75% of US adolescents eat no nuts at all on a typical day. (more…)
Author Interviews, Cognitive Issues, Metabolic Syndrome / 22.12.2014

Prof. Giovambattista Desideri Università degli Studi dell'Aquila Direttore  UOC Geriatria e Lungodegenza Geriatrica Scuola di Specializzazione in Geriatria Scuola di Specializzazione in Medicina d' Interview with: Prof. Giovambattista Desideri Università degli Studi dell'Aquila Direttore  UOC Geriatria e Lungodegenza Geriatrica Scuola di Specializzazione in Geriatria Scuola di Specializzazione in Medicina d'Emergenza-Urgenza Medical Research: What is the background for this study? What are the main findings? Dr. Desideri: Over the past decade, there has been an accumulating body of evidence that indicates that the consumption of cocoa flavanol-containing products can improve vascular function. Though much research has focused on the cardiovascular system, there is reason to believe that some of the benefits of cocoa flavanol consumption could extend also to the brain which is a heavily vascularized tissue that depends on regular blood flow to meet its metabolic demands. Thus, the current study tested the hypothesis that the regular inclusion of cocoa flavanols for 8 weeks could positively affect cognitive function in cognitively-intact older adults. The effects of cocoa flavanol ingestion on various cardiometabolic endpoints, including blood pressure and insulin sensitivity, were also evaluated given consistent evidence of positive effects of flavanols on these outcomes and the potentially influential role of these outcomes on cognitive function. Medical Research: What are the main findings? Dr. Desideri:The study enrolled 90 men and women aged 61-85 years with no evidence of cognitive dysfunction who were assigned to one of three flavanol groups, consuming a drink containing high (993 mg), intermediate ( 520 mg) or low (48 mg) amounts of cocoa flavanols every day for 8 weeks. Among those individuals who regularly consumed either the high-or intermediate-flavanol drinks, there were significant improvements in some measures of age-related cognitive dysfunction.  In the high- and intermediate-flavanol groups, both systolic and diastolic blood pressures were reduced and insulin resistance was significantly improved.   It is not yet fully understood how cocoa flavanols bring about improvements in cognitive function, but the study results suggest that the improvements in insulin resistance and blood pressure could be revealing. (more…)
Author Interviews, Gastrointestinal Disease, Inflammation, Metabolic Syndrome / 26.11.2014

Dr. Andrew Gewirtz PhD Professor & Associate Chair  Department of Biology Georgia State Interview with: Dr. Andrew Gewirtz PhD Professor & Associate Chair Department of Biology Georgia State University Medical Research: What is the background for this study? Dr. Gewirtz: 2010 science paper that discovered that loss of toll-like receptor 5 altered gut microbiota to drive metabolic syndrome Medical Research: What are the main findings? Dr. Gewirtz: It is loss of tlr5 on epithelial cells that alters the microbiota to make it more pro-inflammatory that drives metabolic syndrome. (more…)
Author Interviews, Mediterranean Diet, Metabolic Syndrome, Nutrition / 12.11.2014 Interview with: Dr. Markos Klonizakis Centre for Sports and Exercise Science Sheffield Hallam University, UK Medical Research: What is the background for this study? What are the main findings? Dr. Klonizakis: It is widely accepted that populations in the Eastern Mediterranean sea have historical lower rates of cardiovascular disease, diabetes and cancer. This has been attributed to a great extent, at following a diet based on dishes and ingredients, which are common in this region and are collectively known as “Mediterranean diet”.  Taking into consideration that cardiovascular disease is on the rise, particularly in the Western world, it did make sense to see if such a diet can be adapted for a population that has a largely different culinary tradition and what the results would be if this is combined with exercise of moderate-intensity. We therefore, designed and implemented an 8-week intervention, aiming at older, healthy but previously untrained people, comparing an exercise-only group vs one where exercise was combined with Mediterranean diet. Our work has shown that benefits of this intervention are still evident in the vascular function (measured by the function of the inner vein lining, called the endothelium) and the cardiopulmonary fitness, one year after the end of the intervention. (more…)
AHA Journals, Author Interviews, Diabetes, Heart Disease, Metabolic Syndrome, Weight Research / 12.11.2014

Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director, Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health, LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana Medical Research: What is the background for this study? What are the main findings? Dr. Hu: Many previous studies had small samples, and thus lacked adequate statistical power when the analysis was focused on those who are extremely obese (BMI ≥40 kg/m2). In addition, most epidemiological studies only use a single measurement of BMI at baseline to predict risk of all-cause mortality, which may produce potential bias. The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2. (more…)
Author Interviews, JAMA, Metabolic Syndrome, Weight Research / 07.11.2014 Interview with: Venkatesh L. Murthy, MD, PhD Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology (Nuclear Medicine and Cardiothoracic Imaging Divisions), University of Michigan, Ann Arbor, Michigan and Dr. Ravi Shah MD Cardiology Division, Department of Medicine Massachusetts General Hospital, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: Prior studies in Framingham, MESA and other cohorts have demonstrated that obesity is an important risk factor for the metabolic syndrome. However, the observations that many non-obese individuals develop metabolic syndrome and diabetes and, conversely, that not all obese individuals develop these complications has motivated the search for better markers of risk than BMI. More recently, it has been shown that the location of adipose tissue is an important factor. The amount of visceral fat, which is thought to be more harmful from a metabolic perspective, can be accurately quantified with CT imaging. In many prior studies, waist circumference has been used as an approximate measure of visceral adiposity. For this study, we analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA). We found that the amount of visceral fat (as quantified by CT) was an important predictor of metabolic syndrome, even after adjusting for weight, waist circumference, gender, race, smoking, exercise, serum lipids and glucose. Each additional 100 cm2/m of height of visceral fat was associated with a 29% increase in the risk of developing metabolic syndrome. In contrast, subcutaneous fat burden (also quantified by CT) was a much weaker predictor. One of the very novel findings of our study arises from an analysis of subjects who had multiple CTs longitudinally in MESA. Using these data, we found that change in visceral fat burden was associated with a corresponding 5% increase in the risk of metabolic syndrome. In part, this is because very small changes in weight could result in very large changes in visceral fat. (more…)
Author Interviews, BMJ, Circadian Rhythm, Cognitive Issues, Metabolic Syndrome, Occupational Health / 04.11.2014

Dr. Philip Tucker Department of Psychology | Yr Adran Seicoleg College of Human and Health Sciences | Coleg y Gwyddorau Dynol ac lechyd Swansea University | Prifysgol Abertawe Singleton Park | Parc Singleton Swansea | Abertawe  Medical Research: What is the background for this Interview with: Dr. Philip Tucker Department of Psychology | Yr Adran Seicoleg College of Human and Health Sciences | Coleg y Gwyddorau Dynol ac lechyd Swansea University | Prifysgol Abertawe Singleton Park | Parc Singleton Swansea | Abertawe Medical Research: What is the background for this study? What are the main findings? Dr. Tucker: Shift work, like jet-lag, is known to disrupt workers’ normal circadian rhythms (i.e. their body clocks) and their social life. It is also associated with greater risk of developing ulcers, cardiovascular disease, metabolic syndrome, breast cancer and reproductive problems. Several studies have also shown that shift workers experience heightened fatigue and sleepiness, particularly at night, and this may affect job performance and safety. However, very little is known about the long-term consequences of shift work on cognitive abilities. We followed a large sample of shift workers and non-shift workers over 10 years, testing their cognitive performance every 5 years. We found that the shift workers’ cognitive performance was lower than that of the day workers.  The difference was greatest for those who had worked shifts for more than 10 years. The shift workers’ cognitive function recovered after they quit shift work, but this recovery took at least 5 years from time that they stopped working shifts. The effects could not be attributed to poorer sleep quality among shift workers. Rather, it seems likely that the findings reflect the disruption of the shift workers’ circadian rhythms, which as been shown by other researchers to have an impact on brain structures involved in cognition and mental health over the lifespan. (more…)