Metabolic Syndrome Severity Confers Greater Cardiovascular Risk

MedicalResearch.com Interview with:

Mark D. DeBoer, MD Associate Professor of Pediatrics Division of Pediatric Endocrinology University of Virginia Charlottesville, VA 22908

Dr. DeBoer

Mark D. DeBoer, MD
Associate Professor of Pediatrics
Division of Pediatric Endocrinology
University of Virginia
Charlottesville, VA 22908

MedicalResearch.com: 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.

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One Fatty Meal Results In Metabolic Disturbances

MedicalResearch.com 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

Prof. Michael Roden

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

MedicalResearch.com: 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.

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Living at a Geographically Higher Elevation Is Associated with Lower Risk of Metabolic Syndrome

MedicalResearch.com Interview with:
“The Mountains of Spain” by Nan Palmero is licensed under CC BY 2.0
Pedro 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 

MedicalResearch.com: 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.

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Larger Wrist Size May Suggest Unhealthy Metabolic Syndrome

MedicalResearch.com Interview with:
Ilaria Cavallari, MD
Department of Cardiovascular Sciences
University Campus Bio-Medico
Roma, Italy

MedicalResearch.com: 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).

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Prehypertension in Pregnancy Linked to Postpartum Metabolic Syndrome

MedicalResearch.com Interview with:

Jian-Min Niu Department of Obstetrics Guangdong Women and Children Hospita Guangzhou , China

Dr. Jian Min Niu

Dr. Jian-Min Niu
Department of Obstetrics
Guangdong Women and Children Hospita
Guangzhou , China

MedicalResearch.com: 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.

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Multiple Pregnancies May Raise Metabolic Syndrome Risk in Latina Women

MedicalResearch.com Interview with:

Catherine J. Vladutiu, PhD, MPH Research Assistant Professor, Department of Obstetrics & Gynecology Adjunct Assistant Professor, Department of Epidemiology Chapel Hill, NC

Dr. Catherine Vladutiu

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.

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Short Term High Fat Snacks Linked To Metabolic Syndrome

Suzan Wopereis, Ph.D. TNO, Microbiology and Systems Biology Group Zeist, The Netherlands

Dr. Wopereis

MedicalResearch.com 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.

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Some Non-Obese Adults Still Have Metabolic Syndrome

Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital A member of Alameda Health System Oakland, CA 94602MedicalResearch.com 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.

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Metabolic Syndrome In Youth Linked To Later Life Heart Disease

Mark DeBoerMedicalResearch.com 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.

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Black Overweight Women Have Increased Cardiovascular Risk Even Without Metabolic Syndrome

Michelle Schmiegelow, MD, PhD-studerende Hjertemedicinsk Forskning Gentofte Universitetshospital HellerupMedicalResearch.com 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.

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