BACKGROUND AND OBJECTIVES: A relationship between renin-angiotensin system (RAS) components and metabolic syndrome (MetS) has been suggested, but not elucidated clearly. We examined the levels of RAS components in patients with and without MetS and their association with MetS in Korean population. METHODS: This study was approved by the review boards of the participating institutions and endorsed by the Korean Society of Lipid and Atherosclerosis. We screened 892 Koreans aged ≥20 years who underwent evaluation of hypertension, diabetes, or dyslipidemia at 6 tertiary hospitals in 2015–2016. After excluding patients who were taking diuretics, β-blockers, or RAS blockers, or suspected of primary aldosteronism, 829 individuals were enrolled. Anthropometric and biochemical parameters including aldosterone, plasma renin activity (PRA), and aldosterone-to-PRA ratio were evaluated. The homeostasis model assessment for insulin resistance (HOMA-IR) were used for evaluating insulin resistance. RESULTS: The mean age of the participants was 52.8±12.8 years, 56.3% were male, and their mean systolic and diastolic blood pressures were 133.9±20.0 and 81.2±14.6 mmHg, respectively. The levels of serum aldosterone, but not PRA, were significantly higher in subjects with MetS than in those without (20.6±33.6 vs. 15.3±12.2 ng/dL, p < 0.05), and positively correlated with waist circumference, blood pressure, triglycerides, and glycated hemoglobin. The levels of aldosterone were independently associated with the number of MetS components and HOMA-IR after adjusting for conventional risk factors. CONCLUSIONS: Serum aldosterone levels were higher in Korean adults with MetS than in those without. This finding suggests that increased aldosterone level might be closely associated with insulin resistance.
Adult ; Aldosterone ; Atherosclerosis ; Blood Pressure ; Diuretics ; Dyslipidemias ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Hyperaldosteronism ; Hypertension ; Insulin Resistance ; Insulin ; Male ; Metabolic Syndrome X ; Plasma ; Renin ; Renin-Angiotensin System ; Risk Factors ; Tertiary Care Centers ; Triglycerides ; Waist Circumference

PURPOSE: Elevation in serum alanine aminotransferase (ALT) levels is a biomarker for metabolic syndrome (MS); however, the relationship has not been fully investigated within the reference interval of ALT levels. Our objective was to explore the relationship between serum ALT levels within the reference interval and MS in Chinese adults. MATERIALS AND METHODS: This cross-sectional study included 16028 adults, who attended routine health check-ups at Shengli Oilfield Central Hospital from January 2006 to March 2012. The reference interval of serum ALT level was defined as less than 40 U/L. Logistic regression models and restricted cubic spline were used to evaluate the association of ALT with MS. RESULTS: The prevalence of MS in the total population was 13.7% (6.4% for females and 18.4% for males). Multiple logistic regression showed that ALT levels were positively associated with MS after adjustment for potential confounding factors. The odds ratio of MS in the top quartile was 4.830 [95% confidence interval (CI): 2.980–7.829] in females and 3.168 (95% CI: 2.649–3.790) in males, compared with the ALT levels in the bottom quartile. The restricted cubic spline models revealed a positive non-linear dose-response relationship between ALT levels and the risk of MS in women (p for nonlinearity was 0.0327), but a positive linear dose-response relationship in men (p for nonlinearity was 0.0659). CONCLUSION: Serum ALT levels within the reference interval are positively associated with MS in a dose-response manner. Elevated ALT levels, even within the reference interval, may reflect early dysmetabolic changes.
Adult ; Aged ; Alanine Transaminase/*blood ; Asian Continental Ancestry Group ; Biomarkers/blood ; Confidence Intervals ; Cross-Sectional Studies ; Dose-Response Relationship, Drug ; Female ; Humans ; Logistic Models ; Male ; Metabolic Syndrome X/*enzymology/epidemiology ; Middle Aged ; Odds Ratio ; Prevalence ; Reference Values

Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.
American Heart Association ; Asian Continental Ancestry Group ; Education* ; Health Education ; Humans ; Insurance Carriers ; Japan* ; Mass Screening* ; Metabolic Syndrome X ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity, Abdominal ; Risk Factors ; Social Responsibility ; Waist Circumference

Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.
American Heart Association ; Asian Continental Ancestry Group ; Education ; Health Education ; Humans ; Insurance Carriers ; Japan ; Mass Screening ; Metabolic Syndrome X ; National Heart, Lung, and Blood Institute (U.S.) ; Obesity, Abdominal ; Risk Factors ; Social Responsibility ; Waist Circumference

PURPOSE: Clinical trials have studied the use of soy protein for treating type 2 diabetes (T2D) and metabolic syndrome (MS). The purpose of this study was to outline evidence on the effects of soy protein supplementation on clinical indices in T2D and MS subjects by performing a meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS: We searched PubMed, EMBASE, and Cochrane databases up to March 2015 for RCTs. Pooled estimates and 95% confidence intervals (CIs) were calculated by the fixed-and-random-effects model. A total of eleven studies with eleven clinical variables met the inclusion criteria. RESULTS: The meta-analysis showed that fasting plasma glucose (FPG) [weighted mean difference (WMD), -0.207; 95% CI, -0.374 to -0.040; p=0.015], fasting serum insulin (FSI) (WMD, -0.292; 95% CI, -0.496 to -0.088; p=0.005), homeostasis model of assessment for insulin resistance index (HOMA-IR) (WMD, -0.346; 95% CI, -0.570 to -0.123; p=0.002), diastolic blood pressure (DBP) (WMD, -0.230; 95% CI, -0.441 to -0.019; p=0.033), low-density lipoprotein cholesterol (LDL-C) (WMD, -0.304; 95% CI, -0.461 to -0.148; p=0.000), total cholesterol (TC) (WMD, -0.386; 95% CI, -0.548 to -0.225; p=0.000), and C-reactive protein (CRP) (WMD, -0.510; 95% CI, -0.722 to -0.299; p=0.000) are significant reduced with soy protein supplementation, compared with a placebo control group, in T2D and MS patients. Furthermore, soy protein supplementation for longer duration (≥6 mo) significantly reduced FPG, LDL-C, and CRP, while that for a shorter duration (<6 mo) significantly reduced FSI and HOMA-IR. CONCLUSION: Soy protein supplementation could be beneficial for FPG, FSI, HOMA-IR, DBP, LDL-C, TC, and CRP control in plasma.
Aged ; Blood Glucose/*metabolism ; Blood Pressure ; C-Reactive Protein/metabolism ; Cardiovascular Diseases/prevention & control ; Cholesterol/blood ; Diabetes Mellitus, Type 2/blood/*therapy ; *Dietary Supplements ; Humans ; Lipids/blood ; Metabolic Syndrome X/*blood/prevention & control ; Randomized Controlled Trials as Topic ; Soybean Proteins/*administration & dosage ; *Soybeans

PURPOSE: To describe the relationship between the waist-to-height ratio (WHtR) and cardiometabolic risk factors (CMRFs) and to evaluate the validity of WHtR in identifying adolescents with metabolic syndrome. MATERIALS AND METHODS: We analyzed data from a pooled population of 4068 adolescents aged 10-19 years from the Korean National Health and Nutrition Examination Surveys conducted between 1998 and 2008. Overweight individuals were defined by body mass index (BMI) ≥85th percentile. Those with at least 2 CMRFs among hypertension, hyperglycemia, hypertriglyceridemia, and decreased high-density lipoprotein cholesterol (HDL-C) were classified as having multiple CMRFs. RESULTS: WHtR was significantly related to systolic blood pressure, HDL-C, and triglycerides in both non-overweight and overweight adolescents (all p<0.01). Among overweight adolescents, the area under the curve (AUC) for WHtR in identifying multiple CMRFs was significantly greater than that for BMI (p=0.014). Metabolic syndrome was more common in overweight adolescents with a WHtR of ≥0.5 than in those with a WHtR of <0.5 (p<0.001). In non-overweight adolescents, the prevalences of multiple CMRFs (p=0.001) and metabolic syndrome (p<0.001) were higher in those with a WHtR of ≥0.5 than in those with a WHtR of <0.5. Among those without central obesity, the prevalence of multiple CMRFs was higher in those with a WHtR of ≥0.5 than in those with a WHtR of <0.5 (p=0.021). CONCLUSION: WHtR is a simple and valid index for identifying adolescents with increased cardiometabolic risk and is related to CMRFs even in non-overweight adolescents. In adolescents already screened via BMI and waist circumference (WC), WHtR seems to be of additional help in discriminating those at higher cardiometabolic risk.
Adolescent ; Blood Pressure/physiology ; *Body Height ; Body Mass Index ; Cardiovascular Diseases/*epidemiology ; Child ; Cholesterol, HDL/blood ; Female ; Humans ; Hypertension/complications/epidemiology ; Male ; Metabolic Syndrome X/*epidemiology ; Nutrition Surveys ; Obesity, Abdominal/complications/*epidemiology ; Republic of Korea/epidemiology ; Risk Factors ; Triglycerides/blood ; *Waist Circumference/physiology ; *Waist-Height Ratio ; Young Adult

BACKGROUND: Physical inactivity and reduced energy expenditure lead to increase in obesity among office workers. In this study, we investigated how 10 weeks of high intensity circuit training and working environment improvement can change body composition, physical strength and markers of metabolic syndrome. METHODS: A total of 83 employees at risk for metabolic syndrome participated in 10 weeks program of one-hour circuit training (30 minutes twice weekly) and workplace improvement program, which consisted of dynamic stretching twice daily for all weekdays. Body composition, anthropometry, blood test, muscle strength/endurance and cardiopulmonary function of participants were assessed at the baseline and after 10 weeks. RESULTS: At the end of 10 weeks, significant increases in levels of body composition, serum lipids, muscle strength and cardiopulmonary were observed in metabolic syndrome risk factor group. In body composition, significant improvements of body weight, body mass index, lean body mass, %body fat, visceral adipose tissue, waist and hip circumference and systolic blood pressure, diastolic blood pressure were observed in metabolic syndrome risk factor group. In lipids, hemoglobin A1c and high density lipoprotein were increased significantly in metabolic syndrome risk factor group. In muscle strength and endurance, significant increases were found. Also, there was a significant difference in cardiovascular function of maximal oxygen uptake and total running time among the groups. CONCLUSIONS: These intensive 10 weeks of high intensity circuit training and workplace improvement program were effective in improving body composition, muscle strength/improvement and cardiopulmonary function. Therefore, based on this study result, workplace improvement programs might be more developed and applied for high-risk employees to improve their metabolic syndrome.
Adipose Tissue ; Anthropometry ; Blood Pressure ; Body Composition ; Body Mass Index ; Body Weight ; Circuit-Based Exercise* ; Energy Metabolism ; Hematologic Tests ; Hip ; Intra-Abdominal Fat ; Lipoproteins ; Metabolic Syndrome X ; Muscle Strength ; Muscle Stretching Exercises ; Obesity ; Occupational Health ; Oxygen ; Resistance Training ; Risk Factors ; Running

BACKGROUND/AIMS: This study evaluated the relationship between thyroid nodules and metabolic syndrome (MS) and its components in apparently healthy Koreans. METHODS: We reviewed the records of 3,298 subjects with no noticeable symptoms who underwent thyroid ultrasound imaging as part of a routine check-up between July 2009 and June 2010; of these, 1,308 were excluded based upon predefined criteria. Among the remaining 1,990 patients, we examined the association between MS and its components and the incidence of thyroid nodules. RESULTS: Of the 1,990 subjects included in this study, 38.4% (n = 764) had thyroid nodules and 12.7% (n = 253) had MS. Female sex, older age, higher body mass index, larger waist circumference, higher glycated hemoglobin level, lower thyroid stimulating hormone level, and presence of MS were all closely related with the presence of thyroid nodules (all p < 0.05). Furthermore, the relevant number of MS components showed a positive linear correlation with the occurrence of thyroid nodules (p < 0.001). Evidence of MS alone was not independently associated with thyroid nodules after adjusting for sex and age in a multivariate binary logistic regression analysis; however, glycated hemoglobin for females and waist circumference for males, as well as both age and thyroid stimulating hormone for all patients, were identified as independent predictors for the existence of thyroid nodules (all p < 0.05). CONCLUSIONS: This study suggests a positive relationship between the components of MS and thyroid nodules in an ostensibly healthy Korean population. Our data support the idea that the recent increase in thyroid nodules is partly due to increases in both MS and obesity.
Adult ; Biomarkers/blood ; Body Mass Index ; Chi-Square Distribution ; Cross-Sectional Studies ; Diabetes Mellitus/diagnosis/epidemiology ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Linear Models ; Logistic Models ; Male ; Metabolic Syndrome X/blood/diagnosis/*epidemiology ; Middle Aged ; Multivariate Analysis ; Obesity/diagnosis/epidemiology ; Odds Ratio ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Thyroid Nodule/blood/diagnostic imaging/*epidemiology ; Thyrotropin/blood ; Waist Circumference

BACKGROUND: A biomarker that is of great interest in relation to adverse cardiovascular events is soluble ST2 (sST2), a member of the interleukin family. Considering that metabolic syndrome (MetS) is accompanied by a proinflammatory state, we aimed to assess the relationship between sST2 and left ventricular (LV) structure and function in patients with MetS. METHODS: A multicentric, cross-sectional study was conducted on180 MetS subjects with normal LV ejection fraction as determined by echocardiography. LV hypertrophy (LVH) was defined as an LV mass index greater than the gender-specific upper limit of normal as determined by echocardiography. LV diastolic dysfunction (DD) was assessed by pulse-wave and tissue Doppler imaging. sST2 was measured by using a quantitative monoclonal ELISA assay. RESULTS: LV mass index (β=0.337, P<0.001, linear regression) was independently associated with sST2 concentrations. Increased sST2 was associated with an increased likelihood of LVH [Exp (B)=2.20, P=0.048, logistic regression] and increased systolic blood pressure [Exp (B)=1.02, P=0.05, logistic regression]. Comparing mean sST2 concentrations (adjusted for age, body mass index, gender) between different LV remodeling patterns, we found the greatest sST2 level in the group with concentric hypertrophy. There were no differences in sST2 concentration between groups with and without LV DD. CONCLUSIONS: Increased sST2 concentration in patients with MetS was associated with a greater likelihood of exhibiting LVH. Our results suggest that inflammation could be one of the principal triggering mechanisms for LV remodeling in MetS.
Adult ; Age Factors ; Aged ; Area Under Curve ; Blood Pressure ; Body Mass Index ; Cross-Sectional Studies ; Echocardiography, Doppler ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypertrophy, Left Ventricular/diagnostic imaging ; Interleukin-1 Receptor-Like 1 Protein/*analysis ; Linear Models ; Logistic Models ; Male ; Metabolic Syndrome X/metabolism/*physiopathology ; Middle Aged ; ROC Curve ; Sex Factors ; Ventricular Function, Left/*physiology ; Ventricular Remodeling/physiology

PURPOSE: This study was done to identify prevalence of, and factors influencing metabolic syndrome among long-term care facility patients with schizophrenia. METHODS: A cross-sectional survey was conducted using a 20-item questionnaire. Clinical data for blood triglyceride, HDL-cholesterol, and fasting blood sugar were collected from medical records. Body weight, body fat, body mass index, blood pressure, height, and abdominal circumference were measured. Data for 198 participants were analyzed using t-test, x2 test and logistic regression. RESULTS: Prevalence of metabolic syndrome was 56.1%. The number of persons who overate was significantly higher in the metabolic syndrome group than in the normal group (p<.001). Factors influencing metabolic syndrome were hyperphagia (p<.001), abdominal circumference (p<.001), systolic blood pressure (p=.040), blood triglyceride (p<.001), fasting blood sugar (p=.015), and HDL-cholesterol (p<.001). CONCLUSION: The results indicate that nurses working with patients who have chronic schizophrenic should make an effort to help patients achieve control of overeating behavior and reduce abdominal circumference to prevent metabolic syndrome.
Adipose Tissue ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Body Weight ; Cross-Sectional Studies ; Fasting ; Humans ; Hyperphagia ; Logistic Models ; Long-Term Care ; Medical Records ; Mental Health* ; Metabolic Syndrome X ; Obesity ; Prevalence ; Schizophrenia* ; Triglycerides