Resting Metabolic Rate in Severely Obese Diabetic and Nondiabetic Subjects

Objectives : To compare the resting metabolic rate (RMR) between diabetic and nondiabetic obese subjects and to develop a predictive equation of RMR for these subjects. Research Methods and Procedures : Obese adults (1088; mean age = 44.9 ± 12.7 years) with BMI ≥ 35 kg/m² (mean BMI = 46.4 ± 8.4 kg/m²) were recruited. One hundred forty‐two subjects (61 men, 81 women) were diagnosed with type 2 diabetes (DM), giving the prevalence of DM in this clinic population as 13.7%. RMR was measured by indirect calorimetry, and several multivariate linear regression models were performed using age, gender, weight, height, BMI, fat mass, fat mass percentage, and fat‐free mass as independent variables. Results : The severely obese patients with DM had consistently higher RMR after adjustment for all other variables. The best predictive equation for the severely obese was RMR = 71.767 ? 2.337 × age + 257.293 × gender (women = 0 and men = 1) + 9.996 × weight (in kilograms) + 4.132 × height (in centimeters) + 145.959 × DM (nondiabetic = 0 and diabetic = 1). The age, weight, and height‐adjusted least square means of RMR between diabetic and nondiabetic groups were significantly different in both genders. Discussion : Severely obese patients with type 2 diabetes had higher RMR than those without diabetes. The RMR of severely obese subjects was best predicted by an equation using age, gender, weight, height, and DM as variables.     

Plasma Adiponectin Levels in Overweight and Obese Asians

Objective: Hypoadiponectin has been documented in subjects with obesity, diabetes mellitus, or coronary heart disease, suggesting a potential use of plasma adiponectin in following the clinical progress in subjects with metabolic syndrome (MS). In this study, we investigated the plasma adiponectin levels in relation to the variables of MS among overweight/obese Asian subjects. Research Methods and Procedures: The plasma adiponectin, anthropometric and biochemical measurements, oral glucose tolerance tests (OGTT), and modified insulin suppression tests were performed on 180 overweight/obese Asian subjects [body mass index (BMI) ≥ 23 kg/m²], including 47 subjects with morbid obesity (BMI ≥ 40 kg/m²). Results: The plasma adiponectin levels negatively correlated with BMI, waist-to-hip ratio, fasting plasma glucose, insulin, triglyceride, uric acid levels, hyperinsulinemia, and glucose intolerance in OGTT, but positively with high-density lipoprotein-cholesterol. In contrast, they were not related to blood pressure and total cholesterol. Moreover, insulin sensitivity, measured by quantitative insulin sensitivity check index (QUICKI) or in insulin suppression tests, significantly correlated with the plasma adiponectin levels. Among morbidly obese subjects, only the waist-to-hip ratio correlated with the plasma adiponectin levels. Using multivariate linear regression models, the area under curve of plasma glucose in OGTT and high-density lipoprotein-cholesterol among the overweight/obese subjects and WHR among the morbidly obese subjects were significantly related to the plasma adiponectin levels after adjustment for other variables. Discussion: In overweight/obese Asians, the plasma adiponectin levels significantly correlated with various indices of MS except hypertension. Whether the plasma adiponectin level could be a suitable biomarker for following the clinical progress of MS warrants further investigation.     

Alcohol Consumption in the Severely Obese: Relationship with the Metabolic Syndrome

Objective: The aim of this study was to examine the association between the clinical and biochemical features of the metabolic syndrome and quantity and type of alcohol intake in the severely obese. Research Methods and Procedures: A cross‐sectional study was performed in 486 consecutive severely obese subjects. Data on alcohol consumption was collected by serial clinical interviews and a questionnaire. The relationship between alcohol intake and the clinical and serum chemistry features of the metabolic syndrome was analyzed by multiple statistical techniques. Laboratory measures included lipid profile, fasting blood glucose, hemoglobin A1c, and fasting serum insulin. An indirect index of insulin resistance was calculated using the log‐transformed fasting insulin and glucose product. Results: There were 486 subjects, 84% women, with a mean age of 40.6 ± 10 years (range, 16 to 71 years) and a body mass index of 45.3 ± 7 kg/m² (range, 34 to 77 kg/m²). Alcohol consumers (N = 276) showed a marked reduction in the adjusted odds ratio of type 2 diabetes (odds ratio = 0.29; 95% confidence interval, 0.16 to 0.55) compared with rare or nonconsumers (N = 210). There was a U‐shaped relationship between the amount and frequency of alcohol consumption and fasting triglyceride, fasting glucose, hemoglobin A1c, and index of insulin resistance measurements. Consumers of <100 g/wk had more favorable measures. The effect was attenuated when diabetics were excluded from the analysis. Timing of alcohol consumption did not influence outcome measures. Discussion: Light‐to‐moderate alcohol consumption is associated with a lower prevalence of type 2 diabetes, reduced insulin resistance, and more favorable vascular risk profile in the severely obese. We would propose that light to moderate alcohol consumption should not be discouraged in the severely obese.     

肥胖儿童血清25-羟维生素D水平的研究

目的：探讨肥胖儿童血清25-（OH）D的水平,为临床评估维生素D营养状况与儿童肥胖症关系的研究提供参考。方法：将2009年5月至10月收治的儿童依据体重指数分成3组,抽取空腹静脉血检测血清中25-（OH）D水平,并进行组间比较。结果：通过分析25-（OH）D水平,肥胖组婴儿指标显著低于正常儿和瘦婴儿,统计学分析差异有显著性意义。结论：肥胖婴儿较正常儿和瘦婴儿25-（OH）D水平低,更易患佝偻病。提示防治佝偻病,对肥胖婴儿尤应重视,更要补充维生素D。     

Increased Cortisol Bioavailability,Abdominal Obesity,and the Metabolic Syndrome in Obese Women

Objective: This study was conducted to obtain a detailed profile of hypothalamo‐pituitary‐adrenal (HPA) axis activity and reactivity and its differential relationships with body fat distribution and total fat mass in premenopausal obese women. Research Methods and Procedures: Cortisol responses to stimulation (awakening, food intake, exercise) and suppression (0.25 mg dexamethasone), cortisol metabolism, and tissue sensitivity to glucocorticoids were studied in 53 premenopausal obese women grouped according to their waist‐to hip ratio: women with abdominal body fat distribution (A‐BFD; n = 31) and women with peripheral fat distribution (P‐BFD; n = 22). Results: Comparatively, A‐BFD women had 1) lower awakening salivary cortisol levels; 2) increased salivary responsiveness to a standardized lunch; 3) similar pituitary sensitivity to dexamethasone but decreased sensitivity of monocytes to dexamethasone; 4) similar 24‐hour urinary free cortisol but increased 24‐hour urinary ratio of cortisone‐to‐cortisol; and 5) no difference in corticosteroid binding protein parameters. Discussion: Although abdominal obesity is not very different from generalized obesity in terms of HPA function, subtle variations in HPA axis activity and reactivity are evidenced in A‐BFD premenopausal obese women.     

Metabolic Syndrome in Primary Gout

Background and Objectives. Primary gout has traditionally been associated with obesity, arterial hypertension, and abnormal lipid and glucose homeostasis, but we do not know the prevalence of these vascular risk factors in patients with primary gout from a Mediterranean country. Patients and Method. All patients with primary gout and 2 or more acute arthritis episodes documented by a physician were selected for the study. The diagnosis of MS required ≥3 criteria (ATP III). Patients were classified in two groups: decreased (underexcretors) and normal (normoexcretors) uric acid excretion related to serum urate levels. Results. One hundred and four patients (mean age, 59 years; 100 males) with primary gout were included in the study. MS was diagnosed in 38 subjects (37%). The most frequent triad defining MS was an increased waist circumference, blood pressure, and trygliceride levels. The prevalence of type 2 diabetes mellitus (T2D) was significantly higher in patients with the MS (21/38, 55%) as compared with subjects without the MS (3/66, 5%; p < 0.001). Mean serum urate level in patients with and without MS was identical (8.1 mg/dL), but mean 24-hour uric acid excretion was significantly lower in the former than in the latter (444 ± 110 mg/24-hour/1,73 m² versus 546 ± 221 mg/day/1,73 m²; p = 0.009). Conclusions. The condition of the MS occurs in about one-third of the patients with primary gout. Increased waist circumference, blood pressure, and triglycerides levels is the most frequent MS triad. Diminished urinary uric acid excretion is more severe in gout patients with the MS.     

Percentage Fat in Overweight and Obese Children: Comparison of DXA and Air Displacement Plethysmography**

Objective: To compare percentage body fat (percentage fat) estimates from DXA and air displacement plethysmography (ADP) in overweight and obese children. Research Methods and Procedures: Sixty‐nine children (49 boys and 20 girls) 14.0 ± 1.65 years of age, with a BMI of 31.3 ± 5.6 kg/m² and a percentage fat (DXA) of 42.5 ± 8.4%, participated in the study. ADP body fat content was estimated from body density (D_b) using equations devised by Siri (ADP_Siri) and Lohman (ADP_Loh). Results: ADP estimates of percentage fat were highly correlated with those of DXA in both male and female subjects (r = 0.90 to 0.93, all p < 0.001; standard error of estimate = 2.50% to 3.39%). Compared with DXA estimates, ADP_Siri and ADP_Loh produced significantly (p < 0.01) lower estimates of mean body fat content in boys (?2.85% and ?4.64%, respectively) and girls (?2.95% and ?5.15%, respectively). Agreement between ADP and DXA methods was further examined using the total error and methods of Bland and Altman. Total error ranged from 4.46% to 6.38% in both male and female subjects. The 95% limits of agreement were relatively similar for all percentage fat estimates, ranging from ±6.73% to ±7.94%. Discussion: In this study, conversion of D_b using the Siri equation led to mean percentage fat estimates that agreed better with those determined by DXA compared with the Lohman equations. However, relatively high limits of agreement using either equation resulted in percentage fat estimates that were not interchangeable with percentage fat determined by DXA.     

Relationship between Plasma Adiponectin Levels and Metabolic Risk Profiles in Taiwanese Children

Objective: Adiponectin, a novel adipokine with antiinflammatory and insulin‐sensitizing properties, has an important role in glucose metabolism and is negatively correlated with body fat amount in adults. The purpose of this study was to evaluate the association of plasma adiponectin level with metabolic risk profiles and insulin resistance status among Taiwanese children. Research Methods and Procedures: We enrolled 1248 children (608 boys and 640 girls) to ascertain their demographic, anthropometric, and cardiovascular risk factors distribution in Taipei. We measured plasma insulin, adiponectin, and leptin levels by radioimmunoassay (Linco Research Inc, St. Charles, MO). We calculated an insulin resistance index (IRI) using the Homeostasis Model Assessment model and also calculated an insulin resistance syndrome (IRS) summary score for each individual by adding the quartile ranks from the distribution of systolic blood pressure, serum triglyceride, high‐density lipoprotein‐cholesterol (HDL‐C) (inverse), and insulin levels. Results: In general, the boys had larger BMI, higher systolic blood pressure, serum total cholesterol, and triglyceride, and lower plasma leptin and adiponectin levels than girls. Plasma adiponectin levels were correlated negatively with BMI, leptin, insulin, IRI, and IRS summary score but positively correlated with HDL‐C in both boys and girls. In multivariate regression analyses, adiponectin was negatively associated with insulin (girls only), IRI (girls only), and IRS score, and positively associated with HDL‐C in both genders even after adjusting for age, BMI, plasma leptin level, and other potential confounders. Discussion: These data suggest that plasma adiponectin levels were negatively associated with metabolic risk profiles that may have played a protective role in the development of insulin resistance among Taiwanese school children.     

血清视黄醇结合蛋白-4同儿童肥胖和代谢综合征组分的关系

目的:探讨儿童血清视黄醇结合蛋白-4(retinol-binding protein4,RBP-4),视黄醇,甲状腺素运载蛋白(transthyretin,TTR)等维生素A相关指标与肥胖、胰岛素抵抗以及代谢综合征组分之间的关系。方法:分别随机选取本地区13-15岁体检学生,其中正常对照组和单纯性肥胖组儿童各50例,测定其血清RBP-4、视黄醇、TTR水平;利用空腹胰岛素和定量胰岛索敏感性检测指标评价其胰岛素抵抗;同时测定代谢综合征部分组分水平和亚临床炎症指标。结果:仅5%的青少年存在维生素A营养不足状态。排除年龄、性别、感染等因素的影响后,血清RBP-4水平、视黄醇、RBP-4/TTR摩尔比值以及RBP-4/视黄醇摩尔比值与体重指数、体脂含量以及体脂的中心分布(WHR)等密切相关;RBP-4与代谢综合征组分的甘油三酯水平则存在明显的正相关,而RBP-4/视黄醇摩尔比值则与空腹胰岛素水平存在显著的正相关。结论:RBP-4可能通过视黄醇依赖和/或非视黄醇依赖的方式参与肥胖和代谢综合征的病理过程。     

Combined Impact of Cardiorespiratory Fitness and Visceral Adiposity on Metabolic Syndrome in Overweight and Obese Adults in Korea

Background

Obesity, especially visceral obesity, is known to be an important correlate for cardiovascular disease and increased mortality. On the other hand, high cardiorespiratory fitness is suggested to be an effective contributor for reducing this risk. This study was conducted to determine the combined impact of cardiorespiratory fitness and visceral adiposity, otherwise known as fitness and fatness, on metabolic syndrome in overweight and obese adults.

Methods

A total of 232 overweight and obese individuals were grouped into four subtypes according to their fitness level. This was measured by recovery heart rate from a step test in addition to visceral adiposity defined as the visceral adipose tissue area to subcutaneous adipose tissue area ratio (VAT/SAT ratio). Associations of fitness and visceral fatness were analyzed in comparison with the prevalence of metabolic syndrome.

Results

The high visceral fat and low fitness group had the highest prevalence of metabolic syndrome [Odds Ratio (OR) 5.02; 95% Confidence Interval (CI) 1.85–13.61] compared with the reference group, which was the low visceral adiposity and high fitness group, after adjustments for confounding factors. Viscerally lean but unfit subjects were associated with a higher prevalence of metabolic syndrome than more viscerally obese but fit subjects (OR 3.42; 95% CI 1.27–9.19, and OR 2.70; 95% CI 1.01–7.25, respectively).

Conclusions

Our study shows that visceral obesity and fitness levels are cumulatively associated with a higher prevalence of metabolic syndrome in healthy overweight and obese adults. This suggests that cardiorespiratory fitness is a significant modifier in the relation of visceral adiposity to adverse metabolic outcomes in overweight and obese individuals.     

Advanced Bone Age and Hyperinsulinemia in Overweight and Obese Children

ObjectiveIn obese children, bone age (BA) tends to significantly exceed chronological age (CA). In vitro studies in mice suggest that insulin may directly modulate skeletal growth. We investigated whether there is an association between fasting insulinand BAmaturationinobesechildren.MethodsThe study cohort comprised 74 overweight and obese children ages 4 to 13 years. BA divided by CA was used as an index for bone advancement. Participants were classified into tertiles based on their BA:CA ratio. Advanced BA maturation was defined as the third tertile, with BA:CA > 1.21. Components of the metabolic syndrome, including fasting insulin, fasting glucose, triglycerides, and high-density lipoprotein (HDL) levels, were measured.ResultsChildren with advanced BA were significantly younger, had a higher body mass index (BMI)-Z score (BMI-Z), and were taller than children with bone advancement in the lower tertiles. Females had a 4.7-fold increased risk for advanced BA compared with males (95% confidence interval [CI], 1.29-17.1; P = .02). Children with a BMI-Z ≥ 1.96 and fasting insulin ≤ 30 μU/L had a 3.6-fold increased risk of advanced BA (95% CI, 1.00-12.8; P = 0.05). Moreover, hyperinsulinemia (fasting insulin > 30 μU/L) was associated with a 6.8-fold increased risk for advanced BA, independent of the degree of obesity (95% CI, 1.45-32.1; P = .01).ConclusionMarked hyperinsulinemia is associated with advanced BA in obese children. Insulin appears to modulate skeletal growth in humans. (Endocr Pract. 2014;20:62-67)     

Focus: Microbiome: Treating Obesity and Metabolic Syndrome with Fecal Microbiota Transplantation

The worldwide prevalence of metabolic syndrome, which includes obesity and its associated diseases, is rising rapidly. The human gut microbiome is recognized as an independent environmental modulator of host metabolic health and disease. Research in animal models has demonstrated that the gut microbiome has the functional capacity to induce or relieve metabolic syndrome. One way to modify the human gut microbiome is by transplanting fecal matter, which contains an abundance of live microorganisms, from a healthy individual to a diseased one in the hopes of alleviating illness. Here we review recent evidence suggesting efficacy of fecal microbiota transplant (FMT) in animal models and humans for the treatment of obesity and its associated metabolic disorders.     

儿童与成人阻塞型睡眠呼吸暂停低通气综合征代谢异常特征的比较

目的：探讨儿童及成人阻塞型睡眠呼吸暂停低通气综合症（OSAHS）发病原因、睡眠呼吸紊乱严重程度及合并代谢异常程度的差别。方法：对我院2003年1月1日至20]0年7月1日71例诊断为OSAHS住院患者进行回顾性调查,登记年龄、性男日、发病原因、血压、白细胞计数、中性粒细胞比率、淋巴细胞比率、呼吸暂停低通气指数（AHI）、夜间最低血氧饱和度、微觉醒指数。根据年龄进行分组,年龄〈18岁者为A组,年龄≥18岁者为B组。比较两组发病原因、睡眠呼吸紊乱及合并代谢异常程度的差剐。结果：1．A组慢性扁桃体炎和（或）腺样体肥大发生率明显高于B组（P〈O．01）,鼻中隔偏曲发生率明显低于B组（P〈0．01）。2．与B组比较,A组AHI及微觉醒指数降低,夜间最低血氧饱和度升高（P〈0．01）;3．与B组比较,A组高血压、中性粒细胞比率、谷丙转氨酶比例降低（P〈0．05）。结论：A组睡眠呼吸紊乱程度及代谢异常较B组程度轻,更需关注成人阻塞型睡眠呼吸暂停低通气综合症的综合治疗。     

儿童与成人阻塞型睡眠呼吸暂停低通气综合征代谢 异常特征的比较

目的:探讨儿童及成人阻塞型睡眠呼吸暂停低通气综合症(OSAHS)发病原因、睡眠呼吸紊乱严重程度及合并代谢异常程度的差别。方法:对我院2003年1月1日至2010年7月1日71例诊断为OSAHS住院患者进行回顾性调查,登记年龄、性别、发病原因、血压、白细胞计数、中性粒细胞比率、淋巴细胞比率、呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度、微觉醒指数。根据年龄进行分组,年龄<18岁者为A组,年龄≥18岁者为B组。比较两组发病原因、睡眠呼吸紊乱及合并代谢异常程度的差别。结果:1.A组慢性扁桃体炎和(或)腺样体肥大发生率明显高于B组(P<0.01),鼻中隔偏曲发生率明显低于B组(P<0.01)。2.与B组比较,A组AHI及微觉醒指数降低,夜间最低血氧饱和度升高(P<0.01);3.与B组比较,A组高血压、中性粒细胞比率、谷丙转氨酶比例降低(P<0.05)。结论:A组睡眠呼吸紊乱程度及代谢异常较B组程度轻,更需关注成人阻塞型睡眠呼吸暂停低通气综合症的综合治疗。     

Energy Expenditure in Lean and Obese Prepubertal Children

The relationship between energy expenditure and obesity was examined in prepubertal children. Consenting fifth graders underwent Tanner Staging, weight, height and skinfold measurements. Subjects were selected for further study to obtain equal numbers of girls and boys with a wide range of body composition. Weight, total daily energy expenditure (TDEE) by doubly labeled water (DLW), resting metabolic rate (RMR), and body composition were measured. Children were grouped into level of obesity based on tertiles of subscapular plus triceps skinfolds. The skinfold tertiles did quite well in grouping subjects by degree of obesity, as differences in percent fat in each tertile were significantly different. There were no differences in fat-free mass between the groups, while the highest tertile group weighed 14 kg more than the lowest. For DLW, energy expenditure was calculated using day 8 and day 9 urine samples as the final time point to examine precision. Mean energy expenditure using either day was nearly identical (2220 ± 400 vs. 2300 ± 370 kcal/d), with a CV of the difference of 5.5%. No differences in RMR, energy expended in activity, or TDEE between the three groups were observed. A reduction in RMR or TDEE could not explain differences in obesity in these prepubertal children. However, the fact that the heaviest children expended the same amount of energy in activity and had the same TDEE as the leanest, while weighing 14 kg more, indicates that the obese children had a reduced activity level.     

Central Adiposity Determines Prevalence Differences of the Metabolic Syndrome

Objective: To compare the expression of the metabolic syndrome in Spain and San Antonio, TX, two populations with major differences regarding their cardiovascular risk profile. Research Methods and Procedures: Cross‐sectional analysis of population‐based, epidemiological surveys using the metabolic syndrome definition of the National Cholesterol Education Program. In San Antonio, we limited our analysis to non‐Hispanic whites because non‐Hispanic whites are largely of European ancestry (n = 1339 in San Antonio and 2947 in Spain) Results: In men, increased central adiposity was more prevalent in San Antonio than in Spain (29.7 vs. 23.0%, p < 0.0001); in women, it was less prevalent in San Antonio than in Spain (40.2 vs. 66.4%, p < 0.0001). The metabolic syndrome followed that same pattern: more prevalent in men (28.9 vs. 20.8%, p = 0.019) and less in women from San Antonio (27.1 vs. 30.9%, p < 0.0001). In subjects with the metabolic syndrome, most women had increased central adiposity (92.6% in San Antonio and 97.5% in Spain), and most men had either increased central adiposity or blood pressure (99.2% in San Antonio and 95.0% in Spain). Discussion: Contrary to men, the metabolic syndrome is more prevalent in Spanish women than in women from San Antonio with differences that mirror differences in central adiposity. Central adiposity and blood pressure may be used to exclude the metabolic syndrome. Considering recent secular trends in obesity, we predict there will be an increase in the prevalence of the metabolic syndrome in both populations in the coming years.     

Hair Trace Elements in Overweight and Obese Adults in Association with Metabolic Parameters

The objective of the present study was to investigate the level of toxic and essential trace elements in hair of adult overweight and obese persons as well as its association with metabolic parameters. Hair trace element levels were assessed using inductively coupled plasma mass-spectrometry in 112 overweight and obese patients and 106 lean controls. Serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), glucose, uric acid (UA) levels, and cholinesterase (CE) and gamma-glutamyltransferase (GGT) activity were also assessed. Excessive body weight significantly affected hair trace element levels. In particular, hair Co (33%), Cu (13%), I (30%), Mg (2-fold), Mn (25%), Zn (17%), and Ni (21%) levels were lower, whereas Al (14%) and As levels were higher in comparison to those in the control group. Correlation analysis demonstrated the most significant correlations for hair Mg with body weight, BMI, systolic and diastolic blood pressure, and UA, and for hair Al with body weight, BMI, TC, glucose, TG, CE, GGT, and UA. Multiple regression analysis demonstrated that trace elements were not associated with TC and LDL-C levels neither in crude nor in adjusted models. In turn, crude and adjusted models accounted for 25 and 43% of serum TG variance. The most significant associations were observed for hair Al, Fe, Si, and V in adjusted model. The obtained data demonstrate that obesity-related metabolic disorders may be at least partially mediated by altered trace element and mineral levels.     

Importance of Both Fatness and Aerobic Fitness on Metabolic Syndrome Risk in Japanese Children

Associations between body mass index (BMI), peak oxygen consumption (VO_2peak), and metabolic syndrome (MetS) risk factors have not been adequately studied in Japanese children. Here the relationships between these parameters and the threshold aerobic fitness level necessary for low MetS risk were determined. The participants (299 children; 140 boys and 159 girls, aged 9.1 ± 0.3 years) were divided into four groups using the medians of predicted VO_2peak (_pVO_2peak) and BMI. MetS risk scores were calculated using z-scores. Receiver Operating Characteristic analysis was used to determine the threshold aerobic fitness level necessary for low MetS risk. The MetS risk score of the High BMI group was significantly higher than that of the Low BMI group for both sexes (p < 0.0001). However, the High BMI/High Fitness group had a significantly lower MetS risk score than the High BMI/Low Fitness group for both sexes. The _pVO_2peak cut-off values for low MetS risk were 47.9 and 44.9 ml/kg/min for boys and girls, respectively. Our results suggest that improvements in both fatness and aerobic fitness are important for decreasing MetS risk. We also confirmed the _pVO_2peak of cut-off values necessary for low MetS risk in Japanese children.     

Prevalence of the Metabolic Syndrome in a Bulgarian Female Population Referred for Bone Density Testing

Objective: To investigate the prevalence of the metabolic syndrome in Bulgarian women referred for bone density screening. Research Methods and Procedures: This was a cross‐sectional clinical study. Subjects were 444 consecutive 30‐ to 75‐year‐old Bulgarian women recruited from the outpatients referred for bone density testing (mean age, 52.67 ± 15.19 years; mean BMI, 26.10 ± 5.71 kg/m²). Height (centimeters), weight (kilograms), and blood pressure were measured. BMI and waist‐to‐hip ratio were calculated. Fasting plasma glucose, blood lipids, and immunoreactive insulinemia (Bayer Corp.‐Diagnostics Div., Tarrytown, NY) were determined. Body composition was analyzed by bioimpedance on a leg‐to‐leg analyser (Tanita TBF‐215; Tanita Corporation, Tokyo, Japan). Results: Of all women, 56.76% had a BMI > 25 kg/m², 45.95% had a waist circumference > 88 cm, and 64.64% had a waist‐to‐hip ratio > 0.8; 59.90% had hypertension; 4.05% had fasting plasma glucose > 7.0 mM, and 42.79% had fasting morning immunoreactive insulinemia = 16 UI/liter; 23.65% had hypercholesterolemia; and 26.35% had hypertriglyceridemia. The prevalence of the metabolic syndrome in this sample, as defined by the National Cholesterol and Education Program‐Adult Treatment Panel III, was 34.91%, and by the modified World Health Organization definition was 37.16%. Discussion: We concluded that Bulgarian women 30 to 75 years old referred for bone density testing have a high prevalence of the metabolic syndrome. Therefore, large‐scale prevention programs are needed in this field.     

Bright Liver and Alanine Aminotransferase Are Associated with Metabolic Syndrome in Adults

Objectives: The metabolic syndrome has become a significant health problem worldwide. In this study, we investigated the relationship between the metabolic syndrome, bright liver (BL) by ultrasonography (US), and plasma alanine aminotransferase (ALT) levels among apparently healthy adults. Research Methods and Procedures: A total of 15, 430 nonalcoholic healthy adults without hepatitis B or C were recruited from four nationwide MJ Health Screening Centers in Taiwan in 2000. Metabolic syndrome was defined using the National Cholesterol Education Panel (NCEP) metabolic syndrome criteria or modified NCEP criteria. Based on liver US, subjects were classified into either having BL or not. The relationship between the metabolic syndrome, BL, and ALT levels was examined using multivariate logistic regression analysis. Results: The crude OR of the metabolic syndrome was 13.92 (12.19 using modified NCEP criteria), and the age‐BMI‐sex—adjusted OR was 3.77 (3.71 using modified NCEP criteria) in subjects with BL vs. subjects without BL, respectively. The ORs of the metabolic syndrome were significantly higher in subjects with elevated ALT levels than in those with normal ALT levels. After adjustment for age, sex, and BMI, BL and elevated ALT level were independently associated with increased risk of the metabolic syndrome. Discussion: Presence of BL and elevated plasma ALT level was independently associated with increased risk of the metabolic syndrome in adults. These factors contribute to a list of well‐known risk factors, including obesity, aging, and male sex, and thus can be applied as an additional evaluation for the metabolic syndrome in a clinical setting.