Metabolic syndrome and related disorders最新文献

Objective: This study aimed to evaluate the predictive value of complete blood count-derived inflammatory indices for metabolic syndrome (MetS) in children and adolescents with obesity.

Methods: A cross-sectional study was conducted from January to March 2025. Participants aged 5-17.9 years with obesity were classified into MetS and non-MetS groups according to the International Diabetes Federation pediatric criteria. Participants were further stratified by pubertal stage into prepubertal, pubertal, and postpubertal groups.

Results: A total of 343 subjects with obesity (median age: 13.3 years; interquartile range: 4.74) were studied. MetS was diagnosed in 97 individuals (28.2%). Those with MetS had significantly higher body mass index (BMI), waist circumference, hip circumference, waist-to-height ratio, blood pressure, triglycerides, fasting plasma glucose, insulin levels, and Homeostasis Model Assessment of Insulin Resistance, and lower high-density lipoprotein cholesterol (HDL-C) compared with participants without MetS. Notably, inflammatory markers, including the neutrophil-to-HDL-C ratio, lymphocyte-to-HDL-C ratio, monocyte-to-HDL-C ratio, and platelet-to-HDL-C ratio (PHR), were also elevated in the MetS group. Correlation analyses revealed significant associations between these indices and various cardiometabolic parameters, including insulin resistance markers. Logistic regression analysis identified BMI and PHR as the most robust independent predictors of MetS. Additionally, stage-specific cutoff values for these markers were established according to pubertal development.

Conclusions: The study shows that certain novel inflammatory indices are elevated in children with MetS and are significantly correlated with key cardiometabolic risk factors. These results suggest that such markers could serve as practical tools for early detection of cardiometabolic risk in youth with obesity.

Introduction: Prehypertension (pre-HTN) affects between 25% and 50% of the adult population worldwide and constitutes a significant risk factor for the development of cardiovascular diseases and chronic kidney disease. Although it is not considered a disease, its identification is crucial as it reflects a state of alert to identify individuals at high risk of developing cardiovascular disease. However, the difficulties associated with its diagnosis limit its use in preventive medicine. In this context, the present study aims to analyze the diagnostic utility of markers derived from the lipid profile (TyG index and the ratios triglycerides (TG)/high-density lipoprotein-cholesterol (HDL-c), total cholesterol (TC)/HDL-c, low-density lipoprotein cholesterol (LDL-c)/HDL-c, non-HDL-c/HDL-c, and fasting blood glucose (FBG)/HDL-c) in determining pre-HTN.

Methods: A retrospective study was designed that included the participation of 668 young adults. A logistic regression model was used to examine the associations between the different markers and pre-HTN. The cut-off points of the markers were determined by receiver operating characteristic curve analysis and the Youden index.

Results: A positive and significant association was observed between all markers with the presence of pre-HTN. The cut-off values for the markers that best predicted pre-HTN status were TG/HDL-c ≥2.055 (sensitivity = 62.28%, specificity = 87.03%); TC/HDL-c ≥3.466 (sensitivity = 60.48%, specificity = 91.82%); non-HDL-c/HDL-c ≥2.466 (sensitivity = 60.48%, specificity = 91.82%); and FBG/HDL-c ≥1.726 (sensitivity = 68.26%, specificity = 73.25%).

Conclusions: Our study demonstrated the diagnostic relevance of the different markers for the detection of pre-HTN, suggesting that these markers may be useful in clinical practice for the timely and accurate diagnosis of pre-HTN.

Purpose: Adrenal insufficiency (AI) is an endocrine condition requiring lifelong glucocorticoid replacement treatment. Long-term exposure to glucocorticoids may result in significant metabolic problems, such as insulin resistance, abdominal obesity, dyslipidemia, and increased cardiometabolic risk. The triglyceride-glucose (TyG) index is a simple, inexpensive marker of insulin resistance and metabolic syndrome (MetS), increasingly used in endocrine and metabolic research, but its role in AI remains insufficiently researched. This study aimed to assess the clinical utility of the TyG index in patients with AI.

Method: This was a single-center, cross-sectional observational study including 58 patients with primary or secondary AI receiving glucocorticoid replacement therapy. Demographic, clinical, and anthropometric data were recorded, and body composition was assessed by bioelectrical impedance analysis. The TyG index was calculated using fasting triglyceride and glucose values. MetS was diagnosed according to the International Diabetes Federation 2009 criteria. The relationships between TyG and metabolic risk factors were examined, and TyG levels were investigated in the primary AI and secondary AI groups. The discriminative value of TyG for MetS was determined using receiver operating characteristic (ROC) analysis, including pairwise area under the curve (AUC) comparisons and the Youden-optimal threshold.

Results: The mean age was 44.8 ± 15.6 years, and 28 patients (48.3%) were female. Secondary and primary AI were present in 53.4% and 46.6% of patients, respectively. MetS prevalence was 31.0%. TyG was higher in secondary AI compared with primary AI (8.8 ± 0.7 vs. 8.4 ± 0.5; p = 0.014). TyG values were higher in patients with elevated waist-to-height ratio (WHtR), high waist-to-hip ratio, obesity, and MetS (p < 0.05). ROC analysis showed that TyG had the strongest discriminative value for identifying MetS (AUC = 0.840, 95% confidence interval [CI]: 0.722-0.959; p < 0.001), with a cut-off of 8.49 yielding 94.4% sensitivity and 67.5% specificity, followed by WHtR (AUC = 0.826, 95% CI: 0.719-0.932, p < 0.001) and body mass index (AUC = 0.757, 95% CI: 0.631-0.883, p = 0.002).

Conclusion: This study evaluates TyG in AI and indicates which it is a simple, low-cost marker associated with metabolic risk. TyG may support early identification and risk stratification in this vulnerable population.

Background: The cardiometabolic index (CMI) has emerged as a composite marker of metabolic dysfunction. However, its prognostic value for mortality in early-stage cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. This study aimed to evaluate the association between CMI and mortality risk in individuals with CKM stages 0-3, and to assess whether CMI provides incremental predictive value over body mass index (BMI).

Methods: This retrospective cohort study included 11,280 adults from the National Health and Nutrition Examination Survey 2007-2018 with CKM stages 0-3. CMI was calculated as (triglycerides/HDL-C) × waist-to-height ratio. Mortality outcomes were ascertained through linkage with the National Death Index through December 31, 2019. Survey-weighted Cox proportional hazards regression and restricted cubic splines were used to examine associations. Kaplan-Meier survival curves with log-rank tests were employed to compare survival probabilities across CMI-BMI discordance phenotypes. Random survival forest models compared the predictive performance of CMI versus BMI.

Results: During a median follow-up of 6.2 years, 623 all-cause deaths and 159 cardiovascular deaths occurred. In fully adjusted models, participants in the highest CMI quartile had significantly elevated risks of all-cause mortality [hazard ratio (HR) = 1.55, 95% confidence intervals (CI): 1.15-2.09] and cardiovascular mortality (HR = 1.91, 95% CI: 1.05-3.46) compared with the lowest quartile. Restricted cubic spline analyses revealed significant nonlinear associations, with inflection points at CMI of 2.51 for all-cause mortality and 1.06 for cardiovascular mortality. In the overweight subgroup and among diabetic patients, CMI demonstrated superior risk stratification compared with BMI. Notably, metabolically obese normal-weight individuals exhibited significantly worse survival than metabolically healthy obese individuals.

Conclusions: CMI is independently associated with all-cause and cardiovascular mortality in early-stage CKM syndrome, with evidence of threshold effects. CMI may serve as a valuable complementary tool to BMI for identifying high-risk individuals, particularly among those with metabolically unhealthy phenotypes masked by normal weight status.

Background: Coronary artery calcium (CAC) score is a predictor of ischemic heart disease and closely linked to metabolic syndrome (MS). This study investigates the relationship between CAC and benign hepato-pancreaticobiliary disorders.

Methods: A retrospective, cross-sectional, observational study was conducted on individuals who underwent cardiac computed tomography scans between 2015 and 2022 at a tertiary medical center. Multivariate logistic regression explored the association between CAC and potential confounders. Additionally, a logistic regression model was applied to determine whether CAC independently predicts benign hepato-pancreaticobiliary disorders [steatotic liver disease (SLD), fatty pancreas, gallstones, choledocholithiasis, pancreatic calcifications, and pancreatic duct stones].

Results: Among 2422 individuals, 725 met inclusion. Univariate regression analysis indicated CAC was significantly linked to SLD, older age, male sex, and MS. Both SLD and fatty pancreas showed an association with CAC in individuals with and without MS (P < 0.001). Multivariate analysis demonstrated that CAC was independently associated with increasing age [OR: 1.18 (95% CI: 1.15-1.62), P < 0.001], male sex [OR: 3.12 (95% CI: 2.52-4.26), P < 0.001], MS [OR: 1.29 (95% CI: 1.25-2.45), P < 0.001], SLD [OR: 1.26 (95% CI: 1.12-2.42), P < 0.001], fatty pancreas [OR: 1.79 (95% CI: 1.19-1.98), P < 0.001], gallstones [OR: 1.82 (95% CI: 1.64-2.05), P < 0.001], choledocholithiasis [OR: 1.21 (95% CI: 1.19-2.62), P < 0.001], and pancreatic calcifications [OR: 1.74 (95% CI: 1.12-2.32), P < 0.001], regardless of MS.

Conclusions: The CAC score is correlated with an increased prevalence of SLD, fatty pancreas, and other benign pancreaticobiliary conditions, independent of MS.

Purpose: Steatotic liver disease (SLD) is a prevalent condition that can progress to fibrosis if untreated. The most commonly used screening tool for liver disease is the FIB-4 score, which can help rule out advanced liver fibrosis. This study aims to assess whether a simple tool such as waist circumference (WC) can screen for both hepatic steatosis and fibrosis.

Methods: This study was based on analysis of patient data from the NHANES 2017-2018 database, including WC, laboratory values, and Fibroscan data. Of 9254 participants, 6846 were excluded due to incomplete or missing lab and Fibroscan data (2408 included). Receiver operator characteristics (ROC) curve analyses assessed the performance of WC, fatty liver index (FLI), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in predicting steatosis at two cut-off points: controlled attenuation parameter (CAP) ≥248 dB/m and ≥294 dB/m. ROC analyses also compared WC and FIB-4 performance in predicting significant fibrosis based on liver stiffness measurement (LSM) cutoff: <8.2 kPa (F0-F1) or ≥8.2 kPa (F2-F4). Analyses were performed using JMP Pro version 17.

Results: WC was shown to be a strong predictor of steatosis and fibrosis among men and women. WC and FLI were comparable predictors for steatosis among men; however, FLI outperformed WC as a predictor of steatosis among women. WC and FLI were shown to be more effective predictors of steatosis in men and women at both CAP cutoff values when compared with HOMA-IR. All three measures were more predictive of steatosis in men than in women. In a subgroup analysis of 1053 participants ages 35-65 years, WC outperformed FIB-4 in predicting significant fibrosis.

Conclusion: WC is an independent predictor of hepatic steatosis and fibrosis among US adults. WC should be measured routinely in primary care settings, facilitating earlier intervention for those at risk for liver steatosis and fibrosis.

Background: Sarcopenic obesity (SO), defined as the coexistence of low muscle mass and function and excessive fat mass, is increasingly recognized as a health concern in older individuals with diabetes. Despite its clinical importance, SO often remains undiagnosed in outpatient settings due to complex diagnostic requirements.

Objective: This study aimed to investigate the risk of SO using simple screening tools, namely the SARC-F questionnaire and handgrip strength (HGS), and to identify associated clinical, functional, and metabolic factors in diabetic patients aged 50 and older.

Methods: A cross-sectional analysis was conducted with 276 diabetic outpatients. Risk of SO was defined based on a body mass index of 30 kg/m² or more, combined with either a SARC-F score of 4 or above or low HGS values (below 35 kg for men and 20 kg for women). Data on comorbidities, functionality, falls, depression, and metabolic control were collected.

Results: The prevalence of SO risk was 16.2% with HGS and 8.7% with SARC-F. Falls, depressive symptoms, and reduced quality of life were associated with SARC-F-based SO, while hypertension, elevated HbA1c, and lower quality of life were linked to HGS-based SO.

Conclusion: Simple screening methods can help identify SO risk in diabetic outpatients and support timely clinical decision-making.

Objective: To evaluate the long-term effects of sleeve gastrectomy (SG) on glucose excursion and hypoglycemia in persons without diabetes during the oral glucose tolerance test (OGTT).

Methods: This quasi-experimental study included persons undergoing body contouring surgeries, some of whom had a history of SG, while the remaining did not have a history of SG. An OGTT (75 grams) was undertaken at four time points (before body contouring surgery, immediate postoperative, short-term, and long-term postoperative). Glucose levels were measured at six time points (fasting, 15, 30, 45, 60, and 120 min). Glucose excursion was analyzed using Tai's trapezoidal rule and Doi's weighted average glucose (dwAG). Statistical models included linear and logistic regression.

Results: The study evaluated 125 OGTTs. The SG group exhibited significantly higher rates of level 1 hypoglycemia (12.5%) compared to the non-SG group (3.2%). SG increased the odds of hypoglycemia 8-fold [OR: 8.11, (95% UI: 1.43-45.95)] compared to the non-SG group. Hypoglycemia occurred predominantly at 120 min. Logistic regression indicated no relationship of age, body fat, and gender on hypoglycemia odds. The unified measures (dwAG and Tai's area) demonstrated that glucose excursion was less after SG then with participants without bariatric surgery.

Conclusions: SG alters the OGTT responses, leading to increased risk of late post-load hypoglycemia in participants without diabetes. Data from this study will assist with OGTT management in post-SG patients, and it is suggested that use of unified measures like dwAG may be useful.

Objective: This study examines the impact of body mass index (BMI) on homeostatic model assessment for insulin sensitivity (HOMA-S) and homeostatic model assessment for pancreatic β-cell function (HOMA-B) in adults with obesity but without diabetes. Additionally, the association of key hormones, leptin and gastric inhibitory peptide (GIP), with HOMA indices and BMI has been investigated.

Methods: This cross-sectional study involved 289 adults without diabetes from Hamad General Hospital in Qatar. BMI was analyzed as a predictor of HOMA-S and HOMA-B using adjusted multivariable linear regression. A logistic regression model was used to investigate hormonal predictors of insulin sensitive phenotype (ISP), and results were presented using margins plots, stratified by obesity classes.

Results: We found a strong, linear dose-response relationship between BMI and HOMA indices, with each unit increase in BMI linked to approximately a 2% decline in HOMA-S and a 1% rise in HOMA-B. Subgroup analysis revealed that the effects on ISP were more strongly driven by hormonal variations, particularly leptin and GIP levels, than by BMI alone.

Conclusions: Our findings demonstrate that BMI is a proxy for hormonal variations, particularly in leptin and GIP, which more strongly predict insulin sensitivity. These results support the need for incorporating hormonal markers into obesity-related risk assessment and management strategies.

Sucralose (a.k.a. Splenda when combined with dextrose and maltodextrin) is a popular nonnutritive sweetener (NNS) found in several beverages marketed for health benefits and fitness. This article examines the mechanistic aspects of sucralose's metabolic effects on satiety, obesity, glycemic control, and adipogenesis, along with gut dysbiosis, inflammation, and disruption of intestinal permeability. Some evidence suggests that sucralose may also alter appetite regulation, taste perception, and energy intake. Additionally, there are safety concerns regarding its carcinogenic potential and its epigenetic effect on the fetus due to consistent maternal consumption. Based on current findings of NNS, it was concluded that sucralose may be of use in weight reduction in the short term as an NNS. However, this needs to be weighed against the possible long-term metabolic side effects and safety precautions.