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A systematic literature review of observational studies of the bidirectional association between metabolic syndrome and migraine.
Andreeva, VA, Galan, P, Julia, C, Fezeu, L, Hercberg, S, Kesse-Guyot, E
Diabetes & metabolism. 2019;(1):11-18
Abstract
AIMS: To evaluate all epidemiological evidence in the literature linking the metabolic syndrome (MetS) and migraine in adults. METHODS Database (Medline, Embase; published reports up to November 2017) and manual searches were performed. Information on data collection, sample characteristics, study design, MetS and migraine assessment, and results was extracted from each relevant publication. The methodological quality of each study was also assessed. RESULTS A total of 15 observational epidemiological studies in adults, published between 2009 and 2017, were retrieved. Of these, one employed a prospective design, while the rest had a cross-sectional (13 studies) or case-control (one study) design. Five studies assessed the presence of migraine in individuals with MetS, whereas 10 studies assessed the presence or risk of MetS in migraineurs. Most participants were female hospital outpatients. The sole prospective cohort study reported 11-year MetS incidence of 21.8% in migraineurs with aura, 16.8% in migraineurs without aura and 14.5% in subjects without headaches. Most studies (60%) provided no statistical estimates of association. Methodological flaws included selection biases, lack of power analysis, unsuitable research plans and no multivariable analyses. Meta-analysis was not feasible with the available data. CONCLUSION Our systematic review has identified major gaps in knowledge and weaknesses in research that should provide an impetus for future epidemiological investigations using more rigorous methodology, large general-population prospective cohorts, and substantial data on dietary behaviours and lifestyle.
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Influence of daily fresh pear consumption on biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome: a randomized controlled trial.
Navaei, N, Pourafshar, S, Akhavan, NS, Litwin, NS, Foley, EM, George, KS, Hartley, SC, Elam, ML, Rao, S, Arjmandi, BH, et al
Food & function. 2019;(2):1062-1072
Abstract
Previous research suggests potential for fresh pears as a functional food for promoting cardiometabolic health. The purpose of this randomized, open-label, placebo-controlled, crossover clinical trial was to evaluate the influence of daily fresh pear consumption on blood pressure (primary outcome) and other biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome (MetS). Forty men and women aged 45-65 years with MetS were included and randomly assigned to receive either two medium-sized fresh pears (Pear) or a calorie-matched control drink (Control) per day for each 12-week treatment period, each separated by a 4-week washout period. After 12 weeks of daily fresh pear consumption, systolic blood pressure tended to be reduced (130 ± 2 mmHg vs. 134 ± 2 mmHg at baseline, P = 0.07) and pulse pressure was significantly reduced (51 ± 1 vs. 54 ± 1 at baseline, P < 0.05). At 12 weeks, leptin concentrations were lower in the Pear group than Control (52.5 [7.6, 120.5] ng dL-1vs. 53.4 [5.0, 120.5] ng dL-1, respectively, P < 0.05), and there was a significant group by time interaction (P < 0.05). Leptin concentrations were significantly reduced at 12 weeks compared to baseline in the Pear group (52.5 [7.6, 120.5] ng dL-1vs. 54.8 [6.4, 120.5] ng dL-1 at baseline, P < 0.05) but not in the Control group. Waist circumference was significantly reduced at 12 weeks in the Pear group (107.7 ± 2.0 cm vs. 108.4 ± 2 cm at baseline, P < 0.05) with a trend for a group by time interaction (P < 0.1), and significantly lower in the Pear group than Control (108.1 ± 2.0 cm vs. 108.8 ± 2 cm, P < 0.05) at 6 weeks with a significant group by time interaction (P < 0.05). Conversely, values were significantly increased at 6 weeks (108.8 ± 2 cm vs. 108.3 ± 2.0 cm at baseline, P < 0.05) in the Control group and sustained at 12 weeks. Waist-to-hip ratio was significantly reduced (0.92 ± 0.01 vs. 0.93 ± 0.01 at baseline, P < 0.05) at 12 weeks in the Pear group, and significantly lower than Control at 6 weeks (0.93 ± 0.01 vs. 0.93 ± 0.01, respectively, P < 0.05) and 12 weeks (0.92 ± 0.01 vs. 0.93 ± 0.01, P < 0.05). These findings suggest that daily fresh pear consumption may promote modest improvements in cardiometabolic health in middle-aged/older adults with MetS. This trial was registered at clinicaltrials.gov as NCT02228837.
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Recent advances in managing/understanding the metabolic syndrome.
Aguilar-Salinas, CA, Viveros-Ruiz, T
F1000Research. 2019
Abstract
The metabolic syndrome (MetS) concept gathers in a single entity a set of metabolic abnormalities that have in common a close relationship with ectopic deposit of lipids, insulin resistance, and chronic low-grade inflammation. It is a valuable teaching tool to help health professionals to understand and integrate the consequences of lipotoxicity and the adverse metabolic consequences of insulin resistance. Also, it is useful to identify subjects with a high risk for having incident type 2 diabetes. Systems biology studies have gained a prominent role in understanding the interaction between adipose tissue dysfunction, insulin action, and the MetS traits and co-morbidities (that is, non-alcoholic steatohepatitis, or NASH). This approach may allow the identification of new therapeutic targets (that is, de novo lipogenesis inhibitors for NASH). Treatment targets on MetS are the adoption of a healthy lifestyle, weight loss, and the control of the co-morbidities (hyperglycemia, dyslipidemia, arterial hypertension, among others). The long-term goals are the prevention of type 2 diabetes, cardiovascular events, and other MetS-related outcomes. In the last few decades, new drugs derived from the identification of innovative treatment targets have come on the market. These drugs have positive effects on more than one MetS component (that is, hyperglycemia and weight control). New potential treatment targets are under study.
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Lifestyle Habits, Dietary Factors, and the Metabolically Unhealthy Obese Phenotype in Youth.
Roberge, JB, Van Hulst, A, Barnett, TA, Drapeau, V, Benedetti, A, Tremblay, A, Henderson, M
The Journal of pediatrics. 2019;:46-52.e1
Abstract
OBJECTIVE To determine whether lifestyle habits and dietary factors at age 8-10 years predict the development of metabolically unhealthy obesity 2 years later among children who were previously metabolically healthy obese. STUDY DESIGN The QUebec Adipose and Lifestyle InvesTigation in Youth cohort comprises 630 youth with a parental history of obesity. Metabolically healthy obesity and metabolically unhealthy obesity were defined using cut-offs for the components of pediatric metabolic syndrome. Dietary factors, physical activity, fitness, sedentary behavior, screen time, and sleep duration were measured. Multivariable logistic regressions were used to examine associations. RESULTS At baseline, 48 participants with metabolically healthy obesity were identified; 2 years later, 19 became metabolically unhealthy obese and 29 remained metabolically healthy obese. Every additional daily portion of fruits and vegetables decreased the risk of converting to metabolically unhealthy obesity by 39% (OR 0.61, 95% CI 0.40-0.94). Cumulating more hours of screen time and diets high in saturated fat and sugar-sweetened beverages and low in protein were associated with a tendency to develop metabolically unhealthy obesity. CONCLUSIONS Fruit and vegetable intake and possibly screen time, saturated fat, sugar-sweetened beverages, and protein intake may be important targets for the prevention of cardiometabolic complications in obese children. TRIAL REGISTRATION ClinicalTrials.gov: NCT03356262.
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Management of Diabetes Mellitus in Normal Renal Function, Renal Dysfunction and Renal Transplant Recipients, Focusing on Glucagon-Like Peptide-1 Agonist: A Review Based upon Current Evidence.
Tsai, SF, Chen, CH
International journal of molecular sciences. 2019;(13)
Abstract
Diabetes Mellitus (DM) is a leading cause of both Cardiovascular Disease (CVD) and End-stage Renal Disease (ESRD). After 2008, there has been much evidence presented, and recently the guidelines for sugar control have changed to focus on being more disease orientated. GLP-1 Receptor Agonists (GLP-1R) and sodium glucose cotransporter-2 inhibitors are suggested as the first line towards fighting all DM, CVD and ESRD. However, the benefits of GLP-1R in organ transplantation recipients remain very limited. No clinical trials have been designed for this particular population. GLP-1R, a gastrointestinal hormone of the incretin family, possesses antidiabetic, antihypertensive, anti-inflammatory, anti-apoptotic and immunomodulatory actions. There are few drug-drug interactions, with delayed gastric emptying being the major concern. The trough level of tacrolimus may not be significant but should still be closely monitored. There are some reasons which support GLP-1R in recipients seeking glycemic control. Post-transplant DM is due to an impaired β-cell function and glucose-induced glucagon suppression during hyperglycemia, which can be reversed by GLP-1R. GLP-1R infusion tends to relieve immunosuppressant related toxicity. Until now, in some cases, glycemic control and body weight reduction can be anticipated with GLP-1R. Additional renal benefits have also been reported. Side effects of hypoglycemia and gastrointestinal discomfort were rarely reported. In conclusion, GLP-1R could be implemented for recipients while closely monitoring their tacrolimus levels and any potential side effects. Any added benefits, in addition to sugar level control, still require more well-designed studies to prove their existence.
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The Circadian Syndrome: is the Metabolic Syndrome and much more!
Zimmet, P, Alberti, KGMM, Stern, N, Bilu, C, El-Osta, A, Einat, H, Kronfeld-Schor, N
Journal of internal medicine. 2019;(2):181-191
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Abstract
The Metabolic Syndrome is a cluster of cardio-metabolic risk factors and comorbidities conveying high risk of both cardiovascular disease and type 2 diabetes. It is responsible for huge socio-economic costs with its resulting morbidity and mortality in most countries. The underlying aetiology of this clustering has been the subject of much debate. More recently, significant interest has focussed on the involvement of the circadian system, a major regulator of almost every aspect of human health and metabolism. The Circadian Syndrome has now been implicated in several chronic diseases including type 2 diabetes and cardiovascular disease. There is now increasing evidence connecting disturbances in circadian rhythm with not only the key components of the Metabolic Syndrome but also its main comorbidities including sleep disturbances, depression, steatohepatitis and cognitive dysfunction. Based on this, we now propose that circadian disruption may be an important underlying aetiological factor for the Metabolic Syndrome and we suggest that it be renamed the 'Circadian Syndrome'. With the increased recognition of the 'Circadian Syndrome', circadian medicine, through the timing of exercise, light exposure, food consumption, dispensing of medications and sleep, is likely to play a much greater role in the maintenance of both individual and population health in the future.
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Disentangling the Effects of Monounsaturated Fatty Acids from Other Components of a Mediterranean Diet on Serum Metabolite Profiles: A Randomized Fully Controlled Dietary Intervention in Healthy Subjects at Risk of the Metabolic Syndrome.
Michielsen, CCJR, Hangelbroek, RWJ, Feskens, EJM, Afman, LA
Molecular nutrition & food research. 2019;(9):e1801095
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Abstract
SCOPE The Mediterranean (MED) diet has been associated with a decreased risk of cardiovascular diseases. It is unclear whether this health effect can be mainly contributed to high intakes of monounsaturated fatty acids (MUFA), characteristic for the MED diet, or whether other components of a MED diet also play an important role. METHODS AND RESULTS A randomized fully controlled parallel trial is performed to examine the effects of the consumption of a saturated fatty acid rich diet, a MUFA-rich diet, or a MED diet for 8 weeks on metabolite profiles, in 47 subjects at risk of the metabolic syndrome. A total of 162 serum metabolites are assessed before and after the intervention by using a targeted NMR platform. Fifty-two metabolites are changed during the intervention (false discovery rate [FDR] p < 0.05). Both the MUFA and MED diet decrease exactly the same fractions of LDL, including particle number, lipid, phospholipid, and free cholesterol fraction (FDR p < 0.05). The MED diet additionally decreases the larger subclasses of very-low-density lipoprotein (VLDL), related VLDL fractions, VLDL-triglycerides, and serum-triglycerides (FDR p < 0.05). CONCLUSION The findings clearly demonstrate that the MUFA component is responsible for reducing LDL subclasses and fractions, and therefore causes an antiatherogenic lipid profile. Interestingly, consumption of the other components in the MED diet show additional health effects.
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The Effects of Curcumin on Serum Heat Shock Protein 27 Antibody Titers in Patients with Metabolic Syndrome.
Mohammadi, F, Ghazi-Moradi, M, Ghayour-Mobarhan, M, Esmaeili, H, Moohebati, M, Saberi-Karimian, M, Safarian, H, Tavallaie, S, Ferns, GA, Sahebkar, A
Journal of dietary supplements. 2019;(5):592-601
Abstract
Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease and diabetes mellitus. Inflammation and oxidant stress are features of MetS that can enhance the expression and release of heat shock proteins (Hsps), including the small heat shock protein, Hsp 27, and that may subsequently lead to the production of Hsp27 antibodies (anti-Hsp 27). Curcumin is an anti-inflammatory and antioxidant phytochemical that may ameliorate these features of MetS. We investigated the effects of unformulated curcumin and phospholipidated curcumin on antibody titers to heat shock protein 27 (anti-Hsp 27) in patients with MetS. A randomized double-blind, placebo-controlled clinical trial design was used in 120 patients with MetS (diagnosed according to the International Diabetes Federation [IDF] criteria). Participants were randomly allocated to 3 groups, with 40 individuals per group, that received either 1 g/d curcumin, phospholipidated curcumin, or a placebo for 6 weeks. The changes in serum concentrations of anti-Hsp 27 did not differ significantly between study groups (p = .283). There was no significant difference between baseline and end-of-trial concentrations of anti-Hsp 27 in groups supplemented with curcumin (p = .177), phospholipidated curcumin (p = .798), or placebo (p = .663). Curcumin supplementation (1 g/d) has no significant effects on anti-Hsp 27 titers in patients with MetS.
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High-Intensity Interval Training for Cardiometabolic Disease Prevention.
Campbell, WW, Kraus, WE, Powell, KE, Haskell, WL, Janz, KF, Jakicic, JM, Troiano, RP, Sprow, K, Torres, A, Piercy, KL, et al
Medicine and science in sports and exercise. 2019;(6):1220-1226
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PURPOSE The 2018 Physical Activity Guidelines Advisory Committee systematically searched existing literature reviews to assess the relationship between high-intensity interval training (HIIT) and reduction in cardiometabolic disease risk. METHODS Duplicate independent screenings of 260 articles identified from PubMed®, Cochrane Library, and CINAHL databases yielded suitable data from one systematic review and two meta-analyses. Search terms included a combination of "high intensity" "physical activity/exercise" and "interval training" and outcome-specific terms. The quality of the included reviews was assessed using a tailored version of the AMSTARExBP report on quality. Exposure Subcommittee members graded scientific evidence strength based on a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. RESULTS Moderate evidence indicates that HIIT can improve insulin sensitivity, blood pressure, and body composition in adults with group mean ages ranging from ~20 to ~77 yr. These HIIT-induced improvements in cardiometabolic disease risk factors are comparable with those resulting from moderate-intensity continuous training, and they are more likely to occur in adults at higher risk of cardiovascular disease and diabetes than in healthy adults. Moderate evidence also indicates that adults with overweight or obesity classification are more responsive than adults with normal weight to HIIT-related improvements in insulin sensitivity, blood pressure, and body composition. Insufficient evidence was available to determine whether a dose-response relationship exists between the quantity of HIIT performed and several risk factors for cardiovascular disease and diabetes, or whether the effects of HIIT on cardiometabolic disease risk factors are influenced by age, sex, race/ethnicity, or socioeconomic status. CONCLUSIONS HIIT by adults, especially those with overweight and obesity classification, can improve insulin sensitivity, blood pressure, and body composition, comparable with those resulting from moderate-intensity continuous training.
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Supervised lifestyle intervention for people with metabolic syndrome improves outcomes and reduces individual risk factors of metabolic syndrome: A systematic review and meta-analysis.
van Namen, M, Prendergast, L, Peiris, C
Metabolism: clinical and experimental. 2019;:153988
Abstract
BACKGROUND Metabolic syndrome is characterised by a clustering of metabolic risk factors including abdominal obesity, raised triglycerides, lowered HDL cholesterol, hypertension and impaired glucose tolerance. Multifaceted lifestyle interventions including diet and exercise are recommended as the first-line treatment for the metabolic syndrome. OBJECTIVE To investigate the effects of lifestyle interventions that include both diet interventions and supervised exercise on outcomes for people with metabolic syndrome. METHODS A systematic review and meta-regression was conducted. PubMed, EMBASE, MEDLINE and CINAHL were searched from the earliest date possible until November 2018 to identify randomised controlled trials examining the effects of lifestyle interventions compared to usual care on patient health outcomes and components of metabolic syndrome. Post-intervention means and standard deviations were pooled using inverse variance methods and random-effects models to calculate mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (CI). RESULTS Searching identified 2598 articles, of which 15 articles reporting data from 10 trials, with 1160 participants were included in this review. Compared to usual care, supervised lifestyle intervention demonstrated significant improvements in all but one of the components of metabolic syndrome. Reductions were seen in waist circumference (-4.9 cm, 95%CI -8.0 to -1.7), systolic blood pressure (-6.5 mmHg, 95%CI -10.7 to -2.3), diastolic blood pressure (-1.9 mmHg, 95%CI -3.6 to -0.2), triglycerides (SMD -0.46, 95%CI -0.88 to -0.04) and fasting glucose (SMD -0.68, 95%CI -1.20 to -0.15). Prevalence of metabolic syndrome was reduced by 39% in intervention group participants compared to control group participants (Risk Ratio 0.61, 95%CI 0.38 to 0.96). Improvements in quality of life were not statistically significant. CONCLUSION There is low to moderate quality evidence that supervised multifaceted lifestyle intervention improves multiple risk factors of metabolic syndrome, as well as reducing prevalence of the disease. Health services should consider implementing lifestyle intervention programs for people with metabolic syndrome to improve health outcomes and prevent progression to chronic disease.