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1.
Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies.
Stefan, N, Häring, HU, Cusi, K
The lancet. Diabetes & endocrinology. 2019;(4):313-324
Abstract
The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide. In some patients with NAFLD, isolated steatosis can progress to advanced stages with non-alcoholic steatohepatitis (NASH) and fibrosis, increasing the risk of cirrhosis and hepatocellular carcinoma. Furthermore, NAFLD is believed to be involved in the pathogenesis of common disorders such as type 2 diabetes and cardiovascular disease. In this Review, we highlight novel concepts related to diagnosis, risk prediction, and treatment of NAFLD. First, because NAFLD is a heterogeneous disease, the advanced stages of which seem to be strongly affected by comorbidities such as insulin resistance and type 2 diabetes, early use of reliable, non-invasive diagnostic tools is needed, particularly in patients with insulin resistance or diabetes, to allow the identification of patients at different disease stages. Second, although the strongest genetic risk alleles for NAFLD (ie, the 148Met allele in PNPLA3 and the 167Lys allele in TM6SF2) are associated with increased liver fat content and progression to NASH and cirrhosis, these alleles are also unexpectedly associated with an apparent protection from cardiovascular disease. If consistent across diverse populations, this discordance in NAFLD-related risk prediction between hepatic and extrahepatic disease might need to be accounted for in the management of NAFLD. Third, drug treatments assessed in NAFLD seem to differ with respect to cardiometabolic and antifibrotic efficacy, suggesting the need to better identify and tailor the most appropriate treatment approach, or to use a combination of approaches. These emerging concepts could contribute to the development of a multidisciplinary approach for endocrinologists and hepatologists working together in the management of NAFLD.
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2.
A posteriori healthy dietary patterns may decrease the risk of central obesity: findings from a systematic review and meta-analysis.
Rezagholizadeh, F, Djafarian, K, Khosravi, S, Shab-Bidar, S
Nutrition research (New York, N.Y.). 2017;:1-13
Abstract
Central obesity is a pivotal component of metabolic syndrome, and several studies have investigated the association of dietary patterns and central obesity. However, findings of studies are inconclusive. Therefore, we aimed to conduct the present study to summarize the available data regarding the association of a posteriori dietary patterns and central obesity in adults to test the hypothesis of whether a highly healthy dietary pattern is associated with decreased risk of central obesity. We searched all published English studies to identify related articles in MEDLINE, EMBASE, and Google Scholar databases up to December 2015. The meta-analysis was conducted on 13 studies including 12 cross-sectional studies and 1 case-control study that reported odds ratios (ORs), relative risks, or hazard ratios for risk of central obesity. The between-study variance was assessed using Cochran Q test and I2. Subgroup analysis was applied to define possible sources of heterogeneity. The highest category of healthy/prudent patterns compared with those in the lowest category resulted in significant decrease in the risk of central obesity (pooled OR was 0.81 [95% confidence interval 0.66-0.96]). Pooled results indicated a higher nonsignificant increase in the risk of central obesity (OR was 1.16 [95% confidence interval 0.96-1.35]) in the highest category of Unhealthy/Western pattern compared with those in the lowest category. There was also a significant heterogeneity in the observed associations. We found that sex, country, and continent were the potential sources of heterogeneity. The results of the present meta-analysis showed that a posteriori healthy dietary patterns may decrease the risk of central obesity, whereas no significant association was found between unhealthy dietary patterns and central obesity. Together, the results highlight the need for well-designed and carefully carried out clinical trials based on dietary patterns in future research.
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3.
[Hallmarks of preventive counseling in coronary heart disease patients with abdominal obesity].
Pogosova, NV, Sokolova, OY, Salbieva, AO, Yufereva, YM, Ausheva, AK, Eganyan, RA
Kardiologiia. 2017;(S4):47-52
Abstract
Patients with coronary heart disease (CHD) and abdominal obesity (AO) are a priority group for the most active implementation of secondary prevention efforts. The paper focuses on most challenging issues of cardiovascular risk factors (RFs) correction via comprehensive cardiac rehabilitation (CR) programs in patients with CHD and AO. Based on large randomized clinical trials results, intensive behavioral interventions in the form of counselling are beneficial for such patients especially during the long-term support stage. They produce small but important changes in health behaviors (which translate into weight reduction, more healthy nutrition and higher physical activity) and improve selected intermediate clinical endpoints.
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4.
Comparison of anthropometric measurements of adiposity in relation to cancer risk: a systematic review of prospective studies.
De Ridder, J, Julián-Almárcegui, C, Mullee, A, Rinaldi, S, Van Herck, K, Vicente-Rodríguez, G, Huybrechts, I
Cancer causes & control : CCC. 2016;(3):291-300
Abstract
PURPOSE In epidemiology, the relationship between increased adiposity and cancer risk has long been recognized. However, whether the association is the same for measures of abdominal or whole body adiposity is unclear. The aim of this systematic review is to compare cancer risk, associated with body mass index (BMI), an indicator of whole body adiposity, with indicators of abdominal adiposity in studies in which these indicators have been directly measured. METHODS We conducted a systematic search from 1974 (EMBASE) and 1988 (PubMed) to September 2015 with keywords related to adiposity and cancer. Included studies were limited to cohort studies reporting directly measured anthropometry and performing mutually adjusted analyses. RESULTS Thirteen articles were identified, with two reporting on breast cancer, three on colorectal cancer, three on endometrial cancer, two on gastro-oesophageal cancer, two on renal cancer, one on ovarian cancer, one on bladder cancer, one on liver and biliary tract cancer and one on leukaemia. Evidence suggests that abdominal adiposity is a stronger predictor than whole body adiposity for gastro-oesophageal, leukaemia and liver and biliary tract cancer in men and women and for renal cancer in women. Abdominal adiposity was a stronger predictor for bladder and colorectal cancer in women, while only BMI was a predictor in men. In contrast, BMI appears to be a stronger predictor for ovarian cancer. For breast and endometrial cancer, both measures were predictors for cancer risk in postmenopausal women. CONCLUSIONS Only few studies used mutually adjusted and measured anthropometric indicators when studying adiposity-cancer associations. Further research investigating cancer risk and adiposity should include more accurate non-invasive indicators of body fat deposition and focus on the understudied cancer types, namely leukaemia, ovarian, bladder and liver and biliary tract cancer.
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5.
The Prevalence of Metabolic Syndrome In Chronic Obstructive Pulmonary Disease: A Systematic Review.
Cebron Lipovec, N, Beijers, RJ, van den Borst, B, Doehner, W, Lainscak, M, Schols, AM
COPD. 2016;(3):399-406
Abstract
Type 2 Diabetes Mellitus (T2DM) and cardiovascular diseases (CVD) are common in patients with chronic obstructive pulmonary disease (COPD). Prevention of these co-morbidities in COPD requires knowledge on their risk factors. Metabolic syndrome (MetS) predisposes to the development of T2DM and CVD but its prevalence in COPD remains unclear. The aim of this review was to assess the prevalence of MetS and its components in COPD patients compared to controls and to investigate the contribution of clinical characteristics to MetS prevalence. We systematically searched PubMed and EMBASE for original studies in COPD that have investigated the prevalence of MetS and its components. In total, 19 studies involving 4208 COPD patients were included. The pooled MetS prevalence was 34%. Compared to controls, the prevalence was higher in COPD (10 studies, 32% and 30%, p = 0.001). The three most prevalent components in both COPD and controls were arterial hypertension (56% and 51%), abdominal obesity (39% and 38%) and hyperglycemia (44% and 47%). Compared to COPD patients without MetS, those with MetS had higher body mass index (BMI) (29.9 and 24.6 kg/m(2), p < 0.001), higher forced expiratory volume in 1 second (FEV1) % predicted (54 and 51, p < 0.001) and were more frequently female (31% and 25%, p = 0.011). In conclusion, the prevalence of MetS in COPD patients is high and hypertension, abdominal obesity and hyperglycemia are the most prevalent components. Further studies are needed to evaluate the impact of lifestyle factors and medications on MetS in COPD.
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6.
The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis.
Rabkin, SW
Metabolic syndrome and related disorders. 2014;(1):31-42
Abstract
Epicardial fat (epicardial adipose tissue, EAT) has been implicated in the pathogenesis of coronary artery disease (CAD). The objective of this study was to examine the relationship between EAT and generalized obesity, central or visceral adipose tissue (VAT), and the components of the metabolic syndrome--systolic blood pressure (SBP), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG)--that are linked to CAD. A systematic review of the literature, following meta-analysis guidelines, was conducted until May, 2013, using the search strategy "Obesity" OR "abdominal obesity" OR "metabolic syndrome" OR "metabolic syndrome X" AND "epicardial fat". Thirty-eight studies fulfilled the criteria. There was a highly significant (P<0.00001) correlation between EAT and body mass index (BMI), waist circumference (WC), or VAT. The correlation between EAT and VAT was significantly (P<0.0001) greater than the correlation between EAT and WC, which in turn was significantly greater than the correlation between EAT and BMI. Overall, EAT was 7.5 ± 0.1 mm in thickness in the metabolic syndrome (n=427) compared to 4.0 ± 0.1 mm in controls (n=301). EAT correlated significantly (P<0.0001) with SBP, TGs, HDL, and FBG, but the strength of the association was less than one-half of the relationship of EAT to indices of obesity. The results of multivariate analysis were less consistent but show a relationship between EAT and metabolic syndrome independent of BMI. In summary, the very strong correlation between EAT and VAT suggests a relationship between these two adipose tissue depots. Measurement of EAT can be useful to indicate VAT. Whereas EAT correlates significantly with each of the components of the metabolic syndrome- SBP, TGs, HDL, or FBG-the magnitude of the relationship is considerably and significantly less than the relationship of EAT to BMI. These data show the strong relationship between EAT and BMI but especially with WC and VAT. They also demonstrate the smaller magnitude of the association of EAT with standard coronary risk factors, related to the metabolic syndrome, and suggest that the unique features of this adipose tissue warrant detailed investigation.
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7.
Resistance training, visceral obesity and inflammatory response: a review of the evidence.
Strasser, B, Arvandi, M, Siebert, U
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2012;(7):578-91
Abstract
Intra-abdominal obesity is an important risk factor for low-grade inflammation, which is associated with increased risk for diabetes mellitus and cardiovascular disease. For the most part, recommendations to treat or prevent overweight and obesity via physical activity have focused on aerobic endurance training as it is clear that aerobic training is associated with much greater energy expenditure during the exercise session than resistance training. However, due to the metabolic consequences of reduced muscle mass, it is understood that normal ageing and/or decreased physical activity may lead to a higher prevalence of metabolic disorders. Whether resistance training alters visceral fat and the levels of several pro-inflammatory cytokines produced in adipose tissue has not been addressed in earlier reviews. Because evidence suggests that resistance training may promote a negative energy balance and may change body fat distribution, it is possible that an increase in muscle mass after resistance training may be a key mediator leading to a better metabolic control. Considering the benefits of resistance training on visceral fat and inflammatory response, an important question is: how much resistance training is needed to confer such benefits? Therefore, the purpose of this review was to address the importance of resistance training on abdominal obesity, visceral fat and inflammatory response.
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8.
Prevalence of abdominal obesity in adolescents: a systematic review.
de Moraes, AC, Fadoni, RP, Ricardi, LM, Souza, TC, Rosaneli, CF, Nakashima, AT, Falcão, MC
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2011;(2):69-77
Abstract
The objectives of this study were to (i) review extant literature on the prevalence of abdominal obesity (AO) in adolescents of both sex (10-19 years old); (ii) analyse the cut-off points used for the diagnosis of AO and (iii) compare its prevalence between developed and developing countries. The search was carried out using online databases (MEDLINE, Web of Science, EMBASE, SPORTDiscus, SCIELO and BioMed Central), references cited by retrieved articles and by contact with the authors, considering articles published from the establishment of the databanks until 19 October 2009. Only original articles and those using waist circumference in the diagnosis were considered. Twenty-nine studies met the inclusion criteria. Fourteen of these studies were performed in developed countries. The prevalence of AO varied from 3.8% to 51.7% in adolescents from developing countries. The range of results was smaller among developed countries; with values from 8.7% to 33.2%. Eighteen different cut-off points were used. It was concluded the AO prevalence is high among adolescents, but is not clear what sex has a higher proportion and it is greater in adolescents from developing countries; however, there is no consensus in the literature about the criteria to be used.
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9.
The metabolic syndrome--new and old data.
Pîrcălăboiu, L, Popa, S, Puiu, I, Dinu, RI, Dinu, F, Moţa, M
Romanian journal of internal medicine = Revue roumaine de medecine interne. 2010;(2):193-203
Abstract
Initially called the "X Syndrome" by Reaven, then the "Killer Quartet" by Kaplan, the MS prevalence has dramatically increased in the past decades. The first criteria elaborated by WHO in 1998, and afterwards reformulated in 1999, were conceived by diabetologists as a working instrument for clinical practice and they shall consequently be updated in accordance with the new acquisitions in this field. MS expresses the complex disorder of the organism energetic metabolism, having as central element insulin resistance and compensatory hyperinsulinism, associated with the presence of some risk factors involved in the etiology and/or physiology of atherosclerosis. The interaction between the genetic factors and the acquired ones induces a series of functional anomalies, which finally lead to a high risk of cardiovascular diseases. Abdominal obesity seems to be the most important component of the MS, which may be correlated with systemic inflammation and the decrease of adiponectin concentration. We should not overlook the part played by the other components: plasmatic TG, HDL, LDL - cholesterol, plasmatic glycaemia, blood pressure, microalbuminuria, plasmatic uric acid. The MS patient will be clinically and paraclinically examined by calculating the vascular and metabolic risks and, thus, establishing the therapeutical objectives and targets of every factor in order to maximally reduce the cardiovascular and DM risks. The treatment will be individualized, as present definitions include MS both in patients with clearly expressed diseases (Type 2 DM, Hypertension, coronary disease) as well as in patients with limit modifications. This fact will involve both improvement of lifestyle and drugs treatment, as well. MS prevention more and more imposes itself by individual and populational strategies of preventing obesity, through the educating population to adopt a healthy lifestyle, involving the whole medical staff.
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10.
Metabolic syndrome in Cushing's syndrome.
Chanson, P, Salenave, S
Neuroendocrinology. 2010;:96-101
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Abstract
Although the concept of metabolic syndrome (MetS) as a disease entity continues to be debated, it provides a means by which patients at risk for diabetes and cardiovascular disease can be identified and categorized with routinely available criteria. Insulin resistance plays a central role in these abnormalities. Risk factors include central obesity, elevated fasting glucose, hypertension, elevated serum triglycerides, and low high-density-lipoprotein cholesterol. Various definitions of MetS have been proposed since 1998. Recently, a joint statement by several major organizations concluded that three abnormal values in a series of five criteria determined whether a person had MetS, and that elevated waist circumference was not an obligatory feature. A single set of cutoff points was proposed, except for waist circumference, which should be defined according to population and ethnic group. Cushing's syndrome (CS) represents an archetype of MetS. High glucocorticoid levels lead to muscle, liver and adipocyte insulin resistance. Almost all patients with CS are obese or overweight, and have abdominal visceral adiposity. Many also have glucose metabolism abnormalities (21-60% and 20-47% of the patients have impaired glucose tolerance and diabetes, respectively), hypertension (more than 70% of the patients), and elevated triglyceride levels (20% of the patients). Almost two thirds of CS patients fulfill at least three criteria for MetS. The elevated incidence of diabetes and premature atherosclerosis (directly related to the length of exposure to hypercortisolism), and the increased mortality (particularly cardiovascular mortality) relative to the general population (2 to 4 times higher) show that the predictive value of MetS is also valid in CS. Effective treatment of hypercortisolism improves each of the five MetS components, but MetS and carotid atherosclerosis persist in most patients, and the cardiovascular risk therefore remains elevated. This calls for aggressive treatment of comorbidities and for very long-term follow-up.