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Nutrients
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Metabolic Syndrome: From Etiology to Prevention and Clinical Management
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Metabolic Syndrome: From Etiology to Prevention and Clinical Management

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 August 2019) | Viewed by 217341

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Isabelle Lemieux

E-Mail Website
Guest Editor
Québec Heart and Lung Institute Research Centre, Québec City, QC, Canada
Interests: body fat distribution; cardiovascular disease; lipoprotein-lipid profile; low-grade inflammation; metabolic syndrome; obesity; prevention; type 2 diabetes
Prof. Dr. Jean-Pierre Després

E-Mail
Guest Editor
Québec Heart and Lung Institute Research Centre, Québec City, QC, Canada
Interests: body fat distribution, cardiovascular disease, lipoprotein-lipid profile, low-grade inflammation, intervention studies, metabolic syndrome, obesity, population health, prevention, type 2 diabetes

Special Issue Information

Dear Colleagues,

Although metabolic syndrome has been the topic of countless original papers, review articles, editorials, and books, it has remained at times a subject of confusion and debate. Nevertheless, and although some experts have even questioned its clinical relevance, it is clear that its presence increases the risk of type 2 diabetes and cardiovascular disease. For instance, studies have shown that the presence of metabolic syndrome increases the risk of type 2 diabetes and cardiovascular disease even in the absence of so-called traditional risk factors. More than a decade ago, our team made the point that one could not dissociate the most prevalent form of metabolic syndrome from abdominal obesity, which can be found even among individuals who are not considered obese by body weight standards.

Over the past decades, the development of sophisticated imaging techniques such as computed tomography and magnetic resonance imaging has allowed us to deepen our understanding of the link between abdominal obesity, regional body fat partitioning and cardiometabolic risk. It is now widely accepted that visceral obesity is the most dangerous form of obesity, while subcutaneous obesity is seldom associated with metabolic complications. It has been proposed that excess visceral fat may indicate that an individual’s subcutaneous adipose tissue is unable to serve as an “energy sink” when facing a positive energy balance. Such failure of the subcutaneous metabolic sink may cause lipid accumulation at undesired sites such as the liver, heart, skeletal muscle, kidney and pancreas, a condition described as ectopic fat deposition.

Among effective approaches to prevent, delay or manage the metabolic syndrome, lifestyle changes are key elements, emphasizing the importance of healthy global dietary patterns, regular physical activity and adequate sleep quality.

This Special Issue welcomes original works and up-to-date review papers from scientists investigating various aspects related to the etiology of the metabolic syndrome, its prevention and its management. 

Dr. Isabelle Lemieux
Prof. Dr. Jean-Pierre Després
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Atherogenic dyslipidemia
  • Cardiovascular disease
  • Diabetes
  • Ectopic fat
  • Glucose–insulin homeostasis
  • Hypertension
  • Inflammation
  • Insulin resistance
  • Lifestyle changes
  • Metabolic syndrome
  • Nutrition
  • Pharmacotherapy
  • Physical activity/exercise
  • Pro-thrombotic state

Published Papers (22 papers)

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Editorial

Jump to: Research, Review, Other

7 pages, 250 KiB  
Editorial
Metabolic Syndrome: Past, Present and Future
by Isabelle Lemieux and Jean-Pierre Després
Nutrients 2020, 12(11), 3501; https://doi.org/10.3390/nu12113501 - 14 Nov 2020
Cited by 104 | Viewed by 15870
Abstract
Most clinicians and health professionals have heard or read about metabolic syndrome [...] Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)

Research

Jump to: Editorial, Review, Other

16 pages, 324 KiB  
Communication
Ethnicity and Metabolic Syndrome: Implications for Assessment, Management and Prevention
by Scott A. Lear and Danijela Gasevic
Nutrients 2020, 12(1), 15; https://doi.org/10.3390/nu12010015 - 19 Dec 2019
Cited by 34 | Viewed by 6052
Abstract
The metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors that identifies people at increased risk for type 2 diabetes and cardiovascular disease. While the global prevalence is 20%–25% of the adult population, the prevalence varies across different racial/ethnic populations. In this [...] Read more.
The metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors that identifies people at increased risk for type 2 diabetes and cardiovascular disease. While the global prevalence is 20%–25% of the adult population, the prevalence varies across different racial/ethnic populations. In this narrative review, evidence is reviewed regarding the assessment, management and prevention of MetS among people of different racial/ethnic groups. The most popular definition of MetS considers race/ethnicity for assessing waist circumference given differences in visceral adipose tissue and cardiometabolic risk. However, defining race/ethnicity may pose challenges in the clinical setting. Despite 80% of the world’s population being of non-European descent, the majority of research on management and prevention has focused on European-derived populations. In these studies, lifestyle management has proven an effective therapy for reversal of MetS, and randomised studies are underway in specific racial/ethnic groups. Given the large number of people at risk for MetS, prevention efforts need to focus at community and population levels. Community-based interventions have begun to show promise, and efforts to improve lifestyle behaviours through alterations in the built environment may be another avenue. However, careful consideration needs to be given to take into account the unique cultural context of the target race/ethnic group. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
16 pages, 1396 KiB  
Communication
Dietary Fructose and the Metabolic Syndrome
by Marja-Riitta Taskinen, Chris J Packard and Jan Borén
Nutrients 2019, 11(9), 1987; https://doi.org/10.3390/nu11091987 - 22 Aug 2019
Cited by 162 | Viewed by 21803
Abstract
Consumption of fructose, the sweetest of all naturally occurring carbohydrates, has increased dramatically in the last 40 years and is today commonly used commercially in soft drinks, juice, and baked goods. These products comprise a large proportion of the modern diet, in particular [...] Read more.
Consumption of fructose, the sweetest of all naturally occurring carbohydrates, has increased dramatically in the last 40 years and is today commonly used commercially in soft drinks, juice, and baked goods. These products comprise a large proportion of the modern diet, in particular in children, adolescents, and young adults. A large body of evidence associate consumption of fructose and other sugar-sweetened beverages with insulin resistance, intrahepatic lipid accumulation, and hypertriglyceridemia. In the long term, these risk factors may contribute to the development of type 2 diabetes and cardiovascular diseases. Fructose is absorbed in the small intestine and metabolized in the liver where it stimulates fructolysis, glycolysis, lipogenesis, and glucose production. This may result in hypertriglyceridemia and fatty liver. Therefore, understanding the mechanisms underlying intestinal and hepatic fructose metabolism is important. Here we review recent evidence linking excessive fructose consumption to health risk markers and development of components of the Metabolic Syndrome. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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16 pages, 326 KiB  
Article
Dietary Fat Intake and Metabolic Syndrome in Older Adults
by Alicia Julibert, Maria del Mar Bibiloni, David Mateos, Escarlata Angullo and Josep A. Tur
Nutrients 2019, 11(8), 1901; https://doi.org/10.3390/nu11081901 - 14 Aug 2019
Cited by 32 | Viewed by 6635
Abstract
Background: Metabolic Syndrome (MetS) is associated with higher rates of cardiovascular disease (CVD), type 2 diabetes mellitus, and cancer worldwide. Objective: To assess fat intake in older adults with or without MetS. Design: Cross-sectional nutritional survey in older adults living in the Balearic [...] Read more.
Background: Metabolic Syndrome (MetS) is associated with higher rates of cardiovascular disease (CVD), type 2 diabetes mellitus, and cancer worldwide. Objective: To assess fat intake in older adults with or without MetS. Design: Cross-sectional nutritional survey in older adults living in the Balearic Islands (n = 477, 48% women, 55–80 years old) with no previous CVD. Methods: Assessment of fat (total fat, MUFA, PUFA, SFA, TFA, linoleic acid, α-linolenic acid, marine and non-marine ω-3 FA, animal fat and vegetable fat, cholesterol) and macronutrient intake using a validated food frequency questionnaire, and its comparison with recommendations of the US Institute of Medicine (IOM) and the Spanish Society of Community Nutrition (SENC). Results: Participants with MetS showed higher BMI, lower physical activity, higher total fat and MUFA intake, and lower intake of energy, carbohydrates, and fiber than participants without MetS. Men and women with MetS were below the Acceptable Macronutrient Distribution Range (AMDR) proposed by IOM for carbohydrates and above the AMDR for total fat and MUFAs, and women were below the AMDR proposed for α-linolenic acid (ALA) compared with participants without MetS. Conclusions: Subjects with MetS were less likely to meet IOM and SENC recommendations for fat and macronutrient intakes as compared to non-MetS subjects. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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12 pages, 1082 KiB  
Communication
Assessing and Managing the Metabolic Syndrome in Children and Adolescents
by Mark D. DeBoer
Nutrients 2019, 11(8), 1788; https://doi.org/10.3390/nu11081788 - 2 Aug 2019
Cited by 112 | Viewed by 13357
Abstract
The metabolic syndrome (MetS) is a group of cardiovascular risk factors that are associated with insulin resistance and are driven by underlying factors, including visceral obesity, systemic inflammation, and cellular dysfunction. These risks increasingly begin in childhood and adolescence and are associated with [...] Read more.
The metabolic syndrome (MetS) is a group of cardiovascular risk factors that are associated with insulin resistance and are driven by underlying factors, including visceral obesity, systemic inflammation, and cellular dysfunction. These risks increasingly begin in childhood and adolescence and are associated with a high likelihood of future chronic disease in adulthood. Efforts should be made at both recognition of this metabolic risk, screening for potential associated Type 2 diabetes, and targeting affected individuals for appropriate treatment with an emphasis on lifestyle modification. Effective interventions have been linked to reductions in MetS—and in adults, reductions in the severity of MetS have been linked to reduced diabetes and cardiovascular disease. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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16 pages, 804 KiB  
Article
Validation of Surrogate Anthropometric Indices in Older Adults: What Is the Best Indicator of High Cardiometabolic Risk Factor Clustering?
by Robinson Ramírez-Vélez, Miguel Ángel Pérez-Sousa, Mikel Izquierdo, Carlos A. Cano-Gutierrez, Emilio González-Jiménez, Jacqueline Schmidt-RioValle, Katherine González-Ruíz and María Correa-Rodríguez
Nutrients 2019, 11(8), 1701; https://doi.org/10.3390/nu11081701 - 24 Jul 2019
Cited by 27 | Viewed by 5022 | Correction
Abstract
The present study evaluated the ability of five obesity-related parameters, including a body shape index (ABSI), conicity index (CI), body roundness index (BRI), body mass index (BMI), and waist-to-height ratio (WtHR) for predicting increased cardiometabolic risk in a population of elderly Colombians. A [...] Read more.
The present study evaluated the ability of five obesity-related parameters, including a body shape index (ABSI), conicity index (CI), body roundness index (BRI), body mass index (BMI), and waist-to-height ratio (WtHR) for predicting increased cardiometabolic risk in a population of elderly Colombians. A cross-sectional study was conducted on 1502 participants (60.3% women, mean age 70 ± 7.6 years) and subjects’ weight, height, waist circumference, serum lipid indices, blood pressure, and fasting plasma glucose were measured. A cardiometabolic risk index (CMRI) was calculated using the participants’ systolic and diastolic blood pressure, triglycerides, high-density lipoprotein and fasting glucose levels, and waist circumference. Following the International Diabetes Federation definition, metabolic syndrome was defined as having three or more metabolic abnormalities. All surrogate anthropometric indices correlated significantly with CMRI (p < 0.01). Receiver operating characteristic curve analysis of how well the anthropometric indices identified high cardiometabolic risk showed that WtHR and BRI were the most accurate indices. The best WtHR and BRI cut-off points in men were 0.56 (area under curve, AUC 0.77) and 4.71 (AUC 0.77), respectively. For women, the WtHR and BRI cut-off points were 0.63 (AUC 0.77) and 6.20 (AUC 0.77), respectively. In conclusion, BRI and WtHR have a moderate discriminating power for detecting high cardiometabolic risk in older Colombian adults, supporting the idea that both anthropometric indices are useful screening tools for use in the elderly. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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16 pages, 3290 KiB  
Article
Linseed Components Are More Effective Than Whole Linseed in Reversing Diet-Induced Metabolic Syndrome in Rats
by Siti Raihanah Shafie, Stephen Wanyonyi, Sunil K. Panchal and Lindsay Brown
Nutrients 2019, 11(7), 1677; https://doi.org/10.3390/nu11071677 - 22 Jul 2019
Cited by 12 | Viewed by 4625
Abstract
Linseed is a dietary source of plant-based ω–3 fatty acids along with fiber as well as lignans including secoisolariciresinol diglucoside (SDG). We investigated the reversal of signs of metabolic syndrome following addition of whole linseed (5%), defatted linseed (3%), or SDG (0.03%) to [...] Read more.
Linseed is a dietary source of plant-based ω–3 fatty acids along with fiber as well as lignans including secoisolariciresinol diglucoside (SDG). We investigated the reversal of signs of metabolic syndrome following addition of whole linseed (5%), defatted linseed (3%), or SDG (0.03%) to either a high-carbohydrate, high-fat or corn starch diet for rats for the final eight weeks of a 16–week protocol. All interventions reduced plasma insulin, systolic blood pressure, inflammatory cell infiltration in heart, ventricular collagen deposition, and diastolic stiffness but had no effect on plasma total cholesterol, nonesterified fatty acids, or triglycerides. Whole linseed did not change the body weight or abdominal fat in obese rats while SDG and defatted linseed decreased abdominal fat and defatted linseed increased lean mass. Defatted linseed and SDG, but not whole linseed, improved heart and liver structure, decreased fat vacuoles in liver, and decreased plasma leptin concentrations. These results show that the individual components of linseed produce greater potential therapeutic responses in rats with metabolic syndrome than whole linseed. We suggest that the reduced responses indicate reduced oral bioavailability of the whole seeds compared to the components. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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13 pages, 1044 KiB  
Article
Metabolic Syndrome and Its Associated Early-Life Factors among Chinese and Spanish Adolescents: A Pilot Study
by Jiao Wang, Javier S. Perona, Jacqueline Schmidt-RioValle, Yajun Chen, Jin Jing and Emilio González-Jiménez
Nutrients 2019, 11(7), 1568; https://doi.org/10.3390/nu11071568 - 11 Jul 2019
Cited by 20 | Viewed by 3401
Abstract
Metabolic syndrome (MetS) is a growing problem worldwide in adolescents. This study compared two sample populations of young people in Spain and China, and analyzed the association of birth weight and breastfeeding duration with MetS. A cross-sectional study was conducted in adolescents (10–15 [...] Read more.
Metabolic syndrome (MetS) is a growing problem worldwide in adolescents. This study compared two sample populations of young people in Spain and China, and analyzed the association of birth weight and breastfeeding duration with MetS. A cross-sectional study was conducted in adolescents (10–15 years old); 1150 Chinese and 976 Spanish adolescents. The variables analyzed were anthropometric characteristics, biochemical markers, and demographic characteristics using the same methodology and data collection protocol. Also, birth weight and breastfeeding were retrospectively analyzed during the first year of life. The results showed statistically significant differences between the two groups in reference to body mass index (BMI), blood pressure, triglyceride, glucose, and high-density lipoprotein cholesterol (HDL-C) levels. The MetS prevalence was higher in Spanish adolescents (2.5%) than in the Chinese group (0.5%). Breastfeeding duration was inversely associated with hypertriglyceridemia, low HDL-C, and MetS, whereas higher birth weight was associated with hyperglycemia, low HDL-C, hypertriglyceridemia, and abdominal obesity. Spanish adolescents showed more altered MetS components, and consequently, a higher MetS prevalence than the Chinese adolescents. This made them more vulnerable to cardiometabolic risk. Our results highlight the need for interventions designed by health professionals, which would encourage pregnant women to breastfeed their children. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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11 pages, 2147 KiB  
Communication
Population Approaches Targeting Metabolic Syndrome Focusing on Japanese Trials
by Hitoshi Nishizawa and Iichiro Shimomura
Nutrients 2019, 11(6), 1430; https://doi.org/10.3390/nu11061430 - 25 Jun 2019
Cited by 19 | Viewed by 5321
Abstract
The clinical importance of assessment of metabolic syndrome lies in the selection of individuals with multiple risk factors based on visceral fat accumulation, and helping them to reduce visceral fat. Behavioral modification by population approach is important, which adds support to the personal [...] Read more.
The clinical importance of assessment of metabolic syndrome lies in the selection of individuals with multiple risk factors based on visceral fat accumulation, and helping them to reduce visceral fat. Behavioral modification by population approach is important, which adds support to the personal approach. The complexity of visceral fat accumulation requires multicomponent and multilevel intervention. Preparation of food and physical environments could be useful strategies for city planners. Furthermore, actions on various frameworks, including organizational, community, and policy levels, have been recently reported. There are universal public health screening programs and post-screening health educational systems in Japan, and diseases management programs in Germany. Understanding one’s own health status is important for motivation for lifestyle modification. The U.S. Preventive Services Task Force recommends that primary care practitioners screen all adults for obesity and offer behavioral interventions and intensive counseling. Established evidence-based guidelines for behavioral counseling are needed within the primary care setting. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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13 pages, 1273 KiB  
Article
Metabolic Syndrome in Arab Adults with Low Bone Mineral Density
by Kaiser Wani, Sobhy M. Yakout, Mohammed Ghouse Ahmed Ansari, Shaun Sabico, Syed Danish Hussain, Majed S. Alokail, Eman Sheshah, Naji J. Aljohani, Yousef Al-Saleh, Jean-Yves Reginster and Nasser M. Al-Daghri
Nutrients 2019, 11(6), 1405; https://doi.org/10.3390/nu11061405 - 21 Jun 2019
Cited by 20 | Viewed by 3514
Abstract
There are discrepancies in the reports on the association of metabolic syndrome (MetS) and its components with bone mineral density (BMD) and hence more population-based studies on this subject are needed. In this context, this observational study was aimed to investigate the association [...] Read more.
There are discrepancies in the reports on the association of metabolic syndrome (MetS) and its components with bone mineral density (BMD) and hence more population-based studies on this subject are needed. In this context, this observational study was aimed to investigate the association between T-scores of BMD at lumbar L1–L4 and full MetS and its individual components. A total of 1587 participants (84.7% females), >35 years and with risk factors associated with bone loss were recruited from February 2013 to August 2016. BMD was done at L1–L4 using dual-energy X-ray absorptiometry (DXA). T-Scores were calculated. Fasting blood samples and anthropometrics were done at recruitment. Fasting lipid profile and glucose were measured. Screening for full MetS and its components was done according to the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. Logistic regression analysis revealed that the odds of having full MetS increased significantly from the lowest T-score tertile to the highest one in both sexes (OR, odd ratio (95% CI, confidence interval) of tertile 2 and 3 at 1.49 (0.8 to 2.8) and 2.46 (1.3 to 4.7), p = 0.02 in males and 1.35 (1.0 to 1.7) and 1.45 (1.1 to1.9), p < 0.01 in females). The odds remained significant even after adjustments with age, body mass index (BMI), and other risk factors associated with bone loss. Among the components of MetS, only central obesity showed a significant positive association with T-score. The study suggests a significant positive association of T-score (spine) with full MetS irrespective of sex, and among the components of MetS this positive association was seen specifically with central obesity. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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15 pages, 597 KiB  
Article
Waist Circumference and Abdominal Volume Index Can Predict Metabolic Syndrome in Adolescents, but only When the Criteria of the International Diabetes Federation are Employed for the Diagnosis
by Javier S. Perona, Jacqueline Schmidt-RioValle, Ángel Fernández-Aparicio, María Correa-Rodríguez, Robinson Ramírez-Vélez and Emilio González-Jiménez
Nutrients 2019, 11(6), 1370; https://doi.org/10.3390/nu11061370 - 18 Jun 2019
Cited by 21 | Viewed by 4693
Abstract
We previously reported, using the diagnostic criteria of the International Diabetes Federation (IDF), that waist circumference (WC) and abdominal volume index (AVI) were capable of predicting metabolic syndrome (MetS) in adolescents. This study was aimed at confirming this finding when other diagnostic criteria [...] Read more.
We previously reported, using the diagnostic criteria of the International Diabetes Federation (IDF), that waist circumference (WC) and abdominal volume index (AVI) were capable of predicting metabolic syndrome (MetS) in adolescents. This study was aimed at confirming this finding when other diagnostic criteria are used. A cross-sectional study was performed on 981 Spanish adolescents (13.2 ± 1.2 years). MetS was diagnosed by eight different criteria. Ten anthropometric indexes were calculated and receiver-operator curves (ROC) were created to determine their discriminatory capacity for MetS. Of all diagnostic criteria, the ones proposed by the IDF showed the highest mean values for weight, WC and systolic blood pressure in boys and girls with MetS, and the lowest for glucose and triglycerides in boys. ROC analysis showed that only WC, AVI and body roundness index (BRI) achieved area under the curve (AUC) values above 0.8 in boys, and that fat content, body mass index (BMI), WC, AVI, BRI and pediatric body adiposity index (BAIp) showed AUC values above 0.8 in girls. Importantly, this occurred only when diagnosis was carried out using the IDF criteria. We confirm that WC and AVI can predict MetS in adolescents but only when the IDF’s diagnostic criteria are employed. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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17 pages, 2756 KiB  
Article
Metabolomic Salivary Signature of Pediatric Obesity Related Liver Disease and Metabolic Syndrome
by Jacopo Troisi, Federica Belmonte, Antonella Bisogno, Luca Pierri, Angelo Colucci, Giovanni Scala, Pierpaolo Cavallo, Claudia Mandato, Antonella Di Nuzzi, Laura Di Michele, Anna Pia Delli Bovi, Salvatore Guercio Nuzio and Pietro Vajro
Nutrients 2019, 11(2), 274; https://doi.org/10.3390/nu11020274 - 26 Jan 2019
Cited by 33 | Viewed by 5432
Abstract
Pediatric obesity-related metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD) are increasingly frequent conditions with a still-elusive diagnosis and low-efficacy treatment and monitoring options. In this study, we investigated the salivary metabolomic signature, which has been uncharacterized to date. In this pilot-nested [...] Read more.
Pediatric obesity-related metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD) are increasingly frequent conditions with a still-elusive diagnosis and low-efficacy treatment and monitoring options. In this study, we investigated the salivary metabolomic signature, which has been uncharacterized to date. In this pilot-nested case-control study over a transversal design, 41 subjects (23 obese patients and 18 normal weight (NW) healthy controls), characterized based on medical history, clinical, anthropometric, and laboratory data, were recruited. Liver involvement, defined according to ultrasonographic liver brightness, allowed for the allocation of the patients into four groups: obese with hepatic steatosis ([St+], n = 15) and without hepatic steatosis ([St–], n = 8), and with (n = 10) and without (n = 13) MetS. A partial least squares discriminant analysis (PLS-DA) model was devised to classify the patients’ classes based on their salivary metabolomic signature. Pediatric obesity and its related liver disease and metabolic syndrome appear to have distinct salivary metabolomic signatures. The difference is notable in metabolites involved in energy, amino and organic acid metabolism, as well as in intestinal bacteria metabolism, possibly reflecting diet, fatty acid synthase pathways, and the strict interaction between microbiota and intestinal mucins. This information expands the current understanding of NAFLD pathogenesis, potentially translating into better targeted monitoring and/or treatment strategies in the future. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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16 pages, 686 KiB  
Article
Associations Between Dietary Protein Sources, Plasma BCAA and Short-Chain Acylcarnitine Levels in Adults
by Michèle Rousseau, Frédéric Guénard, Véronique Garneau, Bénédicte Allam-Ndoul, Simone Lemieux, Louis Pérusse and Marie-Claude Vohl
Nutrients 2019, 11(1), 173; https://doi.org/10.3390/nu11010173 - 15 Jan 2019
Cited by 46 | Viewed by 5905
Abstract
Elevated plasma branched-chain amino acids (BCAA) and C3 and C5 acylcarnitines (AC) levels observed in individuals with insulin resistance (IR) might be influenced by dietary protein intakes. This study explores the associations between dietary protein sources, plasma BCAA levels and C3 and C5 [...] Read more.
Elevated plasma branched-chain amino acids (BCAA) and C3 and C5 acylcarnitines (AC) levels observed in individuals with insulin resistance (IR) might be influenced by dietary protein intakes. This study explores the associations between dietary protein sources, plasma BCAA levels and C3 and C5 ACs in normal weight (NW) or overweight (OW) individuals with or without metabolic syndrome (MS). Data from 199 men and women aged 18–55 years with complete metabolite profile were analyzed. Associations between metabolic parameters, protein sources, plasma BCAA and AC levels were tested. OW/MS+ consumed significantly more animal protein (p = 0.0388) and had higher plasma BCAA levels (p < 0.0001) than OW/MS− or NW/MS− individuals. Plasma BCAA levels were not associated with BCAA intakes in the whole cohort, while there was a trend for an association between plasma BCAA levels and red meat or with animal protein in OW/MS+. These associations were of weak magnitude. In NW/MS− individuals, the protein sources associated with BCAA levels varied greatly with adjustment for confounders. Plasma C3 and C5 ACs were associated with plasma BCAA levels in the whole cohort (p < 0.0001) and in subgroups based on OW and MS status. These results suggest a modest association of meat or animal protein intakes and an association of C3 and C5 ACs with plasma BCAA levels, obesity and MS. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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15 pages, 905 KiB  
Article
Healthy Lifestyle and Incidence of Metabolic Syndrome in the SUN Cohort
by Maria Garralda-Del-Villar, Silvia Carlos-Chillerón, Jesus Diaz-Gutierrez, Miguel Ruiz-Canela, Alfredo Gea, Miguel Angel Martínez-González, Maira Bes-Rastrollo, Liz Ruiz-Estigarribia, Stefanos N. Kales and Alejandro Fernández-Montero
Nutrients 2019, 11(1), 65; https://doi.org/10.3390/nu11010065 - 30 Dec 2018
Cited by 71 | Viewed by 6445
Abstract
We assessed the relationship between a healthy lifestyle and the subsequent risk of developing metabolic syndrome. The “Seguimiento Universidad de Navarra” (SUN) Project is a prospective cohort study, focused on nutrition, lifestyle, and chronic diseases. Participants (n = 10,807, mean age 37 [...] Read more.
We assessed the relationship between a healthy lifestyle and the subsequent risk of developing metabolic syndrome. The “Seguimiento Universidad de Navarra” (SUN) Project is a prospective cohort study, focused on nutrition, lifestyle, and chronic diseases. Participants (n = 10,807, mean age 37 years, 67% women) initially free of metabolic syndrome were followed prospectively for a minimum of 6 years. To evaluate healthy lifestyle, nine habits were used to derive a Healthy Lifestyle Score (HLS): Never smoking, moderate to high physical activity (>20 MET-h/week), Mediterranean diet (≥4/8 adherence points), moderate alcohol consumption (women, 0.1–5.0 g/day; men, 0.1–10.0 g/day), low television exposure (<2 h/day), no binge drinking (≤5 alcoholic drinks at any time), taking a short afternoon nap (<30 min/day), meeting up with friends >1 h/day, and working at least 40 h/week. Metabolic syndrome was defined according to the harmonizing definition. The association between the baseline HLS and metabolic syndrome at follow-up was assessed with multivariable-adjusted logistic regressions. During follow-up, we observed 458 (4.24%) new cases of metabolic syndrome. Participants in the highest category of HLS adherence (7–9 points) enjoyed a significantly reduced risk of developing metabolic syndrome compared to those in the lowest category (0–3 points) (adjusted odds ratio (OR) = 0.66, 95% confidence interval (CI) = 0.47–0.93). Higher adherence to the Healthy Lifestyle Score was associated with a lower risk of developing metabolic syndrome. The HLS may be a simple metabolic health promotion tool. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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19 pages, 749 KiB  
Article
Trimethylamine-N-oxide (TMAO) as Novel Potential Biomarker of Early Predictors of Metabolic Syndrome
by Luigi Barrea, Giuseppe Annunziata, Giovanna Muscogiuri, Carolina Di Somma, Daniela Laudisio, Maria Maisto, Giulia De Alteriis, Gian Carlo Tenore, Annamaria Colao and Silvia Savastano
Nutrients 2018, 10(12), 1971; https://doi.org/10.3390/nu10121971 - 13 Dec 2018
Cited by 164 | Viewed by 10729
Abstract
There is a mechanistic link between the gut-derived metabolite trimethylamine-N-oxide (TMAO) and obesity-related diseases, suggesting that the TMAO pathway may also be linked to the pathogenesis of obesity. The Visceral Adiposity Index (VAI), a gender-specific indicator of adipose dysfunction, and the Fatty Liver [...] Read more.
There is a mechanistic link between the gut-derived metabolite trimethylamine-N-oxide (TMAO) and obesity-related diseases, suggesting that the TMAO pathway may also be linked to the pathogenesis of obesity. The Visceral Adiposity Index (VAI), a gender-specific indicator of adipose dysfunction, and the Fatty Liver Index (FLI), a predictor of non-alcoholic fatty liver disease (NAFLD), are early predictors of metabolic syndrome (MetS). In this cross-sectional observational study, we investigated TMAO levels in adults stratified according to Body Mass Index (BMI) and the association of TMAO with VAI and FLI. One hundred and thirty-seven adult subjects (59 males; 21–56 years) were enrolled. TMAO levels were detected using HPLC/MS analysis. Homeostatic Model Assessment of Insulin Resistance (HoMA-IR), VAI and FLI were included as cardio-metabolic indices. TMAO levels increased along with BMI and were positively associated with VAI and FLI, independently, on common potential covariates. The most sensitive and specific cut-offs for circulating levels of TMAO to predict the presence of NAFLD-FLI and MetS were ≥8.02 µM and ≥8.74 µM, respectively. These findings allow us to hypothesize a role of TMAO as an early biomarker of adipose dysfunction and NAFLD-FLI in all borderline conditions in which overt MetS is not present, and suggest that a specific cut-off of TMAO might help in identifying subjects at high risk of NAFLD. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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Review

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10 pages, 260 KiB  
Review
Diet Quality, Saturated Fat and Metabolic Syndrome
by Stéphanie Harrison, Patrick Couture and Benoît Lamarche
Nutrients 2020, 12(11), 3232; https://doi.org/10.3390/nu12113232 - 22 Oct 2020
Cited by 32 | Viewed by 8528
Abstract
Indices reflecting overall diet quality are used globally in research to predict the risk of various diseases and metabolic disorders such as metabolic syndrome (MetS). Such indices are built to measure adherence to current dietary guidelines or to best assess the diet–disease relationship. [...] Read more.
Indices reflecting overall diet quality are used globally in research to predict the risk of various diseases and metabolic disorders such as metabolic syndrome (MetS). Such indices are built to measure adherence to current dietary guidelines or to best assess the diet–disease relationship. Although mostly food-based, dietary guidelines often include recommendations to limit saturated fatty acid (SFA) intake in order to prevent cardiovascular diseases. However, not all diet quality indices consider SFA in their definition of diet quality. Additionally, the relationship between SFA consumption and the development of MetS remains unclear. The purpose of this short review was to explore the association between MetS and various diet quality indices and dietary patterns, with a focus on how SFA contributes to these associations. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
13 pages, 687 KiB  
Review
Negative Energy Balance Induced by Exercise or Diet: Effects on Visceral Adipose Tissue and Liver Fat
by Robert Ross, Simrat Soni and Sarah Houle
Nutrients 2020, 12(4), 891; https://doi.org/10.3390/nu12040891 - 25 Mar 2020
Cited by 26 | Viewed by 10010
Abstract
The indisputable association between visceral adipose tissue (VAT) and cardiometabolic risk makes it a primary target for lifestyle-based strategies designed to prevent or manage health risk. Substantive evidence also confirms that liver fat (LF) is positively associated with increased health risk and that [...] Read more.
The indisputable association between visceral adipose tissue (VAT) and cardiometabolic risk makes it a primary target for lifestyle-based strategies designed to prevent or manage health risk. Substantive evidence also confirms that liver fat (LF) is positively associated with increased health risk and that reduction is associated with an improved metabolic profile. The independent associations between reductions in VAT, LF, and cardiometabolic risk is less clear. In this narrative review, we summarize the evidence indicating whether a negative energy balance induced by either an increase in energy expenditure (aerobic exercise) or a decrease in energy intake (hypocaloric diet) are effective strategies for reducing both VAT and LF. Consideration will be given to whether a dose-response relationship exists between the negative energy balance induced by exercise or diet and reduction in either VAT or LF. We conclude with recommendations that will help fill gaps in knowledge with respect to lifestyle-based strategies designed to reduce VAT and LF. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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15 pages, 1206 KiB  
Review
Sleep Apnea and Sleep Habits: Relationships with Metabolic Syndrome
by Anne-Laure Borel
Nutrients 2019, 11(11), 2628; https://doi.org/10.3390/nu11112628 - 2 Nov 2019
Cited by 63 | Viewed by 8557
Abstract
Excess visceral adiposity is a primary cause of metabolic syndrome and often results from excess caloric intake and a lack of physical activity. Beyond these well-known etiologic factors, however, sleep habits and sleep apnea also seem to contribute to abdominal obesity and metabolic [...] Read more.
Excess visceral adiposity is a primary cause of metabolic syndrome and often results from excess caloric intake and a lack of physical activity. Beyond these well-known etiologic factors, however, sleep habits and sleep apnea also seem to contribute to abdominal obesity and metabolic syndrome: Evidence suggests that sleep deprivation and behaviors linked to evening chronotype and social jetlag affect eating behaviors like meal preferences and eating times. When circadian rest and activity rhythms are disrupted, hormonal and metabolic regulations also become desynchronized, and this is known to contribute to the development of metabolic syndrome. The metabolic consequences of obstructive sleep apnea syndrome (OSAS) also contribute to incident metabolic syndrome. These observations, along with the first sleep intervention studies, have demonstrated that sleep is a relevant lifestyle factor that needs to be addressed along with diet and physical activity. Personalized lifestyle interventions should be tested in subjects with metabolic syndrome, based on their specific diet and physical activity habits, but also according to their circadian preference. The present review therefore focuses (i) on the role of sleep habits in the development of metabolic syndrome, (ii) on the reciprocal relationship between sleep apnea and metabolic syndrome, and (iii) on the results of sleep intervention studies. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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24 pages, 1155 KiB  
Review
Lifestyle and Metabolic Syndrome: Contribution of the Endocannabinoidome
by Vincenzo Di Marzo and Cristoforo Silvestri
Nutrients 2019, 11(8), 1956; https://doi.org/10.3390/nu11081956 - 20 Aug 2019
Cited by 90 | Viewed by 11166
Abstract
Lifestyle is a well-known environmental factor that plays a major role in facilitating the development of metabolic syndrome or eventually exacerbating its consequences. Various lifestyle factors, especially changes in dietary habits, extreme temperatures, unusual light–dark cycles, substance abuse, and other stressful factors, are [...] Read more.
Lifestyle is a well-known environmental factor that plays a major role in facilitating the development of metabolic syndrome or eventually exacerbating its consequences. Various lifestyle factors, especially changes in dietary habits, extreme temperatures, unusual light–dark cycles, substance abuse, and other stressful factors, are also established modifiers of the endocannabinoid system and its extended version, the endocannabinoidome. The endocannabinoidome is a complex lipid signaling system composed of a plethora (>100) of fatty acid-derived mediators and their receptors and anabolic and catabolic enzymes (>50 proteins) which are deeply involved in the control of energy metabolism and its pathological deviations. A strong link between the endocannabinoidome and another major player in metabolism and dysmetabolism, the gut microbiome, is also emerging. Here, we review several examples of how lifestyle modifications (westernized diets, lack or presence of certain nutritional factors, physical exercise, and the use of cannabis) can modulate the propensity to develop metabolic syndrome by modifying the crosstalk between the endocannabinoidome and the gut microbiome and, hence, how lifestyle interventions can provide new therapies against cardiometabolic risk by ensuring correct functioning of both these systems. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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17 pages, 1450 KiB  
Review
Sugar-Sweetened Beverages and Cardiometabolic Health: An Update of the Evidence
by Vasanti S. Malik and Frank B. Hu
Nutrients 2019, 11(8), 1840; https://doi.org/10.3390/nu11081840 - 8 Aug 2019
Cited by 223 | Viewed by 24365
Abstract
Sugar-sweetened beverages (SSBs) have little nutritional value and a robust body of evidence has linked the intake of SSBs to weight gain and risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and some cancers. Metabolic Syndrome (MetSyn) is a clustering of risk [...] Read more.
Sugar-sweetened beverages (SSBs) have little nutritional value and a robust body of evidence has linked the intake of SSBs to weight gain and risk of type 2 diabetes (T2D), cardiovascular disease (CVD), and some cancers. Metabolic Syndrome (MetSyn) is a clustering of risk factors that precedes the development of T2D and CVD; however, evidence linking SSBs to MetSyn is not clear. To make informed recommendations about SSBs, new evidence needs to be considered against existing literature. This review provides an update on the evidence linking SSBs and cardiometabolic outcomes including MetSyn. Findings from prospective cohort studies support a strong positive association between SSBs and weight gain and risk of T2D and coronary heart disease (CHD), independent of adiposity. Associations with MetSyn are less consistent, and there appears to be a sex difference with stroke with greater risk in women. Findings from short-term trials on metabolic risk factors provide mechanistic support for associations with T2D and CHD. Conclusive evidence from cohort studies and trials on risk factors support an etiologic role of SSB in relation to weight gain and risk of T2D and CHD. Continued efforts to reduce intake of SSB should be encouraged to improve the cardiometabolic health of individuals and populations. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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18 pages, 278 KiB  
Review
Physical Activity, Cardiorespiratory Fitness, and the Metabolic Syndrome
by Jonathan Myers, Peter Kokkinos and Eric Nyelin
Nutrients 2019, 11(7), 1652; https://doi.org/10.3390/nu11071652 - 19 Jul 2019
Cited by 293 | Viewed by 26572
Abstract
Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence [...] Read more.
Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence of the metabolic syndrome and its individual components (particularly obesity and insulin resistance) has increased significantly in recent decades, guidelines from various professional organizations have called for greater efforts to reduce the incidence of this condition and its components. While physical activity interventions that lead to improved fitness cannot be expected to normalize insulin resistance, lipid disorders, or obesity, the combined effect of increasing activity on these risk markers, an improvement in fitness, or both, has been shown to have a major impact on health outcomes related to the metabolic syndrome. Exercise therapy is a cost-effective intervention to both prevent and mitigate the impact of the metabolic syndrome, but it remains underutilized. In the current article, an overview of the effects of physical activity and higher fitness on the metabolic syndrome is provided, along with a discussion of the mechanisms underlying the benefits of being more fit or more physically active in the prevention and treatment of the metabolic syndrome. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)

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7 pages, 215 KiB  
Discussion
Metabolic Syndrome—Role of Dietary Fat Type and Quantity
by Peter Clifton
Nutrients 2019, 11(7), 1438; https://doi.org/10.3390/nu11071438 - 26 Jun 2019
Cited by 42 | Viewed by 7577
Abstract
Background: Metabolic syndrome increases the risk of cardiovascular disease (CVD) over and above that related to type 2 diabetes. The optimal diet for the treatment of metabolic syndrome is not clear. Materials and Methods: A review of dietary interventions in volunteers with metabolic [...] Read more.
Background: Metabolic syndrome increases the risk of cardiovascular disease (CVD) over and above that related to type 2 diabetes. The optimal diet for the treatment of metabolic syndrome is not clear. Materials and Methods: A review of dietary interventions in volunteers with metabolic syndrome as well as studies examining the impact of dietary fat on the separate components of metabolic syndrome was undertaken using only recent meta-analyses, if available. Results: Most of the data suggest that replacing carbohydrates with any fat, but particularly polyunsaturated fat, will lower triglyceride(TG), increase high density lipoprotein (HDL) cholesterol, and lower blood pressure, but have no effects on fasting glucose in normal volunteers or insulin sensitivity, as assessed by euglycemic hyperinsulinemic clamps. Fasting insulin may be lowered by fat. Monounsaturated fat (MUFA) is preferable to polyunsaturated fat (PUFA) for fasting insulin and glucose lowering. The addition of 3–4 g of N3 fats will lower TG and blood pressure (BP) and reduce the proportion of subjects with metabolic syndrome. Dairy fat (50% saturated fat) is also related to a lower incidence of metabolic syndrome in cohort studies. Full article
(This article belongs to the Special Issue Metabolic Syndrome: From Etiology to Prevention and Clinical Management)
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