Samara Rosenfeld

This article was originally published on HCPLive.com.

In an effort to understand current trends in metabolic syndrome, a team of investigators provided an update on prevalence trends in the US from 2011-2016.

Robert Wong, MD, MS, and a colleague used data from the National Health and Nutrition Examination Survey to evaluate trends in metabolic syndrome prevalence among adults at least 20 years old. The survey data were cross-sectional, stratified, and a multistage probability sample of the US population taken from 2011-2016. The unweighted response rates ranged from 58.7-69.5%.

Metabolic syndrome was defined based on the National Cholesterol Education Program’s Adult Treatment Panel III. Patients needed to have at least 3 of the following: waist circumference greater than 102 cm in men or 88 cm in women, triglyceride level greater than 150 mg/dL, high-density lipoprotein cholesterol less than 40 mg/dL in men or less than 50 mg/dL in women, systolic blood pressure at least 130 mm Hg or diastolic blood pressure at least 85 mm Hg or taking hypertension medications, or fasting plasma glucose level at least 100 mg/dL or taking diabetes medications.

Wong and the team used weighted data to estimate the unadjusted prevalence of metabolic syndrome. They stratified the data by age group (20-39, 40-59, and at least 60 years old), sex, and race and ethnicity.

There were 17,048 total participants. The weighted metabolic syndrome prevalence was 34.7% (95% CI, 33.1-36.3). Prevalence was not significantly different among men and women (35.1% vs 34.3%; 

=.47) and was highest among “other” race/ethnicity (39%), followed by Hispanic (36.3%) and non-Hispanic white (36%) participants.

There was an increase in the overall crude metabolic syndrome prevalence from 2011-2012 to 2015-2016, but it did not meet statistical significance (from 32.5% [95% CI, 29-36.2] in 2011-2012 to 36.9% [95% CI, 33.9-39.9) in 2015-2016; 

=.07). Metabolic syndrome prevalence increased significantly among those in the youngest age cohort (20-39 years old) from 16.2% to 21.3% (

=.04), for Asian participants (from 19.9% to 26.2%; 

=.008), and Hispanic participants (from 32.9% to 40.4%; 

=.01).

There was a significant increase in prevalence with increasing age among all groups. The prevalence was 19.5% among those 20-39 years old and it increased to 48.6% among those at least 60 years old. There were no significant differences in metabolic syndrome prevalence between men and women in any age group. However, there were significant differences in prevalence among races/ethnicities for each age group. The highest prevalence was among participants who indicated “other” race/ethnicity who were at least 60 years old (64%), followed by Hispanic participants at least 60 years old (57.3%).

While the investigative team found the overall increase in prevalence did not meet statistical significance, there was a significant increase among young adults, and prevalence remained high for those at least 60 years old. The team noted the importance of implementing prevention strategies, including lifestyle modification and the use of medications targeted at those at the highest risk.

The study, “

Trends in the Prevalence of Metabolic Syndrome in the United States, 2011-2016

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Although the investigative team found the overall increase in prevalence did not meet statistical significance, there was a significant increase among young adults, and prevalence remained high for those at least 60 years old. 

Prevalence of Metabolic Syndrome Among Young Adults on the Rise

Overweight, hypertensive patients who enrolled in a self-administered, internet-based health management program had better outcomes than patients who did not join the program, according to recent study findings.

Juan Francisco Lison, MD, PhD, and a team of colleagues investigated the efficacy in terms of body composition and blood pressure parameters of an internet-based intervention. The program had different modules and learning techniques to promote lifestyle changes including physical activity and healthy eating in patients with obesity and hypertension.

Lison, from the Department of Medicine at Cardenal Herrera University in Spain, and the investigators included adults between 18-65 years old with hypertension and who were overweight (BMI >24.9 kg/m2 and <30 kg/m2) or had type 1 obesity (BMI >29.9 kg/m2 and <35 kg/m2). The investigators defined hypertension as systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg, or current use of antihypertensive medication.

Patients were excluded if they had a diagnosis of diabetes, previous ischemic heart disease, cerebrovascular disease, or a severe psychiatric disorder; if they took >3 antihypertensive drugs; had physical impairments precluding participation in physical activity; received any treatment for weight loss elsewhere; or had no access to internet.

The study included 105 participants who were randomly assigned either to the three-month internet-based intervention group (55 patients) or the wait-list control group (50).

The intervention program was called “Live better,” and those in the group received usual medical care and a three-month multimedia, interactive, and self-administered online program comprised of 9 modules. The modules focused on obesity and hypertension and were presented on a webpage which aimed to progressively establish healthy eating habits and increase the patient’s physical activity levels.

Each of the first 5 modules were activated 1 per week, and modules 6-9 were activated every 2 weeks.

Modules included psychoeducation about the meaning of a healthy lifestyle and how to achieve it on a daily basis. Techniques included self-instruction, self-reinforcement, behavioral recording, and homework.

For those in the wait-list control group, patients received standard medical care focused on reducing their cardiovascular risks factors. Standard care included antihypertensive prescription; written lifestyle advice; moderate salt restriction with a list of recommended foods; a low-calorie diet; and advice for physical activity.

The team measured BMI using a body-fat analyzer and used other tests to measure secondary outcomes.

Overall, 510 participants were screened, and 105 were deemed eligible. A two-way analysis showed a significant decrease in BMI, body fat mass, and blood glucose after 3 months in the intervention group, with moderate to large effect size for BMI and body fat mass. There was a borderline significant trend (P=.05) for diastolic blood pressure and insulin.

In the wait-list control group, there was a significant increase in BMI and insulin.

In the intervention and control groups, there was a statistically significant increase in the functional capacity for aerobic exercise.

At 12-months of follow up, there were significant improvements in BMI (mean difference [MD], −.4; 95% CI, −.1 to −.6; P=.005), body fat mass (MD, −2.4; 95% CI, −1.1 to −3.6; P <.001), diastolic blood pressure (MD, −1.8; 95% CI, −.2 to −3.3; P=.03), and blood glucose levels (MD, −2; 95% CI, 0 to −4; P=.04).

Nearly 75% of the intervention group completed the nine-module program.

The findings suggested that the tailored approach for delivering lifestyle changes virtually to patients who were obese with hypertension had positive health benefits.

Additional research could investigate the acceptability and cost-effectiveness of such programs in populations with varied sociodemographic status.

Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial

Study Finds Internet Based Health Management Has Benefits

C-Section Associated With Increased Risk of Obesity, Type 2 Diabetes

," was originally published on our partner site 

A new study has identified a significant association between being born via cesarean delivery and increased risks of obesity and type 2 diabetes in adulthood.

Jorge Chavarro, MD, ScD, and colleagues compared the incidence of obesity and type 2 diabetes between cesarean and vaginal delivery among more than 30,000 women participating in the Nurses’ Health Study II. The study findings suggested that women born by cesarean delivery had a higher risk of developing such conditions during adult life than women born via vaginal delivery.

Chavarro, from the Harvard T.H. Chan School of Public Health, and the team of investigators included 33,226 participants born between 1946-1964. Participants were excluded if they did not provide information on delivery mode and height or weight and were not born of a singleton pregnancy.

Information on height and weight were updated from baseline every 2 years. The investigators calculated body mass index (BMI) from the data. Obesity was defined as a BMI >30 using the World Health Organization (WHO) cutoffs.

Participants reported physician-diagnosed type 2 diabetes on follow-up questionnaires. Cases were confirmed based on American Diabetes Association criteria: >1 classic symptom (excessive thirst; polyuria; weight loss; hunger; pruritus; or coma) plus elevated glucose levels; no symptoms reported but >2 elevated plasma glucose concentrations on >1 occasion; or treatment with insulin or an oral hypoglycemic agent.

The participants’ mean age was 33.8 years old (range, 24-44 years old). Among those included, 3.3% were born by a cesarean delivery. Mothers of those delivered by cesarean section (C-section) had a higher mean prepregnancy BMI than those delivered vaginally (21.7 vs 21.2), were older (mean age at delivery, 28.2 vs 26.2 years old), and were more likely to have preeclampsia (5.0% vs 3.2%), pregnancy-induced hypertension (5.1% vs 3.4%), preterm birth (9.2% vs 4.1%), and low birth weight (8.6% vs 5.9%).

Women who gave birth by C-section were less likely to smoke during pregnancy (22.9% vs 26.1%) and to breastfeed their daughters (32.1% vs 46.1%) than those who had a vaginal delivery.

There were 12,156 cases of obesity and 2014 new cases of type 2 diabetes during nearly 2 million person-years of follow-up. The incidence of diabetes per 10,000 person years was 10.4 among those born vaginally and 14.1 for those born through C-section.

C-section delivery was associated with a higher risk of obesity (RR, 1.09; 95% CI, 1.01-1.18). The incidence of type 2 diabetes was also higher among women born by C-section (HR, 1.42; 95% CI, 1.14-1.76).

The association of C-section delivery with risks of obesity and type 2 diabetes were of comparable magnitude across each low-risk category for such delivery based on maternal characteristics, separately, and when considered together.

Additional research should replicate the association with type 2 diabetes and address the biological mechanisms underlying the link between C-section and increased risk of offspring diabetes and obesity in adulthood.

Association of Birth by Cesarean Delivery With Obesity and Type 2 Diabetes Among Adult Women

Being Born by Cesarean Increases Odds of Obesity and Diabetes 

Fracture Location Related to Increased Mortality

The location of a broken bone can significantly impact the long-term health outcomes of older individuals, according to the new research findings to be presented at the Endocrine Society (ENDO) 2020 Annual Scientific Sessions.

Jacqueline Center, MBBS, FRACP, PhD, and a team of investigators found that older people who had broken bones closer to the center of the body (proximal fractures), such as upper arm or leg, pelvis, and ribs, had a greater risk of being admitted to the hospital for major medical conditions. Such patients also faced a greater risk of dying prematurely following their fracture compared to similarly aged patients without fractures.

The findings highlighted the importance of treating patients for their bone health, Center, from the Garvan Institute of Medical Research in Australia, said in a statement.

“We now have information allowing us to understand why people do badly after a fracture and how we may intervene to improve outcomes,” she added.

Center and her team studied 300,000 patients >50 years old with a low-trauma fracture from the Danish National Database between 2001-2014 The team looked at differences in the reasons for hospital admissions following the fracture and patterns of death between patients with proximal fractures and those with fractures further away from the center of the body (distal)-wrist, ankle, hand, or foot.

The investigators matched people with fractures to those without fracture 1:4 by sex, age, and comorbidity status.

Overall, the team included 212,498 women and 95,372 men with fracture. There were 30,677 (women) and 19,519 (men) deaths over 163,482 and 384,995 person-years of follow up, respectively. Mean age at fracture was 72±11 for women and 75±11 for men. A majority of the patients (75% of men, 60% of women) had >1 comorbidity. Each additional comorbidity led to an increased risk of mortality for all fracture types, but only for proximal did the fracture alone increase mortality risk over comorbidities.

Proximal fractures included hip; femur; pelvis; rib; clavicle; and humerus and had increased mortality compared to those without fractures.

Patients with broken bones at proximal locations had a 1.5- to four-fold greater risk of death over the next 2 years than patients without fractures. The patients with proximal fracturs were also more likely to be admitted to the hospital for cardiovascular disease; cancer; stroke; diabetes; pneumonia; and lung disease.

Mortality risk at 2 years follow-up was increased for proximal fractures regardless of whether they were admitted to the hospital after the injury. Those with distal fractures had similar or lower death risk and similar admission patterns as patients without fractures.

The findings provided insights to why patients with proximal fractures die prematurely, Center concluded.

Additional research should focus on ways to prevent premature deaths related to fractures.

The study, “Understanding Why Older People with Low Trauma Fractures Die Prematurely,” will be presented at the Endocrine Society (ENDO) 2020 Annual Scientific Sessions.”

The Location of Broken Bones Predicts Life Expectancy in Elderly Patients

Screening for hypothyroidism should be considered for patients with alkaptonuria, according to recent study findings.

Shirisha Avadhanula, MD, and colleagues aimed to assess thyroid structure and function in adults with alkaptonuria. The team found a high prevalence of primary hypothyroidism noted in such patients.

Avadhanula, from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health (NIH), and the investigative team included 125 adults with alkaptonuria who were enrolled at the NIH from February 2000-December 2018. The investigators included patients who had thyroid function tests repeated >2 times per week and had information on the medical management of their thyroid disorder. 

The team measured serum thyrotropin and free thyroxine levels by immunoassay and were repeated in each patients a median of 3 times. The results were verified by liquid chromatography with tandem mass spectrometry >1 time during follow-up.

The primary outcome was to analyze the prevalence of thyroid dysfunction in patients with alkaptonuria to compare with the standard US adult population (control group). Additional measures included the association of thyroid dysfunction with age, sex, and thyroid peroxidase antibodies.

The study cohort included 53 women (42.4%) with a median age at first thyrotropin measurement of 45 years old, who were followed up for a median of 93 months.

The prevalence of hyperthyroidism was .8%, which was similar to that of the general population, .5% (difference, .003; 95% CI, -.001 to .04; P=.88). Primary hypothyroidism prevalence was 16% (20 of 125 patients), which was significantly higher than the 3.7% reported among patients in the general population (difference, .12; 95% CI, .1-.24; P <.001).

Women were more likely to have primary hypothyroidism than men (OR, 10.99; 95% CI, 3.13-38.66; P <.001). Those who had thyroid peroxidase antibodies also had higher rates of primary hypothyroidism than those without (OR, 7.36; 95% CI, 1.89-28.62; P=.004).

The investigators did not find a significant difference in the prevalence of thyroid nodules between patients in the study (59.2%) compared to the general population (68%) (difference, .088; 95% CI, -.44 to .73; P=.2) or of cancer (7% vs 5%; difference, .01; 95% CI, -.01 to .17; P=.86).

A majority of the patients presented with overt hypothyroidism and were treated with a median levothyroxine dose of 1.4 Î¼g/kg of body weight.

The findings were consistent to prior research which found that both female sex and presence of thyroid peroxidase antibodies were associated with a higher likelihood of primary hypothyroidism compared with male sex and thyroid peroxidase antibody-negative status in patients with alkaptonuria.

The high prevalence of primary hypothyroidism suggested that screening for the condition in patients with alkaptonuria should be considered, the investigators wrote. The initial screening should occur at the diagnosis of alkaptonuria and should be repeated regularly (every 1-2 years) afterwards.

Additional research could be conducted based on the findings to learn the functional role of homogentisic acid deposition in the thyroid gland.