Postprandial glucose and not triglyceride concentrations are associated with carotid intima media thickness in women with normal glucose metabolism: The Hoorn prandial study (original) (raw)
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Insulin resistance and the metabolic syndrome—or the pitfalls of epidemiology
Diabetologia, 2007
The clustering of dyslipidaemia, hypertension and glucose intolerance, predominantly in overweight individuals, has been ascribed many names, including syndrome X and the metabolic syndrome. In Reaven's original description of syndrome X, a central aetiological role was attributed to insulin resistance, and this assumption has remained as the dominant paradigm for the metabolic syndrome. There are a number of conceptual problems in such a model, particularly those arising from observations that several novel markers, including measures of endothelial dysfunction and of low-grade inflammation, are as closely related to insulin resistance as are the classic components of the syndrome. Because it is difficult to envisage how these traits might develop as a consequence of insulin resistance, such observations indicate the need for a new paradigm to explain the mechanisms of association better. It has been proposed that a state of low-grade inflammation, consequent upon the production of adipocytokines, particularly from truncal fat, explains the observed relationships between insulin resistance and endothelial dysfunction better than does a model revolving around insulin resistance. Furthermore, the inflammatory cytokines generated from adipose tissue may influence vessel endothelial function without elevations in circulating concentrations. This review alludes to several problems inherent in the epidemiological method in understanding disease mechanisms. These include crude biological measures, the use of venous systemic fasting samples, imprecision of assays, naive physiological models, simplistic statistical approaches and, without clinical trials, an inability to test causation. Integrated systems biology needs more complex approaches to investigate disease mechanisms, involving cell, organ, whole organism and population studies.
Circulation, 2009
A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
American Journal of Epidemiology, 2002
The World Health Organization (WHO) and the National Cholesterol Education Program (NCEP) recently proposed definitions for the metabolic syndrome. Little is known of their validity, however. The authors assessed the sensitivity and specificity of the definitions of the metabolic syndrome for prevalent and incident diabetes mellitus in a Finnish population-based cohort of middle-aged men (n = 1,005) followed for 4 years since the late 1980s. Four definitions based on the WHO and NCEP recommendations were compared. All definitions identified persons at high risk for developing diabetes during the 4-year follow-up (odds ratios = 5.0-8.8). The WHO definition including waist-hip ratio > 0.90 or body mass index ≥ 30 kg/m 2 was the most sensitive (0.83 and 0.67) and least specific (0.78 and 0.80) in detecting the 47 prevalent and 51 incident cases of diabetes. The NCEP definition in which adiposity was defined as waist girth > 102 cm detected only 61% of prevalent and 41% of incident diabetes, although it was the most specific (0.89 and 0.90). The WHO definition seems valid as judged by its relatively high sensitivity and specificity in predicting diabetes. The NCEP definition including waist > 102 cm also identifies persons at high risk for diabetes, but it is relatively insensitive in predicting diabetes. diabetes mellitus; hyperinsulinism; hyperlipidemia; hypertension; insulin resistance; obesity Abbreviations: EGIR, European Group for the Study of Insulin Resistance; HDL, high density lipoprotein; NCEP, National Cholesterol Education Program; QUICKI, quantitative insulin sensitivity check index; WHO, World Health Organization.
Link Between Metabolic Syndrome And Diabetes Mellitus: A Pathophysiological Implication
International Journal of Scientific & Technology Research, 2020
Metabolic syndrome (Met S), an escalating problem in modern society, may be defined as a group of risk factors that consists of hypertension, dyslipidemia, hyperglycemia, and central obesity. It can be probably due to lifestyle changes and physical inactivity in an individual. In order to analyze metabolic syndrome on the basis of its components, multiple organizations gave various definitions. Type II Diabetes Mellitus (Type II DM) patients with Metabolic syndrome generally have increasing chances of micro and macrovascular complications. Convincing evidence suggests that obesity and insulin resistance can be classified as underlying pathological conditions of Met S. Early diagnosis could aid in employing primary intervention which includes increasing physical activity and diet modification. This is followed by secondary intervention that consists of drug therapy in order to treat the individual components. This study reviewed that the management of Mets reduces premature mortality...
The Metabolic Syndrome: A Concept Hard to Define
Archives of Medical Research, 2005
The metabolic syndrome integrates, in a single diagnosis, the manifestations of insulin resistance that may lead to increased cardiovascular morbidity and precedes type 2 diabetes. Here we discuss the strengths and limitations of the definitions of the metabolic syndrome and the epidemiology of the syndrome including information from non-Caucasian populations. The definitions proposed by the World Health Organization (WHO) and the National Cholesterol Education Program (NCEP) are the most frequently used. The relative risk of having long-term complications is greater for the WHO definition; this is explained by the inclusion of the insulin resistance criteria. The cut-off points used in these definitions should be, but are not, adjusted for ethnicity; as a result, in non-Caucasian subjects, there is lack of agreement among these criteria. In a Mexican population-based survey the prevalence was 13.61% using the WHO definition and 26.6% using the NCEP-III criteria. Cases identified by the WHO criteria had a more severe form of the disease. We propose that the metabolic syndrome should be viewed as a progressive long-term process that leads to major complications. Its definition should reflect the continuous nature of the disease; the categorical approach of the current criteria oversimplifies the complexity of the syndrome. The threshold for defining abnormality should be based on the associated risk of the identified phenotype. Refinement of the definition of both affected and nonaffected subjects is required. The available definitions include, in each of these categories, heterogeneous groups with a broad range of risk of future complications. Ć 2005 IMSS. Published by Elsevier Inc.
Metabolic syndrome, or What you will: definitions and epidemiology
Diabetes & vascular disease research : official journal of the International Society of Diabetes and Vascular Disease, 2007
The ‘metabolic syndrome’ is a clustering of risk factors which predispose an individual to cardiovascular morbidity and mortality. There is general consensus regarding the main components of the syndrome (glucose intolerance, obesity, raised blood pressure and dyslipidaemia [elevated triglycerides, low levels of high-density lipoprotein cholesterol]) but different definitions require different cut points and have different mandatory inclusion criteria. Although insulin resistance is considered a major pathological influence, only the World Health Organization (WHO) and European Group for the study of Insulin Resistance (EGIR) definitions include it amongst the diagnostic criteria and only the International Diabetes Federation (IDF) definition has waist circumference as a mandatory component. The prevalence of metabolic syndrome within individual cohorts varies with the definition used. Within each definition, the prevalence of metabolic syndrome increases with age and varies with ge...