Diabetes & Metabolism Journal

Original Articles

Basic and Translational Research
Sleeve Gastrectomy with Fundoplication Enhances Metabolic Health in Obese Rats via Ghrelin Pathway Modulation and Multi-Organ Regulation: Xin Li, Aikebaier Aili, Yusujiang Tusuntuoheti, Yusunjiang Aierken, Kelimu Abudureyimu, Weihui Liu; Received May 4, 2025 Accepted November 23, 2025 Published online January 15, 2026; DOI: https://doi.org/10.4093/dmj.2025.0392 [Epub ahead of print]

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Obesity serves as a predominant factor in the progression of metabolic syndrome and type 2 diabetes mellitus. While sleeve gastrectomy (SG) is a well-established surgical intervention, its impact on appetite-regulating hormones, such as ghrelin (GHRL), is limited. Sleeve gastrectomy combined with fundoplication (SGFD) has emerged as a potential strategy to improve metabolic outcomes by modifying both gastric anatomy and gut-brain signaling.
Methods
Sixty-five Sprague-Dawley rats were enrolled. After 8 weeks of high-fat feeding, 48 rats developed diet-induced obesity (DIO). These rats were randomized into four experimental groups: DIO control, sham-operated, SG, and SGFD, alongside a normal control cohort. Biochemical indicators, hormonal fluctuations, and insulin responsiveness were analyzed. Molecular expressions were evaluated through quantitative real-time polymerase chain reaction and Western blotting.
Results
SGFD reduced body weight (−24.7%), food intake (−28.3%), fasting glucose (−37.5%), triglycerides (−42.6%), and serum GHRL (−51.2%) compared with the DIO group (P<0.01). Gastric GHRL, preproghrelin, and ghrelin O-acyltransferase (GOAT) expression were suppressed. Hypothalamic neuropeptide Y (NPY) was downregulated, and AMP-activated protein kinase (AMPK) signaling was robustly enhanced across various tissues. SGFD also improved insulin receptor substrate-1 (IRS-1), glucose transporter type 4 (GLUT4), β-cell function, hepatic lipid oxidation, and brown adipose thermogenesis. SGFD outperformed SG in most metabolic and molecular outcomes (P<0.05).
Conclusion
SGFD provides superior metabolic benefits over SG alone by suppressing GHRL signaling and activating systemic AMPK pathways. SGFD represents a promising surgical strategy for obesity and metabolic syndrome.

Lifestyle and Behavioral Interventions
Association between the Life’s Essential 8 Health Behaviors Score and Mortality Risk in US Adults with Cardiovascular-Kidney-Metabolic Syndrome Stage 0–3: Junlin Zhang, Limei Yin, Yuping Liu, Xiang Xiao, Ping Shuai; Received April 26, 2025 Accepted June 16, 2025 Published online December 12, 2025; DOI: https://doi.org/10.4093/dmj.2025.0366 [Epub ahead of print]

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The American Heart Association’s novel cardiovascular-kidney-metabolic (CKM) syndrome framework underscores the interconnected pathophysiology of metabolic dysfunction, chronic kidney disease, and cardiovascular disease (CVD). While the Life’s Essential 8 (LE8) has demonstrated strong associations with CVD risk in general populations, its prognostic relevance remains unexplored in individuals stratified by CKM syndrome stages.
Methods
This study analyzed longitudinal data from the nationally representative National Health and Nutrition Examination Survey (2005–2018). The eight components of the LE8 metric—diet quality, physical activity, nicotine exposure, sleep health, body mass index, blood lipid profiles, glycemic status, and blood pressure—were systematically evaluated and scored on a 0–100 scale. A Cox proportional hazards regression model was implemented to assess associations between LE8 scores and all-cause mortality risk. Mortality outcomes were prospectively tracked through December 31, 2019, using linked mortality records from the National Center for Health Statistics.
Results
Among 9,152 participants (mean age 45.08±0.29 years; 48.24% male), baseline CKM staging distributed as follows: stage 0 (12.08%, n=916), stage 1 (25.76%, n=2,162), stage 2 (60.02%, n=5,721), and stage 3 (2.14%, n=353). Unexpectedly, during a median follow-up of 7.92 years, the total LE8 score was not related with all-cause mortality in individuals with CKM stage 2–3 (P>0.05). However, fully adjusted analyses revealed a 22% and 13% decreased all-cause mortality risk per 10-points LE8 health behaviors score increment in CKM 0-1 (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.68 to 0.88) and CKM 2-3 (HR, 0.87; 95% CI, 0.81 to 0.93), respectively. Restricted cubic spline models confirmed a negative linear dose-response relationship between health behaviors score and all-cause mortality across all CKM stages 0–3.
Conclusion
This national cohort study establishes LE8 health behaviors score as a robust, linearly associated predictor of all-cause mortality in CKM syndrome populations, independent of disease stage severity. These findings advocate for integrating LE8 health behaviors score into routine metabolic-cardiovascular risk stratification protocols, particularly for early intervention in CKM stage 0–3 individuals.

Metabolic Risk/Epidemiology
Adiponectin as a Predictor of Metabolic Dysfunction-Associated Steatotic Liver Disease and Non-Alcoholic Fatty Liver Disease: A 17-Year Korean Cohort Study: Yeun Soo Yang, Hyun Soo Zhang, Heejin Kimm, Keum Ji Jung, Soyoung Kim, Ji Woo Baek, Sunmi Lee, Sun Ha Jee; Received January 2, 2025 Accepted April 17, 2025 Published online September 8, 2025; DOI: https://doi.org/10.4093/dmj.2025.0007 [Epub ahead of print]

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This study aimed to investigate the association between adiponectin levels and the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) and nonalcoholic fatty liver disease (NAFLD), and to explore the predictive value of adiponectin in the onset of these conditions.
Methods
A 17-year follow-up of 35,026 individuals from the Korean Cancer Prevention Study-II biobank cohort (2004–2021) was conducted. Adiponectin levels were categorized into quintiles. Outcomes were defined as: NAFLD (10th revision of the International Classification of Diseases [ICD-10] K76.0); MASLD (K76.0 with cardiometabolic factors); NAFLD^{-cardiometabolic} (K76.0 without cardiometabolic factors); and non-steatotic liver disease. The cause-specific Cox model accounted for death as a competing risk, with interaction terms for non-proportional hazards.
Results
Our findings indicated a heightened risk of MASLD in individuals in low adiponectin groups. Hazard ratios (HRs) for different adiponectin levels, using Gadipo 5 (≥17.21 μg/mL) as the reference, were: Gadipo 1, HR 3.20 (95% confidence interval [CI], 2.08 to 4.92); Gadipo 2, HR 2.45 (95% CI, 1.59 to 3.76); Gadipo 3, HR 2.02 (95% CI, 1.32 to 3.11); and Gadipo 4, HR 1.59 (95% CI, 1.02 to 2.46). These associations remained consistent across outcomes and models. Sex stratification revealed a stronger association among females. Furthermore, lower adiponectin levels were associated with increased MASLD and NAFLD risk. Similar associations were also observed in individuals with NAFLD^{-cardiometabolic}, indicating consistency across subtypes.
Conclusion
Different adiponectin levels revealed distinct risks. This study emphasizes adiponectin’s potential as a predictive indicator of MASLD and NAFLD, stressing the need for further investigation across diverse demographic groups.

Lifestyle and Behavioral Interventions
Association between Healthy Lifestyle Factors and Metabolic Syndrome Risk: A Prospective Analysis of the Korean Genome and Epidemiology Study: Jialei Fu, Sangah Shin; Diabetes Metab J. 2025;49(4):873-882. Published online March 26, 2025; DOI: https://doi.org/10.4093/dmj.2024.0427

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To investigate the association of adherence to five modifiable lifestyle factors (limiting alcohol, physical activity, limiting smoking, favorable diet quality, and adequate sleep) with metabolic syndrome (MetS) risk in Korean adults.
Methods
Health Examinees Study data were used, and 41,368 participants aged 40 to 69 years were included. Cox proportional hazards regression analyses assessed the associations of individual and combined healthy lifestyle factors (32 and 16 lifestyle profiles in men and women.
Results
During a median 4.2-year follow-up, 6,213 participants were newly diagnosed with MetS. Adherence to more healthy lifestyle factors (4–5 vs. 0–1) could lower MetS risk by 28% and 12% in men and women (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.63 to 0.83 in men; HR, 0.88; 95% CI, 0.78 to 0.99 in women). Each additional healthy lifestyle could reduce the risk of MetS by 10% and 6% in men and women. The pooled analysis yielded similar results based on similar numbers of healthy lifestyle factors, the risk of MetS decreased as the number of healthy lifestyle factors increased.
Conclusion
Adherence to more healthy lifestyle factors was inversely associated with MetS risk. These findings highlight the importance of limiting drinking in managing MetS. Future research should consider the synergistic effects of emerging lifestyle factors, such as sleep duration, on chronic disease development, while focusing on the effects of traditional lifestyle factors.

Metabolic Risk/Epidemiology
Trends in Metabolically Unhealthy Obesity by Age, Sex, Race/Ethnicity, and Income among United States Adults, 1999 to 2018: Wen Zeng, Weijiao Zhou, Junlan Pu, Juan Li, Xiao Hu, Yuanrong Yao, Shaomei Shang; Diabetes Metab J. 2025;49(3):475-484. Published online February 25, 2025; DOI: https://doi.org/10.4093/dmj.2024.0364

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Background
This study aimed to estimate temporal trends in metabolically unhealthy obesity (MUO) among United States (US) adults by age, sex, race/ethnicity, and income from 1999 to 2018.
Methods
We included 17,230 non-pregnant adults from a nationally representative cross-sectional study, the National Health and Nutrition Examination Survey (NHANES). MUO was defined as body mass index ≥30 kg/m² with any metabolic disorders in blood pressure, blood glucose, and blood lipids. The age-adjusted percentage of MUO was calculated, and linear regression models estimated trends in MUO.
Results
The weighted mean age of adults was 47.28 years; 51.02% were male, 74.64% were non-Hispanic White. The age-adjusted percentage of MUO continuously increased in adults across all subgroups during 1999–2018, although with different magnitudes (all P<0.05 for linear trend). Adults aged 45 to 64 years consistently had higher percentages of MUO from 1999–2000 (34.25%; 95% confidence interval [CI], 25.85% to 42.66%) to 2017–2018 (42.03%; 95% CI, 35.09% to 48.97%) than the other two age subgroups (P<0.05 for group differences). The age-adjusted percentage of MUO was the highest among non-Hispanic Blacks while the lowest among non-Hispanic Whites in most cycles. Adults with high-income levels generally had lower MUO percentages from 1999–2000 (22.63%; 95% CI, 17.00% to 28.26%) to 2017–2018 (32.36%; 95% CI, 23.87% to 40.85%) compared with the other two subgroups.
Conclusion
This study detected a continuous linear increasing trend in MUO among US adults from 1999 to 2018. The persistence of disparities by age, race/ethnicity, and income is a cause for concern. This calls for implementing evidence-based, structural, and effective MUO prevention programs.

Citations

Citations to this article as recorded by

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Metabolic Risk/Epidemiology
Longitudinal Association of Changes in Metabolic Syndrome with Cognitive Function: 12-Year Follow-up of the Guangzhou Biobank Cohort Study: Yu Meng Tian, Wei Sen Zhang, Chao Qiang Jiang, Feng Zhu, Ya Li Jin, Shiu Lun Au Yeung, Jiao Wang, Kar Keung Cheng, Tai Hing Lam, Lin Xu; Diabetes Metab J. 2025;49(1):60-79. Published online October 29, 2024; DOI: https://doi.org/10.4093/dmj.2024.0117

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Abstract PDF Supplementary Material PubReader ePub: Background
The association of changes in metabolic syndrome (MetS) with cognitive function remains unclear. We explored this association using prospective and Mendelian randomization (MR) studies.
Methods
MetS components including high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides were measured at baseline and two follow-ups, constructing a MetS index. Immediate, delayed memory recall, and cognitive function along with its dimensions were assessed by immediate 10- word recall test (IWRT) and delayed 10-word recall test (DWRT), and mini-mental state examination (MMSE), respectively, at baseline and follow-ups. Linear mixed-effect model was used. Additionally, the genome-wide association study (GWAS) of MetS was conducted and one-sample MR was performed to assess the causality between MetS and cognitive function.
Results
Elevated MetS index was associated with decreasing annual change rates (decrease) in DWRT and MMSE scores, and with decreases in attention, calculation and recall dimensions. HDL-C was positively associated with an increase in DWRT scores, while SBP and FPG were negatively associated. HDL-C showed a positive association, whereas WC was negatively associated with increases in MMSE scores, including attention, calculation and recall dimensions. Interaction analysis indicated that the association of MetS index on cognitive decline was predominantly observed in low family income group. The GWAS of MetS identified some genetic variants. MR results showed a non-significant causality between MetS and decrease in DWRT, IWRT, nor MMSE scores.
Conclusion
Our study indicated a significant association of MetS and its components with declines in memory and cognitive function, especially in delayed memory recall.

Metabolic Risk/Epidemiology
Metabolic Dysfunction-Associated Steatotic Liver Disease and All-Cause and Cause-Specific Mortality: Rosa Oh, Seohyun Kim, So Hyun Cho, Jiyoon Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim; Diabetes Metab J. 2025;49(1):80-91. Published online August 28, 2024; DOI: https://doi.org/10.4093/dmj.2024.0042

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Background
Given the association between nonalcoholic fatty liver disease and metabolic risks, a new term, metabolic dysfunction- associated steatotic liver disease (MASLD) has been proposed. We aimed to explore the association between MASLD and all-cause, cause-specific mortalities.
Methods
We included individuals with steatotic liver disease (SLD) from the Korean National Health Insurance Service. Moreover, SLD was defined as a fatty liver index ≥30. Furthermore, MASLD, metabolic alcohol-associated liver disease (MetALD), and alcoholic liver disease (ALD) with metabolic dysfunction (MD) were categorized based on alcohol consumption and MD. We also analyzed all-cause, liver-, cancer-, hepatocellular carcinoma (HCC)- and cardiovascular (CV)-related mortalities.
Results
This retrospective nationwide cohort study included 1,298,993 individuals aged 40 to 79 years for a mean follow-up duration of 9.04 years. The prevalence of MASLD, MetALD, and ALD with MD was 33.11%, 3.93%, and 1.00%, respectively. Relative to the “no SLD” group, multivariable analysis identified that MASLD (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.26 to 1.31), MetALD (aHR, 1.38; 95% CI, 1.32 to 1.44), and ALD with MD group (aHR, 1.80; 95% CI, 1.68 to 1.93) have a significantly higher risk of all-cause mortality. Furthermore, MASLD, MetALD, ALD with MD groups showed higher liver-, cancer-, and HCC-related mortality than “no SLD” group. While all-cause specific mortalities increase from MASLD to MetALD to ALD with MD, the MetALD group shows a lower risk of CV-related mortality compared to MASLD. However, ALD with MD group still have a higher risk of CV-related mortality compared to MASLD.
Conclusion
SLD is associated with an increased risk of all-cause, liver-, cancer-, HCC-, and CV-related mortalities.

Citations

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Metabolic Risk/Epidemiology
Harnessing Metabolic Indices as a Predictive Tool for Cardiovascular Disease in a Korean Population without Known Major Cardiovascular Event: Hyun-Jin Kim, Byung Sik Kim, Yonggu Lee, Sang Bong Ahn, Dong Wook Kim, Jeong-Hun Shin; Diabetes Metab J. 2024;48(3):449-462. Published online February 1, 2024; DOI: https://doi.org/10.4093/dmj.2023.0197

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Background
This study evaluated the usefulness of indices for metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), and insulin resistance (IR), as predictive tools for cardiovascular disease in middle-aged Korean adults.
Methods
The prospective data obtained from the Ansan-Ansung cohort database, excluding patients with major adverse cardiac and cerebrovascular events (MACCE). The primary outcome was the incidence of MACCE during the follow-up period.
Results
A total of 9,337 patients were included in the analysis, of whom 1,130 (12.1%) experienced MACCE during a median follow-up period of 15.5 years. The metabolic syndrome severity Z-score, metabolic syndrome severity score, hepatic steatosis index, and NAFLD liver fat score were found to significantly predict MACCE at values above the cut-off point and in the second and third tertiles. Among these indices, the hazard ratios of the metabolic syndrome severity score and metabolic syndrome severity Z-score were the highest after adjusting for confounding factors. The area under the receiver operating characteristic curve (AUC) of the 10-year atherosclerotic cardiovascular disease (ASCVD) score for predicting MACCE was 0.716, and the metabolic syndrome severity Z-score had an AUC of 0.619.
Conclusion
The metabolic syndrome severity score is a highly reliable indicator and was closely associated with the 10-year ASCVD risk score in predicting MACCE in the general population. Given the specific characteristics and limitations of metabolic syndrome severity scores as well as the indices of NAFLD and IR, a more practical scoring system that considers these factors is essential to achieve greater accuracy in forecasting cardiovascular outcomes.

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Metabolic Risk/Epidemiology
Metabolic Dysfunction-Associated Fatty Liver Disease and Mortality: A Population-Based Cohort Study: Kyung-Soo Kim, Sangmo Hong, Hong-Yup Ahn, Cheol-Young Park; Diabetes Metab J. 2023;47(2):220-231. Published online January 12, 2023; DOI: https://doi.org/10.4093/dmj.2021.0327

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Background
We investigated whether metabolic dysfunction-associated fatty liver disease (MAFLD) is associated with an elevated risk of all-cause and cardiovascular mortality using a large-scale health examination cohort.
Methods
A total of 394,835 subjects in the Kangbuk Samsung Health Study cohort were enrolled from 2002 to 2012. Participants were categorized by the presence of nonalcoholic fatty liver disease (NAFLD) and MAFLD as follows: normal subjects; patients with both NAFLD and MAFLD; patients with NAFLD only; and patients with MAFLD only. Cox proportional hazards models were used to analyze the risk of mortality.
Results
During a median 5.7 years of follow-up, 20.69% was patients with both NAFLD and MAFLD, 1.51% was patients with NAFLD only, and 4.29% was patients with MAFLD only. All-cause and cardiovascular death was higher in patients with MAFLD than those without MAFLD (P<0.001, respectively). In patients with MAFLD only, the hazard ratio (HR) of all-cause and cardiovascular death was 1.35 (95% confidence interval [CI], 1.13 to 1.60) and 1.90 (95% CI, 1.26 to 2.88) after adjusting for age, which lost its statistical significance by multivariable adjustments. Compared to patients with less than two components of metabolic dysfunction, patients with more than two components of metabolic dysfunction were a higher risk of cardiovascular death (HR, 2.05; 95% CI, 1.25 to 3.38) and only women with more than two components of metabolic dysfunction were a higher risk of all-cause death (HR, 1.44; 95% CI, 1.02 to 2.03).
Conclusion
MAFLD criteria could identify a high-risk group for all-cause and cardiovascular death.

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Jiwon Yang, Ye Rim Kim, Seong Kyun Na, Seonok Kim, Jihyun An, Ju Hyun Shim
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MAFLD but not MASLD increases risk of all-cause mortality in regional Australia, with components of metabolic syndrome exacerbating factors: 20 year longitudinal, cohort study
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Taoli Fu, Jitao Ling, Huilei Zhao, Kaixin Lin, You Deng, Miao Zhang, Xinrui Qi, Peng Yu, Weichun Lin, Xiao Liu, Anna Di Sessa,
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Metabolic Risk/Epidemiology
Synergistic Interaction between Hyperuricemia and Abdominal Obesity as a Risk Factor for Metabolic Syndrome Components in Korean Population: Min Jin Lee, Ah Reum Khang, Yang Ho Kang, Mi Sook Yun, Dongwon Yi; Diabetes Metab J. 2022;46(5):756-766. Published online January 20, 2022; DOI: https://doi.org/10.4093/dmj.2021.0166

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Background
The present study investigated the role of synergistic interaction between hyperuricemia and abdominal obesity as a risk factor for the components of metabolic syndrome.
Methods
We performed a cross-sectional study using the data of 16,094 individuals from the seventh Korean National Health and Nutrition Examination Survey (2016 to 2018). The adjusted odds ratios of metabolic syndrome and its components were analyzed by multivariate logistic regression analysis. The presence of synergistic interaction between hyperuricemia and abdominal obesity was evaluated by calculating the additive scales—the relative excess risk due to interaction, attributable proportion due to interaction, and synergy index (SI).
Results
There was a synergistic interaction between hyperuricemia and abdominal obesity in hypertriglyceridemia (men: SI, 1.39; 95% confidence interval [CI], 1.01 to 1.98; women: SI, 1.61; 95% CI, 1.02 to 2.69), and low high-density lipoprotein cholesterol (HDL-C) (men: SI, 2.03; 95% CI, 1.41 to 2.91; women: SI, 1.70; 95% CI, 1.05 to 2.95). There was no significant synergistic interaction between hyperuricemia and abdominal obesity for the risk of high blood pressure (men: SI, 1.22; 95% CI, 0.85 to 1.77; women: SI, 1.53; 95% CI, 0.79 to 2.97), and hyperglycemia (men: SI, 1.03; 95% CI, 0.72 to 1.47; women: SI, 1.39; 95% CI, 0.75 to 2.57).
Conclusion
Hyperuricemia and abdominal obesity synergistically increased the risk of hypertriglyceridemia and low HDL-C in both sexes.

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Review

Pathophysiology
Insulin Resistance: From Mechanisms to Therapeutic Strategies: Shin-Hae Lee, Shi-Young Park, Cheol Soo Choi; Diabetes Metab J. 2022;46(1):15-37. Published online December 30, 2021; DOI: https://doi.org/10.4093/dmj.2021.0280

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Insulin resistance is the pivotal pathogenic component of many metabolic diseases, including type 2 diabetes mellitus, and is defined as a state of reduced responsiveness of insulin-targeting tissues to physiological levels of insulin. Although the underlying mechanism of insulin resistance is not fully understood, several credible theories have been proposed. In this review, we summarize the functions of insulin in glucose metabolism in typical metabolic tissues and describe the mechanisms proposed to underlie insulin resistance, that is, ectopic lipid accumulation in liver and skeletal muscle, endoplasmic reticulum stress, and inflammation. In addition, we suggest potential therapeutic strategies for addressing insulin resistance.

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Original Articles

COVID-19
Association of Metabolic Syndrome with COVID-19 in the Republic of Korea: Woo-Hwi Jeon, Jeong-Yeon Seon, So-Youn Park, In-Hwan Oh; Diabetes Metab J. 2022;46(3):427-438. Published online November 26, 2021; DOI: https://doi.org/10.4093/dmj.2021.0105

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Background
Metabolic syndrome (MetS) is reportedly a crucial risk factor for coronavirus disease 2019 (COVID-19). Since the epidemiological studies that examine this association are few and include small samples, we investigated the relationship between MetS and COVID-19 severity and death using a larger sample in the Republic of Korea.
Methods
We analyzed 66,321 patients, 4,066 of whom had COVID-19. We used chi-square tests to examine patients’ characteristics. We performed logistic regression analysis to analyze differences in COVID-19 infection and clinical outcomes according to the presence of MetS.
Results
Although MetS was not significantly associated with COVID-19 risk, acquiring MetS was significantly associated with the risk of severe COVID-19 outcomes (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.34 to 2.91; P=0.001). The mortality risk was significantly higher in COVID-19 patients with MetS (OR, 1.74; 95% CI, 1.17 to 2.59; P=0.006). Patients with abnormal waist circumference were approximately 2.07 times more likely to develop severe COVID-19 (P<0.001), and high-density lipoprotein cholesterol (HDL-C) levels were significantly associated with COVID-19; the mortality risk due to COVID-19 was 1.74 times higher in men with an HDL-C level of <40 mg/dL and in women with an HDL-C level of <50 mg/dL (P=0.012).
Conclusion
COVID-19 is likely associated with severity and death in patients with MetS or in patients with MetS risk factors. Therefore, patients with MetS or those with abnormal waist circumference and HDL-C levels need to be treated with caution.

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Is Lipid Levels Associated with Mortality of COVID-19? A Meta-Analysis
T. Cheng, Z. X. Yin, N. C. Zhang, S. Pang, L. L. Shao, Y. Li
Russian Journal of Genetics.2025; 61(4): 460. CrossRef
Heterogeneity in familial clustering of metabolic syndrome components in the multiethnic GENNID study
Jia Y. Wan, Deborah Goodman, Sukh Makhnoon, Trina M. Norden‐Krichmar, Baolin Wu, Karen L. Edwards
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Identification of shared genetic risks underlying metabolic syndrome and its related traits in the Korean population
Jun Young Kim, Yoon Shin Cho
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Metabolic health is more strongly associated with the severity and mortality of coronavirus disease 2019 than obesity
Hye Yeon Koo, Jae-Ryun Lee, Jin Yong Lee, Hyejin Lee
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Associated Factors with Changes of Metabolic Abnormalities among General Population in COVID-19 Pandemic
Eunjoo Kwon, Eun-Hee Nah, Suyoung Kim, Seon Cho, Hyeran Park
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Association between metabolic syndrome and mortality in patients with COVID-19: A nationwide cohort study
Hyo Jin Park, Jin-Hyung Jung, Kyungdo Han, Jean Shin, Yoojeong Lee, Yujin Chang, Kyeyeung Park, Yoon Jeong Cho, Youn Seon Choi, Seon Mee Kim, Ga Eun Nam
Obesity Research & Clinical Practice.2022; 16(6): 484. CrossRef

Type 1 Diabetes
Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus: Qianwen Huang, Daizhi Yang, Hongrong Deng, Hua Liang, Xueying Zheng, Jinhua Yan, Wen Xu, Xiangwen Liu, Bin Yao, Sihui Luo, Jianping Weng; Diabetes Metab J. 2022;46(1):93-103. Published online August 31, 2021; DOI: https://doi.org/10.4093/dmj.2020.0240

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Background
Both type 1 diabetes mellitus (T1DM) and metabolic syndrome (MetS) are associated with an elevated risk of morbidity and mortality yet with increasing heterogeneity. This study primarily aimed to evaluate the prevalence of MetS among adult patients with T1DM in China and investigate its associated risk factors, and relationship with microvascular complications.
Methods
We included adult patients who had been enrolled in the Guangdong T1DM Translational Medicine Study conducted from June 2010 to June 2015. MetS was defined according to the updated National Cholesterol Education Program criterion. Logistic regression models were used to estimate the odds ratio (OR) for the association between MetS and the risk of diabetic kidney disease (DKD) and diabetic retinopathy (DR).
Results
Among the 569 eligible patients enrolled, the prevalence of MetS was 15.1%. While female gender, longer diabetes duration, higher body mass index, and glycosylated hemoglobin A1c (HbA1c) were risk factors associated with MetS (OR, 2.86, 1.04, 1.14, and 1.23, respectively), received nutrition therapy education was a protective factor (OR, 0.46). After adjustment for gender, age, diabetes duration, HbA1c, socioeconomic and lifestyle variables, MetS status was associated with an increased risk of DKD and DR (OR, 2.14 and 3.72, respectively; both P<0.05).
Conclusion
Although the prevalence of MetS in adult patients with T1DM in China was relatively low, patients with MetS were more likely to have DKD and DR. A comprehensive management including lifestyle modification might reduce their risk of microvascular complications in adults with T1DM.

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Link Between Metabolic Syndrome, Inflammation, and Eye Diseases
Kamila Pieńczykowska, Anna Bryl, Małgorzata Mrugacz
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Metabolic syndrome in type 1 diabetes: higher time above range and glycemic variability revealed by continuous glucose monitoring (CGM)
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Current status, trend changes, and future predictions of the disease burden of type 1 diabetes kidney disease in global and China
Qinghua Yang, Li Jin, Mingwei Luo, Shiwei Xie
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Metabolic syndrome in type 1 diabetes mellitus in adults
R. I. Malievskaya, D. S. Avzaletdinova, I. G. Nasretdinova, I. Z. Urmanova, D. F. Iksanova
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Association between metabolic phenotype and diabetic kidney disease in adult-onset type 1 diabetes patients from China: A multi-center cross-sectional study
Jun Jiang, Peng Wang, Jielong Jiang, Tingmin Zhang, Yu Ding, Xueying Zheng, Sihui Luo, Jinhua Yan, Kuanxiao Tang, Daizhi Yang
Diabetes Research and Clinical Practice.2025; 226: 112347. CrossRef
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Aleksejs Fedulovs, Leonora Pahirko, Kaspars Jekabsons, Liga Kunrade, Jānis Valeinis, Una Riekstina, Valdis Pīrāgs, Jelizaveta Sokolovska
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Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus (Diabetes Metab J 2022;46:93-103)
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Diabetes & Metabolism Journal.2022; 46(3): 515. CrossRef
Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus (Diabetes Metab J 2022;46:93-103)
Gyuri Kim
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Metabolic syndrome associated with higher glycemic variability in type 1 diabetes: A multicenter cross-sectional study in china
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Metabolic Risk/Epidemiology
Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018: Jiun Chae, Moon Young Seo, Shin-Hye Kim, Mi Jung Park; Diabetes Metab J. 2021;45(6):880-889. Published online July 6, 2021; DOI: https://doi.org/10.4093/dmj.2020.0185

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Background
There is a lack of recent research on the changes in risk factors for metabolic syndrome (MetS) in the Asian pediatric population. We aimed to determine the 12-year trends in the prevalence of MetS and relevant lifestyle factors such as smoking, exercise, and calorie intake among Korean adolescents.
Methods
We investigated trends in MetS and lifestyle factors among 6,308 adolescents aged 12 to 18 years from the Korea National Health and Nutrition Examination Survey, 2007 to 2018.
Results
The prevalence of MetS was stable from 2007 to 2018 (1.7% to 2.2%). There were significant increases in the prevalence of central obesity (from 8.1% to 11.2%, P=0.012) and hyperglycemia (from 5.3% to 10.4%, P<0.001) and decreases in hypo-high-density lipoprotein (HDL)-cholesterolemia (from 22.4% to 14.8%, P<0.001). Total calorie intake and calorie intake from fat significantly increased (P<0.001), whereas calorie intake from carbohydrates significantly decreased (P<0.001) during the study period. The proportions of tobacco smokers and regular walkers significantly decreased from 2007 to 2018. After controlling for all covariates, total calorie intake was positively correlated with waist circumference (P<0.05). HDL-cholesterol was negatively associated with carbohydrate consumption (P<0.01) and positively associated with fat consumption (P<0.001). Regular walking and regular strength training were associated with lower waist circumference (P<0.05). Smoking was associated with lower fasting glucose levels (P<0.01).
Conclusion
Although the prevalence rate of MetS is stable among Korean adolescents, the prevalence of central obesity and hyperglycemia has increased greatly in the recent decade. Public education on proper dietary intake and lifestyle modification is required.

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Metabolic Risk/Epidemiology
Longitudinal Change in Myocardial Function and Clinical Parameters in Middle-Aged Subjects: A 3-Year Follow-up Study: Dong-Hyuk Cho, Hyung Joon Joo, Mi-Na Kim, Hee-Dong Kim, Do-Sun Lim, Seong-Mi Park; Diabetes Metab J. 2021;45(5):719-729. Published online June 15, 2021; DOI: https://doi.org/10.4093/dmj.2020.0132

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Background
Metabolic syndrome (MetS) is closely associated with the aging process. However, changes in metabolic conditions and cardiac function that occur in middle aged population remain unclear. We evaluated longitudinal changes in metabolic parameters and cardiac function during a 3-year period in subjects with suspected MetS.
Methods
We studied 191 participants with suspected MetS at baseline and after 3 years. Anthropometric parameters, including waist circumference (WC), and metabolic parameters, including fasting blood glucose and lipid profile were measured. Conventional echocardiography with two-dimensional speckle tracking was performed.
Results
Mean age was 56.2±4.4 years, and there were 97 women (50.8%). Men had increased WC and triglycerides (TG) (WC 91.2±6.8 cm vs. 84.0±8.0 cm, P<0.001; TG 184.4±116.3 mg/dL vs. 128.2±53.6 mg/dL, P<0.001), and reduced global longitudinal strain (GLS) (–15.4%±2.1% vs. –17.1%±2.0%, P<0.001) compared to women. After 3.4 years, values of WC and TG did not change in men but increased in women (all P<0.05). The absolute value of left ventricular (LV) GLS did not change in men but was reduced in women (P=0.011). Change in TG was independently associated with worsening of LV GLS only in women (standardized β, –0.309; 95% confidence interval, –0.130 to –0.009; P=0.025).
Conclusion
In middle aged population, a vulnerable period for metabolic disturbance, cardiac remodeling tended to progress, which was prominent in women. Progression of adiposity and dyslipidemia after menopause may accelerate subclinical cardiac remodeling in middle-aged women. Lifestyle modification and medical interventions may help prevent further cardiac dysfunction in these subjects.

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Positive additive interaction effects of age, sex, obesity, and metabolic syndrome on left ventricular dysfunction
Dan Zhou, Zhongwen Ye, Zhiqiang Nie, Chaolei Chen, Songyuan Luo, Mengqi Yan, Jiabin Wang, Yingqing Feng
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Epicardial Adipose Tissue and Heart Failure, Friend or Foe?
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Lung-Heart Outcomes and Mortality through the 2020 COVID-19 Pandemic in a Prospective Cohort of Breast Cancer Radiotherapy Patients
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Review

Pathophysiology
Hyperinsulinemia in Obesity, Inflammation, and Cancer: Anni M.Y. Zhang, Elizabeth A. Wellberg, Janel L. Kopp, James D. Johnson; Diabetes Metab J. 2021;45(3):285-311. Published online March 29, 2021; DOI: https://doi.org/10.4093/dmj.2020.0250; Correction in: Diabetes Metab J 2021;45(4):622

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The relative insufficiency of insulin secretion and/or insulin action causes diabetes. However, obesity and type 2 diabetes mellitus can be associated with an absolute increase in circulating insulin, a state known as hyperinsulinemia. Studies are beginning to elucidate the cause-effect relationships between hyperinsulinemia and numerous consequences of metabolic dysfunctions. Here, we review recent evidence demonstrating that hyperinsulinemia may play a role in inflammation, aging and development of cancers. In this review, we will focus on the consequences and mechanisms of excess insulin production and action, placing recent findings that have challenged dogma in the context of the existing body of literature. Where relevant, we elaborate on the role of specific signal transduction components in the actions of insulin and consequences of chronic hyperinsulinemia. By discussing the involvement of hyperinsulinemia in various metabolic and other chronic diseases, we may identify more effective therapeutics or lifestyle interventions for preventing or treating obesity, diabetes and cancer. We also seek to identify pertinent questions that are ripe for future investigation.

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Original Articles

Cardiovascular Risk/Epidemiology
Metabolic Syndrome Severity Score for Predicting Cardiovascular Events: A Nationwide Population-Based Study from Korea: Yo Nam Jang, Jun Hyeok Lee, Jin Sil Moon, Dae Ryong Kang, Seong Yong Park, Jerim Cho, Jang-Young Kim, Ji Hye Huh; Diabetes Metab J. 2021;45(4):569-577. Published online January 30, 2021; DOI: https://doi.org/10.4093/dmj.2020.0103

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Background
Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population.
Methods
From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve.
Results
Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III.
Conclusion
The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

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Pathophysiology
Relationships between Islet-Specific Autoantibody Titers and the Clinical Characteristics of Patients with Diabetes Mellitus: Yiqian Zhang, Tong Yin, Xinlei Wang, Rongping Zhang, Jie Yuan, Yi Sun, Jing Zong, Shiwei Cui, Yunjuan Gu; Diabetes Metab J. 2021;45(3):404-416. Published online July 21, 2020; DOI: https://doi.org/10.4093/dmj.2019.0239

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Background

Dysimmunity plays a key role in diabetes, especially type 1 diabetes mellitus. Islet-specific autoantibodies (ISAs) have been used as diagnostic markers for different phenotypic classifications of diabetes. This study was aimed to explore the relationships between ISA titers and the clinical characteristics of diabetic patients.

Methods

A total of 509 diabetic patients admitted to Department of Endocrinology and Metabolism at the Affiliated Hospital of Nantong University were recruited. Anthropometric parameters, serum biochemical index, glycosylated hemoglobin, urinary microalbumin/creatinine ratio, ISAs, fat mass, and islet β-cell function were measured. Multiple linear regression analysis was performed to identify relationships between ISA titers and clinical characteristics.

Results

Compared with autoantibody negative group, blood pressure, weight, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), visceral fat mass, fasting C-peptide (FCP), 120 minutes C-peptide (120minCP) and area under C-peptide curve (AUC_CP) of patients in either autoantibody positive or glutamate decarboxylase antibody (GADA) positive group were lower. Body mass index (BMI), waist circumference, triglycerides (TGs), body fat mass of patients in either autoantibody positive group were lower than autoantibody negative group. GADA titer negatively correlated with TC, LDL-C, FCP, 120minCP, and AUC_CP. The islet cell antibody and insulin autoantibody titers both negatively correlated with body weight, BMI, TC, TG, and LDL-C. After adjusting confounders, multiple linear regression analysis showed that LDL-C and FCP negatively correlated with GADA titer.

Conclusion

Diabetic patients with a high ISA titer, especially GADA titer, have worse islet β-cell function, but less abdominal obesity and fewer features of the metabolic syndrome.

Citations

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Positive Islet Cell Cytoplasmic Antibody and Long‐Term Use of Lipid‐Lowering Agents Are Positively Correlated With Peripheral Atherosclerosis in Patients With Autoimmune Diabetes: A Cross‐Sectional Study
Xinyue Chen, Jie Yu, Yiwen Liu, Xuechen Wang, Fan Ping, Wei Li, Huabing Zhang, Lingling Xu, Yuxiu Li, Mallikarjuna Korivi
Journal of Diabetes Research.2025;[Epub] CrossRef
Relationship between β-Cell Autoantibodies and Their Combination with Anthropometric and Metabolic Components and Microvascular Complications in Latent Autoimmune Diabetes in Adults
Tomislav Bulum, Marijana Vučić Lovrenčić, Jadranka Knežević Ćuća, Martina Tomić, Sandra Vučković-Rebrina, Lea Duvnjak
Biomedicines.2023; 11(9): 2561. CrossRef
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Correlation between Insulin Resistance and Microalbuminuria Creatinine Ratio in Postmenopausal Women
Han Na, Rong Wang, Hai-Long Zheng, Xiao-Pan Chen, Lin-Yang Zheng, Faustino R. Perez-Lopez
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The longitudinal loss of islet autoantibody responses from diagnosis of type 1 diabetes occurs progressively over follow-up and is determined by low autoantibody titres, early-onset, and genetic variants
C L Williams, R Fareed, G L M Mortimer, R J Aitken, I V Wilson, G George, K M Gillespie, A J K Williams, Chitrabhanu Ballav, Atanu Dutta, Michelle Russell-Taylor, Rachel Besser, James Bursell, Shanthi Chandran, Sejal Patel, Anne Smith, Manohara Kenchaiah,
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Review

Drug/Regimen
Fibrates Revisited: Potential Role in Cardiovascular Risk Reduction: Nam Hoon Kim, Sin Gon Kim; Diabetes Metab J. 2020;44(2):213-221. Published online April 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0001

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Fibrates, peroxisome proliferator-activated receptor-α agonists, are potent lipid-modifying drugs. Their main effects are reduction of triglycerides and increase in high-density lipoprotein levels. Several randomized controlled trials have not demonstrated their benefits on cardiovascular risk reduction, especially as an “add on” to statin therapy. However, subsequent analyses by major clinical trials, meta-analyses, and real-world evidence have proposed their potential in specific patient populations with atherogenic dyslipidemia and metabolic syndrome. Here, we have reviewed and discussed the accumulated data on fibrates to understand their current status in cardiovascular risk management.

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Original Articles

Metabolic Risk/Epidemiology
Insulin Resistance Increases Serum Immunoglobulin E Sensitization in Premenopausal Women: Seung Eun Lee, Ji Yeon Baek, Kyungdo Han, Eun Hee Koh; Diabetes Metab J. 2021;45(2):175-182. Published online April 14, 2020; DOI: https://doi.org/10.4093/dmj.2019.0150

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Graphical Abstract Abstract PDF PubReader ePub

Background

Although studies have shown that obesity is associated with aeroallergen sensitization (atopy), controversy still exists. We aimed to investigate the association between metabolic status, obesity, and atopy stratified by sex and menopausal status.

Methods

A total of 1,700 adults from the 2010 Korean National Health and Nutrition Examination Survey were classified into metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) by body mass index and insulin resistance. Atopy was defined as a positive response to at least one aeroallergen. Multiple regression analysis was used to evaluate the risk of immunoglobulin E (IgE) elevation or atopy in relation to the degree of metabolic abnormality and obesity.

Results

In premenopausal women, total IgE was positively correlated with obesity and insulin resistance. MUNO participants had a higher risk of having elevated total IgE compared to MHNO participants (odds ratio [OR], 2.271; 95% confidence interval [CI], 1.201 to 4.294), while MHO participants did not show a significant difference (OR, 1.435; 95% CI, 0.656 to 3.137) in premenopausal women. MUNO, but not MHO was also associated with atopy (OR, 2.157; 95% CI, 1.284 to 3.625). In men and postmenopausal women, there was no significant difference between metabolic status, obesity, and atopy among groups.

Conclusion

Increased insulin resistance is associated with total IgE and atopy in premenopausal women but not in postmenopausal women or men.

Citations

Citations to this article as recorded by

Association of serum total IgE and allergen-specific IgE with insulin resistance in adolescents: an analysis of the NHANES database
Yaping Liu, Xiaoxia Wang, Yong Liu
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Metabolic Risk/Epidemiology
Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients: Younhea Jung, Kyungdo Han, Hae-Young L. Park, Seung Hoon Lee, Chan Kee Park; Diabetes Metab J. 2020;44(3):414-425. Published online December 23, 2019; DOI: https://doi.org/10.4093/dmj.2019.0048

12,644 View
159 Download
53 Web of Science
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Abstract PDF PubReader ePub

Background

This study sought to investigate the associations between metabolic health status, obesity, and incidence of primary open-angle glaucoma (POAG).

Methods

In this nationwide, population-based, longitudinal prospective cohort study conducted using the Korean National Health Insurance System, we categorized all subjects based on presence and severity of metabolic syndrome and obesity. Insurance claims data were used to identify POAG development. Then, Cox regression was applied to calculate the hazard of developing POAG in people with various components of metabolic syndrome, obesity, or their combination.

Results

Of the total 287,553 subjects, 4,970 (1.3%) developed POAG. High fasting glucose, blood pressure, and total cholesterol levels were all associated with increased risk of developing POAG. Regarding obesity level, people with body mass index (BMI) greater than 30 kg/m² were more likely to develop POAG than those with normal BMI. Also, people with greater number of metabolic syndrome components showed a greater POAG incidence. People who are metabolically unhealthy and obese (adjusted hazard ratio [HR], 1.574; 95% confidence interval [CI], 1.449 to 1.711) and those who are metabolically unhealthy nonobese (MUNO: adjusted HR, 1.521; 95% CI, 1.405 to 1.645) but not those who are metabolically healthy obese (MHO: adjusted HR, 1.019; 95% CI, 0.907 to 1.144) had an increased hazard of developing POAG compared with metabolically healthy nonobese (MHNO) subjects.

Conclusion

Metabolic health status and obesity were significantly associated with increased risk of POAG incidence. MUNO subjects but not MHO subjects showed a higher risk of POAG development than did MHNO subjects, suggesting that metabolic status is more important than obesity in POAG.

Citations

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Epidemiology
Association between Change in Alcohol Consumption and Metabolic Syndrome: Analysis from the Health Examinees Study: Seulggie Choi, Kyuwoong Kim, Jong-Koo Lee, Ji-Yeob Choi, Aesun Shin, Sue Kyung Park, Daehee Kang, Sang Min Park; Diabetes Metab J. 2019;43(5):615-626. Published online April 23, 2019; DOI: https://doi.org/10.4093/dmj.2018.0128

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Background

The association between change in alcohol intake and metabolic syndrome is unclear.

Methods

This retrospective cohort consisted of 41,368 males and females from the Health Examinees-GEM study. Participants were divided into non-drinkers (0.0 g/day), light drinkers (male: 0.1 to 19.9 g/day; female: 0.1 to 9.9 g/day), moderate drinkers (male: 20.0 to 39.9 g/day; female: 10.0 to 19.9 g/day), and heavy drinkers (male: ≥40.0 g/day; female: ≥20.0 g/day) for each of the initial and follow-up health examinations. Logistic regression analysis was used to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for developing metabolic syndrome according to the change in alcohol consumption between the initial and follow-up health examinations. Adjusted mean values for the change in waist circumference, fasting serum glucose (FSG), blood pressure, triglycerides, and high density lipoprotein cholesterol (HDL-C) levels were determined according to the change in alcohol consumption by linear regression analysis.

Results

Compared to persistent light drinkers, those who increased alcohol intake to heavy levels had elevated risk of metabolic syndrome (aOR, 1.45; 95% CI, 1.09 to 1.92). In contrast, heavy drinkers who became light drinkers had reduced risk of metabolic syndrome (aOR, 0.61; 95% CI, 0.44 to 0.84) compared to persistent heavy drinkers. Increased alcohol consumption was associated with elevated adjusted mean values for waist circumference, FSG, blood pressure, triglycerides, and HDL-C levels (all P<0.05). Reduction in alcohol intake was associated with decreased waist circumference, FSG, blood pressure, triglycerides, and HDL-C levels among initial heavy drinkers (all P<0.05).

Conclusion

Heavy drinkers who reduce alcohol consumption could benefit from reduced risk of metabolic syndrome.

Citations

Citations to this article as recorded by

The relationship between dietary inflammatory index and all-cause and cardiovascular disease-related mortality in adults with metabolic syndrome: a cohort study of NHANES
Qunwei Ma, Ying Zhang, Daowen Zhang, Cancan Liu, Weiwei Zhu, Guixia Wang, Nannan Xu, Xue Zhang, Rui Huang, Huijun Zhang, Shuhang Xu, Chao Liu, Kuanlu Fan
Frontiers in Endocrinology.2025;[Epub] CrossRef
Genetic Commonalities Between Metabolic Syndrome and Rheumatic Diseases Through Disease Interactome Modules
Yinli Shi, Shuang Guan, Xi Liu, Hongjun Zhai, Yingying Zhang, Jun Liu, Weibin Yang, Zhong Wang
Journal of Cellular and Molecular Medicine.2025;[Epub] CrossRef
Association between Mediterranean diet and metabolic syndrome: analysis of NHANES 2007–2020
Qile Kang, Xuejiao Mei, Chiwei Guo, Yifan Si, Nongrong Wang
International Journal of Food Sciences and Nutrition.2025; 76(2): 209. CrossRef
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Circulation.2025;[Epub] CrossRef
Long‐term alcohol consumption and incident health risk conditions related to cardiometabolic risk markers: A 20‐year prospective cohort study
Sooyeun Choi, Taeyoung Park, Youjin Je
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Javier Tosoratto, Pedro Juan Tárraga López, Ángel Arturo López-González, Carla Busquets-Cortes, Joan Obrador de Hevia, José Ignacio Ramirez-Manent
Journal of Clinical Medicine.2025; 14(13): 4604. CrossRef
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Yee Hui Yeo, Fajuan Rui, Yixuan Zhu, Xiaoming Xu, Xiaoyan Ma, Wenjing Ni, Yuxiang Sun, Xinyu Hu, Chao Wu, Junping Shi, Jie Li, Philip N. Newsome
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Jinlong Huo, Yaxuan Xu, Xingqi Chen, Jie Yu, Lijin Zhao
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Jianyu Huang, Tao Huang, Jinjun Li
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Yongli Yang, Long Wen, Xuezhong Shi, Chaojun Yang, Jingwen Fan, Yi Zhang, Guibin Shen, Huiping Zhou, Xiaocan Jia
Sleep and Breathing.2024; 28(3): 1423. CrossRef
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Marie Chan Sun, Marie A. S. Landinaff, Ruben Thoplan
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Fredrik Åberg, Christopher D. Byrne, Carlos J. Pirola, Ville Männistö, Silvia Sookoian
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Xinwei Peng, Jingjing Zhu, Henry S. Lynn, Xi Zhang
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Siyu Chen, Rui Ding, Xiaojun Tang, Liling Chen, Qinwen Luo, Meng Xiao, Xianbin Ding, Bin Peng
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Yi Lin, Yan-Yan Ying, Si-Xuan Li, Si-Jia Wang, Qing-Hai Gong, Hui Li
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Obesity and Metabolic Syndrome
The Relationship between Thyroid Function and Different Obesity Phenotypes in Korean Euthyroid Adults: Jeong Mi Kim, Bo Hyun Kim, Hyungi Lee, Eun Heui Kim, Mijin Kim, Jong Ho Kim, Yun Kyung Jeon, Sang Soo Kim, In Joo Kim, Yong Ki Kim; Diabetes Metab J. 2019;43(6):867-878. Published online April 3, 2019; DOI: https://doi.org/10.4093/dmj.2018.0130

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Background

Thyroid disease and metabolic syndrome are both associated with cardiovascular disease. The aim of this study was to investigate the correlation between thyroid hormones and obesity sub-phenotypes using nationwide data from Korea, a country known to be iodine replete.

Methods

This study was based on data obtained from the sixth Korea National Health and Nutrition Examination Survey, administered from 2013 to 2015. A total of 13,873 participants aged ≥19 years were included, and classified into four groups: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO), and metabolically unhealthy obesity (MUO) by body fat on the basis of body mass index and metabolic health.

Results

At baseline, serum free thyroxine (fT4) values were significantly higher in the MHNO phenotype (MHNO, 1.27±0.01 ng/dL; MHO, 1.25±0.01 ng/dL; MUNO, 1.24±0.01 ng/dL; MUO, 1.24±0.01 ng/dL, P<0.001) in total study population. However, this significant association no longer remained after adjustment for age, urine iodine concentration, and smoking (P=0.085). After adjustment for confounders, statistically significant association was observed between lower thyroid stimulating hormone (TSH) and MHNO phenotype (P=0.044). In men participants (not women), higher fT4 values were significantly associated with MHNO phenotype (P<0.001). However, no significant association was observed between thyroid function (TSH or fT4) and obesity phenotypes in groups classified by age (cutoff age of 55 years).

Conclusion

Although there was a difference by age and sex, we found that the decrease of TSH and the increase of fT4 values were associated with MHNO.

Citations

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Background

Despite being an anti-obesity hepatokine, the levels of serum angiopoietin-like 6 (ANGPTL6) are elevated in various metabolic diseases. Thus, ANGPTL6 expression may reflect metabolic burden and may have compensatory roles. This study investigated the association between serum ANGPTL6 levels and new-onset metabolic syndrome.

Methods

In total, 221 participants without metabolic syndrome were randomly selected from a rural cohort in Korea. Baseline serum ANGPTL6 levels were measured using an enzyme-linked immunosorbent assay. Anthropometric and biochemical markers were analyzed before and after follow-up examinations.

Results

During an average follow-up period of 2.75 (interquartile range, 0.76) years, 82 participants (37.1%) presented new-onset metabolic syndrome and had higher ANGPTL6 levels before onset than those without metabolic syndrome (48.03±18.84 ng/mL vs. 64.75±43.35 ng/mL, P=0.001). In the multivariable adjusted models, the odds ratio for the development of metabolic syndrome in the highest quartile of ANGPTL6 levels was 3.61 (95% confidence interval, 1.27 to 10.26). The use of ANGPTL6 levels in addition to the conventional components improved the prediction of new-onset metabolic syndrome (area under the receiver operating characteristic curve: 0.775 vs. 0.807, P=0.036).

Conclusion

Increased serum ANGPTL6 levels precede the development of metabolic syndrome and its components, including low high density lipoprotein, high triglyceride, and high glucose levels, which have an independent predictive value for metabolic syndrome.

Citations

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Fetal sex-specific differences in the placental transcriptome of gestational diabetes
Lydia L. Shook, Frédérique White, Kalpana D. Acharya, Sofía Torres-Bigio, Laura Ibanez-Pintor, Daehee Han, François Aguet, Kristin G. Ardlie, Jose C. Florez, Luigi Bouchard, Pierre-Étienne Jacques, S. Ananth Karumanchi, Camille E. Powe, Marie-France Hiver
Scientific Reports.2026;[Epub] CrossRef
Circulating Angiopoietin-like Protein 6 Levels and Clinical Features in Patients with Type 2 Diabetes
Kohzo Takebayashi, Tatsuhiko Suzuki, Mototaka Yamauchi, Kenji Hara, Takafumi Tsuchiya, Toshihiko Inukai, Koshi Hashimoto
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Effects of Accumulated and Continuous High-Intensity Aerobic Exercise on Cardiorespiratory Fitness and Circulating ANGPTL6 Levels in Obese Adolescents
Jiyoung Ahn, Saejong Park
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High serum EDA concentration is associated with metabolic syndrome and its determinants
Xia Deng, Yanyan Li, Tian Gu, Xunan Wu, Ziyan Sun, Haoxiang Li, Ling Yang, Guoyue Yuan
Acta Diabetologica.2024; 62(6): 915. CrossRef
Angiopoietin-Like Proteins: Cardiovascular Biology and Therapeutic Targeting for the Prevention of Cardiovascular Diseases
Eric Thorin, Pauline Labbé, Mélanie Lambert, Pauline Mury, Olina Dagher, Géraldine Miquel, Nathalie Thorin-Trescases
Canadian Journal of Cardiology.2023; 39(12): 1736. CrossRef
Hyperlipidemia and hypothyroidism
Xin Su, Hua Peng, Xiang Chen, Xijie Wu, Bin Wang
Clinica Chimica Acta.2022; 527: 61. CrossRef
Multidimensional Biomarker Analysis Including Mitochondrial Stress Indicators for Nonalcoholic Fatty Liver Disease
Eunha Chang, Jae Seung Chang, In Deok Kong, Soon Koo Baik, Moon Young Kim, Kyu-Sang Park
Gut and Liver.2022; 16(2): 171. CrossRef
Triglyceride and Triglyceride-Rich Lipoproteins in Atherosclerosis
Bai-Hui Zhang, Fan Yin, Ya-Nan Qiao, Shou-Dong Guo
Frontiers in Molecular Biosciences.2022;[Epub] CrossRef
Relationship of ANGPTL6 With Neonatal Glucose Homeostasis and Fat Mass Is Disrupted in Gestational Diabetic Pregnancies
Abel Valencia-Martínez, Ute Schaefer-Graf, Encarnación Amusquivar, Emilio Herrera, Henar Ortega-Senovilla
The Journal of Clinical Endocrinology & Metabolism.2022; 107(10): e4078. CrossRef
Update on dyslipidemia in hypothyroidism: the mechanism of dyslipidemia in hypothyroidism
Huixing Liu, Daoquan Peng
Endocrine Connections.2022;[Epub] CrossRef
RETRACTED ARTICLE: Relationship between the development of hyperlipidemia in hypothyroidism patients
Xin Su, Xiang Chen, Bin Wang
Molecular Biology Reports.2022; 49(11): 11025. CrossRef
Effects of Exercise Intervention on Mitochondrial Stress Biomarkers in Metabolic Syndrome Patients: A Randomized Controlled Trial
Jae Seung Chang, Jun Namkung
International Journal of Environmental Research and Public Health.2021; 18(5): 2242. CrossRef
Angiopoietin-like proteins in atherosclerosis
Yi-Zhang Liu, Chi Zhang, Jie-Feng Jiang, Zhe-Bin Cheng, Zheng-Yang Zhou, Mu-Yao Tang, Jia-Xiang Sun, Liang Huang
Clinica Chimica Acta.2021; 521: 19. CrossRef
Effects of Bariatric Surgeries on Fetuin-A, Selenoprotein P, Angiopoietin-Like Protein 6, and Fibroblast Growth Factor 21 Concentration
Jakub Poloczek, Wojciech Kazura, Ewa Kwaśnicka, Janusz Gumprecht, Jerzy Jochem, Dominika Stygar, Munmun Chattopadhyay
Journal of Diabetes Research.2021; 2021: 1. CrossRef
Hepatokines and Non-Alcoholic Fatty Liver Disease: Linking Liver Pathophysiology to Metabolism
Tae Hyun Kim, Dong-Gyun Hong, Yoon Mee Yang
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Serum levels of angiopoietin-related growth factor in diabetes mellitus and chronic hemodialysis
Semra ÖZKAN ÖZTÜRK, Hilmi ATASEVEN
Cumhuriyet Medical Journal.2021;[Epub] CrossRef
ANGPTL6 Level in Patient with Coronary Heart Disease and Its Relationship with the Severity of Coronary Artery Lesions
蕾任
Advances in Clinical Medicine.2020; 10(05): 714. CrossRef
Investigating the Role of Myeloperoxidase and Angiopoietin-like Protein 6 in Obesity and Diabetes
Mohammad G. Qaddoumi, Muath Alanbaei, Maha M. Hammad, Irina Al Khairi, Preethi Cherian, Arshad Channanath, Thangavel Alphonse Thanaraj, Fahd Al-Mulla, Mohamed Abu-Farha, Jehad Abubaker
Scientific Reports.2020;[Epub] CrossRef
Letter: Increased Serum Angiopoietin-Like 6 Ahead of Metabolic Syndrome in a Prospective Cohort Study (Diabetes Metab J 2019;43:521-9)
Jin Hwa Kim
Diabetes & Metabolism Journal.2019; 43(5): 727. CrossRef
Response: Increased Serum Angiopoietin-Like 6 Ahead of Metabolic Syndrome in a Prospective Cohort Study (Diabetes Metab J 2019;43:521-9)
Jun Namkung, Kyu-Sang Park
Diabetes & Metabolism Journal.2019; 43(5): 729. CrossRef

Epidemiology
Lower Leg Fat Depots Are Associated with Albuminuria Independently of Obesity, Insulin Resistance, and Metabolic Syndrome (Korea National Health and Nutrition Examination Surveys 2008 to 2011): Eugene Han, Nan Hee Cho, Mi Kyung Kim, Hye Soon Kim; Diabetes Metab J. 2019;43(4):461-473. Published online March 7, 2019; DOI: https://doi.org/10.4093/dmj.2018.0081

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Background

Although the involvement of obesity in metabolic disorders is well known, leg fat depot influences on albuminuria have not been determined.

Methods

This population-based, cross-sectional study used a nationally representative sample of 2,076 subjects aged ≥20 years from the Korea National Health and Nutrition Examination Surveys of 2008 to 2011. The ratio of leg fat to total fat (LF/TF ratio) was assessed by dual X-ray absorptiometry, and albuminuria was defined as more than one positive dipstick test or an albumin-to-creatinine ratio of ≥30 mg/g.

Results

Individuals whose LF/TF ratio was in the lowest tertile showed a higher proportion of albuminuria than those in the highest tertile (odds ratio [OR], 2.82; 95% confidence interval [CI], 2.01 to 3.96; P<0.001). This association was observed in both sexes, all age groups, and all subgroups stratified by body mass index, waist circumference, homeostasis model assessments of insulin resistance, and the presence of metabolic syndrome (all, P<0.05). Multiple logistic regression analyses also demonstrated that the lowest LF/TF ratio was independently associated with albuminuria risk (OR, 1.55 to 2.16; all, P<0.05). In addition, the risk of albuminuria was higher in sarcopenic individuals with lower LF/TF ratios than in the highest LF/TF ratio subjects without sarcopenia (OR, 3.73; 95% CI, 2.26 to 6.13).

Conclusion

A lower LF/TF ratio was associated with an increased risk of albuminuria independent of obesity, insulin resistance, and metabolic syndrome, and when combined with sarcopenia, the albuminuria risk synergistically increased. Hence, our findings may have implications to improve risk stratification and recommendations on body fat distribution in the general population.

Citations

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Efficacy and safety of evogliptin in patients with type 2 diabetes and non‐alcoholic fatty liver disease: A multicentre, double‐blind, randomized, comparative trial
Eugene Han, Ji Hye Huh, Eun Y. Lee, Ji C. Bae, Sung W. Chun, Sung H. Yu, Soo H. Kwak, Kyong S. Park, Byung‐Wan Lee
Diabetes, Obesity and Metabolism.2022; 24(4): 752. CrossRef
Muscle fat contents rather than muscle mass determines nonalcoholic steatohepatitis and liver fibrosis in patients with severe obesity
Eugene Han, Mi Kyung Kim, Hye Won Lee, Seungwan Ryu, Hye Soon Kim, Byoung Kuk Jang, Youngsung Suh
Obesity.2022; 30(12): 2440. CrossRef
Albuminuria Is Associated with Steatosis Burden in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease
Eugene Han, Mi Kyung Kim, Byoung Kuk Jang, Hye Soon Kim
Diabetes & Metabolism Journal.2021; 45(5): 698. CrossRef

Obesity and Metabolic Syndrome
The Protective Effects of Increasing Serum Uric Acid Level on Development of Metabolic Syndrome: Tae Yang Yu, Sang-Man Jin, Jae Hwan Jee, Ji Cheol Bae, Moon-Kyu Lee, Jae Hyeon Kim; Diabetes Metab J. 2019;43(4):504-520. Published online February 21, 2019; DOI: https://doi.org/10.4093/dmj.2018.0079

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Background

It has not been determined whether changes in serum uric acid (SUA) level are associated with incident metabolic syndrome (MetS). The aim of the current study was to investigate the relationship between changes in SUA level and development of MetS in a large number of subjects.

Methods

In total, 13,057 subjects participating in a medical health check-up program without a diagnosis of MetS at baseline were enrolled. Cox proportional hazards models were used to test the independent association of percent changes in SUA level with development of MetS.

Results

After adjustment for age, systolic blood pressure, body mass index, fat-free mass (%), estimated glomerular filtration rate, smoking status, fasting glucose, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and baseline SUA levels, the hazard ratios (HRs) (95% confidence intervals [CIs]) for incident MetS in the second, third, and fourth quartiles compared to the first quartile of percent change in SUA level were 1.055 (0.936 to 1.190), 0.927 (0.818 to 1.050), and 0.807 (0.707 to 0.922) in male (P for trend <0.001) and 1.000 (0.843 to 1.186), 0.744 (0.615 to 0.900), and 0.684 (0.557 to 0.840) in female (P for trend <0.001), respectively. As a continuous variable in the fully-adjusted model, each one-standard deviation increase in percent change in SUA level was associated with an HR (95% CI) for incident MetS of 0.944 (0.906 to 0.982) in male (P=0.005) and 0.851 (0.801 to 0.905) in female (P<0.001).

Conclusion

The current study demonstrated that increasing SUA level independently protected against the development of MetS, suggesting a possible role of SUA as an antioxidant in the pathogenesis of incident MetS.

Citations

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Relationship between plasma uric acid levels, antioxidant capacity, and oxidative damage markers in overweight and obese adults: A cross-sectional study
Natalia Albuja-Quintana, Aida M. Chisaguano-Tonato, Maria E. Herrera-Fontana, Sandra Figueroa-Samaniego, José M. Alvarez-Suarez, Aleksandra Klisic
PLOS ONE.2025; 20(1): e0312217. CrossRef
High prevalence of hyperuricemia and the association with metabolic syndrome in the rural areas of Southwestern China: A structural equation modeling based on the Zhuang minority cohort
Xiaofen Tang, Shun Liu, Xiaoqiang Qiu, Li Su, Dongping Huang, Jun Liang, Yu Yang, Jennifer Hui Juan Tan, Xiaoyun Zeng, Yihong Xie
Nutrition, Metabolism and Cardiovascular Diseases.2024; 34(2): 497. CrossRef
Predictive Value of Collagen Biomarkers in Advanced Chronic Kidney Disease Patients
Carina Ureche, Gianina Dodi, Adela Mihaela Șerban, Andreea Simona Covic, Luminița Voroneanu, Simona Hogaș, Radu Andy Sascău, Cristian Stătescu, Adrian Covic
Biomolecules.2023; 13(2): 389. CrossRef
The bidirectional relationship between metabolic syndrome and hyperuricemia in China: A longitudinal study from CHARLS
Wen-Yu Chen, Yan-Peng Fu, Min Zhou
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Correlation between Serum Oxidative Stress Level and Serum Uric Acid and Prognosis in Patients with Hepatitis B-Related Liver Cancer before Operation
Maowen Yu, Chaozhu Zhang, Hongbo Tang, Chaohui Xiao, Hangjun Che
Journal of Healthcare Engineering.2022; 2022: 1. CrossRef
Association between metabolic syndrome and uric acid: a systematic review and meta-analysis
Elena Raya-Cano, Manuel Vaquero-Abellán, Rafael Molina-Luque, Domingo De Pedro-Jiménez, Guillermo Molina-Recio, Manuel Romero-Saldaña
Scientific Reports.2022;[Epub] CrossRef
Acute moderate‐intensity aerobic exercise promotes purinergic and inflammatory responses in sedentary, overweight and physically active subjects
Cesar Eduardo Jacintho Moritz, Franccesco Pinto Boeno, Alexandra Ferreira Vieira, Samuel Vargas Munhoz, Juliete Nathali Scholl, Amanda de Fraga Dias, Pauline Rafaela Pizzato, Fabrício Figueiró, Ana Maria Oliveira Battastini, Alvaro Reischak‐Oliveira
Experimental Physiology.2021; 106(4): 1024. CrossRef
Association between baseline and changes in serum uric acid and incident metabolic syndrome: a nation-wide cohort study and updated meta-analysis
Sen Chen, Nianwei Wu, Chuan Yu, Ying Xu, Chengfu Xu, Yuli Huang, Jian Zhao, Ningxiu Li, Xiong-Fei Pan
Nutrition & Metabolism.2021;[Epub] CrossRef
Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review
Vincent G. Pluimakers, Selveta S. van Santen, Marta Fiocco, Marie‐Christine E. Bakker, Aart J. van der Lelij, Marry M. van den Heuvel‐Eibrink, Sebastian J. C. M. M. Neggers
Obesity Reviews.2021;[Epub] CrossRef
Inverse associations between serum urate and glycemic status in a general population and in persons with diabetes mellitus
Ichiro Wakabayashi
Diabetology & Metabolic Syndrome.2020;[Epub] CrossRef
Association of Serum Uric Acid with Metabolic Syndrome and Its Components: A Mendelian Randomization Analysis
Lu Wang, Tao Zhang, Yafei Liu, Fang Tang, Fuzhong Xue, Wen-Jun Tu
BioMed Research International.2020;[Epub] CrossRef
Association between Serum Uric Acid and Metabolic Syndrome in Koreans
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Obesity and Metabolic Syndrome
Impact of Longitudinal Changes in Metabolic Syndrome Status over 2 Years on 10-Year Incident Diabetes Mellitus: Ji Hye Huh, Sung Gyun Ahn, Young In Kim, Taehwa Go, Ki-Chul Sung, Jae Hyuk Choi, Kwang Kon Koh, Jang Young Kim; Diabetes Metab J. 2019;43(4):530-538. Published online February 20, 2019; DOI: https://doi.org/10.4093/dmj.2018.0111

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Background

Metabolic syndrome (MetS) is a known predictor of diabetes mellitus (DM), but whether longitudinal changes in MetS status modify the risk for DM remains unclear. We investigated whether changes in MetS status over 2 years modify the 10-year risk of incident DM.

Methods

We analyzed data from 7,317 participants aged 40 to 70 years without DM at baseline, who took part in 2001 to 2011 Korean Genome Epidemiology Study. Subjects were categorized into four groups based on repeated longitudinal assessment of MetS status over 2 years: non-MetS, resolved MetS, incident MetS, and persistent MetS. The hazard ratio (HR) of new-onset DM during 10 years was calculated in each group using Cox models.

Results

During the 10-year follow-up, 1,099 participants (15.0%) developed DM. Compared to the non-MetS group, the fully adjusted HRs for new-onset DM were 1.28 (95% confidence interval [CI], 0.92 to 1.79) in the resolved MetS group, 1.75 (95% CI, 1.30 to 2.37) in the incident MetS group, and 1.98 (95% CI, 1.50 to 2.61) in the persistent MetS group (P for trend <0.001). The risk of DM in subjects with resolved MetS was significantly attenuated compared to those with persistent MetS over 2 years. In addition, the adjusted HR for 10-year developing DM gradually increased as the number of MetS components increased 2 years later.

Conclusion

We found that discrete longitudinal changes pattern in MetS status over 2 years associated with 10-year risk of DM. These findings suggest that monitoring change of MetS status and controlling it in individuals may be important for risk prediction of DM.

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Obesity and Metabolic Syndrome
Comparison of Competitive Models of Metabolic Syndrome Using Structural Equation Modeling: A Confirmatory Factor Analysis: Karimollah Hajian-Tilaki; Diabetes Metab J. 2018;42(5):433-441. Published online October 22, 2018; DOI: https://doi.org/10.4093/dmj.2018.0010

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Background

The purpose of this study was to apply the structural equation modeling (SEM) to compare the fitness of different competing models (one, two, and three factors) of the metabolic syndrome (MetS) in Iranian adult population.

Methods

Data are given on the cardiometabolic risk factors of 841 individuals with nondiabetic adults from a cross-sectional population-based study of glucose, lipids, and MetS in the north of Iran. The three conceptual hypothesized models (single factor, two correlated factors, and three correlated latent factors) were evaluated by using confirmatory factor analysis with the SEM approach. The summary statistics of correlation coefficients and the model summary fitting indexes were calculated.

Results

The findings show that a single-factor model and a two-correlated factor model had a poorer summary fitting index compared with a three-correlated factor model. All fitting criteria met the conceptual hypothesized three-correlated factor model for both sexes. However, the correlation structure between the three underlying constructs designating the MetS was higher in women than in men.

Conclusion

These results indicate the plausibility of the pathophysiology and etiology of MetS being multifactorial, rather than a single factor, in a nondiabetic Iranian adult population.

Citations

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International Journal of Molecular Sciences.2020; 21(20): 7617. CrossRef

Obesity and Metabolic Syndrome
Utility of Serum Albumin for Predicting Incident Metabolic Syndrome According to Hyperuricemia: You-Bin Lee, Ji Eun Jun, Seung-Eun Lee, Jiyeon Ahn, Gyuri Kim, Jae Hwan Jee, Ji Cheol Bae, Sang-Man Jin, Jae Hyeon Kim; Diabetes Metab J. 2018;42(6):529-537. Published online September 28, 2018; DOI: https://doi.org/10.4093/dmj.2018.0012

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Background

Serum albumin and uric acid have been positively linked to metabolic syndrome (MetS). However, the association of MetS incidence with the combination of uric acid and albumin levels has not been investigated. We explored the association of albumin and uric acid with the risk of incident MetS in populations divided according to the levels of these two parameters.

Methods

In this retrospective longitudinal study, 11,613 non-MetS participants were enrolled among 24,185 individuals who had undergone at least four annual check-ups between 2006 and 2012. The risk of incident MetS was analyzed according to four groups categorized by the sex-specific medians of serum albumin and uric acid.

Results

During 55,407 person-years of follow-up, 2,439 cases of MetS developed. The risk of incident MetS increased as the uric acid category advanced in individuals with lower or higher serum albumin categories with hazard ratios (HRs) of 1.386 (95% confidence interval [CI], 1.236 to 1.554) or 1.314 (95% CI, 1.167 to 1.480). However, the incidence of MetS increased with higher albumin levels only in participants in the lower uric acid category with a HR of 1.143 (95% CI, 1.010 to 1.294).

Conclusion

Higher levels of albumin were associated with an increased risk of incident MetS only in individuals with lower uric acid whereas higher levels of uric acid were positively linked to risk of incident MetS regardless of albumin level.

Citations

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Yile Tang, Yong Fan, Jin Su, Zisen Yang, Zaoling Liu
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Kai-Chieh Chang, Sin-Yi Huang, Wen-Hsin Tsai, Hao-Wen Liu, Jia-Sin Liu, Chia-Lin Wu, Ko-Lin Kuo
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A predictive model for hyperuricemia among type 2 diabetes mellitus patients in Urumqi, China
Palizhati Abudureyimu, Yuesheng Pang, Lirun Huang, Qianqian Luo, Xiaozheng Zhang, Yifan Xu, Liang Jiang, Patamu Mohemaiti
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Min Jin Lee, Ah Reum Khang, Yang Ho Kang, Mi Sook Yun, Dongwon Yi
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Eo Jin Park, Seung Don Yoo
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Vincent G. Pluimakers, Selveta S. van Santen, Marta Fiocco, Marie‐Christine E. Bakker, Aart J. van der Lelij, Marry M. van den Heuvel‐Eibrink, Sebastian J. C. M. M. Neggers
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Guillermo Mena-Sánchez, Nancy Babio, Nerea Becerra-Tomás, Miguel Á. Martínez-González, Andrés Díaz-López, Dolores Corella, Maria D. Zomeño, Dora Romaguera, Jesús Vioque, Ángel M. Alonso-Gómez, Julia Wärnberg, José A. Martínez, Luís Serra-Majem, Ramon Estr
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Epidemiology
High Proportion of Adult Cases and Prevalence of Metabolic Syndrome in Type 1 Diabetes Mellitus Population in Korea: A Nationwide Study: You-Bin Lee, Kyungdo Han, Bongsung Kim, Sang-Man Jin, Seung-Eun Lee, Ji Eun Jun, Jiyeon Ahn, Gyuri Kim, Jae Hyeon Kim; Diabetes Metab J. 2019;43(1):76-89. Published online August 22, 2018; DOI: https://doi.org/10.4093/dmj.2018.0048

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Background

The prevalence and incidence of type 1 diabetes mellitus (T1DM) in all age groups and the prevalence of metabolic syndrome in patients with T1DM in Korea were estimated.

Methods

The incidence and prevalence of T1DM between 2007 and 2013 were calculated using the Korean National Health Insurance Service (NHIS) datasets of claims. Clinical characteristics and prevalence of metabolic syndrome in individuals with T1DM between 2009 and 2013 were determined using the database of NHIS preventive health checkups.

Results

The prevalence of T1DM in Korea between 2007 and 2013 was 0.041% to 0.047%. The annual incidence rate of T1DM in Korea in 2007 to 2013 was 2.73 to 5.02/100,000 people. Although the incidence rate of typical T1DM was highest in teenagers, it remained steady in adults over 30 years of age. In contrast, the incidence rate of atypical T1DM in 2013 was higher in people aged 40 years or older than in younger age groups. Age- and sex-adjusted prevalence of metabolic syndrome in patients with T1DM was 51.65% to 55.06% between 2009 and 2013.

Conclusion

T1DM may be more common in Korean adults than previously believed. Metabolic syndrome may be a frequent finding in individuals with T1DM in Korea.

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Joungyoun Kim, Sang-Jun Shin, Ye-Seul Kim, Hee-Taik Kang
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Hyo Geun Choi, Min Joung Lee, Sang-Mok Lee
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Cardiovascular Diabetology.2020;[Epub] CrossRef
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Jae Hyeon Kim
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You-Bin Lee, Kyungdo Han, Bongsung Kim, Seung-Eun Lee, Ji Eun Jun, Jiyeon Ahn, Gyuri Kim, Sang-Man Jin, Jae Hyeon Kim
Cardiovascular Diabetology.2019;[Epub] CrossRef
Risk of end‐stage renal disease from chronic kidney disease defined by decreased glomerular filtration rate in type 1 diabetes: A comparison with type 2 diabetes and the effect of metabolic syndrome
You‐Bin Lee, Kyungdo Han, Bongsung Kim, Ji Eun Jun, Seung‐Eun Lee, Jiyeon Ahn, Gyuri Kim, Sang‐Man Jin, Jae Hyeon Kim
Diabetes/Metabolism Research and Reviews.2019;[Epub] CrossRef

Obesity and Metabolic Syndrome
Lack of Evidence of the Role of APOA5 3’UTR Polymorphisms in Iranian Children and Adolescents with Metabolic Syndrome: Samaneh Salehi, Modjtaba Emadi-Baygi, Majdaddin Rezaei, Roya Kelishadi, Parvaneh Nikpour; Diabetes Metab J. 2018;42(1):74-81. Published online February 23, 2018; DOI: https://doi.org/10.4093/dmj.2018.42.1.74

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Background

Metabolic syndrome (MetS) is a complex and multifactorial disorder characterized by insulin resistance, dyslipidaemia, hyperglycemia, abdominal obesity, and elevated blood pressure. The apolipoprotein A5 (APOA5) gene variants have been reported to correlate with two major components of MetS, including low levels of high density lipoprotein cholesterol (HDL-C) and high levels of triglyceride. In the present study, we explored the associations between five single nucleotide polymorphisms (SNPs) of APOA5 gene and the MetS risk.

Methods

In a case-control design, 120 Iranian children and adolescents with/without MetS were genotyped by polymerase chain reaction-sequencing for these SNPs. Then, we investigated the association of SNPs, individually or in haplotype constructs, with MetS risk.

Results

The rs34089864 variant and H1 haplotype (harboring the two major alleles of rs619054 and rs34089864) were associated with HDL-C levels. However, there was no significant association between different haplotypes/individual SNPs and MetS risk.

Conclusion

These results presented no association of APOA5 3’UTR SNPs with MetS. Further studies, including other polymorphisms, are required to investigate the involvement of APOA5 gene in the genetic susceptibility to MetS in the pediatric age group.

Citations

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Polymorphism of the APOA5 gene in patients with primary hyperlipidemia
S. V. Mikhailova, D. E. Ivanoshchuk, N. S. Shirokova, E. V. Shakhtshneider
Complex Issues of Cardiovascular Diseases.2020; 9(2): 38. CrossRef
Association between single nucleotide polymorphisms rs72525532, rs45596738, rs148759216, rs188133936, and rs114627122 of APOA5 gene in children and adolescents with metabolic syndrome
Samaneh Salehi, Modjtaba Emadi-Baygi, Parvaneh Nikpour, Roya Kelishadi
Journal of Shahrekord University of Medical Sciences.2019; 21(4): 175. CrossRef
Is Diabetes & Metabolism Journal Eligible to Be Indexed in MEDLINE?
Sun Huh
Diabetes & Metabolism Journal.2018; 42(6): 472. CrossRef

Review

Obesity and Metabolic Syndrome
Being Metabolically Healthy, the Most Responsible Factor for Vascular Health: Eun-Jung Rhee; Diabetes Metab J. 2018;42(1):19-25. Published online January 26, 2018; DOI: https://doi.org/10.4093/dmj.2018.42.1.19

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The prevalence of obesity is rapidly increasing worldwide. One-thirds of world population is suffering from the deleterious effects of excessive fat and adipose tissue in their body. At the same time, the average life expectancy is becoming higher and higher every decade. Therefore, living healthy and longer is the dream for everyone. Simply being obese is not the primary cause for the consequence of obesity; rather, the depot where the fat is accumulated, is the primary key for the deleterious effects of obesity. Results from historical research suggest that visceral fat increases the risk for cardiovascular and metabolic diseases, such as diabetes, myocardial infarction and ischemic stroke, not subcutaneous fat. Therefore, body mass index (BMI), which reflects body weight relative to height might not reflect the appropriate size of metabolic burden of fat in our body. In contrast, waist circumference, which reflects abdominal obesity, would mirror the metabolic burden of fat better than BMI. Visceral fat is the marker of ectopic fat accumulation. In this review, I will introduce my researches mainly involved in uncovering the clues to the link between metabolic health and cardiovascular disease.

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Jiayi Chen, Yibing Zhu, Junwei Liu, Qingxiu Li, Huimin Shi, Wenjuan Liu, Haiyan Gao, Wei Li, Zhengqin Wu, Bin Sun, Qian Zhang, Haibo Li
The Journal of Clinical Hypertension.2026;[Epub] CrossRef
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Le Zhao, Qisheng Gao
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Yue Cao, Weixing Wen, Hao Zhang, Weiwen Li, Guolin Huang, Yuli Huang
Diabetology & Metabolic Syndrome.2025;[Epub] CrossRef
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Jiaqian Zheng, Weiwen Mao, Mengqian Sang, Xinyu Pan, Yiluo Xie, Yichi Xie
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Jiayi Chen, Yecheng Miao, Qingxiu Li, Qian Zhang, Bin Sun, Zhengqin Wu, Wenjuan Liu, Junwei Liu, Huimin Shi, Haiyan Gao, Wei Li, Yibing Zhu, Haibo Li
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Victoria T. Isaksen, Maria A. Larsen, Rasmus Goll, Eyvind J. Paulssen, Jon R. Florholmen
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Journal of Diabetes Investigation.2020; 11(6): 1583. CrossRef
Hospitalization for heart failure incidence according to the transition in metabolic health and obesity status: a nationwide population-based study
You-Bin Lee, Da Hye Kim, Seon Mee Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Yong Gyu Park, Kyungdo Han, Hye Jin Yoo
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Elizabeth T. Cirulli, Lining Guo, Christine Leon Swisher, Naisha Shah, Lei Huang, Lori A. Napier, Ewen F. Kirkness, Tim D. Spector, C. Thomas Caskey, Bernard Thorens, J. Craig Venter, Amalio Telenti
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Original Articles

Obesity and Metabolic Syndrome
In Vitro Effect of Fatty Acids Identified in the Plasma of Obese Adolescents on the Function of Pancreatic β-Cells: Claudia Velasquez, Juan Sebastian Vasquez, Norman Balcazar; Diabetes Metab J. 2017;41(4):303-315. Published online May 24, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.4.303

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Background

The increase in circulating free fatty acid (FFA) levels is a major factor that induces malfunction in pancreatic β-cells. We evaluated the effect of FFAs reconstituted according to the profile of circulating fatty acids found in obese adolescents on the viability and function of the murine insulinoma cell line (mouse insulinoma [MIN6]).

Methods

From fatty acids obtained commercially, plasma-FFA profiles of three different youth populations were reconstituted: obese with metabolic syndrome; obese without metabolic syndrome; and normal weight without metabolic syndrome. MIN6 cells were treated for 24 or 48 hours with the three FFA profiles, and glucose-stimulated insulin secretion, cell viability, mitochondrial function and antioxidant activity were evaluated.

Results

The high FFA content and high polyunsaturated ω6/ω3 ratio, present in plasma of obese adolescents with metabolic syndrome had a toxic effect on MIN6 cell viability and function, increasing oxidative stress and decreasing glucose-dependent insulin secretion.

Conclusion

These results could help to guide nutritional management of obese young individuals, encouraging the increase of ω-3-rich food consumption in order to reduce the likelihood of deterioration of β-cells and the possible development of type 2 diabetes mellitus.

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Axel Römer, Divya Rawat, Thomas Linn, Sebastian F Petry
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Axel Römer, Thomas Linn, Sebastian F. Petry
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Molecules.2018; 23(6): 1483. CrossRef

Obesity and Metabolic Syndrome
Serum Calcium and the Risk of Incident Metabolic Syndrome: A 4.3-Year Retrospective Longitudinal Study: Jong Ha Baek, Sang-Man Jin, Ji Cheol Bae, Jae Hwan Jee, Tae Yang Yu, Soo Kyoung Kim, Kyu Yeon Hur, Moon-Kyu Lee, Jae Hyeon Kim; Diabetes Metab J. 2017;41(1):60-68. Published online December 26, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.60

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Background

An association between serum calcium level and risk of metabolic syndrome (MetS) has been suggested in cross-sectional studies. This study aimed to evaluate the association between baseline serum calcium level and risk of incident MetS in a longitudinal study.

Methods

We conducted a retrospective longitudinal study of 12,706 participants without MetS who participated in a health screening program, had normal range serum calcium level at baseline (mean age, 51 years), and were followed up for 4.3 years (18,925 person-years). The risk of developing MetS was analyzed according to the baseline serum calcium levels.

Results

A total of 3,448 incident cases (27.1%) of MetS developed during the follow-up period. The hazard ratio (HR) for incident MetS did not increase with increasing tertile of serum calcium level in an age- and sex-matched model (P for trend=0.915). The HRs (95% confidence interval [CI]) for incident MetS comparing the second and the third tertiles to the first tertile of baseline serum calcium level were 0.91 (95% CI, 0.84 to 0.99) and 0.85 (95% CI, 0.78 to 0.92) in a fully adjusted model, respectively (P for trend=0.001). A decreased risk of incident MetS in higher tertiles of serum calcium level was observed in subjects with central obesity and/or a metabolically unhealthy state at baseline.

Conclusion

There was no positive correlation between baseline serum calcium levels and incident risk of MetS in this longitudinal study. There was an association between higher serum calcium levels and decreased incident MetS in individuals with central obesity or two components of MetS at baseline.

Citations

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Brief Report

Obesity and Metabolic Syndrome
A Cutoff for Age at Menarche Predicting Metabolic Syndrome in Egyptian Overweight/Obese Premenopausal Women: Ibrahim Elsehely, Hala Abdel Hafez, Mohammed Ghonem, Ali Fathi, Rasha Elzehery; Diabetes Metab J. 2017;41(2):146-149. Published online November 30, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.2.146

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Previous studies showed that early age at menarche is associated with increased risk of metabolic syndrome. However, the definition of early menarche at these studies was based on background data in the communities at which these studies was carried on. The aim of this work is to determine a cutoff for age at menarche discriminating presence or absence of metabolic syndrome in overweight/obese premenopausal women. This study included 204 overweight/obese women. Metabolic syndrome was defined according to NCEP-ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria. Of a total 204 participants, 82 (40.2%) had metabolic syndrome. By using receiver operating characteristic analysis, age at menarche ≤12.25 year discriminated individuals with from those without metabolic syndrome. The area under the curve was 0.76 (95% confidence interval, 0.70 to 0.83). Sensitivity, specificity, negative predictive value, and positive predictive value were 82%, 70%, 85%, and 64%, respectively. Age at menarche ≤12.25 years predicts the presence of metabolic syndrome in overweight/obese women.

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Review

Fibroblast Growth Factor 21 Protects against Atherosclerosis via Fine-Tuning the Multiorgan Crosstalk: Leigang Jin, Zhuofeng Lin, Aimin Xu; Diabetes Metab J. 2016;40(1):22-31. Published online January 29, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.1.22

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Fibroblast growth factor 21 (FGF21) is a metabolic hormone with pleiotropic effects on energy metabolism and insulin sensitivity. Besides its antiobese and antidiabetic activity, FGF21 also possesses the protective effects against atherosclerosis. Circulating levels of FGF21 are elevated in patients with atherosclerosis, macrovascular and microvascular complications of diabetes, possibly due to a compensatory upregulation. In apolipoprotein E-deficient mice, formation of atherosclerotic plaques is exacerbated by genetic depletion of FGF21, but is attenuated upon replenishment with recombinant FGF21. However, the blood vessel is not the direct target of FGF21, and the antiatherosclerotic activity of FGF21 is attributed to its actions in adipose tissues and liver. In adipocytes, FGF21 promotes secretion of adiponectin, which in turn acts directly on blood vessels to reduce endothelial dysfunction, inhibit proliferation of smooth muscle cells and block conversion of macrophages to foam cells. Furthermore, FGF21 suppresses cholesterol biosynthesis and attenuates hypercholesterolemia by inhibiting the transcription factor sterol regulatory element-binding protein-2 in hepatocytes. The effects of FGF21 on elevation of adiponectin and reduction of hypercholesterolemia are also observed in a phase-1b clinical trial in patients with obesity and diabetes. Therefore, FGF21 exerts its protection against atherosclerosis by fine-tuning the interorgan crosstalk between liver, brain, adipose tissue, and blood vessels.

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Original Articles

Pattern of Thyroid Dysfunction in Patients with Metabolic Syndrome and Its Relationship with Components of Metabolic Syndrome: Prabin Gyawali, Jyoti Shrestha Takanche, Raj Kumar Shrestha, Prem Bhattarai, Kishor Khanal, Prabodh Risal, Rajendra Koju; Diabetes Metab J. 2015;39(1):66-73. Published online February 16, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.1.66

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Background

Thyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS.

Methods

A total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship.

Results

The overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD.

Conclusion

Patients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.

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A Cross-Sectional Study of the Phenotypes of Obesity and Insulin Resistance in Adults with Down Syndrome: Diego Real de Asua, Pedro Parra, Ramón Costa, Fernando Moldenhauer, Carmen Suarez; Diabetes Metab J. 2014;38(6):464-471. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.464

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Background

Despite the confluence of multiple cardiovascular risk factors, subclinical atherosclerotic damage and cardiovascular events remain extremely rare in adults with Down syndrome (DS). We aim to determine the prevalence of obesity and metabolic disorders in an adult cohort with DS and to compare our findings with adults without DS.

Methods

Cross-sectional study of 51 consecutively selected adults with DS living in the community and 51 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Epidemiological data (age and gender), anthropometric data (body mass index and waist-to-height ratio), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, vitamins, and lipid profile) were measured and compared between the groups.

Results

Adults with DS were significantly younger and more often men with a higher prevalence of overweight and obesity than controls. Their waist-to-height ratio was higher, and they more frequently had abdominal obesity. The results of an analysis adjusted for age and gender revealed no differences in fasting insulin levels, homeostatic model assessment indexes, or lipid profile between adults with DS and controls.

Conclusion

Adults with DS presented a high prevalence of overweight and obesity. However, we found no differences in lipid profile, prevalence of insulin resistance, or metabolic syndrome between adults with DS and controls.

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Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance: Alireza Esteghamati, Sina Noshad, Mostafa Mousavizadeh, Ali Zandieh, Manouchehr Nakhjavani; Diabetes Metab J. 2014;38(2):143-149. Published online April 18, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.2.143

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Background

Previous studies evaluating the relationship between serum vaspin concentrations and metabolic syndrome (MetS) have yielded contrasting results. Additionally, contribution of general and abdominal obesity, chronic inflammation, and insulin resistance to this relationship remains unknown.

Methods

In a cross-sectional setting, we investigated the association between vaspin and MetS in 145 subjects ranging from normoglycemia to type 2 diabetes. Vaspin concentrations were measured using enzyme-linked immunosorbent assay.

Results

Women had 29% higher vaspin concentrations compared with men. Subjects with MetS (51% of all participants) had higher vaspin concentrations (P=0.019 in women and P<0.001 in men). In logistic regression, vaspin significantly predicted raised fasting plasma glucose (P<0.001), and raised triglycerides (P<0.001) after controlling for age in both sexes. Moreover, vaspin was the significant predictor for reduced high-density lipoprotein cholesterol and raised waist circumference in women and men, respectively. Considering MetS as a whole, vaspin predicted MetS even after adjustment for age, medications, diabetes, total cholesterol, and waist circumference in both sexes (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.36 to 11.05; P=0.011 for women; OR, 3.16; 95% CI, 1.28 to 7.78; P=0.012 for men). However, this relationship rendered nonsignificant after introducing homeostasis model assessment of insulin resistance (HOMA-IR) in women (P=0.089) and high-sensitivity C-reactive protein (P=0.073) or HOMA-IR in men (P=0.095).

Conclusion

Vaspin is associated with some but not all components of MetS. Vaspin is a predictor of MetS as a single entity, independent of obesity. This relationship is largely ascribed to the effects of insulin resistance and chronic inflammation.

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Letter: Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance (Diabetes Metab J2014;38:143-9)
Sung Hee Choi
Diabetes & Metabolism Journal.2014; 38(3): 240. CrossRef
Response: Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance (Diabetes Metab J2014;38:143-9)
Alireza Esteghamati, Sina Noshad, Mostafa Mousavizadeh, Ali Zandieh, Manouchehr Nakhjavani
Diabetes & Metabolism Journal.2014; 38(3): 242. CrossRef

Relative Skeletal Muscle Mass Is Associated with Development of Metabolic Syndrome: Byung Sam Park, Ji Sung Yoon; Diabetes Metab J. 2013;37(6):458-464. Published online December 12, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.6.458

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Background

Visceral adiposity is related to insulin resistance. Skeletal muscle plays a central role in insulin-mediated glucose disposal; however, little is known about the association between muscle mass and metabolic syndrome (MS). This study is to clarify the clinical role of skeletal muscle mass in development of MS.

Methods

A total of 1,042 subjects were enrolled. Subjects with prior MS and chronic diseases were excluded. After 24 months, development of MS was assessed using NCEP-ATP III criteria. Skeletal muscle mass (SMM; kg), body fat mass (BFM; kg), and visceral fat area (VFA; cm²) were obtained from bioelectrical analysis. Then, the following values were calculated as follows: percent of SMM (SMM%; %): SMM (kg)/weight (kg), skeletal muscle index (SMI; kg/m²): SMM (kg)/height (m²), skeletal muscle to body fat ratio (MFR): SMM (kg)/BFM (kg), and skeletal muscle to visceral fat ratio (SVR; kg/cm²): SMM (kg)/VFA (cm²).

Results

Among 838 subjects, 88 (10.5%) were newly diagnosed with MS. Development of MS increased according to increasing quintiles of BMI, SMM, VFA, and SMI, but was negatively associated with SMM%, MFR, and SVR. VFA was positively associated with high waist circumference (WC), high blood pressure (BP), dysglycemia, and high triglyceride (TG). In contrast, MFR was negatively associated with high WC, high BP, dysglycemia, and high TG. SVR was negatively associated with all components of MS.

Conclusion

Relative SMM ratio to body composition, rather than absolute mass, may play a critical role in development of MS and could be used as a strong predictor.

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Review

Targeting the Peroxisome Proliferator-Activated Receptor-γ to Counter the Inflammatory Milieu in Obesity: Cesar Corzo, Patrick R. Griffin; Diabetes Metab J. 2013;37(6):395-403. Published online December 12, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.6.395

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Abstract PDF PubReader ePub

Adipose tissue, which was once viewed as a simple organ for storage of triglycerides, is now considered an important endocrine organ. Abnormal adipose tissue mass is associated with defects in endocrine and metabolic functions which are the underlying causes of the metabolic syndrome. Many adipokines, hormones secreted by adipose tissue, regulate cells from the immune system. Interestingly, most of these adipokines are proinflammatory mediators, which increase dramatically in the obese state and are believed to be involved in the pathogenesis of insulin resistance. Drugs that target peroxisome proliferator-activated receptor-γ have been shown to possess anti-inflammatory effects in animal models of diabetes. These findings, and the link between inflammation and the metabolic syndrome, will be reviewed here.

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Original Articles

Low Levels of Physical Activity Are Associated with Increased Metabolic Syndrome Risk Factors in Korean Adults: Dong Hoon Lee, Yoon Myung Kim, Yoonsuk Jekal, Sukyung Park, Kyong-Chol Kim, Masayo Naruse, Sun Hyun Kim, Sang-Hwan Kim, Ji-Hye Park, Mi Kyung Lee, Sang Hui Chu, Justin Y. Jeon; Diabetes Metab J. 2013;37(2):132-139. Published online April 16, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.2.132

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Background

Low levels of physical activity (PA) are strongly associated with the development of metabolic syndrome (MetS) and chronic diseases. However, few studies have examined this association in Koreans. The primary purpose of this study was to examine the associations between PA and MetS risks in Korean adults.

Methods

A total of 1,016 Korean adults (494 males and 522 females) participated in this study. PA levels were assessed using the International PA Questionnaire. MetS risk factors were determined using clinically established diagnostic criteria.

Results

Compared with the highest PA group, the group with the lowest level of PA was at greater risk of high triglyceride (TG) in males (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.07 to 3.24) and of hemoglobin A1c ≥5.5% in females (OR, 1.75; 95% CI, 1.00 to 3.04) after adjusting for age and body mass index. Compared with subjects who met the PA guidelines, those who did not meet the guidelines were more likely to have low high density lipoprotein cholesterol in both males (OR, 1.69; 95% CI, 1.11 to 2.58), and females (OR, 1.82; 95% CI, 1.20 to 2.77). Furthermore, those who did not meet the PA guidelines were at increased risk of high TG levels in males (OR, 1.69; 95% CI, 1.23 to 2.86) and abnormal fasting glucose (OR, 1.93; 95% CI, 1.17 to 3.20) and MetS (OR, 2.10; 95% CI, 1.15 to 3.84) in females.

Conclusion

Increased levels of PA are significantly associated with a decreased risk of abnormal MetS components.

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Factor Structure of Indices of the Second Derivative of the Finger Photoplethysmogram with Metabolic Components and Other Cardiovascular Risk Indicators: Tomoyuki Kawada, Toshiaki Otsuka; Diabetes Metab J. 2013;37(1):40-45. Published online February 15, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.1.40

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Background

The second derivative of the finger photoplethysmogram (SDPTG) is an indicator of arterial stiffness. The present study was conducted to clarify the factor structure of indices of the SDPTG in combination with components of the metabolic syndrome (MetS), to elucidate the significance of the SDPTG among various cardiovascular risk factors.

Methods

The SDPTG was determined in the second forefinger of the left hand in 1,055 male workers (mean age, 44.2±6.4 years). Among 4 waves of SDPTG components, the ratios of the height of the "a" wave to that of the "b" and "d" waves were expressed as b/a and d/a, and used as SDPTG indices for the analysis.

Results

Principal axis factoring analysis was conducted using age, SDPTG indices, components of MetS, and the serum levels of C-reactive protein (CRP) and uric acid. Three factors were extracted, and the SDPTG indices were categorized in combination with age as the third factor. Metabolic components and the SDPTG indices were independently categorized. These three factors explained 44.4% of the total variation. Multiple logistic regression analysis revealed age, d/a, serum uric acid, serum CRP, and regular exercise as independent determinants of the risk of MetS. The odds ratios (95% confidence intervals) were 1.08 (1.04 to 1.11), 0.10 (0.01 to 0.73), 1.24 (1.06 to 1.44), 3.59 (2.37 to 5.42), and 0.48 (0.28 to 0.82), respectively.

Conclusion

The SDPTG indices were categorized in combination with age, and they differed in characteristics from components of MetS or inflammatory markers. In addition, this cross-sectional study also revealed decrease of the d/a as a risk factor for the development of MetS.

Citations

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Second Derivative of the Finger Photoplethysmogram Predicts the Risk of Developing Hypertension in Middle-Aged Men
Toshiaki Otsuka, Yasuhiro Nishiyama, Katsuhito Kato, Eitaro Kodani, Tomoyuki Kawada
Journal of Atherosclerosis and Thrombosis.2025; 32(2): 188. CrossRef
Presence of hypertension might pose a potential pitfall in detection of diabetes mellitus non-invasively using the second derivative of photoplethysmography
Ahmet Taş, Yaren Alan, Ilke Kara, Abdullah Savas, Muhammed Ikbal Bayhan, Diren Ekici, Zeynep Atay, Fatih Sezer, Cagla Kitapli, Sabahattin Umman, Murat Sezer
Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization.2024;[Epub] CrossRef
Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review
Malak Abdullah Almarshad, Md Saiful Islam, Saad Al-Ahmadi, Ahmed S. BaHammam
Healthcare.2022; 10(3): 547. CrossRef
Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review
Vincent G. Pluimakers, Selveta S. van Santen, Marta Fiocco, Marie‐Christine E. Bakker, Aart J. van der Lelij, Marry M. van den Heuvel‐Eibrink, Sebastian J. C. M. M. Neggers
Obesity Reviews.2021;[Epub] CrossRef
Age-Related Changes in the Characteristics of the Elderly Females Using the Signal Features of an Earlobe Photoplethysmogram
Jeong-Woo Seo, Jungmi Choi, Kunho Lee, Jaeuk U. Kim
Sensors.2021; 21(23): 7782. CrossRef
Screening Test on Metabolic Syndrome Using Electro Interstitial Scan Instrument

Phawit Norchai, Thipaporn Tharavanij, Picha Suwannahitatorn, Thammanard Charernboon
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Evaluation of Cardiorespiratory Function During Cardiopulmonary Exercise Testing in Untreated Hypertensive and Healthy Subjects
Yahui Zhang, Zhihao Jiang, Lin Qi, Lisheng Xu, Xingguo Sun, Xinmei Chu, Yanling Liu, Tianjing Zhang, Stephen E. Greenwald
Frontiers in Physiology.2018;[Epub] CrossRef
Second derivative of the finger photoplethysmogram and cardiovascular mortality in middle-aged and elderly Japanese women
Noriko Inoue, Hideshi Kawakami, Hideya Yamamoto, Chikako Ito, Saeko Fujiwara, Hideo Sasaki, Yasuki Kihara
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Photoplethysmogram second derivative review: Analysis and applications
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Cardio-Metabolic Features of Type 2 Diabetes Subjects Discordant in the Diagnosis of Metabolic Syndrome: Sa Rah Lee, Ying Han, Ja Won Kim, Ja Young Park, Ji Min Kim, Sunghwan Suh, Mi-Kyoung Park, Hye-Jeong Lee, Duk Kyu Kim; Diabetes Metab J. 2012;36(5):357-363. Published online October 18, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.5.357

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Background

The aim of this study is to investigate the cardio-metabolic parameters and surrogate markers of insulin resistance in a discordant group of type 2 diabetes (T2DM) subjects who satisfy the Adults Treatment Panel (ATP) III criteria, but not the International Diabetes Federation (IDF) criteria, for metabolic syndrome (MetS).

Methods

We assessed the prevalence of MetS in T2DM subjects (n=167) who were selected from subjects registered at the diabetes center of Dong-A University Medical Center. We used the ATP III criteria and the IDF criteria for the diagnosis of MetS and sorted the subjects into 2 MetS groups: one group diagnosed per ATP III criteria (MetSa) and one diagnosed per IDF criteria (MetSi). We then compared the clinical characteristics, metabolic parameters (homeostasis model assessment of insulin resistance, aspartate aminotransferase, alanine aminotransferase, and uric acid values) and co-morbidities (prevalence of microalbuminuria, fatty liver, and cardiovascular disease) between the MetSa, MetSi, and discordant MetS groups.

Results

The prevalence of MetS in the MetSa group (73.6%) was higher than in the MetSi group (62.2%). The MetS prevalence in the discordant group was 11.4%. The discordant group showed no significant differences in clinical characteristics (except waist circumference and body mass index), metabolic parameters, or prevalence of co-morbidities, as compared with subjects with MetS by both criteria.

Conclusion

In this study, cardio-metabolic features of the subjects diagnosed with MetS using ATP III criteria, but not IDF criteria, are not significantly different from those of subjects diagnosed with MetS using both criteria.

Citations

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Clinical analysis of the relationship between cystatin C and metabolic syndrome in the elderly
Ping Liu, Shujian Sui, Dongling Xu, Xiaowei Xing, Caixia Liu
Revista Portuguesa de Cardiologia.2014; 33(7-8): 411. CrossRef
Resolvin D1 reduces ER stress-induced apoptosis and triglyceride accumulation through JNK pathway in HepG2 cells
Tae Woo Jung, Hwan-Jin Hwang, Ho Cheol Hong, Hae Yoon Choi, Hye Jin Yoo, Sei Hyun Baik, Kyung Mook Choi
Molecular and Cellular Endocrinology.2014; 391(1-2): 30. CrossRef
Clinical analysis of the relationship between cystatin C and metabolic syndrome in the elderly
Ping Liu, Shujian Sui, Dongling Xu, Xiaowei Xing, Caixia Liu
Revista Portuguesa de Cardiologia (English Edition).2014; 33(7-8): 411. CrossRef

The Association between Midnight Salivary Cortisol and Metabolic Syndrome in Korean Adults: Yun-Mi Jang, Eun Jung Lee, Dong Lim Kim, Suk Kyeong Kim, Kee-Ho Song; Diabetes Metab J. 2012;36(3):245-250. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.245

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Background

The common characteristics of metabolic syndrome (MetS) and Cushing's syndrome suggest that excess cortisol may be involved in the pathogenesis of MetS. Salivary cortisol measurements are simple and can be surrogates for plasma free cortisol, which is the most biologically active form. We evaluated the association between levels of midnight salivary cortisol and MetS in Korean adults.

Methods

A total of 46 subjects, aged 20 to 70 years, who visited the Health Care Center at Konkuk University Hospital from August 2008 to August 2009 were enrolled. We compared the levels of midnight salivary cortisol in subjects with MetS with those in subjects without MetS. We analyzed the associations between midnight salivary cortisol levels and components of MetS.

Results

Midnight salivary cortisol levels were higher in the MetS group (70±42.4 ng/dL, n=12) than that in the group without MetS (48.1±36.8 ng/dL, n=34) (P=0.001). Positive correlations were observed between midnight salivary cortisol levels and waist circumference, fasting blood glucose, and homeostasis model assessment of insulin resistance. The risk for MetS was significantly higher in subjects with midnight salivary cortisol levels ≥100 ng/dL than in those with levels <50 ng/dL (odds ratio, 5.9; 95% confidence interval, 2.35 to 36.4).

Conclusion

The results showed a positive correlation between midnight salivary cortisol levels and MetS, suggesting that hypercortisolism may be related to MetS.

Citations

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“Feeding the Rhythm”—Effects of Food and Nutrients on Daily Cortisol Secretion: From Molecular Mechanisms to Clinical Impact
Rosa Maria Paragliola, Marco Marchetti, Costanza Montagna, Salvatore Maria Corsello, Gianfranco Peluso
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Sumaiya Irfan, Noorin Zaidi, Kshama Tiwari, Nirupma Lal, Anand Narayan Srivastava, Shivangi Singh
Journal of Cancer Research and Therapeutics.2024; 20(5): 1420. CrossRef
Association of primary allostatic load mediators and metabolic syndrome (MetS): A systematic review
Francis Osei, Andrea Block, Pia-Maria Wippert
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Salivary cortisol levels during Ramadan fasting in hydrocortisone-treated secondary adrenal insufficiency patients
Melika Chihaoui, Wiem Madhi, Meriem Yazidi, Bessem Hammami, Ibtissem Oueslati, Nadia Khessairi, Wafa Grira, Amina Bibi, Moncef Feki, Fatma Chaker
Endocrine.2020; 70(2): 404. CrossRef
Basal cortisol levels and metabolic syndrome: A systematic review and meta-analysis of observational studies
Anderson Garcez, Heloísa Marquardt Leite, Elisabete Weiderpass, Vera Maria Vieira Paniz, Guilherme Watte, Raquel Canuto, Maria Teresa Anselmo Olinto
Psychoneuroendocrinology.2018; 95: 50. CrossRef
Is salivary gland function altered in noninsulin-dependent diabetes mellitus and obesity–insulin resistance?
Jitjiroj Ittichaicharoen, Nipon Chattipakorn, Siriporn C. Chattipakorn
Archives of Oral Biology.2016; 64: 61. CrossRef
The Role of Cortisol in the Pathogenesis of the Metabolic Syndrome
In-Kyung Jeong
Diabetes & Metabolism Journal.2012; 36(3): 207. CrossRef

Metabolic Syndrome versus Framingham Risk Score for Association of Self-Reported Coronary Heart Disease: The 2005 Korean Health and Nutrition Examination Survey: Hye Mi Kang, Dong-Jun Kim; Diabetes Metab J. 2012;36(3):237-244. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.237

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Background

Several studies in Western populations have indicated that metabolic syndrome (MetS) is inferior to the Framingham risk score (FRS) in predicting coronary heart disease (CHD). However there has been no study about the predictability of MetS vs. FRS for CHD in Korea.

Methods

Among the 43,145 persons from the third Korea National Health and Nutrition Examination Survey in 2005, laboratory test and nutritional survey data from 5,271 persons were examined. Participants were also asked to recall a physician's diagnosis of CHD.

Results

The median age was 46 (range, 20 to 78) in men (n=2,257) and 44 (range, 20 to 78) years in women (n=3,014). Prevalence of self-reported CHD was 1.7% in men and 2.1% in women. Receiver operating characteristic curves and their respective area under the curve (AUC) were used to compare the ability of the FRS and the number of components of MetS to predict self-reported CHD in each sex. In men, AUC of FRS was significantly larger than that of MetS (0.767 [0.708 to 0.819] vs. 0.677 [0.541 to 0.713], P<0.01). In women, AUC of FRS was comparable to that of MetS (0.777 [0.728 to 0.826] vs. 0.733 [0.673 to 0.795]), and was not significant.

Conclusion

The data suggested that FRS was more closely associated with CHD compared to MetS in Korean men.

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The Association between Apolipoprotein A-II and Metabolic Syndrome in Korean Adults: A Comparison Study of Apolipoprotein A-I and Apolipoprotein B: Dong Won Yi, Dong Wook Jeong, Sang Yeoup Lee, Seok Man Son, Yang Ho Kang; Diabetes Metab J. 2012;36(1):56-63. Published online February 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.1.56

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Background

Apolipoprotein A-II (apoA-II) is the second-most abundant apolipoprotein in human high-density lipoprotein and its role in cardio metabolic risk is not entirely clear. It has been suggested to have poor anti-atherogenic or even pro-atherogenic properties, but there are few studies on the possible role of apoA-II in Asian populations. The aim of this study is to evaluate the role of apoA-II in metabolic syndrome (MetS) compared with apolipoprotein A-I (apoA-I) and apolipoprotein B (apoB) in Korean adults.

Methods

We analyzed data from 244 adults who visited the Center for Health Promotion in Pusan National University Yangsan Hospital for routine health examinations.

Results

The mean apoB level was significantly higher, and the mean apoA-I level was significantly lower, in MetS; however, there was no significant difference in apoA-II levels (30.5±4.6 mg/dL vs. 31.2±4.6 mg/dL, P=0.261). ApoA-II levels were more positively correlated with apoA-I levels than apoB levels. ApoA-II levels were less negatively correlated with homocysteine and high sensitivity C-reactive protein levels than apoA-I levels. The differences in MetS prevalence from the lowest to highest quartile of apoA-II were not significant (9.0%, 5.7%, 4.9%, and 6.6%, P=0.279). The relative risk of the highest quartile of apoA-II compared with the lowest quartile also was not significantly different (odds ratio, 0.96; 95% confidence interval, 0.95 to 1.04; P=0.956).

Conclusion

Compared with apoA-I (negative association with MetS) and apoB (positive association with MetS) levels, apoA-II levels did not show any association with MetS in this study involving Korean adults. However, apoA-II may have both anti-atherogenic and pro-atherogenic properties.

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Review

Obesity and Metabolic Syndrome in Korea: Sang Woo Oh; Diabetes Metab J. 2011;35(6):561-566. Published online December 26, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.6.561

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In Korea, a person with a body mass index (BMI) ≥25 kg/m² is considered obese, and a person with a BMI ≥30 kg/m² is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.

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Korean Journal of Family Medicine.2019; 40(2): 116. CrossRef
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World Journal of Gastroenterology.2019; 25(33): 4959. CrossRef
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Is nonalcoholic fatty liver disease associated with the development of prostate cancer? A nationwide study with 10,516,985 Korean men
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Prevalence Risk of Metabolic Syndrome Associated with Alcohol Use Behavior in Korean Women
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The Cardiometabolic Burden of Self-Perceived Obesity: A Multilevel Analysis of a Nationally Representative Sample of Korean Adults
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Educational Inequality in Obesity-Related Mortality in Korea
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Fatty liver disease determines the progression of coronary artery calcification in a metabolically healthy obese population
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Korean Journal of Family Medicine.2017; 38(2): 64. CrossRef
Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study
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Association between Milk Consumption and Metabolic Syndrome among Korean Adults: Results from the Health Examinees Study
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Nutrients.2017; 9(10): 1102. CrossRef
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Does Protein Intake Affect Metabolic Risk Factors among Older Adults in Korea?
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Non-Alcoholic Fatty Liver Disease: The Emerging Burden in Cardiometabolic and Renal Diseases
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The association of incident hypertension with metabolic health and obesity status: definition of metabolic health does not matter
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Prevalence of Atopic Dermatitis in Korean Children Based on Data From the 2008-2011 Korean National Health and Nutrition Examination Survey
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The correlation between pancreatic steatosis and metabolic syndrome in a Chinese population
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Sarcopenia is associated with albuminuria independently of hypertension and diabetes: KNHANES 2008–2011
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Original Article

Relationship between Chemerin Levels and Cardiometabolic Parameters and Degree of Coronary Stenosis in Korean Patients with Coronary Artery Disease: Yu-Jin Hah, Nam-Keong Kim, Mi-Kyung Kim, Hye-Soon Kim, Seung-Ho Hur, Hyuck-Jun Yoon, Yoon-Nyun Kim, Keun-Gyu Park; Diabetes Metab J. 2011;35(3):248-254. Published online June 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.3.248

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Background

Chemerin is a novel adipokine that is associated with inflammation and adipogenesis. However, it remains unclear whether chemerin is involved in patients with cardiovascular disease. We investigated whether the serum chemerin levels of Korean patients with coronary artery disease correlated with specific cardiometabolic parameters.

Methods

In total, 131 patients, all of whom had coronary artery stenosis exceeding 50%, participated in this study. Their serum chemerin levels and cardiometabolic parameters were measured. The serum chemerin levels of two groups of patients were compared; those with one stenotic vessel (n=68) and those with multiple stenotic vessels, including left main coronary artery disease (n=63).

Results

Serum chemerin levels correlated positively with the degree of coronary artery stenosis and fasting glucose, triglyceride, total cholesterol, low density lipoprotein cholesterol, and high sensitive C-reactive protein levels. The group with multiple stenotic vessels, including left main disease, had higher chemerin levels than the group with one stenotic vessel (t=-2.129, P=0.035). Multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease (odds ratio, 1.018; confidence interval, 0.997 to 1.040; P=0.091).

Conclusion

Serum chemerin levels have a significant correlation with several cardiometabolic risk factors and the degree of coronary artery stenosis in Korean patients with coronary artery disease. However, multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease. Additional investigations are necessary to fully elucidate the role of chemerin in cardiovascular disease.

Citations

Citations to this article as recorded by

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Sulwon Lecture 2010

Mitochondrial Dysfunction and Insulin Resistance: The Contribution of Dioxin-Like Substances: Hong Kyu Lee; Diabetes Metab J. 2011;35(3):207-215. Published online June 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.3.207

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Abstract PDF PubReader ePub

Persistent organic pollutants (POPs) are known to cause mitochondrial dysfunction and this in turn is linked to insulin resistance, a key biochemical abnormality underlying the metabolic syndrome. To establish the cause and effect relationship between exposure to POPs and the development of the metabolic syndrome, Koch's postulates were considered. Problems arising from this approach were discussed and possible solutions were suggested. In particular, the difficulty of establishing a cause and effect relationship due to the vagueness of the metabolic syndrome as a disease entity was discussed. Recently a bioassay, aryl-hydrocarbon receptor (AhR) trans-activation activity using a cell line expressing AhR-luciferase, showed that its activity is linearly related with the parameters of the metabolic syndrome in a population. This finding suggests the possible role of bioassays in the analysis of multiple pollutants of similar kinds in the pathogenesis of several closely related diseases, such as type 2 diabetes and the metabolic syndrome. Understanding the effects of POPs on mitochondrial function will be very useful in understanding the integration of various factors involved in this process, such as genes, fetal malnutrition and environmental toxins and their protectors, as mitochondria act as a unit according to the metabolic scaling law.

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