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Query: UMLS:C0948265 (metabolic syndrome)
 24,271 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dyslipidemia is now recognized as a significant potential adverse event in HIV-positive patients who are on ART. The tide of evidence continues to flow between the shore of HIV being the primary factor behind increased cardiovascular risk in HIV-positive patients, and the ocean of HAART being the primary cause. However, there clearly is an association between long-term infection with HIV and metabolic abnormalities. HIV-infected adults should undergo evaluation and treatment based on the NCEP ATP III guidelines. The NCEP recommends non-pharmacologic interventions be given a thorough trial prior to consideration of drug therapy. The recommendations also stipulate that intensive therapy with lipid-lowering medications should be used in individuals with metabolic syndrome. This includes aggressive treatment of hypertension, diabetes, and dyslipidemia. The NCEP also emphasizes the importance of smoking cessation, weight reduction, increased physical activity, and a salubrious diet. The fundamental message still is that physicians must treat HIV infection first. The choice of ART depends on many patient-specific factors, of which cardiovascular risk is only one.
J Int Assoc Physicians AIDS Care (Chic) 2003 Sep
PMID:Cardiovascular risk among HIV-positive patients on antiretroviral therapy. 1456 35

The public health burden of type 2 diabetes mellitus has been dramatically increased worldwide. Not only its prevalence rate at present but the increase of its incidence in the near future can create a global health problem. The rapid increase of the total number of newly diagnosed diabetic patients proved to be associated with the increasing prevalence rate of obesity. The metabolic syndrome and type 2 diabetes can contribute to accelerated atherosclerosis and, therefore, the target organ damages can carry a serious problem for the individuals and also for the whole society. It is obvious, that the primary prevention of type 2 diabetes mellitus is of great importance. There is now substantial evidence that type 2 diabetes can be prevented or delayed by lifestyle interventions, i.e. diet and exercise should be the first choice in order to avoid weight gain when preventing diabetes. Pharmacological intervention should not be routinely used to prevent diabetes although results of large clinical trials with metformin and acarbose in subjects with impaired glucose tolerance are available. It is noteworthy that a decrease in the number of newly diagnosed diabetes was observed in prospective, double blind clinical studies evaluating the effect of new antihypertensive drugs (captopril, ramipril, lisinopril, nifedipine GITS, amlodipine, losartan) or lipid-lowering agents (pravastatin) on the cardiovascular morbidity and mortality in high risk patients. In these studies the relative risk reduction of newly diagnosed diabetes was evaluated in comparison to placebo or other drugs in a subgroup of non-diabetic patients at baseline. In addition, the incidence of newly diagnosed type 2 diabetes decreased parallel with weight loss in clinical trials with orlistat, an anti-obesity drug. Although new results were provided by evidence based clinical trials a lot of questions remained to be solved. Further research is necessary to understand better how to facilitate effective primary prevention of type 2 diabetes. Further data are needed to evaluate the clinical significance of currently used antidiabetic drugs and, in addition, the possible role of other drugs (antihypertensives, lipid lowering agents, anti-obesity drugs) should also be investigated in order to identify the optimal primary prevention policy of type 2 diabetes.
Orv Hetil 2003 Sep 28
PMID:[Is type-2 diabetes mellitus preventable?]. 1459 69

Diabesity, that is to say, obesity-dependent diabetes, has emerged as a major public health problem. Though diabesity is basically explained by insulin resistance and pancreatic beta cell dysfunction, new paradigms have evolved to explain these alterations in the context of the modern epidemics of obesity and diabetes. Among these, the association of inflammation with obesity is an important component of the common soil from which diabetes and cardiovascular diseases (CVD) derive. This Review presents our epidemiological findings, based primarily on the ARIC Study, in the context of the other epidemiological studies supporting the inflammatory nature of diabetes, CVD and the metabolic syndrome. We also review the characteristics of the innate immune system, including the molecular interface of innate immunity with metabolism, components of which are responsible for the presence of a state of mild, chronic and systemic inflammation related to diabesity. Finally, we present obesity as an inflammatory condition, obesitis, and propose a conceptual framework that integrates the epidemiological findings with new provocative basic science results.
Clin Chem Lab Med 2003 Sep
PMID:Diabesity: an inflammatory metabolic condition. 1459 60

This article provides an overview of the role of metabolite toxicity, low-grade inflammation and disturbed cellular signaling in obesity, glucose intolerance and diabetes. It also highlights links between this continuum of deteriorating glucose tolerance and atherosclerosis. Obesity, diabetes mellitus, and cardiovascular disease are all related to diet and to the level of physical activity. They have reached epidemic proportions worldwide. Glucose intolerance and diabetes increase the risk of atherosclerotic events. Moreover, obesity, and glucose intolerance or diabetes, are components of the metabolic syndrome, which also imparts an increased cardiovascular risk. There is increasing recognition that common mechanisms contribute to diabetes and cardiovascular disease. Following increased calorie intake and/or decreased physical activity, fuel metabolism generates excess of 'toxic' metabolites, particularly glucose and fatty acids. Homeostasis is affected by the endocrine output from the adipose tissue. Reactive oxygen species are generated, creating oxidative stress, which exerts major effects on signaling pathways, further affecting cellular metabolism and triggering low-grade inflammatory reaction. This perspective on the diabetic syndrome has been reflected in the approach to its treatment, which integrates maintenance of glycemic control with primary and secondary cardiovascular prevention. Laboratory medicine should support diabetes care with an integrated package of tests which, in addition to glycemic control, enable assessment and monitoring of the risk of microvascular complications as well as cardiovascular disease.
Clin Chem Lab Med 2003 Sep
PMID:Obesity, glucose intolerance and diabetes and their links to cardiovascular disease. Implications for laboratory medicine. 1459 80

Adipose tissue is not simply a store of excess energy, but also secretes a variety of proteins into circulating blood that influence systemic metabolism. These include tumor necrosis factor (TNF-alpha), plasminogen activator inhibitor type 1 (PAI-1), leptin, resistine and adiponectin. These are collectively known as adipocytokines. Adiponectin (also referred to as AdipoQ, Acrp 30, apM1 or GBP28) is a novel adipose-specific protein. A recent genome study mapped a susceptibility locus for type 2 diabetes and the metabolic syndrome on chromosome 3q27, where the adiponectin gene is located. Adiponectin is a peculiar adipocytokine because in contrast to the markedly increased levels of many others, as leptin or TNF-alpha, its level is reduced in obesity and type 2 diabetes. The administration of thiazolidinediones, which are synthetic PPARs-gamma ligands, significantly increases the plasma adiponectin concentrations, an effect that could improve insulin sensitivity. Thus, the administration of adiponectin may provide a novel treatment modality for insulin resistance and type 2 diabetes.
Rev Med Liege 2003 Sep
PMID:[Adiponectin: a new adipocytokine]. 1462 49

The Seip Berardinelli or undiagnosed endocrine metabolic syndrome is a rare autosomal recessive pathology mainly described in families of Portuguese origins. This syndrome presents various metabolic disturbances responsible of various dysmorphies. We report the case of two brothers seen during their childhood for respiratory, speaking and feeding problems related to a class 3 of Angle and macroglossia. The object was to study the interaction between the size of the tongue, the prognathism and the disturbances presented in order to organize early surgery (partial glossectomy).
Rev Stomatol Chir Maxillofac 2003 Sep
PMID:[Seip Berardinelli: the effect of the partial tongue resection]. 1463 Dec 34

The relationships between alcohol consumption, serum gamma-glutamyltransferase (GGT) levels, and the prevalence of major coronary risk factors were analyzed cross-sectionally in 2,399 male and 1,402 female middle-aged workers, to clarify the effects of moderate alcohol consumption on the development of the metabolic syndrome. Male moderate drinkers, consuming less than 60 ml of alcohol per day, had a lower prevalence of upper body obesity and low serum HDL-cholesterolemia (LHDLC) in comparison with nondrinkers, but not of hypertension, impaired glucose tolerance or hypertriglyceridemia (HTG). In women, alcohol consumption did not show any significant associations with the coronary risk factors. Men with an elevated serum GGT (EGGT) of 40 U/l or above had a significantly higher odds ratio for all the coronary risk factors as compared with those with normal GGT, even after adjusting for alcohol consumption, together with age, body mass index, cigarette consumption and physical activity. Women with an EGGT of 25 U/l or above had similar findings, although significance was found only in HTG. Nearly 80% and 55% of the appearance of EGGT in men and women were attributable to alcohol consumption, and 20% and 10% of the male and female moderate drinkers had EGGT. These results suggest that even moderate alcohol consumption will increase coronary risk factors characteristic of the metabolic syndrome in drinkers who have an increase in serum GGT. Further studies are required to confirm the causal association between alcohol consumption, increase in serum GGT and development of the metabolic syndrome.
J Occup Health 2003 Sep
PMID:Alcohol consumption, serum gamma-glutamyltransferase levels, and coronary risk factors in a middle-aged occupational population. 1464 70

The prevention of cardiovascular diseases, and more generally of metabolic syndrome, goes with a well chosen diet. However, faced with a raft of often contradictory information, many patients can become disorientated. The role of the practitioner is to supply adapted, personaliZed and scientifically consensual advice. The consumption of certain types of foods naturally concentrated in protective elements should be favoured, such as those rich in folates, omega 3 fatty acids, and potassium, and low in sodium chloride. Furthermore, some new foodstuffs are appearing which have been subjected to modifications in their composition: enriched with certain nutrients or micronutrients, low in sugar and certain fats.... Thus, for example, margarines rich in phytosterols appear interesting despite limitations in their use; similarly, precautions of usage should accompany the consumption of products enriched with omega 3, sweeteners.... These attractive appearing and "gustatively correct" foods of the future will have more and more pronounced health claims. But alimentary innovation, relying on this basis in order to conquer new sections of the market, risks causing new nutritional imbalances. The practitioner must therefore remain sensible with nutritional advice and take account of economic and regional aspects by adapting it for each patient.
Arch Mal Coeur Vaiss 2003 Sep
PMID:[From today's foods to those of the future]. 1465 48

With the increased attention being given to cardiovascular risk factor reduction, the opportunity exists to substantially decrease the largest cause of mortality in diabetic patients. The concept that type 2 diabetes and CVD are linked via a common etiologic pathway (metabolic syndrome) has substantial ramifications for the care of individual patients. Many of the metabolic abnormalities that contribute to both glycemic disorders and CVD are interrelated. For example, hyperinsulinemia and insulin resistance coupled with abdominal obesity further worsens HTN and hyperlipidemia. Likewise, the procoagulant state and endothelial dysfunction increase with worsening glycemic control. Specific interventions include tobacco cessation, a food management and physical activity plan, choice of antidiabetic agent (such as metformin), and use of ACE inhibitors for hypertension and microalbuminuria (Table 5). Programs to enhance cardiovascular risk factor reduction as part of the comprehensive evaluation and management of diabetic patients have been described [95,99]. One community-based program provided free screening to diabetic patients with randomization to either annotated result reports provided to the patient and their physician or results provided by a project nurse (either face-to-face or over the phone). Greater improvements in mean glycohemoglobin, cholesterol, and blood pressure were noted with verbal presentation of results [99]. Recent data from the Centers for Disease Control and Prevention Diabetes Cost-effectiveness Group support the idea that interventions to decrease CVD in diabetics are economically beneficial. Intensive management of hypertension, glycemic control, and hyperlipidemia each improved health outcomes. Hypertension control reduced costs. Although intensive treatment of glucose and hyperlipidemia increased costs, the increase was comparable to that of other frequently used health care interventions [100]. Further directions include further exploration of the implications and management of metabolic syndrome as it relates to CVD prevention. Interventions such as exercise, which can impact on all outcomes, require special attention. Efforts by physicians, health systems, and society are necessary to increase physical activity for individuals of all ages. It makes clinical sense that the recommendations for prevention of CVD in diabetics described in this article may also benefit patients with prediabetes (fasting glucose 110-125 mg/dl), but this remains to be definitively shown.
Prim Care 2003 Sep
PMID:Preventing cardiovascular disease in diabetes and glucose intolerance: evidence and implications for care. 1469 2

Menopausal transition is characterized by ovarian failure and its consequent decrease in female sex steroid production. Earlier studies suggest that an increase and redistribution of body fat during menopause predispose women to cardiovascular disease and metabolic syndrome. In addition, peri- and post-menopausal women seem to have less lean body mass (LBM) compared with pre-menopausal women. Accordingly, a changing ovarian hormonal status may accelerate the loss of muscle mass and result in decreased muscle performance and functional capacity. Hormone replacement therapy (HRT) has been used to treat menopausal symptoms and as a primary prevention therapy in chronic conditions. Inconsistent findings have, however, been published on the effects of HRT on body composition in post-menopausal women. Some studies clearly suggest that HRT counteracts menopause-related changes in body composition whereas others fail to show any difference between post-menopausal HRT users and abstainers. Although cross-sectional studies show conflicting results concerning the association between HRT and muscle performance, experimental trials suggest that deterioration in muscle force during menopause can be prevented by HRT. In the future, longitudinal data need to be collected to confirm changes in body composition and muscle performance during menopausal transition irrespective of age. Although HRT seems to have beneficial effects on body composition and muscle performance in healthy post-menopausal women, there is considerable variation in the effects of HRT between different studies. The underlying mechanism of HRT action on muscle performance is still unclear.
J Endocrinol Invest 2003 Sep
PMID:Body composition and muscle performance during menopause and hormone replacement therapy. 1496 43


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