Метаболический синдром и почки: патогенетически обоснованные нефропротекция и снижение сердечно-сосудистого риска

BACKGROUND: Both obesity and metabolic syndrome are major risk factors of chronic kidney disease (CKD). However, the relations between CKD and these two conditions are not constant in previous studies. We aimed at discovering correlations between body mass index (BMI), metabolic syndrome and CKD disease progression. METHODS: A total of 1,502 patients with late CKD or proteinuria in 2001 ~ 2015 were included for analysis. The endpoints were set to disease progression to end-stage renal disease (ESRD) or death. Patients were divided into different groups according to their BMI and metabolic syndrome status. (BMI ≥ 27 defined as obesity; with or without metabolic syndrome) We analyzed the effect of BMI and metabolic syndrome on CKD progression and mortality. RESULTS: The main result was that patients with BMI ≥ 27 had a lower risk of ESRD and death during the study period. The difference was more significant in patients who was obese but did not have metabolic syndrome. The impact of metabolic syndrome to ESRD and death was hazardous but not statistically significant. CONCLUSION: CKD patients with higher BMI have a better outcome of CKD progression and death, especially in those without metabolic syndrome.

To determine the prevalence of anaemia and the metabolic syndrome with special interest in the coexistence of these two problems as well as the possible links. In a cross-sectional household survey, 1294 men and 1522 women aged 20 years and above were interviewed; anthropometric measurements and blood samples were taken. Metabolic syndrome was defined according to IDF 2005 standard. Anaemia was defined as haemoglobin level below 13 g/dL for men and 12 g/dL for women. The age-adjusted prevalence of metabolic syndrome was 11.2% and of anaemia 24.4%. About 3 percent of the participants had both anaemia and metabolic syndrome. Women had a higher prevalence of both the metabolic syndrome and anaemia than men (14.0 vs 8.4%, 31.5% vs 16.1%). Anaemia coexisted significantly with all the individual components of the metabolic syndrome. Only 7.0% of the sample had anaemia without any individual component of metabolic syndrome. In women, the prevalence of combined anaemia and metabolic syndrome peaked in the age group 50-59 years (9.9%). Women in the highest quartile of serum ferritin had a higher risk of only the metabolic syndrome and coexistence of anaemia and metabolic syndrome. The high prevalence of the metabolic syndrome and anaemia in the area show the urgent need to develop comprehensive strategies aimed at prevention and treatment. In women this coexistence may be related to inflammation but further research is needed.

Obstructive sleep apnea and metabolic syndrome are significant risk factors for cardiovascular diseases. Several reports have shown that sleep duration also has a significant effect on body mass index and cardiovascular diseases. The relationships among obstructive sleep apnea, metabolic syndrome, components of metabolic syndrome, and sleep duration in 275 urban males in Japan were investigated. One in 6 subjects with metabolic syndrome, but only 1 in 40 without metabolic syndrome, had severe obstructive sleep apnea. Sleep duration was significantly shorter in subjects with severe obstructive sleep apnea (5.4 ± 0.9 hrs) than in subjects with non (6.1 ± 0.8 hrs: P < 0.05) or mild obstructive sleep apnea (6.0 ± 0.8 hrs: P < 0.05). Mean sleep duration was significantly shorter in those with than without metabolic syndrome (5.8 ± 0.8 hrs vs. 6.1 ±0.8 hrs: P = 0.026) and was 5.3 ± 1.1 hrs in metabolic syndrome subjects with severe obstructive sleep apnea and 5.9 ± 0.8 (P = 0.021) in metabolic syndrome subjects without severe obstructive apnea. Physicians should take into account the high prevalence of severe obstructive sleep apnea in patients with metabolic syndrome. Sleep duration should be considered as an important factor in studies investigating the prevalence of severe obstructive sleep apnea and metabolic syndrome.

Objective To study the relationship between serum uric acid and insulin resistance in type 2 diabetic patients Methods A total of 728 middle-aged and elderly type 2 diabetic patients were recruited and the anthropometric, clinical and biochemical parameters and fasting serum C-peptide were measured and retrospectively studied.All patients were divided into groups based on the levels of uric acid and on metabolic syndrome diagnosis or not. Results Among a total of 728 patients, the proportion of hyperuricemia was 26.9%(196 /728), and metabolic syndrome(MS)was 64.6%.The levels of body mass index(BMI), waist circumference(WC), systolic pressure(SBP), diastolic pressure(DBP), triglyceride(TG), fasting C-peptide, HOMA(C-Peptide)were significantly higher in hyperuricemia group than in normal uric acid group, while the level of HDL was lower in hyperuricemia group than in normal uric acid group.The proportion of MS was statistically higher in hyperuricemia group(81.6%)than in normal uric acid group(58.3%, P<0.05). Groups Ⅰ, Ⅱ, Ⅲ, Ⅳ-the four quartiles of serum uric acid from low-to high-level were correlated with MS component number of 2.1±1.0, 3.1±1.1, 3.3±1.2, 3.7±0.8, separately, and with HOMA(CP)of 3.7±0.8, 3.7±0.8, 4.0±0.6, 4.1±0.9, separately(all P<0.05). When all patients were divided into groups based on with or without MS, the level of uric acid in MS group was(377.3±43.5)μmol/L, and the proportion of hyperuricemia was 34.0%(160/470), and HOMA(CP)was 3.90±0.72, all were significantly higher than those of non-MS group[(318.2±47.9)μmol/L, 14.0%(36/258), 3.64±0.67]. The levels of serum uric acid in groups with 1-5 components of MS were(285.0±62.8)μmol/L, (335.7±62.7)μmol/L, (367.1±45.0)μmol/L, (377.9±40.2)μmol/L, (389.8±46.6)μmol/L, and HOMA(CP)was 3.6±0.6, 3.7±0.7, 3.9±0.8, 3.9±0.7, 4.3±0.7 separately(P<0.05). Serum uric acid was positively correlated with age, WC, BMI, TG, SBP, fasting C-peptide, and HOMA(CP), while negatively correlated with glycosylated hemoglobin(HbA1C), high density lipoprotein cholesterol(HDL-C). Binary logistic regression showed that the OR value of MS was 1.033 with the increase of serum uric acid, and 95%CI: 1.026-1.041, P<0.05. Conclusions Serum uric acid is correlated with insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes.Hyperuricemia might be a new risk factor for MS. Key words: Diabetes, type 2; Hyperuricemia; Metabolic syndrome X

1539 Background: The WHI Diet Modification (DM) trial randomized 48,835 postmenopausal women with no prior breast cancer to a low-fat dietary intervention or comparison group. After 16.1 years follow-up, the intervention was associated with an 18% reduction in risk of death after breast cancer (P =0.01), with greater reduction (29%) in those with waist circumference≥88 cm (J Clin Oncol 2017). To extend these findings, we examined the influence of the dietary intervention on breast cancer mortality in subgroups defined by number of metabolic syndrome (MS) components with 19.6 years median cumulative follow-up. Methods: WHI DM has been previously described. Four MS components were determined at entry: 1) waist circumference≥ 88 cm, 2) high blood pressure or anti-hypertensive use, 3) high cholesterol history and 4) diabetes history, with women categorized as having 0 (n=10,639), 1-2 (n=30,948), or 3-4 (n=4,246) MS components. Forest plots of hazard ratios (HRs) were generated with P-values for interaction between randomized group assignment and number of MS components. Results: Women with 3-4 MS components were more likely to be Black, be obese (BMI ≥30), and have diabetes (all P &lt; 0.001). Breast cancers in women with 3-4 MS components were less likely to be local stage (P = 0.005) or well differentiated (P = 0.03). The magnitude of reduction in deaths from breast cancer in the dietary intervention vs comparison group increased as the number of MS components increased (interaction P = 0.01). Hazard ratios (HR) and 95% confidence intervals (CI) for death from breast cancer for intervention vs comparison groups for women with 0 MS components was 1.09 95% CI, 0.63-1.87, with risk low in both randomization groups (0.028% and 0.026%, respectively); for women with 1-2 MS components, HR 0.80 95% CI 0.62-1.02; and for women with 3-4 MS components, HR 0.31 95% CI, 0.14-0.69, with risk in the intervention group reduced to 0.026%. Conclusions: Adoption of a low-fat dietary pattern had a greater effect on reducing deaths from breast cancer in women with more MS components, suggesting that this is a high risk group more likely to benefit from the dietary intervention. Clinical trial information: NCT00000611.

Nutrition and Kidney Health: Processing Emerging Evidence About Foods

Objective To investigate the risk factors of insulin resistance(IR)and its relationship with metabolic syndrome in patients after lenal transplantation.Methods 133 renal transplant redpients who had not undergone acute rejection,calcinurine intoxication and severe infection,and had normal renal function and no proteinuria at the 6th month post-transplantation,were involved in the study.They had a history of chronic glomerulonephritis as the primary disease of ESRF but rio diabetes mellitus.108 recipients(CsA group)were treated with CsA,mycophenolate mofetil(MMF)and prednisone after transplantation,19 recipients(Tac group)with tacrolimns(Tac),MMF and prednimne,and 6 recipients with Simlimus,respectively.One year later,blood and urine biochemical tests and physical examinations were performed on the recipients,and HOMA calculated.200 cormnunity residents were randomly selected as controls.Results The incidence of MS in the recipients was 33.1%,significantly higher than controls(15.0%).There was no significant difference in the incidence of obesity and overweight between recipients(29.3%)and controls(37.5%).In recipients with obesity or overweight,the insulin-resistance level and urine albumin level,and the incidence of MS weree significantly higher than those without obesity or overweight.The insulin-resistance level in Tac-treated recipients was markedly higher than CsA-treated recipients,and there was a positive correlation between the blood concentration of Tac and insulin-resistance levd.Microalbuminufia-positive recipients had higher insulin-resistance levels.Metabolic syndrome-complicating recipients had higher insulin-resistance levels than those without metabolic synawme,and higher insulinresistance levels existed in recipients with hypertriglyceridemia or hyperchcllesterolemia,hypertension.Conclusion Obesity or overweight,Tac(especially when blood concentration was higher)were risk factors resulting in imulin-resistanee in kidney transplant recipients.It is suggested that insulin-resistance might be involved in the pathogenesis of metabolic syndrome including hypertrglyceridmaia,hypercbolestemlemia and hypertenion. Key words: Kidney transplantation; Metabolic syndrome X; Insulin resistance

Background/Aims: The metabolic syndrome (MetS), as assessed using dichotomous criteria, is associated with increased risk of future chronic kidney disease (CKD), though this relationship is unclear among African Americans, who have lower risk for MetS but higher risk for CKD. Methods: We performed logistic regression using a sex- and race-specific MetS-severity z-score to assess risk of incident CKD among 2,627 African-American participants of the Jackson Heart Study, assessed at baseline and 8 years later. Based on quartile of baseline MetS severity, we further assessed prevalence of being in the lowest quartile of baseline GFR, the lowest quartile of relative GFR at follow-up, microalbuminuria and incident CKD. Results: Higher MetS-severity was associated with higher prevalence of GFR in the lowest quartile at baseline among males and females. Among African-American females but not males, higher baseline MetS-severity was associated with a higher prevalence of baseline elevations in microabuminuria (p<0.01), steep decline in GFR (p<0.001) and a higher incidence of CKD (p<0.0001). Women in increasing quartiles of baseline MetS-severity exhibited a linear trend toward higher odds of future CKD (p<0.05), with those in the 4^th quartile of MetS-severity (compared to the 1^st) having an odds ratio of 2.47 (95% confidence interval 1.13, 5.37); no such relationship was seen among men (p value for trend 0.49). Conclusion: MetS-severity exhibited sex-based interactions regarding risk for future GFR deterioration and CKD, with increasing risk in women but not men. These data may have implications for triggering CKD screening among African-American women with higher degrees of MetS-severity.

Objective To evaluate the clinical and biochemical characteristics of type 2 diabetics with hyperuricemia and to investi-gate the association between serum uric acid and the number of metabolic syndrome components. Method In the cross-sectional study of 547 type 2 diabetics, we recorded body mass index (BMI), systolic blood pressure(SBP), diastolic blood pressure (DBP), and collected blood samples to measure serum uric acid (UA), fasting plasma glucose (FPG), glycosylated hemoglobin (HbAlc), creatinine (Cr) and blood lipid profile, including tfiglyceride (TG), total cholesterol (TC), low-density cholesterol LDL-C) and high-density cholesterol (HDL-C). Results Compared with the normal UA group, the diabetic patients in the high UA group had significantly increased levels of BMI, SBP, DBP, FPG, Cr, TG, TC and HbA1c (P 0.05). According to their possession of 1, 2, 3 or 4 components of metabolic syndrome, 547 cases were divided into four groups (MSI, MS2,MS3 and MS4). There were significant difference in the levels of UA, BMI, SBP, DBP, Cr, TG, TC, LDL-C and HDL-C among MSI, MS2, MS3 and MS4 (All P < 0.05). Multiple regression analysis showed that UA concentration was positively correlated with sex, TG and Cr (Beta:0. 088,0. 350, 0. 124; P < 0.05, P <0.01, P <0.01) and negatively correlated with HDL-C and HbA1 c(Beta: -0.107, -0.124 ; P <0.01, P <0.01). The con-centration of UA was strongly correlated with serum TG. Conclusions Serum UA level in type 2 diabetics was significantly elevated as the number of metabolic components increased. Abnormal TG had great influence on serum UA. Hyperuricemia was considered to be a dangerous factor of the metabolic syndrome. Key words: Diabetes mellitus,type 2/CO; Hyporuricemia/CO; Uric acid/CO; Metabolic syndrome X

Association between weight status, metabolic syndrome, and chronic kidney disease among middle-aged and elderly Chinese

Metabolic syndrome component combinations and chronic kidney disease: The severance cohort study

Aldosterone and metabolic syndrome are known cardiovascular risk factors associated with increased morbidity and mortality. This review focuses on the recent advances and clinical significance of the relationship between aldosterone and each single component of metabolic syndrome. The possible role of aldosterone receptor antagonist or aldosterone synthetase inhibitor in the treatment of metabolic syndrome is discussed. Key words: Aldosterone; Metabolic syndrome; Insulin resistance; Obesity; Hypertension

PurposeElevated plasma concentration of retinol binding protein 4 (RBP4) has recently emerged as a potential risk factor as a component of developing metabolic syndrome (MS). Therefore, this study aimed to analyse the relationship between components of MS and concentrations of plasma RBP4 in a population of subjects 65 years and older.MethodsThe study sample consisted of 3038 (1591 male) participants of the PolSenior study, aged 65 years and older. Serum lipid profile, concentrations of RBP4, glucose, insulin, C-reactive protein, IL-6, and activity of aminotransferases were measured. Nutritional status (BMI/waist circumference) and treatment with statins and fibrates were evaluated. Glomerular filtration rate (eGFR), de Ritis ratio, and fatty liver index (FLI), as well as HOMA-IR were calculated.ResultsOur study revealed a strong relationship between components of MS and RBP4 in both sexes: plasma RBP4 levels were increased in men by at least 3×, and in women by at least 4×. Hypertriglyceridemia was most strongly associated with elevated plasma RBP4 levels. Multivariate, sex-adjusted regression analysis demonstrated that chronic kidney disease [OR 1.86 (95% CI 1.78–1.94)], hypertriglyceridemia [OR 1.52 (1.24–1.87)], hypertension [OR 1.15 (1.12–1.19)], low serum HDL cholesterol [OR 0.94 (0.92–0.97)], and age > 80 years [OR 0.86 (0.81–0.90)] were each independently associated with RBP4 concentration (all p < 0.001).ConclusionsIn Caucasians 65 years and older, RBP4 serum levels are associated with a number of components of MS, independent of sex and kidney function. Hypertriglyceridemia as a component of MS is most significantly related to RBP4 concentration.

Association of Metabolic Syndrome With Proximal and Synchronous Colorectal Neoplasm

The metabolic syndrome is a construct that has come into common usage over the last few decades. In 1956, Jean Vague1 first demonstrated that upper-body obesity determined predisposition to diabetes mellitus, atherosclerosis, gout, and renal calculi; however, it was the presentation of this concept by Gerald Reaven in his Banting Lecture in 19882 that initiated the current focus on this entity as a clinical and pathological construct. Dr Reaven suggested that 3 major conditions—non–insulin-dependent diabetes mellitus (type 2 diabetes mellitus), hypertension, and coronary artery disease—had an causal commonality (resistance to insulin-stimulated glucose uptake and hyperinsulinemia) and referred to this constellation of abnormalities as “syndrome X.” He did not include abdominal obesity in the original description, nor did he comment significantly on a potential clinical role for his observations. In fact, his concluding sentences stated, “What remains to be seen is the magnitude of the role that resistance to insulin-stimulated glucose uptake plays in the etiology of human disease. I can only hope that this presentation has outlined the possibilities for future efforts to answer this question.” Response by Kahn p 1818 Since that time, this construct has evolved conceptually and functionally into an entity that many refer to as a “syndrome.” More recently, there have been many questions about the legitimacy of this designation, summarized by Kahn et al3 in a September 2005 position statement for the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Their comments called into question many of the assumptions that underlay the designation of “syndrome,” and they posed the following key questions: How clear is the existing definition of the metabolic syndrome for diagnostic purposes? How useful is the syndrome definition in predicting cardiovascular disease (CVD) risk? Do the individual components of the syndrome convey “risk” …