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The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population., (© 2022 Wiley Periodicals LLC.)

Intraocular pressure is associated with metabolic syndrome. C-reactive protein (CRP) is associated with cardiovascular disease, irrespective of the presence of metabolic syndrome. In this study, we examined the synergistic effect of CRP and metabolic syndrome on intraocular pressure.A total of 1041 subjects were included for data analyses in this cross-sectional study. Intraocular pressure was measured using a noncontact tonometer, and serum CRP levels were measured using a commercially available kit.The intraocular pressure was significantly higher in the subjects with metabolic syndrome than in those without (14.1 ± 3.0 vs 13.4 ± 3.0 mm Hg, P = .002). Furthermore, intraocular pressures significantly increased according to CRP tertiles (13.1 ± 3.0, 13.7 ± 3.0, and 13.8 ± 3.0 mm Hg from the lowest to highest tertile of CRP, respectively; P = .002). The highest intraocular pressure was observed in subjects with metabolic syndrome in the highest CRP tertile (P value for trend < .001). Multivariate linear regression analysis revealed that the influence of CRP was independent of metabolic syndrome and that high CRP levels were significantly associated with high intraocular pressure (95% confidence interval: 0.080-1.297, P = .027).In conclusion, systemic inflammation, reflected by serum CRP levels, is associated with high intraocular pressure in subjects with and without metabolic syndrome.

Brain-derived neurotrophic factor (BDNF) plays a role in energy homeostasis. However, the postprandial BDNF change has not been well investigated. We hypothesized that the BDNF increment after oral glucose challenge is associated with body weight.To address this possibility, man adults with obesity in conjunction with metabolic syndrome were compared with normal weight controls at baseline in the initial cross-sectional protocol. The obese subjects then underwent a 12-week program for body-weight reduction in the prospective protocol. The area under the curve (AUC) of serum BDNF was recorded during a 75 g oral glucose tolerant test and the BDNF AUC index was defined as [(AUC of BDNF) - (fasting BDNF2 hours)]/(fasting BDNF2 hours).A total of 25 controls and 36 obese subjects completed the study assessments. In the cross-sectional protocol, the BDNF AUC index was significantly higher in the obese subjects than in the controls (9.0 ± 16.5% vs. - 8.0 ± 22.5%, P = 0.001). After weight reduction (from 97.0 ± 12.5 kg to 88.6 ± 12.9 kg, P < 0.001), the percentage change of body weight was significantly associated with the BDNF AUC index after the study (95% CI between 0.21 and 1.82, P = 0.015). Using 6% weight reduction as a cut-off value, a larger weight reduction was able to reliably predict a negative BDNF AUC index.In conclusion, a high BDNF AUC index was observed for obese men in this study, whereas the index value significantly decreased after body-weight reduction. These findings suggest that postprandial BDNF increment may be associated with obesity., Competing Interests: The authors have no conflicts of interest to disclose.

Background: Several studies have shown that serum bilirubin has a protective effect against cardiovascular disease and that inflammation plays an important role in its pathogenesis. This cross-sectional study investigated whether there was an association between blood total white blood cell count, a simple indicator of inflammation, and serum total bilirubin concentration in a cohort of an adult population in Taiwan., Methods: A total of 2458 apparently healthy adults (1246 men and 1212 women) who attended health examination at a medical centre in central Taiwan were enrolled. We collected anthropometric measurements, fasting blood test results, lifestyle habits and medical history., Results: Total white blood cell counts decreased progressively when the concentrations of total bilirubin increased as demonstrated in the total bilirubin quartiles. Both total bilirubin concentrations and total white blood cell counts showed significant correlations with the components of metabolic syndrome, including triglyceride and high-density lipoprotein cholesterol concentrations. Multivariate linear regression analysis revealed that, for both genders, total bilirubin showed an independent negative correlation with total white blood cell count after adjusting for conventional cardiovascular risk factors., Conclusions: Higher serum total bilirubin concentrations within the reference range were associated with lower blood total white blood cell counts, regardless of other classical cardiovascular risk factors., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: Excessive visceral fat with unbalanced adipokines is a critical pathogenic factor of metabolic syndrome (MetS), which is associated with disorders of the central nervous system and cardiovascular disease. Because brain-derived neurotrophic factor (BDNF) plays an important role in neurons, we examined the relationship of BDNF to MetS, adipose tissue and biomarkers in men., Methods: Thirty-four non-diabetic men with MetS and another 24 age-matched men without MetS were enrolled. In addition to fasting blood samples, the area of adipose tissue at the waist was assessed by magnetic resonance imaging (MRI)., Results: There was no significant difference in serum BDNF concentrations between men with or without MetS (40.9±8.0 vs. 43.2±6.1 ng/ml, P=0.235). However, the serum concentration of soluble vascular cell adhesion molecule-1 (VCAM-1) was higher in the subjects with a lower BDNF level (737±230 vs. 628±115 ng/ml, P=0.025). An inverse correlation between VCAM-1 and BDNF was observed (r=-0.391, P=0.002). After adjusting for visceral adipose tissue, VCAM-1 was found to be independently associated with BDNF [95% confidence interval (-0.025, -0.005), P=0.004]., Conclusion: These data show no difference in serum BDNF levels between the men with MetS and controls. However, serum BDNF was inversely correlated with serum VCAM-1 in men without diabetes., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The aim was to assess the association between metabolic syndrome (MetS) and ankle-brachial index (ABI) in Asians with or without diabetes. In this cross-sectional study, the components of MetS, lipid profiles, and ABI were assessed. A total 441 participants were enrolled, and the ABI was significantly lower (1.09 +/- 0.10 vs 1.12 +/- 0.13, P = .015) in participants with MetS (n = 269) as compared with those without MetS (n = 172). To dissect the influence of diabetes, these 2 groups were further categorized according to either diabetes or not. Ankle-brachial index was highest in participants with neither MetS nor diabetes and lowest in those with both MetS and diabetes (P value for trend <.001). Metabolic syndrome is also an independent risk factor for low ABI in participants with diabetes (P = .018). Thus, MetS is usually associated with lower ABI, most obvious in diabetic participants.

Results of studies regarding the association between the MS and osteoporosis have been largely controversial. The objectives of this study were to measure bone mineral density (BMD) with and without the MS and evaluate the associations between bone mineral loss and the components of the MS. In all, 352 men (mean age 70.6+/-11.9 years) and 468 women (mean age 67.8+/-12.0 years) in Puli township, Taiwan, were enrolled. Height (cm), weight (kg), waist circumference (cm), and blood pressure (mmHg) were measured. Fasting plasma glucose (FPG) and blood lipids were determined. Calcaneal BMD was measured using the ultrasound pulse transmission method. The prevalence of MS was 33.0% in men and 44.2% in women. In subjects with the MS, lower diastolic blood pressure (DBP) in both sexes (p < 0.001), lower triglycerides (p = 0.016) and more central obesity in men (p = 0.011) predicted bone mineral loss. The MS was not associated with bone mineral loss in either of sexes (p = 0.550 in men; p = 0.628 in women).

Statin, a potent lipid-lowering agent, ameliorates the interaction of monocytes and endothelium, a critical step in the atherosclerotic process. However, it remains unclear whether this effect of statin depends on different doses or the presence of metabolic syndrome. In this prospectively double-blind study, 21 hypercholesterolemia subjects, with low-density lipoprotein cholesterol between 130 and 170 mg/dL, received low-dose (10 mg/d) or high-dose (40 mg/d) pravastatin treatment for 8 weeks. We assessed the reduction of monocyte adhesion to cultured endothelium between different-dose groups and the relationship to metabolic syndrome. Total cholesterol and low-density lipoprotein cholesterol were significantly decreased after 40-mg pravastatin treatment (-23.3% +/- 3.7%, P < .001 and -28.8% +/- 3.0%, P < .001), and the reductions were greater than those in the 10-mg group (P = .041 and P = .045, respectively). There was no significant difference in monocyte adhesion between high-dose and low-dose pravastatin treatment. When all subjects were divided into an improvement group and a no improvement group, according to the median of change percentage of monocyte adhesion after pravastatin treatment, there were significantly more subjects with metabolic syndrome in the no improvement than the improvement group (6 vs 1 person, P =.024). Using logistic regression analysis, metabolic syndrome, rather than dose effect of pravastatin, was an independent predictor of interaction between monocytes and endothelium (95% confidence interval = 0.001-0.865, P = .041). Attenuating adhesion between monocytes and endothelium is altered by the presence of metabolic syndrome when hypercholesterolemia subjects receive pravastatin treatment.

Background: Metabolic syndrome is gaining more attention as a special cluster of cardiovascular risks. However, its role, with or without diabetes, in predicting atherosclerosis progression, remains largely undetermined. We investigated the predictors for angiographic coronary atherosclerosis progression in patients with metabolic syndrome and angina pectoris., Methods: Patients with metabolic syndrome and angina pectoris who underwent repeat coronary angiograms and had serum samples at the time of first catheterization were enrolled for analysis (N=113). A modified Gensini scoring system was used to define CAD progression between the index and follow-up angiograms. Those who had significant angiographic progression of coronary disease were classified as the progression group (N=42) and those who did not as the non-progression group (N=71)., Results: There were more cases of diabetes mellitus (52% vs. 31%, p=0.040) in the CAD progression group. The progression group also had higher baseline fasting blood glucose (150+/-73 vs. 117+/-46 mg/dl, p=0.010) but similar LDL cholesterol (114+/-38 vs. 109+/-33 mg/dl, p=0.421) than the non-progression group. In terms of inflammatory markers, there was no difference in hs-CRP (p=0.208), MCP-1 (p=0.514), or sCD40L (p=0.549) between the groups. In binary logistic regression, diabetes mellitus remained a significant predictor of CAD progression (OR 2.43, p=0.030) for patients with metabolic syndrome and angina pectoris, but hs-CRP and LDL-C were not., Conclusion: Diabetes mellitus, but not inflammatory marker hs-CRP or LDL-C, is a significant predictor of angiographic CAD progression in patients with metabolic syndrome and angina pectoris.

The impact the metabolic syndrome (MetS) components on the severity of insulin resistance (IR) has not been reported. We enrolled 564 subjects with MetS and they were divided into quartiles according to the level of each component; and an insulin suppression test was performed to measure IR. In males, steady state plasma glucose (SSPG) levels in the highest quartiles, corresponding to body mass index (BMI) and fasting plasma glucose (FPG), were higher than the other three quartiles and the highest quartiles, corresponding to the diastolic blood pressure and triglycerides, were higher than in the lowest two quartiles. In females, SSPG levels in the highest quartiles, corresponding to the BMI and triglycerides, were higher than in all other quartiles. No significant differences existed between genders, other than the mean SSPG levels in males were greater in the highest quartile corresponding to BMI than that in the highest quartile corresponding to HDL-cholesterol levels. The factor analysis identified two underlying factors (IR and blood pressure factors) among the MetS variables. The clustering of the SSPG, BMI, triglyceride and HDLcholesterol was noted. Our data suggest that adiposity, higher FPG and triglyceride levels have stronger correlation with IR and subjects with the highest BMI have the highest IR.

Aims/hypothesis: The aim of this prospective study was to assess a population-based cohort for the predictors of incident diabetes and metabolic syndrome, which is most likely to lead to cardiovascular disease., Methods: We compared the baseline individual components of metabolic syndrome, adopted from the NCEP ATP III for Asians, in 3629 subjects who developed diabetes, metabolic syndrome, or diabetes and metabolic syndrome to those who remained free of diabetes and metabolic syndrome for 10 years., Results: The incidence rate of diabetes was 7.8% (9.8% in men and 6.3% in women, respectively), and metabolic syndrome was 24.2% (23.4% in men and 24.7% women, respectively). Eighty-five men and 99 women developed diabetes and metabolic syndrome, which yielded incidence rates of 5.7% in men and 4.7% in women. After adjustment for related covariable factors, each component of metabolic syndrome in women, higher triglyceride and greater waist circumference in men, independently predicted future incident diabetes and metabolic syndrome as compared with those who remained free of diabetes and metabolic syndrome., Conclusions/interpretation: These findings suggest that several components of metabolic syndrome independently precede the development of diabetes and metabolic syndrome. Further intervention studies are required to demonstrate the benefits of intervention with all aspects in decreasing the incidence of diabetes and metabolic syndrome in the general population.

The interaction of leukocytes and endothelium plays an important role in the development of atherosclerosis. Previous studies found that adhesion of leukocytes to endothelium is greater in subjects with hypercholesterolemia. It is not clear if metabolic syndrome, a contributing risk factor of cardiovascular disease, is related to this adhesion. Therefore, we conducted a study, in which 48 nondiabetic subjects were enrolled, to determine the relationship between leukocyte adhesion and the components of metabolic syndrome. After a 12-hour overnight fast, subjects' fasting blood was obtained for measurement of lipoprotein concentrations and glucose and insulin levels. Results of the number of monocyte adhesion to human umbilical vein endothelial cells were divided into high monocyte adhesion group and low monocyte adhesion group (n=24 in each group). Plasma concentrations of total cholesterol (245 +/- 5 vs 229+/- 4 mg/dL, P=.021) and low-density lipoprotein cholesterol (LDL-C) (162+/- 4 vs 146+/- 3 mg/dL, P=.003) were both higher in the high monocyte adhesion group than in the low monocyte adhesion group. Monocyte adhesion was significantly correlated to plasma concentrations of LDL-C (r=0.407, P=.002) but not to the total cholesterol (r=0.202, P=.085). However, there was no difference in monocyte adhesion to endothelium between subjects with or without metabolic syndrome, based on the modified criteria from the Adult Treatment Panel III of the National Cholesterol Education Program. Insulin resistance index, presented as homeostasis model assessment insulin resistance, and glucose or insulin responses to oral glucose tolerance test were similar between groups. Our study demonstrated that monocyte adhesion to endothelium has a stronger relationship with the plasma concentration LDL-C than with characteristics of metabolic syndrome.

Thyroid hormones play an important role in regulating energy homeostasis and lipid and glucose metabolism. This study assessed the relationship between free thyroxine and clinical features of metabolic syndrome (MS). A total of 4,938 Taiwanese subjects (2,891 men and 2,047 women with a mean age of 50.1+/-12.6 years) with normal serum free thyroxine levels were enrolled. A modified National Cholesterol Education Program definition of MS was adopted substituting body mass index (BMI) for waist circumference. Serum free thyroxine concentrations were determined by immunoassay. Overall, 14% of subjects had a high fasting glucose, 27% had high blood pressure, 14% had high serum total triglyceride, 8% had low high-density lipoprotein cholesterol, and 18% were obese. The serum free thyroxine concentrations showed a statistically significant correlation with triglyceride and body mass index, respectively (P<.01), but not with blood pressure, glucose level, or high-density lipoprotein cholesterol level. According to the presence of 0, 1, 2, and 3 or more features of MS, age and sex-adjusted means of serum free thyroxine were 17.8+/-3.7, 17.6+/-3.7, 17.5+/-3.7, and 17.1+/-3.3 pmol/L, respectively, with a modest, but statistically significant, decreasing trend (P<.05). When comparing subjects in the highest and lowest quartile of free thyroxine, the former group demonstrated a 2-fold decrease in the odds ratio for MS with 3 or more metabolic features. Low circulating free thyroxine levels, albeit normal, were associated with MS in a Chinese population. Further study is necessary to document the role of thyroid hormones in metabolic abnormalities of MS.

Background and Aims: Metabolic syndrome (MS) consists of a cluster of diseases, including obesity, dyslipidemia, hyperglycemia and high blood pressure. The purpose of the present study was to assess the association of MS with adenomas of the rectosigmoid colon, a well-established precancerous lesion., Methods: A total of 4938 Taiwanese patients (2891 men and 2047 women with a mean age of 50.1 years), who had a physical examination at our hospital between January 2001 and October 2002, were enrolled in this study. All patients underwent a sigmoidoscopic examination to 60 cm from the anus. A modified National Cholesterol Education Program (NCEP) definition of MS was used in this study, in which body mass index (BMI) was substituted for the waist circumference measurement., Results: Overall, 14% of patients had an elevated fasting glucose, 27% had high blood pressure, 14% had an increased triglyceride (TG) level, 8% had low high density lipoprotein (HDL) cholesterol, and 18% were obese. Rectosigmoid polyps were present in 17% of patients, among whom 568 received polypectomy. Pathological findings were hyperplastic in 138 subjects, adenomas in 341, carcinomas in 10, and other benign lesions in 79. In patients without polyps, the adjusted mean TG level and calculated BMI level were lower than those in patients with adenomas. No such difference existed, however, between patients without polyps and those with hyperplastic polyps. The odds ratio of adenomas in situ as compared to either a polyp-free state or the presence of hyperplastic polyps increased significantly with the number of MS diagnostic criteria the patient exhibited., Conclusion: Our study shows that MS is associated with rectosigmoid adenomas in a Chinese population. In patients with rectosigmoid polyps, the coexistence of MS may portend an increased risk of adenomas., (Copyright 2005 Blackwell Publishing Asia Pty Ltd.)

Background and Purpose: People with the metabolic syndrome are at increased risk for developing diabetes mellitus and coronary artery disease (CAD). This study assessed the 5 risk factors of metabolic syndrome in non-diabetic individuals with angiographically-documented CAD., Methods: To estimate the CAD risk associated with metabolic syndrome, we examined the 5 components of metabolic syndrome, defined by the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III, including blood pressure (> or = 130/85 mm Hg), fasting glucose (> or = 110 mg/dL), fasting triglycerides (> or = 150 mg/dL), high-density lipoprotein (HDL) cholesterol level (men < 40 mg/dL; women < 50 mg/dL), and abdominal obesity (waist circumference defined by the Department of Health, Taiwan: men > 90 cm; women > 80 cm) among 139 non-diabetic patients with angiographically-documented CAD and 139 age- and gender-matched non-diabetic control subjects., Results: Metabolic syndrome was found to be more prevalent in subjects with CAD than subjects without CAD (51.8% vs 18.7%; p < 0.001). Multiple logistic regression analysis showed that hypertension was the strongest predictor of CAD, followed by higher fasting glucose and lowered HDL cholesterol. These 5 factors accounted for 41.3% of total risk for CAD without diabetes., Conclusions: Our data revealed that the prevalence of metabolic syndrome was higher in this group of patients with angiographically-diagnosed CAD without diabetes than in controls.

The roles of metabolic syndrome and chronic subclinical inflammation in arterial stiffening and the development of heart failure remain to be elucidated. Whether adiponectin and high-sensitivity C-reactive protein (hs-CRP) were independently related to brachial-ankle pulse-wave velocity (ba-PWV) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in the general population were investigated. Eligible study subjects were 445 Chinese residents aged ≥40 years who participated in a community-based survey, underwent examination of ba-PWV, and had complete data of serum adiponectin, hs-CRP (<10 mg/L), and NT-pro-BNP. Adiponectin, but not hs-CRP, was independently related to ba-PWV (standardized regression parameter −0.107, p <0.05) when age, gender, body mass index, and number of metabolic syndrome components were accounted for. On the other hand, ba-PWV, adiponectin, and hs-CRP were independently related to NT-pro-BNP (standardized regression parameters 0.116, 0.188, and 0.094, respectively; all p <0.05) when age, gender, body mass index, number of metabolic syndrome components, and renal function were accounted for. In conclusion, adiponectin, but not hs-CRP, is independently associated with both ba-PWV and NT-pro-BNP in the general population. Because adiponectin, hs-CRP, ba-PWV, and NT-pro-BNP may represent markers for metabolic syndrome, chronic subclinical inflammation, arterial stiffness, and ventricular dysfunction, respectively, our results suggest that adiponectin may directly modulate both arterial stiffening and ventricular dysfunction. In contrast, hs-CRP may independently contribute to ventricular dysfunction, but not arterial stiffening. [Copyright &y& Elsevier]